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T Shiogai

Publications and source records attributed to T Shiogai.

29 records · Page 2Linked to original sources
PubMed1988

Necessity for ICP monitoring to supplement GCS in head trauma cases.

The necessity for ICP monitoring together with GCS findings to detect deterioration in head trauma cases and determine the treatment required was studied. There were 18 subjects (14 males, 4 females) aged from 11 to 61. Cases of primary brain stem damage were excluded. Eight cases had GCS of 6-10, and 10 cases scores of 11-15. Initial CTs of these cases indicated the following conditions: thin acute extradural haematoma (A-EDH), thin acute subdural haematoma (A-SDH), brain contusion, and single or multiple intracerebral haematoma (ICH). However, in no case was any mass effect clearly shown. Medical decompression (osmotherapy, barbiturate, steroid and mechanical hyperventilation) was carried out with simultaneous ICP monitoring. Based upon our cases which showed a GCS score of 10 or less, ICP monitoring should accompany medical decompression. Where the ICP cannot be maintained below 20 mm Hg, there is a high risk (about 60%) of haematoma enlargement, delayed haematoma, or increasing brain oedema. ICP monitoring in these cases should be maintained for at least one week. Timely surgical decompression is necessary when the ICP stays above 20 mm Hg, the GCS score drops below 10, and repeat CT scan indicates progress of the mass effect.

Adolescent↗
PubMed1987

Evolution of criteria for determination of brain death in Japan.

In 1974, the Japanese EEG Society's Ad Hoc Committee on Brain Death published criteria for determining brain death only in cases of acute gross primary brain lesions. In 1983, a new brain death study group was organized to re-evaluate these criteria. During a 6-month period from March 1, 1984, 217 neurosurgical and neurological clinics and emergency services throughout Japan reported 718 brain deaths caused not only by primary lesions but also by secondary brain lesions and diagnosed as such on the basis of the 1974 criteria excluding the condition of "abrupt fall of blood pressure followed by persistent hypotension". The data derived from the 718 cases in this collaborative study were pooled and analyzed, and it became known that the 1974 criteria still are generally reliable. Some changes have been made, however, and new criteria for determination of brain death adopted.

Advisory Committees↗
PubMed1987

[Tolerance and plasticity against the intracranial pressure in cases of chronic subdural hematoma in the aged brain].

A consecutive series of 94 patients with chronic subdural hematomas (CSDHs) was studied on compensation against intracranial pressure and tolerance, and plasticity from compression of CSDHs, comparing between 47 cases of the aged group over 70 years of age and 47 cases of the younger group under 69 years of age. Better compensation from compression of CSDHs in the aged group was demonstrated from the fact those of long duration from impact to onset of symptoms, few cases with signs of chronic intracranial hypertension and volume of hematoma over 100 ml. But, when CSDHs progressed over 100 ml in size, this compensation mechanism and also tolerance against increased intracranial pressure were deprived. Disturbance of consciousness and anisocoria were shown much more in the aged group on admission. Patients in the aged group demonstrated reduced brain reexpansion and poor clinical recovery during 3 months after surgery. CT performed on 3 months after surgery demonstrated persisting subdural fluid in 63% of cases in the aged group comparing with 8% of those in the younger group. There was significant difference about morbidity between two groups. These study suggests that the plasticity and elastance in the aged brain reduce because of brain atrophy and impairment of cerebral blood flow, then brain reexpansion and clinical improvement may participate in delay regardless of release from compression of CSDHs. It may be urged that the critical age maintaining the plasticity of the brain in cases with SDHs in 75 years of age.

Adolescent↗
PubMed1985

[Cerebrospinal fluid absorption mechanism--based on measurement of CSF flow rate in shunt tube].

The cerebrospinal fluid (CSF) absorption mechanism in cases of hydrocephalus was investigated on the basis of measurements of CSF flow in a shunt tube after ventriculo-peritoneal shunt surgery, monitoring of intracranial pressure, CT findings, radioisotope cisternography, cerebral blood flow, EEG, PSP tests and changes in neurological findings. The subjects were 6 males and 7 females aged from 18 to 70. CSF flow rates in the shunt tubes were between 0.01 and 1.93 ml/min. Calculating the daily volume of CSF flow, the subjects were divided into two groups: Group A (8 patients) with a volume of less than 150 ml/day (0.01-0.25 ml/min), and Group B (5 patients) with between 150 and 500 ml/day (0.01-1.93 ml/min). Monitoring of intracranial pressure prior to the shunt operation was performed in 10 cases. These pressure values ranged between 4 and 25 mmHg (mean: 7-8 mmHg), and there was no difference between the two groups. The pre-and post-operative radioisotope cisternography findings indicated improvement of ventricular dilatation, periventricular lucency and ventricular reflux. After the shunt operations, there was neurological improvement in 6 of the 8 Group A cases but only in 2 of the 5 Group B cases. Considering the CSF flow volumes of the two groups, it appears that in Group A the shunt tube is not the main CSF circulation pathway. This could mean that resistance to CSF absorption in the cerebrospinal space has decreased after the shunt operation and there has been recovery of the physiological CSF absorption pathways. In other words, neurological improvement can be expected in this group A.

Adolescent↗
PubMed1984

[Brain death in a neurosurgical unit in Japan].

Walker states that the incidence of brain death accounts for approximately 1% of all deaths, so that brain death is a common state. According to Jennett et al, the occurrence of brain death is now a relatively frequent event, with about 4000 cases each year in Britain. But the actual circumstances of brain death can not be discovered from any published report. During the last 11 years (1973-1983) at Kyorin University Hospital, we studied 121 cases diagnosed as brain death according to Japanese criteria. The Japanese criteria requires that the pathology be a gross primary brain lesion, so did not concern ourselves with brain deaths due to secondary brain damage. We analysed the factors associated with brain death, that is the annual incidence, age, sex distribution, primary diagnosis and elapsed time from brain death to cardiac death. The increasing incidence of brain death in the last 5 years is probably due to a rise in severely brain-damaged patients (Table 1). In the age distribution, the high number of patients in their fifties presumably reflects the human age tendency for traumatic and vascular disorders respectively (Fig. 1 and Table 2). The fact that males predominate relates to the greater risk faced regarding cerebral trauma (Table 3). The primary diagnoses were cerebrovascular accidents in 60% of the cases especially subarachnoid hemorrhage in 41%, head injury in 31% and brain tumor in 9% (Tables 4 and 5). The elapsed time from brain deaths is measured from diagnosis of clinical brain death to cardiac asystole (Fig. 2). All patients had final cardiac asystole while still being ventilated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Osteoid oteoma associated with intraosseous meningioma. A case report].

A very rare case of intraosseous meningioma accompanied with osteoma is reported. A 57-year-old male was admitted with left chronic subdural hematoma and an operation was immediately performed. At the time of admission skull X-ray film showed a high density area in the right frontoparietal region. Postoperative CT scanning showed no abnormality at standard window, widths and levels or at higher window, widths and levels. 99m Tc MPP scinti gram showed increased activity in the right frontoparietal region. Tomography of the skull indicated hyperostosis involving all layers. This skull tumor was diagnosed as osteoma. At the second operation the osteoma was removed. There seemed to be no changes in the bone and underlying dura. Histological examination indicated multiple microscopic meningotheliomatous meningioma with psammoma bodies in Haversian canals, leading to the conclusion that this was osteoid osteoma. It is suggested that this case be designated as type Lopez II and that it raises some interesting points regarding histogenesis and development of meningioma.

Adult↗
PubMed1983

[Evaluation of brain death by computed tomography].

The absence of cerebral circulation and electrocerebral silence have served as an accurate index of irreversible brain death. It is proposed that computed tomography (CT) findings be evaluated as confirmatory criteria of brain death. To this end, CT evaluation of 14 patients satisfying the conventional criteria of brain death was performed. A.CT finding of severe compression or disappearance of the ventricular system, or so-called "brain tamponade", was seen in 7 (50%) of the 14 patients. Enhanced contrast CT, especially dynamic CT, usually distinctly reveals the cerebral vessels whenever the cerebral blood flow is preserved; conversely, the lack of enhanced brain structures, even comparing attenuation values, indicates the absence of cerebral blood flow. In 7 (70%) of 10 patients, however, there was enhanced contrast of vascular brain structures, especially the circle of Willis, major cerebral arteries, choroid plexuses, and venous sinuses. It is suggested that this result is due to the improvement of demonstrability by CT. The usefulness of CT in the confirmation of brain death lies in visualization of the pathological changes associated with a dead brain, such as "brain tamponade", and the lack of enhanced contrast indicating the absence of cerebral blood flow. The latter point is still problematic as angiography revealed an extremely low cerebral blood flow in a few cases of "dead brain" patients. It is recommended that cerebral blood flow in brain death be evaluated by dynamic CT scanning and correlated with other methods of cerebral blood flow determination (e.g., intravenous digital subtraction angiography).

Adult↗
PubMed1982

[A case of aortitis syndrome associated with hypertensive intracranial hemorrhage (author's transl)].

A case of aortitis syndrome associated with hypertensive intracranial hemorrhage is reported. A 38-year-old female was admitted in 1980 suffering from hypertension and blood pressure difference between the left and right arms which had existed for 10 years. Two weeks prior to admission, she noticed weakness and numbness of the right arm and leg. She was orientated and alert at the time of admission. Her right upper and lower extremities could not function with full strength against resistance. Also, right hemihypesthesia and hemiparesthesia were present. Left arm systolic blood pressure was 195 mmHg. Her pulse was palpable in both radial arteries. CT scans revealed a small high density area in the posterior crus of the internal capsule with a slight mass effect. There was no ventricular dilatation. She was given conservative treatment, such as with antihemorrhagic and antihypertensive drugs, and was discharged with good recovery after three months. Various studies were performed during her hospital stay. Based on angiographic findings, the most probable diagnosis was an extensive type of aortitis syndrome. Hypertension resulted from narrowing of the abdominal aorta and the right renal artery. Pulmonary scintiscanning using 99mTc-macroaggregated albumin revealed that her pulmonary arteries were also involved. Aortitis syndrome is not infrequent, but intracranial hemorrhage following after aortitis syndrome is rare. This may be because the carotid artery is involved in a high incidence of such cases, and therefore the intracranial blood flow is disturbed in most cases. Although the left common carotid artery was involved in the subject case, hypertensive intracranial hemorrhage occurred in the left posterior crus of the internal capsule. In a case of aortitis syndrome, therapy resulting in recirculation to the carotid artery involved is generally carried out in order to improve poor intracranial blood flow. However, it is suggested that control of blood pressure is necessary to prevent intracranial hemorrhage in aortitis syndrome.

Adult↗
PubMed1980

[Three cases of traumatic intracerebral hematoma with ventricular hemorrhage (author's transl)].

Three heavy drinkers, the patients fell down stairs while inebriated and were hit on their heads. Utilizing CT, we found that the hematomas in all three cases were accompanied by ventricular hemorrhage which, in two of the cases, were similar to hypertensive intracerebral hematoma in the basal ganglia. None of the three had a history of hypertension. We are of the opinion that the vulnerability of cerebral arteries, especially in the basal ganglia, of such heavy drinkers added to the traumatic force and led to the pathogenic bleeding. We were unable to find a correlation between the intracerebral hematoma and the site of the hit. It is assumed that immediate removal of the hematoma in cases of intracerebral hematoma with ventricular bleeding can result in the survival of the patient.

Adult↗