Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 28, Issue 5
Displaying 1-15 of 15 articles from this issue
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  • Invasion Test
    A New Technique for Estimating the Invasive Potential of Brain Tumors using Spheroids —Experimental Study—
    Teizo OKUMURA, Junkoh YAMASHITA, Yasuhiko TOKURIKI, Haruhiko KIKUCHI, ...
    1988 Volume 28 Issue 5 Pages 429-435
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.429
    JOURNAL FREE ACCESS
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    In cases of malignant brain tumors, the histological diagnosis may be of prognostic value, but the clinical course is sometimes unpredictable. Malignant brain tumors are destructive mainly through their invasive tendency and the pressure they exert as they grow. It is difficult to evaluate a tumor's invasive capacity in a two-dimensional culture system such as monolayer culture. Although threedimensional culture systems have been used for testing the invasive patterns of some malignant tumors, little is known about the invasive mechanisms of neurogenic tumors. Using a modified “invasion test, ” the authors examined the invasive characteristics of four neurogenic cell lines (T1, 9L, T1A, and T1B). Multicellular tumor spheroids (MTS) were produced from tumor cell colonies consisting of 20 to 30 cells by shake culture. With this method, MTS of constant shape and size were obtainable. Pulsating heart tissue obtained from 9-day-old chick embryos was minced and also shake cultured. The MTS and cultured embryonic chick heart (ECH) fragments were placed together in semisolid agar medium for 2 hours, then cultured in a gyratory shaker for 7 days. Tumor invasiveness was examined by hematoxylin-eosin staining and anti-ECH antibody immunostaining. All cell lines examined were able to form MTS and all proved highly invasive.
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  • A New, in Vitro Technique for Estimating the Invasive Potential of Brain Tumors
    Teizo OKUMURA, Junkoh YAMASHITA, Yasuhiko TOKURIKI, Haruhiko KIKUCHI, ...
    1988 Volume 28 Issue 5 Pages 436-441
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.436
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    The authors previously reported a new, in vitro technique for determining the invasiveness of four rat neurogenic tumor cell lines. Now this method has been modified and applied to the analysis of the invasiveness of human brain tumors.
    Eighty-seven tumors, including 61 gliomas, six metastatic brain tumors, 10 meningiomas, four neurinomas, one melanoma, one hemangioblastoma, two craniopharyngiomas, one chemodectoma, and one pituitary adenoma, were studied. Since gliomas were of primary interest, their invasiveness was studied more extensively. Fresh tumor specimens obtained during craniotomy were immediately minced in Dulbecco's modified Eagles's minimum essential medium containing 20% fetal calf serum to obtain fragments of 300-500 μm in size. These tumor fragments and precultured embryonic chick heart fragments were placed together on semisolid agar (0.35%) for 2 hours at 37°C. These fused tissues were then cultured in a gyratory shaker at 100 rpm for 7 days. From hematoxylin-eosin stained and immunostained serial sections, the degree of invasiveness was determined according to the “classification of invasiveness.” Although there were discrepancies between the histologic findings and the degree of invasiveness in 22.5% of high-grade astrocytomas, conventional histological diagnosis was well correlated with invasiveness in almost all low-grade astrocytomas. This in vitro technique appears to be a simple and useful means of evaluating the invasive potential of brain tumors.
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  • Immunohistochemical and Electron Microscopic Study of Nonfunctioning Pituitary Adenomas
    With Special Reference to Gonadotroph Adenomas
    Hiromichi MIYAZAKI, Shigeo TOYA, Mitsuhiro OTANI, Chieki WADA, Toru KA ...
    1988 Volume 28 Issue 5 Pages 442-447
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.442
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    Immunohistochemical techniques and electron microscopy were employed in a study of nine surgical patients with nonfunctioning pituitary adenomas and no clinical or biochemical evidence of increased hormone secretion. Six of the patients were found to have gonadotroph adenomas, which exhibited extensive immunostaining for gonadotropins, and the remaining three appeared to have null cell adenomas, which showed no reactivity for any pituitary hormone. Clinically, it was difficult to distinguish these two groups of patients. Gonadotroph adenomas are likely to have low secretory activity, resulting in normal or slightly high serum gonadotropin levels. In addition, some common histopathological features were observed in the two groups: a predominantly papillary, sinusoidal pattern; rather poorly developed cell organelles, with the exception of an abundance of mitochondria; and small, round secretory granules dispersed throughout the cytoplasm. It is possible that null cell adenoma produces so little gonadotropin that it is not detectable by immunohistochemistry. In this study, two thirds of the nonfunctioning adenomas were, in fact, gonadotroph adenomas. The authors speculate that there is a common cytogenesis of gonadotroph adenomas and some, if not all, null cell adenomas.
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  • Changes in the Levels and Turnover Rate of Acetylcholine in the Rat Brain following Experimental Cerebral Concussion
    Takamitsu YAMAMOTO, Yoichi KATAYAMA, Sadahiro MAEJIMA, Takashi TSUBOKA ...
    1988 Volume 28 Issue 5 Pages 448-454
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.448
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    The importance of cholinergic transmission in the mechanisms of awakening and orientation is well known. There is general agreement that the postural atonia and coma that are observed in the postconcussion period can be induced by microinjection of cholinergic agents into the pontine tegmentum. Also, the fact that glucose utilization increases in the pontine tegmentum following cerebral concussion suggests that there is an important relationship between cerebral concussion and cholinergic activation in the central nervous system. In this study the levels and turnover rate of acetylcholine (ACh) were measured in rats at 12 minutes and 4 hours following experimental head injury. The measurements, which were compared with those in control rats, were made in the basal forebrain, thalamus, hypothalamus, frontal cortex, amygdala, hippocampus, and pontine tegmenturn by the fluid percussion method. Injured rats exhibited nonfatal, reversible neurological suppression classified as severe concussion. During the period of concussive neurological suppression, ACh levels significantly increased in the hippocampus and pontine tegmentum, but the turnover rate of ACh was accelerated only in the basal forebrain and pontine tegmentum. At 4 hours post-injury, there was no significant change in the turnover rate of ACh in any of the seven sites studied, nor was the averaged ACh turnover rate in these seven areas. These results suggest that increased cholinergic activity in the basal forebrain and pontine tegmenturn following cerebral concussion may be one cause of concussive neurological suppression.
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  • Comprehensive Display of Intracranial Pressure-related Data with a New Minicomputer
    Keita HARA, Susumu NAKATANI, Kohji OZAKI, Takuya IKEDA, Heitaro MOGAMI
    1988 Volume 28 Issue 5 Pages 455-459
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.455
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    Measurement and analysis of intracranial pressure (ICP) are crucial to neurosurgery. It has been asserted that analogue data printouts of ICP do not provide enough information on the actual condition of the patient and make further data processing impossible. Most institutions, however, rely on this simple technique to classify patients, evaluate treatment effectiveness, and even to mathematically and statistically analyze the (possibly inaccurate and unreliable) data obtained. Although several microcomputer systems for ICP data processing have been developed recently, they handle only a fraction of ICP dynamics. The Data General DG 30 Minicomputer, a total system that includes comprehensive color graphic display and digital printing of ICP-related data, was developed with new techniques that improve algorithmic sampling and analysis. Included in the data display are vital signs, trend analysis and histographic array of mean ICP, mean blood pressure, and cerebral perfusion pressure, the ICP power spectrum of the B wave, intracranial compliance, and the A wave. This comprehensive presentation of ICP-related data provides a basis for more objective evaluation of treatment modalities and may contribute substantially to studies of the value of ICP monitoring.
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  • Restoration of Neuronal Activity after Severe Global Ischemia
    Effects of Mannitol and Glycerol
    Shoji MABUCHI, Hiroshi ABE, Yoku NAKAGAWA
    1988 Volume 28 Issue 5 Pages 460-466
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.460
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    The reversibility of neuronal suppression was evaluated in a canine model subjected to global ischemia for 5, 15, or 30 minutes via temporary occlusion of the innominate and left subclavian arteries plus hypotension induced by withdrawal of blood. Systemic blood pressure was decreased until the electroencephalograph became flat and somatosensory evoked potentials (SEP) were undetectable. Recirculation was instituted by release of the occluded arteries and replacement of systemic blood. Recovery of neuronal function following recirculation was assessed in terms of recovery of the primary SEP amplitude (V1) and the cerebral metabolic rate of oxygen (CMRO2), which was calculated by the difference in oxygen concentrations in blood from the femoral artery and the superior sagittal sinus. Also, the effects of mannitol (2 g/kg) and glycerol (1 g/kg) on recovery of neuronal activity were investigated in the 15-minute ischemia model. The agents were intravenously administered prior to production of ischemia or within 30 minutes of recirculation. SEP (V1) recovered well in the 5-minute ischemia group, but in the 15 and 30-minute groups remained at less than 52% of the control values for 6 hours following recirculation. CMRO2 exceeded the control values from 1 to 6 hours following recirculation in the 5-minute ischemia group, which suggested enhancement of metabolism, but in the 15- and 30-minute groups remained lower than in the controls for 6 hours. In animals given mannitol prior to ischemia, SEP (V1) and CMRO2 recovered well; at 4 hours after recirculation, recovery in this group was significantly better than in the other groups. Neither animals given mannitol just after recirculation nor those given glycerol before or after ischemia recovered during 4 hours of observation. The results strongly suggest that, following ischemia of 5 to 15 minutes' duration, brain electrical activity may recover completely and that administration of mannitol prior to the production of ischemia enhances neuronal recovery.
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  • Immunologic Factors in the Recurrence of Glioma
    Motohide OGASHIWA, Yuji ASOH, Tatsuhiro MAEDA, Haruhisa YOKOYAMA, Kazu ...
    1988 Volume 28 Issue 5 Pages 467-472
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.467
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    Glioma often recurs after apparently successful treatment and clinical remission. The effect of the host's immunologic status in such cases is unknown. In this study, the authors attempted to answer the following questions: 1) Is there a relationship between immunity and the recurrence of glioma? 2) Is immunologic monitoring useful in predicting the recurrence of glioma? 3) Which immunologic monitoring system is the most reliable? The subjects were 17 patients with gliomas who were treated between 1980 and 1985 and had tumor recurrence after an interval of clinical remission. They were evaluated during and after remission by means of clinical signs, computed tomography, and immunologic testing, which included measurement of purified protein derivative (PPD), phytohemagglutinin (PHA), the blastogenic response of T-lymphocytes to PHA, the OKT4 and OKT8 lymphocyte subsets, and serum complement CH50.
    The patients were divided into two groups. Group 1 comprised five patients whose tumors showed malignant transformation from grade 2 to grade 3. Group 2 included patients whose tumors were of the same histologic grade initially and on recurrence. In Group 2, six tumors were grade 3 and six were grade 4.
    Lowered immunity at the time of recurrence was demonstrated by the following: 1) a negative change in PPD and/or the PHA skin reaction in 80% of Group 1 and 75% of Group 2 patients; 2) elevation of CH50 in 40% of Group 1 and 58% of Group 2 patients; 3) a change in the blastogenic response of T-lymphocytes to PHA in 40% of Group 1 and 25% of Group 2 patients; and 4) an decrease in OKT4/OKT8 cell ratio in 60% of Group 1 and 38% of Group 2 patients. These patients were immunologically competent during remission. The immunologic changes at the time of tumor recurrence were accompanied by clinical deterioration. However, tumor recurrence could not be predicted from the immunologic parameters studied. Thus, it appears that extension or recurrence of the gliomas was responsible for lowered immunity in these patients, rather than the opposite.
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  • Serum Concentration of Valproic Acid after Rectal Administration
    Shigejirou MATSUMURA, Takeshi SHIMA, Yoshikazu OKADA, Masahiro NISHIDA ...
    1988 Volume 28 Issue 5 Pages 473-476
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.473
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    Valproic acid (VPA) suppositories were given on a trial basis to 53 neurosurgical patients. Suppositories consisting of VPA-Na powder supplemented with neutralized acetic acid and an absorbefacient were well absorbed transrectally. At a single dose of 200 or 600 mg, VPA suppositories failed to produce the optimal serum concentration of 50 to 100 μg/ml. At a dose of 600 mg every 8 hours, the optimal concentration was reached in about 16 hours. However, at an initial dose of 1, 200 mg followed by a dose of 600 mg every 8 hours, the optimal concentration was reached in about 8 hours and remained stabilized thereafter. Thus, this dosage regimen was considered the best. VPA suppositories are both practical and safe in the treatment of head trauma in the acute stage and of cerebrovascular diseases accompanied by gastrointestinal dysfunction, and in the shortterm prevention of postoperative seizures.
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  • Cerebrovascular Accident associated with Toxemia of Pregnancy
    Case Report
    Yuji UEMATSU, Toshikazu KUWATA, Ichiro KAMEI, Munehisa IWAMOTO, Tsuyos ...
    1988 Volume 28 Issue 5 Pages 477-480
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.477
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    A 20-year-old primigravida in the ninth month of pregnancy was hospitalized because of sudden onset of disturbance of consciousness. On admission, she was semicomatose, with right hemiplegia; leg edema and oliguria were also noted. Computed tomography showed a high-density area rimmed by a region of low density in the left putamen and a low-density area in the right putamen. The patient underwent a cesarean section, followed by emergency surgery for evacuation of intracerebral blood. On the 5th day of hospitalization, rebleeding in the left putamen, probably associated with disseminated intravascular coagulation, was detected and treated by aspiration and drainage. Cerebral angiography on day 35 showed diffuse vasospasm of both the anterior and posterior circulation. Three and one half months after admission, the patient was able to walk with a cane and was discharged.
    Cerebrovascular accidents associated with toxemia of pregnancy are rare, and the pathogenesis is unclear. Ischemic change, with thrombosis and/or hemorrhage, is seen in the edematous brain. These changes may be due to vasospasm. Cerebral vasospasm and ischemic changes were observed in this case, as well as hemorrhage into the ischemic lesion. The findings in this case suggest that cerebral vasospasm may be the most important factor in the pathogenesis of cerebrovascular accidents in patients with toxemia of pregnancy.
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  • Multicentric Glioma
    Case Report
    Nobuhiko MIYAZAWA, Reizou Tsuji, Shigeru MITSUKA, Ryo-ichi KIMURA, Aki ...
    1988 Volume 28 Issue 5 Pages 481-485
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.481
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    A 68-year-old woman was hospitalized with expressive aphasia and right hemiparesis. Computed tomography demonstrated three separate mass lesions, one each in the left frontal lobe, left parietal lobe, and left basal ganglia. Following partial removal of the tumors, whole brain irradiation (50 Gy) and chemotherapy were administered. However, the patient progressively deteriorated and died 3 months after surgery. While postmortem examination demonstrated no evidence of a relationship among the three masses, histological examination showed that all three were anaplastic astrocytomas. However, different histological characteristics were noted in the three. The left frontal and parietal lobe tumors contained gemistocytic astrocytoma, the left thalamic tumor exhibited a palisading pattern, and features of subependymal giant cell astrocytoma were found in the tumor near the left lateral ventricle.
    The definition, diagnostic procedure, and characteristic histological findings of multicentric glioma are discussed.
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  • Ruptured Dissecting Aneurysm of the Vertebral Artery
    Case Report
    Atsuro TSUKADA, Kotoo MEGURO, Yoshitaka NAKADA, Kenmei KURAMOTO, Yutak ...
    1988 Volume 28 Issue 5 Pages 486-490
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.486
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    A 42-year-old male was brought to the hospital within 20 minutes of sudden onset of headache followed by loss of consciousness. No spontaneous respiration or cardiac activity was observed, and the patient was regarded as dead on arrival. However, vigorous resuscitative measures restored his sinus rhythm and spontaneous breathing and he eventually regained consciousness. Computed tomography revealed severe subarachnoid hemorrhage, and cerebral angiography showed a dissecting aneurysm of the vertebral artery. Proximal clipping of the vertebral artery was carried out 20 days after admission, and the postoperative course was uneventful.
    The literature contains reports of 29 cases of a dissecting aneurysm of the vertebrobasilar system presenting with subarachnoid hemorrhage. One of the main clinical features in these patients was transient but severe suppression of respiration and impairment of consciousness. It should be emphasized that aggressive resuscitation is often rewarding even in patients considered dead on arrival. Also, this case confirmed that ligation of the vertebral artery proximal to a dissecting aneurysm is safe and effective, and is the treatment of choice in most cases.
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  • Spinal Metastasis detected 11 Years after Initial Treatment for Pineal Germ Cell Tumor
    Case Report
    Katsuzo KUNISHIO, Yoshihiro YAMAMOTO, Masakazu SUGA, Norio SUNAMI, Yuj ...
    1988 Volume 28 Issue 5 Pages 491-497
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.491
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    A metastatic spinal tumor was found in a 28-year-old male 11 years after initial treatment for a pineal tumor. The original tumor had been treated by ventriculoatrial shunting, irradiation, and chemotherapy. The patient underwent laminectomy and subtotal removal of the spinal tumor, which was histologically diagnosed as germinoma. The final diagnosis of metastatic mixed germ cell tumor (mainly teratoma with a germinomatous component) of pineal origin was based on the findings of computed tomography and magnetic resonance imaging, the clinical course, tests for tumor markers, the response of the tumor to radiation therapy, and the histopathological findings. It was inferred that only the germinomatous component of the pineal mixed germ cell tumor had metastasized to the cauda equina.
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  • Spontaneous Regression of Intracranial Malignant Lymphoma
    Case Report
    Nobuto KOJO, Takashi TOKUTOMI, Gihachirou EGUCHI, Shigeyuki TAKAGI, To ...
    1988 Volume 28 Issue 5 Pages 498-503
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.498
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    In a 46-year-old female with a 1-month history of gait and speech disturbances, computed tomography (CT) demonstrated mass lesions of slightly high density in the left basal ganglia and left frontal lobe. The lesions were markedly enhanced by contrast medium. The patient received no specific treatment, but her clinical manifestations gradually abated and the lesions decreased in size. Five months after her initial examination, the lesions were absent on CT scans; only a small area of low density remained. Residual clinical symptoms included mild right hemiparesis and aphasia. After 14 months the patient again deteriorated, and a CT scan revealed mass lesions in the right frontal lobe and the pons. However, no enhancement was observed in the previously affected regions. A biopsy revealed malignant lymphoma. Despite treatment with steroids and radiation, the patient's clinical status progressively worsened and she died 27 months after initial presentation. Seven other cases of spontaneous regression of primary malignant lymphoma have been reported. In this case, the mechanism of the spontaneous regression was not clear, but changes in immunologic status may have been involved.
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  • Subarachnoid Hemorrhage due to Spinal Tumor
    Case Report
    Takuhiro HOTTA, Kazuhiko SUGIYAMA, Takashi SOGABE, Junji GOISHI, Akino ...
    1988 Volume 28 Issue 5 Pages 504-509
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.504
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    An unusual case involving subarachnoid hemorrhage (SAH) associated with an ependymoma is presented. The patient, a 54-year-old male, was hospitalized because of sudden onset of severe headache and urinary retention. Cerebral angiography revealed no abnormality. An intraspinal lesion was suspected when serial lumbar punctures repeatedly yielded dark, brownish fluid. Further neuroradiological examinations (myelography, spinal computed tomography, and selective spinal arteriography) revealed an intraspinal tumor situated at L1-3. The tumor was totally removed with the aid of preoperative transcatheter embolization. Only 56 cases of SAH due to an intraspinal neoplasm have been reported. Such cases are thought to be uncommon and, in many of those reported, diagnosis was difficult. The possibility of an intraspinal tumor should be considered in SAH patients who present with minimal spinal cord or root signs. In terms of locating and characterizing the hypervascular spinal tumor in the present case, as well as selecting appropriate treatment, selective spinal arteriography was the most contributory procedure.
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  • Arteriovenous Malformation associated with Multiple Intracranial Aneurysms
    Case Report
    Shigetaka ANEGAWA, Ryuichiro TORIGOE, Katsuhiko HARADA, Yosuke AIKAWA, ...
    1988 Volume 28 Issue 5 Pages 510-514
    Published: 1988
    Released on J-STAGE: September 05, 2006
    DOIhttps://doi.org/10.2176/nmc.28.510
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    A 33-year-old woman was hospitalized for sudden onset of severe headache. On neurological examination the only abnormalities were mild nuchal rigidity and anisocoria. Angiography revealed an arteriovenous malformation (AVM) in the right temporal tip with aneurysmal shadows in the right middle cerebral, right internal carotid, and contralateral middle cerebral arteries. Through the right frontotemporal approach, the right middle cerebral and internal carotid artery aneurysms were obliterated. The nidus of the AVM was then radically excised. The patient later underwent a second operation for the contralateral aneurysm, without complications. She was discharged without neurological deficits. It has been emphasized that, in cases of intracranial aneurysms associated with an AVM, the aneurysms are located on the feeding arteries or the contributory vessels proximal to the AVM. Hence, some authors have suggested that feeding arteries with increased blood flow are predisposed to the development of aneurysms. However, this patient also had an aneurysm on a vessel that did not feed the AVM. The presence of a “mirror” aneurysm is interpreted as evidence of a congenital anomaly.
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