The possibility for new interferon therapy was investigated using the effect of endogenous human interferon-β (HuIFN-β) on various culture cell lines. Cell lines were exposed to superinduction agents (poly I: poly C, cycloheximide, and actinomycin D) and the production of endogenous interferon analyzed. Quantitative determination of HuIFN-β and messenger ribonucleic acid (mRNA) showed HuIFN-β was induced in all of five glioma cell lines, one of two melanoma cell lines, and all of three lung carcinoma cell lines as well as fibroblasts. Northern blot analysis showed HuIFN-β mRNA induced in glioma cells was identical to that from fibroblasts. Endogenous HuIFN-β induced from glioma cells had a cytostatic or cytocidal effect against various human glioma cell lines, even those resistant to fibroblast-derived HuIFN-β. These results show it may be possible to use the induction of excess endogenous cytotoxic HuIFN-β in human glioma tissue itself.
Melatonin (MLT) secretion was examined in six normal pressure hydrocephalus (NPH) patients before and after ventriculoperitoneal (VP) shunt surgery. Ten healthy subjects were used as controls. Venous blood samples were taken daily at 2 p.m., 8 p.m., 2 a.m., and 8 a.m. Radioimmunoassay of MLT used a new specific antiserum and separation method achieving low cross-reactivity and high-efficiency MLT separation. Plasma levels in the control group at 2 p.m. and 2 a.m. were significantly different, showing diurnal rhythm (DR). The patients' MLT levels before VP shunt were significantly lower than control levels and the DR was absent. Postoperatively, the values were significantly different from preoperative values only at 2 a.m., but the DR reappeared. Thus, in NPH, VP shunt surgery improved the melatonin DR, probably through normalization of the dilated third ventricle.
Eleven patients with a history of moderate or severe angiospasm following ruptured cerebral aneurysm developed spontaneous intracerebral hemorrhage between 31 and 111 months after aneurysm surgery. In all cases, hemorrhage occurred in the ipsilateral hemisphere to the original aneurysm. In nine patients, the hematoma was surgically evacuated and bleeding perforating arteries were resected for histological examination. Computed tomographic scans showed the hematomas to be unusually extended compared to those after hypertensive intracerebral hemorrhage. The histological examination showed various degenerative changes in the elastic lamina and media of the perforating arteries, even though most patients were young and normotensive. These findings suggest that patients who have suffered severe cerebral angiospasm may have a higher risk for subsequent development of intracerebral hemorrhage than those without prior angiospasm.
We evaluated N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) as a method for identifying normal pressure hydrocephalic (NPH) patients eligible for shunting procedures. 123I-IMP SPECT scans were taken before and after cerebrospinal fluid (CSF) taps in NPH cases. Post-subarachnoid hemorrhagic (SAH) patients showed apparent frontal blood flow reduction but non-SAH cases did not. The frontal blood flow increased in comparison with the temporal flow after CSF tapping in SAH cases who benefited most from shunting. Cerebral blood flow study before and after CSF removal is a potential method for classifying NPH patients likely to benefit from the shunting operation.
The authors report the clinicopathological findings in six cases of bacterial intracranial aneurysms. All patients received appropriate high-dose antibiotics, and four were treated surgically. One patient with multiple aneurysms of the main trunks died of disseminated intravascular coagulation. Autopsy disclosed no apparent aneurysm or inflammatory cell infiltration, but a partially interrupted internal elastic lamina and thickened intima were disclosed at the angiographical aneurysm sites. These findings suggest that 1) appropriate high-dose antibiotics are effective against inoperable bacterial aneurysms in the main trunks, 2) new aneurysms may be formed in patients with cyanotic congenital heart disease, because bacterial emboli can directly reach the cerebral circulation and reimplant on the fragile arterial walls after vasculitis. Histological examination of aneurysmal walls revealed inflammatory cell infiltration after resolution of clinical endocarditis. This suggests that both appropriate high-dose antibiotic therapy and surgery should be considered in patients with distal bacterial aneurysms.
The authors report three cases of distal anterior cerebral artery aneurysm presenting as acute subdural hematoma (SDH). Two patients were comatose on admission and died of massive SDH. One patient underwent aneurysmal neck clipping in the chronic stage and returned to normal daily life. A convexity SDH continuous with a wedge-shaped interhemispheric SDH was the characteristic computed tomographic appearance in all cases. There was no accompanying subarachnoid or intracerebral hemorrhage in one case (pure SDH). These cases are 9.4% of 32 ruptured distal ACA aneurysms treated in our institute in the last 14 years, a higher incidence than reported previously.
Metastasis to the brain from esophageal carcinoma is rare. Recently we had four cases, all treated by tumor removal. Three received postoperative whole or local brain irradiation. Anticancer pellets were implanted in two. The postoperative 1-year survival rate was 37.5%, which suggests the prognosis is not worse than for other metastatic brain tumors.
A 32-year-old male with a large arteriovenous malformation (AVM) in the right temporoparietal area presented with features of benign intracranial hypertension. This association is rare. The pathogenesis is believed to be due to cerebral venous hypertension. The excision of the AVM eliminated the intracranial hypertension.
A 65-year-old female developed peduncular hallucinosis 3 days after rupture of a basilar-superior cerebellar artery aneurysm. There were no neurological deficits except slight anisocoria when she first complained of hallucinations. Vasospasm of the perforating arteries to the upper brainstem, rather than direct brainstem damage caused by the bleeding, was probably the cause. Peduncular hallucinosis is possibly the only localizing sign of ruptured upper posterior circulation aneurysm.
A 54-year-old female presented with apparent isolated hypothalamic histiocytosis X associated with diabetes insipidus and Korsakoff's syndrome. Computed tomographic and magnetic resonance imaging demonstrated a single hypothalamic mass. A craniotomy for biopsy found granulation tissue of unknown cause. Further investigation discovered genital bleeding before admission. Biopsy of the cervix uteri revealed histiocytosis X. Further studies showed the disease was restricted to the hypothalamus and the endometrium of the cervix uteri. Low-dose irradiation led to partial regression of the hypothalamic mass and improvement of Korsakoff's syndrome. Even when a diagnosis of isolated hypothalamic histiocytosis X is confirmed, the possibility of another histiocytosis X lesion in an unexpected region must be considered.