[Surgical treatment of occlusive cerebrovascular diseases (author's transl)].
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Biomedical subjects
Publications and source records attributed to H Handa.
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Two cases of venous angioma of the brain are presented. Both were discovered by computed tomography and diagnosed by angiography. The lesion was located in the right frontal lobe in 1 case and in the left cerebellar hemisphere in the other. Neither was operated on because of the deep location or extent of the lesion. The 2 cases showed significant angiographic and hemodynamic differences. The literature on venous angiomas of the brain is reviewed. We proposed classifying venous angiomas into two subgroups based on angiographic findings: those with early-appearing vessels and those without. No significant differences in clinical manifestations were noted between these two subgroups in spite of the hemodynamic differences.
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Recently we have reported a catheter having a balloon which can be released simply by twisting the catheter. In the technique, 2-hydroxyethylmethacrylate (HEMA) has been used as a solidifying liquid to prevent the released balloon from deflating. Since HEMA is not radiopaque, the place and the size of the balloon cannot be visualized under an X-ray image intensifier. The present investigation involves the preparation of a radiopaque, solidifying liquid, by mixing HEMA with a suitable contrast medium such as metrizamide, sodium iothalamate or meglumine sodium iodamide. The use of HEMA-contrast medium mixtures made injection of the solidifying liquids much more controllable.
All the rats were made hypertensive and fed beta-aminopropionitrile. Among them, cerebral aneurysms were never found in rats without carotid ligation. In rats with ligation of one or both common carotid arteries, cerebral aneurysms developed on the vessels where hemodynamic stresses were apparently increased. The relationship of hemodynamics in the circle of Willis to the development of cerebral aneurysms is discussed, being compared with findings in spontaneous lesions in man.
The pre-, intra-, and postoperative hemodynamics were examined by a newly developed ultrasonic Doppler flowmeter in 20 patients undergoing 24 STA-MCA anastomoses. During the operations, no reverse flow was detected in the cortical branch of the middle cerebral artery. After anastomosis, prominent flow changes in direction and in volume were evident in the cortical branches and the flow pattern of the STA changed from an external carotid type preoperatively to an internal carotid type in well functioning bypasses. The results of postoperative studies were not always in good agreement with those of intraoperative studies and bypass function was relatively not good and labile in patients with only stenotic lesions and in those with "moyamoya disease".
A new releasable balloon catheter was developed which has a soluble joint connecting the balloon and the catheter. The joint is made from a polyvinyl alcohol tube and has two electrodes. When a high frequency electrical current is activated, the resulting heat causes the joint to disappear within one second. The type of generator used in the experiment was an Aesculap GK-34. This catheter was used for embolization of carotid-jugular fistulas in dogs.
A 14-year-old boy with a malignant astrocytoma in the third ventricle, who showed reversible delayed radiation effects on the brain, is presented. One and a half months after the completion of a course of radiation therapy, the patient gradually became drowsy complaining of headaches, general malaise and disturbance of gait. The symptoms and abnormalities in the CT scans were the most severe seven months after irradiation and then spontaneously subsided. CT scan could not differentiate it from a recurrence of the tumor when first seen, but was extremely useful in following these findings.
Clinical analyses of 5 cases of cavernomas in the middle fossa were made to define specific clinical and radiological manifestations and thus improve the pre-operative diagnosis and treatment. From diagnostic and operative points of view, cavernomas in the middle fossa must be considered separately from those in other localities. Intracerebral cavernomas are often encountered as the cause of epilepsy. The tumors are demonstrated as calcified avascular masses and can usually be removed easily. Cavernomas in the middle fossa are extraaxial masses and are often misdiagnosed as meningiomas. They are difficult to remove because of massive hemorrhage.
Three hundred thirty-six cases of meningioma were analyzed retrospectively with regard to the recurrence rate and the effect of radiotherapy on recurrent meningiomas. There was recurrence in 14 out of 173 cases (8.1%) after apparently complete removal and in 26 out of 90 cases (28.9%) after obviously incomplete removal. Radiotherapy was given in 7 cases after repeat complete removal of recurrent tumors. It was concluded that irradiation in recurrent menigiomas is of little value, although it might be beneficial occasionally. One of the most important limiting factors in application of radiation therapy to recurrent meningiomas appears to be vulnerability to radiation of the surroundng brain, which has been damaged already.
We experienced 19 histologically verified intracranial malignant lymphomas during the period of 15 years from April 1, 1965 to August 31, 1979. From the analysis of cases of our own and from the literature, the following are considered to be the clinical characteristics of intracranial malignant lymphomas. 1) Males were more affected than females. 2) The highest frequency was observed in the 5th to 7th decades. 3) Increased intracranial pressure, motor disturbance, and psychic or consciouness disturbance were 3 cardinal symptoms. 4) Tumors were localized frequently in the paraventricular region. 5) Angiography revealed hypovascular lesion in many cases, while CT scan showed homogenous, slightly high density lesion which was remarkably enhanced by contrast material. 6) Long survival was rare irrespective of all kinds of treatments. 7) Immunological classification was thought to be useful in prospecting survival time.
Mechanical properties of human intracranial vertebral arteries subjected to subarachnoid hemorrhage were studied. Their pressure-diameter curves are biphasic and have sharp flexion, called flexion points, at a pressure of 181.3 +/- 9.6 mm. Hg when their smooth muscle is activated by KCl 50 mM. The strong vasoconstriction, accompanied by little change in the vascular diameter, is retained up to the pressure level at the flexion point, above which the constriction is released abruptly. The existence of flexion points at a high pressure level is an important mechanical feature in considering the development and treatment of cerebral ischemia produced by vasospasm.
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A complex which is active in in vitro synthesis of adeno-associated virus (AAV) DNA was solubilized from Vero cells that were co-infected with AAV and either adenovirus (Ad5) or a herpes simplex virus type 1 (HSV-1) as the helper virus. The complexes from the Ad5 and HSV-1-infected cells sedimented at 23 S and 28 S, respectively. The optimal conditions for in vitro DNA synthesis for the two types of complex using the endogenous AAV template and the endogenous DNA polymerase, differed with respect to the effect of KCl and K2SO4 concentration. In addition the complex from HSV-1-infected cells, but not that from Ad5-infected cells, was inhibited by phosphonoacetic acid. Thus, the two complexes appear to contain different DNA polymerase activities. This was verified by phosphocellulose chromatography of the DNA polymerases solubilized from the isolated complexes. The major activity in the complex from HSV-1 infected cells was the HSV-induced DNA polymerase with lesser amounts of cellular DNA polymerase alpha and gamma or both. The complex from the Ad5-infected cells contained mainly a cellular DNA polymerase gamma.
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An intracranial dermoid cyst presenting as a radiolucent mass on the plain radiographs of the skull is described.
The plain skull roentgenography, angiography, air encephalography or positive contrast medium ventriculography and computed tomography (CT) of twelve cases of suprasella germinoma were reviewed. In over half of the cases, plain skull roentgenography and angiography showed some abnormalities suggesting a suprasella mass. CT was found to be the most appropriate for routine examination. And air encephalography or positive contrast medium ventriculography offered decisive information.