Biomedical subjects
Publications and source records attributed to S Kuramoto.
An intraorbital hemangioblastoma of the optic nerve is reported in a 23-year-old woman with von Hippel-Lindau disease. The absence of dural attachment and the microscopic findings were characteristic of hemangioblastoma. Four years later the patient developed a cystic hemangioblastoma in the left cerebellum which was successfully treated.
During stereotaxic surgery anatomical structures and their extent on trajectories were identified by neural noise (field potential) obtained by semi-microelectrode technique. Locations of anatomical structures (the white mater, caudate nucleus, thalamus, subthalamic field and nuclei in the subthalamic field) were fed into microcomputer (NEC PC-8001) as 3 dimensional correlates and stored in minifloppy disc system (NEC PC-8031). Data with satisfactory recordings from 48 trajectories from 30 patients (18 parkinsonism, 5 central pain, 7 others) entered this study. Microcomputer was so programmed that locations of the trajectories and electrophysiologically identified anatomical structures at that location in various coronal, sagittal and horizontal planes were displayed. Accumulation of this display from various groups of patients automatically created electrophysiological atlas. For comparison of thus created electrophysiological atlas with anatomical atlas display was made on various sections of the Schaltenbrand and Bailey's Atlas which were also stored in the mimifloppy disc system. Electrophysiological topography of the thalamus and adjacent structures was reasonably similar to anatomical topography with minor, but significant individual variations. In most cases the ventral border of the thalamus was located in the close vicinity of CA-CP line, however, in some cases the thalamus was located deep into the subthalamic field. This was thought to be due to the difficulty in identifying the ventral border of the thalamus by this technique and in such occasions other neurophysiological method for identifying the ventral border of the thalamus, i.e., thalamocortical evoked potential and other stimulation technique, were necessary. Medial aspect of the V. im. nucleus emitted neural noise of different characteristics which in current program was recognized as the subthalamic field. This implies that the medial and lateral aspects of the V. im. nucleus are cytoarchitecturally different and that it is possible to differentiate the medial and lateral aspects of the V. im. nucleus by this technique. The lateral thalamic border, i.e., thalamocapsular border, also showed relatively wide range of individual variations. When various parameters including age, sex, diagnosis and width of the 3rd ventricles were examined for possible cause of these variations, a tendency was noted that the thalamocapsular border was medially placed when the width of the 3rd ventricle was small. In this system it is possible to display sequentially electrophysiologically identified structures along any trajectory. This display method, which was called "tract study," was very usefull for comprehensive understanding of location of trajectory in relation to individually varying anatomical structures...
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The authors described a case of alobar holoprosencephaly with a huge cyst in the posterior fossa, possible representing a Dandy-Walker cyst, and marked cerebellar agenesis in the absence of median facial dysmorphias that has recently been encountered at our clinic.
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A rare case of duplication of the middle cerebral artery with a ruptured aneurysm on its origin during pregnancy was reported. A 29-year-old woman, primipara, was admitted to our clinic at 17 weeks' gestation on June 26, 1979 with a history of sudden onset of severe headache and vomiting, followed by unconsciousness fit for 30 minutes. The patient displayed typical features of subarachnoid hemorrhage. Lumbar puncture revealed bloody CSF. Right carotid angiogram 20 days after admission demonstrated duplication of the middle cerebral artery arising from the terminal internal carotid artery and a small aneurysm at its origin. There was evidence of associated spasm in the internal carotid artery, M1 and A1 portion without hematoma. The patient was treated conservatively for 2 months and then aneurysm surgery was performed. At operation, under the hypotensive anesthesia, on August 21, 1979, the presence of duplication of the middle cerebral artery on the right side and ruptured aneurysm on its origin were confirmed. The neck of aneurysm was completely clipped. Fetal heart rates were monitored by Doptone monitor during the operation. Postoperative course was excellent. Three months postoperatively, the patient went into spontaneous labor, at 40 week's gestation, and delivered a healthy infant. Clinical management of subarachnoid hemorrhage in pregnancy and the relationship between anomaly of the middle cerebral artery and aneurysm were discussed with the literature.
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A case of arterio-venous malformation (AVM) at the right parietal area in association with agenesis of the left internal carotid artery (ICA) is described. A 27-year-old male complained of severe headache and vomiting on September 27th in 1980. He lost his consciousness and became stuporous within several minutes after the ictus. He was then transferred to Kurume University Hospital. On admission, he was semicomatose, anisocoria and left hemiparesis marked in the lower limbs, and bilateral Babinski reflex were noted. A emergency CT scan revealed a round high density area suggesting intracerebral hematoma at the right parieto-occipital area. Right retrograde brachial angiography was then performed which showed a small AVM at the right parietal lobe mainly fed by the right posterior parietal arterial branch, and drained into the superior sagittal sinus, via the subcortial veins. Left MCA bilateral PCA and SCA also were demonstrated on the angiogram. The angiogram suggested on abnormality of the Willis ring. Emergency operation fro the small AVM associated with intracerebral hematoma was then performed. The AVM was sufficiently removed and approximately 80 gr. of intracerebral clots were also evacuated completely. Histological examination indicated a typical small AVM. The postoperative course was uneventful. Left CAG performed by seldinger method from the femoral artery after the operation showed no demonstration of the left ICA. the left common carotid artery was terminated as the external carotid artery without carotid bifurcation at the neck. The left ophthalmic artery was fed by the meningeal artery of the internal maxillary artery. Left vertebrobasilar system was normal. From an angiogram, the agenesis of the left ICA was most suspected. An agenesis of ICA was uncommon among the literature in which there was no case with this anomaly associated with cerebral AVM. The embryological consideration about this case was mainly discussed.
A total of 1026 patients with gastric cancer was followed up for five years after surgery and classified into different groups according to surgeons' assessment of nodal involvement, serosal invasion, peritoneal spread, and hepatic metastasis. The survival of each group was studied by parametric analysis, using the log normal model and three parameters estimated: proportion of patients cured (c), mean (m), and SD of log survival times of patients not cured. With these parameters, compared with the conventional five-year survival or the median time, the survival pattern of each group was delineated in detail, and prognostic inferences beyond the follow-up period were made feasible. Groups with more localized lesions were characterized by higher values of c and m. This implied that although patients in these groups have a better chance of cure, they are exposed to a relatively higher risk of late death due to recurrence. This method proved also useful to compare the prognostic values of different classification and to develop better staging systems.
Retrospective analysis of 15 cases with acute subdural haematoma receiving decompressive hemicraniectomy was carried out in an effort to clarify the beneficial effect and limitation of this operative procedure. The patients in this series were divided into three groups according to postoperative intracranial pressure (ICP). Decompressive hemicraniectomy was effective in lowering ICP in all patients except for the cases that developed acute brain swelling. Overall mortality rate was 66.7% in this series. Preoperative clinical status, and intra- and postoperative ICP and CT findings obtained within 24 hours of operation were correlated with the operative outcome.
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