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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Abdominal imaging 19 (1994), S. 425-426 
    ISSN: 1432-0509
    Keywords: Biliary tract, anomalies ; Aberrant hepatic, duct-Cholangiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 66-year-old Japanese woman whose cystic duct drained into an aberrant bile duct was found to have an intersegmental connection bridging the right anterior and posterior ducts. The patient had cholelithiasis but no history of hepatic trauma, lending support to congenital etiology for the intersegmental duct. In the presence of aberrant bile ducts, a meticulous search may reveal such biliary communications.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords:  Keywords:Cerebral vasospasm; fasudil hydrochloride; intra-arterial infusion; subarachnoid haemorrhage.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  In this pilot study we treated cerebral vasospasm in patients with subarachnoid haemorrhage to assess intra-arterial fasudil hydrochloride. We analysed effects of intra-arterial infusion on angiographically evident cerebral vasospasm in 10 patients including 3 with symptoms of vasospasm. Over 10 to 30 min 15 to 60 mg was administered via the proximal internal carotid artery or vertebral artery following standard angiography, without superselective techniques. A total of 24 arterial territories (21 internal carotid, 3 vertebral) were treated. Angiographic improvement of vasospasm was demonstrated in 16 arterial territories (local dilation in 2, diffuse dilation in 14) in 9 patients. In 2 symptomatic patients, intra-arterial fasudil hydrochloride was associated with resolution of symptoms without sequelae. In the third symptomatic patient the benefit of fasudil hydrochloride was only temporary, and a large cerebral infarction occurred. All asymptomatic patients showed no progression of angiographic to symptomatic vasospasm after treatment with intra-arterial fasudil hydrochloride. No adverse effect was encountered.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Keywords: Keywords: Cerebral vasospasm; interleukin-6; interleukin-8; subarachnoid haemorrhage (SAH).
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  The authors characterized the role of interleukins in the cerebrospinal fluid (CSF) in the development of vasospasm after subarachnoid haemorrhage (SAH), particularly interleukin-6 (IL-6).  Concentrations of interleukin-1β (IL-1 β), IL-6, and interleukin-8 (IL-8) were measured serially in CSF of 24 patients and in serum of 9 patients with SAH and correlated clinically. Additionally, the effects of the same cytokines on the cerebral arteries of dogs were analyzed on angiograms after intracisternal injection. Changes in levels of eicosanoids, angiogenic factors, and soluble cell adhesion molecules were investigated in the CSF of injected dogs.  CSF concentrations of IL-6 and IL-8 were elevated significantly above control levels from the acute stage of SAH until the chronic stage. Patients with symptomatic vasospasm had significantly higher levels of IL-6 as well as IL-8 in CSF on days 5 and 7. Intracisternal injection of IL-6 induced long-lasting vasoconstriction in five out of eight dogs, while IL-8 did not. The diameter of canine basilar artery after IL-6 was reduced 29±5% from pretreatment diameter at 8 hours. Prostaglandins E2 and I2 were elevated in CSF for the first 4.5 hour of this IL-6-induced vasospasm. Neither angioenic factors such as platelet-derived growth factor-AB and vascular endothelial growth factor nor soluble cell adhesion molecules were significantly elevated in CSF.  IL-6, which increases to very high concentrations in CSF after SAH, may be important in inducing vasospasm, as IL-6 produced long-lasting vasoconstriction in the canine cerebral artery, which may be partly related to activation of the prostaglandin cascade.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 132 (1995), S. 59-65 
    ISSN: 0942-0940
    Keywords: Medulloblastoma ; PNET-PF ; grading ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although recently survival of some medulloblastoma patients increased remarcably, it remains a serious diagnosis in others. In order to predict the postoperative prognosis in patients treated for medulloblastoma, a new staging, scoring and grading system was developed. Sixty-six patients operated on microsurgically between 1975 and 1990 at a single neurosurgical center were fully followed-up. No patient was excluded due to a poor postoperative course. Completion of commonly used radiotherapy protocols was attempted in all patients. Survival of patients was evaluated by the Kaplan-Meier method. The following 5 parameters were selected to define subgroups: patients' age, tumour location and histology, degree of resection and presence or absence of metastases. Patients older than 10 years had a better prognosis than individuals aged 10 or less (p〈0.01), patients with lateral tumours had a better prognosis than patients with midline tumours with brain stem infiltration (p〈0.05), patients with complete tumour resection had a more favourable prognosis than individuals with subtotal (p〈0.01) or partial resection (p〈0.001), patients without metastases at the time of diagnosis had a better prognosis than individuals without such evidence (p〈0.001), patients with the desmoplastic tumour variant had a better prognosis than patients with classical tumour histology (p〈0.01). According to the prognosis of a distinct subgroup, scoring points were distributed which correlated with the degree of inter-subgroup significances. The sum of a single patient's scoring points was called the total score. Based on this score, three groups of prognosis were distinguished. The good prognosis group (n=29) showed a significantly better survival (p〈0.05) than the moderate prognosis group (n=26), whereas the moderate prognosis group had a significantly better survival (p〈0.05) than the poor prognosis group (n=11). A Kaplan-Meier survival rate of 62% was found in patients of the good prognosis group, a rate of 22% in the moderate prognosis group, and a rate of 0% in the poor prognosis group. It is concluded that this new staging, scoring and grading system is a simple and recommendable prognostic system for all patients treated surgically for medulloblastoma.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Hypothalamic hamartoma ; precocious puberty ; LH-RH analogue
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We treated a 1-year-old female with a hypothalamic hamartoma and precocious puberty with leuprolide acetate depot, a super long-acting hormone-releasing hormone analogue (Tap-144-SR; [D-Leu6-[des-Gly10-NH2]-LH-RH ethylamide acetate). The infant's major symptoms were genital bleeding and gynaecomastia. The LH-RH analogue (30 μg/kg) was injected subcutaneously once every 4 weeks. Clinical and laboratory manifestations of precocious puberty showed marked improvement. A follow-up after 16 months of treatment, the size of the tumour decreased significantly and remained unchanged for 2 years of further follow-up. To the best of our knowledge, this is the first hypothalamic hamartoma case in whom a decrease of tumour size under treatment with LH-RH analogue has been documented. But, because diagnosis of hamartoma is only based on neuroradiological and not on histological examinations, the possibility of a gangliocytoma cannot be excluded with certainty.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 142 (2000), S. 159-163 
    ISSN: 0942-0940
    Keywords: Keywords: Aneurysm clips; intracranial aneurysm; subarachnoid haemorrhage; titanium.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Background. In spite of advantages for neuro-imaging, titanium aneurysm clips are not yet chosen for routine use for clipping of intracranial aneurysms, probably because their reliability has not been demonstrated in large numbers of cases. We assess reliability and safety of Sugita titanium aneurysm clips for routine clinical use in a large number of operated cases.  Method. Intra-operative performance and safety of Sugita titanium aneurysm clips were evaluated in 347 patients in our institutions. Aneurysms in 261 patients had ruptured; 86 patients had unruptured aneurysms.  Results. A total of 441 clips of 52 different types were used. No early or delayed complications occurred in relation to the titianium clips, such as deformity or slippage of a clip. Patient outcome according to the Glasgow Outcome Scale was similar to that when conventional cobalt-based aneurysm clips were used.  Interpretation. Reliability and safety of Sugita aneurysm clips were demonstrated in a large number of patients. The clips are suitable for routine use in aneurysm surgery.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Keywords: Collateral circulation; intracranial-extracranial bypass surgery; moyamoya disease; nitric oxide.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Background. To investigate whether nitric oxide (NO) contributes to formation of abnormal collateral circulation in patients with moyamoya disease.  Methods. Cerebrospinal fluid (CSF) samples were obtained from the subarachnoid space of the Sylvian fissure during combined bypass surgery for moyamoya disease and kept frozen until NO metabolites, nitrate and nitrite, were measured using a Griess method.  Results. Compared with control CSF obtained from 18 patients with hemifacial spasm, unruptured aneurysm, etc., concentrations of NO metabolites in 26 CSF samples of 18 patients with moyamoya disease were significantly higher (mean±SE; 17.6±1.2 vs. 10.5±1.0 μM, p〈0.01). In eight patients, the CSF samples from both the first and second operation could be obtained. NO metabolite concentrations (20.5±2.3 μM) in CSF obtained from the first surgery decreased to 15.7±1.8 μM (p〈0.01) in CSF obtained from the second, contralateral procedure. The cases of moyamoya disease with greater development of moyamoya vessels at angiographic stage 3 and 4 tended to show higher concentrations of NO metabolites than cases at earlier or later stages with a few moyamoya vessels.  Interpretation. Nitric oxide concentrations in CSF are chronically elevated in moyamoya disease, probably reflecting development of abnormal collateral circulation. i.e. moyamoya vessels. Vascular bypass surgery can reduce abnormal collateral circulation with reduced production of nitric oxide.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 50 (1979), S. 293-298 
    ISSN: 0942-0940
    Keywords: Fibromuscular dysplasia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We report a case diagnosed angiographically as fibromuscular dysplasia. Initially there was a “string of beads” appearance. Two months later tubular stenosis was also apparent, and the clinical picture had progressed.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Germ cell tumour ; chemotherapy ; CDDP ; VP-16
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A co-operative study for patients with intracranial germ cell tumours was performed to analyze their prognosis and the effectiveness of Cisplatin/Etoposide (CDDP/VP-16) chemotherapy. A total of 46 patients; 30 primary and 16 recurrent cases were registered from 15 participating neurosurgical institutions in Japan. Based on histological criteria and tumour markers, they were classified into three groups; germinoma, germinoma with syncytiotro-phoblastic giant cell (STGC), and non-germinomatous malignant tumour. Sixteen patients were treated with CDDP/VP-16 chemotherapy alone and the other 30 patients were treated by a combination of surgery and/or radiation in addition to chemotherapy. Eleven out of 13 patients (85%) with germinoma showed a complete (n=10) or partial (n=1) response to CDDP/VP-16 chemotherapy even if their tumours were recurrent and there was evidence of CSF dissemination. For the germinoma with STGC and non-germinomatous malignant tumour, a high response rate; 100% for the former and 78% for the latter, could also be achieved in both the primary and the recurrent cases except in those cases of immature teratoma. Their survival times were still different between them. Two-year survival was 50% in germinoma with STGC and 48% in non-germinoma, while it was 88% in germinoma cases.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Malignant glioma ; interferon ; nitrosourea ; radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We analysed long-term follow-up results of 175 patients with malignant glioma (110 glioblastoma and 65 anaplastic astrocytoma) treated under five different regimes during the past two decades. The factors of age (less than 40), histology (anaplastic astrocytoma) and type of adjuvant therapy (radiation and chemotherapy) contributed to long survival. The other important factor was the response to adjuvant therapy. Cases of gross total removal or complete response (CR) of a residual tumour to an adjuvant therapy showed a better prognosis. The three and five year survival rate was 42% and 24%, respectively. The highest CR ratio (23%) was seen in patients treated by intravenous injection of interferon and ACNU in addition to radiotherapy (IAR therapy).
    Type of Medium: Electronic Resource
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