Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 18pt2, Issue 4
Displaying 1-10 of 10 articles from this issue
  • —2. Absorption and Circulation of Cerebrospinal Fluid—
    KENICHIRO HIGASHI
    1978 Volume 18pt2 Issue 4 Pages 261-272
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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  • JUJI TAKEUCHI, SHINICHI OHTSUKA, YOSHIHIRO TAKEBE, SOICHI MIWA, TOSHIK ...
    1978 Volume 18pt2 Issue 4 Pages 273-278
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Hypothalamo-pituitary-adrenal (H-P-A) function in 49 patients with suprasellar germinoma, craniopharyngioma, pituitary adenoma, tuberculum sellae meningioma, and other parasellar tumors was investigated. Plasma cortisol and urinary 17-OHCS were evaluated in basal conditions and after the following tests: ACTH, lysinevasopressin, insulin (hypoglycemia), and metopirone.
    Insulin test revealed that H-P-A function was impaired in 44.4% of suprasellar germinomas, 36.4% of craniopharyngiomas, 25.0% of pituitary adenomas, and 20% of tuberculum sellae meningiomas. After treatments, improvements of H-P-A function were observed generally, which probably reflected the improved surgical techniques using microscope.
    H-P-A function was normal when the tumor was confined in the sella turcica, and was first disturbed when tumors reached to the junction of hypothalamus and pituitary stalk or hypothalamus itself. However, the grade of H-P-A dysfunction was not correlated with the extension of tumors into the hypothalamus.
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  • AKIO KUWAYAMA, NAOKI KAGEYAMA, TOSHICHI NAKANE, MASAYOSHI TAKANOHASHI, ...
    1978 Volume 18pt2 Issue 4 Pages 279-285
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Six patients of ACTH dependant Cushing's disease were treated by transsphenoidal resection of pituitary adenomas. Preoperative endocrinological results showed that both plasma ACTH and cortisol were maintained at higher levels and their normal diurnal rhythms were lost. Urinary 17-OHCS excretion was partially suppressed by larger doses of dexamethasone (8 mg). These data was suggestive of pituitary dependent Cushing's disease, rather than ectopic ACTH-producing tumors.
    The sella volume was measured by Di Chiro's method and in 3 cases it exceeded minimally above the upper limit of the normal value, but the other 3 showed completely normal sella. Localized bulging of the sella floor was found in 2 cases by midline lateral tomography. In the A-P tomogram asymmetry of the sella floor was found in one case and localized bulging in other 2 cases. Minimal suprasellar expansion of the tumor was found only in one case by midline pneumotomography. Magnified cerebral angiography with subtraction method or computed tomography was not diagnostic to verify pituitary microadenomas. The indication of pituitary surgery had to be decided mainly by endocrinological findings.
    In only one case the adenoma occupied most of the intrasellar space, but in the other 5 they were microadenomas and 3 of them were buried in the normal glands. Complete resection of the adenoma was attempted, but macroscopically normal tissue was tried to be left as much as possible. Typical Crooke's hyaline changes were found in the normal adenohypophysis in one case and immunohistochemical studies using anti-ACTH serum revealed that the Crooke's cells are still reactive.
    After surgery most patients showed decreased plasma ACTH and cortisol levels and substitution therapy of adrenocortical hormones was necessary for the first one or two months. Rapid clinical remission of Cushing's syndrome was observed in all but one, who might have residual tumor cells due to technical incompleteness.
    Successive endocrinological reevaluation showed that pituitary-adrenal function has been normal or subnormal in 5 cases. One showed no significant improvement. None had pan-hypopituitarism nor any serious side effects, such as liquorrhea and continuous diabetes insipidus.
    Overall results suggest that transsphenoidal resection of pituitary adenomas in Cushing's disease should be located in the center of the treatment.
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  • —Sequential Study of Delayed Enhanced CT and Radioisotope Delayed Scan—
    KIYOHIDE KOMATSU, MATSUTAIRA TSUYUMU, SHIN TSURUOKA, TOHRU FUKUMOTO, H ...
    1978 Volume 18pt2 Issue 4 Pages 287-293
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    This report is mainly based on experiences of CT in 195 cases of brain tumor, 39 cases of which were examined by sequential delayed enhanced CT. The CT findings of these were compared with those of delayed radioisotope scan, operative and histological findings. The results are as follows. Malignant glioma has usually lower density than normal brain tissue on plain CT, and has a ring or irregular shaped circular high density zone on contrast enhanced CT. The density of cystic or necrotic portion increases gradually and reaches its peak in 3 hours after intravenous contrast media injection (ivcmi). In radioisotope scanning, these tumors show higher uptake in delayed scan than early scan. The density of astrocytoma with large or multiple small cysts is very low on CT, and does not increase on enhanced CT. However, in the case of solid astrocytoma with cyst, the density of cystic area reaches its peak in 3 hours after ivcmi. Meningioma is more sharply delineated than other tumors on CT, and its density becomes homogeneously highest immediately after ivcmi for a short time (30 min.), and then begins to decrease rapidly; in radioisotope scan, early scan reveals higher uptake than delayed scan. Acoustic neurinoma is usually characteristic of its major low density area on plain CT, which takes high density after ivcmi in some cases. In metastatic tumor, a large amount of low density area is detected around the metastatic nodules, and the finding of multiplicity offers considerable evidence of its diagnosis.
    The increase in density of brain tumor on CT after ivcmi is probably due to its high vascularity and/or increased permeability of vessels in tumor and/or adjacent tissue, and contrast enhancement of cyst in brain tumor is presumably caused by the exudation and/or transudation of contrast media through the cyst wall. In general, the sequential increase and decrease of density of brain tumor on CT after intravenous administration of contrast media is approximate to the sequential change of uptake of radioisotope in tumor on R I scan. We have classified the brain tumor into 4 groups by its sequential pattern of contrast enhancement on CT; immediate, delayed, continuous, and no enhancement.
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  • —CT Findings—
    TOSHIAKI ABE, NORIO NAKAMURA, HIROAKI SEKINO, TAKASHI SUZUKI, RYUZO IS ...
    1978 Volume 18pt2 Issue 4 Pages 295-301
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    In 54 of 80 infratentorial tumors, neurological as well as radiographical signs of transtentorial upward herniation was investigated.
    The radiological findings were classified into three types; Cerebellar Types, Brain Stem Type, Total Type.
    Computerized tomography (CT) was performed in 16 of 80 infratentorial tumors.
    These CT findings were compared with the each type of radiographical transtentorial upward herniation.
    It was shown that the quadrigeminal cistern was obstructed early in cerebellar tumor which was apt to show the Cerebellar Type of the transtentorial upward herniation.
    On the contrary, the cistern was not obstructed until terminal stage in pontine tumor which was apt to show the Brain Stem Type.
    In cerebello-pontine angle tumor, the quadrigeminal cistern was obstructed asymmetrically, the tumor side was dilatated and the other side was obstructed, which was due to midbrain shift to the contralateral side.
    In conclusion, the following interpretation is reasonable. Quadrigeminal cistern is easily obstructed by upward displacement of the cerebellum and lateral displacement of the midbrain, whereas, it rarely changes its configuration by upward displacement of the brain stem.
    However, we could not find any correlation between radiological and neurological signs in regards to upward herniation.
    It can be said that the progress of radiological transtentorial upward herniation is correlated with neither local pressure nor local cerebral blood flow.
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  • —Chromosome Changes of Brain Tissue Cells during Pre-induction Stage of the Tumor—
    MAKOTO TANAKA, KIYOSHI FUJIWARA, SATOSHI MATSUMOTO
    1978 Volume 18pt2 Issue 4 Pages 303-308
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    In the experiments of transplacental carcinogenesis by ethylnitrosourea (ENU), it is unknown whether or not some cellular component shows abnormal changes before the initial appearance of tumor in the nervous system.
    In order to get some clues for carcinogenic transformation, chromosome constitutions were investigated in in vitro cells after ENU administration. ENU was administered to pregnant rats at the terminal stage of gestation.
    Offsprings were sacrificed on the 2nd day after birth, and cells from brain tissue were cultivated in CO2 incubator for about 50 days. During this period, chromosome analysis were periodically performed.
    Most of cells showed diploid or subdiploid chromosome number and no numerical changes were observed in chromosomes. With the percentage of 0 to 6 of all metaphases in each stage, abnormal chromosomes were observed. The abnormal chromosomes were usually larger than any other normal ones. These chromosomes showed telocentric pattern in figure, but exhibited no regurality in shape and in size. Therefore, the same abnormal chromosomes were not again observed during cultivation.
    This means that this abnormality in chromosome is not transmitted to daughter cells. The unstable changes in chromosome reflects the unstable state of DNA of in vitro cells from ENU treated rat brains, and therefore it seems that these changes are one of representations of cell republication in pre-induction stage of tumor after ENU administration.
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  • HIDEAKI NUKUI, TAKAO NAGAYA, SOUKICHI TANAKA, MOTOMASA KAWAKAMI, TERUT ...
    1978 Volume 18pt2 Issue 4 Pages 309-321
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    Thirteen cases with spontaneous carotid-cavernous fistula found in our clinic during the last 5 years were analyzed.
    The age ranged from 24 to 74 years, and 12 were women.
    Initial symptoms were diplopia in 3 cases, severe orbital pain or headache with nausea and vomiting in 3 cases, dull pain around the orbit in 3 cases, red eye in 2 cases and tinnitus in 2 cases.
    Sings and symptoms at admission were conjuctival injection in 10 cases, chemosis in 5 cases, exophthalmos ranging from 2 to 9 mm, in 10 cases, bruit in 7 cases, disturbance of ocular movement in 7 cases, impairment of visual acuity in 4 cases, orbital pain or headache in 6 cases and tinnitus in 8 cases.
    Angiograms showed that in all cases dural branches of the internal carotid artery were contributors to the shunt and in at least 5 cases branches of external carotid artery were also contributors.
    There were positive correlation between angiographic findings and certain signs and symptoms.
    In all 3 cases with prominent venous drainage, disturbance of visual acuity and ocular movement were noticed. In another 10 cases, disturbance of visual acuity and ocular movements were found in one case and 4 cases, respectively. Furthermore, in 10 cases with posterior venous drainage via the inferior petrosal sinus, 8 cases complainted of tinnitus, but other 3 cases without showing posterior drainage, did not complain of tinnitus.
    Cerebral hemodynamic study was performed in 8 cases. In 7 cases rCBF values were normal and the relative shunt rate was small (10 ?? 23%). In another one case rCBF could not be measured because the shunt rate of the affected internal carotid artery was 100%. These results coincided with the angiographic findings.
    Twelve cases were not operated on and follow-up study ranging from 9 months to 5.2 years were carried out. Clinical symptoms were alleviated in 4 cases and completely disappeared in 8 cases. The follow-up angiography in the latter 3 cases showed disappearance of the shunt.
    Consequently, in cases with small blood deprivation through the shunt and mild clinical symptoms, conservative treatment is recommended unless exacerbation is not noticed.
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  • TARUMI YAMAKI, GENYA ODAKE, YOSHIHARU HORIKAWA, KENZO SUZUKI, MASAHITO ...
    1978 Volume 18pt2 Issue 4 Pages 323-329
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    We report our experience and technique of prefabrication method for cranioplasty, using heat-cured methyl methacrylate (MMA).
    Recently, an autopolymerizing MMA has been a very popular material for cranioplasty. But an autopolymerizing MMA is so irritable to vital tissue that subgaleal effusion has been frequently noted after cranioplasty. And for a large cranial defect, it is difficult to get a good cosmetic result from the one-stage autopolymerizing MMA method. So, we have used a heat-cured MMA as a material of cranioplasty, and a prosthesis was formed preoperatively using an impression technique. In this method, the subgaleal effusion was markedly decreased and excellent cosmetic result was obtained even to a large cranial defect in a shortened operative time.
    The histological reactions to the autopolymerizing MMA and the heat-cured MMA were evaluated experimentally embedding each piece of the two materials in the subcutaneous tissue of the rat. The inflammatory reactions including appearance of foreign body giant cells were far less observed in the subcutaneous tissue around the heatcured MMA.
    This experimental result emphasized the advantage of heat-cured MMA method over autopolymerizing MMA.
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  • NAOMI ISHIYAMA
    1978 Volume 18pt2 Issue 4 Pages 331-339
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
    In order to study epispinal circulation one has to release the cerebrospinal fluid pressure by dural opening. “Water-tight spinal window” which the auther had devised made possible the direct observation of epispinal circulation at the various stages of intrathecal pressure(ITP) less than 110 mmHg in adult dogs. The device requires vertebrectomy of the atlas and the axis for the exposure of the dura, attachment of a glass window having two plastic tubes for pressurization and pressure measurement on to the dura and water-tight sealing around the window with cotton pledget, Biobond® and Aron Alpha A®. The ITP is controlled by the hydrostatic infusion of Lactate-Ringer's solution through the plastic tube attached at the window. By this device “water-tight spinal window, ” we found ITP was equal to that of lateral ventricle.
    Serial fluorescein angiography was performed at 0.5 seconds interval for 15-25 seconds, just the same time as retrograde injection of 0.5% fluorescein sodium solution into the brachial arteries on both side.
    At the level of high cervical cord, unlike the cerebral cortex, microvasculature did not seem to be finely distributed and the fluorescein material only appeared in some of vasculature, not necessarily showing all the vessels in that region. In veins with the diameter of less than 200μ, a laminar flow was observed frequently. Regional circulation time (RCT) was determined by the time between the appearance of the fluorescein material into an artery with the diameter of 100 s and reappearance of the fluorescein in the vein in the same field.
    As the results, the author found when ITP was 7-20 mmHg, RCT was 2.4±0.4 seconds and an elevation of ITP leads to a prolongation of RCT. There was no filling of fluorescein material when ITP was over 80 mmHg.
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  • YOICHI ISHIDA
    1978 Volume 18pt2 Issue 4 Pages 341-350
    Published: 1978
    Released on J-STAGE: December 28, 2006
    JOURNAL FREE ACCESS
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