Wire-guided transoral esophagogastrostomy for carcinoma of the cervical esophagus.
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Anastomosis, Surgical↗
Biomedical subjects
Y Yoshimoto
Publications and source records attributed to Y Yoshimoto.
A pooled analysis of case-control studies of thyroid cancer. II. Menstrual and reproductive factors.
OBJECTIVE: It has been suggested that female hormones, and hence menstrual and reproductive factors, play a role in thyroid cancer etiology. Epidemiological data, however, are limited and inconsistent, partly because of the small number of cases included in each study. To clarify the etiology of thyroid cancer, we conducted a pooled analysis of original data from 14 case-control studies, 4 from the United States, 2 from Asia, and 8 from Europe. METHODS: This analysis included a total of 2,247 female cases of thyroid cancer (80% papillary) and 3,699 control women. Pooled odds ratios (OR) were estimated using logistic regression, conditioning on study and (i) matching sets for individually matched studies, or (ii) quinquennia of age for the other studies. Additional terms for age and history of radiation exposure were included in the regression equations. RESULTS: The OR per year of later menarche was 1.04 (95% confidence interval (CI) 1.0-1.1). Compared to premenopausal women, the OR was 1.3 for women with natural menopause, and 1.8 for those with artificial menopause, but the studies were heterogeneous and the association may be due, at least in part, to diagnostic or ascertainment bias. Parity, spontaneous or induced abortions and history of infertility were not associated with thyroid cancer risk. The OR was above unity in women reporting later age at first birth (OR = 1.1, 95% CI 1.0-1.3 for 5-year delay) and higher in the first years after a birth. CONCLUSIONS: The associations of menstrual and reproductive factors with thyroid cancer risk were generally weak, but appeared stronger among women diagnosed with thyroid cancer at younger ages.
Adenocarcinoma, Papillary↗
Intraparenchymal and intrasylvian haematomas secondary to ruptured middle cerebral artery aneurysms: prognostic factors and therapeutic considerations.
The aim of this study was to investigate prognostic factors and the most appropriate treatment for patients with ruptured middle cerebral artery (MCA) aneurysms in relation to haematoma distribution. Ninety-two patients with ruptured MCA aneurysms, who underwent surgery during the last 11 years from 1986 to 1996, were assigned to one of the three groups according to the haematoma distribution. Group A comprised 17 patients who had an intraparenchymal haematoma (IPH) larger than 30 mm (maximum diameter) with or without subarachnoid haemorrhage (SAH), group B comprised 24 patients having a dense intra-Sylvian fissure haematoma (ISH) larger than 30 mm (maximum diameter) and group C consisted of 52 patients having only diffuse SAH without a localized dense haematoma. The clinical course and factors affecting the outcome of the patients in each group were investigated. Patients in groups A and B had a more severe clinical grade on admission than those in group C. As a result, patients in these two groups had a poorer outcome. In group C, independent life was achieved for 98% of the patients. In group A, the clinical grade on admission and the diameter of the haematoma were significantly correlated with outcome. Initial brain damage due to IPHs seemed to be the main cause of disability, while only 7% developed delayed ischaemic neurological deficits (DIND). In group B, 54% of patients suffered from subsequent brain oedema and DIND occurred in 50%. These factors were related to a poor outcome. The MCA aneurysms tend to have localized dense haematomas, as well as diffuse SAH; the former seems to affect more on the course and outcome of the patients. Accurate assessment of the bleeding patterns in patients with ruptured MCA aneurysms will be useful in helping us predict the clinical course and the most appropriate treatment for these individuals.
Adolescent↗
Increased sarcolemmal permeability in the cerebral artery during chronic spasm: an assessment using DNA-binding dyes and detection of apoptosis.
Alteration of sarcolemmal permeability was evaluated in the cerebral artery after subarachnoid hemorrhage. Significance of membrane dysfunction in the pathogenesis of chronic spasm and contribution of apoptosis were investigated in a canine model. Permeability of the smooth muscle cell (SMC) membrane was assessed by double staining with a hydrophilic (ethidium bromide [EB]) and a lipophilic (Hoechst 33342) DNA-binding dye. Quantitative observations were made with a ultraviolet-fluorescence microscope and a ultraviolet-laser confocal microscope. Occurrence of apoptosis was studied using electrophoresis and TUNEL method. In the normal arteries, nuclei of SMC were stained with Hoechst 33342 but not with EB. In the spastic arteries, SMC in the inner layer of the tunica media were stained with EB. The incidence of EB-positive cells reached maximum on day 7 (45 +/- 19%) and decreased in 2 to 4 weeks (13 +/- 5.2% and 5.0 +/- 2.1%, respectively), in parallel with amelioration of spasm. Electron and light microscopic observations revealed increased density of SMC cytoplasm with widening of the extracellular space. Necrosis was not evident. Apoptosis was not detected by the two methods. These results demonstrate that an augmentation in sarcolemmal permeability takes place during the course of chronic vasospasm and suggest its close correlation to pathogenesis.
Animals↗
Treatment for ruptured aneurysms and screening for unruptured aneurysms.
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Aneurysm, Ruptured↗
Cost-effectiveness analysis of screening for asymptomatic, unruptured intracranial aneurysms. A mathematical model.
BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) due to aneurysmal rupture is a major cause of cerebrovascular disease-related death. This problem could be eliminated by diagnosis and successful treatment of aneurysms before rupture. Recent developments in high-resolution imaging technology have made screening for unruptured aneurysms possible in the general population. Such screening has become widespread in Japan ("No Dokku, " or brain checkup). As a result, unruptured aneurysms are being identified with increasing frequency. However, the economic implications of treatment decisions for unruptured aneurysms have not been analyzed. Therefore, we performed such an analysis. METHODS: We used a Markov model to evaluate the cost-effectiveness of screening for asymptomatic, unruptured intracranial aneurysms. The model involved a set of variables describing discrete health states. Each state was assigned a quality of life score and an associated medical cost. A comparison of the expected outcomes was then made between 2 hypothetical cohorts, one receiving screening and the other no screening. A sensitivity analysis was performed by altering the input values within clinically reasonable ranges to reflect uncertainty in the baseline analysis and then assessing the effects on outcomes. RESULTS: Combining the incremental cost and effectiveness data revealed a cost per quality-adjusted life-year of $7760 for an annual rate of subarachnoid hemorrhage due to unruptured aneurysms (rupture rate) of 0.02; this cost was $39 450 for a rupture rate of 0.01. There was no benefit (negative quality-adjusted life-year benefit) for a rupture rate of 0.005, the rupture rate found in a recently published international cooperative study. The risks of surgery for unruptured aneurysms and the discounting ratio used to assess the impact of timing of costs and benefits on future outcomes also had significant effects on the results. Other variables had little impact on cost-effectiveness. CONCLUSIONS: The cost-effectiveness of screening for an unruptured aneurysm is highly sensitive to the annual rate of subarachnoid hemorrhage due to unruptured aneurysms. The low annual rupture rate seen in the recent large international cooperative study implies that screening asymptomatic populations to identify and treat unruptured aneurysms would not be cost cost-effective.
Adult↗
Cancer mortality among radiological technologists in Japan: updated analysis of follow-up data from 1969 to 1993.
A retrospective cohort study was conducted for 12,195 male radiological technologists who received the occupational exposure to low dose radiation over a long term. A total of 1,097 deaths including 435 from cancer were ascertained by Koseki and death certificates from 1969 to 1993. Cancer mortality among the study population was basically compared with that of whole Japanese men. The significant low SMRs were obtained for all cancers, stomach and lung cancer partly due to Healthy Worker Effect, unlike the results of the early reports with some inappropriateness in the methods. Apparent high risks of lymphatic and hematopoietic cancers were observed, although none of site-specific cancers revealed the statistically significant increase. For these cancers, the SMRs among old sub-cohort were somewhat higher than those of young sub-cohort, whereas similar SMRs for solid cancer were obtained between the two sub-cohorts. The SMR for leukemia reached statistically significant level of 1.75 (95% CI: 1.07-2.71) when using whole professional and technical workers as a standard population. The study results might suggest that the chronic exposure to low-dose radiation enhanced the risk of lymphatic and hematopoietic cancers.
Adult↗
[Acquired pendular nystagmus after pontine hemorrhage].
A 60-year-old hypertensive woman had a pontine hemorrhage that caused slight right hemiplegia, deep sensory disturbance on her right side and dysarthria. Three months after the stroke, she was transferred to our hospital for rehabilitation. Approximately 6 months later, she gradually began to complain of the visual oscillation. Continual, unceasing conjugate vertical/rotatory eye movements were observed. Fixation was momentary at best because of an inability to dampen the spontaneous eye movements. Electrooculography (EOG) showed bilateral vertical/rotatory sinusoidal eye movements of 2.5 Hz frequency and 10- to 35-degree amplitude. Both vertical and horizontal optokinetic nystagmus were absent. Caloric stimulation did not evoke any responses bilaterally. There were no rhythmical movements at similar frequencies in other parts of the body such as palatal myoclonus. MRI revealed not only hematoma mainly at the dorsal pontine tegmentum but also hypertrophy of the inferior olive nucleus, suggesting disruption of the central tegmental tract. Lesions of this tract may be one cause of pendular nystagmus. Several drug therapies were investigated for the nystagmus. There was no response to baclofen 15 mg. Trihexyphenidyl 4 mg was discontinued because of drug-induced hallucinations. Tiapride 600 mg and phenobarbital 90 mg were each slightly effective in reducing both frequency and amplitude of nystagmus. Treatment with clonazepam 1 mg resulted in the striking disappearance of nystagmus. She was aware of this and no longer experienced oscillopsia. Despite the visual benefit, however, the patient did not wish to continue this drug because of drowsiness and muscle relaxation. The potential long-term therapeutic application of clonazepam should be further investigated. To our knowledge, there have been no reports of successful treatment in acquired pendular nystagmus with clonazepam. Therefore, based on this favorable experience, it is suggested that clonazepam should be added to the list of potential therapies for pendular nystagmus.
Anticonvulsants↗
Treatment of cholecystoduodenal fistula by laparoscopy.
We describe a patient with cholecystoduodenal fistula treated by a laparoscopic approach. Use of a flexible videoscope, flexible retractor, and endoscopic transecting stapler allows for laparoscopic treatment of cholecystoenteric fistulae.
Biliary Fistula↗
Primarily extracranial jugular foramen neurinoma manifesting with marked hemiatrophy of the tongue: case report.
BACKGROUND: There have been no detailed descriptions of the clinical symptoms of a primarily extracranial jugular foramen neurinoma (JFN), because this type of tumor is extremely rare. CASE DESCRIPTION: Although the 51-year-old woman presented with only mild complaints of dysphagia and hoarseness, neurologic examination revealed marked left hemiatrophy of the tongue. Although magnetic resonance imaging suggested a JFN, the patient's mild symptoms and normal jugular foramen were potentially misleading in the diagnosis of this patient. Surgical exploration demonstrated that the tumor originated from the extracranial portion of the 10th cranial nerve, extending into the jugular foramen. Subtotal resection ameliorated the 12th cranial nerve palsy. CONCLUSION: The authors present a case of a primarily extracranial JFN manifesting as a 12th nerve palsy. The clinical symptoms and signs produced by a tumor in this extremely rare location are discussed.
Atrophy↗
External hydrocephalus after aneurysm surgery: paradoxical response to ventricular shunting.
OBJECT: The authors sought to investigate the mechanisms and pathophysiological effects of subdural fluid collection after surgery for aneurysmal subarachnoid hemorrhage (SAH). METHODS: The authors retrospectively analyzed the medical records of 76 patients who had undergone craniotomy. The patients included 55 with aneurysmal SAH (SAH group) and 21 with unruptured aneurysms (non-SAH group) who were used as controls. Subdural fluid collection was more common in the SAH than in the non-SAH group (38% compared with 14%, p < 0.05). Although older patients appeared to be at greater risk for subdural fluid collection in both groups (p < 0.05), this condition developed even in relatively young patients with SAH. In the SAH group most subdural fluid collection was associated with ventricular dilation (81%), and a significant correlation was seen between fluid collection and the need for subsequent shunt placement (48% compared with 21%, p < 0.05). These results point to an association between hydrodynamic dysfunction and subdural fluid collection. The course of patients with subdural fluid collection varied from spontaneous resolution to normal-pressure hydrocephalus. Seven patients with persistent subdural collections underwent shunt placement (ventriculoperitoneal [VP] shunt in six and lumboperitoneal in one), which resulted in resolution of fluid collection in all seven. CONCLUSIONS: The results indicate that for most patients in the SAH group, subdural fluid collection represented "external hydrocephalus" rather than simple "subdural hygroma." Decreased absorption of cerebrospinal fluid because of SAH and surgically created tears in the arachnoid membrane communicating with the subdural space were factors in the development of external hydrocephalus. The authors believe that differentiating external hydrocephalus from subdural hygroma is extremely important, because VP shunt placement can be used to treat the former but could worsen the latter.
Absorption↗
[Novel mechanisms for increasing Ca2+ sensitivity of contractile apparatus in smooth muscle].
Smooth muscle contraction is primarily regulated not only by changes in cytosolic Ca2+ concentrations ([Ca2+]i) but also by changes in the force/[Ca2+]i ratio. The use of membrane-permeabilization technique facilitated demonstration of an increase in the level of force at constant [Ca2+]i (Ca2+ sensitization). It was clarified that Rho-associated kinase (Rho-kinase) is a novel mediator of Ca2+ sensitization of the smooth muscle contraction, by introducing the recombinant catalytic domain of Rho-kinase into the cytosol of vascular smooth muscle permeabilized with beta-escin. This review article focuses on novel mechanisms, by which activation of receptor-coupled G-protein(s) increases Ca2+ sensitivity of the contractile apparatus in smooth muscle: Rho-kinase and protein kinase C.
Animals↗
[Recurring intradiploic epidermoid cyst of the skull: a case report].
We report a case of a 65-year-old man with intradipolic epidermoid cyst of the frontal bone. The patient presented with headache and swelling of the forehead. Skull x-ray showed massive destruction of the frontal bone. Magnetic resonance imaging (MRI) revealed an epidural mass without any encroachment of the dura mater. The cystic tumor was removed followed by cranipolasty with methylmethacrylate. Four years later, the tumor recurred in the same region. At the second surgery the bony defect was again replaced with methylemthacrylate plate. Four years after the second operation, the tumor reemerged with some subcutaneous fluid retention. At the third surgery, the remaining tumor capsule was removed as much as possible except for that part which adhered to the superior sagittal sinus. The authors discuss the relationship of tumor recurrence with utilization of methylmethacrylate for cranioplasty in this type of tumor.
Bone Cements↗
Frontal small craniostomy and irrigation for treatment of chronic subdural haematoma.
A new surgical method for the treatment of chronic subdural haematoma is presented. A small craniostomy is made on the superior lateral angle of the forehead just beneath the hair line without hair removal using a high-speed drill. Through this aperture, evacuation and irrigation of the haematoma can be carried out safely. No infections occurred in a series of patients treated in this way, and the recurrence rate was 10% (2/20). The surgical wound was negligible. Because of its simplicity, and the lack of a need for hair removal, the procedure appears to be acceptable as an optional therapeutic modality.
Aged↗
Significance of pupillary reactivity in poor-grade aneurysm patients as a prognostic factor and an indication for active treatment.
Sixty-eight patients with subarachnoid haemorrhage (SAH) who were admitted in a comatose state were studied to determine the factors influencing mortality and to seek criteria for case management. Overall, the functional recovery (good recovery or moderate disability) rate was 33%, with a mortality rate of 50%. Bilaterally unreactive pupils on admission was a powerful predictor of death (p < 0.0001): outcome of these patients was poor regardless of any treatment modalities with a mortality rate of 91% (20/22). Initial poor motor response (abnormal flexion, extension, or nil) was also significantly related with death (p < 0.05). However, motor response was a less powerful predictor than pupillary reactivity. Motor response often altered spontaneously during the 12 h after admission, whereas pupillary reactivity tended to be stable. Initial reactive pupils were shown to be an indicator of spontaneous improvement of motor response. These findings indicate that pupillary reactivity may be a reliable predictor of outcome in poor-grade SAH patients.
Adult↗
Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings.
BACKGROUND AND PURPOSE: Intracranial vertebral artery dissection is an increasingly recognized cause of stroke. However, little is known about its natural history and clinical manifestations, and appropriate management protocol has not yet been established. This study was performed to clarify its clinical course and determine the best management protocol. METHODS: This study is a retrospective clinical and radiographic review of 11 patients with 13 lesions who presented between 1990 and 1996. Patients with a history of trauma and those who presented with subarachnoid hemorrhage were excluded. The 11 patients comprised seven men and four women, who ranged in age from 34 to 71 years, with a mean age of 47 years. Ten patients presented with ischemic symptoms. RESULTS: Although recurrent ischemic attacks were observed in two patients, most (90%) subsequently made a good recovery and returned to their previous lifestyle. Five arteries showed the typical "string sign" or "pearl and string sign" on initial angiography. They changed in the follow-up examinations, which demonstrated either resolution of the stenosis or progression to complete occlusion. In contrast, the angiographic signs of complete occlusion (three arteries) or aneurysmal dilatation without luminal stenosis (four arteries) remained unchanged during the observation period of 5 months to 2.5 years. MRI was a sensitive tool for diagnosing intracranial vertebral artery dissection; intramural thrombus and intimal flap were the two major findings. MR angiography was also useful for demonstrating abnormalities of the arterial signal column such as pseudolumen or aneurysmal dilatation. CONCLUSIONS: The natural history of unruptured intracranial vertebral artery dissection seems relatively benign, with a high probability (62%) of spontaneous angiographic cure. Some persistent aneurysmal dilatation may be amenable to intravascular coil embolization.
Adult↗
Bone changes and carotid atherosclerosis in postmenopausal women.
BACKGROUND AND PURPOSE: Because of increased life expectancy, most postmenopausal women today suffer from osteoporosis and atherosclerotic diseases, which are currently considered unrelated diseases. Our study was aimed at analyzing relations between bone mineral density (BMD) and ultrasonographic assessment of carotid wall characteristics. METHODS: The relation of carotid atherosclerosis to BMD was examined in 30 postmenopausal women aged 67 to 85 years. High-resolution B-mode ultrasonography was performed, and the severity of carotid atherosclerosis was determined by plaque score. BMD was measured by dual-energy x-ray absorptiometry. RESULTS: The correlation of plaque score with low total BMD was r = .549 (P < .002). Multiple linear regression analysis indicated significant correlation of plaque score with total cholesterol level and low total BMD. CONCLUSIONS: Our results suggest a relation between carotid atherosclerosis, one of the major causes of ischemic cerebrovascular diseases, and osteoporosis.
Absorptiometry, Photon↗
Early fatal rebleeding from a cerebellar cavernous malformation--case report.
A 25-year-old female patient presented with hemorrhage from a cerebellar cavernous malformation manifesting as headache and vomiting. She died of massive rebleeding within 1 week of the previous hemorrhage. The natural history of cavernous malformations was considered relatively benign, with significant hemorrhage being uncommon. The present case suggests that emergency surgery should be performed for patients with unstable clinical conditions and/or those with a significant mass effect in the cerebellum or the brainstem.
Adult↗