Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 17pt2, Issue 6
Displaying 1-10 of 10 articles from this issue
  • JUN-ICHI KAWAFUCHI
    1977 Volume 17pt2 Issue 6 Pages 467-485
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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  • TAKAHIKO ASAI
    1977 Volume 17pt2 Issue 6 Pages 487-492
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Previous experimental studies have demonstrated an increased rate of the CSF production following bleeding episodes in the ventriculo-cisternal perfusion system.
    Preliminary trials of the autologous blood injection into the system showed the same effect. However, when serum only was applied into the system, cerebrospinal fluid (CSF) was produced for a short period up to two to three times as much as an ordinary case, whereas the red blood cell (RBC) suspension failed to show any effect on the production rate.
    These two blood components did not affect the absorpting mechanism of CSF.
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  • TAKAHIKO ASAI
    1977 Volume 17pt2 Issue 6 Pages 493-498
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Bradykinin was proved by a pharmacological technique, as a substance to bring about the overproduction of CSF on occasion of intraventricular bleeding or subarachnoid hemorrhage and to be formed from serum mixed with CSF.
    It is suggested that bradykinin affects vessels, especially venules, where it participates in the CSF production and increases their permeability, and that it accelerates the production of CSF through the walls.
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  • —Role of Local Hyperfibrinolysis—
    TOSHIO KOMAI, HARUHIDE ITO, TETSUMORI YAMASHIMA, SHINJIRO YAMAMOTO
    1977 Volume 17pt2 Issue 6 Pages 499-505
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Local fibrinolytic activity is studied to explain the physiopathogenesis of chronic subdural hematoma.
    1. Using FDP-kit (Wellcome, England), FDP levels in hematoma fluid and serum are determined in 15 cases with unilateral hematoma and a case with bilateral hematoma. The FDP values in all hematomas are higher than 20 μg/ml. Two cases show the FDP values over than 320 μg/ml. The FDP values in hematoma fluid is always higher than that in serum of the same patient. The FDP values in hematoma fluid correlate to the volume of hematoma in fluid type subdural hematomas.
    2. The levels of fibrinolytic activity in hematoma fluid and plasma are determined in 12 cases with subdural hematoma by Enzo-diffusion fibrin plate (Hyland, U.S.A.). Active plasmin, available plasmin and total plasminogen in hematoma fluid are not found in all cases with subdural hematoma. The fibrinolytic activity in hematoma fluid is remarkably lower than that in plasma in all cases. Absence of plasminogen might be for consumption.
    3. The amounts of tissue active plasmin in 7 cases and tissue plasminogen activator in 8 cases are measured by modified Astrup's method.
    Tissue active plasmin levels in dura maters, outer membranes and inner membranes are 3.7-7.2 mm (average 6.1 mm), 4.3-6.5 mm (5.5 mm) and 0-4.8 mm (1.7 mm), respectively.
    Tissue plasminogen activator levels in dura maters, outer membranes and inner membranes are 0-5.5 mm (average 2.7 mm), 3.3-8.1 mm (6.1 mm) and 0 mm, respectively. The tissue activator level is highest in the outer membrane.
    4. Fibrinolysis autography by Todd's method demonstrates the remarkable fibrinolysis around the vessels of outer membrane. The fibrinolysis in tissue increases with time.
    5. After clotting of subdural hemorrhage, capsule (grows out) from the dura mater. Then tissue plasminogen activator in outer membrane would activate fibrinolytic system in order to absorb subdural clot. If the fibrinolytic activity is adequate, the clot could be absorbed. If the fibrinolytic activity is excess, it would inhibit the coagulating system in vessels of outer membrane and so that the continual or intermittent bleeding from outer membrane would occur into subdural cavity. As the result, the FDP levels in hematoma fluid increase and the amounts of plasminogen decrease for consumption. Such fibrinolytic bleeding from outer membrane of hematoma induces gradually the enlargement of hematoma and clinical symptoms appear after a latent interval.
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  • —Effects of Blood and Its Breakdown Products—
    MINORU HAYASHI, HIROYUKI FUJII, SHINOBU MARUKAWA, TETSUO KITANO, HIDEN ...
    1977 Volume 17pt2 Issue 6 Pages 507-515
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    An intense intracranial hypertension plays a most important role for syndrome following subarachnoid hemorrhage. This work was made to characterize intracranial hypertension and identify the responsible components of blood. Continuous recording of ICP was made in dogs after intracisternal infusion of some amount of fresh blood, incubated blood, oxyhemoglobin, methemoglobin, heroin and bilirubin.
    1. Infusion of whole blood in amount of 10 ml or red blood cells equivalent to 10 ml of whole blood produced increase of ICP 200 to 300 mm H2O which started 9 to 12 hours later and continued for about 8 to 16 hours. Infusion of RBC ghost produced a minor rise of ICP for a short period. Infusion of plasma did not produce a noticeable intracranial hypertension. Intense intracranial hypertension which reached the level of 600 to 1, 000mm H2O was found after infusion of incubated blood, oxyhemoglobin, heroin and bilirubin.
    2. Spike-like elevations (pressure waves) were superimposed on elevated basal pressure. The pressure waves could be classified into three types. The first type of pressure waves were with durations of 30 seconds to 3 minutes and were accompanied with simultaneous decreases in systemic blood pressure (SBP). They were observed in the first or mild stage of increased ICP. The second type of pressure waves were with durations 10 to 30 seconds, and they accompained marked increases in SBP. The third type of pressure waves belonged to the first one as far as the durations are concerned, i.e. 30 to 40 seconds, but they were accompanied with little changes in SBP.
    3. The histological examination revealed that intracisternal infusions of blood components invariably produced leptomeningitis. The changes increased in the following order; whole blood, incubated blood, hemoglobin and heme component of hemoglobin. Cell infiltration was most noticeable in the base of the brain. An irregular arrangement of ependymal layer and perivascular cell infiltration were also found in the floor of the fourth ventricle.
    4. It is concluded that an intense rise in ICP in acute stage of subarachnoid hemorrhage is produced by instability or paralysis of cerebral vasomotor activity due to brain stem dysfunction, although brain edema and the accumulation of CSF by meningeal reaction are also responsible.
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  • HIROSHI TAKAGI, YOSHIO MIYASAKA, TAKESHI SAITO, TAKASHI OHWADA, KENZOH ...
    1977 Volume 17pt2 Issue 6 Pages 517-523
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Continuous recordings of intracranial pressure (ICP) in 41 postoperative cases with ruptured saccular aneurysm were made by subdural balloon method. The time course of ICP roughly fell into four types.
    Type 1 : ICP did not exceed 18 mm Hg all through the course.
    Type 2: ICP elevated up to 18-37 mm Hg range, between 10 to 12 hours following surgery.
    Type 3: ICP elevated above 37 mm Hg during the first 12 hours.
    Type 4: ICP was controlled by the ventricular drainage which was placed at the time of operation.
    The preoperative factors which had most significant relationship to those four types were; the interval from the last subarachnoid hemorrhage to operation, the presence of arterial spasm before operation and clinical grade described by Hunt and Hess. Other factors such as number of attacks of subarachnoid hemorrhage and location of the aneurysm had little relationship to the ICP types. It was found that the continuous monitoring of ICP has a considerable value in controlling the elevated ICP in postoperative cases with ruptured aneurysm, especially in those who have high operative risks.
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  • HIDEAKI NUKUI, TAKAO NAGAYA, SOHKICHI TANAKA, MOTOMASA KAWAKAMI, TERUT ...
    1977 Volume 17pt2 Issue 6 Pages 525-532
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Fourty-eight cases over 60 years of age with the ruptured intracranial aneurysm were surgically treated. Satisfactory occlusion of the aneurysm with clipping of ligation was attained in 44 cases and plastic coating was performed in 4 cases.
    In 3 cases with a large intracerebral hematoma, the early operation was carried out and 2 cases died of the gastrointestinal bleeding and progressive cerebral vasospasm after the operation.
    In 45 cases, the operation was carried out more than 2 weeks after the subarachnoid hemorrhage. In 4 cases (9%), additional neurological symptoms developed after the operation and the occlusion of the main cerebral artery occured in 2 cases out of these cases related to the operative procedure. Three cases (7%) died of rebleeding due to the incomplete clipping, acute emphysema and agranulocytosis respectively.
    Thirty-five cases were followed up for 3 months to 10 years. At the time of this follow-up study, 25 (71%) were either free from symptoms or only with minor neurological deficits. Seven cases (20%) had moderate to severe symptoms; 4 cases had complications noticed more than 1.5 months after the operation and considered to be unrelated to the surgical maneuvar, 2 cases had various neurological deficits exsisted before the operation and only one case had the deficit related to the operative procedure. Three cases (9%) had died of pulmonary carcinoma and pneumonia 3 months to 10 years after the operation.
    Eighteen cases, including 10 cases over 65 years of age, were operated with microsurgical techniques more than 2 weeks after the bleeding. In this group, only one case died of agranulocytosis and no case became disabled.
    These results indicate that the direct intracranial operation using microsurgical techniques should be the first choice of the treatment in aged patients who are able to make a daily living without any complaints and do not have severe complications before the bleeding. Furthermore, even when prolonged initial unconsciousness and arteriosclerosis of intracranial vessels are present, the operation can be performed safely by delicate procedures using microsurgical techniques.
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  • KATSUYA NISHIMARU, TERUO OMAE, TAKENORI YAMAGUCHI
    1977 Volume 17pt2 Issue 6 Pages 533-537
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Fourty-nine patinets with focal neurological deficits lasting for less than 24 hours (TIA), were followed up for 6 to 169 months averaging 65 months. During the follow-up period 9 cases (18.4%) developed stroke and 13 cases (26.5%) died. Among the latter 2 died of cerebral infarction. In relation to subsequent stroke, clinical features and angiograms of the TIA-giving artery were analysed. Angiographic findings in 12 patients with non-embolic cerebral infarction preceded by TIA were also studied. Subsequent stroke developed more frequently in patients with more than 10 episodes of TIA and with arterial stenoses of 50% and over in diameter.
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  • TAKESHI KAWASE, MASAHIRO MIZUKAMI, HIROSHI KIN, SHIGEO TOYA, HIROTOSHI ...
    1977 Volume 17pt2 Issue 6 Pages 539-549
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Serial fluorescein cortical angiography (FCA) was performed on 13 patients with ischemic cerebrovascular diseases at the time of by-pass operation (STA-MCA anastomosis), in order to know the microcirculatory changes before and after anastomosis. In 6 out of those patients, the pressure of the middle cerebral artery(MCAP)was simultaneously measured at the site of anastomosis. In all the patients, the diagnosis of cerebral ischemia was obtained by both clinical and angiographic findings. Out of these pateints, 6 had moderate neurological deficits such as hemiparesis or dysphasia, and 7 had severe neurological deficits such as hemiplegia, aphasia or disturbance of consciousness. Twelve patients had either middle cerebral or internal carotid occlusion, and one had intracranial carotid stenosis. Preoperative brain scintigram and CT scan were also carried out in 10 and 3 patients respectively.
    In six patients who were operated within fifteen days of onset, prolongation of regional circulation time (RCT) was found without any morphological change of the vessels. After anastomosis, focal hyperemia(shortening of RCT with vasodilation) was observed in a reperfused area. MCAP of the patients in this group was markedly elevated after venous injection of hypertensive agents. Those findings seem to suggest the existence of vasomotor dysfunction in the ischemic areas. In four patients, who were operated after nine to twenty days of onset, RI accumulation on brain scintigrams or marked contrast enhancement on CT scans were observed. Furthermore, patchy extravasations of fluorescein dye were also observed in all cases on FCA, after abrupt elevation of perfusion pressure (after drug induced hypertension, reconstructive surgery, or spontaneous recanalization). In one of these cases, spotted hemorrhages were also observed around venules, which suggests the possibility of hemorrhagic infarction after by-pass operation. In four patients who were operated after one month of onset, organic changes such as narrowing or occlusion of small vessels were observed and focal hyperemia after anastomosis could not be seen.
    From above results, the time course of occlusive cerebrovascular diseases may be divided into three stages in terms of cerebral microcirculation; Ist Stage of vasomotor dysfunction (within 15 days of onset), IInd Stage of breakdown of blood brain barrier (after one to three weeks of onset), and IIIrd Stage of organic change of vasculature( after one month of onset).
    In one series, only three patients, who had mild neurological deficits and were operated in stage I, has been improved. This suggests that the operation in stage I may be of benefit to the patient with mild neurological deficits. On the contrary, operation in stage II may accelerate the brain edema, or may cause the hemorrhagic infarction. Neurological improvement may not be expected by operation in stage III.
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  • KUNIHIKO OBATA
    1977 Volume 17pt2 Issue 6 Pages 551-555
    Published: 1977
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Neuromuscular transmission was investigated in combined culture of skeletal muscle cells and nervous tissue obtained from the chick embryo. Spontaneous endplate potentials (EPP's) recorded from the muscle cells were considered to indicate formation of the junction. The EPP's were observed in some muscle cells after several hours of culture with nervous tissue. In several cases the first EPP's appeared 15-30 min after a nerve process had reached the muscle. Polyneuronal innervation of single muscle cell was usual in the older culture. Not only the spinal cord but also the ciliary ganglion and the medulla oblongata formed the neuromuscular junction. On the other hand no junction was found in culture of the cerebellum, cerebrum, dorsal root ganglion and sympathetic ganglion.
    These observations were discussed in connection with development of the nervous system in the body.
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