Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 17pt2, Issue 1
Displaying 1-10 of 10 articles from this issue
  • —1 Experimental and Clinical Correlation of the Regulatory Centers in the Brain—
    YASUHIKO MATSUKADO
    1977 Volume 17pt2 Issue 1 Pages 5-12
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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  • HIDEO UENO
    1977 Volume 17pt2 Issue 1 Pages 13-22
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Four to 5 months after exposure of the right occipital lobe of the monkey to 3500 rads of X-irradiation there is a proliferative and degenerative lesion accompanied by a massive break in the blood brain barrier. The resulting vasogenic edema caudes gross swelling in the ipsilateral hemisphere, compression of the contralateral hemisphere with ventricular dilatation, and distortion of midline structures, which may result in herniation through the incisura and the foramen magnum. The regional cerebral blood flow, determined by 14[C] antipyrine method, at successive stages in the development and resolution of the delayed brain swelling shows a reduction of blood flow in the white and gray matter, first regionally, then throughout the ipsilateral hemisphere and finally throughout the whole brain. This fact may be explained by an increase of the local tissue pressure in the early stage, and an increased general pressure that is a decease of the cerebral perfusion pressure in the late stage. In the stage of resolution of CSF pressure the cerebral blood flow shows moderate recovery in the whole brain, but there remains a diffuse depression suggesting a long term impairment in cellular metabolism and/or blood flow mechanism.
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  • —Especially the Significance of Continuous Monitoring of VFP and CSF Pulse Wave in Hydrocephalic Infants—
    KEN-ICHI TAJIMA
    1977 Volume 17pt2 Issue 1 Pages 23-29
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    In hydrocephalic infants the advance of the shunting procedure improved their survival rate. Some cases, however carefully the patients were managed, showed poor prognosis. The purpose of this study is to clarify the relationship between the ventricular fluid pressure (VFP) and the post operative course in hydrocephalic infants.
    Twenty-three hydrocephalic infants with marked by dilated ventricles were studied; all of them underwent continuous monitoring of VFP by means of an intra-ventricular catheter connected to an externally placed pressure transducer and an amplifier chart recorder. A test injection of 5 ml of physiological saline solution was also made through the ventricular catheter and the resulting change in VFP was observed.
    The results are as follows: 1) CSF pulse wave; most of the hydrocephalic patients showed simple and monophasic wave form and the amplitude depended on the mean pressure except for fatal hydrocephalic infants. 2) Resting pressure; during long term continuous monitoring resting VFP in survival cases showed various kinds of pressure waves such as Lundberg's A wave, but in some total cases with extremely dilated ventricles, there was no noticeable fluctuation. 3) Volume induced change of VFP; in most hydrocephalic infants, the raised VFP caused by the injection of 5 ml of saline showed delayed falling.
    Continuous monitoring of VFP and its analysis in hydrocephalic infants may help to decide their indication of the shunting procedure.
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  • HIROSHI YAMADA, NAOKI KAGEYAMA, MASATAKA TAJIMA
    1977 Volume 17pt2 Issue 1 Pages 31-38
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    There have been many references to the complications that result from the surgical treatment for hydrocephalic children, but only a few papers about radiological changes of skull following the procedure have been reported. During the last 6 years 120 cases of pediatric hydrocephalic patients were treated with ventriculo-atrial (V-A) or ventriculo-peritoneal (V-P) shunts. Significant skull changes were observed radiologically in those patients who showed increased head circumference at the time of initial surgical procedure performed after the age of one year. Selection of cases for this study was made upon the following criteria.
    1. The diagnosis of hydrocephalus with enlarged skull and dilated ventricles was confirmed on the basis of cerebral pneumoencephalography and other diagnostic studies.
    2. The shunting procedure was performed after one year of age.
    3. The head circumference at the initial operation was over 50 cm.
    4. The patients had been followed for at least 2 years after the initial operation.
    5. Adequate pre and postoperative skull films were available.
    20 cases were selected using the above criteria, and 15 cases among these cases showed significant radiological skull changes.
    The radiological abnormalities of the skull are as follows: 1) Thicking of the vault, 12 cases. 2) Premature fusion of sutures, 12 cases. 3) Marked reduction in size of the sella turcica, 9 cases. 4) Lamination of the diploe, 6 cases. 5) Others: thickening of the cribriform plate, thickening of the planum sphenoidale and calcification of subdural hematoma etc.
    These alterations of the skull are due to inward growth of the inner table of the skull in response to the prolonged cerebrospinal fluid shunting precedure and probably due to reduction of cerebrospinal fluid pressure and pulsation. Marked skull changes were observed in cases of marked hydrocephalus with brain atrophy or hypoplasia, but no difference were observed between the patients with V-A and V-P shunting procedures.
    These skull changes, especially premature fusion of sutures, may affect prognosis of children. But adequate treatment of these patients with the apparatus available at present seems to be difficult. We feel that it is important to make diagnosis in early stage and that the surgical treatment for infantile hydrocephalus should be performed before the size of the skull and ventricles are makedly increased. The appropriate shunting apparatus to prevent excessive low intracranial pressure should be selected for the operative procedure for these patients.
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  • —Part 1 : Evaluation of the Electrical Activities Recorded from the Smooth Muscles of the Basilar Artery with Vasospasm—
    HIROSHI TSUTSUMI, KEN-ICHI INABA, YUJI MIYAZAKI
    1977 Volume 17pt2 Issue 1 Pages 39-45
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Since the investigations by Brawley and coworkers it has been known that cerebral vasospasm is a biphasic phenomenon: the acute phase occurs within minutes after the subarachnoid hemorrhage and lasts less than one hour. The chronic phase occurs 3 to 24 hours after the hemorrhage. Numerous workers so far have carried out studies on the vasospasm based on the assumption that the vasospasm is due to functional constriction of the smooth muscles of the cerebral arterial wall. However, it has not been demonstrated whether the vasospasm, not only in the acute phase but also in the chronic phase, is actually a functional spasm of the arterial smooth muscles or not. To investigate such basic problems related to the cerebral vasospasm, we attempted to record and evaluate the electrical activity from the smooth muscles of the arterial wall in vivo which underwent experimentally induced vasospasm. The results thus obtained were as follows.
    1. No spontaneous electrical activity was recorded from the intact basilar arteries of normal dogs. From the basilar arteries of the denervated dogs, however, electrical activities, spikes with 100 to 200 msec. duration and less than 1 mV amplitude, were induced by intravenous injection of epinephrine.
    2. Similar electrical activities were reocrded during the entire course of the acute phase of vasospasm. The onset of the electrical activity coincided with the onset of vasospasm and they lasted less than 120 minutes.
    3. In the chronic phase of vasospasm no electrical activity was recorded from the arteries which definitely showed the phenomenon of so-called vasospasm. Even when epinephrine was administrated to the denervated dogs with the chronic phase of vasospasm, no electrical activity of the arterial wall could be induced.
    From these experimental results, we concluded that the acute phase of vasospasm is due to functional constriction of the arterial smooth muscles, and that it is not due to functional constriction in the chronic phase but is due to some organic changes of the arterial wall.
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  • —Course and Degree of Vasospasm—
    SHUNRO ENDO, JIRO SUZUKI
    1977 Volume 17pt2 Issue 1 Pages 47-53
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Cerebral vasospasm plays an important role in determining the prognosis of the patient, but the true nature and cause of it is still a great mystery. The course and the degree of cerebral vasospasm in cats is discussed in this report.
    Vasospasm of the basilar artery is induced by application of fresh blood, or blood and cerebrospinal fluid mixture incubated at 37°C for 2 to 16 days in 57 cats. In the group with fresh blood or mixtures incubated for over 15 days, the severity of induced vaso-constriction is light and the duration is short. Mixtures incubated for 5 to 10 days induced severe and prolonged vasoconstriction. The prolongation of severe vaso-constriction induced by the 7-days incubated mixture with clotted components is definitely longer than one by the mixture without clotted components. This incubation period for inducing severe vasospasm coincides with the course of vasospasm after the onset of subarachnoid hemorrhage in our clinical experience.
    This experimental study strongly suggests the existance of vasospasmogenic substance in the blood liberated into the subarachnoid space of the patient. It begins to act on about 3 days after subarachnoid hemorrhage, acts strongly during about 5 to 10 days, and disappears after 15 days.
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  • NOBUYUKI SHITARA, TAKESHI KOHNO, KINTOMO TAKAKURA
    1977 Volume 17pt2 Issue 1 Pages 55-62
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    The role of cellular synchronization using Colcemid as pretreatment for combined chemoradiotherapy was investigated. C6 rat brain tumor cells were cultured in RPMI 1640 medium containing 10-5-10-7 mol. of Colcemid for 24 hours. The basic cell kinetics were analysed with pulse-cytophotometer, which facilitated the analysis of tumor cell cycle phase distribution according to the DNA content. The effect of Colcemid depended on the concentration. The minimal concentration showing continuous blocking during 48 hours after removal of the drug was 10-6 mol. G1 fraction with 2C DNA content was reduced from 74% to 36%. G2, M phase with 4C DNA content increased from 9% to 28%. S-phase-cells increased from 17% to 31 %. Polyploid cells in the tetraploid cell cycle were recongized. Further studies are necessary for ellucidating the mechanism about the leakage of some arrested cells in metaphase into tetraploid cell cycle system. The resting 36% cells in G0 — G1 peak with 2C DNA content might be evaluated as diploid G0 fraction.
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  • —Correlation with Nuclear Scan and Angiography—
    SHIZUO OI, JOSEPH H. GALICICH
    1977 Volume 17pt2 Issue 1 Pages 63-70
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Results of Computerized Axial Tomography with or without intravenous contrast (60% Conroy) in 47 patients with metastatic brain tumor were analyzed. Twelve patients had lesions of the lung and eleven carcinoma of the breast. Ten other primary sites are represented in this series. These data were compared to isotope brain scan (Tc99) done in 31 and angiography in 17 of these same patients. A total of 67 tumors were demonstrated. Thirty-eight patients had single metastasis.
    Without the use of contrast, 47/66 tumors were identified on computerized axial tomography. An additional 19 tumors were positively demonstrated by use of intravenous contrast. In the 35 patients given the contrast agent, 34/49 lesions revealed enhancement. Peri-tumor edema was demonstrable in 61 lesions.
    In the cases available for comparison (17) there was little demonstrable correlation between hypervascularity as seen on angiography and contrast medium enhancement.
    Five of thirty eight tumors found on computerized axial tomography were not identified by Tc99 scan. The area of increased uptake on Tc99 scan was larger than measurments of the tumor in 29/33 lesions but smaller than the area of peri-tumor edema in all but 2 instances.
    This study reveals that in neoplasms metastatic to brain, computerized axial tomography is superior to Tc99 scan in regard to diagnosis, determination of tumor size and extent of edema.
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  • RYUZO ISHIYAMA, MASAHARU YASUE, SYOUICHI SANADA, KENJI YUKI, NORIO NAK ...
    1977 Volume 17pt2 Issue 1 Pages 71-77
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Carniopharyngiomas are usually located in the intracranial cavity, predominantly at the suprasellar region although they may be found at times within the sella. However, craniopharyngiomas developing in the nasopharynx and the sphenoid sinus, have been very exceptionally reported.
    Recently the authors have experienced two cases of such a rare localization. The first one is the case that invaded and destructed the floor of the middle fossa and nasopharynx, originating in the sphenoid bone. The second one is the case that formed a large cyst in the sphenoid sinus.
    This report includes the demonstration of clinical menifestations, clinico-pathological differentiation as well as bibliographical discussions of these two rare cases.
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  • JYOJI HANDA
    1977 Volume 17pt2 Issue 1 Pages 79-87
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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