Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
28 巻, 8 号
選択された号の論文の15件中1~15を表示しています
  • 田中 孝幸, 小林 達也, 服部 和良, 高橋 立夫, 伊藤 雅文, 景山 直樹, 木田 義久, 池田 哲夫, 松井 正顕
    1988 年 28 巻 8 号 p. 761-766
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    During the past few years hyperthermia as cancer therapy has been studied with great enthusiasm, both clinically and experimentally. Some investigators have used a microwave antenna or radiofrequency current for hyperthermia of malignant brain tumors, but with these methods it is difficult to treat only the tumor without damaging normal brain tissue. The authors developed a system by which hyperthermia can be applied locally via an implant. Brain tumors were induced in rats by intracerebral implantation of T9 gliosarcoma cells (106 cells). Ten days after inoculation, a ferromagnetic seed was implanted in the tumor and a single application of hyperthermia was delivered. The temperature around the implant was maintained at 45.5±0.3°C for 30 minutes. The effect of a single treatment was assessed in terms of length of survival and morphological changes in the tumor.
    The average survival time of the control group (n=23) was 20 days, whereas that of the treated group (n=27) was 29 days. The difference was statistically significant (p<0.01) . The pathological findings were as follows: 1) Immediately after hyperthermia, the tissue around the implant was necrotic, the intercellular spaces were enlarged, and the vessels were dilated. 2) In the long survivors, there were large areas of necrosis and accumulation of lymphocytes within the tumor tissue. 3) In one rat that survived, a large cavity was found where the tumor had been, and no tumor cells were detected on microscopic examination. 4) Immunohistochemical study with rat T cell monoclonal antibody demonstrated diffuse distribution of T lymphocytes within the tumor tissue. T lymphocyte subpopulations included helper and suppressor/cytotoxic T cells. These results are highly encouraging in terms of the potential for hyperthermia in the treatment of brain tumor.
  • 引地 基文
    1988 年 28 巻 8 号 p. 767-771
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    This study was designed to improve understanding of the pathogenesis of air embolism and thereby contribute to the development of effective preventive techniques. Dural venous sinus pressure (confluens sinuum pressure: CSP) was measured in pentobarbital-anesthetized mongrel dogs under conditions of spontaneous and controlled respiration, head elevation, neck compression, abdominal compression, drug- or bleeding-induced hypotension, extraneous fluid administration, and drug-induced hypertension. CSP was lower during controlled than during spontaneous respiration. When the head was raised, CSP decreased almost linearly, reaching -2.3±2.8 (mean±SD) mmHg at 45°. Upon neck compression, CSP increased significantly; even at a cuff pressure of only 5 mmHg, the negative pressure returned to zero. However, abdominal compression had little effect. Bleeding-induced hypotension caused a decrease in CSP, to 0.3±1.4 mmHg at a blood pressure of 90 mmHg. On the other hand, CSP increased markedly following fluid administration (except in the case of saline) and induced hypertension. These results suggest that continuous neck compression, fluid administration, avoidance of hypotension, and induced hypertension contribute to the prevention of air embolism.
  • 大平 貴之, 戸谷 重雄, 高瀬 守一朗, 中村 芳樹, 宮崎 宏道, 中務 正志, 井端 由紀郎
    1988 年 28 巻 8 号 p. 772-778
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    Brainstem auditory evoked potentials (BAEPs) were monitored intraoperatively during 44 posterior fossa operations. Technically satisfactory recordings were obtained from 42 patients (95%) and, in 41 of these cases (98%), the intraoperative changes in BAEPs were correlated with the postoperative neurological findings. The functional integrity of the brainstem was assessed by intraoperative BAEP monitoring in 33 patients. Transient, reversible changes were observed in six (18%), and none had postoperative brainstem dysfunction. The functional integrity of the auditory pathway was monitored in 11 cases, and nine of these patients (82%) exhibited alterations of BAEP waveforms. Transient, reversible dysfunction occurred in three, and permanent changes in six (obliteration in five). Seven patients experienced postoperative hearing loss, six of whom had intraoperative changes in BAEPs that became permanent. The seventh had only transient derangement during surgery. BAEP monitoring appeared to be a much more sensitive indicator of auditory than of brainstem function.The study suggests that the maximum delay in wave V latency in reversible dysfunction is about 1.0 msec. Therefore, surgery should be interrupted before the wave V latency is delayed by 1.0 msec, in order to avert postoperative neurological deficits. However, when BAEP changes are rapid, it is extremely difficult to halt the surgical procedure before such alterations become irreversible. The authors conclude that a more timely indicator of reversible trauma must be developed.
  • 長尾 省吾, 久山 秀幸, 室田 武伸, 須賀 正和, 谷本 尚穂, 河内 正光, 西本 詮
    1988 年 28 巻 8 号 p. 779-785
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    The complications and outcome with three different approaches to direct surgical exploration of pineal tumors were studied in 16 consecutive patients. Among the 16 pineal tumors were three two-cell pattern germinomas, one mature teratoma, five mixed germ cell tumors, three astrocytomas, one ependymoma, one metastatic lung cancer, one hemangioblastoma, and one epithelial cyst. The parietal transcallosal approach (Dandy) was employed in eight cases. Four of these patients showed disconnection syndrome, memory and intellectual disturbances presumably due to splitting of the corpus callosum. Left sensorimotor disturbance and homonymous hemianopsia secondary to compression of the right parieto-occipital lobe were also observed in six patients postoperatively. However, these deficits tended to disappear within 1 to 2 months, especially in the younger patients. The single hemangioblastoma was totally excised via the occipital transtentorial approach (Jamieson), with complications of truncal ataxia and slurred speech. Seven tumors were removed by the infratentorial supracerebellar approach (Krause), with no complications. Thus, the infratentorial supracerebellar approach may be the safest and most effective means of removing a pineal lesion. The outcome of patients with mixed germ cell tumors (three of five died within 1 year) and astrocytomas (two of three died within 3 years) was poor, whereas that of patients with germinoma and mature teratoma was excellent. The long-term prognosis of patients with pineal tumors appeared to depend on the type of tumor, the response to irradiation, and whether or not excision was total.
  • 鈴木 明文, 安井 信之, 波出石 弘, 佐山 一郎, 朝倉 健
    1988 年 28 巻 8 号 p. 786-790
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    The outcome of cerebral vasospasm in aged patients with ruptured intracranial aneurysms was compared with that in younger patients. Patients with brain damage due to previous stroke, intracerebral hematoma, or surgical complications were excluded from the study. The study population consisted of 143 patients hospitalized between 1982 and 1986. Neck clipping of ruptured aneurysms and continuous ventricular drainage were carried out within 3 days after onset. At 3 months after subarachnoid hemorrhage the incidence of poor clinical results was significantly higher in patients over 64 years of age than in younger patients (p<0.005). Therefore, in this study “aged” was defined as 65 years of age or older. There were 25 patients in the aged group (eight males and 17 females; mean age, 68±3 years). The younger group comprised 118 patients (62 males and 56 females; mean age, 52±8 years). The clinical manifestations of cerebral vasospasm were evaluated 3 months after subarachnoid hemorrhage and classified as either transient or permanent. Between the aged and younger groups there were no differences in the extent of subarachnoid hemorrhage, the incidence of vasospasm as demonstrated by angiography, or the incidence of symptomatic vasospasm. However, the incidence of permanently symptomatic vasospasm was significantly higher in the aged group (81.8% of all patients with symptomatic vasospasm) than in the younger group (30.2%) (p<0.01). Systemic complications appeared to have a greater effect on symptoms of vasospasm in the aged than in the younger patients.
  • 頃末 和良, 石田 和彦, 浜野 聖二, 栗原 英治, 井沢 一郎, 長尾 朋典, 玉木 紀彦, 松本 悟
    1988 年 28 巻 8 号 p. 791-797
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    Superficial temporal artery-middle cerebral artery (STA-MCA) bypass is widely accepted as an effective treatment for ischemic cerebrovascular disease in terms of improvement of cerebral blood flow in the ischemic region. However, the indications for and timing of STA-MCA bypass in the acute stage of ischemic stroke have not been established. Isovolemic hemodilution has been shown to temporarily raise collateral perfusion in acutely ischemic brain regions distal to occluded cerebral arteries. The authors performed isovolemic hemodilution in 26 cases of cerebral ischemia within 72 hours of the onset of symptoms. This resulted in a 30% increase in regional cerebral blood flow (rCBF) in the area supplied by the affected MCA, leading to rapid neurological improvement in 18 patients. Nine of these 18 were randomly assigned to the early bypass group, in which STAMCA bypass was performed within 2 days of hemodilution. In the delayed bypass group, which included the remaining nine patients, bypass was performed more than 30 days after hemodilution. In the early group, rCBF in the affected MCA region increased by 18% and the neurological score (NS) improved by 10% within 1 month postoperatively. In the delayed group, follow-up examination 1 to 2 months after hemodilution, rCBF in the affected MCA region and NS had returned nearly to pretreatment levels. Moreover, in this group STA-MCA bypass improved neither rCBF nor neurological status. It can be concluded that isovolemic hemodilution temporarily increases rCBF in the ischemic territory and enhances the potential reversibility of neuronal damage in patients with acute ischemic stroke. Neuronal damage may be reversed and rCBF may be significantly improved if blood flow is re-established by surgical means (STA-MCA bypass) within hours or days following hemodilution.
  • 岩崎 喜信, 阿部 弘, 多田 光宏, 井須 豊彦, 秋野 実, 金田 清志
    1988 年 28 巻 8 号 p. 798-801
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors describe six cases of thoracic disc disease successfully treated by anterior spinal cord decompression via the transpleural or retroperitoneal approach. The patients included two with ossification of the posterior longitudinal ligament, one with a soft disc, and three with spondylosis (two of whom had ossification of the yellow ligament at the level of the spondylosis). The lesions were situated at the Th7 to L2 levels. In all cases the protruding disc, spur, or ossified ligament was completely removed. In five cases bone grafting was performed, and in three, anterior internal fixation was accomplished with a Kaneda device. All six patients' neurological deficits improved. Thus, when neurological deficit results from anterior pressure on the dural tube at the thoracic level, anterior decompression is an effective therapeutic procedure.
  • 椎骨動脈へのdistal embolismの予防策について
    皆河 崇志, 小池 哲雄, 佐々木 修, 阿部 博史, 田中 隆一, 青木 広市, 新井 弘之
    1988 年 28 巻 8 号 p. 802-807
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors present two patients, both 46-year-old males, with subclavian steal syndrome successfully treated by percutaneous transluminal angioplasty (PTA). One patient complained of fatigability of the right arm of several years' duration. Angiograms revealed irregular stenosis of the proximal subclavian artery. The second patient had suffered transient attacks of dizziness, dysesthesia of the left upper extremity that was exacerbated by exertion, and transient pain and pallor of the homolateral fingers. The last symptom indicated embolic blockage of the blood supply to the finger arteries. Both patients underwent PTA via the femoral artery, during which procedure the homolateral vertebral artery was occluded with a transbrachial balloon catheter in order to prevent an embolism entering the vertebral artery. No complications occurred, and both patients' clinical symptoms disappeared immediately after PTA. Angiograms obtained 3 months postoperatively demonstrated sufficient dilatation of the treated segments of the subclavian arteries and antegrade flow in the vertebral artery in both cases. Temporary balloon occlusion of the homolateral vertebral artery during PTA appears to be an appropriate means of preventing the migration of emboli into the vertebral artery.
  • 高橋 潤, 牧田 泰正, 鍋島 祥男, 鄭 台〓, 欅 篤, 宮本 義久
    1988 年 28 巻 8 号 p. 808-811
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    Migration of peritoneal tubes was observed in two cases of ventriculoperitoneal (VP) shunting. The first patient had undergone revision of VP shunting for hydrocephalus at the age of 7 months. He had been well until the age of 16 months, when umbilical erosion was noted. Physical examination revealed that the distal tip of the peritoneal tube (non-spiral wire type) was protruding through the umbilicus. However, the patient was well, and the tube was replaced. The removed tube was contaminated with Staphylococcus aureus, but administration of antibiotics prevented postoperative infection. The second patient, an 8-month-old boy, was brought in because of failure to thrive and feeding difficulty 5 months after VP shunting for hydrocephalus. Physical examination disclosed that the distal tip of the peritoneal tube (again, a non-spiral wire type) was protruding through the anus. The cerebrospinal fluid obtained by puncture of the fontanelle yielded a turbid fluid. There was no evidence of peritonitis. The distal tube was removed, and ventricular drainage, along with administration of antibiotics, was maintained for 1 month. The shunting system was then revised.
    There have been 53 reported cases of migration of shunting tubes, most of which were located in the bowel. Transumbilical migration has been previously reported only once. In that case as well as ours, Pudenz peritoneal tubes without a spiral wire were used. However, several authors have noted an increased incidence of spontaneous extrusion of the Raimondi type peritoneal tube with a spiral wire. Meningitis and/or ventriculitis carried the worst prognosis. Patients with VP shunts should be regularly examined to avoid the sort of rare complication described here.
  • 症例報告と文献的考察
    杉田 保雄, 重森 稔, 上垣 正巳, 徳永 孝行, 倉本 進賢, 中村 康寛, 森松 稔, John J. KEPES
    1988 年 28 巻 8 号 p. 812-815
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    An 18-year-old female developed convulsive seizures and was hospitalized 3 months after their onset. On admission, she displayed no neurological deficits. Plain computed tomography showed a high-density area in the right frontal lobe. A ring-like enhanced mass lesion was visualized on contrast infusion. At surgery, a 3 × 3 × 3-cm cystic tumor was found in the right frontal lobe. On histological examination the tumor exhibited high cellularity and pleomorphism and contained spindle-shaped cells and bizarre, multinucleated giant cells, findings suggestive of a glioblastoma multiforme or malignant mesenchymal tumor. However, neither necrosis nor mitotic figures were evident. The tumor cells were surrounded by a dense network of reticulin fibers, and peroxidaseantiperoxidase staining was positive for cytoplasmic glial fibrillary acidic and S-100 proteins. These findings confirmed the diagnosis of pleomorphic xanthoastrocytoma. The clinicopathological features of pleomorphic xanthoastrocytoma are discussed.
  • 鰐渕 博, 門脇 弘孝, 平沢 恭子, 久保 長生, 加川 瑞夫, 喜多村 孝一
    1988 年 28 巻 8 号 p. 816-822
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors describe a case of congenital brain tumor associated with massive intracerebral hemorrhage. The patient, a 2, 230-g male, was born at full term after an uneventful pregnancy and delivery. Fourteen hours after delivery he developed dyspnea and a feeble, irritable cry. A computed tomographic scan obtained on the 2nd day of life disclosed a massive intracerebral hemorrhage and an irregular, enhanced area of high density in the right temporoparietal region. The tumor was removed and was histologically diagnosed as a benign astrocytoma.
    A review of the literature revealed that congenital brain tumors often do not manifest in the perinatal period. Initial manifestations at birth are large head or hydrocephalus and, after birth, gradual onset of hydrocephalus or functional deterioration due to hemorrhagic stroke. Among the 33 reported cases, 16 (48%) were detected through tumor bleeding and 12 were found at autopsy. Glioma was the most common among congenital brain tumors with bleeding in the neonatal period. Radical surgery offers the best possibility of long-term survival for these patients.
  • 正名 好之, 狩野 光将, 中島 義和, 前田 泰孝, 生塩 之敬, 早川 徹, 最上 平太郎
    1988 年 28 巻 8 号 p. 823-827
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    A 34-year-old male had occasionally experienced severe low back pain. Thoracic and lumbar plain X-rays and tomography showed enlarged interpedicular spaces and anteroposterior distances of the spinal canal at the thoracolumbar level. Myelography demonstrated epidural compression from the Th11 to the L2 vertebral levels. Amipaque computed tomography (CT) myelography showed a flattened spinal canal and a contrast-enhanced mass extending from the Th11 to the L2 vertebral levels. Magnetic resonance imaging revealed a mass situated in the same region, as well as compression of the spinal cord. A Th12 through L2 laminectomy was performed. When the dura and the adherent cyst wall (thickened arachnoid) were incised, liquid spurted out. The cyst cavity communicated with the subarachnoid space through a small pore. The pore was ligated and the cyst was subtotally excised. The redundant dura overlying the cyst wall was sutured to eliminate the dead space. The removed cyst wall was composed of thickened and partially hyalinized arachnoid. No inflammation was detected. Immediately after surgery, the patient's low back pain disappeared. Amipaque CT myelography performed 30 days postoperatively demonstrated restoration of the dural sac.
  • 白川 尚哉, 中川 洋, 伊藤 博文, 原 彦夫, 浅野 元脩
    1988 年 28 巻 8 号 p. 828-832
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    A 35-year-old female who had been undergoing hemodialysis for 8 years because of renal failure developed back pain and paraplegia. A neurological examination demonstrated complete paraplegia with sensory level at Th4, loss of position sense and areflexia of the legs, positive Babinski's sign, and atonic anal sphincter. Myelography via the lumbar route disclosed a complete block at Th4, with displacement of the cord to the right by an epidural mass lesion. Five days after the onset of paraplegia, a Th3 through Th5 laminectomy was performed and an encapsulated abscess containing creamy pus was totally removed. The pathological diagnosis was non-specific abscess. On the 7th postoperative day, the sensory level started to drop down and within 3 weeks the patient was able to move her legs. Now, 8 months after surgery, she is able to walk with the help of a cane. Spinal epidural abscess is relatively rare. The authors describe its clinical manifestations and review the literature. Early diagnosis and prompt surgical decompression of the cord are considered essential to recovery from paraplegia. However, even delayed surgery may be successful, as shown in this case.
  • 横山 達智, 井原 清, 加藤 祥一, 織田 哲至
    1988 年 28 巻 8 号 p. 833-837
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    A 29-year-old male was referred for assessment of an expanding left parietal skull lesion. Physical examination revealed a tender, cystic lesion in the left parietal area and a firm, nontender protuberance of the left parieto-occipital skull. Skull X-rays showed a zone of radiolucent defects and extensive areas of bony sclerosis. Computed tomography disclosed an area of bone lysis and areas of bony sclerosis. A bone scan with 99mtechnetium polyphosphate demonstrated a defect and extensive uptake. External carotid and vertebral angiograms showed dilatation of the meningeal artery, faint accumulation of contrast medium, aneurysmal distension, and early-filling veins in the areas of bony sclerosis. At surgery, a hemorrhagic, cystic lesion, which had completely eroded the inner and outer tables of bone, was found. It was surrounded by thickened, soft, gritty skull bone. Micro-scopic studies revealed cavernous spaces surrounded by multiple benign-appearing giant cells characteristic of an aneurysmal bone cyst, as well as regions of fibrous dysplasia. The difficulties in the differential diagnosis of cyst formation in fibrous dysplasia and aneurysmal bone cyst are discussed.
  • 園田 寛, 吉田 顕正, 大塚 忠弘, 高木 修一, 松角 康彦
    1988 年 28 巻 8 号 p. 838-842
    発行日: 1988年
    公開日: 2006/09/05
    ジャーナル フリー
    The authors report the coexistence of a cerebral aneurysm and a cerebral venous angioma, which is very rare, in a 24-year-old female admitted because of sudden onset of severe headache and convulsive seizures. There were no abnormal neurological findings other than meningeal irritation. Plain computed tomography (CT) showed an intraventricular hematoma and contrast-enhanced CT demonstrated a umbrella-shaped region of high density in the right parietal lobe. Right serial carotid angiography disclosed slight enlargement of the branches of the middle cerebral artery and, in the late arterial to capillary phase, blushing was evident in the right parietal lobe. The small medullary veins converged into a single large vein that penetrated the brain and drained into the superior sagittal sinus in the venous phase. A vertebral angiogram demonstrated a saccular-appearing aneurysm in the plexal segment of the right posterolateral choroidal artery, which was joined distally to the venous angioma. These angiographic findings resemble those of peripheral artery aneurysms associated with moyamoya disease. It is possible that the aneurysm arose through hemodynamic stress and ruptured into the ventricle. Numerous types of vascular anomalies have been reported in the literature. This case further illustrates that there are several transitional types to be included in the proposed classifications, such as Russell and Rubinstein's.
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