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1

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Stump pressure as a guide to the safety of permanent occlusion of the internal carotid artery (1996)

Kurata, A. ; Miyasaka, Y. ; Tanaka, Ch. ; [et al.]

Springer

Acta neurochirurgica 138 (1996), S. 549-554

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ISSN: 0942-0940

Keywords: Balloon test occlusion ; stump pressure ; back pressure ; 99 mTc-HMPAO SPECT

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary Does the absolute value of the stump pressure (post-occlusion back pressure) become a useful index of a good collateral circulation? The authors continuously monitored the mean arterial pressure before, during and after 20-minute balloon test occlusion in 24 patients. The stump pressure was then compared with the results of99 mTc-hexa-methyl propyleneamine (99 mTc-HMPAO) single photon emission computed tomography (SPECT) performed after 20 minutes of test occlusion. Patients who failed to tolerate even brief periods of carotid occlusion and showed asymmetric decreases in cerebral blood flow (CBF) on SPECT were divided into high and moderate risk groups. Those with no significant change in CBF on the occluded side formed the minimum risk group. Mean stump pressure was over 50 mmHg in three of a total of 13 patients in the high and moderate risk groups, and below 50 mmHg in two of the 11 patients in the minimum risk group. The ratios of the initial mean stump pressure to the pre-occlusion mean arterial pressure (%) and of the final mean stump pressure at the end of occlusion to the post-opening mean arterial pressure (%) did not exceed 58% in any patient in the high and moderate risk groups, and were at least 60% in all patients of the minimum risk group. Maintenance of a mean stump pressure of 60% or more of the mean systemic pressure during test occlusion may be a more useful index of a good collateral circulation than the absolute value of mean stump pressure.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF01411175

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2

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The Influence of Vascular Pressure and Angiographic Characteristics on Haemorrhage from Arteriovenous Malformations (2000)

Miyasaka, Y. ; Kurata, A. ; Irikura, K. ; [et al.]

Springer

Acta neurochirurgica 142 (2000), S. 39-43

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ISSN: 0942-0940

Keywords: Keywords: Arteriovenous malformation; haemorrhage; vascular pressure.

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary ¶ Background. The present study was designed to determine whether there is a physiological explanation for the predisposition of patients with certain angiographic characteristics to haemorrhage from cerebral arteriovenous malformations (AVMs). Methods. Intra-operative measurement of feeding artery pressure (FAP) and intravascular pressures in the draining venous system [draining vein pressure (DVP) and cranial sinus pressure (SP)] were performed for 30 AVM cases using direct puncture of the vessels. The correlation between pressures and previously described angiographic characteristics predisposing to haemorrhage were evaluated. Findings. Small nidus size and only one draining vein increased the risk of haemorrhage. FAP and DVP are both inversely related to the number of draining veins and the size of the AVMs. DVP was significantly higher in AVMs with haemorrhage (23.1±8.7 mmHg) than in those without (13.5±4.4), as was FAP (58.6±12.8 as opposed to 38.7±4.7) (p〈0.05). Moreover, the difference between systemic blood pressure and the FAP with haemorrhagic AVMs (17.0±9.5 mmHg) was significantly lower than that in nonhaemorrhagic cases (33.7±5.5) (p〈0.05). The pressure difference between the feeding artery and draining vein was not significant between the haemorrhagic and nonhaemorrhagic groups. There was no significant difference of SP between haemorrhagic and nonhaemorrhagic patients. Interpretation. The present study suggests that a high DVP probably induced by high resistance in the venous drainage system, as well as a high FAP, may contribute to the development of haemorrhage from AVMs, and physiologically supports previous reports that small AVMs and AVMs with only one draining vein are susceptible to haemorrhage.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s007010050005

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3

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The Factors Influencing Haematoma Volume due to Arteriovenous Malformations (1999)

Miyasaka, Y. ; Tanaka, R. ; Kurata, A. ; [et al.]

Springer

Acta neurochirurgica 141 (1999), S. 385-388

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ISSN: 0942-0940

Keywords: Keywords: Arteriovenous malformation; cerebral haemorrhage; haematoma volume; angiography; computed tomography.

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary Haemorrhage due to cerebral arteriovenous malformations (AVMs) varies from massive, requiring urgent operations, to clinically silent. The present study was designated to identify factors influencing haematoma size, and the pathophysiological mechanisms of massive haemorrhage were studied. 55 patients with intracerebral haematomas due to supratentorial AVMs were included in this study. Angiographic and clinical findings were retrospectively evaluated in relation to haematoma size. Statistical analysis demonstrated that small size and the presence of only one draining vein were high risk factors for massive haemorrhage. The haematoma volume in small AVMs (30±4 cm3) was significantly larger than in other AVMs (7±3 cm3) (p=0.0005). AVMs with only one draining vein were associated with massive haematoma volume as compared to AVMs with two or more draining veins (30±4 versus 11±3 cm3, p=0.0023). Our previous study demonstrated that feeding artery pressure (FAP) was significantly higher in AVMs with haemorrhage than in those without, as was draining vein pressure (DVP), and FAP and DVP were inversely related to the number of draining veins and the size of the AVMs. Thus, in small AVMs and AVMs with only one draining vein, local increase in DVP may thus contribute to massive haemorrhage.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s007010050314

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A source of haemorrhage in adult patients with moyamoya disease: The significance of tributaries from the choroidal artery (1996)

Irikura, K. ; Miyasaka, Y. ; Kurata, A. ; [et al.]

Springer

Acta neurochirurgica 138 (1996), S. 1282-1286

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ISSN: 0942-0940

Keywords: Moyamoya disease ; intraventricular haemorrhage ; angiography ; choroidal artery ; medullary artery

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary This study concerns 19 patients over 16 years of age with Moyamoya disease. Ten cases of intracranial haemorrhage, as the initial haemorrhagic event in patients aged from 21 to 55 (haemorrhagic group) and 9 cases of ischaemic events in 18- to 53-year-old patients (ischaemic group) were included. All haemorrhages were associated with intraventricular haemorrhages (IVH); and all but one case of thalamic haemorrhage were thought to be primary IVH (2 cases of small paraventricular haemorrhage; 2 of small haemorrhages in the splenium; 5 with no intracerebral haematoma). In the 9 patients of the ischaemic group, there were 2 cases of transient ischaemic attacks and 7 of cerebral infarction. Angiographic evaluations demonstrated that the abnormal basal vessel formation and the collateral supplies from the external carotid arteries were poorly developed in both groups. In contrast, the collateral circulation via the choroidal and posterior pericallosal arteries was well demonstrated. Furthermore, marked enlargement of the choroidal arteries and the medullary arteries derived from them was seen more frequently in the haemorrhagic group. These findings suggested that the haemodynamic load in the vessels supplying the walls of the posterior parts of the ventricles and the periventricular region was increased, especially in the haemorrhagic group. Those vessels were considered to be important sites of IVH in adult patients with Moyamoya disase.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF01411056

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5

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The Value of Long-Term Clinical Follow-up for Cases of Spontaneous Carotid Cavernous Fistula (1998)

Kurata, A. ; Miyasaka, Y. ; Kunii, M. ; [et al.]

Springer

Acta neurochirurgica 140 (1998), S. 65-72

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ISSN: 0942-0940

Keywords: Keywords: Spontaneous CFF; long-term follow-up; transarterial embolization

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary To clarify the value of clinical long-term follow-up with radiological examination, ranging from 12 to 63 months (average: 35 months), 18 consecutive patients suffering from spontaneous carotid cavernous fistula (CCF), were studied prospectively. Five aged patients without aggressive symptoms were treated conservatively, and the other 13 underwent transarterial embolization. The radiological follow-up was primarily by magnetic resonance angiography (MRA), performed from 2 to 6 times (average: 4.1 times) during the follow-up period. In three cases, CCFs persisted, but the other fifteen (83%) demonstrated complete cure as defined by long-term follow-up MRA. The three patients with persistent CCFs were comparatively young, less than 60 years old, had no atherosclerotic factors and demonstrated multiple venous drainage routes with cortical venous drainage on angiography. In two of them, the symptoms completely disappeared, and the other had only mild chemosis. However, surprisingly, in two, MRA revealed residual CCF with drainage into only cortical veins through the sphenoparietal sinus, this radiological finding being well known to signify danger. During the follow-up period, central retinal vein thrombosis occurred in two cases. The common point in these cases was that the superior ophthalmic vein was the only venous drainage route. This is also a point requiring care. We therefore emphasize the importance of careful long-term radiological follow-up for spontaneous CCF patients even when their symptoms improve or disappear. MRA is particularly suitable for this purpose and applicable in the out-patient clinic because of its non-invasive nature.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s007010050059

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6

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Correlation between clinical features and prognosis of local recurrence after breast-conserving therapy (2000)

Shin, E. ; Takatsuka, Y. ; Okamura, Y. ; [et al.]

Springer

International journal of clinical oncology 5 (2000), S. 22-28

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ISSN: 1437-7772

Keywords: Key words Breast cancer ; Breast-conserving therapy ; Local recurrence ; Prognosis

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Background. In patients with early stage breast cancer who have breast-conserving therapy (BCT), the impact of local recurrence on the risk of distant metastasis is still controversial. Local recurrence after BCT is an uncommon event, so it is impossible to determine a standard treatment method by a clinical trial because not enough patients can be enrolled. Methods. Between February 1988 and December 1997, 399 patients with clinical stage I and II breast cancer underwent BCT in our department. Of these 399 patients, 22 developed local recurrence during this period. To assess the relationship between their clinical characteristics and prognosis, we performed a retrospective review of these 22 patients. Results. The 5-year overall survival rate after local recurrence was 66.7%. All four patients who had cutaneous or inflammatory type recurrence developed distant metasta-sis after salvage treatment. Of three patients with multiple recurrence, two developed disseminated disease after salvage treatment. Two of four patients treated by repeat lumpectomy developed further local recurrence after salvage lumpectomy. Conclusion. To improve prognosis in patients with multiple, cutaneous, or inflammatory recurrence, aggressive adjuvant systemic therapy may be required after salvage surgery.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s101470050005

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7

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Experimental saccular aneurysms (1994)

Guglielmi, G. ; Ji, C. ; Massoud, T. F. ; [et al.]

Springer

Neuroradiology 36 (1994), S. 547-550

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ISSN: 1432-1920

Keywords: Saccular aneurysms ; Interventional neuroradiology ; Experimental aneurysm ; Intracranial aneurysm ; Animal model

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract A new technique for surgical construction of experimental lateral saccular aneurysms on the common carotid artery of swine is described. It involves end-to-side suturing of an isolated segment of vein to an artery. During a short period of parent artery clamping, an elliptical arteriotomy is fashioned through the open-ended vein graft, the open end of which is subsequently tied and clamps are removed to form an aneurysmal vein pouch. The principal advantage of this technique is the short period of vascular clamping necessary to isolate a segment of the parent artery. This prevents severe endothelial injury and prolonged postoperative vasospasm, both of which may promote intra-aneurysmal thrombosis. Narrow- or wide-necked aneurysms can be created. Steps in the surgical construction of this model are detailed, and specific advantages of using swine are highlighted.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF00593518

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8

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Thromboangiitis obliterans: classic and new morphological features (2000)

Kurata, A. ; Franke, F. E. ; Machinami, R. ; [et al.]

Springer

Virchows Archiv 436 (2000), S. 59-67

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ISSN: 1432-2307

Keywords: Key words Thromboangiitis obliterans ; Atherosclerosis ; Thromboembolism ; Arteritis ; Pathology

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract The clinical and pathological concept of thromboangiitis obliterans (TAO, Buerger’s disease) is still controversial. While the clinical criteria of TAO are relatively well defined, the etiology is unknown and its diagnosis based on pathology is confusing, since there is no consensus on the precise pathological criteria for TAO. To investigate the morphological features that differentiate TAO from arteriosclerosis obliterans (ASO) or thromboembolism, and to clarify the morphological independence of TAO, we studied 94 amputated specimens of lower extremities, including 31 specimens from patients with a clinical diagnosis of TAO and 31 autopsy specimens as control cases. It was revealed that most of the classic morphological features described by Buerger and others are not helpful when considered independently in the differential diagnosis, except for intact internal elastic lamina. In addition, findings of intimal inflammation, intact media and absence of medial calcification were demonstrated to be common in both TAO and thromboembolism. Statistical analysis in the present study, the most comprehensive thus far, showed that novel findings of onion-like-shaped recanalizing vessels in the occluded arteries, adventitial fibrosis without medial fibrosis, swelling of the endothelium of the vasa vasorum and edema beneath the external elastic lamina were characteristic of TAO and would be helpful in a differential diagnosis. When a combination of these morphological features is present, diagnosis of a presumed overlap of TAO and ASO in the same site of the vessel concerned is possible. Furthermore, comparison of statistical evaluations based on morphological features performed in various diagnostic groups implies that the clinical diagnosis of TAO is currently underestimated because the results of the analysis of morphological features of specimens in which TAO was suspected or specimens selected on the basis of a broad and nonspecific definition of TAO were surprisingly similar to the results in strictly defined TAO cases. Our findings suggest that injury and regeneration of minute vessels such as recanalizing vessels and vasa vasorum play a part in the pathogenesis of TAO.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/PL00008199

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