The levels of platelet-activating factor (PAF) and lipid metabolites related to choline glycerophospholipid were measured in the plasma and hematoma samples obtained from patients with chronic subdural hematoma. The ratio of lyso-choline glycerophospholipids (lysoPC) to choline glycerophospholipids (PC) in hematoma correlated with the interval between the onset of symptoms and surgery. PC and lysoPC fatty acyl moieties in plasma and hematoma were essentially similar. These results suggest that the lysoPC to PC ratio in hematoma can determine the age of the chronic subdural hematoma, and that the origin of hematoma may be circulating blood. The levels of PAF in the plasma of chronic subdural hematoma patients were significantly greater than in healthy volunteers. PAF may be involved in the enlargement of chronic subdural hematoma.
The immunophenotypes in three cases of primary malignant lymphomas of the brain were analyzed by flow cytometry using a panel of monoclonal antibodies. In all three cases the immunophenotypes were CD 10 negative, CD 19 positive, and CD20 positive, and in two cases human leukocyte antigen (HLA)-DR positive. CD20 showed high positivity (80-97%), while CD19 revealed low positivity (30-50%). These neoplastic cells apparently became malignant at the B-cell differentiation stage, when they expressed both CD19 and CD20. Differentiation continued until CD19 was no longer expressed, when further differentiation stopped between the last stage of B-cell differentiation and the early stage of plasma cell formation (Case 3 was CD38 positive). Case 1 was immunoblastic type lymphoma and the cells were both surface immunoglobulin and HLA-DR negative. At least 40% of Case 2 cells showed both B-cell and T-cell markers. Immunophenotypic study can help determine the cell lineage, clonality, and stage of differentiation of lymphoid neoplasms.
Growth inhibition assays using radioisotope or dye are used to detect transforming growth factor-β(TGF-β). Here, we describe a modified bioassay using crystal violet for the quantitative detection of TGF-β1 and TGF-β2. The procedure is based on staining Mv1Lu mink lung epithelial cells with crystal violet, followed by measurement of the absorbance at 570 nm in individual wells of a 96-well microtiter plate. The number of Mv1Lu cells correlated with the eluted dye intensity. The sensitivity of the bioassay to recombinant TGF-β1 and TGF-β2 increased approximately twofold by using only 500 Mv1Lu cells in microtiter wells. The bioassay was used to measure TGF-β3 activity in the culture supernatant from glioblastoma cells. Culture supernatants were untreated or acid-activated to quantify the active or total TGF-β, and neutralized with anti-TGF-β1 and⁄or anti-TGF-β2 antibody to measure the activity. Both TGF-β1 and TGF-β2 were detected in the untreated and acid-activated supernatants, and the amounts were calculated by extrapolating from the known recombinant TGF-β1 or TGF-β2 dilution curve. Our results show that the modified bioassay using crystal violet can measure the levels of TGF-β1 and TGF-β2 in culture supernatants from malignant glioma cells.
The cavernous sinuses of 50 adult cadavers were examined to investigate the relationships of the blood vessels and cranial nerves, important structures during surgery in this sinus. The first and second divisions of the fifth cranial nerve were embedded in the deep dural layer of the cavernous sinus and were supplied by the two main branches of the intracavernous carotid artery. The meningohypophyseal artery supplied the sixth cranial nerve in Dorello''s canal and the third and fourth cranial nerves where they entered the dura. The inferolateral trunk supplied the third, fourth, fifth, and sixth cranial nerves. The size of the meningohypophyseal artery was usually inversely proportional to the size of the inferolateral trunk. The capsular artery did not supply the cranial nerves. The cavernous sinus can be approached through various routes: a) superior, through the anteromedial or medial triangle; b) lateral, through the paramedial, Parkinson''s, anterolateral, and lateral triangles; c) inferior, through the posterolateral and posteromedial triangles; and d) from the inferomedial walls. The choice of surgical approach depends mainly on the location of the lesion to be treated.
Serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in 73 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm to evaluate cerebral vasospasm. Twenty-six (35.6%) of the 73 patients developed ischemic neurological symptoms associated with cerebral vasospasm, which were reversible in all except four patients (5.5%) who demonstrated low-density areas associated with vasospasm on computed tomographic scans. In general, the flow velocities in the middle cerebral arteries began to increase soon after onset of SAH, reaching the maximum between days 8 and 10, subsequently decreasing gradually. There was no significant difference in the highest value and the time course of flow velocities between symptomatic vasospasm and asymptomatic vasospasm patients. Patients with symptomatic vasospasm demonstrated two typical time courses of flow velocities: rapid increases in flow velocities that preceded the clinical manifestations of vasospasm (16 patients, 61.5%), and no rapid increases in flow velocities despite the presence of ischemic symptoms (10 patients, 38.5%). In the latter, angiograms demonstrated vasospasm in segments distal to those evaluated by TCD examination. These results showed that the degree of cerebral vasospasm cannot be assessed only by the absolute flow velocities. CBF was measured two to 10 (mean 4.7) times within 3 weeks of SAH using the 133Xe intravenous injection method. The CBF value remained stable even during the period of major risk of vasospasm. However, the CBF was significantly lower in patients with symptomatic vasospasm on days 8, 9, 10, 13, 14, and 15, when compared with patients without symptomatic vasospasm. Patients who developed ischemic neurological symptoms due to vasospasm without increased flow velocity also showed a low CBF value. The combination of serial TCD and CBF measurements, using the former for early detection of vasospasm and the latter for evaluation of cerebral ischemia, is at present the best method for diagnosis of vasospasm.
A 57-year-old male suffered a fatal subarachnoid hemorrhage due to ruptured infundibular widening of the internal carotid-posterior communicating artery junction, confirmed by autopsy. Infundibular widening is a preaneurysmal or aneurysmal lesion and indicates angiographic follow-up and control of blood pressure when identified.
A 47-year-old female presented with an unusual association of convexity meningioma with chronic subdural hematoma, manifesting as headache and left hemiparesis 10 days before admission. Computed tomography showed an isodense right frontal tumor with significant enhancement postcontrast and a hypodense subdural hematoma in the right frontotemporal area. Craniotomy exposed an extracerebral tumor facing a liquefied subdural hematoma encapsulated by outer and inner membranes. The hematoma was evacuated and the tumor was totally removed. Histological examination revealed a meningothelial meningioma with hemangiopericytic components. Microscopic examination of the hematoma capsule revealed a cluster of meningothelial cells in the outer membrane.
A 65-year-old female presented with a rare intestinal leiomyosarcoma metastasis to the skull manifesting as a mass beneath the scalp. She was free of neurological and physical symptoms on admission. The tumor was totally removed with normal surrounding bone and dura. The histological diagnosis was leiomyosarcoma. Ultrastructural and immunohistochemical studies demonstrated the smooth muscle origin of the tumor. Such patients in good physical condition should be immediately treated surgically to achieve the best chance of survival.
A 64-year-old male presented with a unique choroid plexus metastasis from gastric cancer. Computed tomography and magnetic resonance imaging demonstrated a moderately enhanced mass in the lateral ventricle. The tumor was totally removed and histological examination revealed adenocarcinoma. Systemic investigation revealed gastric cancer. The differential diagnosis for intraventricular masses should include the possibility of metastasis from unidentified primary lesions.
A modified provocative test to assess the safety of embolization of cerebral and spinal arteriovenous malformations is described. The modified test uses successive amobarbital and lidocaine injections to elicit any possible neurological deficit, both mixed with radiopaque material to visualize the distribution of the anesthetic in the vessels. The modified provocative test caused no false negative results in 11 patients tested, compared to six of 27 patients with the unmodified method.