Neurologia medico-chirurgica

Demonstration of Proliferating Cell Nuclear Antigen (PCNA /Cyclin) in Glioma Cells

Kazuo TABUCHI, Chiho HONDA, Paul K. NAKANE

1987 Volume 27 Issue 1 Pages 1-5
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.1

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Proliferating cell nuclear antigen (PCNA/cyclin), a non-histone, acidic nuclear protein commonly believed to be strictly confined to proliferating cells, was successfully demonstrated exclusively in the nuclei of human glioma cells both in vitro and in situ by an indirect immunoperoxidase method. Speckled nucleoplasmic staining for PCNA, with variable nucleolar staining, was observed in approximately 37% of cultured human glioma (KY) cells in exponential growth, whereas only 14% of subcutaneous KY tumor cells from inoculated nude mice stained unequivocally positive for nuclear PCNA. A direct comparison of this method and autoradiography would be valuable. However, immunocytochemical demonstration of PCNA appears to be a simple method of estimating the proliferative activity of glioma cells, since the number of PCNA-positive KY cells closely corresponds to the number of S phase cells that exhibit nuclear uptake of bromodeoxyuridine.

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The Effectiveness of Combination Therapy with Hu IFN-β and A CNU against Malignant Glioma

Hitomi ENOMOTO, Jun YOSHIDA, Naoki KAGEYAMA

1987 Volume 27 Issue 1 Pages 6-10
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.6

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Combination therapy with human fibroblast interferon (Hu IFN-β) and 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) was administered against a cell line of human malignant glioma transplanted into nude mice, and the histological changes were examined. The mice were divided into four groups (control, Hu IFN-β ACNU, and combination therapy). The drugs were administered intraperitoneally.
As in an earlier in vitro study, ²²⁾ the anti-proliferative effect in the combination therapy group was significantly greater than that in the other groups. In the combination therapy group the histological findings also revealed more degenerative changes, such as a tendency for tumor cells to separate from each other, an increase in multinucleate giant cells, and extensive necrosis.
As an adjunct to surgery, combination therapy with Hu IFN-β and ACNU may be a significantly effective treatment for malignant gliomas.

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Effect of Surgery on Brain Edema associated with Intracerebral Hematoma and Arterial Hypertension

—An Experimental Study—

Shizuo HATASHITA, Junpei KOIKE, Shozo ISHII

1987 Volume 27 Issue 1 Pages 11-17
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.11

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We studied brain edema produced by intracerebral hematoma and arterial hypertension in order to determine whether or not surgical intervention increases the edema. Intracerebral hematoma was produced by stereotactic injection of 1.0 ml of autologous blood into the subcortical white matter of cats. Arterial hypertension was induced for 30 minutes by inflation of a balloon situated in the descending aorta. The hematoma was aspirated through a burr hole or a craniectomy in the frontoparietal bone. The animals were divided into four groups; 1) intracerebral hematoma with normal arterial pressure; 2) intracerebral hematoma with arterial hypertension; 3) burr hole aspiration of hematoma during hypertension; and 4) hematoma removal and craniectomy during hypertension. A sham-operated group served as the control. Brain edema was evaluated 48 hours after the procedures, on the basis of macroscopic observation, the blood-brain barrier permeability to Evans blue, and the water content of the brain tissue. We also evaluated the animals' survival during the 48 hours after the insult. Brain edema was greater in animals with intracerebral hematoma and arterial hypertension than in those with hematoma and normal blood pressure. In the hypertensive cats there was no difference in brain edema between those not treated and those subjected to burr hole aspiration of the hematoma. However, craniectomy following hematoma removal during hypertension increased brain edema and shortened the survival time. This indicates that the combination of hypertension, hematoma removal, and craniectomy produces the greatest degree of edema and that hematoma removal per se does not affect the development of edema.

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Percutaneous Thermocoagulation of Trigeminal Ganglion

Hirokuni SONODA, Shosuke TAKAHASHI, Kenji KODAMA, Noriko HARA, Yasuhir ...

1987 Volume 27 Issue 1 Pages 18-23
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.18

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Fifty-five patients with classical trigeminal neuralgia underwent percutaneous thermocoagulation of the trigeminal ganglion (PTTG). There were no failures attributable to anatomic abnormalities having prevented penetration of the foramen ovale. On the basis of immediate postoperative facial sensation, the patients were divided into three groups: anesthetic (n = 20), analgesic (n = 24), and hypesthetic (n = 11). All patients in the anesthetic group, 22 (92%) in the analgesic group, and eight (73%) in the hypesthetic group have remained pain-free postoperatively. The remaining patients' pain were reduced to a tolerable level.
During follow-up, four patients in the analgesic group and three in the hypesthetic group experienced mild pain; only one required medical treatment for his pain. Three patients in the analgesic group and four in the hypesthetic group have had a full recurrence of pain, giving recurrence rates of 13% and 36%, respectively. Pain recurred at an average of 20 months postoperatively in the analgesic group and 7 months postoperatively in the hypesthetic group. We are following 45 patients required no surgical treatment after PTTG for 7 to 39 months. Masseter weakness was observed in nine (16%) of the 55 patients. Fourteen (25%) experienced unpleasant facial sensations, which were severe in two patients in the anesthetic group.
Complete pain relief without recurrence was achieved in patients whose PTTG produced trigeminal anesthesia, and the degree of postoperative discomfort was directly related to the amount of sensory deficit produced. We concluded that accurate placement of the electrode in the trigeminal ganglion and a more precise lesioning with utilization of small graded increments of the temperature will be important to decrease the incidence of postsurgical complaints.

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Postsurgical Disappearance of Dementia without Increased Cerebral Blood Flow in Hydrocephalic Patients

Masayuki MATSUDA, Shokei TAKAYAMA, Ken-ichi MATSUMURA, Jyoji HANDA

1987 Volume 27 Issue 1 Pages 24-30
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.24

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Cerebral blood flow (CBF) was measured by the 133-Xe inhalation method in four hydrocephalic patients without signs of increased intracranial pressure. Dementia decreased markedly after shunting procedures in two patients and after removal of posterior fossa tumors in the other two patients. The preoperative average hemispheric CBF was subnormal in three patients; it did not increase when dementia disappeared, within 7 to 21 days postoperatively, in any of the four patients. The cerebral circulation time, measured by dynamic computed tomography in three patients, was prolonged before operation and returned to normal after operation reflecting improvement in the microcirculation of the affected tissue. The results of this study demonstrate that disappearance of dementia following surgical intervention in hydrocephalic patients, possibly including those with normal-pressure hydrocephalus, is not always accompanied or preceded by increased CBF as measured by the conventional method.

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Cerebellar Tuberculoma

—A Case Report and Review of the Literature—

Shinichiro WAKISAKA, Tohru SOEJIMA, Shigeaki MATSUOKA

1987 Volume 27 Issue 1 Pages 31-36
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.31

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A case of a solitary cerebellar tuberculoma in a 67-year-old male is presented. The patient showed signs and symptoms of acute obstructive hydrocephalus, necessitating surgical removal of the tumor. Combined treatment with antituberculosis drugs, not only pre and postoperatively but also intraoperatively, proved beneficial, and postoperative meningitis did not develop. Steroids also produced dramatic clinical improvement without causing spread of the tuberculosis. Since intracranial tuberculoma is rarely encountered in present-day Japan, it is not likely to be considered when signs and symptoms suggest an intracranial mass lesion. Therefore, it must be emphasized that the first and most important step in the diagnosis of intracranial tuberculoma is to suspect it. The incidence and ages of patients as well as the locations of intracranial tuberculomas, their relationship to tuberculous abscesses, neuroradiological features, and therapeutical methods are reviewed.

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Huge, Dense, Cystic Craniopharyngioma with Unusual Extensions

—Case Report—

Satoshi KUWABARA, Hirotaka SEO, Susumu ISHIKAWA

1987 Volume 27 Issue 1 Pages 37-41
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.37

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A 24-year-old female patient presented with a cystic craniopharyngioma that appeared on a computed tomographic (CT) scan as a huge, homogeneous, high-density mass extending into the left temporal lobe and posterior fossa. She had undergone partial removal of a suprasellar tumor and cyst aspiration 17 years previously, at the age of 7. The tumor recurred with atypical clinical symptoms. Unusual clinical manifestations are discussed and an explanation for the CT appearance of the tumor, based on chemical analysis of the cyst content, is proposed.

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Intracranial Multiple Berry Aneurysms associated with Fibromuscular Dysplasia and Mixed Connective Tissue Disease

—Case Report—

Toshio MASUZAWA, Noboru NAKAHARA, Seiichi KOBAYASHI

1987 Volume 27 Issue 1 Pages 42-50
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.42

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A rare case of multiple intracranial berry aneurysms associated with fibromuscular dysplasia (FMD) and mixed connective tissue disease (MCTD) is reported together with a review of the literature, particularly that of Japan.
The patient was a 59-year-old woman who had a subarachnoid hemorrhage during the course of MCTD. Angiographically, multiple intracranial aneurysms and “string of beads” were demonstrated in both cervical internal carotid arteries. The three aneurysms of the left internal carotid and middle cerebral arteries were treated surgically, and the remaining aneurysms in the right middle cerebral artery and at the top of the basilar artery were to be treated at a later date. Although the immediate postoperative course was uneventful, 1 month after surgery the patient died suddenly of sepsis with disseminated intravascular coagulation. At autopsy, FMD involving medial fibroplasia with aneurysms was found in the internal carotid and renal arteries. The intracranial aneurysms showed features typical of saccular aneurysms related to the arterial fork. Other than the aneurysms, no changes due to FMD were noted in the cerebral arteries. Although characteristic MCTD lesions were present in the visceral organs, no specific changes due to MCTD were seen in the brain.
Among the 29 patients with cervico-cephalic FMD reported in Japan, 15 had intracranial aneurysms. These included four cases of multiple aneurysms and 11 cases of rupture. No association between FMD and MCTD has been reported in the world literature.

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Spinal Malignant Fibrous Histiocytoma producing Cord Compression

—Case Report—

Youichi ITOYAMA, Akinobu FUKUMURA, Yoshihiro ITOH, Seishi TAKAMURA, Ya ...

1987 Volume 27 Issue 1 Pages 51-55
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.51

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Malignant fibrous histiocytoma is a well known neoplasm that probably originates from histiocytes and involves not only soft tissue but also bone. The favorite sites of this tumor are the extremities; the central nervous system is rarely involved. Recently we treated a 65-year-old female who presented with neurological symptoms of spinal cord compression at the level of Thl and Th2. A computed tomographic scan revealed a huge extradural tumor in that area. The tumor was subtotally removed, and the histological diagnosis was malignant fibrous histiocytoma. Although eight similar cases have been reported, this is the first reported case from Japan, according to our review of the literature.

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Ruptured Intracranial Mycotic Aneurysm associated with Acute Subdural Hematoma

—Case Report—

Kuniaki BANDOH, Jun SUGIMURA, Yasuaki HOSAKA, Suguru TAKAGI

1987 Volume 27 Issue 1 Pages 56-59
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.56

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A case of ruptured intracranial mycotic aneurysm associated with acute subdural hematoma is presented. A 26-year-old woman with cardiac valve disease who had been intermittently febrile for 2 weeks suddenly became comatose. There had been no head injury. At the time of admission, a cardiac murmur was audible and petechiae were noted on the conjunctivae and fingers, suggesting a diagnosis of bacterial endocarditis. The blood culture yielded Streptococcus faecalis. The computed tomographic scan revealed an intracerebral hematoma and acute subdural hematoma. Angiography disclosed an aneurysm at the distal middle cerebral artery. Such a combination of intracranial mycotic aneurysm and acute subdural hematoma is very rare.

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Acute Subdural Hematoma of Arterial Origin in a Patient with a Lumboperitoneal Shunt

Nobuhiko AOKI

1987 Volume 27 Issue 1 Pages 60-62
Published: 1987
Released on J-STAGE: September 21, 2006

DOIhttps://doi.org/10.2176/nmc.27.60

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A patient who developed a subdural hygroma following emplacement of a lumboperitoneal shunt was found to have an acute subdural hematoma following a minor head trauma. At surgery, a ruptured cortical artery was identified as the source of bleeding. The pathoetiology of the acute subdural hematoma appeared to be rupture of the cortical artery, which protruded into the subdural hygroma through a defect in the arachnoid. The potential risk of acute subdural hematoma, even after minor head trauma, in a patient with cerebrospinal fluid diversion via a lumboperitoneal shunt, is discussed.

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