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Biomedical subjects

H Mishina

Publications and source records attributed to H Mishina.

At least 19 recordsLinked to original sources
PubMed2001

Penetrating injury of the brain by the burr of a high-speed air drill during craniotomy: case report.

The most critical complications of craniotomy are caused by the plunging of a skull drill, and there have been no reports of penetrating brain injury caused by the broken burr of a high-speed air drill during craniotomy. Left orbitofrontal craniotomy was performed to clip two aneurysms in a 44 year old man. While cutting the lateral orbital rim with the burr of an Ultra Power surgical drill system, the burr broke off and penetrated the frontal lobe down to the falx cerebri. There were no discernible contusion or haemorrhage in the brain. The accident occurred because a long burr for the angled attachment of a Surgairtome was erroneously attached to the angled attachment of an UltraPower surgical drill. The mismatch between the steel strength and torque of the two burrs designed for different drill systems seemed responsible for breakage of the burr. We learned a valuable lesson from this failure: that all new instruments, including high-speed air drills, must be studied carefully so that staff become thoroughly familiar with their handling.

Adult↗
PubMed2000

Arteriovenous malformation of the medulla oblongata supplied by the anterior spinal artery in a child: treatment by microsurgical obliteration of the feeding artery.

We report a unique case of a 3-year-old boy with a pial arteriovenous malformation (AVM) in the medulla. The patient presented with a subarachnoid hemorrhage. Magnetic resonance (MR) imaging revealed a 3 x 1 cm flow void area in the premedullary cistern that was compressing the medulla posteriorly. Cerebral angiography and MR angiography showed an aneurysm-like vascular pouch that was fed by the anterior spinal artery and had multiple draining veins. The case was diagnosed as a fistula-type AVM. Treatment options consisted of endovascular embolization or open surgery. We used a left far lateral approach to obliterate the anterior spinal artery. Immediately after the clip was applied to the feeding artery, the pouch began to shrink, and the color of the draining veins changed from red to blue. An intraoperative angiography showed that the AVM had disappeared. The patient recovered fully 1 month after surgery. This case was classified as fistula-type AVM, pial arteriovenous fistula (AVF). Microsurgical obliteration of the anterior spinal artery is considered to be the treatment of choice for perimedullary AVF located in the premedullary cistern if the endovascular treatment is not considered to be feasible.

Arteries↗
PubMed1998

[Surgical interruption of draining vein or dural sinus: treatment for petrotentorial dural arteriovenous malformation].

The authors report three cases with petrotentorial dural arteriovenous malformation who underwent surgical interruption of the draining vein or dural sinus. They discuss the rationale and feasibility of this surgical procedure. Case 1 (70-year-old man) presented with trigeminal neuralgia and cerebellar ataxia caused by subarachnoid and cerebellar hemorrhage. Case 2 (68-year-old man) with trigeminal neuralgia due to venous mass effect. Case 3 (48-year-old man) with dementia caused by venous ischemia in the bilateral thalami. Cases 1 and 2 underwent lateral suboccipital craniotomy followed by infratentorial supracerebellar approach, and the draining vein was interrupted by aneurysmal clip under the cerebellar tentorium. Case 3 underwent surgical occlusion of the straight sinus by occipital transfalcine transtentorial approach after transarterial embolization had failed. Intraoperative digital subtraction angiography revealed the disappearance of dural AVMs in all three cases. The clinical symptoms disappeared postoperatively, and follow-up 6-vessel-angiography 2, 20, 11 months later, respectively, revealed no recurrence of dural AVMs. It has recently been proposed that many cranial dural AVMs with leptomeningeal venous drainage require only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination. The striking clinical and radiological improvement in these cases emphasizes the pivotal role of surgical occlusion of the draining vein for petrotentorial dural AVMs which are not amenable to cure by endovascular procedures.

Aged↗
PubMed1996

Dural arteriovenous malformation manifesting as tic douloureux.

BACKGROUND: Although cerebral arteriovenous malformation (AVM) is an established cause of trigeminal neuralgia, dural AVM has rarely been reported to cause tic douloureux. Treatment of dural AVM in the tentorial and torcular regions by transarterial embolization is rarely curative. It has recently been proposed that many cranial dural AVMs with leptomeningeal venous drainage require only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination. CASE REPORT: We present a case of 65-year-old man with typical trigeminal neuralgia caused by a dural AVM. Carotid angiography revealed a dural AVM in the petrotentorial region with enlarged and serpiginous draining veins, which compressed the trigeminal nerve. Facial pain had been completely relieved for 2 months after successful transarterial embolization, but the symptom recurred. The patient subsequently underwent surgical interruption of the draining veins just beneath the cerebellar tentorium. The dural AVM disappeared, and the trigeminal neuralgia was completely relieved. CONCLUSION: The literature concerning the etiology of tic douloureux is reviewed and the selection of treatment modality of this case is discussed. The striking clinical and radiologic improvement in this case emphasizes the pivotal role of simple interruption of the arterialized vein for petrotentorial dural AVMs, which are not amenable to cure by endovascular procedures.

Aged↗
PubMed1995

Reversible dural arteriovenous malformation-induced venous ischemia as a cause of dementia: treatment by surgical occlusion of draining dural sinus: case report.

We report a unique case of thalamic dementia caused by tentorial dural arteriovenous malformation (AVM), which was successfully treated by surgical occlusion of the straight sinus after attempts to occlude the dural AVM by endovascular procedures had failed. The tentorial dural AVM was fed by bilateral posterior meningeal arteries and occipital arteries, with early retrograde venous drainage into the straight sinus, inferior sagittal sinus, basal vein of Rosenthal, and dural veins in the falx cerebri. The venous ischemia in bilateral thalamus was revealed as low-density areas in computed tomographic scans, as high-intensity areas in T2-weighted magnetic resonance images, and as decreased cerebral blood flow and increased cerebral blood volume in single-photon positron emission computed tomography. Because this patient was not amenable to cure by endovascular embolization, an open surgical approach, surgical occlusion of the draining venous channel (the straight sinus), was performed. Postoperatively, dural AVM in angiography and venous ischemia in bilateral thalamus were resolved, as revealed by magnetic resonance imaging and single-photon positron emission computed tomography. Dementia caused by bilateral thalamic ischemia was also resolved. This case clearly illustrates the pathophysiological mechanism of venous ischemia in the bilateral thalamus to cause reversible dementia.

Brain Ischemia↗
PubMed1994

Relationship of cerebral blood flow, cerebral metabolism, and electroencephalography to outcome in acute experimental compression ischemia--barbiturate effects on delayed brain swelling.

Acute compression ischemia was induced in 30 cats by progressive inflation of an epidural balloon, followed by rapid decompression. Changes in intracranial pressure, mean arterial blood pressure, cerebral blood flow (CBF), arteriovenous oxygen difference (AVDO2), cerebral metabolic rate of oxygen (CMRO2), and electroencephalography (EEG) were studied in 13 untreated animals and in seven animals receiving barbiturate. Ten cats with cardiovascular or respiratory problems, or intracranial hematoma were excluded from the study. In untreated animals, six (46%) survived with no brain swelling and were classified as the "no swelling group," and seven (56%) died from fatal brain swelling and were classified as the "delayed swelling group." All animals with barbiturate therapy showed no brain swelling. Serial measurement of CBF, AVDO2, and CMRO2 indicated the existence of postischemic delayed hypoperfusion associated with relative hypermetabolism in untreated animals. Good recovery of CBF and CMRO2 was observed in the "no swelling group," and poor recovery in the "delayed swelling group." The time course of the total fast-wave components on EEG was quite similar to that of CMRO2, and the time course of the "CBF index," which is % fast-wave component of EEG divided by AVDO2, was similar to that of CBF. Barbiturates reduced CMRO2 and fast-wave component during administration, possibly improving the relatively hypermetabolic state, and reduced the mortality rate to 0%. The maximum effects of barbiturate could be expected by administering the drug at the stage of delayed hypoperfusion with relative hypermetabolism, indicated by rapid recovery of the % fast-wave component, high AVDO2, and low CBF index.

Animals↗
PubMed1994

[Two cases of surgically treated malignant primary tumors originated from the pulmonary artery].

Two surgically treated cases of malignant tumors which originated inside of the pulmonary artery were reported. A 62-year-old female with an undifferentiated sarcoma and a 24-year-old male with a malignant fibrous histiocytoma were successively operated on in two months for the release of their chief complaints of exertional dyspnea. In the first case the tumor was resected completely, although partially resected in the second case. Preoperatively, noninvasive examinations including the echocardiography, the computed tomography and the magnetic resonance imaging confirmed the presence of these tumors in the main pulmonary arteries in both cases and also the invasion to the vessel wall with the growth to the pericardial cavity in the second case. Both patients are doing well and has been followed up at the out-patient department 22 and 20 months after surgery, respectively.

Adult↗
PubMed1993

Pathophysiology of brain swelling after acute experimental brain compression and decompression.

Global ischemia was created by controlled expansion of an epidural balloon for 25 minutes in Group A (six cats) and for 5 minutes in Group B (six cats). The alterations of intracranial pressure, arteriovenous oxygen content difference, cerebral metabolic rate of oxygen, cerebral blood flow, and electroencephalogram were observed until brain death or 24 hours' survival with normal intracranial pressure. The animals were then killed for brain histological examination. In four other cats, a 2% solution of Evans blue dye (4 mg/kg) was injected intravenously--immediately after deflation--resulting in 25 minutes of global ischemia. Two other cats received 5 minutes of global ischemia. The cats were killed 1 hour later. Abrupt swelling occurred in Group A, and no swelling was found in Group B. A transient absolute hyperemia was found immediately after deflation in both groups. The cerebral blood flow and cerebral metabolic rate of oxygen decreased markedly with low arteriovenous oxygen content difference and flat electroencephalogram in Group A, compared with gradual recovery of cerebral blood flow and cerebral metabolic rate of oxygen with high arteriovenous oxygen content difference and reappearance of electroencephalogram activity in Group B. The extravasation of Evans blue was observed on the compressed cerebral hemisphere, thalamus, hypothalamus, and brain stem in swelling animals and only on the compressed hemisphere in nonswelling animals. Histologically, the damage and congestive dilation of capillary, degeneration, and necrosis of neuronal and glial cell were found prominently on the hypothalamus and brain stem in the swelling group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Reinforcing aerosol cisplatin for radiotherapy of laryngeal cancer.

To attain its increased tumor concentration and to avert its systemic adverse effects, aerosol cisplatin (CDDP) was incorporated into radiotherapy (RT) of laryngeal cancer. Nine patients were asked to inhale the aerosol following each RT session. Their clinical tumor response was favorable, and histopathologic survey in selected cases revealed elimination of viable cancer cells. However limited, there have been no reports of cancer recurrence yet. This reinforcing plan of aerosol CDDP for RT bleomycin would certainly offer a better way of treating laryngeal cancer, and probably those malignancies facing the nasopharyngobronchial airway as well.

Aerosols↗
PubMed1991

AVDO2 and EEG as indicators for treatment of post-traumatic brain swelling--experimental study.

A cat model of compression ischemia using epidural balloon inflation investigated: 1) the relationship between postischemic cerebral blood flow (CBF) and metabolism and brain swelling, 2) the use of arteriovenous oxygen difference (AVDO2) and electroencephalographic (EEG) frequency band analysis for monitoring CBF and cerebral metabolism, and 3) indications for selecting the therapy. Global ischemia was induced by brain compression, followed by rapid decompression, and AVDO2, CBF, cerebral metabolic rate for oxygen, and EEG were monitored. The animals were divided into delayed brain swelling and no swelling groups. The severity of compression ischemia influenced the recovery of CBF and cerebral metabolism. The AVDO2 and EEG reflected the CBF and cerebral metabolism. These parameters are useful in selecting the therapy for focal brain injury.

Animals↗
PubMed1991

[Radiotherapy combined with aclarubicin and neocarzinostatin in cancer of the gallbladder].

Cancer of the gallbladder is radioresistant. When a case of such was found inoperable, she was subjected to radiotherapy combined with aclarubicin and neocarzinostatin. Therapeutic effectiveness was confirmed at autopsy as she later succumbed to uterine cervical cancer. Thus, the present radiochemotherapeutic regimen would probably provide a means of overcoming those radioresistant inoperable malignancies. Intravenous administrations of appropriate antibiotics such as azthreonam and reniran may probably be helpful in the prevent ion and treatment of septic peritonitis possible during the course of reinforced radiotherapy of the abdomen.

Aclarubicin↗
PubMed1990

Medroxyprogesterone acetate for lung cancer.

A 70-year-old man having severe ischemic heart diseases developed bilateral, duplicate lung cancer of large cell and squamous cell types. Chemoimmunotherapy consisting of carmofur, picibanil inhalation, i.m. sizofilan, and peroral bestatin was started, and 3 months later, peroral medroxyprogesterone acetate was added. The tumor regressed, and the patient survived more than 34 months. This type of nonaggressive regimen may thus be useful for tumors other than adenocarcinomas, too.

Aged↗
PubMed1990

Reinforcing radiotherapy of gallbladder cancer with aclarubicin and neocarzinostatin.

Cancer of the gallbladder is radioresistant. When a 59-year-old woman was found to have an inoperable cancer of the gallbladder, she was subjected to radiotherapy combined with aclarubicin and neocarzinostatin. Therapeutic effectiveness was confirmed at autopsy as she later succumbed to uterine cervical cancer. Thus, the present radiochemotherapeutic regimen would probably provide a means of overcoming those radioresistant inoperable malignancies.

Aclarubicin↗
PubMed1990

[Rupture of intracranial aneurysm due to intravascular metastasis of choriocarcinoma. Case report].

A 55-year-old female was admitted to the Juntendo Izunagaoka Hospital, because of sudden onset of motor aphasia and right hemiparesis. Neurological examination on admission revealed drowsy state, bilateral papilledema, motor aphasia, and right hemiparesis. Computed tomography showed a subcortical hematoma in the left frontoparietal region associated with perifocal edema. Left carotid angiography revealed a fusiform aneurysm at a peripheral branch of the central artery. There was no tumor stain on cerebral angiograms. A combination procedure was carried out during emergency surgery, including evacuation of the intracerebral hematoma and removal of the thrombus-like material from the aneurysmal cavity followed by wrapping the aneurysm with fascia. Histological examination of the thrombus-like material demonstrated that it was a neoplastic embolus of choriocarcinoma. Serum (2600 mIU/ml) and urinary (7200 mIU/ml) human chorionic gonadotropin levels were elevated. The features of neoplastic aneurysm due to choriocarcinoma are reviewed and discussed.

Brain Neoplasms↗
PubMed1990

[The measurement of extra vascular lung water using a thermal-sodium double indicator dilution technique in patients undergoing surgery for esophageal cancer].

The Extra Vascular Lung Water (EVLW) was measured using the thermal sodium double indicator dilution technique in 21 patients undergoing surgery for esophageal cancer. This measurement is an important parameter in the control of the respiratory function. In the 16 cases without pulmonary complications, the preoperative EVLW was 5.3 +/- 0.2 (mean +/- SEM) ml/kg and the immediate postoperative EVLW was 4.8 +/- 0.4 ml/kg. This change was significant (p less than 0.05), but within 24 hours the EVLW returned to almost the same levels as those recorded before surgery. In only 3 cases, the EVLW were elevated beyond 7.5 ml/kg, but these high EVLW levels did not continue for more than 12 hours. Of the 5 patients with pulmonary complications, only two experienced pulmonary edema. Their preoperative EVLW levels were normal, but the immediate postoperative EVLW levels were significantly elevated beyond 10 ml/kg. These elevated levels were observed before the PaO2, the portable chest roentgenograms and the other test results changed following surgery. The high EVLW levels beyond 7.5 ml/kg continued for 72 hours after surgery. We found no correlation between the EVLW and measureable hemodynamic parameters (Cardiac Index, Pulmonary Wedge Pressure, Colloid Osmotic Pressure-Pulmonary Wedge Pressure gradient) during the observation period. In the other cases with pulmonary complications (2 cases were pneumonia, one was atelectasis with pneumonia), the changes in the EVLW levels were the same as for the cases without pulmonary complications. These results indicate that the EVLW is the optimum parameter for the control of the respiratory function and early diagnosis of pulmonary edema after surgery for esophageal cancer.

Esophageal Neoplasms↗
PubMed1988

Cancer incidence in the population of Nagasaki City 30 years after atomic bombing.

In order to attest the evolutionary hypothesis of non-epithelial-epithelial tumor shift (Okuyama and Mishina 1986), the published cancer incidence data for the population of Nagasaki City during the period of 1973-1977 was studied along with appropriate control populations of Fukuoka City, and Miyagi and Osaka prefectures. Significant increments of non-epithelial tumors including leukemias, and epithelial tumors such as cervical cancers and choriocarcinomas were observed. An inference was made to the post-atomic bomb radiation carcinogenesis that different organ systems responded to that irradiation with different oncogenic patterns: Neoplasms of the pre-vertebral organs (non-epithelial organ systems) were the first to react and tapered long (curve type I); Tumors of the vertebral but pre-mammalian (those of the digestive tract, respiratory and thyroid) could have formed two separate peaks, one for the early and high dosage and the other for the late and low dosage (II); With breast cancer or the mammalian symbol tumor, there was a single peak reflecting the cohort of reproductives (III). The evolutionary and phylogenetic progression could have taken place from I through III. Thus, cancer incidence analysis may be helpful in deciphering the atomic bomb radiation carcinogenesis.

Adolescent↗
PubMed1987

Intratumoral doxycycline for skin metastases of human malignancies.

As soon as its inducibility of lethality via prompt deprivation of heavy metals and HDL-cholesterol was born out, an intratumoral administration of doxycycline, an anti-prokaryotic agent, was undertaken in 7 patients presenting with skin metastases from a variety of malignancies. Complete remission of these lesions was attained in 6. The histological observation of elongated areas of acellularity along with central vessels appeared to suggest doxycycline-mediated cellular disintegration, resulting in empty tumor cords. Specific tumor selectivity of the treatment can be sustained by the intra- and/or peri-tumoral confinement of the agent. The technique may constitute a novel mode of cancer cell elimination.

Adult↗