Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 27, Issue 12
Displaying 1-14 of 14 articles from this issue
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  • Effects of Forskolin on Cultured Glioma Cells
    Chiho HONDA, Kazuo TABUCHI, Takashi OHMOTO
    1987 Volume 27 Issue 12 Pages 1133-1138
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1133
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    Forskolin is one of the factors that activate adenylate cyclase, which increases the intracellular level of cyclic adenosine monophosphate (AMP). The growth inhibitory effect of forskolin on human glioma (KY) cells was examined both in vitro and in vivo. The cytotoxic effect was evaluated by colony formation assay, and the cytokinetic effect by deoxyribonucleic acid (DNA) histograms using flow cytometry as well as by immunohistochemical study with anti-bromodeoxyuridine (BrdU)-monoclonal antibody. Morphological changes of forskolin-treated KY cells were observed under both light and electron microscopy. The change in the water-soluble protein fraction of KY cells after forskolin treatment was analyzed by two-dimensional polyacrylamide gel electrophoresis.
    It was found that the growth inhibitory effect of forskolin on KY cells in vitro was dose-dependent up to a concentration of 10 μM. However, cytotoxicity was not observed even at 100 μM. DNA histograms of KY cells treated with 10 μM forskolin did not reveal abolition of any specific phase of the cell cycle, although the both DNA histograms and immunohistochemical study with anti-BrdU-monoclonal antibody demonstrated a reduced number of cells in the S phase. Thus, in KY cells forskolin appears to accumulate in the non-proliferating cell pool. KY cells treated with forskolin showed not only morphological differentiation but also a change in the protein fraction. Certain acidic proteins, including S-100 protein, were markedly increased in these cells. When KY tumors were transplanted into nude mice, intraperitoneal injection of 1 mg/kg/day of forskolin for 10 days resulted in suppression of tumor growth by 47% (wet weight) and a significant decrease in the proportion of cells in the S phase. These results indicate that forskolin may be useful as an anti-glioma agent.
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  • Effect of Combined Treatment with X-irradiation and 5-fluorouracil in Multicellular Spheroids of Rat Glioma
    Kenji KUWAHARA, Ryuichi KATAKURA, Teruaki MORI, Jiro SUZUKI, Takehito ...
    1987 Volume 27 Issue 12 Pages 1139-1146
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1139
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    The effect of combined treatment with X-irradiation and 5-fluorouracil (5-Fu) on the spheroids of rat glioma clone-6 cells was compared with that on exponentially grown monolayer cells. Isobolographic analysis showed the effect of the combined treatment to be supra-additive in both multicellular spheroids and monolayer cells when irradiation followed 24 hours of treatment with 5-Fu.
    X-irradiation prior to 5-Fu treatment showed an additive effect. The effect of X-irradiation on spheroids was enhanced after 3 hours of 5-Fu treatment, whereas its effect on monolayer cells was augmented only when prior 5-Fu treatment exceeded 12 hours. Potentiation of the effect of X-irradiation on spheroids by prior treatment with 5-Fu is thought to be due to reoxygenation of previously hypoxic cells and partial synchronization of proliferating cells. These results suggest that when X-irradiation is applied shortly after 5-Fu treatment the effect on solid tumors is selectively enhanced, while the effect on actively proliferating normal tissues is reduced.
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  • The Identification of Proliferating Cells in Nervous System Neoplasms by Use of the Monoclonal Antibody Ki-67
    Taichiro SHIBATA, Peter C. BURGER, Paul KLEIHUES
    1987 Volume 27 Issue 12 Pages 1147-1151
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1147
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    In an estimate of the proliferative potential of nervous system neoplasms in 100 adult patients, the proliferating cells (G1, S, G2, and M phases) were demonstrated immunohistochemically by means of the monoclonal antibody Ki-67. The percentage of cycling cells was calculated in immunostained frozen sections by the peroxidase-antiperoxidase method. The histologic grade and known biologic behavior of gliomas were reflected in the percentages of stained cells, which ranged from 0.3% in a pilocytic astrocytoma to 17.2% in a glioblastoma multiforme. All three cases in which stained cells constituted over 20% were metastatic carcinoma. The percentage of stained cells in pituitary adenomas showed a wider range (0.2-3.7%) than that of the S-phase fraction obtained by Nagashima et al. (0.1-1.5%). These results indicate that Ki-67 staining is technically suitable as a routine method of estimating the proliferating cell fraction of nervous system neoplasms, and this information may be useful in predicting their biologic behavior.
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  • The Role of Endothelial Cells in the Relaxation of Cerebral Arteries and Arachidonic Acid Metabolism
    Kenji KANAMARU, Shiro WAGA, Tadashi KOJIMA, Kiyoshige FUJIMOTO, Hiroji ...
    1987 Volume 27 Issue 12 Pages 1152-1157
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1152
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    Vascular responses to acetylcholine (ACh) and calcium ionophore A23187 were characterized in the rings of canine basilar artery. In preparations precontracted to a stable plateau by 3×10-7 M 5-hydroxytryptamine or 3×10-6 M prostaglandin F2α, A23187 (10-9-10-7 M) elicited significant relaxation of the basilar rings when the endothelium was intact. The ability of a ring to relax in this manner depends upon the presence of the endothelium, according to the evidence obtained by scanning electron microscopy, and the same concentration of A23187 did not relax vascular tissues in which the endothelium was artificially disrupted. On the other hand, ACh (10-7-10-3 M) produced negligible relaxation of canine basilar artery with intact endothelium. Indomethacin pretreatment (1.5×10-5 M) did not affect the A23187-induced relaxation, whereas preincubation with the lipoxygenase inhibitors nordihydroguaiaretic acid (1.5×10-5 M) and AA861 (10-5 M) prevented its relaxant effect. These results suggest that endothelium-dependent relaxation of canine basilar artery by A23187 may be mediated by one or more noncyclooxygenase metabolites.
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  • Clinical Significance of Intracerebral Hematomas following Aneurysmal Rupture
    Shingo KAWAMURA, Akifumi SUZUKI, Ichiro SAYAMA, Nobuyuki YASUI
    1987 Volume 27 Issue 12 Pages 1158-1166
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1158
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    The purpose of this study was to elucidate the clinical significance of intracerebral hematomas (ICH) following aneurysmal rupture. The subjects were 115 patients (mean age, 59 years) with ruptured aneurysms associated with ICH. The sites of the ruptured aneurysms were the middle cerebral artery in 53, the anterior communicating artery in 35, the distal anterior cerebral artery in 15, and the internal carotid artery in 12. The aneurysms were surgically treated in 94 cases. Pre-operatively, 13 were completely conscious, 26 were drowsy, 25 were stuporous, 21 were semicomatose, and nine were comatose. The interval between the last attack of bleeding and surgery was 24 hours or less in 63, 2 to 3 days in 18, 4 to 14 days in 11, 20 days in one, and 29 days in one. The mean follow-up period was 3 years. Forty-two patients died. Among the remaining 73 patients, 40 recovered with minimal or no neurological deficit, 16 had significant deficit but were able to function independently, three required partial assistance, and 14 were fully dependent. To more clearly assess the clinical significance of ICH, the authors separately evaluated the outcomes of the 79 patients who did not have intraoperative or postoperative complications, massive intraventricular hematomas, or symptomatic vasospasm, all of which influenced the clinical course markedly. Of these 79 patients, all 17 who did not undergo surgery died, while five surgical patients did not survive. Of the remaining surgical patients, 40 had complete or near-complete recovery, 13 were independently functional but had significant neurological deficit, two required assistance, and two were entirely dependent. There was no difference in outcome between patients with dominant-side and those with nondominant-side ICH. The favorable surgical results may be attributable to the fact that most operations were performed as soon as possible following aneurysmal rupture and the ICH were mainly subcortical. Also, among surgical cases, the incidence of symptomatic vasospasm was half that observed by the authors previously in patients without ICH. In all patients with bilateral, medium-to-large hematomas the outcome was poor regardless of whether or not surgery was performed.
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  • Orbital Mucocele
    Report of Three Cases
    Tadashi NISHIYAMA, Yasuo KAWAMURA, Keiji KAWAMOTO, Terumi OKUYAMA, Nob ...
    1987 Volume 27 Issue 12 Pages 1167-1172
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1167
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    Three patients with unusual orbital mucoceles all presented with proptosis and ptosis. None had a history of trauma or sinus infection. In each case, computerized tomography (CT) demonstrated a well-defined, homogeneously isodense mass in the superior orbit, which displaced the globe inferiorly. There was no apparent continuity between the orbital mass and the sinuses. In Case 2 the administration of contrast medium showed enhancement of the rim of the lesion. Magnetic resonance imaging (MRI) in Case 3 clearly revealed the location and soft tissue characteristics of the lesion, and the isointense nature of the mass. Orbitotomies by the transcranial supraorbital approach, which is considered to be the procedure of choice for superior orbital lesions, disclosed cysts containing mucinous fluid; all three were excised. In Case 1, the cyst was separated from the frontal sinus by the ossified wall. In Cases 2 and 3, the cyst communicated with the anterior ethmoid sinus through a small orifice in the medial orbital wall. Histological study of the cyst walls demonstrated columnar or cylindrical ciliated epithelium, which is compatible with mucocele. The mechanisms of mucocele formation and the role of CT and MRI in differentiating this lesion from other intraorbital lesions are discussed.
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  • Neurofibromatosis with Extracranial Vertebral Arteriovenous Fistulae
    Case Report
    Takamichi KUBOKURA, Naoko SANNO, Seigo KOYAMA, Toshihiko NISHIMURA, Ky ...
    1987 Volume 27 Issue 12 Pages 1173-1179
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1173
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    A 38-year-old female was hospitalized complaining of left cervical pain. On physical examination, bruits were audible in the painful region. Plain X-rays of the cervical spine showed widening of intervertebral foramina and scalloping of the vertebral bodies at C2-C5. Left vertebral angiography disclosed aneurysmal dilatation and arteriovenous fistulae at the C3 and C4-C5 levels of the artery. The right vertebral artery, bilateral occipital arteries, left thyrocervical trunk, and costocervical trunk were associated with the fistulae as collateral pathways to the left vertebral artery. In a sequential procedure, the left vertebral artery was clipped just proximal to the posterior inferior cerebellar artery, the lower fistula was occluded by a detachable balloon, and muscle was packed to the abnormal vessel close to the upper fistula. After treatment the bruits diminished and the radiculomyelopathy abated. Arteriovenous fistulae should arouse suspicion of neurofibromatosis. Auscultation of the neck and angiography are recommended for patients with neurofibromatosis presenting with radiculomyelopathy. Intravascular surgery with a detachable balloon is considered very effective for extracranial vertebral arteriovenous fistulae.
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  • Intracranial Cystic Meningioma associated with Multiple Aneurysms and a Venous Angioma
    Case Report
    Kazumaro YOKOI, Tetsuo KANNO, Kazuhiko NONOMURA, Tsukasa KAWASE, Kazun ...
    1987 Volume 27 Issue 12 Pages 1180-1184
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1180
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    A 50-year-old male was hospitalized with headache and visual disturbance. Computerized tomography revealed a cystic lesion in the left occipital area as well as a small, hyperdense lesion in the left posterior fossa. On angiograms the left occipital lesion appeared to be a meningioma and the left posterior fossa lesion a venous angioma. In addition, the right carotid angiogram revealed an A2 aneurysm and the right vertebral angiogram showed a basilar top aneurysm. The left occipital lesion and both aneurysms were treated surgically. The left occipital lesion was diagnosed as meningotheliomatous meningioma. Cystic meningioma is rare, accounting for only 1.2-2.2% of all meningiomas. Also, aneurysms are associated with only 2.5-4% of all brain tumors. To the authors' knowledge, this is the first reported case of the cystic meningioma associated with multiple aneurysms and a venous angioma.
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  • Astrocytoma in the Medulla Oblongata diagnosed by Magnetic Resonance Imaging
    Surgical Case Report
    Toshihiro SUGA, Shin-ichiro TAKAHASHI, Makoto SONOBE, Keiji KOSHU, Shi ...
    1987 Volume 27 Issue 12 Pages 1185-1189
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1185
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    A 22-year-old male was admitted to Mito National Hospital with complaints of persistent, progressive dysphagia, hoarseness, and numbness over his entire body. Neurological examination showed bilateral 7th, 9th, and 10th nerve paralysis, tetraparesis, sensory disturbance of the whole body, and hyper-reflexia of all extremities. Pale, low-density areas in the medulla oblongata and upper cervical spinal cord were detected by conventional computed tomography. Magnetic resonance imaging (MRI) disclosed low-signal masses involving those areas and in the lower cervical cord. Suboccipital craniotomy exposed a solid, firm, well demarcated intramedullary tumor in the medulla oblongata. The tumor was removed en bloc and was histologically diagnosed as a pilocytic astrocytoma. The postoperative course was uneventful and the patient's symptoms improved dramatically. Postoperative MRI revealed no residual tumor in the medulla oblongata or upper cervical cord. This case illustrates the value of preoperative MRI, which precisely delineates the location and extent of the tumor and greatly facilitates direct surgery of the medulla oblongata.
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  • Spinal Accessory Nerve Neurinoma in the C2 Spinal Canal
    Case Report
    Shoichiro KAWAGUCHI, Hideyuki OHNISHI, Takashi YUASA, Hiroyuki HASHIMO ...
    1987 Volume 27 Issue 12 Pages 1190-1194
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1190
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    A 38-year-old female was hospitalized with complaints of progressive motor weakness and numbness of all four extremities. The neurological findings were right accessory nerve palsy, tetraparesis, sensory impairment below the level of the C3 dermatome, and positive Romberg's sign. There was no evidence of von Recklinghausen's disease. Myelography, metrizamide computed tomography (CT) myelography, and enhanced CT revealed an intradural, extramedullary mass lesion at the C2 spinal level. Laminectomy was performed from C1 through C3. The tumor was located in the right C2 subarachnoid space lateral to the spinal cord and was connected to the right spinal accessory nerve trunk. It was totally removed. Histological examination revealed an Antoni type B neurinoma. The postoperative course was uneventful.
    Spinal accessory nerve neurinoma is very rare; only 10 cases have been reported in the literature and, to the authors' knowledge, there have been no reports of such tumors confined entirely to the spinal canal. The authors believe this to be the first reported case.
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  • Dural Arteriovenous Malformation with Uncommon Draining Veins in the Anterior Fossa
    Case Report
    Takeo ABUMIYA, Hiroyasu KAMIYAMA, Junichi MURATA, Mitsuru NUNOMURA, Yo ...
    1987 Volume 27 Issue 12 Pages 1195-1200
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1195
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    A case of dural arteriovenous malformation (AVM) in the anterior cranial fossa is reported. A 61-year-old male was hospitalized because of sudden onset of severe headache, vomiting, mild hemiparesis, and lethargy. Computerized tomography disclosed left frontal subcortical and frontotemporal subdural hematomas. Angiography revealed an AVM in the anterior cranial fossa, fed by the bilateral anterior ethmoidal arteries and drained by the left olfactory and left fronto-orbital veins. The latter veins had large, varicose dilatations and drained to the basal vein of Rosenthal. Two weeks after artificial embolization, surgical evacuation of the hematoma and removal of anomalous vessels, including a varicose dilated vein, were carried out. The involved dura at the olfactory groove was coagulated rather than totally removed. According to literature, the dural AVM in this region is fed primarily by the anterior ethmoidal artery and drains via the leptomeningeal veins into the superior sagittal sinus. Varicose dilatation of a draining vessel is considered a characteristic angiographical finding. The high incidence of bleeding from dural AVMs in this region is related to the varicose dilatation. The drainage capacity of the elongated leptomeningeal veins is insufficient, and the high arterial pressure in the AVM leads to the development of varicose dilatation and intracranial hemorrhage.
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  • Human Chorionic Gonadotropin producing Tumor of the Cauda Equina
    Case Report
    Nobuo TAKENAKA, Touru MINE, Kouichi UCHIDA, Keiji SUZUKI, Yoshiaki TAK ...
    1987 Volume 27 Issue 12 Pages 1201-1207
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1201
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    A 14-year-old male who had been previously treated by ventriculoperitoneal (VP) shunting and irradiation for a pineal tumor subsequently developed a human chorionic gonadotropin (HCG)- producing tumor of the cauda equina. Three years after the VP shunting procedure he developed progressive right lower monoparesis and sacral pain. On myelography and metrizamide computed tomography myelography a movable, solitary mass 3 cm in diameter with complete block was found in the cauda equina. A L2-L4 laminectomy, performed with the patient in the prone position, revealed a dark red tumor with a thin connective capsule infiltrating into the right fourth lumbar nerve. The tumor was totally removed, along with the nerve root. Histological inspection showed the tumor to be a germinoma having a seminoma-like appearance and containing syncytiotrophoblastic giant cells. The HCG and HCG-β subunit titers were high, especially in the cerebrospinal fluid, serum, and tumor tissue, whereas alpha-fetoprotein and carcinoembryonic antigen were negative. HCG and HCG-β in serum and cerebrospinal fluid decreased to normal following chemotherapy. Solitary spinal metastases should be surgically removed. Irradiation and chemotherapy may also be effective against malignant HCG-β-producing tumors.
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  • Neurofibromatosis with Occlusion of Internal Carotid Artery and Malignant Astrocytoma
    Case Report
    Yoshitaka OKIMURA, Soichi SUNADA, Nobuo OKA, Akira YAMAURA
    1987 Volume 27 Issue 12 Pages 1208-1213
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1208
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    A 38-year-old female presented with headache and weakness of the left upper extremity. At the age of 9 years she had had several episodes of transient left hemiparesis, which had apparently been induced by crying. Her mother and one of her siblings had documented neurofibromatosis. Physical examination on admission disclosed café au lait spots and fibroma molle. Neurological examination revealed mild memory disturbance, bilateral papilledema, left hemiparesis, and left hemihypesthesia. Computed tomography showed a high-density mass between the frontal horns and dilatation of the lateral ventricle with periventricular low density. Cerebral angiography demonstrated occlusion of the right internal carotid artery and abnormal vascular networks resembling those of moyamoya disease. A diagnosis of neurofibromatosis with occlusion of the right internal carotid artery and malignant astrocytoma was established.
    Cerebrovascular lesions are uncommon in patients with neurofibromatosis. Only 34 cases of neurofibromatosis with occlusive cerebrovascular lesions have been reported in the literature. The clinical features and angiographic findings of this syndrome are discussed, with special reference to moyamoya disease.
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  • Human Chorionic Gonadotropin-producing Intrasellar Germinoma
    Case Report
    Yuji TOMONO, Akio HYODO, Tadao NOSE, Yutaka MAKI
    1987 Volume 27 Issue 12 Pages 1214-1218
    Published: 1987
    Released on J-STAGE: September 21, 2006
    DOIhttps://doi.org/10.2176/nmc.27.1214
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    A 15-year-old female was hospitalized because of amenorrhea, loss of appetite, polyuria, and polydipsia that had persisted for 2 years. Endocrinological examination revealed a high serum level of human chorionic gonadotropin (HCG) (74 mIU/ml) and hyperprolactinemia. Computed tomograms showed an intrasellar mass lesion with limited suprasellar extension. A histological diagnosis of germinoma was made after surgery via the transsphenoidal route. The tumor responded well to radiation therapy and the serum HCG became negative within a short time. Immunohistochemical study involving the peroxidase-antiperoxidase technique demonstrated immunoreactive HCG not only in syncytiotrophoblastic giant cells but also in mononuclear cells, which could not be differentiated from epithelioid tumor cells. The neuroradiological and immunohistochemical peculiarities of this case are discussed.
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