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H Hadeishi

Publications and source records attributed to H Hadeishi.

At least 19 recordsLinked to original sources
PubMed2002

Role of hypothermia in the management of severe cases of subarachnoid hemorrhage.

Mild hypothermia is thought to have a brain protective effect to pathophysiological conditions, which are caused by severe brain damage including brain injury and cerebral stroke. In this paper, general aspects of this treatment as history, pathophysiological effect, and problems are summarized. Also, the clinical effects of hypothermic therapy for a subarachnoid hemorrhage are reviewed. Main targets of the therapy for this disease are severe primary brain damage caused by the attack itself and secondary ischemic brain damage after delayed vasospasm. But even now, there are no fully established data about the effect of hypothermia at such conditions after subarachnoid hemorrhage. The results of our study of cerebral blood flow and cerebral oxygen metabolism using positron emission tomography are presented to show the physiological effect of hypothermia on human brain after severe brain damage caused by subarachnoid hemorrhage. In conclusion, effect of hypothermia on subarachnoid hemorrhage is not confirmed yet and reported data is limited, so that additional studies, especially controlled studies, would be recommended.

Adult↗
PubMed2000

Cerebral blood flow and oxygen metabolism during mild hypothermia in patients with subarachnoid haemorrhage.

Cerebral blood flow and O2 metabolism during hypothermia (33-34 degrees C) was evaluated in 5 patients with aneurysmal subarachnoid haemorrhage by positron emission tomography (PET). Their preoperative clinical condition was WFNS scale IV or V. The patients received surface cooling postoperatively, and were maintained in a hypothermic state during transfer for radiological examination. Positron emission tomography revealed a decrease in cerebral blood flow and O2 metabolic rate. Cerebral blood flow was 34.8+/-15.1 ml/100 ml/min and the O2 metabolic rate was 1.85+/-0.61 ml/100 ml/min in areas of the middle cerebral artery ipsilateral to the ruptured aneurysms, whereas these values were 30.8+/-7.1 and 2.21+/-0.45 ml/100 ml/min, respectively, on the contralateral side. This represents a decrease of 37+/-27% compared to normal cerebral blood flow and 52+/-16% compared to normal O2 metabolic rate (p < 0.02) in the ipsilateral areas, and decreases of 44+/-13% and 43+/-12%, respectively, on the contralateral side. The present results reflected the luxury perfusion state in almost all cases and provide the first PET evidence of decreased cerebral blood flow and metabolic rate of O2 during hypothermia in humans.

Adult↗
PubMed1999

Postoperative anticonvulsant prophylaxis for patients treated for cerebral aneurysms.

The incidences of postoperative seizures and side effects were evaluated in 193 patients with cerebral aneurysm who received anticonvulsant prophylaxis and underwent 224 craniotomies for cerebral aneurysms between 1993 and 1995. The patients were 73 males and 120 females aged between 31 and 80 years. One hundred and sixteen patients had ruptured cerebral aneurysms and 108 had unruptured aneurysms. Phenytoin followed by valproic acid were administered. Early postoperative seizures occurred in five patients (4 with ruptured and 1 with unruptured aneurysms) within 14 days after surgery. Late postoperative seizures occurred in four different patients with ruptured aneurysms more than 14 days after surgery. The presence of cortical lesions detected by cerebral computed tomography and occurrence of symptomatic vasospasm were correlated with the occurrence of early postoperative seizure (p < 0.05). Three of the four patients with late postoperative seizure had cortical lesions and two were receiving continued medication. Side effects that warranted discontinuation of therapy were seen in the follow-up period in 12.9% of patients. Anticonvulsant prophylaxis is not recommended due to the higher incidence of side effects than seizure, except in patients in poor clinical condition for the purpose of brain protection. Otherwise, anticonvulsant medication should be initiated at the time of the initial seizure attack.

Adult↗
PubMed1999

How should a subarachnoid hemorrhage grading scale be determined? A combinatorial approach based solely on the Glasgow Coma Scale.

OBJECT: The purpose of this study was to present a combinatorial approach used to develop a subarachnoid hemorrhage (SAH) grading scale based on the patient's preoperative Glasgow Coma Scale (GCS) score. METHODS: There are 4094 different combinations that can be used to compress the 13 scores of the GCS into two to 12 grades. Break points, the positions in the scale in which two adjacent scores connote a significantly different outcome, are obtained by a direct comparison of the GCS and the Glasgow Outcome Scale (GOS). Guided by the break points, the number of combinations to be considered can be limited. All possible combinations are statistically analyzed with respect to intergrade differences in outcome. Single combinations, with the maximum number of grades having maximum intergrade outcome differences for each corresponding set of adjacent grades, must be selected. The authors verified the validity of this combinatorial approach by retrospectively analyzing 1398 consecutive patients with aneurysmal SAH who underwent surgery within 7 days of the last hemorrhage episode. The patients' GCS scores were assessed just before surgery and their GOS scores were estimated 6 months post-SAH. The combinatorial approach yields only one acceptable grading scale: I (GCS Score 15); II (GCS Scores 11-14); III (GCS Scores 8-10); IV (GCS Scores 4-7); and V (GCS Score 3). CONCLUSIONS: The combinatorial approach, guided by the break points, is so simple and systematic that it can be used again in the future when revision of the grading scale becomes necessary after development of new and effective treatment modalities that improve patients' overall outcome.

Age Factors↗
PubMed1998

Arterial occlusive lesions following wrapping and coating of unruptured aneurysms.

Seven patients (mean age 57 years) developed arterial occlusive lesions following both wrapping and coating during surgery for unruptured aneurysms. Five patients had no risk factors for arteriosclerosis, and two had hypertension or diabetes mellitus. The aneurysms were located in the middle cerebral artery in four cases, and the internal carotid artery in three. Both 100%-cellulose cotton (Bemsheet) and cyanoacrylate glue (Biobond) were used as reinforcement materials. Postoperative angiography revealed complete clipping, and no parent artery stenoses, although one patient had a non-symptomatic diffuse narrowing in the entire carotid fork 7 days following surgery. Three patients had progressive stroke 4-5 weeks following surgery, and two had no symptoms. Both reinforcement materials were used as little as necessary in the last two patients, but they had either transient ischemic attacks or progressive stroke 2 months following surgery. Arterial steno-occlusion was confirmed angiographically in all patients. These vascular lesions were probably induced by both direct toxicity of the cyanoacrylate glue and fibrosis or granuloma formation caused by the cotton fibers. The observed angiographical reversibility suggests that the cyanoacrylate glue is more likely to be the cause of the lesions than the cotton fibers.

Aged↗
PubMed1998

[Japan Coma Scale as a grading scale of subarachnoid hemorrhage: a way to determine the scale].

BACKGROUND: The grading scale for subarachnoid hemorrhage (SAH) with inter-grade outcome differences is essential for evaluating the effectiveness of newly developed therapeutic modalities. Although Hunt's grade and WFNS scale have been widely used, these grading scales do not meet this requirement. We previously proposed a revised WFNS scale based solely on the Glasgow Coma Scale (GCS) that has intergrade outcome differences of high-level significance. The Japan Coma Scale (JCS) has been long and widely used in Japan. The purpose of this study is to show whether it is possible to determine a reasonable SAH grading scale based on the JCS and to show a way to determine an SAH grading scale. PATIENTS AND METHODS: We retrospectively analyzed 1398 consecutive cases of aneurysmal SAH operated on within Day 7 of the latest onset. The preoperative JCS and GCS were evaluated just before the surgery and the Glasgow Outcome Scale (GOS), analyzed with numerical transformation (1 = dead to 5 = good recovery), was estimated at 6 months after the onset. All 510 possible combinations of scores of JCS were statistically tested under the following 2 assumptions; (1) JCS = 0 and JCS = 100 fall into a single independent grade. (2) No other single JCS score should fall into a single grade. RESULTS: The outcome differences between JCS 0 and 1, and 100 and 200 are significant. The outcome difference between JCS 30 and 100 is relatively higher than any other set of 2 scores of JCS. Only 5 combinations are practical among the candidates to be analyzed. Out of 510 combinations, the following combination shows the highest inter-grade outcome differences; I (JCS = 0, n = 375, mean GOS = 4.78) II (JCS = 1, 2; n = 310; mean GOS = 4.47) III (JCS = 3-30; n = 476; mean GOS = 3.96) IV (JCS = 100; n = 96; mean GOS = 3.10) V (JCS = 200, 300; n = 141; mean GOS = 2.33). In JCS, the mean outcome of JCS = 3 is worse than those of JCS = 10, 20, and 30. The outcome difference between JCS 0 and 1 is only significant in patients over 60 years old. CONCLUSION: Taking all the 510 possible combinations of JCS into consideration, we obtained a reasonable combination containing 5 grades. Although this grading scale showed good inter-grade outcome differences, JCS is not preferable to GCS as a consciousness evaluation system in the acute phase of SAH. We emphasize the importance of this way to determine a grading scale with a combinatorial approach, which can be applicable for re-evaluating the grading scales in the future.

Age Factors↗
PubMed1997

Subacute and chronic subarachnoid hemorrhage: diagnosis with fluid-attenuated inversion-recovery MR imaging.

PURPOSE: To evaluate fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) imaging in the detection of subacute and chronic subarachnoid hemorrhage. MATERIALS AND METHODS: The authors performed 19 FLAIR MR imaging examinations at 0.5 T in 14 adult patients with subarachnoid hemorrhage 3-45 days after the ictus and 22 FLAIR examinations in 22 adult control subjects. The detection of subacute and chronic subarachnoid hemorrhage on FLAIR images was compared with the detection on conventional spin-echo MR and computed tomographic (CT) images. RESULTS: In the detection of subacute subarachnoid hemorrhage, FLAIR (100% detection) was significantly superior to T1-weighted imaging (36% detection, P < .01), T2-weighted imaging (0% detection, P < .02), and CT (45% detection, P < .02 [Fisher exact test]). Although FLAIR imaging (63% detection) was superior in chronic subarachnoid hemorrhage detection, there were no statistically significant differences between modalities. FLAIR imaging demonstrated all subarachnoid hemorrhage areas as high-signal-intensity areas within 18 days and up to a maximum of 45 days after the ictus. In a blind comparison, no FLAIR images acquired in control subjects were confused with those acquired in patients. CONCLUSION: FLAIR diagnostic images are superior to conventional MR or CT images in patients with subacute subarachnoid hemorrhage.

Acute Disease↗
PubMed1997

Penetrating head injury caused by chopstick--case report.

A 4-year-old boy suffered a transorbital penetrating head injury caused by falling on a wooden chopstick while walking. The chopstick was removed completely, but full diagnosis was delayed for 3 years because the entry wound had not appeared to be serious. The patient later experienced rhinorrhea of cerebrospinal fluid (CSF), and recurrent bacterial meningitis. Surgical repair of the CSF fistula at the anterior skull base was performed when the patient was 7 years old. Previous penetrating head injury should be considered in patients with recurrent CSF fistula and meningitis.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1996

Glasgow Coma Scale in the prediction of outcome after early aneurysm surgery.

OBJECTIVE: A prospective study was performed to analyze whether the Glasgow Coma Scale (GCS) was useful in predicting the outcome after early surgical intervention for aneurysmal subarachnoid hemorrhage (SAH). METHODS: In a consecutive series of 765 patients who underwent surgery for aneurysms within 7 days after SAH, the level of consciousness was assessed by the GCS just before surgery and the outcome was graded by the Glasgow Outcome Scale 6 months after surgery. RESULTS: The patient distribution in accordance with the GCS sum scores in descending order from 15 to 3 was as follows: 334, 140, 58, 27, 20, 26, 27, 19, 26, 17, 20, 27, and 24 patients, respectively. In general, the higher the preoperative GCS score was, the better the surgical outcome was. The overall surgical result was significantly correlated with the preoperative GCS score (rs = 0.615, P < 0.001). With respect to the levels that distinguish the outcome along the GCS axis, a significant difference in the outcome was observed only between the GCS scores of 15 and 14 (P < 0.001, Wilcoxon test). CONCLUSION: The GCS proved useful in the preoperative evaluation of patients with SAH, in terms of outcome prediction. It is suggested that the SAH scale proposed by the World Federation of Neurosurgical Societies be reexamined, because differences in outcomes were not clear between the GCS scores of 13 and 12 or between those of 7 and 6, in which Grades III and IV and Grades IV and V are differentiated in the scale, respectively.

Adult↗
PubMed1996

Extracranial-intracranial high-flow bypass using the radial artery between the vertebral and middle cerebral arteries. Technical note.

Carotid ligation and vascular reconstruction following radical neck dissection were required in a patient with carotid artery rupture associated with an infected salivary fistula. An extracranial-intracranial high-flow bypass was performed using a radial arterial graft between the V3 segment of the vertebral artery and the M2 segment of the middle cerebral artery. Postoperative angiograms confirmed sufficient blood flow through the bypass graft into the ipsilateral internal carotid arterial system. No clinical signs of ischemia were observed postoperatively. This V3-M2 bypass procedure appears to be an effective means of controlling catastrophic bleeding from a ruptured carotid artery, thus allowing the wound to heal completely.

Carcinoma, Squamous Cell↗
PubMed1995

Cerebral blood flow and oxygen metabolism in hemiparetic patients with chronic subdural hematoma. Quantitative evaluation using positron emission tomography.

BACKGROUND: It remains unclear why chronic subdural hematoma (CSH) can cause hemiparesis, although the contribution of impaired cerebral blood flow and metabolism has been suggested. METHODS: We studied six hemiparetic patients (five men, one woman; mean age 60.5 +/- 7.5 years) with unilateral CSH using positron emission tomography. The 15O2 steady state technique was used to measure regional cerebral blood flow (rCBF), regional oxygen extraction fraction (rOEF), and regional cerebral metabolic rate of oxygen (rCMRO2), followed by the 1-minute inhalation of C15O to measure regional cerebral blood volume (rCBV). RESULTS: On the hematoma side, rCBF and rCMRO2 were significantly reduced in the caudate nucleus and the cingulate gyrus. We observed a tendency toward reduced levels of rCBF and rCMRO2 in the lentiform nucleus. rCBV was not elevated. rOEF was significantly elevated in the lentiform nucleus, the cingulate gyrus, the frontal gray matters under the hematoma and the semioval center. On the nonhematoma side, rCBF and rCMRO2 were normal except for the significant reduction in the cingulate gyrus. rCBV was elevated in the lentiform nucleus, the middle temporal gyrus and the inferior frontal gyrus. rOEF was elevated significantly in the cingulate gyrus, the precentral gyrus and the semioval center. CONCLUSIONS: Our hemiparetic patients with CSH were observed to have a circulatory disturbance of blood; it was manifested by an elevation of rOEF, specifically in the hemisphere adjacent to the hematoma. This circulatory disturbance was highly pronounced and resulted in a consistent reduction in rCBF and rCMRO2 in the anterior central cerebral area such as the caudate nucleus, the lentiform nucleus and the cingulate gyrus.

Aged↗
PubMed1995

Mastoid canal and migrated bone wax in the sigmoid sinus: technical report.

A study of the migration of bone wax into the sigmoid sinus through the mastoid canal is reported here. In 7 of 161 patients who underwent retromastoid craniectomy, the postoperative soft tissue window image computed tomographic scans demonstrated a hypodense mass in the ipsilateral sigmoid sinus. The density value of the hypodense mass ranged from -34 to -79 Hounsfield units, which was neither as low as that of air nor as high as that of cerebrospinal fluid, but was comparable to that of fat tissue or bone wax. The continued presence of all of these masses in the sigmoid sinus was confirmed 1 month to 2 years after surgery. These computed tomographic findings suggested that this abnormal hypodense mass might be a migrated fragment of the bone wax that had been used for the control of venous bleeding from the mastoid emissary vein, because each of the seven affected patients had a large mastoid foramen and a large quantity of bone wax had been needed to control the bleeding during retromastoid craniectomy. No other material with the potential to migrate into the sigmoid sinus had been applied as a packing material. In two of the seven patients, venous magnetic resonance angiography after surgery demonstrated that the ipsilateral sigmoid sinus was not patent and the computed tomographic scans also revealed that the hypodense masses occupied the sigmoid sinus. It is concluded that the intrasurgical application of a large quantity of bone wax to control the bleeding from the large emissary veins carries a risk of the migration of bone wax into the sigmoid sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Japan coma scale in the prediction of outcome after early surgery for aneurysmal subarachnoid hemorrhage].

The value of the 10-grade Japan Coma Scale (JCS) as a means of evaluating patients undergoing early aneurysm surgery was assessed in terms of its relationship to surgical outcome. The 13-grade Glasgow Coma Scale (GCS) was also assessed, and comparisons were made between the two. A series of 765 patients who underwent aneurysm surgery within 7 days after hemorrhage were evaluated both by JCS and GCS immediately prior to surgery, and outcome was assessed by the Glasgow Outcome Scale (GOS) 6 months postoperatively. Both the JCS and GCS scores were significantly correlated with surgical outcome (JCS vs GOS: rs = 0.586, GCS vs GOS: rs = 0.615, p < 0.001). There was no significant difference between the correlation coefficients for outcome of the JCS and GCS. In general, the better the JCS or GCS score was, the better the surgical outcome was, however, outcome among those with a JCS score of 3 was poorer than among those with a score of 10, 20, or 30. The results of this study indicate that both JCS and GCS are useful in predicting surgical outcome, but the GCS may be better than the JCS because of the problem with the score of 3 in the latter.

Acute Disease↗
PubMed1994

Serial transcranial Doppler flow velocity and cerebral blood flow measurements for evaluation of cerebral vasospasm after subarachnoid hemorrhage.

Serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in 73 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm to evaluate cerebral vasospasm. Twenty-six (35.6%) of the 73 patients developed ischemic neurological symptoms associated with cerebral vasospasm, which were reversible in all except four patients (5.5%) who demonstrated low-density areas associated with vasospasm on computed tomographic scans. In general, the flow velocities in the middle cerebral arteries began to increase soon after onset of SAH, reaching the maximum between days 8 and 10, subsequently decreasing gradually. There was no significant difference in the highest value and the time course of flow velocities between symptomatic vasospasm and asymptomatic vasospasm patients. Patients with symptomatic vasospasm demonstrated two typical time courses of flow velocities: rapid increases in flow velocities that preceded the clinical manifestations of vasospasm (16 patients, 61.5%), and no rapid increases in flow velocities despite the presence of ischemic symptoms (10 patients, 38.5%). In the latter, angiograms demonstrated vasospasm in segments distal to those evaluated by TCD examination. These results showed that the degree of cerebral vasospasm cannot be assessed only by the absolute flow velocities. CBF was measured two to 10 (mean 4.7) times within 3 weeks of SAH using the 133Xe intravenous injection method. The CBF value remained stable even during the period of major risk of vasospasm. However, the CBF was significantly lower in patients with symptomatic vasospasm on days 8, 9, 10, 13, 14, and 15, when compared with patients without symptomatic vasospasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Local application of calcium antagonists inhibits intimal hyperplasia after arterial injury.

The local effect of the calcium channel antagonist diltiazem and the protein kinase inhibitor 1-5-(isoquinoline sulfonyl)-5-homopiperazine HCL (HA1077) on neointimal formation after arterial injury were investigated by the use of a perivascular drug-delivery system. Bilateral carotid artery balloon injury was produced in 130 rats. In six groups of 10 rats each, diltiazem or HA1077 at three doses (low, 0.2 mg; medium, 1 mg; high, 5 mg) was mixed with the drug-delivery polymer poly(vinyl) alcohol and applied to the adventitial surface of the injured right carotid artery enclosed by a Silastic cuff; 10 control animals received polyvinyl alcohol only in the silastic cuff. In all animals, the contralateral injured artery without the cuff served as a control. At 10 and 20 days after the injury, the intimal cross-sectional area was determined from light microscopic sections for the injured segment of both carotid arteries. In six additional groups of 10 rats each, treated as above, levels of diltiazem and HA1077 in plasma were measured at periods from 1 hour to 5 days after perivascular application. At 10 days after endothelial injury, animals receiving high-dose diltiazem or HA 1077 (5 mg) demonstrated significant reductions in neointimal area compared with polyvinyl alcohol controls for both treated and contralateral untreated vessels. At 20 days after injury, neointimal hyperplasia was inhibited only on the treated side in both high-dose groups. Perivascular diltiazem and HA1077 at lower doses (1 or 0.2 mg) did not affect neointimal area at 10 or 20 days in either treated or untreated arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1993

Unruptured aneurysms associated with ischaemic cerebrovascular diseases. Surgical indication.

Out of 3435 patients with ischaemic cerebrovascular disease 2540 cases were investigated using cerebral angiography. In 127 of them (5%) aneurysms were found, but without clinical evidence of subarachnoid haemorrhage (SAH). 45 cases were operated upon and 82 were treated conservatively. Five of these 82 cases (6%) suffered from SAH 3 months to 10 years (mean interval 5.6 years) after the angiographic diagnosis. Four of these 5 patients with SAH died. Among the 45 surgical cases follow-up was uneventful in 29 (64%). The other 16 cases postoperatively showed neurological deterioration (36%), which was transient in 6 but with only minor improvement in 10. Of these 10 cases 2 died from cerebral infarction related to intra-operative temporary vascular occlusion respectively myocardial infarction. Thus surgical mortality was 4% and permanent morbidity 18%. Causes of postoperative neurological deterioration were partly related to general arteriosclerotic changes and special fragility of the ischaemic brain, and partly to operative technique (excessive brain retraction, damage to cortical veins, occlusion of major vessels or damage to perforators, temporary artery occlusion). Apparently in cases with ischaemic cerebrovascular diseases operative procedures, which in other cases as a rule are well tolerated, may produce harmful effects. Therefore, in these cases, the indication for operative treatment of so far silent aneurysms should be restricted to patients who are in good general condition with longer life expectancy as far as the vascular disease is concerned, and without major neurological deficit. Furthermore, the operative technique should be especially gentle and atraumatic.

Adult↗