[Trial of percutaneous hepatic cryo therapy: preliminary report].
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Animals↗
Biomedical subjects
S Kuramoto
Publications and source records attributed to S Kuramoto.
[Intermittent intra-arterial chemotherapy using subcutaneously implanted reservoir for hepatocellular carcinoma and liver metastasis of colorectal carcinoma].
Hepatectomy has been performed as a treatment for hepatocellular carcinoma (HCC) and metastatic liver carcinoma. The prognosis has improved, but it is not sufficient. In our department hepatic arterial infusion chemotherapy using subcutaneous implanted reservoir has been undertaken in 21 of 66 patients who underwent hepatectomy in hepatocellular carcinoma and 13 of 30 in liver metastasis of colorectal carcinoma since 1986. There was no significant difference between the group with and without arterial infusion chemotherapy in HCC but there was a significant difference in metastasis of colorectal carcinoma. In unresectable cases, intra-arterial chemotherapy was undertaken, but there was no significant difference. On the other hand, 26 of 58 cases receiving arterial infusion chemotherapy have shown complications.
Antineoplastic Combined Chemotherapy Protocols↗
[Basic studies of intra-arterial hyperthermic treatment].
Basic studies on intra-arterial hyperthermic treatment (1AHT) were conducted in rabbits implanted with VX2 tumor inside the thigh. For the purpose of determining the best temperature, saline added Adriamycin (ADM) (2 mg/body) that heated up to a predetermined objective temperature was injected. At 3 days after administration, the intratumor concentration of ADM (ITCA) and blood laboratory data were obtained. ITCA of the 53 degrees C group (1.13 +/- 0.41 micrograms/g) was significantly higher than those in the 23 degrees C group. In the 58 degrees C group, BUN, CPK, and creatinine were elevated. These data suggested that the best temperature of IAHT was about 53 degrees C. The treated rabbits were divided into 4 groups (heated saline added ADM, heated saline, non-heated saline added ADM, control) and the tumor growth rates after IAHT were investigated. The tumor size of the groups treated by heated saline was inhibited compared with that in the other two groups. There was no elevation of intratumor temperature in spite of IAHT. At 2 days after the IAHT, patho logically there were vacuolar degeneration in the arterial endothelial cells near the tumor, and narrowing of involved artery. These results suggest that the antitumor effect by IAHT is related with blood supply without hyperthermic effect.
Animals↗
[Emergency manual aspiration for severe hypertensive cerebellar hemorrhage].
We treated 16 patients with hypertensive cerebellar hemorrhage and coma, or deep coma. Their ages ranged from 44 to 79 years (mean age: 66.3 years). Manual aspiration was performed in 9 patients and suboccipital craniectomy was performed in 7 patients. The difference in outcome between the manual aspiration group and the suboccipital craniectomy group with severe hypertensive cerebellar hemorrhage was then evaluated. Manual aspiration was performed for 4 patients in coma, and 5 in deep coma, with a mean age of 69.0 years. The average size of the hematoma was 48.7mm and the mean volume was 31. 7ml on CT scan. The mean interval from admission to operation was about 60 minutes. The mean aspiration rate was 79.6% and 7 patients (77.8%) had a good response to drainage. The suboccipital craniectomy patients included 5 in coma, and 2 in deep coma, with a mean age of 63.4 years. The average size of the hematoma was 51.1 mm and the mean volume was 33.1 ml on CT scan. The mean interval from admission to operation was about 112 minutes and the mean evacuation rate was 86.4%. The results were as follows: 1) After manual aspiration, 5 patients (55.6%) had a good outcome and 2 patients (40%) with deep coma showed good recovery. In contrast, after suboccipital craniectomy only 2 patients (28.6%) had a good outcome and all of the deep coma patients showed poor recovery. 2) The outcome may be most strongly influenced by the duration from admission to operation. 3) All patients with a hematoma volume of over 30 ml had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Acute subdural hematoma caused by mild head trauma in the aged].
We encountered 8 cases of acute subdural hematoma caused by mild head trauma in the aged. In this report, these cases were analyzed, taking into consideration clinical symptoms, CT scan, operative findings and outcome. The age ranged from 70 to 92 years (mean age of 79.7 years). 4 patients were male and 4 female. Head trauma was caused by falls in 4 patients, but in the other 4 patients the causes were unknown. Initial symptoms were headache, nausea and vomiting in 5 patients and mild disturbance of consciousness with lucid intervals in 3 patients. Seven patients had more than 100 on JCS and less than 9 on GCS on admission. Small craniotomy (HITT) was performed in 4 patients. Large craniotomy was performed in 2 patients, and decompressive craniectomy was carried out in 2 patients. The bleeding focus came from the cortical artery of the middle cerebral artery in 4 patients, cerebral contusion in 2 patients, and was unknown in 2 patients for HITT. CT scan on admission showed mixed density area of acute subdural hematoma in all of the patients, and intraventricular hemorrhage, intracerebral hemorrhage and subarachnoid hemorrhage in 3 patients. CT scan after operation revealed a new area of cerebral contusion in 3 patients, delayed traumatic intracerebral hematoma (DTICH) in 2 patients, and hypertensive intracerebral hemorrhage in 1 patient. Two patients recovered to good and fair without general complication. But the outcome in 5 patients with general complication was poor for 3 patients and fatal for 2 patients. In conclusion, large craniotomy is recommended because of bleeding from the cortical artery of the middle cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
[Multiple intracranial aneurysms following radiation therapy for pituitary adenoma; a case report].
A report is made here on a rare case in which occurrence of multiple cerebral aneurysm was observed after radiotherapy. The case was that of a female aged 51 who was hospitalized with the chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during the patient's hospitalization, and multiple cerebral infarction was also observed by CT scanning and MR imaging. Therefore, conservative treatments including intensified endocrine-supplementing treatment, centering on thyroid hormone, were attempted. The patient's thyroid gland function and hyperlipidemia improved but the consciousness disorder persisted. Exacerbation of the consciousness disorder occurred suddenly 6 weeks after the patient's hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifurcation of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery and irregularity of wall width in the central artery including the terminal region of the internal carotid artery. These findings were not observed at the initial hospitalization and were considered to have been formed newly afterwards. Further, these findings were observed unexceptionally in all the radiated fields. The patient died 8 weeks after hospitalization, and no autopsy finding was obtained. From the above, we presumed that radiation vasculopathy caused by the radiation therapy made one year previously, had led to the formation of multiple cerebral aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenoma↗
[Significance of the cerebral venous system in the development of DIND in subarachnoid hemorrhage].
The significance of superficial venous system in the development of delayed ischemic neurological deficit (DIND) was studied retrospectively in 18 patients with ruptured aneurysm of the middle cerebral artery (MCA). Neck clipping of the aneurysms was performed via the pterional approach within 72 hours after onset of subarachnoid hemorrhage. All patients were in grade I or II of the Hunt and Hess Grading, and in group 2 or 3 on Fisher's CT classification. The age ranged from 32 to 71 with 48.1% being the mean age. The aneurysm was located on the left side in 5 patients, and on the right side in 13 patients. Arterial and venous phase were evaluated on the pre-and post operative angiograms in these patients. Arterial narrowing was divided into localized and diffuse types according to the degree, and its distribution in the arterial tree. In the venogram, opacification of the superficial sylvian veins (SSV) was the main thing evaluated. Arterial narrowing was observed in 16 cases (9; localized, 7; diffuse). In some cases, visualization of the SSV was poor or fair, and in others it was normal. DIND, including motor deficit or disturbance of consciousness, developed in 10 cases (transient; 6, permanent; 4). The patients with normal visualization of SSV on the postoperative angiogram had good outcome, even if they had diffuse arterial narrowing. On the other hand, the outcome was only fair or poor in those patients who had poor visualization of the SSV, irrespective of arterial narrowing.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Interhemispheric arachnoid cyst; report of three cases].
Three operated cases of the interhemispheric arachnoid cyst were reported. Case 1: a 58-year-old female suffering from progressive right hemi-rigidity and gait disturbance for the past two years. Case 2: a 66-year-old female was admitted with chronic headache. MRI demonstrated a large interhemispheric cyst in these two patients. Case 3: a 6-month-old male had frequent episodes of tonic seizure. MRI demonstrated interhemispheric cyst and agenesis of the anterior part of corpus callosum. The resection of the cystic wall via the interhemispheric approach was performed for all cases. General convulsive seizure developed in the early stage following operation in case 1 and case 2, in spite of routine administration of prophylactic anticonvulsant. The seizures were well controlled thereafter. In all cases, the cyst disappeared on the follow up CT. Simple resection of cyst wall is effective in the surgical treatment of interhemispheric arachnoid cysts.
Aged↗
First sutureless closure of a colotomy: short-term results of experimental laser anastomosis of the colon.
To assess the possibility of laser anastomosis of the colon, experimental laser closure of colotomies was performed. Transverse colotomies (average 20.7 mm) in New Zealand white rabbits (n = 20) were closed with a 1,064-nm Nd:YAG laser at a pulsating 0.5-W wave of power, using guy sutures to approximate the tissue edges. The laser energy was applied through a specially designed hand piece and hand-held 600-microns gas-cooled noncontact quartz fiber to produce a satisfactory tissue welding. Similar colotomies were closed using a single layer of interrupted sutures of 5-0 Maxon (Davis & Geck, Pearl River, NY) in a control group (n = 20). Bursting pressure and index of narrowing were recorded immediately after anastomosis and at 1, 4, and 7 days following surgery. Bursting pressure of the laser-welded closure at 1 day was significantly lower than that of the sutured controls (P less than 0.01); however, all rabbits recovered uneventfully. There was a marked decrease in adhesion formation following laser anastomosis (P less than 0.05). Conversely, one control rabbit showed functional stenosis at 4 days. Histologic study revealed an accelerated healing in the laser group. The index of narrowing was significantly higher in the laser group than in the control group (P less than 0.05). The completely water-sealed laser anastomosis reduces adhesions and is comparable to conventional suture anastomosis of the colon.
Anastomosis, Surgical↗
Lymphocytic hypophysitis and pulmonary sarcoidosis. Report of a case.
Lymphocytic hypophysitis is one of the causes of hypopituitarism in the postpartum period. Some of these patients have been reported to have other organ-specific autoimmune diseases, and the disease is considered to be autoimmune in nature. The authors describe a unique case of lymphocytic hypophysitis in a young woman. She had hemianopia that developed three days after delivery. Computed tomography scans revealed an intrasellar mass lesion. Secretions of adrenocorticotropic hormone and growth hormone were decreased. Although no organ-specific autoantibodies were detected in her serum, OKT4-positive helper T lymphocytes were increased in peripheral blood. Pituitary biopsy at craniotomy showed typical features of lymphocytic hypophysitis. Pulmonary and eye sarcoidosis developed 11 months after the delivery. This is, to the authors' knowledge, the first case of lymphocytic hypophysitis associated with sarcoidosis in other organs.
Adult↗
Multiple primary brain tumors of different histological types--report of two cases.
Simultaneous development of histologically different primary brain tumors aside from phacomatoses or previous irradiation is rare, and its preoperative diagnosis is still difficult. We report two such cases, a 49-year-old male with an acoustic neurinoma and a cerebellar hemangioblastoma and a 69-year-old female with a parietal convexity meningioma and an ipsilateral frontal lobe astrocytoma. The tumors in the first case developed closely, so some local stimulation probably acted as a developmental factor. However, the tumors in the second case developed in distant areas and were considered coincidental.
Brain Neoplasms↗
Diffuse axonal injury and early intracranial sequelae in severe head injury.
The importance of diffuse axonal injury (DAI) and early intracranial sequelae was studied in 107 patients with diffuse and focal brain injuries. Comprehensive neuropathological study was also undertaken in 24 fatal patients. The mortality rate was clearly the highest in traumatic subarachnoid hemorrhage, followed by acute subdural hematoma, cerebral contusion with delayed hematoma formation, traumatic intracerebral hematoma, diffuse cerebral swelling, DAI with classical features, and finally nearly normal on computed tomographic scans. The mean flow velocities in the middle cerebral artery recorded by transcranial Doppler ultrasound were variable in diffuse brain injury, but commonly decreased on the hematoma side depending on increased intracranial pressure and decreased cerebral perfusion pressure in focal brain injury. Deep-seated hemorrhagic lesions did not expand in diffuse brain injury, but sizable hematoma developed within 24 hours in focal brain injury. The platelet count was significantly lower in patients with poor outcomes in focal brain injury. Histological evidence of classical DAI was found in eight (50%) of 16 cases with focal brain injury. DAI of varying severity is the common subjacent lesion in patients with severe head injury, but the final outcome varies greatly with different lesion types.
Axons↗
[Giant aneurysm of the middle cerebral artery presenting with complex partial seizure. Case report].
A 24-year-old female who had had several attacks of complex partial seizures was admitted after minor head trauma. There was no neurological deficit on admission, but a large oval calcification was incidentally found in the left temporal region on the plain skull film. Computed tomography scan and carotid angiography revealed a giant thrombosed aneurysm which arose from the M2 portion of the left middle cerebral artery. Focal spike discharges were found on the left temporal region on conventional electroencephalography. Left frontotemporal craniotomy and opening of the left sylvian fissure disclosed a giant aneurysm at the M2 portion of the left middle cerebral artery. The neck of the aneurysm was buried in the dome of the aneurysm and the parent artery was curved at an acute angle at the site of the neck. The aneurysm was excised and end-to-end anastomosis of the main stem of the M2 portion was successfully performed. Postoperative course was uneventful and the patient became completely free from seizures. The surgical technique and the possible mechanism of complex partial seizure in this patient are described.
Adult↗
Multiple brain tumors of different cell types with an unruptured cerebral aneurysm--case report.
A rare case of coexistent Burkitt-type lymphoma and meningioma associated with an unruptured cerebral aneurysm is presented. A 49-year-old male complaining of headache and right hemiparesis was admitted to our hospital. Neuroradiological examination revealed a multinodular mass in the left frontal convexity and an unruptured cerebral aneurysm at the M1 portion of the left middle cerebral artery. He underwent an operation for tumor removal and aneurysm clipping. Histological examination revealed the tumor to be a typical meningotheliomatous meningioma without malignancy. However, a second operation was necessary for another tumor invading into the left frontal lobe, which proved to be a Burkitt-type lymphoma. The second tumor may have been resulted from irritative effect of the first tumor, but the aneurysm was considered purely coincidental.
Brain Neoplasms↗
External dislocation of the metallic device of a shunt valve, an unusual long-term complication of the Holter valve--case report.
The case of a 20-year-old male with a mechanical disruption of a shunt valve in which proximal metal portion of the Holter valve was dislocated out of silicone casing is reported. In the three cases previously reported by Zander and Campiche (1980), mechanical traction force exerted on the two metallic extremities of the Holter valve incrusted on the growing skull was incriminated as the causative mechanism. In the present case, growth-related mechanical traction force was exerted on the extended portion of the shunt system. This suggests that the shunt valve of this type can be a locus minoris to long-standing mild mechanical traction force exerted on the extended portion of the shunt system.
Adult↗
[Classification of DNA histogram perturbed with 5-FU and its clinical application].
Analysis of cell kinetics may be beneficial for evaluation of the therapeutic effect of anticancer agents. Therefore, using flow cytometry, the authors could classify perturbations of DNA histogram of cultured colon cancer cells treated with 5-FU into 4 types. Perturbation of DNA histogram of cancer cells treated with 5-FU of different concentrations was closely associated with the degree of cell damage indicated by the growth curve. Then, tumor samples before and after injection of 5-FU were collected from 9 preoperative patients with colon cancer and classified into the above 4 types. The results show that 2 cases were classified into type I (S/G1 ratio: 1.5 greater than, G1.G2M comparison: G1 greater than G2M) and another two into type IV (CV ratio: 1.5 less than or equal to, S/G1 ratio: 1.5 less than or equal to, G1.G2M comparison: G1 greater than G2M). However, 5 cases could not be classified (not evaluated) because of the absence of stemline and the presence of heterogeneity in tumor samples. The authors consider that the classification of perturbation of DNA histogram is a useful method to evaluate the degree of cell damage with 5-FU, if tumor samples are appropriately selected and analysis is made with careful attention.
Aneuploidy↗
[A case of bacterial aneurysm following Hardy's operation].
Intracranial mycotic aneurysm of extravascular origin is reported. A 64 year-old male developed headache and visual disturbance. Computed Tomography (CT) revealed high density mass lesion with contrast enhancement in the intra- and suprasellar lesion. He was then admitted to our hospital under the diagnosis of pituitary adenoma. But he suddenly complained of headache and loss of vision during hospitalization. An emergency operation using the transsphenoidal approach was performed. The pathological diagnosis was craniopharyngioma. Postoperative radiation therapy was carried out using a tumor dose of 50Gy. Two months after the operation, he suffered from rhinorrhea and high fever. He was admitted again and treated with high doses of antibiotics. Two weeks after admission, he suddenly lost consciousness. A CT scan revealed an aneurysm of the anterior temporal artery. Immediately, removal of the hematoma and resection of the aneurysm were performed. Microscopic examination showed that inflammatory cells had infiltrated the aneurysmal wall, and lymphocytes and plasma cells had gathered around the microabscess. This rare case is discussed with other related cases in the literature.
Aneurysm, Infected↗