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Biomedical subjects

R Tsugane

Publications and source records attributed to R Tsugane.

At least 19 recordsLinked to original sources
PubMed1992

Entrapment of the temporal horn: a form of focal non-communicating hydrocephalus caused by intraventricular block of cerebrospinal fluid flow--report of two cases.

In two cases of entrapment of the temporal horn, computed tomography demonstrated the typical appearance of a comma-shaped homogeneous area isodense with water surrounded by a periventricular low-density area. The cause was probably choroid plexitis resulting in obstruction of the cerebrospinal fluid pathway at the atrium. External drainage followed by shunt emplacement is indicated.

Adult↗
PubMed1992

[Problems in general management during barbiturate therapy].

Sixty-three patients (aged from 4 to 75 years) who had suffered severe head injury or cerebrovascular disease were placed on barbiturate regimens in which intravenous administration was given in amounts of 1-4 mg/kg/hr. Dobutamine and dopamine were also administered to prevent cardiac failure and renal failure. Immediate and delayed complications caused by barbiturate therapy were investigated and analyzed. Immediate complications included tachycardia which was seen in 16 cases (25%), and hypotension in 14 cases (22%), respectively. Higher incidence of those complications was noted among the patients who underwent surgery. Delayed complications included hypokalemia (41 cases, 65%), liver dysfunction hypernatremia (24 cases, 38%), infection (21 cases, 33%), cardiac failure (8 cases, 13%) and renal failure (1 case, 2%), respectively. Therefore, in patients treated under barbiturate regimens great care should be taken in order to avoid above mentioned complications.

Adolescent↗
PubMed1992

Intracranial arterial reconstructive surgery for unclippable aneurysms. An application of microvascular suturing.

Intracranial arterial reconstructive techniques were used in three patients for whom conventional neck clipping was not feasible due to the size, location or symptoms of their aneurysms. In the first case, complicated by subarachnoid hemorrhage, a giant aneurysm in the right middle cerebral artery was excised and the stump of the parent arteries was reconstructed in end-to-end and end-to-side fashion. The second case had a large thrombosed aneurysm in the left vertebral artery compressing the medulla oblongata, with small perforators originating from the proximal posterior inferior cerebellar artery (PICA) feeding the brainstem. The PICA was transposed to cerebellar cortical artery and the aneurysm excised. The third case presented with TIA and small infarctions were observed in the left thalamus. A giant, partially thrombosed, aneurysm in the left posterior cerebral artery (PCA) was trapped with a revascularization of the distal PCA from the superior cerebellar artery in side-to-side fashion. Indications for these intracranial arterial reconstructions in aneurysmal surgery were discussed and pertinent literature was reviewed.

Adolescent↗
PubMed1991

Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease.

There were 55 patients (soft disc, 21 and spondylosis, 34) who underwent anterior cervical discectomy without fusion (ACD) using an operating microscope. Discectomy of a single level was performed on 48 cases and two levels on 7. There were 37 patients with radiculopathy, and 18 patients with myelopathy or myeloradiculopathy who were followed clinically for 2-13 years postoperatively. Overall 81% of patients were improved in soft disc herniation, and no significant differences were noted between the group of radiculopathy and myelopathy. In spondylosis all but one patient reported initial relief of their preoperative symptoms; however, overall improvement was noted in only 16 patients (47%). The causes of symptomatic deterioration after ACD for spondylosis were later symptomatic recurrence in 5 patients, severe neck pain in 4, and development of new symptoms due to adjacent spur formation in 2. The authors eventually added interbody fusion in 4 cases. Cervical spine roentgenograms almost always showed a loss of height of the interspace and an anterior angulation immediately after ACD, but the alignment of the spine tended to improve with time, so that, at last follow-up, 82% had a good alignment. A spontaneous osseous fusion occurred in 74% of cases. An adjacent spur formation was observed in 3 patients with spondylosis. The most troublesome complication was neck and/or scapular pain. This pain usually subsided spontaneously, but this continued for more than 4 years postoperatively in 4 patients with spondylosis. Using an operating microscope ACD is a safe and effective procedure for patients with soft disc herniation, but the authors still prefer anterior cervical discectomy with interbody fusion for the patients with advanced spondylosis.

Cervical Vertebrae↗
PubMed1991

[Optimal hypervolemic therapy for symptomatic vasospasm].

Thirty-five patients with symptomatic vasospasm (SV) following aneurysmal subarachnoid hemorrhage (SAH) were managed according to a method based on hemodynamic manipulation, monitored by Swan-Ganz catheter. Nine out of these had delayed surgery. For those who developed SV, the pulmonary wedge pressure (Pcwp) and/or central venous pressure (CVP) were immediately increased up to the point at which neurological deficit was reversed by rapid injection of fresh frozen plasma, albuminates, low molecular dextrose, and glycerol. On this regimen, patients were closely observed for any neurological change. Then the hemodynamic parameters were maintained as optimal values until they could be reduced below optimal values without reappearance of neurological deficit. In inoperable patients, special attention was given in making a decision about discontinuing the regimen. The results were compared with thirty-seven patients with SV who were treated with conventional hypervolemic therapy (CHT) by continuous administration of albuminates. In the treatment of CHT, optimal values could hardly be established, so the same hemodynamic parameters were applied in all the cases. From this study, in the majority of the cases optimal values were found as follows: Pcwp up to 10-15 mmHg, and CVP below 11 cmH2O. On the contrary, in 20% of patients, neurological deficit was reversed by increasing CVP to a point not above 7 cmH2O. Correlation between neurological reversal and systemic blood pressure was not statistically significant. After this regimen (OHT), 74% of patients showed immediate improvement after volume expansion, and, in 80%, outcome was good, while 20% died. The motor function at the time of discharge was more than 3 on the manual test in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Venous Pressure↗
PubMed1991

[A case report: abscess of the cavum septi pellucidi].

A rare case of an abscess in the cavum septi pellucidi (CSP) is described and previously reported cases are reviewed. A 60-year-old male was admitted to the hospital because a diagnosis of cerebellar hemisphere infarction was made on CT scan. Seven years earlier, the patient had undergone a craniotomy for aneurysm clipping, and a ventriculo-peritoneal shunt was installed for normal pressure hydrocephalus 14 days after the aneurysmal rupture. On his second hospitalization CT scan also demonstrated CSP but this was not associated with ventriculomegaly. He was placed on a rehabilitation regimen and his hospital course was uneventful. Two months later, however, he developed hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone. After analysis of CSF obtained from the shunting device, a diagnosis of meningitis was made and CSF culture revealed E. coli infection. A part of the peritoneal tubing was torn and missing when the tube was removed from the peritoneal cavity and converted to outer drainage. Being treated with intrathecal and intravenous antibiotics administration, the meningitis subsided. However, CT scan taken twelve days after the onset of the infection showed an abscess in CSP which showed ring enhancement after contrast media. Therefore, the patient continued to receive intravenous antibiotics to counter the mass effect due to the abscess. The abscess had disappeared on follow-up CT scan obtained ten days later. The patient, however, eventually expired after iatrogenic hypernatremia associated with acute renal failure. The patient was submitted to an autopsy. The authors speculate that the abscess developed through a retrograde cisternal route after infection which had originated from bowel perforation by the peritoneal shunt tube.

Brain Abscess↗
PubMed1989

Indications for cisternal drainage in conjunction with early surgery in ruptured aneurysms and timing of its discontinuation.

The efficacy of cisternal drainage in association with early aneurysmal surgery remains highly controversial. The authors attempted to clarify the indications for this procedure and the proper timing of drainage removal in a series of 205 patients with no evidence of intracerebral hematoma who underwent surgical obliteration of bleeding aneurysms within 72 hours after subarachnoid hemorrhage. The 136 patients in whom cisternal drainage was performed constituted Group A and the remaining 69 patients Group B. The acid-base balance and lactate concentration were measured serially in cisternal cerebrospinal fluid (CSF) and arterial blood of 33 patients. Subarachnoid blood demonstrated by computed tomography (CT) was graded according to the system of Fisher et al. The outcome at 6 months did not differ significantly between Groups A and B among patients of preoperative CT grade 2 and clinical grades I-II. However, among patients of CT grade 3 or clinical grade III, those in Group A had better outcomes. The rates of symptomatic vasospasm in Groups A and B were 39.7% and 40.6%, respectively. However, persistent vasospasm was more frequent in Group B (11.8% vs. 26.1%), particularly in CT grade 3 patients. Ventricular enlargement was more prevalent in Group A (33% vs. 17%). CSF pH higher than arterial pH after the 7th postoperative day was associated with a poor outcome and was fairly well correlated with a rise in CSF HCO3- and a fall in CSF PCO2. CSF lactate increased with clinical deterioration but was not well correlated with preoperative CT findings, total volume of CSF outflow, or prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Low-dose dopamine treatment of patients in nonketotic hyperosmolar hyperglycemic coma].

In the acute neurosurgical setting, nonketotic hyperosmolar hyperglycemic coma (NHC) is thought to be caused by cerebral dehydration therapy and administration of steroids, glycerol, or mannitol. The mortality of this complication is reportedly very high, and is due to acute renal and/or cardiac failure. The authors evaluated the effect of low-dose dopamine (LDD; 1 to 5 micrograms/kg/min) administration in 10 patients with this syndrome. LDD was given to five patients. In these cases, hypovolemia was treated under central venous pressure monitoring with an iso-osmolar hyponatremic lactate solution given in a volume greater than the urine output. After the hypovolemia was corrected, the fluid was administered in a volume equal to the urine output until the serum osmolarity was normalized. In the five patients not given LDD, a large quantity of hypotonic solution was rapidly administered. In all patients treated with LDD, the urinary sodium increased and the urinary output stabilized. Consequently, the excess urea-nitrogen and serum sodium were quite easily washed out. The total net intake volume for the normalization of serum osmolarity was small and the duration of treatment was much shorter than that of patients not treated with LDD. The LDD regimen was not associated with complications, such as aggravation of cerebral edema, renal failure, or cardiac failure. On the other hand, three of the five patients not given LDD died of acute renal and/or cardiac failure without normalization of laboratory data. It is emphasized that this therapy, which results in beta-effect of catecholamine, sodium diuresis, and increased renal blood flow, is a practical means of managing acute neurosurgical cases complicated by NHC.

Adult↗
PubMed1979

Non-communicating hydrocephalus caused by dural arteriovenous malformation.

The case of a female infant with a non-communicating hydrocephalus caused by an enormously dilated straight sinus and the dilated posterior one third of the sagittal sinus is presented. These sinuses drained a torcular dural arteriovenous malformation. Conray ventriculography revealed a complete obstruction of the junction of the aqueduct and fourth ventricle with cephaloventral displacement of the ventricular system by the dilated sinuses. Placement of a ventriculoperitoneal shunt was followed by artificial embolization, by selective catheterization, into the dural feeding arteries.

Arteries↗
PubMed1978

A newly designed multipurpose microneurosurgical head frame. Technical note.

A new multipurpose head frame has been designed for microneurosurgery. It consists of a head holder with a frame to hold self-retaining brain retractors, hand rests, instrument holders, a plate for cotton patties, and skin-flap retractors. It has been satisfactorily used in 100 operations for 1 year.

Humans↗
PubMed1976

[Supratentorial extradural hematomas following posterior fossa craniectomy (author's transl)].

Five cases of the supratentorial extradural hematomas secondary to the posterior fossa craniectomy were reported. The site of the hematoma was far from the operative field and two cases showed acute course and three were rather mild. The symptoms of this complication were the unsuspected sensorium disturbance, anisocoria and the non-functioning ventricular drainage. Two cases died of this complication and two were severely disabled. The mechanism of this complication is not clearly understood. The lowering of the ventricular pressure by the ventricular tap during the operation may play significant role in the formation of the extradural hematoma. The younger age of the cases and the long history of increased intracranial pressure were stressed in the literature. The significance of the management of the ventricular pressure during the operation was emphasized. The prevention is the best treatment.

Adult↗
PubMed1975

Scotomatous defects in the central visual field in pituitary adenomas.

In a series of 46 cases of pituitary adenomata (34 solid, 6 with yellow cyst, and 6 with hemorrhagic cyst), we found central scotomatous field defects in 8 patients. Of these 8 scotomatous cases 4 were associated with tumour containing a hemorrhagic cyst. We suggest that rapid expansion of the tumour is one of the principal etiological factors in the production of scotomatous instead of bitemporal field defects in patients with pituitary adenomas.

Adenoma↗
PubMed1975

Bulk flow in the cerebrospinal fluid system of the dog.

Ventriculo-cisternal, intracranial subarachnoid-to-subarachnoid space and spinal subarachnoid space perfusions were carried out on dogs. The perfusate contained inulin as a tracer and the design of these experiments was based upon the concept that inulin leaves cerebrospinal fluid (CSF) compartments only by means of bulk absorption, and that actual diffusion and active transport of inulin is negligibly small. Inulin was removed from different CSF spaces by bulk absorption at rates which varied linearly with hydrostatic pressure. The rate of formation of CSF is equal to inulin clearance plus the difference between outflow and inflow rates. The total CSF formation in dogs weighing 12 to 17 kg was measured as 0.065 ml/min, and 58.5 per cent of this amount was found to come from extraventricular CSF space. The rates are independent of hydrostatic pressure in the range studied.

Animals↗