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Biomedical subjects

K Yada

Publications and source records attributed to K Yada.

At least 109 records · Page 6Linked to original sources

[An operated case of cervical spontaneous hematomyelia].

We have reported a case of cervical spontaneous hematomyelia caused by cavernous hemangioma. A 47-year-old woman experienced a sudden onset of pain in the neck on 5 December 1979. One week after the onset she began to have tetraparesis. There was a rapidly increasing weakness of the extremities and she was referred to our department on 25 December 1979. At the time, the positive neurological findings were flaccid tetraplegia, bilateral loss of all sensory perception below the C4 level and urinary retention. Chest x-ray films demonstrated an elevation of right diaphragma. Roentgenograms of the cervical spine were normal. Emergency myelography via cisternal puncture revealed a central filling defect at the level of C3-C5. But there was no displacement of dentate ligament on lateral view, suggesting an intramedullary mass lesion. Laminectomy from C2 to Th1 and evacuation of the intramedullary blood clot at C3-C5 level were performed successfully. Microscopic examination of clots revealed cavernous hemangioma. The postoperative course was uneventful and the patient gradually improved in her motility. In the review of the literature including our case, vascular malformations are the commonest cause of spontaneous hematomyelia. They are found 12 out of 18 cases (Table 1). The symptoms of spontaneous hematomyelia are characterized by sudden onset of pain and rapid development of long tract sign in a previously asymptomatic individual. Operated cases are summarized in table 2. Good operative results are obtained 6 out 9 cases. We will emphasize that in a case of spontaneous hematomyelia with acute progression of transverse myelopathy, early diagnosis and operation are extremely important, and for this purpose, myelography is considered to be one of the most useful examinations.

Diagnosis, Differential↗

[A case of pleomorphic xanthoastrocytoma (Kepes) (author's transl)].

A case of pleomorphic xanthoastrocytoma, the first case in Japan, is reported. This is a 25-year-old woman with a history of convulsive seizures which were initiated on her left arm 13 years prior to admission, On admission, physical and neurological examinations revealed no abnormalities. CT-scan disclosed a large well-defined low density area in the right fronto-temporal region. A small peripheral portion of the low density area was enhanced by contrast media. The high density area located immediately beneath the inner table of the skull. Right carotid angiogram showed a large avascular area corresponding to the cystic lesion. At the operation, there was a mural nodule in the frontal cortex involving the leptomeninges. The tumor was relatively soft and was milky-white in color. Under this tumor was a large cyst containing xanthochromic fluid. The mural nodule was totally removed and the cyst was widely opened. Postoperative course was uneventful and she received a radiation therapy (5500 rads). She was discharged without any neurological deficits. Histologically, the tumor was highly cellular. The tumor cells were markedly pleomorphic showing bizarre giant cells and multinucleated cells. However, tumor necroses and mitotic figures were absent. With immunoperoxidase method and PTAH stain, these tumor cells were confirmed to be astrocytic. In some areas, tumor cells were surrounded by reticulin fibers. Many tumor vessels presented marked hyalinous degeneration. By electron microscopy, many tumor cells contained lipid droplets. This case was considered to be pleomorphic xanthoastrocytoma (Kepes). Pleomorphic xanthoastrocytoma was designated by Kepes et al in 1979 as a new tumor entity. They described clinical and pathological characteristics of this tumor as follows. The age of the patients were young and the tumors were frequently cystic. The tumors were superficially located in the brain and involved the leptomeninges. Despite marked nuclear pleomorphism, mitotic figures of the tumor cells or necroses were rare. In contrast to their pleomorphic cytology, the biological behavior of this tumor appeared to be favorable. The authors stressed the clinical and pathological significance of this tumor. Because, this is the tumor with malignant appearance in light microscopy, but with favorable prognosis.

Adult↗

Cervical radiculomyelopathy caused by deposition of calcium pyrophosphate dihydrate crystals in the ligamenta flava. Case report.

A case of cervical radiculomyelopathy caused by multiple calcified nodules in the ligamenta flava is presented. Roentgenological examination of the cervical spine showed radiopaque nodular lesions, 7 x 7 x 5 mm in size, located in the paramedian portion of the posterior spinal canal. The nodules were removed surgically and they were confirmed to be calcifications of ligamenta flava. Microscopic examination of the nodules with the polarized light revealed extensive deposition of crystals. By x-ray diffraction study, the crystal was determined as calcium pyrophosphate dihydrate (CPPD: Ca2P2O7 . 2H2O). Although CPPD deposition in the cartilage has been known as pseudo-gout syndrome, deposition in the ligament has been reported only in a few cases. This is the first case with radiopaque calcified nodules in the ligamenta flava causing spinal cord compression, the composition of which proved to be CPPD.

Calcium Pyrophosphate↗

Modified Limberg flap for lumbosacral meningomyelocele defects.

We have recently developed a technique for closing round or wide oval lumbosacral meningomyelocele defects by modifying the Limberg flap. Four cases of repair of lumbosacral meningomyelocele were treated, with good skin closure in 3. The indications for and advantages of our method are discussed.

Humans↗