Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 27, Issue 9
Displaying 1-15 of 15 articles from this issue
  • Light Microscopic Immunohistochemical Study
    Shobu SHIBATA, Masaaki FUKUSHIMA, Takafumi JINNOUCHI, Kazuo MORI
    1987 Volume 27 Issue 9 Pages 815-818
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Evans blue, horseradish peroxidase (HRP), and lanthanum have long been used as tracers in experimental brain edema, but these substances appear to modify in vivo reactions. In this study, to exclude such foreign body reactions, ischemic and traumatic cerebral edema was produced in rats previously inoculated with HRP, and leakage of anti-HRP antibodies from microvessels and their migration into brain tissue, as well as absorption of edema fluid by the ventricular lining were observed. Wistar rats were immunized with four HRP booster shots in four weeks. Ischemic and traumatic cerebral edema were produced by means of transcarotid embolization and cold injury techniques, respectively. Immunohistochemical techniques were used to observe the location of anti-HRP antibodies. Three hours after embolization, no leakage of anti-HRP antibodies from capillaries was observed in the ischemic lesion and surrounding brain tissue. However, 24 hours after embolization, leakage of anti-HRP antibodies from venules and capillaries in the ischemic lesion was clearly detected. Uptake of anti-HRP antibodies by neurons and glial cells was also noted. Anti-HRP antibodies migrated along the nerve fibers in the white matter and reached the subependymal layer of the lateral ventricle. The drainage sites for anti-HRP antibodies were those not protected by the blood-brain barrier, that is, the subfornical region at the root of the choroid plexus of the lateral ventricle, the pineal body at the root of the choroid plexus of the third ventricle, the hypophysis and its vicinity, and the choroid plexus itself. The findings in the cold injury model were similar to those in the ischemic model at 24 hours after embolization.
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  • Kozo ABE
    1987 Volume 27 Issue 9 Pages 819-824
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The author tested the effect of the Ca-antagonist nicardipine hydrochloride on the development of post-ischemic cerebral edema. Global ischemia lasting for 30 minutes was experimentally produced in rats by means of Pulsinelli's technique, following which brain circulation was reinstituted. The animals were divided into three groups. The rats in Group 1 received a single intravenous injection of 0.05 mg/kg of nicardipine prior to the onset of ischemia. Group 2 were given the same pretreatment as those in Group 1 and also received daily intraperitoneal injections of 0. 1 mg/kg of nicardipine for 7 days after the ischemic insult. Group 3 comprised untreated control animals. The changes in water content, free fatty acids, and extracellular concentrations of K+ and Ca++ ions in the brain during and after ischemia were measured by means of a gravimeter, gas chromatography, and double ion-sensitive microelectrodes, respectively. Survival rates in Group 1 (54.5%) and Group 2 (84.6%) at 7 days after recirculation were significantly higher than that in the control group (23.1%) . Significant increases in the cerebral water content of the controls were observed at two peaks, the first at 30 minutes (early edema) and the second at 72 hours (late edema) following recirculation. Late edema did not develop in the Group 2 animals. In control rats, the brain free fatty acid concentration increased 4-fold during ischemia and rapidly normalized shortly after recirculation. The accumulation of free fatty acids was thought to reflect an ischemiainduced increase in Ca-dependent catabolism. However, premedication with nicardipine did not modify the change in the free fatty acid concentration during or after ischemia. Electrophysiological study of the cerebral cortex during ischemia revealed an increase in extracellular K+ ions followed by a decrease in extracellular Ca++ ions, suggesting that there was an influx of Ca into intracellular compartments. This Ca influx was suppressed in 43.5% of the animals treated with nicardipine.
    Nicardipine appears to suppress the development of late cerebral edema during recirculation following a 30-minute global ischemic insult in rats. However, the data indicate that this suppression is not directly related to the effect of nicardipine on free fatty acid metabolism.
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  • Toshimitsu AIDA, William J. BODELL
    1987 Volume 27 Issue 9 Pages 825-830
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The cytotoxic and cytogenetic effects of 1 (4-amino-2-methyl-5-pyrimidinyl) methyl-3 (2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) treatment on two cell lines derived from human malignant glioma were studied. Compared to SF-126 cells, SF-188 cells were 7-fold more resistant to ACNU and were cross-resistant to 1, 3-bis-(2-chloroethyl)-1-nitrosourea (BCNU). In contrast to the results obtained with chloroethylnitrosoureas, SF-188 cells were more sensitive to nitrogen mustard (HN2) and cis-diamminedichloroplatinum (II) (cis-Pt) than were SF-126 cells. The number of sister chromatid exchanges (SCEs) induced by ACNU, BCNU, HN2, and cis-Pt was well correlated with cell survival in both cell lines. SF-188 cells had 70% fewer deoxyribonucleic acid (DNA) interstrand crosslinks with ACNU treatment than did SF-126 cells. Compared to SF126 cells, the O6-methylguanine alkylation product was removed more rapidly from DNA in SF-188 cells treated with 3H-methylnitrosourea.
    These results suggest that DNA interstrand crosslinking may cause cell death and SCE induction in cells treated with ACNU and that one of the mechanisms of cellular resistance to ACNU is repair of O6-alkylguanine derivatives in DNA. This repair process prevents DNA interstrand crosslinks, which reduces both cytotoxic effects and SCE induction by ACNU.
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  • Jun SHINODA, Hiromu YAMADA, Noboru SAKAI, Takashi ANDO, Yoshiaki MIWA
    1987 Volume 27 Issue 9 Pages 831-840
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The purposes of this in vitro study were twofold: 1) to estimate the activities of peripheral blood lymphocytes (PBLs) obtained from patients with recurrent or residual malignant gliomas and treated with recombinant interleukin 2 (HL-2), and 2) to investigate a simpler method by which rIL-2 can be used to activate enough killer cells having sufficient cytotoxicity for adoptive immunotherapy (AIT).
    PBLs were obtained from eight patients with recurrent or residual intracranial malignant gliomas (5 glioblastomas and 3 anaplastic astrocytomas). The cells were suspended in complete medium (CM) consisting of RPMI 1640 containing 10% heat-inactivated human serum, 100 IU/ml penicillin G, and 50μg/ml streptomycin. The cell suspensions were divided into the following seven groups and cultured for 10 days. Group I: Culture in CM only; Group II: Culture in CM which, for the first 48 hours, contained 0.2% phytohemagglutinin (PHA) ; Group III: Culture in CM containing 0.2% PHA; Group IV: Culture in CM containing 0.4 U/ml rIL-2; Group V: Culture in CM containing 0.8 U/ml rIL-2; Group VI: Culture in CM containing 2.0 U/ml rIL-2; Group VII: Culture in CM containing 0.4 U/ml rIL-2 which, for the first 48 hours, contained 0.2% PHA. Cell numbers, morphological changes, various lymphocyte subsets, and natural killer (NK) activity were analyzed.
    The cells cultured with rIL-2 (Groups IV, V, and VI) exhibited prominent NK activity, but after 10 days the cell numbers were inadequate for AIT. Treatment with rIL-2 containing 0.2% PHA for the first 48 hours (Group VII) resulted in slightly weaker NK activity than occurred in Groups IV, V, and VI, but cell proliferation was extensive. The cells in Group VII were estimated to be suitable for anti-tumor AIT.
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  • Yasuyuki SATO, Yoshimi MATSUOKA, Toru NAKAMURA
    1987 Volume 27 Issue 9 Pages 841-847
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors reviewed 24 cases of primary intracranial germinomas treated at Osaka City University Hospital between November, 1972 and June, 1984. The group comprised 17 males and seven females ranging in age from 8 to 45 years (mean, 19 years). Fourteen of the germinomas were in the pineal region, nine were in the suprasellar region, and one was in the fourth ventricle. Fourteen of the tumors were histologically verified prior to treatment. Radiation therapy was administered in all cases. Only two tumors were surgically removed. Seven patients have died; the overall 5-year survival rate was 60%. In five of the 15 cases (33%) in which only the brain was irradiated initially, spinal metastases developed during the post-irradiation period. None of the eight patients who underwent initial irradiation of the entire neuraxis developed spinal metastasis. The authors conclude that irradiation of the entire neuraxis is mandatory in patients with germinoma, in the interest of preventing dissemination to the spinal cord. In two instances metastasis to the peritoneal cavity occurred through the ventriculo-peritoneal shunt, and in both cases it was the cause of death. To prevent such fatal metastasis, the shunt system must be ligated or removed when the primary intracranial tumor shrinks or disappears following radiation therapy.
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  • Evaluation of its Pathogenesis by Magnetic Resonance Imaging, and Surgical Treatment
    Norihiko TAMAKI, Noriaki KOJIMA, Takayuki SHIRAKUNI, Satoshi MATSUMOTO
    1987 Volume 27 Issue 9 Pages 848-855
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The clinical findings and results of surgery in 33 cases of Chiari type I and II malformations were reviewed. Twenty patients with Chiari malformations were examined by magnetic resonance imaging (MRI), which furnished valuable information concerning the pathogenesis of and surgery for these malformations. MRI provided precise delineation of 1) the extent of herniation of the cerebellar tonsils and inferior vermis; 2) the degree of compression of the upper cervical cord and medulla; 3) the extent of cervicomedullary kinking; 4) the condition of the spinal cord, particularly whether or not a syringohydromyelia was present; 5) the nature of the communication between the fourth ventricle and syringohydromyelia or subarachnoid space; 6) the association of craniocervical anomalies and other brain malformations; and 7) the overall ventricular size. MRI also revealed the position, extent, and inner architecture of the syringohydromyelia, which could be classified as one of two types: smooth and cylindrical without septa, or a fusiform, expanded cavity having transverse septae or narrow, tubular interconnecting segments. For the latter type, syringostomy appeared not to be indicated.
    On the basis of the surgical results and the findings obtained by MRI, surgical bony and dural decompression in the region of the foramen magnum and upper cervical canal appear to be sufficient therapy in cases of Chiari malformations without syringohydromyelia. For those accompanied by syringohydromyelia, separation and wide opening of the fourth ventricle in addition to bony and dural decompression may be desirable. This procedure establishes a free flow of cerebrospinal fluid from the fourth ventricle and basal cistern to the spinal subarachnoid space.
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  • Age at the Time of Surgery as a Factor in the Postoperative Clinical Course
    Yoshiharu MATSUSHIMA, Yoshio TAKASATO, Takekane YAMAGUCHI, Hitoshi TAB ...
    1987 Volume 27 Issue 9 Pages 856-860
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors evaluated 25 pediatric patients with moyamoya disease who underwent encephaloduro-arterio-synangiosis (EDAS) for cerebrovascular oligemia. All patients' blood gases were monitored during surgery. Five of the 25 patients developed complications after EDAS. A 19month-old girl had a left-sided hemiconvulsion 14 days postoperatively, followed by left hemiparesis. A 21-month-old girl awoke from anesthesia without apparent problems but later, after persistent crying, developed left hemiparesis. A 27-month-old boy had left hemiparesis preoperatively, which diminished after EDAS. On day 13 after EDAS, an enhanced area in the right frontotemporal cortex was found by computed tomography; 3 months later, the site showed atrophy. A 16year-old girl exhibited slight dysphasia and alexia 4 days after EDAS, and a 17-year-old girl had slight dysarthria for 5 days after EDAS. Patients with and without postoperative problems were compared in terms of steroid usage, preoperative laboratory findings, blood pressure, and intraoperative blood gas profile. There were no significant differences between the two groups. The patients were then assigned to three groups according to age at operation. Patients in Group A were less than 6 years of age, those in Group B 6 to 15 years old, and those in Group C over 15 years of age. Postoperative problems occurred in 3/7 in Group A and 2/3 of Group C, whereas none of the 15 patients in Group B had complications after surgery. The authors recommend that patients with moyamoya disease under age 3 and over age 15 be managed very carefully and that their families be educated regarding the possible sequelae of surgery.
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  • Report of Three Cases
    Yasumichi TANAKA, Rihei TAKEDA, Jyoji NAKAGAWARA, Takehiko SASAKI, Tos ...
    1987 Volume 27 Issue 9 Pages 861-866
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Three patients with proximal vertebral artery occlusive disease were treated by extracranial surgical reconstruction. Two patients (Cases 1 and 2) had symptoms of vertebrobasilar insufficiency and one (Case 3) had severe headache. Angiography demonstrated bilateral vertebral stenosis in Case 1, right stenosis and left occlusion in Case 2, and right hypoplasia and left stenosis in Case 3. In Case 2, the left vertebral artery was occluded at its origin and was reconstituted via the thyreocervical trunk at the C3 level. Right carotid angiography during left carotid artery compression failed to demonstrate blood flow through the left carotid artery in Cases 1 and 3. The posterior communicating arteries were hypoplastic or absent bilaterally and right vertebral angiography did not demonstrate blood flow in the left vertebral artery in Case 3. Three types of surgical procedures were undertaken: left proximal vertebral artery to common carotid artery end-to-side anastomosis in Case 1; left external carotid artery to midcervical vertebral artery end-to-side anastomosis in Case 2; and transposition of the left vertebral artery to the distal subclavian artery with end-to-side anastomosis in Case 3. The authors successfully performed surgical reconstruction of the proximal vertebral artery by means of internal carotid artery shunting in Case 1 and external shunting between the carotid and vertebral arteries in Case 3, to avoid the danger of carotid and vertebral artery cross-clamping during the anastomoses.
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  • Long-term Follow-up
    Shingo KAWAMURA, Nobuyuki YASUI, Akifumi SUZUKI, Hidenori OHTA, Hiroya ...
    1987 Volume 27 Issue 9 Pages 867-876
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Extracranial-intracranial (EC/IC) bypass as surgical treatment for ischemic cerebrovascular diseases has been performed since 1973. The reliability of the authors' mehtods of selecting candidates for EC/IC bypass were evaluated through long-term follow-up of 14 patients (mean age, 54 years) who underwent bypass surgery for 50% to 95% stenosis in the intracranial portion of the internal carotid artery (ICA) and/or the middle cerebral artery (M1 or M2) . The interval from the last stroke to bypass surgery ranged from 22 hours to 6 months (mean, 42 days). Computed tomography, cerebral angiography, cerebral blood flow (CBF), and somatosensory evoked potentials (SEP) were evaluated preoperatively. Seven patients were considered candidates for EC/IC bypass because they had decreased hemispheric or regional CBF. In 3 of these 7, improvement or worsening were shown by electroencephalography (EEG) and measurement of SEP during druginduced hypertension or hypotension (drug-induced EEG and SEP test: DEE test). In the other 7 patients bypass surgery was felt to be indicated on the basis of the angiographic findings and the preoperative clinical course. The bypass was patent in 12 patients and not patent in 2. The term of follow-up averaged 4.4 years. One patient experienced a transient ischemic attack in the ICA on the affected side, and another suffered an additional reversible ischemic neurological deficit (RIND) in the vertebrobasilar (VB) system; the latter patient died of a stroke in the VB system 1.5 years after the RIND. Nine of the 14 patients were leading an independent, useful life at the last follow-up visit, and 5 had died, 1 of a stroke and 1 of purulent meningitis. In 3 cases the cause of death was unknown. EC/IC bypass appears somewhat effective in preventing cerebral ischemia, although the mortality rate in this study was rather high (42%). Considering the results of the Cooperative EC/ IC Bypass Study, selecting candidates on the basis of clinical symptoms and angiographic evidence of steno-occlusion of the main trunk of the carotid system is not satisfactory. The patients most likely to benefit from EC/IC bypass will be those in whom the procedure improves CBF and cerebral metabolism. Measurement of CBF and cerebral metabolism, as well as DEE testing, are indispensable in determining whether or not EC/IC bypass is indicated.
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  • Case Report
    Mitsuru NUNOMURA, Toyohiko Isu, Tomohiro IMAI, Hiroshi ABE, Munetaka Y ...
    1987 Volume 27 Issue 9 Pages 877-881
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 64-year-old female was admitted with chief complaints of paroxysmal hemifacial spasm and low-tone noise, which she experienced in the ipsilateral ear synchronously with the spasm. Impedance audiometry performed during spasms showed reduction or disappearance of the acoustic reflex (AR) and elevation of the AR threshold on the affected side. These phenomena could also be elicited by voluntary contraction of the affected side of the face. The patient underwent microvascular decompression of the facial nerve, which abolished both the facial spasm and the low-tone noise. The abnormal AR patterns revealed the spasm as well as synkinesis of the stapedius muscle. The abnormal contraction of the stapedius muscle is believed to have generated the low-tone noise.
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  • Case Report
    Hiroyuki KINOUCHI, Motonobu KAMEYAMA, Satoru FUJIWARA, Jiro SUZUKI
    1987 Volume 27 Issue 9 Pages 882-886
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The authors report a rare case of membranous obstruction of Magendie's foramen with internal hydrocephalus. A 30-year-old male was referred from another hospital because of dilatation of the entire ventricular system, as evidenced by computed tomography (CT). The patient had suffered headache, dizziness, nausea, and vomiting for several years. On admission, bilateral papilledema was prominent. A ventriculoperitoneal shunt was emplaced on the next day. Postoperative CT showed that the lateral and third ventricles had decreased in size, while the fourth ventricle was still enlarged. The patient rejected further surgery and was discharged. Three months later the symptoms reappeared. The patient underwent a suboccipital craniectomy, which revealed a semi-translucent membrane obstructing Magendie's foramen. The membrane was resected, and histopathological examination disclosed that it was composed of loose connective tissue, which was partially cellular and contained hemosiderin deposits, covered by a layer of flattened cells. After surgery, all symptoms disappeared and the patient was discharged. At 6 months after discharge, the fourth ventricle had decreased in size.
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  • Case Report
    Yasuhiro KOJIMA, Akihito SAITO, Ilu KIM
    1987 Volume 27 Issue 9 Pages 887-891
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 48-year-old female developed multiple cerebral aneurysms in association with atypical moyamoya disease. At the age of 43, the basilar-superior cerebellar artery junction aneurysm was clipped successfully. Four years later a new aneurysm developed at the interpeduncular segment of the left posterior cerebral artery. It enlarged, ruptured, and was clipped successfully. Operative indication for cerebral aneurysms in the presence of cerebrovascular moyamoya disease based on radiological and operative findings, as well as their mechanism of development, are discussed.
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  • Case Report
    Kazuko KAMIYA, Tetsuji INAGAWA, Ren NAGASAKO
    1987 Volume 27 Issue 9 Pages 892-898
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 43-year-old male developed headache, restlessness, urinary incontinence, and right hemiparesis 15 months after partial gastrectomy for adenocarcinoma of the stomach. Computed tomography (CT) scan on admission showed a crescent-shaped low-density area in the right frontotemporal region and a midline shift to the left. Under the diagnosis of chronic subdural hematoma, burr hole irrigation was performed. Following the procedure, the patient became lucid and the hemiparesis disappeared. However, 7 days later the disturbance of consciousness and right hemiparesis recurred. CT scan revealed re-retention, and irrigation was repeated. Nests of adenocarcinoma cells were found in the xanthochromic fluid obtained during the procedure and the diagnosis was subdural hematoma due to dural metastasis. The patient died 8 days later. The autopsy revealed dural metastatic tumor and a subdural hematoma over the right hemisphere. Histological examination disclosed intravascular tumor cells in the inner and outer layers of the dura, extending to the hematoma cavity. Twenty-eight similar cases were reported in the literature. In the present case, there was probably sudden, rapid growth and sloughing of tumor cells at the metastatic focus in the dura at the end stage of cancer. It is presumed that the hematoma developed secondarily to a bleeding tendency due to bone marrow metastasis.
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  • Case Report
    Seiya KATO, Akira OGAWA, Tetsuo KOGURE, Tokuo WADA, Tsuneo NAMIKI, Jir ...
    1987 Volume 27 Issue 9 Pages 899-903
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 23-year-old woman was admitted complaining of a lump in the middle occipital region. She had noticed the lump 8 months previously, and it had rapidly increased in size. Physical and neurological examinations were otherwise normal. Plain skull X-rays showed an osteolytic area having a reticular pattern in the occipital bone. Selective external carotid angiography demonstrated feeding arteries from the middle meningeal and occipital arteries. Following its chemical embolization with estrogen, the tumor was totally removed. Histologic study revealed the formation of vascular channels characteristic of sarcoma; the diagnosis was angiosarcoma. The postoperative course was uneventful. However, about 1 year postoperatively the patient developed right hemiparesis and left oculomotor palsy, and she died 6 months later because of tumor infiltration into the midbrain.
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  • Autopsy Report and Review of the Literature
    Masafumi YAMASHITA, Masayuki OOKAWA, Takeo FUKUSHIMA, Masamichi TOMONA ...
    1987 Volume 27 Issue 9 Pages 904-908
    Published: 1987
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 42-year-old man was found in a comatose state, and computed tomography scans disclosed a massive intraventricular hemorrhage. Continuous ventricular drainage was carried out as an emergency measure. However, the patient died about 22 hours after the onset. At autopsy, a tangle of vessels in the glomus chorioideum and a dilated, tortuous vein on the surface of the choroid plexus were found in the left lateral ventricle. Microscopic examination of the glomus chorioideum revealed an angioma composed of arteries and veins of varying size and thickness on both sides.
    Choroid plexus angioma is uncommon and most often occurs in children and adolescents. Bilateral lesions have been reported in only five cases. Because of the potential for intraventricular hemorrhage and the tendency for recurrence, surgical removal of angiomas is recommended.
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