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Biomedical subjects

Shunro Endo

Publications and source records attributed to Shunro Endo.

70 records · Page 4Linked to original sources

A rare case of shunt malfunction attributable to blockage of a Codman-Hakim programmable shunt valve.

BACKGROUND: We report a rare case of shunt malfunction resulting from blockage of a Codman-Hakim programmable shunt valve by fibrinoid-like tissues. HISTORY: The patient had undergone shunt system placement for hydrocephalus after hemorrhagic infarction at the age of 8 months; a Codman-Hakim programmable shunt valve was used at that time. LATER COURSE: Two years after shunt placement, the boy suffered from irritability and poor activity when the aforementioned shunt malfunction arose following valve blockage by fibrinoid-like tissues. He underwent shunt revision and was subsequently free of symptoms.

Cerebral Hemorrhage↗

Chlamydia pneumoniae infection is not involved in carotid artery stenosis.

Recent studies have suggested the existence of a close relationship between Chlamydia pneumoniae infection and atherosclerosis. However, it has been speculated that C. pneumoniae infection is not associated with early atherosclerosis but with advanced atherosclerosis. In the present study, we test this hypothesis. In 524 consecutive patients who underwent cerebral angiography were recruited for the study. From the films obtained during angiography, percent stenosis of neck internal carotid artery was calculated according to the method of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Serum C. pneumoniae IgG and IgA antibodies were measured by a commercial ELISA enzyme immunoassay kit. Cerebrovascular risk factors such as age, gender, hypertension, diabetes mellitus, hyperlipidemis and smoking were assessed by interview. Old age above 60 years and diabetes mellitus were found to be independent risk factors for carotid artery stenosis in this study after adjustment for cerebrovascular risk factors. When we defined carotid artery stenosis as the presence of greater than 30% stenosis of one artery, there was no association after adjustment for other risk factors between C. pneumoniae IgG and IgA seropositivity and the presence of carotid artery stenosis for any cut-off value of seropositivity. When we defined carotid artery stenosis as the presence of greater than 70%, there was also no association between C. pneumoniae IgG and IgA seropositivity and the presence of carotid artery stenosis for any cut-off value of seropositivity. These results suggest that C. pneumoniae infection is not associated with carotid artery atherosclerosis.

Analysis of Variance↗

Generators of visual evoked potentials for faces and eyes in the human brain as determined by dipole localization.

Human visual evoked potentials were recorded during presentation of photos of human and animal faces and various face features. Negative waves with approximate peak latencies of 165 msec (N170) were bilaterally recorded from the occipito-temporal regions. Mean peak latencies of the N170 were shorter for faces than eyes only. Analyses of amplitudes of evoked potentials indicated that the N170 elicited by faces reflected activity of a specific neural system which was insensitive to detailed differences among individual faces regardless of species, and consequently suggest that this system might function to detect existence of faces in general. On the other hand, the mean amplitude of the N170 elicited by human eyes was significantly larger than those by animal eyes. These differences in response latencies and amplitudes of the N170 suggest existence of at least 2 different visual evoked potentials with similar latencies (i.e., N170) which are sensitive to faces in general and human eyes, respectively. Dipole source localization analysis indicated that dipoles for the N170 elicited by eyes were located in the posterior inferior temporal gyrus, and those for faces, located initially in the same region, but moved toward the fusiform and lingual gyri at the late phase of the N170. The results indicated that information processing of faces and eyes separated at least as early as the latency of the N170 at the posterior inferior temporal gyrus as well as the fusiform and lingual gyri, and might provide neurophysiological and anatomical bases to an initial structural encoding stage of human faces.

Adult↗

Modulation of tissue-type plasminogen activator expression by platelet activating factor in human glioma cells.

PURPOSE: For tumor growth, proteolytic remodeling of the extracellular matrix (ECM) is a key factor. To determine proteolytic activity in human glioma cells, fibrinolytic activity, mRNA expression of fibrinolytic factors, and fibrinolytic inhibitors were studied in human glioma cell lines. The effect of platelet activating factor (PAF), a potent mediator of inflammatory and immune responses, on this fibrinolytic activity was also examined. METHODS: The fibrinolytic activities of conditioned medium and cell lysates from human glioma cell lines, A172, T98G, U87 and TM1 were studied by fibrin plate zymography. mRNA expression of tissue plasminogen activator (tPA), urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitors (PAI-1, PAI-2) was measured by Northern blot analysis. PAF was added to the medium, and its effects on cell proliferation, fibrinolytic activity, mRNA expression of plasminogens and inhibitors were studied. RESULTS: mRNA expression of plasminogens and inhibitors differed between individual cell lines. Only the medium and cell lysates from A172 cells revealed fibrinolytic activity. A172 cells showed mRNA expression of tPA. PAF at low concentrations, such as 1 nM, stimulated A172 cell proliferation, and high concentrations of PAF inhibited proliferation. PAF stimulated tPA release into the conditioned medium. mRNA expression of tPA was stimulated by low concentrations of PAF and inhibited by high concentrations. CONCLUSION: The variability of mRNA expression of plasminogen activators (PAs) between different glioma cell lines may indicate that plasminogens and their inhibitors do not directly correlate with brain tumor growth. PAF may be an important factor in the local control of fibrinolytic activity in glioma and its proliferation.

Blotting, Northern↗

Growth hormone-secreting pituitary adenoma confined to the sphenoid sinus associated with a normal-sized empty sella.

We present a case of growth hormone (GH)-secreting ectopic pituitary adenoma confined to the sphenoid sinus associated with a normal-sized empty sella. It has been well known that acromegaly is sometimes associated with an empty sella. However, such a case usually has a macroadenoma and an empty sella that is large. The authors considered the possible mechanisms of the association between a normal-sized empty sella and an ectopic pituitary adenoma in the sphenoid sinus as the following. Primary empty sella existed originally, and the pituitary adenoma developed later. The adenoma extended into the sphenoid sinus because of the pulsatile intracranial cerebrospinal fluid pressure.

Empty Sella Syndrome↗

Malignant fibrous histiocytoma originating at the site of a previous fronto-temporal craniotomy.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. MFH occurrence in the bones of the skull is extremely rare, and, to our knowledge, it has not been reported in a patient with a history of craniotomy. A 69 year old woman presented with a large mass in the left fronto-temporal bone. The patient's medical history included a left fronto-temporal craniotomy 8 years prior to the present admission for neck clipping of an aneurysm of the left middle cerebral artery. Following preoperative work up, the skull tumor was resected, and pathology showed that the mass was composed of spindle-shaped fibroblastic cells arranged in a storiform pattern, and of numerous multinucleated giant cells. A diagnosis of MFH was established. The patient died of intracranial hemorrhage from a subsequent tumor 22 months after resection of the first tumor.

Aged↗

Blade crossing of a pure titanium clip applied to a cerebral aneurysm--case report.

Titanium aneurysm clips are superior to cobalt clips in radiological features, biocompatibility, and hypoallergenicity, but the mechanical characteristics are less advantageous. A 56-year-old man was referred to our department due to dizziness and slurred speech. Cerebral angiography unexpectedly disclosed an aneurysm of the right middle cerebral artery. The patient underwent right frontotemporal craniotomy and neck clipping of the aneurysm with a commercially pure titanium clip. After application of the clip, the clip blades crossed and nearly sheared the wall of the aneurysm. The mechanical characteristics of titanium aneurysm clips require careful consideration because of possible clip malfunction.

Equipment Failure↗

Multiple intracranial seeding of craniopharyngioma after repeated surgery--case report.

A 17-year-old woman presented with a rare case of intracranial seeding of craniopharyngioma after repeated surgery. She initially presented with secondary amenorrhea and visual impairment. Magnetic resonance imaging revealed a suprasellar mass. Subtotal removal of the tumor was performed. The diagnosis was adamantinomatous craniopharyngioma. Seven months later, the patient underwent a second operation for recurrence of the craniopharyngioma. Subsequently, ventriculoperitoneal (VP) shunting and gamma knife surgery were performed. Twenty-seven months after the first operation, multiple cystic lesions were found in the right frontal and temporal lobes. Positive tumor cytology was observed in the cerebrospinal fluid obtained from the VP shunt chamber. These tumors were subtotally resected. However, the patient died from consecutive tumor recurrence 4 years after the initial diagnosis.

Adolescent↗

Etizolam, an anti-anxiety agent, attenuates recurrence of chronic subdural hematoma--evaluation by computed tomography.

Etizolam, an anti-anxiety agent which is an antagonist of platelet-activating factor receptors, was administered to patients with chronic subdural hematoma (CSH) after hematoma removal to assess the effectiveness for preventing recurrence compared with control patients not given the drug after surgery. The remaining volumes of subdural hematomas on brain computed tomography were measured approximately 1 month after removal. Volume in the etizolam group (15 patients) was significantly smaller than in the control group (24 patients). Hematoma recurrence was not detected in the etizolam group 3 months after surgery, but occurred in the control group. The difference was significant. Etizolam administration may be useful for the prevention of recurrence of CSH.

Aged↗

Endoscopic ventriculocystostomy through the septum pellucidum via the contralateral anterior horn--technical note.

Paraventricular fluid cysts have recently been treated by endoscopic fenestration performed from the cysts to the ventricular system. However, correct orientation and safe navigation of the endoscope may be difficult in patients with abnormal anatomy. Endoscopic fenestration from the ventricular system to a cyst was performed through penetration of the septum pellucidum via the anterior horn of the contralateral lateral ventricle. The advantage of this approach is correct orientation and introduction of the endoscope to the periventricular lesion because the usual landmarks can be identified in the normal contralateral lateral ventricle.

Adult↗

Aberrant nuclear factor-kappaB activity and its participation in the growth of human malignant astrocytoma.

OBJECT: It has been suggested that nuclear factor (NF)-kappaB, a pleiotropic transcription factor, controls cell proliferation. The authors examined NF-kappaB activity and its participation in the growth of human malignant astrocytoma. METHODS: The authors examined NF-kappaB activity in human malignant astrocytoma cell lines and high-grade astrocytoma tissues by using electrophoretic mobility shift assays and immunohistochemical studies, respectively. In addition, messenger (m)RNA expression of p50 and RelA, which are representative subunits of NF-kappaB, and IkappaBalpha, which is a representative inhibitory protein of NF-KB, were analyzed using Northern blot hybridization in the astrocytoma cell lines. Furthermore, alterations in DNA synthesis and cell growth in the astrocytoma cell lines were examined after inhibition of NF-kappaB activity by RelA antisense oligodeoxynucleotide. The authors found NF-kappaB activity in all astrocytoma cell lines and high-grade astrocytoma tissues that were examined, but not in the fetal astrocyte strain or in normal cerebral tissue. Expression of p50, RelA, and IkappaBalpha mRNA was found in the fetal astrocyte strain and normal adult brain tissue, in addition to the astrocytoma cell lines. The relative levels of expression of these mRNAs were similar among these cell lines, the cell strain, and normal tissue. The RelA antisense oligodeoxynucleotide specifically reduced the levels of RelA mRNA expression and NF-kappaB activity in the astrocytoma cell lines, thus significantly inhibiting their DNA synthesis and cell growth. CONCLUSIONS: Human malignant astrocytoma cells have aberrant NF-KB activity, which promotes their growth. This activity is not associated with aberrant expression of p50 and RelA.

Age Factors↗

[Traumatic vertebral arteriovenous fistula caused by an injury due to penetration by pieces of glass: case report].

We reported a case of a 79-year-old male with traumatic vertebral arteriovenous fistula. The patient was admitted with hemorrhagic shock due to arterial bleeding caused by a penetrating injury of the neck. Cervical CT showed free air at the level of the lamina of C1. Injury of the vertebral artery was suspected. The right vertebral angiogram showed an arteriovenous fistula between the V3 portion of the right vertebral artery and the suboccipital venous plexus with retrograde intracranial venous drainage. The patient underwent endovascular treatment of the parent vertebral artery occlusion, which successfully obliterated the arteriovenous fistula.

Aged↗

Dural arteriovenous fistulae developing at different locations after resolution of previous fistulae: report of three cases and review of the literature.

We present three cases of unusual dural arteriovenous fistulae developing at other dural sinuses after resolution of initial lesions by treatment. In all three cases, the second lesions developed at different sinuses ipsilateral to the initial lesions, and the intervals between the resolution of the initial lesions and the appearance of the second lesions was <12 months. Clinical characteristics, including those previously reported, are discussed.

Central Nervous System Vascular Malformations↗

[Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment--report of two cases].

Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.

Adult↗

One-piece pedunculated frontotemporal orbitozygomatic craniotomy by creation of a subperiosteal tunnel beneath the temporal muscle: technical note.

OBJECTIVE: We have developed a simple and easy modification of the orbitozygomatic approach using one-piece pedunculated craniotomy. This modification prevents atrophy of the temporal muscle, resulting in temporal fossa depression and atrophy of the free bone graft resulting in the occurrence of bone pits along the line of the craniotomy. METHODS: The key points of this modification are as follows. The scalp flap is elevated in the plane between the superficial and deep layers of the temporal fascia. The temporal muscle is dissected from the temporal plane by performing subperiosteal elevation with intact insertion to the superior temporal line of the temporal muscle, which results in the creation of a subperiosteal tunnel beneath the temporal muscle. The one-piece fronto-orbitozygomatic bone flap is hinged on the temporal muscle. RESULTS: After the surgeons had received full training in the procedures and anatomic findings related to this craniotomy in 10 cadaveric heads, surgery was performed for paraclinoid or parasellar tumors in five patients. Although temporary pulsatile exophthalmos occurred after surgery in one patient, no craniotomy-related complications occurred during or after surgery. Because the bone flap is fragile at the frontozygomatic suture, fixation with a small titanium plate was required in three of five patients at the end of the operation. All patients were pleased with the cosmetic results of surgery during a minimum follow-up period of 6 months. CONCLUSION: The modifications described in this article reduce the risk of atrophy of the temporal muscle and improve the cosmetic results without limitation of operative exposure.

Bone Plates↗

Measurement of basilar artery bending and elongation by magnetic resonance cerebral angiography: relationship to age, sex and vertebral artery dominance.

Elongation and bending of the basilar artery are frequently observed in both normal and pathological subjects. However, their mechanism of generation remain unclear. In the present study, we measured basilar arteries in patients and normal subjects using magnetic resonance angiography (MRA) and estimated the relationships between these anatomical changes and some factors such as age, sex and vertebral artery dominance. A total of 510 subjects underwent MRA. Basilar artery length (BAL), bending length (BL), or side of bending of basilar artery was estimated on the plain images including the basilar artery in two groups with and without vertebral union. BAL was longer in males than in females (P = 0.0009) and correlated with age (P < 0.0001) in the population with vertebral union, while BL did not differ between genders and was not correlated with age in this population. Both BAL and BL were longer in subjects with vertebral artery dominance than in subjects with equivalent-sized vertebral arteries in the population with vertebral union (P < 0.0001 and P = 0.0005). No difference in the frequency of basilar artery bending was observed between males and females and no correlation was observed between the frequency of basilar artery bending and ages in subjects without vertebral artery union. A significant negative correlation between the side of bending of the basilar artery and dominant side of vertebral arteries was found for group of all patients (P < 0.0001). BAL growth may mainly depend on aging, and the presence of vertebral artery dominance may contribute to the growth of BAL while BL growth may depend on vertebral artery dominance mainly in the contralateral direction.

Adolescent↗