Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 25, Issue 3
Displaying 1-12 of 12 articles from this issue
  • Mitsusuke MIYAGAMI, Takashi TSUBOKAWA, Barry H. SMITH, Paul L. KORNBLI ...
    1985 Volume 25 Issue 3 Pages 159-167
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors have studied the distribution of factor Vi-related antigen (FVMR: Ag) using both immunohistochemical and immunoelectron microscopic techniques with periodate-lysine-paraformaldehyde fixation and tubular bodies (Weibel-Palade bodies) in endothelial cells in 15 cases of gliomas and 3 samples of non-tumor brain tissue. Twelve glioblastoma, 1 ependymoma, 1 astrocytoma grade II, and 1 oligodendroglioma were evaluated. On FVIIIR: Ag study 7 non-filial tumors (2 metastatic tumor, 3 meningioma, 1 hemangioblastoma, and 1 chordoma) were compared with gliomas.
    FVIIIR: Ag was localized to the vascular lumen, to the intercellular spaces between endothelial cells (apparently without tight junctions), and to the endothelial cell basement membrane. In the cytoplasm of the endothelial cells FVIIIR: Ag was found in the endoplasmic reticulum, perinuclear space, intracytoplasmic vacuoles, vesicles, and luminal surfaces of endothelial cell membranes. Characteristic of malignant tumors (6 out of 7), especially in the cases having endothelial proliferation or hyperplasia, it was strongly-positive at the dilated endoplasmic reticulum, whereas only 1 of 5 benign tumors showed such staining. These findings suggest that FVfIR: Ag synthesis occurs more effectively in the endothelial cells of malignant tumors, such as glioblastoma.
    The tubular body (Weibel-Palade body) observed in the endothelial cells of the glioma vessels consisted of a membrane-limited round, oval or elongated intracytoplasmic body (about 0.1-0.2 μm) which contained tubules of 150-200 Å outer diameter. Tubular bodies were classified into two types. One of them, mature type, is relatively electron dense, the other, immature type, has a relatively pale matrix. The immature types were located in close proximity to the Golgi complex or endoplasmic reticulum. Tubular bodies were common only in the endothelial cells in the marginal zones of glioblastoma with respect to the increased microvessels. In the endothelial cells of glioblastoma they appeared more prominently consistent with neovascularity than with benign glioma. It is suggested that large numbers of tubular bodies may be a marker for proliferating endothelial cells.
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  • Correlation between Clinical Stage and T Cell Subsets
    Itaru INOUE, Jun YOSHIDA, Kyozo KATO, Toshihiko WAKABAYASHI, Tatsuya K ...
    1985 Volume 25 Issue 3 Pages 168-176
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The humoral and cellular immunity of fifty-two patients with malignant brain tumor was analysed by measurement of various immunological parameters with regard to their clinical condition, which was divided into three stages; initial, recurrent and terminal. Immunological parameters analysed in this study were the level of immunoglobulin, number of lymphocytes, percentage of IgG Fc receptor positive T cells, blastogenesis with PHA, PPD skin test and T cell subsets. T cell subsets were studied by flow cytometry using OKT monoclonal antibodies. The immunity of the patients with malignant brain tumor was almost normal in the initial stage and decreased in the recurrent and terminal stages. Especially, the percentage of OKT 4 positive cells in lymphocytes decreased and the percentage of OKT 8 positive cells in T cells increased with deterioration of the clinical stages. Consequently the ratio of OKT 4 to OKT 8 positive cells decreased markedly.
    The effect interferon (IFN) as a biological response modifier was also analysed by T cell subsets in nine patients with recurrent malignant brain tumor. After administration of IFN, the percentage of OKT 4 positive cells in T cells increased and consequently the ratio of OKT 4 to OKT 8 positive cells increased.
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  • Takaaki TAKIZAWA
    1985 Volume 25 Issue 3 Pages 177-180
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    High-resolution computerized tomography (CT) images can detect deep brain commissures, internal capsules and pathological lesions. The intercommissural plane can be determined by a reconstructed sagittal CT image of deep midline structures. The individual CT atlas of the brain of a patient permits precise target identification, and eliminates the need for contrast ventriculography.
    Three patients, who underwent successful CT-guided stereotaxic implantation of deep brainstimulating electrodes using a Brown-Roberts-Wells apparatus for the control of chronic pain, are reported. The target of two patients who had intractable pain caused by cancer was the thalamic relay nucleus. As the stimulation was effective in controlling the pain, the amounts of analgesics could be reduced. The target of one patient who had thalamic pain was the internal capsule and the pain relief has been excellent. Intraoperative electrophysiological assessments were available to confirm the correct target.
    Stereotaxic implantation of deep brain electrodes may be the best indication of CT-guided functional neurosurgery. Since this method is easy and accurate, its application to poor risk patient is feasible.
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  • Toshihiko KUROIWA, Junji KITAMURA, Tomio OHTA
    1985 Volume 25 Issue 3 Pages 181-186
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Widespread use of computed tomography (CT) has provided greater precision in the early diagnosis of the acute stage traumatic intracranial hematoma, enabling minor cases to be treated conservatively. In an effort to determine conditions under which conservative treatment is possible, 52 of 150 patients with acute stage traumatic intracranial hematoma, who exhibited a favorable course with conservative management were evaluated in detail.
    The patients who underwent conservative treatment comprised 7 cases with extradural hematoma, 18 with subdural hematoma, 24 with intracerebral hematoma and 3 with combined hematoma. The maximal amount of hematoma measured from CT scan was within 20 cm3 in extradural hematoma, within 7 cm3 in subdural hematoma and within 15 cm3 in intracerebral hematoma. The consciousness levels of all the patients were within 10 in each hematoma type after 3-3-9 scale during the course except for an initial few hours.
    Patients with acute stage traumatic intracranial hematoma, without definite local symptoms, and with a consciousness level within 10 should be treated conservatively, to avoid unnecessary craniotomy.
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  • Takao MACHI, Ryutaro MAEYAMA, Tosuke TAKAKI, Shogo YOSHIURA, Itsuma KA ...
    1985 Volume 25 Issue 3 Pages 187-194
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    In cases of chronic subdural hematoma (CSH), brain computerized.tomography (CT) scans frequently disclose a low density band in the posterior fossa (LDBP) between the lateral margin of the cerebellum and the adjacent petrous bone/tentorium cerebelli.
    Out of 121 cases of CSH, 56 (46%) showed the LDBP. The LDBP was mostly ipsilateral to the side of the CSH or bilateral. The frequency of the LDBP had no correlation with the severity of the cerebral midline shift or the thickness of the hematoma. As normal controls, CT scans of 257 cases in which no organic lesions were detected were used. Also 30 cases with dementing diseases, 2 cases with spinocerebellar degeneration and 428 cases of other neurological diseases such as head trauma other than CSH, brain tumor, cerebrovascular disease etc. were studied as disease controls. The incidence of the LDBP in both controls was significantly lower than in CSH. Therefore, the LDBP in cases of CSH was considered to be a significant associated finding of CT scans. The mechanism of the LDBP is discussed.
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  • Problems in Evaluation of the Hydrocephalic State and Selection for Intrauterine Shunt Procedure
    Shizuo OI, Hiroshi YAMADA, Koji SASAKI, Satoshi MATSUMOTO
    1985 Volume 25 Issue 3 Pages 195-202
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Since the development of diagnostic procedures for fetal congenital anomalies, active trials of surgical approaches during fetal life have been carried out. However, evaluation of the fetal hydrocephalic state, apart from assessing the size of enlarged ventricles, is limited at present. Determining the surgical indication for shunt during fetal life is probably the most difficult problem in the management of fetal hydrocephalus.
    Familial cases of fetal hydrocephalus diagnosed in the fetal stage are presented and the surgical indications for in utero treatment are discussed. In these cases, whole body computerized tomography (CT) in the third trimester was found to be more useful than ultrasound for evaluation of the hydrocephalic state. They received ventriculo-peritoneal shunt operation immediately after birth and did fairly well, showing normal development and rapid cerebral reconstitution in followup CT. Congenital hydrocephalus children are analyzed in light of the relationship between the period of increased intracranial pressure before the shunt operation and the mental outcome.
    Analysis of 24 cases showed that all with intelligence quotient (IQ) of more than 80 had their initial shunt operation within 60 days after noting the first sign of increased intracranial pressure, whereas of the patients with an IQof below 20, only five dysraphic patients received the shunt operation within 40 days. These five patients had a poor outcome in their IQ scale despite early treatment. Thus, only 5 out of the 24 patients (20.8%) had the possibility of an irreversible change of their hydrocephalic state during the fetal stage.
    It was suggested that fetal hydrocephalus cases actually requiring early treatment, i.e., intrauterine shunt procedure, were relatively few, the majority doing well with the regular management of infantile hydrocephalus. Early treatment is the ideal in the management of congenital hydrocephalus, but there are unsolved problems, including the selection of cases and the necessity for technical improvements in the present shunt procedure for fetal hydrocephalus.
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  • With Special Reference to Fibrinopeptides A and Bβ15-42
    Hajime TOUHO, Akihiko HINO, Kenzou SUZUKI, Satoshi KUBO, Kimiyoshi HIR ...
    1985 Volume 25 Issue 3 Pages 203-208
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    It is well known that abnormalities of coagulation and fibrinolysis frequently take place in the acute stage of cerebrovascular diseases and head injuries. Especially, disseminated intravascular coagulation often increases and influences the prognosis of the diseases.
    Coagulation and fibrinolytic studies were performed in five cases with hypertensive intracerebral hemorrhage and one case with head injury in their acute stage. Test items were prothtombin time, partial thromboplastin time, platelet count, fibrin and fibrinogen degradation products, α2-plasmin inhibitor, antithrombin III, fibrinogen, besides, fibrinopeptide A (FPA) and fibrinopeptide Bl1542 (FPBβ). Blood was collected from the peripheral vein and the internal jugular vein at the jugular bulb. In one case with hemorrhage and the case with head injury, disseminated intravascular coagulation took place at the insults, and the tests were followed up to day 17. The following results were obtained: 1) Within twenty-four hours after the onset, FPA and FPBβ were significantly higher than the control, while the other tests were within normal limits. 2) And FPA had a tendency to be higher than FPBβ in the peripheral and jugular veins. 3) The values of FPA and FPBfl were especially high in the two cases in which disseminated intravascular coagulation broke out at the insults. 4) With heparin andor gabexate mesylate therapy, FPA and FPBβ responded faster than in the other tests.
    It is assumed that damage of cerebral tissue occasionally brings about disseminated intravascular coagulation, and that FPA and FPBβ are excellent indices for predicting disseminated intravascular coagulation and for the therapy.
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  • Report of an Autopsy Case
    Yoshimi CHONO, Kazuyoshi UENO, Mitsuru NUNOMURA, Yuzuru OHTA, Mikio NO ...
    1985 Volume 25 Issue 3 Pages 209-214
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Histopathological examination of cerebrovascular occlusive lesions with von Recklinghausen's disease has rarely been reported. The authors are presenting an autopsy case of von Recklinghausen's disease with the occlusion of bilateral proximal middle cerebral arteries (M1), basal moyamoya, and an anterior communicating artery aneurysm.
    A 60-year-old female suffered a subarachnoid hemorrhage with drowsiness and nuchal rigidity. Although the neck-clipping was performed without any trouble, the patient died of pneumonia 26 days after the operation. Histopathological examination revealed hypoplasia of bilateral M1 and extensive arteriosclerotic changes of the circle of Willis.
    The authors concluded that the primary hypoplasia of bilateral M1 induced basal moyamoya as collateral circulation and hemodynamic stresses facilitated the formation of the anterior communicating artery aneurysm. It is not clear whether there is any etiological relationship between hypoplasia of the bilateral M1 and von Recklinghausen's disease.
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  • Report of Two Cases
    Shuichi ABE, Kiyotaka FUJII, Kenichi NISHIMURA, Kensuke KUROKAWA
    1985 Volume 25 Issue 3 Pages 215-218
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Two cases of azygos anterior cerebral artery aneurysm are reported. Case 1 was a 53-year-old male. He had an attack of left hemiparesis two months before admission. An enhanced computerized tomography (CT) scan demonstrated a ring enhancement in the right frontal lobe adjacent to the falx. An azygos anterior cerebral artery was visualized on the right and left carotid angiograms. The aneurysm was situated at the distal end of the azygos artery. The azygos artery was confirmed at the operation and the aneurysmal neck was wrapped without any serious deficit. Case 2 was a 60year-old male. He was suddenly seized with a headache and soon became unconscious. He was immediately hospitalized and a CT scan demonstrated a subarachnoid hemorrhage. The left carotid angiography with contralateral compression revealed an azygos artery and an aneurysm in its proximal portion. The azygos artery was confirmed at the operation and the aneurysmal neck was wrapped. After the operation, however, he developed mutism, paresis of the lower extremities and urinary incontinence. Frequent association of the azygos artery with aneurysm may suggest congenital factors in the development of cerebral aneurysms. From an anatomical point of view, circulatory disturbances followed by brain damage may develop in bilateral cerebral hemispheres by clipping the azygos anterior cerebral artery aneurysm. Therefore, care should be taken to avoid such a risk in operations.
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  • Yoshihisa MIYAMOTO, Satoshi NAKASU, Yoko NAKASU, Jyoji HANDA
    1985 Volume 25 Issue 3 Pages 219-222
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of cerebellar hematoma developed after a seemingly uneventful frontotemporal craniotomy is reported. On the basis of reviewing the available literature, such a postoperative intracerebral hematoma arising at a site remote from the craniotomy seems to be rare.
    In the immediate postoperative period, a diagnosis of an intracerebral hematoma at a site remote from the field of the preceding craniotomy tends to be delayed. Although rare, one should always be alert to the possibilities of such a formidable but potentially salvageable complication taking place, when the condition of the patient in the immediate postoperative period is unexplainable from the findings and procedures of the preceding craniotomy.
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  • Case Report
    Takashi KAWAMOTO, Kenichi KITAOKA, Hiroshi ABE, Nishio NAKAMURA
    1985 Volume 25 Issue 3 Pages 223-228
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A benign osteoblastoma case of the atlas is reported.
    The patient, a 54-year-old male, was admitted because of nuchal pain. General examination revealed a tenderness of the posterior neck with paravertebral muscle spasms, but the neurological examination was not remarkable. Cervical spine radiography revealed an osteolytic and partially sclerotic lesion of the atlas with a thin bony shell. Bone scintigraphy showed a round high uptake. Computerized tomography scan disclosed a mixed density mass. Myelography revealed smooth indentation of the posterior subarachnoid space at C1-2 level. Angiography showed a faint tumor stain. The tumor was totally removed, and histological examination of the surgical specimen showed the characteristic features of a benign osteoblastoma. The nuchal pain disappeared, and there has been no recurrence.
    Benign osteoblastoma is a rare benign bone tumor. It manifests a distinct predilection for the spine, and represents 3.7% of all tumors of the spine. Moreover, about a half of the benign osteoblastoma of the spine are accompanied with some neurological deficit.
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  • Report of Three Cases
    Satoshi NAKAO, Shinichi SATO, Taro FUKUMITSU, Masahiro OGATA, Hirofumi ...
    1985 Volume 25 Issue 3 Pages 229-234
    Published: 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Cranial metastases of hepatocellular carcinoma are rarely reported, even in the Orient and Africa where this carcinoma is one of the relatively common malignancies. In this communication, three cases with cranial metastasis of hepatocellular carcinoma are reported and the relevant literature is reviewed.
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