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Biomedical subjects

K Kunishio

Publications and source records attributed to K Kunishio.

70 records · Page 4Linked to original sources
PubMed1987

[A case of pituitary hyperplasia associated with primary hypothyroidism].

A thirteen-year-old girl was admitted complaining of short stature and anemia. The low titers of her serum T3 and T4 and the abnormally high TSH level represented primary hypothyroidism. Although she had normal sellar size, CT demonstrated an intra- and suprasellar round mass with homogeneous enhancement. With thyroid replacement therapy the enhanced mass diminished on CT within 5 months, and her symptoms regressed. Twelve cases with radiological diminution of pituitary mass or visual field improvement after thyroid replacement therapy are reviewed. They were considered to be pituitary hyperplasia, rather than pituitary adenoma, caused by long-standing untreated hypothyroidism. In four of them, the pituitary mass on CT was diminished after the therapy. Characteristic CT findings of pituitary hyperplasia, including our case, was a round isodensity mass with homogeneous enhancement in the midline of the pituitary region. In the experimental studies, pituitary hyperplasia is based on the feedback mechanism of hypothalamic-pituitary-thyroid axis, and ultimately autonomous pituitary adenoma may occur. Pituitary mass with hypothyroidism, visual field defect, amenorrhea or galactorrhea tend to be mistaken for prolactinoma or non-functioning adenoma with pituitary hypothyroidism. Thorough endocrinological examination must be carried out. The first choice of treatment for this type of pituitary mass should be thyroid replacement therapy. If there is no improvement of visual field, no regression of pituitary mass on CT, or continuing high TSH levels, then pituitary surgery must be considered.

Adolescent↗
PubMed1987

[Application of the RI-counting method in CSF rhinorrhea].

Some diagnostic procedures for CSF rhinorrhea have been reported, but they can not always identify and localize CSF leakage. This method, using intranasal cotton pledgets after the intrathecal injection of radioisotope (111In-DTPA) is thought to be reliable, informative and innocuous for localizing the sites of CSF leakage. This technique was named RI-counting method, and applied in two cases that were difficult to diagnose especially with positional-loading. The patients were first in the supine position, then in the sitting position, after the intrathecal injection of radioisotope and the intranasal insertion of cotton pledgets. After exchanging these pledgets, the patients were set in the prone position. After measuring the radioactivity of these pledgets and of 1 ml of blood, the ratios of the radioactivity of the pledgets to that of the blood were calculated. In case 1 the ratios of the left sphenoethmoid recess and the left middle meatus were significantly higher when the patient took the prone position, but in the supine or sitting position the ratios were in the normal range. In case 2 the ratio of right olfactory cleft was significantly higher in the sitting position or neck flexion. Both cases were operated and demonstrated that the location of the CSF leakage was presumable by using RI-counting method, regarding the anatomical relationship between the intranasal sites of pledgets and the opening of the paranasal sinuses. Positional-loading seemed to be essential. We obtained 72 pledgets of patients without CSF rhinorrhea, and the ratios of radioactivity of these pledgets had a mean value (M) of 0.156 and a standard deviation (SD) of 0.107.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrospinal Fluid Rhinorrhea↗
PubMed1986

Screening and treatment of unruptured cerebral aneurysms.

Thirty outpatients with unruptured cerebral aneurysms screened by computed angiotomography have been analysed and followed up in our clinic since 1979. Seventeen were men and the age range was 41 to 74 years old (mean 57.7 years). Patients had no or only mild neurological symptoms, such as headache, sensorimotor or speech impairment and others, which were scarcely related to the unruptured aneurysms themselves. It is important to realize that these first aneurysms which remain unruptured, have a primary significance to the individual in the protective aspect of an initial subarachnoid haemorrhage. Operation was successfully performed in fifteen patients. Transient aggravation of previous diseases, e.g. cerebral infarction, occurred in three after operation. Follow-up studies of fifteen patients without operation revealed no change in eight and some worsening or death due to other or previous diseases in six. One died of aneurysmal rupture in the 5th month after its detection. Because of the low operative risk, we advocate the operative treatment of unruptured aneurysms, following careful selection of the indicated patients.

Adult↗
PubMed1986

[Cystic cerebral tuberculoma--a case report].

A case of cystic cerebral tuberculoma is presented. A 63-year-old man was admitted initially to a sanatorium in May, 1983, for the treatment of pulmonary tuberculosis. He developed headache and vomiting, and suddenly had a right hemiconvulsion on September 27, 1983. Gradually he developed right hemiparesis and motor aphasia. CT scan revealed a well defined, ring-like enhanced mass with multiloculated cysts in the left fronto-parietal lobe. So, he was transferred to our hospital on February 3, 1984. Neurological examination revealed that he had motor aphasia and right hemiparesis. Left carotid angiogram showed light tumor stain in the left fronto-parietal lobe, and 99mTc brain scan detected increased uptake in this area. A left fronto-parieto-temporal craniotomy was performed and a subcortical mass was excised en bloc. The mass had multiloculated cysts containing xanthochromic fluid. Histologically, the mass was cystic cerebral tuberculoma. Cystic cerebral tuberculomas have rarely been reported even before the introduction of antituberculous chemotherapy. The pathogenesis of the cysts in this particular case was considered that the caseous material would have undergone liquefaction by enzymes liberated from degenerated and fragmented inflammatory cells.

Brain Diseases↗
PubMed1986

[Rapid growth and rupture of a newly originated aneurysm near the clipped middle cerebral artery aneurysm].

A 38-year-old man was admitted to our hospital because of severe headache following reduced level of consciousness on February 13, 1979. He was lethargic and showed neck stiffness. A lumbar puncture revealed bloody cerebrospinal fluid. Left carotid angiography showed a berry aneurysm of 11 mm in diameter at the bifurcation of the middle cerebral artery (MCA). Rebleeding occurred on February 21, and he fell into semicoma. But, his consciousness recovered to lethargy on the next day. On February 26, a direct intracranial operation was performed and a Sugita clip was placed to the aneurysmal neck. The postoperative course was uneventful. But, left carotid angiography on 8th day after operation showed a newly originated aneurysm proximal to the operated aneurysm. On the 12th postoperative day, he suddenly fell into coma. CT showed subarachnoid blood in the basal cisterns and intraparenchymal hematoma in the left temporal lobe. On the same day, left carotid angiography was performed and it showed the enlarged aneurysm. He died on the 19th day after operation. Autopsy was not performed. Three factors have been considered dealing with the recurrence of the operated aneurysm in the previous reports: first, local fragility of the vascular wall due to the clip edge. Secondly, macro- or microscopic residual aneurysmal neck, thirdly, broken or slipped clip. Our case had the following characteristics from the angiographical and operative findings: the orifice of the operated aneurysm was situated on the superior side of the parent artery and the aneurysm protruded posterosuperiorly at an angle of approximately 90 degrees to the long axis of M1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Bilateral agenesis of internal carotid arteries].

The authors present angiographic and computed tomographic demonstration of bilateral agenesis of internal carotid arteries. The patient was a seventy-six years old man who had been admitted to our hospital because of right hemisparesis and disorientation. In addition to the left chronic subdural hematoma, computed angiotomography showed the dilated basilar artery and dilated posterior communicating arteries. However, the bilateral internal carotid arteries were not recognized. Burr hole and irrigation were performed, then neurological deficits and symptoms were disappeared. Hematoma was 150 ml. Though axial transverse computed tomograms of base of skull demonstrated the absence of bilateral carotid canals. On aortography, the right common carotid artery and vertebral artery were supplied from the innominate artery and the left common carotid artery and vertebral artery were supplied from the left dilated subclavian artery. Bilateral retrograde brachial angiograms demonstrated the internal carotid circulation, which was supplied through bilateral dilated posterior communicating arteries. Basilar artery was also in a large caliber. Bilateral ophthalmic arteries were opacified from external carotid artery via the middle meningeal artery. Ten cases of bilateral agenesis of internal carotid arteries have been reported previously. The findings of angiograms and computed tomograms on the agenesis of bilateral internal carotid arteries were discussed. This anomaly is important on cerebral hemodynamics and embryology.

Aged↗
PubMed1986

[Agenesis of the left internal carotid artery, common carotid artery and main trunk of the external carotid artery associated with multiple cerebral aneurysms: case report].

A case of agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with multiple cerebral aneurysms is presented. No similar case has been reported before. A 70-year-old man who had severe headache was admitted to the neurological department of Matsuyama Shimin Hospital. On admission he demonstrated nuchal rigidity and motor aphasia. CT scan revealed subarachnoid hemorrhage with intracerebral hematoma in the left temporal area. Right common carotid angiography, bilateral retrograde brachial angiography and aortography demonstrated an agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with aneurysms of the anterior communicating artery, left middle cerebral artery and basilar tip. And these revealed that the left middle cerebral artery was fed from the basilar artery via the dilated left posterior communicating artery, and the left ophthalmic artery was originated from the left middle cerebral artery. CT of the base of the skull revealed no carotid canal on the left side. We confirmed these findings by operation. The importance of altered hemodynamic forces on the circle of Willis produced by the agenesis of the internal carotid artery and the embryological considerations are discussed.

Aged↗
PubMed1986

[A case of convexity cavernous hemangioma associated with meningioma].

A case of convexity cavernous hemangioma associated with sellar meningioma with parasellar extension is presented. A 61-year-old female who had complained of left blepharoptosis and diplopia was admitted to our hospital. On admission she showed left oculomotor nerve palsy. Plain CT revealed an isodense mass in the sellar and parasellar region. Computed angiotomography demonstrated that this mass was enhanced heterogeneously and filled the sellar turcica and extended superiorly. And homogeneously enhanced mass in the convexity without mass effect was observed. Angiogram revealed no tumor stain in any phase. With these findings, this case was diagnosed as the multiple meningiomas preoperatively. Left frontotemporal craniotomy was carried out, and subtotal removal of sellar and parasellar tumor and total removal of convexity tumor were performed. Pathologically the sellar and parasellar tumor was diagnosed as meningioma, convexity tumor as cavernous hemangioma derived from dura mater. Convexity cavernous hemangioma derived from dura mater is very rare, only one case was reported previously. Only 2 cases of cavernous hemangioma associated with meningioma have been reported in the literature. Correlation between cavernous hemangioma and meningioma is discussed. It is possible to owe this complication to the developmental abnormality concerning with inner factor like genetic factor and so on, because both tumors are mesodermal origin. However it is proper to regard that this complication occurred by chance.

Female↗
PubMed1984

Coronal computerized angiotomography for the diagnosis of isodense chronic subdural hematoma.

The authors demonstrate the value of coronal computerized angiotomography for the diagnosis of and screening for isodense chronic subdural hematoma. Specific features of coronal computerized angiotomograms include 1) thick lines of high density with slight convexity; 2) lines of high density parallel with the inner table of the skull; or 3) high-density dotted lines away from the inner table. These high-density lines or dots represent the superficial cerebral veins and cortical branches of the middle cerebral artery, which have been displaced by the hematoma. When these characteristic features are revealed on noninvasive coronal computerized angiotomography, cerebral angiography may be unnecessary.

Aged↗
PubMedDate not supplied

Computed angiotomography of unruptured cerebral aneurysms.

Twenty-seven unruptured cerebral aneurysms in 25 patients were detected by computed angiotomography. A comparison of the computed angiotomographic features in common aneurysm sites with plain CT and conventional arteriography was carried out. An isodense, round cisternal defect and a calcification or high-density mass in the basal cisterns on plain CT are important findings suggestive of unruptured aneurysms larger than 7 mm in diameter. The identification of the aneurysm, as well as of the afferent and efferent arteries on computed angiotomography is essential for the direct diagnosis of smaller unruptured aneurysms related to the circle of Willis. This is possible in a number of cases when the aneurysms are relatively large. It appears that the aneurysm size must be larger than 3 mm in diameter to permit its recognition on the basis of angiotomography and the avoidance of false-positive findings.

Adult↗
PubMedDate not supplied

Identification of CSF fistulas by radionuclide counting.

A radionuclide counting method, performed with the patient prone and the neck flexed, was used successfully to diagnose CSF rhinorrhea in two patients. A normal radionuclide ratio (radionuclide counts in pledget/radionuclide counts in 1-ml blood sample) was obtained in 11 normal control subjects. Significance was determined to be a ratio greater than 0.37. Use of radionuclide counting method of determining CSF rhinorrhea is recommended when other methods have failed to locate a site of leakage or when posttraumatic meningitis suggests subclinical CSF rhinorrhea.

Adult↗