Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 24, Issue 6
Displaying 1-10 of 10 articles from this issue
  • Its Relation to the Subarachnoid Dissemination and Metastasis of the Tumor
    Jun-ichi KURATSU, Yasuji ISHIMARU, Ryoichi KURANO, Shozaburo UEMURA
    1984 Volume 24 Issue 6 Pages 371-375
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The purpose of this report is to clarify whether or not brain tumor cells have a glycoprotein adhesive factor (AF) of the cancer cell surface. Recent clinical observations have indicated that subarachnoid dissemination and metastasis of brain tumors are not infrequent. Therefore, experimental work was undertaken in order to determine the dissociation ability of tumor cells. Brain tumor multicellular spheroids were used as an experimental model for tumor cell dissemination in the cerebrospinal fluid, and it was found that some of the brain tumor cells formed spheroids easily, whereas other did not. An adhesive factor, a glycoprotein isolated from rat ascites hepatoma cell surface, was used to determine the cause of this difference. The indirect immunofluorescence technique utilizing anti-adhesive factor antibody clearly demonstrated the presence of AF on the cell surfaces of glioblastoma, astrocytoma, ependymoma, and teratocarcinoma, indicating that the cells of brain tumors that have a tendency to form spheroids have AF on their cell surface. On the contrary, oligodendroglioma and medulloblastoma cells were devoid of AF. The results coincided fairly well with clinical experience, and it was suggested that agents enhancing production of AF could prevent tumor cell dissociation into the subarachnoid space or the ventricles.
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  • Evaluation of Intratumoral Injection of BCG and a Streptococcus Pyogenes Preparation
    Ryuichi TANAKA, Kentaro SEKIGUCHI, Yasuo SUZUKI, Hachiki SOBUE, Norio ...
    1984 Volume 24 Issue 6 Pages 376-384
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The anti-tumor effect of local immunotherapy using BCG and Picibanil, a Streptococcus pyogenes preparation, was evaluated in experimental and human malignant brain tumors.
    BCG and Picibanil produced an identical inflammatory cell reaction in the C3HHe mouse brain after intracerebral injection. BCG had no direct cytocidal effect on Rous sarcoma virus-induced malignant glioma cells of the mouse in vitro. A mixture of the mouse glioma cells and BCG was inoculated into the subcutaneous tissue and brain of the syngeneic mice. The development and growth of subcutaneous and brain tumors were inhibited remarkably by the addition of 100-1, 000 μg of BCG to 2×105 subcutaneously transplanted tumor cells, and by the addition of 50-500 μg of BCG to 1×104 intracerebrally transplanted tumor cells. Intratumoral injection of 5 mg of BCG showed a significant suppression of the growth of subcutaneous tumors which could not be obtained by the systemic administration of the same dose of BCG. The enhancement of tumor-specific immunity was obtained in this mouse-tumor system by the repeated immunization of a mixture of irradiated tumor cells and BCG.
    Thirteen patients with malignant brain tumors, 12 anaplastic gliomas and one metastatic tumor, received repeated intratumoral injections of Picibanil through one to two intratumorally implanted tubes. All patients tolerated this therapy, and the morbidity rate was acceptable. Significant tumor regression was noted on CT scans in 6 of 11 patients for whom scanning was performed. Histologic examinations of the post-therapy specimens obtained from 9 patients revealed that inflammatory cell reactions were evoked in all of the tumors, although the extent of the inflammatory reactions varied from tumor to tumor and was mostly localized to an area surrounding the intratumoral tubes.
    Combination therapy of local Picibanil injection and systemic administration of ACNU as maintenance immunochemotherapy was performed in another series of anaplastic glioma patients. Among the 10 patients who were followed for more than 2 years after treatment, 5 survived more than 2 years and 4 obtained long-term survivals of 71, 58, 44 and 43 months postoperatively.
    In conclusion, local immunotherapy is worth employing as maintenance immunochemotherapy for anaplastic glioma patients.
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  • Shoji ASARI, Katsuzo KUNISHIO, Norio SUNAMI, Yuji YAMAMOTO, Toru SATOH ...
    1984 Volume 24 Issue 6 Pages 385-389
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    CT diagnosis of isodense chronic subdural hematoma (SDH) is difficult and often a source of false-negative results. Coronal computed angiotomographic views were very useful for the diagnosis of isodense chronic SDH, even if thin or bilateral. Seven chronic SDH cases in which the precontrast scans demonstrated the same density as the brain were studied. Patients were placed in a supine position with the head extended and the gantry was angled at approximately 60° to the canthomeatal line in order to obtain coronal computed angiotomographs. Contrast enhancement was achieved by the intravenous “minimum dose bolus” injection method. Three of the seven cases showed changes secondary to mass effect such as shift of the ventricle, compression, or obliteration of the Sylvian fissures and cortical sulci. Five cases showed a high-density line with medial convexity or in parallel with the inner table of the skull and 2 cases showed a high-density dotted line away from the inner table. The high-density line or dots represented the superficial cerebral veins or cortical branches of the middle cerebral artery which were displaced medially by the hematoma. Thus, all the cases could be correctly diagnosed. When these findings are obtained, angiography may be unnecessary.
    Moreover, computed angiotomography is decidedly advantageous in that it is not only useful for the diagnosis of hematoma but also provides a clear and simultaneous visualization of the pathological and anatomical changes in the neighboring structures such as the cerebral parenchyma, cisterns, and ventricles. Such information is not obtainable by angiography or digital subtraction angiography.
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  • Takaaki TAKIZAWA, Akira MATSUMOTO, Shoju SATO, Akira SANO, Kazunori TA ...
    1984 Volume 24 Issue 6 Pages 390-395
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    One hundred and ninety-seven cases with closed head injury were encountered from April 1980 to December 1982. Computerized tomography (CT) scans of these cases showed traumatic intracranial organic lesions such as epidural hematoma, subdural hematoma, and brain contusion. Among these cases, 23 (11.7%) had only subarachnoid hemorrhage on CT scan, which was performed within several hours of the injury. The five adult patients whose CT scans showed massive subarachnoid hemorrhage in the basal, prepontine, and perimesencephalic cisterns had severe brain-stem damage, and their outcomes were poor. Four adult patients whose CT scans showed moderate subarachnoid hemorrhage in the basal cistern had disturbances of consciousness without brain-stem dysfunction, and their outcomes were fair. Impact sites of injury in the seven of 10 patients with small subarachnoid hemorrhage localized in the ambient and/or quadrigeminal cisterns, were face or forehead. This suggested that subarachnoid hemorrhage was produced by shear strain at the craniocervical junction due to hyperextension of the head or by impact at the tentorial notch. All of these cases recovered, but three of the 10 patients had peripheral oculomotor palsy. The four children had relatively good outcomes compared with the adult cases. The outcomes of the 23 cases as measured 3 months after injury according to the Glasgow Outcome Scale were as follows; good recovery 13, moderate disability 4, severe disability 1, vegetative 1, and dead 4.
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  • Seigo NAGAO, Norio SUNAMI, Takumi TSUTSUI, Yutaka HONMA, Fumiyuki MONM ...
    1984 Volume 24 Issue 6 Pages 396-400
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Correlations between changes in wave V of the auditory brain-stem response, intracranial pressure, and neurological signs of uncal herniation as graded by Plum and Posner were investigated in 12 patients with supratentorial mass lesion. In three of the five patients who later showed signs of uncal herniation, the latency of wave V, which presumably originated in the inferior colliculus, was already significantly prolonged. In 6 cases which progressed to the early third nerve stage of uncal herniation, the latency of wave V was prolonged in 5 cases. In 7 cases which progressed to the late third nerve stage or worse, the latency was prolonged in 6 cases and suppressed in one. In four of six attempts (three cases), lowering of the intracranial pressure by 10% glycerol solution resulted in normalization of the latency of wave V without clinical improvement. These results strongly indicate that measurement of wave V can predict the beginning of uncal herniation and can assess the effectiveness of medical or surgical decompression on brain-stem function.
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  • Yusuke SAWADA, Daikai SADAMITSU, Kazuyuki NISHIDE, Toshihisa SAKAMOTO, ...
    1984 Volume 24 Issue 6 Pages 401-408
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The effects and indications of barbiturate therapy for reduction of posttraumatic intracranial hypertension were investigated using an ultrashort acting barbiturate, thiamylal, in 48 severely head-injured patients, who showed initial intracranial pressure (ICP) of over 15 mmHg and could be monitored for at least 72 hours after admission. Two different kinds of barbiturate schedules and doses were used; mild barbiturate therapy (MBT) and advanced barbiturate therapy (ABT). In both schedules, the goal was to keep ICPs under 30 mmHg, as a rule. In 16 patients given MBT and in 13 given ABT, the ICPs were kept under 30 mmHg, but this level could not be achieved in 19. The mean initial ICPs for these three groups were 21 mmHg for MBT, 33 mmHg for ABT, and 52 mmHg for those who were not controlled. Although their initial ICP levels were widely scattered, there were no cases with initial ICPs of over 40 mmHg in which intracranial hypertension was controlled by either schedule. There were five unusual cases in the series. Three cases showed brain death, although their ICPs were kept under 30 mmHg. Two cases whose ICPs could not be controlled also showed brain death, even though their initial ICPs were comparatively low (under 30 mmHg). The main lesion in the former three cases was in the brain stem, and the latter two cases had an ischemic accident after trauma.
    It is concluded that barbiturate therapy may provide a satisfactory effect reduction in posttraumatic intracranial hypertension for patients whose initial ICPs are under 40 mmHg and whose main lesion is neither a primary global ischemic lesion nor a brain-stem injury.
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  • Nobuyuki YASUI, Akifumi SUZUKI, Hidenori OHTA, Hiroyasu KAMIYAMA, Shin ...
    1984 Volume 24 Issue 6 Pages 409-415
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors summarized 368 cases of ruptured anterior communicating (ACo), internal carotid (IC), and middle cerebral (MC) aneurysms (AN) who were admitted within seven days of their last attack during a period from 1976 to 1982. They were managed according to established principles of treatment. Radical operations for cerebral aneurysm were done as early as possible except in cases with vasospasm, irreversible brain-stem damage, posterior circulation aneurysm, severe systemic complication, age greater than seventy or lack of consent for surgery. Operative approaches for cerebral aneurysm were selected so as to minimize brain retraction. For example, the interhemispheric approach was used for ACo AN, and the transsylvian approach for IC and MC AN together with methods to decrease brain volume (ventricular drainage, mannitol administration, etc). Management of cerebrospinal fluid, decompressive procedures, or hypervolemic and hypertension therapy were occasionally performed. Clinical results were discussed in terms of clinical grading for cerebral aneurysms.
    Overall mortality was 70 cases (19%) and morbidity 65 cases (17.7%). Forty out of 46 cases with conservative treatment died. Two hundred and thirty-two out of 322 operated cases (72%) recovered, 30 cases (9.3%) died, and 60 cases (18.6%) were dependent. Causes of poor clinical outcome (135 cases, 36.7% of total) related to the severity of the attack (39 cases, 28.9%), re-attack after the admission (23 cases, 17%), vasospasm during the hospital course (42 cases, 31.1 %), operative complications (16 cases, 11.9%) and other complications (15 cases, 11.1%). Vasospasm was the most important cause of poor outcome in the mild to moderately ill patients, whereas intracerebral hematoma was the most important cause of poor outcome among the severely ill. Good clinical outcomes in severely ill cases were linked with operative timing following the attack and cause of severity. It was also pointed out that the operative procedures and techniques played important roles in outcome in acute surgery.
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  • Endocrinological Cure by Surgical Removal —Case Report—
    Hiroaki HONDO, Ryuichi TANAKA, Motoharu YOKOYAMA, Hiroshi SATO
    1984 Volume 24 Issue 6 Pages 416-420
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A rare case of true precocious puberty due to hypothalamic hamartoma which was cured endocrinologically by surgical removal is presented.
    The patient was a 20-month-old female infant. At the age of 5 months left salpingo-oophorectomy had been performed because of genital bleeding, pubic hair, enlargement of the breasts, and abdominal tumor, but no tumor cells were found histologically. Postoperatively, no regression of sexual characteristics was recognized. She weighed 16 kg and measured 89 cm in length. Neurological examination was normal, and the bone age had advanced to 37-41 months. Enhanced computerized tomography (CT) scans and metrizamide CT cisternograms demonstrated a small mass protruding from the tuber cinereum into the interpeduncular cistern. Diurnal rhythms of serum luteinizing hormone and follicle-stimulating hormone showed nocturnal secretion. Luteinizing hormone-releasing hormone (LH-RH) test and estrogen test demonstrated ‘pubertal response’. Right fronto-temporal craniotomy was performed and the tumor was subtotally removed. The surgical specimen revealed histologically normal brain tissue, and hamartoma was diagnosed. The postoperative course was uneventful and the genital bleeding disappeared. Three months after surgery, the diurnal rhythm of the gonadotropins was normalized, as were responses on the LH-RH and estrogen tests.
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  • Case Report
    Koji TAKASAKI, Tetsuhiko ASAKURA, Katsumi NAKAMURA, Masahiro SASAHIRA, ...
    1984 Volume 24 Issue 6 Pages 421-426
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Multiple meningiomas are generally uncommon, and the incidence is approximately 1-2% of all meningioma cases.
    A 63-year-old female patient complained of an episode of unconsciousness. Neurological examination revealed choked discs and left homonymous hemianopsia. Plain craniograms showed multiple calcifications in the right hemicranium. Right carotid angiography revealed abnormal vessels and multiple tumor stains. Computerized tomographic scans confirmed the existence of multiple highdensity tumors in the frontal lobe, sphenoidal ridge, parasellar region, middle fossa, and occipital region, all within the right hemicranium. Surgery was performed in three stages; the frontal, sphenoidal, and parasellar meningiomas were removed in the first stage, the occipital tumors were removed in the second, and the middle fossa tumors were removed in the third. Postoperatively, slight disorientation and left hemiparesis were recognized, but the patient was discharged with fair recovery.
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  • Case Report
    Hideo NAKAJIMA, Tsuneta MITSUI, Mamoru SUZUKI, Katsutoshi TAKEI, Yohic ...
    1984 Volume 24 Issue 6 Pages 427-432
    Published: 1984
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of cerebral sparganosis is reported. A 40-year-old male with left hemihypesthesia of 3 years duration developed memory disturbance during the last 6 months. In March 1981, the patient experienced a generalized convulsive seizure and was admitted to hospital. Computerized tomography scan demonstrated an abnormal high-density area with minimal contrast enhancement in the right temporal lobe, suggesting a benign glioma. A temporoparietal craniotomy was performed, and a living white tapeworm of approximately 10 cm in length was found. The parasite thus removed from the brain as a Sparganum of Diphyllobothrium erinacei. Counter-current immunoelectrophoresis of the patient's serum supported the diagnosis. The granulomatous lesion caused by the parasite manifested Gaseous necrosis with Langhans giant cells and with small scattered calcified bodies and infiltrated cells. It was presumed that the cerebral involvement was related to the patient's habit of eating raw the meat of a local carp, Cryprinus caprio.
    Case reports of cerebral sparganosis are rare. Only 3 cases have been recorded in the literature. In two of them, a dead worm was detected at autopsy, while in the other and in the present case, a living worm was demonstrated at surgery.
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