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Katsutoshi Takayama,
Toshiaki Taoka,
Hiroyuki Nakagawa,
Kaoru Myouchin,
Takeshi Wada,
Toshiteru Miyasaka,
Masahiko Sakamoto,
Akio Fukusumi,
Satoru Iwasaki, Ryota Kimura,
Shinichiro Kurokawa,
Kimihiko Kichikawa
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ABSTRACT: The Carotid WALLSTENT (CWS) and Filter-Wire EZ (FWEZ) embolic protection devices for use in carotid arterial stenting (CAS) were newly approved for national health insurance coverage in Japan in April 2010. This article describes our initial experience of CAS using the CWS and FWEZ.
A group of 14 patients (12 men, 2 women; mean age 70.1 years, range 59-83 years) with 15 carotid artery stenoses at high risk for carotid endarterectomy were treated by CAS using the CWS and FWEZ. Of these stenoses, 5 were symptomatic with ≥50% stenosis of the common or internal carotid artery (ICA), and 10 were asymptomatic with ≥80% stenosis. The rates of technical success, ICA flow impairment during filter protection, periprocedural ischemic stroke, 30-day major adverse events (MAEs) (stroke, death, myocardial infarction), and development of new ischemic lesions on diffusion-weighted imaging (DWI) were assessed.
CAS was successful in all cases. There was no ICA flow impairment, periprocedural ischemic stroke, or MAEs. DWI showed new ipsilateral ischemic lesions in only one patient (6.7%).
Our initial clinical experience using the CWS and FEWZ for CAS was generally excellent, and the incidence of postprocedural ischemic lesions was low.
Japanese journal of radiology 01/2011; 29(1):51-8. · 0.65 Impact Factor
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ABSTRACT: Collagen XVIII is a component of the highly specialized extracellular matrix associated with basement membranes of epithelia and endothelia. In the normal kidney, collagen XVIII is distributed throughout glomerular and tubular basement membranes, mesangial matrix, and Bowman's capsule. Proteolytic cleavage within its C-terminal domain releases the fragment endostatin, which has antiangiogenic properties. Because damage to the glomerular basement membrane (GBM) accompanies immune-mediated renal injury, we investigated the role of collagen XVIII/endostatin in this disorder. We induced anti-GBM glomerulonephritis in collagen XVIII alpha1-null and wild-type mice and compared the resulting matrix accumulation, inflammation, and capillary rarefaction. Anti-GBM disease upregulated collagen XVIII/endostatin expression within the GBM and Bowman's capsule of wild-type mice. Collagen XVIII/endostatin-deficient mice developed more severe glomerular and tubulointerstitial injury than wild-type mice. Collagen XVIII/endostatin deficiency altered matrix remodeling, enhanced the inflammatory response, and promoted capillary rarefaction and vascular endothelial cell damage, but did not affect endothelial proliferation. Supplementing collagen XVIII-deficient mice with exogenous endostatin did not affect the progression of anti-GBM disease. Taken together, these results suggest that collagen XVIII/endostatin preserves the integrity of the extracellular matrix and capillaries in the kidney, protecting against progressive glomerulonephritis.
Journal of the American Society of Nephrology 09/2010; 21(9):1445-55. · 9.66 Impact Factor
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ABSTRACT: To introduce reliable and minimally invasive virtual surgical planning for superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery using three-dimensional (3-D) rotational reconstruction digital subtraction angiography (DSA).
Twenty-eight consecutive patients (11 women and 17 men) with cerebrovascular insufficiency due to internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion (n = 16), ICA or MCA stenosis (n = 6), and moyamoya or moyamoya-like disease (n = 6) underwent rotational DSA. Anatomical locations of the appropriate donor branch of the STA, the most suitable recipient of MCA and squamous sutures on the skull surface, were visualized using 3-D reconstruction imaging. Localization of the minicraniotomy, the skin incision on top of the superficial temporal artery branch, and the anastomosis point were accurately determined by virtual surgical planning.
According to preoperative assessments, the minimum necessary skin incision and small craniotomy were successfully achieved. The preselected artery was found without additional craniotomy and anastomosed at the putative point in all patients. Perioperative complications did not arise and all bypasses remained patent on follow-up.
Preoperative 3-D virtual surgical planning assessments are exactly consistent with operative findings. Such assessments avoid unnecessary manipulation and simplify the surgical procedure. This imaging technique is helpful for planning STA-MCA bypass surgery.
Acta Neurochirurgica 05/2010; 152(9):1535-40; discussion 1541. · 1.52 Impact Factor
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ABSTRACT: Aristolochic acid (AA) nephropathy, first reported as Chinese herbs nephropathy, is a rapidly progressive tubulointerstitial nephropathy that results in severe anemia, interstitial fibrosis and end-stage renal disease. Tubulointerstitial injury was studied in a mouse model of AA nephropathy to determine whether low-dose darbepoetin alpha (DPO) treatment prevents acute tubular necrosis and interstitial fibrosis.
AA was administered to C3H/He mice intraperitoneally and some mice were also treated with 0.1 microg/kg of DPO weekly starting on the day of AA administration or on day 28. At 28, 56 or 84 days, blood and urine samples were collected and mice were sacrificed for histological assessment of the kidneys.
AA-treated mice developed anemia, elevation of serum creatinine, severe tubular injury similar to acute tubular necrosis and progressive interstitial fibrosis. Although early treatment with low-dose DPO had minimal effects on the hematocrit, it significantly ameliorated acute tubular injury and interstitial inflammation through increasing the survival of tubular cells. As a result, it contributed to preservation of peritubular capillaries and reduction of interstitial fibrosis.
Low-dose DPO treatment conferred protection against acute tubular damage and attenuated interstitial fibrosis in a mouse model of AA nephropathy. Early administration of low-dose DPO may prevent the progression of acute tubular necrosis and the subsequent renal fibrosis in human AA nephropathy.
Nephron Experimental Nephrology 11/2009; 114(2):e69-81. · 1.86 Impact Factor
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Ryosuke Matsuda,
Yasushi Motoyama,
Yasuhiro Takeshima, Ryota Kimura,
Junichi Iida,
Mitsutoshi Nakamura,
Hideaki Mishima,
Young-Su Park,
Hidehiro Hirabayashi,
Hiroyuki Nakase,
Toshisuke Sakai
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ABSTRACT: A 68-year-old woman was referred t o our urological department with the complaint of hematuria and right abdominal mass. Contrast-enhanced computed tomography (CT) revealed renal tumor and multiple lung metastases. Right nephroureterectomy was performed. Pathological examination was transitional cell carcinoma. After nephroureterectomy, combination chemotherapy consisting of methotrexate, doxorubicin and cisplatin was performed. Oral administration of tegafur was continued outside the hospital. Eight months after the nephroureterectomy, she suffered from left hemiconvulsion and was transferred to our hospital. Contrast-enhanced CT of the head revealed a heterogeneous enhancement tumor in the parietal lobe. Surgical resection was performed by right parietal craniotomy. Because the tumor was invasive in the superior sagittal sinus, subtotal removal of the tumor was performed. Pathological examination indicated transitional cell carcinoma the same feature as in the renal pelvis. After surgical resection, she was treated by gamma knife stereotactic radiosurgery. She returned to ordinary life, but 7 months later tumor recurrence took place. Repeated surgical resection and stereotactic radiosurgery was performed, but she died 44 months after the initial nephroureterectomy due to the relapse of brain metastasis. Brain metastasis of renal pelvic carcinoma is extremely rare, and we have found only three case reports. We describe the course of our patient, and review the three cases of brain metastasis of renal pelvic carcinoma that are in the literature.
No shinkei geka. Neurological surgery 03/2009; 37(2):179-82. · 0.13 Impact Factor
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ABSTRACT: To date the severity of the consequences of venous occlusion on the brain has been underestimated in neurosurgical practice.
However, recently much attention has been paid to brain injury following cerebral venous circulation disturbances (CVCDs)
as a result of the increasing number of neurosurgical operations for aged patients and the development of skull base neurosurgery
[1–5].
12/2005: pages 181-185;
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ABSTRACT: Ruptured de novo aneurysms, compared with the usual subarachnoid hemorrhage, commonly occur in younger patients and are extremely rare in elderly patients. We discuss their etiology and report the case of a ruptured de novo aneurysm in a 77-year-old woman.
American Journal of Neuroradiology 05/2005; 26(4):915-6. · 2.93 Impact Factor
