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Biomedical subjects

K Tsuchiya

Publications and source records attributed to K Tsuchiya.

809 records · Page 45Linked to original sources
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Clinical aspects of argyrophilic grain disease.

Argyrophilic grain disease (AGD) is a dementia in the senium characterized by limbic involvement in the form of massive occurrence of argyrophilic and tau-positive grains in the neuropil. The main affected areas in the limbic system are the hippocampal as well as entorhinal regions, and subsequently the amygdaloid nucleus, where mild to moderate degrees of tissue degeneration are also often observed. Retrospective evaluation of 4 patients with AGD revealed common clinical features which consist of memory disturbance, relatively preserved cognitive function and personality change characterized by emotional disorder with aggression or ill temper. Such clinical characteristics are consistent with limbic involvement, and therefore AGD is thought to be a type of limbic dementia. The lack of Klüver-Bucy syndrome, which constitutes the basic part of limbic dementia, may indicate chronic, progressive and mild degeneration in the limbic areas in this disease.

Aged↗
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Pre- and postcontrast FLAIR MR imaging in the diagnosis of intracranial meningeal pathology.

PURPOSE: Few reports address the use of fluid-attenuated inversion-recovery (FLAIR) images of the brain in the diagnosis of extraaxial lesions. Our purpose was to assess the value of FLAIR images, including postcontrast ones, in the diagnosis of intracranial meningeal diseases. METHODS: We reviewed precontrast (n=24) and postcontrast (n=20) FLAIR images obtained from 25 patients with infectious meningitis (n=13), carcinomatous meningitis or dissemination of primary brain tumor (n=7), dural metastasis (n=3), and others (n=2) in comparison with fast spin-echo T2-weighted and postcontrast T1-weighted images. RESULTS: In lesion detectability, precontrast FLAIR images were significantly superior to fast spin-echo T2-weighted images but inferior to postcontrast T1-weighted images. There was no significant difference between postcontrast T1-weighted and FLAIR images. CONCLUSION: Precontrast FLAIR images can substitute for conventional fast spin-echo T2-weighted images. Postcontrast FLAIR images have diagnostic potential equivalent to conventional postcontrast T1-weighted images.

Adolescent↗
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Familial amyotrophic lateral sclerosis with posterior column degeneration and basophilic inclusion bodies: a clinical, genetic and pathological study.

We report an autopsy case of familial amyotrophic lateral sclerosis (FALS). The patient was a Japanese woman with hereditary burden. Family history revealed 12 patients with FALS over four generations. She developed muscle weakness of the proximal part of the upper extremities at age 42, followed by dysarthria, dysphagia, muscle weakness and atrophy in the lower extremities, spasticity, hyperreflexia and Babinski's sign. At age 44, she needed ventilatory support. At age 45, she died of bronchopneumonia. The total duration of the disease was three years and one month. Genetic study showed the absence of a mutation in the Cu/Zn superoxide dismutase-1 gene. Neuropathological examination revealed not only neuronal loss in the upper and lower motor neuron and Clarke's column, but also degeneration of the pyramidal tracts, middle root zone of the posterior column and posterior spinocerebellar tract. Bunina bodies and Lewy body-like inclusion bodies were absent. A few basophilic inclusion bodies were present in the neurons of the brain stem and anterior horn of the lumbar cord. Based on these clinical, genetic and pathological findings with a review of the literature, we concluded that our case was the first reported case of FALS with posterior column involvement and basophilic inclusion bodies.

Adult↗
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Dementia with Lewy bodies showing advanced Lewy pathology but minimal Alzheimer pathology--Lewy pathology causes neuronal loss inducing progressive dementia.

The present study concerns an autopsied case of dementia with Lewy bodies (DLB) showing advanced Lewy pathology but minimal Alzheimer pathology. The patient was a 50-year-old Japanese male without inheritance. His initial symptoms at the age of 43 suggested the diagnosis ofjuvenile idiopathic Parkinson's disease (PD), but were followed by memory disturbance 1 year later. He showed parkinsonism, dementia, personality change, fluctuating cognition and visual hallucinations 3 years later. Neuroradiological examination revealed moderate brain atrophy, predominantly in the frontal and temporal lobes. Neuropathological examination demonstrated a widespread occurrence of Lewy bodies (LB) with LB-related neurites not only in the brainstem but also in the cerebrum. The present case showed Lewy pathology which corresponded to stage IV by our staging and was parallel to neuronal loss. There was marked neuronal loss with many LB-related neurites in the CA2 of the hippocampus. Neurofibrillary tangles (NFT) were almost restricted to the entorhinal cortex, while senile plaques were absent. Consequently, the present case was pathologically diagnosed as having DLB of the neocortical type, pure form. In the present study, we suggest that Lewy pathology in the cerebral cortex could be responsible for progressive dementia.

Alzheimer Disease↗
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Atypical late-onset dementia characterized by limbic degeneration with coiled bodies and argyrophilic threads.

This report concerns an autopsy case of late-onset dementia with atypical neuropathological features. The patient was a Japanese man who was 83 years old at the age of death. At 73 years, he developed behavioral disorders, including emotional changes, and dementia. He died at the age of 83. A neuropathological study revealed largely confined involvement of the limbic regions, characterized by degeneration consisting of neuronal loss with a spongy state and gliosis. Massive tau-positive oligodendroglial coiled bodies and argyrophilic threads were also observed mainly in these regions. Although the clinicopathological findings of the present case showed some similarities to those of a unique subtype of frontotemporal dementia, including mesolimbocortical dementia, argyrophilic grain disease, corticobasal degeneration and dementia with tangles, there seems to be no suitable category of neurodegenerative disease into which our case can be classified. Further study is needed to determine whether the present case could be classified as an atypical case of these diseases or represents a new entity.

Aged↗
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Experimental avascular necrosis of the femoral capital epiphysis and induced subluxation of the hip in young rabbits.

We attempted to clarify experimentally the effect of hip joint incongruity on the necrotic femoral head. Twenty-four immature rabbits were divided into three groups: group I (12 rabbits), interruption of the epiphyseal artery and immobilization of the knee in extension for inducing subluxation of the hip; group II (six rabbits), interruption of the epiphyseal artery; group III (six rabbits), opening of the capsule (with preservation of the epiphyseal artery) and immobilization of the knee in extension. Radiographic examination of the hips of the rabbits in group I showed severe deformation of the necrotic femoral head with subluxation. These radiographic findings appeared similar to those of human hip joints affected with Perthes' disease.

Animals↗
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Lewy body disease with and without dementia: a clinicopathological study of 35 cases.

The pathological basis for dementia in Lewy body disease (LBD) remains controversial. While some investigators propose that cortical lesions are responsible, others favor a subcortical basis for this dementia. Brains from 35 patients with LBD (11 demented with diffuse LBD; 12 demented and 12 non-demented with a brainstem type of LBD) were clinicopathologically examined to elucidate the pathological differences between demented and non-demented patients with LBD. In cases of diffuse LBD, the cortical lesions were found to be responsible for the dementia. In some of the cases (25%) with the brainstem type of LBD, the dementia was attributed to an Alzheimer pathology, while in many cases (75%), degeneration in the subcortical nuclei, mainly the nucleus basalis of Meynert, played a major role in the dementia.

Aged↗
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Right ventricular balloon pumping.

Right ventricular balloon pumping (RVBP), i.e., using a balloon inserted into the right ventricular cavity to expel the blood into the pulmonary artery, was developed in this study. The balloon, which had an unstretched volume of approximately 15 ml, was made of polyurethane. In this experiment the balloon was inserted into the right ventricle via the right auricle or the apical area of the right ventricle. It was found that even when the natural heart was not beating, the pulmonary arterial blood flow could be maintained above 80 ml/min . kg body weight and the central venous pressure could be kept normal by combining RVBP and LVA. When the natural heart was beating but weak, the amount of increase of the pulmonary arterial blood flow induced by the application of RVBP depended on the degree of right heart failure, but RVBP could supply a sufficient flow rate to compensate for the failure of the right ventricle. Regurgitation through the tricuspid valve was scarcely ever found during RVBP.

Animals↗
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Brain tumors with ipsilateral cerebral hemiatrophy.

Brain tumors with secondary ipsilateral cerebral hemiatrophy are so rare that only seven cases have been reported in the literature. Three new cases are presented and the clinical findings in all 10 cases are reviewed. The diagnostic value of computed tomography (CT) is emphasized. The authors conclude that nodular high-density lesions located deep in the cerebrum and showing slight contrast enhancement on CT may be associated with ipsilateral cerebral hemiatrophy in young male patients with slowly progressive hemiparesis, dementia, and personality change. In such cases, early diagnosis of germinoma and subsequent radiotherapy may prevent unnecessary surgery.

Adolescent↗
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Improved surgical treatment of tricuspid insufficiency in combined valvular diseases.

Tricuspid insufficiency is not infrequent in combined valvular diseases. We used Carpentier's De Vega's or Bex's annuloplasty with our own modification in combined tricuspid insufficiency and found the results much more satisfactory compared with previous methods. Of 152 patients with acquired valvular disease, 24 with combined valvular disease underwent one of these procedures. During the same period, three tricuspid valve replacements, using a glutaraldehyde-treated xenograft, were performed in patients with severly damaged tricuspid valves. Simultaneous procedures for other valves were open mitral commissurotomy in 14, mitral valve replacement in 9 and aortic and mitral valve replacement in 4 patients. Despite the seriousness of their preoperative condition, 25 of 27 patients survived, resulting in a mortality rate of 7.4%. We believe that these annuloplasty methods represent a remarkable progress in the treatment of tricuspid valve insufficiency in combined valvular diseases.

Adult↗
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3D-CT angiography of cerebral aneurysms with spiral scanning: comparison with 3D-time-of-flight MR angiography.

To compare the clinical value of three-dimensional (3D)-CT angiography using spiral scanning and 3D-time-of-flight (TOF) MR angiography in the diagnosis of cerebral aneurysms, the results of these studies were compared in 12 patients with a total of 17 aneurysms. In seven of the 17 aneurysms, anatomic details were visualized better by 3D-CT angiography than by MR angiography. Both studies demonstrated five aneurysms equally well. MR angiography delineated three aneurysms better than 3D-CT angiography. Both studies failed to demonstrate two very small aneurysms. In 3D-CT angiography, aneurysms were viewed from many view angles, allowing the assessment of the spatial relationship between an aneurysm and the surrounding vascular and bone structures. Considering the use of contrast material and irradiation, 3D-CT angiography is of value in delineating aneurysms which are equivocal on MR angiography. In addition, 3D-CT angiography is a potential preoperative adjunct to conventional angiography.

Aged↗
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Preliminary evaluation of fluid-attenuated inversion-recovery MR in the diagnosis of intracranial tumors.

PURPOSE: To report our preliminary results in the application of a turbo fluid-attenuated inversion-recovery (FLAIR) MR technique to the diagnosis of intracranial tumors and to assess the clinical usefulness of this technique. METHODS: Thirty-four patients with various intracranial tumors were studies with MR imaging, including a turbo FLAIR sequence. FLAIR images were compared with images obtained with conventional spin-echo sequences. RESULTS: Except for 2 lesions in 1 patients, tumor signal intensities on FLAIR images were consistent with those shown on T2-weighted spin-echo images. FLAIR images showed peritumoral edema more clearly than T2-Weighted and proton density-weighted images when the tumor itself was not hyperintense. In 8 of 23 patients in whom edema was associated with tumor, FLAIR images provided better definition between edema and tumor than did T2-weighted and proton density-weighted images. In 5 patients, FLAIR images depicted different signal intensity between cerebrospinal fluid and a cystic or necrotic component. In 20 of 22 patients, postcontrast FLAIR images showed contrast enhancement comparable to that seen on postcontrast T1-weighted images. CONCLUSION: Turbo FLAIR images can supplement conventional spin-echo images in the diagnosis of intracranial tumors.

Adolescent↗