Biomedical subjects

Yutaka Hirashima

Publications and source records attributed to Yutaka Hirashima.

At least 19 recordsLinked to original sources

PubMed2006

Warning headache of subarachnoid hemorrhage and infarction due to vertebrobasilar artery dissection.

OBJECTIVES: The authors describe the clinical features of headache in patients with vertebrobasilar artery dissection (VBAD) and emphasize the importance of recognition of warning headaches preceding subarachnoid hemorrhage. Headache in VBAD is already recognized, but the natural history and clinical features of the warning headache have not been well elucidated. METHODS: The clinical features of 30 patients with VBAD were analyzed retrospectively. RESULTS: Of the 30 VBAD patients, 16 presented with subarachnoid hemorrhage and 14 with ischemia. Headache (without any other symptoms or signs) was detected in 70% of patients with subarachnoid hemorrhage and 50% of patients with infarction. The headache started acutely, was localized to the occiput or nape of the neck, was sharp and severe in intensity, and was different from any previously experienced headaches. The interval from onset of headache to diagnosis of subarachnoid hemorrhage or infarction was 1 to 10 days. Three patients had sudden severe warning headaches without any evidence of subarachnoid hemorrhage at initial presentation and deteriorated within 24 hours due to subarachnoid hemorrhage, demonstrated later on computed tomography. Angiographic findings of patients with warning headaches were nonspecific compared with those of patients without headache. CONCLUSIONS: The present study confirms a high frequency of headache in patients with VBAD. Sudden severe occipital and nuchal pain, even without subarachnoid hemorrhage or any neurologic deficit, should be considered as a warning sign of subarachnoid hemorrhage. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography should be performed urgently for screening of patients with a warning headache to prevent resultant life-threatening major vascular events.

Aged↗

PubMed2005

Adenovirus-mediated expression of heparin cofactor II inhibits thrombin-induced cellular responses in fibroblasts and vascular smooth muscle cells.

Heparin cofactor II functions as a physiological inhibitor of thrombin activity. The rate of inactivation of thrombin by heparin cofactor II is increased in the presence of dermatan sulfate, which is produced by fibroblasts or smooth muscle cells. To elucidate the role of heparin cofactor II in the extravascular cells, we induced expression of heparin cofactor II in cultured human fibroblasts or vascular smooth muscle cells using adenovirus-mediated gene transfer. After infection of adenovirus vector, these cells secreted heparin cofactor II protein into culture medium. The expressed heparin cofactor II formed the complex with exogenous thrombin and inhibited the proteolytic activity of thrombin. Expression of heparin cofactor II by infection of adenovirus vector inhibited thrombin-induced tissue-type plasminogen activator and interleukin-6 releases from fibroblasts and thrombin-induced interleukin-6 release from vascular smooth muscle cells. These findings show that fibroblasts and vascular smooth muscle cells expressing heparin cofactor II are resistant to thrombin-induced cellular responses.

Adenoviridae↗

PubMed2005

Inhibition of cellular proliferation and induction of apoptosis by curcumin in human malignant astrocytoma cell lines.

Nuclear factor (NF)-kappaB is known to control cellular proliferation and apoptosis. In malignant astrocytoma cells, it was reported that NF-kappaB was activated aberrantly and promoted their proliferation. Thus, inhibition of NF-kappaB activity is considered to be a promising therapeutic strategy for malignant astrocytoma. Recently, curcumin, the major constituent of turmeric, was reported to inhibit NF-kappaB activity. In this study, we investigated inhibitory effects of curcumin on NF-kappaB activity and cellular proliferation, and induction of apoptosis by curcumin in human malignant astrocytoma cell lines. Alteration of NF-kappaB activity in NP-2 human malignant astrocytoma cell line after treatment with curcumin was examined using electrophoretic mobility shift assay. Alterations of DNA synthesis and cellular growth in five human malignant astrocytoma cell lines after treatment with curcumin were examined using [(3)H]thymidine incorporation assay and the trypan blue dye exclusion method, respectively. Induction of apoptosis by curcumin in NP-2 and NP-3 human malignant astrocytoma cell lines was examined by DNA-fragmentation analysis and morphological observation. We found that the NF-kappaB activity in NP-2 was significantly reduced by curcumin. The DNA synthesis and the cellular growth were inhibited by curcumin in dose-dependent manner in all the five malignant astrocytoma cell lines. Nuclear condensation and fragmentation, and DNA fragmentation were observed in both NP-2 and NP-3 after the treatment with curcumin. These results indicate that curcumin inhibits the cellular proliferation and induces apoptosis in human malignant astrocytoma cell lines. These results are considered to be resulted from the inhibition of NF-kappaB activity by curcumin.

Antineoplastic Agents↗

PubMed2005

Lower incidence of symptomatic vasospasm after subarachnoid hemorrhage owing to ruptured vertebrobasilar aneurysms.

OBJECTIVE: In this study, we evaluated the difference in incidence of symptomatic vasospasm between ruptured aneurysms in the anterior and posterior circulation using multiple logistic regression analysis. METHODS: A total of 145 consecutive patients who underwent surgery for aneurysms within 72 hours after subarachnoid hemorrhage (SAH) were studied. RESULTS: The ruptured aneurysm was in the anterior circulation in 128 patients (88.3%) and in the posterior circulation in 17 patients (11.7%). Forty patients (27.6%) had symptomatic vasospasm and 105 patients (72.4%) did not. Univariate and multivariate analyses were performed to assess relationships among various variables and the occurrence of symptomatic vasospasm after SAH. Finally, Grade III to V (Hunt and Hess grade) and Group 3 (Fisher's classification) on admission were found to be independently positively associated with the occurrence of symptomatic vasospasm while ruptured vertebrobasilar aneurysm were negatively associated. CONCLUSION: Although a poor clinical grade and a severe SAH classification on admission such as Hunt and Hess grade and Fisher's classification are established powerful predictors of symptomatic vasospasm, ruptured vertebrobasilar aneurysm are for the first time reported to be a predictor of symptomatic vasospasm based on results of a recent reliable statistical analysis.

Aged↗

PubMed2005

Duration of cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage for prevention of symptomatic vasospasm and late hydrocephalus.

The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p = 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p = 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.

Adult↗

PubMed2005

Vidian artery as a collateral channel between the external and occluded internal carotid arteries--case report--.

A 68-year-old man presented with occlusion of the internal carotid artery (ICA) manifesting as a 6-month history of progressive sensory and motor disturbance of the left lower limb. Angiography clearly demonstrated a collateral arterial network between the ICA and external carotid artery (ECA) through the vidian artery, a small branch of both the ICA and ECA. The vidian artery may form an unusual but important ECA-ICA collateral pathway in patients with occlusive lesion of the ICA.

Aged↗

PubMed2005

Mechanical injury of the subthalamic area during stereotactic surgery followed by improvement of trunk, neck, and face tremor--case report--.

A 50-year-old man had undergone right nucleus ventrointermedius (Vim) thalamotomy 1 year previously, resulting in the disappearance of left hand tremor. However, he presented with right distal and proximal tremor including the axial trunk, neck, and head. Deep brain stimulation (DBS) of the left Vim for these symptoms was unsuccessful. Attempts were made to stimulate the left Vim, nucleus ventralis lateralis, and subthalamic nucleus (STN), but no significant improvement was obtained after repeat surgery. However, subsequent improvement of the symptoms including proximal tremor was very marked even without DBS stimulation. Brain magnetic resonance imaging demonstrated lesion and edema in the posteromedial area of the STN. Mechanical injury of the area caused by the surgical procedures may have contributed to the improvement in his persistent symptoms.

Electric Stimulation Therapy↗

PubMed2005

Effect of platelet-activating factor receptor antagonist, etizolam, on resolution of chronic subdural hematoma--a prospective study to investigate use as conservative therapy.

Inflammatory reaction is very important for formation of the neomembrane of chronic subdural hematoma (CSDH). The present study evaluated medical treatment with the platelet-activating factor receptor antagonist, etizolam, for the resolution of CSDH, and the factors indicating surgery or conservative therapy. Alternate patients were assigned to the etizolam group or control group without medical treatment. Patients in the etizolam group received 3.0 mg etizolam per day for 14 days. A total of 53 patients were followed up for at least 6 months. Univariate analysis of differences in demographic characteristics, clinical findings, and initial computed tomography (CT) findings, and multiple logistic regression analysis of the relationship between etizolam treatment and requirement for surgery using age, sex, low density of hematoma on CT, and paresis as confounders were performed. Etizolam treatment (adjusted odds ratio [OR] 0.156, 95% confidence interval [CI] 0.024-0.999, p = 0.049) was negatively correlated with requirement for surgery. Low density of hematoma (adjusted OR 0.125, 95% CI 0.019-0.846, p = 0.033) was found to be an independent negative predictor, and paresis as an initial symptom (adjusted OR 6.35, 95% CI 1.04-38.7, p = 0.045) was an independent positive predictor of requirement for surgery. Etizolam administration can promote the resolution of CSDH, especially at the stage of hygroma appearing as low density on CT. Surgery is recommended if the patient presents with paresis.

Administration, Oral↗

PubMed2005

Decrease in platelet count as an independent risk factor for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage.

OBJECT: Increased platelet consumption is expected in patients with cerebral vasospasm, according to data from clinical and experimental studies. The authors investigated sequential changes in platelet counts in patients with subarachnoid hemorrhage (SAH) and the difference in platelet consumption between patients with and those without symptomatic vasospasm (SV). Variables related to platelet count as well as other clinical and radiological variables were analyzed as independent predictors of SV. METHODS: One hundred consecutive patients who had undergone surgery within 48 hours after SAH onset were entered in the study. Clinical and radiological variables and blood cell counts, including red blood cells, white blood cells, and platelets, after SAH were retrospectively examined. Twenty of these variables were entered into univariatete and multivariate analyses to determine predictors for SV. After SAH, the platelet count decreased to a minimum and then increased rapidly to levels greater than those recorded on admission. This change was specific to SAH, and platelet consumption was more severe in patients with SV than in those without. There were three independent predictors of SV: a ratio of the lowest platelet count and the admission count greater than 0.7 (odds ratio [OR] 0.322, 95% confidence interval [CI] 0.124-0.834, p = 0.0196) and a history of hypertension (OR 0.338, 95% CI 0.126-0.906, p = 0.0311) were negatively significant (that is, decreases the occurrence of SV), and a Fisher Grade 3 (OR 4.42, 95% CI 1.48-13.2, p = 0.0077) was positively significant (that is, increases the occurrence of SV). CONCLUSIONS: The association between a decrease in platelet count and the occurrence of SV indicates the important role of platelets in the pathophysiology of vasospasm following SAH.

Adult↗

PubMed2005

[Dural arteriovenous fistula involving the cavernous sinus as the cause of intracerebral venous hemorrhage: a case report].

A case of cavernous sinus dural arteriovenous fistula (CS-DAVF) presenting intracerebral venous hemorrhage was reported. An 81-year-old woman was suffered from generalized convulsion accompanied by right conjunctival hyperemia and edema. Computed tomography scan revealed intracerebral hematoma involving right putamen and perifocal edema extraordinarily expanded to inferior part of the right frontal lobe and insular cortex. Cerebral angiography showed a CS-DAVF with retrograde leptomeningeal venous drainage (RLVD) not only to superficial middle cerebral vein but to basal vein of Rosenthal (BVR). Transvenous embolization was performed using mechanically detachable coils and free fibered platinum coils. After embolization, RLVD disappeared and conjunctival symptoms were improved. Hemorrhagic risk of this patient was discussed, based on her angiographical findings. We speculated that deep venous drainage to BVR through uncal vein, in case with poor venous collateral geometry, is one of the risk factor of cerebral hemorrhage.

Aged↗

PubMed2004

Huge arachnoid cyst in the posterior fossa: controversial discussion for selection of the surgical approach.

CASE REPORT: We report a case of a huge posterior fossa arachnoid cyst with hydrocephalus. This 15-month-old girl presented with macrocrania and psychomotor retardation. Magnetic resonance (MR) imaging demonstrated ventriculomegaly and a huge cystic lesion in the posterior fossa. A membranectomy was performed microscopically and the patient had a good postoperative course. OUTCOME: Magnetic resonance imaging 1 year after the operation revealed adequate reduction in the size of the ventricle and cyst. Progressive macrocrania discontinued and normal development was obtained.

Arachnoid Cysts↗

PubMed2004

Brain temperature in patients with chronic hydrocephalus after subarachnoid hemorrhage.

The relationships between temperature indices and clinical condition on admission or improvement after ventriculoperitoneal (VP) shunting were evaluated in patients with subarachnoid hemorrhage (SAH). Brain temperatures were measured at intervals of 1 cm from the brain surface to the lateral ventricle at shunt operation. Rectal temperature was also measured. The difference between intraventricular and rectal temperatures was correlated with age (p = 0.0486), Glasgow Coma Scale (p = 0.0129), Hunt and Hess grade (p = 0.0101), and improvement score after VP shunting (p = 0.0104). Measurement of brain temperature may predict the outcome of VP shunting in patients with SAH.

Adult↗

PubMed2004

Supratentorial dynamic computed tomography for the diagnosis of vertebrobasilar ischemic stroke.

Dynamic computed tomography (CT) is an established method for the evaluation of perfusion in acute ischemic stroke, but is not frequently used to assess infratentorial ischemia. Eleven patients with vertebrobasilar ischemia underwent dynamic CT on admission and/or during the follow-up period. The time of appearance (TA) and time to peak (TTP) were mapped and differences in TA (deltaTA) and TTP (deltaTTP) between the bilateral middle cerebral artery and posterior cerebral artery (PCA) territories were calculated. Conventional angiography and brain imaging including CT and magnetic resonance imaging were also performed. The TA and TTP maps obtained within 48 hours after onset exhibited time delay in eight of nine patients in the bilateral PCA territories. deltaTA and deltaTTP were greater in patients with stenosis or occlusion of the bilateral vertebral arteries or the basilar artery, and in patients without collateral circulation via the posterior communicating arteries than in control subjects. Furthermore, TA and TTP normalized dramatically in patients with recanalization of the arteries. deltaTA and deltaTTP were also normalized. deltaTA and deltaTTP were negatively correlated with the time from onset to examination. Dynamic CT can provide important information in patients with vertebrobasilar ischemic stroke, and may allow the diagnosis of acute ischemia and monitoring of the course.

Aged↗

PubMed2004

Tension pneumocephalus after a neuroendoscopic procedure--case report.

A 60-year-old female presented with gait disturbance, urinary incontinence, and recent memory disturbance. Computed tomography and magnetic resonance imaging revealed a partially calcified mass lesion without enhancement in the left caudate head and mild ventriculomegaly. She underwent endoscopic tumor biopsy. The histological diagnosis was astrocytoma grade 2. After the endoscopic procedure she presented with prolonged consciousness disturbance caused by tension pneumocephalus. Tension pneumocephalus is one of the potential complications of neuroendoscopic procedures.

Astrocytoma↗

PubMed2004

Japan Carotid Atherosclerosis Study: JCAS.

The recent randomized trials, North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Asymptomatic Carotid Atherosclerosis Study, have demonstrated the effectiveness of carotid endarterectomy to reduce the incidence of cerebral infarction in patients with symptomatic and asymptomatic high-grade carotid artery stenosis. However, no studies on Japanese patients have been done until now, and recent progress in endovascular stent treatment has been made. The present prospective, multicenter (not randomized) trial, the Japan Carotid Atherosclerosis Study, has started to analyze present practice and propose treatment guidelines for Japanese patients. Here, the protocol and early results of 565 patients registered until the end of January 2004 are presented.

Carotid Artery Diseases↗

PubMed2004

Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopy--case report.

A 48-year-old woman presented with a unique case of isolated third and fourth ventricles associated with neurosarcoidosis, manifesting as upward gaze palsy. She had a past history of surgery for intracranial sarcoid granuloma 10 years previously and placement of a ventriculoperitoneal shunt 3 years later. Magnetic resonance imaging revealed isolated third and fourth ventricles. Endoscopic plasty of the right foramen of Monro, fenestration of the septum pellucidum, and revision of the ventriculoperitoneal shunt were performed. Postoperatively the size of the third and fourth ventricles was reduced, and the upward gaze palsy resolved. Endoscopic treatment is less invasive and effective for the treatment of multiple septum formation in the ventricular system.

Female↗

PubMed2004

Idiopathic interdural hematoma looking like a "Chinese dumpling"--case report.

A 79-year-old man presented with an interdural hematoma manifesting as headache. Computed tomography revealed a right parietal intracranial hematoma. Magnetic resonance imaging revealed the hematoma had divided the dura mater into two layers. Craniotomy was performed and a dural pouch containing a solid hematoma was totally removed. Histological examination showed the hematoma had divided the meningeal dura into two layers. This case confirms the location of interdural hematoma.

Aged↗

PubMed2003

A case of occult intrasacral meningocele presented with atypical bowel symptoms.

CASE REPORT: We report a case of an occult intrasacral meningocele. An 11-year-old boy presented with atypical bowel symptoms, severe constipation, and stool incontinence. Magnetic resonance (MR) imaging disclosed an intrasacral cyst containing cerebrospinal fluid (CSF). We diagnosed an occult intrasacral meningocele and performed perforation of the cyst and closure of the fistula. The patient was free from constipation and stool incontinence after the operation. DISCUSSION: We discuss the clinical features and neuroradiological findings of this rare condition.

Child↗