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Biomedical subjects

Y Hosobuchi

Publications and source records attributed to Y Hosobuchi.

At least 37 records · Page 2Linked to original sources
PubMed1986

Use of antidromic evoked potentials in placement of dorsal cord disc electrodes.

Intraoperative recordings of somatosensory evoked potentials were made in 16 patients undergoing implantation of a dorsal cord stimulation system. Antidromic recordings, obtained by stimulating through the dorsal cord electrode placed in the epidural space and recording over peripheral nerves in the painful region of the body, and much higher signal-to-noise ratios and could be obtained with greater reliability than standard orthodromic recordings. When the placement of the electrode was adjusted to obtain evoked responses in the painful region, paresthesias referred to that region were obtained in virtually every case. Use of this procedure allows implantation and internalization of the electrodes in a single procedure under general anesthesia, and reduces the necessity of subsequent revisions.

Chronic Disease↗
PubMed1986

Treatment of experimental stroke with opiate antagonists. Effects on neurological function, infarct size, and survival.

The effects are reported of acute and long-term continuous administration of three opiate antagonists--naloxone, naltrexone, and diprenorphine--on neurological function, survival, and infarct size in a feline model of acute focal cerebral ischemia. All three drugs produced statistically significant improvement in motor function following acute administration without concomitant changes in level of consciousness; saline had no effect. Naloxone and naltrexone significantly prolonged survival (p less than 0.01); diprenorphine did not. Infarct size was not altered by any treatment administered. These findings confirm previous work suggesting that, with the appropriate methodology, treatment with opiate antagonists partially reverses neurological deficits. They also show that opiate antagonists prolong survival in certain conditions of acute and subacute focal cerebral ischemia without altering the area of infarcted tissue.

Animals↗
PubMed1986

Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970-1984).

Chronic electrical stimulation of the subcortical area of the brain by implanted electrodes provides satisfactory control of a number of intractable pain syndromes that are refractory to medication. This series of 122 patients who underwent electrode implantation for the control of severe chronic pain was evaluated over a follow-up period of 2 to 14 years. Of the 65 patients with pain of peripheral origin, who were treated with stimulation of the periaqueductal gray region (PAG), 50 obtained successful pain control. Of 76 patients with a deafferentation pain syndrome, 44 obtained control of the dysesthesia with stimulation of the subcortical somatosensory region. Nineteen patients with both leg and back pain received electrodes in the PAG and the somatosensory regions; whereas back pain was relieved by PAG stimulation, dysesthetic leg pain was controlled more effectively by somatosensory region stimulation. The electrical stimulation technique appears to provide long-term pain control safely, with few side effects or complications.

Adult↗
PubMed1986

Dynorphin effects on plasma concentrations of anterior pituitary hormones in the nonhuman primate.

The role of dynorphin-(1-13) and dynorphin-(1-10)-amide in the neuroendocrine control of primate anterior pituitary hormones was studied in nonrestrained, ovariectomized rhesus monkeys. The effects of these opioids on plasma concentrations of prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and thyrotropin (TSH), and interactions with naloxone are reported here. Intravenous administration of dynorphin-(1-13), 30 to 120 micrograms/kg, significantly increased plasma PRL levels 3- to 4-fold. These PRL increases occurred within 5 min and levels remained elevated for at least 60 min. Administration of naloxone (1.0 mg/kg i.v.) antagonized the rise in PRL levels. Dynorphin-(1-13) had no significant effect on plasma LH, FSH or TSH levels. Dynorphin-(1-10)-amide (30-120 micrograms/kg) increased plasma PRL levels 2- to 4-fold at 5 to 40 min after administration. Plasma LH levels were significantly depressed 100 to 120 min postdrug. Dynorphin-(1-10)-amide produced no change in plasma FSH or TSH levels. These results indicate that dynorphin is involved in the modulation of PRL and perhaps LH secretion, although not affecting TSH or FSH release.

Animals↗
PubMed1986

Treatment of experimental stroke with the opiate antagonist win 44,441-3 effects on neurologic function, infarct size, and survival.

Cats were treated using a blinded protocol with either the dextrorotary or levorotary form of WIN 44,441-3 injected subcutaneously six hours after middle cerebral artery occlusion, followed by continuous subcutaneous infusion. The levorotary form acutely improved neurologic function in 90% of animals, whereas the dextrorotary form had no effect. Survival rate and infarct size were the same in both groups. These results further implicate the kappa receptor in the pathophysiology of cerebral ischemia.

Animals↗
PubMed1986

Focal cerebral ischemia in the cat: effect of naloxone on cortical blood flow and neurological deficit following middle cerebral artery occlusion.

The effect of the opiate antagonist naloxone on both the neurological deficit and regional cortical blood flow after middle cerebral artery occlusion in the cat was investigated. In animals with mild symptoms, naloxone did not consistently produce a significant behavioral effect. In all cats with neurological deficits, including hemiplegia or severe hemiparesis, 2 mg/kg naloxone administered intravenously 4 h after the ischemic lesion produced a reversal of neurological symptoms. This effect began within 2 min following naloxone injection and lasted for approximately 20 min. Animals were then anesthetized and cortical blood flow was measured by the hydrogen clearance method. Average cortical blood flow on the side of the occlusion was 50% that of the control side. Naloxone produced a significant additional decrease of 19.5% in cortical blood flow in the ischemic hemisphere, whereas no effect on blood flow on the control side was noted. Thus, although naloxone appears to temporarily reverse the severe neurological deficits resulting from middle cerebral artery occlusion in the cat, this effect appears to be accompanied by a decrease in local blood flow to the ischemic cortex.

Animals↗
PubMed1985

Treatment of stroke with opiate antagonists--effects of exogenous antagonists and dynorphin 1-13.

We studied the effects of acute and long-term, continuous administration of six opioid compounds--naloxone, naltrexone, diprenorphine, leucine enkephalin, dynorphin 1-13, and dynorphin 3-13--on neurologic function, survival, and infarct size in a feline model of acute focal cerebral ischemia. Acutely, naloxone, naltrexone, and diprenorphine significantly improved motor function over baseline scores; the other drugs and saline (control) had no effect. In the long-term condition, no substance administered significantly affected level of consciousness, sensory function, or pupillary reactions. Naloxone, naltrexone, and dynorphin 1-13 significantly prolonged survival (p less than 0.1); the other substances had no effect. Evaluations of cat brains postmortem showed that the infarcts involved the sensory and motor cortex, internal capsule, and caudate nucleus. Infarct size was unaltered by any treatment administered; results among groups were remarkably similar. In evaluations of opiate receptor binding characteristics, high-affinity binding of ekylketocyclozocine was significantly reduced in the right (occluded) side of the cortex. Dynorphin 1-13 given 8 h postocclusion but before sacrifice increased this binding affinity to the previous level in non-occluded cortex. The observed protective effect of dynorphin 1-13 warrants further investigation. Our results support the involvement of endogenous opioid peptides in the pathophysiology of cerebral ischemia and suggest that, administered appropriately, opiate antagonists may be useful in the treatment of focal ischemic neurologic deficits.

Acute Disease↗
PubMed1985

Reduced anesthetic requirement after electrical stimulation of periaqueductal gray matter.

To determine whether electrical stimulation of the periaqueductal gray region decreases anesthetic requirement, the authors studied the effect of such stimulation on the MAC of halothane and 60% nitrous oxide in 33 patients. These patients, who were undergoing implantation of a radio-frequency-coupled receiver and connection of that receiver to electrodes previously implanted in the periaqueductal gray area, were assigned randomly to receive (n = 16) or not receive (n = 17) electrical stimulation 1 h before surgery. The mean value (+/- SEM) for the minimum alveolar concentration of halothane combined with 60% nitrous oxide was significantly less (P less than 0.001) for patients who were stimulated preoperatively (0.15 +/- 0.05%) than for those who were not (0.51 +/- 0.02%). The authors conclude that stimulation of the periaqueductal gray region decreases anesthetic requirements and believe that at least three mechanisms are possible: a nonspecific narcotic-like effect, a specific effect on a pain pathway, or an effect on specific neural pathways that affect anesthetic requirements secondary to changes in regional concentrations of neurotransmitters.

Anesthesia, Inhalation↗
PubMed1985

Electrical stimulation of the cervical spinal cord increases cerebral blood flow in humans.

Ten patients were studied to determine the effect of spinal cord stimulation on CBF. In 5 patients using a cervical spinal cord stimulator, the stimulation produced a significant increase in CBF in the hemisphere ipsilateral to the induced paresthesia. Thoracic cord stimulation, used by the other 5 patients, had no effect on CBF. Atropine had no effect on the alteration in CBF produced by cervical cord stimulation. Indomethacin, however, partially blocked the effect. These heuristic observations may have implications for the future treatment of cerebrovascular insufficiency in humans.

Adult↗
PubMed1984

Naloxone reversal and morphine exacerbation of neurologic deficits secondary to focal cerebral ischemia in baboons.

The effects of an opiate agonist (morphine) and antagonist (naloxone) on neurologic function in conditions of acute and subacute focal cerebral ischemia were tested in a baboon model. Fourteen baboons (Papio papio) underwent unilateral transorbital microsurgical occlusion of the middle cerebral artery (MCA). Blood pressure, heart rate and core temperature were monitored continuously; frequent arterial blood gas measurements were made. Cardiac output, cardiac filling pressures, and regional cerebral blood cross-flow were measured in selected baboons. Naloxone administered intravenously consistently reversed hemiparesis and hemiplegia in all baboons for as long as they lived (4 h to 8 days postocclusion). Morphine administered intravenously converted hemiparesis to hemiplegia; this effect was naloxone-reversible. There were no significant changes in any parameter measured after the administration of either drug. Phenylephrine (used to elevate mean arterial pressure to 20 mm higher than the highest pressure measured after naloxone administration) and isoproterenol (used to elevate cardiac output to 1 l/min higher than the highest value measured after naloxone administration) produced no change in neurologic function. It appears that naloxone can reverse, and morphine exacerbate, focal ischemic neurologic deficits produced in baboons by MCA occlusion. The observed changes in neurologic function are not associated with or mediated by alterations in core temperature or cardiopulmonary functions.

Animals↗
PubMed1984

A subcortical correlate of P300 in man.

Event-related potentials in visual and auditory target detection tasks were recorded simultaneously from the scalp, somatosensory thalamus and periaqueductal gray in a chronic pain patient with electrodes implanted subcortically for therapeutic purposes. Short latency tactile responses confirmed the location of the thalamic electrodes. Rare auditory stimuli which were detected by the subject were accompanied by a prominent P300 component at the scalp, and by negative activity at the subcortical sites with the same latency as the scalp positivity. This activity was not seen in responses to frequent non-target stimuli and was not dependent on an overt motor response. Similarly, rare visual stimuli generated a scalp P300 and negative activity subcortically; both scalp and subcortical waves had a longer latency than in the auditory experiment. The reaction time was similarly longer to visual targets. These data are inconsistent with a hippocampal generator for P300, but are consistent with a generator in the thalamus or more dorsally located structures.

Adult↗
PubMed1984

Anesthesia does not increase opioid peptides in cerebrospinal fluid of humans.

One theory of narcosis postulates that inhaled anesthetics produce general anesthesia by causing the release of endogenous opioid peptides. In the present study, however, the concentration of immunoreactive beta-endorphin-like material (eight patients) or leu-enkephalin (four patients) did not increase in cerebrospinal fluid of patients 5 min after induction of anesthesia with thiopental, 2-5 mg/kg and N2O 70%; after an additional 10 min, during which halothane was added; at 5, 15, and 60 min after surgical incision; or after 30 min in the recovery room. Therefore, any contribution of the endorphin system to the production of general anesthesia does not appear to require the release of beta-endorphin.

Analgesia↗
PubMed1984

Stereotactic heavy-ion Bragg peak radiosurgery for intra-cranial vascular disorders: method for treatment of deep arteriovenous malformations.

The present paper represents the first clinical report of the use of stereotactically-directed narrow beams of helium ions from the 184-inch Synchrocyclotron at the Lawrence Berkeley Laboratory for the radiosurgical treatment of life-threatening vascular disorders of the brain, including inoperable or inaccessible deep arteriovenous malformations (AVMs) and carotid artery-cavernous sinus fistulas ( CCFs ). We describe the methods developed for stereotactic neuroradiological imaging and stereotactic helium-ion Bragg peak radiosurgery in the evaluation and treatment of the first 55 patients with deep AVMs in a clinical research protocol. We discuss the diagnosis and epidemiological characteristics of the diseases, the neurosurgical and radiosurgical methods of treatment available and the initial experience of stereotactic helium-ion Bragg peak radiosurgery , including stereotactic neuroradiological evaluation, treatment planning, heavy-ion beams, patient treatment protocol, early clinical results, patient evaluation and follow-up studies planned, and conclusions thus far obtained.

Adult↗
PubMed1984

Brachytherapy of recurrent malignant brain tumors with removable high-activity iodine-125 sources.

Thirty-seven patients harboring recurrent malignant primary or metastatic brain tumors were treated by 40 implantations of high-activity iodine-125 (125I) sources. All patients had been treated with irradiation and most had been treated with chemotherapeutic agents, primarily nitrosoureas. Implantations were performed using computerized tomography (CT)-directed stereotaxy; 125I sources were held in one or more afterloaded catheters that were removed after the desired dose (minimum tumor dose of 3000 to 12,000 rads) had been delivered. Patients were followed with sequential neurological examinations and CT scans. Results of 34 implantation procedures were evaluable: 18 produced documented tumor regression (response) for 4 to 13+ months; five, performed in deteriorating patients, resulted in disease stability for 4 to 12 months. The overall response rate was 68%. In 11 patients, implantation did not halt clinical deterioration. At exploratory craniotomy 5 to 12 months after implantation, focal radiation necrosis was documented in two patients whose tumor had responded initially and then progressed, and in three patients whose disease had progressed initially (four glioblastomas, one anaplastic astrocytoma); histologically identifiable tumor was documented in two of these patients. All improved after resection of the focal necrotic mass and are still alive 10, 15, 19, 24, and 25 months after the initial implantation procedure; only one patient has evidence of tumor regrowth. The median follow-up period after implantation for the malignant glioma (anaplastic astrocytoma and glioblastoma multiforme) group is 9 months, with 48% of patients still surviving. While direct comparison with the results of chemotherapy is difficult, results obtained in this patient group with interstitial brachytherapy are probably superior to results obtained with chemotherapy.

Adolescent↗
PubMed1984

Use of the argon surgical laser in neurosurgery.

The argon surgical laser has been used in 68 neurosurgical procedures that included the removal of intracranial and intraspinal tumors, spinal cord fenestration for syringomyelia, and the production of dorsal root entry zone lesions. Characteristics that make the argon surgical laser a useful microneurosurgical instrument include the availability of a fiberoptic delivery system, a laser spot size that can be varied continuously between 0.15 and 1.5 mm, a single laser-aiming and treatment beam, the transmission of argon laser light through aqueous media such as irrigating or cerebrospinal fluids, and improved hemostasis compared to conventional techniques. The argon laser is limited primarily by its relatively low power output (less than 16 W), which makes the excision of large tumors difficult. However, even with these limitations, which can be used to advantage in the proper setting, the authors' laboratory and clinical experience suggests that the argon surgical laser may be useful in certain microneurosurgical operations.

Adolescent↗
PubMed1984

Cavernous sinus fistula caused by intracavernous rupture of a persistent primitive trigeminal artery. Case report.

A persistent carotid-basilar anastomosis (primitive trigeminal artery), identified by four-vessel vertebral angiography, was shown to be the cause of a cavernous sinus fistula in a 51-year-old woman. The fistula, but not the primitive artery, was identified on a carotid arteriogram. Because of the flow contribution from the posterior circulation, balloon embolization via the carotid system failed, and the fistula was repaired through a direct surgical approach. The operative technique is described and the hemodynamic aspects of a cavernous sinus fistula that is related to this primitive anastomosis are reviewed.

Cavernous Sinus↗
PubMed1984

Pain relief from dorsal root entry zone lesions made with argon and carbon dioxide microsurgical lasers.

Argon and carbon dioxide microsurgical lasers were used to produce lesions in the dorsal root entry zone (DREZ) experimentally in six cats and surgically in 21 patients who had denervation pain syndromes. The technique of producing lesions, the histological and physiological changes seen in the cat spinal cord, and the results of treatment in the clinical series are discussed. Lesions were produced within the DREZ without new involvement of the dorsal column system or corticospinal tract in all but one patient. Based on their subjective evaluation, two-thirds of the patients were relieved of more than 50% of their preoperative pain. These experimental results and clinical experience suggest that the argon and carbon dioxide lasers effectively produce localized microsurgical lesions in the DREZ. The concept that an abnormality involving either neurons in the substantia gelatinosa or internuncial fibers in Lissauer's tract is responsible for pain in patients with primary sensory nerve deafferentation is discussed.

Adult↗