The antitumor effect of 5'-deoxy-5-fluorouridine (5'-DFUR) against experimental glioma cells was investigated in vitro and in vivo. 5'-DFUR is a newly synthesized masked compound of 5-FU, which is activated only in the presence of pyrimidine nucleoside phosphorylase. This enzyme has been reported to exist much more in malignant tumors, such as Sarcoma 180 and Ehrlich ascites carcinoma, than in normal tissues. The activities analysed in 9L, RG12, and 203GL cells were 24.3, 75.1, and 8.1% respectively of the activity in Sarcoma 180. Normal rat brain showed 22.8% of the activity. Growth curves of cultured 9L and RG12 cells showed a dose-dependent 5'-DFUR antitumor effect when it was used at a concentration of over 10 μgml. The colony forming rate of 9L cells treated with 20 μgml of 5'-DFUR decreased to 10%. The inhibition rate of 203GL cells transplanted subcutaneously into C57BL mice was 52.3% in weight, and that of human glioblastoma cells transplanted subcutaneously into nude mice was 20.9% in size after treatment with 5'-DFUR, 400 mgkgday for ten consecutive days. When 9L cells were transplanted intracranially into CD Fisher rats, their median survival time became four days longer than that of non-treated rats. Flowcytometric analysis of in vitro 9L cells and in vivo 203GL cells showed an accumulation in the cells between the 2C and 4C components after treatment of 5'-DFUR. It seems that a delay in DNA synthesis occurred in the presence of this drug. This newly synthesized antitumor drug is expected to be effective for the treatment of malignant brain tumors.

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Twenty supratentorial malignant astrocytoma cases were examined to determine the relationship between clinical characteristics and survival time, using maltivariate analysis.
Inclusion of the S-phase cell percentage and polyploid cell percentage, obtained from DNA histograms by cytofluorometry was found to be important for predicting the survival time. The six most important characteristics for predicted survival were; location of tumor, Karnofsky scale at discharge, S-phase cell percentage, number of operations, polyploid cell percentage, and the extent of tumor removal. Using this mathematical model, the predicted survival times were calculated for three additional cases and were compared with the actual survival times; the respective results were 10 months and 11.45 months (Case 1), 13 months and 16.45 months (Case 2), and 21 months and 21 months (Case 3, still alive). The clinical importance of these prognostic factors are discussed.

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The effect of local administration of human interferon-α (IFN) to seventeen patients with primary brain tumor was investigated. Their histological diagnoses were glioblastoma (10), astrocytoma (3), medulloblastoma (1), ependymoma (1), ependymoblastoma (1), and pontine glioma (1) . IFN therapy was started when any sign of tumor recurrence was manifested by clinical symptoms and/or computed tomography scans. IFN was administered through a Ommaya reservoir or by intrathecal injection. Each injection consisted of 10⁶I.U. of IFN. The patients were divided at random into two groups. In the first group (9 cases), IFN was administered once or twice a week (intermittent group). In the second group (8 cases), IFN was administered every day for one month followed by a one month suspension of administration (daily group).
The average duration of the IFN therapy was 4.1 months for the intermittent group and 1.9 months for the daily group. The average total dose of IFN administered was 11.2×10⁶I.U. in the intermittent group and 40.4×10⁶I.U. in the daily group. No tumor regression was seen in the intermittent group. However, in two out of eight cases in the daily group, a decrease of the tumor volume to less than 50% of the initial volume and augmentation of natural killer activity were seen. Complete remission could not be obtained either by local or systemic administration of IFN. Local administration might be better than systemic administration from the viewpoint of a direct anti-tumor effect.

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The effect of interferon (human interferon-α; IFN) on the primary brain tumors has been reported. A decrease in the tumor volume of less than 50% of the initial volume was observed in two out of seven cases of systemic administration of IFN, and in two out of eight cases of daily local administration. Changes of the DNA pattern in the tumor tissue, of performance status of the patients, and of the mean survival time after IFN therapy were investigated.
DNA histograms were obtained by cytofluorometry on 6 glioblastomas and 2 medulloblastomas before and after IFN therapy. In the two clinically effective cases, a decrement of the S phase and an increment of the G₀, G₁ phases were observed after IFN therapy. These findings might reflect inhibition of cell transition from G₀, G₁ phases into the S phase by IFN.
Performance status and mean survival time of the IFN treated group (12 cases of glioblastoma) were compared with 53 previous cases of malignant astrocytoma and glioblastoma, treated by surgery and irradiation. The Karnofsky performance status for pre- and post-IFN therapy was 50.8% and 27.5%, respectively. These statuses were similar to those for the pre- and post-third operation (48.3%, 23.3%) for the recurrent malignant gliomas. Furthermore, the mean survival times after second operation were 10.9 months through IFN therapy, and 9.7 months through third operation, respectively. Therefore, it was concluded that IFN therapy might be as effective as the third operation for recurrent malignant gliomas.

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It is the purpose of this paper to discuss differences between intracranial aneurysms associated with Moyamoya disease and usual saccular aneurysms. Thirty six published cases of bilateral Moyamoya disease with 42 intracranial aneurysms, including a case of the authors, were reviewed. Ten cases of unilateral Moyamoya disease with 14 intracranial aneurysms and 5 cases of unidentified Moyamoya disease with 7 intracranial aneurysms, in which it remained unknown whether the Moyamoya vessel was unilateral or bilateral, are also being referred to. The predominant symptoms of the 36 cases were classified the hemorrhagic type (79%), ischemic type (12%), and others (9%). Incidence of the hemorrhagic type was higher than in the general Moyamoya disease (P<0.05). Of the 42 intracranial aneurysms in the 36 cases, 2 aneurysms (5%) in 1 case (3%) were fusiform and the others were all saccular or spherical. They were located, except for 1 unknown case in a major artery in 24 cases, or 59%, and the peripheral artery in 17 cases, or 41%. This high incidence of peripheral artery aneurysm might be characteristic of the Moyamoya disease. The 24 major artery aneurysms were present in the carotid system in 37.5% and in the vertebro-basilar system in 62.5%, showing a predominance in the posterior circulation (P<0.001). The carotid aneurysms occurred more frequently in the C2-4 portion of the internal carotid artery than in the C1 portion. The vertebrobasilar aneurysms had a markedly higher occurrence in the top portion of the basilar artery. The 17 peripheral artery aneurysms were located in the basal ganglia or its surrounding area (82%) and in an anastomotic vessel, except in the basal ganglia area (18%). The size of the peripheral artery aneurysm was significantly smaller than that of the major artery aneurysm (P<0.005). The peripheral artery aneurysms showed a tendency either to an increase or a decrease in size; they sometimes disappeared or bled. Of the 3 peripheral artery aneurysms which were examined histologically, 2 were reported to be true aneurysms and 1 false. No fundamental differences were found between the intracranial aneurysms associated with the bilateral Moyamoya disease and those with the unilateral and unidentified Moyamoya disease.

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The intracranial aneurysms associated with Moyamoya disease were analyzed on the basis of the origin and location of the hemorrhage. The study was performed using 41 cases collected from the literature including a case of the authors' own. Of the 41, 27 were cases of bilateral Moyamoya disease with intracranial hemorrhage, 9 of unilateral Moyamoya disease, and 5 of unidentified Moyamoya disease, in which it remained unknown whether the Moyamoya vessel was unilateral or bilateral. This report used the diagnostic criteria adopted by the research team of the Japanese Ministry of Health and Welfare for the Moyamoya disease. The definition of the aneurysm was limited to one with a size greater than 1 mm in maximum diameter, confirmed by angiography, operation, or autopsy. Among the 13 cases of Moyamoya disease with major artery aneurysms, the origin of the hemorrhage was the aneurysm in 3 cases, Moyamoya vessels in 3, and unknown in 7. Primary subarachnoid hemorrhage (SAH) occurred in all the cases in which aneurysm was the origin of the hemorrhage. Of the 14 Moyamoya disease cases with peripheral artery aneurysms, the origin of the hemorrhage was aneurysm in 6 cases, Moyamoya vessels in 1, and unknown in 7. Intracerebral or intraventricular hemorrhage occurred in all the 6 cases in which the origin of hemorrhage was peripheral artery aneurysm. These findings suggested that the original hemorrhage was caused as a result of a rupture of the intracranial aneurysm with the Moyamoya disease and they were divided into three groups according to the hemorrhage site: 1) major artery aneurysms which caused the primary SAH just like the usual saccular aneurysms, 2) basal ganglia aneurysms which caused intracerebral or intraventricular hemorrhage, and 3) other anastomotic vessel aneurysms which might cause the primary SAH, though not previously reported. It was also assumed that in the Moyamoya disease without the aneurysm or with the unruptured aneurysm, the intracranial hemorrhage occurred as a result of a rupture of the peripheral portion of the perforating artery which constituted the Moyamoya vessels, and the hemorrhage was located in the intracerebral or intraventricular regions.

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In the treatment of head injuries, before the CT scan was generally used, the level of consciousness had long been considered to be of utmost importance in evaluating the clinical condition of patients, especially to differentiate intracranial hematoma. CT scan provides a very useful armamentarium for finding the intracranial pathology easily and safely.
In three cases a very thin epidural hematoma, shown on the initial CT examination taken several hours after the trauma, had increased in size to such an extent that surgical intervention was necessary, and in one case, evacuation of an acute epidural hematoma on one side resulted in a massive epidural hematoma on the opposite side. In the two cases, hypertonic solution was given at another hospital after CT examination which revealed a very thin epidural hematoma. Both patients were reported to be alert then. After episodes of frequent vomiting, followed by a restless state in one case, their consciousness dropped to a semicoma. A second CT was taken immediately after the deterioration, to reveal a massive epidural hematoma. A patient, who was alert on admission and had a very thin intracranial clot on CT, taken 80 minutes after the trauma, vomited frequently during the routine X-ray examination and deteriorated rapidly into a semicomatous state with anisocoria 70 minutes after the initial CT examination. A massive epidural hematoma was noted in the second CT.
Judging from the chronological sequence of the head injury, namely, initial CT examination, deterioration, and confirmation of a large amount of intracranial blood clots, it was obvious that bleeding started again after the initial CT examination, resulting in the massive hematoma. It is reasonable to assume that in certain cases bleeding may start by acute lowering of the intracranial pressure, as well as by elevation of blood pressure andor extensive fluctuation of intracranial pressure in patients who are restless andor vomit frequently. In order to avoid any possible development of hazardous hematoma in those in which intracranial surgical lesions have been excluded by the initial CT examination, heavy sedation and use of effective antiemetics should be used, even if such medication would mask the level of consciousness. The latter disadvantages are well counteracted by repeated CT examination. Hypertonic solutions should not be given at the early stages of the head injury, unless cerebral herniation seems to be urgent.

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The patient, a 12-year-old school boy, fell on the road while running, and suffered an impact injury on the left forehead. He immediately noticed blurred vision in the left eye. Neurological examination was normal apart from blurred vision of the left eye. Ophthalmologic examination 9 months later disclosed a visual field defect, impairment of visual acuity and optic atrophy in the left eye. He was suspected of having a left optic canal fracture. On surgery, there was no fracture of the optic canal. However, the left optic nerve was markedly compressed against the optic roof by the left internal carotid artery. The left optic nerve was decompressed by unroofing of the optic canal. Postoperatively the visual field defects considerably improved. From these findings, it was speculated that his internal carotid artery was distorted, resulting in a compression of the optic nerve following the head injury.

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Two cases of intracranial chondrosarcoma are being reported.
A 27-year-old female had initial symptoms of blurred vision and slight proptosis on the left. CT scan disclosed an isodense to slightly high dense mass in the left ethmoid sinus which extended to the orbit, maxillary sinus, and anterior cranial fossa. The mass showed marked contrast enhancement. Angiograms showed evidence of an extracerebral mass in the anterior cranial fossa, and irregularly dilated tumor vessels. No apparent tumor stain was demonstrated. The mass was totally extirpated and the histological diagnosis was that of a Grade 1 chondrosarcoma (histological grading after Mankin et al.).
A 44-year-old male had been complaining of.a right orbital pain for years. Skull radiograms and CT scan demonstrated a mottled calcification in the right middle cranial fossa. CT scan revealed no contrast enhancement. Angiograms showed an avascular mass and no abnormal vascularity. The tumor was totally removed and the histological diagnosis was that of a Grade 1 chondrosarcoma.
Chondrosarcomas may be infiltrative, can recur and may sometimes give rise to distant metastasis. It is well known that there is considerable variation in the potential for recurrence and metastasis, and that there is no way of predicting the biological behaviour of these tumors on the basis of a histological examination.
CT scan, coupled with contrast enhancement, clearly delineates the extent of the tumor, displacement and distortion of the brain, and other surrounding tissues. Angiography may still be an important method of choice; chondrosarcomas are not always avascular and most tumors, which showed angiographically visible tumor vessels and stain, carried a poor prognosis.

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Extrathoracic metastases of malignant thymomas are very uncommon. Metastasis to the central nervous system has been documented in only sixteen patients. This paper reports the case of a 61year-old male, having malignant thymoma with multiple intracranial metastatic lesions. Partial removal of the metastatic lesions was followed by radiation therapy and chemotherapy. However, the patient expired 7 weeks later or one year after the onset of the symptoms. The nature, incidence, diagnosis, and treatment of metastatic malignant thymoma are discussed with review of the literature.

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A 56-year-old male was admitted with one episode of generalized convulsions. The patient had been placed on steroid therapy for aplastic anemia, which had induced diabetes mellitus. His neurological and physical findings and laboratory data including the erythrocyte sedimentation rate, white blood cell count with differentials, and C-reactive protein, were all normal. Computerized tomography showed an enhanced mass with perifocal edema in the right parietal lobe. The chest X-ray showed an infiltrate in the right upper field. A metastatic brain tumor from the lung was suspected. At surgery, the tumor was encapsulated and cystic, containing a greenish-yellow fluid. Pathological and bacteriological examination showed a brain abscess by Nocardia asteroides. The postoperative course was uneventful with sulfisoxazole, 4 g daily, for 6 months. It is stressed that such infections are increasing with the recently more frequent use of immunosuppressive agents.

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