A new approach to the treatment of malignant glioma is cytokine gene therapy to produce growth inhibitors in cells. Previously, we showed that human glioma cells selectively transfected with the gene of interferon (IFN)-β and/or IFN-γ by our novel liposomes tagged with monoclonal antibody against a glioma-associated antigen achieved a remarkable growth inhibition effect. In the present experiment, we demonstrated the effectiveness of gene therapy against glioma cells using liposomes bearing a plasmid containing the gene for tumor necrosis factor (TNF)-α. We also found that the effect of endogenous TNF-α was enhanced by treatment of IFN-γ prior to the transfection with the TNF-α gene.
Ultrastructural examinations of the cerebral vascular wall following subarachnoid hemorrhage (SAH) demonstrated that collagen fibrils developed in the muscle layer near the adventitia in the early stage of SAH and increased in number and volume with time. These findings suggest that accelerating factors of collagen synthesis in the muscle layer may be released from the adventitial side, and collagen synthesis is induced by extravascular factors. The changes of collagen volume with time suggest collagen to be an important phenomenon of persistent vasospasm after SAH. Histoimmunological studies showed that increased collagen fibers in the tunica media were mainly type III collagen, implying that cerebral vasospasm may be related to chemical inflammation.
Many cases of spontaneous occlusion of the circle of Willis (moyamoya disease) have been reported in Japan, but the worldwide distribution is unclear. The total number of cases in each country reported in the literature and complications were evaluated. A total of 1063 cases have occurred worldwide excluding Japan. Cases were observed most frequently in Asia and in people of non-Caucasian origin.
Five cases of nontraumatic intradiploic arachnoid cysts in elderly patients are reported. All cysts were located in the occipital bone and appeared as well-demarcated radiolucent lesions. The cysts were multiple in three cases. Presenting symptoms included headache or dizziness, but most lesions were asymptomatic and found incidentally. In the most recent three cases, magnetic resonance (MR) imaging revealed intradiploic cysts containing cerebrospinal fluid (CSF) with cerebellar herniation. Operation found the cysts filled with CSF and dural defects through which cerebellar tissue was herniating. In two patients, CSF leakage from the outer table occurred. Intradiploic arachnoid cyst seems to be congenital in origin but commonly found in the elderly. MR imaging is the most useful diagnostic method for differential diagnosis from other osteolytic skull lesions.
A 53-year-old mentally handicapped female with hereditary hemorrhagic telangiectasia complicated by pulmonary arteriovenous fistula developed a recurrent brain abscess in the left frontal region. She responded well to surgical drainage and antibiotic therapy. Previously, she had two brain abscesses of the left parieto-occipital and right parietal regions removed on separate occasions at 38 and 40 years of age. Although pulmonary arteriovenous fistula was eventually confirmed by angiography at age 41 years, surgical removal of the pulmonary lesion was not indicated due to multiplicity and large vascular shunting. Early recognition of pulmonary arteriovenous fistula in patients with hereditary hemorrhagic telangiectasia is emphasized for diagnosis of brain abscess and prevention of recurrence.
A 20-year-old male was admitted comatose immediately after a motorcycle accident. Initial computed tomography demonstrated traumatic subarachnoid hemorrhage, and the diagnosis of traumatic internal carotid artery occlusion was established by angiography. Conservative management improved his symptoms, but eventually he died from delayed traumatic apoplexy. Traumatic internal carotid artery occlusion is relatively rare, but is serious and requires early diagnosis and treatment. For patients with severe head trauma and vascular occlusion, anticoagulants are contraindicated, and frequent follow-up angiography is recommended.
A 2-year-old boy with unilateral moyamoya disease demonstrated progression to the bilateral condition 1 year later. Previous reports of progression from unilateral to bilateral moyamoya disease showed that all patients were children or relatively young, and developed ischemic symptoms as the initial manifestation. These findings suggest that a considerable proportion of unilateral pediatric cases are in the initial stage of moyamoya disease and will progress to the contralateral side in the future.
A 75-year-old female with chronic renal failure diagnosed as Wegener''s granulomatosis was receiving steroids and immunosuppressive agents when subarachnoid hemorrhage developed. Cerebral angiography showed a fusiform aneurysm arising from an angular branch of the left middle cerebral artery. Hemorrhage occurred and the aneurysm was excised by emergency surgery. Microscopic examination of the aneurysm revealed dense infiltration of hyphae identified as Aspergillus. She died of subsequent hemorrhage. Autopsy showed numerous Aspergillus hyphae in the lung. Fungal mycotic aneurysm should be considered in the differential diagnosis of an immunocompromised patient with subarachnoid hemorrhage.
A 48-year-old male presented with a metastatic skull base tumor located on the right of the clivus and the sphenoid sinus, which originated from adenocarcinoma of the stomach. The initial symptom was abducens nerve paralysis and there were no symptoms of upper gastrointestinal tract throughout the course. This gastric cancer, which rarely metastasizes to the central nervous system or osseous system, caused multiple bone metastases which produced the neurological symptoms.
A 44-year-old male with Pierre Robin syndrome and funnel chest was diagnosed with a tumor of the cerebellar vermis and spontaneous pneumothorax. He received tube thoracostomy for pneumothorax and ventriculoperitoneal shunt for hydrocephalus, followed by radiological examination, subtotal removal of the tumor, pneumonorrhaphy, and chemoradiotherapy. Light microscopy of the tumor sample revealed marked pleomorphism of the tumor cells and numerous giant cells, without mitotic figures. Microcystic changes due to vasogenic edema were also evident throughout the tumor. Electron microscopy showed more than 50% of all tumor cells to be oncocytes, with numerous mitochondria in the cytoplasm. The tumor was diagnosed as anaplastic astrocytoma of an oncocytic type.