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Biomedical subjects

Shodo Fujioka

Publications and source records attributed to Shodo Fujioka.

18 recordsLinked to original sources
PubMed2006

Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms.

OBJECTIVE: To compare the preoperative and postoperative health-related quality of life (QOL) and psychological state of patients with asymptomatic unruptured intracranial aneurysms (ICAs) who underwent elective surgery. METHODS: Out of 67 patients who underwent neck clipping of ICAs, we assessed the QOL of 61 patients using Short Form-36 (SF-36); their psychological state was rated on the Hospital Anxiety and Depression Scale (HADS) before, 3 months, and 1 and 3 years after treatment. RESULTS: The preoperative mean scores for each of the eight SF-36 domains except bodily pain were significantly lower in the study population than in the reference population. 14 (20.9%) patients experienced surgical complications defined as neurological deterioration and/or abnormal CT findings within 30 days of the operation. Despite some complications, the QOL of all operated patients returned to the mean level of the reference population 3 years after treatment. At 3 months after surgery, the scores for psychosocial activities and general health perception were transiently below the preoperative levels. According to the HADS, the patients experienced mild anxiety before the operation; it disappeared by the third postoperative month. CONCLUSIONS: Preoperatively, patients with unruptured ICAs reported a significantly decreased QOL. It further declined transiently after elective surgery, but it returned to the mean level recorded for the reference population within 3 years. Our findings suggest that these patients derived significant QOL benefits from their surgery. Hence subjective QOL issues should be considered in deciding whether treatment-related risks and their natural history, such as their potential rupture, warrant surgery of asymptomatic unruptured ICAs.

Aged↗
PubMed2006

Efficacy of edaravone in cardioembolic stroke.

OBJECTIVE: We investigated the efficacy of edaravone in patients with cardioembolic stroke. METHODS: Cardioembolic stroke patients were treated with drip intravenous infusion of edaravone (ED group, n=141) for 7 days, and were retrospectively compared with a historical-controlled cohort of similar patients (control group, n=114). RESULTS: Early improvement (between day 0 and day 10), defined as change in National Institutes of Health Stroke Scale (NIHSS), was seen more frequently in mild patients (NIHSS on admission < or = 7) among the ED group than in the control group (change in NIHSS +2 vs. -2, respectively, p=0.013). Similar efficacy was not seen in the moderate to severe (NIHSS >7) patients. Independent patients (modified Rankin Scale < or = 2) 6 months after the onset were likely to be less frequent in the ED than the control group (28% versus 41%; p=0.066). Other clinical outcomes in the ED group were not significantly different from those in the control group. CONCLUSION: The results suggest that edaravone may only be effective in mild patients with cardioembolic stroke.

Aged↗
PubMed2006

Rotational vertigo associated with parietal cortical infarction.

A 65-year-old woman experienced sudden positional vertigo with rightward, horizontal nystagmus that resolved within days. MRI revealed a left parietal lobe infarction involving the supramarginal gyrus. The patient experienced a transient recurrence of vertigo after 7 days but MRI failed to reveal the presence of any new lesions; furthermore, the patient's EEG was normal. We suggest that this patient's vertigo was due to her parietal cortical infarction.

Aged↗
PubMed2006

Cavernous malformation of the optic chiasm: case report.

We report a 14-year-old boy with cavernous malformation of the optic chiasm. He had a 2-year history of gradually worsening visual disturbance. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a suprasellar mass, findings compatible with craniopharyngioma. The mass was biopsied and histological examination confirmed cavernous malformation. On the second day after the biopsy, he suffered chiasmal apoplexy due to intratumoural haemorrhage, lost visual acuity and developed a field cut. Cavernous malformations arising from the optic nerve and chiasm are extremely rare; only 29 cases have been reported to date. Most patients manifested acute visual acuity and visual field disturbances. Although MRI findings of cavernous malformations in the brain parenchyma have been reported, MRI findings on the optic nerve and chiasm may not be completely diagnostic. Of the 29 documented patients, 16 underwent total resection of the lesion without exacerbation of their preoperative symptoms; in some cases, resection was complicated by risk of damage to the surrounding neural tissue. As patients may suffer intratumoural haemorrhage after biopsy or partial removal of the lesion, the advisability of surgical treatment of cavernous malformations of the optic nerve and chiasm must be considered carefully.

Adolescent↗
PubMed2006

Endovascular treatment of ruptured aneurysms associated with fenestrated basilar artery. Two case reports.

Two patients with ruptured aneurysm associated with fenestrated basilar artery (BA) were treated using the endovascular approach. Angiography showed these patients had different types of BA bifurcation. One type had two points of bifurcation and a bridging artery in the BA fenestration, with the aneurysm at the bifurcation of the right loop of the fenestration. The aneurysm had different appearances on right and left vertebral angiograms. The other type had only one point of bifurcation, and the appearance of this aneurysm was similar on both angiograms. To ensure successful embolization, bilateral vertebral angiography should be performed for complete assessment of the morphological characteristics of aneurysm associated with fenestrated BA.

Adult↗
PubMed2006

[Decompressive craniectomy for ischemic stroke].

We analysed retrospectively 15 consecutive patients with cerebral infarction undergoing decompressive craniectomy. Ninety-three percent of patients survived, and 53% of them were partially dependent (Barthel Index > 0). We defined the partially dependent patients as good outcome group, and totally dependent as poor outcome group. In good outcome group, compared with poor outcome group, there are more frequent left hemispheric lesion (50%: 0%, p = 0.029), and pre-operative JCS < or = II-30 (62.5%: 14.3%, p = 0.057). Although many patients were severely disabled, 79% of the patients and their family answered that having operation was correct choice. All the patients in good outcome group acquired the ability of oral feeding and communication skill. 87.5% of the patient in good outcome group was satisfied with the outcome. Based on these results, we emphasized that comprehensive evaluations, including satisfaction scale and QOL assessment necessary to decide the indication of decompressive craniectomy for ischemic stroke.

Activities of Daily Living↗
PubMed2005

Hyperacute diffusion-weighted imaging abnormalities in transient ischemic attack patients signify irreversible ischemic infarction.

BACKGROUND: To characterize the frequency and clinical features of diffusion-weighted imaging (DWI) abnormalities in the hyperacute phase of transient ischemic attacks (TIAs). METHODS: We performed DWI in 21 consecutive patients with TIA (mean age 64 years; 17 men and 4 women) during both the hyperacute phase (within 6 h after onset) and subacute phase (within 2-9 days after onset). RESULTS: DWI abnormalities were present in the hyperacute phase in 11 patients (positive group) and absent in the other 10 patients (negative group). These groups could not be differentiated based on the clinical characteristics. In the subacute phase, all 11 patients from the positive group had abnormalities on MRI including T2-weighted and fluid attenuation inversion recovery images as well as DWI, with lesions being located in regions similar to those observed in the hyperacute phase. Of the 10 patients in the negative group, new DWI abnormalities were noted in 2 during the subacute phase. CONCLUSIONS: Approximately half of TIA patients in whom MRI was performed in the hyperacute phase had DWI abnormalities, all of which persisted in the subacute phase. The findings suggest that essentially all hyperacute DWI abnormalities in TIA patients may indicate irreversibility and signify the presence of brain infarction.

Adult↗
PubMed2005

[A patient with Vibrio vulnificus meningoencephalitis].

A 76-year-old man with liver cirrhosis and diabetes mellitus was admitted to our hospital because of bacterial meningoencephalitis. He had eaten raw fish 2 days before onset. He also developed septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome and panophthalmitis of the right eye. Vibrio vulnificus was isolated from the blood culture. Extensive therapy including antibiotics and nafamostat methylate, resulted in full recovery except for right blindness. The necrotizing fasciitis, which is common with Vibrio vulnificus infection, had not been complicated in this patient.

Aged↗
PubMed2005

[A case of migraine with aura who showed no visual symptom].

A 22-year-old man experienced a severe migraine on left side of the head with an aura including aphasia and a numbness on the right hand. A migraine with an aura of sensory disturbance on the both hands recurred immediately after cerebral angiography. Further examinations including MRI and angiography did not reveal any evidence of cerebrovascular diseases. Aphasic migraine was diagnosed in this patient. At all attacks, this patient never experienced visual aura which was common in the previous reports of migraine.

Adult↗
PubMed2005

[Portal vein thrombosis associated with hepatic encephalopathy].

A 54-year-old man who had been administered chlormadinone acetate 3 months after prostatectomy for prostate cancer, acutely developed disorientation and memory disturbance. Six days later, he experienced high grade fever and epigastralgia. He was suspected to have hepatic encephalopathy, because the Fischer ratio was low although serum ammonia level remained normal. Further examinations including abdominal echography and CT scan disclosed a thrombus extending from the portal vein to the superior mesenteric vein together with abnormal collateral vessels originating from the portal vein. He was successfully treated with warfarin potassium, urokinase and heparin sodium. It was suggested that the patient developed hepatic encephalopathy due to portal-systemic circulation shunting secondary to portal vein thrombosis.

Drug Therapy, Combination↗
PubMed2005

[A case of unilateral ischemic stroke with ipsilateral limb-kinetic apraxia].

A 74-year-old man developed aphasia, weakness of the right upper extremity and left limb-kinetic apraxia. Brain MRI showed an infarct in the area supplied by the left middle cerebral artery. Cerebral angiography revealed high grade stenosis with plaques of bilateral proximal internal carotid arteries. The carotid endarterectomy of the left carotid artery was performed three months later. After this operation his left limb-kinetic apraxia improved. We considered transhemispheric diaschisis, callosal apraxia or diagonistic dyspraxia as a possible cause of this rare symptom.

Aged↗
PubMed2005

[Normalization of physical activity on acute ischemic stroke].

The purpose of present study is to clarify the association between early normalization, orthostatic hypotension (OH) and neurological deterioration in patients with acute ischemic stroke. The authors retrospectively performed scheduled ambulation in 162 consecutive patients who were diagnosed as having ischemic stroke without them being comatose. Blood pressure and neurological findings were examined during the orthostatic tolerance test. OH was occurred in 86 (53.1%) of all patients. Neurological worsening were found in 22 of them during all clinical course, although worsening closely associated with orthostatic tolerance was only two of them. Significant OH was occurred in the patients with cerebral arterial stenosis on head-tilt 60 degrees after 15 minutes (p = 0.001). And the patients who have atrial fibrillation also yield OH on sitting immediately after (p = 0.041) and 5 minutes after moving (p = 0.035). Because symptomatic OH were rarely observed in the patients with acute ischemic stroke without them being comatose, early ambulation could be achieved safely.

Aged↗
PubMed2005

[Traumatic extracranial vertebral artery dissection treated with coil embolization--a case report].

We reported a 37-year-old man who developed vertigo, dysarthria and left hemiparesis following neck pain. Magnetic resonance imaging (MRI) demonstrated infarct in the right superior cerebellar artery (SCA) territory. Duplex color-flow imaging detected dissection (double lumen) in the right vertebral artery (VA) at the level of the C4-C6 vertebra (V2 segment). Cerebral angiography showed irregular narrowing in the right V2, and occlusion of the right SCA. These findings suggested that dissection in the right V2 caused artery-to-artery embolism in the right SCA. Despite administration of anti-thrombotic agents, he recurrently suffered from transient ischemic attacks. Serial duplex color-flow imaging echography revealed that the dissection of the right VA gradually became more stenotic and extended to the distal site. Coil-embolization of the right VA by endovascular therapy was performed, and thereafter the dissecting lesion of the right VA was completely occluded and ischemic attacks disappeared.

Adult↗
PubMed2005

[Prolonged factors of length of hospital stay in acute ischemic stroke].

The purpose of this study was to determine factors that extend the length of hospital stay in patients with ischemic stroke in acute hospital. Clinical data of 462 consecutive patients with acute ischemic stroke were retrospectively researched. These subjects were divided into two groups; short stay group (length of hospital stay < or = 14 days, 238 patients) and long stay group (length of hospital stay > 14 days, 224 patients). Using multivariate statistical methods, the independent factors associated with prolonged hospital stay were investigated. Independent and significant factors associated with prolonged hospital stay were National Institutes of Health Stroke Scale score on admission (OR, 1.072: 95% CI, 1.021 to 1.125), transient ischemic attack (OR, 0.142: 95% CI, 0.021 to 0.966), any complications during hospital stay (OR, 7.975: 95% CI, 3.539 to 17.971) and interval between offer to discharge (OR, 1.441: 95% CI, 1.294 to 1.605). It was suggested that control of complication could decrease length of hospital stay in patients with ischemic stroke in acute hospitals.

Aged↗
PubMed2004

Contribution of angiotensin-converting enzyme and angiotensin II to ischemic stroke: their role in the formation of stable and unstable carotid atherosclerotic plaques.

BACKGROUND: The angiotensin-converting enzyme/angiotensin II (ACE/Ang II) system is a strong contributor to intimal hyperplasia in atherosclerotic lesions. To illuminate its role in ischemic stroke, we examined the expression of ACE/Ang II in stable and unstable carotid atherosclerotic plaques from symptomatic and asymptomatic patients. METHODS: Using immunohistochemical methods, we studied differences between carotid atherosclerotic lesions obtained at carotid endarterectomy (CEA) from symptomatic (n = 36) and asymptomatic (n = 28) patients. The specimens were classified as stable (n = 30) and unstable (n = 34) plaques, and their fibrous cap, lipid core, and shoulder lesion were examined. We used antibodies against smooth muscle cells (SMC), macrophages, endothelial cells (EC), ACE, and Ang II. RESULTS: Of 28 lesions from asymptomatic patients, 20 (71.4%) manifested features characteristic of stable plaques: the expression of ACE/Ang II co-localized with SMC, EC, and macrophages in the shoulder lesion. In contrast, 26 of 36 symptomatic lesions (72.2%) exhibited the typical features of unstable plaques: dense accumulations of macrophages near the luminal surface in the shoulder lesion and weak immunoreactivity for ACE/Ang II, EC, and SMC. Furthermore, most of the lesions were accompanied by early stage atherosclerotic lesions (satellite lesions) that were strongly immunoreactive with macrophages, EC, and ACE/Ang II. CONCLUSIONS: ACE/Ang II expression may induce the proliferation of SMC and EC and result in the formation of carotid atherosclerotic plaques with a thick fibrous cap. Notably, the shoulder lesion of unstable plaques exhibited a thin fibrous cap and faintly expressed ACE/Ang II. Lack of the ACE/Ang II system may contribute to the final step in plaque rupture.

Actins↗
PubMed2002

Evaluation of delayed appearance of acetazolamide effect in patients with chronic cerebrovascular ischemic disease: feasibility and usefulness of SPECT method using triple injection of ECD.

UNLABELLED: The purpose of this study was to verify the feasibility and usefulness of a new SPECT method, called triple injection of (99m)Tc-ethylcysteinate dimer (TIE), in evaluation of the delayed or poor appearance of acetazolamide (ACZ) effects in patients with chronic cerebral ischemic disease. METHODS: Three equal-volume splits of (99m)Tc-ethylcysteinate dimer were intravenously administered, and 1,000 mg ACZ were used as a vasodilator. A middle cerebral artery territory in the lateral ventricle was used as a region of interest. The data at rest and at 7.5 and 20 min after ACZ challenge (ACZ 7.5 and ACZ 20, respectively) were obtained by dynamic SPECT, and a time response curve to ACZ was obtained through the relative ratio of regional counts to the data at rest, not through regional cerebral blood flow. Nine cases of complete occlusion of the internal carotid artery (IC) and 6 cases of severe IC stenosis were analyzed. RESULTS: In 12 healthy volunteers (24 cerebral hemispheres) using a placebo (negative control), the values at rest and at rest 7.5 and rest 20 (corresponding to ACZ 7.5 and ACZ 20, respectively) were 100%, 100.4% +/- 2.8%, and 99.6% +/- 3.6%, respectively, indicating the accuracy of the TIE method. In a positive control using 24 normal cerebral hemispheres, prompt maximal vasoreactivity at ACZ 7.5 (124.5% +/- 8.0%) was confirmed, as was continuous vasoreactivity until ACZ 20 (130.1% +/- 12.8%). The values between ACZ 7.5 and ACZ 20 were not statistically different. Patients with complete IC occlusion exhibited a poor response at ACZ 7.5 despite a normal response at ACZ 20 (delayed response). Furthermore, in patients with severe IC stenosis, restoration of cerebrovascular reactivity after carotid endarterectomy was confirmed not only at ACZ 20 but also at ACZ 7.5. CONCLUSION: The TIE method using SPECT may be a potentially useful and sensitive strategy in clinical evaluation of the delayed or poor appearance of ACZ effects in patients with chronic cerebrovascular ischemic disease.

Acetazolamide↗
PubMed2002

[Serial magnetic resonance images in patient with the middle cerebral artery dissection].

A 30-year-old man suffered from transient left hemiparesis and was admitted under the clinical diagnosis of transient ischemic attack. Cerebral angiogram on admission disclosed severe stenosis at the horizontal portion of the right middle cerebral artery. Magnetic resonance images (MRI) on axial view showed a linear enhanced lesion along the stenosis. Images on sagittal view disclosed a crescent-like lesion surrounding a flow void of the middle cerebral artery. After administration of aspirin, he had never suffered from hemiparesis. The enhanced lesion of the middle cerebral artery gradually disappeared on MRI. Although the middle cerebral artery showed temporary improvement of the stenotic lesion, it finally occluded 9 months after the onset. A diagnosis of spontaneous dissection of the right middle cerebral artery was made. The process of the arterial hemodynamics, such as a shrinking of the pseudo-lumen and a flow improvement in the true lumen, was well documented on serial MRI with Gd-DTPA and serial MRA.

Adult↗