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Biomedical subjects

H Touho

Publications and source records attributed to H Touho.

89 records · Page 5Linked to original sources
PubMed1989

[Diaphragmatic pacing by electrical stimulation of the phrenic nerve--a case report].

A four-year-old boy had traffic accident and was transferred to our hospital with cardiorespiratory arrest, on March 24, 1986. After resuscitation, quadriplegia and apnea were sustained. Computed tomography (CT) scan on the day of admission only demonstrated subarachnoid hemorrhage and plain roentgenograms of the skull and cervical spine showed no abnormalities. He opened his eyes to verbal order one week later, but apnea and quadriplegia sustained. CT scan obtained on that day demonstrated no abnormalities but roentgenogram of the cervical spine showed atlanto-axial dislocation. On May 26, 1986, he was treated with densectomy through transoral approach. Furthermore, on June 19, he underwent laminectomy of the atlas, partial craniectomy of the occipital bone, and posterior fusion with iliac bone graft. However, apnea continued, and bilateral diaphragmatic pacemaker (Avery Laboratory Inc.) was planed: On Sept. 18, platinum and silicone rubber electrodes were surgically implanted on the both phrenic nerves at the cervical portion. Each electrode was connected by lead wire and connector to a radio-frequency receiver which was implanted in a subcutaneous abdominal pocket. An external transmitter supplied electrical power and information of the stimulation to the implanted receiver by radiofrequency across the skin. Pacing time was gradually prolonged and continuous pacing for four hours could be successfully gained by March, 1987. Pneumonia once occurred in the course of gradual prolongation of the pacing time. The ideal candidates for diaphragmatic pacing are patients with normal phrenic nerves, diaphragm, and lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Apnea↗
PubMed1989

[Stable xenon CT-CBF study with measurement of end-tidal xenon concentration--correction by arterial concentration of xenon].

Non-invasive methods with monitoring end-tidal stable xenon (ETXes) are described for estimating local cerebral blood flow (LCBF) and local partition coefficient (L lambda). 30% of Xes in oxygen was inhaled for 240 sec and exhaled for 160 sec during serial CT scannings after denitrogenation with pure oxygen breathing. During the examination, serial samplings of arterial blood and continuous monitoring of ETXes were performed to determine build up range (A) and build up rate constant (K) of artery. Calculated A and K using the arterial sampling (Aa and Ka, respectively) were compared with the calculated A and K using the continuous monitoring of ETXes (Ae and Ke, respectively) in 109 patients with epilepsy, head trauma, or cerebrovascular diseases. Ae and Ke had significantly positive correlation with Aa and Ka, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1988

Mapping of local cerebral blood flow with stable xenon-enhanced CT and the curve-fitting method of analysis.

A noninvasive method is described for estimating local cerebral blood flow (LCBF) and local partition coefficients by means of computed tomographic scanning during inhalation of 30% stable xenon gas in oxygen. Time-dependent xenon concentrations in arterial blood and brain tissue during the wash-in and washout phases are used to calculate partition coefficients and LCBF values by means of a least-squares curve-fitting analysis. Control values for partition coefficient and LCBF obtained from control subjects with minor head trauma in the chronic stage were compatible with those in several past reports, and reproducibility was satisfactory. The theoretic grounds underlying this new method of curve-fitting analysis are discussed.

Adult↗
PubMed1988

[Measurement of local cerebral blood flow by computerized tomography with inhalation of stable xenon and curve-fitting method].

Non-invasive methods are described for estimating local cerebral blood flows (LCBF) and local partition coefficients (L lambda) during inhalation of 30% stable xenon gas (Xe) in oxygen during CT scanning. After the denitrogenation with pure oxygen breathing, 30% Xe is inhaled for four minutes to minimize subanesthetic effects with a rubber face-mask and the delivery system of Xe. Local time-delta Hounsfield units curve during the Xe wash-in and wash-out phase is utilized in order to calculate L lambda and LCBF using a least squares curve fitting analysis. Calculated L lambda and LCBF with the new method manifested reasonable distribution between the grey and white matters, and reproducibility was excellent in our study. Several case studies of patients with cerebral infarction are presented to demonstrate the characterization of L lambda and LCBF patterns in various tissues and theoretical grounds underlying the new method of curve fitting analysis are discussed.

Adolescent↗
PubMed1987

Intrahepatic migration of a peritoneal shunt catheter: case report.

The intrahepatic migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system (low pressure Pudenz valve and low pressure Pudenz peritoneal catheter) is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by metrizamide shuntography and abdominal computed tomography. To our knowledge, this is the second case complicated with migration of a peritoneal shunt tube into the liver.

Aged↗
PubMed1987

[Measurement of energy expenditure in the acute stage of head injury (Part I)].

Oxygen consumption (VO2), carbon dioxide production (VCO2), resting metabolic expenditure (RME), RME of that expected for an uninjured resting person of equivalent age, sex, and body surface area (RME%), nitrogen balance, and protein calorie contribution (PCC) were measured in 8 patients with head injury. Metabolic measurements were carried out with the technique of indirect calorimetry from onsets to 14th day. Mean values of VO2 and VCO2 were 298 ml/min, 236 ml/min respectively on admission and those decreased gradually. Mean values of RME%, nitrogen balance, and PCC were 130.6%, -14.5 gm/day, and 17.3% respectively on admission. And those three values significantly decreased on 14th day in those 8 patients. From those facts, it was implied that hypermetabolism and hypercatabolism existed, and measurement of energy expenditure was indispensable to supply enough calorie maintaining body weight and immunocompetence in the acute stage of head injury.

Acute Disease↗
PubMed1986

Metabolism in acute cerebrovascular disease.

Oxygen consumption (VO2), CO2 production, respiratory quotient, resting metabolic expenditure (RME), and urine catecholamine levels were measured in 52 patients with acute cerebrovascular disease. RME correlated positively with urinary norepinephrine and epinephrine excretion; its maximum value was 187% higher than expected for an uninjured resting person of equivalent age, sex, and size. VO2 correlated positively with the urinary catecholamine excretion. These facts imply that the sympathetic nervous system might directly influence VO2 and RME. Moreover, the hypermetabolic state should be taken into consideration when caring for patients with cerebrovascular disease, as malnutrition might cause weight loss and a decrease in immunity.

Adult↗
PubMed1986

Relationship between abnormalities of coagulation and fibrinolysis and postoperative intracranial hemorrhage in head injury.

Abnormalities of coagulation and fibrinolysis in 12 head-injured patients were studied in early (within 24 hours of onset) and late (10th to 17th day after onset) stages. alpha 2 Plasmin inhibitor (alpha 2PI), antithrombin III (ATIII), and fibrinopeptide A (FPA) and B beta 15-42 (FPB beta) were measured in particular, in addition to the usual tests (platelet count (PLT), prothrombin time (PT), partial thromboplastin time, fibrinogen, and fibrin/fibrinogen degradation products (FDP)). alpha 2PI was abnormally lower, and FPA and FPB beta were much higher; fibrinogen and ATIII were moderately lower in the early stage than in the late stage in 6 head-injured patients with postoperative intracranial hemorrhage. alpha 2PI, ATIII, and fibrinogen were moderately lower and FPA was moderately higher in the early stage than in the late stage in 6 head-injured patients without postoperative intracranial hemorrhage. PLT and fibrinogen were lower, alpha 2PI was much lower, and FPA was much higher in the 6 patients with postoperative intracranial hemorrhage than in the 6 patients without postoperative intracranial hemorrhage. One patient with acute epidural and subdural hematomas had recurrent postoperative intracerebral hematoma twice. This recurrent hemorrhage was due to disseminated intravascular coagulation (DIC) caused by primary brain damage and was associated with extremely high FPA and FPB beta levels and abnormally low alpha 2PI and PLT. Fresh-frozen plasma and intravenous low-dose heparin were administered after the two recurrent hemorrhages, after which FPA and FPB beta normalized immediately, although other screening tests showed only gradual improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Metabolic response in the acute stage of cerebral infarction--with special reference to oxygen consumption and resting metabolic expenditure].

Oxygen consumption, carbon dioxide production, respiratory quotients, and resting metabolic expenditure were measured in 23 patients with cerebral infarction in their acute stage. Metabolic measurement were carried out with the technique of indirect calorimetry on their admission within two days from the onsets. At the same time, urine was collected twenty-four hours to measure urinary catecholamine excretion. Mean value of resting metabolic expenditure was 115.1% and this positively correlated with urinary catecholamine, especially noradrenaline excretion. Maximum value of resting metabolic expenditure was up to 187.1% of that expected for an uninjured resting person of equivalent age, sex, and body surface area. Oxygen consumption and carbon dioxide production also positively correlated to urinary catecholamine excretion. On the other hand, respiratory quotients did not have any significant correlation with oxygen consumption, carbon dioxide production, resting metabolic expenditure, or urinary catecholamine excretion. From those facts, it was implied that overactivity of sympathetic nervous system existed in their acute stage of cerebral infarction, and the overflow might directly influence oxygen consumption, carbon dioxide production, and resting metabolic expenditure, and moreover we had to take into consideration of hyper-metabolic state to manage patients with ischemic cerebrovascular diseases as malnutrition might cause weight loss and immune incompetence.

Adult↗
PubMed1984

[Coagulation-fibrinolysis abnormalities in acute stage of subarachnoid hemorrhage (Part 1)--With special reference to the relation between cerebral vasospasm and fibrinopeptides A and B beta].

It is well known that abnormalities of coagulation and fibrinolysis frequently take place during the course of cerebrovascular diseases. In this paper, coagulation and fibrinolytic studies were performed during the course of acute stage through chronic stage of subarachnoid hemorrhage. Tested items were partial thromboplastin time, prothrombin time, FDP, alpha 2-plasmin inhibitor, antithrombin III, fibrinogen, besides, fibrinopeptide A (FPA), and fibrinopeptide B beta (FPB beta) which were being worthy of note. Blood were sampled from peripheral vein (V) and internal jugular vein at jugular bulb (J). And, moreover, cerebrospinal fluid (L) were collected as possible as we could for measuring FPA and FPB beta. The obtained results were summarized as follows; Within forty-eight hours from the onset of subarachnoid hemorrhage, FPA-V, J,L and FPB beta-V, J,L were statistically higher than those of control. FPA-J and FPB beta-V, J, within forty-eight hours from the onset were statistically higher in the cases with brain death than in the survived cases. On the third to fifth day from the onset when so called cerebral vasospasm became apparent to begin, FPA and FPB beta had a tendency to be higher than other periods. Increase of fibrinogen delayed from the peaks of FPA and FPB beta showing the peaks at the seventh to the fourteenth day from the onset of subarachnoid hemorrhage. In three cases with symptomatic vasospasm, FPA and FPB beta showed maximal values two to four days prior to the appearance of symptomatic cerebral vasospasm. Other tests were all within normal limits.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Large ependymal cyst of the cerebello-pontine angle in a child.

Most ependymal cysts occur intracerebrally, with a few cases situated in the subarachnoid space. The cerebellopontine angle is a common site for arachnoid cysts, but a very rare site for ependymal cysts. A case is described here of a large ependymal cyst in the cerebellopontine angle. A 12-year-old girl with left hearing disturbance was admitted. CT and MRI revealed a cystic tumor in the left cerebellopontine angle. At operation, we obtained a discrete thin-walled cyst which had arisen from a continuation of the choroid plexus of the lateral foramen of Luschka, which had no connection with the arachnoid. The cyst proved to be an ependymal cyst.

Cerebellar Diseases↗
PubMedDate not supplied

Cerebellar primary germ-cell tumor in a young boy.

Germ cell tumors originating in the posterior fossa are very rare. Described herein is a case of primary germ cell tumor (yolk sac tumor) found in the cerebellar vermis. A 5-year-old boy who complained of headache was admitted. CT and MRI revealed a tumor with diffuse enhancement by contrast medium in the right cerebellar vermis. Total removal was performed and a diagnosis of medulloblastoma or ependymoma was suspected. However, the tumor proved to be a yolk sac tumor with embryonal carcinomatous components from histological findings. Abnormally high levels of alpha-fetoprotein were found in blood and cerebrospinal fluid. Extensive examination indicated that the intracranial lesion had not metastasized from a primary extracranial tumor.

Cerebellar Neoplasms↗
PubMedDate not supplied

Intraarterial digital subtraction angiography for definitive diagnosis of intracranial aneurysms.

Comparisons between digital subtraction angiography and conventional angiography have frequently been made in the radiologic literature, and the high quality and several advantages of the former have been reported. In this study, 101 patients with intracranial aneurysms were examined only by intraarterial digital subtraction angiography; no conventional angiography was used. High-quality images were consistently obtained, facilitating an accurate and definitive diagnosis of intracranial aneurysm. Magnification radiography and stereography using intraarterial digital subtraction angiography were done to obtain a more precise diagnosis. Five small intracranial aneurysms with diameters of 1.0 to 2.0 mm could be detected. The procedure was considered to be as reliable and as safe as conventional angiography, used previously. Important advantages of intraarterial digital subtraction angiography include reduced procedural time and decreased contrast agent burden, factors that will ensure broader application of this procedure for definitive diagnosis of intracranial aneurysms as experience with the technique accumulates.

Adult↗
PubMedDate not supplied

Comparison of dynamic CT and stable xenon CT in ischemic cerebrovascular disease.

PURPOSE: To investigate a new hemodynamic parameter that can be obtained by dynamic CT and that reflects cerebral blood flow (CBF), in patients with ischemic cerebrovascular disease. METHODS: CBF and hemodynamic parameters including the area under the time-dependent contrast-medium dilution curve (A) and mean transit time (MTT) were measured in 23 patients with ischemic cerebrovascular disease. They included 17 patients in the chronic stage (more than 1 month after onset) and six with acute occlusion of the internal carotid or middle cerebral artery (within 24 hours of onset). CBF measurement was conducted by inhalation of stable xenon during CT scan and the hemodynamic study was performed using dynamic CT. RESULTS: CBF in the territory of the middle cerebral artery had an inverse correlation with MTT. (A) divided by (MTT) defined as (f) had a significantly positive correlation with CBF (MTT = 18.66 - 0.495.CBF + 0.005.CBF2, r = .730, P < .001). CONCLUSION: This parameter (f) is thought to represent a relative CBF and it can be used in evaluation of the hemodynamic status in ischemic cerebrovascular disease.

Aged↗