Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 28, Issue 1
Displaying 1-15 of 15 articles from this issue
  • Hirofumi NAKAI, Hiroshi MATSUDA, Mirko DIKSIC, Eiichi TAKARA, Ernst ME ...
    1988 Volume 28 Issue 1 Pages 1-10
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    External coincidence counting was used for simultaneous estimation, in the 2-fluoro-2-deoxy-D-glucose (2-FDG) model, of the lumped and apparent rate constants (i.e., for a white/gray matter mixture). Eleven normal cats were studied. During a programmed 2-[18F]FDG infusion that kept a constant arterial plasma concentration of 2-[18F]FDG [Cp*(t)] for 45 minutes, the time course of cerebral tissue activity [Ci*(t)] was monitored by external coincidence counting. The apparent rate constants were estimated from Ci*(t) and Cp*(t) by a nonlinear least squares optimization method. The lumped constant (LC) estimate was obtained by fitting the ratio of extraction fractions of glucose and 2-[18F] FDG by use of a nonweighted, nonlinear least squares fitting method.
    The estimated apparent rate constants, k1*, k2*, k3*, and the LC were 0.074 ± 0.005 min-1, 0.129 ± 0.007 min-1, 0.021 ± 0.001 min-1, and 0.395 ± 0.016, respectively (mean ± SEM). The focal cerebral metabolic rate for glucose detected in the brain was 28.7 ± 1.5 μmol/100 gm/min (mean ± SEM). The influence of arterial plasma glucose (CP), the LC, and the metabolic index [MI = k1*k3*/(k2* + k3*)] on the stability of the cerebral glucose utilization rate was examined. Negative correlations between CP and LC, and CP and MI were observed. However, there was a positive correlation between the LC and the MI. The method applied in this study should be very useful in the detection of changes in the kinetics of 2-[18F]FDG under pathophysiological conditions in animals. Because of the short half-life of this isotope, repeated measurements are possible.
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  • —Intra-animal Comparison before and after Middle Cerebral Artery Occlusion—
    Hirofumi NAKAI, Hiroshi MATSUDA, Eiichi TAKARA, Mirko DIKSIC, Yasokazu ...
    1988 Volume 28 Issue 1 Pages 11-17
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Changes in the lumped and transfer rate constants for 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG) were studied before and 16 hours after bilateral middle cerebral artery (MCA) occlusion in four cats. The time course of cerebral tissue radioactivity [Ci*(t)] in a volume of brain was monitored by external coincidence counting during a programmed infusion of 2-[18F]FDG. The arterial plasma concentration [Cp*(t)] of the tracer was kept constant during the first 45 minutes. The apparent rate constants were estimated from the Ci*(t) and CPp*(t) by a weighted, nonlinear least squares fitting method. The lumped constant (LC) was estimated from the fit of the ratio of extraction fractions of glucose and 2-[18F]FDG by a nonweighted, nonlinear least squares fitting. At 16 hours after MCA occlusion, the k1* was 39% lower, the k2* 19% lower, the k3* 27% lower, and the LC 74% higher relative to the preocclusion values. A 65% reduction in glucose utilization was also observed.
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  • Minoru MAEDA, Makoto MIYAOKA, Shozo ISHII
    1988 Volume 28 Issue 1 Pages 18-26
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The autoradiographic [14C]deoxyglucose method for quantitative determination of local cerebral glucose utilization (LCGU) was used to study the compensatory process following hemilabyrinthectomy in adult cats. In the critical stage when the cats were uncompensated, LCGU in the deafferented vestibular nuclei was well below that of the intact side. Increased LCGU was seen in contralateral nucleus reticularis parvocellularis, the bilateral nuclei pontis, and the ipsilateral abducens nucleus and its ventral parts. Activity levels in the inferior olive were essentially unchanged. In the cerebellum, the posterior vermis and the nodulofloccular lobe were very active. LCGU in the cerebellar nuclei was not noticeably changed. In the compensatory stage, the rate of LCGU in the deafferented vestibular nuclei had increased to that of the intact side. The increased LCGU was bilaterally evident in the nuclei reticularis parvocellularis, gigantocellularis, and lateralis, and superior colliculus. The posterior vermis, nodulus, and cerebellar nuclei were active.
    Destruction of the vermis, fastigial nuclei, and surrounding white matter produced marked imbalance during walking and a tremor of the head during feeding. These signs subsided very gradually. Interruption of the transreticular vestibular crossed connection produced severe motor disturbances on standing, walking, and feeding, and normal function was not restored. These findings suggest that vestibular compensation results from the combined activity of many brainstem and cerebellar structures, where intervestibular crossed pathways are considered an important factor in compensation.
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  • Nobutaka KAWAHARA, Hiroshi TANAKA, Tetsuya SAKAMOTO, Masaru SASAKI, To ...
    1988 Volume 28 Issue 1 Pages 27-33
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    We have developed two monitoring systems, which we have applied to 78 critically ill patients in our neurosurgical intensive care unit. The first, a multidimensional neurological monitoring system employing a signal processor, serially and automatically monitors body temperature, auditory brainstem response (ABR), electroencephalographic power spectrum, intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The second, which we have termed the cerebrosystemic hemodynamic profile, measures ICP, CPP, and ten other cardiovascular parameters. Using the multidimensional neurological monitoring system, we observed progressive loss of ABR waves in a case of brain death, transient prolongation of the wave V following a steep increase in ICP in a patient with a reruptured aneurysm, and gradual prolongation of ABR waves with an increase in ICP in a patient with transtentorial herniation.
    This system comprehensively monitors supra- and infratentorial conditions and provides, in real time, objective information concerning pathophysiological processes within the cranium. The cerebrosystemic hemodynamic profile clearly delineates the optimal cardiovascular conditions for control of increased ICP, especially in the context of barbiturate therapy and severe fluid imbalance. Used in combination, these two monitoring systems may provide valuable guidance for treatment by virtue of their ability to accurately evaluate the pathophysiological processes that occur following severe brain damage.
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  • Kotoo MEGURO, Charles H. TATOR
    1988 Volume 28 Issue 1 Pages 34-41
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    We conducted a retrospective study in which we related the outcome of spinal cord injury to the presence of serious accompanying injuries. From 1974 through 1979, 144 patients with spinal cord trauma were admitted to the Acute Spinal Cord Injury Unit of Sunnybrook Medical Centre, 27 (19%) of whom had other major injuries of Grade 3 or higher according to the Abbreviated Injury Scale. These additional injuries included, among others, cerebral contusion, hemothorax, major intraabdominal bleeding, and femoral fracture. These 27 patients (Group 1) were compared to the 117 patients (Group 2) who had only spinal cord injuries.
    The two groups were similar in age and sex distribution. The incidence of hypotension on admission was higher in Group 1 (59%) than in Group 2 (7%) (p<0.001). In Group 1, 74% had either complete cord injury or incomplete injury with severe paresis, whereas only 58% of Group 2 had injuries of this magnitude. This difference was even more pronounced at discharge, when 78% of Group 1 were in the complete or severe injury categories, as compared with 52% in Group 2 (p<0.02). The Sunnybrook Cord Injury Recovery Index from admission to discharge was 1.9% in Group 1 and 19.8% in Group 2 (p<0.01), indicating that Group 2 patients had much better recovery. Mortality during hospitalization was 19% in Group 1 and 4% in Group 2 (p<0.01).
    Our results indicate that patients with spinal cord injury accompanied by other major injuries had more severe initial neurological deficits, poorer neurological recovery, and a higher mortality rate than those with cord injury alone. The higher incidence of hypotension in Group 1 may have played a significant role in the less favorable neurological outcome.
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  • —Fine Structural Studies in Vivo and in Vitro—
    Hiroshi KAMITANI, Hideaki MASUZAWA, Jinichi SATO, Itaru KANAZAWA, Mich ...
    1988 Volume 28 Issue 1 Pages 42-48
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The histogenesis of intracranial hemangiopericytoma has been the subject of considerable debate. Using tumor tissue taken at surgery from a 35-year-old male patient, we studied the fine structure of hemangiopericytoma. Both in vivo and in vitro, electron microscopy has shown characteristic features of the pericytes of Zimmermann, which are quite different from those of meningioma. Among the most outstanding and consistent features of the hemangiopericytoma that we studied were cytoplasmic triangular or rod-shaped dense bodies, an intercellular basement membrane, and electron-dense materials. These findings suggest leiomyoblastic differentiation of hemangiopericytoma cells and support the proposition that pericytes are precursors of smooth muscle cells.
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  • —Surgical Indications and Approaches—
    Toshio MATSUSHIMA, Masashi FUKUI, Katsutoshi KITAMURA, Kiyotaka FUJII, ...
    1988 Volume 28 Issue 1 Pages 49-56
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    We present 18 cases of arteriovenous malformation (AVM) in the basal ganglia. The results of seven cases of definitive surgery are reported in detail and are compared with those of 10 nonsurgical and one nondefinitive surgical cases. Among those available for follow-up, three of the seven nonsurgical and one nondefinitive surgical patients died of rebleeding. On the other hand, all seven patients who underwent definitive surgery are doing well, and their signs and symptoms were not aggravated by surgery. AVMs in the basal ganglia are classified into four types according to site: lateral, medial, mixed, and anteroinferior in relation to the internal capsule. The nidus was totally removed in two medial and four lateral cases. Eight of the 11 nonsurgical and nondefinitive surgical cases were of the mixed type and most had large nidi, and those that were totally removed were small or medium-sized. The surgical accessibility of AVMs in the basal ganglia and the current surgical approaches are discussed in terms of their locations and sizes.
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  • —Report of Two Cases—
    Hirotaka SUGIYAMA, Haruyuki KANAYA, Michihiro KIRIKAE, Haruhiko HASEGA ...
    1988 Volume 28 Issue 1 Pages 57-65
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Regional cerebral blood flow (rCBF) in two patients with middle cerebral artery stem occlusion (one characterized by persistent occlusion and the other by spontaneous recanalization) was measured repeatedly by dynamic single-photon emission computed tomography and 133Xe gas steady-state inhalation. With the exception of complete recanalization in one patient, the pathophysiology in the two cases appeared essentially the same. These cases are described and the problems of measuring and interpreting rCBF in cerebral infarction are addressed. The concept of a “homeostatic mechanism of cerebral energy supply” is also discussed.
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  • —Successful Removal by Transcallosal Approach: Case Report—
    Kenji KIKUCHI, Kazuo WATANABE, Masayoshi KOWADA
    1988 Volume 28 Issue 1 Pages 66-69
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    We treated a patient with an arteriovenous malformation within the third ventricle. The vascular malformation was fed by the right medial posterior choroidal, posterior thalamoperforating, and thalamogeniculate arteries and drained into the vein of Galen. The lesion was approached via the interhemispheric transcallosal route and totally extirpated. The literature concerning arteriovenous malformations involving the ventricular system is reviewed in the context of primary intraventricular hemorrhage, and surgical approaches to the third ventricle are discussed.
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  • —Case Report—
    Yasuhiko TOKURIKI, Junkoh YAMASHITA, Haruhiko KIKUCHI, Reinin ASATO, H ...
    1988 Volume 28 Issue 1 Pages 70-73
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A 43-year-old male presented with a low-density mass on computed tomographic scans; the mass did not exhibit contrast enhancement. The tumor was subtotally removed, and the intraoperative diagnosis was trochlear nerve neurinoma. Six other cases have been reported. The characteristic symptoms and signs of this tumor appear to be unusual facial sensations and signs of brain stem compression rather than trochlear nerve palsy.
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  • —Report of Two Cases—
    Hiroshi HASEGAWA, Shoji BITOH, Amami KATOH, Keizou YAMAMOTO, Yasushi K ...
    1988 Volume 28 Issue 1 Pages 74-77
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    We report two cases of malignant scalp tumor in young individuals. A 9-year-old girl with recurrent occipital dermatofibrosarcoma protuberans underwent radical resection of the tumor. The extent of the tumor was determined by means of serial frozen sections, and the scalp defect was immediately reconstructed by moving of the skin flaps. In the second case, a 24-year-old male developed squamous cell carcinoma from a long-standing scar in the right retroauricular region. The lesion was radically removed, along with the underlying bone. Descriptions of these two cases and a review of the literature are presented.
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  • —Case Report—
    Tohru HORIKOSHI, Shigeru MITSUKA, Ryoichi KIMURA, Akira FUKAMACHI, Hid ...
    1988 Volume 28 Issue 1 Pages 78-82
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    We encountered a very rare case of renal cell carcinoma metastatic to the pituitary gland. The patient presented with complaints of headaches and visual disturbance. Physical examination disclosed bitemporal hemianopsia and panhypopituitarism. Radiological findings suggested a pituitary tumor, and surgery was performed via the subfrontal approach. Eosinophilic cells were present in the histological tumor specimens, which led us to the incorrect diagnosis of pituitary adenoma. After dural metastases developed, the primary renal tumor was confirmed. The intracranial metastatic lesions were removed and the primary kidney lesion was embolized.
    Four other reported cases of renal cell carcinoma metastatic to the sellar region are reviewed. In one of the cases, as in ours, an erroneous initial diagnosis of pituitary adenoma was made.
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  • —Case Report—
    Akira UCHINO, Masayuki MATSUNAGA, Takaharu NAKAMURA, Kanji EGASHIRA, M ...
    1988 Volume 28 Issue 1 Pages 83-85
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    An elderly woman presented with a huge falx meningioma partially supplied by the posterior meningeal branch of the ascending pharyngeal artery, which arose from the cervical portion of the internal carotid artery. The findings in this case suggested that opacification of the ascending pharyngeal artery is important in making the diagnosis, even when supratentorial meningeal abnormalities are encountered.
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  • —Case Report—
    Kazuya NAGATA, Norihiko BASUGI, Tomio SASAKI, Keisuke HASHIMOTO, Shiny ...
    1988 Volume 28 Issue 1 Pages 86-90
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    An intraventricular meningioma of the fourth ventricle was carefully removed by means of a contacttype Nd-YAG laser, without neurological sequelae. A review of the literature revealed the extreme rarity of this type of tumor. The clinical features and surgical techniques are discussed.
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  • —Case Report—
    Tetsuji ORITA, Kunihiko HARADA, Katsuhiro YAMASHITA, Tomomi OKAMURA, H ...
    1988 Volume 28 Issue 1 Pages 91-94
    Published: 1988
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    An elderly male presented with the rarity of a chronic subdural hematoma accompanied by an extracapsular hemorrhage. A computed tomographic finding peculiar to this condition is the presence of a two-layer structure consisting of an inner high-density area and an outer low-density area. This feature and the possible mechanism of extracapsular hemorrhage are discussed.
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