The in vivo efficacy of T-cell growth factor (TCGF)-dependent tumor-specific cytotoxic T lymphocyte (CTL) clone against a syngeneic murine malignant glioma (a 20-methylcholanthrene-induced ependymoblastoma of C57BL/6 mouse origin, 203-glioma) was investigated. Prior to this goal, the immunobiological properties of TCGF were first characterized in culture supernatants of concanavalin A (Con A)-activated murine (C57BL/6) or rat (Wistar) lymphocytes, respectively.
5×10⁶/ml lymphocytes were cultured with 2 μg/ml Con A in RPMI-1640 medium supplemented with 2% fetal calf serum for 48 hours. The culture supernatants (Con A sup) were concentrated by ammonium sulphate precipitation and partially purified by successive diethylaminoethyl (DEAE)-cellulose ion exchange chromatography and Sephadex G-100 gel filtration. TCGF was assayed for a quantitative analysis using a TCGF-dependent murine glioma-specific CTL clone (G-CTLL). The major portion of TCGF activity in murine and rat Con A sup was recovered in the 50 to 80%, and 40 to 80% (NH₄)₂SO₄ fraction, respectively. These activities were found in proteins of (3.0 ?? 3.6) × 10⁴, (1.2 ?? 1.8) × 10⁴ daltons in size as estimated by gel filtration, respectively and eluted from ion exchange chromatography in a NaCl gradient on 150, and 50 mM, respectively. It was also found that rat Con A sup contained TCGF activity approximately 8 times as much as murine Con A sup and that the CTL activity of sensitized T lymphocytes was fully enhanced in a short-term culture with TCGF. The substantial in vivo anti-tumor activity of G-CTLL cell line was observed from the intracranial Winn-type neutralization assay and the systemic adoptive transfer assay.
Accordingly, this new experimental approach to the specific immunotherapy with TCGF and the cloned CTL line such as G-CTLL may be particularly useful for malignant gliomas.

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Cis-diamminedichloroplatinum (II) (cis-DDP) is a square-planar platinum coordination complex that is the parent compound representing a relatively new family of anti-cancer agents and is a potent radiosensitizer. This study was undertaken to identify the combined treatment effect of cis-DDP and irradiation in a rat brain tumor model. The brain tumor model was produced in CDF male rats by stereotaxic inoculation of cells (D-74, F-98 glioma clone).
For the first series using F-98, the median survival time of the control group was 31 days. Cis-DDP alone, 5 mg/kg dose of cis-DDP on Day 10, produced 37 days (P=0.002). Irradiation alone, 750 rads X-ray dose on Day 10, 13, and 15, produced 44 days (P<0.001). The combined treatment of cis-DDP plus irradiation resulted in 55 days with a 77.4% increase in the life span (%ILS). The median survival time of the combined treatment was significantly longer than that of the irradiation alone (P=0.038). For the second series using D-74, the median survival time of the control group was 21.5 days. Cis-DDP alone produced no significant increase in survival time. Irradiation alone produced 27.5 days with 27.9% ILS (P<0.001) and the combined treatment resulted in 32.0 days with 48.8% ILS. The median survival time of the combined treatment was significantly longer than that of irradiation alone (P<0.001). The third series assessed the schedule dependency of the combined treatment effect using D-74. The single dose of cis-DDP (5 mg/kg) on Day 10 produced no significant increase. Irradiation alone (1, 500 rads) on Day 10 resulted in 26.0 days with 26.8% ILS (P<0.001). The combined treatment group receiving cis-DDP 24 hours or 1 hour prior to irradiation on Day 10 showed a significant increase in the median survival time of 29 days with 41.4% ILS or 30 days with 46.3% ILS and the median survival time of the combined treatment was significantly longer than that of irradiation alone (P=0.040, P=0.008). Also a significant increase of the median survival time was observed when cis-DDP was administered 6 hours after irradiation (29 days with 41.4% ILS) (P=0.024).
In conclusion, cis-DDP alone showed a significant direct increase in the survival time on F-98 glioma but not on D-74 glioma. Cis-DDP has a significant radiation enhancement effect which was demonstrated by using three different drug/irradiation schedules. There was no particular timing for the enhancement effect between cis-DDP and irradiation.

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Since 1977, 19 cases of malignant glioma (13 glioblastomas, 6 anaplastic astrocytomas) have been operated on with a CO₂ laser. The ages of the patients varied from 11 to 73, with an average of 47. A total of 31 operations were performed in these 19 cases.
The infiltration of the tumors was analyzed using the Daumas-Duport 3-D configuration classification of gliomas. Then, based on the analysis, the usefulness of the laser for each type of tumor was evaluated. Even in the Type I-D group (malignant glioma periphery showing either no or very limited infiltration), two of the three cases demonstrated recurrence within one year and nine months, respectively. In the Type II-D group (infiltrating glioma beyond the tumor tissue proper), the average survival term of nine of the 11 cases was 13 months after laser surgery. Independent of the 3-D configuration, tumors infiltrating beyond the basal ganglia or the opposite hemisphere via the corpus callosum cannot be totally removed, even with a laser.
Thus, the recurrence of malignant glioma cannot be suppressed solely by laser surgery. However, by using a CO₂ laser for malignant glioma, hemostasis can be sufficiently controlled and the tumor can be removed as much as possible in a short time without exerting a mechanical effect on the surrounding normal brain tissue.

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The author performed 11 extracranial - intracranial (EC/IC) bypasses with interposed saphenous vein grafts, 10 for the anterior circulation and 1 for the posterior circulation. The revascularization for the posterior circulation was a bypass to the proximal posterior cerebral artery (P-3 segment). The patency rate of the bypasses with the vein grafts was 82%. Two bypasses were occluded postoperatively, probably because the vein grafts were twisted or the venous valves were not in good condition.
The mean bypass flow rate of the EC/IC bypass with an interposed vein graft was 99 ml/min intraoperatively and 126 ml/min postoperatively. The mean values of the routine superficial temporal artery - middle cerebral artery (STA-MCA) anastomosis were 39 ml/min and 52 ml/min, respectively. The mean regional cerebral blood flow (M rCBF) which was measured postoperatively with ¹³³Xe injection through the vein graft was 48.7 ml/100 g/min (PCO₂ 41.2 mmHg, n=5) which was within normal limits. On the other hand, the postoperative M rCBF in the cases of routine STA-MCA anastomosis, which was measured with ¹³³Xe injection through the STA (donor) was 27.8 ml/100 g/min (PCO₂ 40.4 mmHg, n = 4). These data show that the EC/IC bypass with a vein graft increases the intracranial blood flow more significantly than the STA-MCA anastomosis.
In the present series, 2 cases died postoperatively. One death was due to slipping out of the ligature which was placed at the side branch of the vein graft. The author recommends that the side branches should be ligated at two or three separate places. The other case had a multiple occlusive cerebrovascular disease and died due to myocardial infarction 2 days postoperatively. The preoperative Master ECG had been normal. Therefore, no coronary angiography had been performed. The autopsy showed, however, 90% and 60% stenoses of both coronary arteries. In cases of multiple occlusive disease, it is recommended that a coronary angiography should be performed before considering an operative intervention.

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Coagulation study was performed on 40 patients who were admitted shortly after a blunt head trauma, and platelet count, prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation product concentration, and fibrinogen concentration were determined. Patients with any possible cause, other than a head injury, were excluded. Twenty seven cases (67.5% of all patients) showed at least one or more abnormal record in the coagulation tests, and 6 cases (15%) developed DIC according to the laboratory data. Three patients out of six DICs showed apparent clinical signs of coagulopathy. Seven patients out of the 40 cases examined expired, of which 5 cases belonged to the DIC group. In one autopsy case fibrin microthrombi were found by immunofluorescence staining in the renal glomeruli.
Using the Glasgow Coma Scale on the patients when admitted, the relationship between clotting abnormalities and severity of the cerebral injury were analyzed. The results indicated that the DIC occurred in a significant number of patients with severe head trauma and that the fibrin degradation product (FDP) assay was the most useful test indicating the severity of cerebral injury of all coagulation tests. One of the patients in this series was found to have a highly elevated FDP concentration, and the patient later developed a delayed intracerebral hematoma.

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Six cases of normal perssure hydrocephalus (NPH) were found among 160 surgical cases of intracranial hematoma due to severe head injury, in the past 10 years. Out of the 160 cases, 80 were followed up. The incidence of post-traumatic NPH was 3.7%, or 7.5% in the followed-up cases. After a little improvement following the removal of intracranial hematoma, these cases showed prolonged disturbance of consciousness or a delayed recovery rate and a progressive enlargement of the ventricle without cerebral atrophy on CT scan. Diagnosis of post-traumatic NPH was made by the plateau level of clinical improvement accompanied by absence of intracranial hypertension and a progressive ventricular dilatation shown by an increased bicaudate cerebroventricular index on CT scan.
Radioisotope serum albumin cisternography revealed disturbance of cerebrospinal fluid (CSF) circulation in all these cases and was a reliable tool for determining the indication for a shunting operation, which brought a marked improvement in five patients.
The authors believe that the shunting operation should be tried on post-traumatic NPH patients who do not show cerebral atrophy.
Presence of a subarachnoidal and a contusional hemorrhage on brain surfaces, noted in the operation, suggests the need to pay attention not only to the disturbance of the conventional extracerebral CSF pathway, but to that of the intracerebral pathway as regards the pathogenesis of post-traumatic NPH.

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Out of 30 cases of suspected normal pressure hydrocephalus (NPH) and/or secondary communicating hydrocephalus which showed mental disturbance and ventricular dilatation on CT scan and/or by pneumoencephalography, 18 showed a lumbar CSF pressure within normal limits, seven over 200 mmH₂O, and five under 100 mm H₂O. On 16 cases, continuous spinal drainage (CSD) was performed. The CSD procedure consisted of placing an epidural anesthesia catheter into the lumbar subarachnoid space for about 7 days. The amount of drained CSF was limited to 150-200 ml/day and was adjusted according to the clinical symptoms. If a certain improvement in the clinical symptoms was noted, the patient was diagnosed as a treatable communicating hydrocephalus and was then submitted to a shunting operation. The authors achieved 100% success in the shunting operations of the 13 cases, which fulfilled the above diagnostic criteria. The other three cases, without the effective CSD, did not show any satisfactory results from the shunting operation.
CSF drainage test has reportedly been performed to diagnose the reversible brain changes and indications for the shunting operation. This test appears to have the same meaning as the CSD in the early stage of NPH or in the high pressure hydrocephalus, and is also less cumbersome to patients than the CSD. But, in the late stage of NPH and in the low pressure hydrocephalus, this test is apparently unable to predict the effectiveness. The CSD should be performed in cases with an ineffective CSF drainage test. In secondary hydrocephalus, especially in NPH, the most important factor in the success of the shunting operation, should be that there are still reversible changes in the brain tissue on the circumference of the ventricles. Therefore, NPH should mean the condition of the brain and not the name of a disease. The authors would like to name the treatable secondary hydrocephalus as the “Adams-Hakim's syndrome”, and to classify it into the low pressure type, normal pressure type, and high pressure type.

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Occlusion of the aqueduct of Sylvius and the foramena of Luschka and Magendie results in an abnormal dilatation of the fourth ventricle, because cerebrospinal fluid produced in the fourth ventricle collects excessively within it. This dilated fourth ventricle, i.e., isolated fourth ventricle, is easily diagnosed by computed tomography and is curable by shunting of the ventricle. The isolated fourth ventricle has recently been recognized as a new clinical entity, but its pathophysiology is not fully understood.
In this communication, two cases with isolated fourth ventricle are reported and the relevant literature is reviewed.

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An older case of spinal teratoma was reported. The patient, a 51-year-old female, was referred because of gait disturbance. Neurological examination revealed a slight motor weakness (L4-S3), sensory disturbance (L5-S1) in the right lower leg and right positive Babinski's sign. Plain X-ray film of the spine showed flattening of the pedicles (Th12-L2) and scalloping of the vertebral bodies (Th11-L4). A metrizamide myelogram demonstrated a complete block at the Th12 vertebral level. Spinal computed tomography revealed high density and low density areas and calcification. Th11 through L3 laminectomy was performed and a solid white tumor with a cyst was subtotally removed. The postoperative course was uneventful. A histopathological examination of the tumor showed it to be a teratoma.
Among the 68 previously reported cases of the spinal teratoma, ten were elderly or above 40 years of age. In the elderly cases, the tumor locations were mostly limited to the lumbosacral region. In this case, spinal computed tomography was very useful in making the preoperative diagnosis.

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A case of spontaneous intracranial extradural hematoma is presented. A 11-year-old girl was admitted to a local hospital, because of fever, headache, and vomiting. At that time the patient was drowsy and incontinent of urine. Computerized tomography showed a large left frontal hematoma and she was transferred. Admission examination revealed a somnolent but well oriented girl with a temperature of 37.4°C. There was bilateral papilledema with retinal bleeding. Routine laboratory studies revealed moderate leucocytosis and an increased erythrocyte sedimentation rate. Angiography revealed a left frontal, large hypovascular mass with a pseudoaneurysm of the middle meningeal artery. Craniotomy disclosed an extradural fresh clot and arterial bleeding from the middle meningeal artery in the welldeveloped granulation tissue. Histologically, this granulation tissue contained numerous dilated vessels and focal hemorrhages.

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A 54-year-old female was admitted for a sudden headache, vomiting, and disturbance of consciousness. Computerized tomography at admission revealed a subarachnoid hemorrhage. When the left carotid angiography was carried out 2 hours after the onset, she was almost alert and had no neurological deficits. Anterior-posterior view of the angiography showed a large ophthalmic aneurysm, 20×20 mm in diameter, but no arteriosclerotic changes. Deterioration of consciousness and a right hemiparesis were noted immediately after the performance of a lateral view of the angiography, which revealed an aneurysm with niveau formation in its lumen and occlusion of the left internal carotid artery just distal to the aneurysm. The left carotid angiographies performed 20 days and 4 months after the onset showed recanalization of the internal carotid artery and reduction of the aneurysmal size. Gradual improvement of her neurological deficits was noted. Clipping of the aneurysmal neck with 2 large clips was performed under temporary occlusion of the left cervical internal carotid artery 5 months after the onset.
It was thought that the hemodynamic alteration could have occurred during the angiography, which pushed out a part of the intra-aneurysmal thrombus into the periphery of the parent artery.

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