[Indication of stereotactic aspiration for hypertensive intracerebral hematoma].
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Cerebral Hemorrhage↗
Biomedical subjects
S Sakaki
Publications and source records attributed to S Sakaki.
[Treatment for cardiac rupture following acute myocardial infarction].
We experienced thirty-three patients with cardiac free wall rupture following acute myocardial infarction (AMI). Twelve patients received reperfusion therapy. Surgical closure of cardiac rupture was performed in twelve patients under cardiopulmonary bypass (CPB). Two of these patients were placed on percutaneous cardiopulmonary support system (PCPS) immediately after the onset of blow out rupture. Cardiac rupture occurred in 19 patients within 3 days from the onset of AMI (early rupture) and in 14 patients 4 days after the onset (delayed rupture). All five patients with successful reperfusion were in the early rupture group, while there were no patients with successful reperfusion in the delayed rupture group. In 12 surgical patients, 7 patients had blow out rupture and 5 patients had oozing rupture. In 7 patients with blow out rupture, four patients could not be disconnected from CPB and 2 patients had cerebral death. One patient received PCPS support showed no mental disturbance after surgery, but he died of renal failure 6 days after surgery. Three out of 5 patients with oozing rupture survived. The interval from the onset of hypotension to establishment of cardiopulmonary support was 5 minutes and 60 minutes in two patients using PCPS. However it averaged 94 minutes in 5 patients using usual CPB. It is suggested that early reperfusion therapy may prevent delayed cardiac rupture following AMI, and surgical therapy using PCPS may be useful for the treatment of cardiac blow out rupture.
Adult↗
[Giant calcified meningioma after radiation therapy for previous ependymoma: a case report].
We presented a case of secondary giant meningioma with dense calcification (brain stone) after radiation therapy for primary ependymoma removed 25 years before. A 31-year-old man was referred to our hospital because of generalized convulsion. He had received extirpation of an ependymoma in the left frontoparietal region and postoperative radiation therapy 25 years before. Skull X-ray and CT revealed a giant brain stone in the left parietal region. It was totally removed en bloc. Photomicrograph of the specimen showed proliferation of arachnoid cell-like tumor cells in narrow spaces surrounded by marked calcified lesions which showed partial ossification. The etiology and therapy of this tumor were discussed.
Adult↗
Cranial fasciitis of childhood: a case report.
Cranial fasciitis of childhood is very rare, only 17 cases having been reported in the literature. We report an additional case of this rare disease. The patient was a 5-year-old boy who complained of left exophthalmos and double vision. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large epidural mass in the left frontal region that had invaded into the underlying anterior skull base. The tumor showed homogeneous, low density with nonhomogeneous contrast enhancement on the CT scans, and low intensity on the T1-weighted and high intensity on the T2-weighted MRI images. A whitish-pink, elastic, hard tumor was revealed in the epidural space in the left anterior cranial fossa, which was totally excised with curettage of the affected anterior skull base. The origin of the tumor was suspected to be the fibrous connective tissue of the sphenofrontal suture. The histological diagnosis was that of cranial fasciitis. There was no evidence of recurrence 1 year postoperatively.
Child, Preschool↗
Improvement in local cerebral blood flow measurement in gerbil brains by prevention of postmortem diffusion of [14C]iodoantipyrine.
Postmortem diffusion of [14C]iodoantipyrine, which distorts the image of cerebral blood flow, can occur in at least three steps; from decapitation until the brain is frozen, while frozen sections on coverslips are thawed, and when dried sections are applied to x-ray film. In the present study, the first two steps were modified to reduce the time during which brain tissue was wet. When the brains of gerbils were taken out of the skulls and immersed in chilled isopentane (-45 degrees C), 90-95 s elapsed between decapitation until the brain tissues were frozen. However, immersion of whole heads in liquid nitrogen after decapitation decreased the time to 25 s. The autoradiograms had better contrast after the freezing procedure with liquid nitrogen than after that with chilled isopentane. The drying time of the thawed sections was markedly reduced by blowing hot air across the sections on a hot plate, and this resulted in clearer images on autoradiograms. In most of the tissues with values of cerebral blood flow over 100 ml 100 g-1 min-1 as measured using the conventional drying method, the corresponding values were higher if the modified method was used. In contrast, in tissues with values less than 100 ml 100 g-1 min-1, the corresponding values were lower. Moreover, the differences between flows in adjacent small brain structures were less clear if the sections were dried by the conventional method. Reducing the time during which postmortem brains or sections are wet can help prevent [14C]iodoantipyrine diffusion artifacts.
Animals↗
[Left ventricular function in mitral regurgitation--relation to postoperative survival and left ventricular contractile state after mitral valve replacement].
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Adult↗
Association of meningioma and ependymoma--case report.
We report the rare association of a meningioma and an ependymoma in a young boy. A meningioma was detected in the left cerebellopontine angle at age 8 months, and an ependymoma in the left frontal lobe 2 years later. Chromosomal analysis was normal, and his family showed no signs of phacomatosis. Both tumors were totally removed, and he recovered well after both operations.
Brain Neoplasms↗
Global left ventricular performance and regional systolic function after suture annuloplasty for chronic mitral regurgitation.
BACKGROUND: In surgery for chronic mitral regurgitation, the mitral subvalvular apparatus, including annulus, may play an important role in preserving left ventricular (LV) performance. The suture annuloplasty for mitral regurgitation allows annular contraction of the mitral valve. The potential effects of suture annuloplasty on the postoperative LV performance have not been fully defined. METHODS AND RESULTS: Global and regional LV function in 12 patients with suture annuloplasty were compared with 12 patients with conventional mitral valve replacement (MVR). Cineangiography and echocardiography were obtained before and 10.8 months after surgery. End-diastolic volume index and end-systolic volume index decreased significantly in both groups after surgery (p < 0.01). Ejection fraction remained unchanged in the suture annuloplasty group, whereas it decreased significantly in the MVR group after surgery (p < 0.01). There was a significant inverse relation between ejection fraction and end-systolic wall stress in the two groups after surgery (suture annuloplasty group, r = -0.69, p = 0.01; MVR group, r = -0.60, p = 0.04). The intercept on the y axis was significantly (p < 0.005) higher in the suture annuloplasty group than in the MVR group. In the suture annuloplasty group, cross-sectional area ejection fraction at the mitral valve level and at the papillary muscle level by LV two-dimensional echocardiography remained unchanged after surgery. In the MVR group, they decreased significantly after surgery (p < 0.01). There was a significant correlation between the cross-sectional area ejection fraction and the global ejection fraction at both levels after surgery. Therefore, the improvement of the regional wall motion can be attributed to the improvement of the global LV performance after suture annuloplasty. CONCLUSIONS: These data suggest that suture annuloplasty can provide more desirable postoperative LV systolic performance than conventional MVR by preserving both the contraction of the mitral annulus and the mitral valvular-ventricular interaction.
Echocardiography↗
[Emergency coronary artery bypass grafting in patients with severe pump failure complicating acute myocardial infarction].
Thirty patients with severe pump failure (Killip's degree III or more) complicating acute myocardial infarction (MI) underwent emergency coronary bypass grafting (CABG). Average age was 66 years old and CABG was performed 2.6 days after the onset of MI. The patients were divided into two groups according to the mechanisms that can bring about severe pump failure: 19 patients had large MI alone (G-I). The other 11 patients had severe ischemia occurring either at areas distant from the site of coronary occlusion or in the previous area at risk (G-II). To estimate the ventricular wall motion quantitatively, the left ventricular wall was divided into 17 segments. Each segment was graded on a four-point scale: akinesis, 3; severe hypokinesis, 2; hypokinesis, 1; normal 0. Wall motion score was estimated by summing the number of asynergic segments score. In G-I, Cardiac index (CI (l/min/m2)) increased from 2.03 +/- 0.91 to 2.68 +/- 0.73 and pulmonary wedge pressure (PCWP (mmHg)) decreased from 28 +/- 5 to 15 +/- 5, 72 hours after the surgery (p < 0.01). In G-II, CI increased from 2.17 +/- 0.78 to 3.17 +/- 1.01 and PCWP decreased from 29 +/- 6 to 13 +/- 5 after the surgery (p < 0.01). There was no difference in preoperative and postoperative hemodynamics between two groups. The wall motion score at the risk area did not change postoperatively (from 16 +/- 7 to 17 +/- 9 in G-I, from 15 +/- 8 to 11 +/- 5 in G-II).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Assessment of the size and distribution of the coronary artery selected for bypass grafting using myocardial contrast echocardiography during coronary artery bypass surgery].
We assessed the size and distribution of the native coronary artery selected for bypass grafting, using myocardial contrast echocardiography by injection of sonicated agents into a saphenous vein graft, during surgical revascularization. A total of 69 saphenous vein grafts (LAD, 16; D1, 10; OM, 13; PL, 13; RCA, 17) were performed in 36 patients with right dominant system at preoperative coronary angiogram. The size of the area of revascularized myocardium was quantified with the ratio of its circumference to a full circle depicted on the left ventricular short-axis view at the mid-papillary level. The extents of the revascularized area to LAD stenosing at the proximal portion was 28 +/- 6% and stenosing at the intermediate portion was 23 +/- 6%. D1, 10 +/- 2%; OM, 17 +/- 3%; PL, 22 +/- 6%, RCA, 17 +/- 5%. The extent of the areas perfused by the totally occluded coronary arteries with collateral vessels was similar to those perfused by the partially occluded coronary arteries. In conclusion, myocardial contrast echocardiography enabled the intraoperative assessment of the geometry of regional myocardial perfusion, and was very useful for the intraoperative evaluation of the effectiveness of the indicated surgical procedure.
Arteries↗
[A successful surgical repair of acute postinfarction mitral papillary muscle rupture].
We reviewed a case who underwent early operation for acute postinfarction papillary muscle rupture. The patient was a 75-year-old male who was admitted to our hospital with cardiogenic shock required endotracheal intubation and intraaortic balloon support. The period to operation was 6 days from the onset of inferior myocardial infarction, and 2 days from the onset of postinfarction papillary muscle rupture. The posterior papillary muscle of mitral valve was totally ruptured and the mitral valve was replaced with a mechanical prosthesis (SJM 27 mm). Postoperative clinical course was not smooth, but the patient was going well. We believe to get good results for early operations of postinfarction papillary muscle rupture unless operative chances were lost.
Aged↗
[Cervical spinal cord injury caused by a broken acupuncture needle: a case report].
Spinal cord injury is a rare but considerable complication of acupuncture. A case with cervical spinal cord injury caused by a broken acupuncture needle was reported and sixteen previously reported cases including our case were reviewed. A 49-year-old woman was treated by herself with acupuncture on the nuchal region for occipitalgia, and the needle was accidentally broken during the treatment. Six hours later she noticed pain and numbness in the right upper and lower extremities. Neurological examination revealed slight impairment of temperature, pain and touch sensation on the right extremities. Plain X-ray film and CT scan showed a broken needle in the interspinous ligament between C1/C2 vertebrae, the tip of the needle appearing to be in the spinal canal. The needle was removed surgically nineteen days after the accident. Intraoperative fluoroscopic monitoring with injection of dye enabled the needle to be found without difficulty. Postoperative course was uneventful, and her pain and sensory impairment gradually disappeared. Once the diagnosis for cervical spinal cord injury by an acupuncture needle is made, the needle should be removed surgically as soon as possible, especially prior to the development of motor symptoms. This is because movement of the needle in the spinal cord is considered to be a main possible cause of the development and progression of symptoms.
Acupuncture Analgesia↗
[The long-term prognosis of coronary artery bypass surgery--the influence of preoperative left ventricular volume on the prognosis of cardiac death].
We have assessed the long-term prognosis about cardiac death of isolated coronary artery bypass surgery from 1972 to 1988 in 361 consecutive patients. The duration of follow-up were from 0.4 years to 14.6 (mean 5.7) years. Of the 361 study patients, the operative morality was 4.7% (17 patients) and 29 patients (8.0%) died during follow-up, 11 (3.0%) of which were from cardiac causes. Actuarial survival rate was 85.2% at 10 years after surgery. The 10 year-survival rate was similar for patients with single, double, triple vessel disease, and left main trunk disease (94.5%, 83.7%, 75.1% and 89.1%, respectively). For patients with and without old myocardial infarction, the 10 year-survival rate was significantly different (75.4% and 93.3%, respectively) (p less than 0.005). In order to detect which factors of preoperative cardiac function among cardiac index, LV end-diastolic pressure, LV end-diastolic volume index, LV end-systolic volume index, and LV ejection fraction influenced the long-term prognosis, multivariant regression analysis was performed. Only LV end-systolic volume index was a significant factor, and the discriminative point was 50 ml/m2. For patients with LV end-systolic volume index less than 50 ml/m2 and greater than or equal to 50 ml/m2, the 10 year-survival rate was significantly different (88.3% and 32.9%, respectively) (p less than 0.005). In conclusion, the most significant factor influencing longterm prognosis after coronary artery bypass surgery was left ventricular end-systolic volume, indicating the importance of preventing preoperative dilatation of left ventricle.
Actuarial Analysis↗
Kinetic behavior of technetium-99m-HMPAO in the human brain and quantification of cerebral blood flow using dynamic SPECT.
The kinetic behavior of 99mTc-hexamethylpropyleneamine oxime (HMPAO) in the human brain was investigated in 11 patients with various brain diseases (176 regions), using dynamic SPECT and a four-compartment model with five parameters (K1: rate constant for the transport of HMPAO from blood to brain, K2: backdiffusion from brain to blood, K3: conversion to a hydrophilic form in the brain, K5: conversion to a nondiffusible form in the blood, and fa: fraction of radioactivity attributable to the vascular compartment). Although K1 correlated well with cerebral blood flow (CBF) measured by the 133Xe inhalation method (Xe-CBF) (r = 0.888), its value was underestimated by 28.9% +/- 11.9%, indicating a low extraction fraction (E) for HMPAO. From E = K1/CBF, a regression equation of E = 0.857 - 0.00335. Xe-CBF was obtained. Significant correlations were observed for K2 versus Xe-CBF (r = 0.679), for K3 versus Xe-CBF (r = 0.483), for K3/(K2 + K3) versus Xe-CBF (r = -0.487), for K3/K2 versus Xe-CBF (r = -0.501), and for K2 + K3 versus Xe-CBF (r = 0.655), but not for K1/K2 versus Xe-CBF (r = 0.005). Thus, this model was useful for elucidating the kinetic behavior of HMPAO in the human brain, and correction for E appears to be indispensable for accurate CBF quantification using HMPAO.
Adult↗
Intracellular calcium levels in canine basilar artery smooth muscle following experimental subarachnoid hemorrhage: an electron microscopic cytochemical study.
Changes in intracellular calcium levels in canine basilar arterial smooth muscle were semiquantitatively measured by an electron microscopic cytochemical technique using a combined oxalate-pyroantimonate method. Measurements made after subarachnoid hemorrhage were compared with those made after contraction induced by prostaglandin F2 alpha. Fifteen minutes after topical application of the drug, when the basilar artery was constricted by 20%, 15% of smooth muscle cells contained a large amount of intracellular calcium. One hour later, the diameter of the basilar artery and intracellular calcium precipitation returned almost to control levels. Fifteen minutes after the first intracisternal injection of autologous blood, when acute vasospasm was angiographically evident, 13% of smooth muscle cells contained a large amount of calcium. After 1 h, when acute vasospasm had already abated, the number of smooth muscle cells containing a large amount of calcium markedly increased to 37% and some smooth muscle cells showed early degenerative findings such as intracytoplasmic vacuoles including calcium accumulation. After 48 h, when delayed vasospasm had already started, the calcium deposits and early degenerative changes had decreased significantly. After 49 h and 4 days (1 h and 48 h after the second injection of blood), the change in the amount of calcium was the same as at 1 h and 48 h after the first injection, respectively, but degeneration of smooth muscle cells increased. Therefore, acute vasospasm after subarachnoid hemorrhage may be caused by an initial elevation of intracellular calcium levels, as is the case with drug-induced contraction.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Pediatric orbital eosinophilic granuloma with intra- and extracranial extension--case report.
A rare case of eosinophilic granuloma of the orbit in a 3-year-old boy presented as right upper eyelid swelling and proptosis. Computed tomographic scanning revealed a soft-tissue dense mass in the lateral wall of the right orbit. Magnetic resonance (MR) imaging demonstrated tumor extension into the orbit, anterior and middle cranial fossae, and extracranial region. The tumor was completely removed. Histological diagnosis was eosinophilic granuloma. No evidence of recurrence was found 14 months later. MR imaging is useful for diagnosis of the lesion, and particularly for surgical management.
Child, Preschool↗
Foramen magnum decompression for syringomyelia associated with basilar impression and Chiari I malformation--report of three cases.
Anterior or posterior decompression of the foramen magnum was performed in three patients with syringomyelia associated with basilar impression and Chiari I malformation. The operative results were evaluated using the pre- and postoperative magnetic resonance (MR) images. Two patients with combined anterior and posterior cervicomedullary compression due to basilar impression and tonsillar descent received suboccipital craniectomy, upper cervical laminectomy, and dural plasty without any intradural manipulations via the posterior approach. One patient with prominent anterior cervicomedullary compression due to basilar impression and a sharp clivoaxial angle was operated on by the transoral anterior approach. Postoperatively, all patients showed a sustained shrinkage of the syrinx and rounding of the flattened cerebellar tonsils. Two patients showed upward movement of the herniated tonsils. All patients had improved symptoms during 2-4 years follow-up. Treatment of syringomyelia associated with basilar impression and Chiari I malformation requires more efficient decompressive procedures at the foramen magnum based on neurological and MR findings.
Adult↗
Dural arteriovenous malformation of the transverse and sigmoid sinus with special reference to its pathological features.
A case of posterior fossa dural arteriovenous malformation (AVM) is reported. In the surgical specimen the internal elastic lamina of the dura mater around the sinus was defective in places where nests of dural vascular anomalies protruded into the sinus lumen, suggesting that the AVM was congenital in origin.
Cranial Fossa, Posterior↗