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Biomedical subjects

T Aruga

Publications and source records attributed to T Aruga.

At least 55 records · Page 3Linked to original sources

"Dolichoectatic" intracranial vertebrobasilar dissecting aneurysm.

We report five patients with intracranial vertebrobasilar dissecting aneurysms, all of whom had ischemic symptoms. Angiographically, four of the five cases revealed distention and elongation of the vertebrobasilar artery like dolichoectasia and one irregular stenosis, the so-called "string sign". Magnetic resonance imaging disclosed all dolichoectatic dissecting lesions by demonstrating intimal flaps, double lumen, or subacute clot in the false lumen. We also present a successful demonstration of slow flow in the false lumen by gradient refocused magnetic resonance imaging scan with partial flip angle by the cardiac gating method. It is suggested that many of the classical "dolichoectasia" may include dissecting lesions.

Aged↗

Prognostic factors for local control in nasopharyngeal cancer (NPC): analysis by multivariate proportional hazard models.

Despite the development of meticulous radiation therapy techniques, the local control of the nasopharyngeal cancer (NPC) remains unsatisfactory. We examined retrospectively the clinicopathologic factors which have impact upon local recurrence-free survival (LRFS) of the 67 patients with NPC who had been irradiated greater than or equal to 40 Gy with curative intent from 1975 through 1988. Three-year LRFS rate was 63%. T stage, histology, the presence of accompanying lymphocytic infiltration, and the properness of radiation therapy had influence upon LRFS with a statistical significance. Multivariate proportional hazard models showed that T stage and pathology retained significance. Radiation therapy properness emerged as a third factor when only the patients irradiated greater than or equal to 60 Gy were included in the analysis. From these results, three groups with low, moderate, and high risk of shortened LRFS could be separated. This risk classification could contribute to the stratification criteria of future study for the improvement of local control by new modalities.

Adult↗

[Anesthetic experience of a child with moyamoya disease].

The authors report four anesthetic experiences of a child with moyamoya disease for two occasions of angiography and bilateral encephalo-duro-arterio-synangiosis (EDAS). For angiography anesthesia was maintained with inhalation of halothane-nitrous oxide-oxygen under spontaneous respiration. During the first angiography PaCO2 was 59.5mmHg and 55.2mmHg and it was 56.0mmHg during the second angiography. For EDAS, anesthesia was managed under controlled ventilation and avoiding hyperventilation. Blood pressure was stable. The patient awoke well. Under anesthetic management of a child with moyamoya disease who has normal cardiopulmonary function, the significant factor causing brain ischemia is hyperventilation.

Anesthesia↗

[Some practical problems and several methodological trials in continuous intracranial pressure monitoring].

The continuous intracranial pressure monitoring has been widely applied in intensive or critical care, but there are various kinds of methods for its monitoring at present. One hundred and forty-one cases mostly with severe head injury were subject to the intracranial pressure recordings in the critical care ward in Department of Emergency Medicine, University of Tokyo Hospital, from October, 1980 through May, 1983, and in Neurosurgical Unit, Showa General Hospital, in April and May, 1984. The authors made several methodological trials for the monitorings in them and compared with one another from the aspect of clinical practice. The subarachnoid catheter was inserted into the subarachnoid or sometimes into the subdural spaces by way of the burr hole in 112 cases and proved not to demonstrate in some cases the intracranial pressure waves clearly due to so called damping phenomenon but to indicate the reliable values, or trustworthy mean pressures in all the cases except for impending brain dead patients with swollen hemispheres and least cerebrospinal fluid remained in intracranial subarachnoid spaces. The ventricular fluid pressure was monitored in nine cases and was most dependable as well as the subarachnoid pressure. The ventricular cannulation and its maintenance were, however, difficult when the ventricles were compressed or deviated, which were often experienced in acute severe head injury and also in impending brain death just because of the same above mentioned reasons. These demerits were attempted to be conqured with epidural pressure monitorings such as the fiberoptic sensor (Ladd) in 17 cases, the intracranial catheter tip pressure transducer (Gaeltec) in nine cases and the sensor of bioimplantable polymer (Plastimed) in three cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Measurement of extravascular lung water by double-indicator dilution method amd its clinical assessment].

In this study, thermal-dye double-indicator dilution method using Lung water computer (Edwards Laboratories) was used to detect the changes of extravascular lung water (EVLW) in 14 patients, including 8 head injuries, one multiple injury, and 5 burns. The coefficient of variation of multiple readings at the same time was 5.04 +/- 3.64% (M +/- SD, n = 180), so reproducibility was excellent. EVLW showed no correlation with cardiac index, Qs/Qt ratio, PAO2/PaO2 ratio, and PaO2/FiO2 ratio, but did show significant correlation with pulmonary capillary wedge pressure (PCWP) (r = 0.50, n = 54, p less than 0.01). In non-septic period of burn patients, EVLW showed good correlation with COP-PCWP gradient (r = -0.75, n = 54, p less than 0.01), better correlation than with PCWP only. In septic period, it had no correlation with the gradient, probably due to the enhanced pulmonary capillary permeability. Although it is very difficult to determine the threshold of EVLW to diagnose pulmonary edema, the elevation of EVLW appeared earlier than the changes of X-ray films. In estimate of EVLW, we must always take into consideration changes in effective vascular bed and pulmonary capillary permeability. The measurement of EVLW was also of much help in the differential diagnosis of pulmonary edema and other lung diseases.

Adolescent↗

[The effect of high frequency jet ventilation on intracranial pressure in the patients with severe head injury].

The effect of high frequency jet ventilation (HFJV) on intracranial pressure (ICP) in the series of seven patients with severe head injury was studied. These patients received mechanical ventilation for respiratory failure accompanied with neural damage or circulatory shock and for ICP control by decreasing PaCO2. ICP was measured continuously by subarachnoid catheter method connected to Gould P-50 strain-gage transducer and controlled by hyperventilation and/or osmotic diuretics during acute phase. Arterial pressure, central venous pressure and intratracheal pressure were measured continuously in the same way. Arterial blood gases were analysed by BG-I of Technicon Co. Ltd. At the weaning from respirator, two methods were applied. One was conventional IMV (with PEEP) and/or CPAP by using IMV mode of Servo 900 respirator or T-piece together with PEEP valve and another was new-fashioned HFJV. Mean intratracheal pressure (mPit) was fixed at 0 mmHg (control value), 5, 10 and 15mmHg in both methods by adjusting PEEP valve or driving pressure of HFJV. The result is that in the same patients ICP was significantly lower during HFJV than IMV/CPAP when mPit was 5 and 10mmHg. Only three cases having been studied at 15mmHg of mPit because circulatory condition would not permit it, significant difference of ICP between HFJV and IMV/CPAP was not detected. PaCO2, being suspected to be the cause of lower ICP of HFJV group, was studied too. But blood gas analysis showed no significant difference neither PaCO2 nor PaO2. The fluctuation of CVP reflecting the change of intrathracic pressure was smaller in HFJV group than in IMV/CPAP group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗