Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 25, Issue 10
Displaying 1-12 of 12 articles from this issue
  • Akira ANDOH
    1985 Volume 25 Issue 10 Pages 787-792
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The influence of the cerebellopontine angle operation on highly vulnerable tissues, particularly on the auditory tract as well as the nerve is an important question. Retraction of a cerebellar hemisphere is an inevitable manipulation in the operation via the posterior fossa. In the search for a clinically applicable meaning, experiments were performed on dogs. In experiment I, the functional effect of the manipulation on the auditory tract up to the inferior colliculus was studied in relation to the auditory brainstem response (ABR) and corresponding anatomical changes; in experiment II, the long-term effect of a partial section of the cochlear nerve on audibility, which is nearly inevitably inflicted in acoustic tumor surgery aiming at preservation of hearing was studied.
    Experiment I disclosed that wave V disappeared even by such cerebellar retraction as about 1/5 of the diameter of the cerebellum without a morphological change of the brainstem, suggesting occurrence of a dysfunction of the auditory tract in the brainster. With further retraction of the cerebellar hemisphere, there were marked change in ABR in all wave forms. This fact suggests the possible usefulness of intraoperative ABR monitoring in clinical practice. In experiment II, three out of 8 dogs lost ABR and failed to recover during the follow-up, suggesting that, once the cochlear nerve has been damaged, even by a partial section of the nerve, its functional prognosis may be poor. This poses a clinical problem as a late postoperative deafness in the surgery of acoustic tumors aiming at preservation of hearing.
    Download PDF (473K)
  • Nobuyuki SUZUKI, Tetsuo KANNO, Yutaka NAGATA, Taiji KATO
    1985 Volume 25 Issue 10 Pages 793-799
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Calcium ions have been implicated in the regulation or modulation of various cell functions. Calmodulin, a calcium modulator protein in the cell, may play an important role in cell proliferation. If the calcium ion level in the cell can be altered by the addition of calmodulin antagonist, the aberrant growth of glioma may be regulated. The authors, therefore, intended to examine the effect of a calmodulin antagonist W-7, on a cultured glioma cell strain (GA-1), which is chemically induced from a rat glioblast.
    The results are as follows: 1) Inhibition dose of W-7 to 50% of normal cell growth, was 50 μM. W-5, a dechlorinated structural analog of W-7, which had a lower affinity to calmodulin showed no definite inhibition on GA-1 growth. 2) At lower concentrations of W-7 (12.5 μM) in the cultured medium, deoxyribonucleic acid (DNA) synthesis in GA-1 was not markedly inhibited, but ribonucleic acid (RNA) and protein syntheses were strongly suppressed. 3) At higher concentrations of W-7 (25 to 75 μM), DNA, RNA, and protein syntheses were all suppressed. 4) Calmodulin content of GA-1 cell (58.0±3.0 pg/mg soluble protein) was lowered to half of the control level by the addition of W-7 within 2 hours and was maintained afterwards at the lower level. These results indicate that administration of calmodulin antagonist W-7 may be effective for nonsurgical treatment of glioma.
    Download PDF (396K)
  • Nobuyuki SUZUKI, Tetsuo KANNO, Yutaka NAGATA, Taiji KATO
    1985 Volume 25 Issue 10 Pages 800-804
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Calmodulin is an ubiquitous Ca2+-binding protein which regulates a number of Ca2+-dependent functions. The cell calmodulin content increases after the synthetic phase and reaches the maximum level at G2 and early mitotic phases. Moreover, malignant transformation was found to represent a general mechanism that results in a specific increase in the intracellular content of calmodulin. When the calmodulin content in the tumor cells can be altered by administration of a calmodulin antagonist, growth of the transplanted glioma may be regulated. In this paper, the antitumor effect of calmodulin angatonist W-7 was examined in a rat glioma transplant model.
    1) The control of intraperitoneally transplanted rats had a mean survival of 16.7±1.6 days after transplantation. W-7 1.0 mg/kg intraperitoneal injection for 10 days showed 37.8% increased life span (ILS) (P<0.01). W-7 3.0 mg/kg also showed 15.0% ILS (P<0.05). 2) The control of intracerebrally transplanted rats had a mean survival of 19.4±2.2 days after transplantation. No increase in the life span was observed in intracerebrally transplanted rats compared to the control at a dosage of W-7 1.0 mg/kg or 3.0 mg/kg intraperitoneal injection for 10 days. 3) Local application of W-7 1.0 mg/kg into the transplanted tumor in the cerebrum for 10 days showed 12.4% ILS (P<0.01), and 18.0% ILS (P<0.05) was obtained at the dosage of 3.0 mg/kg local application for 10 days. From these results, it is expected that direct injection of a calmodulin antagonist W-7 into the tumor is effective for the treatment of glioma.
    Download PDF (329K)
  • Takashi KONDO, Shuji SHIMAZAKI, Mario BROCK
    1985 Volume 25 Issue 10 Pages 805-809
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Sodium nitroprusside (SNP) is employed to reduce systemic blood pressure in cerebrovascular surgery. Its application has also been suggested to improve cerebral vasospasm when administered intravenously or intra-arterially in combination with a-adrenergic agents. The purpose of this study is to investigate the vascular response of normal and elevated intracranial pressure (ICP).
    Twelve adult cats were anesthetized and intubated. Each animal was paralysed and mechanically normoventilated. ICP was measured through a 22G needle into the left lateral ventricle and connected to a strain gauge transducer. Different levels of ICP were achieved using an artificial cerebro-spinal fluid, which exerted a variable hydrostatic pressure via a 21G cannula introduced into the cisterna magna. The effects of SNP were studied in each animal at three ICP levels: normal (control), 20 mmHg, and 40 mmHg. A catheter was inserted into the left internal carotid through the lingual artery, and SNP (40 μg/kg/min) was infused intra-arterially through this catheter.
    Administration of SNP always caused an increase of ICP. This increment degree of ICP caused by SNP (ΔICP=ICPSNP-ICPinitial) was more marked in the control group with normal ICP, amounting to 5.27±2.51 mmHg (P<0.01). In the groups with ICP levels of 20 and 40 mmHg, ΔICP were 2.21±0.66 and 0.21±0.40 mmHg, respectively (not significant). Comparison of the three groups revealed that the increase of ICP of the groups with mild or high ICP was significantly lower than that of the control group (t-test, P<0.01 for 20 mmHg and P<0.001 for 40 mmHg group). As the initial level of ICP was raised, ΔICPs decreased. The results confirmed the observations made by other investigators that SNP has an influence on ICP. Because cerebral autoregulation should be intact at the ICP levels as such induced in the present study (20 and 40 mmHg), the high-dosage (40 μg/kg/min) and the route of administration of SNP in this series (internal carotid) might exert a direct influence on the cerebral vessel walls. SNP seems to cause cerebral vasoparalysis and disturb pressure autoregulation.
    Download PDF (324K)
  • Osamu TOYODA, Hideaki NUKUI, Satoru HORIKOSHI, Shigeru MITSUKA, Hideo ...
    1985 Volume 25 Issue 10 Pages 810-817
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    It has been reported that vasospasms are frequently associated with changes in blood coagulability, which may play an important role in symptomatic vasospasms. To verify this point experimental studies were performed to analyze the changes of blood coagulability after subarachnoid hemorrhage (SAH) and to investigate the effect of the platelet coagulation inhibitor. SAH was produced by cisternal injection of autogeneous arterial blood in 50 mongrel dogs. Blood sampling and angiography were carried out every 1-3 days and the basilar artery was histologically examined 7-8 days after the bleeding.
    No changes of prothrombin time, partial thromboplastin time and activated coagulation time were noted before or after the bleeding and also by the oral administration of the platelet aggregation inhibitor. Increase of the platelet aggregation rate was noted from one day after SAH. Increase of fibrinogen on day 1-3 and return to the basal value on day 7-8 after SAH were also observed. These changes were prevented by oral administration of the platelet aggregation inhibitor though no angiographical and histological changes were induced. These findings indicate that this drug has the potential of preventing symptoms of vasospasms after SAH.
    Download PDF (691K)
  • Case Report
    Tetsumori YAMASHIMA, Kengo KASHIHARA, Hiroichi KAWANO, Toshihiko KUBOT ...
    1985 Volume 25 Issue 10 Pages 818-825
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Light and electron microscopic studies were conducted on myonecrosis following cerebral arterial spasm in meningitis.
    A 34-year-old female developed fever, headache and vomiting. Neurological examination revealed a drowsy state, nuchal stiffness and hemiparesis. Spinal puncture revealed a purulent fluid containing 1, 219/mm3 cells. She deteriorated steadily into semicoma 10 days after onset. Computerized tomography scan showed low density areas in bilateral basal ganglia and cerebellar hemispheres. Angiography showed vasospasm of the major cerebral arteries and vasodilatation of the left Sylvian arteries. Repeated angiography two months after onset showed a diffuse narrowing of these arteries. She died of uncal herniation 67 days after onset.
    Autopsy two hours after death disclosed softening in the territories of spastic arteries. Microscopically, the circle of Willis showed concentric stenosis due to an intimal proliferation. The media was remarkably atrophied and fibrotic with an infiltration of polymorphonuclear leucocytes. Electron-microscopically, the media disclosed numerous degenerating or necrotic smooth-muscle cells. The degenerating cells showed dissolution of myofilaments with resultant fine granular or filamentous material. The necrotic cells were abundant in vacuoles, lysosomes and dense bodies. The cytoplasm was eventually replaced by cellular debris and numerous collagen fibrils.
    Download PDF (1152K)
  • Comparison with Conventional Method
    Yoriyoshi KUMAGAI, Kintomo TAKAKURA, Michio OHTA, Jun IKEBE, Yoriaki K ...
    1985 Volume 25 Issue 10 Pages 826-831
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Intracranial pressure (ICP) measurement from the epidural space is desirable mainly because of its high protection against infections. The main problem, however, is how to exclude the effect of tension of the dura mater which makes the epidural pressure lower than ICP. The authors developed a hydrostatic pressure balance method, which keeps the nonelastic soft detector membrane contacting flat with the dura mater. The detector pouch is filled with saline of the proper volume and its pressure is transmitted to the pressure transducer through a slender tube. This pressure transmission through a tube realizes in principle an insensitive feature during the rotation of the patient's head, which otherwise causes a marked error from the true ICP. Over 60 clinical usages assure practical and infection-free features of this system. This system demonstrated high speed response and satisfactory accuracy. The pouch was easily inserted during craniotomy and extracted without any surgical procedures. It was also confirmed experimentally that this system is hardly affected by small particles or blood clots lying between the pouch and the dura mater. A comparison with conventional methods is discussed.
    Download PDF (374K)
  • Shobu SHIBATA, Kazuo MORI, Tadayoshi MORIYAMA, Keisei TANAKA, Jiro MOR ...
    1985 Volume 25 Issue 10 Pages 832-836
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    During periods from January, 1981 to December, 1983, 51 patients (31 malignant astrocytomas, 17 glioblastomas, and others 3) were treated with radiochemotherapy using Nimustine hydrochloride, ACNU (group B) and radiochemoimmunotherapy with Picibanil®, OK-432 (group A) by randomized controlled study. Group A consisted of 24 patients and group B of 27 patients. The differences in the background of the two groups were not statistically significant. Survival curves of both groups were shown by the Kaplan-Meier method. The postoperative survival rate at 1 year and 2 years were 70% and 30%, respectively, equal in both groups, and the differences between groups A and B were not statistically significant by the Cox-Mantel test. The side effects by group B therapy were most prominent in the bone marrow, and severe leukopenia occurred. However, group A therapy suppressed leukopenia after 2 months. Immunological parameters, such as purified protein derivative skin reaction test did not change, but streptococcal Su-polysaccharide skin reaction test became positive after group A therapy.
    Download PDF (221K)
  • Yasuo SUZUKI, Ryuichi TANAKA, Teruo MIYAKAWA, Norio TAKEDA
    1985 Volume 25 Issue 10 Pages 837-843
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    In order to evaluate the effectiveness of radiation therapy for metastatic brain tumors, 62 patients with metastatic brain tumor were studied by means of computed tomography (CT) scans during and subsequent to radiation therapy. Results were as follows: After therapy there was complete remission in 23% of patients (14/62), partial remission in 42% (26/62), minor remission in 19% (12/62), and no change in 16% (10/62). None of the patients showed an increase in size. The response rate of the various histological types of lung cancer was 90% (9/10) in undifferentiated carcinoma, 56% (10/18) in adenocarcinoma, and 33% (1/3) in squamous cell carcinoma. In patients who showed a decrease in the tumor size at the completion of radiation therapy, more than a 50% reduction in the tumor size was often obtained with a dose of 20 to 40 Gy. In the follow-up CT after radiation therapy, a delayed effect was observed in 23 out of 35 patients (66%). The delayed effect was generally noted during the first 3 months after completion of radiation therapy. The result suggests that timing of the CT evaluation is very important for observing the effect of radiation therapy and additional new therapeutic methods. The response rate was 36% in 25 patients treated by radiation alone and 49% in 37 patients treated by radiation combined with chemotherapy, although statistically not significant. Improvement of neurological findings was noted in 47 patients (76%), and clinical response seemed to correlate with response in CT. Thirty-one patients died of cancer. Twenty-two of the 31 died of advancing systemic cancer without recurrence of brain lesion. Death from progressive brain lesion resulted in only 29% of the patients. This shows that the length of survival is not an appropriate indicator of therapeutic efficacy.
    The results in this series suggest that serial CT scan is the best objective way to evaluate treatment and that the majority of patients with metastatic brain tumor have benefited from radiation therapy.
    Download PDF (468K)
  • Hiroyuki YOKOTA, Shiro KOBAYASHI, Kouzo YAJIMA, Shozo NAKAZAWA, Masami ...
    1985 Volume 25 Issue 10 Pages 844-849
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Eleven cases of traumatic intracerebellar hemorrhage caused by severe head injury were presented and examined for their neurological signs, associated computed tomography (CT) findings and their outcome. These cases were divided into two types. The first is an acute type, which showed intracerebellar hemorrhage on the initial CT, and the second is a delayed type, which showed a hemorrhage on a subsequent CT without any findings in the posterior fossa in the initial CT scanning. The state of consciousness on admission of these patients was 8 or less by the Glasgow Coma Scale except for one case. Signs of brain stem injury were frequently seen on admission, such as absence of oculocephalic reflex, respiratory disturbance, and conjugate deviation of the eyes. Cerebellar signs were not usually observed. Nine out of 11 patients died and the Glasgow Outcome Scales of the two surviving cases were severe disability and persistent vegetative state. Associated CT findings of supratentorial region were observed in all cases of the acute type and three cases (75%) of the delayed type. There was not much difference in the neurological signs and the associated CT findings between the acute type and the delayed type. These results suggest that a strong impact acted on a supratentorial region as well as on the posterior fossa. With the introduction of CT scan, it has become much easier to diagnose this pathology. These cases suggest that a prompt evacuation of the hematoma or decompression of the posterior fossa should be attempted to yield satisfactory clinical results.
    Download PDF (480K)
  • Case Report
    Akira UTOH, Kikuo SUDA, Hajime ARAI, Takeyoshi SHIMOJI, Minoru MAEDA
    1985 Volume 25 Issue 10 Pages 850-854
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of sagittal synostosis with increased intracranial pressure is reported. The patient was an 8-year-old boy who presented early morning headache and vomiting. Continuous intracranial pressure monitoring revealed high basal pressure and pressure waves (mainly B-waves) during sleep. The patient underwent bilateral parasagittal craniectomies. The intracranial pressure was again measured 4 weeks after the operation. Although the basal pressure had not change, the pressure waves disappeared. His symptoms disappeared after the operation. At present, he is attending school without any problems.
    It is generally considered that there is no indication for surgery for single premature closure of the suture in a patient over 1 year of age. However, some authors advocate surgery in cases, where continuous intracranial pressure shows abnormal waves. It might be advisable to record the continuous intracranial pressure, to determine whether an operation is indicated or not in patients with single craniosynostosis.
    Download PDF (331K)
  • Case Report
    Fumitsugu MATSUMOTO, Hidekazu MATSUURA, Akimasa UMEDA, Hiromichi SATOH
    1985 Volume 25 Issue 10 Pages 855-860
    Published: October 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case is presented in which an enlargement of an intraventricular arteriovenous malformation (AVM) was noted over the period of two years. The patient, a 15-year-old male, was first admitted in December 1980, at the age of 13 years, when he had a sudden onset of headache. Computed tomography (CT) scan showed an intraventricular hemorrhage. Cerebral angiography revealed a small AVM in the left frontal lobe. He was treated conservatively and discharged. In October 1981, the patient was readmitted because of a recurrent intraventricular hemorrhage and was treated conservatively. The third admission was at the age of 15, in November 1982, at which time he suffered again from the intraventricular hemorrhage seen on CT scan. Cerebral angiography showed an enlarged AVM which was supplied by one of the medial lenticulostriate arteries. A right frontotemporal craniotomy was performed in December 1982. As the initial step, the feeding artery was clipped and the AVM located in the wall of the left frontal horn was completely resected microscopically through the transcallosal approach. The histological examination showed a typical AVM. Transcallosal surgery is a useful approach for lesions in the anterior ventricular system. It is assumed that the enlargement of the AVM occurred in the periventricular area which was weakened in resistance by recurrent hemorrhages. No neuropsychological complications were encountered following the section of the anterior part of the corpus callosum.
    Download PDF (644K)
feedback
Top