Biomedical subjects

S Tsunoda

Publications and source records attributed to S Tsunoda.

At least 199 records · Page 11Linked to original sources

PubMed1991

[Staphylococcus aureus sepsis in patients with hematological malignancies: increase in MRSA sepsis].

From January 1978 to August 1990, Staphylococcus aureus bacteremia (SAB) were identified in 31 patients with hematological malignancies at Jichi Medical School hospital. Mortality due to SAB was 48.4% (15/31). Of the variables analyzed, four factors were significantly associated with a poor prognosis; elderly age (p = 0.015), high granulocyte count (more than 500/microliters) (p = 0.015), presence of DIC (p = 0.011) and presence of pneumonia (p = 0.023). The incidence of methicillin-resistant SAB was 32.3% (10/31) and the first patient developed in 1985. Although not statistically significant, there was a trend of higher mortality for methicillin-resistant SAB (70%) than for methicillin-sensitive SAB (38.1%). Most strains of methicillin-resistant Staphylococcus aureus were sensitive to minocycline, chloramphenicol and vancomycin.

Adult↗

PubMed1990

The influence of volume expansion with induced hypertension on vessel reactivities, the blood-brain barrier, and cerebral infarction in cats with one-hour occlusion of the middle cerebral artery.

Thirty anesthetized cats were randomly assigned to three groups of 10 cats each: a 10% hydroxyethyl starch-treated group (10% HAES group), a 6% hydroxyethyl starch-treated group (6% HAES group), or a control group. Cerebral pial arterial reactivities were measured by means of intravital microscopic observation through a cranial window. The middle cerebral artery of the cat was clipped for 1 hour using the transorbital approach, 5 hours later Evans blue dye was injected intravenously, and 30 minutes later the animals was killed. Administration of hydroxyethyl starch or saline was started 15 minutes before clipping and lasted for 1 hour. Total volume administered was 10 ml/kg. Systemic arterial pressure was elevated to about 30 to 40% higher than the resting value by administration of dopamine soon after clipping and maintained for 1 hour. In the hydroxyethyl starch-treated groups, the sizes of infarctions and Evans blue dye leakage were significantly smaller than in the control group. Dye leakage in the 10% HAES group was larger than in the 6% HAES group (statistically significant). Regarding pial arterial reactivities, the caliber of arteries was different in each group after reopening of the clip. Arteries in the control group first returned to some 20% of resting state and redilated 40% or more, arteries in the 6% HAES group returned almost to the resting calibers, and arteries in the 10% HAES group constricted by -20% of the resting calibers. Moreover, 8 of 10 cats in the 10% HAES group showed extravasation of red cells. Only one cat in the 6% HAES group showed extravasation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Effects of repeated temporary clipping of the middle cerebral artery on pial arterial diameter, regional cerebral blood flow, and brain structure in cats.

Temporary clipping of the major arterial trunk is an important maneuver to control excessive unexpected bleeding in neurosurgical operations; however, repeated temporary clipping can give rise to severe neurological deficits after surgery. The present study was performed to confirm and explain these clinical findings. Initially, a single 20-minute or 1-hour occlusion of the middle cerebral artery was performed in each of 5 cats. Pial arterial diameter was determined by video imaging, regional cerebral blood flow was measured by autoradiography, and cerebral edema and infarction were observed. In the 20-minute occlusion group, no abnormal changes were found 5 hours after recirculation. In the 1-hour occlusion group, pial arteries were dilated by 45%, and regional cerebral blood flow increased to more than twice the resting cortical values. The extent of cerebral edema was 41.2 +/- 7.5% (SE) and infarction was 34.5 +/- 9.5% (SE) of the hemisphere. In the second experiment, three 20-minute occlusions of the middle cerebral artery in a 1-hour interval were performed in 20 cats. In 10 of them, thiopental (40 mg/kg) was used to protect the brain. In the group without barbiturate treatment, pial arteries were dilated by 40% at the end of experiment, regional cerebral blood flow decreased to about 70% compared with single 20-minute occlusion, cerebral edema was 19.5 +/- 8.1% (SE), and infarction was 8.1 +/- 3.7% (SE) of the hemisphere. In the treated group, these were only trivial changes. The effect of repeated clipping may cumulatively cause brain damage, and barbiturates should be used whenever repeated clipping is necessary.

Animals↗

PubMed1990

Is Chiari I malformation in the aged initiated by mechanical factors? Report of three cases.

Three cases in which the signs and symptoms of Chiari I malformation were induced and worsened after the occurrence of supratentorial mass lesions are reported. The symptoms improved markedly after removal of the supratentorial lesions in these cases. In the first case, a meningioma in the right parietal region coexisted with Chiari I malformation. Although the cerebellar ataxia and nystagmus disappeared after tumor removal, decompressive surgery for the malformation was performed because of upper cervical nerve symptoms and the patient recovered completely. In the second case, the symptoms first occurred after a car accident, and a computed tomographic scan revealed not only a subdural hematoma, but also tonsillar herniation due to Chiari I malformation. After evacuation of the hematoma and decompressive surgery on the craniospinal junction, the symptoms disappeared. In the third case, the symptoms of malformation developed gradually with depression and gait disturbance. A meningioma in the left frontal region coexisted with Chiari I malformation. Although the symptoms improved remarkably after tumor removal, decompressive surgery on the craniospinal junction was performed because of upper cervical nerve symptoms, and the patient recovered completely. These clinical findings indicate that a supratentorial mass lesion may provoke the symptoms of Chiari I malformation in the aged.

Aged↗

PubMed1990

Hemangioblastomas of the central nervous system--immunohistochemical and ultrastructural study.

Immunohistochemical studies using immunoperoxidase staining for glial fibrillary acidic protein (GFAP), S-100 protein, and factor VIII-related antigen (VIII-RAg) were performed on 10 hemangioblastomas of the central nervous system to determine the origin of stromal cells. No cytoplasmic immunoreactivity for anti-GFAP, anti-S-100 protein, or anti-VIII-RAg was detected in most stromal cells. A small number of GFAP-positive cells were found only in the periphery of the tumor; they were thought to be trapped astrocytes or stromal cells taking up GFAP. Most stromal cells had abundant, clear cytoplasm with some microfilaments and lipid vacuoles. Cylindrical cytoplasmic processes and intermediate junctions were observed in some stromal cells, but most cells did not possess any junctional device. No stromal cell possessed any feature clearly suggesting endothelial cells or pericytes. Our immunohistochemical and ultrastructural investigations did not support the theories of stromal cell origin from astrocytes or endothelial cells. We concluded that stromal cells can be regarded as an aberrant cell type of angiogenic mesenchymal derivation.

Adolescent↗

PubMed1990

[The influence of volume expansion with induced hypertension on vessel reactivities, blood-brain-barrier, cerebral edema and infarction].

Eighteen anesthetized cats were randomly divided into 3 groups. One group was treated with 10 ml/kg of 6% hydroxyethyl starch (HES). Another group was treated with 15 ml/kg, and there was a control group. There were six cats in each group. Cerebral pial arterial reactivities were measured by means of intravital microscopic observation through a cranial window. Middle cerebral artery (MCA) was clipped for 70 minutes using a transorbital approach. Five hours later, Evans blue dye was injected intravenously and then the animals were killed. Administration of HES or Ringer's solution (control) was started 15 minutes before clipping of MCA. Systemic arterial pressure was elevated by using dopamine at the same time as the MCA occlusion was carried out. Pial arteries dilated soon after the clipping of MCA in all three groups, but showed different patterns in each group after recirculation of MCA. In the control group, they returned to 20% of their dilated state first, but, after about 4 hours, they redilated by 45% at the end of experiment periods. In the group treated with 10 ml/kg of 6% HES, they remained in an almost resting state after MCA recirculation, but in the group with 15 ml/kg, they constricted by 10% at the end of the experiment periods. Regarding the Evans blue dye extravasation, cerebral edema and infarction, they were largest in the control group. But animals treated with 15 ml/kg of 6% HES showed significantly larger Evans blue dye extravasation and cerebral edema than that of animals with 10 ml/kg. However cerebral infarctions were almost the same sizes in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

[Intraventricular arachnoid cyst appearing with attacks of orbital pain: case report and review of the literature].

While there have been 5 cases of intraventricular arachnoid cyst published in the literature, the occurrence in the anterior horn of the lateral ventricle has not been reported. We report a case of intraventricular arachnoid cyst of the anterior horn causing attacks of orbital pain. A 30-year-old man was admitted with frequent attacks of orbital pain on his right side. Neurological examination revealed no abnormality. Plain CT showed a cystic dilatation of the anterior horn of the right lateral ventricle, and enhanced CT showed a deviation of the septal veins to the left side. T1-weighted MRI demonstrated a low-intensity mass in the anterior horn of the right lateral ventricle, and T2-weighted image demonstrated the mass as having high intensity. PEG in the sitting position showed no filling of air into the right lateral ventricle due to obstruction of the right foramen of Monro. The patient underwent an operation under a diagnosis of intraventricular benign cyst. The cyst wall was subtotally removed and the right foramen of Monro was opened. Histological examination of the specimen showed an arachnoid membrane with prolific collagen fibers. From an embryological point of view, the arachnoid membrane is derived from the arachnoid cell. We think intraventricular arachnoid cysts to originate from the remnants of the arachnoid cell on the tela choroidea or on the choroid plexus like intraventricular meningiomas.

Adult↗

PubMed1990

[Calf impedance plethysmographic evaluation of peripheral sympathetic nerve activity--comparison with microneurographic analysis].

Although the method of impedance plethysmography made it possible to evaluate the vascular resistance of lower extremities, the actual correlation to the sympathetic nerve activity is not known. We performed examinations of microneurography and impedance plethysmography of the lower extremities, in six healthy volunteers, placed on a tilting table. Blood pressure, heart rate, muscle nerve sympathetic activity to calf muscles (microneurography), calf vascular resistance (impedance plethysmography) were simultaneously recorded with increasing angles of the head-up tilting (0, 30, 60 degrees). With the increase of tilting angles, sympathetic nerve activity and the calf vascular resistance significantly increased and these values were statistically correlated to the increase of tilting angles (expressed as sine function). Moreover, a statistically significant positive correlation was observed between the sympathetic nerve activity and vascular resistance. We concluded that the impedance plethysmographic method for measurement of calf vascular resistance is a good indicator for evaluating the peripheral sympathetic nerve activity.

Adult↗

PubMed1990

[123I-iodoamphetamine single photon emission computed tomography in three patients with amyotrophic lateral sclerosis].

We examined the 123I-iodoamphetamine SPECT for 3 patients with ALS, who were clinically diagnosed. Patient 1 was a 31-years-old man, who had bilateral muscle weakness of his upper extremities, and spasticity in lower extremities. Patient 2 was a 51-years-old woman, who had marked weakness of her upper extremities and bulbar sign. Patient 3 was a 68-years-old man, who had severe degree of marked weakness of his upper extremities and mild bulbar signs. Cerebral cognitive function were all normal in three patients. Computed tomographic and magnetic resonance imagings showed moderate degree of cortical atrophy in patient 1, but no abnormalities in patients 2 and 3. In 123I-IMP SPECT, however, hypoperfusion were recognized on the bilateral fronto-parietal border zone areas in these three patients with ALS. It was suggested that patients with ALS showed varying degrees of impaired perfusion in the fronto-parietal border zone areas in spite of normal cognitive functions.

Adult↗

PubMed1990

[Immunohistochemical study of placental form of glutathione S-transferase in human brain tumors and fetal brains].

The activity of glutathione S-transferase placental form (GST-pi) was examined in 100 cases including various histologic subtypes and grading of human brain tumors and 10 cases of fetal brains by immunohistochemical studies. The 69% of cases with brain tumors were shown to be positive for GST-pi. This activity in neuroepithelial tumors tended to increase in order to tumor grading, however, medulloblastoma and primitive neuroectodermal tumor (PNET) were not immunoreactive with GST-pi. Embryonal carcinoma showed strong staining, although fetal brains were negative. The metastatic brain tumors showed the same reactivity with GST-pi as those of original carcinomas. Moreover, the difference of GST-pi activity was investigated on some brain tumors treated with or without antitumor drug, such as 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU). The 85% of recurrent cases showed strong staining with GST-pi, and GST-pi activity seemed to be increased after treated with ACNU. The present study indicated that GST-pi might be a useful marker for human brain tumor, as the same conclusion was applicable to other neoplastic lesions examined previously. It is suggested that the increased GST-pi activity with malignancy of tumor may indicate the tendency to recurrence. The presence of such activity in tumor cells may also imply their acquired multidrug resistance. Our findings suggest that the evaluation of GST-pi activity in brain tumors will offer a predictive value for eventual behavior of the tumor.

Biomarkers, Tumor↗

PubMed1990

[Impedance plethysmographic evaluation of sympathetic activity to lower extremity].

Impedance plethysmographic analysis was performed in two cases of late cortical cerebellar atrophy (LCCA) and two cases of Shy-Drager syndrome. Blood pressure, heart rate and peripheral hemodynamics (arterial blood flow and vascular resistance of lower extremity) were measured during head-up tilting. In cases of LCCA, there was no decrease of blood pressure by tilting up. Impedance plethysmography showed significant increase in vascular resistance of lower extremity and heart rate was also increased. In cases of Shy-Drager syndrome, however, marked decrease of blood pressure was shown during tilting up, while there was no significant change in heart rate and vascular resistance of lower extremity was decreased. Therefore, in cases of Shy-Drager syndrome, decrease of peripheral sympathetic activity to lower extremity was suggested. Impedance plethysmography of lower extremity is simple, non-invasive and useful method to assess the status of peripheral sympathetic activity.

Aged↗

PubMed1990

[Magnetic resonance imaging of rheumatoid pannus in cranio-vertebral synovial joints--report of an operated case].

MRI imaging can provide useful informations as to the status of the brain stem and spinal cord in patients with rheumatoid cervical spine disease. Especially MRI made it possible to visualize the soft tissue mass in the cranio-vertebral joints. However, as far as we know, there is no report describing the pathology of the soft tissue mass diagnosed by MRI. We would like to report an operated case of RA, showing that the soft tissue mass was verified as the so-called rheumatoid pannus in the field of pathology. A 67-year-old woman was admitted to our hospital because of tetraparesis and anterior limitation of neck movements. She had been suffering from rheumatoid arthritis for 17 years. On admission, her consciousness was alert. Cranial nerves were normal except for swallowing disturbance, hoarseness, weakness of neck and tongue muscles. Muscle weakness with atrophy was observed on both upper and lower extremities. Pain and touch sensations were involved below the C3 spinal levels. Laboratory examination showed mild degree of anemia, positive RA test and 40 times value of antinuclear antibody. Brain CT and cerebro-spinal fluid were normal. X-ray of cranio-vertebral joints showed erosive and sclerotic changes of the atlas and odontoid process. Metrizamide CT myelography revealed that C1 spinal cord or medulla was compressed and flattened. A soft tissue mass surrounding the odontoid process was revealed by MRI with Toshiba 0.15 tesla apparatus, showing low signal intensity on T1 image, and low and partially high signal intensity in T2 image. The first operation was done with laminectomy and posterior fusion of occipital bone and C2 spinal process.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

[Coma, hyperviscosity syndrome, hyperammonemia and myelofibrosis in a patient with IgG, lambda type multiple myeloma].

A 63-year-old man was admitted to our hospital with tremor and somnolence, followed soon by coma. Anemia and retinal bleeding were observed. The blood smear exhibited rouleaux formation and leukoerythroblastosis. A bone marrow aspiration resulted in dry tap. The biopsy specimens revealed remarkable infiltration of myeloma cells with fibrosis. The M-component of IgG-lambda type and hyper-ammonemia were detected in the serum. Liver and renal functions, however, were within normal range. His consciousness recovered after plasmapheresis. Two courses of VMCP (vincristine, melphalan, carboquone and prednisolone) did not affect the paraproteinemia. Five courses of VAD (vincristine, adriamycin and dexamethasone) could lower the level of IgG. He died of pneumonia. The plasma of some patients with multiple myeloma may contain unidentified factors which increase the plasma ammonia.

Ammonia↗

PubMed1989

[Time course of blood velocity changes and clinical symptoms related to cerebral vasospasm and prognosis after aneurysmal surgery].

Cerebral vasospasm is a major complication associated with subarachnoid hemorrhage. In spite of extensive research, the pathogenesis of vasospasm remains obscure, and clinical management has so far been extremely difficult. For the evaluation of the efficacy of any treatment and the timing of operation, the development and resolution of the arterial narrowing should be monitored. It is important to know the correlation between the change in flow velocity and the course of clinical symptoms. In this study, the blood flow velocity in the different arteries was measured at short intervals (at least every third day) with transcranial Doppler ultrasonography, in eighteen patients with ruptured cerebral aneurysm. Flow velocity changes began to accelerate from 3 days after surgery, and reached the maximum value between 7 and 10 days, with normalization occurring within the following 2 weeks. The changes showed a significant relationship to the severity of vasospasm, the side of the operative approach, and the administration of calcium antagonist. Based on our results, we categorized the flow velocity changes of vasospasm for clinical practice as follows. (1) A slight acceleration of up to 120 cm/s in MCA and 90 cm/s in ACA was defined as within the normal range. In this state vasospasm was never observed angiographically. (2) Flow velocity changes between 120 and 140 cm/s were a subcritical state. These changes were seen in vasospastic patients who did not develop ischemic deficits. (3) Flow velocity changes of over 140 cm/s in MCA and 100 cm/s in ACA were critical vasospasm, since all of the patients who developed ischemic symptoms were in this group. Velocity changes higher than 170 cm/s in MCA and 130 cm/s in ACA seem to indicate a critical condition with a tendency to develop into brain infarction. The comparison between the time course of the flow velocity changes and clinical status showed that in symptomatic vasospasm the increase in velocity occurred before the manifestation of clinical symptoms. The transcranial Doppler measurements help to identify those patients who have a high risk of developing neurological deficits due to vasospasm, and help to select those who would benefit from preventive treatment in asymptomatic stage.

Adult↗

PubMed1989

[Ectopic meningioma of the ethmoid sinus: case report and a review of the literature].

A rare case of ectopic meningioma of the ethmoid sinus is reported. A 57 year-old male patient was admitted with complaints of anosmia and headache. Computed tomography revealed a relatively high-density mass in the bilateral ethmoid and sphenoid sinuses. The mass was markedly enhanced after intravenous administration of contrast medium. The cerebral angiography showed tumor stains fed by bilateral internal and external carotid arteries with right side dominance. The tumor in the ethmoidal sinus was removed by otolaryngologists at first and then the tumor in the sphenoid sinus was removed using sublabial transseptal sphenotomy. The histological examination resulted in a diagnosis of transitional meningioma with psammoma bodies. The tumor in this case is suspected to have originated from heterotopic meningocytes or meningocytes accompanying the perineural sheath of the olfactory nerve.

Cerebral Angiography↗

PubMed1989

[Therapeutic irradiation of brain tumor and cerebrovasculopathy].

The first case was a 5-year-old girl treated with a total of 6000 rads after total removal of a left temporoparietal tumor extending into the basal ganglia. About 4 years after completion of the radiation therapy, she showed left hemiplegia and deterioration in her level of consciousness. A plain CT scan showed calcification in the region of the bilateral basal ganglia and low density area in the right fronto-parietal region. An enhanced CT revealed gyral enhancements in the pre- and postcentral gyrus of the right hemisphere. Left carotid angiograms showed a narrowing of the horizontal portion and an occlusion of the distal portion of the left anterior cerebral artery. The distal portion of the right anterior cerebral artery was filled through the anterior communicating artery. Right carotid angiograms revealed an occlusion of the terminal portion of the internal carotid artery, retrograde filling of the anterior and middle cerebral arteries by leptomeningeal anastomosis via the posterior cerebral artery, and partial filling of the anterior cerebral artery via the anterior falx artery. Preoperative arteriography did not show occlusion and stenosis of the cerebral arteries. Superficial temporal artery-middle cerebral artery anastomosis in the right hemisphere was performed. Regional cerebral blood flow measured during operation increased from 34 to 72 ml/100 gr/min due to the surgery. About two weeks after surgery, left hemiplegia disappeared completely. The second case was a 67-year-old man who had received radiotherapy, following surgery of a chromophobe pituitary adenoma. About one year after irradiation he began to complain of gait disturbance and dysarthria.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

[Diagnosis and treatment of dysplasia of the uterine cervix].

The accuracy of diagnosis and the results of treatment for dysplasia of the uterine cervix are analyzed. Three hundred and thirty-seven cases of mild, 231 of moderate and 200 of severe dysplasias have been treated at Kitasato University Hospital. By cytology 40.4% of mild, 74.5% of moderate and 89.0% of severe dysplasias were judged suspicious or positive, and the accurate cytopathological detection rate was 19.8%, 16.1% and 60.1%, respectively. Abnormal colposcopic findings such as M, P and W were observed in more than 95% of cases with dysplasia. The area of abnormal findings tends to be large as the lesion becomes more severe. Mild dysplasia progressed to cervical cancer in 1.5%, moderate dysplasia in 2.4% and severe dysplasia in 9.4%. Conservative therapy by laser vaporization or conization was used for 31 mild, 96 moderate and 114 severe dysplasias. The cure rate of each dysplasia was 100%, and pregnancy following laser therapy was encountered in 28 cases without abnormal course. It is concluded that colposcopy is more useful in diagnosis of mild and moderate dysplasia than cytology, and conservative laser treatment is an effective method for dysplasia.

Adult↗

PubMed1989

[Sleep apnea in well-controlled myasthenia gravis].

UNLABELLED: Polygraphic monitoring of the respiratory status during sleep provides a definitive test for the presence of the sleep apnea syndrome. This syndrome has been recognized in various kinds of neurological disorders. However, as far as we know, there have been no reports of describing the sleep apnea syndrome in myasthenia gravis (MG). We conducted overnight polygraphic sleep studies of 10 patients of clinically well-controlled MG. PATIENTS: We examined 10 patients of MG (4 men and 6 women). The subtypes of MG were IIA(1), IIB(8) and V(1) according to Osserman's criteria. RESULTS: Six patients, with an average age of 47.8 and the average duration of 6.2 years, had polysomnographically obstructive and central types of sleep apnea, appearing longer than 10 seconds and more than 30 times in one night. Their mean Apnea Index (AI) was 14.6. The duration of mean apnea was 23.4 seconds and 99.0 times the average frequency. On the other hand, in four patients of MG, averaged age at 30.8 and for a 0.9-year duration, the sleep apnea syndrome was never seen. Therefore, the longest duration of MG tended to have the sleep apnea syndrome. DISCUSSION: Six out of the 10 patients of MG had obstructive and central types of the sleep apnea syndrome. Since their respiratory functions examined in a daytime were normal and the physical findings concerned with MG were well controlled by medications, our findings of nocturnal sleep apnea might be indicative of a central cholinergic system disturbance in MG during sleep.

Adult↗