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81.
A basal encephalocele often shows an insidious clinical course. Only two cases of temporal lobe encephalocele accompanied with tension pneumocephalus have previously been reported. In this paper, we describe a case of lateral sphenoid sinus encephalocele presenting with intraventricular tension pneumocephalus. A 54-year-old man was referred to our institution presenting with intraventricular tension pneumocephalus. He had undergone ventriculoperitoneal shunt placement for postmeningitis hydrocephalus 3 months before this admission. Precise imaging examinations detected evidence suggestive of a lateral sphenoidal sinus recess encephalocele. Endoscopic transnasal approach was performed for surgical repair of the encephalocele. The encephalocele was removed with subsequent repair of the bony defect. Histological examination showed that the encephalocele includes a part of the ventricular system. This indicates that air might enter directly into the ventricular system after rupture of the temporal lobe encephalocele. A lateral sphenoid sinus encephalocele would potentially cause intraventricular tension pneumocephalus, although pneumocephalus is an extremely unusual complication of this type of basal encephaloceles. 相似文献
82.
Purpose The purpose of this study was to examine the effects of nicardipine-induced hypotension on cerebrovascular CO2 reactivity in patients with diabetes mellitus under sevoflurane anesthesia.
Methods Nineteen diabetic patients, and 11 nondiabetic patients (serving as controls), undergoing elective orthopedic, cardiovascular,
or thoracic surgery were included in the study. The diabetic patients were divided into three groups according to the antidiabetic
therapy they were receiving, i.e., diet therapy (n = 6), oral antidiabetic drugs (n = 7), and insulin (n = 6). Anesthesia was maintained with 1.0 minimum alveolar concentration of sevoflurane. Absolute and relative cerebrovascular
CO2 reactivity was calculated using a 2.5-MHz pulsed transcranial Doppler (TCD) probe for the continuous measurement of mean
blood flow velocity in the middle cerebral artery (Vmca). The cerebrovascular CO2 reactivity was measured both at baseline and during hypotension by increasing the ventilatory frequency by 4 to 7 breaths·min−1. Nicardipine was used to induce hypotension.
Results We found that values for the Bispectral index (BSI), baseline mean blood pressure, endtidal CO2 (PetCO
2), and Vmca were essentially identical in all patients, irrespective of the type of antidiabetic treatment being taken. Values
for absolute and relative CO2 reactivity in insulin-dependent patients, at both baseline blood pressure and during hypotension, were lower than those in
patients in the antidiabetic drug, diet, and control groups (during hypotension, absolute CO2 reactivity: diet group: 3.2 ± 0.9; oral antidiabetic drug group: 3.2 ± 0.7; insulin group: 1.5 ± 0.6; control group: 3.4
± 0.8 cm·s−1·mmHg−1, [P < 0.05 insulin group vs the other groups]; relative CO2 reactivity: diet group, 6.3 ± 1.0; oral antidiabetic drug group, 6.5 ± 0.8; insulin group, 3.5 ± 0.8; control group, 6.5
± 0.7%·mmHg−1, [P < 0.05 insulin group vs the other groups].
Conclusion We concluded that cerebrovascular CO2 reactivity in insulin-dependent patients is impaired during nicardipine-induced hypotension under sevoflurane anesthesia. 相似文献
83.
Repair of an Abdominal Aortic Aneurysm with a Remarkably Dilated Meandering Artery: Report of a Case
Sakamoto S Yamauchi S Yamashita H Imura H Maruyama Y Ochi M Shimizu K 《Surgery today》2007,37(2):133-136
A 73-year-old man on dialysis for chronic renal dysfunction was referred to our hospital for surgical treatment of an abdominal
aortic aneurysm (AAA). Preoperative angiography showed a remarkably developed meandering artery branching from the inferior
mesenteric artery (IMA). The superior mesenteric and celiac arteries were occluded at the origin, and all blood flow to the
abdominal organs was apparently supplied by collateral circulation from the IMA. Considering the risk of mesenteric ischemia
after aortic clamping in conjunction during surgery, we used a perfusion catheter with a 12-F balloon to create a shunt to
the IMA from the subclavian artery. The operation was successful and the patient recovered uneventfully. We describe this
surgical procedure for its effectiveness in preventing postoperative mesenteric ischemia in a rare case of an AAA with complex
branching lesions. 相似文献
84.
Takao M Komatsu F Oae K Miyamoto W Uchio Y Ochi M Matsushita T 《Archives of orthopaedic and trauma surgery》2007,127(8):685-690
Introduction Flat foot and/or metatarsal primus varus are the major causes of hallux valgus, and it is important to correct these deformities
in order to prevent the recurrence of this condition. We demonstrate the clinical and radiological assessment of the correction
of hallux valgus, metatarsal primus varus, and flat foot after proximal oblique-domed osteotomy of the metatarsus with distal
soft tissue reconstruction.
Materials and methods Twenty-seven feet of 22 patients with moderate or severe hallux valgus who had undergone proximal oblique-domed osteotomy
were studied. After the adductor hallucis tendon was cut at the attachment of the proximal phalanx and at the sesamoid bone,
the osteotomy was performed 3 cm dorsal-distal to the metatarsocuneiform joint to transfer distal fragment approximately 5 mm
in the plantar direction, and rotated laterally decreasing the first–second intermetatarsal angle to 5 degrees.
Results The mean AOFAS score was 54.1 ± 2.8 points at pre-operation and 92.8 ± 4.8 points at the most recent follow-up (P < 0.0001). Significant improvement was seen between the hallux valgus angle (P < 0.0001), first–second intermetatarsal angle (P < 0.0001), first–fifth intermetatarsal angle (P < 0.0001), talar pitch (P = 0.0032), and calcaneal plantar angle (P = 0.0327) before surgery and at one year after surgery. The average improvement of the talar pitch and calcaneal plantar
angle was 2.6 ± 1.4 and 2.4 ± 1.5 degrees, respectively.
Conclusion This study suggest that proximal oblique-domed osteotomy of the metatarsal as a surgical procedure for the treatment of moderate
or severe hallux valgus with flat foot can be recommended to correct the longitudinal arch of the foot and the first–second
intermetatarsal angle. 相似文献
85.
Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines 总被引:2,自引:0,他引:2
Miura F Takada T Kawarada Y Nimura Y Wada K Hirota M Nagino M Tsuyuguchi T Mayumi T Yoshida M Strasberg SM Pitt HA Belghiti J de Santibanes E Gadacz TR Gouma DJ Fan ST Chen MF Padbury RT Bornman PC Kim SW Liau KH Belli G Dervenis C 《Journal of Hepato-Biliary-Pancreatic Surgery》2007,14(1):27-34
Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis),
according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management
of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment
may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For
severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After
hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed.
For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic,
percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with
mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade
II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation,
elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy.
For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary
peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective
cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general
medical condition. 相似文献
86.
Inoue K Tanii H Abe S Nata M Nishimura Y Nishida A Kajiki N Yokoyama C Kaiya H Fukunaga T Okazaki Y 《Psychiatry and clinical neurosciences》2006,60(6):736-745
The number of suicides in Japan has increased from approximately 22 000 per year from 1988 to 1997 to >30 000 per year since 1998. Likewise, the number of suicides has been increasing in Mie Prefecture. The purpose of the present study was to examine the incidence of and circumstances surrounding all suicide cases during 1996-2002 in Mie Prefecture and to compare the data with those from 1989 to 1995. In Mie Prefecture, the age-specific suicide rate during the second 7-year period included marked increases among men aged 50-59 and 60-69 years. Among women, the age-specific suicide rate increased with age during both 7-year periods. During the second period, psychiatric disorders as causative factors increased in all generations. They were especially important for women of the younger generation, whereas economic problems were the most common causative factor among men aged 40-64. Physical illness as a causative factor in suicide was high among the elderly, but among the other age groups this factor trailed behind economic difficulties for men and psychiatric disorders for women. To prevent suicide, social cooperation as well as a plenitude of visiting nurses and psychiatric care is required, and early detection and treatment are also important. 相似文献
87.
Kanagawa T Fukuda H Tsubouchi H Komoto Y Hayashi S Fukui O Shimoya K Murata Y 《Brain research》2006,1111(1):36-40
Hypothermia is a potential therapy for cerebral hypoxic ischemic injury of not only adults but also neonates. However, the side effects of hypothermia in the developing brain, where a massive amount of neurogenesis occurs, remain unclear. We investigated the proliferation of neural progenitor cells by systemic application of the thymidine analog 5-bromodeoxyuridine (BrdU) in neonatal rats in a severe hypothermic environment. The rat pups were divided into two groups, a hypothermia group (30 degrees C: n=10) and a normothermia group (37 degrees C: n=10). After the pups were placed for 21 h in each environment, 100 mg/kg/day of BrdU was injected intraperitoneally to label dividing cells, and then the pups were sacrificed at 24 h. We examined the number of BrdU-labeled cells in the subventricular zone of the periventricle and the subgranular zone of the dentate gyrus. In the hypothermic environment, BrdU-labeled cells significantly decreased in number in the dentate gyrus, but not in the periventricular region. Thus, the severe hypothermic environment induced a decrease of neurogenesis in the neonatal rat. These observations are noteworthy regarding clinical hypothermia therapy following cerebral hypoxic ischemic injury during the perinatal period. 相似文献
88.
89.
Nobuyuki Hiraoka Kenji A. Takahashi Yuji Arai Kei Sakao Osam Mazda Tsunao Kishida Kuniaki Honjo Sakae Tanaka Toshikazu Kubo 《Journal of orthopaedic research》2011,29(3):354-360
Subchondral bone is a candidate for treatment of osteoarthritis (OA). We investigated the effects of intra‐articular injection of hyaluronan (IAI‐HA) on subchondral bone in rabbit OA model. OA was induced by anterior cruciate ligament transection, with some rabbits receiving IAI‐HA. OA was graded morphologically, and expression of mRNA was assessed by real‐time RT‐PCR. Tissue sections were stained with hyaluronan‐binding protein, and penetration of fluorescent hyaluronan was assessed. The in vitro inhibitory effect of hyaluronan on MMP‐13 was analyzed in human osteoarthritic subchondral bone osteoblasts (OA Ob) by real‐time RT‐PCR and ELISA. Binding of hyaluronan to OA Ob via CD44 was assessed by immunofluorescence cytochemistry. Expression of MMP‐13 and IL‐6 mRNA in cartilage and subchondral bone, and morphological OA grade, increased over time. IAI‐HA ameliorated the OA grade and selectively suppressed MMP‐13 mRNA in subchondral bone. IAI‐HA enhanced the hyaluronan staining of subchondral bone marrow cells and osteocyte lacunae. Fluorescence was observed in the subchondral bone marrow space. In OA Ob, hyaluronan reduced the expression and production of MMP‐13, and anti‐CD44 antibody blocked hyaluronan binding to OA Ob. These findings indicate that regulation of MMP‐13 in subchondral bone may be a critical mechanism during IAI‐HA. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:354–360, 2011 相似文献
90.
Yukiko Aono Hisashi Hasegawa Yuji Yamazaki Takashi Shimada Toshiro Fujita Takeyoshi Yamashita Seiji Fukumoto 《Journal of bone and mineral research》2011,26(4):803-810
Fibroblast growth factor 23 (FGF‐23) plays causative roles in the development of several hypophosphatemic rickets/osteomalacia such as X‐linked hypophosphatemic rickets/osteomalacia (XLH) and tumor‐induced rickets/osteomalacia. Patients with hypophosphatemic rickets/osteomalacia often complain of muscle weakness and bone pain that severely affect daily activities of these patients. The purpose of this study was to examine whether anti‐FGF‐23 antibodies, which have been shown to improve hypophosphatemia and rachitic changes of juvenile Hyp mice in a murine model of XLH, also ameliorate hypophosphatemic osteomalacia and affect muscle force and spontaneous motor activity in adult Hyp mice. Repeated injections of anti‐FGF‐23 antibodies increased serum phosphate and 1,25‐dihydroxyvitmain D levels and enhanced mineralization of osteoid in adult Hyp mice, whereas bone length did not change. We found that grip strength was weaker and that spontaneous movement was less in adult Hyp mice than in wild‐type mice. In addition, FGF‐23 antibodies increased grip strength and spontaneous movement. These results suggest that the inhibition of excess FGF‐23 action not only ameliorates hypophosphatemia and impaired mineralization of bone but also improves muscle weakness and daily activities of patients with FGF‐23‐related hypophosphatemic rickets/osteomalacia. © 2011 American Society for Bone and Mineral Research. 相似文献