脳卒中
Online ISSN : 1883-1923
Print ISSN : 0912-0726
ISSN-L : 0912-0726
28 巻 , 4 号
選択された号の論文の66件中1~50を表示しています
  • 峰松 一夫, 矢坂 正弘, 豊田 一則
    2006 年 28 巻 4 号 p. 477-480
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    背景及び目的:抗血栓療法中に発生する出血性合併症,特に頭蓋内出血の実体と対策を明らかにする.
    方法:循環器病研究委託費15公-1,分担研究課題(1)に対する後ろ向きおよび前向きの多施設共同研究.
    結果:後ろ向き共同研究は,急性期脳出血947例を対象とした.抗血栓療法中の脳出血は全体の32%を占めた.抗血栓治療患者は他の患者に比べて,高齢で,男性,糖尿病,脳梗塞・心疾患の既往,小脳出血,入院約24時間後の血腫増大例が多かった.前向き共同研究では,抗血栓療法症例約4,000例を19カ月間(中央値)にわたって観察した.重症出血合併症の発症率は,抗血小板薬単剤服用患者で6.4/1,000人・年,複数の抗血小板薬例で9.8,ワルファリン例で10.7,両者の併用例で18.9であった.
    結論:抗血栓療法中に発症した脳出血が脳出血全体の約1/3を占めた.抗血栓薬多剤服用例で重症出血合併が多かった.
  • 宮坂 和男, 寺山 靖夫, 橋本 信夫
    2006 年 28 巻 4 号 p. 481
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 山下 哲男, 浦川 学, 安田 浩章, 野川 茂, 傳法 倫久, 本多 満
    2006 年 28 巻 4 号 p. 482-487
    発行日: 2006/12/25
    公開日: 2009/12/07
    ジャーナル フリー
    Xenon CT CBF examination has much radiation exposure because of frequent scanning of the same slice. First, we did questionnaire investigation in Japanese 202 institutions in three months since December, 2004. The questionnaire result showed that the number of scan slices was 2.6±1.3 (mean±SD). The number of scans per one slice was 9.3±1.7. The x-ray tube voltage was 120 kV in most institutions. The x-ray tube current was 347±128 mAs. We got an answer from a 54 institution about CTDIw value. The radiation exposure in these institutions was 1, 108.3+/-874.4 mGy·cm.
    Second, we studied the influence that decrease of scan frequency gave to radiation exposure and cerebral blood flow value. In a 4 slices scan with a CT device of CTDIw 39.6 mGy, radiation exposure decreased by 634 mGy when we changed scan frequency from seven times to three times. The decrease of scan frequency resulted in cerebral blood flow increase of 3-5ml/100mg/min. In conclusion, among Japanese institutions, number of scan slices and scan frequency per one slice were various. Making of a guideline and reconsideration of the scan conditions are necessary for reduction of radiation exposure.
  • 平野 照之, 米原 敏郎, 稲富 雄一郎, 橋本 洋一郎, 内野 誠
    2006 年 28 巻 4 号 p. 488-492
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Background and Purpose: Although parenchymal hypoattenuation (PH) indicates severe ischemic injury, brain swelling without concomitant hypoattenuation (BS) is thought to be more benign. We have clarified the clinical significance of BS.
    Methods : A total of 53 patients (34 men, 19 women, mean 69.7 years old) with acute embolic stroke was enrolled. PH and BS were evaluated on baseline CT. Residual cerebral blood flow (rCBF) was determined by 99mTc-HMPAO SPECT performed within 6 hours of onset. Difference in patients' age, gender, neurological severity (NIHSS), CT time and rCBF, were evaluated among patients with PH, BS and negative early CT signs (NEG) using one-way ANOVA with Scheffe's post hoc analysis. Results : The CT time (F = 4.369, P = 0.018) and the rCBF (F=7.881, P = 0.001) were significantly different among NEG (16 patients), BS (5 patients), and PH (32 patients) groups. BS was observed within 3 hours of onset. CT time was significantly longer in PH group compared to NEG group. PH and BS groups exhibit significant lower rCBF compared to NEG group, although no statistical difference was observed between BS and PH groups.
    Conclusions: We speculated that BS was observed within early hours of onset, and then accompanied by concomitant parenchymal hypoattenuation.
  • 森脇 博, 岡崎 周平, 山田 直明, 成冨 博章
    2006 年 28 巻 4 号 p. 493-498
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Non-contrast CT and diffusion-weighted MRI (DWI) are widely used for assessing patients with acute ischemic stroke including candidates for thrombolytic therapy. Early CT signs, still a gold standard as the diagnostic measure for thrombolysis, are quite subtle and strongly depend on image quality. We evaluated 76 patients (47 male, mean age 71.0 yrs) with ischemic stroke of the anterior cerebral circulation who underwent CT and DWI within 6 hours of onset. The scans were examined separately by two neurologists in a blinded fashion with knowledge of the affected hemisphere. Detection of acute ischemic changes were significantly higher on DWI (72/76, 95%) compared with that on CT (50/76, 66%)(P<0.0001), especially in cases with subcortical lesions (P<0.001). Detection of the lesion with more than 33% of MCA involvement, which should exclude from the thrombolitic therapy, was somewhat higher for DWI (26/26, 100%) compared with CT (22/ 26.85%).
    DWI is more sensitive than CT in the identification of acute ischemic stroke and can visualize major ischemia more easily than CT. Additional studies are required to determine whether these advantages of DWI are clinically relevant in the management of patients with acute stroke.
  • 原田 雅史, 森田 奈緒美, 西谷 弘, 宇野 昌明, 永廣 信治, 和泉 唯信, 梶 龍兒
    2006 年 28 巻 4 号 p. 499-503
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    CT is a widely used imaging modality for diagnosis of cerebral vascular disease. However, the sensitivity of detection at early stage of cerebral infarction is not adequate depending on the ability of observers and instruments. The high sensitivity of diffusion-weighted imaging on MRI for the diagnosis of acute cerebral infarction has bee reported. Furthermore, MRI can demonstrate perfusion and vascular information without usage of contrast medium. In addition, the recent work showed that susceptibility imaging on MRI has the same quality to detect acute cerebral hemorrahge as CT. We consider that MRI has a possibility to become the first selected modality for the acute cerebral infarction.
  • 守屋 里織, 足立 智英, 後藤 淳, 荒川 千晶, 溝井 令一, 高木 誠
    2006 年 28 巻 4 号 p. 504-509
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Branch atheromatous disease has been recognized as one of the types of stroke which is often associated with clinical deterioration. We investigated the correlation between diffusion weighted imaging (DWI) findings and clinical courses of 33 patients with BADs in the territory of the lenticulostriate arteries. The DWI findings associated with the poor outcomes (modified Rankin Scale ; mRS>or = 3) are (1) the larger lesion size in a direction perpendicular to axial section and (2) the lesions located in the inferior portion of basal ganglia. The findings correlated with progressive motor deficits are (1) the lesions closer to the posterior limb of internal capsule (medial type) and (2) the lesions located in the inferior portion of basal ganglia. These characteristics of DWI may play an important role to distinguish the progressing ischemic strokes as BAD from non-progressing ones.
  • 薬師寺 祐介, 横田 千晶, 板橋 亮, 峰松 一夫
    2006 年 28 巻 4 号 p. 510
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 佐々木 真理, 山田 恵, 渡部 嘉之, 松井 美詠子, 井田 正博
    2006 年 28 巻 4 号 p. 511-513
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Diffusion-weighted imaging (DWI) is widely applied for evaluating patients with acute ischemic stroke. However, its display conditions are different among institutions, and reliability of the apparent diffusion coefficient (ADC) has not been validated enough. Recently, we proposed an easy-to-use technique to standardize display conditions, in which window width and level are normalized by the signal intensity of brain tissue on b0 images. We carried out a multi-institutional multivendor study, and revealed that the technique successfully minimized difference in the display condition among institutions and vendors. On the other hand, we found that the ADC value is significantly different among vendors and static magnetic fields, suggesting that the ADC should be evaluated semiquantitatively. Standardization and technical advancement are considered to be necessary to improve reliability of DWI in acute stroke managements.
  • 長尾 毅彦, 井田 正博, 元良 健一, 新井 健史, 吉澤 寿, 小林 美紀, 有馬 留志, 石川 みずき, 片山 泰朗, 横地 正之
    2006 年 28 巻 4 号 p. 514-518
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    目的:脳梗塞急性期において, Susceptibility-Weighted Image (SWI)を用いた高分解能3D MR Venographyにより,造影剤を使用しない脳循環評価を試みた.
    方法:発症24時間以内の皮質を含む急性期脳梗塞21例を対象とし,3D FLASH法TE=40msecで撮像した,撮像時間は約5分30秒.この方法は,脳組織中のoxy-Hbと静脈のdeoxy-Hbの磁化率差を強調させた撮影法である.
    臨床情報を伏せた状態で,塞栓子による血管閉塞部位,静脈灌流障害の有無をSWI上で読影し,他の撮像方法と比較した.
    結果:17/21例で静脈灌流異常によるIncreased BOLD sign(IBS)を認め,misery perfusionを反映する所見と考えた.IBS所見は,T2強調画像で血管性浮腫を認める時期には消失した.13/21例で,動脈主幹部に低信号を呈する塞栓子を検出しえた.
    結論:脳梗塞急性期において,SWIは非侵襲的に頭蓋内の灌流状態を評価可能であり,その所見はmisery perfusionを反映するものであると考えられるため,SWIで異常を認めた症例には,perfusion imageの適応を検討すべきである.同時に,この撮像法は塞栓子検出やmicrobleeds評価に関しても有用と思われた.
  • 小林 祥泰, 山浦 晶
    2006 年 28 巻 4 号 p. 519
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 松澤 佑次
    2006 年 28 巻 4 号 p. 520
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 北村 明彦, 今野 弘規, 山岸 良匡, 磯 博康, 嶋本 喬
    2006 年 28 巻 4 号 p. 521
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 横田 千晶, 今村 剛, 清原 裕, 高田 達郎, 粕谷 潤二, 板橋 亮, 桑城 貴弘, 中垣 英明, 川瀬 佳代子, 峰松 一夫
    2006 年 28 巻 4 号 p. 522-526
    発行日: 2006/12/25
    公開日: 2009/12/07
    ジャーナル フリー
    Patients with metabolic syndrome (MetS) are at high-risk for future cardiovascular events. The relationship between MetS and stroke in Japan, however, has not yet been elucidated. We assessed an association of MetS with ischemic stroke. We performed a cross-sectional study consisting of consecutive 311 patients with ischemic stroke (M/F 209/102, mean age of 70 years) who were admitted to our hospital within the first 7 days from February 1 in 2004, and of 611 people (418/204, mean age of 70 years) in a general population in Hisayama town. The diagnosis of MetS was made according to the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP), the World Health Organization (WHO), International Diabetes Federation (IDF), and the Japanese Society of Internal Medicine (JSIM). MetS was present in 24% of the stroke patients by NCEP, 15% by WHO, 25% by IDF, and 21 % by JSIM definition. The number of traditional vascular risk factors was significantly correlated with the presence of ischemic stroke. Stroke patients had more frequently hypertension (relative risk 2.5), diabetes mellitus (3.8), low HDL-cholesterol (13.1), increased level of CRP (3.2), and less frequently hypertriglyceridemia (0.3), hypercholesterolemia (0.5) as compared to people in Hisayama town. MetS of any definitions was not significant risk factor for ischemic stroke in this study.
  • 高橋 一夫, 卜蔵 浩和, 飯島 献一, 長井 篤, 山口 修平, 小林 祥泰
    2006 年 28 巻 4 号 p. 527-530
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    メタボリックシンドロームとその危険因子数と脳梗塞発症のリスクを男女別に検討した.1988年~2002年までの脳ドック受診者中,過去に脳卒中の既往がなく,脳梗塞発症の有無を追跡し得た2,726例(男1,507例,女1,219例,平均年齢57.4±7.9歳平均追跡期間6.3±3.8年)を対象とした.メタボリックシンドロームの診断基準は我が国のものに準じたが,ウエスト周囲径に関しては男女ともBMI(body massindex)25以上で代用した.メタボリックシンドロームは男性で139%,女性で4.3%に認めた.女性ではメタボリックシンドローム有り群は無し群と比較し有意に脳梗塞発症のリスクが7.7倍(95%信頼区間:2.0~288)高かったが,男性では両群間に有意差を認めなかった.さらに,BMI25以上に加え,脂質異常(TG150mg/dl以上かつ/又はHDL40mg/dl未満),血圧異常(収縮期130mmHg以上かつ/又は拡張期85mmHg以上),血糖値異常(空腹時110mg/dl以上)の3つの危険因子がいくつあるかで群分けし,これらの群をBMI25未満かつ上記の危険因子数0の正常群と比較し,年齢,喫煙で調整を行い,脳梗塞発症のリスクを男女別に検討した.BMI25以上の男性では危険因子数0,1,2でも脳梗塞発症に関し有意差なく,危険因子数3になると脳梗塞のハザード比は6.5倍(11~14.0)になった.一方,BMI25以上の女性では,危険因子数0では有意な脳梗塞発症は認めなかったが,危険因子数1で4.1倍(1.0~41.5),危険因子数2で28.8倍(2.1~389),危険因子数3で23.9倍(1.1~505)と有意に脳梗塞を発症した。以上より,脳梗塞発症に関しては,明らかな男女差があり,特に女性においてメタボリックシンドロームの関与が強いことが示唆された.
  • 今村 剛, 清原 裕, 土井 康文, 米本 孝二, 谷崎 弓裕, 二宮 利治, 井林 雪郎, 飯田 三雄
    2006 年 28 巻 4 号 p. 531
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 小久保 喜弘, 岡山 明
    2006 年 28 巻 4 号 p. 532
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 小久保 安昭, 松森 保彦, 近藤 礼, 佐藤 慎哉, 嘉山 孝正
    2006 年 28 巻 4 号 p. 533
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 東儀 英夫, 山本 悌司
    2006 年 28 巻 4 号 p. 534
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 内山 真一郎, 折笠 秀樹, 後藤 信哉, 島田 和幸, 池田 康夫
    2006 年 28 巻 4 号 p. 535-537
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    J-TRACE is a nationwide multi-center cooperative study to prospectively observe vascular events during 2 to 4 years of period in patients with stroke, MI and atrial fibrillation (afib), which are three major thromboembolic diseases. Until July 24, 2006, 6, 163 patients have been registered at 273 sites. We analyzed interim results of the baseline data.
    History of stroke (14.1 %) was far more common than history of MI (2.9%) in stroke patients, while history of stroke (6.3%) was less frequent than history of MI (8.2%) in MI patients. History of stroke (15.1%) was far more frequent than history of MI (3.7%) in afib patients. Hypertension was the most frequent risk factor (71.8%) in stroke patients, while hypercholesterolemia was the most frequent risk factor (64.2%) in MI patients. Average number of risk factors was higher in MI patients (2.32) than in stroke patients (1.87). Hypertension, hypercholesterolemia, history of MI, and age >75 years were more frequent in afib patients with than without history of stroke. Patients with more than two of hypertension, diabetes, and hypercholesterolemia in addition to obesity were more frequent among patients with MI (23.6%) than stroke (14.1%) or afib (13.1%) patients.
  • 松本 昌泰, 内山 真一郎, 島田 和幸, 池田 康夫
    2006 年 28 巻 4 号 p. 538
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 豊田 一則, 矢坂 正弘, 長田 乾, 長尾 毅彦, 坂本 知浩, 後藤 淳, 山本 正博, 内山 真一郎, 是恒 之宏, 岩出 和徳, 高 ...
    2006 年 28 巻 4 号 p. 539-543
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    To determine clininal features of Japanese patients who developed intracerebral hemorrhage (ICH) while receiving antithrombotic agents, we performed a retrospective study based on the medical records of 947 patients with nontraumatic ICH from 11 institutes between 1999 and 2003. On the treatment with antithrombotic therapy were 31.6% of the patients (20.7% of patients taking antiplatelets, 8.1% taking warfarin, and 2.5% taking both). The proportion of cerebellar hemorrhage to total ICH increased from 5% of the patients without antithrombotics to 9% of those on antithrombotic therapy (p=0.046). Advanced age (p<0.0001), male gender (p=0.0001), diabetes mellitus (p=0.045), history of ischemic stroke (p<0.0001), heart diseases (p<0.0001), and hematoma growth on computed tomography during the initial 24 hours (p=0.0043) were more frequent in ICH patients taking antithrombotic agents than in the others.
  • 有馬 久富, 尾前 照雄, Chalmers John, Woodward Mark, Anderson Craig, Macmahon S ...
    2006 年 28 巻 4 号 p. 544
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 長谷川 泰弘, 安井 信之, 畑 隆志, 岡田 靖, 豊田 章宏, 豊田 百合子, 成冨 博章, 峰松 一夫
    2006 年 28 巻 4 号 p. 545-549
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    "Guideline for Stroke Treatment 2004" published in Japan strongly recommended that acute stroke patients should be managed in dedicated stroke care unit or stroke unit. We conducted a nation-wide survey of all hospitals providing acute stroke care. We sent a questionnaire to 7, 835 hospitals and obtained 2, 603 answers (33.2%). According to the meta-analysis by Stroke Unit Trialists' Collaboration, service organizations were classified into five categories as a hierarchy in descending order as follows ; acute stroke units, comprehensive stroke units, mixed rehabilitation ward, mobile stroke team, and general medical ward. Only 8.3% of hospitals had organized stroke units (acute stroke units ; 0.9%, comprehensive stroke units ; 7.4%), and 63.8% of hospitals managed acute stroke patients in general medical words. The categorization of stroke service organizations was highly correlated with the number of patients admitted in a year. We compared performance levels of the key elements recommended for establishing primary stroke centers by the Brain Attack Coalition among the five categories, such as acute stroke teams, stroke units, written care protocols, and an integrated emergency response system, availability and interpretation of computed tomography scans 24 hours everyday, access to neurosurgeon within 2 hours and rapid laboratory testing. Currently there are very few hospitals with performance levels required for the primary stroke center. More importantly, measures were taken for the quality improvement of stroke care only by 6.5% of hospitals. Intravenous thrombolytic therapy is now widely available in Japan. Establishment of clearly defined stroke units or stroke care units is urgently needed.
  • 永井 洋士, 松山 琴音, 高原 志津子, 橋田 寿美, 郡山 達男, 松本 昌泰
    2006 年 28 巻 4 号 p. 550-553
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Progression of investigator-initiated clinical trials has been hampered by the lack of efficient and costless infrastructure for driving the trials, with a paucity of definitive clinical evidence derived from our country. In order to construct such infrastructure without spoiling pertinent quality, this study prepared electronic data capture and its facilitating systems for a large-scale clinical trial model : multi-center randomized controlled trial for the secondary prevention of stroke, which is called J-STARS. Particularly, we have developed 1) web-based patient registration and data collection system, 2) automatic mail delivery system notifying follow-up data submission, and 3) PDF-based severe adverse events reporting system. Also, we have determined laborsaving data management procedure for the trial, in which bad data are extracted from the database and inquiry mails are semi-automatically sent out. By the preparation of these systems and procedure, infrastructure for conducting investigator-initiated large-scale clinical trials appears to be constructed. The infrastructure can be applied to the trials in other medical fields, potentially allowing for a promotion of such trials in our country.
  • 徳光 直樹, 白井 和歌子, 相澤 希, 佐古 和廣
    2006 年 28 巻 4 号 p. 554-559
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    平成14年7月より北海道・道北地域15市町村を対象とし道北脳卒中共同研究(NOHSS)を開始した.平成14年7月1日以降発症の症候性脳血管障害を前向きに登録し,病型・危険因子・転帰・再発率を解析した.調査開始より平成17年6月30日までの3年間の集計を報告する.全脳卒中792例で,発症率は4.09(対1,000人/年),平均年齢71.0±12.1歳で男女比57.4%:42.6%.脳卒中病型分布は脳梗塞64.1%,脳出血26.3%,くも膜下出血9.3%であった.脳梗塞病型別ではラクナ梗塞38.0%,アテローム血栓性梗塞33.7%,心原性脳塞栓18.5%であった.再発は全792例中38例で,脳梗塞の年間再発率はラクナ梗塞2.6%,アテローム血栓性梗塞6.9%,心原性脳塞栓13.6%であった.道北地域の脳卒中は全国調査と比べ脳出血の占める割合が高く,また脳梗塞ではラクナ梗塞がいまだ高率であった.
  • 佐渡島 省三, 榊 寿右
    2006 年 28 巻 4 号 p. 560
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 大木 宏一, 星野 晴彦, 田邊 亜矢, 鈴木 則宏
    2006 年 28 巻 4 号 p. 561-565
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Dysphagia is a common and disabling symptom in stroke patients, and prediction of prolongation of dysphagia in its acute stage is very important from several standpoints, including selection of the treatment strategy, planning of care, and the QOL of the patients.
    We retrospectively analyzed the data of 33 stroke patients in whom videofluoroscopy (VF) had been performed to check for the swallowing function, and investigated the predictive factors for dysphagia after stroke. Of the 33 patients, 25 patients had had ischemic stroke and 8 had had hemorrhagic stroke. Twenty patients (39%) could take their regular meals orally by the 30th hospital day, while 12 patients (36%) developed pneumonia during the first 30 days of hospitalization. Predictive factors of taking regular diet by oral feeding were 1) consciousness level, 2) location of lesions, and 3) severity of dysphagia as assessed by VF. While a predictive factor for pneumonia was advanced age of the patient. Dysarthria was not a predictor of dysphagia.
    Comprehensive evaluation of the swallowing function by detailed clinical evaluation and VF should be conducted in acute stroke patients, to enable timely identification and management of dysphagia in these patients.
  • 太田 文人, 平出 祐一, 内川 幸夫
    2006 年 28 巻 4 号 p. 566
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 卜部 貴夫, 田中 亮太, 山城 一雄, 宮元 伸和, 水野 美邦
    2006 年 28 巻 4 号 p. 567-571
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Background : The purpose of this study was to assess the prevalence of impaired glucose tolerance (IGT) and insulin resistance in stroke patients without previously known diabetes by performing a 75g oral glucose tolerance test (75g OGTT).
    Methods : We recruited 203 stroke patients (atherothrombotic infarction (ATI) ; 42.2%, lacunar infarction (LI) ; 29.6%, cardioembolic infarction (CE) ; 11.3%, cerebral hemorrhage (Hem) ; 11.8%, transient ischemic attack ; 3.9%, others; 1.2%). 75g OGTT was used to evaluate the disorders of glucose metabolism. We investi-gated the relationships between the incidence of IGT and insulin resistance using HOMA-R and stroke sub-types.
    Results : The disorders of glucose metabolism were present in 62.7% of patients without previously known diabetes. Diabetes and IGT were diagnosed in 38% and 28%, respectively, of patient with ATI. IGT was observed 35% with a single risk factor (hypertension or hyperlipidemia) and 65% with two risk factors (both of hypertension and hyperlipidemia). HOMA-R was markedly higher level in patients with ATI than with another stoke subtypes.
    Conclusions : A screening by 75g OGTT was useful for diagnosis of the disorders of glucose metabolism in patients with no prior history of diabetes. Insulin resistance might be an important role for the progression of atherosclerosis in patients with ATI.
  • 中根 博, 古賀 政利, 湧川 葉子, 横山 葉子, 長尾 哲彦, 井林 雪郎
    2006 年 28 巻 4 号 p. 572-576
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Confusion often occurs in acute brain infarction, but its character and effective therapy have not been examined well. We divided 49 patients with acute brain infarction into the confusion group (20 patients) and the non-confusion group (29), and compared the character of each group. The confusion group showed older age (79±2 years old vs. 72±2, p=0.0075) and lower scores of Hasegawa Dementia Scale (15.3±1.8 vs. 21.2±2.1, p=0.0183) than the non-confusion group. Right hemisphere lesions, especially the front-parietal lesions, were more often observed in the confusion group. Four of 5 patients who did not receive pharmacotherapy and only 7 of 15 patients who received pharmacotherapy, recovered from confusion. On the other hand, recovery from confusion was quicker in patients with pharmacotherapy than without pharmacotherapy. Patients with confusion stayed significantly longer in the hospital (72.9±11.3 days vs. 48.9±6.2, p < 0.05) and modified Rankin Scale was significantly higher in patients without confusion (2.6±0.3 vs. 1.9±0.3, p<0.05). According to these results, patients with confusion showed poorer outcome. We need to establish effective therapies against confusion in acute brain infarction.
  • 鈴木 謙介, 山崎 友郷, 安田 宗義, 松村 明, 鯨岡 裕司, 木村 泰, 小松 洋治, 小林 栄喜
    2006 年 28 巻 4 号 p. 577-581
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Systemic complications such as pneumonia, urinary tract infection, heart failure and others had affects to the outcome of the patients of intracranial hemorrhage. Systemic complications were occurred in 40% of all intracranial hemorrhage patients and in even 20% of the patients who had only a slight illness over Glasgow Coma Scale 13. Infectious diseases accounted 60% of all complications in the intracranial hemorrhage patients. We founded new stroke care unit (SCU) and changed some strategies for these complications. Aggressive endotracheal intubation and prophylactic antibiotics administration were very effective to decrease the rate of aspiration pneumonia which was the most common complication in the patients of intracranial hemorrhage. However these new strategies reduced the rate of systemic infectious complications, the outcome of these patients was improved only to "moderate" from "poor". Reduction of systemic complications led to decrease the rates of death and vegetative state due to intracranial hemorrhage. We emphasized the importance of intensive care for acute stage of intracranial hemorrhage in SCU, because it made the patients possible to leave from bedridden.
  • 磯谷 栄二, 久保田 叔宏, 大野 喜久郎
    2006 年 28 巻 4 号 p. 582
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 酒向 正春, 石川 誠, 堀 智勝
    2006 年 28 巻 4 号 p. 583
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 阿部 康二, 河瀬 斌
    2006 年 28 巻 4 号 p. 584
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 足立 芳樹, 林 美和, 中島 健二
    2006 年 28 巻 4 号 p. 585-589
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    CADASIL is an inherited cerebrovascular disease that cause migraine-like headache and recurrent stroke. Mutations of Notch3 gene on chromosome 19 are responsible for CADASIL. Usually these mutations might change the number of cysteine residue. We examined the mutation of Notch3 gene in independent 21 Japanese patients with leukoaraiosis without hypertension. Four patients were in our hospital, and 17 patients were from other hospitals in mainly Western Japan. We examined the DNA extracted from the peripheral blood in all patients with informed consent. We analyzed exon 3-4, 11 and 19 of Notch3 with PCR-sequencing method. In seven patients, we examined samples obtained by skin biopsy to detect GOM (granular osmiophilic materials) with electron microscope. Five patients revealed to have mutations related with cysteine (R90C, C123Y, R133C, R153C and R169C) and one patient with V237M had GOM in arterioles of skin. Then six patients were diagnosed to have CADASIL. We could not find GOM in other 6 biopsy samples including three geneticaly diagnosed CADASIL patients. All patients diagnosed as CADASIL had family history of stroke.
    We think CADASIL is popular also in Japan, and genetic examination should be done in patients with leukoaraiosis without hypertension especially who had family history of stroke.
  • 中山 智祥, 浅井 聰, 佐藤 直之, 相馬 正義
    2006 年 28 巻 4 号 p. 590-595
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Background—deCODE genetics, Inc. identified a candidate locus (STRK1) for cerebral infarction with a significant LOD score at 5q12 in Caucasians in 2002, and subsequently identified the PDE4D gene as a susceptibility gene at this locus in 2003. The aims of this haplotype-based case-control study were to confirm, using microsatellite markers and single nucleotide polymorphisms (SNPs), whether PDE4D is also a susceptibility gene for cerebral infarction.
    Methods—Cerebral infarction was defined as non-cardiogenic ischemic stroke with signs and symptoms lasting longer than one month in duration. We genotyped 208 Japanese cerebral infarction patients and 270 non-cerebral infarction controls for 31 SNPs, three dinucleotide microsatellites, and one tetranucleotide vari-able number tandem repeat. Haplotypes were constructed and their frequencies compared between the cere-bral infarction patients and the controls.
    Results—Seven haplotype blocks were found in the STRKI locus by the linkage disequilibrium analysis. The haplotype-based case-control study revealed that, in addition to the region of the PDE4D gene (p = 0.002), another region (p<0.001) also existed within the STRK1 locus.
    Conclusions—Our results suggest that there may be a susceptibility region other than that of the PDE4D gene within the locus in Japanese subjects.
  • 熊井 康敬, 大星 博明, 石川 英一, 杉森 宏, 鴨打 正浩, 北園 孝成, 井林 雪郎, 飯田 三雄
    2006 年 28 巻 4 号 p. 596-599
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Brain edema is a major and often mortal complication of brain ischemia. Vascular endothelial growth factor (VEGF) is also known as a potent vascular permeability factor and may play detrimental roles at the acute stage of brain infarction. We explored protective effects of gene transfer of soluble flt-1 (sFlt-1), a natural inhibitor of VEGF, on focal brain ischemia. Adenoviral vectors encoding sFlt-1 or β-galactosidase were injected into the lateral ventricle 90 minutes after photochemical distal middle cerebral artery occlusion in male spontaneously hypertensive rats. The transduced sFlt-1 was released into the cerebrospinal fluid from the ventricular wall and significantly increased 1 and 7 days after sFlt-1 transfection. Seven days after ischemia, sFlt-1 gene transfer significantly attenuated infarct volume (by 29%) and monocyte/macrophage infiltration (by 27%) although there were no reductions in angiogenesis by sFlt-1 overexpression. These results suggest that sFlt-1 gene therapy targeting brain edema in acute stage of brain ischemia may be usefulness for brain infarction.
  • 高木 康志, 橋本 信夫
    2006 年 28 巻 4 号 p. 600-605
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    胚性幹細胞(embryonic stem cell,EScell)は受精卵の内部細胞塊由来で,それより様々な細胞に分化することが知られている.我々はES細胞より誘導した神経幹細胞を脳虚血モデルに移植し,その生着及び分化を免疫組織学的方法で検討した.脳虚血モデルに移植したマウスES細胞由来,サルES細胞由来神経細胞は生着し,分化していることが確認された.今回の結果はES細胞由来神経幹細胞が脳虚血に対する神経細胞移植治療の有力な候補となりうることを示すものである.
  • 管 玉青, 吉田 泰二
    2006 年 28 巻 4 号 p. 606
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 加藤 健吾, 島崎 久仁子, 神谷 達司, 横田 英典, 宮脇 貴裕, 小黒 恵司, 上田 雅之, 雨宮 志門, 西山 康裕, 須田 智, ...
    2006 年 28 巻 4 号 p. 607-611
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    局所脳虚血急性期での骨髄間葉系幹細胞(MSC)の投与により,梗塞巣の縮小効果が報告されている.われわれは,SD系RATを用いて90分間の中大脳動脈脈閉塞(MCAO)モデルを作成し,3時間後に静脈内投与・脳室内投与,大槽内投与および脳内投与でMSCを移植しGFP蛍光を指標として,投与方法におけるMSCの分布を検討した.またTTC染色を用いてMCAO48時間後に梗塞巣の縮小効果を評価した.梗塞側の側脳室内投与では,投与側の側脳室に近接した線条体に著明な集積を示し,大脳皮質にわずかの集積を認めるのみであった.静脈内投与では線条体,大脳皮質のペナンブラ領域に多く集積を認めた.集積は線条体でより強かった.大槽内投与では投与部位周囲の視床・線条体・大脳皮質に著明な集積を認めた.MSCは大脳皮質よりも線条体に集積しやすい傾向を示した.これに対して,梗塞巣の縮小効果は線条体よりも大脳皮質で効果が大きかった.MSCがわずかしか存在しない部位にもかかわらず梗塞巣の縮小効果が骨髄細胞が多く集積した部位よりも大きかったことより,MSCによる脳保護効果は移植細胞や周囲のグリア細胞よりの栄養因子などの放出など間接的な要因によるものが考えられる.また,脳へのMSCの集積は投与付近のペナンブラ領域に速やかに集積するものと考えられた.
  • 堀田 祥史, 本望 修, 原田 邦明, 寶金 清博, 濱田 洋文
    2006 年 28 巻 4 号 p. 612
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 亀田 雅博, 新郷 哲郎, 魚住 喬, 松井 利浩, 三好 康之, 伊達 勲
    2006 年 28 巻 4 号 p. 613-617
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The aim of cell transplantation is to replace damaged area. But transplanted neural stem/progenitor cells (NSPCs) didn't treat lesion core. We transplanted adult NSPCs modified to secrete GDNF in order to make transplanted NSPCs replace ischemic area more effectively.
    NSPCs were harvested from subventricular zone (SVZ) of adult rats and cultured with EGF by using neurosphere technique. Expanded NSPCs were transfected with fiber-mutant F/RGD adenovirus containing GDNF (NSPC-GDNF) or EGFP (NSPC-EGFP) gene. The best transfection efficiency was derived from GDNF ELISA. At first, NSPC-GDNF or NSPC-EGFP cells were transplanted into the ischemic boundary zone of MCAO model of Wistar rats in the acute stage (allogenic transplantation). NSPC-GDNF group had a significantly better result in behavioral test and infarction volume than NSPC-EGFP group. Subsequently, NSPC-GDNF or NSPC-EGFP cells were transplanted into the damaged CAI of global ischemia model of Fischer344 rats in the chronic stage (syngenic transplantation). NSPC-GDNF cells migrated and differentiated into neuron as replacing the damaged CAI of hippocampus partially. Moreover, NSPC-GDNF group had shown the activation of neurogenesis of endogenous NSPCs.
    Consequently, we confirm NSPC-GDNF have neuroprotective effect and can replace damaged area. We think this result suggests that NSPC-GDNF cells can bring a good result in autologous-transplantation.
  • 森 悦朗, 永田 泉
    2006 年 28 巻 4 号 p. 618
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 北澤 和夫, 村岡 尚, 石坂 繁寿, 青山 達郎, 長島 久, 小山 徹, 小林 茂昭, 本郷 一博
    2006 年 28 巻 4 号 p. 619-622
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    脳卒中急性期のrt-PA製剤が使用可能となった.この薬は急性期脳梗塞の予後を改善すると期待される静注薬であるが,一方で出血性梗塞のリスクが高いため,使用時間が発症から3時間以内に制限されており,適応症例が少ないことが予測された.今回,われわれは,2004年1月から12月に当脳卒中・脳神経センターに入院した急性期脳梗塞371症例にて,治療適応症例数と問題点を検討した.結果)発症から来院までの時間は2時間以内61例(16%),3時間以内89例(24%)であった.治療対象となる2時間以内61例の脳梗塞の内訳は脳塞栓48%,アテローム血栓性20%,ラクナ16%で塞栓症が多かった.慎重投与症例を除く適応に全て合致する症例はわずかに14例で全体の4%であった.この脳梗塞急性期治療を浸透させるためには,市民や開業医への啓蒙活動が非常に重要である.
  • 赤荻 英理, 松田 信二, 根本 有子, 町田 利生, 樋口 佳則, 沖山 幸一, 芹澤 徹, 本間 甲一, 小野 純一
    2006 年 28 巻 4 号 p. 623-627
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Background and Purpose:Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) within 3 hours after onset of cerebral ischemia was approved in Japan in October 2005. Preceding using rt-PA for acute cerebral infarction, we built a simulation model of patient flow using inpatient data and clarified issues of in-hospital systems.
    Methods:We retrospectively analyzed consecutive 485 patients with acute ischemic stroke admitted in our center from May 2002 to October 2005. We analyzed the patients who arrived at our center within 120 minutes after the onset, because at least 60 minutes by the admission will be required for evaluating of patient status and informed consent. We estimate the ratio of patients who fulfilled inclusion criteria for intravenous administration of rt-PA in the patients with acute ischemic stroke. We also assessed interval from the arrival to the admission in these patients and factors related to the interval.
    Results:There were 148 patients (30.5%) who arrived at our center within 120 minutes after the onset of symptoms. There were 94 men and 54 women. Age was 73.9±10.0 years-old (Mean±SD). The time from the onset to the arrival was 78.8±39.8 minutes. Baseline National Institutes of Health Stroke Scale (NIHSS) was 12.4±9.6. In these patients, only 32 patients (21.6%) fulfilled criteria for the inclusion prior to the admission. The remaining patients were excluded due to the following reasons:unknown onset time, 55; regression of symptoms, 11; mild symptom (NIHSS54), 47; history of intracranial hemorrhage, 3;convulsion, 3; extensive early CT sign, 35 and other reasons, 8. In the included 32 patients, five patients needed more than 180 minutes from the onset to the admission. Finally, 27 patients (5.6% in the all patients) admitted within 180 minutes after the onset and fulfilled the inclusion criteria. In 148 patients, 81 patients were not admitted within 60 minutes after the arrival. Sixty-seven patients were admitted within 60 minutes after the arrival and had significant higher NIHSS than those admitted more than 60 minutes. Age, referral hospital, ambulance or arrival time was not significant factor for the interval from the arrival to the admission.
    Conclusion: We estimated the candidate for acute thrombolysis using intravenous rt-PA to be 5.6% of total patients with acute ischemic stroke. Patient evaluation frequently required more than 60 minutes prior to the admission, even if the patients arrived at our center within 120 minutes after the onset. We should establish the in-hospital system to reduce the time for patient evaluation.
  • 原 靖幸, 和田 邦泰, 寺崎 修司, 東 大弼, 平野 照之, 内野 誠
    2006 年 28 巻 4 号 p. 628-632
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    脳梗塞急性期に対するrt-PA(アルテプラーゼ,以下t-PA)を用いた経静脈的血栓溶解療法が本邦で保険適応となる以前の1年間において,t-PAの適応であったと推定される症例、の抽出を行った.発症7日以内の脳梗塞および一過性脳虚血発作(TIA)患者264例中,発症3時間以内の来院は99例(37.5%),2時間以内の来院は78例(29.5%)であった.心原性脳塞栓症と一過性脳虚血発作で発症から来院までの時間が短い傾向であった.3時間以内来院例において75歳以上は42例であり,42.4%を占めた.禁忌項目を除いたt-PA適応症例は31例(11.7%)であったが,慎重投与項目のNIHSS score 23点以上,JCS 100以上,さらに年齢75歳以上などを除くと,適応症例は11例(4.2%)に減少した.t-PAの有効性を向上させるためには,発症-来院時間短縮へのいっそうの取り組みが重要であるが,加えて75歳以上の高齢者に対するt-PAの安全性や有効性の確立に向けた慎重な症例の蓄積も必要である.
  • 植田 敏浩, 伊藤 敦史, 正田 大介, 野越 慎司, 阿部 新, 小濱 るり子, 松井 和子, 中溝 知樹, 田畑 修, 栗田 竜子, 松 ...
    2006 年 28 巻 4 号 p. 633-639
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    We investigated the treatment outcome of revascularization for acute ischemic stroke and reviewed therapeutic strategy of endovascular therapy and intravenous rt-PA therapy after the approval of rt-PA. We performed adaptive determination of revascularization using MRI (DWI/PWI) for all acute stage, and intravenous rt-PA therapy was performed only for confirmed cases in a principal bronchus artery in MRA.
    We took intravenous rt-PA therapy for cardioembolic MCA occlusion of less than 3 hours and performed endovascular treatment which were the brain blood vessel expansion technique that we used UK intraarterial injection or a balloon and stent for besides it. As for the treatment strategy of revascularization, that we perform the treatment that conformed to eligibility criteria of intravenous rt-PA therapy is recommended for future acute stage without receiving it for a case of less than 3 hours than the onset. In addition, it should be reviewed adaptation of brain endovascular treatment for the patient beyond three hours by evaluating cerebral circulation dynamics by imaging such as DWI/PWI MR. As for the revascularization, maintenance of early transportation organization of the local acute stroke patient and architecture of inside the hospital organization are important for acute stage after intravenous rt-PA therapy certification.
  • 古井 英介, 松本 康史, 清水 宏明, 江面 正幸, 高橋 明, 藤原 悟
    2006 年 28 巻 4 号 p. 640
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 吉井 仁, 塚越 敬子, 八木 俊輔, 中井 紀嘉, 鈴木 康弘, 辻 裕丈, 松井 克至, 長田 成幸
    2006 年 28 巻 4 号 p. 641
    発行日: 2006/12/25
    公開日: 2009/06/05
    ジャーナル フリー
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