巻号一覧
44 巻, 5 号
選択された号の論文の11件中1～11を表示しています
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Original Articles
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Mamoru MURAKAMI, Tomoyuki HAMASAKI, Satoshi KIMURA, Daisuke MARUYAMA, ...2004 年 44 巻 5 号 p. 225-233
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスThe management and outcome were retrospectively investigated in patients with chronic renal failure receiving maintenance blood purification who suffered intracranial hemorrhage. Patients with intracerebral hemorrhage (ICH, n = 36) or subarachnoid hemorrhage (SAH, n = 5) were evaluated. Both groups were initially managed using continuous hemofiltration (HF) after admission, except for two patients with SAH receiving maintenance peritoneal dialysis. Patients with ICH were managed with HF three times a week after computed tomography showed decreased peripheral edema. Nafamostat mesilate was used as the anticoagulant for both continuous HF and HF. Hemodialysis (HD) three times a week was initiated after confirming the absence of neurological deterioration using HF. Craniotomy was not performed in any patient with ICH, but if necessary, the hematoma was aspirated using burr-hole surgery. Angiography was performed on the day of admission in patients with SAH. Delayed neck-clipping surgery was performed after continuous HF for 2 weeks with lumbar cerebrospinal fluid drainage. In patients with ICH, continuous HF was continued for 2-9 days after admission (mean 5.2 ± 2.2 days), followed by 2-9 courses of HF (mean 4.7 ± 2.1 courses). HD was initiated 9-26 days after admission (mean 15.5 ± 4.6 days). Favorable outcomes were achieved by 13 of the 36 patients with ICH and two of the five patients with SAH, whereas 22 patients with ICH and three patients with SAH died. Death occurred in 12 of 16 patients with ICH and diabetic nephropathy. In contrast, 10 of 20 non-diabetic patients with ICH had favorable outcomes. Ten of the 16 patients with initial GCS ≤8 and six of the 20 with GCS ≥9 were diabetic. Therefore, there were significant differences between diabetic and non-diabetic patients (p = 0.05). Poor outcomes in diabetic patients with ICH are caused by primary brain damage, reflected in the initial disturbance of consciousness.
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Takashiro OHYAMA, Yoshichika KUBO, Hiroo IWATA, Waro TAKI2004 年 44 巻 5 号 p. 234-241
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスβ-Tricalcium phosphate (β-TCP) combined with recombinant human bone morphogenetic protein-2 (BMP-2) was examined as a substitute for autograft for packing into interbody fusion cages in the canine lumbar spine model. Discectomy and interbody cage fusion were performed at three disc spaces in eight dogs. Examination of microradiographs and histological sections of the lumbar spine at 16 weeks postsurgery revealed three fusions in the autograft cages (Group A), three in the β-TCP cages (Group B), and five in the β-TCP-BMP-2 cages (Group C). The mean percentage of trabecular bone area in the cages was 51.9% in Group A, 48.8% in Group B, and 65.6% in Group C. Mean percentage of trabecular bone formation and mechanical stiffness were highest in the cages filled with β-TCP and BMP-2. Combination of BMP to β-TCP may act as an osteoconductive and osteoinductive bone graft substitute in clinical spine surgery.
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Case Reports
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—Case Report—Yasunori FUJIMOTO, Kazunori YAMANAKA, Yoshikazu NAKAJIMA, Kazuhiro YOS ...2004 年 44 巻 5 号 p. 242-244
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA 59-year-old woman presented with subarachnoid hemorrhage. Conventional angiography and three-dimensional computed tomography (3-D CT) angiography showed a saccular aneurysm at the junction of the azygos anterior cerebral artery (ACA) and the left A1 segment. This aneurysm was associated with a fenestration of the right hypoplastic A1 segment. The aneurysm neck was completely clipped, preserving the azygos ACA and other perforators. Aneurysm of the azygos ACA is almost always located at the distal bifurcation, and rarely at the proximal end. Proximal azygos ACA aneurysm can mimic anterior communicating artery aneurysm. Therefore, accurate preoperative diagnosis is critical using 3-D CT angiography as well as conventional angiography, and close follow up of patient is necessary to monitor for development of a de novo aneurysm at the distal bifurcation of the azygos ACA.
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—Two Case Reports—Junkoh YAMAMOTO, Shigeru NISHIZAWA, Mitsuo YAMAGUCHI, Soichi AKAMINE, ...2004 年 44 巻 5 号 p. 245-248
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA 71-year-old man presented with sudden onset of vertigo and a 77-year-old man suffered consciousness disturbance. Diffusion-weighted magnetic resonance (MR) imaging on admission showed hyperintense areas in the left cerebellar hemisphere in the first patient and in the brainstem in the second patient. Both patients were treated with argatroban and edaravone, and the neurological deficits markedly improved one month after admission. T2-weighted MR imaging one month after the onset showed much smaller hyperintense areas compared with the findings on admission in both patients. These results indicate that findings of hyperintense areas by diffusion-weighted MR imaging in the acute stage of ischemic cerebrovascular disease indicate not only the ischemic core but also parts of the reversible incomplete ischemic lesion and suggest that intensive treatment in the acute stage might reverse ischemic brain damage in some patients.
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—Case Report—Takashi MITSUHASHI, Mitsuya WATANABE, Yukoh OHARA, Shizuo HATASHITA, H ...2004 年 44 巻 5 号 p. 249-254
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA 58-year-old female presented with a unique case of multifocal primary intracerebral malignant fibrous histiocytoma (MFH) manifesting as partial seizure. Neuroimaging showed a mass lesion in the right frontal lobe, which was totally removed. The histological diagnosis was MFH. Follow-up neuroimaging one month after surgery showed another lesion rapidly growing in the left frontal lobe. This lesion was totally removed, and identified as MFH. Her condition gradually worsened. Neuroimaging performed 3 months after first operation revealed bilateral recurrence. She died of respiratory failure 7 months after the initial diagnosis of MFH. Primary intracranial MFH is an extremely rare entity with only 31 cases of solitary tumor previously reported.
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—Case Report—Arvind G. KULKARNI, Atul GOEL, Dattatraya MUZUMDAR2004 年 44 巻 5 号 p. 255-257
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA 15-year-old male presented with pain in the back and paresthesia and weakness of both lower limbs progressing for 6 months. Magnetic resonance imaging revealed a mass lesion occupying the spinal canal at the T-10 to T-11 levels, which had severely compressed the cord. At surgery, a firm and cartilaginous tumor originating from the facet joint was radically excised. The patient showed rapid neurological recovery following the surgery. Histological examination revealed that the lesion was osteochondroma. Such lesions are extremely rare in the lower thoracic spine and osteochondroma arising from the thoracic facet joint is unique.
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—Case Report—Satoshi MAESAWA, Masakazu TAKAYASU, Yasukazu KAJITA, Mitsuhiro YOSHIDA ...2004 年 44 巻 5 号 p. 258-262
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA 29-year-old woman presented with mild tetraparesis caused by an intramedullary cervical cord tumor extending from the C-5 to C-6 levels associated with rostral and caudal syrinxes extending to the C-1 and C-7 levels. Transcranial motor evoked potential (MEP) monitoring was carried out during tumor resection using high-frequency repetitive electrical stimulation. When the rostral syrinx was opened, the MEP amplitude in the right upper limb suddenly decreased by about 50%. When the caudal syrinx was opened, the amplitude immediately recovered to the baseline. During dissection of the attachment of the tumor, the amplitude decreased again by 70%, and did not recover. The tumor was totally removed. The histological diagnosis was ependymoma. Postoperatively, motor weakness in the right arm deteriorated but gradually recovered. The initial loss of amplitude on opening of the rostral syrinx may have resulted from distortion of the intramedullary pressure that compromised function of the motor tract nearby. Opening of the caudal syrinx normalized the intramedullary pressure and allowed the MEP to recover. Intraoperative monitoring of MEPs is valuable in minimizing injury to corticospinal pathways, but care must be taken in evaluating changes in MEP. Intramedullary spinal tumors with associated syrinxes are not rare, so surgeons should realize that opening of a syrinx can lead to MEP changes.
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—Case Report—Osman SIMSEK, Cumhur KILINCER, Hasan SUNAR, Mustafa Kemal HAMAMCIOGLU, ...2004 年 44 巻 5 号 p. 263-265
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA 32-year-old man presented with a combined penetrating stab injury of the spinal cord and the aorta caused by a knife wound in his back at the low thoracic level. The knife had broken, and part of the blade had been retained in the wound, passing through the spinal canal and into the aortic lumen. The patient was treated in two steps: the aorta was repaired by a thoracotomy, then spinal exploration was carried out through a laminectomy. Because of the tamponade effect of the foreign body, it was necessary to delay removal of the blade until vascular control had been achieved. Any sign of a penetrating body passing through the spine should suggest careful evaluation to detect any visceral injury, and multidisciplinary treatment should be planned.
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—Case Report—Hiroaki TORII, Toshiyuki TAKAHASHI, Hiroaki SHIMIZU, Mika WATANABE, Te ...2004 年 44 巻 5 号 p. 266-268
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスA healthy 33-year-old man presented with an intramedullary tuberculoma of the thoracic spinal cord manifesting as a 2-month history of progressive paraparesis and sphincter dysfunction. Magnetic resonance imaging showed ring enhancement of the intramedullary thoracic lesion with perifocal edema. General physical examination was unremarkable with no signs of inflammation except for a positive finding by the tuberculin skin test. Total resection of the intramedullary mass was performed through a posterior myelotomy following T11-12 laminectomy. Histological examination revealed a granulomatous lesion that contained Langhans giant cells, inflammatory cells, and caseating necrosis. Acid-fast bacilli staining of the specimens was positive, and cultures grew Mycobacterium tuberculosis. Postoperatively, the paraparesis and sphincter dysfunction improved sufficiently for the patient to return to his ordinary activities. Intramedullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression.
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Technical Note
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—Technical Note—Kenji SUGIU, Atsushi KATSUMATA, Noboru KUSAKA, Wataru SASAHARA, Koji T ...2004 年 44 巻 5 号 p. 269-274
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスThe combined use of Guglielmi detachable coils (GDCs) and newly developed mechanically detachable platinum coils (Detach Coil System: DCS) was evaluated for the endovascular treatment of 10 patients with cerebral aneurysms. The number and total length of detachable coils placed into the aneurysms, the detaching time for each coil, and any technical problems were recorded and evaluated. Sixty GDCs and 60 DCSs were used. The detachment time for the DCS (mean 21 seconds) was faster than that for the GDC (mean 2 minutes 35 seconds). One DCS moved inside the aneurysm during the mechanical detachment maneuver, but was successfully placed. Neither detachment system influenced the behavior of the other system during coil implantation. The DCS includes a useful J-shape coil, whereas the GDC can be detached safely in fragile aneurysms. The DCS is also cheaper. The coil systems complemented one another and the combination optimized cost and operating time.
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EBM of Neurosurgical Disease in Japan
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—Incidence, Outcome, and Comparison With the International Subarachnoid Aneurysm Trial—Fusao IKAWA, Naohiko OHBAYASHI, Yasutaka IMADA, Toshinori MATSUSHIGE, ...2004 年 44 巻 5 号 p. 275-276
発行日: 2004年
公開日: 2005/02/24
ジャーナル オープンアクセスThe data for subarachnoid hemorrhage (SAH) from the Japanese Standard Stroke Registry Study (JSSRS) were analyzed to evaluate the incidence of SAH according to age, neurological grading and outcome, and outcome of surgical clipping, for comparison with the International Subarachnoid Aneurysm Trial (ISAT). From the JSSRS data, the peak incidence of SAH was the sixth decade in males and the eighth decade in females. The overall mortality was 22%, and good outcome, better than 2 on the modified Rankin Scale (mRS), at discharge was achieved in 58% of cases. Radical treatment was performed in 62.6% of all SAH cases, 58.7% with surgical clipping and 3.2% with endovascular coiling. Poor outcome, worse than 3 on the mRS, occurred in 26.6% of patients under 60 years, 47.3% between 60-69 years, 54.2% between 70-79 years, and 72.9% 80 years or over. From the ISAT data, 88% of patients were in grades 1-2 of the World Federation of Neurological Surgeons (WFNS) grading system in both surgical clipping and endovascular coiling groups, 94% in grades 1-3, and 98% in grades 1-4. Poor outcome, worse than 3 on the mRS, at 2 months occurred in 25.4% and 36.4% of patients with endovascular coiling and surgical clipping, respectively. Limiting the patients in the JSSRS to WFNS grades 1-2 showed poor outcome, worse than 3 on the mRS, occurred in 12.8%, and in grades 1-3 and 1-4 occurred in only 16.3% and 23.0%, respectively.
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