Clinical features of elderly patients with type 2 diabetes.
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Adipose Tissue↗
Biomedical subjects
M Fukui
Publications and source records attributed to M Fukui.
A new amyloidogenic transthyretin variant, [D38A], detected by electrospray ionization/mass spectrometry.
A new variant of transthyretin (TTR) was detected by mass spectrometry (MS) in a 63-year-old Japanese female patient suffering from amyloidosis. TTR was analyzed by 2-dimensional liquid chromatography coupled with electrospray ionization MS. Variant TTR showed extra peaks in addition to normal TTR peaks. The extra peaks were about 44 Da smaller than normal TTR peaks, and the abundance of variant peaks showed about 80% of the corresponding normal free and adduct peaks. Direct genomic DNA sequencing of TTR exon 2 showed both adenine and cytosine in the position corresponding to the second base of codon 38. This codes for a variant alanine (GCT) as well as the normal aspartic acid (GAT), indicating that the case is heterozygous for the substitution, [D38A].
Amyloid↗
[Clinical experience of image-guided neurosurgery with a frameless navigation system (StealthStation)].
We have applied the frameless navigation system (StealthStation) to various neurosurgical procedures to examine its usefulness. The system consists of a UNIX based workstation that creates triplanar and 3-dimensional images; an infrared optical digitizer with camera array; a reference-light-emitting diode (LED) array (e.g., reference array); and pointer probe modified by the addition of LEDs. This system was used to assist in placing a minimal skin incision and craniotomy in 4 cases, to determine the tumor/brain interface in 2 cases, to target the subcortical lesion in one case, and to correlate bony structure with a skull base tumor in 3 cases. The combined use with magnetic source imaging of the somatosensory cortex allowed a fast orientation of eloquent areas in 2 cases with peri-Rolandic tumor. This system, thus, was proved to be a useful adjunct to open-tumor biopsy or resection.
Adult↗
[Carbamazepine induced hyponatremia].
Carbamazepine (CBZ) is a drug which can induce the syndrome of inappropriate antidiuretic hormone (SIADH). Until 1980's, there were reports regarding CBZ-induced SIADH, but it is rarely reported these days. We here report two cases of CBZ-induced SIADH. Hyponatremia in these cases was rapidly improved by withdrawal of administration of CBZ. According to the previous reports, the rate of hyponatremia in patients receiving CBZ is not small. It ranges from 48% to 31%. As CBZ is frequently used for patients with epilepsy and neuralgia, not only their blood CBZ concentration but also their serum Na level should be monitored.
Adult↗
[General anesthesia with propofol and fentanyl for adult cardiac surgery].
We employed propofol anesthesia with a restricted dose of fentanyl in adult cardiac surgery with the aim of early tracheal extubation and evaluated its effects on the intraoperative factors and postoperative recovery compared with those of a previous benzodiazepine-fentanyl regimen. During surgery, control group patients (n = 17) received intermittent bolus of benzodiazepines and fentanyl without restriction, whereas propofol group patients (n = 17) received continuous administration of propofol and the restricted dose of fentanyl (20 micrograms.kg-1). There were no significant differences in the times to eye opening (average 2.4 hr vs 1.6 hr, respectively, P = 0.30) and tracheal extubation (average 5.4 hr vs 4.0 hr, P = 0.25) between the groups. Both groups had similar postanesthetic circulatory status: cardiac index (average 3.6 l.min-1.m-2 vs 3.4 l.min-1.m-2, P = 0.46). The propofol group patients required smaller doses of vasodilators during cardiopulmonary bypass (average PGE1: 0.096 microgram.kg-1.min-1 vs 0.047 microgram.kg-1.min-1, P = 0.046, NTG: 0.69 microgram.kg-1.min-1 vs 0.31 microgram.kg-1.min-1, P = 0.009). It is suggested that propofol-based anesthesia could replace the previous regimen with no adverse hemodynamic effects and might have a potential to provide faster recovery and improve peripheral circulatory status in adult cardiac surgery.
Adult↗
Macrophage infiltration and heme oxygenase-1 expression correlate with angiogenesis in human gliomas.
Macrophages are key participants in angiogenesis. In this study on human brain tumors, we first investigated whether macrophage infiltration is associated with angiogenesis and malignant histological appearance. Immunostaining of macrophages and small vessels in resected glioma specimens indicated that numbers of infiltrating macrophages and small vessel density were higher in glioblastomas than in astrocytomas or anaplastic astrocytomas. Macrophage infiltration was closely correlated with vascular density in human gliomas. Heme oxygenase-1 (HO-1), which is the rate-limiting enzyme in heme catabolism, was also associated with activated macrophages. Expression of mRNA encoding HO-1 was correlated with macrophage infiltration and vascular density in human glioma samples. Infiltrating macrophages were positively stained with anti-HO-1 antibody by immunohistochemical analysis, and in situ hybridization for HO-1 indicated that HO-1 was expressed in infiltrating macrophages in gliomas. HO-1 gene may be a useful marker for macrophage infiltration as well as neovascularization in human gliomas.
Adolescent↗
[Surgical treatment for intractable epilepsy: update and future].
For successful surgical treatment of intractable epilepsy, identification of the epileptogenic area and functional cortex, by using the intracranial electrodes such as subdural and depth electrodes, is important. Since 1994, via chronic subdural electrodes recording, we performed anterior temporal lobectomy with hippocampectomy for 18 patients with temporal lobe epilepsy. For 10 patients with extratemporal lobe epilepsy, cortical resection of the epileptogenic cortex was performed. For the epileptogenic cortex overlapping with functional area, we added the multiple subpial transection. Favorable postoperative seizure outcome was obtained in most of the patients. Although non-invasive presurgical evaluation modalities such as MRI, video-EEG monitoring, MEG, and FDG-PET are useful in the diagnosis of epilepsy, it is impossible to localize precisely the exact epileptogenic zone and functional cortex.
Electrodes, Implanted↗
[Cortical dysplasia: focal cortical dysplasia and epilepsy].
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Brain Neoplasms↗
[Usefulness of T2* weighted magnetic resonance image in the diagnosis of head injury on chronic stage].
T2* weighted gradient echo image has heightened diagnostic sensitivity to hemorrhage, which is attributed to magnetic susceptibility-induced static field inhomogeneities arising from paramagnetic blood breakdown products such as hemosiderin, which shorten T2*. We examined 4 cases of head injury in chronic stage by T2* weighted images and assessed the clinical application of this sequence for diagnosis of the intracranial lesion. All patients underwent CT scan on acute stage and long-term follow up was performed. In all cases, abnormally low signals in the brain and subarachnoid space were more conspicuous with the T2* weighted image than with any of the conventional sequences. In 2 cases with diffuse axonal injury, of which lesions were not detected on acute stage CT scan, hypointensity area was clearly demonstrated in the cerebral peduncle and corpus callosum on T2* weighted images. Selection of T2* weighted image into the routine MR examination of patients with chronic stage of the head injury is recommended.
Adult↗
[Temporal lobe epilepsy associated with old intracerebral hemorrhage due to capillary telangiectasis in the temporal lobe: case report].
A case of 45-year-old female, who presented with temporal lobe epilepsy was reported. The patient was found to have old intracerebral hemorrhage due to capillary telangiectasis in the temporal lobe. On the intraoperative electrocorticography, frequent paroxysmal activities were recorded independently both on the medial and lateral aspects of the temporal lobe. Even after resection of the lateral temporal lobe, frequent paroxysmal discharges were noted on the hippocampus. Histologically, there are astrogliosis and hemosiderin deposits in the white matter around the telangiectasis and the old hematoma. It is postulated that the hippocampus gained secondary epileptogenicity.
Adult↗
[Assessment of oxygen transport in individual splanchnic organs using critical oxygen extraction].
Vulnerability in individual organs under ischemic stress can be assessed by critical oxygen extraction (critical O2ER). We measured critical O2ER in the whole-body, total splanchnic organs, liver and gut using a biphasic regression model of the oxygen delivery-consumption relationship in 7 dogs subjected to hemorrhagic stress under 1% isoflurane anesthesia. The difference in critical O2ER between the whole-body and total splanchnic organs was not significant, while hepatic critical O2ER was significantly larger than that of the gut (P < 0.05), 89.7 +/- 2.4% (mean +/- SD) and 66.1 +/- 5.1%, respectively. This finding indicated that the liver functions well under ischemic conditions due to its excellent ability to extract oxygen. The anatomical character of the sinusoid and the microcirculatory improving effect of isoflurane may affect the ability of oxygen extraction of the liver. The critical threshold of hepatic venous oxygen saturation as a marker of hepatic oxygen imbalance was considered to be below 10%.
Anesthesia, Inhalation↗
[Influence of scalp shaving on prevention of postoperative intracranial infection].
Shaving of the whole scalp is ordinarily performed prior to neurosurgical operation. Although it is performed in order to prevent postoperative intracranial infection, there has been no apparent basis for this practice published in previous reports. We examined whether shaving the whole scalp reduced the rate of postoperative infection or not. We divided 274 cases, who received their first intracranial operation in the last 2 years, into two groups; a whole shaving group and a partial shaving group. We compared the rate of postoperative intracranial infection between the two groups according to age, diagnosis, operation, operation time and placement of drainage. Overall, 12 cases out of 274 (4.38%) had postoperative intracranial infection. The long operation time and the long term placement of drainage mechanism increased the postoperative intracranial infection rate. There was no postoperative intracranial infection in 74 patients who received burr-hole/twist-drill operation. As for craniotomy/craniectomy operations, 7 cases out of 83 (8.4%) in the partial scalp-shaving group whole scalp shaving group and 5 cases out of 117 (4.2%) had postoperative intracranial infections. Thus, there was no significant difference in the rate of postoperative intracranial infection between the two groups, if anything, the whole scalp shaving group tended to show a higher rate. According to these results, partial scalp shaving did not increase the rate of postoperative intracranial infection. Considering that patients who have lost their hair find it embarrassing to return to society, it is well to know that the whole scalp shaving is not absolutely necessary for all first craniotomy.
Craniotomy↗
[Schizencephaly: clinical and MRI features].
We report the clinical and neuroimaging features of 4 cases with schizencephaly. Case 1 had bilateral schizencephaly with open-lip on the right and closed-lip on the left. Case 2 had unilateral schizencephaly with closed-lip on the left and subcortical heterotopia on the right. Case 3 had unilateral schizencephaly with closed-lip on the left. Case 4 had bilateral closed-lip schizencephaly. Although all cases except for Case 3 had bilateral lesions, neurodevelopmental outcome was generally good; Case 1 and 3 had mild hemiparesis. All patient have epilepsy which are well-controlled with antiepileptic drugs. Thus, the clinical presentation of schizencephaly, even if bilateral lesions, are quite variable.
Adolescent↗
[A case of successful thromobolytic therapy in a patient with cerebral embolism during angiography].
We report a case of successful thromobolytic therapy in a patient with cerebral embolism during angiography. A 57 year-old male lost his consciousness during angiography. His neurologic symptoms were semi-comatose and right oculomotor palsy. According to these symptoms, we estimated the lesion in the right midbrain. Immediately after we denied a cerebral hemorrhage by computed tomography, we infused 60,000 u of urokinase intravenously within an hour from the onset followed by diffusion weighted magnetic resonance imaging (DW-MRI). DW-MRI showed hyper-intense lesion in the midbrain. We sequentially performed thrombolytic therapy with urokinase by selective cerebral angiography within three hours from the onset. His symptoms gradually resolved, but his consciousness was still confused state. His all neurologic symptom completely resolved in the next day after hyperbaric oxygenation therapy.
Angiography↗
[The effect of microgravity on induced mutation through DNA synthesis during space flight].
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DNA↗
Multiple combined indirect procedure for the surgical treatment of children with moyamoya disease. A comparison with single indirect anastomosis and direct anastomosis.
Considering three different bypass procedures now in use, (single indirect nonanastomotic bypass procedure, multiple combined indirect (MCI) nonanastomotic procedure and direct anastomosis), the authors attempted to identify the most appropriate bypass procedure for treating ischemic-type moyamoya disease in children. The authors performed three procedures (the original encephaloduroarteriosynangiosis [EDAS] alone, the frontotemporoparietal combined indirect bypass procedure, and the superficial temporal artery--middle cerebral artery [STA-MCA] anastomosis with encephalomyosynangiosis [EMS]) on 72 hemispheres in 50 patients with pediatric moyamoya disease. Analyses were then performed to compare postoperative collateral vessel formation found on angiograms, complications, and clinical improvements. Postoperative collateral formations were observed in more than two-thirds of the MCA distribution after the EDAS alone, the MCI procedure, and the direct anastomosis in 44%, 52%, and 74% of the surgically treated hemispheres, respectively. In addition, frontal encephalomyoarteriosynangiosis of the MCI bypass procedure formed collateral vessels of the anterior cerebral artery distribution in 94% of the treated hemispheres. Postoperatively, clinical symptoms resolved in 56%, 63%, and 74% of the treated sides 1 year after EDAS alone, MCI procedure, and the direct anastomosis, respectively. One patient suffered a minor stroke after EDAS alone, two patients developed epidural hematomas after the MCI procedure, and one patient suffered a major stroke and one patient a minor stroke after undergoing direct anastomosis. The direct anastomosis procedure was found to result in the best postoperative collateral vessel formation and clinical improvement. However, the single and multiple combined indirect nonanastomotic bypass procedures were found to be safer than direct anastomosis. Furthermore, the frontotemporoparietal combined indirect bypass procedure caused the formation of collateral circulation not only in the MCA but also in the ACA distribution. Based on analysis of these findings, the authors recommend the MCI procedure as the appropriate surgical procedure in the treatment of children with moyamoya disease, although the best treatment is the STA-MCA anastomosis with EMS when feasible.
Journal Article↗
Primitive neuroectodermal tumors.
The primitive neuroectodermal tumors (PNETs) of Hart and Earle constitute an important fraction of pediatric brain tumors that are clinically characterized by their aggressive behavior. In 1983, Rorke expanded the term "PNET" to include all small cell embryonal neoplasms of neuroectodermal origin, regardless of the location of the tumor. More recently, Dehner also proposed the terms "central" and "peripheral" PNETs, and the provocative concept of "PNET" has now come to encompass a diverse group of tumors in both the central and peripheral nervous systems. The acronym "PNET" has thus become a confusing and controversial term in the diagnosis and classification of pediatric embryonal tumors. We reviewed ten papers concerning the various aspects of PNETs.
Journal Article↗
Combined chemotherapy and radiation therapy for central nervous system germ cell tumors: preliminary results of a Phase II study of the Japanese Pediatric Brain Tumor Study Group.
The authors conducted a multiinstitutional phase II study to establish a postsurgical combined chemotherapy and radiation therapy regimen for patients with primary germ cell tumors of the brain. After surgical debulking of the tumor and histological verification, patients were divided into three therapeutic groups: good prognosis, intermediate prognosis, and poor prognosis. Patients received two kinds of chemotherapy (three courses) prior to receiving radiation therapy: carboplatin-etoposide combination ([CARB-VP]: carboplatin 450 mg/m(2) on Day 1, etoposide 150 mg/m(2) on Days 1-3) or ifosphamide-cisplatin-etoposide combination ([ICE]: ifosphamide 900 mg/m(2), cisplatin 20 mg/m(2), and etoposide 60 mg/m(2) on Days 1-5). Patients in the good prognosis group (those with germinomas) were treated with CARB-VP followed by local radiation therapy (24 Gy). Patients in the intermediate prognosis group received CARB-VP followed by local radiation therapy (50 Gy); they received five additional chemotherapy treatments. Patients in the poor prognosis group received ICE followed by whole craniospinal radiation therapy; they also received five additional chemotherapy treatments. Eighty-two patients were evaluated. For the 56 patients with germinomas, a 93% rate of complete remission after treatment was achieved. The remission rate was 76% for 21 patients in the intermediate prognosis group, and no recurrence was detected during a median follow-up period of 2.6 years. In the group of five patients with poor prognosis, the disease in three patients progressed during chemotherapy or radiation therapy and they died within 6 months. There were no serious complications in the surviving patients. The authors found their treatment protocols to be currently effective for patients with germinomas and those with an intermediate prognosis.
Journal Article↗