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Biomedical subjects

J Mizuno

Publications and source records attributed to J Mizuno.

At least 19 recordsLinked to original sources
PubMed2002

Cervical amyotrophy caused by hypertrophy of the posterior longitudinal ligament.

STUDY DESIGN: A case report. OBJECTIVES: To report a case of cervical amyotrophy caused by hypertrophy of the posterior longitudinal ligament (HPLL). SETTING: Department of Neurological Surgery, Aichi Medical University, Aichi, Japan. METHODS: The patient had severe muscular atrophy in the deltoid and triceps with slight localized hypesthesia in the C5 area and severely unstable gait due to diminished vibration sense in the knees and ankles. Magnetic resonance imaging (MRI) showed expanded cord compression from C4 to C6 with intramedullary high-signal intensity due to HPLL. Transverse image MRI was useful to identify the HPLL. RESULTS: Resection of HPLL was achieved by an anterior approach. Histological findings of the surgical specimens showed thickening of the ligamentous tissue with proliferation of chondrocytes. CONCLUSIONS: HPLL should be included as a causative pathology of cervical spondylotic amyotrophy. Careful neurological examination including sensory examination of the lower limbs should be performed to avoid confusion with motor neuron disease.

Cervical Vertebrae↗
PubMed2001

Primary amyloidoma of the thoracic spine presenting with acute paraplegia.

BACKGROUND: Primary solitary amyloidoma of the spine is a rare disease characterized by localized deposition of amyloid. To the best of our knowledge, there have been only 14 cases previously reported in the literature. Patients with focal spinal amyloidoma usually have relatively long symptomatic periods preoperatively, ranging from 3 weeks to 6 years (mean: 12 months). Only two reported patients had acute paraplegia. We add a third case of a thoracic spine amyloidoma presenting with acute paraplegia. CASE DESCRIPTION: A 65-year-old man presented with a three-day history of progressive paraplegia and urinary retention. He was found to have severe cord compression at T2 on magnetic resonance imaging. He underwent emergent decompressive laminectomy with instrumentation for spinal stabilization. Histopathology revealed abundant amyloid deposits. A systemic work-up was negative for amyloidosis. The patient showed marked neurological improvement with residual mild spastic gait after 1 year. CONCLUSIONS: Primary spinal amyloidoma with acute paraplegia is rare. One-stage surgery combining prompt decompression and stabilization of the spinal column is mandatory in cases of spinal amyloidoma with acute myelopathy, because primary solitary amyloidoma carries a good prognosis.

Acute Disease↗
PubMed2001

Combined anterior and posterior instrumentation in severe fracture-dislocation of the lower cervical spine with help of navigation: a case report.

The authors report a case of severe fracture-dislocation of C6-C7 with dural and spinal cord damage causing quadriplegia. The patient was treated surgically with circumferential stabilisation. Intense spinal instrumentation with pedicle screw fixation in addition to anterior decompression and plate fixation was essential for restoring the original vertebral column. This technique of internal fixation provided a more rigid anchor, however the risk to the neurovascular structures could not be completely eliminated. Therefore, the combined anterior and posterior stabilisation assisted with a navigation system was a safer and reasonable surgical treatment for this patient with severe cervical injuries.

Adult↗
PubMed2001

Analysis of hypertrophy of the posterior longitudinal ligament of the cervical spine, on the basis of clinical and experimental studies.

OBJECTIVE: The goal of this study was to elucidate the pathophysiological features and treatment of hypertrophy of the posterior longitudinal ligament (HPLL) of the cervical spine. HPLL is defined as a pathological thickening of the posterior longitudinal ligament (PLL), causing spinal cord compression. Incomplete decompression via removal of only coexisting herniated intervertebral discs or spondylotic spurs might be performed, resulting in unsatisfactory surgical outcomes, when the PLL becomes abnormally thickened and contributes to myelopathy. METHODS: Patients with HPLL who underwent cervical decompression surgery were selected. Medical records and radiographs were retrospectively reviewed, to obtain data on the pre- and postoperative clinical conditions of the patients. Autopsy cases with HPLL proven by low-energy x-ray examinations were chosen for assessment of the pathological characteristics. RESULTS: Seventeen men and three women with HPLL underwent treatment via an anterior approach, with direct removal of HPLL. Nineteen patients developed myelopathy, whereas one patient developed radiculopathy. Radiologically, all HPLL cases exhibited coexisting herniated intervertebral discs and 10 exhibited small segmental ossifications of the PLL. Magnetic resonance imaging or computed tomographic myelography revealed extensive cord compression across the vertebral endplate level. The average preoperative Benzel modified Japanese Orthopaedic Association score was 10.8, and the average postoperative score was 13.2. Histological examinations revealed thickening of the PLL with proliferation of chondrocytes, together with various degenerative changes. CONCLUSION: Patients with HPLL can benefit from an anterior approach with direct removal of the HPLL and associated herniated intervertebral discs or ossification of the PLL. Cervical polytomography, computed tomography, and magnetic resonance imaging are useful in establishing a diagnosis of HPLL.

Adult↗
PubMed2001

Frank-Starling mechanism retains recirculation fraction of myocardial Ca(2+) in the beating heart.

Myocardial Ca(2+) handling in excitation-contraction coupling is the second primary determinant of energy or O(2) demand in a working heart. The intracellular and extracellular routes remove myocardial Ca(2+) that was released into the sarcoplasma with different Ca(2+): ATP stoichiometries. The intracellular route is twice as economical as the extracellular route. Therefore the fraction of total Ca(2+) removed via the sarcoplasmic reticulum, i.e., the recirculation fraction of intracellular Ca(2+) (RF), determines the economy of myocardial Ca(2+) handling. RF has conventionally been estimated as the exponential decay rate of postextrasystolic potentiation (PESP). However, we have found that PESP usually decays in alternans, but not exponentially in the canine left ventricle beating above 100 beats/min. We have succeeded in estimating RF from the exponential decay component of an alternans PESP. We previously found that the Frank-Starling mechanism or varied ventricular preload did not affect the economy of myocardial Ca(2+) handling. Then, to account for this important finding, we hypothesized that the Frank-Starling mechanism would not affect RF at a constant heart rate. We tested this hypothesis and found its supportive evidence in 11 canine left ventricles. We conclude that RF at a constant heart rate would remain constant, independent of the Frank-Starling mechanism.

Action Potentials↗
PubMed2001

Two-staged operation for thoracolumbar osteomyelitis following methicillin-resistant staphylococcus aureus infection of a craniectomy wound--case report.

A previously healthy 53-year-old woman developed pyogenic vertebral osteomyelitis (PVO) manifesting as progressive lumbago following wound infection of a decompressive craniectomy performed for brain contusion caused by a traffic accident. Magnetic resonance imaging disclosed vertebral osteomyelitis at T-12 and L-1 with paravertebral abscess. Anterior debridement and fusion using autografts were performed at the first operation. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the abscess specimen. Antibiotic therapy resolved the infection. Pedicle screw fixation was performed at the second operation. The patient became free from back pain and no recurrence of infection was seen. The diagnosis of PVO is frequently observed or delayed because of the nonspecific symptomatic presentation in the early stage. Coexistent infection or trauma makes early diagnosis more difficult. Indications and timing of instrumentation for the spinal column infected with MRSA is difficult. Two-staged operation with anterior debridement and posterior instrumentation after eradication of the infection is a safe and effective procedure for MRSA vertebral osteomyelitis.

Craniotomy↗
PubMed2001

[Convulsion following the combination of single preoperative oral administration of enoxacine and single postoperative intravenous administration of flurbiprofen axetil].

We experienced a case of convulsion following the combination of single oral administration of enoxacine before an emergency operation and single postoperative intravenous administration of flurbiprofen axetil. The patient was an 87-year-old female referred to our hospital for severe abdominal pain. She was diagnosed as having the strangulation ileus, then underwent the emergent operation of partial resection of the necrotic small intestine under general anesthesia. Unfortunately we did not know that she had temporarily received oral enoxacine 200 mg, a new quinolone, administered by the previous doctor on the day before the operation. After the operation, flurbiprofen axetil 50 mg, a nonsteroidal anti-inflammatory drug, was given intravenously in thirty seconds due to postoperative pain. One minute after administration of the drug, she immediately developed a convulsive fit, severe disturbance of consciousness and apnea. We then administered at once, a single dose of diazepam intravenously for convulsion treatment, kept her airway open and controlled her ventilation. Convulsion disappeared in a minute and her condition improved gradually. We suspect that convulsive seizure may have been induced by the drug interaction between single oral dose of enoxacine before the operation and single intravenous dose of flurbiprofen axetil after the operation. We also suspect that the serum concentration of enoxacine was kept high because of metabolic disturbance and renal dysfunction resulting from her old age and dehydration. This case suggests that medication before the emergency operation must be considered in anesthetic management because of the possible side effect such as convulsion induced by the drug interaction between neuquinolones and anti-inflammatory drugs.

Administration, Oral↗
PubMed2001

[Treatment with stellate ganglion block, continuous epidural block and ulnar nerve block of a patient with postherpetic neuralgia who developed complex regional pain syndrome (CRPS)].

We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. She had been suffering from continuous and spasmodic burning pain, hyperalgesia, allodynia, drop in skin temperature, sudmotor disturbance, edema, constructure of the joints, muscle atrophy and bone atrophy of her right upper extremity probably due to postherpetic neuralgia (PHN) associated with complex regional pain syndrome (CRPS). She received right stellate ganglion block (SGB), continuous cervical epidural block and right ulnar nerve block. Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve.

Analgesia, Epidural↗
PubMed2001

[Usefulness of epidural infusion of ketamine for relief of localized superficial pain].

Three patients with localized superficial pain had their pain alleviated by single epidural infusion with low dose ketamine. The patients are as follows: a 62-year-old female with herpetic neuralgia on her right sixth thoracic nerve area; a 52-year-old male whose left shoulder, anterior chest and abdomen had been burned by acetylene gas; and a 49-year-old male whose bilateral hands suffering from frostbite by propane gas. Epidural tube insertion to administer a single dose of 10 mg ketamine with lidocaine or bupibacaine was performed in all the three patients. They were administered single epidural infusion of 10 mg ketamine with lidocaine or bupibacaine everyday and they continued to receive epidural block with lidocaine or bupivacaine including buprenorphine or morphine. Therefore, we suspect that single epidural infusion of ketamine, an antagonist for N-methyl-D-aspartic acid receptor, could be an effective and useful alternative treatment in patients with various refractory localized superficial pain of either acute or chronic nature.

Analgesia, Epidural↗
PubMed2001

[Stump pain relieved by continuous intravenous ketamine infusion therapy].

We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. On examination, we found his left foot skin hard, lustrous, and with sweating disturbance, allodynia and hyperpathia. As intravenous administrations of ketamine 10 mg and thiamylal 50 mg were positive as a drug challenge test, we performed intravenous ketamine infusion at 1 mg.kg-1.hr-1 for 1 hour and a half. After this treatment, his visual analogue scale (VAS) improved dramatically to 0 mm, and night pain, allodynia and hyperpathia disappeared for three days. Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.

Excitatory Amino Acid Antagonists↗
PubMed2001

[Usefulness of epidural administration of ketamine for relief of postherpetic neuralgia].

Four patients with postherpetic neuralgia had their pain alleviated by epidural administration of ketamine. No oral non-steroidal anti-inflammatory drugs and anti-depressant drugs were effective in all cases. Lidocaine or bupivacaine was administered epidurally to all four patients. When these patients stated that they did not feel pain reduced, they received epidural infusion of ketamine at doses from 5 mg to 20 mg with lidocaine or bupivacaine and their postherpetic neuralgia was controlled. Therefore with these cases, we suspect that epidural administration of ketamine, an antagonist for N-methyl-D-aspartic acid receptor, could be an effective and useful alternative treatment in a patient with refractory postherpetic neuralgia.

Aged↗
PubMed2001

[Anesthetic management of a patient with von Recklinghausen disease complicated with spinal tumor and severe spinal deformity].

We had three occasions of giving anesthesia to a patient with von Recklinghausen disease complicated with spinal tumor and spinal deformity. A 49-year-old male patient who had suffered from von Recklinghausen disease since 35 years of age developed slight low respiratory function due to neurofibroma in the spinal canal and the paravertebral lesion and severe kyphoscoliosis in the lumbar spine which were checked by lumbar X-ray, abdominal ultrasonography and computed tomography during the preoperative period. Transurethral biopsy of the bladder tumor, internal urethrotomy for the urethral stricture and vesical lithotripsy for the bladder stone were performed under general anesthesia. Elevated position of his head and lower extremities and slight right lateral decubitus position were employed during anesthetic induction and semi-Trendelenburg's position during anesthetic maintenance. Convalescence after each operation was uneventful. He was comfortable and had a safe perioperative course. He showed no unward change in neurological symptoms during the post-operative period. This case suggests that we must take the complication such as spinal tumor and spinal deformity into consideration for anesthetic management of patients with von Recklinghausen disease and select the appropriate anesthetic method and patient's position.

Anesthesia, General↗
PubMed2000

Lumbar herniated disc presenting with cauda equina syndrome. Long-term follow-up of four cases.

BACKGROUND: Cauda equina syndrome is a relatively rare presenting symptom of lumbar herniated discs. Early operative decompression is advocated, but it may not always restore the bladder function. In such cases, knowing the long-term outcome of bladder or sphincter disturbances is quite useful in planning the management of these patients. METHODS: Hospital records of patients operated on for lumbar herniated discs were reviewed. Charts and imaging studies of those patients who presented with classic cauda equina syndrome were analyzed. RESULTS: There were 4 patients (2.8%) of 144 consecutive surgical series of lumbar disc herniation, whose presenting symptom was classic cauda equina syndrome. Postoperatively, the patients had been followed at the clinic for a mean period of 6.4 years. Certain characteristic findings were noted on patients' neurological and radiological examinations. Although the recovery process of bladder function was very slow, taking months to years, all four patients achieved almost normal voiding with no major impairment of daily activities. CONCLUSIONS: Even if short-term recovery of bladder function is poor after lumbar disc surgery for cauda equina syndrome, the long-term outcome is not necessarily so. We should follow up on these patients with such measures as intermittent self-catheterization and drug therapy, expecting slow but steady recovery of bladder and sphincter function.

Adult↗
PubMed2000

An integrated service digital network (ISDN)-based international telecommunication between Samsung Medical Center and Hokkaido University using telecommunication helped radiotherapy planning and information system (THERAPIS).

This study introduces the integrated service digital network (ISDN)-based international teleradiotherapy system (THERAPIS) in radiation oncology between hospitals in Seoul, South Korea and in Sapporo, Japan. THERAPIS has the following functions: (1) exchange of patient's image data, (2) real-time teleconference, and (3) communication of the treatment planning, dose calculation and distribution, and of portal verification images between the remote hospitals. Our preliminary results of applications on eight patients demonstrated that the international telecommunication using THERAPIS was clinically useful and satisfactory with sufficient bandwidth for the transfer of patient data for clinical use in radiation oncology.

Japan↗
PubMed2000

Logistic time constant of isometric relaxation force curve of ferret ventricular papillary muscle: reliable index of lusitropism.

We have found that a logistic function fits the left ventricular isovolumic relaxation pressure curve in the canine excised, cross-circulated heart more precisely than a monoexponential function. On this basis, we have proposed a logistic time constant (tau(L)) as a better index of ventricular isovolumic lusitropism than the conventional monoexponential time constant (tau(E)). We hypothesize in the present study that this tau(L) would also be a better index of myocardial isometric lusitropism than the conventional tau(E). We tested this hypothesis by analyzing the isometric relaxation force curve of 114 twitches of eight ferret isolated right ventricular papillary muscles. The muscle length was changed between 82 and 100% L(max) and extracellular Ca(2+) concentrations ([Ca(2+)](o)) between 0.2 and 8 mmol/l. We found that the logistic function always fitted the isometric relaxation force curve much more precisely than the monoexponential function at any muscle length and [Ca(2+)](o) level. We also found that tau(L) was independent of the choice of the end of isometric relaxation but tau(E) was considerably dependent on it as in ventricular relaxation. These results validated our present hypothesis. We conclude that tau(L) is a more reliable, though still empirical, index of lusitropism than conventional tau(E) in the myocardium as in the ventricle.

Animals↗
PubMed2000

[A case of hypothyroidism found by delayed awakening after the operation].

We report a case of hypothyroidism found by delayed awakening after surgery. A 55-year-old male patient had been suffering from elevated creatine phosphokinase (CPK) and cartinoembryonic antigen (CEA) of unknown origin before the operation. Laparoscopic cholecystectomy was performed under general anesthesia combined with epidural block. Hypotension, low arterial oxygen saturation, hypothermia and metabolic acidosis developed and continued during the operation. Awakening was delayed for about two hours postoperatively. Specific examination resulted in a definitive diagnosis of hypothyoidism. We should pay careful attention to any patient with elevated CPK and CEA of unknown origin before surgery, continuous hypotension, respiratory and circulatory failure and metabolic disorder during surgery, and delayed awakening after surgery that may be the result of hypothyroidism.

Aged↗
PubMed2000

[A case of acute pancreatitis that occurred after an operation of the lumbar spine].

A 56-year-old female, who had been suffering from heart failure and diabetes mellitus, underwent posterior instrumentation in the prone position and anterior interbody fusion in the right lateral decubitus position for pyogenic spondylitis between the fourth and fifth lumbar spine under general and epidural anesthesia. We induced hypotensive anesthesia by using continuous infusion of dopamine, prostaglandin E1 and nitroglycerin in order to prevent heart failure and reduce the blood loss. After the operation, the patient complained of upper abdominal pain, nausea and vomiting. We found high levels of serum amylase and other pancreatic enzymes. The massive gas of small intestine was pooled in abdominal X-P, and the pancreatic head was slightly swollen in abdominal CT and US. Therefore we came to the diagnosis of postoperative acute pancreatitis. We administered a single bolus intravenous infusion of ulinastatine and continuous venous infusion of gabexate mesilate. As the serum amylase level gradually decreased, the patient improved. We suspect that postoperative pancreatitis was due to invasive anesthetic and surgical stress on the patient who had had pancreatitis in the preoperative period.

Anesthesia, Epidural↗