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Biomedical subjects

H Kin

Publications and source records attributed to H Kin.

At least 73 records · Page 4Linked to original sources
PubMed1976

Is angiographic spasm real spasm?

Systematic morphological study of the cerebral arteries was made in six autopsy cases of ruptured aneurysms. The time course of the arterial luminal narrowing was observed by repeated angiograms, and segments of the narrowed arteries were studied histologically. Various histological changes were found consistent with the angiographic findings. We have devided these into three stages according to the duration of the disease. In the acute stage (less than one day) the contraction of the medial smooth muscle cells may be the main cause of the luminal narrowing. In the subacute stage, arteries showed a reduction in lumen size with medial thickening, marked corrugation of the internal elastic lamina, and thrombus formation attached to the endothelial surface. If vasoconstriction remained localized to the same segment for several days, the intimal or medial thickening and thrombus might produce the luminal narrowing consistent with the angiographic narrowing. In the chronic stage (more than two weeks), most cases showed dilatation of the arterial lumen on angiography. These arteries showed frank necrosis of the smooth muscle cells histologically. In a case which demonstrated progressive luminal narrowing on angiograms over 2 weeks, the arterial wall showed luminal narrowing with cellulofibrous thickening of the intima and organization of the thrombus. The presence of these structural changes in the narrowed arteries seen at angiography seems to be very important for proper understanding and treatment of vasospasm.

Acute Disease↗
PubMed1976

[Communicating hydrocephalus following the rupture of intracranial aneurysm (author's transl)].

It is well recognized that the communicating hydrocephalus following the rupture of intracranial aneurysms is one of the factors which cause the disturbance of consciousness in acute stage and the impairment of mental functions in chronic stage. In this report we analyzed the surgical experience with this complication and discussed the mechanisms which cause the ventricular dilatation. 1. The communicating hydrocephalus following the rupture of intracranial aneurysms is devided into the acute form and the chronic form. 2. Acute communicating hydrocephalus may develop with 24 hours after the onset and the incidence is about 10% (6 out of 66 cases). 3. Intraventicular pressure is high in acute communicating hydrocephalus and becomes normal in chronic stage. 4. The incidence of the chronic communicating hydrocephalus is about 10% (6 out of 66 cases). 5. There are two types of chronic communicating hydrocephalus. One develops from acute form and another develops gradually after onset. Among 6 chronic communicating hydrocephalus, 3 developed from acute form, 2 showed slowly progressive ventricular dilatation and 1 admitted with hydrocephalus at chronic stage resepctively. 6. The intraventricular pressure of the acute form is high and the chronic form shows high pressure in acute stage, intermittent high pressure wave lasting 20-30 minutes in subacute stage and normal pressure in chronic stage when the ventricle is dilated. 7. The mechanisms of ventricular dilatation in normal pressure hydrocephalus are discussed on the basis of the continuous monitoring of intraventricular pressure in cases with rupture of intracranial aneurysm. 8. Indication of shunting procedures whould be determined by combination of clinical pictures, ventriculocranial index, findings of cisternography and EEG. Our operative criteria are presented.

Acute Disease↗
PubMed1975

[Surgical experience of aged patients with ruptured intracranial aneurysms (author's transl)].

Outcome of 77 cases with ruptured intracranial aneurysms above 60 years of age was reported. 44 cases were treated conservatively and 33 cases surgically. 1. Among conservatively treated group, 10 cases died after initial hemorrhage and 14 cases after second hemorrhage. The mortality rate was 55%. 2. Among surgically treated group, 11 cases died and 4 cases had severe neurological deficits following the direct intracranial operation. The mortality and morbidity rate was 33% and 12% respectively. 3. These results indicate that the direct intracranial operation should be the first choice of treatment to the aged patients also. 4. Intracranial complications occured more frequently than the extracranial one during intra and postoperative course. Among them normal pressure hydrocephalus was the comonnest. 5. Occlusion of the main cerebral artery occured in 5 cases related to operative procedure. Outcome of 4 cases of them was poor. Microsurgical technique should be used in order to prevent these conditions which tend to occur in aged patients.

Adult↗
PubMedDate not supplied

Bilateral internal biliary drainage of hilar cholangiocarcinoma with modified Gianturco Z stents inserted via a single percutaneous tract.

PURPOSE: Modified Gianturco Z stents were used in five patients with hilar cholangiocarcinoma to permit bilobar hepatic drainage via a single percutaneous tract. PATIENTS AND METHODS: After successful negotiation of strictures from the ipsilateral hepatic duct to the contralateral hepatic duct and the common bile duct, a modified endoprosthesis--made by connecting two double-body Z stents with two stainless steel wires in order to leave a space in between--was implanted in one stricture and a 'space' was located at the hepatic confluence. A second endoprosthesis, a two- to six-body Z stent, was introduced into the second stricture through the 'space' of the initial endoprosthesis and was implanted so that a part of the endoprosthesis should overlap the initial endoprosthesis. RESULTS: Optimal positioning of the two endoprostheses was successful in all patients. CONCLUSION: The technique seems simple, safe, and reliable in reconstructing the bilateral hepatic ductal systems via a single percutaneous approach in patients with hilar cholangiocarcinoma.

Bile Duct Neoplasms↗
PubMedDate not supplied

Perioperative serum procalcitonin concentrations in patients with acute aortic dissection.

We investigated the perioperative serum procalcitonin (PCT) concentrations in 5 consecutive patients who underwent surgery for acute aortic dissection (2 men, 3 women; mean age 72 +/- 9 years, age range 52-81 years). Surgery used cardiopulmonary bypass with deep hypothermic circulatory arrest. Blood samples were taken prior to surgery, upon arrival in the intensive care unit, and 6, 12, 18, 24, and 48 h after intensive care unit arrival. Prior to surgery, the PCT level was 4.2 +/- 3.4 (range 0.8-8.3) ng/ml. The PCT increase was greatest at 24 h (5.8 +/- 4.5 ng/ml). Preoperatively, the C-reactive protein concentration was 8.0 +/- 8.3 (range 0.9-23.8) mg/dl, and the white blood cell count was 8.5 +/- 3.1 x 10(3). C-reactive protein continued to increase at 48 h, while the white blood cell count peaked at 24 h. In spite of no symptoms of infectious diseases or septicemia, all patients had a significant preoperative PCT elevation. This finding may have something to do with the specific preoperative condition of acute aortic dissection. However, more clinical investigation is needed to clarify the PCT changes during and after surgery for acute aortic dissection.

Acute Disease↗
PubMedDate not supplied

Computed tomographic findings of good prognosis for hemiplegia in hypertensive putaminal hemorrhage.

Computed tomography (CT) findings were analyzed in 17 patients with hypertensive putaminal hemorrhage accompanied by hemiplegia which had subsided almost completely by conservative therapy within one month after the onset. In such patients a high density area was not seen at the level of the lateral ventricles on CT scan. To study the reason for this, the relationship between the extent of a hematoma and the level at which the pyramidal tract was destroyed was investigated. From consideration of the process of destruction of the pyramidal tract by a hematoma, it seemed that CT findings at the level of the bodies of the lateral ventricles, rather than at the level of the posterior limb of the internal capsule, were of value in evaluating the prognosis of hemiplegia in putaminal hemorrhage.

Adult↗
PubMedDate not supplied

Surgical treatment of primary intracerebral hemorrhage- Part 1: new angiographical classification.

A new angiographical classification of primary intracerebral hemorrhage is presented. We have clarified the predilection sites of intracerebral hemorrhage and the advancing direction of the hematoma by studying autopsy cases. Furthermore, we tried to detect the presence or absence of destruction of the internal capsule and ventricular rupture by means of angiography. Our classification, introducing the idea of dynamic changes of hematoma advancement from localized to advanced type, can be applied to clinical practice. This classification, along with the patient's level of consciousness, it felt to be the most important indication for operation.

Cerebral Angiography↗
PubMedDate not supplied

Comparative angiographic and histological evaluations of intracranial atherosclerosis in hypertensive and normotensive subjects.

Cerebral atherosclerosis without luminal narrowing has been found macroscopically and by angiographic examinations in some patients with cerebral hemorrhage. In order to clarify the histology of non-stenotic atherosclerosis of the cerebral vessels, we examined cleared specimens and serial sections of the main trunks of the cerebral arteries. The middle cerebral artery was selected in 20 cases of cerebral hemorrhage and 7 cases of cerebral infarction. Non-stenotic atherosclerosis was found frequently in cases of cerebral hemorrhage, while most patients with cerebral infarction showed stenotic cerebral atherosclerosis. We counted the numbers of medial smooth muscle cells in 10 autopsied cases of cerebral hemorrhage and 6 of cerebral infraction. The mean numbers of smooth muscle cells per unit area in the patient with cerebral hemorrhage were less than those in cerebral infraction. In cerebral hemorrhage, the main trunks of the cerebral arteries were dilated, probably as a result of the damage to medial muscle cells and higher blood pressure during the course of intimal thickening. It is considered that arterial hypertension spreads to the peripheral, small arteries through the main trunks without luminal narrowing of the cerebral vessels.

Adult↗
PubMedDate not supplied

Hepatic resection for liver metastasis of sigmoid colon cancer after incomplete percutaneous microwave coagulation therapy.

We report a case of colon cancer with liver metastasis that had been treated previously by sigmoidectomy and partial hepatic segmentectomy. A 55-year-old woman presented with two asynchronous liver metastases, which were treated with percutaneous microwave coagulation therapy. However, evaluation by dynamic computed tomography one week later showed incomplete necrosis in at least one tumor. Surgical resection was subsequently performed and histopathological examination showed the presence of viable cancer cells in both tumors. We conclude that surgical resection is perhaps the best curative method of treatment of metastatic liver tumors of colorectal carcinomas and that dynamic computed tomography is not always accurate for evaluating the effect of microwave coagulation therapy.

Electrocoagulation↗