Neurologia medico-chirurgica

Recent Advance in the Study of Cerebral Death

KAZUO TAKEUCHI

1978 Volume 18pt2 Issue 7 Pages 535-543
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.535

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Brain Tumors in the Aged

KAZUO TAKEUCHI

1978 Volume 18pt2 Issue 7 Pages 545-550
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.545

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Fifty-five cases of brain tumors over the age of sixty were analysed. Classification as to the type of tumor gave 19 metastatic tumors, 11 gliomas, 11 meningiomas, 6 pituitary adenomas, 4 acoustic neurinomas and 4 miscellaneous tumors. Among gliomas 6 cases were glioblastoma multiforme. In cases of metastatic tumors, the lung came first as the primary site.
Difficulties in diagnosis of brain tumors in the aged which had been heretofore emphasized by many authors, could be solved by introduction of computed tomography. Among 47 surgical cases of the author's series, only 2 cases of metastatic brain tumors died within 1 month after operation. Postoperative mortality rate of brain tumors in the aged was 4.3 per cent. However, postoperative survival period of gliomas in this age groups was much shorter than that of total gliomas in whole adult groups. The cause of such poor prognosis was discussed.

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Perturbation of Cell Kinetics on 9L Rat Brain Tumor Treated with BCNU, In Vitro and In Vivo

KAZUHIRO NOMURA, TAKAO HOSHINO

1978 Volume 18pt2 Issue 7 Pages 551-557
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.551

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Kinetic changes induced by 1, 3-bis(2-chloroethyl)-l-nitrosourea (BCNU) in 9L rat brain tumor were studied in vitro and in vivo by means of conventional autoradiography and flow cytometry (FCM). In vitro, 5 μg/ml BCNU, which resulted in 99% cell kill as measured by the colony forming efficiency assay, had the effects that most cells (more than 90%) were accumulated in G₂ or M phase after one cell division, while cells in early G₁ when BCNU had been given progressed to G₂ and never divided. These effects were also revealed in vivo by using CD Fisher rats bearing 9L brain tumors treated with LD₁₀ dose of BCNU which caused 99.9% cell kill.
Accumulation of cells in G₂ was also shown by flow cytometric study, but this time showed only 50% accumulation of cells at maximum 54 hrs after BCNU treatment. Rest of cells still remained in 2C peak of tumor even 78 hrs after treatment. Growth fraction of this tumor was 47-55%. This result suggests that these cells in 2C peak of tumor consisted of G₀ cells. In summary, effects of BCNU on 9L rat brain tumor cells in vivo were well correlated with that in vitro so far as cycling cells were concerned. But it should be noticed that G₀ cells could remain there even 78 hrs after BCNU treatment. These data also indicate that in vitro study was useful for estimation of the effects of BCNU treatment in vivo if the doses used for treatment in vivo could expect the same cell kill as that in vitro by colony forming efficiency assay. (Supported in part by CA-13525 and CA-19992 from NCI)

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Role of Local Fibrinolytic Activity on Rebleeding of Ruptured Aneurysm

TAKUO HASHIMOTO

1978 Volume 18pt2 Issue 7 Pages 559-568
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.559

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The fibrinolytic activity of cerebrospinal fluid has been studied in 60 cases with subarachnoid hemorrhage by Astrup's biochemical method. In 26 cases of them the fibrinolytic activity of CSF has been measured repeatedly during early stage of subarachnoid hemorrhage. It increased especially in the first one week after subarachnoid hemorrhage in all cases, and decreased gradually when the rebleeding of reptured aneurysm did not take place. On the other hand, increased fibrinolytic activity of CSF was detected repeatedly or gradually when rebleeding occured afterward. These results suggested the relationship between rebleeding of ruptured aneurysm and increased fibrinolytic activity of CSF.
The authers forcasted the rebleeding of subarachnoid hemorrhage and determined the best time of operation by monitoring of fibrinolytic activity in CSF. Compared with alteration of fibrinolytic activity of CSF, the fibrinolytic activity of serum was normal continuously after subarachnoid hemorrhage. It has been suggested that local fibrinolysis would cause rebleeding of ruptured aneurysm.
Fibrin-fibrinogen degradation products (FDP) was increased in CSF with subarachnoid hemorrhage. FDP, D fraction was detected in bloody CSF, but FDP, X, Y, and E fractions were not detected in CSF with subarachnoid hemorrhage immunologically. This result also suggested increased local fibrinolysis.
Localization of fibrinolytic activity in tissue has been studied in 9 aneurysms and 5 arterio-venous malformation by Todd's fibrin slide technique and immunofluorence study. Increased activity was seen in adventitia and endothelium of ruptured aneurysm, arachnoid menbrane, area of brain softening and wall of vessels of arterio-venous malformation. Increased fibrinolytic activity in CSF with subarachnoid hemorrhage must be released from these structures. The authors emphasized the important role of local fibrinolytic activity on rebleeding of ruptured aneurysm.

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Serious Cases of the Hypertensive Intracerebral Ganglionic Hemorrhage

TETSUO KANNO, KIMITOSHI SANO, TAICHIRO SHIBATA, KAZUHIRO KATADA, KAZUO ...

1978 Volume 18pt2 Issue 7 Pages 569-578
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.569

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Mortality of the hypertensive intracerebral ganglionic hematoma is still high. One of its reasons is that the treatment of very serious cases is difficult by either conservative therapy or surgical therapy. The purpose of this paper is to seek the possibility to save this very serious case. The results were following;
1) In the past three years since CT was available, 100 cases of intracerebral ganglionic hematoma were treated surgically. Among these cases, 22 serious cases of which CT showed a large volume of hematoma extending even into the ventricles were involved.
2) In these serious cases, the hematoma completed its spread within three hours after the attack which was verified with CT examination.
3) When the hematoma was seen spreading during CT examination, severe vomiting developed along with high blood pressure usually more than 200 mmHg.
4) The serious cases were devided into two sub-groups according to the way of hematoma spreading. The first group should be called “thalamic sparing group” of which the original bleeding point was located in putamen. The second group should be called “thalamic non-sparing group, ” of which the original bleeding point was located in thalamus. The thalamic sparing group did not spread into thalamus even if a large volume of hematoma was noted in all ventricles. Therefore, the so-called “combined type” corresponded to the spreading type of the thalamic hemorrhage, whereas the putaminal hemorrhage did never become the combined type.
5) We applied the following surgical method to treat these serious cases.
(1) Insertion of big catheters into the bilateral posterior horns to wash out the clots in ventricles.
(2) Removal the main hematoma by the transsylvian fissure approach.
(3) Removal of the clots in the fourth ventricle, if necessary.
However, by this surgery, only 3 cases in the thalamic sparing group and 2 cases in the thalamic non-sparing group were saved.
6) To improve the operative results, the hematoma removal within three hours after the attack might be recommended. To decrease the number of the serious cases, the hypotension therapy and anti-emetic therapy just at the attack might be useful.

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Surgical Indication of Arteriovenous Malformation at Ventrolateral. Craniocervical Junction

KITARO KAMADA, YASUHIKO NAKATA, NORIYUKI IIDA, TAKAHIDE SHIMOMURA, YUT ...

1978 Volume 18pt2 Issue 7 Pages 579-586
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.579

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We presented four cases of arteriovenous malformation in the vicinity of medulla oblongata, located ventrolaterally at the craniocervical junction.
All cases developed subarachnoid hemorrhage and the initial symptoms were not specific except for the severe nuchal rigidity and headache. Three cases were surgically treated. Satisfactory results were obtained by clipping of the feeding arteries and coagulation of the abnormal vessels with bipolar coagulator. One case died of fourth attack on the second day after admission and was autopsied.
Bilateral vertebral angiography is the best for diagnosis and the open mouth projection is essential because a shortened vascular figures of vertebral arteries can be corrected and because abnormal vessels can be found usually in the open mouth space. In our cases, C₂ radiculomedullary artery, anterior spinal artery, posterior spinal artery and the abnormally dilated artery branching from posterior inferior cerebellar artery and vertebral artery to flow into the lateral-inferior portion of medulla oblongata participated as feeding arteries.
As the lesion located at the lateral and ventral surface of medulla oblongata, the surgical procedures were difficult totally to remove. If the anterior spinal artery is not the main feeding artery, the operating purpose can be attained by clipping or ligaturing the other feeding arteries and then coagulating the abnormal vessels as much as possible. When the main feeding artery is the anterior spinal artery and the arteriovenous malformation locates in the medulla oblongata, it is impossible to treat this surgically by the dorsal approach. It may be necessary to carry out the other ways such as the transclival approach.

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Blood Pressure Measurement of the Cerebral Artery with Strain Gauge Forceps

—A Trial of Quantitative Measurement of Intraarterial Blood Pressure—

TETSURO MIZUTANI, KENICHIRO SUGITA, NAOKI KAGEYAMA

1978 Volume 18pt2 Issue 7 Pages 587-594
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.587

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In order to measure blood pressure (BP) of the vessels without damage, forceps with a pair of strain gauges has been designed and the applicability to quantitative BP measurement with the forceps was examined.
Using 42 mongrel dogs BP of various arteries was measured by the strain gauge forceps and intraarterial cannulation method simultaneously. When the force of forceps made the artery to collapse, it was called“Maximum Force of Forceps” (MFF). MFF was well proportional to the intraarterial cannulation BP.
Small pieces of human cerebral arteries, obtained from 7 autopsies, were also examined by strain gauge forceps loading by hydrostatic pressure. From the results of measurement of human cerebral arteries in hydrostatic pressure, a formula was introduced. With the formula intraarterial pressure could be calculated from the diameter of artery and MFF. The formula was applied to measure the blood pressure during surgery of STA-MCA anastomosis, AVM, aneurysm and carotid cavernous sinus fistula.
Success of vascular anastomosis could be demonstrated quantitatively with measuring blood pressure of cortical MCA in STA-MCA anastomosis before and after the procedure. The change of blood pressure of draining vessel could show the extent of obstruction of feeding arteries in each step of extirpation of AVM. In carotid cavernous sinus fistula, remarkable change of blood pressure of intracranial internal carotid artery could be discerned after trapping of the fistula. In aneurysm operation, blood pressure measurement of parent artery helps detecting the stenosis after clipping or ligation of wide neck aneurysm.

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Neuroradiological Diagnosis of Third and Para-third Ventricular Tumors

—Part 2 Tumors Developing within the Third Ventricle and Tumors Invading Mainly the Anterior Portion of the Third Ventricle (1)—

JUSUKE ITO

1978 Volume 18pt2 Issue 7 Pages 595-608
Published: 1978
Released on J-STAGE: December 28, 2006

DOIhttps://doi.org/10.2176/nmc.18pt2.595

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