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Biomedical subjects

M Hasue

Publications and source records attributed to M Hasue.

At least 19 recordsLinked to original sources
PubMed2001

New technique for application of fibrin sealant: rubbing method devised to prevent cerebrospinal fluid leakage from dura mater sites repaired with expanded polytetrafluoroethylene surgical membranes.

OBJECTIVE: The effectiveness of a strong, pressure-tight method for fibrin sealant application was experimentally and clinically evaluated, using expanded polytetrafluoroethylene (ePTFE) surgical membranes. METHODS: Two application methods were examined in two groups. For Group 1, 1 ml each of Solutions A and B was simply sprayed over the surface (spray method). For Group 2, a small amount of Solution A was rubbed into the sutured site and then Solutions A and B were sprayed over the surface (rubbing method). In the experimental study, a moment pressure elevation test and a continuous stepwise pressure elevation test were performed for both groups. The clinical study was conducted using 350 patients undergoing craniotomies. The ePTFE surgical membrane was used for 180 patients but not the other 170 patients. RESULTS: In the experimental study, the bursting pressures were 51.4 +/- 13.0 cm H2O for Group 1 and 129 +/- 35.0 cm H2O for Group 2 in the moment pressure elevation test and 27.0 +/- 6.7 cm H2O and 100 +/- 31.9 cm H2O, respectively, in the continuous stepwise pressure elevation test. The sealing effect was significantly greater for Group 2 than for Group 1 in both tests (P < 0.001). In the clinical study using ePTFE surgical membranes, the rubbing method significantly reduced the incidence of postoperative cerebrospinal fluid leakage (1.4%), compared with the spray method (18.3%), when external decompression was not concomitantly used (P < 0.01). CONCLUSION: The sealing effect of fibrin sealant on cerebrospinal fluid leakage was significantly greater with the rubbing method than with the spray method. The strong sealing effect obtained with the rubbing method is thought to result from firm linkage between the ePTFE surgical membrane and the fibrin sealant and also from fibrin being formed even in needle holes and spaces in the sutured site.

Adolescent↗
PubMed1998

Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study.

STUDY DESIGN: A retrospective case-control study was performed using the radiographs taken at the first hospital visit in two groups; in one group, spondylolisthesis developed after the first hospital visit, and, in the other, spondylolisthesis had not developed over 10 years. OBJECTIVES: To determine possible radiographic differences between these two groups to clarify the pathoanatomic mechanisms of anterior slipping. SUMMARY OF BACKGROUND DATA: The etiology of degenerative spondylolisthesis, for example, underlying pathoanatomic mechanisms such as dysfunction of the disc or horizontalization of the lamina and the facets, has been difficult to resolve, because radiographs taken before the occurrence of the slip have not been available in previous investigations. METHODS: Sixty-nine patients with spondylolisthesis in whom degenerative spondylolisthesis developed after the first hospital visit and for whom radiographs taken before the slip were available were studied retrospectively. In 63 patients slipping did not develop over 10 years, with or without intervertebral instability; these patients were studied as a control group. The radiographs taken before and after the occurrence of the slip in the patients with spondylolisthesis were examined and compared with those without spondylolisthesis. Dysfunction of the disc, horizontalization of the lamina and the facets, and the sagittal alignment of the facet joints were assessed in each group. RESULTS: Patients in whom anterior slipping developed had signs indicating that horizontalization of the lamina and the facets had occurred before the slip. However, the patients in whom spondylolisthesis did not develop had no horizontalization of the lamina and the facets at the first hospital visit or during the follow-up period. There was no significant difference in dysfunction of the disc between the cases with and without spondylolisthesis. Sagittal alignment of the facet joints was seen more frequently in the patients in whom slipping occurred than in patients with no spondylolisthesis, but approximately 40% of the patients in whom slipping occurred did not demonstrate sagittal alignment. CONCLUSION: Horizontalization of the lamina and the facets is a pathoanatomic risk factor that can predispose for the development of degenerative spondylolisthesis. If dysfunction of the disc occurs in addition to these conditions, spondylolisthesis may develop.

Adult↗
PubMed1998

Primary meningeal malignant fibrous histiocytoma with cerebrospinal dissemination and pulmonary metastasis.

Primary intracranial malignant fibrous histiocytoma (MFH) is very rare, and not much is known about its clinical features. The authors report a case of left temporal leptomeningeal MFH, with consequent cerebrospinal fluid (CSF) dissemination and pulmonary metastasis. The clinical features of this case and the therapeutic prognosis of 17 cases reported previously in the literature were reviewed.

Cerebrospinal Fluid↗
PubMed1998

Does traumatic subarachnoid hemorrhage caused by diffuse brain injury cause delayed ischemic brain damage? Comparison with subarachnoid hemorrhage caused by ruptured intracranial aneurysms.

OBJECTIVE: To examine whether traumatic subarachnoid hemorrhage (TSAH) caused by severe diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome, as does aneurysmal subarachnoid hemorrhage (ASAH). METHODS: We examined 99 patients with diffuse brain injury with TSAH and 114 patients with ASAH. Computed tomographic (CT) findings, cerebral blood flow, and neurological outcomes were assessed during the acute and subacute phases and were compared between the two groups. RESULTS: The distribution of subarachnoid hemorrhage on the CT scans differed between the two groups. Unlike ASAH, TSAH was not limited to cisterns surrounding the circle of Willis but extended to supratentorial regions and interhemispheric fissures. Computed tomography-detected subarachnoid hemorrhage disappeared very early with TSAH and gradually with ASAH. In the ASAH group, mean cerebral blood flow decreased to 75% of normal during the acute phase and decreased a further 10% during the subacute phase. In the TSAH group, mean cerebral blood flow decreased to 85% of normal during the acute phase and increased slightly during the subacute phase. Neurological deterioration and in-hospital death peaked on Day 0 in association with TSAH and showed twin peaks in association with ASAH. The incidence of low-density areas on the CT scans was significantly higher with ASAH than with TSAH. All low-density areas on the CT scans of patients with ASAH corresponded to vascular territories, but low-density areas on the CT scans of patients with TSAH were rarely associated with vascular territories and contained deep-seated or gliding contusion types. CONCLUSION: The findings suggest that the incidence of vasospasm is low in association with TSAH and that the cause is different compared with ASAH. There is no evidence that the presence of TSAH in cases of diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome.

Acute Disease↗
PubMed1996

Spinal intermittent claudication due to cervical and thoracic degenerative spine disease.

STUDY DESIGN: Neurogenic intermittent claudication can be caused by spinal cord compression. In this study, 20 patients with spinal intermittent claudication due to degenerative spine diseases were evaluated. OBJECTIVES: This study clarified the clinical features and pathomechanism of spinal intermittent claudication due to degenerative spine diseases. SUMMARY OF BACKGROUND DATA: Spinal intermittent claudication may either be produced by intrinsic or extrinsic lesions. Little is known about spinal intermittent claudication due to extrinsic lesions such as spinal cord compression. Twenty patients with spinal intermittent claudication, caused by cervical or thoracic lesions, who were given surgical treatment except for one, were studied. Their main subjective symptoms were tightness, weakness, and numbness in the lower limbs and a strangulated sensation in the trunk to lower limbs. The objective findings were occurrence and/or aggravation of spinothalamic signs. METHODS: The gait loading test was performed on these 20 patients. Selective spinal angiography was performed on the patients with thoracic myelopathy and its therapeutic effects were evaluated. A radiographic assessment was made in all patients. RESULTS: The subjective symptoms and objective findings were reproduced by the gait loading test. Selective spinal angiography temporarily relieved or improved the spinal intermittent claudication due to the thoracic myelopathy. Spinal intermittent claudication disappeared immediately after surgical treatment. CONCLUSIONS: Circulatory impairment of the spinal cord seems to be closely related to the etiology of spinal intermittent claudication. Besides providing diagnostic information, selective spinal angiography may also have a temporary therapeutic effect.

Adult↗
PubMed1996

[Effects of traumatic subarachnoid hemorrhage on pathological properties in diffuse brain injury: a comparison with aneurysmal subarachnoid hemorrhage].

As a result of recent advances in continuous monitoring equipment, it has been reported that vasospasm (VS) and delayed ischemic neurological deficit (DIND) occur as frequently in traumatic subarachnoid hemorrhage (TSAH) as in subarachnoid hemorrhage due to ruptured intracranial aneurysm (ASAH), and these VS and DIND have been reported to affect the outcome of TSAH adversely in many cases. When we compared TSAH secondary to diffuse brain injury (DBI) with ASAH, however, these two conditions were evidently different from each other in nature. Then we compared laboratory data, clinical course, and outcomes of TSAH associated with DBI with those of ASAH, to determine whether TSAH results in poor outcomes of DBI. On CT scans, patterns of SAH distribution were different from each other, and SAH was detected in 76% of the patients with ASAH on day 4, whereas only 2.0% of the patients with TSAH had detectable SAH on day 3. The incidence rates of detectable SAH in both groups remained significantly different from each other after day 2. The cerebral blood flow (CBF) decreased to around 75% of the normal flow in the acute stage of ASAH, and it decreased further to around 65% in the subacute stage. In TSAH, in contrast, CBF varied widely among the patients. The average CBF decreased to about 70% in the acute stage, and then it increased to around the lower limit of the normal range in the subacute stage. The urinary output and serum concentration of low molecular protein compositions in TSAH were markedly different from those in ASAH. In addition, the contour of a low density area (LDA) in CT scans in the subacute-chronic stage was the same as that of the area supplied by the artery being constricted due to cerebro-vascular spasm in ASAH. In TSAH, in contrast, hardly any LDA had a form that was suggestive of this conjuction, with cerebro-vascular spasm and the incidence rate of LDAs was significantly different from that for ASAH. About 30% of the patients with ASAH had ventricular enlargement, which was diagnosed as normal pressure hydrocephalus by cisternography, in the chronic stage. Surgical shunting was effective for these patients. In TSAH, ventricular enlargement was observed in more than 50% of the patients, but almost none of these patients underwent surgical shunting, because it resulted from cerebral atrophy. Regardless of causes of SAH, the severer SAH was, the more often patients had a poor outcome. The outcome of TSAH was, however, significantly poorer than that of ASAH. When SAH was traumatic, it disappeared by the time VS developed and, in addition, changes in CBF and the form and incidence rate of LDAs were different from those in ASAH. We concluded that, although TSAH is an adverse prognostic factor for DBI, it does not contribute to poor outcomes of DBI by giving rise to DIND caused by VS.

Acute Disease↗
PubMed1994

Anatomic and radiographic study of dorsal root ganglia.

Anatomic and radiographic studies were made to investigate normal variation of dorsal root ganglia in lumbosacral roots. The spinal nerves could be divided into two groups, with and without bifurcation of ventral nerve root and dorsal root ganglion. The bifurcated group was further classified into three types. L4 and L5 nerve roots were all bifurcated, and S1 were all nonbifurcated. The positions of dorsal root ganglia were classified into three types: intraspinal, intraforaminal, and extraforaminal. At L4 and L5 nerve roots, they were mostly intraforaminal, whereas at S1, they were mostly intraspinal. Proximally placed ganglia had a high frequency of ganglionic indentation. The incidence of intraspinal dorsal root ganglia was much higher clinically than in anatomic studies. Variations in connecting patterns or positions of dorsal root ganglia may be related to the occurrence and variety of radicular symptoms. The dorsal root ganglia is clinically important, and its location may correspond to clinical symptoms.

Adult↗
PubMed1993

Pain and the nerve root. An interdisciplinary approach.

Based on the experimental and clinical results in the literatures and the author's experience, a working hypothesis for the pathomechanism of radicular pain is proposed. When the nerve root is involved, mechanical and circulatory changes are produced. Inflammatogenic materials may leak from the degenerative disc and facet into the nerve root, causing chemical radiculitis. These changes can be followed by nerve fiber and cell changes including blockage of axonal flow and demyelination, causing ectopic discharges and cross talk. Disturbed or enhanced synthesis and transport of neuropeptides can also be elicited. These multifactorial changes may finally result in sensitization of both the central and peripheral nervous systems, causing radicular pain.

Ganglia, Spinal↗
PubMed1992

[Time-related changes in the cerebral blood flow in subarachnoid hemorrhage due to ruptured cerebral aneurysm].

Cerebral blood flow (CBF) was determined by the 123I-IMP SPECT reference sample method in 39 patients with subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm. They were examined according to the time lapse after onset, severity, CT findings, and prognosis. These 39 patients were admitted to our medical center within 36 hours after the onset, and SAH and ruptured aneurysm were diagnosed by CT scan and angiography, respectively. Patients with intraventricular hemorrhage, intracerebral hematoma, and other severe complications were excluded. The stage of SAH was divided into three, by designating the day of onset as day 0: day 0-4 as the acute stage, day 5-20 as the subacute stage, and day 21 and after that as the chronic stage. Acute stage surgery was conducted within 48 hours after the onset on principle. Hyperdynamic therapy and cisternal drainage were conducted in severe case of SAH. The prognosis was evaluated with Glasgow outcome scale (GOS). The average CBF was 33.39, 29.44, and 33.15 in the acute, subacute, and chronic stages, respectively. These are values lower than the reference sample value, 43.39 (ml/100 g/min). Only a small number of cases, however, revealed vasospasm by angiography conducted in the acute stage. There was a correlation between the CT severity in the acute stage and the decrease in CBF. In the group with low density area (LDA) on CT due to delayed cerebral ischemia in the subacute stage, the average CBF was 28.28 and 23.95 in the acute and subacute stages, respectively. These values were significantly lower than 35.97 and 32.45, respectively, in the group without LDA.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression.

The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.

Adult↗
PubMed1990

[Intracranial hematoma accompanying bleeding tendency: therapeutic practice and analysis of literature].

Therapies and prognoses covering fifteen cases of intracranial hematoma (ICrH) accompanying various types of bleeding tendency (BTD) were studied along with a secondary analysis of the pertinent references. Fifteen cases were divided into two groups, Group A comprising 11 cases of ICrH accompanying primary BTD, and Group B comprising four cases of ICrH accompanying secondary BTD caused by various underlying diseases. Group A included four cases of hemophilia A (Hp-A), two cases of factor XIII deficiency (FXIII-d), three cases of thrombocytopenia (Th-p) and two cases of vitamin K deficiency (VK-d). The four cases of Hp-A responded favorably, with good prognoses, to a supplementary therapy alone. This result was endorsed by the development of therapy as documented in the references. The combined five cases of FXIII-d and Th-p tended without exception, to show good prognoses in the wake of a combination therapy of supplementary treatment and surgical procedure. As regards FXIII-d, there was an inter-reference difference in supplementary doses. Many references shared the view that splenectomy was essential to the treatment of Th-p in general, and idiopathic thrombocytopenic purpura in particular. The current study also suggested that gammaglobulin in large doses would serve as an effective therapy. The two cases of VK-d suffered from a serious degree of lingering neurologic manifestations, although their lives were saved. Even though there is an established therapy for it, VK-d was found to be a problem with poor functional prognosis showing the importance of the preventive approach. Group B was classified into the acute type and the subacute type depending on the rate of pathologic development. As underlying diseases DIC and myelofibrosis due to acute myeloblastic leukemia, and Th-p due to aplastic anemia were noted in two cases in each group. Of these, two cases of the subacute type were able to be saved, while two cases of the acute type followed poor prognostic courses resulting, eventually, in death. The following were found to be responsible fatal factors: 1) causes of BTD which involved both mechanisms of coagulation and hemostasis, 2) non-removal of the underlying disease, in which case supplementary therapy tended to be futile, and 3) the underlying disease per se as a danger to the life of the patient. In conclusion, therapeutic rationale and prognosis in ICrH accompanying primary type of BTD will benefit from the implementation of an adequate augmentative therapy as in the ordinary type of ICrH.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

Classification by position of dorsal root ganglia in the lumbosacral region.

In order to determine the incidence of the proximally placed L5 and S1 dorsal root ganglia, 144 patients with lumbosacral radiculopathy were investigated. All of the patients underwent nerve root infiltration for depicting the nerve root. Using some bony landmarks on the anteroposterior radiculogram, the dorsal root ganglia were classified into three types: intraspinal, intraforaminal, and extraforaminal. The intraspinal type was further subdivided into subarticular and sublaminar types. The intraspinal type is more common in the S1 than in the L5 root, regardless of age and sex. Although the proximally placed dorsal root ganglia may offer a locus minoris resistantiae for neural irritation and compression, its role for symptom production of radiculopathy should be further analyzed.

Adolescent↗
PubMed1988

Combined contrast studies in lumbar spine diseases. Myelography (peridurography) and nerve root infiltration.

Successive performances of the morphologic and functional diagnostic procedures of myelography and/or peridurography along with nerve root infiltration were attempted for evaluating lumbar spine disorders with radicular symptoms. With this combination, the compressed area of the involved nerve root can be specified morphologically and the responsible root level can be assessed functionally. Physical examinations and the above procedures showed that there are three types of cases: cauda equina, radicular, and mixed; and that the responsible level is usually single. The type of decompression procedure can be predetermined, and the extent of decompression can be minimized by the specification of the responsible level and the type of nerve involvement. Symptoms improved in all operated cases after surgery.

Adult↗
PubMed1986

Anatomic features of the furcal nerve and its clinical significance.

Attention must be paid to the furcal nerve when analyzing lumbosacral radicular symptoms, especially when neurologic findings are atypical and the responsible level cannot be assessed. An anatomic and clinical study of the furcal nerve showed the following: the furcal nerve was found in all dissections, and it arises at the L4-root level in most dissections (93%); the furcal nerve has its own anterior and posterior root fibers and its own dorsal nerve root ganglion. This proves that the furcal nerve is an independent nerve root. Neurologic symptoms, suggestive of two roots being involved, are frequently due to furcal nerve compression.

Adult↗