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Ishikawa M, Uchiyama T, Okawa A, Soma N, Ikota M, Aoki K, Naritaka H, Kusaka G. Ultrasonography monitoring with Superb Microvascular Imaging during cerebrovascular surgery. Clin Neurol Neurosurg 2024; 238:108175. [PMID: 38428059 DOI: 10.1016/j.clineuro.2024.108175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Ultrasonography (US) is used as a real-time dynamic imaging modality during neurosurgery. A novel Doppler US technique, Superb Microvascular Imaging (SMI), can be used to visualize low-velocity flow of small vessels at high resolution with high frame rates. We visualized vessel flow using this US SMI technique and contrast agent during cerebrovascular surgery. METHODS Forty-three patients with an unruptured cerebral aneurysm (control), ischemic and hemorrhagic moyamoya disease, carotid artery stenosis, hemangioblastoma, severe stenosis of the middle cerebral artery, venous angioma, and intracerebral hemorrhage (ICH) underwent neurosurgery with US SMI monitoring using a contrast agent. The diameter, length, and number of penetrating vessels were analyzed in patients with an unruptured cerebral aneurysm (control), moyamoya disease, and ICH. RESULTS Diameter and length of cerebral penetrating vessels were significantly increased in patients with moyamoya disease and ICH compared to control patients. The number of penetrating vessels was increased in moyamoya disease patients compared to control and ICH patients. In hemorrhagic moyamoya disease, flow in the penetrating vessels originated from a deep periventricular point and extended to the cerebral surface. Pulsatile cerebral aneurysms during clipping surgery and carotid artery stenosis during carotid endarterectomy were easily identified by SMI. Drastically increased vessel flow in patients with a hemangioblastoma or a venous angioma was observed. CONCLUSION Using the US SMI technique and contrast agent, we obtained useful flow information of the vascular disease structure and intracerebral deep small vessels during cerebrovascular surgery. Further quantitative analysis will be informative and helpful for cerebrovascular surgery.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiyaku, Saitamacity, Saitama 330-8503, Japan; Department of Neurosurgery, Nerima Hikarigaoka Hospital, Tokyo, Japan; Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan.
| | - Taku Uchiyama
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiyaku, Saitamacity, Saitama 330-8503, Japan
| | - Atsuya Okawa
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiyaku, Saitamacity, Saitama 330-8503, Japan
| | - Natsumi Soma
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiyaku, Saitamacity, Saitama 330-8503, Japan
| | - Masashi Ikota
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiyaku, Saitamacity, Saitama 330-8503, Japan
| | - Kazuyasu Aoki
- Department of Neurosurgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Heiji Naritaka
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
| | - Gen Kusaka
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiyaku, Saitamacity, Saitama 330-8503, Japan
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Ishikawa M, Ota Y, Naritaka H, Katoh S. Endoscopic ultrasound imaging with high flow mode for endonasal transsphenoidal pituitary surgery. J Clin Neurosci 2021; 89:329-335. [PMID: 34119288 DOI: 10.1016/j.jocn.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
Intraoperative ultrasound during transsphenoidal surgery (TSS) for pituitary tumors has been reported. In reports of endonasal ultrasound (US), Doppler US vessel images were informative and effective in endoscopic TSS. We performed endoscopic US imaging with high flow mode, which is a novel technology, to visualize small vessels during endonasal endoscopic TSS. Six patients (five with pituitary adenomas and one with Rathoke's cleft cyst) underwent endoscopic US-assisted TSS. A small endoscopic US probe (Olympus, BF-UC260FW; diameter, 6.9 mm) was inserted transsphenoidally to the sellar floor and into the sella turcica, and endoscopic US monitoring was performed. By rotating the endoscopic US probe, the internal carotid artery, anterior cerebral artery, middle cerebral artery, various small vessels, optic nerve, and residual tumor were clearly visualized on the endoscopic US images. Real-time animated vessel images around the tumor could be generated when needed during TSS. The tumors were removed without leakage of cerebrospinal fluid in the six patients, and their visual acuity was restored. Endoscopic US with high flow mode can visualize not only main cerebral arteries but also intracranial small vessels on B-mode US images. Pituitary tumors were clearly recognized and removed safely and precisely by monitoring the cerebral artery and its small branches as landmarks.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan.
| | - Yasushi Ota
- Department of Otorhinolaryngology, Toho University Sakura Medical Center, Chiba, Japan
| | - Heiji Naritaka
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
| | - Shojiro Katoh
- Department of Orthpedics, Edogawa Hospital, Tokyo, Japan
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Ishikawa M, Terao S, Kagami H, Inaba M, Naritaka H. Intralateral and Perilateral Ventricular Arteries on Original Axial Magnetic Resonance Angiography in Adult Moyamoya Disease. Eur Neurol 2021; 84:119-123. [PMID: 33780954 DOI: 10.1159/000514429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with moyamoya disease often develop cerebral infarction and hemorrhage, but the ischemic and hemorrhagic subtypes are difficult to diagnose prior to disease onset. We aimed to differentiate the ischemic and hemorrhagic subtypes of moyamoya disease by analyzing the intralateral and perilateral ventricular arteries on the original axial magnetic resonance angiography (MRA) images. METHODS We retrospectively analyzed the intralateral and perilateral ventricular arteries on the original axial time-of-flight (TOF)-MRA images of 18 patients with hemorrhagic moyamoya disease, 25 patients with ischemic moyamoya disease, and 22 control patients with unruptured aneurysms. RESULTS There were significantly more intralateral and perilateral ventricular arteries on the original axial MRA images in the patients with hemorrhagic moyamoya disease (6.3 ± 2.7) than in those with ischemic moyamoya disease (0.8 ± 0.9) and those with unruptured aneurysms (0.4 ± 0.8). CONCLUSION The intralateral and perilateral ventricular arteries on the original axial TOF-MRA images might suggest the hemorrhagic type of moyamoya disease prior to onset.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
| | - Satoshi Terao
- Department of Neurosurgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Hiroshi Kagami
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Makoto Inaba
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Heiji Naritaka
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
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Ishikawa M, Masamoto K, Hachiya R, Kagami H, Inaba M, Naritaka H, Katoh S. Neurosurgical intraoperative ultrasonography using contrast enhanced superb microvascular imaging -vessel density and appearance time of the contrast agent. Br J Neurosurg 2020:1-10. [PMID: 32648779 DOI: 10.1080/02688697.2020.1772958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Ultrasonography (US) provides real-time information on structures within the skull during neurosurgical operations. Superb microvascular imaging (SMI) is the latest imaging technique for detecting very low-velocity flow with minimal motion artifacts, and we have reported on this technique for intraoperative US monitoring. We combined SMI with administration of contrast agent to obtain detailed information during neurosurgical operations.Materials and methods: Twenty patients diagnosed with brain tumor (10 meningiomas, 5 glioblastomas, 2 hemangioblastomas, 1 schwannoma, 1 malignant lymphoma, 1 brain abscess) underwent neurosurgery under US with SMI and contrast agent techniques. Vessel density and appearance time following contrast administration were analyzed.Results: Flow in numerous vessels was not visualized by SMI alone, but appeared following injection of contrast agent in all cases. Flow in tumors was drastically enhanced by contrast agent in schwannoma, hemangioblastoma and meningioma, compared to normal brain tissue. Flows in the dilated and bent vessels of glioblastoma were also enhanced, although flow in hypoechoic lymphoma remained inconspicuous. The characteristics of tumor vessels were clearly visualized and tumor borders were demonstrated by the difference between tumor flow and brain flow, by the increased tumor vessel density and decreased appearance time of contrast agent compared to normal brain vessels.Conclusions: The combination of SMI and contrast agent techniques for intraoperative US monitoring could provide innovative flow images of tumor and normal brain. The neurosurgeon obtains information about tumor flow and tumor borderline before tumor resection.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Tachikawa Hospital, Tokyo, Japan.,Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
| | - Kazuto Masamoto
- Faculty of Informatics and Engineering, University of Electro-Communications, Tokyo, Japan
| | - Ryota Hachiya
- Faculty of Informatics and Engineering, University of Electro-Communications, Tokyo, Japan
| | - Hiroshi Kagami
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Makoto Inaba
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Heiji Naritaka
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
| | - Shojiro Katoh
- Department of Orthopedics, Edogawa Hospital, Tokyo, Japan
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Naritaka H, Ishikawa M, Terao S, Kojima A, Kagami H, Inaba M, Kato S. Ultrasonographic superb microvascular imaging for emergency surgery of intracerebral hemorrhage. J Clin Neurosci 2020; 75:206-209. [PMID: 32204956 DOI: 10.1016/j.jocn.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/09/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
Ultrasonography (US) has been used as a reliable imaging modality, providing real-time information during neurosurgical operations. One recent innovative US technique, superb microvascular imaging (SMI), visualizes small vessels and flow, which are not detected with standard US with doppler. We apply SMI to intraoperative US monitoring in emergency surgery for intracerebral hemorrhage (ICH). Eleven consecutive patients with ICH underwent endoscopic emergency surgery under US monitoring with SMI. After performing a small craniotomy, US images were obtained using SMI, a fusion technique, and a contrast agent technique, with the probe on the brain surface during surgery. Fusion images were obtained with the probe on the head before craniotomy in some patients. Animated US images with SMI could differentiate hematoma containing no vessels from brain tissue, and flow images using SMI and contrast agent techniques clarified the borderlines. Animated fusion images of intraoperative US and preoperative CT provided information on the extent of hematoma and residual hematoma during emergency surgery. We made various fusion CT images showing intracranial hematoma with US probes and decided on the skin incision line before beginning surgery, as if we were using a neuronavigation system. US with SMI, contrast agent, and fusion techniques provide information on the extent of intracranial hematoma and residual hematoma with no vessels and no flow. Monitoring by US and fusion CT images is useful for ICH surgery as a next-generation neuronavigator.
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Affiliation(s)
- Heiji Naritaka
- Department of Neurosurgery, Edogawa Hospital, 2-24-18 Higashikoiwa Edogawaku, Tokyo 133-0052, Japan
| | - Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, 2-24-18 Higashikoiwa Edogawaku, Tokyo 133-0052, Japan; Department of Neurosurgery, Tachikawa Hospital, Tokyo, Japan.
| | - Satoshi Terao
- Department of Neurosurgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Atsuhiro Kojima
- Department of Neurosurgery, Saitama City Hospital, Saitama, Japan
| | - Hiroshi Kagami
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Makoto Inaba
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shojiro Kato
- Department of Orthopedics, Edogawa Hospital, Tokyo, Japan
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Ishikawa M, Soma N, Kojima A, Naritaka H. Straightening the trigeminal nerve axis by complete dissection of arachnoidal adhesion and its neuroendoscopic confirmation for trigeminal neuralgia without neurovascular compression. Interdisciplinary Neurosurgery 2017. [DOI: 10.1016/j.inat.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ishikawa M, Sugawara H, Tsuji T, Nagai M, Kusaka G, Naritaka H. Clinical significance of the coexistence of carotid artery plaque and white matter disease in patients with symptomatic cerebral infarction. Clin Neurol Neurosurg 2017; 163:179-185. [PMID: 29132058 DOI: 10.1016/j.clineuro.2017.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/23/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Symptomatic cerebral infarction (CI) can occur in patients without main cerebral artery stenosis or occlusion. This study investigated the unique features of carotid artery plaque and white matter disease (WMD) in patients with symptomatic CI and transient ischemic attack (TIA) but without stenosis or occlusion of a main cerebral artery. PATIENTS AND METHODS We studied 647 patients who underwent both carotid ultrasound examination and brain magnetic resonance images. Plaque score (PS), plaque number, maximal plaque intima-media thickness and grades of WMD were examined. Subjects were divided into four groups, the CI group, TIA group, myocardial infarction (MI) group and risk factor (RF) group. Plaque and WMD were analyzed in cerebral ischemia group (CI and TIA), compared to non-cerebral ischemia groups and to a high PS group and a high WMD grade group from the RF group. RESULTS Both of each value of plaque and grades of WMD in the cerebral ischemia group were significantly higher than those in other groups. Grades of WMD in the cerebral ischemia group were significantly higher than those in the high PS group, although there was no significant difference of the each value of plaque between the two groups. The each value of plaque in the cerebral ischemia group was also significantly higher than those in the high WMD grade group, although there was no significant difference of grade of WMD between the two groups. CONCLUSION Simultaneous increases in carotid artery plaque and WMD are associated with symptomatic CI, which is not caused by stenosis or occlusion of a main cerebral artery.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, Japan; Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan.
| | - Hitoshi Sugawara
- Division of General Medicine, Department of the Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Toshiyuki Tsuji
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Mutsumi Nagai
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Gen Kusaka
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan
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Ishikawa M, Kojima A, Terao S, Nagai M, Kusaka G, Naritaka H. Cochlear Nerve Action Potential Monitoring for Preserving Function of an Unseen Cochlear Nerve in Vestibular Schwannoma Surgery. World Neurosurg 2017; 106:1057.e1-1057.e7. [PMID: 28755914 DOI: 10.1016/j.wneu.2017.07.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intraoperative monitoring of cochlear nerve action potential (CNAP) has been used in patients with small vestibular schwannoma (<15 mm) to preserve cochlear nerve function. We performed surgery for a larger vestibular schwannoma under CNAP monitoring with the aim of preserving cochlear nerve function, and compared the data with findings from 10 patients with hemifacial spasm who underwent microvascular decompression surgery. CASE DESCRIPTION We report the case of a patient with a 26-mm vestibular schwannoma and normal hearing function who underwent neurosurgery under electrophysiological monitoring of the facial and cochlear nerves. Amplitudes of evoked facial muscle responses were maintained at approximately 70% during the operation. The latency of wave V on brainstem auditory evoked potential (BAEP) increased by 0.5 ms, and amplitude was maintained at approximately 70% of the value at the beginning of the operation. Latencies of P1, N1, and P2 on CNAP did not change intraoperatively. These latencies were comparable to those of 10 normal patients with hemifacial spasm. CNAP monitoring proved very useful in confirming the location of the cochlear nerve in the operative field and preserving cochlear nerve function. Both facial nerve function and hearing acuity were completely preserved after tumor removal, and wave V latency on BAEP returned to normal and was maintained in the normal range for at least 2 years. CONCLUSIONS CNAP monitoring is extremely useful for preserving the function of the unseen cochlear nerve during vestibular schwannoma surgery.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan; Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Atsuhiro Kojima
- Department of Neurosurgery, Saitama City Hospital, Saitama, Japan
| | - Satoshi Terao
- Department of Neurosurgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Mutsumi Nagai
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Gen Kusaka
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Heiji Naritaka
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
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Ishikawa M, Kusaka G, Terao S, Nagai M, Tanaka Y, Naritaka H. Improvement of neurovascular function and cognitive impairment after STA-MCA anastomosis. J Neurol Sci 2017; 373:201-207. [PMID: 28131187 DOI: 10.1016/j.jns.2016.12.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/02/2016] [Accepted: 12/28/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In patients with severe steno-occlusive disease of a main cerebral artery, decreased cerebrovascular reserve (CVR) and cognitive impairment without causative focal lesions on magnetic resonance imaging have been reported. We examined ipsilateral and contralateral CVR and cognition before and after superficial temporal artery-middle cerebral artery (MCA) anastomosis operation in patients with internal carotid artery (ICA) or MCA occlusion. METHODS In 30 patients with ICA or MCA occlusion, cognitive impairment, and decreased CVR, we examined cognition, CVR, leukoaraiosis grades, and blood data. Data from 15 patients who underwent anastomosis were compared to that in 15 patients who did not undergo anastomosis, and to bilateral data already reported on 65 patients with severe steno-occlusive disease. RESULTS Cerebral blood flow, CVR, and cognition improved after anastomosis compared to before, and compared to patients without anastomosis; improved values were maintained for 5years. CVR recovered after anastomosis, matching the linear relationship between ipsilateral and contralateral CVR seen in the 65 patients. CONCLUSION The postoperative improvement in cognition and synchronized recovery on the regression line between CVR of the ipsilateral occlusion and contralateral sides may suggest that the CVR is widespread and nonselectively related to cognitive function.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, Japan; Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan.
| | - Gen Kusaka
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Satoshi Terao
- Department of Neurosurgery, Saiseikai Central Hospital, Japan
| | - Mutsumi Nagai
- Department of Neurosurgery, Sano Kosei Hospital, Japan
| | - Yuichi Tanaka
- Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Japan
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Ishikawa M, Ota Y, Nagai M, Kusaka G, Tanaka Y, Naritaka H. Ultrasonography Monitoring with Superb Microvascular Imaging Technique in Brain Tumor Surgery. World Neurosurg 2017; 97:749.e11-749.e20. [DOI: 10.1016/j.wneu.2016.10.111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 01/16/2023]
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Ishikawa M, Sugawara H, Nagai M, Kusaka G, Tanaka Y, Naritaka H. Collateral Flow and White Matter Disease in Patients with Internal Carotid Artery Occlusion. Eur Neurol 2016; 77:56-65. [PMID: 27924799 DOI: 10.1159/000453548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND When an internal carotid artery (ICA) occludes, a patient may develop cerebral infarction (CI). We investigated whether CI caused by ICA occlusion (ICAO) is associated with collateral flow through the anterior and posterior communicating arteries (ACoA and PCoA). METHODS In 100 patients with ICAO, we investigated CI and white matter disease by performing an MRI and the anatomy of the ACoA and PCoA were investigated by performing magnetic resonance angiography. All patients were divided into the symptomatic CI group or the no-CI group. The collateral flow pathway was estimated by the anterior cerebral artery (ACA)-PCoA score and the collateral flow volume after ICAO was estimated by the middle cerebral artery (MCA) flow score, based on how well the MCA was visualized. RESULTS Of 100 patients with ICAO, the symptomatic CI group included 36 patients. ACA-PCoA score and white matter disease grades were significantly higher in the CI group (indicating poor collateral flow). More than 80% of patients with an ACA-PCoA score of 4 (poor collateral) experienced symptomatic CI. Thirty-one symptomatic CI patients (86%) had an MCA flow score of 1 or 2 (decreased MCA flow). CONCLUSION The ACA-PCoA score and white matter disease grade may suggest an increased risk of CI following ICAO.
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Affiliation(s)
- Mami Ishikawa
- Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan
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Fukunaga A, Naritaka H, Fukaya R, Tabuse M, Nakamura T. Povidone-Iodine Ointment and Gauze Dressings Associated With Reduced Catheter-Related Infection in Seriously Ill Neurosurgical Patients. Infect Control Hosp Epidemiol 2015; 25:696-8. [PMID: 15357164 DOI: 10.1086/502464] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstbactPovidone-iodine ointment and gauze covered by transparent dressings were compared with transparent dressings alone in historical controls (both changed twice weekly) in neurosurgical patients needing catheter placement for prolonged periods. Colonization and bloodstream infection were both reduced with the new method (P<.01 and P= .062, respectively).
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Affiliation(s)
- Atsushi Fukunaga
- Department of Neurosurgery, Saiseikai Kanagawaken Hospital, Yokohama City, Japan
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Fukunaga A, Naritaka H, Fukaya R, Tabuse M, Nakamura T. Our Method of Povidone-Iodine Ointment and Gauze Dressings Reduced Catheter-Related Infection in Serious Cases. Dermatology 2006; 212 Suppl 1:47-52. [PMID: 16490975 DOI: 10.1159/000089199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In experiment 1, we evaluated our method of catheter care at subclavian vein insertion sites for the control of catheter-related infections in seriously ill neurosurgical patients who needed prolonged catheter placement, compared with an older method. In our method, the insertion site was prepared with 10% povidone-iodine solution, followed by application of 10% povidone-iodine ointment, and covered with sterile gauze and a transparent polyurethane dressing. The older method was based on 1996 guidelines for the prevention of intravascular device-related infections. Catheter colonization and mortality were both found to be significantly reduced with our method (p = 0.0214, p = 0.0379, respectively). In experiment 2, we evaluated whether a regimen of catheter care with 10% povidone-iodine ointment was more effective than that without povidone-iodine ointment for the prevention of infections. This suggested effectiveness of 10% povidone-iodine ointment for reduction of infection. Our method of catheter care was useful even in seriously ill neurosurgical patients.
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Affiliation(s)
- Atsushi Fukunaga
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
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Fukunaga A, Tabuse M, Naritaka H, Nakamura T, Akiyama T. Spontaneous resolution of nontraumatic bilateral intracranial vertebral artery dissections. Neurol Med Chir (Tokyo) 2002; 42:491-5. [PMID: 12472213 DOI: 10.2176/nmc.42.491] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 49-year-old man presented with nontraumatic bilateral intracranial vertebral artery dissections without subarachnoid hemorrhage manifesting as Wallenberg's syndrome on the right. Magnetic resonance imaging revealed an infarct in the right dorsolateral aspect of the medulla oblongata. Antiplatelet therapy was administered. Vertebral angiography performed on the 9th hospital day (Day 9) revealed pearl and string sign in the right vertebral artery and narrowing of the left vertebral artery. Second angiography performed on Day 25 showed no change, but third angiography performed on Day 74 revealed spontaneous resolution of the bilateral vertebral artery dissections. Magnetic resonance angiography performed on Day 250 showed no evidence of dissection. However, magnetic resonance imaging revealed a small infarct in the splenium of the corpus callosum. Spontaneous resolution of stenotic dissections of the bilateral vertebral arteries is extremely unusual. Serial cerebral angiography and magnetic resonance angiography are very important for monitoring the time course of changes in patients with vertebral artery dissections.
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Affiliation(s)
- Atsushi Fukunaga
- Department of Neurosurgery, Saiseikai Kanagawaken Hospital, Yokohama, Japan.
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Kobayashi I, Oka H, Naritaka H, Sato Y, Fujii K, Kameya T. Expression of Pit-1 and growth hormone-releasing hormone receptor mRNA in human pituitary adenomas: difference among functioning, silent, and other nonfunctioning adenomas. Endocr Pathol 2002; 13:83-98. [PMID: 12165656 DOI: 10.1385/ep:13:2:83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We analyzed the expression of Pit-1 and growth hormone-releasing hormone receptor (GHRH-R) mRNA in various types of functioning and nonfunctioning adenomas using a quantitative reverse transcriptase polymerase chain reaction (RT-PCR) method. Among clinically nonfunctioning adenomas, tumors considered as silent adenomas were reclassified on a pathologic basis. Competitive RT-PCR showed that the levels of Pit-1 and GHRH-R mRNA expression in silent somatotroph adenomas and silent prolactinomas were similar to those in the corresponding functioning adenomas. In silent thyrotroph adenomas, both mRNAs showed high levels of expression that were similar to those in functioning and silent somatotroph adenomas. The results suggest that the cause of the silence in these tumors seems to be in the downstream to transcription of Pit-1 gene in the signaling pathway leading to hormone secretion. Competitive RT-PCR assay could distinguish silent adenomas of the Pit-1 group from the other nonfunctioning adenomas in the expression levels of Pit-1 and GHRH-R mRNAs. In the future, precise diagnosis of various adenomas may become possible by assaying transcription factors such as steroidogenic factor-1 and thyrotroph embryonic factor, which are thought to be related to adenohypophyseal cytodifferentiation.
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Affiliation(s)
- Ikuo Kobayashi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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16
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Shimizu K, Takamiya Y, Furuhata S, Naritaka H, Kameya T. Cystic lesion at the foramen magnum disseminated from a pituitary adenoma--case report. Neurol Med Chir (Tokyo) 1999; 39:606-11. [PMID: 10487040 DOI: 10.2176/nmc.39.606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 38-year-old male presented with a cystic lesion at the foramen magnum due to intracranial dissemination from a pituitary adenoma. The primary tumor had required reoperation for regrowth twice. The tumor at the foramen magnum was removed surgically. Two smaller solid tumors were located in the left parietal convexity and the right temporal lobe. The former tumor was also removed surgically and the latter was observed. Histological examination showed the typical characteristics of pituitary adenoma in both surgical specimens. Immunohistochemical staining with MIB-1 and p53 antibodies showed low (< 1%) and negative reaction. Patients with pituitary adenoma, even benign tumors, must be carefully followed up for signs of metastasis.
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Affiliation(s)
- K Shimizu
- Department of Neurosurgery, Tachikawa Hospital, Tokyo
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17
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Abstract
GH-producing adenomas clinically are endocrine-active tumors accompanied with acromegaly in most instances. However, GH-producing adenomas apparently unassociated with acromegaly, or so-called silent somatotroph adenomas (SSA), have recently been reported but rarely. The reported cases are characterized by normal or slightly elevated serum levels of GH but without acromegaly. Tumor cells contain moderate, trace or no GH immunoreactivity. We experienced 7 cases of SSA which were not always similar in morphology and pathogenetic mechanism. They could be further divided into the following 3 subtypes. Subtype 1 (N = 2): a moderate number of cells were immunopositive for GH, and GH mRNA was also expressed in moderate or numerous cells. Densely granulated cells were noted. It is assumed that inhibition of hormone release into circulation. Subtype 2 (N = 3): a small number of cells were immunopositive for GH, while GH mRNA was expressed in numerous tumor cells. They were sparsely granulated cells containing fibrous bodies. These findings suggest that posttranslational processing of the gene product may be defective. Subtype 3 (N = 2): Only a scattered number of cells were immunopositive for GH and GH mRNA was co-localized in immunopositive cells. They were sparsely granulated cells containing poorly developed organelles that did not resemble those of typical sparsely granulated GH cells. The findings indicate that adenoma cells are largely immature with minimal GH lineage differentiation.
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Affiliation(s)
- H Naritaka
- Department of Pathology, Kitasato University School of Medicine, Kanagawa, Japan
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18
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Oka H, Kameya T, Sato Y, Naritaka H, Kawano N. Significance of growth hormone-releasing hormone receptor mRNA in non-neoplastic pituitary and pituitary adenomas: a study by RT-PCR and in situ hybridization. J Neurooncol 1999; 41:197-204. [PMID: 10359139 DOI: 10.1023/a:1006151001536] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined the expression of human growth hormone-releasing hormone receptor (GHRH-R) mRNA in both non-neoplastic pituitary tissues and pituitary adenomas by reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ hybridization (ISH). RT-PCR analysis showed that all of the non-neoplastic pituitaries and all GH-producing adenomas, one prolactinoma and one third of the non-functioning adenomas expressed GHRH-R mRNA. ISH demonstrated that all of GH-producing adenomas and two prolactinomas expressed GHRH-R mRNA. The expression of GHRH-R mRNA in GH-producing adenomas was greater than that in the other adenomas by RT-PCR and ISH. GHRH-R mRNA detected by ISH was observed only in GH cells from the pituitary gland of a young girl. In pituitary adenomas, a diffuse signal was observed in the cytoplasm of all of the GH-producing adenomas and in two prolactinomas. Expression of GHRH-R mRNA was not seen in normal prolactin cells, or in any adenomas other than GH-producing adenomas and a few prolactinomas. These results suggest that GHRH-R mRNA plays a role mainly in the function of GH-producing adenomas but may also play a role in function of some prolactinomas.
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Affiliation(s)
- H Oka
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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19
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Abstract
A pituitary adenoma with neuron-like differentiation in the sella turcica is reported. Sections of the tumor showed a mixture of adenoma cells, ganglionic cells, and neuropil-like structures by light microscopy. Both pituitary adenoma cells and large cells recognized as ganglionic cells by H&E were strongly immunoreactive for both growth hormone (GH) and prolactin (PRL), which indicated that these large cells had properties similar to those of pituitary adenoma cells. Furthermore, electron microscopy (EM) revealed characteristic low electron-dense secretory granules as well as GH-type large electron-dense secretory granules in adenoma cells, neuropils, and swollen bulbs of neuronal endings, which indicated that these three populations may be of the same origin. Furthermore, we could not find typical cell bodies of ganglionic cells by EM. These results are consistent with a hypothesis that attempts to explain the origin of the neuronal components by the neuronal differentiation of adenoma cells. Thus, the best designation of our tumor may be "pituitary adenoma with neuron-like differentiation."
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20
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Ozawa Y, Kameya T, Kasuga A, Naritaka H, Kanda N, Maruyama H, Saruta T. A functional thyrotropin- and growth hormone-secreting pituitary adenoma with a ultrastructurally monomorphic feature: a case study. Endocr J 1998; 45:211-9. [PMID: 9700474 DOI: 10.1507/endocrj.45.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A 38-yr-old female with a TSH- and GH-secreting pituitary adenoma is described, who had both overt symptoms, hyperthyroidism and acromegaly. Her serum TSH was not suppressed despite high concentrations of free T3 and free T4, and her alpha-subunit/TSH molar ratio was high. Her serum GH was consistently high, and was not suppressed by an oral glucose tolerance test. Preoperative testing revealed that, although the TSH response was impaired, TSH, alpha-subunit and GH were increased by TRH injection, and that these hormones were reduced by bromocriptine or somatostatin analog. Although she did not have hyperprolactinemia, the in vitro culture and immunohistochemical studies revealed that the adenoma cells produced and released PRL, in addition to TSH, alpha-subunit and GH. Immunohistochemical studies showed the presence of GH in the cytoplasm of many adenoma cells. TSH beta-positive adenoma cells were less frequently seen than GH-positive adenoma cells. No cells showed the coexistence of GH and TSH beta, and a few cells were positive for PRL. By electron microscopy, the adenoma was found to be composed of a single cell type resembling thyrotrophs, and did not have any characteristics of somatotrophs. This case was considered to be of interest, because the adenoma was ultrastructurally monomorphous, but immunohistochemically polymorphous.
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Affiliation(s)
- Y Ozawa
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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21
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Zhou X, Kudo A, Kawakami H, Hirano H, FAYED M, MAKITA T, SUZAKI E, KATAOKA K, Katsumata O, Fujimoto K, Yamashina S, USUDA N, JOHKURA K, SUGANUMA T, SAWAGUCHI A, NAGAIKE R, KAWANO JI, OINUMA T, Izumi SI, Iwamoto M, Shin M, Nakano PK, Ueda T, Ishikawa Y, Kubo E, Miyoshi N, Fukuda M, Akagi Y, Miki H, Nakajima M, Yuge K, Taomoto M, Tsubura A, Shikata N, Senzaki H, MASUDA A, NAGAOKA T, OYAMADA M, TAKAMATSU T, Furuta H, Hata Y, Yokoyama K, Takamatsu T, Itoh J, Takumi I, Kawai K, Serizawa A, Sanno N, Teramoto A, Osamura R, MATSUTA M, MATSUTA M, I N, TAKAHASHI S, KAWABE K, LIEBER MM, JENKINS RB, SASANO HIRONOBU, IINO KAZUMI, SUZUKI TAKASHI, NAGURA HIROSHI, Ge YB, Ohmori J, Tsuyama S, Yang DH, Murata F, JOHKURA K, LIANG Y, MATSUI T, NAKAZAWA A, HIGUCHI S, MATSUSHITA Y, Naritaka H, Kameya T, Sato Y, Inoue H, Otani M, Kawase T, KUROOKA Y, NASU K, KAMEYAMA S, MORIYAMA N, YANO J, TSUJIMOTO G, Matsushita T, Oyamada M, YAMAMOTO H, MATSUURA J, NOMURA T, SASAKI J, NAWA T, KITAZAWA R, KITAZAWA S, KASIMOTO H, MAEDA S, WATANABE J, Mino K, KONDO K, KANAMURA S, Ueki T, Takeuchi T, Nishimatsu H, Kajiwara T, Moriyama N, Kawabe K, Tominaga T, Kobayashi KI, Minei S, Okada Y, Yamanaka Y, Ichinose T, Hachiya T, Hirano D, Ishida H, Okada K, HASEGAWA H, WATANABE K, ITOH J, HASEGAWA H, UMEMURA S, YASUDA M, TAKEKOSHI S, OSAMURA R, WATANABE K, TAKEDA K, HOSHI T, KATO K, OHARA S, KONNO R, ASAKI S, TOYOTA T, TATENO H, NISHIKAWA S, SASAKI F, Ito Y, Matsumoto K, Daikoku E, Otsuki Y, SANO M, UMEZAWA A, ABE H, FUKUMA M, SUZUKI A, ANDO T, HATA JI. Abstracts. Acta Histochem Cytochem 1998. [DOI: 10.1267/ahc.31.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | - M.H. FAYED
- Department of Anatomy, Faculty of Veterinary Medicine Tanta University
- Department of Veterinary Anatomy, Faculty of Agriculture, Yamaguchi University
| | - T. MAKITA
- Department of Veterinary Anatomy, Faculty of Agriculture, Yamaguchi University
| | - Etsuko SUZAKI
- Department of Anatomy, Hiroshima University School of Medicine
| | - Katsuko KATAOKA
- Department of Anatomy, Hiroshima University School of Medicine
| | | | | | | | - Nobuteru USUDA
- Department of Anatomy and Cell Biology, Shinshu University School of Medicine
| | - Kohhei JOHKURA
- Department of Anatomy and Cell Biology, Shinshu University School of Medicine
| | | | | | | | | | | | - Shin-ichi Izumi
- Department of Histology and Coll Biology, Nmgmeaki University School of Medicine
| | | | - Masashi Shin
- Department of Histology and Coll Biology, Nmgmeaki University School of Medicine
| | | | | | | | | | | | | | | | - H. Miki
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - M. Nakajima
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - K. Yuge
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - M. Taomoto
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - A. Tsubura
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - N. Shikata
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - H. Senzaki
- Department of Ophthalmology and Pathology, Kansai Medical University
| | - Atsushi MASUDA
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Takanori NAGAOKA
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Masahito OYAMADA
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Tetsuro TAKAMATSU
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Hirokazu Furuta
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Yoshinobu Hata
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Keiichi Yokoyama
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Tetsuro Takamatsu
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | | | | | - K. Kawai
- Div of Diag Pathol Tokai Univ Sch of Med
| | | | | | | | | | | | | | - Nishiya I
- Departments of Obstetrics and Gynecology
| | - Satoru TAKAHASHI
- Department of Urology, Faculty of Medicine, The University of Tokyo
| | - Kazuki KAWABE
- Department of Urology, Faculty of Medicine, The University of Tokyo
| | | | | | - HIRONOBU SASANO
- Department of Pathology, Tohoku University School of Medicine
| | - KAZUMI IINO
- Department of Pathology, Tohoku University School of Medicine
| | - TAKASHI SUZUKI
- Department of Pathology, Tohoku University School of Medicine
| | - HIROSHI NAGURA
- Department of Pathology, Tohoku University School of Medicine
| | - Y-B Ge
- Department of Anatomy, Faculty of Medicine, Kagoshima University
| | - J. Ohmori
- Department of Anatomy, Faculty of Medicine, Kagoshima University
| | - S. Tsuyama
- Department of Anatomy, Faculty of Medicine, Kagoshima University
| | - D-H Yang
- Department of Anatomy, Faculty of Medicine, Kagoshima University
| | - F. Murata
- Department of Anatomy, Faculty of Medicine, Kagoshima University
| | - Kohei JOHKURA
- Department of Anatomy and Cell Biology, Shinshu University School of Medicine
| | - Yan LIANG
- Department of Anatomy and Cell Biology, Shinshu University School of Medicine
| | - Toshifumi MATSUI
- Department of Geriatric Medicine, Tohoku University School of Medicine
| | - Ayami NAKAZAWA
- Department of Anatomy and Cell Biology, Shinshu University School of Medicine
| | - Susumu HIGUCHI
- National Institute of Alcoholism, National Kurihama Hospital
| | | | - Heiji Naritaka
- Department of Pathology, Kitasato University, Department of Neurosurgery, Keio University
| | - Toru Kameya
- Department of Pathology, Kitasato University, Department of Neurosurgery, Keio University
| | - Yuichi Sato
- Department of Pathology, Kitasato University, Department of Neurosurgery, Keio University
| | - Hiroshi Inoue
- Department of Pathology, Kitasato University, Department of Neurosurgery, Keio University
| | - Mitsuhiro Otani
- Department of Pathology, Kitasato University, Department of Neurosurgery, Keio University
| | - Takeshi Kawase
- Department of Pathology, Kitasato University, Department of Neurosurgery, Keio University
| | - Yuji KUROOKA
- Department of Uroloby, Faculty of Medicine, The University of Tokyo
| | - Kimio NASU
- Department of Molecular Biology, Reserch Laboratories, Nippon Shinyaku Co. Ltd
| | - Shuji KAMEYAMA
- Department of Uroloby, Faculty of Medicine, The University of Tokyo
| | - Nobuo MORIYAMA
- Department of Uroloby, Faculty of Medicine, The University of Tokyo
| | - Junichi YANO
- Department of Molecular Biology, Reserch Laboratories, Nippon Shinyaku Co. Ltd
| | - Gozo TSUJIMOTO
- Division of Pediatric Pharmacology, National Children's Medical Reserch Center
| | - Tsutomu Matsushita
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Masahito Oyamada
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine
| | - Hitoshi YAMAMOTO
- Department of Oral Anatomy, School of Dentistry, Iwate Medical University
| | - Junko MATSUURA
- Department of Anatomy, Okayama University Medical School
| | - Takako NOMURA
- Department of Anatomy, Okayama University Medical School
| | - Junzo SASAKI
- Department of Anatomy, Okayama University Medical School
| | - Tokio NAWA
- Department of Oral Anatomy, School of Dentistry, Iwate Medical University
| | | | | | - Hideyoshi KASIMOTO
- Department of Pathology
- Department of Orthopaedic Surgery, Kobe University School of Medicine
| | | | - Jun WATANABE
- Department of Anatomy, Kansai Medical University
| | - Kazuto Mino
- Department of Anatomy, Kansai Medical University
| | | | | | - Tetsuo Ueki
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | - Takumi Takeuchi
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | - Hiroaki Nishimatsu
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | - Takahiro Kajiwara
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | - Nobuo Moriyama
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | - Kazuki Kawabe
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | - Takashi Tominaga
- Department of Urology, Faculty of Medicine, The University of Tokyo Department of Urology, Mitsui Memorial Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M. YASUDA
- Dept of Pathol Tokai Univ Sch of Med
| | | | | | | | - Kazuo TAKEDA
- Department of Anatomy, Kansai Medical University
| | - Tatsuya HOSHI
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Katsuaki KATO
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Shuichi OHARA
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Ryo KONNO
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Shigeru ASAKI
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Takayoshi TOYOTA
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Hiroo TATENO
- Departments of Pathology, Medicine and Obstetrics and Gynecology, the Tohoku University School of Medicine
| | - Sumio NISHIKAWA
- Department of Biology, Tsurumi University School of Dental Medicine
| | - Fumie SASAKI
- Department of Biology, Tsurumi University School of Dental Medicine
| | - Yuko Ito
- Department of Anatomy and Biology, Osaka Medical College
| | | | - Eriko Daikoku
- Department of Anatomy and Biology, Osaka Medical College
| | | | - Makoto SANO
- Department of Pathology, Keio University School of Medicine
| | | | - Hitoshi ABE
- Department of Pathology, Keio University School of Medicine
| | - Mariko FUKUMA
- Department of Pathology, Keio University School of Medicine
| | - Atsushi SUZUKI
- Department of Pathology, Keio University School of Medicine
| | - Takashi ANDO
- Department of Pathology, Keio University School of Medicine
| | - Jun-ichi HATA
- Department of Pathology, Keio University School of Medicine
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22
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Furuhata S, Kameya T, Tsuruta T, Naritaka H. Clinical and ultrastructural comparison of immunohistochemically inactive and gonadotropin-producing pituitary adenomas. Neurol Med Chir (Tokyo) 1995; 35:227-30. [PMID: 7596465 DOI: 10.2176/nmc.35.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A clinicoendocrinological and ultrastructural comparison of immunohistochemically inactive pituitary adenomas from 14 patients and gonadotropin-positive pituitary adenomas from 26 patients was carried out. Clinicoendocrinological characteristics were similar except the male to female ratios. The immunohistochemically unstable antigenicity of gonadotropin prevents clear immunohistochemical characterization, but the difference between the two types is not absolute and may be an indication of a cell line relationship.
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Affiliation(s)
- S Furuhata
- Department of Neurosurgery, Tachikawa Kyosai Hospital, Tokyo
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23
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Naritaka H, Kameya T, Sato Y, Furuhata S, Okui J, Kamiguchi Y, Otani M, Toya S. An Atypical Acidophil Cell Line Tumor Showing Focal Differentiation Toward Both Growth Hormone and Prolactin Cells. Endocr Pathol 1995; 6:239-246. [PMID: 12114745 DOI: 10.1007/bf02739888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of giant pituitary adenoma in a child. Computerized tomography (CT) scan revealed a suprasellar extension tumor mass with hydrocephalus. There was no clinical evidence of acromegaly, gigantism, and other hormonal symptoms. Endocrinologic studies showed within normal value of serum growth hormone (GH: 4.2 ng/mL) and slightly increased levels of prolactin (PRL: 78 ng/mL) and other pituitary hormone values were within normal range. On suppression test by bromocryptin, both GH and PRL levels were reduced. Histopathological findings revealed that the tumor consisted of predominantly chromophobic and partly eosinophilic adenoma cells. Immunohistochemical staining detected GH and PRL in a small number of distinctly different adenoma cells, respectively. Nonradioactive in situ hybridization (ISH) also showed GH and PRL mRNA expression in identical immunopositive cells. Electron microscopy (EM) demonstrated adenoma cells with moderate or small numbers of two types of dense granules and without fibrous body which are characteristic of sparsely granulated GH-cell adenomas. The adenoma does not fit into any classification but may be an atypical acidophil cell line tumor showing focal differentiation toward both GH and PRL cells.
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24
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Furuhata S, Kameya T, Tsuruta T, Naritaka H, Toya S. Colocalization of growth hormone (GH) and glycoprotein subunit alpha in GH-producing pituitary adenomas in acromegalic patients. Acta Neuropathol 1994; 87:568-71. [PMID: 7522387 DOI: 10.1007/bf00293316] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty-one consecutive cases of pituitary adenoma in acromegalic patients were studied by immunohistochemistry. All adenomas contained cells immunoreactive with the anti-alpha-subunit of gonadotropic hormones (alpha; 0.6-53% of tumor cells) as well as with anti-growth hormone (GH; 4-74% of tumor cells). In serial section study, most cells immunoreactive with anti-alpha were identical to cells immunoreactive with anti-GH. There was a positive correlation between the percentages of cells immunoreactive for alpha in GH cells [alpha (%)/GH(%)] and those for prolactin (PRL) in immunoreactive tumor cells (PRL(%)/[PRL(%) + GH(%)]) in mixed GH cell-PRL cell adenomas, suggesting that the alpha-subunit may play a role in emergence of PRL cells.
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Affiliation(s)
- S Furuhata
- Department of Pathology, Kitasato University School of Medicine, Kanagawa, Japan
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25
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Furuhata S, Kameya T, Tsuruta T, Naritaka H, Otani M, Toya S. Mixed growth hormone cell- prolactin cell pituitary adenoma with acromegaly: α-subunit most growth hormone cells. Endocr Pathol 1992; 3:201-204. [PMID: 32370425 DOI: 10.1007/bf02921363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 51 -year-old woman with mixed growth hormone (GH) cell-prolactin (PRL) cell pituitary adenoma is presented. She had clinical signs due to hypersecretion of GH and PRL. Resected tissue was studied immunohistochemically and morphologically. The serial sections revealed that GH and α-subunit were co-localized in most cells, while GH and PRL were localized in different cells.
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Affiliation(s)
- Shigeru Furuhata
- Department of Pathology, Kitasato University School of Medicine, Kanagawa
| | - Toru Kameya
- Department of Pathology, Kitasato University School of Medicine, Kanagawa
| | - Tomoko Tsuruta
- Department of Pathology, Kitasato University School of Medicine, Kanagawa
| | - Heiji Naritaka
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjyuku-ku, 160, Tokyo, Japan
| | - Mitsuhiro Otani
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjyuku-ku, 160, Tokyo, Japan
| | - Shigeo Toya
- Department of Neurosurgery, Keio University School of Medicine, Shinanomachi, Shinjyuku-ku, 160, Tokyo, Japan
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