Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 17pt1, Issue 1
Displaying 1-11 of 11 articles from this issue
  • Atsushi IKEYAMA, Shigeru MAEDA, Hajime NAGAI, Masahiro FURUSE, Isemi I ...
    1977 Volume 17pt1 Issue 1 Pages 1-7
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    A new pressure transducer for epidural application which the authors developed to reduce the following four factors generally affecting epidural pressure (EDP) values registered on a transducer; 1) transducer characteristics, 2) effects of dural tension, 3) stress concentration effect due to minute irregularities on the dural surface, and 4) adhesion effect between the dura and transducer, is reported. Thus, if the theoretical coplanar measurement is obtained, the values registered by this pressure transducer closely approximates those of the cerebrospinal pressure directly beneath the dura. Even with these improvements, some discrepancies are observed between EDP and intraventricular pressure (IVP).
    When EDP and IVP are compared, it is found that the difference in both values increases as IVP is higher in the same case, and EDP is usually higher than IVP. These discrepancies are mainly attributed to the fact that stress concentration effects could not be entirely eliminated. It was considered that a certain leeway percentage should be established as a safeguard in reading EDP values. No conclusion could be made as to the pressure gradient between EDP and IVP.
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  • Eiichi TANI, Shogo YAMAGATA, Yuko ITO
    1977 Volume 17pt1 Issue 1 Pages 9-18
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Canine basilar artery was studied in vivo and in vitro. Cell membranes of vascular smooth muscle were differentiated into caveolae intracellulares zones and caveolae-free zones, both of which were generally arranged in an alternate manner and parallel to the long axis of the smooth muscle cell. The caveolae intracellulares, about 60 nm in diameter, were neatly oriented in one to several rows with a center-to-center distance of about 80 nm. Adherens, gap, and tight junctions were occasionally found in the smooth muscle. In vitro study of canine basilar artery suggested the necessity of extracellular Ca supply for prolonged contraction, and strontium was selectively deposited in sarcoplasmic reticulum and mitochondria.
    Prolonged vasospasm was produced in the canine basilar artery by the injection of fresh blood or norepinephrine into the chiasmatic cistern. The caveolae intracellulares of vascular smooth muscle were found to be increased in number in vasospasm. In thin sections, myonecrosis was found in a small number of muscle cells, while a large number of muscle cells appeared intact. The most characteristic change was the appearance of aggregated granules and vesicles in the widened extracellular space between smooth muscle cells, particularly in the periphery of muscular layer and beneath the elastic lamina. The granules were spherical, 50-100 nm in diameter and were often surrounded by a single membrane and contained a dense osmiophilic core of about 40-90 nm diameter. In addition, the elastic lamina often became loose and corrugated or broken.
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  • Shunichi YONEDA, Masayuki MATSUDA, Yukio SHIMIZU, Hiroshi GOTO, Hajime ...
    1977 Volume 17pt1 Issue 1 Pages 19-28
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    An electrothromosis technique was employed for the treatment of large or deep-seated arteriovenous malformation with the use of a newly devised stereotactic apparatus and electrode holder.
    Beryllium copper wire needles were inserted into the feeding artery and nidus by control operative angiography. The number of electrodes depend on the size of the angioma. In large arteriovenous malformation, 30 to 60 electrodes are needed. A positive direct current of 2 to 10 mA was applied for a period of 30 to 60 minutes until thrombus formation is angiographically confirmed.
    Four cases of scalp cirsoid angioma were successfully treated by this method. Two cases of thrombosed cerebral aerteriovenous malformation were radically removed without being interrupted by bleeding. Two patients with deep-seated arteriovenous malformations were treated by a combination of conventional craniotomy and stereotactic method with electrothrombosis. A case of recurrent carotid cavernous fistula was also treated successfully with this method.
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  • Jun KARASAWA, Haruhiko KIKUCHI, Seiji FURUSE, Toshisuke SAKAKI, Yasuji ...
    1977 Volume 17pt1 Issue 1 Pages 29-37
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    An operation to place the temporal muscles on the brain surface, namely EncephaloMyo Synangiosis, was carried out on 10 patients with “Moyamoya” disease lacking the middle cerebral artery on the brain surface for anastomosis.
    Postoperative superselective deep temporal angiogram proved the development of rich vascular supply from the temporal muscle to the brain surface. Satisfactory clinical improvements were seen in nine patients. The remaining one child with transient ischemic attacks (TIA) and major neurological deficits showed slight improvement in spite of being unable to take care of himself. The other nine patients also showed improved electroencephalographic findings. Significant blood supply through the external carotid system to the operated area of the brain was shown in some cases by appearance of diffuse slow activity when the common carotid artery on the same side was compressed.
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  • YUZO YAMAKAWA, Hideyuki KOSAKA, Hirofumi NAGATOMI
    1977 Volume 17pt1 Issue 1 Pages 39-42
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    The authors report a case of hemophilia B complicated by subacute subdural hematoma after minor head injury, which was successfully managed by surgery and the use of concentrates of plasma factor IX (Konyne).
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  • Akira YAMAURA, Hiroyasu MAKINO
    1977 Volume 17pt1 Issue 1 Pages 43-53
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    It has been our observation that in the presence of concave deformity of the skin flap following large decompressive craniectomy, unexpected neurological deterioation would occur independently of the primary disease or natural improvement would be unduly impaired, and that such unfavorable phenomena were reversed by cranioplasty. In order to know the true incidence and the nature of this phenomenon, 33 consecutive cases were analyzed. Nine of 30 patients (30%) with flat or sinking skin flap showed prompt improvement following cranioplasty. The best 'candidates' for maximum benefit of cranioplasty were those with moderate grade neurological deficits in addition to the presence of concave deformity of skin flap (successful rate of 88%; 7 among 8 patients). Other factors influencing the results were primary disease (favorable to meningioma), time elapse from the decompressive craniectomy, presence of shunt system, CSF pressure and EEG changes before and after cranioplasty. EEG changes had well coincided with clinical course.
    The characteristic phenomenon would be described as “the syndrome of the sinking skin flap, ” considering that neurological deterioration may be due solely to effect of concave deformity of the skin flap upon the underlying brain tissue.
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  • Senichiro KOMAKI, Ritsuko KOMAKI, Hongyung CHOI, Francisco CORREA-PAZ
    1977 Volume 17pt1 Issue 1 Pages 55-62
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Three cases of secondary intracerebral tumor, fibrosarcoma, glioblastoma multiforme and reticulum cell sarcoma-microglioma are reported. Two of the irradiated cases are thought to be radiation-induced. To our knowledge, glioblastoma multiforme following irradiation is the first case reported. A case of reticulum cell sarcoma-microglioma is thought to be induced by immunosuppressive agents. It is difficult to diagnose induced tumors by angiogram, but the possibility of this diagnosis should be borne in mind when dealing with a patient who has had radiation therapy or immunosuppressive agents. The unusual features of the angiogram, other than recurrence of tumor, suggests this possibility.
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  • Akira HAKUBA, Shuro NISHIMURA, Kiyoaki TANAKA, Hiroshige KISHI, Tohru ...
    1977 Volume 17pt1 Issue 1 Pages 63-77
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Meningiomas which arise from the clivus are extremely rare. According to Dany8), the incidence of this tumor is 8.4% of the meningiomas of the posterior fossa and 0.125% of all brain tumors. The clinical features of the clivus meningioma consist of asymmentrical bilateral cranial nerve involvements (especially V, VII, VIII, IX, X), cerebellar and long tract signs and increased intracranial pressure. Practically, VAG and CAG are the most useful diagnostic procedures.
    Results of treatment have been quite disappointing, primarily because of the position of the mass which is anterior to the brain stem and in direct contact with the vertebral and/or basilar artery. Most neurosurgeons would consider it to be inoperable and would simply perform a biopsy or partial removal. However, when the tumor is not too large and hard, total removal of a clivus meningioma should be tried with some precautions. The approach must be chosen to provide the shortest access to the main feeders, and multisided exposure should be obtained according to the location and the extension of the tumor. The results which have been obtained in our own 6 cases are encouraging.
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  • Masahiro FURUSE, Tatsuya KOBAYASHI, Satoru UMEMURA, Akio KUWAYAMA, Ken ...
    1977 Volume 17pt1 Issue 1 Pages 79-86
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Postoperative outcome of intracranial meningiomas was studied with consideration to the role of intraosseous lesions on their recurrences. Overall recurrences were found in 20 out of 90 follow-up patients, and five of these meningiomas were regarded as extracranial recurrences (25% in ratio). Bone changes associated with tumorous invasion were roentgenologically revealed in all cases of extracranial recurrence. Bone scintigraphy with 99mTc-EHDP was productively utilized to detect the extent of osseous involvement. Noticably such bone changes were exhibited even at the early stage of clinical manifestation, and tumorous invasions were microscopically detected in all bone specimens taken from the site adjacent to dural attachment. It is noteworthy that intraosseous invasion of intracranial meningiomas probably occurs at relatively early stages of tumor growth and plays a possibly significant role in tumor recurrence, in particular in cases of meningiomas seated at the base of skull.
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  • Takao HOSHINO, Kenneth T. WHEELER, Kazuhiro NOMURA
    1977 Volume 17pt1 Issue 1 Pages 87-93
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Nuclei selected from various areas of normal brain tissue (rat, canine and man) were isolated by means of tissue grinding, stained with Acriflavin-Feulgen, and the amount of DNA in each individual nucleus was measured. It would appear that two distinct populations of diploid cells exist in the cerebral gray matter, either with regard to their absolute DNA content (approximately 10% more than the diploid amount) or with regard to their ability to be stained by Acriflavin-Feulgen. Microscopic examination of nuclei sorted from each population revealed that those which carried a “hyperdiploid” amount of DNA consisted primarily of nuclei with diameters of 12-16 μm in contrast to nuclei in the other peak with diameters of 6-8 μm. These results suggest that some neuronal nuclei in the cerebral gray matter, e.g. pyramidal and Betz cells, may contain a “hyperdiploid” amount of DNA as measured by FCM. The possible biological significance of this observation is not understood at this time.
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  • Toshiaki TAKIZAWA
    1977 Volume 17pt1 Issue 1 Pages 95-105
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Thermal effects on the brain, spinal cord and muscles were studied in electrocoagulation and laser photocoagulation. The experiments were performed on cats and rabbits. The monopolar and bipolar electrodes of the electrosurgical unit were applied to the tissues in comparison with the carbon dioxide laser surgical unit.
    The experiments were divided into the following two groups: 1) Morphological studies with optical microscope and electron microscope. 2) Temperature measurements with the non-contact infrared thermometer, microthermistor and thermograph.
    Minimal lesion was obtained by laser photocoagulation in comparison with electrocoagulation. The size of the lesion increased proportionately to the output power in electrocoagulation, but in laser photocoagulation the width of the brain edema remained within 300 μ. Only tissue defects produced by laser vaporization increased proportionately to the output power and the exposure time.
    The temperature at the focus of the laser beam was measured with the non-contact infrared thermometer which indicated 1, 500°C. The temperature within the tissue adjacent to the focus was measured with a microthermistor. In laser photocoagulation, the maximum increase was about 10°C at a point 1 mm from the focus. The temperature change occured within 30 sec when the laser irradiation lasted for 2 sec at 15 W. In bipolar coagulation, the temperature rise was 2.5°C at 3 mm from the electrode and the change lasted for 23 sec. In monopolar coagulation, the maximum rise was about 18°C at 3 mm from the electrode at an output power of 2 W, and the change lasted also for 23 sec.
    A conspicuous feature in thermography was the very steep temperature gradient extending from the laser focus to the surrounding tissue. This means that in lasing the thermal effect is highly restricted.
    But the most prominent feature of the laser is the so-called “vaporization”: The laser can vaporize tissues hemostatically in situ, which is impossible with the electrosurgical unit.
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