Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 16pt2, Issue 3
Displaying 1-10 of 10 articles from this issue
  • [in Japanese]
    1976 Volume 16pt2 Issue 3 Pages 189-200
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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  • T. HOSHINO, E. TEL, M. BARKER, M. L. ROSENBLUM, K. NOMURA
    1976 Volume 16pt2 Issue 3 Pages 201-206
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    A rat brain tumor model was prepared by stereotactically implanting 4×104 cultured 9L tumor cells in the cerebral hemisphere. The tumor bearing rats exhibited weight loss after two weeks, developed neurological symptoms several days later and died 19-20 days post-implant. Tumor take was 100% and the lethal tumor weighed 279 mg. The tumors had a doubling time of 39.5 hours. Cell kinetic parameters determined by PLM curve analysis 14-16 days post-implant were: TC-19.3 hrs.; TG1-8.6 hrs.; TS-7.6 hrs.; TG2-2.9 hrs.; and TM-0.2 hrs. The growth fraction was 0.55 and the cell loss factor was 0.24.
    The effectiveness of combined modality therapy on this model was analyzed in terms of survival, tumor size and colony forming efficiency. BCNU administered on day 16 post-implant produced an ILS of 122% while treatment on day 10 produced an ILS of only 60%, which corresponded to a 3-3.5 log cell kill and 2-2.5 log cell kill, respectively. Microsurgical removal of tumors on days 13 and 16 post-implant produced an ILS of 28% (1 log cell kill) and 56% (2 log cell kill). Surgery performed more than 3 days before or after BCNU therapy was less effective than BCNU alone on day 16. An ILS of over 200% (< 7 log kill) was achieved when BCNU was given 1 hr. before or 1 hr. and 12 hrs. after surgery performed on day 16. BCNU was not effective when administered during the surgical procedure. Cell kinetic parameters of both perturbed and unperturbed tumor cell populations can be used to design even more effective combined modality therapy.
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  • FUMIKAZU TAKEDA, SOKICHI TANAKA, JUN-ICHI KAWABUCHI, TAKASHI NAKAJIMA
    1976 Volume 16pt2 Issue 3 Pages 207-214
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Three cases out of 153 histologically verified gliomas in the Department of Neurosurgery, Gunma University, were pathologically considered as multicentric gliomas. The clinical and autopsy findings were described and the pathological criteria of multicentricity of gliomas (gliomas of multifocal origin) were discussed.
    1. In Case I, a 55-year-old male, discrete tumors were observed at autopsy in the right frontal and left posterior temporal lobe, respectively. The histological diagnosis was anaplastic astrocytoma. The patient died 18 months after the onset. Surgical intervention was not performed, but irradiation was given.
    2. In Case 2, a 53-year-old female, hemorrhagic-necrotic masses were found in the right parietal and occipital lobe, respectively. Histologically, both tumors were anaplastic astrocytoma. Neither operation nor irradiation was given. The patient died 5 months after the onset.
    3. In Case 3, a 56-year-old male, discrete tumors were found in the splenium of the corpus callosum and the cerebellar vermis. Ventriculoperitoneal shunt was performed and irradiation was given, but the patient died 3 months after the onset. Autopsy revealed that both tumors were separately situated, and histologically were glioblastomas.
    4. Though a local meningeal and ependymal invasion of each tumor existed at autopsy, there were no secondary diffuse meningeal and ependymal deposits which would suggest dissemination of the growth through cerebrospinal fluid pathways. Serial sectioning of the specimens disclosed the discontinuity between each discrete tumor. Anatomical relationship of the vascular distribution of each tumor did not support the possibility of hematogeneous spread. These findings strongly suggested the multicentricity of the gliomas, as in the cases in the literature.
    5. In the available literatures are listed more than 200 cases with multicentric gliomas, including 5 cases reported in Japan. Plural neoplasms within the cranial cavity are considered to be of multifocal origin when the histology of the neoplasms is different from each other, but debatable when the histology is similar. The criteria of the multicentricity of gliomas are, at present, no more than an elimination of metastasis and extension of the growth through various possible pathways. It should be improved by the further study of still unreported cases and by accumulation of future cases.
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  • SHINTARO MORI, SHIGEJIRO MATSUMURA, YASUNORI KODAMA, TOHRU UOZUMI, MAS ...
    1976 Volume 16pt2 Issue 3 Pages 215-225
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    1. Thirteen of 35 chromophobe adenoma cases revealed abnormally high blood levels of prolaction (1380-15000 ng/ml). In these cases high levels of prolactin was disclosed in the cerebrospinal fluid and the media in which the tumor specimens were incubated. Three of these 13 cases were verified to have had recurrence in 3 years after treatment, while the other 22 cases with relatively lower prolactin levels showed no recurrence. Quantitative determination on PEG, according to our own method, showed that tumor size of these abnormally high prolactin cases was larger than that of relatively lower prolactin cases. Abnormally high blood levels of prolactin were found to maintain more than 1000 ng/ml after surgery and irradiation.
    2. Sixteen cases of growth hormone secreting adenoma was examined endocrinologically. From the examination of GH responsiveness to various stimuli, these 16 cases were supposed to be classified to 3 types, i.e. TRH-responsive type (8 cases), LH-RH-responsive type (4 cases) and non-responsive type (4 cases). In 5 cases of the TRH-responsive type, the basal blood levels of GH decreased significantly in one year after irradiation.
    3. In three groups of pituitary adenomas, i.e. prolactin secreting adenoma (13 cases), GH secreting adenoma (16 cases) and non-functining adenoma (22 cases), the frequency of impaired ACTH and gonadotropin secretion was observed to be the highest in prolactin secreting adenomas and the lowest in GH secreting adenomas, however the frequency of impaired TSH secretion was the highest in GH secreting adenomas and the lowest in the prolactin secreting adenomas.
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  • —Experimental Study of the Ependymal Layer with HRP and Electron Microscopy—
    MASAHARU ITO
    1976 Volume 16pt2 Issue 3 Pages 227-236
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    The author defined the term “compensated hydrocephalus” as follows: It demonstrates normal cerebrospinal fluid pressure but has enlarged ventricles in its chronic stage after the impaired cerebrospinal fluid (CSF) circulation being restored through a pathological subsidiary pathway. A series of animal experiments was performed to reveal a part of the pathophysiological conditions and the effects of shunting procedures as a treatment of hydrocephalus.
    Adult mongrel dogs were the choice as experimental animals. Kaolin suspension (20 mg/kg. 0.7 ml of artificial CSF) was introduced into the cisterna magna and dogs were observed for more than two months. Using Pudenz's shunt system, ventriculo-peritoneal shunt operations were performed for a group of the compensated hydrocephalus and these dogs were observed for an additional three weeks thereafter.
    After the injection of 30 mg of Horseradish Peroxidase (HRP) as a tracer, the perfusion of the 2% glutaraldehyde and 2.5% paraformaldehyde fixative solution was made at 30 min., 60 min., 2 hrs. and 3 hrs. for electron microscopical study of the ependymal and subependymal layers of the ventricular system in these three groups.
    There was neither interruption nor deficit of the ependyma of the lateral ventricle of the compensated hydrocephalus as it might be observed in the specimen from acute hydrocephalus, but there were some spindle shaped separations of the ependymal intercellular spaces. The organelles such as endoplasmic reticulum were reduced in number considerably and this indicated the trace of the so-called CSF edema. In shunted hydrocephalic dogs, these organelles restored its normal figure. The injected HRP was absorbed quickly through the ependymal intercellular space in hydrocephalic dogs. The most marked difference in these three groups became prominent 2 hrs. after the injection. Although in hydrocephalic dogs, the HRP already disappeared from the ependymal intercellular spaces, in shunted dogs, it remained markedly in the ependymal intercellular space as well as in the depth of the myeline sheath. The latter demonstrated a close similarity to the picture seen in normal dogs. The author considered that the movement of the HRP in the ependymal and subependymal layers indicated newly established transependymal pathological pathways in the hydrocephalic dogs and this is improved in the dogs in which shunting procedures were added.
    This investigation showed that the compensated hydrocephalus, which was reached at the heavy cost of the brain parenchyma, was not following the process to cure in spite of its normal CSF pressure. The ependymal and subependymal layers returned to its normal morphological conditions after the shunt operation.
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  • TAKUJI TAKAGI, RYOJI NAGAI, HIDEKAZU FUKUOKA, MASATOSHI OZAWA, IKUO MI ...
    1976 Volume 16pt2 Issue 3 Pages 237-245
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Subdural hematoma of the posterior fossa is infrequent, but lethal in the newborn. We have already reported the successful surgical treatment of a case of posterior fossa subdural hematoma. The patient is now 27 months old and is still shunt dependent. Her body development is normal and her development quotient is 89. Since then, we experienced two other cases, but they died.
    The second case was a 6-hour-old male infant who was born with breech presentaion and 2nd degree of asphyxia was seen. Immediately after the birth, oxygen was administered to the patient who was in a syncope state. In 60 minutes, respiratory like movements were observed. One hour and a half later, grunting and twitching of the eyelids occurred. The patient died 26 hours postpartum.
    The third case was a 42-day-old male infant who was delivered by cesarean section. Two days before admission to the hospital vomiting, apneic spells and convulsions occurred. Subdural hematomas were present in the left frontal region and in the posterior fossa. He died 5 days after the operation.
    In the past 17 years, 134 autopsies with intracranial hemorrhages were carried out within 14 days after birth at the Dept. of Pathology and 18 cases of the posterior fossa subdural hematoma were discovered. Twenty one cases consist of 3 treated cases and 18 untreated cases, discovered at autopsy. Labour patterns are classified as follows; natural delivery 10, breech 5, forceps or vacuum 4 and cesarean section 2. From the standpoint of maturity, 10 cases are mature and 11 cases are premature infants. One of the clinical findings at admission is increased tension of the anterior fontanelle which is the foremost objective sign in the posterior fossa subdural hematoma of the newborn. Clinical diagnosis prior to autopsies were pulmonary hemorrhage 6, IRDS 4, intracranial hemorrhage 3 and others in the untreated cases. The average period of survival of 19 cases excluding case 1 and case 3 was 4.5 days and the range was 0 to 10 days. Case 3 was thought to be exceptional, because initial symptoms occured 40 days postpartum instead of within 15 days after birth.
    As for the hemorrhage site, these 21 cases can be divided into 4 groups. Group I : the hematoma is present mainly under the base of the brain and surrounding the brainstem. 10 cases belong to group 1. Group 1 cases are often complicated by serious supratentorial hemorrhages. In some cases, the whole brain was seen floating in the blood. Group II: the hematoma is present between the tentorium cerebelli and the superior surface of the cerebellum. Seven cases belong to this group. Group III: the hematoma is present under the lower surface of the cerebellum. Three cases belong to this group. Group IV: the hematoma is present on all the circumference of the cerebellum. One case belongs to this group.
    In this report, we want to emphasize that as far as the clinical diagnosis is concerned, ventriculography is important as a rule when the coronal subdural taps are negative and that reflux brachial angiography is needed lest the presence of hematoma in other sites should be overlooked.
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  • TAKASHI TSUBOKAWA, AKIO KOTANI, HIROSHI NISHIMOTO, YOICHI KATAYAMA, NO ...
    1976 Volume 16pt2 Issue 3 Pages 247-254
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Recurrence of intractable pain was observed following basomedial thalamotomy, in spite of making a lesion as wide as possible at both the neo and paleo-spinothalamic pathway.
    As a last resort for prevention of recurrence, the relay nucleus stimulation for selection of the candidate among the cases suffered from intractable pain was applied in clinical cases. The mechanism of inhibitory modulating effect of relay nucleus stimulation upon the medial thalamic neuron responding to noxious stimuli was also studied in experimental animals.
    Experimental Results: The neurons responded to noxious stimuli in the medial thalamic nucleus are divided into 2 types; one group (F-type neuron) shows activation of action potentials with about 20 msec. latency; the other (I-type neuron) shows inhibition upon the spontaneous activities. The F-type cell is pre or post-synaptically inhibited while the I-type cell disinhibited by conditioning stimulation in the thalamic relay nucleus, although the relay nucleus does not directly connect with the medial nucleus. The inhibitory modulating effect by stimulation of the thalamic relay nucleus is suppressed following the sensori-motor cortical ablation, or making lesion in the anteromedial thalamic area.
    It may be concluded that the conditioning stimulation of the thalamic relay nucleus produces the inhibitory modulating effect through the cortical or intrathalamic fiber connections upon pain perceptive activity at the medial thalamic nucleus.
    Clinical Observations: In clinical cases whose intractable pains were suppressed by conditioning stimulation of thalamic relay nucleus, the medial thalamotomy had excellent long lasting pain killing effects.
    It is concluded that the pain relief effects of medial thalamotomy can be predicted before the destruction of thalamic nucleus by application of conditioning stimulation in the thalamic relay nucleus.
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  • YOSHIAKI MAYANAGI, A. EARL WALKER
    1976 Volume 16pt2 Issue 3 Pages 255-263
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    In 12 rhesus monkeys the injection of alumina cream into the temporal cortex, amygdala or hippocampus induced seizures after a latent periods of six weeks to three months. Clinically the attacks are characterized by an arrest of movement, staring, unresponsiveness to most stimuli, wandering conjugate eye movements, automatisms, twitching of the contralateral ear and less commonly vocalization, chewing, hiccoughing, vomiting, adversive head movements and twitching of the face. The spiking from the amygdala and hippocampus, which usually fire together, propagates to the temporal cortex and multiple subcortical structures including the hypothalamus, anterior perforated space, anteromedial thalamus, cingulate gyrus, putamen, globus pallidus, subthalamus and mesencephalic reticular formation : from the temporal cortex to the amygdala and hippocampus, and secondarily to the diencephalic structures. There is a fairly consistent sequence of preferential propagation. Although spiking occurs in the temporal cortex, amygdala and hippocampus at different times, no specific structural correlation with clinical manifestations could be established. The interictal spikes tended to remain within the temporal lobe, and were influenced by sleep. Generalization of the seizures usually occurs from progressive involvement of more and more subcortical and cortical structures.
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  • —with Special References to the Autoregulation at Epileptogenic Foci—
    TADATO OIKAWA, HARUYUKI KANAYA, NIELS A. LASSEN
    1976 Volume 16pt2 Issue 3 Pages 265-271
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    rCBF measurements were performed in six patients with focal cortical epilepsy by using the 254 Detector Dynamic Gamma Camera with 133Xe clearance technique and rCBF patterns were displayed on colour TV with digital memories for 16 colours and graphs. After injections of Angiotensin rCBF measurements were also performed. Those rCBF changes between ictal or interictal phases and injection of Angiotensin were compared to each other.
    The results obtained were as follows:
    1. Six patients showed focal hyperaemia in the same regions of epileptogenic foci. Especially the patient with status hemi-epilepticus showed 2-10 times increased rCBF compared with nonfocal areas.
    2. The patients with cryptogenic etiology and glioblastoma showed marked disturbances of autoregulation in focal hyperaemic areas and also mild disturbances in non-focal areas.
    3. The patients with preoperative and postoperative meningioma showed no disturbances of autoregulation in both focal and non-focal areas.
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  • HAYAO SHIGA, AKIRA YAGISHITA, YUTAKA KURU
    1976 Volume 16pt2 Issue 3 Pages 273-278
    Published: 1976
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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