巻号一覧
18pt2 巻, 2 号
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―Central inhibitory systemの機構―坪川 孝志1978 年 18pt2 巻 2 号 p. 89-97
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーPDF形式でダウンロード (549K) -
景山 直樹, 桑山 明夫, 高野橋 正好, 吉田 純, 深谷 皓孝, 岡田 力, 杉田 慶―郎1978 年 18pt2 巻 2 号 p. 99-108
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーTwenty-three patients with active acromegaly were subjected to transsphenoidal microsurgery, during the past two years. These patients were preoperatively classified into 14 TRH responders, 5 LH-RH responders and 2 nonresponders. L-DOPA and bromocryptine effectively reduced serum growth hormone (GH) levels in most of TRH responders, but in none of LH-RH responders and non-responders.
Pre and post-operative basal serum GH levels ranged between 9.0 and 484.0 ng/ml, 3.6 and 80.6 ng/ml, respectively. In 19 patients who could be followed up longer than 3 months, post-operative serum GH concentrations were below 10 ng/ml in 14 patients, but in many cases abnormal GH responses to TRH and LH-RH were still present. However, in 6 cases abnormal GH responsiveness to TRH or LH-RH was reverted to normal, preserving normal GH increase after insulin hypoglycemia. Overall results suggest that surgical success is very high when the tumor is localized in the sella.
Autonomy of GH secretion by the surgical specimen from 4 patients was found to be continuing a month later by the culture method and rich secreting granules were confirmed in the cytoplasm.
These results suggest that the primary lesion in acromegaly would be in the pituitary gland, being partly influenced by hypothalamic factors.
Revertion of abnormal GH responsiveness to non-specific releasing hormone is a good indicator of the completeness of the operation and these provocative tests are very useful for postoperative follow-up study in acromegaly. L-DOPA or bromocryptine treatment should be applied to cases with insufficient operative results.抄録全体を表示PDF形式でダウンロード (549K) -
桑村 圭一, 松本 悟, ANTHONY J. RAIMONDI, FRANCISCO A. GUTIERREZ1978 年 18pt2 巻 2 号 p. 109-115
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリー2才以下乳幼児脳腫瘍の52症例につき検討した.腫瘍は男性に多く(男61%,女39%),1才以下の例では天幕上に多く認められた.病理学的特徴は一般に巨大腫瘍で,かつ広範囲浸潤性を示し,組織学的には未分化型細胞を多く認め,通常腫瘍発育は急速である.これらの点は特に新生児脳腫瘍(9例)に顕著であった.臨床的には,頭囲拡大,嘔吐,不機嫌(irritable)を主徴とし,その87%に脳室拡大を認めた.すなわち水頭症,脳圧充進を特徴とし,このため“congenital hydrocephalus”とのみ診断された症例もあり,乳幼児水頭症の診断における脳腫瘍の重要性が強調された.腫瘍による閉塞性水頭症に対しては,first stepの手術として積極的にシャント手術が行われ,この方法の有効性が指摘された.消化管出血は後頭蓋窩腫瘍(第IV脳室近傍部)例で,かつステロイド剤使用時のみに認められた.追跡調査で,astrocytomaの予後は比較的良好(絶対2年生存率61.5%)であったが,medulloblastomaのそれはきわめて不良であり,通常術後3カ月以内に死亡した.2才以下medulloblastomaの予後は,それ以外の年長児groupの予後に比し非常に不良であった.抄録全体を表示PDF形式でダウンロード (470K) -
阿部 弘, 小林 直樹, 伊藤 輝史, 田代 邦雄, 都留 美都雄1978 年 18pt2 巻 2 号 p. 117-124
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーThirty-nine samples of meningiomas were studied with respect to activities of N-acetyl-glucosaminidase, β-glucuronidase, acid phosphatase, and arylsulfatase. Meningiomas were classified as meningotheliomatous (4), transitional (12), fibroblastic (6), angioblastic (3), malignant (11), and unclassified types (3). Samples were obtained at surgery and homogenized in 0.32 M-sucrose. The total activities were measured using a Triton X-100 (0.1 %) activated sucrose suspension of tissue. Elevation in total activities of four enzymes in the tumor samples over the control grey and white matter values was highly significant except in samples of angioblastic meningiomas. This was particularly striking in glucosaminidase. Malignant meningiomas showed the greatest increase in total activities. A sevenfold increase of glucosaminidase and two to fourfold increase of β-glucuronidase, acid phosphatase and arylsulfatase were seen. Moderate increase of activities of four enzymes were seen in meningotheliomatous, transitional, and fibroblastic types. Activities of angioblastic meningiomas, three samples of hemangioblastic variant, did not show any increase compared with normal brain.
It appears, therefore, that the high activities of lysosomal enzymes are to be viewed as characteristic of malignant meningiomas and this can serve to distinguish them from other types of meningiomas.抄録全体を表示PDF形式でダウンロード (609K) -
澤田 徹, 水上 公宏1978 年 18pt2 巻 2 号 p. 125-133
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーPathogenesis and etiologic factors in transient ischemic attack (TIA) were briefly reviewed with emphasis on intra and extracranial atherosclerotic changes and indication for surgery.
TIA is a clinical syndrome, which can only be defined by clinical features and is not confined to specific pathological changes in the brain or in the vascular system. Various pathogenic concepts and etiologic factors have been reported in the literature. The vasospasm theory in pathogenesis of TIA is now almost abandoned. There have been no experimental findings nor any other grounds to assume that vasospasm frequently causes TIA. Most patients with TIA become symptom-free by anticoagulation and many other evidences suggest that vast majorities of TIA are due to thromboembolism including so-called “microembolism.” However, transient fluctuations of cerebral perfusion pressure can also be a causative factor of TIA in a small number of cases, as pointed out by DennyBrown (so-called “cerebrovascular insufficiency”). In either case, the main etiologic factor can be attributed to atherosclerotic changes in the intra and extracranial arteries. Incidences of vascular changes in the intracranial cerebral arteries seem to be higher in this country than in European countries or in the USA.
In rare cases of TIA, various other pathogenic conditions, such as polycythemia, thrombocytosis, kinkings and coilings of the cervical arteries, subclavian steal syndrome, moyamoya disease, etc, have been reported or experienced.
Thromboendarterectomy of the cervical arteries and superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis have been tried for surgical management of TIA. From a pathogenic point of view, thromboendartectomy is recommended for cases of TIA, which is caused by thromboembolism originated from atherosclerotic foci in the cervical arteries, while STA-MCA anastomosis might possibly be applied to cases of cerebrovascular insufficiency due to various vascular changes such as stenosis of the middle cerebral artery, internal carotid occlusion, and moyamoya disease.抄録全体を表示PDF形式でダウンロード (585K) -
高木 偉, 榊 三郎, 木元 克治, K-A. HOSSMANN1978 年 18pt2 巻 2 号 p. 135-140
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーThe reactivity of pial arteries to local changes in pH, ion activity and alpha sympathetic agents was investigated during recovery from 1 hour's ischemia using a topical application on filter paper.
Cats were anesthetized with pentobarbital sodium and were submitted to one hour's complete cerebral ischemia by intrathoracic arterial clamping in combination with induced hypotension. Upon recirculation after one hour of ischemia, CBF increased above the preischemic level with marked dilatation of the pial vessels. Hyperemia lasted up to about one hour after recirculation, and was followed by delayed decrease in cerebral blood flow (postischemic hypoperfusion). The pial arteries at this time constricted by more than 20% indicating that the reduction in blood flow was due to an increased vascular tone. During this phase the vascular reactivity to pH and ion activity was distinctly reduced compared with that in normal state.
Blocking of calcium ions by EDTA or the topical application of high concentration of phentolamine, on the other hand, showed marked dilatation of the pial arteries up to 130% and the constricting effect of norepinephrine was similar to that in controls.
From the results obtained in this study, it is concluded that ischemic vessels are still able to respond to the topical application of pharmacological agents, although the reactivity to the changes in pH or ion activity is distinctly reduced. Failure of improving cerebral blood flow after ischemia by systemic administration of vasoactive drugs, therefore, seems to be due to the impermeability of the blood brain barrier rather than to the postischemic unresposiveness of pial arteries to these drugs.抄録全体を表示PDF形式でダウンロード (328K) -
神山 和世, 畑中 光昭, 桜井 芳明, 鈴木 二郎1978 年 18pt2 巻 2 号 p. 141-143
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーA 28-years-old female was the only one case who had an aneurysm arising from the posterior communicating artery itself in a total of 1, 080 cases of saccular aneurysms handled by our clinic. Most of the so-called posterior communicating artery aneurysms are actually internal carotid-posterior communicating artery junction aneurysms. The incidence of aneurysms arising from the posterior communicating artery itself is reported to be 0 to 3.3% of the total cases. In our case, treatment by trapping at the posterior communicating artery was performed.抄録全体を表示PDF形式でダウンロード (187K) -
―精神発達面を中心として―久間 祥多, 山ロ 和郎1978 年 18pt2 巻 2 号 p. 145-149
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリー1. Psychological testing were applied to 20 hydrocephalic patients who had had shunt operations before 1973. Thirty percent of the patients showed IQ above 80, 15% between 79 and 70, and 55% below 69. Considering the cause of hydrocephalus, the best result was seen in the patients with unknown etiology. The next was in meningomyelocele. The worst was in meningitis.
2. There was a correlation between frontal cortical thickness and mental development. Patients with cortical thickness of less than 0.8 cm showed poor developement.
3. Mental developement cannot be evaluated sufficiently by IQ score alone. After analysing the pattern of subtest score, further systemic tests must be performed. On the basis of these examinations, mental rehabilitation or educational therapy are indicated.抄録全体を表示PDF形式でダウンロード (301K) -
―特に視神経鞘切開法の意義―上村 孝臣, 飯坂 陽一, 数野 隆人, 大木 紘1978 年 18pt2 巻 2 号 p. 151-157
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーOut of 8 cases of optic nerve injury patients treated between 1971 to 1974, the most recent 4 cases underwent decompression with the optic nerve sheath incision and these cases proved to have good postoperative recovery.
1. Sheath incision contributed to the early recovery (within 7 days) of visual acuity in most cases.
2. All sheath incision cases recovered useful visual acuity (0.01 or better) postoperatively.
3. Sheath incision is apparently useful to improve visual acuity in patients who suffered edema or circulatory insufficiency of the nerve.
4. Sheath incision can be applied in cases of total blindness as shown in Case 8 of our series.抄録全体を表示PDF形式でダウンロード (333K) -
石田 陽一1978 年 18pt2 巻 2 号 p. 159-169
発行日: 1978年
公開日: 2006/12/28
ジャーナル フリーPDF形式でダウンロード (1261K)
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