Neurologia medico-chirurgica

Morphological Change of Cerebral Mantle or Ventricular Size in Infantile Hydrocephalus and Its Significance

—Especially, from the Point of View of Patho-histological Findings and Intraventricular CSF Pulse Wave—

TETSURO MIWA

1979 Volume 19 Issue 4 Pages 319-326
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.319

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Epidemiological Survey of Vegetative State Patients in the Tohoku District, Japan

—Special Reference to the Follow-up Study after One Year—

SUSUMU SATO, HITOSHI IMAMURA, KOMEI UEKI, HIROYUKI ARAI, KIMIKAZU KONN ...

1979 Volume 19 Issue 4 Pages 327-333
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.327

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An epidemiological survey of vegetative state patients (VSP) was conducted in the Tohoku District, Japan from 1975 through 1977.
In the survey of 1976, we collected data on 219 VSP and performed follow-up study on these cases during 1977. Of the total 219 VSP, 14 cases (6%) improved and recovered from the vegetative state, 80 cases (36.7%) died, 110 cases (50%) remained unchanged, and 11 cases (5%) were loss during follow-up.
The recovery from VSP was higher in younger age patients (under 60) compared to older age patients (above 60). No difference in recovery rates were noted by the causes of brain damage.
Of the 14 patients who recovered, 11 (80%) recovered from the vegetative state within 2 years from onset. Eight patients received various treatments, i.e. forceful intracarotid injection of own arterial blood (auto-blood pumping therapy), systemic administration of levodopa or amantazine, intrathecal injection of nicholine, etc., while the remaining 6 patients were not treated by such specific remedies. In reply to our questionnaire, none of our survey staff reported that any of these treatments were specifically effective in treating VSP.
Forty of the 80 deceased cases (50%) died within 2 years, 25 cases (31%) lived more than 3 years, and 7 (8.6%) lived more than 5 years. Pulmonary infection, heart failure, and renal insufficiency were the most common causes of VSP deaths.
The incidence rate of VSP during this year (1977) was 1.10 and the prevalence rate on December 31, 1977, was 2.21 person per 100, 000 population. The annual incidence rate of 1976 through 1977 was 0.85 person per 100, 000 population.
Sufficient nursing care and financial aid for VSP and their families were emphasized as extremely important to prevent them from falling into familial collapse.

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Treatment of Malignant Glioma by Immunotherapy Using Lymphocytes Sensitized with Tumor-specific Immune RNA

REIZO MITA, TAKASHI IWABUCHI

1979 Volume 19 Issue 4 Pages 335-341
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.335

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Ten cases of malignant glioma (5 primary and 5 recurrent) were treated with passive immunization by lymphocytes sensitized with tumor-specific immune RNA. This immunotherapy was given either after surgery, surgery and radiotherapy or surgery and chemotherapy. Supernatant of 5, 000×G of tumor or sediment of 105, 000 x G of tumor was used as tumor antigen. Normal lymphocytes were sensitized by incubation with RNA. These sensitized lymphocytes were injected intravenously in doses as much as 7 ?? 15×10⁸.
At the present time, the longest survival period among the 5 primary case patients who received immunotherapy is 29 months and this patient is still alive. One patient died at 11 months after surgery. Two out of 5 recurrent cases were treated with surgery and immunotherapy, and they died at 7 and 8 months following surgery, respectively. Three out of 5 recurrent cases were treated with either surgery, radiation and immunotherapy, or surgery, chemotherapy and immunotherapy. One patient died at 13 months and 2 are still alive 20 months and 36 months after operation, respectively.
The following immunological responses were studied for each patient: leucocyte count, T-cell count, skin test of DNCB, PPD, PHA, blastogenic activity against PHA, machrophage imigration inhibitory test, and serum immuno-globulin. Increase in blastogenic activity against PHA was observed in some of long survival cases after immunotherapy.
Those patients who were not provided immunotherapy, and were treated by surgery, surgery and radiation therapy, or surgery and chemotherapy, survived less than 27 months.

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Prealbumin Subfractions in Brain Tumors

—With Special Reference to Ontogenic Changes—

JIRO UKI, HIROSHI INOUE, HIROMICHI YAMAZAKI, MINORU MURATA, RYOICHI KI ...

1979 Volume 19 Issue 4 Pages 343-354
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.343

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Prealbumin (PA) and its subfractions were analyzed to find their significance in the central nervous system from ontological and oncological points of view, using 7.5% polyacrylamide gel disc electrophoresis according to Ornstein⁵¹⁾ & Davis.¹⁴⁾
Tissues of 11 cases of normal human cerebrum, ranging from 5 or 6 months gestation to 64 years old, and 26 cases of brain tumor which included 12 gliomas, 8 meningiomas and 6 neurinomas were analyzed. Body fluids of 11 cases of brain tumor cysts, 12 ventricular cerebrospinal fluid with various neurological diseases, and 20 sera from the normal and the diseased were analyzed.
1. Tissue PA was subfractionated into five major peaks in the normal human brain, which we labeled PI through PV from the anodal side to the cathodal. In most of the brain tumors more than five peaks were subfractionated.
2. Concentration of PA subfractions changed in the developmental course in human brain. Among them, PIII and PIV changed remarkably in the fetal brain, namely, higher PIII and lower PIV levels were noted when compared to those of the adult brain. PI and PII showed no change during life.
3. Brain tumor had the same tendency as fetal brain regarding concentration of PIII and PIV subfractions.
4. PA III/IV ratios were compared as an index for showing some similarity in fetal brain and brain tumor tissues, and some tendency between them were observed.
5. PA fraction has been named as “neuronin” by Bowen et al.^7)8)9)58) and as “SPR protein” by Kawakita³²⁾, and some of its subfractions have been identified, for instance, PI as S 100, PIV as 14-3-2 or antigen α, PV as a sensitive index for hypoxia or neurotubulin protein. PIII as well as PII still have not been identified.
Further analysis of these proteins, immunochemically as well as electrophoretically, might answer the question of whether or not there are oncofetal proteins in the central nervous system.

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Immunological Study of RSV-induced Mouse Brain Tumor

I Induction of Tumor Specific Cytotoxic T Cells

KUNIO NAKAGAWA, YUTAKA MAKI

1979 Volume 19 Issue 4 Pages 355-360
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.355

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Brain tumor was induced with Rous sarcoma virus (RSV) in adult inbred mice of A/J as a model of human malignant brain tumor. This brain tumor could not be transplanted to allogenic mice of C3H/He and BALB/c. Moreover, the syngeneic animals which had undergone surgical removal, did not take the secondary challenge of the same tumor cells. These results suggest the presense of the tumor specific transplantation antigen (TSTA) associated with major histocompatibility complex (MHC). The tumor specific cytotoxic T cells were induced against this brain tumor using ⁵¹Cr release assay. Cytotoxic T cells were also induced when the tumor cells were inoculated intracranially, and their cytotoxic activity was higher in spleen cells than in lymph node cells. The brain has no lymphatic tissues. It may be possible that soluble tumor antigens shedding from cell surfaces may induce the cytotoxic T cells. More precise analysis of immune responses against the brain tumor may be necessary for the sake of immunological therapy.

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The Posterior Trans-sylvian Approach for Thalamic Hemorrhage

AKIRA GEGA, SHOZABURO UTSUMI, HIDEOKI TERADA, YOSHIKI IIDA, TETSUO HAR ...

1979 Volume 19 Issue 4 Pages 361-366
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.361

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This paper reports the removal of an intracerebral hematoma of the thalamus extending laterally or posterolaterally by a surgical route called the posterior trans-sylvian approach.
The posterior part of the sylvian fissure is opened under an operating microscope and the most posterior part of the island of Reil, which is the angiographical sylvian point, is approached along the transverse gyrus of Heschl. Then, the outer wall of the intracerebral hematoma can be punctured, and removed.
This approach was performed in four cases. A representative case is presented. The operative timing and the indication for the thalamic hemorrhage are discussed.

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Delayed Radiation Necrosis of the Brain

AKIRA OGAWA, TOKUO WADA, TORU TEDO, TSUNEO NAMIKI

1979 Volume 19 Issue 4 Pages 367-372
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.367

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Six cases (5 male, 1 female, 17-50 years of age) of delayed radiation necrosis of the brain are presented. Associated condition of these cases were 4 pituitary adenomas, 1 acromegaly and 1 mid-brain tumor. Each case received ⁶⁰Co-irradiation therapy ranging from 4, 850 to 6, 000 rads in tumor dose. Increased intracranial pressure due to space occupying lesion was evident in all cases after 1 to 6 years following radiotherapy. These included headache, vomiting, loss of consciousness, and hemiplegia. The cases were divided into the following two groups by length of latent periods after radiotherapy; one group whose symptoms occurred after 1 to 2 years, and the other group whose symptoms occurred after 4 to 6 years, respectively. Surgical excision of the mass was performed in all cases. Histopathologically, the former group was characterized by coagulation necrosis of the brain tissue while the latter group was characterized by macroscopically evident cyst formation containing bloody fluid. After surgery the symptoms improved, but some neurological deficits remained in the former group. On the contrary, the symptoms were completely eradicated in the latter group. We concluded that the surgical excision of the necrotic or cystic mass was useful for treatment of radiation necrosis.

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Computed Tomography and Ruptured Intracranial Aneurysm in Acute Stage

HIDENORI OHTA, ZENTARO ITO, KENJI NAKAJIMA, AKIFUMI SUZUKI, TSUNEZABUR ...

1979 Volume 19 Issue 4 Pages 373-381
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.373

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We analyzed 87 CT scannings from 74 cases performed between the onset day and the 14th day after the last episode of SAH in preoperative state to evaluate characteristic findings of SAH in acute stage and sequential changes of CT findings.
Locations of ruptured aneurysms were: anterior communicating artery (31), internal carotid artery (20), middle cerebral artery (19), anterior cerebral artery (2), and vertebro-basilar artery (2). EMI scanner CT-1000 and recently CT-1010 were used for scanning.
Attenuation of extravasated blood occured after the 4th day, and became more particular at the 2nd week on CT. Within 3 days after onset, diagnostic value to locate aneurysm was about 70%/ of all cases, but this fell into 11 % at the 2nd week. On the 2nd week after onset, we could see secondary changes due to SAH, especially the influence of vasospasm. These were brain swelling, cerebral infarction and ventricular enlargement. At the first week of onset, extravasated blood still remained as high absorption areas in high percentage, and the influence of vasospasm appeared only in a few cases on CT. (1) Subarachnoid hematoma, (2) intraventricular hematoma, (3) intracerebral hematoma and(4) ventricular enlargement were selected as indicators of acute stage SAH. These findings were scored from “0” to “3” according to severity and were totaled. We termed this total score as the “CT score.”
CT score correlated well with the severity and results of patients at discharge. There was a tendency to develop vasospasm corresponding to the qrade of subarachnoid hematoma.
CT was very useful in treatment, especially in determining timing and approach of operation. Our principle in treating SAH patients is to execute radical operation as early as possible (within 3 days after onset if possible) to prevent rerupture, evacuate subarachnoid hematoma and intracerebral hematoma at the same time, and also to continuously perform ventricular drainage and external decompression if necessarily.
We concluded that computed tomography was useful in diagnosis, estimation of prognosis, and also in treatment of SAH patients due to ruptured intracranial aneurysm in the acute stage.

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Low Density Area around the Intracranial Meningioma

—A Computer-assisted Tomographic Study—

TADASHI KOJIMA, SHIRO WAGA, MAKOTO SAKAKURA, YOSHISUKE YAMAMOTO, ATSUN ...

1979 Volume 19 Issue 4 Pages 383-389
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.383

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The authors studied the characteristics of low density area accompanied by intracranial meningiomas on computer-assisted cranial tomography (CT). In 1977 8 cases were experienced; 2 had no low density area, 3 had grade I edema and another 3 had grade III edema, according to the classification of brain edema proposed by Kazner et al. The conclusions are as follows :
1) Grade I edema on CT may not represent pathological edema in intracranial meningiomas, but may show dilated subarachnoid space around the tumors. The entrapped CSF space can be well defined, crescentic in shape and narrow.
2) Grade II and III edema on CT may represent pathological edema. The difference between grade II and III simply is one of spread and extent of edema, which would be influenced by the size and location of the tumor, tissue pressure gradient, compromising of cerebrovascular bed and function of the falx and/or tentorium as a barrier or buffer.
3) It would be reasonable to assume that if the edema on CT disappears completely soon after surgery for meningiomas, it may chiefly consist of increase in water content in the white matter, and if it persists and delays its disappearance after surgery, it may be associated with breakdown of myelin in the edematous brain.

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Neuro-otological Findings on the Posterior Fossa Lesions

—Part I Clinical Significance of Abnormal Eye Position and Eye Movement—

ATSUSHI KOMATSUZAKI

1979 Volume 19 Issue 4 Pages 391-397
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.391

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