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Ichiro Kawahara Keisuke Tsutsumi Yuki Matsunaga Hideaki Takahata Tomonori Ono Keisuke Toda Hiroshi Baba 《Acta neurochirurgica》2013,155(8):1543-1548
Background
Mild cerebrospinal fluid (CSF) hypovolemia is a well-known clinical entity, but critical CSF hypovolemia that can cause transtentorial herniation is an unusual and rare clinical entity that occurs after craniotomy. We investigated CSF hypovolemia after microsurgical aneurysmal clipping for subarachnoid hemorrhage (SAH).Method
This study included 144 consecutive patients with SAH. Lumbar drainage (LD) was inserted after general anesthesia or postoperatively as a standard perioperative protocol. CSF hypovolemia diagnosis was based on three criteria.Results
Eleven patients (7.6 %) were diagnosed with CSF hypovolemia according to diagnostic criteria in a postoperative range of 0–8 days. In all patients, signs or symptoms of CSF hypovolemia improved within 24 hours by clamping LD and using the Trendelenburg position.Conclusions
As a cause of acute clinical deterioration after aneurysmal clipping, CSF hypovolemia is likely under-recognized, and may actually be misdiagnosed as vasospasm or brain swelling. We should always take the etiology of CSF hypovolemia into consideration, and especially pay attention in patients with pneumocephalus and subdural fluid collection alongside brain sag on computed tomography. These patients are at higher risk developing of pressure gradients between their cranial and spinal compartments, and therefore, brain sagging after LD, than after ventricular drainage. We should be vigilant to strictly manage LD so as not to produce high pressure gradients. 相似文献106.
Nakamura M Tanaka H Nagayoshi Y Nakashima H Tsutsumi K Ohtsuka T Takahata S Tanaka M Okada H 《Journal of gastroenterology》2012,47(4):452-460
Background
The hedgehog (Hh) signaling pathway is aberrantly activated in many cancers. Overproduction of sonic hedgehog (Shh), a ligand in the Hh pathway, increases Hh signaling activity by inhibiting Patched-1 (Ptch1), a suppressive receptor in the Hh pathway. The purpose of this study was to establish a novel strategy for treating pancreatic cancer and other Hh-dependent cancers through control of the tumor-suppressive function of Ptch1. 相似文献107.
Tsutsumi K Ohtsuka T Mori Y Fujino M Yasui T Aishima S Takahata S Nakamura M Ito T Tanaka M 《Journal of gastroenterology》2012,47(6):678-685
Background
Because of the rarity and variety of pancreatic neuroendocrine tumors (PNETs), there have been few reports regarding the indication for lymph node dissection in patients with these tumors. This study aimed to evaluate the risk of lymph node metastasis of PNETs based on the tumor size and hormonal production.Methods
Data for a total of 66 patients who had PNETs resected at our department between 1987 and 2010 were retrospectively studied. The clinicopathological features, including the disease-specific survival rate, were assessed based on the status of lymph node metastasis at the time of initial surgical resection. Then the cut-off point of tumor size to predict lymph node metastasis was estimated.Results
There were 12 patients (18%) with lymph node metastasis. The frequency of lymph node metastasis tended to be higher in gastrinomas than that in other tumors (43 vs. 15%; P?=?0.08). The size of PNETs with lymph node metastasis was significantly larger than that of the PNETs without metastasis (P?=?0.04). The postoperative survival rate in the PNET patients with lymph node metastasis was significantly lower than that in the patients without metastasis (P?0.0001). Only 2 (8%) of 26 PNETs with a tumor size of <15?mm had lymph node metastasis, and both of these were gastrinomas. On the other hand, 10 (25%) of the remaining 40 PNETs with a tumor size of ≥15?mm had lymph node metastasis. Notably, there were no PNETs with lymph node metastasis in 22 non-gastrinomas with a tumor size of <15?mm.Conclusions
Non-gastrinomas with a tumor size of ≥15?mm and all gastrinomas would be an indication for pancreatectomy with lymph node dissection. 相似文献108.
109.
Norifumi Tsutsumi Morimasa Tomikawa Munenori Uemura Tomohiko Akahoshi Yoshihiro Nagao Kozo Konishi Satoshi Ieiri Jaesung Hong Yoshihiko Maehara Makoto Hashizume 《Surgical endoscopy》2013,27(6):2178-2184
Background
The recent development of open magnetic resonance imaging (MRI) has provided an opportunity for the next stage of image-guided surgical and interventional procedures. The purpose of this study was to evaluate the feasibility of laparoscopic surgery under the pneumoperitoneum with the system of an open MRI operating theater.Methods
Five patients underwent laparoscopic surgery with a real-time augmented reality navigation system that we previously developed in a horizontal-type 0.4-T open MRI operating theater.Results
All procedures were performed in an open MRI operating theater. During the operations, the laparoscopic monitor clearly showed the augmented reality models of the intraperitoneal structures, such as the common bile ducts and the urinary bladder, as well as the proper positions of the prosthesis. The navigation frame rate was 8 frames per min. The mean fiducial registration error was 6.88 ± 6.18 mm in navigated cases. We were able to use magnetic resonance–incompatible surgical instruments out of the 5-Gs restriction area, as well as conventional laparoscopic surgery, and we developed a real-time augmented reality navigation system using open MRI.Conclusions
Laparoscopic surgery with our real-time augmented reality navigation system in the open MRI operating theater is a feasible option. 相似文献110.
Keiji Tsutsumi Tetsuyoshi Horiuchi Tatsuro Aoyama Kazuhiro Hongo 《Journal of clinical neuroscience》2013,20(12):1783-1786
Isolated primary malignant lymphoma rarely arises from the anterior visual pathway. A 59-year-old previously healthy man presented with progressive, painless, bilateral visual disturbance. Neurological imaging revealed an enhancing mass arising from the optic chiasm. Open biopsy was carried out under monitoring of visual evoked potentials and a histopathological diagnosis of diffuse large B-cell lymphoma was made. As systemic examination did not show any evidence of systemic lymphoma, we concluded that this patient had an isolated primary malignant lymphoma at the anterior visual pathway. 相似文献