Search PubMed⌕ Search

Biomedical subjects

H Kishi

Publications and source records attributed to H Kishi.

At least 91 records · Page 5Linked to original sources
PubMed1998

[Management of elderly patients with incidentally discovered unruptured aneurysms].

Long-term natural history of unruptured cerebral aneurysms is not found frequently. Hence, the indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk involved in surgery. Clinical features of fourteen elderly patients aged over 70 years with incidentally discovered unruptured aneurysms were analyzed. Two were male and 12 were female, with ages ranging from 70 to 82 years (mean: 74.5 years). Aneurysms were located in the anterior circulation in 13 patients and in the posterior circulation in 1 patient. One patient had multiple aneurysms, that is, bilateral middle cerebral aneurysms. The size of all these aneurysms was less than 10 mm. The indication for surgery was determined case by case. General information about the natural history of incidentally discovered aneurysms was given to the patients and their relatives. Informed consent was based on the fact that subarachnoid hemorrhage was associated with a poor prognosis, while excellent operative results were common in patients with unruptured aneurysms. Five patients agreed to surgical treatment. Four of them, their ages being 70, 70, 72 and 72 years old, with aneurysms located on the middle cerebral arteries, underwent neck clipping of their aneurysms with no operative morbidity or mortality. However, the remaining one patient was not recommended for surgery in spite of her consent to having it, because of her high age (82 years) and the location of her aneurysm (intracavernous internal carotid artery). Consequently, 10 patients who didn't receive surgery were followed-up at periods ranging from 3 months to 7 years. Two patients developed rupture of the aneurysms, either proven (one patient) or presumed (one patient). The former patient made an uneventful recovery after surgery, but the latter died. None of the remaining eight patients have experienced rupture of the aneurysms. It is our clinical impression, however, that they harbor an unruptured aneurysm with at least mild trepidation. With the rapid aging of the population, withholding aneurysm surgery merely because a patient is elderly may not necessarily be the most appropriate decision. Our conclusions are as follows: (1) Elderly patients in their early seventies are apt to agree to having surgical treatment for their unruptured aneurysms. (2) The cases reported herein show that asymptomatic middle cerebral artery aneurysms were able to be clipped very safely. (3) Most patients have experienced a decrease in quality of life from knowing they are living with an unruptured aneurysm.

Age Factors↗
PubMed1998

[Application of ultrafast 3D-CT in cervical spine injury].

The authors investigated the usefulness of the ultrafast three-dimensional computed tomography (UF-3D-CT) in cervical spine injury. At Osaka City General Hospital, between April 1995 and March 1998, the authors examined 38 patients with cervical spine injury using UF-3D-CT. The ultrafast CT reduces scanning time. There were no complications associated with the examination. We examined 12 patients with vertebral body fracture, 11 patients with lamina fracture, 8 cases with subluxation including locking facet, 2 patients with atlanto-axial dislocation and 8 patients without bony abnormality. Results suggested that UF-3D-CT was very useful for helping us to understand the bony deformity and the relationship between the bone and the important vessels. UF-3D-CT is very useful for preoperative evaluation and pathophysiological evaluation in cervical spin injury.

Adolescent↗
PubMed1998

[Development of a high-resolution pinhole SPECT system using dual-head gamma camera for small animal studies].

We developed a high-resolution pinhole SPECT system using dual-head gamma camera (PRISM-2000XP) for small animal, and evaluated the performance of this system. Two pinhole-inserts (Pb) were mounted on the same unit, and it was not attached to the detector but the gantry of gamma camera. We designed two kinds of pinhole collimators with different rotating radii, 40 mm (Type-I) and 50 mm (Type-II). The diameter of the pinhole is 1 mm for both types. The field of view (FOV) and magnification were 45.8 mm phi and 4.25 for Type-I, 57.4 mm phi and 3.40 for Type-II, respectively. We measured full width at half maximum (FWHM) of line spread function using a 99mTc line source. Measured FWHM values were 1.65 mm using Type-I and 1.91 mm using Type-II at the center of FOV in the center slice. The volume sensitivity of this system was 8.54 kcps/MBq/ml (Type-I) and 5.68 kcps/MBq/ml (Type-II). We could observed 1.2 mm phi cold spot in the resolution phantom using Type-I. In conclusion, this system is available for SPECT measurement of small animal studies.

Animals↗
PubMed1997

The structure and function of the actin-binding domain of myosin light chain kinase of smooth muscle.

In addition to its kinase activity, the myosin light chain kinase (MLCK) of smooth muscle has an actin binding activity through which it can regulate the actin-myosin interaction of smooth muscle (Kohama, K., Okagaki, T., Hayakawa, K., Lin, Y., Ishikawa, R., Shimmen, T., and Inoue, A. (1992) Biochem. Biophys. Res. Commun. 184, 1204-1211). In this study, we have analyzed the actin binding activity of MLCK and related it to its amino acid sequence by producing native and recombinant fragments of MLCK. Parent MLCK exhibited both calcium ion (Ca2+) and calmodulin (Ca2+/CaM)-sensitive and Ca2+/CaM-insensitive binding to actin filaments. The native fragment, which consists of the Met1-Lys114 sequence (Kanoh, S., Ito, M., Niwa, E., Kawano, Y., and Hartshorne, D. J. (1993) Biochemistry 32, 8902-8907), and the recombinant NN fragment, which contains this 1-114 sequence, showed only Ca2+/CaM-sensitive binding. An inhibitory effect of the NN fragment on the actin-myosin interaction was observed by assaying in vitro motility and by measuring the actin-activated ATPase activity of myosin. The recombinant NN/41 fragment, which is constructed without the Met1-Pro41 sequence of the NN fragment, lost both the actin binding activity and the inhibitory effect. We confirmed the importance of the 1-41 sequence by using a few synthetic peptides to compete against the NN fragment in binding to actin filaments. The experiments using recombinant fragments and synthetic peptides also revealed that the site for CaM-binding is the Pro26-Pro41 sequence. The site for the Ca2+/CaM-insensitive binding, which is shown to be localized between the Ca2+/CaM-sensitive site and the central kinase domain of MLCK, exerted no regulatory effects on the actin-myosin interaction.

Actins↗
PubMed1997

Follicle-stimulating hormone regulation on its receptor messenger ribonucleic acid levels in cultured rat granulosa cells.

Our studies using immature rat granulosa cells cultured in serum-free medium on collagen-coated dishes indicated that FSH receptor mRNA levels do not change for at least 4 days of culture in the absence of hormone treatment. Addition of FSH (30 ng ml[-1]) led to a reduction of FSH receptor mRNA for a short time (6 h), followed by an increase in FSH receptor mRNA levels that reached maximum of around 200% of the initial level within 2-3 days after the addition of FSH. Following the addition of 10 nM PMA, FSH receptor mRNA levels were decreased to 50% of the pretreatment levels. During prolonged exposure to PMA, gradual recovery of the FSH receptor mRNA level was observed, and it was significantly higher than the control level at 48 h. The inactive phorbol ester 4 alpha-phorbol-12,13-didecanoate did not depress FSH receptor mRNA levels. Downregulation of the FSH receptor mRNA was detectable at a PMA concentration of 1 nM. The two predominant FSH receptor mRNA transcripts, ca. 5.5 and 2.4 kb, respectively, appeared to be equally affected by SH and PMA treatments. To examine the role of PKC mediation of the effect of FSH on FSH receptor mRNA levels, granulosa cells were treated with the PKC inhibitor, H-7, and FSH. Although, FSH receptor mRNA levels decreased to 50% of control in the cells treated with FSH alone, the addition of H-7 (0.1 nM) caused no decline in FSH receptor mRNA levels relative to the control in the cells treated with FSH. On the other hand, inhibition of FSH receptor mRNA by FSH was partially suppressed by the PKC-selective inhibitor bisindolylmaleimide. The mRNA turnover experiments showed that the half-life of FSH receptor transcripts was unaffected by PMA exposure.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1997

Down-regulation of LH/hCG receptor in rat cultured granulosa cells.

Initial experiments established the experimental conditions necessary for the induction of LH receptor mRNA down-regulation in granulosa cells isolated from diethylstilbestrol (DES)-primed immature rats. LH/hCG receptor mRNA was first induced in granulosa cells by incubating them for 24 h with FSH. Exposure of granulosa cells to a second dose of gonadotropin caused a decrease in LH/hCG receptor mRNA and binding levels after 4 h. This effect was transient, by 12 h the mRNA levels had returned to control levels, and by 24 h the mRNA levels were higher than the control. To evaluate the ability of cAMP to down-regulate the receptor, cells were exposed to 8-Br-cAMP. The pattern of sustained decrease in LH/hCG receptor mRNA levels seen with 8-Br-cAMP was similar to that with gonadotropins. The presence of activin with FSH or hCG is more effective than FSH or hCG alone in inducing LH/hCG receptor down-regulation in rat granulosa cells. The LH/hCG receptor mRNA levels decreased in a dose-dependent manner in the presence of increasing concentrations (30-100 ng/ml) of activin with FSH. These observations indicate that an increase in cAMP causes down-regulation of LH/hCG receptor mRNA and contributes to the effect of FSH and hCG, whereas basal cAMP activity is required for LH/hCG receptor mRNA expression.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1997

Cytokine- and neuropeptide-mediated differentiation in retinal pigment epithelial cells in vitro.

To determine the mechanism of growth and differentiation of retinal pigment epithelial (RPE) cells it is important to understand the pathogenesis of several retinal diseases. Recently it has been reported that several cytokines and neuropeptides regulate the growth of RPE cells. In this study, the role of cytokines and neuropeptides in melanin synthesis, which is one indication of the RPE cell differentiation, was examined using chick RPE cells in vitro IL-1beta, TNF-alpha, substance P, beta-endorphin and methionine-enkephalin stimulated the melanin synthesis of RPE cells in a dose-dependent manner. The most effective concentrations of these agents on RPE cell melanin synthesis were not the same as that for RPE cell proliferation. These results indicate that cytokines and neuropeptides play an important role not only for the growth but also for the differentiation of RPE cells.

Animals↗
PubMed1997

Effect of phorbol ester on the regulation of LH/hCG receptors.

Granulosa cells have been used to study the regulation of LH/hCG receptor protein and mRNA expression. Phorbol 12-myristate 13-acetate (PMA) dose-dependently attenuates the increases in LH/hCG receptor mRNA and protein induced by FSH and forskolin (FSK). The presence of PMA caused a decrease in cAMP production stimulated by FSH and FSK. These results suggest that PMA-mediated decreases in cAMP are a major factor in PMA-mediated decreases in LH/hCG receptor mRNA. On the other hand, in the presence of 8-Br-cAMP, PMA significantly increased LH/hCG receptor mRNA and protein, with maximal stimulation between PMA concentrations of 3 to 30 nM (1.5 fold) with 8-Br-cAMP. These findings suggest that activation of protein kinase C by PMA attenuates the increase in cAMP accumulation induced by FSH but enhances the effect of cAMP on LH/hCG receptor expression, and that the inhibitory and stimulatory effects of PMA on LH/hCG receptor content are correlated with regulation of LH/hCG receptor mRNA levels. Since the half-life study revealed no change in the stability of the LH/hCG receptor mRNA following PMA treatment, a change in the rate of LH/hCG receptor gene transcription must be responsible for the change in the LH/hCG receptor mRNA levels.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1997

Vertebral artery occlusion after subarachnoid hemorrhage from a dissecting aneurysm of the vertebral artery: case report.

BACKGROUND: Generally speaking, occlusion of the vertebral artery is a finding of a dissecting aneurysm associated with completed stroke. We present a case of a vertebral dissecting aneurysm that produced subarachnoid hemorrhage (SAH). Angiography on the day of hemorrhage, however, demonstrated complete occlusion of the vertebral artery. CASE PRESENTATION: A 44-year-old hypertensive woman suffered a sudden onset of headache and vomiting followed by loss of consciousness due to SAH. Angiography on the day of hemorrhage revealed a complete occlusion of the right vertebral artery just distal to the dissecting aneurysm. This is the first report of such a case. The patient was still considered to be at significant risk of rerupture. Craniotomy and clip occlusion of the right vertebral artery and the origin of the right posterior inferior cerebellar artery were carried out to trap the thin-walled sac. At discharge, the patient had recovered completely except for some left limb ataxia, which subsequently disappeared. CONCLUSIONS: Two options are available for the treatment of such a case: surgical or medical treatment. We employed surgery. Which is the preferred approach, however, is a difficult judgment to make at this juncture.

Adult↗
PubMed1997

Effects of passive immunization against inhibin on ovulation rate and embryo recovery in holstein heifers.

The effects of acute neutralization of endogenous inhibin on ovulation rate and circulating FSH levels were investigated. Nine or ten days after estrus, 5 heifers were given a single injection of 75 ml iv inhibin antiserum produced in a castrated male goat, while another 5 were given the same amount of a castrated male goat serum. All heifers were given injections of PGF2alpha im at 48 h and 60 h after the serum injection. Those exhibiting an estrus were artificially inseminated with frozen-thawed semen. Seven or eight days after the insemination, ova or embryos were collected using a non-surgical method. Administration of inhibin antiserum resulted in a significant increase in the number of medium-sized follicles compared with the number in the control animals. The number of large follicles in the inhibin-neutralized animals was 4.8 +/- 2.4 (mean +/- SEM; n = 5) on the day of estrus, while there was a single large follicles in the ovaries of control animals. Seven or eight days after estrus, 3 to 16 ova or embryos were recovered from 4 of 5 animals, and 64 % of the total ova/embryos were transferable. Administration of inhibin antiserum produced a significant increase in the concentrations of plasma FSH from 12 to 72 h after the serum injection compared with the levels in the control animals (P < 0.05). After the onset of estrus, preovulatory LH and FSH surges were noted in inhibin-neutralized animals and magnitude of the rise in each hormone was similar to the control animals. The present study demonstrates that a single injection of the inhibin antiserum induces multiple ovulations probably by enhancing FSH secretion, and that recovery of embryos is equal to that observation after an ordinary FSH treatment.

Journal Article↗
PubMed1997

Effects of passive immunization against oestradiol-17beta and inhibin on the secretion of gonadotrophin in the cyclic golden hamster (Mesocricetus auratus).

To investigate the physiological importance of oestradiol-17beta and inhibin in the regulation of gonadotrophin secretion in the cyclic golden hamster, females were passively immunized against two hormones. When 200 microL antiserum against oestradiol-17beta (oestradiol-AS) was given on Day 3 (Day 1 = day of ovulation), the preovulatory gonadotrophin surge was completely blocked for 24 h and the length of the oestrous cycle was also prolonged for one day. In the group given 200 microL oestradiol-AS on Day 3, basal levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) increased slightly and superovulation (19.6+/-0.8, mean+/-s.e.m.) occurred. When 200 microL antiserum against inhibin (inhibin-AS) was given at 1100 hours on Day 3, a dramatic increase in plasma FSH and a slight increase in LH were noted, resulting in superovulation (38.2+/-2.6) on the expected Day 1. The present study indicates clearly that inhibin plays a major role in regulating the specific ovulation rate in the hamster through the control of FSH secretion. Present results also indicate that oestradiol-17beta suppresses basal LH secretion. Oestradiol-17beta may act as an indicator of the follicular maturation, and the high plasma concentration of oestradiol-17beta noted from Day 3 to Day 4 may play an important role in determining the timing of initiation of the preovulatory gonadotrophin surge.

Animals↗
PubMed1997

Temporal changes in inhibin, steroid hormones, and steroidogenic enzymes during induced follicular atresia in the hypophysectomized cyclic hamster.

The time course for loss of ability of Graafian follicles to secrete inhibin and estradiol was investigated during induced follicular atresia. Cyclic hamsters were hypophysectomized on Day 1 (estrus) and injected s.c. with 30 IU eCG. Thereafter, these animals were given a single i.p. injection of antiserum to eCG on the morning of Day 4 to induce follicular atresia in a rapid and predictable manner. A drastic fall in plasma levels of estradiol and testosterone was noted within 1 h, whereas relatively high levels of plasma inhibin were maintained until 12 h, followed by an abrupt decline by 24 h. The first histological signs of pyknosis in granulosa cells appeared by 4 h, and breakdown of the mural granulosa layer was observed in most follicles by 8-12 h after immunoneutralization of circulating eCG. According to immunohistochemical analysis, inhibin activity was unchanged in granulosa cells at 12 h followed by a slight decline by 24 h, whereas positive reaction for aromatase in these cells rapidly declined by 8 h. Immunoreactivity of 17alpha-hydroxylase/C17,20-lyase (CYP 17) was also reduced in theca cells by 8 h. These results indicate that granulosa cells continue to secrete inhibin during the process of follicular atresia, although these cells quickly shut off the secretion of estradiol, and theca cells shut off the secretion of testosterone. The present results indicate as well that a rapid decline of estradiol and testosterone in plasma is an early sign of atresia in antral follicles. These results, therefore, suggest that the loss of enzymatic activity of aromatase in granulosa cells and CYP 17 in theca cells is a part of the process of follicular atresia.

Animals↗
PubMed1997

Contributions of endogenous inhibin and estradiol to the regulation of follicle-stimulating hormone and luteinizing hormone secretion in the pregnant rat.

To examine the contributions of endogenous inhibin and estradiol to the regulation of FSH and LH secretion in the pregnant rat, some rats were passively immunized against inhibin and/or estradiol, and others were ovariectomized, on Days 5, 10, 15, and 20 of pregnancy. Ovarian and uterine venous blood was collected separately to confirm the sources of inhibin and steroid hormones during pregnancy. Immunoreactivity of inhibin in the placenta was also examined by RIA. Levels of inhibin in ovarian venous plasma were significantly higher than those in peripheral plasma during pregnancy. No difference was observed between the levels of inhibin in uterine venous plasma and peripheral plasma. No immunoreactivity of inhibin was detected in placental homogenate from rats at Days 10, 15, and 20. FSH secretion significantly increased after immunoneutralization of inhibin during pregnancy. A marked increase in FSH secretion was noted on Days 5 and 20, and the smallest increase was observed on Day 15. Administration of estradiol antiserum (AS) alone did not induce a significant increase in FSH secretion on any day of pregnancy. However, a synergistic effect of estradiol AS and inhibin AS was observed on Day 20. On Days 5, 10, and 20, administration of inhibin AS or estradiol AS induced a significant increase in LH secretion. A synergistic effect of inhibin AS and estradiol AS on LH secretion was observed on Day 5. On Days 5 and 10, significantly high LH secretion was noted in ovariectomized rats as compared with that in rats treated with both inhibin AS and estradiol AS, indicating that other ovarian hormones such as progesterone may be involved in the suppression of LH secretion in these stages of pregnancy. These data indicate that both inhibin and estradiol, predominantly secreted from the ovary, are involved in the regulation of gonadotropin secretion during pregnancy as during the estrous cycle in the rat.

Animals↗
PubMed1997

Combination of tracheal gas insufflation and airway pressure release ventilation.

STUDY OBJECTIVE: We hypothesized that the continuous gas flow administration delivered through an insufflation catheter positioned above the carina during airway pressure release ventilation (APRV) would facilitate carbon dioxide (CO2) elimination, resulting in normocarbia with a substantially reduced peak airway pressure (Paw). To test this hypothesis, we compared intermittent positive pressure ventilation (IPPV), tracheal gas insufflation (TGI), APRV, and combined TGI and APRV (TGI + APRV). DESIGN: Animal study with random application of four ventilatory modes in a canine restrictive-thorax model with and without pulmonary edema. SETTING: Research laboratory at Kumamoto (Japan) University School of Medicine. SUBJECTS: Six mongrel dogs. INTERVENTIONS: Application of four ventilatory modes (IPPV, TGI, APRV, and TGI + APRV). MEASUREMENTS AND RESULTS: TGI + APRV facilitated CO2 elimination. The peak Paw was significantly lower during TGI + APRV than during IPPV (nonpulmonary edema model; 15 +/- 4 vs 28 +/- 9 cm H2O; p < 0.05; pulmonary edema model: 20 +/- 4 vs 34 +/- 10 cm H2O; p < 0.05). Normocarbia was observed in both models. Neither TGI nor APRV alone maintained normocarbia. CONCLUSION: The combined use of TGI and APRV is a more effective method of maintaining normocarbia with reduced peak Paw than either IPPV or APRV alone.

Animals↗
PubMed1997

[Intraoperative aneurysmal rupture at the neck].

Intraoperative rupture of an aneurysm can lead to disastrous results when the rupture occurs at the neck. The authors have encountered eight cases (5%) of intraoperative rupture in a series of 155 patients. All patients were operated on in the acute stage by one of the authors of this paper (T.Y.). In six cases, the aneurysm ruptured at the dome and in two, at the neck. We report these two patients with intraoperative rupture at the neck. The first case, a 50-year-old female, developed SAH, but a 4-vessel study failed to show an aneurysm. The second series of angiograms obtained ten days later showed a broad-based, left proximal A1 aneurysm. It was decided to employ a right pterional approach. The aneurysm was arising from the right A1 segment just proximal to the anterior communicating artery. The neck was wide, with thin walls. Thus, it seemed better to apply a clip parallel to the A1 segment axis than to apply it from a direction perpendicular to the A1 segment axis. However, the right pterional approach precluded a parallel clipping, so the blades of a clip were applied perpendicularly. The clip seemed not to be completely across the neck of the aneurysm. After applying a temporary clip to the A1 segment proximal to the aneurysm, the clip blades were opened and advanced just when bursting of the sac at the base occurred and microvascular suture repair was required to control the bleeding. The second case, a 57-year-old female, underwent clipping of a right IC-PC aneurysm. However, two years postoperatively, the patient again suffered SAH. Cerebral angiography at this time revealed a relatively large recurrent IC-PC aneurysm in which the old clip was situated on the dome of the aneurysm. Aneurysmal clipping was performed on the day of rupture. Tough granular tissue was removed from the ICA, PcomA, aneurysmal neck, and the old clip. After the true neck was identified, a straight clip was applied to the neck parallel to the ICA. Soon after the clipping, arterial bleeding occurred near the neck. The ruptured aneurysm was trapped using two temporary clips. A curved clip was applied to the ruptured neck, including the wall of the ICA, to control the bleeding. This clipping caused a substantial stenosis of the ICA. Both patients demonstrated postoperative neurological deficits due to ischemia caused by temporary clipping. These encounters dramatically demonstrated that a very thin-walled aneurysm or a recurrent aneurysm has a fragile neck. In surgical treatment of these unusual aneurysms, a clip should be placed on the neck parallel to the parent artery. Furthermore, temporary clipping is advisable when dissecting the neck or applying the clip to the neck to reduce the damage to the neck.

Aneurysm, Ruptured↗
PubMed1997

[Rupture of previously documented asymptomatic saccular intracranial aneurysms].

The authors report four cases of patients with documented asymptomatic intact aneurysms that subsequently ruptured. Case 1 involves a 64-year-old woman who had two unruptured aneurysms, i.e., an anterior communicating artery aneurysm and a posterior inferior cerebellar aneurysm, both were discovered during evaluation of cerebral ischemic symptoms. At that time, only the posterior inferior cerebellar aneurysm was clipped. Seven years later, the patient bled fatally from a 5-mm untreated anterior communicating artery aneurysm that had measured approximately 3 mm on an angiogram obtained 7 years earlier. Case 2 is that of a 50-year-old woman who bled from an anterior communicating artery aneurysm that had been discovered 6 years earlier when she suffered subarachnoid hemorrhage (SAH) from a left middle cerebral artery aneurysm. At that time, she had refused surgery for the anterior communicating artery aneurysm. She recovered well from the second SAH. Case 3 is that of a 74-year-old woman who bled from a left paraclinoid internal carotid artery aneurysm that had been discovered incidentally 3 years earlier during evaluation of vertigo. She had not agreed to have a clipping at that time the aneurysm was first discovered because of her age and the difficult location of the aneurysm. She eventually made an uneventful recovery. In the fourth case, during evaluation of cerebral ischemic symptoms, a 59-year-old man was discovered to have a large basilar bifurcation aneurysm. He underwent a craniotomy for clipping of the aneurysm. The aneurysm, however, was unclippable and was instead coated with Bemsheet. Four months later, the patient bled from the aneurysm and entered a vegetative state. The indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. The cases reported herein show that asymptomatic aneurysms, especially anterior communicating aneurysms and aneurysms once exposed surgically, do carry a certain risk for future hemorrhage and should not be dismissed as innocuous. Neurosurgeons have recognized the importance of considering life expectancy in managing patients with asymptomatic, unruptured, intracranial aneurysms. With the rapid aging of the population, withholding aneurysm surgery merely because a patient is elderly may not necessarily be the most appropriate decision.

Aged↗
PubMed1997

[Management of subarachnoid hemorrhages without detectable aneurysm].

In this study, 21 patients with subarachnoid hemorrhage (SAH) but negative angiography were evaluated. Angiography was performed twice on each patient, that is, on admission and at 2 weeks following admission. All patients had severe headache of sudden onset, a characteristic manifestation of SAH. Clinical grades on admission (Hunt and Kosnik classification) were generally good: 17 patients were in grade I or II and 4 patients were in grade III. SAH was confirmed by the presence of subarachnoid clot on CT in all cases. Based on the distribution of SAH, CT findings were classified into two patterns, i.e., perimesencephalic and non-perimesencephalic patterns. Four patients showed the perimesencephalic pattern and the remaining 17 the non-perimesencephalic. The period of follow-up ranged from 20 days to 11 years 6 months, with a mean of 6 years 10 months. Except for three recent cases, the mean follow-up period in 8 years 9 months. Exploratory craniotomies probing for aneurysms have been performed in four patients, but no aneurysms have been found in any of these cases. Clinical deterioration associated with vasospasm was observed in one patient. A communicating hydrocephalus requiring a shunting procedure was observed in three patients showing the non-perimesencephalic type CT pattern. Rebleeding occurred in one patient who subsequently died of what may be a dissecting aneurysm of the vertebral artery. One patient who was able to return to full activity experienced symptoms attributable to SAH such as frequent headaches and increased fatigability. Complete recovery was observed in the remaining 19 patients. Two of them, however, later died due to myocardial infarction and aging, respectively. Given these generally positive outcomes, it should be possible to inform such patients of the benignity of their condition. Angiography may not demonstrate a ruptured aneurysm on initial examination in all cases of aneurysmal SAH. Serial angiography, however, can provide a definite diagnosis of the dissecting aneurysm. Therefore, repeat angiography, particularly, when possible, digital subtraction angiography, is necessary to rule out aneurysmal SAH. While small aneurysms or microaneurysms are often found through exploratory craniotomy, we do not agree with the opinion that surgery may be appropriate for certain patients with SAH but with negative angiography. The natural history concerning rebleeding in such cases, as well as morbidity and mortality associated with hemorrhage, remains to be defined. Furthermore, there are reservations regarding whether coagulation of these abnormalities with bipolar cautery constitutes definitive treatment.

Adult↗