Long-term cultures of murine glioma-specific killer T cell clone (G-CTLL) were established. G-CTLL cells were maintained in T cell growth factor (TCGF)-dependent exponential proliferative culture for more than 7 months, over which time the cells continued to mediate antigen-specific cytotoxic activity. The cytotoxic activity of the G-CTLL cells was blocked by adding only anti Lyt-2, but not Lyt-1, monoclonal antibody.
An attempt was made to evaluate the biological effect on the central nervous system (CNS) and the in vivo and in vitro antitumor effect of argon laser photoirradiation with or without fluorescein pretreatment. Injury to the CNS was dose-dependently evaluated by exposing mouse brains to an activating argon laser of 514.5 nm wave length, and the photoactivating effect was evaluated by exposing spinal cords of cats after administration of fluorescein. Retardation or temporary arrest in growth of mouse fibrosarcoma (Fsa II) implanted subcutaneously in C3H mice, was accomplished by exposing the tumor to an activating argon laser of 514.5 nm wave length after administration of fluorescein. Photoirradiation by argon laser proved to be dose-dependently lethal to cultured glioma cells. This preliminary study suggests a new method of treatment of human gliomas. At the same time, an extensive thermal effect to the CNS was observed.
Twelve cases of adult cerebral glioblastomas were treated by high dose radiotherapy using Linac X-rays, and compared with 26 cases of conventional fractionated radiotherapy (200 rads 5 times weekly). The value of TDF (time, dose, and fractionation factor) was about 100 in both series. The survival rates in the high dose radiotherapy vs the conventional fractionated radiotherapy were as follows: one year survivals were 67% vs 65%; two year survivals 49% vs 8%; and three year survivals 24% vs 4%. The survival curve for the high dose radiotherapy group was superior to that of the conventional fractionated radiotherapy group, though there was no significant difference between them (p = 0.24). Tumor recurrences was accompanied by necrosis in most cases. Coagulative necrosis of the tumor and surrounding brain tissue was profound in the high dose radiotherapy group. In one case, no residual tumor was recognized at autopsy. In another case, resected mass lesions showed only cerebral radionecrosis at the second and third operations. No serious side effects have yet been recognized in the high dose radiotherapy group.
The operative results from 35 cases of carotid endarterectomy using no internal shunt were analyzed. In all cases, 300-800 ml of 20% mannitol were used before and during surgical occlusion of the internal carotid artery. The average occlusion time was 34.5 minutes, and the longest was 59 minutes. The internal carotid stump pressure was measured in 19 cases. Thirteen cases showed 50 mmHg or below, and six cases were 25 mmHg or below. The operative mortality rate was 0%, but one patient showed a transient motor weakness which continued for two hours after the operation. Three patients died of heart disease during the follow-up period. There was a considerable relationship between the stump pressure and the presence of collateral circulation on preoperative angiography. The stump pressure of all cases without collateral circulation through the anterior and posterior communicating arteries was less than 38 mmHg. Judging from collateral circulation on preoperative angiography and stump pressure, it was concluded that carotid endarterectomy without internal shunt can be performed more safely with the adequate administration of 20% mannitol.
The authors report five patients of aneurysmal subarachnoid hemorrhage (SAH) with arterial hypotension which occurred immediately after the ictus and were not the sign of terminal stage. The patients consisted of three males and two females of ages ranging from 32 to 76 years (average 51 years). They had had no previous SAH attacks and no cardiopulmonary diseases except for arterial hypertension in one patient and chronic bronchitis in another. The site of ruptured aneurysm was the internal carotid artery in three patients, the middle cerebral artery in one, and the vertebral artery in one. All were admitted within two hours after ictus. The clinical manifestations on admission were severe disturbance of consciousness in four patients, remarkable pulmonary edema in two, abnormal electrocardiogram in four, and arterial hypotension (systolic blood pressure≤80 mmHg) in all patients. In four patients, recovery from arterial hypotension and stabilization of arterial blood pressure was accomplished after adequate treatment, but one patient showed paroxysmal hypertension and hypotension which resulted in aneurysm rebleeding during the acute stage. Clipping of aneurysms was successfully performed in two patients. Two patients died due to rebleeding, two patients were discharged with no neurological signs and one patient with slight dementia. There was no mortality associated with cardiopulmonary complications including arterial hypotension. The mechanisms of the arterial hypotension in these patients were speculated as the following: 1) effect of SAH to the vasomotor center of brain stem; 2) stimulation to the parasympathetic nerve center; 3) vasovagal reflex to meningeal irritation caused by aneurysmal SAH; and other unknown causes. In the acute stage of SAH, the autoregulation of cerebral blood flow might be disrupted and prolonged arterial hypotension is probably fatal. In this syndrome, early correct diagnosis and early treatment are important.
The authors describe two cases of aneurysms arising from the proximal end of the fenestrated anterior cerebral artery. Case 1: A 43-year-old male suddenly developed severe headache. Angiography demonstrated an aneurysm arising from the proximal end of the fenestrated anterior cerebral artery, and the neck of the aneurysm was clipped. The patient expired due to vasospasm. On autopsy, medial defects were noted in the neck and dome of the aneurysm. Case 2: A 70-year-old female experienced a sudden onset of severe headache and vomiting, followed by consciousness disturbance. CT scan revealed a high density area in the left Sylvian fissure cistern. Left carotid angiography disclosed the presence of aneurysms at the fenestrated anterior cerebral artery and the middle cerebral artery. Based on the CT findings, it was considered that the aneurysm of the middle cerebral artery had ruptured. Surgery was not performed because of complications. Angiographic demonstration of the fenestrated anterior cerebral artery has been rare, with only 8 reported cases, and only 1 autopsy case of aneurysm on the fenestrated anterior cerebral artery has been known. From the histological and hemodynamic standpoints, the mechanism involved in the development of such aneurysms is considered to closely resemble that of common saccular aneurysms.
A case of multiple cerebral aneurysms associated with cerebrovascular moyamoya disease was reported. In this case, reduction and disappearance of bilateral internal carotid artery aneurysms and the enlargement and accompanying new development of basilar artery aneurysms were demonstrated on follow-up cerebral angiograms. Possible mechanisms of the disappearance and development of cerebral aneurysms in the presence of cerebrovascular moyamoya disease were discussed.
A 42-year-old female was admitted because of numbness on the right half of the body, motor weakness in the right upper extremity, and unconsciousness. The patient complained of an increase in appetite and gradual weight gain. A diagnosis of pituitary microadenoma with Cushing's disease had been made. Neurological examination revealed drowsiness, expressive aphasia, right hemiparesis, and neck stiffness. A plain craniogram showed a normal sella turcica. CT scans showed a left putaminal hemorrhage with marked midline shift to the right. On the 4th hospital day, after correction of subnormal serum electrolytes which had been worsened by the administration of steroid and hypertonic solutions, a craniotomy was performed to evacuate the hematoma and the patient's condition improved. Eight weeks after the craniotomy, a transsphenoidal pituitary adenomectomy was carried out. The adenoma (3 mm in diameter) was histologically confirmed to be a mucoid cell adenoma. Cases of hypertensive intracerebral hemorrhage associated with Cushing's disease have rarely been reported despite the common occurrence of systemic hypertension and vulnerability to bruising. In such cases, the intracerebral hematoma should be evacuated to prevent further deterioration of the subnormal serum electrolyte level caused by steroid and osmotherapy.
Optic canal involvement in fibrous dysplasia of bone is relatively common though only 9 cases of surgical intervension have been reported. A 49-year-old male complained of blurred vision and loss of visual acuity of the right eye with swelling of the right side of the forehead for one year. He had already been diagnosed as having fibrous dysplasia from right third rib biopsy 12 years before, and also from operation of pathological fracture of the right femoral neck 9 years later. On admission in June 1980, his visual acuity of the right eye was 0.04 though it had been 1.0 9 years earlier. No other neurological deficit were seen. Because of the progressive loss of vision, transfrontal decompression of the right optic canal was performed. Visual acuity gradually improved in the postoperative follow up period and about 2 years later, it was 0.5. When loss of vision is progressive, transfrontal approach to unroof the optic canal seems indicated. The safe and steady way in operation seems to be careful dissection under the operating microscope using a high-speed airtome with a diamond tip. If the location of optic canal is hard to distinguish because of the thickened bone and tortuous elongation of the canal, the dura mater should be opened to detect the proximal end of the optic canal when begining unroofing.
A case of parasagittal meningioma which extended through the sinus into the internal jugular vein and presented as a neck mass was reported. The patient was a 37-year-old woman, admitted with a right-sided neck mass. CT scan with constant enhancement revealed a high-density mass at the right parietooccipital and parasagittal areas including the superior sagittal sinus, confluens, and lateral sinus. Right parietooccipital craniotomy was performed and the tumor of the parietooccipital and parasagittal area was removed. The posterior third of the superior sagittal sinus and right lateral sinus, which were filled with tumor, were also removed. Six months later, a second operation consisting of right occipital craniotomy with suboccipital craniectomy was performed and the tumor of the tentorium was removed. The sigmoid sinus, jugular bulb, and internal jugular vein which were filled with tumor were also removed. Both intracranial and extracranial tumors were histologically diagnosed as transitional type meningioma without obvious histological malignancy. The mechanism of tumor extension of this patient was extremely specific. Venous transmission of tumor cells must have played an important role. Five cases of meningioma presenting as a neck mass along the nerves or lymph nodes have been reported in the literature. However, a growth of meningioma in the internal jugular vein as a neck mass has not hitherto been reported.
This 66-year-old farmer had a one year history of headache and visual disturbance. On admission, he was severely emaciated and blood examination showed leukocytosis. Precontrast CT showed a low density area in the right frontal lobe. Postcontrast CT demonstrated a high density area in the right frontal base and a multilobular ring-like enhancement in the right frontal lobe. The lesion was diagnosed as brain abscess and was treated by antibiotics. The patient's general condition, however, became worse and signs of cerebral herniation appeared. A large right fronto-temporal decompressive craniotomy was done and the pus in the cavity was aspirated with a needle through the dura. The pus was cultured in Sabouraud's dextrose agar and Aspergillus was identified. Amphotericin B was administered, but the patient expired on the 12th day after operation. Autopsy revealed a fistula formation between the sphenoidal sinus and the frontal base, and the sphenoidal sinus was filled with pus. A large brain abscess with multiple cavities existed in the right frontal lobe, and from it numerous Aspergillus were microscopically recognized. Aspergillus was not found in other organs including the lungs. It was assumed that the primary lesion of aspergillosis was in the sphenoidal sinus which then invaded the frontal base via the fistula to form a multilobular abscess in the frontal lobe.