Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 23, Issue 9
Displaying 1-11 of 11 articles from this issue
  • The Catecholamine Nerve Fibers and the Localization of Monoamine Oxidase Activity
    Toshio MASUZAWA, Hiroshi SHIMABUKURO, Fumiaki SATO
    1983 Volume 23 Issue 9 Pages 693-696
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    To determine the ultracytochemical localization of monoamine oxidase (MAO) activity of normal rat choroidal epithelium, the cerium method was used. The electron dense reaction products of MAO activity were found only along the external membrane of mitochondria. A modified fluorescent Faglu method was also employed and catecholamine nerve fibers were identified along vessels of the choroid plexus.
    The possible relation between MAO and catecholamine nerve fibers was briefly discussed.
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  • Experimental Study
    Norio SUNAMI, Yutaka HONMA, Takumi TSUTSUI, Humiyuki MONMA, Shun-ichir ...
    1983 Volume 23 Issue 9 Pages 697-704
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The effect of supratentorial mass lesions on the local cerebral blood flow (1CBF) of the brain-stem was evaluated with special reference to the following three points. 1) The level of the intracranial pressure (ICP) at which the 1CBF of the brain-stem begins to decrease. 2) Alterations in the 1CBF of the upper brain-stem at the beginning of uncal herniation. 3) Alterations in the 1CBF of the medulla oblongata during the Cushing response.
    Using 40 cats, platinum electrodes were placed stereotaxically in the thalamus (Th), inferior colliculus (IC), and medulla oblongata (MO) for measurement of 1CBF by the hydrogen clearance method. The 1CBF of the brain-stem was serially measured before and after intermittent increase in ICP produced by inflation of an extradural balloon. Arterial blood pressure and supra and infratentorial extradural pressures were continuously recorded. The mean control 1CBF in the Th, IC, and MO were 37.5±9.9, 42.1±8.6, and 30.7±4.9 ml/100 g/min, respectively. At 20 to 30mmHg of supratentorial pressure (STP), the 1CBF of the Th started to decrease, and at 20 to 30mmHg of infratentorial pressure (ITP), the 1CBF of the IC started to decrease. Finally, at 40 to 60mmHg of ITP, the 1CBF of the MO was affected. At the beginning of the uncal herniation suggested by anisocoria, the mean 1CBF of the IC abruptly decreased from 33.7 to 19.6 ml/100 g/min (n = 16). In this stage, the pressure gradient between the supra and infratentorial spaces was 24.6±11.4mmHg. The Cushing response was evoked at STP 93.4±14.6mmHg and ITP of 49.9±6.8mmHg (n=16). The blood pressure significantly increased from 121.5 to 140.OmmHg. However, immediately before and during vasopressor response, little change was noted in the mean cerebral perfusion pressure (CPP) of the posterior fossa, i.e., from 89.0 to 89.6mmHg. The 1CBF of the MO did not show significant change either, i.e., from 22.8 to 20.9 ml/100 g/min. The data suggested that in supratentorial mass lesion, the 1CBF of the thalamus decreased first, followed by the 1CBF of the inferior colliculus, and then of the medulla oblongata. At the beginning of uncal herniation, the 1CBF of the upper brain-stem markedly decreased. During the Cushing response, the 1CBF of the MO did not change significantly.
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  • Hiroaki KOGA, Shuhei NISHIMURA, Teruaki KAWANO, Hirohisa ONO, Kazuo MO ...
    1983 Volume 23 Issue 9 Pages 705-710
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Digital subtraction angiography (DSA), high resolution real time B-mode scanner (HRS), and pulsed doppler sonography were used to examine the cervical carotid lesions. Seventeen patients were studied by DSA before or after conventional angiography. To obtain good images, exposures were performed in both oblique positions. Sometimes, repeat studies were required with different degrees of obliquity to obtain more information. Subtracted images were obtained in real time, and post processing, especially remasking, was used to improve the image quality. In 28 carotid arteries of 17 patients, good images were obtained through such procedures. The quality of detecting carotid lesions with DSA was fairly good (sensitivity of 85%, specificity of 100%, accuracy of 93%). HRS demonstrated minor irregularities or slight stenosis within the lumen of the carotid artery, while the doppler examination appeared to be more useful in demonstrating obstructions of the carotid artery. It was concluded that DSA is a safe and reliable noninvasive screening method for detection of occlusive carotid disease.
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  • A Study of Epicerebral Microcirculation by Fluorescein Angiography
    Shigekazu TAKEUCHI
    1983 Volume 23 Issue 9 Pages 711-719
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Fluorescein angiography (FAG) was performed during encephalo-myo-synangiosis on the cortical surface of the frontotemporal lobe in 15 hemispheres of 11 patients with moyamoya disease to study the epicerebral microcirculation. Initially, 0.05 ml/kg weight of 1 % sodium fluorescein was injected into the common carotid artery of the exposed brain, and about 5 minutes later, 5 ml of 10% fluorescein was injected into the peripheral vein. Fluorescence of the surface vessels was recorded photographically using an electric motor-driven camera and Kodak Tri-X pan film with 36 frames, taking up to 1.3 exposures per second.
    The time interval between carotid injection of the dye and the first filling of the cortical arteries varied in each gyrus or in each part of each gyrus, and was markedly delayed in most parts. In seven hemispheres of seven patients, the vessels of some cortical surfaces were not filled even in the last frame, 26.9 seconds after carotid injection of the dye. By venous injection, however, the dye appeared in all vessels of the exposed areas before the last frame. Regional circulation time, which was the transit time of the dye from a small artery to a nearby small vein with the diameter of about 100 to 200μm, was prolonged in most parts and took more than 10 seconds in some areas of five hemispheres of four patients. The average regional circulation time took more than 5 seconds in six hemispheres of five patients. Extravasation of the dye was seen around the small arteries in some areas of five hemispheres of four patients.
    FAG findings were well correlated with those of conventional cerebral angiography, especially with the filling pattern of the middle cerebral arteries, but were slightly correlated with the findings of preoperative computed tomographic scans and cerebral blood flow values measured by the 133Xe inhalation method.
    The heterogeneous patterns of the epicerebral microcirculation in patients with moyamoya disease were considered to be caused by the blood supply originating from multiple collateral pathways and by the extensive occlusion of the main arteries.
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  • A Study of Regional Cerebral Blood Flow by 133Xe Inhalation Method
    Shigekazu TAKEUCHI
    1983 Volume 23 Issue 9 Pages 720-728
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Regional cerebral blood flow (rCBF) was measured by the 133Xe inhalation method in 19 patients with moyamoya disease aged 5 to 46 and compared with that in 17 healthy volunteers aged 7 to 67.
    In healthy volunteers, mean hemispheric flow values (mCBF) in the steady state decreased and cerebrovascular resistance (CVR) increased with advancing age. Most young patients showed low values of mCBF in both hemispheres in comparison with healthy volunteers. A significant difference of mCBF between both hemispheres was observed in eight young patients. The side of lower mCBF corresponded well with clinical manifestations in seven patients. About half of the young patients showed higher values of CVR than young healthy volunteers. Lower mCBF was correlated with lower intelligence quotient values in 10 school children with moyamoya disease.
    The distribution of rCBF showed a hyperfrontal pattern in healthy volunteers. However, in the patients, regional distribution of hemispheric flow showed a different pattern with low flow in the upper frontal region and mean flow in the posterotemporal and the occipital regions. Most of the relatively ischemic foci which showed a reduction of more than 15% of mCBF, corresponded to low density lesions in computed tomographic scans, but low density lesions did not always correspond to relatively ischemic foci.
    rCBF measurements were carried out during hyperventilation in five healthy volunteers and in one patient, and during 5% CO2 inhalation in one healthy volunteer and two patients. CO2 reactivity was uniformly present in the hemispheres of healthy volunteers. rCBF in both hemispheres was reduced by hyperventilation, more markedly in the patient than in healthy volunteers. On the other hand, in two patients, the flow was increased in the temporooccipital regions and was decreased in the frontal region by 5% CO2 inhalation, and mCBF was slightly increased.
    Encephalomyosynangiosis (EMS) or both EMS and superficial temporal-middle cerebral artery anastomosis was performed on 28 sides of 17 patients. Postoperative rCBF measurements in 21 sides of 12 young patients indicated a gradual increase of mCBF in 14 sides of nine patients from 3 months after surgery.
    These results indicate that rCBF measurements by the 133Xe inhalation method are useful in determining cerebral hemodynamics in patients with moyamoya disease, especially in children.
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  • Mitsuhiro HARA, Chikafusa KADOWAKI, Tatsuhiro MAEDA, Yoshifumi KONISHI ...
    1983 Volume 23 Issue 9 Pages 729-734
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The possibility of using the Plastimed® Sensor (No. 8645-14), developed by Dr. Hirsch for measurement of intracranial pressure (ICP) of infants was investigated in adults.
    The Plastimed Sensor was used to measure ICP in 27 adult cases (10 cases of head injury, eight cases of ruptured intracranial aneurysm, six cases of hypertensive intracranial bleeding, and three other cases) for periods ranging from one to 10 days with an average of 6 days. Both intraventricular pressure and epidural pressure were monitored. In four cases, a Konisberg Sensor was simultaneously used to monitor epidural pressure for comparison. The ICP monitored with the Plastimed Sensor was almost the same as the epidural pressure monitored by the Konisberg Sensor and intraventricular pressure monitored by conventional means.
    The Plastimed Sensor can be used in adult cases. It is economical and disposable, and installation is simple. In addition, it can be used for long-term monitoring of ICP because there is no risk of meningitis.
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  • Kazuhiro NOMURA, Soichiro SHIBUI, Yoshimasa MIKI, Masae KAKEHI, Toshio ...
    1983 Volume 23 Issue 9 Pages 735-740
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    An afterloading procedure using irridium 192 seeds was developed for the control of residual tumors after surgical removal. This technique made possible the delivery of an expected radiation dose to the lesion with minimum dosage to normal brain tissue. So far thistechnique was used for recurrent glioma patients who had already been treated with over 50 Grey (Gy) of radiation to the lesion externally. For implantation in the tumor, a 45 cm closed-ended flexible polyethylene guide tube with an inner diameter of 1.8 mm and outer diameter of 2.2 mm was used. A flexible polyethylene tube with an inner diameter of 0.5 mm and an outer diameter of 1.0 mm, accommodated the radiation source. At surgery for tumor removal, the guide tubes were aligned on a mesh (Oxycel® gauze) and fixed to the tumor bed using silver clips. The external portion of these tubes were anchored to the scalp. Radiation therapy began soon after the patient recovered from surgery. The radiation sources were inserted into the guide tubes and the dose for each patient was determined from the computer outputs of dose distribution calculated from the actual localization of the sources in the tissue. Total dose to the lesion was about 50-66 Gy at a 0.5 cm depth from the surface of the tumor bed.
    Four patients were treated with this technique. The first case (malignant astrocytoma) was complicated by the tubes slipping out during therapy, and died 20 months afterwards. The second case (malignant oligodendroglioma) completed this therapy, survived for 20 months, and expired due to metastatic lesions in other portions of the brain. The other two cases were still alive without recurrence over 6 and 7 months after the therapy. The results indicated that this procedure should be considered for the recurrent glioma patient.
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  • Surgical Treatments and Long-term Results
    Masao MOTOMOCHI, Yasumasa MAKITA, Sachio NABESHIMA, Tetsuya ITAGAKI, T ...
    1983 Volume 23 Issue 9 Pages 741-746
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The long-term results of 15 cases of spasmodic torticollis who had undergone different surgeries since January 1967 were studied. There were nine males and six females with an average age at surgery of 38.9 years. They included seven cases of the rotatory type, five cases of antecollis, and three cases of retrocollis. Electromyographic (EMG) abnormalities, which decided the surgical method and extent, were elicited in all cases. Thirteen cases underwent bilateral section of the C1 through C3 anterior roots (with or without unilateral C4) and spinal roots of the accessory nerves. Myotomies of the sternocleidomastoid muscle, the trapezius muscle, etc. were performed five times for four cases, and bilateral stereotactic thalamotomy was done in one case. Another case underwent neurovascular lysis of the bilateral spinal accessory nerves with excellent result, although its follow-up period has been only 7 months. The follow-up period ranged between 15 years 5 months and 7 months (6 years 5 months average). The early results were excellent in three cases, good in six, and fair in six. The long-term assessment found excellent condition in only one case, good in three, fair in seven, unchanged in three, and worse in one. These later results were worse, indicating deterioration of symptoms with time. Postoperative EMG gave some information about outcome. The cases with cervical spondylosis had worse results than did those without. The cases of retrocollis showed the worst results. Unilateral section of the anterior C4 root caused no practical respiratory disturbance. The conventional surgeries for spasmodic torticollis improved the symptoms, but were not totally satisfactory to the patients. On the other hand, the recently introduced method of neurovascular lysis preserved the physiological functions and might elucidate the etiology of spasmodic torticollis.
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  • Case Report
    Masami UEGAKI, Osamu NAKASHIMA, Norifumi KUSANO, Shigeyuki TAKAGI, Mas ...
    1983 Volume 23 Issue 9 Pages 747-750
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Scalp neurofibroma is a rare manifestation of von Recklinghausen's disease.
    This 17-year-old female presented with massive swelling on the right side of the head. There was no family history of von Recklinghausen's disease. Physical examination revealed café-au-lait spots on the body, but no other neurofibromas. The tumor was totally removed. Histological examination confirmed a neurofibroma with mucoid degeneration.
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  • Case Report
    Nobuhito NONAKA, Junichi KURATSU, Giichi MIURA, Yasuhiko MATSUKADO
    1983 Volume 23 Issue 9 Pages 751-754
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Multicentric cerebral gliomas have rarely been reported in the literature and most of the cases were composed of similar histological types of glioma. The authors experienced one case of multicentric cerebral glioma which consisted of bifrontal independent gliomas with different histological characteristics.
    A 54-year-old female was admitted with one month's history of impaired mental concentration and dull occipital headache. Neuro-radiological examination revealed two relatively well circumscribed tumor masses, one in the medial side of the right frontal lobe and the other in the opercular region of the left frontal lobe. CT scan demonstrated complete independence of these two tumors and angiography showed them to have different features. They were removed independently by two frontal craniotomies. The right medial frontal lobe tumor was glioblastoma multiforme and the left opercular tumor was oligodendroglioma.
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  • A Case of Hemangioendothelioma and Two Cases of Cirsoid Aneurysm
    Sadayasu TANI, Keiji KAWAMOTO, Yasuo KAWAMURA, Hiroshi MATSUMURA, Mino ...
    1983 Volume 23 Issue 9 Pages 755-760
    Published: 1983
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Three cases of vascular tumor of the scalp were presented.
    A 4-month-old girl underwent an operation for a vascular tumor of the scalp which had been noticed as a birth mark and had recently increased in size. The specimen was histologically proven to be hemangi oendothelioma.
    The second case was an 11-year-old girl whose tumor of the scalp, having been recognized as a birth mark, had become prominent and pulsatile for the last 2 years without any history of trauma. The tumor was angiographically and histologically interpreted as cirsoid aneurysm.
    The third case was a 21-year-old female complaining of a pulsatile swelling at the occiput following a blunt head injury. The angiography demonstrating a complex vascular network composed of a number of feeding arteries and markedly dilated tortuous draining veins documented the origin of this tumor, cirsoid aneurysm, to be congenital and not traumatic.
    Cirsoid aneurysms, though occasionally located after trauma, were considered to be the development of a persistent primitive arteriovenous communication within the scalp and should be differentiated strictly from arteriovenous fistulae, which consist of a simple arteriovenous shunt caused without doubt by trauma to the head.
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