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Biomedical subjects

T Iwakoshi

Publications and source records attributed to T Iwakoshi.

14 recordsLinked to original sources
PubMed1999

Intra-arterial vein bypass using a vein-loaded stent system to occlude wide-necked aneurysms: an experimental study in dogs.

We treated 13 experimental wide-necked aneurysms of lateral type produced in dog carotid arteries with a vein-loaded stent system consisting of an autologous vein graft, a vein-carrier stent, and two other self-expanding Z-shaped stents. The vein-loaded stent, made by connecting the autologous vein graft to the vein-carrier stent, was implanted in the common carotid artery to seal the aneurysm's orifice, after which two booster stents were deployed. The distal stent was placed to fix the distal end of the vein graft, and the proximal stent was placed at the proximal venous portion of the vein-loaded stent to reinforce its proximal end. In this manner an intra-arterial bypass was established across the aneurysm. Of 13 aneurysms seven were completely occluded, preserving the parent artery. The remaining six procedures resulted in parent artery occlusion because of failures in stent deployment. Angiograms performed in within 1 week six successfully treated dogs revealed the parent artery to be patent in four but thrombosed in two. Histological study of successful cases showed as smooth intima with slight endothelial hypertrophy and partially organised thrombus. The intraluminal features were also observed with a vascular endoscope at the time of treatment in four dogs and at the time of follow-up angiography in two. The appearances corresponded well to the macroscopic findings in the specimens. Our vein-loaded stent system offers complete closure of the orifice, which does not occur with conventional stent placement. The method is believed to show clinical promise for treating wide-necked aneurysms not curable by embolisation of the sac.

Aneurysm↗
PubMed1997

Abnormal cerebral blood flow associated with antiphospholipid antibody syndrome--four case reports.

Patients with antiphospholipid antibody syndrome manifesting as neurological symptoms (one patient with twice repeated cerebral ischemic symptoms in the left parietal and frontal lobes, and the other patient with cerebral infarction of the right temporal lobe) and non-neurological symptoms (one patient with occlusion of the superior mesenteric artery and the other patient with thrombophlebitis) underwent cerebral blood flow (CBF) studies using xenon-enhanced computed tomography. The patients with neurological symptoms had decreased CBF at the affected sites. The patients with non-neurological symptoms had decreased CBF in the left parietal and temporal lobes and/or corona radiata. Subtle preclinical thrombosis may cause chronic cerebral hypoperfusion in patients with antiphospholipid antibody syndrome.

Adult↗
PubMed1997

Effect of cisternal papaverine on cerebral blood flow in patients with subarachnoid hemorrhage--three case reports.

Three patients presenting with subarachnoid hemorrhage due to aneurysmal rupture underwent cerebral blood flow (CBF) measurements before and after cisternal injection of papaverine hydrochloride. One patient showed prominent increases in CBF in the frontal lobe and basal ganglia after injection of papaverine, but paradoxical decreases in the parietal lobe and corona radiata. The other two patients had poor CBF response. Dense clotting in the basal cisterns may have prevented diffusion of the agent so that only the proximal trunks of the internal carotid, anterior cerebral, and middle cerebral arteries were dilated in the former case. The dilation of proximal trunks of cerebral arteries might steal blood flow from the parietal lobe and corona radiata, where the intraparenchymal arteries were maximally dilated and cerebrovascular reserve capacity was poor.

Adult↗
PubMed1996

Coagulation and fibrinolysis study after local thrombolysis of a cerebral artery with urokinase.

Coagulation and fibrinolysis factors were studied in six patients after local thrombolysis with urokinase (720,000 IU). Transient abnormalities, such as prolonged prothrombin time, decreased plasminogen and alpha 2-antiplasmin activities, decreased fibrinogen, and increased fibrin degradation products were seen on the day after thrombolysis, but tended to return to the normal range on the 4th day except for one patient who suffered from disseminated intravascular coagulation. Antithrombin III activity did not change so much. Therefore, the dosage of urokinase should be as low as possible to prevent fluctuations in the coagulation and fibrinolysis system.

Aged↗
PubMed1995

Hemifacial spasm in Albright's hereditary osteodystrophy with pseudopseudohypoparathyroidism and nephrogenic diabetes insipidus--case report.

A 30-year-old male with Albright's hereditary osteodystrophy, pseudopseudohypoparathyroidism, and nephrogenic diabetes insipidus presented with hemifacial spasm persisting for 2 years. This association is extremely unusual. Angiography revealed markedly tortuous carotid and vertebral arteries inconsistent with his age. Neurovascular decompression of the left vertebral artery achieved only partial resolution of the spasm.

Adult↗
PubMed1995

Subarachnoid hemorrhage of unknown origin associated with Weber-Christian disease--case report.

A 58-year-old female, who had suffered from Weber-Christian disease for 26 years, presented with subarachnoid hemorrhage. Cerebral angiography showed dilatation of the basilar tip. An operation was performed in the chronic stage. The wall of dilated basilar artery was tough, but that of the right superior cerebellar artery was very thin and three small aneurysms were found on the right middle cerebral artery. Blood levels of fibrin degradation products, plasmin-alpha 2-plasmin inhibitor complex, and thrombin-antithrombin III complex were increased. The abnormality of the coagulation-fibrinolysis system and the fragility of the cerebral arteries related to Weber-Christian disease were probably the cause of the subarachnoid hemorrhage.

Basilar Artery↗
PubMed1994

Incidental white matter lesions identified on magnetic resonance images of normal Japanese individuals--correlation with age and hypertension.

Incidental white matter high-intensity lesions are frequently seen on T2-weighted magnetic resonance (MR) images of the brain in older people. The incidence increases with advancing age or hypertension. Brain MR images of 59 normal individuals were examined to analyze this phenomenon. The total number of white matter high-intensity lesions correlated significantly with age (p = 0.004) or systolic blood pressure (p = 0.03). The 60- to 69-year-old group demonstrated a very close correlation of white matter lesions with systolic (p = 0.02) and diastolic blood pressure (p = 0.01), in contrast to the 50- to 59-year-old group. Hypertensive subjects in their 60s are thought to develop more white matter lesions than subjects in their 50s.

Adult↗
PubMed1994

Early changes in volume and non-enhanced volume of acoustic neurinoma after stereotactic gamma-radiosurgery.

The effectiveness of stereotactic gamma-radiosurgery for treating acoustic neurinoma was evaluated by measuring the volumes of the tumor, non-enhanced tumor, and cerebellar edema in 13 patients with acoustic neurinoma who were followed up for 9 to 15 months (median 12.7 mos) after treatment. The tumor volume and non-enhanced volume tended to reach a maximum after 6 months, and cerebellar edema volume after 9 months, then decreased gradually thereafter. Hearing loss tended to increase gradually, but involvement of the facial nerve was transient.

Aged↗
PubMed1994

[Stereotactic radiosurgery of intracranial meningiomas].

Stereotactic radiosurgery for intracranial meningiomas was attempted using a 201-source cobalt gamma knife. Forty patients bearing 42 tumors were involved in this study. Their ages ranged from 30 to 91 years, with an average of 55.1 years. The most frequent sites of origin were the parasellar and petroclival regions. The mean tumor diameter was 27.2mm and the marginal tumor dose of radiosurgery ranged from 10 to 20Gy, depending on tumor location and size. Serial imaging studies with MRI were obtained in all 40 cases, in which minor tumor shrinkage was demonstrated in 7.9%, 40.0% and 53.3% at 6, 12 and 18 months after radiosurgery respectively. Only two tumors became enlarged after the treatment. Obvious low signal intensity on MRI, indicating central tumor necrosis, was found in 32% at 12 months and 40% at 18 months. Four large tumors over 40mm in mean diameter were treated by staged radiosurgery with intervals of 1.5 to 7 months. A similar good response was able to be obtained in all 4 cases, even though they were treated with a marginal dose less than 12Gy. Symptomatic edema occurred in 5 cases (12.5%) within 12 months and required corticosteroid therapy and hyperosmotic diuresis. In conclusion stereotactic radiosurgery has proved to be an effective and relatively safe method for the treatment of intracranial meningiomas.

Adult↗
PubMed1994

[Clinical presentations and MRI findings of angiographically occult vascular malformations].

Various clinical features as well as MRI findings of AOVM (angiographically occult vascular malformation) were studied. Amongst our patients, since January 1988, there have been 30 cases of symptomatic AOVM (20 males, 10 females) including 3 cases with multiple lesions. The age ranged from 3 to 60 years of age, with a mean of 33.4 years. The locations of symptomatic lesions were in the cerebral hemisphere (15), the thalamus (4), the brain stem (8) and in the cerebellum (3). The initial presentations of these 30 cases were either by hemorrhage (18), convulsive seizure (9) or by progressive neurological deficits (3). The initial presentation was not related to the patient's age and the size of the lesion, but apparently related to the location of AOVM. Most of the lesions in the cerebral hemisphere presented seizures, but all of the lesions in the thalamus, the brain stem and the cerebellum disclosed hemorrhage as an initial presentation. In fact it was noticed that brain stem lesions tend to cause repetitive hemorrhage in a relatively short period. AOVM lesions were clearly visualized with T2-weighted MRI images, consisting of high intensity cores with surrounding low intensity rims. Most of the symptomatic lesions were partially enhanced by Gd-DTPA with varied intensity. Dynamic changes in size and enhancement pattern on MRI were occasionally seen, usually accompanied with episodes such as hemorrhage or neurological deterioration. Although AOVMs were angiographically negative some strands indicating draining veins were observed on MRI in several cases. In contrast, none of the nonsymptomatic lesions (22 lesions) demonstrated enhancement effects with Gd-DTPA.

Adolescent↗
PubMed1993

Magnetic resonance angiography of arteriovenous malformation in the brainstem.

The magnetic resonance (MR) angiography appearance of arteriovenous malformation (AVM) in the tegmentum and pons is described. The interpeduncular perforating branches of the posterior cerebral artery and median pontine branches of the basilar artery were seen more clearly by MR angiography than by conventional angiography. MR angiography was very useful for the follow-up of AVM after stereotactic radiosurgery.

Adolescent↗
PubMed1993

Magnetic resonance angiography of arteriovenous malformation in the thalamus.

A comparative study of magnetic resonance angiography and conventional angiography of arteriovenous malformation in the thalamus showed that both methods clearly visualized the feeding arteries: perforating branches of the posterior cerebral artery, posterior choroidal artery and lenticulostriate artery. Draining veins such as the internal cerebral vein were also demonstrated well.

Adolescent↗
PubMed1993

[Gamma-radiosurgery of metastatic brain tumors].

Twenty-six cases of various brain metastases were treated with Gamma-knife. Their primary sites were: lung in 13, colon in 5, breast in 2, kidney in 2, liver in 1, ovary in 1, and a malignant melanoma. The origin of one case was not verified. There were 11 single and 15 multiple metastases. In total 70 tumors were involved. Following localization with MRI and dose planning using a computer system, radiosurgery was carried out. Tumors were treated with the maximum dose between 24 and 50Gy, and with the marginal dose between 12 and 25Gy. Early follow-up results demonstrated favorable responses chiefly by tumor shrinkage, central tumor necrosis or by decreased peritumoral edema. In fact after radiosurgery, the rates of tumor shrinkage were 55.7%, 61.8% and 66.7% at 3, 6 and 9 months respectively. The tumor control rates, including regressed and stable tumors, were 98.6%, 97.1 and 85.7 at 3, 6 and 9 month intervals respectively. Meanwhile, 14 cases were neurologically improved, and another 4 showed either no perceivable change. Neurological deterioration occurred in 4 cases by progression of brain metastasis in 2 and by perifocal edema after radiosurgery. Recurrent brain metastases occurring after radiosurgery were treated with a repetition of Gamma-knife surgery in 4 cases, resulting in good tumor control. In conclusion most of the brain metastasis can be well controlled by radiosurgery for relatively long period of time.

Adult↗