Biomedical subjects
Publications and source records attributed to S Kuramoto.
Two cases of extracerebral cavernous hemangioma in the middle fossa are reported. Cerebral angiography showed a large avascular mass lesion in each case, but the tumors were very vascular at operation. Recovery of vision occurred in one case postoperatively. Diagnosis and treatment of these tumors are discussed.
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UNLABELLED: There are many problems about the cause, pathophysiology and treatment of acute brain swelling under intracranial hypertension frequently encountered in the neurosurgical clinics. Generally, rapid increase of the cerebral vasoparesis caused by unknown etiology is thought to be the main cause of acute brain swelling under intracranial hypertension. Moreover, disturbance of the cerebral venous circulatory system is discussed recently by many authors. But, research from the point of systemic respiration and hemodynamics is necessary for resolving these problems. This experiment was designed to study the effects of respiration and hemodynamics on the cerebral vasoparesis. METHOD: Using 22 adult dogs, acute intracranial hypertension was produced by epidural balloon inflation sustained at the level of 300 - 400 mmH2O. Simultaneously with measurement of intracranial pressure at the epidural space, superior sagittal sinus pressure, respirogram, systemic blood pressure (femoral artery), central venous pressure, common carotid blood flow, EKG and bipolar lead EEG were monitored continuously. The experimental group was divided by the respiratory loading into 5 groups as follows: control (6 cases), 10% CO2 hypercapnia (4 cases), 10% O2 hypoxia (4 cases), stenosis of airway (5 cases), 100% O2-controled respiration (3 cases). RESULTS AND CONCLUSIONS: 1) Cerebral vasoparesis under acute intracranial hypertension took place earlier and showed more rapid progression in groups of stenosis of airway, hypercapnia and hypoxia than control group of spontaneous respiration in room air. No occurrence of cerebral vasoparesis was found out in a group of 100% O2 controlled respiration. It is proved that increased airway resistance or asphyxia, hypercapnia and hypoxia have strictly reference to the occurrence and progression of cerebral vasoparesis and for the prevention of cerebral vasoparesis, correct 100% O2 cont rolled respiration is effective. 2) From the hemodynamic change, the progression of rapid increase of cerebral blood volume with increase of blood volume in the superior sagitta sinus during cerebral vasoparesis under intracranial hypertension is presumed. It is suggested from the superior sagittal sinus pressure in various experimental groups that the site, reactivity and disturbed degree of the cerebral venous system are changed by the difference of respiratory or ventrilatory state and the cerebral venous circulatory disturbance has also reference to the occurrence of acute brain swelling. 3) During cerebral vasopareris under acute intracranial hypertension, remarkable supression of respiration, increased central venous pressure and increased common carotid blood flow were observed. It is concluded that the reaction of systemic hemodynamics following respiratory change effects on cerebral circulation markedly and they are being important factors to occurrence of acute brain swelling.
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Junctional dilatation of the posterior communicating artery was investigated on 1,286 carotid angiograms, which were displayed to 750 patients for recent five years in our department, and the following results were obtained. 1) Incidence; The junctional dilatation was seen on 96 out of 750 cases (12.8%), whereas on angiograms, this was 105 times out of 1,286 angiograms. A difference in ratio of appearance between men and women was not statistically significant. 2) Comparison between the left and right side; 58 cases of junctional dilatation was seen out of 633 cases (9.2%) on the left side, and 47 out of 653 cases (7.2%) on the right side respectively. Bilataral junctional dilatations were seen only 9 out of 536 cases. There was no difference in appearance of the junctional dilatation on either side. 3) Relationship to age; There was a very few cases of junctional dilatation under the age of 20, while it rapidly increased in 3 to 4 decades. The incidence of junctional dilatation was seen in 32 out of 329 patients (9.7%) under 40 years of age, which was 6.7% of angiograms, on the other hand the incidence increased to 15.2% (64/421) over 40 years of age, which was 9.3% of angiograms (p less than 0.05). 4) The incidence of visualization of posterior communicating artery and posterior cerebral artery relation to junctional dilatation. We divided cases into the following 3 groups. (a) Type I: Visualization of partial or whole length of the posterior communicating artery (76.2%). (b) Type II: Visualization of the proximal portion of the posterior cerebral artery (18.1%). (c) Type III: Visualization of whole length of the posterior cerebral artery (5.7%). 5) Shape and size of junctional dilatation: The shape of dilatation could be divided into a funnel shape and a round shape. The funnel shape was seen in 32 cases (30.5%) and the round shape was seen in 73 cases (69.5%). Also the most of cases was larger than 2 mm in diameter.
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Prognostic significance of postoperative changes in serum albumin and urea concentrations as well as their ratio was statistically evaluated in 73 patients with suture line leakage of the abdominal alimentary tract. Increase in serum urea was associated with poor prognosis regardless of the site of leakage. Although the serum albumin concentration was poorly correlated to prognosis, its ratio to serum urea was of more prognostic significance than the urea value alone. When the ratio of the serum albumin nitrogen to the urea nitrogen fell below 10, there was a sharp rise in mortality as well as in morbidity, associated with poor local defense reaction, high incidence of spreading peritonitis, severe systemic complications, and decreased tolerance to tube feeding as well as parenteral hyperalimentation. A special therapeutic policy was suggested for the management of leakage in patients with critically low albumin/urea ratios.
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