Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 48, Issue 11
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Elevation of Growth Hormone-Releasing Hormone Receptor Messenger Ribonucleic Acid Expression in Growth Hormone-Secreting Pituitary Adenoma With Gsα Protein Mutation
    Naoyuki SAKAI, Kyongsong KIM, Naoko SANNO, Daizo YOSHIDA, Akira TERAMO ...
    2008 Volume 48 Issue 11 Pages 481-488
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.481
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    Growth hormone-releasing hormone (GHRH) stimulates not only the synthesis and secretion of GH but also the proliferation of normal somatotrophs. The expression of GHRH receptor (GHRHR) is regulated by GHRH, both of which are known to be expressed in human GH-secreting pituitary adenoma cells. Somatic mutations in the subunit of Gsα protein (gsp), lead to the constitutive activation of adenylyl cyclase in pituitary adenomas that secrete GH. It has not been examined how gsp mutations influence GHRHR expression in GH-secreting adenomas. We therefore analyzed the expression levels of GHRHR messenger ribonucleic acid (mRNA) in GH-secreting pituitary adenomas focusing on a gsp mutation. Furthermore, we investigated the effect of GHRH on the expression of GHRHR mRNA in primary cultures of GH-secreting pituitary adenoma cells. GHRHR mRNA expression levels were significantly elevated in gsp mutation-positive GH-secreting adenomas compared with those in gsp mutation-negative ones. In primary-cultured GH-secreting adenoma cells, the increase of GH secretion in response to GHRH was shown in both gsp mutation-positive and -negative adenoma cells with a significantly higher response in the latter adenoma cells. GHRH increased GHRHR mRNA expression level in gsp mutation-negative adenoma cells while it was not influenced by GHRH in gsp mutation-positive adenoma cells. These results suggest that gsp mutations up-regulate GHRHR mRNA expression in GH-secreting pituitary adenoma cells, and that gsp mutations desensitize the adenoma cells to GHRH in terms of their GHRHR mRNA expression probably because of their saturation of GHRH signaling.
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  • Delayed Hyponatremia Following Transsphenoidal Surgery for Pituitary Adenoma
    Jae Il LEE, Won Ho CHO, Byung Kwan CHOI, Seung Heon CHA, Geun Sung SON ...
    2008 Volume 48 Issue 11 Pages 489-494
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.489
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    The incidence and risk factors of symptomatic and asymptomatic hyponatremia were investigated in 94 patients who underwent transsphenoidal surgery and serum sodium level monitoring between January 2002 and December 2006. The records were retrospectively reviewed to determine the incidence and risk factors (age and sex, tumor size, endocrinologic findings) of hyponatremia. Postoperatively, the serum sodium levels of the patients were measured at least once within 2 or 3 days. Hyponatremia was found in 17 of the 94 patients, of whom 7 became symptomatic. The mean sodium level of symptomatic patients with hyponatremia at diagnosis was 123.5 mEq/l, compared with 129.8 mEq/l of asymptomatic patients. The serum sodium levels began to fall on mean postoperative day 7 and reached nadir on mean day 8. All 17 patients with hyponatremia were treated with mild fluid restriction. Four symptomatic patients with severe hyponatremia were treated with 3% hypertonic saline infusion in addition to fluid restriction. One symptomatic patient with severe hyponatremia was treated with fluid restriction only. All patients recovered within 5 days of management. Sex, tumor type, and tumor size did not correlate with development of delayed hyponatremia, but patients aged ≥50 years were more likely to develop hyponatremia. Postoperative hyponatremia after transsphenoidal surgery is more common than previously reported and may lead to fatal complications. Therefore, all patients should undergo serum electrolyte level monitoring regularly for at least 1 or 2 weeks after transsphenoidal surgery.
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  • Usefulness and Limitations of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography for the Detection of Malignancy of Orbital Tumors
    Junichi MIYAMOTO, Kazunori TATSUZAWA, Kei OWADA, Takuya KAWABE, Hiroya ...
    2008 Volume 48 Issue 11 Pages 495-499
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.495
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    Fluorine-18-fluorodeoxyglucose positron emission tomography ([18F]FDG PET) was assessed as a method for providing information about the malignancy of orbital tumors. Twelve patients with 13 orbital tumors underwent [18F]FDG PET followed by biopsy or tumor removal via a transcranial approach. The accumulation ratio between the tumor and the contralateral normal tissue (T/N ratio) was calculated for 10 of the 13 lesions. The T/N ratio in benign lesions was compared with that in malignant tumors. Histological examination identified 7 lesions as malignant: anaplastic astrocytoma of the optic nerve in 1 patient, which recurred as glioblastoma of the optic nerve, malignant lymphoma of mucosa-associated lymphoid tissue type in 1 patient, malignant melanoma in 1 patient, adenoid cystic carcinoma in 2 patients, and adenocarcinoma (unknown origin) in 1 patient. The T/N ratio was 1.06 ± 0.03 (mean ± standard deviation) in benign tumors, and significantly higher at 1.81 ± 0.27 in malignant tumors (p = 0.0027). Both patterns of high and iso uptake of [18F]FDG were found in orbital pseudotumor. [18F]FDG PET can determine the malignancy of orbital tumors, but cannot distinguish malignant tumor from inflammatory disease such as pseudotumor.
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  • Induction of Cyclooxygenase-2 Expression by Interleukin-1β in Human Glioma Cell Line, U87MG
    Seijiro TANIURA, Hideki KAMITANI, Takashi WATANABE, Thomas E. ELING
    2008 Volume 48 Issue 11 Pages 500-505
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.500
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    Cyclooxygenase-2 (COX-2) is up-regulated in most high-grade gliomas, and high COX-2 expression is associated with aggressive character and poor prognosis. However, the effect of COX-2 in human glioma cell lines is not well known. This study examined the effect of several stimuli, including interleukin-1β (IL-1β) and carcinogens, on COX-2 induction in normal astrocyte cells and human glioma cell lines U87MG, A172, and T98G. IL-1β-induced COX-2 expression strongly at both protein and messenger ribonucleic acid levels in only the U87MG cells of the glioma cell lines. Furthermore, carcinogen induced COX-2 expression. Similar findings were also observed in normal human astrocyte cells. The U87MG glioma cell line is a good model for COX-2 induction in glioma cell lines.
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Case Reports
  • Subarachnoid Hemorrhage Caused by Rupture of a Distal Anterior Inferior Cerebellar Artery Aneurysm
    —Three Case Reports—
    Atsushi SAITO, Akiko NISHINO, Ichiro SUZUKI, Hiroyasu SUZUKI, Akihiro ...
    2008 Volume 48 Issue 11 Pages 506-511
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.506
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    Three female patients, two under 35 years old, presented with ruptured aneurysms of the distal anterior inferior cerebellar artery (AICA) manifesting as subarachnoid hemorrhage. The first patient had a ruptured saccular aneurysm of the meatal loop of AICA, which was treated by direct neck clipping. The second patient had a ruptured aneurysmal lesion that arose from a microvascular anomaly of the dorsolateral portion of the AICA, which was successfully treated by trapping. The third patient was dead on arrival, and autopsy revealed a ruptured saccular aneurysm in the meatal loop of the AICA. The mechanism of development of distal AICA aneurysm remains unclear, and some cases indicate a complicated causal relationship between the aneurysms and vascular anomalies. Neurosurgeons need to carefully evaluate the vascular structure around the aneurysms by preoperative angiography in each case, and select the most appropriate strategy.
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  • Rupture of a Concomitant Unruptured Cerebral Aneurysm Within 2 Weeks of Surgical Repair of a Ruptured Cerebral Aneurysm
    —Case Report—
    Yuichi SATO, Shunsuke KAKINO, Kuniaki OGASAWARA, Yoshitaka KUBO, Hirok ...
    2008 Volume 48 Issue 11 Pages 512-514
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.512
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    A 53-year-old man presented with subarachnoid hemorrhage (SAH) in the left sylvian fissure. Preoperative computed tomography angiography revealed symmetrical aneurysms located at the bifurcations of the right and left middle cerebral arteries (MCAs). The left MCA aneurysm responsible for the SAH was clipped. The patient received post-surgical volume expansion treatment that did not induce hypertension. His systolic blood pressure ranged from 170 to 225 mmHg between the day of the first surgery and the 11th postoperative day. The postoperative course was uneventful until the 11th postoperative day when the patient suffered another SAH in the right sylvian fissure. The right MCA aneurysm was responsible for the second SAH and was clipped. The patient had multiple risk factors for rupture of concomitant unruptured aneurysm including a large, multilobed aneurysm, hypertension, smoking, and a family history of aneurysmal SAH. The present case suggests that all aneurysms should be simultaneously treated using endovascular coil embolization or several craniotomies if the patient has multiple risk factors.
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  • Internal Trapping Following Proximal Clipping for a Ruptured Partially Thrombosed Giant Aneurysm of the Vertebral Artery
    —Case Report—
    Yuzo TERAKAWA, Akinori YAMAMURA, Naoaki MURAYAMA, Hitomi KIMURA, Toshi ...
    2008 Volume 48 Issue 11 Pages 515-518
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.515
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    A 52-year-old woman presented with a partially thrombosed giant aneurysm of the vertebral artery (VA) manifesting as a 3-month history of left hemiparesis. She developed subarachnoid hemorrhage during hospitalization and underwent emergency surgery for surgical proximal clipping and ventricular drainage with decompressive suboccipital craniectomy. She underwent additional surgery for endovascular coil embolization of the aneurysm and the affected distal VA on the 7th postoperative day. Although she suffered transient lower cranial nerve pareses and respiratory failure, her neurological condition improved gradually and she returned home with only slight ataxia and hoarseness 3 months after surgery. Magnetic resonance imaging obtained 28 months postoperatively revealed a remarkable decrease in the size of the aneurysm as well as reduction of the mass effect on the brainstem. Combined proximal clipping and internal trapping can solve the problems associated with treatment of giant aneurysms of VA by either direct surgery or endovascular surgery, and should be considered as a therapeutic option for giant aneurysms of the VA.
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  • Intra-axial Brainstem Malignant Melanoma Mimicking Cavernous Angioma
    —Case Report—
    Mitsuya WATANABE, Yasuaki NAKAO, Takuji YAMAMOTO, Kentaro MORI, Ryo WA ...
    2008 Volume 48 Issue 11 Pages 519-521
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.519
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    A 41-year-old female presented with repeated pontine hemorrhage. Magnetic resonance imaging showed the pontine hemorrhage as a heterogeneously enhanced mass mimicking cavernous angioma. The mass lesion was removed via a midline suboccipital approach. Histological examination showed malignant melanoma cells. No cutaneous lesion was found and positron emission tomography found no abnormalities. Our presumptive diagnosis was primary intra-axial brainstem malignant melanoma. The possibility of malignant melanoma should be considered in patients with intra-axial brainstem lesion associated with repeated hemorrhages.
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  • Development of Testicular Alpha-Fetoprotein-Secreting Germ Cell Tumor 3 Years After Treatment of Intracranial Lesion Identified as Non-secreting Germ Cell Tumor on the Basis of Clinical Data
    —Case Report—
    Satoshi TAKAHASHI, Kazunari YOSHIDA, Shuji MIKAMI, Mototsugu OYA, Take ...
    2008 Volume 48 Issue 11 Pages 522-525
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.522
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    A 22-year-old Asian male developed testicular alpha-fetoprotein (AFP)-secreting germ cell tumor 3 years after treatment of a disseminated intracranial lesion identified as non-secreting germ cell tumor on the basis of clinical data. Magnetic resonance imaging showed a massive lesion with necrosis appearing as hypointense on T1- and hyperintense on T2-weighted imaging, with heterogeneous enhancement. The blood AFP level was as high as 129 ng/ml (previously, as low as 5 ng/ml) and abdominal computed tomography showed para-aortic lymph node swelling. Left orchidectomy was performed and histological examination indicated the presence of AFP-secreting germ cell tumor despite severe necrosis of the tissue. Improved chemoradiotherapy for intracranial germ cell tumor will lead to long-term survival of most patients with germ cell tumor. Patients may subsequently develop germ cell tumors at other sites in the body. Therefore, follow up should monitor for tumor recurrence not only in the brain but also in other locations.
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  • Transanal Prolapse of a Ventriculoperitoneal Shunt Catheter
    —Case Report—
    Hidenori MATSUOKA, Tetsuro TAKEGAMI, Daisuke MARUYAMA, Tomoyuki HAMASA ...
    2008 Volume 48 Issue 11 Pages 526-528
    Published: 2008
    Released on J-STAGE: November 25, 2008
    DOIhttps://doi.org/10.2176/nmc.48.526
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    A 4-year-old girl presented with asymptomatic bowel perforation and transanal protrusion of a ventriculoperitoneal (VP) shunt catheter. She had undergone repair of myelomeningocele at birth and subsequent VP shunting for congenital hydrocephalus 1 month later. Seven months after VP shunting, she underwent revision of the peritoneal catheter. She complained of abdominal pain and nausea at the age of 4 years. She was treated conservatively for 1 month for intestinal obstruction. One month later, her mother noticed the shunt catheter protruding from her anus. Computed tomography (CT) of the abdomen revealed that the peritoneal catheter had migrated into the colon, and CT of the head showed symmetrical dilation of the ventricles. The shunt system was removed immediately, repair of the fistula in the sigmoid colon was performed, and external ventricular drainage was continued for 6 weeks until shunt replacement. One month after the first operation, intestinal obstruction recurred. Duplication of the terminal ileum was removed to prevent further recurrence of the intestinal obstruction. She underwent ventriculoatrial shunting 2 weeks after the second operation and was discharged without neurological sequelae.
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Editorial Committee
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