Twenty operated cases of angiographically unrecognized microaneurysm (AUM) have been analysed with special reference to intra-operative observations and clipping-technique. Among the patients with intracranial aneurysms that the authors' facility has operated upon, the incidence of asymptomatic incidental AUM that was 2 mm or smaller amounted to 3.7%. Thirteen cases of AUM were found on the middle cerebral artery; four AUMs arose from the M1 portion, four from the bifurcation, and five from the second bifurcation. Sixty percent of AUMs were recognized on the parent arteries of ruptured aneurysms. In 90% of cases the AUMs were broad based in shape and in 70% of cases exhibited a thin-walled neck and a thin-walled fundus. Intra-operative findings revealed four reasons why AUMs were not visible in the pre-operative angiograms: (1) the AUM was sandwiched between two arteries; (2) the AUM was completely hidden by a contiguous large or giant aneurysm; (3) the AUM was diagnosed by pre-operative angiogram as a bleb of the contiguous aneurysm; (4) the AUM was not visible on angiograms because the height of the AUM was extremely low. Twelve cases of AUM were successfully clipped using four different clipping techniques; (1) clipping parallel to the bifurcation in four, (2) clipping parallel to the parent artery in four, (3) pinch-clipping in two of the cases, and (4) cross clipping in two of the cases. The other eight cases were wrapped and coated. AUMs may be present during the direct operation of intracranial aneurysms and in intravascular surgery. Neurosurgeons and neuroradiologists need to explain the possible existence of AUMs to patients and their families.

Adult↗

PubMed1997

Effects of a cardioselective M2 receptor antagonist, AF-DX 116, on ventricular arrhythmias in dogs.

AF-DX 116 is a cardioselective M2 receptor antagonist and, thus, it should induce sinus tachycardia. Since normal ventricular automaticity is suppressed by atrial overdriving, AF-DX 116 might become an antiarrhythmic drug and act by increasing the sinus node automaticity. Ventricular arrhythmia models used in this study were induced either by two-stage coronary ligation, digitalis, or adrenaline in beagle dogs. AF-DX 116 (0.3 mg/kg i.v.) tended to increase the sinus rate of the conscious beagles compared to the pre-drug level (although the effect was not significant) but had no antiarrhythmic effect (i.e., there was no decrease in the arrhythmic ratio defined as the number of PVC divided by the total heart rate) on the ventricular tachycardia (VT) induced 24 h after aseptic ligation of the left anterior descending coronary artery. AF-DX 116 did not alter the blood pressure. The drug also did not suppress digitalis-induced VT and did not increase the atrial rate, which was already increased to about 210 beats/min by ouabain. AF-DX 116 decreased the arrhythmic ratio, 9 min after bolus injection, and increased the atrial rate in the adrenaline VT model. The maximum plasma concentration of AF-DX 116 reached nearly 1microg/ml 1 min after the bolus injections in the digitalis and adrenaline arrhythmia experiments, which is close to the maximum concentration expected to be attained in the clinical application of this drug. Although AF-DX 116 increased the heart rate, under the present experimental conditions of increased atrial rate, the extent of tachycardia was not strong enough to suppress the 24-h coronary ligation and digitalis-induced arrhythmias. The late onset of the antiarrhythmic effect of AF-DX 116 on adrenaline-induced arrhythmia cannot be explained by the overdrive suppression mechanism.

Animals↗

PubMed1997

Duodenal but not gastric transection disturbs motility of the sphincter of Oddi in the dog.

The aim of the present study was to elucidate the effect of gastric and duodenal transection on biliary manometry in anesthetized dogs. The basal biliary pressure and increase in pressure during saline perfusion at rates of 1.0 and 1.5 ml/min were studied in intact controls, during infusion of cholecystokinin (CCK) alone, and after gastric and duodenal transection. CCK dose-dependently lowered the basal pressure and the increase in pressure during perfusion. Gastric transection 1.5 cm proximal to the pylorus did not affect these parameters. In contrast, duodenal transection 1.0 cm distal to the pylorus significantly increased these parameters compared to all other groups. These observations suggest that the proximal duodenal transection, as performed during conventional distal gastrectomy, may contribute to the pathogenesis of postgastrectomy gallstone formation by altering motor function of the sphincter of Oddi.

Animals↗

PubMed1997

Cancellation of motion artifact in MRI due to 2D rigid translational motion.

A new algorithm for cancelling MRI artifact due to translational motion in the image plane is described. Unlike the conventional iterative phase retrieval algorithm, in which there is no guarantee for the convergence, a direct method for estimating the motion is proposed. In the previous approach, the motions in the readout(x-) direction and the phase encoding(y-) direction are estimated simultaneously. However, the feature of the each x- and y-directional motion is different. Based on the analysis of their features, each x- and y-directional motion is cancelled by different algorithms in two steps. First, we notice that the x-directional motion corresponds to a shift of the x-directional spectrum of the MRI signal, so the x-directional motion can be cancelled by shifting the spectrum in inverse direction. Next, the y-directional motion is cancelled using a new constraint, with which the motion component and the true image component can be separated. The algorithm is shown to be effective by simulations.

Algorithms↗

PubMed1997

Intraoperative cardiovascular collapse in an infant with Arnold-Chiari malformation.

We report a case of an infant with a diagnosis of Arnold-Chiari malformation who developed acute cardiovascular collapse during posterior fossa decompression surgery. Haemodynamic manifestations were hypotension and bigeminy characterized by resistance to conventional resuscitation. The aetiology was considered to be due to brainstem compression exerted to control surgical bleeding from an inadvertently lacerated sinus at an unusual site, the rim of the foramen magnum. Restoration of blood pressure and disappearance of arrhythmia immediately followed removal of the brainstem compression rather than volume or pharmacological resuscitation.

Arnold-Chiari Malformation↗

PubMed1997

Measurement of cortical bone density in the radius by peripheral quantitative computed tomography in hemodialysis patients.

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Bone Density↗

PubMed1997

The basic hospital and renal replacement therapy in the Great Hanshin Earthquake.

Explore the source record for details and available documents.

Crush Syndrome↗

PubMed1997

Acute hydrocephalus in posterior fossa injury.

This is the first known report of the use of computerized tomography (CT) scanning to examine acute hydrocephalus in posterior fossa injury. Of the 1802 patients with acute head trauma treated at Funabashi Municipal Medical Center, 53 (2.9%) had suffered injury to the posterior fossa. Of these, 12 patients (22.6%) had associated acute hydrocephalus: nine patients with acute epidural hematoma (AEH) and three with intracerebellar hematoma and contusion (IH/C). There was a significant relationship between cases of AEH with hydrocephalus and supratentorial extension, hematoma thickness of 15 mm or more, and abnormal mesencephalic cisterns. In cases of IH/C, bilateral lesions and no visible fourth ventricle were significant causes of hydrocephalus. According to these results, possible mechanisms of acute hydrocephalus in posterior fossa injury may be as follow: in cases of AEH, hematoma that extends to the supratentorial area compresses the aqueduct posteriorly and causes hydrocephalus; in cases of IH/C, hematoma and contusional lesions may directly occlude the fourth ventricle and cause acute hydrocephalus. Seven patients suffering from AEH with acute hydrocephalus underwent evacuation of their hematoma without external ventricular drainage. In these cases, CT scanning showed that the hydrocephalus improved immediately after evacuation of the hematoma. Two patients suffering from IH/C with hydrocephalus underwent a procedure for evacuation of the hematoma and external ventricular drainage. The authors do not believe that ventricular drainage is necessary in treating posterior fossa AEH. However, both evacuation of the hematoma and ventricular drainage are necessary in cases of IH/C with hydrocephalus to provide the patient with every chance for survival. There was no significant difference in mortality rates when cases of AEH with acute hydrocephalus (0%) were compared with cases of AEH without hydrocephalus (7.7%). The observed mortality rates in cases of IH/C with hydrocephalus and those without hydrocephalus were 100% and 15.4%, respectively; this is statistically significant.

Acute Disease↗

PubMed1997

[Fast cine MR coronary angiography compared with conventional coronary angiography: criteria for coronary artery stenosis].

Magnetic resonance coronary angiography (MRA) was performed in 5 healthy volunteers and 13 patients to evaluate its diagnostic capability. Ten to 15 continuous cross sections were obtained for each coronary artery using fast cardiac cine MR (FASTCARD) with breath-hold, and reconstructed images were made. The control study showed good demonstration of the left main, proximal left anterior descending (Seg. 6) and proximal right (Seg. 1, 2) coronary arteries. Abnormal findings were classified as interruption, stenosis (severe or mild), irregularity, or decreased signal, and they were compared with the findings of conventional angiography in proximal segments (Seg. 1,2,5,6). Twelve of 15 lesions with significant stenosis (> 75%) were depicted as interruption or severe stenosis (sensitivity 80%). The sensitivity was 100% (6 of 6 lesions) in the right coronary artery and 67% (6 of 9 lesions) in the left coronary artery. The positive predictive value was 75% (12 of 16). Comparison at each segment revealed that the sensitivity, specificity and accuracy for interruption or severe stenosis were 92%, 79%, and 86%, respectively, for severe stenosis (> 90%), and 85%, 79%, and 83% for significant stenosis (> 75%). Interruption or severe stenosis on MRA is presumed to be an appropriate criterion for the detection of significant stenosis in the proximal coronary artery.

Adult↗

PubMed1997

[A case of retroperitoneal fibrosarcoma in the perirenal space].

A case of retroperitoneal fibrosarcoma is reported. A 52-year-old man with the complaint of left abdominal mass was referred to our hospital. Computed tomography showed a left retroperitoneal tumor surrounding the left kidney in the perirenal space. Angiography showed some feeding vessels from the branch of the posterior segmental artery of the left kidney. The tumor was completely resected with the left kidney, but para-aortic lymph node metestases were found. Histopathological diagnosis was a retroperitoneal fibrosarcoma with lymph node metastases. The patient died of the disease 3 months after the operation.

Fibrosarcoma↗

PubMed1997

[Renal cell carcinoma diagnosed by ring-like growth of preexistent calcification: a case report].

A 53-year-old woman was referred for further examination of a left renal cyst detected ultrasonographically during a health checkup. Computerized tomography (CT) scan and magnetic resonance imaging revealed an irregular cystic mass at the center of the left kidney as well as a calcified lesion at the left upper pole. Angiography and cyst puncture confirmed the cystic mass to be unilocular and benign. However, followup CT scan after 22 months demonstrated enlargement of the calcification into a ring-like configuration 3 cm in diameter. Since the lesion showed neovascularity on angiography, radical nephrectomy was performed. Histopathological diagnosis was renal cell carcinoma, alveolar type, common type at the center, but solid type, spindle cell type at the periphery.

Calcinosis↗

PubMed1997

[Multi-drug antiemetic treatment and effect of treatment duration of concurrent steroids--for complete control of chemotherapy-induced nausea/vomiting in gynecological cancer].

Antiemetic effect and safety of concurrent administration of ondansetron and other antiemetics (dexamethasone, domperidone and ethyl loflazepate), given for complete suppression of nausea/vomiting, were examined in 46 patients (109 courses) with gynecological cancer receiving single high-dose of cisplatin or carboplatin. As for the delayed emesis, antiemetic effect depending on the steroid treatment duration, given concurrently to ondansetron, was compared. The results were as follows; 1. In 78 courses, anticancer drugs were given concurrently to cisplatin or carboplatin only on Day 1. In the remaining 31 courses, those drugs were concurrently administered up to Day 6 at the longest. 2. Complete suppression (i.e., no onsets) rate of acute emesis was 64.2% (70/109 courses) for nausea, and 84.4% (92/109 courses) for vomiting. 3. When the complete suppression depending on duration of concomitant steroid was examined mainly in patients receiving CAP (cyclophosphamide, adriamycin and cisplatin), higher antiemetic effect, especially in nausea, was observed in those on concomitant steroids for 3 days compared to that for 1 day. 4. The food intake rate improved along with nausea symptoms. 5. No adverse event or laboratory abnormality due to the multi-antiemetic treatment was observed. Based on the above, the efficacy of the antiemetic treatment in this study was confirmed. In delayed emesis, concurrent steroids given for 3 days after chemotherapy were considered effective and were also regarded to improve food intake.

Administration, Oral↗

PubMed1997

[Antithymocyte globulin as conditioning regimen for bone marrow transplantation].

Bone marrow transplantation was performed with a conditioning regimen including antithymocyte globulin (ATG) for 8 patients with HLA-compatible unrelated donors or HLA mismatched donor. Administration of ATG was halted due to side effects in only 1 case, but the other cases were had no adverse reaction. During administration of ATG, platelet counts did not decrease rapidly, but platelet infusion was not effective in some cases. As compared between patients with conventional allogeneic BMT, autologous BMT or peripheral blood stem cell transplantation and those with ATG administration, no obvious difference was seen between the two groups in lymphocyte counts, CD3, CD4, CD8 and CD20 positive cells. No patient with ATG saffered graft failure or acute GVHD. However, cytomegalovirus infection was observed more frequently than in patients without ATG. In hematological malignancy, relapse was more frequent than in patients without ATG.

Adolescent↗

PubMed1997

[A case of spontaneous rupture of renal cell carcinoma].

Spontaneous rupture of the kidney is uncommon. We report a case of spontaneous rupture of the kidney due to a renal cell carcinoma. A 53-year-old man presented with right renal tumor. Computed tomography demonstrated a 70 mm right renal tumor which involved the entire upper pole of the kidney and extended into the renal vein. A few days later, the patient had sudden severe right flank pain. Computed tomography of the abdomen revealed a large perirenal hematoma of the right kidney. Angiography demonstrated no vascular abnormality. Nephrectomy was performed. The histological examination showed rupture of a renal cell carcinoma in the right kidney.

Carcinoma, Renal Cell↗