PubMed Health⌕ Search

Biomedical subjects

K Kinugasa

Publications and source records attributed to K Kinugasa.

At least 37 records · Page 2Linked to original sources
PubMed1994

Cellulose acetate polymer thrombosis for the emergency treatment of aneurysms: angiographic findings, clinical experience, and histopathological study.

Cellulose acetate polymer solution is a liquid thrombotic material that hardens into the shape of an aneurysm into which it is injected. Therapy using this solution is a rapid technique that helps prevent the rupture of aneurysms, especially those that extravasate contrast material during angiography in the acute stage of subarachnoid hemorrhage. Using this polymer solution and an endovascular technique, we treated two patients who had aneurysms of the basilar and anterior communicating arteries with extravasation of contrast material during angiography a few hours after the initial subarachnoid hemorrhage. In one patient with an aneurysm of the anterior communicating artery, the aneurysm's wall was perforated with the catheter during neurointerventional procedures. In both patients, postoperative angiograms demonstrated obliteration of the aneurysmal dome, including the site of extravasation or perforation. The parent artery and surrounding perforating branches were preserved. Although we do not advocate aggressive therapy for patients who bleed during angiography, we pursued this therapy in these two patients because of the opportunity to introduce cellulose acetate polymer in an attempt to preserve the patients' lives. Unfortunately, both patients died. Histopathological studies performed at the time of autopsy demonstrated that the luminal surface of cellulose acetate polymer was covered with thrombus by 6 days after cellulose acetate polymer thrombosis. By 10 days, the thrombus had a prominent fibrin network, a concentrated plasma component, and few fibrocytes adhering to its luminal surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Direct thrombosis of a pseudoaneurysm after obliteration of a carotid-cavernous fistula with cellulose acetate polymer: technical case report.

A 55-year-old man who suffered a head injury resulting in a left traumatic carotid-cavernous fistula was successfully treated with an intravascular detachable balloon. A pseudoaneurysm formed adjacent to the balloon. Seven months after the initial procedure, treatment with cellulose acetate polymer, a new liquid thrombotic material, occluded the pseudoaneurysm and preserved the internal carotid artery.

Aneurysm, False↗
PubMed1994

Selection and combination of techniques for treating spontaneous carotid-cavernous sinus fistulas.

Twenty-eight patients with spontaneous carotid-cavernous sinus fistulas (CCFs) were treated using a variety of techniques. Three of four patients with direct CCFs underwent intravascular embolization with a detachable balloon. Embolization with polyvinyl alcohol particles through an external carotid endoarterial route was used in six patients with indirect CCFs, and with ethylene-vinyl alcohol copolymer solution in two. Patients undergoing these conventional treatments, including embolization of the meningeal branches of the external carotid artery, had less satisfactory outcomes. The transvenous approach using minicoils through the inferior petrosal sinus was successful in eight patients. One patient treated using the transvenous approach using copper wire through the ophthalmic vein had worsening of visual acuity and field. Unsuccessful transvenous embolization in four patients required direct surgical exposure and embolization with spring coils. Spontaneous cures occurred in four patients. Direct CCFs with high flow rates were best treated with the detachable balloon or coil technique through a internal carotid endoarterial route. Indirect CCFs were best treated with the minicoil through the inferior petrosal sinus. If these techniques fail, direct surgical exposure allows placement of coils into the cavernous sinus.

Adult↗
PubMed1993

A case of pontine lacunar infarction with ulcerative colitis.

We present the case of a young man who experienced a sudden onset of pure motor hemiplegia in association with ulcerative colitis. Based on a review of earlier reports, ulcerative colitis was suspected to be the background disease leading to cerebral infarction. A cerebral infarction of the lacunar type in the right ventromedial aspect of the upper pons was seen on magnetic resonance images. These images detected small lesions in the brain stem, and were used to follow-up their transitions.

Adolescent↗
PubMed1993

Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angiograms.

Moyamoya syndrome is defined as the development of collateral anastomosis pathways at the base of the brain, associated with chronic progressive stenosis of the carotid fork. Both reconstructive vascular surgery and conservative strategies are used to treat this syndrome, but the latter cannot prevent the disease from progressing. We describe the procedure of encephalo-duro-arterio-myo-synangiosis (EDAMS), and report the results in 17 patients (28 sides) who underwent EDAMS. The clinical symptoms of moyamoya disease include transient ischemic attacks, reversible ischemic neurological deficits, stroke, seizures, Gerstmann's syndrome, involuntary movements, or mental retardation resulting from the lack of cerebral blood flow. The clinical results of EDAMS were poor in one patient, fair in two, good in five, excellent in eight, and fair on one side and excellent on the other side in one patient. Postoperative angiograms showed widespread collateral circulation on the ischemic brain surface in patients undergoing EDAMS.

Adolescent↗
PubMed1993

Contralateral external carotid-to-middle cerebral artery graft using the saphenous vein. Case report.

A variation of the extracranial-intracranial arterial bypass, using a long saphenous vein graft, is presented. The saphenous vein graft was inserted from the contralateral external carotid artery to the distal middle cerebral artery to replace the common and internal carotid arteries in a patient with a large neck tumor that invaded the common and internal carotid arteries, the esophagus, and the trachea. The patient had a positive balloon Matas' test. The saphenous vein was covered with an artificial vascular graft so that turning of the head or movement of the mandible did not displace or compress the graft. A large volume of flow began immediately after anastomosis. A description of the case and the operative technique is presented herein.

Aged↗
PubMed1993

Superficial temporal artery interposition graft after resection of bilateral anterior cerebral arteries. Case report.

A patient with an olfactory neuroblastoma in the frontal skull base was treated with primary tumor excision and partial resection of the A2 segment of both anterior cerebral arteries (ACA's). Revascularization was carried out using a superficial temporal artery (STA) interposition graft between the proximal and distal stumps with A3 segment-to-A3 segment end-to-side anastomosis. This technique established flow to the peripheral territories of the ACA's through the interposed STA graft. The technical aspects and possible role of this procedure are presented.

Adult↗
PubMed1992

Direct thrombosis of aneurysms with cellulose acetate polymer. Part I: Results of thrombosis in experimental aneurysms.

The authors have developed a liquid material for thrombosing aneurysms. This material is a mixture of cellulose acetate polymer and bismuth trioxide dissolved in dimethyl sulfoxide. On contact with blood, the dimethyl sulfoxide diffuses and cellulose acetate polymer forms, which balloons when slowly injected into the blood. The polymer solidifies from surface to core in 5 minutes. Cellulose acetate polymer was injected directly into experimental aneurysms created in 10 dogs; it rapidly hardened in the shape of the aneurysms, completely obliterating them but preserving the parent vessels in all cases. No distal migration of the polymer was seen. The good results of this experimental trial led to a clinical study using a cellulose acetate polymer, as described in Part II.

Aneurysm↗
PubMed1992

Direct thrombosis of aneurysms with cellulose acetate polymer. Part II: Preliminary clinical experience.

The authors report the treatment of seven intracranial aneurysms in six patients with direct infusion of cellulose acetate polymer solution, a new liquid thrombotic material. These aneurysms were considered inoperable because of their size or location, or because of the patient's neurological condition. This material avoids the difficulties associated with balloon occlusion, and completely fills even irregularly shaped aneurysms. Cellulose acetate polymer solution hardens in about 5 minutes and remains solid once inside the aneurysm. Because this technique is less invasive than surgery, it can be used for high-risk patients in the acute stage of subarachnoid hemorrhage. Transient motor aphasia occurred in one patient. A small residual neck, which caused rebleeding 3 months after the treatment, remained in another patient. This article describes the new material, the procedure for direct thrombosis, and preliminary clinical results.

Adult↗
PubMed1992

[A case of pheochromocytoma in pregnancy].

A 29-year-old woman was referred to our hospital at the 34th week of her first pregnancy with a diagnosis of severe pregnancy-induced hypertension. A diagnosis of pheochromocytoma was made by elevated values of serum and urinary noradrenaline. Ultrasonography and computed tomography revealed a left adrenal tumor. Caesarean section combined with removal of the tumor at the 36th week of gestation was performed with a satisfactory result obtaining a healthy mother and an infant. Current management of patients with a pheochromocytoma during pregnancy is discussed.

Adrenal Gland Neoplasms↗
PubMed1992

[Unbranched-site aneurysm of intracranial internal carotid artery].

Most intracranial saccular aneurysms arise from the angle between a parent vessel and an arterial branch. Saccular aneurysms without relation to any arterial branch are rare. During the last 24 years, 210 patients with intracranial internal carotid artery (ICA) aneurysms were directly operated on at our institution. We found eight saccular aneurysms arising from intracranial ICA without relation to any arterial branch. So we call them unbranched-site aneurysms of intracranial ICA, and describe their unique characteristics. Of the eight cases with unbranched-site aneurysm of intracranial ICA, three were men and five were women. The age ranged from 31 to 61 years with an average age of 48. Seven cases suffered a subarachnoid hemorrhage due to ruptured unbranched-site aneurysm, and the other case had been admitted to our department because of accompanying ruptured left internal carotid-posterior communicating aneurysm. All cases of unbranched-site aneurysm presented intraoperative and/or angiographic findings of arteriosclerosis, and five of the patients had a past history of hypertension. Of the four unbranched-site aneurysms at the C2 portion of ICA, two arose from the lateral wall, one arose from the superior wall and the other arose from the infero-lateral wall of ICA. Of the four unbranched-site aneurysms at the C1 portion of ICA, three arose from the superior wall and the other arose from the supero-medial wall of ICA. Radical operation was performed in all cases and intraoperative rupture occurred in two cases. It was suggested that arteriosclerotic change in the arterial wall, and local hemodynamic stress played important roles in the development of unbranched-site aneurysms of intracranial ICA.

Adult↗
PubMed1991

[Direct embolization with occluding spring embolus for large aneurysm and carotid-cavernous fistula].

The authors describe a technique using occluding spring emboli for direct obliteration of an unclippable large aneurysm, and carotid-cavernous fistula (CCF) which failed to be occluded by transarterial and transvenous approaches. Case 1: This 44 year-old man had a history of head trauma 30 years ago. He was admitted to our department on October 16, 1989, because of an aneurysm incidentally found by a CT scan taken for the examination of his vertigo. Angiograms revealed a large aneurysm at the C3 portion of the right internal carotid artery. A right frontal craniotomy was performed on November 2, 1989, but neck clipping of the aneurysm was impossible, because it was a pseudoaneurysm with quite a fragile neck. Subsequently, fourteen occluding spring emboli were inserted into the aneurysm through a polyethylene catheter directly into the aneurysmal dome. Postoperative angiograms showed almost complete obliteration of the aneurysm with good preservation of the parent artery. Case 2: This 26 year-old woman without a history of head trauma was admitted to our department on May 10, 1989, complaining of right conjunctival injection and exophthalmos. Angiograms revealed a spontaneous CCF which had a single orifice at the C4 portion of the right internal carotid artery and drained through the superior ophthalmic vein and inferior petrosal sinus. Initially, transarterial and transvenous approaches were tried, but the attempts were unsuccessful. Subsequently, a right frontotemporal craniotomy was performed on August 8, 1989, and 27 occluding spring emboli were placed into the cavernous sinus through a polyethylene catheter which had been inserted directly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Primary myelofibrosis with extramedullary haematopoiesis of the skin transformed into acute megakaryoblastic leukemia].

A 70-year-old man, who had been diagnosed as primary myelofibrosis in 1987 at Tokyo Women's Medical School, was admitted to our hospital because of left hip-joint pain in May 1988. Physical examinations revealed marked hepatosplenomegaly and multiple reddish papules on the skin. The peripheral blood showed marked leukoerythroblastosis and severe anemia with poikilocytosis. Bone marrow aspirations were dry tap. Needle biopsy of iliac crest showed a diffuse fibrosis. Biopsy of the papules showed an extramedullary haematopoiesis. He was treated with low dose Ara-C for seven days. Although hepatosplenomegaly and skin papules were reduced, he died of pneumonia a month later. At autopsy, leukemic cells massively infiltrated into the multiple organs, including bone marrow. The cells were identified with megakaryoblast, as those were positive for factor VIII related antigen. As far as we know, this is the third case of primary myelofibrosis transformed into acute megakaryoblastic leukemia.

Aged↗
PubMed1987

Artificial embolization with isobutyl-2-cyanoacrylate for the treatment of carotid-ophthalmic aneurysm.

A large carotid-ophthalmic aneurysm was successfully obliterated by the combined treatment of clipping the aneurysmal neck and intraaneurysmal injection of isobutyl-2-cyanoacrylate. Reflux of the glue into the artery was prevented by temporary trapping of the carotid artery. The obliteration of an aneurysm with isobutyl-2-cyanoacrylate is an effective procedure in cases where clipping of the aneurysmal neck is not completed due to technical difficulties.

Bucrylate↗