Ninety-five studies of regional cerebral blood flow were performed in 52 patients with ruptured intracranial aneurysms. Cerebral blood flow was measured by the ¹³³Xe clearance method using multiple detectors and regional values were averaged for each patient to obtain mean hemispheric values (mean CBF). The changes in mean CBF were analyzed under various pathophysiological conditions following rupture of intracranial aneurysms and were discussed with special reference to clinical prognosis. The results were as follows:
1) In general, diffuse reduction in CBF was found and continued for a long time in spite of improvement of clinical grades. Reduction in flow was bilateral but was greater on the side of the lesion in 3 cases studied.
2) The degree of reduction correlated well with the clinical grade of neurological deficits. The values of mean CBF in Grades I . II, III and IV patients were 39.4±7.6, 32.7±6.0, 25.7±5.8 ml/100g/min, respectively.
3) Arterial spasm was often associated with a reduction in mean CBF. A good correlation of spasm with decreased mean CBF was found in 8 cases studied both at the presence and at the absence of spasms; the values were 29.6±5.0 and 39.3±6.5 ml/100g/min, respectively. Reduction in mean CBF, however, was found even at the absence of spasm and spasm was not necessarily associated with depressed flow.
4) Twelve cases with intracerebral hematoma and four cases with hydrocephalus were usually associated with marked reduction in mean CBF, 29.5±5.3 and 27.0±3.7 ml/100g/min, respectively.
5) Patients without neurological deficits whose preoperative mean CBF were over 30 ml/100g/min showed good clinical results. The mean CBF ranging 20 to 40 ml/100g/min was found in patients with some neurological deficits. Marked reduction in preoperative mean CBF resulted in poor clinical prognosis.
It was concluded that analysis of cerebral blood flow was useful in determining the time for surgical intervention and indicative of a good prognosis of cerebral function and survival.

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Clinical analysis of postoperative complications were made in 1, 000 cases of intracranial saccular aneurysm. Psychiatric symptoms, motor disturbances, and aphasia were observed in 107 cases (11.5%), 74 cases (7.1%) and 20 cases (2.1 %), respectively in 929 discharged cases.
Moreover, metabolic disturbances of water and electrolytes and gastro-intestinal bleeding were found in 60 cases (6.0%) and 19 cases (1.9%), respectively in 1, 000 surgically treated cases including cases of death during hospitalization.
Psychiatric symptoms were apt to develop in cases of vertebro-basilar artery aneurysm, multiple aneurysm and anterior communicating aneurysms.
There were some tendencies that the poorer the preoperative grade was, the higher the occurrence rate of psychiatric symptoms was.
Concerning the timing of surgery, psychiatric symptoms developed most frequently in cases operated at 3-7th day after the subarachnoid hemorrhage. Most of the postoperative psychiatric symptoms consisted of disorientation, character changes. and Korsakoff's syndrome, and they improved in 63% of 107 cases at the time of follow-ups. The occurrence rate of other complications were also investigated in relation to the site of aneurysm, preoperative grading and the timing of surgery in this report.

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Perturbed cellular kinetics of experimental C₆ brain tumor under the effect of chemotherapeutic agents and physical condition was investigated for establishing the optimal regime of brain tumor synchronization as pretreatment for radiotherapy. Cultured C₆ strain was treated for 72 hours with Vincristine, Vinblastine, ACNU, BCNU, 5-FU, Methotraxate, Bleomycin, hyperthemia or microwave irradiation. The cell cycle distribution was analysed by the histograms of pulse-cytophotometry with DNA specific fluorescent stain of ethidium bromide in cell suspension. The quantitative evaluation of cell cycle phase was obtained using a computerized mathematical model. Potent synchronization in the G₂-M phase was observed in the group treated with Vincristine, Vinblastine, ACNU and BCNU. In the Vincristine and ACNU-treated group, G₂-M phase accumulation increased gradually during 72 hrs. Maximum level of G₂-M phase was 47.6% of diploid cell population by 72 hrs-contact with Vincristine, and 47.2% by ACNU (control 10%). In the Vinblastine and BCNU-treated group, G₂-M phase-accumulation increased rapidly during 24 hrs. and then the accumulated cells in G₂-M phase became dead within 72 hrs. Hyperthemia (40°) accumulated 37% of total cells into the G₂-M phase. In other treatments, the cells in G₂-M phase were below 30% of total cells. Significant synchronization depends on concentration, exposure time and tumor specificity of agents, even in vitro system.
The effect of combined use of ACNU and Vincristine was investigated in vivo in intracerebrally innoculated C₆ tumor. A relatively low amount of proliferating fraction was shown in comparison with cultured C₆ glioma. After the 9th day from innoculation, combined administration of Vincristine, 0.025 mg/kg on 3 successive days, and ACNU, 0.8 mg/kg, on 2 successive days from the second day of Vincristine was intravenously performed via femoral vein of rats. The administration of Vincristine 0.25mg/kg and ACNU 0.8 mg/kg was also tried in the same regimen in another group of rats. The cells in G₂-M phase increased to 21% in lower concentration and 29% of total cells in higher concentration (control 6%). These results showed the possibility of the choice of vinca alkaloids and nitrosourea derivatives for cellular synchronization as pretreatment for radiotherapy.

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Fifteen pituitary adenomas with hyperprolactinemia obtained at surgery were studied by an indirect immunoperoxidase technique for the demonstration of prolactin. (Anti-human prolactin was supplied by NIAMDD.) The immunoreactive prolactin was revealed in the cytoplasm of the tumor cells in 13 cases, which were classified into two types according to the population of prolactin cells and the intracytoplasmic localization of immunoreactive prolactin.
Type I—8 cases—
The adenomas of this type consisted of numerous prolactin cells, which accounted for more than 90% of the tumor cells. These were strongly suggested to be the primary prolactin producing adenomas. Immunoreactive prolactin was characteristically found in the form of ‘Nebenkern’ in the cytoplasm of these adenoma cells, while it distributed evenly throughout the cytoplasm in normal prolactin cells. This finding suggested discrepancy of the hormone syntheses between normal and neoplastic prolactin cells. Clinically, serum prolactin levels were over 1, 000 ng/ml, and the tumor sizes were variable from intrasellar types to larger ones showing remarkable suprasellar extensions.
Type II—5 cases—
The proportion of prolactin cells was only 10 ?? 30% of the tumor cells, which also contained growth hormone and/ or luteinizing hormone in two cases. These adenomas, consisting of prolactin cells and some other cell types, might be considered to show the ‘chimera’ like proliferation. In contrast with Type I, intracytoplasmic immunoreactive prolactin was detected unevenly in each prolactin cells. Clinically, serum prolactin levels were about 100 ng/ml, and all the tumors of this type showed moderate or marked suprasellar extensions. From this viewpoint, the interruption of prolactin inhibiting factor (PIF) might play some role to activate prolactin cells of these adenomas. Since the immunohistochemical findings well reflected the serum prolactin levels in most cases, it might be considered that the origin of hyperprolactinemia can be attributed to the tumor itself.

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We conducted intraoperative radiotherapy using Linac 12 MeV electron in the amount of 3, 000 rads to a 42-yearold male sufferring from a malignant tumor of right occipital lobe, and Linac 12 MeV electron 2, 000 rads to a 62year-old male afflicted with a left frontal lobe tumor.
The effect of acute stadium of radiotherapy for malignant brain tumor was bleeding, hyperemia interstitial swelling and degeneration of the vascular wall. In the delayed radiation necrosis, hyaline degeneration of the vascular wall and thrombosis reported in literatures. The vascular changes in the acute stadium of radiotherapy is considered to be correlated with the incidence of the delayed radiation necrosis.

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1. We studied serum PRL abnormalities inpatients with various disorders of hypothalamo-hypophyseal system. When the basal serum PRL level was above 300 ng/ml, the presence of pituitary adenoma was strongly suggested.
2. Of 16 pituitary adenomas with hyperprolactinemia, 9 were associated with acromegaly (6 males, 3 females) and 7 with Forbes-Albright syndrome (amenorrhea-galactorrhea syndrome). Galactorrhea was also found in 6 of these 9 acromegalic patients, interestingly 3 of them were male cases. Amenorrhea was seen in all female cases with hyperprolactinemia except for one acromegalic case.
3. Serum PRL levels ranged from 46.2 to 508.2 ng/ml (mean: 203.2 ng/ml) in acromegalic patients and from 222.0 to 2100.0 ng/ml (mean: 1289.9 ng/ml) in patients with Forbes-Albright syndrome. Thus, the latter showed significantly higher levels of serum PRL.
4. Acromegalic patients showed more than 50% increment of serum PRL to TRH infusion, whereas, almost all patients with Forbes-Albright syndrome did less than 50%.
5. Intratumoral hemorrhage was found in 4 patients with Forbes-Albright syndrome by surgery. Two of them had episodes of pituitary apoplexy preoperatively.
6. It should be emphasized that early diagnosis and treatment is essential to normalize the dysfunction of hypothalamo-hypophyseo-gonadal axis. We consider that in patients with Forbes-Albright syndrome, visual disturbances and galactorrhea could be cured in almost all patients and ovarian dysfunction could also be normalized about more than half by transsphenoidal surgery combined with CB-154 and/or irradiation.

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We have studied the diagnostic value of computed tomography cisternography in the evaluation of altered CSF dynamics and lesions which affects the morphology of the basal cisterns, such as extraaxial tumors in 35 patients. Twenty-two patients received metrizamide for the evaluation of CSF dynamics, mainly of communicating hydrocephalus, 9 for skull base tumors such as pituitary adenomas and CP angle tumors, and 4 for congenital cystic lesions such as porencephaly or arachnoid cyst. Diazepam or phenobarbital was used before intrathecal injection of metrizamide. In most cases, metrizamide was introduced through the lumbar intrathecal route, except for 2 cases which were through cisterna magna puncture and 2 cases into the lateral ventricles via Ommaya's reservoir. Two to 10 ml of metrizamide solution with a concentration of 170 mgI/ml was used. The patients were kept in 30 degrees Trendelenburg position, or kept in the horizontal supine position. Computed tomography with EMI scanner (CT1010) was performed 1, 3, 6, 24, 48 hours and occasionally 72 hours after the injection. In normal CSF dynamics, basal cisterns are clearly visualized one hour after injection. At 3 hours, cisterns are more clearly opacified with metrizamide. At 6 hours, the amount of metrizamide is slightly decreased from basal cisterns. Sylvian and interhemispheric fissures and convexity subarachnoid spaces and sulci become more distinctly opacified. At 24 hours, basal cisterns become almost free of metrizamide and diffuse increased absorption of the cerebral surface and possible cerebral parenchyma are noted. At 48 hours, no metrizamide is detected by CT. The fourth ventricular filling is sometimes seen in normal cases. In abnormal CSF flow pattern, ventricular reflux of metrizamide, persistent or transient, is noted. In such cases, periventricular low density area is often observed on plain CT. In a case shown at Fig. 6, periventricular low density area shows statistically significant increase in Hounsfield units at 6 and 24 hours after metrizamide injection. This suggests periventricular resorption of metrizamide. The site of cisternal block is clearly visualized. Delayed convexity flow is also noted. Detailed morphology of the subarachnoid cisterns can be analysed with the use of CSF enhancement with metrizamide, especially by the 320 × 320 matrix high definition picture. The presence or absence of suprasellar extension of a tumor is exactly diagnosed. A CP angle tumor is also diagnosed as a filling defect. An arachnoid cyst and porencephalic cyst can be diagnosed in relation with CSF flow pattern.
The side effects we have observed are headache (10/35), nausea (9/35) and vomiting (6/35). No convulsion has appeared.

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The author investigated the sequential morphological changes at the site of carotid endarterectomy (CE) in cats with light microscope and scanning electron microscope (SEM).
Adult cats were anesthetized with ketamine-HCl and the right common carotid artery was exposed. After an intravenous administration of 1, 000 units heparin-Na, arterial wall was incised linearly and CE was completed by removing the endothelium, internal elastic laminae (IEL) and a part of muscle layers of the media for a distance of approximately 0.5 cm under surgical microscope. The artery was closed with 10-0 monofilament nylon. Animals were sacrificed at the acute phase (5, 10, 15, 30 min. and 1, 4, 5 days), reparative phase (1, 2, 3 weeks) and mature phase (4, 8 weeks).
1) Acute phase—At the earliest interval, the luminal surface of endarterectomized lesion was covered with small thrombi, but with the lapse of time small thrombi were decreased in number and a thin layer of adherent platelets without development of a thrombus was observed. 2) Reparative phase—The regeneration of the endothelium took place from the unendarterectomized border of the induced lesion. The central portion of CE had not yet completed the protrusions which were formed by the new endothelial cells, showing an amorphous smooth surface. At the center of the lesion, luminal surface was also covered with blood cells except areas of the smooth surface. The smooth surface appeared as the result of fusion of flattened platelets. Similar structures were seen at the advancing front of sheets of the regenerated endothelium. These findings seemed to suggest that the regeneration of the endothelium was influenced by preceded fusion of the platelets and that regeneration of endothelium took place not only from the each end of unendarterectomized vascular wall but also from islands of endothelium appeared at a number of different places over luminal surface. Under light microscopic observation, no IEL was identified by observations in reparative phase. There was poorly stained layer of amorphous material underneath the regenerated endothelial cells. 3) Mature phase—Endarterectomized area was covered completely with new endothelial cells and blood cells were not seen on the luminal surface. However, linings of the new endothelial cells were irregular and different from normal ones.

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