Biomedical subjects

R Tsugane

Publications and source records attributed to R Tsugane.

At least 37 records · Page 2Linked to original sources

PubMed1997

Prognostic factors in delayed ischaemic deficit with vasospasm in patients undergoing early aneurysm surgery.

We have examined prognostic factors in delayed ischaemic deficit attributed to vasospasm following subarachnoid haemorrhage (SAH) and early aneurysm surgery. Among 605 patients with SAH, 201 patients developed a delayed ischaemic deficit and 137 of these underwent early surgery. These 137 patients were classified into groups A and B by outcome at 3 months after SAH (group A: the delayed ischaemic deficit was associated with an adverse outcome; group B: no adverse outcome). Factors indicating an unfavourable outcome were as follows: (i) older age; (ii) poor WFNS grade on admission; (iii) Fisher's scale of 4; (iv) intracerebral haemorrhage; (v) delayed ischaemic deficit following rerupture; (vi) complications of surgical intervention; (vii) delayed ischaemic deficit with disturbance of consciousness; (viii) lack of immediate improvement with hypervolaemic therapy; and (ix) intracranial complications after hypervolaemic therapy. We suggest that the reversibility of a delayed ischaemic deficit is determined by preceding brain damage and/or surgical complications.

Adult↗

PubMed1997

Surgical indications in patients with an intracerebral hemorrhage due to ruptured middle cerebral artery aneurysm.

In this retrospective study, the authors analyzed surgical outcomes in patients who suffered an intracerebral hemorrhage (ICH) as a result of a ruptured middle cerebral artery aneurysm. They studied 47 patients who underwent early aneurysm surgery and hematoma evacuation within 24 hours after onset of ICH. The types of ICH were classified into three groups according to their appearance on computerized tomography scanning: 1) temporal ICH; 2) intrasylvian hematoma; and 3) ICH with diffuse subarachnoid hemorrhage (SAH). Overall, 25 patients (53%) achieved a favorable outcome and 18 (38%) died. Factors that could be used to predict a favorable outcome included age less than 60 years, temporal ICH, World Federation of Neurological Surgeons Grade II or III, absence of a surgical complication, and a hematoma volume less than 25 ml. In the patients with temporal ICH, eight of nine patients achieved a good recovery and no patient developed a surgical complication or delayed ischemic deficit. The significant prognostic factor in patients with an intrasylvian hematoma was surgery within 6 hours after onset of symptoms. In patients with temporal ICH or intrasylvian hematoma, the results of the initial neurological examination did not accurately predict outcome. On the other hand, in patients with ICH and diffuse SAH, those patients who developed an ICH with a volume greater than 25 ml had a poor prognosis. These results indicate that aggressive surgical treatment should be performed in patients with a temporal ICH or an intrasylvian hematoma, regardless of the neurological findings on admission; in patients with ICH and diffuse SAH, a careful review of surgical indications is required.

Aged↗

PubMed1997

Cerebral hemodynamics and histological changes following acute cerebral venous occlusion in cats.

Using an acute cerebral venous occlusion model prepared by injecting cyanoacrylate into the cerebral venous system, superior sagittal sinus pressure (SSSP) and regional cerebral blood flow (r-CBF) were measured. In the same model, changes in cerebral metabolism at the site of r-CBF measurement were observed using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Cases were classified according to occlusion site: group SSS [occlusion of the superior sagittal sinus (SSS) only], group LS[occlusion of SSS plus lateral sinus (LS)] and group CV[SSS and LS plus cortical veins (CV)]. In groups SSS and LS, SSSP changed very little up to 6 hours after occlusion. In group LS, r-CBF decreased slightly, but the change was not significant. In contrast, an increase in SSSP and decrease in r-CBF were observed in group CV. Phosphorus MRS also demonstrated a decrease in phosphocreatinine (PCr) and adenosine triphosphate (ATP) and increase in inorganic phosphorus (Pi) following occlusion. Histopathological examination of group CV revealed dramatic changes, including the development of intracerebral hematoma and edema. Experimental application of the proposed model revealed that widespread occlusion of the sinuses can cause an increase in intravenous pressure with a concomitant decrease in r-CBF, resulting in metabolic complications such as a decrease in PCr and ATP and an increase in Pi.

Acute Disease↗

PubMed1995

[Management of delayed ischemic neurological deficit in subarachnoid hemorrhage before aneurysmal surgery].

The incidence of rerupture during the period of delayed ischemic neurological deficit (DIND) was studied in patients with aneurysmal subarachnoid hemorrhage (SAH) before surgical aneurysmal obliteration, and optimal management of DIND for preventing rerupture is discussed. At Tokai University Hospital, 511 patients with SAH were admitted during the 5-year period from 1988 to 1992. Of these, 247 had not undergone obliteration of the aneurysm neck within 3 days after SAH. In this group, 31% (77 patients) developed DIND. Of these 77 patients, 40 were managed with induced hypertension and/or hypervolemic therapy for DIND (25 with both (group 1), 15 with normotensive hypervolemic therapy (group 2)), and 37 did not receive either kind of therapy (group 3). The incidences of rerupture were as follows: all SAH patients: 11.5%; group 1: 48%; group 2: 7%; group 3: 11%. The incidence of rerupture in group 1 was significantly higher than that in the other groups. On the other hand, the favorable outcome rate (excellent and good) was as follows: group 1: 40%; group 2: 73%; group 3: 22%. This rate was significantly higher in patients who received normotensive hypervolemic therapy, than in other groups. This study suggests that, to avoid rerupture and unfavorable outcome, normotensive hypervolemic therapy is the optimal management approach in patients with DIND after SAH who have not undergone obliteration of the aneurysmal neck.

Aneurysm, Ruptured↗

PubMed1994

Detection of norepinephrine distribution in rats with adrenal medulla autotransplants using 125I-meta-iodobenzyl guanidine.

The viability of autologous adrenal medullary transplants was evaluated using 125I-meta-iodobenzyl guanidine (MIBG), an adrenal medullary scanning agent. Bilateral cavities in the caudate nuclei were made stereotaxically in Wistar rats. One week later, the left adrenal medulla was resected by microsurgery, followed by reoperation of the cranium and implantation of a 0.5-1.0 mm diameter fragment of the adrenal medulla into the right caudate nucleus. Six weeks after the second operation, MIBG was administered intravenously. Specimens from both cerebral hemispheres, from the right adrenal medulla and blood were analysed by radioactivity counting. The radioactivity present in the blood of the transplanted group of 11.40 +/- 2.35 cpm mg-1 (mean +/- S.E.M.) was significantly higher than in the control group of 4.97 +/- 1.16 cpm mg-1 (P < 0.05). Radioactivity present in the right hemisphere of the transplanted group was 0.66 +/- 0.03 cpm mg-1, also significantly higher than in the control group which was 0.47 +/- 0.04 cpm mg-1 (P < 0.01). Autoradiography revealed increased radioactivity in the area of the transplants, which was also confirmed histologically.

3-Iodobenzylguanidine↗

PubMed1993

Development of akinetic mutism and hyperphagia after left thalamic and right hypothalamic lesions.

A case of childhood post-traumatic akinetic mutism is presented. The patient showed a hyperphagic condition while recovering from akinetic mutism. He had lesions in the left interlaminal nucleus of the thalamus, right globus pallidus, and right dorsomedial nucleus of the hypothalamus. Laboratory data indicated slightly disturbed hypothalamic functions. In general, akinetic mutism can be seen with bilateral destructive lesions, while hyperphagia may occur after destruction of dorsomedial hypothalamic nucleus, but it is very rare. This is the first reported case of akinetic mutism caused by a unilateral lesion.

Akinetic Mutism↗

PubMed1993

Intracranial complications of hypervolemic therapy in patients with a delayed ischemic deficit attributed to vasospasm.

This investigation has revealed the frequency of various intracranial complications that may result from hypervolemic therapy for a delayed ischemic deficit following subarachnoid hemorrhage (SAH). Among 323 patients with SAH, 112 patients developed a delayed ischemic deficit, 94 of whom underwent hypervolemic therapy. Infarction due to vasospasm was found ultimately in 43 of these 94 patients. Twenty-six patients (28%) developed an intracranial complication during hypervolemic therapy: cerebral edema was aggravated in 18, and a hemorrhagic infarction developed in eight. In 13 of 18 patients with aggravation of edema, delayed ischemic deficit developed within 6 days after the SAH; at that time, a massive new infarction was found in four and edema in 10 patients. After hypervolemic therapy, the 18 patients with aggravation of edema deteriorated rapidly, and 14 of them died. In every case in which hemorrhagic infarction followed hypervolemic therapy, a new infarct was found on computerized tomography (CT) when the delayed ischemic deficit became apparent. Hemorrhagic infarction developed as the delayed ischemic deficit resolved, with one exception. In patients who sustained no complication from hypervolemia, the incidence of both massive new infarction and edema at the time when the delayed ischemic deficit was manifested was only 1%. In 44 of 68 patients who sustained no complication from hypervolemia, the delayed ischemic deficit was manifested on or after the 7th day following the SAH. This study suggests that hypervolemic therapy is contraindicated in a patient who is found to have a massive abnormality on CT at the time when a delayed ischemic deficit is manifested, especially when it occurs within 6 days after the SAH. To avoid hemorrhagic infarction, it is important to discontinue hypervolemic therapy as soon as the delayed ischemic deficit resolves.

Adult↗

PubMed1992

Entrapment of the temporal horn: a form of focal non-communicating hydrocephalus caused by intraventricular block of cerebrospinal fluid flow--report of two cases.

In two cases of entrapment of the temporal horn, computed tomography demonstrated the typical appearance of a comma-shaped homogeneous area isodense with water surrounded by a periventricular low-density area. The cause was probably choroid plexitis resulting in obstruction of the cerebrospinal fluid pathway at the atrium. External drainage followed by shunt emplacement is indicated.

Adult↗

PubMed1992

[Problems in general management during barbiturate therapy].

Sixty-three patients (aged from 4 to 75 years) who had suffered severe head injury or cerebrovascular disease were placed on barbiturate regimens in which intravenous administration was given in amounts of 1-4 mg/kg/hr. Dobutamine and dopamine were also administered to prevent cardiac failure and renal failure. Immediate and delayed complications caused by barbiturate therapy were investigated and analyzed. Immediate complications included tachycardia which was seen in 16 cases (25%), and hypotension in 14 cases (22%), respectively. Higher incidence of those complications was noted among the patients who underwent surgery. Delayed complications included hypokalemia (41 cases, 65%), liver dysfunction hypernatremia (24 cases, 38%), infection (21 cases, 33%), cardiac failure (8 cases, 13%) and renal failure (1 case, 2%), respectively. Therefore, in patients treated under barbiturate regimens great care should be taken in order to avoid above mentioned complications.

Adolescent↗

PubMed1992

Intracranial arterial reconstructive surgery for unclippable aneurysms. An application of microvascular suturing.

Intracranial arterial reconstructive techniques were used in three patients for whom conventional neck clipping was not feasible due to the size, location or symptoms of their aneurysms. In the first case, complicated by subarachnoid hemorrhage, a giant aneurysm in the right middle cerebral artery was excised and the stump of the parent arteries was reconstructed in end-to-end and end-to-side fashion. The second case had a large thrombosed aneurysm in the left vertebral artery compressing the medulla oblongata, with small perforators originating from the proximal posterior inferior cerebellar artery (PICA) feeding the brainstem. The PICA was transposed to cerebellar cortical artery and the aneurysm excised. The third case presented with TIA and small infarctions were observed in the left thalamus. A giant, partially thrombosed, aneurysm in the left posterior cerebral artery (PCA) was trapped with a revascularization of the distal PCA from the superior cerebellar artery in side-to-side fashion. Indications for these intracranial arterial reconstructions in aneurysmal surgery were discussed and pertinent literature was reviewed.

Adolescent↗

PubMed1991

Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease.

There were 55 patients (soft disc, 21 and spondylosis, 34) who underwent anterior cervical discectomy without fusion (ACD) using an operating microscope. Discectomy of a single level was performed on 48 cases and two levels on 7. There were 37 patients with radiculopathy, and 18 patients with myelopathy or myeloradiculopathy who were followed clinically for 2-13 years postoperatively. Overall 81% of patients were improved in soft disc herniation, and no significant differences were noted between the group of radiculopathy and myelopathy. In spondylosis all but one patient reported initial relief of their preoperative symptoms; however, overall improvement was noted in only 16 patients (47%). The causes of symptomatic deterioration after ACD for spondylosis were later symptomatic recurrence in 5 patients, severe neck pain in 4, and development of new symptoms due to adjacent spur formation in 2. The authors eventually added interbody fusion in 4 cases. Cervical spine roentgenograms almost always showed a loss of height of the interspace and an anterior angulation immediately after ACD, but the alignment of the spine tended to improve with time, so that, at last follow-up, 82% had a good alignment. A spontaneous osseous fusion occurred in 74% of cases. An adjacent spur formation was observed in 3 patients with spondylosis. The most troublesome complication was neck and/or scapular pain. This pain usually subsided spontaneously, but this continued for more than 4 years postoperatively in 4 patients with spondylosis. Using an operating microscope ACD is a safe and effective procedure for patients with soft disc herniation, but the authors still prefer anterior cervical discectomy with interbody fusion for the patients with advanced spondylosis.

Cervical Vertebrae↗

PubMed1991

[Optimal hypervolemic therapy for symptomatic vasospasm].

Thirty-five patients with symptomatic vasospasm (SV) following aneurysmal subarachnoid hemorrhage (SAH) were managed according to a method based on hemodynamic manipulation, monitored by Swan-Ganz catheter. Nine out of these had delayed surgery. For those who developed SV, the pulmonary wedge pressure (Pcwp) and/or central venous pressure (CVP) were immediately increased up to the point at which neurological deficit was reversed by rapid injection of fresh frozen plasma, albuminates, low molecular dextrose, and glycerol. On this regimen, patients were closely observed for any neurological change. Then the hemodynamic parameters were maintained as optimal values until they could be reduced below optimal values without reappearance of neurological deficit. In inoperable patients, special attention was given in making a decision about discontinuing the regimen. The results were compared with thirty-seven patients with SV who were treated with conventional hypervolemic therapy (CHT) by continuous administration of albuminates. In the treatment of CHT, optimal values could hardly be established, so the same hemodynamic parameters were applied in all the cases. From this study, in the majority of the cases optimal values were found as follows: Pcwp up to 10-15 mmHg, and CVP below 11 cmH2O. On the contrary, in 20% of patients, neurological deficit was reversed by increasing CVP to a point not above 7 cmH2O. Correlation between neurological reversal and systemic blood pressure was not statistically significant. After this regimen (OHT), 74% of patients showed immediate improvement after volume expansion, and, in 80%, outcome was good, while 20% died. The motor function at the time of discharge was more than 3 on the manual test in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Venous Pressure↗

PubMed1991

[A case report: abscess of the cavum septi pellucidi].

A rare case of an abscess in the cavum septi pellucidi (CSP) is described and previously reported cases are reviewed. A 60-year-old male was admitted to the hospital because a diagnosis of cerebellar hemisphere infarction was made on CT scan. Seven years earlier, the patient had undergone a craniotomy for aneurysm clipping, and a ventriculo-peritoneal shunt was installed for normal pressure hydrocephalus 14 days after the aneurysmal rupture. On his second hospitalization CT scan also demonstrated CSP but this was not associated with ventriculomegaly. He was placed on a rehabilitation regimen and his hospital course was uneventful. Two months later, however, he developed hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone. After analysis of CSF obtained from the shunting device, a diagnosis of meningitis was made and CSF culture revealed E. coli infection. A part of the peritoneal tubing was torn and missing when the tube was removed from the peritoneal cavity and converted to outer drainage. Being treated with intrathecal and intravenous antibiotics administration, the meningitis subsided. However, CT scan taken twelve days after the onset of the infection showed an abscess in CSP which showed ring enhancement after contrast media. Therefore, the patient continued to receive intravenous antibiotics to counter the mass effect due to the abscess. The abscess had disappeared on follow-up CT scan obtained ten days later. The patient, however, eventually expired after iatrogenic hypernatremia associated with acute renal failure. The patient was submitted to an autopsy. The authors speculate that the abscess developed through a retrograde cisternal route after infection which had originated from bowel perforation by the peritoneal shunt tube.

Brain Abscess↗

PubMed1989

Time course of CSF lactate level in subarachnoid haemorrhage. Correlation with clinical grading and prognosis.

Cisternal and/or ventricular cerebrospinal fluid (CSF) and arterial blood lactate and acid-base balance were measured serially in 38 patients with aneurysmal subarachnoid haemorrhage (SAH). Based on daily clinical assessment, the patients and accordingly the samples were divided into two groups according to the grading of the World Federation of Neurosurgical Societies (W.F.N.S.). In cisternal CSF, samples of Grade III-V showed significantly higher lactic acidosis than those of Grade I-II. The time course of lactate and pH in poor prognosis groups had a significant tendency of lactic acidosis, especially on the 5th, 6th, 7th day after SAH. Ventricular CSF lactate increased even without CSF acidosis in Groups III-V. Measurement of CSF lactate, especially from the cisterna magna is useful as an indicator of prognosis and changes of intracranial environment following SAH.

Acid-Base Equilibrium↗

PubMed1989

Atrial natriuretic polypeptide in patients with subarachnoid haemorrhage due to aneurysmal rupture. Correlation to hyponatremia.

Measurement of plasma alpha-humanANP (ANP) and antidiuretic hormone (ADH) in 28 cases with aneurysmal subarachnoid haemorrhage (SAH) was carried out, and then compared with control subjects who were infused with hypertonic saline. In cases with hyponatremia (HN), statistical correlation between control subjects and cases without HN was not evident with regards to ANP and plasma osmolality (Posm), excreted fraction of filtrated sodium (FENa) and urinary Na/K. Furthermore, they secreted supernumerarilly in spite of HN. Cases with HN were further subdivided into two groups, they were those cases with negative total sodium balance at the time of appearance of HN, and those cases without total negative sodium balance. In the former, central venous pressure had a tendency to decrease, however, secretion of ANP and ADH was statistically not different in either groups. It appears that ANP regulated urinary sodium excretion against an osmotic or sodium load acts as a maintenance of homeostasis as an osmotic regulator. Cases with HN in which secretion of ADH was physiological, ANP secreted supernumerarilly in spite of hypoosmonaemia and hypovolaemia. Our findings may contribute to a better understanding of the pathophysiological processes leading to hyponatremia in cases with cerebral disorders, and may help to improve the treatment possibilities.

Adult↗

PubMed1989

Indications for cisternal drainage in conjunction with early surgery in ruptured aneurysms and timing of its discontinuation.

The efficacy of cisternal drainage in association with early aneurysmal surgery remains highly controversial. The authors attempted to clarify the indications for this procedure and the proper timing of drainage removal in a series of 205 patients with no evidence of intracerebral hematoma who underwent surgical obliteration of bleeding aneurysms within 72 hours after subarachnoid hemorrhage. The 136 patients in whom cisternal drainage was performed constituted Group A and the remaining 69 patients Group B. The acid-base balance and lactate concentration were measured serially in cisternal cerebrospinal fluid (CSF) and arterial blood of 33 patients. Subarachnoid blood demonstrated by computed tomography (CT) was graded according to the system of Fisher et al. The outcome at 6 months did not differ significantly between Groups A and B among patients of preoperative CT grade 2 and clinical grades I-II. However, among patients of CT grade 3 or clinical grade III, those in Group A had better outcomes. The rates of symptomatic vasospasm in Groups A and B were 39.7% and 40.6%, respectively. However, persistent vasospasm was more frequent in Group B (11.8% vs. 26.1%), particularly in CT grade 3 patients. Ventricular enlargement was more prevalent in Group A (33% vs. 17%). CSF pH higher than arterial pH after the 7th postoperative day was associated with a poor outcome and was fairly well correlated with a rise in CSF HCO3- and a fall in CSF PCO2. CSF lactate increased with clinical deterioration but was not well correlated with preoperative CT findings, total volume of CSF outflow, or prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Low-dose dopamine treatment of patients in nonketotic hyperosmolar hyperglycemic coma].

In the acute neurosurgical setting, nonketotic hyperosmolar hyperglycemic coma (NHC) is thought to be caused by cerebral dehydration therapy and administration of steroids, glycerol, or mannitol. The mortality of this complication is reportedly very high, and is due to acute renal and/or cardiac failure. The authors evaluated the effect of low-dose dopamine (LDD; 1 to 5 micrograms/kg/min) administration in 10 patients with this syndrome. LDD was given to five patients. In these cases, hypovolemia was treated under central venous pressure monitoring with an iso-osmolar hyponatremic lactate solution given in a volume greater than the urine output. After the hypovolemia was corrected, the fluid was administered in a volume equal to the urine output until the serum osmolarity was normalized. In the five patients not given LDD, a large quantity of hypotonic solution was rapidly administered. In all patients treated with LDD, the urinary sodium increased and the urinary output stabilized. Consequently, the excess urea-nitrogen and serum sodium were quite easily washed out. The total net intake volume for the normalization of serum osmolarity was small and the duration of treatment was much shorter than that of patients not treated with LDD. The LDD regimen was not associated with complications, such as aggravation of cerebral edema, renal failure, or cardiac failure. On the other hand, three of the five patients not given LDD died of acute renal and/or cardiac failure without normalization of laboratory data. It is emphasized that this therapy, which results in beta-effect of catecholamine, sodium diuresis, and increased renal blood flow, is a practical means of managing acute neurosurgical cases complicated by NHC.

Adult↗

PubMed1989

[Case report: hemiballism due to a putaminal cavernous hemangioma].

A rare case of reversible hemiballism due to putaminal pathological process in a 51-year-old woman is described. She was hospitalized for evaluation of hemiballism and muscle weakness on the left side. A cranial computed tomography scan demonstrated a high density lesion in the right putamen with enhancement on delayed scan. Angiographic examination revealed no apparent abnormalities. Magnetic resonance imaging with T1 weighted showed a isodense lesion in the right putamen, while T2 weighted image revealed a ring like low signal area around a high signal lesion. These findings were compatible with the diagnosis of cavernous hemangioma. In order to establish the final diagnosis, CT-guided stereotaxic biopsy was carried out. But histological specimen showed only gliosis and calcification. Immediately after the biopsy, a small hemorrhage took place in the right putamen extending to the head of caudate nucleus head. Following this episode, hemiballism ceased, however, it gradually returned along with absorption of hemorrhage. The speculated pathophysiology of this on-and-off hemiballism was as follows; it initially developed as the result of suppression of inhibitory fibers from the striatum to the pallidum by a minor hemorrhage of putaminal cavernous hemangioma, and ceased by declining the activities of the pallidum due to interruption of excitatory fibers from the thalamus and the cortex to the striatum.

Brain Neoplasms↗