Biomedical subjects

Kazuo Kitazawa

Publications and source records attributed to Kazuo Kitazawa.

7 recordsLinked to original sources

PubMed2006

Subtle computed tomography abnormalities in cerebral deep sinus thrombosis.

A patient with cerebral deep sinus thrombosis, which was not diagnosed on the first examination, is reported. A 46-year-old woman presented with headache and vomiting. Neurological examination and a brain computed tomography (CT) scan showed no obvious abnormal findings. The patient suffered disturbed consciousness on the day after the examination, and was admitted to our emergency centre. A CT scan and magnetic resonance imaging revealed an ischaemic lesion in the left basal ganglia, suggesting deep sinus occlusion. Anticoagulant therapy was administered. One day after admission, a CT scan showed a haematoma and severe brain swelling in the same region. Cerebral angiography demonstrated a straight sinus occlusion. Intracranial pressure was not controlled with hypothermia, and the patient died 25 days after admission. Review of the initial CT scan revealed subtle, early findings of deep venous thrombosis that were missed on first examination.

Anticoagulants↗

PubMed2006

Continuous suction method in superficial temporal artery-middle cerebral artery anastomosis surgery. Technical note.

A new method was developed to maintain a bloodless microscopic operative field for superficial temporal artery-middle cerebral artery (MCA) anastomosis surgery. A silicone suction tube with multiple holes is placed circumferentially under the reflected dural flaps around the craniotomy. Blood and irrigated saline are continuously aspirated by the tube. Use of this method in nine patients significantly reduced the mean MCA trapping time (24.0 +/- 2.8 min) compared with nine patients treated using the conventional method (30.1 +/- 4.6 min). MCA trapping time is shortened because the surgery is not interrupted for manual suctioning of bloody cerebrospinal fluid.

Adult↗

PubMed2006

Middle cerebral artery occlusion associated with acute myocardial infarction in the perioperative period--case report.

A 68-year-old woman with no history of cardiac events suffered acute myocardial infarction after surgery for middle cerebral artery (MCA) occlusion manifesting as transient left motor weakness. Diffusion-weighted magnetic resonance imaging revealed multiple infarctions in the right cerebral hemisphere. Magnetic resonance angiography and cerebral angiography demonstrated an occlusion at the horizontal segment of the right MCA and no collateral circulation. Cerebral blood flow study 6 weeks after the initial presentation indicated decreased blood flow in the right cerebral hemisphere. Superficial temporal artery-MCA anastomosis was conducted to prevent recurrent cerebral infarction. Two hours after surgery, her systolic blood pressure fell to 60 mmHg and her consciousness worsened. Emergency coronary angiography indicated occlusion of the right coronary artery. Percutaneous coronary intervention was successfully performed and the subsequent course was uneventful. Preoperative evaluation of the coronary artery may be necessary before surgery for cerebral ischemic disease in both the intracranial and extracranial arteries.

Aged↗

PubMed2006

[Case of leptomeningeal carcinomatosis effectively treated with intrathecal chemotherapy using ventriculoperitoneal shunt].

A 70-year-old man presented with dizziness, headache and hearing loss. He was admitted to our hospital because of increasing unsteadiness of gait. Magnetic resonance imaging of the brain revealed meningeal thickening with enhancement. The lumbar puncture revealed high opening pressure. The cerebrospinal fluid showed pleocytosis, high carcinoembryonic antigen (CEA) concentration, and presence of neoplastic cells, leading to the diagnosis of leptomeningeal carcinomatosis. Systemic investigation for primary neoplasm identified a Bormman type 3 gastric cancer (papillary adenocarcinoma with micropapillary pattern). Except for the meninges, no metastatic lesions could be detected. A ventriculoperitoneal shunt (Codman Hakim Programmable Valve) was placed for management of intracranial hypertension and intrathecal chemotheray. He was started on oral S-1 (TS-1) combined with intrathecal methotrexate injection using the VP shunt reservoir. In two weeks, headache and hearing loss completely disappeared and gait disturbances started to improve. CSF findings also improved remarkably with disappearance of neoplastic cells and almost normalization of CEA. For the next five months, he was well on oral S-1 and monthly intrathecal chemotherapy, being able to walk using a walker and to stay at home. He subsequently developed posterior cortical symptoms such as prosopagnosia and cortical blindness and gradually lapsed into coma. He died from pneumonia one year after the onset of neurological symptoms. At autopsy, primary gastric cancer was found but much reduced in size. No peritoneal metastasis could be found. In the brain, leptomeningeal carcinomatosis involved the occipital lobes, the base of the temporal lobe, and the cerebellum. We suggest that intrathecal chemotherapy using ventriculoperitoneal shunt with programmable valve system could be an effective method for the treatment of meningeal carcinomatosis.

Adenocarcinoma, Papillary↗

PubMed2005

Postoperative vasospasm of unruptured paraclinoid carotid aneurysms: analysis of 30 cases.

This study was conducted to determine the incidence, severity, and causes of delayed vasospasm after clipping of unruptured paraclinoid aneurysms of the internal carotid artery (ICA). A retrospective analysis was made of 30 patients, who underwent clipping of unruptured paraclinoid aneurysms in our institution between 1991 and 1998. We compared angiograms before and after operation and classified them into two groups: vasospasm group and non-vasospasm group. Eleven variables were assessed as to their relationship to delayed vasospasm. There were 9 patients (30%) in the vasospasm group, of which 3 patients (10%) were clinically symptomatic. For all symptomatic patients, aggressive treatment, including triple-H therapy, was conducted with good outcome. The number of clips used (p<0.04) and temporary occlusion of the ICA (p<0.005) were statistically significant factors associated with the incidence of vasospasm. It is suggested that mechanical stimulation to the vascular wall of the ICA is responsible for causing spasm in addition to intraoperative bleeding around the dural ring.

Adult↗

PubMed2005

A saccular-like dissecting aneurysm of the anterior cerebral artery that developed 2 years after an ischemic event.

BACKGROUND: A rare case of a growing dissecting aneurysm, which was located at the horizontal (A1) segment of the anterior cerebral artery (ACA), is reported. CASE DESCRIPTION: A 53-year-old woman experienced left hemiparesis and alien hand syndrome. A computerized tomography scan showed an infarction in the right frontal lobe, and cerebral angiography revealed a false lumen and intimal flap at the A1 segment of the ACA. Magnetic resonance angiography demonstrated that the stenosis progressed 6 months later and improved 1 year later. Cerebral angiography showed a saccular-like aneurysm 2 years later. The surgery was planned for prevention of aneurysmal rupture. The aneurysm, which was cocoon shaped, was exposed surgically and was resected. Histological examination of the aneurysm showed arterial dissection. The postoperative course was uneventful without additional neurological deficits. CONCLUSION: This is the first case report of A1 dissecting aneurysm presenting with an ischemic event in the literature. The sequential change of the configuration was curious to develop aneurysmal dilatation in 2 years. Long-term follow-up is necessary even after disappearance of the arterial dissection.

Aortic Dissection↗

PubMed2003

En Bloc removal of soft tumors within the brain parenchyma using spoon retractors: traction-dissection method. Technical note.

BACKGROUND: En bloc removal of soft tumors within the brain parenchyma has rarely been performed. We describe a safe technique for en bloc removal of the tumors using a spoon retractor, which enables retraction while holding the soft mass upward. METHODS: Dissection of a tumor mass is performed under traction of the surrounding brain tissue by retracting the mass using a spoon retractor. A dissection plane is first established in a relatively safe area, not opposite the critical area, after a corticotomy. The dissection plane is then extended toward the critical side. After circumferential dissection of the tumor mass, the dissection is continued spirally into deeper regions by retracting and holding the mass upward using a spoon retractor. In this way, the tumor is removed en bloc. CONCLUSIONS: The traction-dissection method using spoon retractors is useful in performing en bloc removal of soft tumors within the brain parenchyma less invasively and provides an appropriate operating field even at depth, reducing intraoperative bleeding, and in vascular rich tumors, possibly preventing tumor seeding in cases of malignant tumors.

Brain Neoplasms↗