Biomedical subjects

M Akino

Publications and source records attributed to M Akino.

At least 55 records · Page 3Linked to original sources

PubMed1990

Infiltrating spinal angiolipoma causing myelopathy: case report.

We present a case of an infiltrating spinal angiolipoma demonstrating extension into the vertebral body and the spinal epidural space. The infiltration into the epidural space caused myelopathy. About 40 cases of spinal angiolipoma and angiomyolipoma have been reported; however, only a few cases have been the infiltrating type. The radiological findings were similar to those of vertebral hemangioma, but poor enhancement of the angiolipoma on contrast-enhanced computed tomographic scans differentiated between them. The infiltrating epidural tumor was removed, and the clinical symptoms improved remarkably. Total removal of the tumor and stabilization of the involved vertebral body using the anterolateral approach may be desirable when a diagnosis of angiolipoma or angiomyolipoma is confirmed preoperatively.

Aged↗

PubMed1990

A case of systemic lupus erythematosus--its clinical and MRI resemblance to multiple sclerosis.

We documented a case of systemic lupus erythematosus with clinical features of multiple sclerosis who developed transverse myelopathy. Magnetic resonance imaging showed the presence of an abnormal high signal intensity in the gray matter of a swollen spinal cord corresponding to the patient's neurological deficits. After two previous episodes of exacerbation and remission consistent with the clinical diagnosis of multiple sclerosis, right hemiparesis and hemisensory disturbances ensued, then lupus nephritis was confirmed by a renal biopsy.

Antibodies, Antinuclear↗

PubMed1990

[Effect of mannitol administration and myelotomy on acute experimental spinal cord injury: investigation by spinal cord evoked potential].

The authors reported the changes in spinal cord evoked potential following impact injury by the weight-dropping technique in untreated and treated animals. The effect of mannitol and myelotomy therapy on spinal cord evoked potential in experimental spinal cord injury was discussed. (Materials and Methods) 32 adult dogs, ranging in weight from 9 to 13 kg, were used. 28 dogs received 300 gm-cm contusion of the T10 spinal cord. Eight dogs were not treated and twenty dogs were treated with mannitol. Ten dogs were treated with intravenous continuous infusion of mannitol (1g/kg/hr) 30 minutes after the injury, and ten dogs with intravenous bolus injection of mannitol (2 g/kg) at 30 minutes and 3 hours after the injury. At one hour after the injury, five dogs with 400 gm-cm contusion were treated with posterior midline myelotomy. The spinal cord evoked potential following direct stimulation of the spinal cord was recorded from the epidural space for 5 hours. The recording electrode was located cephalad to the site of the impact injury. (Results and Discussion) In each group, the amplitude of I potential decreased remarkably immediately after the injury. Subsequently, gradual recovery was obtained. In the untreated 300 gm-cm contusion group, no apparent improvement was seen from one hour after injury. On the other hand, in the mannitol-treated group, the recovery of the amplitude was superior to that found in the untreated group at a significant level of P less than 0.05. However, in the group with intravenous bolus injection of mannitol, the recovery was transient.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

[Anterolateral approach to giant cell tumor in T4 vertebral body].

A case of giant cell tumor involving the Th4 vertebral body is reported. A 27-year-old man, who had a 2 month history of back pain and paraparesis, was admitted to our department in August, 1986. On the first admission, he manifested severe paraparesis and sensory disturbance below the Th5 dermatome level. Neuroradiological examination demonstrated an epidural tumor involving the Th4 vertebral body and compressing the spinal cord. Emergency laminectomy for decompression and biopsy was performed. The surgical specimen was a giant-cell tumor. 6 weeks after the first operation, total removal of the tumor and anterior fusion of the Th 3-5 with iliac bone graft was performed through the anterolateral transthoracic approach. Postoperative course was uneventful. A curative resection and immediate stabilization was thus able to be undertaken through the anterolateral transthoracic approach, when the epidural tumor was confined to the thoracic vertebral body.

Adult↗

PubMed1990

[Metastatic Grawitz's tumor to the cauda equina: case report].

A case of Grawitz's tumor metastasizing to the cauda equina is presented. A 51-year-old male was hospitalized due to severe low back pain radiating to the left lower extremity. Neurological examination showed only hyporeflexia of the left patella reflex and positive Lasegue's sign. MRI showed intradural mass at the L4 level. Preoperatively, we diagnosed a cauda equina tumor. A laminectomy of both L3 and L4 was performed, and total removal of the cauda equina tumor was performed. Microscopically, the tumor cells were large, the appearance of the cytoplasm ranging from optically clear with sharply outlined boundaries, to deeply granular, with many transitional forms. These histological findings were typical findings of Grawitz's tumor, and were the same as those of this patient's renal tumor. Finally, we diagnosed Grawitz's tumor metastasizing to the cauda equina. Metastatic cauda equina tumor from outside the central nervous system is very rare and only 7 cases have been reported. This case is the first one of Grawitz's tumor spreading to the cauda equina.

Carcinoma, Renal Cell↗

PubMed1990

[MR imaging of cervical disc disease: value GRASS imaging].

Since magnetic resonance imaging (MRI) technology has been greatly improved, MRI for cervical disc disease has become widely used in many facilities. Among non-invasive procedures, MRI is regarded as one of the most useful ones. Conventional myelography, CT myelography, and MRI were performed on 10 patients with cervical disc disease. The authors discussed the correlation between conventional myelography, CT myelography, and MRI as regards their ability to determine the localization and the laterality of disc protrusion and osteophyte. In our MRI study, we use both short-echo (SE) images and GRASS images. The parameters of our GRASS included 5mm-thick sections. TR = 200, TE = 20, and flip angles of 10 degrees. This pulse sequence generates images with high signal cerebrospinal fluid (CSF), resulting in a high-contrast CSF-spinal cord, osteophyte, and disc protrusion. As yet, although it easily shows the localization and laterality of the disc and/or osteophyte, image quality of the GRASS is not yet sufficient to allow us to evaluate detailed deformity of the spinal cord and nerve root. The authors stress the usefulness of this GRASS image for the evaluation of suspected cervical disc disease.

Adult↗

PubMed1990

[Clinical and neuroradiological features of syringomyelia associated with Chiari malformation].

The clinical presentation and radiological features were analyzed in 30 cases of syringomyelia associated with Chiari malformation. None of the patients had spinal dysraphism. The age on admission ranged from 6 to 59 years with a mean of 27 years. Syringomyelia was diagnosed by CT myelography and or MRI from 1982 to 1988. The initial symptoms were skeletal abnormality (43%) such as scoliosis (12 cases) or pes cavus (one case), unilateral pain or numbness (40%) and unilateral motor weakness (17%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (57%), muscle weakness (57%), muscle atrophy (37%) and lower cranial nerve palsy (40%). The neurological findings were asymmetrical in all patients. The characteristic neurological findings in the cases presenting under 20 years of age were unilateral sensory and motor deficits (61%) with decreased or absent deep tendon reflex on the same side. The localization of the syrinx in axial section varied according to the level even in the same case. In 15 cases with unilateral sensory disturbance or unilateral sensory and motor deficit, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance in the cervical or thoracic level. On the other hand, in 15 cases with bilateral sensory and motor deficit, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[A case of intramedullary spinal cord metastasis from adenocarcinoma of corpus uteri].

The authors present a case of a woman with intramedullary spinal cord metastasis from adenocarcinoma of the corpus uteri. Such a case was not able to be found in the literature. A 54 year-old woman complained of right upper extremity weakness and headache. CT scan showed abnormality, and removal of a brain tumor was performed. After that, total hysterectomy, retroperitoneal lymphadenectomy and chemotherapy was carried out. Three months later, she suddenly experienced bilateral weakness in her lower extremities. After a few days she was unable to walk. Gd-DTPA enhanced MRI showed an abnormal mass at the upper part of the conus medullaris. Total removal of the intramedullary tumor was performed and adenocarcinoma was diagnosed histopathologically.

Adenocarcinoma↗

PubMed1989

Significance of spinal cord swelling in the prognosis of acute cervical spinal cord injury.

Seven cases of acute cervical cord injury examined by CT-myelography are reported. Cord swelling was observed in 2 patients who developed complete lesions. Another 5 cases had an incomplete lesions. Spinal cord swelling indicated severe cord damage. External decompression seemed to have little effect on cord swelling. When cord swelling is absent, neurological improvement was expected though the initial neurological state showed severe deficits. A further 4 patients who had an acute cervical cord injury who were treated by myelotomy at the injury site are also reported. Two patients obtained significant improvement in upper limb function. The presence or absence of cord swelling as shown by CT-myelography is important for diagnosing the severity of cord damage. Myelotomy in the immediate post-accident period may relieve the effects of cord swelling.

Acute Disease↗

PubMed1989

Mobile schwannoma of the cauda equina diagnosed by magnetic resonance imaging.

Three cases of a mobile cauda equina schwannoma, preoperatively diagnosed by magnetic resonance imaging, are described. When dealing with tumors of the cauda equina, it is important to carry out a second magnetic resonance imaging scan after changes in posture, bearing in mind the possibility of mobility of the tumor.

Adult↗

PubMed1989

Magnetic resonance imaging in cases of spinal dural arteriovenous malformation.

Two patients with spinal dural arteriovenous malformations associated with intramedullary changes confirmed by the T2-weighted magnetic resonance imaging (MRI) scans are reported. The characteristics of the MRI findings for these 2 patients were as follows. 1) In the T2-weighted spin-echo image, intramedullary changes observed by MRI were visualized as a high signal intensity area at the level where delay in venous circulation of the spinal cord was revealed by the angiography of the spinal cord. 2) After the obliteration of the arteriovenous shunt by surgical management, intramedullary changes remarkably decreased and disappeared with the disappearance of swelling of the spinal cord observed preoperatively. After that, the atrophy of the spinal cord was shown. 3) The level, extent, and severity of intramedullary changes were decided by the condition of the level where the radiculospinal vein, as the flowing vein, refluxes into the coronal venous plexus and venous flow occurs through the radiculospinal vein into the epidural veins. We suspect that intramedullary changes shown by the T2-weighted MRI scan chiefly represent edema of the spinal cord, caused by an increase in venous pressure due to venous congestion of the spinal cord. MRI is a very useful diagnostic aid to detect intramedullary changes associated with a spinal dural arteriovenous malformation and to evaluate therapeutic results after surgery.

Angiography↗

PubMed1989

[Myelotomy for acute cervical cord injury. Report of four cases].

Four cases of acute cervical cord injury treated by posterior midline myelotomy are described. The initial neurological examinations of these four patients indicated complete cord lesions. On plain neck X-rays, two exhibited anterior dislocation and two showed no bony injury other than ossification of the posterior longitudinal ligament. Myelography via C1/2 lateral puncture showed complete block of the subarachnoid space in two cases, and incomplete block in the other two. Computed tomographic myelography revealed cord swelling in all cases. Posterior midline myelotomy was performed after administration of a steroid and mannitol, or reduction of spinal dislocation. The time from injury to myelotomy ranged from 5 to 21 hours. No patient developed new deficits postoperatively. During long-term follow-up, which ranged from 10 to 19 months, all patients showed improvement in motor function of the upper extremities. Sensory disturbances also diminished to some degree. However, in one patient, who underwent myelotomy 18 hours after injury and had shown progressive neurological deterioration before surgery, the improvement in motor function was only slight. In this case, earlier myelotomy may have been more beneficial. These results support the indication for myelotomy in cases of acute cervical cord injury with cord swelling. Particularly if performed early, this procedure is effective in preventing secondary neurological damage.

Acute Disease↗

PubMed1989

[Surgical treatment of syringomyelia. Selection of surgical procedures].

The surgical approach to syringomyelia is controversial. In this study, the authors evaluated the results of various operative procedures applied in 31 patients with syringomyelia. Syringomyelia was associated with Chiari malformation in 17 cases, with spinal adhesive arachnoiditis in nine, with trauma in three, and with epidural arachnoid cyst in one. One case was idiopathic. A total of 38 operations were performed. Syringosubarachnoid shunting was applied in 17 patients, syringoperitoneal shunting in 11, terminal syringostomy in three, ventriculoperitoneal shunting in three, lumboperitoneal shunting in two, foramen magnum decompression (suboccipital craniectomy plus upper cervical laminectomy) and terminal syringostomy in one, and foramen magnum decompression with syringosubarachnoid shunting in one. The postoperative follow-up period ranged from 2 to 55 months (average, 26 months). Of the 31 patients, 23 showed neurological improvement, five were unchanged, and three deteriorated. Among the last three, one patient with Chiari malformation developed shunt malfunction due to arachnoiditis after syringosubarachnoid shunting. In two patients with syringomyelia secondary to adhesive arachnoiditis, the spinal cord was damaged by extensive separation of the arachnoid membrane at surgery. On the basis of the results in these 31 cases, the authors conclude that syringosubarachnoid shunting is effective for syringomyelia associated with Chiari malformation if syringomyelia is responsible for the clinical symptoms. Post-traumatic syringomyelia and syringomyelia secondary to adhesive arachnoiditis should be treated by syringoperitoneal shunting. If hydrocephalus is present, ventriculoperitoneal shunting is indicated. Finally, terminal syringostomy is no more effective than syringosubarachnoid or syringoperitoneal shunting.

Arnold-Chiari Malformation↗

PubMed1989

[Spinal cord evoked potential in experimental spinal cord injury: the changes of spinal cord evoked potential following impact injury, and the correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs].

The authors reported the changes of spinal-cord-evoked potential following impact injury by the weight dropping technique (Allen's method). The correlation between the change in amplitude of the spinal-cord-evoked potential after injury, and the prognosis for motor recovery of the legs was discussed. The spinal cord of adult dogs was traumatized by the weight dropping technique (Allen's method) at the level of Th10. The trauma consisted of a 300 gm-cm impact injury, a 400 gm-cm impact injury, and a 500 gm-cm impact injury. The spinal-cord-evoked potential following direct stimulation of the spinal cord was recorded from the epidural space for 5 hours. The recording electrode was located cephalad to the site of the impact injury. The stimulating electrode was located at the caudal site of the injured area. The motor function of the dogs was observed by clinical scale for rating hind limb motor function (modified Tarlov score) for one month after the trauma. The recovery of the spinal cord evoked potential following impact injury by the weight dropping technique could be estimated one hour after trauma in the 300 gm-cm injury, 30 minutes after trauma in the 400 gm-cm injury and immediately only after trauma in the 500 gm-cm injury. A greater reduction of amplitude of I potential was noted with the higher energy injury (p less than 0.05). There was no parallel correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs. However, the changes in amplitude corresponded moderately well to the prognosis of motor function.

Animals↗

PubMed1988