It is well known that the effective duration of barbiturate's anesthesia is rather to become longer when a certain quantitative combination between barbiturate and cardiazol is applied. Experiments were made to clarify the functional significance of DM and VL in this mechanism. The results were obtained as follows. 1. Such items as arousal reaction, muscular discharge of fore-and-hind limbs, recruiting response and spike-and-wave were evoked by stimulation of DM and VL to discover that the barbiturate acted differently from the cardiazol for the responses induced by DM stimulation and VL stimulation.2.8Hz-DM,8Hz-VL and 100Hz-VL stimulation displayed an inhibitory effect on muscular discharge of fore-and-hind limbs evoked by stimulation of cerebral cortex. The inhibitory effect therof was stronger at 100Hz-VL stimulation.100Hz-DM stimulation induced the facilitatory effect and the inhibitory effect respectively.3. In the experiments of muscular discharge of fore-and-hind limbs evoked by stimulation of hippocampus,8Hz-DM,100Hz-DM and 8Hz-VL stimulation showed the inhibitory effect, but on the contrary, a facilitatory effect was observed at 100Hz-VL stimulation. 4. Both stimulation of DM and VL produced almost no effects either on nociceptive reflex discharge or M wave. However, on H wave,8Hz and 100Hz-DM stimulation showed the inhibitory effect and 8Hz and 100Hz-VL the facilitatory effect. 5. On the afferent average evoked potentials of the cerebral cortex induced by the sciatic nerve stimulation, both DM and VL stimulation, on one hand, showed the facilitatory effect, on such early components as N1 and N2, at which time its effect was stronger when DM was stimulated than when VL was stimulated. On the other hand, on such late components as N4 and N5, DM stimulation showed the facilitatory effect and VL stimulation the inhibitory effect. 6. Both DM and VL stimulation at 8Hz and 100Hz produced the inhibitory effect on the intestinal movement, under which effect 100Hz stimulation acted much stronger than 8Hz stimulation and VL stimulation acted much stronger than DM stimulation. 7. Following the afore-mentioned experiments, a comparative analysis was made to respectively observe the effects of artane, biperiden and CDP-choline on the muscular discharge by VL stimulation and by hippocampus stimulation. This experiment made it clear that diphenylhydantion showed the stronger inhibitory effect on the muscular discharge by VL stimulation than by the hippocampus stimulation. But on the contrary, artane, biperiden and CDP-choline showed the stronger inhibitory effect on the muscular discharge by the hippocampus stimulation than by the VL stimulation. 8. In order to clarify the relationship between the site of stimulation of VL and the inhibitory effect of artane, biperiden and CDP-choline, the flexor and the extensor of the fore-and-hind limbs were indivisually examined. It was thus ascertained that with artane and biperiden, the site of the inhibitory effect was located at the ventromedian site of VL and that with CDP-choline, it was located at the dorsolateral site of VL. These experimental results well, prove that DM and VL have quite different effects with each other on the extrapyramidal system and that there might be a possibility to determine which drug(s) can effect on Parkinsonism's rigidity and/or tremor by examining the effects of drugs on the muscular discharge by VL stimulation.
A seventy years-old male, teacher, was admitted to Kansai Medical School Hospital because of the recurrent Stokes-Adams' attacks on April 28,1971. On admission, his Ecg showed 1° AV block (PR interval=0.44 sec) and on chest XP cardiac silhouette was normal in size and shape (CTR=49%). He was on predonisone 15 mg/day for chronic uveitis of the left eye. During the attacks, Ecg revealed complete AV block with idioventricular rhythm or 2: 1 AV block. On May 21,1971, a permanent cardiac pacing system was implanted by thoracotomy. Medtronic R-inhibited demand type pulse generator, Chardak® Model 5880 and a connector lead with bipolar myocardial electrodes Model 6914 were used. The electrodes were indwelled on the free wall of the left ventricle. The lead was led through the right side of the anterior mediastinum to the left upper abdominal wall, in which the generator was implanted. The cardiac pacing functioned well until March 18,1973, twenty-three months after the implant, when the pulse generator was electively exchanged with that of Model 5942. During those 2 years, aortic regurgitation was developed. Chest XP revealed cardiac enlargement (CTR=59%), and the pulse pressure became widened. Seven months after the exchange, as the patient recognized arrhythmia and a decrease in pulse rate, he was admitted to monitor Ecg. His rhythm and pulse rate, however, did not revealed any abnormalities at all. Under a suspicion of pulse generator malfunction, the generator was removed to exchange with the same model on October 15,1973. On the following day, an abnormal pacing rhythm manifested itself on the monitor Ecg. The basic pacing interval was 0.84 sec, and all the QRS complexes were artificially induced. When the paced QRS complexes incidentally fell on slightly after P wave (PR interval=0.18 -0.28 sec) the following pacing intervals prolonged to 1.24 sec, as if the pulse generator were inhibited by sensing T wave. Chest XP was examined in details and one of the implanted myocardial electrodes was found to bend at 3mm from its tip. It was supposed that the electrodes was broken but electrically still competent and when atrial and ventricular contractions were incidentally synchronized, the ventricular contraction became so forceful to cause a break-away of the electrode for a moment, which was sensed by the generator as an inhibitory stimulus for resetting its demand mechanism. Thereupon, the broken electrode was disconnected from the generator and the unipolar myocardial pacing system was introduced. During this procedure, the patient experienced an episode of Stokes-Adams' attack. Two days later, then, frequent ventricular premature beats appeared on the monitor Ecg. Chest XP again obtained showed pneumo-hydrothorax of the right side. The Stokes-Adams' convulsion during the procedure was thought to cause suction of the air along through the pacing lead from the open wound to the right lung, this in turn aggravating heart failure to develop ventricular premature beats. The pneumo-hydrothorax and premature beats disappeared completely 3 days later. Thereafter, the cardiac pacing was going on well without any trouble or complication. On September 8,1975, the pulse generator was again electively removed to exchange with Xytronl Model 5951. At the present time, the broken fragment of the electrode parts from the reminder by a few milimeters.
SDS-polyacrylamide gel electrophoresis revealed that hemagglutinin(glycoprotein) induced by vaccinia virus infection was deteted in the isolated nuclear envelope fraction. The glycoproteins were synthesized specifically in the IHD-J (hemagglutination positive strain) infected cells. Hemagglutination of chicken red blood cells was observed in the presence of the nuclear envelopes. It was suggested that the glycoproteins in the nuclear envelopes are virus induced hemagglutinin.
In order to evaluate the anti-ulcer drugs, their effects against the ulcer formation were studied in rats. The ulcers were experimentally produced by 18 hour-ligation of the pyrolus after 48 hour-fasting (Shay ulcer) and by 20 hour-confinement of the rat in the water immersed cage after 24 hour-fasting (stress ulcer). The rats were treated by anti-ulcer drugs promptly after above mentioned procedure. The stomach so obtained were carefully studied with references to the severity of the ulcer formation, the amount of the gastric jouce, its total acidity and pepsin activity, being compared to the controled stomach which were obtained from the rats without any pre-treatment. The severity of the ulcer formation were scored to obtain ulcer index according to number and size of the ulcer formed and nature of the gastric mucosa and the perforation of the wall. Pepsin activity was determined according to Bonfils' method with auther's own modification. Addition of Folin and Ciocalteu's Phenol agent to the sample at the last step of Bonfils' original procedure was proved to improved the accuracy and sensitivity of its measurement. 1) Human placental extract was administered intraperitoneally with a dose of 100,200,300,400 and 500mg before the ulcer experiment. In Shay ulcer experiment, the extract was most effective with a dose of 400mg and of 200mg, with regards to the anti-ulcer and anti-pepsin actions, respectively. The rat group pretreated by the extract showed significantly lower ulcer index, smaller gastric secretory volume, lower pepsin activity level as compared to the control group (P<0.01). In stress ulcer experiment, the extract was proved to be effective with regard to ulcer index. 2) Urogastrone was administered intravenously with a dose of 0.1 to 2. Omg. The drug revealed its most prominent anti-ulcer action with a dose of 0.3mg while its anti-pepsin action was not observed at any dose levels. The group pretreated by urogastrone showed lower ulcer index, higher pH level of the gastric jouce than the control (p<0.01). In stress ulcer experiment, anti-ulcer action of urogastrone revealed a dose-dependency and reached its maximum at a O.5mg dose level. The group pretreted by this drug showed significantly lower ulcer index than the control group (p<0.01). 3) Basic alminum sucrose sulfate was administered by a dose of 200,300,400, or 500mg in stress ulcer experiment and 5,10,15,25,50, or 100mg in Shay ulcer experiment. In Shay ulcer experiment, the drug revealed 100% anti-ulcer action at the dose level of 25mg or more. Its anti-pepsin action showed a dose-dependency. The group pretreated by this drug showed significantly lower ulcer index, pepsin activity total acidity and higher pH as compared to the control (p<0.01). In stress ulcer experiment, this drug showed its maximum effect against ulcer formation with a dose level of 300mg. 4) Secretin was administered intraperitoneally with a dose of 1.0 to 7.0 units. In Shay ulcer experiment, anti-ulcer and anti-pepsin action of this drug were proved to be most powerful with a dose of 1 unit and of 7 units, respectively. Dose-dependency of these effects, however, was not clearly observed. The rat group pretreated by secretin revealed significantly lower pepsin activity level (p<0.01) and lower ulcer index (p<0.05) as compared to the control group, in Shay ulcer and stress ulcer experiments, respectively. 5) Among the four anti-ulcer drugs used in this study, basic alminum sucrose sulfate was proved to be most effective against ulcer formation as well as acidity and pepsin activity of the gastric jouce in the rat ulcer experiments.
An electrophysiological study was made concerning the effects on the cerebral blood flow of rabbits by application of contact lens. The results obtained are as follows; I. In about 50% of the cases, the cerebral blood flow increased by application of contact lens. However, in about 33% of the cases, the cerebral blood flow decreased. 2. It was assumed that the increase of cerebral blood flow was due to the decrease of activity of the reticular formation, which was elicited from the contact lens, and that the decrease of cerebral blood flow was due: to the increase of activity of the reticular formation. 3. It was understood that the decrease of cerebral blood flow might explain the symptoms observed in those who have difficulty in wearing contact lenses.
It has been already 10 years since the Department of Neurosurgery was founded in Kansai Medical University, and it is quite appropriate at present to sum up the cases which were admitted and treated in our clinic during past 10 years and to analyze them. Neurosurgical staff, started with five neurosurgeons in 1965, has remarkably expanded and the members who have been intimately connected to our department in the clinical and research activities consist of 12 approved neurosurgeons and nine neurosurgical trainees. The main categories of neurosurgical cases include cerebral vascular diseases (cerebral aneurysms comprise a little less than 50% of all CVD), craniocerebral injuries and neoplasms of the nervous system in order of frequency. The frequency of the vascular diseases increased progressively year by year and the craniocerebral injuries became less and less frequent. Anual numbers of neoplasm of the nervous system have been fairly constant throughout and among these the glial tumors have been the most frequent. Meningiomas, pituitary adenomas and metastatic tumors are next frequent in the order mentioned.
So called solitary bone cysts have been reported to occur mostly in metaphysis of a long bone of the growing skeleton, but scarcely in the skull bone. We have recently experienced a case of a skull bone cyst 10 years after head injury. The patient,33 year-old, male, sustained head injury with a depressed fracture in the right parietal region 10 years ago by a fall of a motor cycle, and he had been treated conservatively. On the day of his admission, he had a tonic convulsion of the left fingers accompanied with dyspneic sensation, but he had never been unconsious during the attack. On admission, no neurological abnormalities were noted except for bilateral increased tendon reflexes. In the right parietal region, a slight protrusion 8×8×1 cm was noted on palpation. On X-ray examination there was a localized thickening of the skull in the right parietal area about 6 times as much as an adjacent skull thickness. No tumor was demonstrated at the site of the thickened skull by right carotid angiography. At operation, there was a slight protrusion of the skull which was of perfectly normal appearance. By turning the thickened skull bone as a flap, a cyst was encountered, which contained yellow fluid. The inner most part consisted of two tables and intervening diploe and considered to be the depressed fragments at the time of injury. The possible mechanisms of a bone cyst were discussed, and we assume that subperiosteal ossification over the hematoma which elevated the periosteum from the depressed bone, filling in the depressed area, resulted in a bone cyst in this case.
Eleven cases of traumatic optic nerve injury had been treated operatively in our clinic. All cases were male and the patients were struck on the areas above or lateral to the orbit by a fall from a bicycle or a motor cycle in most cases. The unroofing of the optic canal was performed after various intervals from the trauma and in only three cases it was more or less effective. One of these three cases was briefly summarized; Case 10, an 8 y. o. boy, had restored visual acuity to 0.02 by the operative treatment on the third day from the trauma. No fracture nor deformity of the optic canal was noted on the X-ray films. Fracture of the medial wall, however, was noted at the time of operation and no apparent contusion of the optic nerve was found, but the optic nerve was seen to be bulged after unroofing. Two critical factors, the interval between operation and trauma and the degree of injury, seem to determine the functional prognosis after the operative treatment. Decompression of the optic nerve should be undertaken as soon as possible after the trauma and, as the value of X-ray examination to visualize the optic canal fracture is limited, the operative decompression of the optic canal may be indicated promptly from the clinical state of the patient. The unroofing of the optic canal was performed through the transfrontal intradural approach because of easiness of orientation and complete unroofing for full length of the optic canal, and of less blood loss than through the extradural route.
Neurosurgical emergency group was organized in 1969 for emergency surgical care of intracranial hematomas in a private hospital which is situated at Noda-Hanshin, Osaka City. The group consists of six neurosurgeons and usually three of them are called when a neurosurgical case is admitted to the hospital day or night. Analysis of 105 cases of acute intracranial hematoma which needed prompt surgical exploration revealed that the transportation of these cases to proper emergency care unit had not always been satisfactory. Up to forty per cent of these cases were transported to our emergency ward via an emergency hospital where adequate neurosurgical treatment could not be given, and these cases were transferred largely extra-hospital-hours. Analysis of cases which were directly transported from the site of injury also disclosed that in some cases it took too much time to decide to take a patient to our emergency unit. As our system is not such that a team of neurosurgeons capable enough to perform prompt craniotomy is attending at the hospital 24 hours, the start of operation depends on how prompt neurosurgeons can de called for. The problems lie in the fact that every neurosurgeon has his own duty at the university hospital or at the research laboratory. Although our system has contributed to care emergency cranial injuries in Osaka districts, ideal emergency organization, which has 24 hour care system by attending neurosurgeons capable of prompt neurosurgical examination and exploration should be established.
Plasma renin activity was measured in 38 patients with essential hypertension in the following conditions: 1) at rest, supine position under normal sodium intake, 2) after 4 hours ambulation under normal sodium intake, 3) at rest, supine position after 4 days of sodium restricted diet (sodium intake was less than 30 mEq a day), 4) after oral administration of 80 mg furosemide and 4 hours ambulation under sodium restricted diet. These patients were classified into three subgroups; low, normal and high PRA groups according to PRA levels after furosemide administration and 4 hours ambulation under sodium restricted diet. Blood pressure, age, sex, known duration of hypertension, renal functions, findings of eye grounds, cerebrovascular disturbances, cardiac disturbances, sodium balance, urinary sodium excretion, hematocrit, serum sodium and potassium, blood urea nitrogen, serum creatinine were investigated in these three subgroups. 1) Forty-five % of the investigated patients with essential hypertension exhibited low plasma renin values,37% had normal values and 18% exhibited high renin values. 2) Low PRA was found more often in the older age group, in women and in cases with enlarged heart and longer duration of hypertension. 3) The hematocrit values were low in the following order: low, normal, and high renin groups. There was a statistically significant difference between low and high renin groups. 4) The sodium balance was negative in 67% of low renin cases. In the low renin cases daily excretion of sodium was greater than in high or normal renin cases even after the sodium intake was restricted. 5) There were no significant differences among these three groups as for systolic and diastolic blood pressure, PSP, GFR, BUN, serum Na and K and serum creatinine. 6) There were no significant differences among these three groups as for findings of eye grounds, myocardial disturbances, cerebrovascular disturbances and severeness of illness. 7) From these results, it can be assumed that the low renin cases were in the state of relative volume expansion. There was no evidence that low renin patients were relatively protected from development of cardiovascular complications.