35 results on '"Shiigai M"'
Search Results
2. Photoelectrical detection of nitrogen-vacancy centers by utilizing diamond lateral p–i–n diodes
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Murooka, T., primary, Shiigai, M., additional, Hironaka, Y., additional, Tsuji, T., additional, Yang, B., additional, Hoang, T. M., additional, Suda, K., additional, Mizuno, K., additional, Kato, H., additional, Makino, T., additional, Ogura, M., additional, Yamasaki, S., additional, Hatano, M., additional, and Iwasaki, T., additional
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- 2021
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3. Usefulness of Subtraction of 3D T2WI-DRIVE from Contrast-Enhanced 3D T1WI: Preoperative Evaluations of the Neurovascular Anatomy of Patients with Neurovascular Compression Syndrome
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Masuda, Y., primary, Yamamoto, T., additional, Akutsu, H., additional, Shiigai, M., additional, Masumoto, T., additional, Ishikawa, E., additional, Matsuda, M., additional, and Matsumura, A., additional
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- 2014
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4. Clinical Implications of Atrial Fibrillation Provoked by Acetylcholine.
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Shibata K, Wakabayashi K, Ikeda N, Ishinaga T, Kusakabe Y, Masaki A, Aizawa N, Shimazu S, Furuya T, Nakamura Y, Sato C, Nishikura T, Shiigai M, Mutou M, Honye J, and Tanno K
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- 2024
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5. Peri-mesencephalic subarachnoid hemorrhage due to venous aneurysm associated cerebellar arteriovenous malformation: a case report.
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Hirata K, Shiigai M, Uemura K, Matsumaru Y, and Ishikawa E
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- Humans, Cerebellum diagnostic imaging, Cerebral Angiography, Subarachnoid Hemorrhage complications, Subarachnoid Hemorrhage diagnostic imaging, Arteriovenous Malformations complications, Aneurysm complications, Intracranial Aneurysm complications, Intracranial Aneurysm diagnostic imaging, Intracranial Arteriovenous Malformations complications, Intracranial Arteriovenous Malformations diagnostic imaging
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- 2023
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6. Acute gastric dilatation with superior mesenteric artery syndrome after binge eating.
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Amano A, Hayashi D, Hara H, Konishi T, Shiigai M, and Imai H
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- Humans, Dilatation, Pathologic, Acute Disease, Mesenteric Artery, Superior, Superior Mesenteric Artery Syndrome diagnosis, Superior Mesenteric Artery Syndrome etiology, Gastric Dilatation diagnosis, Gastric Dilatation etiology, Binge-Eating Disorder
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- 2023
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7. Arteriovenous fistula of the clival diploic vein associated with arteriovenous fistula of the posterior condylar canal.
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Hirata K, Kato N, Yamazaki T, Yasuda S, Shiigai M, and Matsumaru Y
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- Aged, Angiography, Digital Subtraction, Cranial Fossa, Posterior diagnostic imaging, Humans, Male, Meningeal Arteries, Arteriovenous Fistula therapy, Embolization, Therapeutic
- Abstract
We herein report a rare case of a patient with a clival diploic vein arteriovenous fistula (AVF) associated with a posterior condylar canal AVF and discuss the radiological features of clival diploic vein AVF during decision-making on treatment strategies. A 69-year-old male patient with one-year history of pulsatile tinnitus was evaluated with magnetic resonance angiography, which revealed a dilated venous structure. Digital subtraction angiography revealed AVFs located in the clivus and posterior condylar canal. The clival diploic vein AVF was fed by the right internal maxillary artery and the petrous branch of middle meningeal artery and shed to the posterior condylar canal only through an intraosseous vein in the jugular tubercle. Although a catheter could not be navigated into the venous pouch in the clivus, the AVFs were successfully obliterated by transvenous embolization of the venous pouch in the posterior condylar canal.
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- 2021
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8. [Surgical Treatment for Congenital Bronchial Atresia and Intralobar Sequestration in the Same Lobe].
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Kamiya K, Ozawa Y, Konishi T, Watanabe A, Shiigai M, and Sakai M
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- Bronchi diagnostic imaging, Bronchi surgery, Humans, Lung, Male, Mediastinum, Tomography, X-Ray Computed, Young Adult, Bronchopulmonary Sequestration diagnostic imaging, Bronchopulmonary Sequestration surgery
- Abstract
A 21-year-old man who had a history of pneumonia twice presented with chest discomfort. Computed tomography( CT) revealed dilatation of the atretic bronchus that was not continuous with the proximal one, and surrounding hyper-lucent lung fields in the outer and mediastinal sides of the right basal segment, and the absence of B10b+c. CT also demonstrated the presence of A10b+c in the former field and the aberrant artery from the inferior phrenic artery in the latter. Right basal segmentectomy was performed under the diagnosis of congenital bronchial atresia and intralobar sequestration. Pathological diagnosis accorded with preoperative one.
- Published
- 2021
9. Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report.
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Takahashi T, Ikeda G, Igarashi H, Konishi T, Araki K, Hara K, Akimoto K, Miyamoto S, Shiigai M, Uemura K, Ishikawa E, and Matsumaru Y
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Background: Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA., Case Description: A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient's medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21., Conclusion: In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)
- Published
- 2021
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10. A case of severe pneumonia with viremia caused by adenovirus B7 identified by off-label use of a multiplex PCR system.
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Sakakura A, Akashi Y, Shiigai M, Isono H, Suzuki H, and Hirose Y
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Severe infection with human adenovirus (HAdV) is uncommon in adults, and the lack of reliable point-of-care testing makes the diagnosis challenging. A 39-year-old immunocompetent Indian man developed severe pneumonia, and his condition became life-threatening despite antimicrobial therapy. While sputum and blood cultures remained negative, a multiplex PCR respiratory panel (Filmarray Respiratory Panel), which is only approved for use with nasopharyngeal samples, detected HAdV in the serum and tracheal aspirates on day 5. We therefore initiated ganciclovir, steroids, and intravenous immunoglobulin. The patient's respiratory condition improved significantly, and he eventually recovered without complications. We later confirmed that conventional PCR of serum detected HAdV-B7. Our case illustrated that a respiratory panel using multiplex PCR successfully detected HAdV in unapproved samples. Such off-label analyses may support the early diagnosis of infections caused by pathogens that are difficult to identify by routine microbiological examination., (© 2020 The Authors.)
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- 2020
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11. Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery.
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Terakado T, Nakai Y, Ikeda G, Tsukada K, Hanai S, Akutagawa K, Igarashi H, Konishi T, Shiigai M, and Uemura K
- Abstract
We herein report a case of a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery that was treated using the stent-jack technique. After parent artery occlusion of the distal vertebral artery, stenting of the posterior inferior cerebellar artery was performed. Further coiling was needed because distal vertebral artery recanalization occurred due to transformation of the coil mass. The stent-jack technique for a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery is effective; however, careful attention to recanalization after stenting is needed due to transformation of the coil mass.
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- 2020
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12. Atypical femoral hernia called Laugier's hernia: clinical features, radiological findings, and management at a single center.
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Miyamoto R, Shiigai M, Hoshiai S, Inagaki Y, Ikeda N, and Oda T
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- Aged, Aged, 80 and over, Female, Humans, Male, Multidetector Computed Tomography, Polypropylenes, Retrospective Studies, Surgical Mesh, Hernia, Femoral diagnostic imaging, Hernia, Femoral surgery, Herniorrhaphy
- Abstract
Purpose: Laugier's hernia is a rare clinical entity compared with a typical femoral hernia. Therefore, the clinical features, radiological findings, and appropriate treatment strategies remain largely unclear. In this study, we present 15 Laugier's hernia cases. Additionally, we review the relevant literature and discuss the clinical features, radiological findings, and appropriate treatment strategies pertaining to Laugier's hernia compared with a typical femoral hernia., Methods: Among 1260 hernia patients, we retrospectively enrolled 15 Laugier's hernia patients (1.19%) and 89 femoral hernia patients (7.06%) who underwent herniorrhaphy and compared the demographic characteristics and radiological findings between the two groups., Results: Regarding the patient characteristics, a significant difference was observed in the presence of pain (p < 0.001) and ileus symptoms (p = 0.001). Regarding the hernia characteristics, significant differences were observed in the size of the hernial sac (p = 0.001), contents of the hernial sac (p = 0.003), repositioning of the hernial sac (p < 0.001), and repair with polypropylene mesh (p < 0.001). The characteristic multi-detector computed tomography (MDCT) findings enabled the preoperative diagnosis of Laugier's hernia versus conventional femoral hernia., Conclusion: Surgeons should be alert to the possibility of atypical femoral hernias while examining femoral hernia or inguinal hernia patients. If Laugier's hernia is suspected, preoperative MDCT is recommended.
- Published
- 2020
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13. Detection of the artery of Adamkiewicz using multidetector row computed tomography in patients with spinal arteriovenous shunt disease.
- Author
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Hoshiai S, Shiigai M, Konishi T, Nakai Y, and Masumoto T
- Abstract
Purpose: To plan a treatment strategy for a spinal arteriovenous shunt (SAVS), identifying the artery of Adamkiewicz (AKA) and its origin is indispensable. However, detecting the AKA is very difficult in patients with an SAVS when using computed tomography angiography (CTA) by the usual method to find the hairpin curved artery because dilated drainage veins nearly always coexist with the hairpin curved AKA. We designed a method to identify the AKA by focusing on the diameter and pathway of the anterior radiculomedullary arteries (RMAs)., Material and Methods: Seven consecutive patients with an SAVS were surveyed. They underwent contrast-enhanced CTA and conventional angiography from January 2009 to December 2012. Two readers evaluated the CTA images and assumed that the AKA was the artery that ran through the anterior portion of the neural foramen and continued to pass on the ventral side of the spinal cord., Results: Among the seven patients, nine AKAs were detected with conventional angiography. When using our method, seven AKAs and six AKAs were identified on CTA by Reader 1 and Reader 2, respectively. The average sensitivity was 72.3%, and the specificity, accuracy, positive predictive value, and negative predictive value were sufficiently high (i.e. > 85%) for both readers. The kappa value for detecting the AKA was 0.98., Conclusions: Detecting the origin of the AKA with CTA is challenging in patients with an SAVS. However, focusing on the diameter and pathway of the RMAs may allow successful identification., Competing Interests: The authors report no conflict of interest., (Copyright © Polish Medical Society of Radiology 2020.)
- Published
- 2020
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14. Dural Sinus Thrombosis with Nonsymptomatic Persistent Falcine Sinus: A Case Report.
- Author
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Shioya A, Mashiko R, Shiigai M, Nakai Y, Takahashi N, Kobayashi H, Irie T, and Tamaoka A
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- Anticoagulants therapeutic use, Anticonvulsants therapeutic use, Central Nervous System Vascular Malformations diagnostic imaging, Central Nervous System Vascular Malformations physiopathology, Cerebrovascular Circulation, Cranial Sinuses diagnostic imaging, Female, Humans, Sagittal Sinus Thrombosis diagnostic imaging, Sagittal Sinus Thrombosis drug therapy, Sagittal Sinus Thrombosis physiopathology, Status Epilepticus diagnosis, Status Epilepticus drug therapy, Status Epilepticus physiopathology, Treatment Outcome, Young Adult, Central Nervous System Vascular Malformations complications, Cranial Sinuses abnormalities, Sagittal Sinus Thrombosis etiology, Status Epilepticus etiology
- Abstract
A 24-year-old woman was admitted to our hospital after convulsive status epilepticus. A cerebral magnetic resonance venography revealed a persistent fetal falcine sinus. Additionally, the posterior third of the superior sagittal sinus was hypoplastic and the abnormal deep venous drainage was accompanied. These abnormalities had already been detected by magnetic resonance imaging several years ago. In the present scan, we discovered a sinus thrombosis in the hypoplastic superior sagittal sinus. In the cerebral angiography, we observed delayed venous return in the left parieto-occipital lobe and hypothesized that cerebral venous stasis due to the thrombus caused the convulsive status epilepticus. The patient was treated with intravenous administration of heparin along with an antiepileptic drug, and she recovered with no neurological defects. In the present case, the falcine sinus and the anomalous venous return were likely congenital while the status epilepticus was derived from thrombosis in the hypoplastic superior sagittal sinus. Although the falcine sinus functioned as an alternative pathway for the superior sagittal sinus, the hypoplastic superior sagittal sinus itself may also play an important role as a venous drainage channel., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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15. Endoscopic endonasal cyst fenestration into the sphenoid sinus using the mucosa coupling method for symptomatic Rathke's cleft cyst: a novel method for maintaining cyst drainage to prevent recurrence.
- Author
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Kino H, Akutsu H, Tanaka S, Hara T, Miyamoto H, Sakamoto N, Takano S, Masumoto T, Shiigai M, Ishikawa E, and Matsumura A
- Abstract
Objective: Rathke's cleft cyst (RCC) is a benign cystic lesion with a relatively high incidence of local recurrence that occasionally requires repeat surgery. To prevent recurrence, simple cyst fenestration and drainage of the cyst contents to the sphenoid sinus is recommended, but it occasionally recurs. The authors postulated that obstruction of fenestration is a main cause of recurrence, and they developed a method, named the "mucosa coupling method (MC method)," that maintains persistent drainage. In this method, the RCC epithelium and the mucosa of the sphenoid sinus are connected, which promotes re-epithelialization between the two epithelia, maintaining persistent drainage. The outcome of this method was compared with that of conventional cyst fenestration., Methods: In a consecutive series of 40 patients with RCC, the surgical strategy was changed during the study period: from December 2009 to September 2014 (the conventional period), 24 patients were scheduled to be treated using the conventional fenestration method, whereas from September 2014 to September 2017 (the MC period), 16 patients were scheduled to be treated using the MC method. However, because of an intraoperative CSF leak, the fenestration was closed during surgery in 3 patients in the conventional period and 2 in the MC period; therefore, these 5 patients were excluded from the analysis. Twenty-one patients treated with the conventional fenestration method (conventional group) and 14 patients treated with the MC method (MC group) were analyzed. All patients regularly underwent MRI after surgery to detect reaccumulation of cyst contents. The rate of reaccumulation with and without reoperation, visual outcomes, endocrinological outcomes, and postoperative complications were compared between these two groups., Results: The median follow-up period in all 35 patients was 48.0 months (range 1-96 months), 54.0 months (range 1-96 months) in the conventional group and 35.5 months (range 12-51 months) in the MC group. No reaccumulation was detected on MRI in the 14 patients in the MC group, whereas it was noted in 9 (42.9%) of 21 patients in the conventional group, and 2 of these 9 patients required repeat surgery. There were no significant differences in visual and endocrinological outcomes and complications between these two groups., Conclusions: The MC method for RCC is effective for preventing obstruction of cyst fenestration, which contributes to preventing cyst reaccumulation. Furthermore, this method is equivalent to the conventional fenestration method in terms of visual and endocrinological outcomes and the complication rate.
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- 2019
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16. The Concavity of the Maximal Expiratory Flow-Volume Curve Reflects the Extent of Emphysema in Obstructive Lung Diseases.
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Mochizuki F, Iijima H, Watanabe A, Tanabe N, Sato S, Shiigai M, Fujiwara K, Shimada T, Ishikawa H, Kanazawa J, Yatagai Y, Masuko H, Sakamoto T, Muro S, and Hizawa N
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- Aged, Asthma complications, Asthma diagnosis, Asthma physiopathology, Female, Humans, Lung diagnostic imaging, Lung physiopathology, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Emphysema complications, Pulmonary Emphysema diagnosis, Respiratory Function Tests methods, Sensitivity and Specificity, Severity of Illness Index, Tomography, X-Ray Computed methods, Maximal Expiratory Flow-Volume Curves, Pulmonary Disease, Chronic Obstructive physiopathology, Pulmonary Emphysema physiopathology, Spirometry methods
- Abstract
A concave-shaped maximal expiratory flow-volume (MEFV) curve is a spirometric feature in chronic obstructive pulmonary disease (COPD). The MEFV curve is characterized by an increase in the Obstructive Index, which is defined as a ratio of forced vital capacity to the volume-difference between two points of half of the peak expiratory flow on the MEFV curve. We hypothesized that the Obstructive Index would reflect the severity of emphysema in patients with COPD and asthma-COPD overlap (ACO). Thus, the aim of this retrospective study was to evaluate whether the Obstructive Index on spirometry is associated with the extent of emphysema on computed tomography (CT) in patients with COPD, ACO, and asthma (N = 65, 15, and 53, respectively). The percentage of low-attenuation volume (LAV%) and wall area (WA%) were measured on CT. The Obstructive Index was higher in patients with COPD and ACO than in those with asthma. Spearman correlation showed that a greater Obstructive Index was associated with a higher LAV%, but not WA%. Multivariate analysis showed that Obstructive Index was associated with LAV% (standardized β = 0.43, P < 0.0001) independent of other spirometric indices. The Obstructive Index is a useful spirometric index that reflects the extent of emphysema.
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- 2019
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17. Safety margin of radiofrequency ablation for hepatocellular carcinoma: a prospective study using magnetic resonance imaging with superparamagnetic iron oxide.
- Author
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Fukuda K, Mori K, Hasegawa N, Nasu K, Ishige K, Okamoto Y, Shiigai M, Abei M, Minami M, and Hyodo I
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- Aged, Aged, 80 and over, Carcinoma, Hepatocellular diagnostic imaging, Catheter Ablation methods, Female, Humans, Liver diagnostic imaging, Liver surgery, Liver Neoplasms diagnostic imaging, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Tomography, X-Ray Computed methods, Treatment Outcome, Carcinoma, Hepatocellular surgery, Ferric Compounds, Liver Neoplasms surgery, Magnetic Resonance Imaging methods, Magnetite Nanoparticles, Radiofrequency Ablation methods
- Abstract
Purpose: In radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), it is difficult to assess the ablative margin (AM) precisely by comparing pre- and post-RFA CT images. We prospectively studied the AMs using magnetic resonance imaging (MRI) with pre-administered superparamagnetic iron oxide (SPIO). SPIO is safe for kidney disease patients., Materials and Methods: Hepatocellular carcinoma patients were treated with RFA within 8 h of SPIO administration. On T2*-weighted MRI performed 4-7 days later, AM was visualized as a hypointense rim. The ablation status was classified as AM(+) if the rim completely surrounded the tumor, AM(0) if the rim was partly discontinuous without tumor protrusion, and AM(-) if the rim was partly discontinuous with tumor protrusion. The minimal thickness of AM was measured. AM(-) tumors were re-treated consecutively., Results: In total, 85 HCCs ablated in 76 patients were evaluated. The local recurrence rate at 3 years was 2% for AM(+) tumors and 34% for AM(0) tumors (p < 0.01). In addition, no local recurrence was seen in the tumors with an AM of ≥ 2 mm., Conclusion: MRI with pre-administered SPIO is useful for determining the AM precisely, and an AM of ≥ 2 mm is recommended for curative RFA., Trial Registration Number: This study was registered with UMIN Clinical Trials Registry (UMIN 000025406).
- Published
- 2019
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18. The Visualization Methods of Occluded Dural Sinus for Safe Transvenous Embolization of Dural AVFs.
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Hosoo H, Tsuruta W, Nakai Y, Shiigai M, Sato M, Ito Y, Takigawa T, Marushima A, Ishikawa E, Yamamoto T, Matsumaru Y, and Matsumura A
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- Aged, Catheters, Cavernous Sinus surgery, Central Nervous System Vascular Malformations therapy, Cranial Sinuses diagnostic imaging, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Cavernous Sinus diagnostic imaging, Central Nervous System Vascular Malformations diagnostic imaging, Cranial Sinuses surgery, Embolization, Therapeutic methods
- Abstract
Background: Transvenous embolization (TVE) via occluded sinus is one option for the treatment of dural arteriovenous fistulas. Understanding of the anatomical characteristics of the occluded sinus is difficult. It is often hard to reach the shunt point because of some risk of vessel perforation., Methods: We assessed usefulness of T1 Volumetric Isotropic TSE Acquisition (VISTA) Black Blood (BB) and 3D-T1 Fast Field Echo (FFE) for the evaluation and visualization of an occluded sinus. Evaluation of T1 VISTA BB and 3D-T1 FFE was performed preoperatively. TVE was performed via the occluded sinus while referring to the visualized reconstruction image., Results: Fourteen cases of TVE were performed between 2009 and 2015. The entire occluded sinus, including both thrombus and blood flow, was seen as the high-intensity region on 3D FFE T1 gadlinium (Gd). On the other hand, thrombus was seen as the iso- or high-intensity region and blood flow as the low-intensity region on T1 VISTA BB. The maximum intensity projection reconstruction image of 3D FFE T1Gd could visualize the whole occluded sinus and was useful for microcatheter maneuver. Total shunt obliteration was achieved in 13 cases (92.8%) except for one., Conclusions: Magnetic resonance imaging evaluation of the occluded sinus using both T1 VISTA BB and 3D FFE T1Gd gives us valuable information of the occluded sinus regarding the development and the course of the occluded sinus, the length of the thrombotic occlusion, and leads to safer catheter maneuvers in TVE., (Copyright © 2019. Published by Elsevier Inc.)
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- 2019
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19. Transvenous Embolization of Dural Arteriovenous Fistula of the Anterior Condylar Confluence via the Intercavernous Sinus Assisted by Bone Subtraction Computed Tomography Angiography.
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Sakakura K, Nakai Y, Ikeda G, Shiigai M, Watanabe N, Uemura K, Zaboronok A, Ishikawa E, and Matsumura A
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- Aged, 80 and over, Central Nervous System Vascular Malformations diagnostic imaging, Cerebral Angiography, Computed Tomography Angiography, Cranial Sinuses diagnostic imaging, Female, Humans, Treatment Outcome, Central Nervous System Vascular Malformations therapy, Cranial Sinuses surgery, Embolization, Therapeutic methods
- Abstract
Background: Dural arteriovenous fistulae (dAVFs) of the anatomically complex anterior condylar confluence (ACC) are often examined by computed tomography (CT) angiography and conventional angiography before treatment. Contrasted vessels often overlap with skull bones in enhanced CT scan and make it difficult to detect the shunt point of the dAVF. Bone subtraction CT angiography (BSCTA) can overcome this limitation and allow for superior imaging of dAVFs that may help to find an alternative access for catheterization., Case Description: An 80-year-old woman suffered from right ear tinnitus, headache, and an audible bruit. Preoperative imaging showed a dAVF of the ACC. It was fed by the bilateral ascending pharyngeal artery, drained to the internal jugular vein (IJV) via the inferior petrosal sinus, and had an intraosseous shunt pouch. We therefore performed transvenous embolization (TVE) via the intercavernous sinus because the angle between the anterior condylar vein and the IJV was too sharp to catheterize vessels through the ipsilateral IJV., Conclusions: Understanding the inherently complex and individually unique venous anatomy of the ACC is crucial for treatment of dAVFs. BSCTA is an effective visualization technique for dAVFs of the ACC and allows for precise preoperative vascular structure evaluation. We suggest that in the case of the angle between the ACV and the IJV being too sharp to catheterize vessels through the ipsilateral IJV, TVE via the intercavernous sinus can be efficiently used., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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20. First case of a bloodstream infection caused by the genus Brachybacterium.
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Tamai K, Akashi Y, Yoshimoto Y, Yaguchi Y, Takeuchi Y, Shiigai M, Igarashi J, Hirose Y, Suzuki H, and Ohkusu K
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- Actinomycetales Infections blood, Actinomycetales Infections diagnosis, Actinomycetales Infections drug therapy, Aged, 80 and over, Anti-Infective Agents therapeutic use, Bacteremia blood, Bacteremia diagnosis, Bacteremia drug therapy, Biopsy, Needle, C-Reactive Protein analysis, Creatinine analysis, DNA, Bacterial genetics, Humans, Male, Micrococcaceae genetics, RNA, Ribosomal, 16S genetics, Actinomycetales Infections microbiology, Bacteremia microbiology, Lumbar Vertebrae pathology, Micrococcaceae isolation & purification
- Abstract
An 83-year-old previously self-sufficient man was referred to our hospital for a fever, severe tenderness over the lumbar spine, and elevated C-reactive protein levels. Computed tomography revealed fluid collection in the intervertebral space of L3/4. Gram-positive, short rod-shaped bacteria were isolated from two sets of blood cultures. A 16S rRNA sequence analysis of an isolate showed a similarity of 98.1% to the nearest type strain Brachybacterium squillarum JCM 16464
T . Biochemical characteristics of the presently isolated strain differed from those of the most closely related species of the genus Brachybacterium. The patient was successfully discharged on day 73 of admission with antimicrobial therapies and showed no recurrence during outpatient visits. Brachybacterium spp. have mainly been isolated from the environment, and human Brachybacterium infections have rarely been documented to date. To our knowledge, this is the first clinical isolation of Brachybacterium sp. as a causative pathogen of bloodstream infection., (Copyright © 2018. Published by Elsevier Ltd.)- Published
- 2018
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21. Implementation of Point-of-Care Molecular Diagnostics for Mycoplasma pneumoniae Ensures the Correct Antimicrobial Prescription for Pediatric Pneumonia Patients.
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Hayashi D, Akashi Y, Suzuki H, Shiigai M, Kanemoto K, Notake S, Ishiodori T, Ishikawa H, and Imai H
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- Adolescent, Anti-Bacterial Agents pharmacology, Child, Female, Humans, Macrolides pharmacology, Macrolides therapeutic use, Male, Quinolones pharmacology, Quinolones therapeutic use, Tetracycline pharmacology, Tetracycline therapeutic use, Time Factors, Anti-Bacterial Agents therapeutic use, Drug Prescriptions, Mycoplasma pneumoniae isolation & purification, Pathology, Molecular methods, Pneumonia drug therapy, Pneumonia microbiology, Point-of-Care Systems
- Abstract
Mycoplasma pneumoniae is a leading causative pathogen of pneumonia among pediatric patients, and its accurate diagnosis may aid in the selection of appropriate antimicrobial agents. We established a rapid reporting system of a polymerase chain reaction (PCR) examination for M. pneumoniae that enables physicians to obtain test results approximately 90 minutes after ordering the test. In this study, we evaluated the impact of this system on antimicrobial prescriptions for pediatric pneumonia patients after its implementation from May 2016 to April 2017. In total, we identified 375 pediatric pneumonia patients, and the results of the rapid PCR examinations for Mycoplasma pneumoniae were reported immediately in 90.7% of patients (340/375), with physicians able to use these results to decide on patients' management before the prescription of antimicrobial agents. Of the 375 pediatric pneumoniae patients, M. pneumoniae was detected in 223 (59.5%). Among the 223 M. pneumoniae-positive pneumonia cases, antimicrobial agents for atypical pathogens (macrolides, tetracyclines or quinolones) were prescribed in 97.3% (217/223) at the initial evaluation, and their prescription rates increased to 99.1% (221/223) during management. In contrast, antimicrobial agents for atypical pathogens were prescribed only in 10.5% of 152 M. pneumoniae-negative pneumonia cases at the initial evaluations, and only 1 additional case was prescribed clarithromycin for persistent symptoms during management. In conclusion, we show that molecular technology could be applicable in the field of point-of-care testing in infectious disease, and its implementation will ensure the correct antimicrobial prescription for pediatric pneumonia patients.
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- 2018
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22. [Dissecting Internal Carotid Aneurysm Causing Epistaxis:A Case Report].
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Kino H, Tsuruta W, Ito Y, Takigawa T, Shiigai M, Marushima A, Nakai Y, Yamamoto T, and Matsumura A
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- Aged, 80 and over, Carotid Artery, Internal, Cerebral Angiography, Female, Humans, Aortic Dissection complications, Aortic Dissection diagnostic imaging, Aneurysm, Ruptured, Carotid Artery Diseases complications, Carotid Artery Diseases diagnostic imaging, Epistaxis etiology, Intracranial Aneurysm complications, Intracranial Aneurysm diagnostic imaging
- Abstract
We report a rare case of a ruptured dissecting internal carotid aneurysm caused epistaxis without a history of trauma or infection. An 89-year-old woman experienced epistaxis and suffered from hemorrhagic shock at her previous hospital. Head computed tomography(CT)images revealed a ruptured internal carotid aneurysm protruding into the Onodi cell, the most posterior ethmoidal sinus, which extends superolaterally to the sphenoid sinus. Cerebral angiography demonstrated a multilobular-shaped dissecting aneurysm with a maximal diameter of 6.7mm at the cavernous portion of the internal carotid artery(ICA). Overlapping stenting was performed to prevent recanalization. However, a fatal subarachnoid hemorrhage occurred 2 days after the procedure due to the progression of the dissection to the intracranial ICA. The anatomical characteristics of the ethmoidal sinus could be associated with the occurrence of epistaxis. A ruptured small ICA aneurysm with an Onodi cell might cause epistaxis without a history of trauma or infection.
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- 2018
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23. Clinical features and seasonal variations in the prevalence of macrolide-resistant Mycoplasma pneumoniae .
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Akashi Y, Hayashi D, Suzuki H, Shiigai M, Kanemoto K, Notake S, Ishiodori T, Ishikawa H, and Imai H
- Abstract
Background: Mycoplasma pneumoniae is a common pathogen causing pneumonia; macrolide-resistant strains are rapidly spreading across Japan. However, the clinical features of macrolide-resistant M. pneumoniae pneumonia have not been well established. Here, we evaluated the clinical characteristics and seasonal variations in the prevalence of M. pneumoniae with macrolide-resistant mutations (MRM)., Methods: The monthly prevalence of MRM in M. pneumoniae strains isolated from May 2016 to April 2017 was retrospectively analyzed, and the clinical characteristics of pneumonia cases with MRM were compared to those of cases without MRM. The M. pneumoniae isolates and point mutations at site 2063 or 2064 in domain V of 23S rRNA were evaluated by the GENECUBE system and GENECUBE Mycoplasma detection kit., Results: Mycoplasma pneumoniae infection was identified in 383 cases, including 221 cases of MRM (57.7%). The MRM prevalence was 86.3% (44/51) between May and July 2016, demonstrating an apparent decrease in September 2016, subsequently reaching 43.0% (34/79) in November 2016. Mycoplasma pneumoniae pneumonia was diagnosed in 275 cases, including 222 pediatric and 53 adult cases. Macrolide use preceding evaluation was found to be the only feature of MRM pneumonia cases both in children (odds ratio [OR] 3.86, 95% confidence interval [CI]:1.72-8.66) and in adults (OR 7.43, 95% CI: 1.67-33.1)., Conclusions: The determination rate of MRM varied widely throughout the year, and our study demonstrated the challenges in predicting M. pneumoniae with MRM based on clinical features at diagnosis. Therefore, continuous monitoring of the prevalence of MRM is warranted, which may help in selecting an effective treatment.
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- 2018
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24. Endostapling the aberrant artery filled with embolized coils for intralobar pulmonary sequestration: a report of two cases.
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Sakai M, Ozawa Y, Konishi T, Watanabe A, and Shiigai M
- Abstract
Intrapulmonary sequestration is a rare congenital bronchopulmonary malformation. Surgery is generally standard treatment, and thoracoscopic resection has been accepted recently. Some patients have inflammatory change of the sequestrated lung and adhesion to the adjacent organs. In those cases, it is difficult to identify the aberrant artery. In thoracoscopic surgery cases, fatal intraoperative hemorrhage from the aberrant artery has been reported. We describe two patients with infected intralobar pulmonary sequestration who were treated by endostapling the aberrant artery filled with embolized coils. A 28-year-old man who had complained of right back pain and high fever was admitted to our hospital. The chest computed tomography (CT) scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the right lower lobe. An aberrant artery entered the consolidation from the celiac trunk. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery, which had a diameter of 10 mm and was filled with metallic coils. A 51-year-old woman who had complained of repeated pneumonia was admitted to our hospital. The chest CT scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the basal segment of the right lower lobe. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery arising from the right inferior phrenic artery, which had a diameter of 5 mm and was filled with coils. Both patients' clinical courses were uneventful postoperatively. Pathological examinations confirmed intralobar pulmonary sequestration with pneumonia. Endostapling with coils for treating the aberrant artery in pulmonary sequestration is a simple and safe technique of thoracoscopic resection. A coil-embolized artery can be identified easily in the inflamed, scarred pulmonary ligament, and intraoperative bleeding from the aberrant artery can be prevented., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2018
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25. Enlarged mediastinal air cyst in a patient with bronchial diverticula localized in the left main bronchus: a case report with surgical and bronchoscopic findings.
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Ichimura H, Ozawa Y, Shiigai M, Shiotani S, Kikuchi K, and Sato Y
- Abstract
Background: A mediastinal air cyst is a rare computed tomography (CT) finding. Once the lesion is identified, it is difficult to diagnose and treat. Meanwhile, bronchial diverticula have been reported as a CT finding observed in certain pulmonary pathologic conditions. We encountered the case of an enlarged mediastinal air cyst accompanied with bronchial diverticula and upper lobe-dominant fibrous changes of the lung., Case Presentation: A 69-year-old man with a chronic cough who had regularly visited a chest physician for upper lobe-dominant pulmonary fibrosis was referred to our hospital for the examination of an enlarged mediastinal air cyst. Chest CT exhibited an air cyst (size, 30 mm) connected to the lumen of the left main bronchus (LMB) and multiple tiny outpouches only on the LMB. Flexible bronchoscopy showed bubbling from slits or indentations of the bronchial mucosa only in the LMB but not in the right main bronchus or lobar bronchus. For therapeutic diagnosis, we removed the air cyst. Based on clinical, surgical, and pathological findings, we diagnosed the air cyst as an enlarged bronchial diverticulum., Conclusions: This is the first case wherein bronchoscopic and surgical findings of bronchial diverticula and an enlarged bronchial diverticulum are reported. There are possible pathogenic mechanisms in cases of pulmonary disease that are attributable to enlargement of the bronchial diverticula.
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- 2017
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26. [A Case of Ruptured Anterior Communicating Artery Aneurysm with Visual Field Defects and Deteriorating to Severe Vision Loss].
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Sakakura K, Ikeda G, Nakai Y, Watanabe N, Shiigai M, Uemura K, Yamamoto T, and Matsumura A
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- Aneurysm, Ruptured complications, Aneurysm, Ruptured surgery, Humans, Intracranial Aneurysm, Magnetic Resonance Imaging, Male, Middle Aged, Multimodal Imaging, Subarachnoid Hemorrhage etiology, Subarachnoid Hemorrhage surgery, Tomography, X-Ray Computed, Aneurysm, Ruptured diagnostic imaging, Subarachnoid Hemorrhage diagnostic imaging, Vision Disorders etiology
- Abstract
Although Terson's syndrome is a well-known cause of vision loss due to intracerebral aneurysm rupture, optic nerve neuropathy can also occur because of other causes. Here, we report such a case, i.e., a ruptured anterior communicating artery aneurysm accompanied by vision loss and visual field disturbances due to a cause other than Terson's syndrome. A 47-year-old man presented with right superior altitudinal hemianopia. Computed tomography (CT) showed subarachnoid hemorrhage (SAH), and three-dimensional CT angiography revealed an anterior communicating artery aneurysm. Coil embolization was performed. Right visual acuity degenerated to blindness in the acute stage. MRI performed on day 7 post-admission revealed that the aneurysm had swollen and made contact with the right optic disk. On the basis of the patient's clinical course, we believe that the deterioration in his visual acuity could have been due to ischemic optic neuropathy (ION) resulting from SAH, and the subsequent edema and poor blood perfusion may be attributed to spasm. In cases of visual disturbance associated with SAH, as in our case, it is important to perform MRI to evaluate the damage or risk to the optic nerve as soon as possible. (Received December 26, 2016; Accepted June 9, 2017; Published October 1, 2017).
- Published
- 2017
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27. [Dural Arteriovenous Fistula with Acute Visual Loss Manifestation:A Case Report].
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Goto M, Tsuruta W, Fujiwara Y, Ikeda G, Ito Y, Sugiura Y, Shiigai M, Nakai Y, Yamamoto T, and Matsumura A
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- Acute Disease, Aged, Central Nervous System Vascular Malformations complications, Central Nervous System Vascular Malformations therapy, Cerebral Angiography, Embolization, Therapeutic, Humans, Magnetic Resonance Imaging, Male, Transverse Sinuses, Central Nervous System Vascular Malformations diagnostic imaging, Vision Disorders etiology
- Abstract
In this report, we are describing a rare case of dural arteriovenous fistula(DAVF)followed by an isolated symptom of bilateral visual acuity disturbance. The patient was a 67-year-old man suffering from progressive bilateral visual acuity disturbance. Angiography revealed a diffuse arteriovenous fistula in the left transverse-sigmoid sinus affected by severe venous congestion. Visual acuity disturbance is likely to have been caused by increased intracranial pressure(IICP). Venous congestion as well as visual acuity were gradually improved following three transarterial embolizations. It is possible that a gradual progression of the clinical condition has caused only visual acuity disturbance without any other IICP symptoms, which is similar to pseudotumor cerebri. Should an unexplained visual acuity loss occur, the case should be investigated by considering DAVF.
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- 2016
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28. [A Case of Spontaneous Putaminal Hemorrhage Responsible for the Rupture of Charcot Artery].
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Sakakura K, Ikeda G, Shiigai M, Nakai Y, Watanabe N, Uemura K, Yamamoto T, and Matsumura A
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- Cerebral Angiography, Computed Tomography Angiography, Humans, Male, Middle Aged, Arteries diagnostic imaging, Putaminal Hemorrhage diagnostic imaging, Rupture diagnostic imaging
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- 2016
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29. Spontaneous Hemoperitoneum in Pregnancy Treated with Transarterial Embolization of the Uterine Artery.
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Konishi T, Mori K, Uchikawa Y, Hoshiai S, Shiigai M, Ohara R, and Minami M
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- Adult, Female, Hemoperitoneum diagnostic imaging, Humans, Pregnancy, Pregnancy Complications diagnostic imaging, Tomography, X-Ray Computed, Treatment Outcome, Embolization, Therapeutic methods, Hemoperitoneum therapy, Pregnancy Complications therapy, Uterine Artery diagnostic imaging
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- 2016
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30. Double Coaxial Microcatheter Technique for Glue Embolization of Renal Arteriovenous Malformations.
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Uchikawa Y, Mori K, Shiigai M, Konishi T, Hoshiai S, Ishigro T, Hiyama T, Nakai Y, and Minami M
- Subjects
- Adhesives therapeutic use, Adult, Aged, Arteriovenous Malformations diagnostic imaging, Contrast Media, Female, Humans, Iodized Oil, Kidney diagnostic imaging, Male, Middle Aged, Radiography, Treatment Outcome, Arteriovenous Malformations therapy, Embolization, Therapeutic instrumentation, Embolization, Therapeutic methods, Enbucrilate therapeutic use
- Abstract
Purpose: To demonstrate the technical benefit of the double coaxial microcatheter technique for embolization of renal arteriovenous malformations (AVMs) with n-butyl cyanoacrylate and iodized oil (glue)., Materials and Methods: Six consecutive patients (1 man and 5 women; mean age 61 years; range 44-77 years) with renal AVMs were included. Five patients had hematuria, and one had a risk of heart failure due to a large intrarenal arteriovenous shunt. All patients underwent transarterial embolization using glue and the double coaxial microcatheter technique with outer 2.6F and inner 1.9F microcatheters. After glue injection, the inner microcatheter was retracted, while the outer microcatheter was retained. We assessed the complications and clinical outcomes of this technique., Results: Technical success was achieved in all patients. In 9 sessions, 34 feeding arteries were embolized with glue using the double coaxial microcatheter technique, 1 was embolized with glue using a single microcatheter, and 2 were embolized with coils. The double coaxial microcatheter technique was useful for selecting small tortuous feeding arteries, preventing glue reflux to the proximal arteries, and approaching multiple feeding arteries without complete retraction of the microcatheters. As a minor complication, glue migrated into the venous system in four patients without any sequelae. In all patients, favorable clinical outcomes, including hematuria cessation in five patients and improvement of the large intrarenal arteriovenous shunt in one patient, were obtained without deterioration of renal function., Conclusion: Glue embolization with the double coaxial microcatheter technique was useful for treating renal AVMs with multiple tortuous feeding arteries.
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- 2015
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31. [A Case of Traumatic Carotid Cavernous Fistula Treated with a Single Procedure Selective Transarterial Embolization Using Hydrogel Coils].
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Matsumura H, Ito Y, Nakai Y, Nakamura K, Shiigai M, Tsuruta W, Uemura K, and Matsumura A
- Subjects
- Adult, Carotid-Cavernous Sinus Fistula diagnosis, Cerebral Angiography methods, Humans, Hydrogel, Polyethylene Glycol Dimethacrylate, Male, Treatment Outcome, Arteriovenous Fistula therapy, Carotid Arteries surgery, Carotid-Cavernous Sinus Fistula therapy, Cavernous Sinus surgery, Embolization, Therapeutic methods
- Abstract
A 30-year-old man was admitted to our hospital after a bicycle accident. Proptosis, conjunctival congestion, and orbital vascular bruit appeared one month after the accident. Neuroradiological findings showed a traumatic carotid cavernous fistula(CCF). CCF is a pathologic arteriovenous shunt between the carotid artery and cavernous sinus. A detachable balloon was the standard device used for treatment of high flow direct CCF, although it is currently unavailable in Japan. Therefore, many other constructive strategies are being developed. We successfully treated this patient with single transarterial embolization using hydrogel coils. Hydrogel coils are platinum coils coated with polymeric water gels, and can be used at a prospect of delayed volume expansion. In our case, the patency of the internal carotid artery was maintained using the coils, and the symptoms improved shortly after the procedure. The use of hydrogel coils for the treatment of CCF appears to be safe and effective.
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- 2015
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32. Optic chiasmal edema observed on T2-weighted MR images: a reversible finding in obstructive hydrocephalus.
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Hiyama T, Masumoto T, Shiigai M, Akutsu H, Matsumura A, and Minami M
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Brain Edema diagnosis, Hydrocephalus diagnosis, Magnetic Resonance Imaging methods, Optic Chiasm
- Abstract
Purpose: To evaluate the clinical significance of optic chiasmal edema (OCE) observed in hydrocephalus., Materials and Methods: Twenty patients with obstructive hydrocephalus and eight patients with communicating hydrocephalus were recruited. We classified both groups into OCE-positive and negative subgroups on three-dimensional T2-weighted images. In the obstructive hydrocephalus group, the pre- and postoperative periventricular hyperintensity (PVH) grade, Evans index, and third ventricle diameter were compared between the subgroups. The visual disturbances were reviewed in the medical records., Results: Eleven obstructive hydrocephalus patients (55 %) had OCE, while none of communicating hydrocephalus patients did. OCE was improved in all patients postoperatively. Preoperative PVH grade was significantly higher in the OCE-positive subgroup (p < 0.01). There were no statistically significant differences in the other indices. Visual disturbances were observed in two OCE-negative patients alone., Conclusion: OCE is a reversible finding frequently observed in obstructive hydrocephalus and may not be associated with visual disturbances.
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- 2015
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33. Usefulness of subtraction of 3D T2WI-DRIVE from contrast-enhanced 3D T1WI: preoperative evaluations of the neurovascular anatomy of patients with neurovascular compression syndrome.
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Masuda Y, Yamamoto T, Akutsu H, Shiigai M, Masumoto T, Ishikawa E, Matsuda M, and Matsumura A
- Subjects
- Adult, Aged, Female, Hemifacial Spasm diagnostic imaging, Humans, Magnetic Resonance Angiography methods, Male, Middle Aged, Radiography, Retrospective Studies, Trigeminal Neuralgia diagnostic imaging, Image Interpretation, Computer-Assisted methods, Imaging, Three-Dimensional methods, Nerve Compression Syndromes diagnostic imaging, Neuroimaging methods
- Abstract
Background and Purpose: High-resolution 3D MR cisternography techniques such as 3D T2WI-driven equilibrium radiofrequency reset pulse (DRIVE) are used preoperatively to assess neurovascular anatomy in patients with neurovascular compression syndrome, but contrast between vessels and cranial nerves at the point of neurovascular contact is limited. The postprocessing technique subtraction of 3D T2WI-driven equilibrium radiofrequency reset pulse from contrast-enhanced 3D T1WI (sDRICE) provides both high spatial resolution and excellent contrast in depicting the neurovascular contact. We evaluated the usefulness of sDRICE compared with 3D T2WI-DRIVE., Materials and Methods: Twelve patients who underwent microvascular decompression for hemifacial spasm or trigeminal neuralgia were examined preoperatively with 3D T2WI-DRIVE and sDRICE. Two neuroradiologists retrospectively analyzed and scored lesion conspicuity, defined as the ease of discrimination between offending vessels and compressed nerves or the brain stem at the neurovascular contact. They also quantitatively analyzed the contrast and contrast-to-noise ratio at the neurovascular contact., Results: The lesion conspicuity scores of sDRICE images were significantly higher than those of 3D T2WI-DRIVE for all 12 patients (P = .006) and the 6 cases of hemifacial spasm (P = .023) but were not significantly higher in the 6 trigeminal neuralgia cases alone (P = .102). For all 12 patients, the contrast-to-noise ratio between the offending vessels and the brain stem and between the vessels and nerves on sDRICE images was significantly higher than that on 3D T2WI-DRIVE (P = .003 and P = .007, respectively). Among these structures, the contrast values were also significantly higher on the sDRICE than on the 3D T2WI-DRIVE (P < .001) images., Conclusions: The postprocessing technique sDRICE is useful to evaluate neurovascular anatomy and to improve contrast and the contrast-to-noise ratio in patients with neurovascular compression syndrome., (© 2015 by American Journal of Neuroradiology.)
- Published
- 2015
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34. Pararenal Lymphatic Cyst Infection Caused by Helicobacter cinaedi.
- Author
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Akashi Y, Igarashi J, Suzuki H, Rimbara E, Shibayama K, Nin S, Tamai K, Yaguchi Y, Shiigai M, Oikawa T, and Suzuki M
- Subjects
- Adult, Bacteremia drug therapy, Bacteremia microbiology, Ceftriaxone therapeutic use, Helicobacter genetics, Helicobacter isolation & purification, Helicobacter Infections drug therapy, Helicobacter Infections microbiology, Humans, Japan, Lymphocele diagnostic imaging, Male, Multilocus Sequence Typing, RNA, Ribosomal, 16S genetics, Radiography, Bacteremia diagnosis, Helicobacter Infections diagnosis, Lymphocele diagnosis
- Abstract
A 43-year-old man was referred to our hospital for an acute-onset fever and left flank pain. He had been previously diagnosed with lymphangioma, and abdominal computed tomography showed pararenal cysts with fat stranding around the left kidney, of which infection was subsequently confirmed on magnetic resonance imaging. Gram-negative spiral bacilli were isolated from two sets of blood cultures, and Helicobacter cinaedi was identified using 16S rRNA sequencing. The patient was successfully treated with ceftriaxone therapy without recurrence. A multilocus sequence typing analysis indicated the current H. cinaedi strain differed from previous strains isolated in Japan.
- Published
- 2015
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35. Anatomical risk factors for ischemic lesions associated with carotid artery stenting.
- Author
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Ikeda G, Tsuruta W, Nakai Y, Shiigai M, Marushima A, Masumoto T, Tsurushima H, and Matsumura A
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- Aged, Aged, 80 and over, Brain Ischemia epidemiology, Carotid Artery, Common diagnostic imaging, Carotid Artery, Common pathology, Carotid Artery, Internal diagnostic imaging, Carotid Artery, Internal pathology, Diffusion Magnetic Resonance Imaging, Female, Humans, Magnetic Resonance Angiography, Male, Retrospective Studies, Risk Factors, Treatment Outcome, Brain Ischemia etiology, Carotid Arteries diagnostic imaging, Stents adverse effects
- Abstract
The purpose of this study was to investigate the anatomical risk factors for ischemic lesions detected by diffusion-weighted imaging (DWI) associated with carotid artery stenting (CAS). DWI was performed within four days after CAS in 50 stenotic lesions between January 2008 and September 2013. We retrospectively analyzed the correlation between the anatomical factors and ischemic lesions associated with CAS. Post-procedural DWI revealed new ischemic lesions after 24 (48%) of the 50 CAS procedures. All three patients with common carotid artery tortuosity, defined as the presence of severe angulation (less than 90 degrees) in the common carotid artery, developed new ischemic lesions. However, there were no significant differences between the patients with and without tortuosity, likely due to the small number of cases. Meanwhile, seven of eight patients with internal carotid artery tortuosity, defined as the presence of severe angulation (less than 90 degrees) in the cervical segment of the internal carotid artery, developed new ischemic lesions. A multivariate analysis showed internal carotid artery tortuosity (odds ratio: 11.84, 95% confidence interval: 1.193-117.4, P= 0.035) to be an independent risk factor for the development of ischemic lesions associated with CAS. Anatomical factors, particularly severe angulation of the internal carotid artery, have an impact on the risk of CAS. The indications for CAS should be carefully evaluated in patients with these factors.
- Published
- 2014
- Full Text
- View/download PDF
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