Biomedical subjects

Jun-ichi Kuratsu

Publications and source records attributed to Jun-ichi Kuratsu.

At least 19 recordsLinked to original sources

PubMed2007

Moyamoya disease associated with midaortic syndrome.

We report a 1-year-old girl who presented moyamoya disease associated with midaortic syndrome. She had been treated for cardiac failure and severe hypertension due to midaortic syndrome until she suffered seizure and repeated cerebral ischemic attack. Cerebral angiography revealed stenosis of the bilateral internal carotid artery at its terminal portion. She was successfully treated with encephaloduroarteriosynangiosis, and ischemic attack ceased postoperatively. This is the first report of moyamoya disease with midaortic syndrome. Although cerebral ischemic attack has been effectively managed by encephaloduroarteriosynangiosis, renovascular hypertension is still difficult to control.

Aortic Coarctation↗

PubMed2006

Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms.

OBJECTIVE: To compare the preoperative and postoperative health-related quality of life (QOL) and psychological state of patients with asymptomatic unruptured intracranial aneurysms (ICAs) who underwent elective surgery. METHODS: Out of 67 patients who underwent neck clipping of ICAs, we assessed the QOL of 61 patients using Short Form-36 (SF-36); their psychological state was rated on the Hospital Anxiety and Depression Scale (HADS) before, 3 months, and 1 and 3 years after treatment. RESULTS: The preoperative mean scores for each of the eight SF-36 domains except bodily pain were significantly lower in the study population than in the reference population. 14 (20.9%) patients experienced surgical complications defined as neurological deterioration and/or abnormal CT findings within 30 days of the operation. Despite some complications, the QOL of all operated patients returned to the mean level of the reference population 3 years after treatment. At 3 months after surgery, the scores for psychosocial activities and general health perception were transiently below the preoperative levels. According to the HADS, the patients experienced mild anxiety before the operation; it disappeared by the third postoperative month. CONCLUSIONS: Preoperatively, patients with unruptured ICAs reported a significantly decreased QOL. It further declined transiently after elective surgery, but it returned to the mean level recorded for the reference population within 3 years. Our findings suggest that these patients derived significant QOL benefits from their surgery. Hence subjective QOL issues should be considered in deciding whether treatment-related risks and their natural history, such as their potential rupture, warrant surgery of asymptomatic unruptured ICAs.

Aged↗

PubMed2006

Sellar repair with resorbable polyglactin acid sheet and fibrin glue in endoscopic endonasal transsphenoidal surgery.

BACKGROUND: Cerebrospinal fluid leakage after transsphenoidal surgery represents a serious problem. Various methods to prevent postoperative CSF leakage are available, but immediate and tight dural closure is still difficult. The efficacy of a novel sellar repair was described. METHODS: The sellar repair using absorbable PGA sheet and fibrin glue was applied to 18 consecutive patients with sellar tumors that include 13 pituitary adenomas, 2 craniopharyngiomas, 2 Rathke's cleft cysts, and 1 meningioma within 135 patients who were treated with endoscopic endonasal transsphenoidal approach. The reaction speed and strength between PGA sheets and fibrin glue were examined in vitro. RESULTS: Polyglactin acid sheets were adhered to the rabbit skin with fibrin glue within 3 minutes and withstood a pressure of more than 220 mm Hg. Postoperative CSF leakage of the patients was not observed in any patients, and excellent adhesion of the PGA sheets to surrounding mucosa was estimated by endoscopic observation after the surgery. CONCLUSIONS: Repair of the sellar floor with PGA sheet and fibrin glue is a safe and effective method to prevent postoperative CSF leakage, which decreases the necessity for lumbar drainage after the operation.

Absorbable Implants↗

PubMed2006

Sodium orthovanadate enhances proliferation of progenitor cells in the adult rat subventricular zone after focal cerebral ischemia.

Neuronal progenitor cells able to produce new neuron and glia persist in the adult central nervous system (CNS). Their proliferation is up-regulated by growth factors or cytokines under some pathological conditions, including ischemia. Because sodium orthovanadate (SOV), a protein tyrosine phosphatase inhibitor, can up-regulate tyrosine kinase-linked growth factor receptor signaling via the inhibition of tyrosine residue dephosphorylation, it may be capable of enhancing progenitor cells. To investigate the effect of SOV on progenitor cells in the subventricular zone (SVZ), we injected rats intraperitoneally with 50 mg/kg bromodeoxyuridine (BrdU) and 12.5 or 25 mM SOV or BrdU and saline (control) on days 1 to 7 after middle cerebral artery occlusion. The density of BrdU-positive cells in the ipsilateral SVZ showed a significant SOV dose-dependent increase. This effect was found only in the ipsilateral and not contralateral SVZ, and it was not found in nonischemic rats. Double immunolabeling with BrdU and double cortin, a marker of migrating neuroblast, revealed that the density of double-positive cells increased significantly in an SOV dose-dependent manner. Terminal deoxynucleotidyl transferase dUTP nick-end labeling staining suggested that the SOV-induced increase was not due to antiapoptotic effects. Treatment with SOV also significantly increased the density of cells positive for BrdU and phosphorylated Akt and BrdU and phosphorylated extracellular signal-regulated kinase (ERK). We postulate that ischemia triggers off the proliferation of SVZ cells by bioactive factors such as growth factors and that SOV enhances the proliferation of only triggered-off SVZ cells with Akt and ERK activation. Our findings suggest that SOV may aid in the self-repair of the postischemic CNS.

Animals↗

PubMed2006

Alleviation of camptocormia by bilateral subthalamic nucleus stimulation in a patient with Parkinson's disease.

Camptocormia, known also as "bent spine syndrome", is characterized by involuntary truncal flexion of the thoraco-lumbar spine that appears in the sitting or standing position. Although Parkinson's disease (PD) is the most frequent etiologic factor, this postural disorder responds poorly to levodopa or other medications. We report a PD patient in whom chronic bilateral subthalamic nucleus stimulation produced a striking alleviation of camptocormia.

Aged↗

PubMed2006

CHOP is involved in neuronal apoptosis induced by neurotrophic factor deprivation.

Neurotrophic factors are essential for the survival of neurons. We found that the endoplasmic reticulum (ER) stress-C/EBP homologues protein (CHOP) pathway to be activated during neurotrophic factor deprivation-induced apoptosis in PC12 neuronal cells and in primary cultured neurons, and this apoptosis was suppressed in the neurons from chop(-/-) mice. In addition, we found that CHOP is expressed in the subventricular zone (SVZ) and striatum of the young adult mouse brain. The number of apoptotic cells in the SVZ decreased in chop(-/-) mice. These results indicate that the ER stress-CHOP pathway plays a role in neuronal apoptosis during the development of the brain.

Animals↗

PubMed2006

Complete suppression of paroxysmal nonkinesigenic dyskinesia by globus pallidus internus pallidal stimulation.

Stereotactic functional surgery is being explored as potential therapies for medically intractable paroxysmal dyskinesias (PxD). We report on a 59-year-old man in whom stimulation of globus pallidus internus produced immediate and sustained relief of paroxysmal non-kinesigenic dyskinesia secondary to a rotator cuff tears on the left shoulder. Our finding strongly suggests that altered function of neuronal circuits of the basal ganglia underlies the manifestation of PxD.

Chorea↗

PubMed2006

Impact of bilateral pallidal stimulation on DYT1-generalized dystonia in Japanese patients.

Early-onset generalized dystonia attributable to a DYT1 gene mutation is a hyperkinetic movement disorder that responds poorly to pharmacotherapy. In this video brief, we show that continuous bilateral stimulation of the globus pallidus internus produced sustained and marked improvements in the motor symptoms and functional disabilities of Japanese patients with DYT1-generalized dystonia.

Adolescent↗

PubMed2006

Treatment of unruptured duplicated middle cerebral artery aneurysm: case report.

BACKGROUND: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). The origin of the DMCA lies between the anterior choroidal artery and the distal end of the ICA. The association of cerebral aneurysm and DMCA is rare. CASE DESCRIPTION: In this 63-year-old woman, preoperative angiography and 3-dimensional computed tomography angiography revealed an aneurysm at the origin of the DMCA. The aneurysm was clipped and superficial temporal artery-DMCA anastomosis was performed. She was discharged with no neurologic deficits. Duplication of the middle cerebral artery can be divided into 2 types based on whether the site of separation from the ICA is at the top of the ICA (type A) or between the ICA top and the anterior choroidal artery (type B). The diameter of type A DMCA is comparable with that of the main middle cerebral artery trunk; in type B, it is smaller. In all 18 previously reported cases, the aneurysm was associated with type B DMCA. CONCLUSION: For appropriate treatment planning, it is necessary to determine the DMCA type and the anatomic relationship between the aneurysm and the DMCA. In patients with type B DMCA, the possibility of aneurysm formation should be considered.

Anastomosis, Surgical↗

PubMed2006

Cavernous malformation of the optic chiasm: case report.

We report a 14-year-old boy with cavernous malformation of the optic chiasm. He had a 2-year history of gradually worsening visual disturbance. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a suprasellar mass, findings compatible with craniopharyngioma. The mass was biopsied and histological examination confirmed cavernous malformation. On the second day after the biopsy, he suffered chiasmal apoplexy due to intratumoural haemorrhage, lost visual acuity and developed a field cut. Cavernous malformations arising from the optic nerve and chiasm are extremely rare; only 29 cases have been reported to date. Most patients manifested acute visual acuity and visual field disturbances. Although MRI findings of cavernous malformations in the brain parenchyma have been reported, MRI findings on the optic nerve and chiasm may not be completely diagnostic. Of the 29 documented patients, 16 underwent total resection of the lesion without exacerbation of their preoperative symptoms; in some cases, resection was complicated by risk of damage to the surrounding neural tissue. As patients may suffer intratumoural haemorrhage after biopsy or partial removal of the lesion, the advisability of surgical treatment of cavernous malformations of the optic nerve and chiasm must be considered carefully.

Adolescent↗

PubMed2006

Rapidly enlarging chordoid meningioma with abundant mucin production.

This 77-year-old woman with a rapidly enlarging chordoid meningioma first noticed a growing, non-pulsatile, nonpainful soft mass in the left temporal region after a head trauma 2 years earlier. Neuroimaging showed a homogeneously enhanced osteolytic mass lesion in the left temporal bone. Surgery revealed an extradural tumor without significant adhesions. Histopathologically it was a meningioma with features reminiscent of chordoma. Most of the tumor cells contained mucin-rich chordoid elements. Immunohistochemically, the lesion was positive for vimentin and epithelial membranous antigen; it was negative for cytokeratin and S-100 protein. Based on these findings a diagnosis of chordoid meningioma was made. We posit that the rapid enlargement of the tumor over a relatively short period was attributable to its high mucin-producing activity.

Aged↗

PubMed2006

Third ventricular ependymal cyst presenting with acute hydrocephalus.

Ependymal cysts are generally located in the cerebral parenchyma but rarely found in the third ventricle. A 4-year-old boy presented with headache, vomiting, and upward gaze palsy. His consciousness gradually deteriorated in the course of 6 h. A magnetic resonance imaging study disclosed dilation of the lateral ventricle and a cystic mass in the third ventricle. We performed an endoscopic resection of the cyst wall. The cyst originated on the lateral wall of the third ventricle and obstructed the aqueduct. Histological examination confirmed a diagnosis of ependymal cyst. The patient recovered quickly and his headache and nausea disappeared. Third ventricular ependymal cysts are a rare cause of acute hydrocephalus but an important differential diagnosis. Their neuroendoscopic resection can resolve disturbances in cerebrospinal fluid circulation, is useful for cyst wall removal, and appears to be superior to shunt placement.

Acute Disease↗

PubMed2006

Endovascular treatment of ruptured aneurysms associated with fenestrated basilar artery. Two case reports.

Two patients with ruptured aneurysm associated with fenestrated basilar artery (BA) were treated using the endovascular approach. Angiography showed these patients had different types of BA bifurcation. One type had two points of bifurcation and a bridging artery in the BA fenestration, with the aneurysm at the bifurcation of the right loop of the fenestration. The aneurysm had different appearances on right and left vertebral angiograms. The other type had only one point of bifurcation, and the appearance of this aneurysm was similar on both angiograms. To ensure successful embolization, bilateral vertebral angiography should be performed for complete assessment of the morphological characteristics of aneurysm associated with fenestrated BA.

Adult↗

PubMed2006

Low-grade astroblastoma recurring with extensive invasion.

A 17-year-old male presented with morning headache and double vision. Neuroimaging revealed a lobulated enhanced mass lesion with a blurred margin and remarkable peritumoral edema, and high uptake of methionine. The gray, soft, well-circumscribed mass was grossly totally resected. Histological examination showed the tumor cells were well differentiated with the perivascular pseudorosette pattern with broad, non-tapering processes radiating towards a central vessel without anaplastic features such as necrosis and endothelial proliferation. The histological diagnosis was low-grade astroblastoma. Follow-up magnetic resonance imaging demonstrated local recurrence 5 months later. Second surgery was followed by adjuvant radiotherapy and combination chemotherapy. Histological examination disclosed wide invasion by tumor cells into the subpial and perivascular space of the surrounding brain tissue. Follow-up magnetic resonance imaging demonstrated further recurrence around the tumor cavity. Surgical removal followed by six courses of combination chemotherapy (ifosfamide, cisplatin, and etoposide) resulted in complete remission of the tumor. Although gross total resection of astroblastoma usually results in long-term survival, some of these yet unfamiliar tumors may develop a more malignant character.

Adolescent↗

PubMed2006

Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience.

OBJECT: To determine the indications for surgery in patients harboring asymptomatic meningiomas, the authors retrospectively analyzed the natural course and surgical outcome of asymptomatic meningiomas and then compared these to the natural course and surgical outcome of symptomatic meningiomas. METHODS: Between 1989 and 2003, 1434 patients harboring meningiomas, who were treated in Kumamoto Prefecture, Japan, were enrolled in this study. Six hundred three patients had asymptomatic lesions and 831 had symptomatic ones. The authors analyzed the sizes of the lesions at detection, their growth over time, and any appearances of symptoms associated with previously asymptomatic meningiomas. The authors then compared the surgery-related morbidity rates associated with asymptomatic and symptomatic meningiomas arising at different locations. Of the 603 asymptomatic meningiomas, 351 (58.2%) were treated conservatively. Tumor growth was observed in 25 (37.3%) of 67 patients who participated in follow up for longer than 5 years, and symptoms developed in 11 (16.4%) of the 67 patients over a mean follow-up period of 3.9 years. Among the 213 patients with surgically treated asymptomatic meningiomas, the morbidity rate was 4.4% in patients younger than 70 years of age and 9.4% in those 70 years of age or older. Although the total morbidity rate was lower in patients with asymptomatic lesions than in those with symptomatic ones, it exceeded 6% in patients whose asymptomatic tumors were located at the convexity or falx. CONCLUSIONS: Approximately 63% of asymptomatic meningiomas did not exhibit tumor growth, and only 6% of all patients with these lesions experienced symptoms during the observation period. To avoid surgery-related incidences of morbidity in patients with asymptomatic meningiomas, conservative treatment with close follow-up review may be the best therapeutic strategy.

Adolescent↗

PubMed2006

Histological study of paramedian dorsal root ganglia in an infant with split cord malformation. Case report.

The authors present a histological study of resected tissue obtained from an 18-month-old girl with split cord malformation Type II whose right foot was smaller than her left. Magnetic resonance imaging revealed duplication of the spinal cord below the level of L-1. On laminectomy it was discovered that the cord was tethered in the lumbosacral region. The resected tissue contained the cluster of paramedian dorsal root ganglia unique to this congenital anomaly. On histological examination, the ganglion cells expressed not only neuronal markers but also a marker for muscle cells indicative of pathological development of the midline structure. Further histological study is necessary to gain a deeper insight into this congenital disease and to obtain additional information for use in surgical planning.

Female↗

PubMed2005

Modulation of torsinA expression in the globus pallidus internus is associated with levodopa-induced dyskinesia in hemiparkinsonian rats.

TorsinA is the causative protein of DYT1 dystonia, a major representative of hyperkinetic movement disorders. In this study, the distribution of torsinA was investigated in the basal ganglia of hemiparkinsonian rats with or without levodopa-induced dyskinesia (LID). Two months after 6-hydroxydopamine (OHDA) treatment, Wistar-albino rats were subjected to intermittent intraperitoneal injection of levodopa/benserazid (LID-group, n=5) or vehicle (control, n=5) for 21 days. Immunohistochemical analysis disclosed that in the caudal portion of the entopeduncular nucleus (EP), homologous to the globus pallidus internus (GPi) in primates, on the parkinsonian side, there was a significant decrease of torsinA-immunopositive neurons in rats with LID, but not in those without LID. However, Nissl-staining showed no loss of GPi neurons in rats with LID. In both groups, there was no significant difference between ipsi- and contralateral sides with respect to the density of torsinA-positive neuronal cells in the striatum, globus pallidus externus, and subthalamic nucleus. Ours are the first data to demonstrate the specific modulation of torsinA expression in the basal ganglia of the hyperkinesia model, suggesting that GPi neurons containing torsinA possess pathologic plasticity for LID.

Animals↗

PubMed2005

Double microcatheter technique for endovascular coiling of wide-neck aneurysms using a new guiding device for the transcarotid approach: technical note.

In the endovascular treatment of cerebrovascular diseases, positioning the guiding catheter is of great importance. In cases where vessel tortuosity prohibits positioning the guiding catheter in the carotid artery via the femoral approach, we use a direct carotid approach via common carotid artery puncture. For direct puncture of the common carotid artery we devised a 6-Fr sheath with double insertion points. This new device facilitates the use of double microcatheters and provides safe and effective vascular access.

Aged↗