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Biomedical subjects

M Tsuyumu

Publications and source records attributed to M Tsuyumu.

35 records · Page 2Linked to original sources
PubMed1978

Clearance of edema fluid into cerebrospinal fluid. A mechanism for resolution of vasogenic brain edema.

The authors present the results of an investigation studying the resolution of vasogenic brain edema using cold injury in cats. The appearance of RISA-I131 and sucrose-C14 lebeled edema fluid in the ventricular cerebrospinal fluid (CSF) was assessed by means of ventriculocisternal perfusion. The effect of low- or high-pressure perfusion on edema spread was determined by measuring the water, sodium, RISA-I131, and sucrose-C14 content of serial tissue blocks taken from the injured cortex through the white matter to the ventricular ependyma. The findings indicate that increasing the hydrostatic pressure gradient between edematous brain and CSF enhances the clearance of edema fluid into the ventricular CSF. This was conclusively demonstrated with low-pressure ventricular perfusion which markedly diminished the amount of edema close to the ventricles compared to the controls. The concentration of albumin, sodium, and potassium to the fluid removed from the tissue during low-pressure perfusion indicates that bulk flow was the primary method of edema movement through the extracellular space. With high-pressure perfusion the concentration profiles suggested alternative mechanisms of edema resolution, such as diffusion and reabsorption into capillaries.

Animals↗
PubMed1976

[Meningioma in the aged--on its differential diagnosis (author's transl)].

Despite vast improvement in diagnostic techniques in neurosurgery during the past few decades, there still remain a significant number of intracranial tumors in geriatric age group, which are not recognized in the early course of the disease or during life. We are now focusing on the diagnostic problems of meningiomas in the geriatric age group and stressing the significant value of brain scanning in the differential diagnosis of brain tumors from cerebral vascular disease or other conditions. During about 10-year period, a total of 36 intracranial tumours in cases over 60 year old have been studied. Sixteen of these tumors are meningiomas and form the basis of this report. The age of these cases was between 60 and 83 years with average of 70.5. There were two males and 14 females. As to the location, four were parsagittal and falx meningiomas, three were at tuberculum sellae, two were at sphenoidal ridge, one was at tentorium in location. Twelve cases were erroniously diagnosed and confusion with cerebrovascular disease was most common. We analysed the onset and the progression of symptoms of our 16 cases, and picked up and stressed the four peculiarities of geriatric meningiomas. The first one is that the onset of symptoms is very sudden, almost precipitate, and the subsequent clinical course may be so rapidly progressive. The six patients in our cases were included in this group. A case among those was verified to be complicated with intratumoral hemorrhage, and another one with a subdural hematoma. The vast contrast to the first group is the second peculiarity. The meningioma especially in the geriatric age group may frequently unfold a clinical picture, which by its very insidious onset and slow development may be even unrecognized during life. The third is that patients developed dementia, at the onset in two cases and in any course of this disease in six. All too frequently in these instances the tumor has been overlooked and wrongly diagnosed as a senile dementia or psychosis. The fourth is that the meningioma developed with intermittent, recurrent and streotyped cerebral symptoms including epilepsy. We presented a case with intermittent aphasia due to a convexity meningioma on the dominant side. In almost all cases, manifestation of increased intracranial pressure was absent or not significant. There was found a papilledema in only one case, and cerebrospinal fluid revealed a normal pressure in six out of eight cases in which lumbar puncture was performed. It was proved that brain scanning was one of the most useful adjuncts in the diagnosis of brain tumor in the aged even in serious conditions. Changing brain scan patterns in association with clinical course is a useful diagnostic guide in differentiating tumors from cerebrovascular accidents. The serial scan density change is more meaningful if the clinical course is considered. Scanning should be done as soon as possible when the brain tumor is suspected and should be rescanned if necessary.

Age Factors↗
PubMed1976

[A case of hemangioblastoma associated with spina bifida occulta, persistent metopic suture, thyroid adenocarcinoma, vertebro-occipital anastomosis and erythrocytosis (author's transl)].

We presented a case of hemangioblastoma associated with spina bifida occulta, persistent metopic suture, thyroid adenocarcinoma, vertebro-occipital anastomosis and erythrocytosis. We have not found a hemangioblastoma with these associations, as far as we have seen in the literature. 36-year-old male was admitted with complaints of nausea, vomiting and ataxic gait in June, 1970. On admission, the examination revealed no evidence of increased intracranial pressure except for elevated CSF pressure by lumbar puncture and incoordination. The peripheral blood count disclosed slight erythrocythemia. Vertebral angiography revealed a vascular lesion of 2.0 cm in diameter situated almost in the midline of caudal cerebellum receiving its blood supply from the right posterior inferior cerebellar artery. In addition, a right vertebro-occipital anastomosis was visualized. Plain reoentgenograms showed persistent metopic suture and spina bifida occulta of C 5 - 6. After admission, installation of Ommaya reservoir and decompressive suboccipital craniectomy were performed, and a thyroid papillary adenocarcinoma was totally removed. After discharge, he had been well for two years until a month previously to the second admission, when he commenced to have again headache, nausea, and vomiting with ataxic gait. Vertebral angiography showed the tumor enlarged in size measuring 4.0 X 5.0 cm and the tumor stain was more irregular and less homogenous than 3 years before. Brain scan revealed an increased uptake in the midline of the posterior fossa. After readmission, in April, 1973, he gradually developed dysphagia, disturbance of articulation and inactivity of mentality and died from pneumonia in October, 1974. Autopsy revealed a vascular tumor originated from the medial portion of the right cerebellum and the tumor showed multiple cyst formation in the rostral part in contrast to the caudal solid mass. Histologically the tumor tissue was composed of capillaries supported by fine argyrophilic fibers, large clear interstitial cells containing lipid granules and hemosiderin pigment. Carcinoma of the right lobe of the thyroid was found with metastasis to the bone marrow, lungs and anterior cervical lymphnodes and lymphnodes at the left supraclavicular angle. Bone marrow showed marked erythropoiesis. The case reported here provides an evidence to suggest that there is more than a random relationship between hemangioblastoma, dysraphic state and thyroid carcinoma. The other association, the vertebrooccipital anastomosis may result from the enhanced demand of blood supply by hemangioblastoma but this speculation needs further examination.

Abnormalities, Multiple↗
PubMed1976

[Evaluation of shunt therapy in normal pressure hydrocephalus-surgical results in neurological conditions (author's transl)].

This presentation is a study of 18 patients diagnosed as having normal pressure hydrocephalus and treated by CSF diversion procedures. Pre- and postoperative neurological conditions of these patients were evaluated, compared, and analysed. There were 56% of males and 44% of females and the number of patients under 60 and over 61 were equal. The histories and clinical findings in all suggested a diagnosis of normal pressure hydrocephalus. In 12, the two thirds of patients, showed progressive intellectual deterioration, ataxic gait and/or incontinence following subarachnoid hemorrhage. Similar neurological features were preceded by craniocerebral trauma in one, megadolichobasilar artery in one and superior sagittal sinus thrombosis in one. Three cases were idiopathic. 169Yb cisternography, transfer test of radioisotope to blood, angiography and in some cases pneumoencephalography were performed in the usual manner to confirm the diagnosis. Attempts have been made to correlate the surgical results with the ages of patients, the duration of symtoms, and the causes of hydrocephalus. Neurological symptoms were divided into three groups. Group "A" is composed of mental deterioration, lack of spontaneity and willingness, mutism and disorientation, groups "B" includes gait disturbance and group "C" incontinence. The results of surgical treatment were analyzed according to the three groups of symptoms not only in the percentage of cases who improved but also in the time interval from the time of shunting to the appearance of operative results. The results are as follows. The good surgical improvements were achieved in the cases of under 70 years old, in the case of NPH of known causes, such as subarachnoid hemorrhage, craniocerebral trauma, and in the cases operated on within three months after the onset of symptoms. Recovery of "A" symtoms was achieved not only sooner after the operation but also in more cases than those of "B" and "C" symptoms. The correlation was analyzed between the duration or symptoms and time interval after the shunting and the appearance of operative results. Although no correlation was obtained in "A" symptoms, the sooner was shunting performed, the earlier appeared the operative results in "B" and "C" symptoms. In conclusion, it appeared from the results of the present study, that in addition to the integration of the results of different examinations such as isotope cisternography, air study and angiography, the combination of the patient data such as ages, duration of symptoms and the cause of hydrocephalus are essential in selecting the patients for shunting operation. If the diagnosis of normal pressure hydrocephalus is confirmed and surgical improvement is predicted, the patient should be shunted as soon as possible to obtain a good surgical results especially in mental symptoms, which is the important factor in performing rehabilitation therapy.

Adult↗
PubMed1975

Radioisotope scanning for the spinal cord tumor.

Radioisotope scanning with 99mTc-pertechnetate or 67Ga-citrate for the spinal cord tumors was reported. Six patients with spinal cord tumors including 2 ependymomas, 1 neurinoma, 1 metastatic medulloblastoma, 1 metastatic astrocytoma, and 1 metastatic pinealoma as well as 6 patients with non-neoplastic lesions were examined with this method. Two out of 6 cases with tumors showed positive scans and two equivocal scans. This new method is different from myeloscintigraphy and radioisotope angiography as already reported. It directly demonstrates tumor itself like brain scanning and is very useful as nontraumatic method for screening spinal cord lesions, especially in poor risk patient. The usefulness and limitation of this method are discussed.

Adult↗
PubMed1975

[Regional cerebral blood flow in senile patients with meningiomas (author's transl)].

We investigated the regional cerebral blood flow of 4 meningioma patients who were all of ages over 60 years old. The average age of the patients was 68 years. Cerebral blood flow was determined by the 133Xe clearance method of Lassen and Ingvar. By extra-cranial recording of the radioactivity from the freely diffusible inert gas 133Xe, which dissolved in saline, was injected into the internal carotid artery, a clearance curve was obtained from the cerebral hemisphere. This curve could be resolved into two monoexponential clearance functions that corresponed to the flow in the grey and white matter. Graphical analysis of the original curve allowed the estimation of the relative weight of these two tissue components as well as of the mean cerebral blood flow. In three patients, regional cerebral blood flow was measured both pre- and post-operatively and these values were compared. Focal rCBF disturbances could be detected in agreement with the tumor location as verified directly or by other diagnostic procedures. That is, a relative hyperemia was detected at the areas corresponding to the tumor site. Mean fg (the flow in the grey matter) of four patients was 77.3 +/- 14.0 ml/100 g/min on the tumor areas, 48.1 +/- 6.6 ml/100 g/min on the peritumoral regions, 63.1+/- 4.1 ml/100 g/min on the non-tumoral regions. CBFr (average cerebral blood flow) of non-tumoral areas in the four patient was 36.6 +/- 2.4 ml/100 g/min and that of the peri-tumoral area, 33.1 +/- 7.9 ml/100g/min. These figures are moderately smaller than that of the normal one. A comparison between the neurological features and regional flow values noted in patients who had a removal of menigiomas indicated that the flow values of non-tumoral area increased markedly a month after operation, instead of only slight or no improvement in neurological features. Although our cases with rCBF studies are still too few to warrant conclusions, it seems that post-operative follow-up of mean cerebral blood flow changes might be rather greater help in the assessment of prognosis after operation of meningiomas than fg (the flow in the grey matter).

Aged↗
PubMed1975

[Radioisotope cisternographic study on cerebrospinal fluid circulation after subarachnoid hemorrhage].

Although recent advance in neurological surgery has diminished mortality rate of aneurysmal surgery, there still exist several complex problems for the management of aneurysms. Persistent neurological deficits or clinical deterioration after subarachnoid hemorrhage can result from subsequent communicating hydrocephalus which can be treated by shunting operation. We have studied alterations in the cerebrospinal fluid (CSF) circulation after SAH in 43 patients. Sources of hemorrhages were aneurysm in 30 cases, arteriovenous malformation in 6 and unknown in 7. Radioisotope cisternography was performed using 0.5 to 1.0 mCi of 169Yb-DTPA which was given intrathecally by lumbar injection. Results of cisternogram were classified into 4 groups and 7 subgroups; group 0: non filling (4%), group I: persistent ventricular filling (45%), A) absence of convexity flow (11%), B) partial convexity flow (34%), group II: transient ventricular filling (23%), A) delayed convexity flow (11%), B) normal convexity flow (12%), group III: no ventricular filling (28%), A) delayed convexity flow (17%), B) normal convexity flow (11%). The radioactivity in serial blood samples was measured by a well-type scintillation counter. Three types of curves for transfer of 169Yb-DTPA from CSF to blood were classified; delayed type, medium type, and normal type. In delayed type, the count ratio of blood activity at 24 hr to that at 3 hr is over 30%. In normal type, it is below 10%. There was a close correlation between cisternogram and transfer curve. In most cases with persistent ventricular filing, the transfer curve showed a delayed type. The relationship of cisternogram to classification of patient's condition by Hunt was studied. The grade of patient's condition was found to be closely related to the degree of abnormality in CSF circulation. The existence of rebleeding in the patients history was also found to influence the degree of abnormality in CSF circulation. However, single bleeding may also cause abnormality, such as persistent ventricular filling on cisternogram. In regard to the site of aneurysms, those of anterior communicating artery appeared to cause communicating hydrocephalus more frequently. Laterality of convexity flow was analyzed in 17 cases. All cases with internal carotid aneurysms showed decreased activity on the side of bleeding. Shunt operation was performed on 10 cases according to the results of cisternography, transfer curve, pneumoencephalography, and angiography. Seven cases showed improvement and 2 died of other complications soon after the shunt, and the effect of the procedure cannot be evaluated. Patients with clinical signs of NPH and abnormal cisternogram (group I) with evidence of ventricular dilatation are indicated for shunting operation.

Adult↗