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Biomedical subjects

T Inamura

Publications and source records attributed to T Inamura.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Medulloblastoma with neuronal differentiation: a report of five cases].

This report presents a retrospective analysis of 5 patients who were treated for cerebellar medulloblastoma with neuronal differentiation. Four males and 1 female ranged in age from 6 months to 9 years at the time of diagnosis. Total removal of the tumor was achieved in 3 patients, and partial removal in 2. While these tumors were composed of small cells and had regions resembling desmoplastic medulloblastoma, they in part showed neuronal characteristics which included parallel row or linear array arrangements of tumor cells in an eosinophilic fibrillary matrix. Postoperatively, 3 patients received craniospinal radiation therapy, one received local radiation to the primary site, and the remaining one received only systemic chemotherapy. During the follow-up period of 3.8-25.2 years, 4 patients have been in continuous remission with mild to moderate neurological deficits, while the remaining one died 3.9 years after surgery. The clinical and anatomic pathological features of medulloblastomas with neuronal differentiation are reviewed while the therapeutic problems associated with these tumors are also discussed.

Cerebellar Neoplasms↗
PubMed2000

[Usefulness of ultrasonography in a case of spontaneous carotid-cavernous fistula: a case report].

Since spontaneous carotid-cavernous fistula (CCF) is a dural arterio-venous fistula at the cavernous sinus, which is different from traumatic CCF and CCF associated with a ruptured aneurysm at the cavernous internal carotid artery, cerebral angiography is required in order to differentiate these condition. We here report a case of spontaneous CCF, in which a result of ultrasonographic evaluation of cervical arteries well corresponded with that of cerebral angiography. Ultrasonography showed increased blood flow and decreased pulsatility index in the ipsilateral external carotid artery, contralateral internal and external arteries, and these values in all arteries resolved within normal range after the interventional embolization. Ultrasonography is less invasive examination and can be easily performed even in outpatients for observation of spontaneous CCF.

Blood Flow Velocity↗
PubMed2000

[A case of effective urgent irradiation therapy for metastatic spine tumor].

A 74-year-old man noticed weakness in bilateral lower limbs 2 months prior to admission. The weakness had rapidly progressed and he could not stand by himself on admission. All thoracic vertebral bodies showed mosaic pattern on T 2 weighted-image. At Th 10 and Th 11, two enhanced masses compressed spinal cord posteriorly. Basal-serum tumor markers, such as LDH, ALP, total-acid phosphatase and prostatic acid phosphatase were elevated, metastatic spine tumor from prostatic carcinoma was suspected. Biopsy specimen from its prostate revealed low differentiated adenocarcinoma. Because sphincter dysfunction progressed rapidly after admission, we started 3 Gy/day irradiation within 24 hr from its appearance targeting both Th 10 to L 1 vertebral bodies and the prostate in total 30 Gy. The clinical symptoms started to resolve immediately, and the disappearance completely within 7 months. This case illustrated that urgent irradiation was effective for broad metastatic spinal tumor with rapidly progressive neurological deficits.

Adenocarcinoma↗
PubMed2000

[Small epidermoid induced trigeminal neuralgia unrecognized by conventional CT and MRI for over 25 years].

A 65-year-old woman had been conservatively treated as idiopathic trigeminal neuralgia for over 25 years, because conventional computed tomography (CT) and magnetic resonance imaging(MRI) showed no abnormality in the cerebello-pontine(CP) angle cistern. She received a detailed MRI by constructive interference in steady state and diffusion weighted image(DWI) sequences. Those sequences on MRI well demonstrated a epidermoid tumor in the CP angle cistern, and the removal of the tumor completely resolved the neuralgia. Since a small epidermoid in the CP angle cistern seems to be unrecognized by conventional CT and MRI, detailed evaluation by DWI sequence, which has been widespread recently, is required for patients with trigeminal neuralgia.

Aged↗
PubMed2000

[Relationship between cardiac natriuretic peptide (ANP/BNP) and fluid intake in patients with subarachnoid hemorrhage].

Several authors described elevated natriuretic peptides, atrial natriuretic peptide(ANP) and brain natriuretic peptide (BNP), in patients with subarachnoid hemorrhage(SAH), which were account for inappropriate antidiuretic hormone(SIADH) or cerebral salt wasting syndrome(CSW). Although the secretion of natriuretic peptide depends on the total blood volume, central venous pressure, and cardiac output volume, the volume of fluid intake in patients with SAH had not been taken in consideration in previous report. We here examined the relationship between fluid intake and the natriuretic peptides in two cases without cardiac failure. ANP elevated 2 or 3 days after SAH and remained in normal range for 2 weeks. BNP elevated when the volume of fluid intake was increased, and BNP did not elevate during the periods with lower fluid intake. Several authors proposed the possibility of iatrogenic factor in natriuresis after SAH and these results supported this opinion.

Adult↗
PubMed1999

Serial MRI of cerebral infarcts before and after removal of an atrial myxoma.

We describe a cerebral infarct caused by atrial myxoma. A 30-year-old woman with an atrial myxoma presented with a right hemisensory deficit. MRI carried out before and after removal of the myxoma, showed multiple small bilateral white-matter infarcts which increased in number up to the surgery. A lesion in the left thalamus, which enlarged and showed contrast enhancement 4 months before surgery, resembled an old cerebral infarct by the time the myxoma was removed. The number of lesions stopped increasing after surgery. We suggest that atrial myxomas should be removed even in asymptomatic patients, to prevent cerebral infarcts due to embolism of tumour or thrombus.

Adult↗
PubMed1999

Combining steady-state constructive interference and diffusion-weighted magnetic resonance imaging in the surgical treatment of epidermoid tumors.

We describe the usefulness of three-dimensional Fourier transformation-constructive interference in steady-state (CISS) imaging and diffusion-weighted imaging (DWI) in the pre- and postoperative magnetic resonance imaging evaluation of intracranial epidermoid tumors. Two surgically proven epidermoid tumors in the cerebellopontine (CP) angle were not identified in conventional T1- and T2-weighted images because of a signal intensity similar to that of cerebrospinal fluid (CSF). CISS images clearly demonstrated displacement of the cranial nerves and a shift caused by a lesion in the cistern, but the signal intensity of the tumor by CISS was not sufficiently different from that of CSF to demonstrate the tumor directly. Using DWI, the tumor in the cistern was shown clearly by its increased signal intensity. Together, CISS and DWI compensated for each other's disadvantages, and this combination was useful in guiding surgical treatment of epidermoid tumors in the CP cistern.

Adult↗
PubMed1999

Selective transvascular delivery of oligodeoxynucleotides to experimental brain tumors.

Optimal therapeutic strategy for malignant brain tumors is controversial. Recent studies of viral or nonviral gene therapy in rats emphasize the need for a selective delivery system. We examined whether phosphorothioate oligodeoxynucleotides (lacZ 2157, 5'-GTGGCGTCTGGCGGAAAACC-3') could be selectively delivered transvascularly into experimental brain tumors following intracarotid infusion of bradykinin, a specific blood-tumor barrier opener. The specificity of 32P-labeled complementary antisense lacZ 2157 and the stability of lacZ 2157 in vivo were confirmed using slot-blotting hybridization method and polyacrylamide gel electrophoresis. Concentrations of lacZ 2157 after intracarotid injection (2 mg/kg, 10 microg/kg/min) with or without bradykinin were determined in the brain, tumor tissue, liver, kidney, and plasma. The transfer ratio of lacZ 2157 from the plasma to the tissues was calculated and expressed as tissue content relative to plasma content of lacZ 2157 per mg tissue (Do, microl/mg). Delivery of lacZ 2157 to tumor tissue increased 3.24 times with bradykinin over delivery in controls (0.0243 +/- 0.0176 vs. 0.00750 +/- 0.00389; p < 0.05). Delivery of lacZ 2157 to ipsilateral and contralateral cerebral cortex to the tumor, and delivery to the contralateral basal ganglia, did not increase significantly with bradykinin. These results indicate that such transvascular delivery with bradykinin can deliver a relatively large amount of oligodeoxynucleotide selectively to brain tumors without affecting normal brain.

Animals↗
PubMed1999

Effect of intracarotid bradykinin infusion on cerebral blood flow in dogs.

We examined whether intracarotid infusion of bradykinin altered circulation in the normal canine brain. Twenty-four anesthetized dogs were divided into four groups receiving different doses of bradykinin (1, 2.5, 5, and 10 micrograms kg-1 min-1). Regional cerebral blood flow (rCBF) was measured continuously using laser Doppler flowmetry through a burr hole in the frontal bone. Systemic blood pressure (SBP) and heart rate (HR) were monitored simultaneously. Higher doses of bradykinin significantly but temporarily decreased rCBF and SBP immediately after the start of infusion; these parameters rapidly recovered and then were stable through the rest of the infusion. During this period, percent change in rCBF and SBP was small, and differences between groups were not significant. On the other hand, HR increased during infusion and remained high. SBP, rCBF, and HR returned to pre-infusion levels after bradykinin was stopped. The results suggest that intracarotid infusion of bradykinin for treatment of brain tumors would be safe in terms of circulation to the uninvolved brain.

Animals↗
PubMed1999

Human chorionic gonadotrophin in CSF, not serum, predicts outcome in germinoma.

OBJECTIVES: Some intracranial germinomas, which may contain syncytiotrophoblastic giant cells (STGCs), are associated with a mildly to moderately increased human chorionic gonadotropin (HCG) concentration in serum, and patients with such germinomas are thus treated more aggressively than those with "pure" germinoma. However, the patients with germinoma and detectable HCG in CSF but not in serum have been classified and treated similarly to those with "pure" germinomas. The outcome of these patients and the relevance of HCG in the CSF were analysed. METHODS: The outcomes of patients with germinoma and increased serum HCG concentration (n=7) were compared with those of patients having detectable HCG titre in the CSF but not in the serum (n=5). RESULTS: Both groups in our series received similar treatments and also showed similar recurrence rates. The 40% recurrence rate in the group with HCG only in CSF did not correspond to the rate typical for "pure" germinoma: these tumours would be expected to have a better outcome. An additional patient whose CSF HCG were raised without increased serum HCG at recurrence is presented. CONCLUSIONS: It is recommended that patients with an increased HCG concentration in CSF should be considered to have "HCG producing germinoma", and they should be treated and followed up accordingly.

Adolescent↗
PubMed1999

[Clinical experience of image-guided neurosurgery with a frameless navigation system (StealthStation)].

We have applied the frameless navigation system (StealthStation) to various neurosurgical procedures to examine its usefulness. The system consists of a UNIX based workstation that creates triplanar and 3-dimensional images; an infrared optical digitizer with camera array; a reference-light-emitting diode (LED) array (e.g., reference array); and pointer probe modified by the addition of LEDs. This system was used to assist in placing a minimal skin incision and craniotomy in 4 cases, to determine the tumor/brain interface in 2 cases, to target the subcortical lesion in one case, and to correlate bony structure with a skull base tumor in 3 cases. The combined use with magnetic source imaging of the somatosensory cortex allowed a fast orientation of eloquent areas in 2 cases with peri-Rolandic tumor. This system, thus, was proved to be a useful adjunct to open-tumor biopsy or resection.

Adult↗
PubMed1999

[Carbamazepine induced hyponatremia].

Carbamazepine (CBZ) is a drug which can induce the syndrome of inappropriate antidiuretic hormone (SIADH). Until 1980's, there were reports regarding CBZ-induced SIADH, but it is rarely reported these days. We here report two cases of CBZ-induced SIADH. Hyponatremia in these cases was rapidly improved by withdrawal of administration of CBZ. According to the previous reports, the rate of hyponatremia in patients receiving CBZ is not small. It ranges from 48% to 31%. As CBZ is frequently used for patients with epilepsy and neuralgia, not only their blood CBZ concentration but also their serum Na level should be monitored.

Adult↗
PubMed1999

Macrophage infiltration and heme oxygenase-1 expression correlate with angiogenesis in human gliomas.

Macrophages are key participants in angiogenesis. In this study on human brain tumors, we first investigated whether macrophage infiltration is associated with angiogenesis and malignant histological appearance. Immunostaining of macrophages and small vessels in resected glioma specimens indicated that numbers of infiltrating macrophages and small vessel density were higher in glioblastomas than in astrocytomas or anaplastic astrocytomas. Macrophage infiltration was closely correlated with vascular density in human gliomas. Heme oxygenase-1 (HO-1), which is the rate-limiting enzyme in heme catabolism, was also associated with activated macrophages. Expression of mRNA encoding HO-1 was correlated with macrophage infiltration and vascular density in human glioma samples. Infiltrating macrophages were positively stained with anti-HO-1 antibody by immunohistochemical analysis, and in situ hybridization for HO-1 indicated that HO-1 was expressed in infiltrating macrophages in gliomas. HO-1 gene may be a useful marker for macrophage infiltration as well as neovascularization in human gliomas.

Adolescent↗
PubMed1999

[Anesthetic management of a patient with Ludwig's angina].

A 71-year-old woman with cellulitis of the floor of the mouth, referred to as "Ludwig's angina", underwent emergency tracheostomy under general anesthesia, for the control of airway narrowing caused by sublingual and submandibular swelling with tongue elevation. Because difficult airway had been suspected by preoperative assessment, feasible options of intubation in our hospital, including laryngeal mask, fiberoptic intubation and transtracheal jet ventilation, were prepared prior to induction of anesthesia. Anesthetic induction was carried out with propofol and suxamethonium, and subsequently tracheal intubation could be performed with difficulty under condition of partial visualization of vocal cord. Anesthetic maintenance with local anesthesia and continuous infusion of propofol 6 mg.kg-1.hr-1 was carried out during tracheostomy procedure, and this procedure was done uneventfully. Because airway control still remains a top priority in Ludwig's angina, feasible options of airway control should be prepared before induction of anesthesia if tracheostomy was required in a patient with this disease.

Aged↗
PubMed1999

[Influence of scalp shaving on prevention of postoperative intracranial infection].

Shaving of the whole scalp is ordinarily performed prior to neurosurgical operation. Although it is performed in order to prevent postoperative intracranial infection, there has been no apparent basis for this practice published in previous reports. We examined whether shaving the whole scalp reduced the rate of postoperative infection or not. We divided 274 cases, who received their first intracranial operation in the last 2 years, into two groups; a whole shaving group and a partial shaving group. We compared the rate of postoperative intracranial infection between the two groups according to age, diagnosis, operation, operation time and placement of drainage. Overall, 12 cases out of 274 (4.38%) had postoperative intracranial infection. The long operation time and the long term placement of drainage mechanism increased the postoperative intracranial infection rate. There was no postoperative intracranial infection in 74 patients who received burr-hole/twist-drill operation. As for craniotomy/craniectomy operations, 7 cases out of 83 (8.4%) in the partial scalp-shaving group whole scalp shaving group and 5 cases out of 117 (4.2%) had postoperative intracranial infections. Thus, there was no significant difference in the rate of postoperative intracranial infection between the two groups, if anything, the whole scalp shaving group tended to show a higher rate. According to these results, partial scalp shaving did not increase the rate of postoperative intracranial infection. Considering that patients who have lost their hair find it embarrassing to return to society, it is well to know that the whole scalp shaving is not absolutely necessary for all first craniotomy.

Craniotomy↗
PubMed1999

[A case of successful thromobolytic therapy in a patient with cerebral embolism during angiography].

We report a case of successful thromobolytic therapy in a patient with cerebral embolism during angiography. A 57 year-old male lost his consciousness during angiography. His neurologic symptoms were semi-comatose and right oculomotor palsy. According to these symptoms, we estimated the lesion in the right midbrain. Immediately after we denied a cerebral hemorrhage by computed tomography, we infused 60,000 u of urokinase intravenously within an hour from the onset followed by diffusion weighted magnetic resonance imaging (DW-MRI). DW-MRI showed hyper-intense lesion in the midbrain. We sequentially performed thrombolytic therapy with urokinase by selective cerebral angiography within three hours from the onset. His symptoms gradually resolved, but his consciousness was still confused state. His all neurologic symptom completely resolved in the next day after hyperbaric oxygenation therapy.

Angiography↗