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Biomedical subjects

K Kiya

Publications and source records attributed to K Kiya.

At least 19 recordsLinked to original sources
PubMed2001

Nutcracker phenomenon demonstrated by three-dimensional computed tomography.

We report a 15-year-old girl with nutcracker syndrome (NCP) in whom three-dimensional helical computed tomography (3D helical CT) was useful for diagnosis; angiographic imaging using 3D helical CT provided fine outlines of the vascular structures in NCP, i.e., a compression of the left renal vein between the aorta and the superior mesenteric artery and the abnormal acute angle between them. Thus, a 3D helical CT enables precise depiction of the anatomical characteristics of renal vasculature and, therefore, may be a useful alternative imaging technique instead of conventional examinations, such as invasive venography or digital subtraction angiography. Further study in a large number of children with vascular abnormalities would be worthwhile.

Adolescent↗
PubMed2001

Postoperative cortical venous infarction in tumours firmly adherent to the cortex.

It is sometimes difficult to separate extra-axial tumours from the cortical veins in case of tumours attaching tightly to the cortex and the cortical veins. We present two patients having a postoperative cortical venous infarction. A 59 year old female had convexity meningioma above the motor cortex where abnormal cortical anastomotic veins developed. Transient hemiparesis occurred after total removal of the tumour because of venous infarction and cyst formation resulting from sacrifice of these veins which were tightly adherent to the tumour surface. A 15 year old boy with immature teratoma of the pineal region, showing several draining veins around the vascular-rich tumour, presented transient drowsiness, diplopia and partial impairment of bilateral visual acuity postoperatively because of localised cortical brain and venous damage. It is important to make an effort to preserve main cortical veins during operation as much as possible, even if the tumour adheres to the cortical surface.

Adolescent↗
PubMed2000

Delayed cerebral radiation necrosis occurring twice at different regions and times in a patient with a metastatic brain tumour.

No case of histopathologically confirmed delayed cerebral radiation necrosis (DCRN) that occurred twice at different regions and times in the same patient has been previously reported. We present a patient with such a rare clinical course and who is surviving long-term (over 13 years) with a history of a distant metastasis of a malignant tumour. To diagnose DCRN preoperatively was very difficult. However, surgical extirpation seemed to be effective for DCRN. The patient is still in a good performance status after surgery.

Brain↗
PubMed2000

A modified burr-hole method 'galeoduroencephalosynangiosis' in a young child with moyamoya disease. A preliminary report and surgical technique.

We performed combined indirect surgical procedures using encephaloduroarteriomyosynangiosis and a burr-hole method according to descriptions by Suzuki et al. and Kawaguchi et al. with some modifications in a 4-year-old child with moyamoya disease. Transient ischemic attacks on both sides completely disappeared within 1 month and never occurred during 2.5 years follow-up period. This surgical procedure may have enough value as the first operation to prevent ischemic damage in the territories of both the anterior cerebral artery and middle cerebral artery in children with moyamoya disease.

Anterior Cerebral Artery↗
PubMed2000

[Usefulness of selective cerebral angiography by transradial approach].

Transradial angiography has recently emerged as an alternative to the transfemoral or transbrachial approach, especially for coronary procedures. However, there have been few studies on cerebral angiography using the transradial approach. The purpose of this study was to assess the outcomes, complications, and limitations of selective cerebral angiography via the transradial approach. Selective cerebral angiography by the right transradial approach using 100-cm-long 4-F catheters was performed in 83 patients. Using five types of catheters, the success rates of selective catheterization to the right vertebral artery, right common carotid artery, left common carotid artery, and left vertebral artery were 40/44 (91%), 68/68 (100%), 62/62 (100%), and 14/25 (56%), respectively. Puncture failed in one patient, and a guidewire could not be introduced beyond the radial artery loop in one patient. Radial artery spasm occurred in one patient, but was relieved immediately after nitroglycerin injection through the sheath with side holes. Subcutaneous bleeding occurred in six patients, but no obvious hematomas were noted. Occlusion or stenosis of the radial artery occurred in five patients, but no ischemic symptoms were observed in any of the cases. This study suggested that selective cerebral angiography can be performed safely using the transradial approach.

Adolescent↗
PubMed1999

Brain metastasis of Merkel cell carcinoma. Case report and review of the literature.

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine tumor that is locally aggressive and has potential for metastatic spread. However, brain metastases are rare, and therapy for such tumors has never reported. The authors present a 48-year-old woman with MCC of the left elbow and a right cerebellar metastasis. After the right cerebellar mass was totally resected, radiation treatment and chemotherapy were performed. Eight cases of brain metastasis have been reported in the literature, but only 5 have been presented in sufficient detail for analysis. Therapy for brain metastases has always been palliative whole-brain irradiation and chemotherapy except for our patient, who underwent total removal of the tumor and survived for 11 months without neurological deficit. Except in the case of 1 with a particularly radiosensitive MCC, the patients with brain metastases died within 9 months after detection of the brain lesions. If possible, aggressive excision of brain metastases as well as of the primary lesion should be done.

Carcinoma, Merkel Cell↗
PubMed1998

[Multivariate analysis of intentional temporary vessel occlusion in aneurysmal surgery].

Temporary vessel occlusion (TO) for aneurysmal clipping is an effective technique to facilitate dissection between aneurysm and parent vessels, and to place a permanent clip at the aneurysmal neck precisely. However, several unsolved problems remain regarding the overall safety and risk resulting from this technique. The authors examined a series of patients in whom mannitol 500 ml, tocopherol acetate 500 mg, and phenytoin 500 mg were administered intravenously as ischemic protection during TO for the aneurysmal clipping. The study comprises a nonconcurrent retrospective analysis of 144 consecutive aneurysm clippings performed with the aid of intentional TO at the Hiroshima Prefectural Hospital from 1985 to 1995. To identify technical and patient-specific risk factors for perioperative stroke, factors studied included duration, location of the temporary clip application, number of occlusive episodes, patient sex, age, and preoperative neurological status, timing of operation, as well as postoperative, temporary or permanent, neurological deficits (ND) due to TO were used. Overall frequency of postoperative ND due to TO manifested clinically and radiologically were 9.0% and 9.7%, respectively. In both univariate and multivariate analysis there were no significant factors relevant to the ND. However, duration of the temporary occlusion time over 20 minutes was the factor most influential on the ND due to TO. Duration of the temporary occlusion time was shown to have no link with outcome. Based on our findings the authors conclude that temporary vessel occlusion within 20 minutes with anti-ischemic drugs is a relatively safe adjunct to aneurysmal surgery.

Adult↗
PubMed1997

[The usefulness of radiotherapy in the management of intracranial meningioma: a review of 29 patients].

Twenty-nine patients with intracranial meningiomas were treated with a high-energy linear accelerator (4-10 MV. X rays and electron beams) between 1980 and 1992 at the Hiroshima Prefectural Hiroshima Hospital. We investigated the relationships between tumor size and tumor response, histological type and tumor response, and grade of operation using Simpson's classification and recurrence rate. Meningiomas were greatly reduced between 1 month and 46 months after radiotherapy, the average being 14 months. In the group with a tumor size of less than 5 cm2, 3 patients obtained CR, 5 patients NC and 1 patient PD. Tumor response was 89% in the group with a combination of CR with NC. In the group with a tumor size of 5 to 20 cm2, 2 patients obtained PR, 1 patient NC and 1 patient PD. Tumor response was 75% in the group with a combination of PR with NC. In the group with a tumor size of more than 20 cm2, 3 patients showed NC, 3 patients PD. Tumor response was 50% in the group with NC. In the group with a tumor size of less than 20 cm2, tumor response was 85%. In the group with a tumor size of more than 20 cm2, it was 50%. Though there were no statistically significant differences between the two groups, a tumor size of less than 20 cm2 had a tendency to be more responsive than one of more than 20 cm2. The response of meningioma of the transitional type was worse than that of the meningothelial type and fibroblastic type. Fourteen patients after Simpson grade II or III operation were free of recurrence. The results of this study support the role of radiotherapy for meningioma which is less than 20 cm2, and also for treatment after Simpson grade II or III operation.

Adult↗
PubMed1997

[A surgery for an acute case of a ruptured aneurysm associated with idiopathic thrombocytopenic purpura: a case report].

A surgery for an case acute of a ruptured aneurysm with idiopathic thrombocytopenic purpura (ITP) is very rare. We encountered a case of a ruptured basilar artery (BA) superior cerebellar artery (SCA) aneurysm associated with ITP. A successful operation was carried out while the patient was in the acute stage. The patient was a 63-year-old female. She has been suffering from ITP for two years, when she experienced a sudden severe headache and vomitting on May 5, 1995. She was referred to our hospital as a case of subarachnoid hemorrhage estimated to be in group 2 according to the Fisher grade. Her neurological condition caused by the subarachnoid hemorrhage was grade 2 according to Hunt & Kosnik classification, and she was classified according to WFNS as grade 1. The number of platelets was, however, 2.3 x 10(4)/mm3 on admission. Cerebral angiography showed the aneurysm at the bifurcation of BA and SCA. The administration of platelet transfusion, betamethasone and gamma-globulin induced an increase of the number of platelets to 8.7 x 10(4) mm3 just before the operation. Neck clipping for the aneurysm was performed using platelet transfusion via the right pterional approach 25 hours after the onset. No tendency to bleed was recognized during the operation. The number of platelets was kept constantly at the level between 16.9 x 10(4)/mm3 and 22.0 x 10(4)/mm3 during the postoperative course with the administration of betamethasone. The postoperative course was good with no manifestations of delayed ischemic neurological deficits.

Acute Disease↗
PubMed1996

Diagnosis of carotid-cavernous fistulas with magnetic resonance angiography--demonstrating the draining veins utilizing 3-D time-of-flight and 3-D phase-contrast techniques.

This study assessed the ability to diagnose carotid-cavernous fistulas (CCFs) non-invasively using magnetic resonance angiography (MRA). Both three-dimensional time-of-flight (3-D TOF) MRA and three-dimensional phase-contrast (3-D PC) MRA were compared with conventional cerebral angiography in nine patients with CCFs. CCFs were grouped according to Barrow's classification. In all cases, 3-D TOF MRA revealed an inferior petrosal sinus as a draining vein. 3-D PC MRA demonstrated a dilated and tortuous superior ophthalmic vein (SOV) and reflux of the SOV in seven patients. In conclusion, CCFs can be diagnosed with MRA alone by demonstrating the drainging veins.

Adult↗
PubMed1996

[Indication of early surgery in elderly patients with ruptured intracranial aneurysms--the comparison between surgical and conservative therapy].

The purpose of this study was to investigate the indication of direct early surgery for elderly cases aged over 70 years with ruptured intracranial aneurysms. The result of early surgical treatment in 39 elderly cases was analyzed and was compared with that of conservative treatment in 39 elderly patients. According to the multiple logistic analysis, surgery was only significant factor influenced the outcome, however, Hunt & Kosnik grade (HKG), activity of daily life (ADL) before subarachnoid hemorrhage (SAH) and past history were related to the outcome. The outcome in the direct early surgical group statistically correlated (p < 0.05) with preoperative HKG, although the outcome in the conservative group did not correlate with HKG. The outcome in conservative group was miserable because of rerupture or poor preoperative neurological grade. The indication of direct early surgery for elderly cases with ruptured intracranial aneurysms should be considered as follows, HKG 1 to 3, ADL before SAH 1, no or minor past history and age under 84 since most elderly patient was 84 in our series. Direct early surgery in elderly patients seems to improve the outcome under these indications.

Activities of Daily Living↗
PubMed1995

Cavernous sinus meningioma presenting as orbital apex syndrome. Diagnostic methods of dynamic MRI, spoiled GRASS (SPGR) image.

Orbital apex syndrome is a symptomatologic complex. In this paper, the usefulness of several clinical diagnostic MR methods in preparing for surgery is discussed. These include dynamic MRI and the spoiled GRASS (SPGR) image for a cavernous sinus meningioma presenting with orbital apex syndrome. A 53 year old man, who had right cavernous sinus tumor presenting with orbital apex syndrome, was examined by several new MRI techniques. The tumor was partially removed and fibroblastic meningioma was confirmed pathologically.

Humans↗
PubMed1995

Demonstration of the venous systems with gadolinium-enhanced three-dimensional phase-contrast MR venography.

The purpose of this study was to evaluate the usefulness and advantages of gadolinium-enhanced three-dimensional phase-contrast MR venography for demonstrating the venous systems. The three-dimensional phase-contrast MR venography was performed with a velocity encoding gradient settings from 5 to 20 cm/s on 22 normal subjects. In 8 of normal subjects, gadolinium-enhanced phase-contrast MR venography was performed. 22 subjects (100%) had detectable flow in the sphenoparietal sinus, transverse sinus, basal vein, and internal cerebral vein. With a VENC setting at 10 cm/s, venous system was visualized selectively and clearly. Detection ratio in inferior petrosal sinus, superior petrosal sinus, and superior ophthalmic vein increased from 0% to 25%, from 28.6% to 62.5%, and from 28.6% to 37.5%, respectively, after administration of gadopentate dimeglumine. In conclusion, gadolinium-enhanced three-dimensional phase-contrast MR venography was useful for demonstrating the venous systems.

Adolescent↗
PubMed1995

MRI of intracranial germ cell tumours.

We reviewed MRI findings in proven intracranial germ cell tumours in 22 cases, 12 of whom received Gd-DTPA. On T1-weighted images, the signal intensity of the tumour parenchyma was moderately low in 19 cases and isointense in 3; on T2-weighted images, it was high in all cases. Regions of different intensity thought to be cysts were found in 17 (77%): 7 of 12 patients with germinoma (58%) and in all other cases. Of the 13 patients with pineal lesions T1-weighted sagittal images showed the aqueduct to be obstructed in 5, stenotic in 7 and normal in 1. Strong contrast enhancement was observed in all 12 cases. Of the 14 patients with suprasellar lesions, 5 were found to have an intrasellar extension, and in 3 of these, the normal pituitary gland, which could be distinguished from the tumour, was displaced anteriorly. Ten patients (45%) had multiple lesions.

Adolescent↗