Biomedical subjects
Publications and source records attributed to K Ohata.
We report a symptomatic Rathke's cleft cyst associated with hypophysitis in a 61-year-old woman. We demonstrate the MRI features and discuss the pathophysiology. To the best of our knowledge this is the first description of a Rathke's cleft cyst shrinking after high-dose steroid therapy.
BACKGROUND: To evaluate the surgical approach and clipping of aneurysms located at the carotid cave region. METHOD: Between 1980 and 1998 we have adopted the well known ipsilateral approach for exposure and securing of carotid cave aneurysms. In four patients, we had the opportunity to use a contralateral approach to carotid cave aneurysms, with easier dissection and application of a simple aneurysmal clip. The visual acuity of the patients did not deteriorate from the pre-operative level. FINDING AND INTERPRETATION: Aneurysms located at the carotid cave region may be approached easily and safely through a contralateral craniotomy with application of the aneurysm clip from an angle medial and inferior to the optic nerve.
OBJECTIVE: To evaluate a contralateral approach to aneurysms located in the internal carotid artery cave and proximal C4 segments. METHODS: In six adult cadaveric head sides, proposed aneurysms in the carotid cave or proximal C4 segments were approached via contralateral craniotomies. We summarize the approach in the following steps: 1) frontotemporal orbital craniotomy, 2) drilling of the lateral sphenoid wing and opening of the dura along the frontotemporal base, 3) drilling of the planum sphenoidale and the tuberculum sellae more extensively toward the aneurysm side and opening of the sphenoid sinus, 4) drilling of the medial part of the anterior clinoid process on the side of the aneurysm and removal of the superior, medial, and inferior walls of the optic canal, 5) opening of the optic sleeve, and 6) opening of the space between the medial wall of the internal carotid artery C2-C3 segments and the lateral edge of the pituitary gland. RESULTS: The contralateral approach to expose the opposite internal carotid artery cave and proximal C4 segments provided excellent views of the region, without mobilization or retraction of either the optic nerve or the carotid artery. CONCLUSION: We recommend that this approach be used only for selected aneurysms, which are small and directed medially, anteriorly, or inferiorly, in the defined locations.
Surgical outcome of intramedullary spinal cord ependymoma was investigated in order to define the treatment strategy. We have operated on 18 cases of intramedullary spinal cord ependymoma based on the principle of radical resection. The follow-up periods ranged from 10 months to 249 months with an average of 86.2 months. Postoperative neurological status in the long follow-up periods was compared to the pre-operative status and was correlated with the histological grade of malignancy. Total removal of the tumour was achieved in 17 cases, and subtotal removal followed by radiation therapy was conducted in 1 case. There was neither surgical mortality nor radiological evidence of recurrence in the long-term follow-up periods. The final outcome of the neurological condition was improved in 1 case, unchanged in 15 cases (including a case of subtotal removal) and deteriorated in 2 cases. The deterioration was in the form of gait disturbance due to the worsening of proprioception in 2 cases and dysaethesia in 1 case. Histological examination showed no evidence of anaplasia in 6 cases, evidence of early anaplasia in 10 cases, and moderate evidence of anaplasia in 2 cases. No relationship between the histological malignancy and clinical course was found. Intramedullary spinal cord ependymoma should be removed radically as early as possible while taking great care to avoid posterior column injury. Histologically malignant ependymoma might be a clinical exception.
OBJECT: Cavernous sinus cavernomas are rare lesions associated with high rates of intraoperative mortality and morbidity resulting from profuse bleeding. In this paper, the authors report their experience in treating five patients with histologically confirmed cavernous sinus cavernomas and describe the efficacy of induced hypotension in facilitating excision of the lesion. METHODS: All five patients were women ranging in age from 25 to 54 years, with an average age of 42 years. The mass was small in one and large (>3 cm in diameter) in four. In one patient with a large mass, cardiac arrest occurred after the craniotomy, and remarkable reduction in the size of the cavernoma was evident on postmortem examination. The other three large lesions were successfully removed piecemeal after induction of hypotension (60-80 mm Hg systolic pressure), which remarkably reduced the mass and the bleeding during surgery. In the remaining patient, who had a small lesion, the cavernoma was removed in one piece. CONCLUSIONS: Cavernous sinus cavernoma can be thought of as a cluster of sinusoidal cavities, the size of which varies depending on the systemic blood pressure. During surgery, reduction of the mass and control of bleeding from the cavernoma can be achieved by inducing hypotension, which enables the safe excision of this lesion. This technique should be considered by surgeons resecting a cavernous sinus tumor, especially when cavernoma is suspected.
The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.
Metaldehyde has been widely used as a main ingredient of solid fuel for making fire and slug baits in Japan. It is also marketed as a color flame tablet for party goods (ENGELFIRE). Consequently, children have been poisoned by eating such tablets which they mistook for candy. As a result, poison information center calls are increasing. According to POISINDEX, the treatment for metaldehyde poisoning consists in prevention of adsorption by activated charcoal, seizure control and airway protection. However, the optimum dose of charcoal is not established. We studied the quantitative adsorption capacity of activated charcoal for acute oral toxicity of metaldehyde in rats. In vivo toxicity and absorption tests for metaldehyde in Wister rats were done. The detoxifying effect of activated charcoal on metaldehyde toxicity and inhibition of metaldehyde absorption were investigated. Ratios used of po activated charcoal given 30 min after dosing to 400 mg metaldehyde/kg po were 5:1, 2:1, 1:1, 0.5:1. Serum metaldehyde was determined by gas chromatography in the control group (no charcoal) and the various experimental groups. Metaldehyde mortality was completely prevented at the ratio of 5:1. Gastrointestinal absorption of metaldehyde was reduced significantly by 45.3% in comparison to the control rats. There was no acetaldehyde detected in the serum of the metaldehyde-dosed rats. Metaldehyde poisoning may be prevented by early po administration of activated charcoal in a ratio of > 5:1 compared to metaldehyde. The theory that acetaldehyde is the primary toxic agent in metaldehyde poisoning should be re-evaluated.
A patient developed delayed facial nerve palsy at the level of House-Brackmann grade I to grade III 10 days after vestibular schwannoma surgery by the suboccipital transmeatal approach. The palsy had completely recovered after one month. Immunological study showed reactivation of herpes simplex and magnetic resonance (MR) imaging demonstrated an abnormal enhancement pattern of the facial nerve; intense enhancement of the distal intracanalicular segment and labyrinthine segment, similar to the MR findings for Bell's palsy. A prospective control study on the enhancement pattern of the functionally preserved facial nerve after vestibular schwannoma surgery in six cases showed a similar pattern to that of the normal facial nerve. Based on these findings, we propose the hypothesis that herpes simplex reactivation is an underlying cause of delayed facial palsy after vestibular schwannoma surgery.
Electrophoretical mobility shift assay (EMSA) is a simple, rapid, and highly sensitive technique for detection of single- or double-stranded DNA-binding proteins such as transcription factors in crude nuclear extracts (F.M. Ausubel, R. Brent, R.E. Kingston, D. D. Moore, J.G. Seidman, J.A. Smith, K. Struhl (Eds.), Current Protocols in Molecular Biology, Greene Publishing Associates and Wiley-Interscience, 1989, pp. 12.0.1-12.2.10 [1]; J. Carey, Gel Retardation. Methods Enzymol., 208 (1991) 103-117 [2]). By using this technique, it is possible to quantify the abundance, relative affinity and binding specificity of DNA-binding proteins. Since proteins which bind specifically to radiolabeled DNA probes retard the mobility of the probe during electrophoresis (it also called gel retardation assay), discrete bands correspond to the individual DNA-protein complexes. Furthermore, EMSA allows one to determine which member(s) of a certain protein family are included in the DNA-protein complex by means of specific antibodies raised against the DNA-binding protein (supershift assay).
OBJECT: In this paper the authors report on sigmoid sinus occlusion as a surgical complication in seven of 143 operations in which a presigmoidal-transpetrosal approach was used. METHODS: Five patients (Cases 1-5) developed occlusion within 40 days after surgery, and in the remaining two (Cases 6 and 7) occlusion was detected 5.4 and 6.4 years postsurgery by means of cerebral venography, which was performed in 40 of the remaining 138 patients. Of the two patients with occlusion of the hypoplastic transverse sinus, one (Case 1) did not develop symptoms and the other (Case 2) developed brain edema with transient aphasia. Of the three patients suffering from occlusion of the dominant sigmoid sinus, one (Case 3) developed severe intracerebral hemorrhages and had a poor prognosis; one (Case 4) developed profuse supra- and infratentorial brain edema with consciousness disturbance; and the other (Case 5) developed hemorrhagic infarction in the temporal lobe accompanied by aphasia. Two patients whose sinus occlusion was detected later (Cases 6 and 7) did not develop symptoms and displayed well-communicated transverse sinuses. In Case 7, a dural arteriovenous malformation formed at the site of the sinus occlusion. Laceration of the sigmoid sinus was suspected as the cause of occlusion in Cases 2, 3, and 7; compression of the sinus in Cases 5 and 6, sinus laceration and postoperative dehydration in Case 4; and laceration and compression of the sinus in Case 1. CONCLUSIONS: Differences in the clinical course among these patients were attributed to anatomical variations in the venous system. Occlusion of the sigmoid sinus should be weighed as a potential complication when selecting candidates for the presigmoidal-transpetrosal approach.
We investigated the characteristic features of intramedullary spinal cord tumour associated with neurofibromatosis type 1 (NF-1). We have experienced 44 cases of pathologically confirmed intramedullary spinal cord tumour. Diagnosis of NF-1 was done according to the criteria set by the National Institute of Health Consensus Development Conference. Within the described population NF-1 was diagnosed in two patients. Both the patients were male and histopathologically the tumours were anaplastic astrocytoma and glioblastoma multiforme respectively. 6 cases of NF-1 associated with intramedullary spinal cord tumour based on the above diagnostic criteria have so far been reported, including our 2 cases. Of these 6 cases, 5 were male and in one sex was not described. The tumour was an astrocytoma in all 6 cases. This finding suggested that intramedullary spinal cord tumour associated with NF-1 tends to occur predominantly in males and that histopathologically the tumour is likely to be an astrocytoma. We conclude that the criteria proposed by the National Institute of Health Consensus Development Conference are contributory in making an accurate pre-operative pathological diagnosis of intramedullary spinal cord tumour associated with NF-1.
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Cosmid clone containing swine endothelin-1 (EDN1) gene, cosEDN1, was isolated from swine cosmid library using swine EDN1 cDNA as a probe. The sequence analysis of cosEDN1 DNA revealed that the swine EDN1 gene consists of 5 exons, spanning approximately 6.5 kb. In the 5'-upstream region of the EDN1 gene, AP-1 and NF-1 elements were found, suggesting the possibility that the expression of swine EDN1 gene is controlled by protooncogene products Fos and Jun, and TGF-beta. Fluorescence in situ hybridization (FISH) using cosEDN1 DNA as a probe demonstrated that EDN1 gene resides on swine chromosome 7p13- > pter.
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Cranial malignant fibrous histiocytomas are rare tumors. Most are hypervascular, destructive masses that are similar to other malignant lesions and to malignant fibrous histiocytomas found elsewhere in the body. We describe a myxoid malignant fibrous histiocytoma of the temporal bone, possibly of dural origin, with features that more closely resembled a meningioma at CT, MR imaging, and angiography.
Operative indication and risk factors for unruptured cerebral aneurysms were discussed. During the past 11 years, 38 aneurysms in 33 patients with a mean age of 54 years were operated on. All aneurysms were located in the anterior circulation; 16 were of carotid artery, 15 of the middle cerebral artery, 4 of the anterior communicating artery, and 3 of the distal anterior cerebral artery. Six cases (18.2%) developed neurological deficits postoperatively. The deficits were permanent in 3 cases (morbidity 9.1%). There was one operative death (mortality 3.0%). Operative risk factors were analyzed in 4 particular cases. Of these 4 cases, two cases had large aneurysms (14 and 16mm in diameter) located at carotid-ophthalmic and at the inferior wall of the carotid arteries, respectively. One developed unilateral blindness possibly due to operative manipulation, and the other showed hemiparesis with aphasia due to postoperative carotid stenosis caused by clipping. Of the rest 2 cases; one with multiple (carotid and middle cerebral) aneurysms developed hemiparesis because of postoperative stenosis of the atheromatous parent artery caused by clipping, and the other, with a large (17mm) aneurysm at the distal anterior cerebral artery, died of postoperative intracerebral hematoma. Both of these cases were associated with cerebral ischemic disease. All cases that developed postoperative neurological deficits had varying degrees of hypertension. Reviewing our series and other reports, it can be said that age is one of the most important factors that influence operative mortality. However, a lower risk of rupture develops as age increases. For those under 70 years of age, operation is considered safe in healthy individuals, especially among those without hypertension. However, in cases where there are large aneurysms, multiple lesions, less accessible locations and cerebral ischemic disease, operative risks should be kept in mind. Operative morbidity in these cases is relatively high compared to that found among others. Therefore, planning a meticulous surgical strategy and further careful operative manipulation are essentials, when surgical treatment is indicated.
Suprasellar tumors including pituitary adenomas and craniopharyngiomas, in the case of normofixed or postfixed chiasma and ruptured anterior communicating artery aneurysms in the acute stage, can be approached with minimum brain retraction, increased exposure, and safe manipulation in the shortest possible distance via biorbitofrontobasal interhemispheric approach. Fourteen patients with pituitary adenomas, 3 with craniopharyngiomas, 7 with meningiomas, 2 with mucoceles, 1 with osteoma, and 3 with ruptured anterior communicating aneurysms in the acute stage were operated on, using this approach with excellent results. The operative technique and its results are detailed.
Oryzatensin (Gly-Tyr-Pro-Met-Tyr-Pro-Leu-Pro-Arg) is an ileum-contracting and immunostimulating peptide derived from rice albumin. The mechanisms for the ileal contraction that it induces, consisting of rapid and slow components, were examined. The rapid contraction was mediated by histamine release and the slow contraction by a prostaglandin E2-like substance, judging from the effects of various pharmacological inhibitors and antagonists on ileal contraction and titration of histamine release. The contractile profile was very similar to that of human complement C3a(70-77), which is the COOH-terminal octapeptide of C3a and has, although less potent, qualitatively the same biological activities as C3a. Oryzatensin showed homology with C3a(70-77) and affinity for C3a receptors (IC50 = 44 microM) by radioreceptor assay. This is the first report of a food-derived bioactive peptide acting through complement C3a receptors.