To determine the immunohistochemical localization of Na+, K+-ATPase in the normal adult canine and rat choroidal epithelium, the indirect immunoperoxidase technique was employed. Rabbit antiserum to purified canine renal outer medulla Na+, K+-ATPase was prepared. The specificity of the antiserum was confirmed by Ouchterlony's method, biochemical inhibitory effect, and au toradio graphic immunoblotting method. When the rabbit immunoglobulin that was purified from the Na+, K+-ATPase antiserum through DEAE (diethylaminoethyl) -cellulose ion exchange chromatography was used for immunoperoxidase staining of the choroid plexus, intense immunoreactive staining was present on the epithelial cells of the choroid plexus in both animals, but was not found in the tissue around the vessels. Staining was especially confined to the apical surfaces of the epithelial cells. Both the canine and rat choroid plexus are rich in Na+, K+-ATPase, and it can be estimated that the enzyme plays an important role in cerebrospinal fluid secretion.
Experimental models of meningeal gliomatosis (MG) were established by intracisternal inoculation of rat C6 and 9L gliomas. The response of these experimental models to chemotherapy and in vitro chemosensitivity were studied in both cell lines. Cell suspensions of 1 × 107 C6 and 9L glioma cells were injected subcutaneously into the cisterna magna of Wistar and Fisher 344 rats, respectively. The tumor cells inoculated into the cisternae of the rats developed rapidly and the rats died in approximately 20 days. The pathophysiology of these MG models was similar to that of human MG. MG rats were treated by intravenous administration of bleomycin (BLM, 5 mgkg), 1-(4amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU, 15 mgkg), 1, 3-bis(2-chloroethyl)-1-nitrosourea (BCNU, 15 mgkg), or by a combination of BLM and ACNU or BCNU on Day 5 after inoculation. In the rats inoculated with C6 glioma cells, the control group had a mean survival time of 14.3±2.9 (SD) days, and single-agent chemotherapy failed to prolong the mean survival time. In the rats inoculated with 9L glioma cells, the control animals had a similar mean survival time of 14.3±3.1 days, but single-agent chemotherapy with ACNU or BCNU prolonged the mean survival time to 25.7±5.2 days and 26.8±4.3 days, respectively. Combined therapy using BLM and ACNU or BCNU increased the mean survival time to 37.5±8.8 days and 39.1±8.1 days, respectively. These survival times were significantly longer than those obtained with single-agent therapy. In vitro chemosensitivity assay was carried out by the monolayer culture technique. Cytotoxic activity of ACNU was measured by determining the drug concentration for 50% growth inhibition (IC50), which was obtained by plotting the logarithm of the drug concentration against the growth rate (percentage of control) of the treated cells. The IC50 values of ACNU for C6 and 9L glioma cells were 8.3 μgml and 0.88 μgml, respectively. C6 glioma cells were more resistant to ACNU than 9L glioma cells. It was concluded that in vitro chemosensitivity assay correlated with in vivo chemosensitivity assay in MG models and that these MG models were useful as a chemosensitivity assay system in vivo.
Changes in local cerebral blood flow and oxygen metabolism in cases of ruptured aneurysm were studied by positron CT using 15O as a positron emitter. During continuous inhalation of C15O2 and 15O2 gases, seven slices (16 mm in thickness) were simultaneously obtained by positron CT. Based on the data from the C 1502 study, images of cerebral blood flow (CBF) were obtained. Further, the data from both the C15O2 and 15O2 studies were used to obtain images of oxygen extraction ratio (OER) and cerebral metabolic rate for oxygen (CMRO2). Six cases of ruptured aneurysm were studied, and, among them, two cases were studied two or more times. In normal cases, images of CBF and CMRO2 were quite similar, indicating a coupling of flow and metabolism. In cases of ruptured aneurysm, the area of decreased blood flow was wider than that shown on X-ray CT. A mild decrease in flow was noted even in cases that showed minimal or no change on X-ray CT. Asymmetry of cerebellar blood flow between the two hemispheres was noted in large supratentorial infarction or hematoma. In one case of focal increase in OER, neurological abnormalities disappeared after several days, whereas in a case of focal decrease in OER, deficits did not improve. Thus, OER might be a good indicator of neurological recovery. However, movements of patients, which must be overcome through proper positioning, sometimes created artifacts that did not allow for precise assessment.
To clarify the evolution of traumatic intracerebral hematoma (TICH), initial computerized tomography (CT) scans of 28 TICH cases performed within one hour after head trauma were studied along with their follow-up CT scans. They were classified into the following two groups; per-acute group included seven cases in which TICH was completed on the initial CT scans taken within one hour after head injury and acute group included 21 cases in which the initial CT scans revealed isodensity or high density spot and repeat CT scans disclosed TICH by 48 hours after injury. In the per-acute group, initial CT scans showed a homogeneous, well defined, and high density mass (1.5-6.5 cm in diameter). In sequential CT scans of the three cases, the hematoma did not increase but spontaneously disappeared. Other four cases died early after head trauma. Their initial CT scans revealed a large high density mass (3-6.5 cm in diameter) combined with other extracerebral hemorrhages. In the acute group, initial CT scans demonstrated isodensity or high density spot and sequential CT scans showed mottled appearance of salt & pepper appearance, and after a while showed fusion of small high density areas to become a massive high density area (contusional hematoma) by 48 hours after injury. In six cases of this group, the contusional hematoma was removed within 24 hours after injury and in one case at 3.5 days. In other 14 cases, the hematomas shrank or disappeared spontaneously. From these results, it was considered that evolution of TICH's were classified into the two groups; per-acute group resulting from rupture of vessels and acute group resulting from contusion.
CT examination of sellar lesions was studied from the methodological aspect in 141 CT scans performed in 59 patients with suspected pituitary lesions. The basic scanning line was determined in parallel to the line from the tuberculum to the dorsum sella using a “scout view” device. The angles formed by the orbito-meatal line and the tuberculumdorsum sella line as measured in 50 adults were 1.8±6.4° in males and −6.4±4.8° in females. Therefore, if the CT scanner is not equipped with a scout view, these mean angles may be used as the basic scanning line. Contiguous sections were obtained with a CTT 8800 scanner at 1.5 mm intervals through the sella, under the radiographic condition of 120 kV, 500 mA and 2 pulses, which proved suitable for the detection of minor lesions below 10 mm in size and for examination of the pituitary stalk. Window width of 250 or 300 Hounsfield units and window levels ranging from 50 to 60 were well suited to the detection of small lesions. Not only the axial sections but also coronal and sagittal computer reconstructions were helpful in the detection of lesions. Twenty-eight cases of pituitary adenoma, 3 of empty sella alone, and 1 of sphenoidal mucocele were confirmed by CT scan. The pituitary adenomas consisted of 8 Type I, 13 Type II, 2 Type III, and 5 Type IV after the classification of Hardy. By enhancement with a contrast medium, the normal pituitary appeared higher in density than the brain, and the intrapituitary small tumor appeared slightly lower in density than the normal pituitary. CT scanning under the above-mentioned display condition could discriminate the tumor from the normal pituitary in at least 24 cases which were surgically confirmed. Shifting or bending of the pituitary stalk found in the reconstructed coronal or sagittal sections were useful for the diagnosis of intrasellar pituitary tumors. The empty sella was effectively diagnosed by CT cisternography using metrizamide as a contrast medium.
A 26-year-old worker suffered an accident in which his right arm was caught in a machine. Although he could flex his fingers, wrist, and elbow, he was unable to extend them. Nevertheless, he was able to elevate his arm horizontally. Hypesthesia was present over the forearm, and a brachial plexus injury was suggested. He suddenly felt severe pain in the right arm one month after the injury. He then felt a stabbing or stinging sensation over his right arm. He evidenced clenching and wrenching of the elbow, and an aggravated sensation of pain irradiated centrifugally whenever his right arm or fingers were touched or moved passively. Stellate ganglion block was performed. Neurolysis of the right radial nerve, right axillary nerve block and thermocoagulation, cervical epidural block, and subarachnoid block were done. These procedures resulted in only slight or transient effects. When admitted to the neurosurgical department 20 months after the injury, his immobile arm showed pale, cold skin, hyperalgesia, and muscular atrophy accompanied by severe pain. Percutaneous electrodes were inserted in the epidural space for electrical stimulation of the spinal cord. This stimulation resulted in an increased endorphin level in the cerebrospinal fluid. The effects of this procedure lasted for 3 months, but the pain recurred. Spinal ganglia C7, C8, Thl, and Th2 were then removed. Results were excellent for 5 months of follow-up. When sympathectomy has little effect on chronic causalgia, spinal ganglionectomy is recommended.
Histological changes of the cerebral arteries taken from 3 patients who died of cerebral vasospasm after subarachnoid hemorrhage were investigated and compared with those of 10 dogs with experimental vasospasm induced by a subarachnoid injection of 0.15-0.20 mgkg of epinephrine. The cerebral arteries of the human autopsy cases known to have undergone spasm exhibited a wide lumen with thin media resulting from necrosis of the smooth muscle cells. These necrotic smooth muscle cells were replaced by scattered, eosinophilic cellular debris, especially in the outer layer of the media. In the experimental study, the subarachnoid injection of epinephrine produced frank necrosis of the smooth muscle cells and marked dilatation of the arterial lumen, especially in 5 dogs, and was associated with hypothalamic infarctions and inflammatory swellings of small subarachnoid arteries. Dogs sacrificed artificially revealed myonecrotic changes that were uniformly and intensely stained with eosin, whereas those of spontaneous death revealed myonecrosis similar to human autopsy cases. It is suggested that myonecrosis might be formed as a result of prolonged, intense contraction induced by epinephrine as well as by vasoactive exudates from the hypothalamic lesions or the small subarachnoid arteries.
A case of dissecting aneurysm of the vertebro-basilar artery diagnosed angiographically and histologically is reported. A 31-year-old female suddenly developed severe headache and vomiting. On admission, 9 hours later, the patient was somnolent, and signs of diffuse brain stem lesion were manifest. Cerebrospinal fluid, craniogram, and computerised tomography scan showed no abnormal findings. Left vertebral angiography showed intimal separation of the basilar artery as a “double lumen'” on lateral projection. The patient was given conservative treatment, but died 12 days later of brain stem hemorrhage. Pathological examination showed that the dissection occurred twice: the first subintimal dissection started at the left vertebral artery 15 mm proximal to the vertebral union, and extended to the proximal portion of the left anterior inferior cerebellar artery; the second dissection occurred in the basilar artery and caused the brain stem hemorrhage. The prognosis for dissecting aneurysm of the vertebro-basilar system, especially involving the basilar artery, is very poor, and the authors think that surgical procedure, such as ligation, trapping, or anastomosis, in the early stage, based on a correct angiographical diagnosis, is most beneficial.
The patient was a 25-year-old male, who sustained a head injury and was found to have an asymptomatic arachnoid cyst of the middle cranial fossa and a frontal subdural space. Complete communication between the subdural space and the subarachnoid space was recognized on CT performed 5 days after the injury, but not on CT 35 days after the injury. No hemorrhage was found in the subdural space on follow-up CT. Operation was performed 42 days after the injury. It was found that the subdural space contained xanthochromic fluid and that the capsule of the hygroma was very similar histologically to that of chronic subdural hematoma in adults. In this case, tear of the arachnoid membrane and accumulation of CSF in the subdural space were considered to have been essential for the formation of chronic subdural hygroma. It was thought that adults with brain atrophy and infants with craniocerebral disproportion, like those with arachnoid cyst, tend to have their arachnoid membrane torn by minor head injury and that this tends to form chronic subdural hygroma. It was reported that chronic subdural hygroma might be transformed into chronic subdural hematoma. Tearing of the arachnoid membrane might be one important factor in the development of chronic subdural hematoma.
Granular cell myoblastoma in the orbit is an extremely rare disease. One such case is reported here. Radiological and computerized tomographic appearance, findings at surgery, and pathology are presented, and treatment of this lesion is discussed. The surgical findings strongly indicated the cytological origin of this tumor to be the peripheral myelinated nerve.
A case of an epithelial cyst lying above the diaphragma sellae associated with a cerebral aneurysm is reported. A 49-year-old female was admitted because of recurrent episodes of transient weakness of the left limbs. Cerebral angiography showed mild stenosis of the right carotid siphon and an aneurysm arising from the left internal carotid artery. Computerized tomography scan disclosed a round highdensity mass in the suprasellar region. The transient ischemic attack was well controlled by antiplatelet therapy. Neck clipping of the aneurysm and the removal of the tumor were achieved through the pterional route. The cyst wall was lined with ciliated cuboidal cells and non-ciliated PAS-positive cells. The rare occurrence and the origin of the cyst are briefly discussed.