Neurologia medico-chirurgica

Effect of Perfluorochemicals on Radiation Therapy in a 9L Rat Glioma Tumor Model

Kazuyoshi KOROSUE, Takashi KOKUNAI, Keiichi KUWAMURA, Norihiko TAMAKI, ...

1984 Volume 24 Issue 4 Pages 227-232
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.227

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Perfluorochemicals (Fluosol-43) are characterized by their small size and high propensity for carrying oxygen and carbon dioxide, and also have the ability of improving the cerebral microcirculation. This study was undertaken to identify the combined effect of perfluorochemicals and irradiation in a rat brain tumor model. Brain tumors were induced by intracerebral implantation of 9L rat glioma cells (7×10⁵ cells) into male CD Fisher 344 rats, weighing about 100 g.
To test the possibility of enhancing superoxide radical (O₂‾) toxicity by Fluosol-43 treatment, tumor-bearing rats were treated with the drug diethyldithiocarbamate (DDC), an inhibitor of superoxide dismutase (SOD) which eliminates the 0₂‾ radical in cells. After 1 hour of intraperitoneal infusion of 1 gkg DDC, the SOD activity in the brain and brain tumor decreased to 48% and 79% of that of the controls respectively. The tumor-bearing rats were randomly divided into 4 groups; control, DDC alone, DDC with oxygen, and DDC plus Fluosol-43 with oxygen. The tumors of the control animals had a mean colony forming efficiency of 18.3±5.8 (SD) %. The mean colony forming efficiency of DDC alone, DDC with oxygen, and DDC plus Fluosol-43 with oxygen treated tumors was 13.4±4.2%, 10.5±4.9%, and 5.2±4.3% recpectively. Tumor-bearing rats were randomly divided into 6 groups; control, Fluosol-43 with oxygen, radiation alone (1, 500 rads), radiation with oxygen, Fluosol-43 plus radiation, and Fluosol-43 plus radiation with oxygen. The control animals has a mean survival time of 14.2±1.3 (SD) days and the Fluosol-43 with oxygen group showed no prolongation of the mean survival time. The radiation alone, radiation with oxygen, and Fluosol-43 plus radiation groups prolonged the mean survival time to 16.1±2.3 days, 15.6±1.6 days, and 15.5±2.3 days respectively (P<0.01) . The Fluosol-43 plus radiation with oxygen group showed a mean survival time of 19.8±2.4 days, which was significantly longer than that of the radiation with oxygen group (P<0.01).
Perfluorochemicals (Fluosol-43) with oxygen may have a synergistic effect on the radiation therapy for malignant brain tumor. Fluosol-43 with oxygen might have oxygenated the hypoxic cells to make them sensitized to radiation.

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Interferon-modification of the in vitro Radiation Response in Cultured Human KNS-42 Cells

Kazuyoshi KOROSUE, Norihiko TAMAKI, Satoshi MATSUMOTO, Iwao TAKESHITA, ...

1984 Volume 24 Issue 4 Pages 233-239
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.233

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The efficacy of combined interferon radiation therapy in cultured human KNS-42 glioma cells was examined. Beta type human fibroblast interferon inhibited the multiplication of KNS-42 cells in a dose-dependent manner. The inhibitory effect was thought to be due to supression of the cells entering the S-phase. KNS-42 cells were treated with interferon before or after irradiation. The effect of the treatments was assayed by growth and survival curves. According to a cell growth analysis, the combined treatment had a greater anti-proliferative effect than the radiation or the interferon treatment alone. When interferon was given before irradiation, it tended to reduce the shoulder of the X-ray survival curve in a dose-dependent manner until the shoulder totally disappeared. The slope itself, however, was only moderately affected by interferon. The mechanism of this synergistic interaction between interferon and X-rays was possibly due to a partial synchronizing effect of interferon on the cells by blocking them in a G₁S boundary phase, the radiosensitive stage of the cell cycle. When interferon was given immediately after irradiation, it tended to reduce the slope in a dose-dependent manner. The shoulder disappeared almost totally even with a low dose of interferon. These results suggest that interferon may be useful as a radiosensitizing agent in tumor therapy.

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Time Course of the Dynamics of Cerebrospinal Fluid Circulation in Hypertensive Intracerebral Hemorrhage

Yasutaka MAEDA, Mamoru TANEDA

1984 Volume 24 Issue 4 Pages 240-244
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.240

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The dynamics of cerebrospinal fluid (CSF) circulation in 20 cases with hypertensive intracerebral hemorrhage was estimated with radioisotope cisternography (RIC) using In-111-DTPA. CT scan was performed simultaneously to observe the changes in the intracranial pathologies. The findings in RIC were classified into four types; normal circulation, ventricular reflux, ventricular stasis, and subarachnoid block over ipsilateral convexity.
Among 20 cases examined with RIC in the acute stage, normal circulation was demonstrated in 11 cases (55.0%), ventricular reflux in 1 case (5.0%) and a subarachnoid block over ipsilateral convexity in 8 cases (40.0%). In the subacute stage, 11 out of 17 cases (64.6%) showed normal circulation, 3 (17.7%) ventricular reflux and 3 (17.7%) a subarachnoid block over ipsilateral convexity. Of 8 cases in the chronic stage, 5 cases (62.5%) showed normal circulation, 1 case ( 12.5%) ventricular reflux, 1 case (12.5%) ventricular stasis, and 1 case (12.5%) a subarachnoid block over ipsilateral convexity.
Ventricular reflux and ventricular stasis which were demonstrated mainly in the later stage, seemed to be caused by blood in the CSF, because all cases with such abnormalities in RIC had a hematoma in the ventricle at the onset of hemorrhage, and none of the cases without rupture of the hematoma into the ventricle showed such abnormalities. A subarachnoid block over the ipsilateral convexity which was mainly observed in the acute stage and which frequently disappeared in the chronic stage was caused by the mass effect of the hematoma and the surrounding edema, because it was observed only in cases with larger hematomas. In 6 cases which developed ventricular dilatation in the chronic stage, 3 had a normal finding by RIC and the ventricular dilatation was probably caused by brain atrophy after absorption of a hematoma. The other 3 cases showed ventricular stasis by RIC and the disturbance in the CSF circulation may partly contribute to the ventricular dilatation. Thus, follow-up studies by RIC after a hypertensive intracerebral hemorrhage revealed consecutive pathophysiological changes in the CSF circulation in accordance with the intracranial pathological changes.

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Digital Subtraction Angiography for Hemodynamic Evaluation of Cerebrovascular Reconstructive Surgery

Kazuo YAMADA, Toru HAYAKAWA, Toshiki YOSHIMINE, Yukitaka USHIO, Takuya ...

1984 Volume 24 Issue 4 Pages 245-250
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.245

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From May, 1982 to May, 1983, 300 consecutive patients were examined by intravenous digital subtraction angiography (DSA) using the Philips DVI system, which had a 512×512 matrix for video-imaging. Of those patients, 160 were diagnosed as having ischemic cerebrovascular disease. Attention was focused on 17 cases who were treated by a extracranial-intracranial (EC-IC) bypass and 5 cases treated with vascular reconstruction in the neck. Forty ml of contrast material was injected as a bolus from the antecubital vein, and serial images were stored in the video-disk recording system. The postprocessing mode was used for image processing. In 10 preoperative patients the regional cerebral blood flow (rCBF) and DSA studies were compared.
Diagnostic accuracy of major artery occlusions was adequate both in the neck (2224, 92%) and the intracranial cavity (66, 100%). However, diagnosis by the DSA system of major artery stenosis in the neck and intracranial cavity was not adequate (less than 60% accuracy). Vascular perfusion patterns of DSA and rCBF data correlated well in 6 out of 10 preoperative patients. However, no correlation was found in patients with interhemispheric steal.
DSA could accurately diagnose the patency of a superficial temporal-middle cerebral arterial bypass and a venous graft. The amount of blood flow through a EC-IC bypass had good correlation with the preoperative cortical vascular perfusion in DSA.
DSA was useful as a relatively noninvasive diagnosis for the hemodynamic evaluation of patients with ischemic cerebrovascular diseases.

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Pituitary Adenoma in a 9-Year-Old Boy

Case Report and Review of the Literature

Masaru MATSUMURA, Ryoichi KIMURA, Minoru MURATA, Ichiro HANDA

1984 Volume 24 Issue 4 Pages 251-256
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.251

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A 9-year-old boy was referred in July 1982 because of a 4-month history of headache in the frontal area. He had also developed a visual disturbance. The physical examination was normal. The visual field test showed bitemporal hemianopsia and his visual acuity was Vd 0.5 and Vs 0.2. A mild optic nerve atrophy without papilledema was seen in the left optic fundus. Endocrine evaluation demonstrated a deficit in the GH secretion both in the baseline and in provocation. X-ray examination of the skull demonstrated a slightly enlarged sella turcica. Computerized tomography revealed a slightly high-dense mass at the intrasellar and suprasellar areas with homogeneous enhancement. Transcranial selective resection of the pituitary adenoma was performed, using a surgical microscope. The tumor was diagnosed by histological examination to be a chromophobe adenoma. The postoperative course was uneventful. The patient had Lineac teletherapy, receiving a tumor dose of 5, 100 rads. At follow-up after 10 months, the visual field and acuity had returned to almost normal. To date, 32 cases of such tumor have been reported. The clinical significance and treatment of this adenoma are discussed.

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Gangliocytoma

Case Report and Review of the Literature

Hideyuki KOSAKA, Hidetaka WADA, Isao FUWA, Toshiyuki OGAWA

1984 Volume 24 Issue 4 Pages 257-264
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.257

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A 16-year-old boy, with a more than 4-year history of partial seizure, was found to have a wellcircumscribed subcortical tumor mass in the left parietal lobe. The tumor, which was partially cystic, was totally removed and a histological examination using light and electron microscopes was consistent with gangliocytoma. There was neither evidence of malignancy, nor recurrence of the tumor over a follow-up period of more than 3 years.
Sixty-eight cases of ganglion cell tumors including the present case were collected from the literature. The tumors belonged to a rather hamartomatous entity, occurred most frequently in early childhood and adolescence, and showed a slight preponderance in males. The average duration of the symptoms was 2 years 7 months. No specific tumor symptoms or signs were encountered, and these were mostly dependent on the size or location of the growth. Increased intracranial pressure was observed in 62% of the cases, whereas 70% of the cases showed some localized neurological signs and 40% were accompanied by seizures. The tumors occurred more frequently in the cerebral hemisphere, especially in the temporal lobe. Multicentric tumor occurrence was extremely rare. In general, the prognosis was favorable and the best outcome was observed in cases of total resection. Only eight cases showed recurrence and radiation therapy appeared ineffective.

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Cerebral Cysticercosis Characteristic CT Findings related with Pathological Findings

—Case Report—

Katsuharu MUNEKATA, Eiki KOBAYASHI, Akira MATSUMURA, Yutaka MAKI, Yuji ...

1984 Volume 24 Issue 4 Pages 265-270
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.265

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A case of cerebral cysticercosis is reported. A 39-year-old male had a 20-year history of convulsions. He had never travelled overseas. CT scan demonstrated a small calcified spot in the left temporal lobe and a ring-like enhanced area surrounded by perifocal low density in the left frontal lobe. Both lesions were sited in subcortical areas. The frontal lesion was removed and examined pathologically, matching it with the CT findings.
The CT scan was very useful in the diagnosis of this disease. The possibility of cerebral cysticercosis must be raised, if intracranial punctate calcifications, ventricle dilatations, small low density areas in the parenchymal region, and low density areas with contrast enhancement are observed. In the case of cortical lesions, a well-enhanced capsule with both intracapsular enhanced structures and a cystic low density area may be important points for distinguishing this disease from a brain tumor or a brain abscess.

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Familial Occurrence of Multiple Vascular Malformations of the Brain

Yoshiaki TAKAMIYA, Hideichi TAKAYAMA, Kazuo KOBAYASHI, Tohru MINE, Kei ...

1984 Volume 24 Issue 4 Pages 271-277
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.271

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Two multiple vascular malformation cases of the brain were reported. Case 1, a 32-year-old male, who had had syncopal attacks at the age of 28, suddenly developed left hemiparesis and left hypesthesia. The CT scan demonstrated a right parietal intracerebral hematoma and seven small calcifications. Right carotid angiography demonstrated no abnormal findings. The hematoma was evacuated and a small mass with high vascularity, which was histologically proven to be an arteriovenous malformation was excised. A largest calcified mass in the right temporal lobe was also excised. The histopathological diagnosis was cavernous angioma. There was no previously reported case of multiple cavernous angioma, associated with a cerebral arteriovenous malformation. Case 2, a sister of Case 1 was in good health until she was 23 years old, when she suddenly developed right hemiparesis and right hypesthesia. The CT scan demonstrated a left fronto-parietal intracerebral hematoma and six small calcifications similar to those in Case 1. Left carotid angiography showed no abnormal findings except for the mass signs. The liquefied hematoma was evacuated and a small mass in the wall of the cavity was excised. The histopathological diagnosis was venous angioma. This was considered to be a case in which multiple cavernous angiomas and a venous angioma coexist in the same brain. Familial occurrences of cavernous angiomas are rare. Six families with this disease have already been described in the literature. Awareness of the possibility of familial involvement may aid in the early diagnosis of cavernous angioma and other vascular malformations.

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Tension Pneumocephalus after Head Injury Associated with Nitrous Oxide Anesthesia for Extracranial Operation

Case Report

Daikai SADAMITSU, Yusuke SAWADA, Kazuyuki NISHIDE, Toshiharu YOSHIOKA, ...

1984 Volume 24 Issue 4 Pages 278-282
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.278

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A case of tension pneumocephalus associated with the use of nitrous oxide as an anesthetic agent for surgery is reported.
The patient was a 30-year-old male, admitted with multiple injuries caused by a traffic accident. On admission, his consciousness was slightly disturbed but no other neurological deficits were assessed. The computerized tomography (CT) scan revealed a small amount of air in the frontal subdural and intracerebral spaces. A skull X-ray showed a short linear fracture on the frontal bone. A basal skull fracture was suspected by clinical findings but was not comfirmed by X-ray examination. Six hours after an operation for open fractures of tibia and fibra under general anesthesia with 66% nitrous oxide, neurological deficits suddenly occurred. A CT scan and a skull X-ray showed a marked increase in the size of the subdural air. Twelve hours later, the air diminished according to a follow-up X-ray and the neurological deficits gradually decreased spontaneously. A CT scan on the 4th hospital day showed no intracranial air collection.
In this case the use of nitrous oxide was suspected to play an important role in the genesis of tension pneumocephalus. It was concluded that the use of nitrous oxide should be avoided in the cases of multiple injuries with basal skull fractures.

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Traumatic Spinal Epidural Hematoma Associated with Severe Head Injury

Case Report

Masatomo YAMASHITA, Tetsuya SAKAMOTO, Masaru SASAKI, Haruhiko TSUTSUMI ...

1984 Volume 24 Issue 4 Pages 283-288
Published: 1984
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.24.283

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A 17-year-old male was hit by a car while driving a motorcycle and suffered multiple injuries, including facial lacerations, black eyes, and blunt trauma to the anterior chest wall. X-ray films showed fractures of the skull, the left clavicle, and the right scapula, but the pelvis and the vertebrae were negative for fracture. A CT scan of the brain showed an acute epidural hematoma. As signs of cord compression appeared gradually, a metrizamide myelography and a metrizamide CT scan were performed. Myelography disclosed a partial block at the T3-4 level. The metrizamide CT scan showed fracture of the T2 lamina and an epidural mass lesion of low density which displaced the spinal column to the left-anterior. Nine days after admission, decompressive laminectomy was performed with findings of blood clots mixed with fat tissue in the extradural space from T 1 to T4. Three months after the operation, he was able to walk with clear consciousness and full bladder control.
A traumatic spinal epidural hematoma is a rare clinical entity. Most of the 20 spinal epidural hematomas collected from the literature showed back pain, progressive flaccid paraplegia or tetraplegia, sensory disturbance, and urinary retention. It should be worth while to perform surgical decompression 24 or even more hours after the onset, if development of paraplegia is slow and incomplete.

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