Biomedical subjects

K Hida

Publications and source records attributed to K Hida.

At least 19 recordsLinked to original sources

PubMed2000

Externally Supported, Noncoated, Knitted Dacron Graft and Gelatin-Coated Knitted Dacron Graft with Rings for Peripheral Arterial Reconstruction.

During the last 14 years, externally supported noncoated knitted Dacron grafts (EXS) and gelatin-coated knitted Dacron grafts with rings (GEL) were used in 176 patients for femoropopliteal bypass (F-P), femorofemoral bypass (F-F) and axillofemoral bypass (Ax-F). In the EXS group, 58 F-P above knee (ak), 42 below knee (bk), 25 F-F, and 19 Ax-F surgeries were performed. Twenty-three F-Pak, 5 F-Pbk, 26 F-F, and 8 Ax-F surgeries were performed in the GEL group. In the F-Pak, primary patency at 5 and 9 years was 75.5 and 53% for the EXS and that at 3 and 5 years was 75.0 and 60.0% for the GEL (n.s.). In the F-Pbk, primary patency at 5 and 10 years was 60.5 and 29.5% for the EXS, while patency at 1 year was 11.1% for the GEL (P < 0.05). In both the EXS and the GEL groups, the F-Pak surgery showed better outcomes than the F-Pbk surgery. The outcomes of the F-P grafts implanted into the legs with claudication were better than those performed for the limb salvage cases. Primary patency of the F-F and the Ax-F showed no differences and there were also no differences between the graft types. For F-Pak surgery, the EXS is the graft of choice. The GEL is not suitable for F-Pbk surgery. For F-F and Ax-F reconstruction, both the EXS and the GEL are acceptable.

Journal Article↗

PubMed2000

Chronological changes in MRI findings of spinal dural arteriovenous fistula.

BACKGROUND: Intramedullary high-intensity changes on T2-weighted magnetic resonance images (MRI) occur in patients with spinal dural arteriovenous fistulas (AVF). Reduction of the high-intensity area after treatment has been noted; however, there are still questions about whether the change is related to preoperative clinical grade, postoperative improvement, or efficacy of treatment. This study tried to clarify the relationship between chronological changes in the high intensity area with the treatment and clinical course. METHODS: Chronological changes in an intramedullary high-intensity area after surgery were retrospectively analyzed in recent 13 patients with spinal dural AVFs who were treated and followed by MRI. RESULTS: Preoperative intramedullary high-intensity areas were observed on T2-weighted images in all cases. The extent of the high-intensity area correlated with preoperative neurological deficits. The intramedullary high-intensity area was reduced or diminished after successful interruption of AVFs. The high-intensity area started to decrease within 1 to 4 months after treatment in all patients, and disappeared at 2 weeks to 23 months in seven patients. The reduction may suggest interruption of the fistula and improvement of venous circulation, but was not always correlated to clinical improvement. The intramedullary high-intensity areas rapidly disappeared in two patients, but did not clearly correspond to the clinical improvement. CONCLUSIONS: The time course of postoperative MRI changes is helpful for evaluating the efficacy of treatment after surgery for spinal dural AVFs.

Adult↗

PubMed2000

Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of syringosubarachnoid (S-S) shunting for syringomyelia with Chiari malformation. The authors describe the technical methods of performing the S-S shunt and the clinical results, including shunt malfunction. METHODS: Forty-nine patients underwent S-S shunting. These patients were divided into three groups according to differences in the surgical technique used. Group I patients underwent laminectomy plus midline myelotomy and had a shunt tube placed in the dorsal subarachnoid space. Group II patients underwent laminectomy plus dorsal root entry zone myelotomy and had a shunt tube placed in the dorsolateral subarachnoid space. Group III patients underwent hemilaminectomy plus dorsal root entry zone myelotomy and had a shunt tube placed in the ventrolateral subarachnoid space. RESULTS: Clinical results were generally satisfactory, especially in terms of pain relief, in all three groups. However, 10 patients among Groups I and II required follow-up surgery because of shunt problems; no second surgery was necessary for any patient in Group III. CONCLUSION: The S-S shunt was very effective in deflating the syrinx, and the clinical results were satisfactory. Therefore, even though foramen magnum decompression is a very effective treatment, S-S shunting should be reevaluated and not rejected; it should be considered as one of the major surgical options. To prevent the possibility of cord injury by myelotomy or shunt malfunction, the dorsal root entry zone should be selected as the myelotomy site, and the shunt tube should be inserted into the ventral subarachnoid space at the cervical level.

Adolescent↗

PubMed1999

Pediatric syringomyelia with chiari malformation: its clinical characteristics and surgical outcomes.

BACKGROUND: Most reports regarding pediatric syringomyelia have focused not only on Chiari malformation, but also on spinal dysraphism. However, the clinical characteristics of syringomyelia with spinal dysraphism are quite different from those of syringomyelia due to Chiari Type I malformation. The objectives of this study were to identify clinical characteristics of pediatric syringomyelia and to determine whether surgery prevents or corrects the scoliosis associated with syringomyelia. METHODS: We reviewed the records of 16 pediatric patients with syringomyelia and Chiari Type I malformation. The patients' ages ranged from 3 to 15 years, with mean age of 9.8 years. None of the patients had spinal dysraphism. RESULTS: Nystagmus was observed in 2 of the 16 patients, motor weakness in 8 patients, sensory disturbance in 10 patients, and scoliosis in 13 patients. As the initial surgical procedure, foramen magnum decompression (FMD) was performed in seven patients and syringo-subarachnoid (S-S) shunting in nine patients. The motor function improved in 7 of the 8 affected patients, and the sensory disturbance improved in 9 of the 10 affected patients. The magnetic resonance images obtained after the surgery revealed marked decrease of the syrinx size in all patients. Of the 13 patients with scoliosis, 5 showed improvement, 5 stabilization, and 3 deterioration. CONCLUSIONS: Compared with adolescent and adult syringomyelia, pediatric syringomyelia shows a much lower incidence of sensory disturbance and pain, but quite a high incidence of scoliosis. Surgery is effective in improving or stabilizing scoliosis in these patients.

Adolescent↗

PubMed1999

Screening for genes up-regulated in 5/6 nephrectomized mouse kidney.

BACKGROUND: In diabetic and nondiabetic renal diseases, glomerular hyperfiltration is believed to play a central role in the subsequent progression of glomerulosclerosis and interstitial renal scarring. To identify genes involved in the process of hyperfiltration and hypertrophy, a polymerase chain reaction (PCR)-based subtraction method, that is, representational difference analysis of cDNA (cDNA-RDA), was employed. METHODS: Ten-week-old ICR mice were 5/6 nephrectomized and sham operated. After two weeks, mRNAs were isolated from control and remnant kidneys and were subjected to the cDNA-RDA procedure. RESULTS: We identified 10 known and 9 novel genes. Among 19 clones, 12 clones (8 known and 4 novel) showed 1.5- to 6-fold up-regulation by Northern blot analyses. The remaining seven clones were rarely expressed genes and were barely detected by Northern blot analyses, and their up-regulated expression was confirmed by Southern blot analysis using the PCR-amplified representative amplicons. The known genes included kidney androgen-regulated protein, major urinary protein, lysozyme M, metalloproteinase-3 tissue inhibitor, chaperonin 10, cytochrome oxidase I, epsilon-sarcoglycan, ribosomal protein S3a, G-proteingamma10 subunit, and splicing factor 9G8. All of the isolated known genes have not been reported to be up-regulated in the nephrectomized mouse kidney and suggest the possible role of androgen action, mitochondrial functions, matrix metabolism, cell-matrix interactions, and intracellular signaling events in the initiation of the progressive renal injury of the remnant kidney. Furthermore, cDNA-RDA facilitates the discovery of novel genes, including two kidney-specific genes. CONCLUSIONS: The isolated known and novel genes may be involved in the pathobiological process of initial hyperfiltration and hypertrophy of remnant kidney.

Animals↗

PubMed1999

Syringo-subarachnoid shunt for syringomyelia using partial hemilaminectomy.

Syringo-subarachnoid shunt (S-S shunt) is one of the established surgical procedures for syringomyelia. However, this procedure requires a laminectomy which may lead to spinal column complications. We present a modified form of S-S shunt using a partial hemilaminectomy; a S-S shunt is placed via the dorsal root entry zone into the anterior subarachnoid space which is considered to be an ideal site for the drainage of the syrinx fluid. This technique will decrease the incidence of neuronal and spinal complications after surgery and avoid subarachnoid adhesions around the shunt tube. Between 1992 and 1997, a total of 24 patients with syringomyelia have been treated with this surgical procedure without any complications. Collapse of the syrinx was achieved in all cases. The authors believe that the procedure is an effective surgical treatment for syringomyelia and can be applied safely to adolescent and child cases.

Adolescent↗

PubMed1999

Anterior approach to intramedullary hemangioblastoma: case report.

OBJECTIVE AND IMPORTANCE: Intramedullary spinal cord tumors are generally operated on by using the posterior approach. However, the posterior approach may not be suitable for a tumor in the anterior part of the spinal cord. In this report, we describe a case of a cervical intramedullary tumor that was successfully removed by using the anterior approach. CLINICAL PRESENTATION: A 48-year-old woman presented with lower cranial nerve disturbance and motor weakness of the upper extremities. Magnetic resonance imaging revealed a large extensive syrinx and an intramedullary enhanced tumor at the C6 level. The tumor was located at the left of the anterior part of the spinal cord. INTERVENTION: Based on these findings, the anterior approach was used in performing a corpectomy of C5 and C6. The tumor was highly vascular and was resected without resulting in any operative deficits. The pathological diagnosis was hemangioblastoma. CONCLUSION: The present case suggests that the anterior approach is an important option among surgical approaches to the intramedullary tumor in cases in which the tumors are small in size and are located in the anterior part of the cervical cord.

Cervical Vertebrae↗

PubMed1999

Functional prognosis after treatment of spinal dural arteriovenous fistulas.

Functional prognosis after treatment for spinal dural arteriovenous fistulas (SDAVFs) was retrospectively analyzed in 13 consecutive patients aged 38 to 73 years (mean 57 years) treated during the last 5 years. The duration of symptoms before diagnosis ranged from 3 to 72 months (mean 23 months). Neurological symptoms were examined before and 6 months after the treatment. Seven patients underwent embolization as the initial treatment. In four of six patients, N-butyl 2-cyanoacrylate (NBCA) embolization achieved complete obliteration of SDAVF. The other two patients with incomplete embolization and one embolized with polyvinyl alcohol particles underwent subsequent surgical treatment. Six patients were treated by direct surgery. Complete disappearance of SDAVF was confirmed in all nine patients treated surgically. Improvement of gait and micturition disturbance after the treatment was noted in six of 10 and three of six patients, respectively. Long duration of symptoms and high grade of neurological symptoms were associated with a poor functional outcome. NBCA embolization and surgery are curative treatments for SDAVF, but the functional prognosis is not always satisfactory. Embolization is the first choice of treatment for SDAVF because it is less invasive and relatively safe. However, when complete obliteration is not achieved, prompt surgery is recommended because a long duration of symptoms will result in a poor functional prognosis.

Adult↗

PubMed1999

Anterior approach for dumbbell type cervical neurinoma.

A one-stage anterior approach was performed in four patients for total removal of dumbbell type neurinoma at the cervical level. In each case, the neurinoma compressed the spinal cord in the cervical canal, developed anteriorly through the intervertebral foramen, and compressed the vertebral artery. A conventional cervical anterior approach at the tumor site was performed, followed by confirmation of the tumor located outside the spinal canal. After identification of the vertebral artery, corpectomy was carried out and the extradural component of the tumor was resected. In cases with a portion of the tumor located also within the dura mater, the dura mater was opened for removal of the intradural tumor. We found the anterior approach to be effective for the total removal of some kinds of cervical dumbbell type neurinomas.

Adult↗

PubMed1999

Results of the surgical treatment of perimedullary arteriovenous fistulas with special reference to embolization.

OBJECT: This retrospective study was performed to evaluate the results of surgical treatment and the use of preoperative embolization in managing patients with perimedullary arteriovenous fistulas (AVFs). METHODS: The authors studied 20 consecutive patients with perimedullary AVFs who underwent surgical treatment. Arteriovenous shunts were at the level of the cervical spine in five patients, the thoracic spine in 12, and the conus medullaris in three patients. Of the 20 AVFs, three were fed by the anterior spinal artery only, three by the posterior spinal artery, and 14 by both the anterior and posterior spinal arteries. Nine patients had varices that compressed the spinal cord. Eleven patients underwent surgery, and nine patients underwent surgery combined with adjuvant preoperative embolization. Preoperative embolization remarkably reduced blood flow through the AVFs and facilitated subsequent surgical procedures. Postoperative angiography revealed complete disappearance of the AVFs in 16 patients. However, small fistulas persisted in the other four patients, whose large lesions were fed by the anterior spinal artery. Postoperatively, neurological status was improved in 11 patients, unchanged in eight, and worse in one patient. CONCLUSIONS: Effective interruption of a spinal arteriovenous shunt was achieved by surgery in all cases, even when the anterior spinal artery was involved. For large and high-flow AVFs, embolization proved to be a useful adjunct to surgery.

Adolescent↗

PubMed1998

A split cord malformation.

This report describes a case of split cord malformation without a septum. A 2-year-old boy presented with a 3-month history of neurogenic bladder. MRI did not show any apparent abnormality around the conus medullaris. However, CT myelography clearly demonstrated the presence of a split filum terminale. The patient underwent laminectomy of L1-5 laminas and untethering of the split filum terminale. CT myelography was superior to MRI in diagnosing split cord malformation in this case. As MRI is currently regarded as the superior imaging modality, this reported case may have been missed because the pathology was not apparent on MRI.

Cauda Equina↗

PubMed1998

Limb salvage and survival rates among elderly patients with advanced limb ischemia.

The purpose of this study was to clarify the incidence of limb salvage and patient survival rates among elderly patients with advanced leg ischemia. We reviewed the records of 159 patients treated for advanced ischemia over a 15-year period at Aichi Medical University, 74 of whom were aged over 75 years and 85, between 65 and 74 years. There was a collective total of 186 limbs; 82 in the older group and 104 in the younger group. The older group had a greater proportion of women, and a higher incidence of coronary heart disease, pulmonary dysfunction, and acute onset of advanced ischemia than the younger group. Limb salvage was achieved in 73% of the affected limbs in the older group and in 92% of the limbs in the younger group. The poor limb salvage rate in the older group was mainly related to the high initial amputation rate. Early recognition of the sentinel ischemic signs before the ischemia is essential, especially in the elderly. Timely revascularization should be attempted whenever possible, and it should not be abandoned simply because the patient is deemed too old. The 1-, 3-, and 5-year survival rates in the older group were 59%, 28%, and 23%, respectively, which were markedly poorer than the expected survival rates of the age- and sex-matched Japanese population at 1, 3, and 5 years, which were 93%, 79%, and 65%, respectively. Thus, advanced limb ischemia carries a poor prognosis to the point of being life-threatening, and further continuous systemic management with the collaboration of physicians and surgeons must be provided even after the patient has left the hospital.

Aged↗

PubMed1998

Spinal intrathecal actinomycosis: a case report.

BACKGROUND: Actinomycosis of the central nervous system is a rare disease that most frequently forms cerebral abscesses. In the present report, we describe an extremely rare case of spinal intrathecal actinomycosis. CASE PRESENTATION: A 33-year-old man presented with high fever followed by back pain and paraparesis. Magnetic resonance imaging (MRI) with gadolinium-diethylene-triamine penta-acetic acid (Gd-DTPA) enhancement (Gd-MRI) displayed an irregularly enhanced mass lesion at the thoraco-lumbar junction that mimicked an intramedullary tumor with exophytic growth. Surgical exploration 7 months after the onset of the high fever revealed intrathecal granulation tissue with small abscess formation. Another surgical exploration was carried out 2 months after the first operation because the patient developed progressive paraparesis and showed an intrathecal ring-like enhancement that was detected with Gd-MRI. Actinomyces organisms were finally identified histologically in the surgical specimen. CONCLUSIONS: The clinical course and serial changes of Gd-MRI findings are important considerations when this rare and infectious spinal lesion is suspected.

Abscess↗

PubMed1998

Cerebral metastasis in patients with uterine cervical cancer.

We report on eight patients who developed brain metastases following uterine cervical cancer. The mean interval between diagnosis of the primary cancer and diagnosis of the brain metastasis was 28.4 months (range: 6.1-61.8 months). Nausea and vomiting due to increased intracranial pressure were the most frequent symptoms. Surgical excision of the brain lesions, followed by postoperative radiotherapy, was performed in three patients. The other five patients received only cranial radiotherapy. When the metastatic brain lesions were detected, other distant metastatic lesions were confirmed at the same time in five patients. The median survival time after diagnosis of the brain metastases was only 3.0 months.

Adenocarcinoma↗

PubMed1998

Spontaneous shrinkage of lumbosacral lipoma in conjunction with a general decrease in body fat: case report.

OBJECTIVE AND IMPORTANCE: We describe a rare case of a lumbosacral lipoma that shrank spontaneously in parallel to a general loss of body fat. Although early prophylactic surgery is generally recommended for lumbosacral lipomas, the observation made in this case may provide an important implication regarding the conservative management of this disorder. CLINICAL PRESENTATION: A 9-year-old male patient with a subcutaneous lipoma at the sacral level was found to have a lumbosacral lipoma in the spinal canal and tethered spinal cord, as revealed by magnetic resonance imaging. The patient showed no neurological or urological deficits, except for a mild pes cavus deformity. INTERVENTION: Follow-up magnetic resonance imaging performed 4 years later revealed a significant decrease in the size of the lumbosacral lipoma. The patient became very thin and showed no neurological deterioration during the follow-up period. The shrinkage of the lipoma was considered to be in association with the general loss of body fat. CONCLUSION: The control of body weight may be an important factor in the conservative management of patients with lumbosacral spinal lipomas.

Child↗

PubMed1998

Magnetic resonance imaging findings in ossification of the posterior longitudinal ligament of the cervical spine.

OBJECT: Because of the lack of magnetic resonance (MR) signal from cortical bones, MR imaging is inadequate for diagnosing ossified lesions in the spinal canal. However, MR imaging provides important information on spinal cord morphology and associated soft-tissue abnormality. The purpose of this study is to determine the role of MR imaging in the diagnosis and treatment of patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. METHODS: The authors reviewed MR imaging findings in 42 patients with cervical OPLL who were examined with a superconducting MR imaging system. The types of OPLL reviewed included eight cases of continuous, 21 cases of segmental, and 13 cases of the mixed type. All patients were treated surgically either by anterior (26 cases) or posterior decompression (16 cases). CONCLUSIONS: The T1-weighted images clearly demonstrated the spinal cord deformity caused by OPLL. Associated disc protrusion was found to be present at the maximum compression level in 60% of the patients in this series. The highest incidence of disc protrusion (81%) was found in patients with segmental OPLL. Intramedullary hyperintensity on T2*-weighted imaging was noted in 18 patients (43%). The neurological deficits observed in these 18 patients were significantly more severe than those observed in the other 24 patients. Postoperative MR imaging revealed improvement in the spinal cord deformity, although the intramedullary hyperintensity was still observed in most cases. The present study demonstrates the importance of associated disc protrusion in the development of myelopathy in patients with cervical OPLL. Magnetic resonance imaging findings may be used to help determine the actual levels of spinal cord compression and to suggest the method of surgical treatment.

Adult↗

PubMed1998

[Cervical epidural hematoma caused by cervical twisting after epidural anesthesia: a case report].

A case of cervical epidural hematoma caused by cervical twisting after epidural anesthesia was reported. A 41-year-old man who had had anterior fusion of C5 - 7 using a plate due to cervical spondylosis fifteen months before admission, had undergone epidural anesthesia through the C7/T1 interspace without difficulty for shoulder pain in a pain clinic. Two hours after injection, he complained of severe pain in his neck and both shoulders just after cervical twisting as was his custom. Within minutes he noted paresis of his left extremities. Neurological examination on admission revealed left side dominant tetraparesis and loss of pain and temperature sensations below the level of T4 on his right side. Laboratory data analysis and coagulation tests were normal. CT scans and MRI demonstrated an epidural hematoma with a small amount of air extending from C3 to the upper margin of C7. Four hours after the onset, a laminoplasty was performed from C3 to C7 with total removal of the hematoma. No bleeding site or any vascular abnormality was found to account for the hematoma formation. He was discharged with good recovery after operation. Most of the reported epidural hematomas associated with epidural anesthesia were related to coagulopathy, anticoagulant therapy or difficult puncture. On review of the literature, this is the first case of spinal epidural hematoma cause by cervical twisting after spinal anesthesia and which was without impaired coagulation or difficult spinal puncture. Cervical epidural hematoma should be considered as a possible complication in patients with pain or neurological deficits after some cervical manipulations.

Adult↗

PubMed1997

Activation of the p21(Waf1/Cip1) promoter by the ets oncogene family transcription factor E1AF.

p21(Waf1/Cip1) is one of the key regulatory proteins in cell cycle, terminal differentiation, and apoptosis. Its promoter was shown to be transactivated by the wild-type p53 protein as well as in a p53-independent manner. In this report, we demonstrate that E1AF, an ets-related transcription factor, activates the human p21(Waf1/Cip1) promoter by interacting with the ets-binding sites located close to the two previously identified p53-responsive elements. Northern blot analysis revealed that p21(Waf1/Cip1) and E1AF were correlatively upregulated in response to cisplatin treatment in SiHa cells. Transient expression assays demonstrated that E1AF can activate the p21(Waf1/Cip1) promoter-driven luciferase reporter gene in SiHa cells. The p21(Waf1/Cip1) promoter activity was also increased in p53-null Saos2 osteosarcoma cells, but was markedly reduced when the ets-binding sites were deleted. These results indicate that E1AF positively regulates transcription from the p21(Waf1/Cip1) promoter in response to genotoxic stresses.

Adenovirus E1A Proteins↗