Search PubMed⌕ Search

Biomedical subjects

Y Sawamura

Publications and source records attributed to Y Sawamura.

At least 73 records · Page 4Linked to original sources
PubMed1999

Evaluation of application techniques of fibrin sealant to prevent cerebrospinal fluid leakage: a new device for the application of aerosolized fibrin glue.

OBJECTIVE: This report evaluates the sealing effects of fibrin sealant applied on the dura mater using different techniques. METHODS: Three application methods were studied: a sequential layer method, a simultaneous method using a cannula, and a spray method using a newly developed spray device. The sealing effects of these methods were compared using in vitro histological analysis and a pressure resistance test. The clinical efficacy of the fibrin sealant to prevent water leakage through the dura mater was retrospectively analyzed in a total of 509 patients. The process of absorption of a clinically applied fibrin clot in vivo was examined using surgical specimens. RESULTS: The fibrin plate made using the spray method withstood a hydrostatic pressure greater than 200 cm H2O. A scanning electron microscopic study of the fibrin clots showed that the sequential and simultaneous methods produced a fibrin fiber network; in contrast, our spray method formed a dense fibrin tissue in which the fibrin molecules fused together forming stratified laminae. Of the 295 supratentorial craniotomies during which spraying was used, postsurgical cerebrospinal fluid leakage occurred in 9 cases (3.1%), whereas of the 214 craniotomies during which spraying was not used, cerebrospinal fluid leakage occurred in 19 cases (8.9%). Histological examinations of 10 surgical specimens obtained during second craniotomies revealed that the spray-made fibrin clots had been gradually replaced by mature granulation composed of collagenous connective tissue. CONCLUSION: The optimal technique for applying fibrin sealant is the spray method that aerosolizes fibrin glue and produces a tough fibrin plate.

Administration, Topical↗
PubMed1999

Schwannoma of the oculomotor nerve: a case report with consideration of the surgical treatment.

OBJECTIVE AND IMPORTANCE: Oculomotor schwannoma is extremely rare. We report a case of oculomotor schwannoma with consideration of its surgical management. CLINICAL PRESENTATION: A 64-year-old woman with a history of chronic headache underwent a computed tomographic scan, which revealed a mass lesion in the right prepontine cistern. She had no neurological deficits at admission. INTERVENTION: The tumor originated from the right oculomotor nerve. It was subtotally removed, leaving a tiny part attached to the nerve. The nerve trunk was preserved. A pathological examination revealed a schwannoma. Transient right oculomotor nerve palsy occurred postoperatively, but it improved almost completely. CONCLUSION: The tumor in the present case was resected, preserving serviceable oculomotor function. However, among 16 patients reported in the literature, all but one developed or maintained severe postsurgical oculomotor nerve palsy. We conclude that surgical resection generally is not indicated for oculomotor schwannomas, excluding large tumors that cause intractable symptoms.

Cranial Nerve Neoplasms↗
PubMed1999

Development of a handpiece and probes for a microsurgical ultrasonic aspirator: instrumentation and application.

OBJECTIVE: To address the several disadvantages of currently available ultrasonic aspirators used in microsurgery, new instruments were designed for neurosurgical use under a microscope. DESCRIPTION OF INSTRUMENTATION: The weight of the handpiece was reduced to 90 g. Two types of angled probes were constructed. Keyhole-type probes have 93- and 112-mm lengths, a 2.2-mm tip diameter, and 9.5- and 11.2-mm sheath diameters at the most proximal site and produce a tip amplitude of 300 microm (supplied by 23.5-kHz ultrasonic power). Needle-type probes have 89- and 171-mm lengths, a 1.9-mm tip diameter, and 3.5- and 3.3-mm sheath diameters at the proximal site and produce a tip amplitude of 70 microm. All of these instruments are compatible with magnetic resonance imaging. METHODS: The newly developed handpiece and probes were used in an experimental model. The 119 mass lesions treated included giant thrombosed aneurysms, various gliomas, vestibular schwannomas, deep-seated meningiomas, clival tumors, and suprasellar tumors. EXPERIENCE AND RESULTS: The handpiece and probes were safely used in regions that are difficult to access, such as the third ventricle and the cerebellopontine angle. It was possible to manipulate the needle-type probe in the suprasellar region through the transsphenoidal route, and the probe was very efficient for thrombectomy in giant aneurysms. The ultrasonic power of keyhole-type probes was sufficient to remove meningiomas. CONCLUSION: This newly developed neurosurgical handpiece with angled probes has great utility for microscopic dissections, because of its small size and light weight.

Brain Neoplasms↗
PubMed1999

Frequent co-alterations of TP53, p16/CDKN2A, p14ARF, PTEN tumor suppressor genes in human glioma cell lines.

In this study we established the simultaneous status of TP53, p16, p14ARF and PTEN tumor suppressor genes in 34 randomly chosen human glioma cell lines. Nine cell lines (26.4%) harbored mutations or deletions in all four tumor suppressor genes and 22 cell lines (64%) had alterations in at least three. Mutations/deletions were found at the following frequencies: TP53 (76.5%), p14ARF (64.7%), p16 (64.7%), PTEN (73.5%). Thus, there was a high incidence of alterations in the cellular pathways involving the p53 transcription factor (94.1%), the retinoblastoma protein (64.7%) and the PTEN phosphatase (73.5%) and 91% of cell lines carried mutations in two or more pathways. This provides the first clear genetic evidence that these tumor suppressors participate in biological pathways which are functioning separately/independently in glioma cells. The status of the gene alterations did not correlate with tumorigenicity in immunocompromized mice or any clinical parameters. Although the mutation rate was higher in glioma cell lines than that reported for glioma tissues, the alterations were molecularly representative of those found in adult de novo glioblastoma. This study highlights the importance of developing therapeutic approaches applicable to tumors with a broad range of genetic alterations and also provides an invaluable panel of glioma cell lines to make this possible.

Adult↗
PubMed1999

Galea-cranium suture method for prevention of the subcutaneous fluid collection--technical note.

A simple method is described for preventing cerebrospinal fluid (CSF) from collecting in the subcutaneous space following a supratentorial osteoplastic craniotomy. A few pairs of oblique holes through which suture materials may pass are made by drilling in the surface cortex of the bone flap. The galea aponeurotica is sutured to the bone flap by means of these holes. These galea-cranium sutures reduce the subgaleal free space in which pooling of CSF or hematoma may occur.

Cerebrospinal Fluid↗
PubMed1999

Surgical anatomy for direct hypoglossal-facial nerve side-to-end "anastomosis".

OBJECT: In this study the authors investigated the histomorphometric background and microsurgical anatomy associated with surgically created direct hypoglossal-facial nerve side-to-end communication or nerve "anastomosis." METHODS: Histomorphometric analyses of the facial and hypoglossal nerves were performed using 24 cadaveric specimens and three surgically obtained specimens of severed facial nerve. Both the hypoglossal nerve at the level of the atlas and the facial nerve just distal to the external genu were monofascicular. The number of myelinated axons in the facial nerve (7228 +/- 950) was 73.2% of those in the normal hypoglossal nerve (9778 +/- 1516). Myelinated fibers in injured facial nerves were remarkably decreased in number. The cross-sectioned area of the normal facial nerve (0.948 mm2) accounted for 61.5% of the area of the hypoglossal nerve (1.541 mm2), whereas that of the injured facial nerve (0.66 mm2) was less than 50% of the area of the hypoglossal nerve. Surgical dissection and morphometric measurements were performed using 18 sides of 11 adult cadaver heads. The length of the facial nerve from the pes anserinus to the external genu ranged from 22 to 42 mm (mean 30.5 +/- 4.4 mm). The distance from the pes anserinus to the nearest point on the hypoglossal nerve ranged from 14 to 22 mm (mean 17.3 +/- 2.5 mm). The former was always longer than the latter; the excess ranged from 6 to 20 mm (mean 13.1 +/- 3.4 mm). Surgical anatomy and procedures used to accomplish the nerve connection are described. CONCLUSIONS: The size of a half-cut end of the hypoglossal nerve matches a cut end of the injured facial nerve very well. By using the technique described, a length of facial nerve sufficient to achieve a tensionless communication can consistently be obtained.

Accessory Nerve↗
PubMed1999

[Acquired pulmonary stenosis caused by mediastinal mature teratoma: a case report].

A 13-year-old girl was admitted with a sudden onset of chest oppression. Mediastinal teratoma was suspected on chest X-ray and CT scan. A grade 2/6 systolic murmur was heard at the upper left sternal area and cardiac catheterization showed mild pulmonary stenosis. After resection of the tumor, the murmur disappeared and histopathological diagnosis was mature teratoma. This is a rare case report of pulmonary stenosis caused by mediastinal mature teratoma.

Adolescent↗
PubMed1999

Type A aortic dissection involving a right-sided aortic arch.

We report a rare case of a 39-year-old man with type A aortic dissection involving a right-sided aortic arch with the symptom of vascular ring. Computed tomography scanning and angiography were performed to define the extent of the dissection and the anatomy of the branching vessels. The ascending aorta was replaced through a median sternotomy and right thoracotomy using a hypothermic cardiopulmonary bypass associated with selective cerebral perfusion and partial circulatory arrest, and his symptom of vascular ring disappeared postoperatively.

Adult↗
PubMed1999

[Relation between temporomandibular joint disorder and subjective symptoms of fatigue].

An investigation was performed for the purpose of guaging the relation between temporomandibular joint disorder on the one hand and occupational category and subjective symptoms of fatigue on the other. Subjects were 2,414 workers (1,598 male, 816 female) in small and medium size enterprises at 67 workplaces in Hiroshima Prefecture. A comparison of cases with and without temporomandibular joint disorder showed that there were more complaints of fatigue among those with the disorder. Given these indications that temporomandibular joint disorder was related to occupation, it is possible that temporomandibular joint disease may be a work-related disease.

Adult↗
PubMed1998

Occult neurohypophyseal germinomas in patients presenting with central diabetes insipidus.

Although neurohypophyseal germinoma is known be a common initial symptom in cases of diabetes insipidus (DI), its radiological detection may take months or years even by a high-resolution magnetic resonance (MR) imaging. The term "occult neurohypophyseal germinoma" denotes such cases, but its clinical picture remains obscure. Of seven patients with neurohypophyseal germinoma presenting with DI during the last 5 years, three patients showed no evidence of tumor at the onset of DI and were treated as "idiopathic" DI. Neurohypophyseal germinoma was eventually diagnosed in these three patients as the tumor became evident on sequential MR imaging studies and the patients were successfully treated with chemotherapy and radiation therapy. To delineate the clinical features of the occult neurohypophyseal germinoma, the authors analyzed endocrinological aspects and MR images in these patients and compared them with those in two patients with true idiopathic DI and four patients with overt neurohypophyseal germinoma and DI. Nine previously reported cases in the literature were reviewed. During the stage at which the germinoma gave no notable change on MR images, patients often displayed anterior pituitary dysfunction, particularly growth hormone (GH) deficiency, or an elevation of serum or cerebrospinal fluid human chorionic gonadotropin-beta. Preceding the appearance of an obvious tumor mass, a slight swelling of the pituitary stalk with loss of normal hyperintensity of the posterior pituitary lobe was a common finding on MR imaging. Central DI associated either with an enlarged stalk, decreased GH secretion, or an elevated serum human chorionic gonadotropin-beta should prompt the diagnosis of an occult germinoma.

Journal Article↗
PubMed1998

CD44 expression and growth factors.

Soluble factors such as growth factors and cytokines present in the tumor microenvironment regulate a variety of genes associated with malignant properties of tumor cells such as growth, migration, invasion, and metastatic capacities. CD44 is a multi-functional adhesion molecule involved in cell to cell and cell to extracellular matrix interaction, the trapping of growth factors and cytokines, and the regulation of cell traffic. Growth factors and cytokines modify the expression, selective isoform splicing and functions of CD44, resulting in changes in the biological properties of the cells. These include adhesion of circulating tumor cells to endothelium and body cavities, and survival in response to growth factors presented by the CD44 molecule. The modification of CD44 on both tumor and host cells by growth factors may play an important role in tumor progression.

Animals↗
PubMed1998

Absence of p53 gene mutations in a tumor panel representative of pilocytic astrocytoma diversity using a p53 functional assay.

Although p53-gene mutations occur with significant frequency in diffuse low-grade and high-grade astrocytomas, and are postulated to play an important role in tumorigenesis in these cases, the role of the p53 gene in pilocytic astrocytomas remains unclear. Published data using DNA-based assays for p53-gene analysis in these tumors have shown contradictory results in mutation frequency (0-14%). It is not known whether these heterogeneous results stem from the biological diversity of this tumor group or from technical problems. To re-evaluate p53-gene status in pilocytic tumors, we analyzed 18 tumors chosen to represent the clinical and biological heterogeneity of this tumor type with respect to anatomical location, patient age, gender, ethnic origin (Caucasian or Japanese) and the concomitant occurrence of neurofibromatosis type 1 (NF1). All primary tumors were histologically diagnosed as pilocytic astrocytoma (WHO grade I), except for one anaplastic pilocytic astrocytoma (WHO grade III) which developed in an NF1 patient and recurred as glioblastoma multiforme (WHO grade IV). p53 mutations were detected using an assay in yeast which tests the transcriptional activity of p53 proteins synthesized from tumor mRNA-derived p53-cDNA templates. None of 18 tumors, including 3 NF1-related tumors, showed p53-gene mutations between and including exons 4 and 11. We conclude that p53-gene mutations are extremely rare findings in pilocytic astrocytomas, and are absent even in those exceptional cases in which malignant progression of such tumors has occurred.

Adolescent↗
PubMed1998

Selective sensitivity to radiation of cerebral glioblastomas harboring p53 mutations.

Recent studies suggest that a balance may exist between the cell cycle arrest and apoptosis-inducing functions of the p53 tumor suppressor gene. Adenoviral p21 transduction attenuates apoptosis, whereas deletion of the p21 gene promotes it, and p21-null xenografts respond better than isogenic p21-wild type tumors to irradiation. Hence, the role of p53 in dictating the clinical response to radiotherapy and chemotherapy may be more complex than previously thought. We have analyzed survival and radiation response (regrowth-free period) of 42 patients with glioblastomas whose p53 status was determined by a sensitive yeast functional assay. Multivariate analysis revealed that p53 mutation is associated with longer survival (P < 0.02). Among 36 radiation-treated patients, the regrowth-free period after treatment was significantly longer for tumors with p53 mutations (P < 0.0001), and p53 mutation was the sole independent factor predictive of radiotherapeutic response (P < 0.01). Survival time after regrowth was independent of p53 status, suggesting that the difference in survival was related to the treatment rather than to the intrinsic aggressiveness of the tumor. Thus, in this Northern Japanese population, p53 mutation is a marker for better radiation response in glioblastomas, and this results in significantly longer survival.

Adolescent↗
PubMed1998

Short alternative splice transcripts of the mdm2 oncogene correlate to malignancy in human astrocytic neoplasms.

The mdm2 oncogene encodes a 90-kDa nuclear phosphoprotein that binds and inhibits the function of the p53 tumor suppressor protein. It was recently reported that the expression of alternatively spliced variants of mdm2 correlated with malignancy in ovarian tumors and bladder carcinomas. We analyzed the presence of alternatively spliced mdm2 variants and studied their correlation to p53 status in a total of 66 human astrocytic tumors, including 32 glioblastomas multiforme, 17 anaplastic astrocytomas, 12 astrocytomas, and 5 pilocytic astrocytomas, using a specific nested reverse transcription-PCR technique. The full-length mdm2 transcript was demonstrated in all of the cases. Multiple-sized PCR products were found in 29 cases. Two of 5 pilocytic astrocytomas (40%), none of 12 astrocytomas, and 5 of 17 anaplastic astrocytomas (29%) showed alternative splice variants. In contrast, 22 of 32 glioblastomas (69%) showed the presence of splice variants, demonstrating a significantly higher frequency than in lower-grade astrocytomas (P < 0.0003). A majority of the splice variants were 707 base-type (mdm2-b), which was confirmed by sequence analysis. There was no apparent correlation of the presence of mdm2 splice variants with p53 gene status. These results suggest a new role for mdm2, independent of p53 gene status, as an oncogene in the development of malignant astrocytic tumors.

Alternative Splicing↗
PubMed1998

[Left ventricular rupture following mitral valve replacement with preservation of posterior leaflet].

Left ventricular rupture following mitral valve replacement (MVR) with preservation of the posterior leaflet is presented. A 63-year-old man underwent combined AVR, MVR with preservation of the posterior leaflet and TAP under cardiopulmonary bypass with moderate hypothermiat to 28 degrees C and tepid blood cardioplegia. Although a 31-mm valve would fit to the mitral position, a 27 TEKNA was chosen for MVR. Beyond the cardiopulmonary bypass, a left ventricular rupture was found. Cardiopulmonary bypass was re-stated and the aortic clamp was replaced. After removal of the mitral valve prosthesis, an internal tear was detected below the anterolateral commissural area (Type I). The tear was repaired with two 3-0 monofilament buttressed sutures incorporated with felt strips and covered with a bovine pericardial patch by several interrupted pledgeted mattress sutures. Gelatin-resorcin-formaldehyde/Glutaraldehyde glue (GRF) was used to reinforce the ruptured myocardium and to fix a bovine pericardial patch to the affected ventricular wall. Then the prosthesis was re-seated. Although the aortic clamp time was 319 mins., the patient was weaned from the cardiopulmonary bypass easily with the prophylactic use of IABP. The patient was discharged and returned to his previous job.

Aortic Valve↗
PubMed1998

[Open distal anastomosis or aortic balloon occlusion technique during complete aortic arch replacement].

The technique of open distal anastomosis or application of aortic balloon occlusion catheter designed to occlude the descending thoracic aorta have been used in 33 and 19 patients, respectively, to control bleeding during the procedure of distal anastomosis for complete aortic arch replacement with a prosthetic graft. These two techniques allowed us a simple approach to the lesion and the avoidance of clamp injury to the fragile aortic tissue. Open distal anastomosis was applied for 91% patients of operated aortic dissection and all emergent cases, it's duration ranged from 10 to 110 minutes with an average of 58 minutes under 18.2 degrees C of lowest esophageal temperature. On the other hand, aortic occlusion balloon was inserted for mainly true aortic aneurysm patients without an emergency, and helped to maintain the perfusion pressure on a lower part of body around 50 mmHg by the 1550 ml/min in an average of perfusion flow femoral artery under 21.2 degrees C of temperature. The difference of postoperative renal and liver function evaluated by serum enzyme levels of total bilirubin, GOT, GPT, LDH, creatinine and BUN did not reach to statistical significance between the patients using open distal anastomosis and balloon occlusion, however, the incidence of postoperative complication including either renal, liver dysfunction, abdominal problem or paraplegia was significantly higher in the patient group with open distal technique. Either open distal anastomosis or aortic balloon occlusion technique would be appropriately selected according to the patient's characteristics or the condition of aortic disease to be operated.

Aged↗