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Neurologia Medico-chirurgica

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https://www.readbyqxmd.com/read/28070115/proposal-for-a-prospective-registry-for-moyamoya-disease-in-japan
#1
Ken Kazumata, Masaki Ito, Haruto Uchino, Hiroshi Nishihara, Kiyohiro Houkin
The number of clinical research papers published worldwide on moyamoya disease (MMD) has increased recently. However, the majority of the literature comprises retrospective single-center studies collecting data on small numbers of patients. Several multi-center studies are ongoing in Japan; however, the current data are insufficient for comprehensively outlining the various characteristics of MMD. To enhance our knowledge on epidemiologic, vascular, and genetic aspects of MMD, a prospective multicenter registry will be established in Japan that will help to streamline clinical research as well as improve clinical treatments and long-term outcomes...
January 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28070114/development-of-database-and-genomic-medicine-for-von-hippel-lindau-disease-in-japan
#2
Shunsaku Takayanagi, Akitake Mukasa, Hirofumi Nakatomi, Hiroshi Kanno, Jun-Ichi Kuratsu, Ryo Nishikawa, Kazuhiko Mishima, Atushi Natsume, Toshihiko Wakabayashi, Kiyohiro Houkin, Shunsuke Terasaka, Masahiro Yao, Nobuo Shinohara, Taro Shuin, Nobuhito Saito
von Hippel-Lindau (VHL) disease is a hereditary tumor disease in which tumors develop in multiple organs, not only as hemangioblastomas (HBs) in the central nervous system, but also as kidney tumors, pheochromocytomas, and so on. Much about the epidemiology of VHL disease remained unknown until fairly recently in Japan, leading to calls for the establishment of a VHL disease epidemiological database in Japanese. To elucidate its epidemiology in Japan, the Japanese Ministry of Health, Labour and Welfare created the VHL Disease Study Group, which was put in charge of carrying out a nationwide epidemiological survey...
January 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28025467/mechanical-thrombectomy-using-the-trevo-provue-in-50-consecutive-patients-with-anterior-circulation-stroke-a-single-center-experience-after-approval-of-the-stent-retriever-in-japan
#3
Taichiro Imahori, Kazuhiro Tanaka, Junji Koyama, Atsushi Arai, Ryoji Shiomi, Hirofumi Iwahashi, Akiyoshi Yokote, Kazushi Matsushima, Daisaku Matsui, Makoto Kobayashi, Atsushi Fujita, Kohkichi Hosoda, Eiji Kohmura
Mechanical thrombectomy using the stent retriever has been proven to be effective for select patients with acute ischemic stroke. We evaluated our early experience using the device after its approval in 2014 in Japan, with a special emphasis on the occlusion site. Fifty consecutive endovascular revascularization procedures for treating anterior acute large vessel occlusion were performed using the Trevo ProVue as the first-line device at our institute between April 2015 and March 2016. Focusing on the involvement of the M1-M2 bifurcation with deployment or retrieval of the stent retriever, we regarded the middle cerebral artery M1 mid-portion as the boundary and divided the cases into proximal (n = 26) and distal (n = 24) groups...
December 27, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28025426/life-and-medical-ethics-in-pediatric-neurosurgery
#4
Mami Yamasaki
Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child's condition accurately and evaluate the outcome...
December 26, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28003570/correlations-between-cognitive-impairments-and-employment-status-in-patients-with-diffuse-axonal-injury
#5
Shin Hirota, Motoki Inaji, Tadashi Nariai, Mutsuya Hara, Masashi Tamaki, Taketoshi Maehara, Hiroki Tomita, Osamu Tone
Patients with diffuse axonal injury (DAI) may initially present with prominent physical impairments, but their cognitive dysfunctions are more persistent and are attributable to later unemployment. In this study, we analyzed how the findings of early and delayed neuropsychological assessments correlated with employment outcome of patients with DAI. A total of 56 patients with DAI without motor or visual dysfunction were included in this study. The neuropsychological battery consisted of the Wechsler Adult Intelligent Scale - Revised (WAIS-R), Wechsler Memory Scale - Revised (WMS-R), Trail Making Test (TMT), Wisconsin Card Sorting Test (WCST), and Word Fluency Test (WFT)...
December 22, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27980285/convection-enhanced-delivery-of-therapeutics-for-malignant-gliomas
#6
Ryuta Saito, Teiji Tominaga
Convection-enhanced delivery (CED) circumvents the blood-brain barrier by delivering agents directly into the tumor and surrounding parenchyma. CED can achieve large volumes of distribution by continuous positive-pressure infusion. Although promising as an effective drug delivery method in concept, the administration of therapeutic agents via CED is not without challenges. Limitations of distribution remain a problem in large brains, such as those of humans. Accurate and consistent delivery of an agent is another challenge associated with CED...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27980284/roles-of-the-wada-test-and-functional-magnetic-resonance-imaging-in-identifying-the-language-dominant-hemisphere-among-patients-with-gliomas-located-near-speech-areas
#7
Tatsuya Ishikawa, Yoshihiro Muragaki, Takashi Maruyama, Kayoko Abe, Takakazu Kawamata
This study examined the accuracy of functional magnetic resonance imaging (fMRI) in identifying the language-dominant hemisphere and the situations in which the Wada test can be skipped among patients with gliomas located near speech areas. We examined 74 patients [48 men (64.9%); mean ± standard deviation age of 42.7 ± 13.6 years (range: 13 to 70 years); 71 right-handed, 2 left-handed, and 1 ambidextrous] with gliomas located near speech areas. All patients underwent the Wada test and fMRI, and 34 patients underwent awake surgery...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27928096/extremely-late-recurrence-21-years-after-total-removal-of-immature-teratoma-a-case-report-and-literature-review
#8
Yui Mano, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Yukihiko Sonoda, Teiji Tominaga
Immature teratoma (IMT) is normally treated by resection and adjuvant therapy. The present unusual case of recurrent germinoma occurred 21 years after total resection of pineal IMT. A 3-year-old boy presented with headache, disturbance of consciousness, and Parinaud's syndrome. Magnetic resonance (MR) imaging revealed a pineal mass lesion, and total resection of the tumor was achieved. The histological diagnosis was mature teratoma. He did not receive further treatment, and did well without recurrence for 20 years...
December 7, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27725522/treatment-result-in-the-initial-stage-of-kanazawa-mobile-embolectomy-team-for-acute-ischemic-stroke
#9
Naoyuki Uchiyama, Kouichi Misaki, Masanao Mohri, Tomoya Kamide, Yuichi Hirota, Ryo Higashi, Hisato Minamide, Yukihiko Kohda, Takashi Asahi, Katsuo Shoin, Masayuki Iwato, Daisuke Kita, Yoshitaka Hamada, Yuya Yoshida, Mitsutoshi Nakada
Five recent multicenter randomized controlled trials (RCTs) have clearly shown the superiority of mechanical thrombectomy in large vessel occlusion acute ischemic stroke compared to systemic thrombolysis. Although 14 hospitals in Ishikawa prefecture have uninterrupted availability of systemic thrombolysis, mechanical thrombectomy is not available at all of these hospitals. Therefore, we established a Kanazawa mobile embolectomy team (KMET), which could travel to these hospitals and perform the acute reperfusion therapy...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27432512/safety-and-effectiveness-of-drip-ship-and-retrieve-paradigm-for-acute-ischemic-stroke-a-single-center-experience
#10
Nagayasu Hiyama, Shinichi Yoshimura, Manabu Shirakawa, Kazutaka Uchida, Yoshiharu Oki, Seigo Shindo, Kou Tokuda
: This study analyzed the efficacy and safety of the "drip, ship, and retrieve (DSR)" approach used to improve patient access to thrombectomy for acute stroke. METHODS: The study participants were 45 patients who underwent thrombectomy following intravenous tissue plasminogen activator between September 2013 and August 2015. Patients were divided into two groups according to whether they were transferred from another hospital (DSR group; n = 33) or were brought in directly (Direct group; n = 12)...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27385058/door-to-needle-time-under-60-minutes-and-picture-to-puncture-under-90-minutes-initiatives-and-outcomes-in-reducing-time-to-recanalization-for-cerebral-major-artery-occlusion
#11
Takahiro Ota, Masayuki Sato, Tatsuo Amano, Yuji Matsumaru
The adoption of stent retrievers has significantly improved outcomes of intravenous treatment for acute stroke due to major artery occlusion, and reducing the time to recanalization may achieve further improvements. We reviewed reductions in "door-to-needle time" (DNT) and "picture-to-puncture time" (P2P), as the results of measures to consolidate stroke response capabilities in our hospital, and compared treatment outcomes in acute recanalization patients. We investigated DNT by the route of admission for 96 consecutive patients who received intravenous tissue plasminogen activator between July 2012 and June 2015...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27357086/histopathological-findings-in-brains-of-patients-who-died-in-the-acute-stage-of-poor-grade-subarachnoid-hemorrhage
#12
Junichiro Satomi, Hiromu Hadeishi, Yasuji Yoshida, Akifumi Suzuki, Shinji Nagahiro
Patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) are likely to die due to irreversible acute-stage primary brain damage. However, the mechanism(s) and pathology responsible for their high mortality rate remain unclear. We report our findings on the brains of individuals who died in the acute stage of SAH. An autopsy was performed on the brains of 11 SAH patients (World Federation of Neurosurgical Societies grade 5) who died within 3 days of admission and who did not receive respiratory assistance...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27333939/drip-and-ship-thrombolytic-therapy-supported-by-the-telestroke-system-for-acute-ischemic-stroke-patients-living-in-medically-under-served-areas
#13
Teruyoshi Kageji, Fumiaki Obata, Hirofumi Oka, Yasuhisa Kanematsu, Ryo Tabata, Kenji Tani, Hiroyasu Bando, Shinji Nagahiro
There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Prefectural Kaifu Hospital (TPKH), located in rural Japan, can relay CT or MRI scans and other patient data via their smart phone to off-site stroke specialists...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27319302/comparison-of-flow-impairment-during-carotid-artery-stenting-using-two-types-of-eccentric-filter-embolic-protection-devices
#14
Kouhei Nii, Masanori Tsutsumi, Hitoshi Maeda, Hiroshi Aikawa, Ritsuro Inoue, Ayumu Eto, Kimiya Sakamoto, Takafumi Mitsutake, Hayatsura Hanada, Kiyoshi Kazekawa
We investigated the angiographic findings and the clinical outcomes after carotid artery stenting (CAS) using two different, eccentric filter embolic protection devices (EPDs). Between July 2010 and August 2015, 175 CAS procedures were performed using a self-expandable closed-cell stent and a simple eccentric filter EPD (FilterWire EZ in 86 and Spider FX in 89 procedures). The angiographic findings (i.e., flow impairment and vasospasm) at the level of EPDs, neurologic events, and post-operative imaging results were compared between the FilterWire EZ and the Spider FX groups...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27194178/ultrasound-guided-femoral-artery-access-for-minimally-invasive-neuro-intervention-and-risk-factors-for-access-site-hematoma
#15
Kota Kurisu, Toshiya Osanai, Ken Kazumata, Naoki Nakayama, Takeo Abumiya, Hideo Shichinohe, Yusuke Shimoda, Kiyohiro Houkin
Although ultrasound (US) guidance for venous access is becoming the "standard of care" for preventing access site complications, its feasibility for arterial access has not been fully investigated, especially in the neuro-interventional population. We conducted the first prospective cohort study on US-guided femoral artery access during neuro-interventional procedure. This study included 64 consecutive patients who underwent US-guided femoral artery access through 66 arterial access sites for diagnostic and/or neuro-interventional purposes...
December 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27680330/status-and-future-perspectives-of-utilizing-big-data-in-neurosurgical-and-stroke-research
#16
Ataru Nishimura, Kunihiro Nishimura, Akiko Kada, Koji Iihara
The management, analysis, and integration of Big Data have received increasing attention in healthcare research as well as in medical bioinformatics. The J-ASPECT study is the first nationwide survey in Japan on the real-world setting of stroke care using data obtained from the diagnosis procedure combination-based payment system. The J-ASPECT study demonstrated a significant association between comprehensive stroke care (CSC) capacity and the hospital volume of stroke interventions in Japan; further, it showed that CSC capabilities were associated with reduced in-hospital mortality rates...
November 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27680329/current-trends-and-healthcare-resource-usage-in-the-hospital-treatment-of-primary-malignant-brain-tumor-in-japan-a-national-survey-using-the-diagnostic-procedure-combination-database-j-aspect-study-brain-tumor
#17
Koji Yoshimoto, Akiko Kada, Daisuke Kuga, Ryusuke Hatae, Hideki Murata, Yojiro Akagi, Kunihiro Nishimura, Ryota Kurogi, Ataru Nishimura, Nobuhiro Hata, Masahiro Mizoguchi, Tetsuro Sayama, Koji Iihara
We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed...
November 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27666343/combination-of-palonosetron-aprepitant-and-dexamethasone-effectively-controls-chemotherapy-induced-nausea-and-vomiting-in-patients-treated-with-concomitant-temozolomide-and-radiotherapy-results-of-a-prospective-study
#18
Masahide Matsuda, Tetsuya Yamamoto, Eiichi Ishikawa, Hiroyoshi Akutsu, Shingo Takano, Akira Matsumura
Concomitant use of temozolomide (TMZ) and radiotherapy, which is the standard therapy for patients with high-grade glioma, involves a unique regimen with multiple-day, long-term administration. In a previous study, we showed not only higher incidence rates of chemotherapy-induced nausea and vomiting (CINV) during the overall study period, but also substantially higher incidence rates of moderate/severe nausea and particularly severe appetite suppression during the late phase of the treatment. Here, we prospectively evaluated the efficacy of a combination of palonosetron, aprepitant, and dexamethasone for CINV in patients treated with concomitant TMZ and radiotherapy...
November 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27616319/enhancing-neurosurgical-education-in-low-and-middle-income-countries-current-methods-and-new-advances
#19
Kevin E Liang, Ilia Bernstein, Yoko Kato, Takeshi Kawase, Mojgan Hodaie
Low- and middle-income countries (LMICs) face a critical shortage of basic surgical services. Adequate neurosurgical services can have a far-reaching positive impact on society's health care and, consequently, the economic development in LMICs. Yet surgery, and specifically neurosurgery has been a long neglected sector of global health. This article reviews the current efforts to enhance neurosurgery education in LMICs and outlines ongoing approaches for improvement. In addition, we introduce the concept of a sustainable and cost-effective model to enhance neurosurgical resources in LMICs and describe the process and methods of online curriculum development...
November 15, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27302300/working-conditions-and-lifestyle-of-female-surgeons-affiliated-to-the-japan-neurosurgical-society-findings-of-individual-and-institutional-surveys
#20
Takamitsu Fujimaki, Soichiro Shibui, Yoko Kato, Akira Matsumura, Mami Yamasaki, Isao Date, Kazuhiro Hongo, Satoshi Kuroda, Mitsunori Matsumae, Naoyuki Nakao, Kaori Sakurada, Shoko Shimokawa, Takamasa Kayama
To investigate the working conditions of female neurosurgeons in Japan, two surveys were conducted by The Japan Neurosurgical Society: one involving female neurosurgeons themselves and the other involving the chiefs of neurosurgical departments. The responses were received from 224 (43.8%) female neurosurgeons and 496 (61.2%) departmental chiefs. About half (50.2%) of the female neurosurgeons were married and 39.2% had children (average number of children, 1.27). Their work was full-time in 80.6% of cases; on average, they worked 51...
November 15, 2016: Neurologia Medico-chirurgica
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