Biomedical subjects

K Hashi

Publications and source records attributed to K Hashi.

At least 55 records · Page 3Linked to original sources

PubMed1996

[Distinctions of petroclival meningioma with perifocal edema on adjacent brain stem].

Although the most frequent benign tumor of the central nervous system, meningioma may be associated with extensive peritumoral edema. Whereas, peritumoral edema in the brain stem along the tumor in the infratentorial region has not been given sufficient recognition. Among 44 meningiomas attached to the petrous bone, 25 cerebellopontine angle meningiomas and 17 petroclival meningiomas, peritumoral edema in the brain stem along the tumor were clearly demonstrated on T2 weighted images of MRI in three petroclival meningiomas (6.8% of all clival and 17.6% of petroclival meningiomas). Attempts were made to surgically remove all of these tumors. However, during surgery an arachnoid/pial layer between the tumor and brain stem was destroyed completely and small perforating arteries were found to be encased in the tumor at the level of the associated edema. So surgical dissection of the tumors from the brain stem was quite difficult. By attempting radical removal of the tumor in the first case, even meticulous dissections caused direct surgical damage in the brain stem due to the obliteration of small perforating vessels. In the second case, a thin layer of the tumor remnant beside the brain stem was left intentionally, but a severe damage of the brain stem also occurred due to the obliteration of small perforating vessels. In the third case, only bulk reduction of the tumor was attempted to minimize the mass effect to the brain stem and the tumor located beside the brain stem with edema and encasing the cranial nerves and the perforating arteries from the vertebrobasilar artery was left untouched. This surgical attempt caused a transient worsening of a swallowing disturbance, but was not associated with the brain stem damage in this case. In meningiomas attached to the clivus, existence of associated peritumoral edema in the adjacent brain stem on T2 weighted images on MRI may be caused by the destruction of a arachnoid/pial layer and the encasement of small perforating vessels. The attempt at tumor dissection from the brain stem at the level of the edema was very difficult and led to serious surgical complications due to direct damage to the brain stem. In such cases, the surgery should aim at achieving a simple bulk reduction and the tumor beside the brain stem with edema should be left untouched.

Aged↗

PubMed1996

[Clinicopathological findings in symptomatic Rathke's cleft cyst: correlation between enhancement effects on MRI and histopathology of the cyst wall].

We have studied MR images and the histopathology of eight patients with symptomatic Rathke's cleft cysts. Six cases showed visual disturbance and two showed galactorrhea. In five, the cyst fluid had low signal intensity on T1-weighted images and high intensity on T2-weighted images; in 2, the cyst fluid had high intensity on both T1 and T2-weighted images; in 1, the cyst fluid had high intensity on T1-weighted images and low intensity on T2-weighted images. Enhancement of the cyst wall by Gd-DTPA was able to be distinguished in six cases: two patients showed no enhancement, two showed thin enhancement and the remaining two, thick enhancement. Fluid aspiration and total resection of the cyst wall was performed in all patients (three cases by the transcranial approach and five by the transsphenoidal approach). Normal pituitary glands were found in all cases during the operations. Histopathologically, ciliated epithelium with goblet cells was recognized in three cases. Non-ciliated epithelium was recognized in the other five. Stratified squamous component was recognized in one case and secondary inflammation, in another. Normal pituitary tissue was recognized in five cases. Immunohistochemically, ciliated and non-ciliated epithelium was successfully stained for detecting antibody against epithelial membrane antigen and/or carcinoembryonic antigen. Two cases with no enhancement of the cyst wall by Gd-DTPA showed only ciliated epithelium. Two cases with thin enhancement of the cyst wall had single layer epithelium with normal pituitary tissue. Two cases with thick enhancement of the cyst wall showed single layer epithelium with its stratified squamous component or with secondary inflammation. A close relationship was suggested between the enhancement effect on MRI and histopathology of the cyst wall.

Adult↗

PubMed1996

[Seizures as a late complication of bromocriptine therapy in patients with prolactin-producing macroadenomas: correlation between lateral extension of the adenoma and seizure onset].

Seizures have been reported as a late complication of medically treated prolactin-producing macroadenomas with lateral extension. Nine prolactin-producing macroadenomas with lateral extension to the cavernous sinus were treated with bromocriptine alone. In all cases, rapid decrease of serum prolactin level was recognized and in eight cases, evidence of tumor shrinkage on CT or MRI was demonstrated. During medical treatment, symptomatic seizures occurred in three cases. MRI showed small residual tumors on the medial surface of the temporal lobe in all these patients. Additionally, a hypointense signal on both T1- and T2-weighted images was recognized around the residual tumor. It was consistent with hemosiderin, a result of intratumoral hemorrhage caused by bromocriptine. On the contrary, the remaining six patients without seizures during treatment did not show abnormal hypointense signals on the medial surface of the temporal lobe. Seizures occur with a high incidence as a late complication of medical treatment of prolactin-producing macroadenomas with intradural supracavernous extension. The patients with seizure show hemosiderin deposit, which may be the trigger of the seizure, within the medial surface of the temporal lobe after bromocriptine therapy.

Adenoma↗

PubMed1996

[Evaluation of carotid artery stenosis with three-dimensional CT angiography and surgical revascularization].

The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to June 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r = 0.987, p < 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination.

Angiography, Digital Subtraction↗

PubMed1996

[Prognosis after total removal of craniopharyngiomas via the frontobasal interhemispheric approach].

Prognosis after total removal of craniopharyngiomas via the frontobasal interhemispheric approach is reviewed. Seventeen patients with craniopharyngiomas were operated on in Sapporo Medical University Hospital between January, 1985 and December, 1993. In eleven patients, lamina terminalis was incised and in the last six patients, it was left intact. Tumors were completely resected in all patients. After removal of the tumor, hypothalmic--pituitary functions, visual functions and psychometric functions were examined. Two of the 17 cases showed hypernaturemia and fourteen (82%) had permanent DI. Fourteen patients are receiving DDAVP and all are receiving endocrine replacement. Of fourteen patients who had disturbance of their visual acuity, nine (64%) improved. Five of six patients (83%) who presented visual field defect showed improvement in their deficits. Thirteen patients had a psychometric assessment at the time of follow-up examination. Full-scale intelligence quotient scores were distributed as follows: three above 120, five between 90 and 109, three between 70 and 79 and two below 69. Four (32%) had some impairment of memory. Concerning the QOL after total removal of craniopharyngiomas via the frontobasal interhemispheric approach, thirteen patients (76%) are leading normal lives, and three (18%) are leading nearly normal lives but require some help to overcome mild deficits. One (6%) has suffered a significant handicap.

Adolescent↗

PubMed1996

[Hearing preservation and tinnitus following removal of acoustic neurinomas].

Thirty-five cases of unilateral acoustic neurinomas were analyzed with special reference to the postoperative eighth cranial nerve function. An additional three cases of bilateral acoustic neurinomas associated with neurofibromatosis were also analyzed. Out of a total of 40 neurinomas in all, 38 cases were retrospectively reviewed. The thirty-five cases of unilateral acoustic neurinomas were summarized as follows. The patients' age ranged from 23 to 69 years old. The tumor size varied as follows; 7 cases were confined to the internal acoustic meatus, 4 cases were 20 mm or less in their maximum diameter, 13 cases were 30 mm or less, and 11 cases were more than 30 mm. The consistency of the tumor was classified as being solid in 27 cases, and being cystic in 8 cases. Hearing had been maintained in 27 cases on admission, serviceable in 17 cases, unserviceable in 10 cases and deaf in 8 cases. Operations were performed via the retromastoid suboccipital approach in all cases. The facial nerve was anatomically preserved in all cases. On the other hand, the cochlear nerve was anatomically preserved in 14 out of 35 cases (40%). The preservation ratio of the cochlear nerve showed a negative correlation to the tumor size. In 17 cases with preoperative serviceable hearing, preservation of the cochlear nerve was attempted, which resulted in a 65% anatomical preservation. However, hearing was preserved in 4 cases (36%). Serviceable hearing was preserved in only 2 cases. Tinnitus developed in 20 cases preoperatively, and then occurred postoperatively in 11 cases. Tinnitus was prominently aggravated in 2 cases in which the cochlear nerves were preserved, which resulted in unserviceable hearing. There was a statistically significant correlation between cochlear nerve preservation and the postoperative presence of tinnitus (Fisher's exact probability test: P = 0.0106 < 0.05). Tinnitus was aggravated just after the operation. However, it gradually improved and vanished as the hearing showed a recovery to a slight degree in one case. Three cases of bilateral acoustic neurinomas in neurofibromatosis were also summarized. One case received the operation only on the unilateral side. The remaining two cases were operated bilaterally. To preserve serviceable hearing on at least one side, partial removal of the tumor was performed under the monitoring of auditory brain stem response and/or cochlear microphonic potential. Serviceable hearing on at least one side was maintained in all three cases. In conclusion, hearing preservation can be expected after removal of the acoustic neurinomas under the following situations; hearing acuity of less than 50-60dB in preoperative pure tone audiogram, tumor size of less than 20 mm in maximum diameter, cases with preservation of cochlear nerve and of the internal auditory artery during the operation, and no injury to the labyrinth during the operation. In some cases, tinnitus becomes aggravated in the case with cochlear nerve preservation associated with unserviceable hearing. Furthermore, the degree of tinnitus shows a decrease as postoperative hearing improves in some cases.

Adult↗

PubMed1996

[Characteristics of visual impairment complicated with planum sphenoidale and tuberculum sellae meningiomas and their surgical results].

It is well known that it is difficult to remove the planum sphenoidale and tuberculum sellae meningioma without damaging the optic nerves. The visual outcome after this operation has been unacceptable in such tumors, especially in large ones. This review propounds a strategy to secure visual acuity through operation. A total of eight cases are summarized. In five midline symmetrical meningiomas, the tumors compressed the nerves at the portion of the optic chiasma, causing a typical bitemporal hemianopsia. Four large tumors were resected by the frontobasal interhemispheric approach to minimize the intraoperative damage to the optic chiasma, and a small one was removed by the pterional approach. Visual deficits were recovered immediately after the operation in all cases without any surgical complications. Three meningiomas were attached to the lateral part of the planum sphenoidale or tuberculum sella. Although the sizes were relatively small in all cases, they caused ipsilateral severe visual loss by direct compression to optic nerves. MRI and three-dimensional CT angiography showed the tumor extension into the optic canal. The ipsilateral pterional approach was selected in these cases. To avoid additional nerve damage, we tried to reduce the tension of nerves which were compressed by the tumors. We removed the anterior clinoid process and opened the optic canal before surgical manipulation of the tumor. In two cases, tumors severely compressed the optic nerves from the medial side, and nerves were stretched laterally. Great care was required to separate the optic nerves from tumors in those two cases. In contrast, the resection seemed to be very easy in one of the cases where the optic nerve was displaced infero-medially. Visual symptoms were improved in all cases, although one case became worse temporarily. Although planum sphenoidale and tuberculum sellae meningiomas are still troublesome, appropriate preoperative management would allow us to expect an excellent visual outcome. Especially, selection of the surgical approach should be based on the anatomical analysis of the nerve displacement.

Adult↗

PubMed1995

Novel modification of ceramide: rat glioma ganglioside GM3 having 3-O-acetylated sphingenine.

A novel O-acetylated GM3 containing 3-O-acetyl 4-sphingenine was isolated with one having a non-acetylated base from transplanted rat glioma tissue. The presence and position of the acetyl group were estimated by one- and two-dimensional proton nuclear magnetic resonance, and fast atom bombardment-mass spectrometries. In addition, the O-acetyl GM3 showed higher immunological activity toward anti-melanoma antibody in the presence of non-acetylated GM3 in complement-dependent liposome lysis than did non-acetylated or acetylated GM3 alone in the liposome, suggesting enhancement of immunological reactivity of the intact tumor cells by a small amount of O-acetyl GM3.

Animals↗

PubMed1995

Interleukin 4 enhances ganglioside GD3 expression on the human fibroblast cell line WI-38.

Human fibroblast cell line WI-38 cultured in vitro was treated with a human recombinant IL-4 at concentrations of 1 to 100 U/ml to examine the alteration of glycosphingolipid (GSL) expression of the cells. Neutral GSL of non-treated WI-38 cells consisted of CMH (GlcCer), CDH, CTH, and Gb4Cer; CMH and CTH were the major components. The acidic GSL were composed of GM3 as the predominant component and other minor gangliosides including GD3. The neutral GSLs did not change in profile during the treatment with IL-4, while the acidic GSLs showed a prominent change, an increase of GD3 content. The increase of GD3 was detectable with IL-4 concentrations over 1 U/ml, and reached a plateau at 10 U/ml, where the amount of GD3 was almost equal to that of GM3. The GD3 increase occurred at 24 h after the IL-4 treatment, and lasted for at least 96 h, as long as IL-4 remained present in the culture media. The GD3 synthase (sialyltransferase) level was found to be increased in an IL-4 dose-dependent manner. IL-4 did not influence the growth or morphological appearance of WI-38 cells. The results demonstrate a novel biological effect of IL-4, modulating GSL in non-hematopoietic cells.

Cell Line↗

PubMed1995

Isotonic mannitol and the prevention of local heat generation and tissue adherence to bipolar diathermy forceps tips during electrical coagulation. Technical note.

The authors observed temperature levels of saline and mannitol on the tips of bipolar diathermy forceps during application of power to the forceps and compared the effects of irrigation with saline and isotonic mannitol on electrical coagulation of vessels during neurosurgical operations. There was a marked rise in the temperature of saline corresponding to increased output power of the coagulator; there was no rise in the temperature of the mannitol. Irrigation with isotonic mannitol during surgery resulted in a considerable reduction of adherence of burned tissue and blood clots to forceps tips during coagulation of both arteries and veins compared with that which occurred during irrigation with saline. These results demonstrate that irrigation with an isotonic mannitol surpasses that with conventional ionic fluids, such as a saline, for prevention of both tissue adherence to bipolar diathermy forceps and removal of heat generated during electrical coagulation.

Burns↗

PubMed1995

[Spinal intradural arachnoid cyst associated with enlarged filum terminale].

This is a report of a spinal intradural arachnoid cyst associated with an enlarged filum terminale. A 9-year-old female was admitted to our hospital complaining of lumbosacral pain. Neurological examination revealed no abnormal findings. CT scan showed a round shaped mass lesion in the right dorsolateral side of the spinal canal between the level of L1 to S1/2. The mass lesion disclosed isodensity and was not enhanced. A small low density mass lesion was visualized in the dural sac at the same level. MRI showed the mass lesion with low signal intensity on the T1-weighted image, and high signal intensity on the T2. The small mass lesion in the dural sac was demonstrated with low signal intensity on the T1 and T2-weighted image. In addition to this finding, Chiari malformation type I was disclosed. It was suspected that this mass lesion was extradural arachnoid cyst associated with an enlarged filum terminale. Osteoplastic laminotomy between L3 to S1/2 was performed, and an arachnoid cyst was found in the intradural space. It compressed the cauda equina and enlarged tough filum terminale. The cyst was removed subtotally, and the filum terminale was cut off. Postoperative course was uneventful and the lumbosacral pain disappeared. It was thought that this pain might be derived from the intradural arachnoid cyst, or the enlarged filum terminale.(ABSTRACT TRUNCATED AT 250 WORDS)

Arachnoid Cysts↗

PubMed1995

[Diagnosis of ruptured and unruptured cerebral aneurysms with three-dimensional CT angiography (3D-CTA)].

Three-dimensional CT angiography (3D-CTA) is a new, minimally invasive technique for the diagnosis of cerebral aneurysms. The purpose of this study is to compare the diagnostic value of 3D-CTA for ruptured and unruptured cerebral aneurysms with that of MR angiography (MRA) and digital subtraction angiography (DSA). Forty-one cases consisting of 11 cases of ruptured aneurysms and 30 cases of unruptured aneurysms, with a total of 67 cerebral aneurysms, were included in this study. 3D-CTA was performed with a bolus injection of nonionic contrast medium on the SOMATOM PLUS-S scanner and the ProSeed Accell scanner. Three-dimensional images were obtained by both shaded surface reconstruction (SSR) method and maximum intensity projection (MIP) method. The CT values of cisternal clot in cases of ruptured cerebral aneurysms did not exceed 90HU in any of the cases. The effect of SAH was, therefore, eliminated in the SSR images through a threshold level processing of a CT value of 150HU. All the cerebral aneurysms were visualized by this process. With regard to the detectability of cerebral aneurysms, 3D-CTA was able to demonstrate cerebral aneurysms with diameters of larger than 1mm as well as giant aneurysms which MRA would sometimes fail to reveal. 3D-CTA was superior to MRA and DSA in making diagnosis of small aneurysms such as those with diameters of less than 3mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[A case of systemic lupus erythematosus associated with cerebral infarction and cerebral hemorrhage].

This is a report of cerebral infarction and cerebral hemorrhage derived from systemic lupus erythematosus. A 49-year-old male was admitted to our hospital due to dysarthria and supranuclear facial palsy. He had been suffering from SLE and medicated incompletely since 9 years prior to admission. A CT scan showed a small infarction in the left parietal area. An angiography revealed a tapering stenosis of the left carotid siphon and an occlusion of the left vertebral artery at the cisternal portion. On the 13 days after the admission, he complained of a high fever and right hemiparesis. The CT scan disclosed newly multiple small infarctions in the left parietal area. The angiography showed the progressing of the tapering stenosis at the left carotid siphon, and demonstrated the narrowing of the left superior temporal artery and ophthalmic artery in addition to the disappearance of a left posterior communicating artery. High dose of steroid was given to him, but cerebral hemorrhage and huge left cerebral infarction were complicated. On the 26 days after the admission, his general condition was worsened and died. It was considered that the cerebral infarction and hemorrhage might be derived from the vasculitis of SLE.

Cerebral Angiography↗

PubMed1995

[A case of growing up aneurysms with occlusion of basilar artery].

This is a report of unruptured aneurysms with occlusion of the basilar artery. A 61-year-old female was admitted to our hospital because of dysarthria and numbness of her left face. Angiography revealed occlusion of the basilar artery and severe arteriosclerosis of the bilateral cerebral carotid arteries. Pcom was not visualized on bilateral carotid angiogram. These neurological signs were considered to be derived from vertebrobasilar insufficiency by occlusion of the basilar artery. Right STA-SCA anatomosis was performed to prevent brain stem infarction. Postoperative angiography showed a good filling of both PCA and SCA by collateral circulation via a right STA and an unruptured basilar top aneurysm. Seven months after the bypass surgery, angiography disclosed that the basilar top aneurysm was visualized clearly, and its size was unchanged. The fact that there was no thrombus formation in the aneurysm was considered to be due to ticlopidine, and the hemodynamic changes after the bypass surgery were suspected to have increased the intraaneurysmal pressure. Therefore we performed neck clipping of the basilar top aneurysm by using a right pterional approach. Two years after the second operation, the patient complained of severe headache and vomiting. CT scan showed subarachnoid hemorrhage, and angiography demonstrated a newly developed aneurysm which might have ruptured on left internal carotid anterior choroidal artery bifurcation. Emergency neck clipping of the second aneurysm was performed, and the patient showed a good postoperative course. The newly developed second aneurysm might have been caused by severe arteriosclerosis and hypertension in addition to hemodynamic stress.

Arterial Occlusive Diseases↗

PubMed1995

[Percutaneous transluminal angioplasty for cervical carotid artery stenosis].

Percutaneous transluminal angioplasty (PTA) was attempted in 16 patients (17 procedures) with cervical internal carotid artery (ICA) stenosis. Among the 16 patients, 14 were male and 2 were female aged from 44 to 76 years (average 63.4 years). One had cerebral infarction on the acute stage, and the other 15 were in the chronic stage. On CT scan and MRI, there were nine multiple lacunar infarctions and seven watershed infarctions. On angiographical findings, 13 had Rt.-ICA stenosis and 4 had Lt. ICA stenosis. Stenotic lesion existed beyond the level of the third cervical vertebral body in eleven cases, and so-called long segmental stenosis ranged from 3 to 5 cervical vertebral bodies in 3 cases. Before PTA, 14 patients underwent a balloon occlusion test for 3 to 20 minutes (average 9 minutes). Neurological symptoms of hemiparesis or sensory disturbance occurred in 3 patients during balloon inflation, but these disappeared completely after balloon deflation. It took from 1.5 to 2 hours (average 1.7 hours) to carry out PTA including the balloon occlusion test. All cases had satisfactory results with no morbidity or mortality. The mean stenosis ratio of pre-PTA, approximately 80% (55-93%), improved to that of 22% (0-50%) after PTA. Bradycardia and hypotension occurred transiently in 9 cases during and after PTA, but no symptoms remained by atropine sulfate and catecholamine infusion intravenously. In the following 1 to 26 months (mean 9.0 months) after PTA, 3 cases restenosed. The restenosis was recognized by MR angiography after 8 to 26 months (average 15.7 months) of PTA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[Bleeding from unruptured dissecting aneurysm in the vertebral artery after proximal clipping].

This is a case report of a patient with unruptured dissecting aneurysm in the vertebral artery that bled after being treated by proximal clipping. A 53-year-old male was admitted to our hospital due to transient right hemiparesis which occurred 20 days prior to his admission. He had been medicated for hypertension for the previous 33 years. CT scan and MRI showed lacunar infarction in the left corona radiata, and an aneurysm was accompanied with clot in the prepontine cistern. Angiography revealed a dissecting aneurysm in the right intracranial vertebral artery. His right hemiparesis was derived from infarction in the left corona radiata. It was likely that the dissecting aneurysm might rupture in the future. Proximal clip ping was performed to prevent rupture of the aneurysm. After clipping of the right vertebral artery distal to the PICA, the wall of the aneurysm appeared to be drawn toward the clip blades and to be tensed by the blades. Four hours after the operation, he complained of severe headache, and experienced a sudden loss of consciousness and the immediate development of a deep comatose state. CT scan disclosed massive SAH in the right cerebellopontine and basal cistern. Repeat angiography demonstrated that the aneurysm was not visualized and the right vertebral artery distal to the aneurysms was opacified through the left vertebral artery. Ventricular drainage was performed, but the patient died on the 20th day after bleeding. It was suspected that the aneurysmal clip might have produced shear force on the weak adventitia of the dissecting aneurysms and that the intra-aneurysmal pressure might have increased because of blood back-flow via the contralateral vertebral artery after the proximal clipping.

Aortic Dissection↗

PubMed1994

The incidence and treatment of asymptomatic, unruptured cerebral aneurysms.

The importance of early detection by various radiological techniques of asymptomatic, unruptured aneurysms as a means of preventing subarachnoid hemorrhage (SAH) is discussed in this report. Four hundred volunteers underwent clinical and radiological evaluations between March, 1988, and September, 1992. Studies included a neurological examination as well as digital subtraction cerebral angiography via a femoral arterial catheter, computerized tomography, T1- and T2-weighted magnetic resonance (MR) imaging of the whole brain, and MR angiography. The evaluation revealed 27 asymptomatic, unruptured intracranial aneurysms in 26 volunteers, for an incidence of 6.5%. The subjects ranged in age from 39 to 71 years, with an average of 55 years. The aneurysms were located on the internal carotid artery in 13 cases (48%), the anterior communicating artery in six (22%), the middle cerebral artery in six (22%), and the basilar artery in two (7%). Aneurysms ranged in size from 5 mm or less in 16 cases, 6 to 10 mm in nine, and 11 to 15 mm in one; one aneurysm was more than 15 mm, with a maximum diameter of 2 cm. Volunteers with a family history of SAH within the second degree of consanguinity showed a higher incidence of aneurysms (17.9%). Aneurysm clipping was performed on 20 of the 26 cases with no significant morbidity or mortality. These findings support the contention that aggressive early detection of unruptured aneurysms may improve the outcome in patients harboring cerebral aneurysms by preventing the devastating effects of SAH.

Adult↗

PubMed1994

[A case report of interstitial pneumonia caused by granulocyte colony-stimulating factor].

Several clinical trials have demonstrated that granulocyte colony-stimulating factor (G-CSF) accelerates the recovery of neutropenia in chemotherapy-induced bone marrow suppression. In this report, we describe a 46-year-old female with glioblastoma multiforme who developed interstitial pneumonia due to administration of G-CSF during the phase of immunochemoradiotherapy-induced neutropenia. Thirty-three days after starting immunochemoradiotherapy (ACNU, VCR, IFN -beta, radiation), she developed neutropenia (1,000/microliters). Administration of G-CSF at doses of 125-250 micrograms/day led to an increase of peripheral neutrophil counts. Eleven days later, the patient developed sudden severe respiratory failure and cyanosis with worsening of lung shadows. Blood gas levels on room air were PaO2 49.3mmHg, PaCO2 28.0mmHg, and pH 7.46. At this time, her neutrophil count had risen to 26,080/microliters. LDH and alpha - HBD had also increased to 1,439 IU/l and 1,117IU/l respectively. Chest radiograph and CT scan demonstrated interstitial pneumonia. After treatment with methyl prednisolone, her respiratory symptoms were gradually resolved. A number of side-effects have been reported with granulocyte-macrophage colony-stimulating factor (GM-CSF). These include fluid retention with pericardial and pleural effusion, fever, bone pain, fatigue, and rash. This report also suggests that G-CSF might be a cause of interstitial pneumonia during the phase of immunochemoradiotherapy-induced neutropenia.

Brain Neoplasms↗