Biomedical subjects
Publications and source records attributed to K Hasuo.
We report a patient in whom a varix occurred with a venous angioma, a rare combination of cerebral vascular malformations. During our review of the 7 previously reported cases, we discovered that all 8 venous angiomas were relatively large and supratentorial, and that the varices involved the veins draining then.
We report a patient with an epidermoid carcinoma an extremely rare brain tumour, in the right cerebellopontine angle cistern. Contrast enhancement is the most important feature for differential diagnosis of epidermoid carcinomas from atypical benign epidermoid cysts.
Combined use of magnetoencephalography (MEG), functional magnetic resonance imaging (f-MRI), and motor evoked potentials (MEPs) was carried out on one patient in an attempt to localise precisely a structural lesion to the central sulcus. A small cyst in the right frontoparietal region was thought to be the cause of generalised seizures in an otherwise asymptomatic woman. First the primary sensory cortex was identified with magnetic source imaging (MSI) of somatosensory evoked magnetic fields using MEG and MRI. Second, the motor area of the hand was identified using f-MRI during hand-squeezing. Then transcranial magnetic stimulation localised the hand motor area on the scalp, which was mapped onto the MRI. There was a good agreement between MSI, f-MRI and MEP as to the location of the sensorimotor cortex and its relationship to the lesion. Multimodality mapping techniques may thus prove useful in the precise localisation of cortical lesions, and in the preoperative determination of the best treatment for peri-rolandic lesions.
We report two cases of cholesterol granuloma in the middle cranial fossa. On CT the lesions appeared as a nonspecific, nonenhancing soft-tissue mass with bone erosion. On MRI they were seen as areas of high signal intensity surrounded by a low-intensity peripheral zone on both T1- and T2-weighted images. Cholesterol granuloma is thought to occur when pneumatised cells in the temporal bone become obstructed. Although this lesion usually occurs in the petrous bone, it can extend to the middle cranial fossa. The diagnosis and surgical management are discussed.
A phase II study of a new combination therapy was performed using intraarterial (i.a.) cisplatin and Adriamycin in combination with i.v. methotrexate and vincristine for 27 patients with invasive urinary bladder carcinoma of stages T2-3NOMO, and the therapeutic effects were assessed. Methotrexate (20 mg/m2) was given i.v. on days 1,15, and 22, and vincristine (0.7 mg/m2) was injected i.v. on day 2 before i.a. infusion therapy and on days 15 and 22. The i.a. chemotherapy was performed after both superior gluteal arteries had been embolized using 3- or 5-mm stainless-steel coils. A mixture of cisplatin (50-70 mg/m2) and Adriamycin (20 mg/m2) was infused i.a. via both internal iliac arteries over a period of 20-30 min. Angiotensin II (mean dose, 21 micrograms) was simultaneously infused i.a. in 15 of 27 patients. In 24 of the 27 patients, at least 2 cycles of full-dose chemotherapy were completed. The dose was decreased in the remaining 3 patients because of their poor health status and advanced age. Among the 27 patients, 9 and 14 had complete (CR) and partial responses (PR), respectively; 3 manifested no change (NC), and 1 had progressive disease (PD). The objective response rate (CR+PR) was 85.2%. Among the 27 patients staged T2-3 NOMO, 6 (CR, 1; PR, 5) underwent total cystectomies and 18 (CR, 8; PR, 8; NC, 2) had transurethral resection of a bladder tumor (TUR-Bt) or partial resections following chemotherapy. The remaining 3 diminished-dose patients had no surgery. Of the 27 patients, 22 were alive after a median follow-up period of 21+ (range, 7-48+) months. No significant side effect was observed except for lower extremity paresthesias in 5 patients (18.5%). These results point to the effectiveness of this therapy and to the possibility of urinary bladder preservation in patients with invasive, advanced urinary bladder cancers.
The brain lesions were studied by magnetic resonance imaging (MRI) in 29 HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), 43 multiple sclerosis (MS) (11 with a primary progressive course: PPMS and 32 with a relapsing-remitting course: RRMS), 23 collagen-vasculitis and 54 HTLV-I-seronegative patients with other non-inflammatory neurological disorders (OND), according to the size of the lesions and their location in the brain (deep and subcortical white matter, periventricular white matter, infratentorial region and gray matter). Semiquantitative MRI analyses revealed the followings. (1) The frequency of either small or large lesions located in the periventricular as well as deep and subcortical white matter was significantly higher in HAM/TSP than in OND patients (p < 0.006, chi 2 test). In addition, the number of small lesions in the deep and subcortical, and periventricular white matter was significantly greater in HAM/TSP than in OND patients (p < 0.0003, Mann-Whitney U-test). (2) The HAM/TSP patients significantly exceeded the collagen-vasculitis patients in the frequency and the number of small lesions located in the periventricular region (p < 0.0001, chi 2 test, and p < 0.05, Mann-Whitney U-test, respectively), although no difference was found in case of those in the deep and subcortical white matter. (3) The HAM/TSP group had a lower frequency of small deep and subcortical white matter, small infratentorial and large periventricular lesions than the entire MS group (p < 0.05, chi 2 test). The PPMS group greatly exceeded the HAM/TSP group in the number of MRI lesions in all brain regions (p < 0.05, Mann-Whitney U-test), whereas RRMS and HAM/TSP patients showed a similar number of lesions (p > 0.1, Mann-Whitney U-test). Both the difference between HAM/TSP and collagen-vasculitis and the similarities between HAM/TSP and RRMS in the MRI features suggest that although all commonly have a vasculitic process as a necessary component, some other factor, probably with demyelinating effects, is operative HAM/TSP.
The authors report a case of bilateral chronic subdural hematoma in a 25-year-old woman who had occipital and neck pain. Magnetic resonance imaging revealed progressive caudal descent of the cerebellar tonsils (acquired Chiari I malformation) and a large eccentric syrinx in the spinal cord from the C3-T7 levels. Spontaneous disappearance of the chronic subdural hematomas resulted in radiographic resolution of both lesions, as well as clinical improvement. Theories of syringomyelia formation, the relationship to acquired Chiari I malformation, and the implications of this case are discussed.
PURPOSE: We evaluate the usefulness of neoadjuvant chemotherapy for bladder cancer. MATERIALS AND METHODS: The usefulness of neoadjuvant, modified methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy was evaluated in 36 patients with locally advanced bladder cancer. RESULTS: Of 36 patients 12 achieved a clinical complete response and 17 had a partial response. Of the 12 patients who achieved a clinical complete response the bladder was preserved in 11 and all patients were disease-free at a median of 33 months. No significant toxicity was observed. CONCLUSIONS: This chemotherapy is useful for locally advanced bladder cancer and the feasibility of bladder preservation in patients with a clinical complete response was suggested.
To clarify the topographical relationship between peri-Rolandic lesions and the central sulcus, we carried out presurgical functional mapping by using magnetoencephalography (MEG), functional magnetic resonance imaging (f-MRI), and motor evoked potentials (MEPs) on 5 patients. The sensory cortex was identified by somatosensory evoked magnetic fields using MEG (magnetic source imaging (MSI)). The motor area of the hand region was identified using f-MRI, during a hand squeezing task. In addition, transcranial magnetic stimulation localized the hand motor area on the scalp, which was mapped onto the MRI. In all cases, the sensory cortex was easily identified by MSI and the results of MSI correlated well with the findings obtained by the intraoperative recording of somatosensory evoked potentials. In contrast, the motor cortex could not be localized by f-MRI due to either the activated signal of the large cortical vein or the lack of any functional activation in the area of peri-lesional edema. MEPs were also unable to localize the entire motor strip. Therefore, at present, MSI is considered to be the most reliable method to localize peri-Rolandic lesions [corrected].
Since 1982 we have developed and successfully performed lipiodolization on 205 patients with unresectable hepatocellular carcinoma. The 1-, 2-, 3-, 4-, and 5-year survival rates were 55.6%, 31.7%, 16.3%, 8.7%, and 2.9%, respectively, while the median survival was 413 days, and 20 patients survived longer than 3 years after the first lipiodolization. Our study demonstrated that the factors for a comparatively good prognosis were as follows: patient older than 50 years, nodular type hepatocellular carcinoma < 5 cm in diameter, negative tumor invasion of portal vein, < 10 intrahepatic metastases, serum alpha-fetoprotein level < 400 ng/ml, and Okuda stage I. Lipiodolization did not cure hepatocellular carcinoma. It did, however, in this study, achieve a prolongation of the patient's survival.
We examined 13 patients with chronic carbon monoxide (CO) poisoning by magnetic resonance imaging (MRI); all of them had been in an explosion in a coal mine 25 years previously. Symmetrical globus pallidus lesions were observed in 12, as was degeneration of the white matter, with focal cortical atrophy. The temporal parietal and occipital lobes were usually affected, the parietooccipital region being the most frequently and extensively damaged. Of the 12 patients with white matter degeneration 7 had definitely asymmetrical cortical and subcortical lesions. There were 6 patients with dilated temporal horns, probably due to atrophy of the hippocampal gyri. A history of CO inhalation and an awareness of the typical distributions of lesions are important for recognition of the effects of CO poisoning, especially when patients are in the chronic stage.
The clinical features of 6 children who are probable sufferers of "unilateral" Moyamoya disease are here reported. They showed angiographic findings which were compatible with those of Moyamoya disease, albeit only on one side. They did not, however, show any basic aetiologic factors. The age of onset, the clinical symptoms and the findings of electroencephalography, angiography, and positron emission tomography in these cases were also quite similar to those in the cases of Moyamoya disease except for unilateral involvement. All 6 patients underwent either direct or indirect EC-IC bypass surgery. In 3 children who received encephalo-duro-arterio-synangiosis, an indirect bypass procedure, the collateral circulation was well formed postoperatively. In the follow-up study, 2 of the 6 cases starting with a unilateral lesion developed bilateral involvement later. However, the other 4 cases persisted in showing only unilateral involvement. These 4 cases may suggest the existence of "unilateral" Moyamoya disease in the paediatric age, and it is recommended that such cases be treated similarly to those of bilateral Moyamoya disease.
The radiological evaluation of central nervous system has been dramatically altered by the advent of MR imaging. MR imaging is a versatile modality that has been applied in almost all kinds of disorders in the brain, spinal cord and the surrounding structures. However, there are some limitations, such as low detectability of subarachnoid hemorrhage or calcifications, difficulty in visualization of bony details, and various kinds of artifacts. On the other hand, there have also been considerable technical advances in other imaging modalities, such as spiral CT, doppler US, etc. With the continuous advance in each imaging modality, their roles and the strategy in the diagnosis of disorders in central nervous system will be changed. In this review, the present status and current roles of various imaging modalities, such as plain X-ray, CT, MR imaging, nuclear medicine, ultrasound, angiography and myelography, are discussed.
In our ongoing studies on the hemodynamics of splenic artery aneurysms (SAA) in portal hypertension, 32 patients with portal hypertension were examined by duplex sonography and angiography. Four out of 32 (12.5%) had SAA, and SAA(+) and SAA(-) groups were formed. On duplex sonography, splenic venous blood flow in the SAA(+) group (1058 +/- 211 ml/min) increased more than in the SAA(-) group (423 +/- 173 ml/min, p < 0.01), but there was no significant difference in portal venous flow. On angiography, there were significant differences in the diameters of the splenic arteries between the SAA(+) group (7.5 +/- 0.5 mm) and the SAA(-) group (5.6 +/- 1.0 mm, p < 0.01). All patients (100%) in the SAA(+) group had prominent portosystemic shunts, while 8 out of 28 (28.6%) in the SAA(-) group had these shunts (p < 0.05). Thus, there seems to be a splenic hyperkinetic state in patients with SAA and portal hypertension, a finding which may closely relate to the pathogenesis of SAA.
Forty-one lesions of intracranial and spinal diseases underwent magnetic resonance (MR) imaging at both standard-dose (0.1 mmol/kg) and double-dose (0.2 mmol/kg) levels of gadolinium (Gd)-DTPA in order to reassess the optimal dose of Gd-DTPA. Each patient received an initial injection of 0.1 mmol/kg and an additional dose of 0.1 mmol/kg 5 min later. In quantitative analysis of contrast enhancement ratios of the enhancing part of the lesion, choroid plexus, cavernous sinus and pituitary stalk were significantly (P < 0.01) increased in double-dose studies. For visual comparison, we defined delineation as the extent to which the lesion may be defined; detectability was defined as the ability to visualize the lesion. With respect to delineation, double-dose studies were superior to standard-dose studies in nine of 20 intraaxial tumor (four of eight malignant gliomas, three of eight benign gliomas and two of four metastatic brain tumors) and five of six cerebral infarcts. The detectability of the lesion was improved in four cases (one astrocytoma, two metastatic brain tumors and one cerebral infarct) in double-dose studies. It was concluded that contrast-enhanced MR imaging using double doses of Gd-DTPA may be useful in the detection and evaluation of the extent of intraaxial lesions enhanced by Gd-DTPA.
BACKGROUND: Because transcatheter arterial embolization (TAE) has been shown to be effective in patients with unresectable hepatocellular carcinoma (HCC), the question arises whether TAE has an equivalent or superior effect on resectable HCC compared with surgery. To clarify this point, the authors compared the therapeutic results achieved by surgery and TAE in patients with early-stage HCC and well-preserved liver function, who were independently treated by two different policies in two separate departments of the same university hospital during the same period. METHODS: From 1983 to 1987, 67 patients with HCC underwent hepatic resection at the Department of Surgery of Kyushu University Hospital. During the same period, TAE was the treatment of first choice for HCC, and surgical resection was not chosen in the Department of Internal Medicine of the hospital. TAE was done in 68 patients, who were evaluated blindly in terms of liver function reserve and roentgenographic resectability of the tumor. Among the 68 patients, 20 were thought to have anatomically and functionally resectable disease. The therapeutic results obtained in the two groups were compared. RESULTS: The 1-year, 3-year, and 5-year cumulative survival rates for 67 patients undergoing surgery, including one operative death and four hospital deaths, were 89.1%, 74.6%, and 54.6%, respectively. However, the rates were 90.0%, 50.0%, and 17.5%, respectively, for the 20 patients treated with TAE; these differences were statistically significant (P < 0.05). CONCLUSIONS: Surgery can offer more favorable results in patients with early-stage HCC compared with TAE.
Five patients with primary biliary cirrhosis (PBC) underwent cerebral magnetic resonance (MR) imaging to evaluate subclinical hepatocerebral degeneration. All patients were neurologically asymptomatic, but three of the five patients had symptoms such as jaundice and itching. Symmetrically hyperintense globus pallidi were observed on T1-weighted images in four of the five patients. One remaining patient who had normal MR images was an asymptomatic fresh case. Patients with markedly hyperintense globus pallidi also had mildly increased signal intensities in the surrounding structures. On proton-density- and T2-weighted images, there were no abnormal signals in the globus pallidi any of the patients. Portal-systemic collateral vessels were demonstrated in three of the four patients with abnormal MR images. The mechanisms by which T1-shortening of the globus pallidi occurs remains obscure. We believe that both portal-systemic collaterals and cholestasis play a prominent role in the cause of cerebral abnormalities on T1-weighted images.
Magnetic resonance (MR) images of seven patients with olivary degeneration caused by cerebellar or brain stem haemorrhages were reviewed. In four patients with cerebellar haemorrhage, old haematomas were identified as being located in the dentate nucleus; the contralateral inferior olivary nuclei were hyperintense on proton-density- and T2-weighted images. In two patients with pontine haemorrhages, the old haematomas were in the tegmentum and the ipsilateral inferior olivary nuclei, which were hyperintense. In one case of midbrain haemorrhage, the inferior olivary nuclei were hyperintense bilaterally. The briefest interval from the ictus to MRI was 2 months. Hypertrophic olivary nuclei were observed only at least 4 months after the ictus. Olivary degeneration after cerebellar or brain stem haemorrhage should not be confused with ischaemic, neoplastic, or other primary pathological conditions of the medulla.