Advances in neuroradiological diagnostic equipment have made even the diagnosis of brainstem vascular lesions much easier. To understand neu-rological symptomatology more precisely, however, it is necessary to know the microanatomy of brainstem blood supply in relation to brainstem structures and clinical manifestations of brainstem vascular lesions. Currently, several incorrect classifications of brainstem blood supply are used throughout the world. Such classifications have been proposed without the study of brainstem structures and vascular distribution by serial sections of the brainstem. We propose that it is best to classify clinical manifestations of brainstem vascular lesions according to the anatomical sites of the lesions and precise knowledge of blood supply. This paper discusses this point and shows that intracerebral vascular syndromes should be named by the vascular supplying areas, not by the subarachnoid vessels.

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We analyzed 21 patients, each with a giant meningioma (more than 6cm maximum diameter) calculated from contrast enhanced computed tomography (CT) images or magnetic resonance images (MRIs) . The volumes of the tumors were measured by an image analyzer to study the correlation of the volume with sex, age, site of development, pathology, outcome and maximum diameter of the image. The results of the present study can be summarized as follows: 1) Tumor volume ranged from 16.6 cm³ to 78.7cm³ (mean, 34.0cm³) . 2) Mean tumor volume was greater in men than in women. 3) The maximum diameters on the images did not proportionally represent tumor volumes (r=0.54) . 4) There was no correlation between tumor volume and patient age (r=0.29) ; between volume and site of development, nor between volume and pathology. 5) Patients with malignant pathology had poor prognoses regardless of tumor volume. Measurement of tumor volume with the help of an image analyzer provides important information for the treatment of clinical patients.

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Endothelin-1 (ET-1) localization in dental and skeletal tissues was examined immunocytochemically using a biotin-streptoavidin-horseradish peroxidase method in paraffin sections. Mouse anti-ET-1 monoclonal antibody was used as the primary antibody. In teeth and periodontal tissues, intense immunostaining was observable mainly in periodontal ligament cells, i.e. fibroblasts, osteoblasts, osteoclasts, and vascular endothelial cells. Dental pulp, dentine, cementum, bone matrix, and gingival connective tissues were nonimmunoreactive. In the gingival epithelium, cells in the basal, prickle, and glanular layers stained intensely, whereas those of the keratinized layer were devoid of immunostaining. In metaphyseal bone marrow, intense immunostaining was observed over osteoclasts, osteoblasts, young osteocytes, and vascular endothelial cells. Bone and cartilage matrices, as well as chondrocytes in resting and proliferating zones, were, however, negative for immunoreaction. These results indicate that ET-1 is present in the cells of dental, periodontal, and bone tissues. Its wide distribution may reflect its involvement in various cellular functions in these tissues.

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A histopathologic study based on serial sections of the conduction system was performed on 31 cases with chronic advanced or complete atrio-ventricular (AV) block. The patients were divided into 3 groups according to the injured portion of the conduction system: group 1 with lesions in the AV node or its approach, 4 patients; group 2 with lesions in His bundle, 10 patients; and group 3 with lesions of bundle branches and/or His bundle, 17 patients. The frequency of lesion site agreed with other reports. Fibrosis of the conduction system has been reported as the cause of conduction disturbance, but the etiology has not been made clear. In group 1, peri-cardial inflammation was seen in 3 of 4 cases. In group 2, inflammatory infiltration was noted in only 2 cases. Idiopathic fibrosis of conduction tissue or calcification of the AV ring was evident in 6 of 10 cases. In group 3, not only Lev disease and Lenègre disease but also perimyocarditis and its sequela were seen. Perimyocarditis and its sequela could be observed in 9 of 17 cases. Therefore, the occurrence ratio of perimyocarditis was higher than anticipated.

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Occipitovertebral anastomosis was examined in 22 cadavers after injection of polyvinyl acetate through the ipsilateral common carotid artery to reveal the precise morphology. There were anastomotic channels in 14 cadavers. The anastomotic forms of the channels were classified into two types. Type 1 had a direct anastomosis (8 cadavers), and type 2 had net-like anastomoses (6 cadavers) . The branching portion from the occipital artery was 7.9 mm (mean) posteromedial from the mastoid process, and the joining portion to the vertebral artery was 7.1 mm (mean) lateral from the posterior atlanto-occipital membrane. The inside diameter of the anastomotic channels, measured with the help of an image analyzer, was 0.36mm (mean) . As the occipitovertebral anastomosis occurs frequently, a careful intravascular operation through the occipital artery should be performed. Neurosurgeons must always keep in mind that direct anastomosis is more frequent than net-like anastomosis in sub-occipital muscles.

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The existence of hazardous chemical wastes in drinking water has always been a social problem. In a particular epidemiological study, the preva-lence of congenital cardiac defects in a very localized industrial area contami-nated by industrial chemicals, such as dichloroethylene (DCE) and trichloro-ethylene (TCE) was relatively highs. The report gave clear evidence of the teratogenicity of DCE and TCE, and warnings were issued. The proportion of offspring with congenital heart defects was greater for parents exposed during the critical period of fetal development of the cardiovascular system. In our previous study, experiments with chick embryos revealed significant cardiac teratogenesis and abnormal tissue dynamics, particularly if TCE was introduced in early stages of developer ent . The purpose of the present investigation was to determine whether DCE would also cardiac anomalies associated with func-tional and histological changes encountered in the TCE experiment using chick embryos. Also, electro-physiological changes were followed to find evidence of the pathophysiological mechanisms. Early on day 4 of incubation, 0.05 ml of 15 μM or 20μM DCE solution was administered on the chorioallantoic membrane of developing chick embryos. A wide spectrum of cardiovascular malformations was noted in the DCE experimental group. Abnormal electro-cardiographic changes including low voltage QRS and ST segmental variations were observed 6 to 30 minutes after DCE application. Ultrastructually, the cellular degeneration of the embryonic myocardium was quite prominent, especially in the primitive ventricular area. Comparing the cardiac anomalies of the TCE experiment with those of the DCE experiment, DCE induced a lesser degree of developmental arrest type cardiovascular anomalies.

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A previous study, with two dimensional polyacrylamide gel electro-phoresis (2D-PAGE), revealed no α_l-acid glycoprotein (AGP) in normal sera on 2D-PAGE, but it was apparent in cerebrospinal fluid (CSF) . We quantita-tively and qualitatively evaluated AGP in CSF. Quantitative analysis of AGP in CSF indicated that AGP might be synthesized in the central nervous system (CNS) and increase in CSF on the occasion of a CNS-accident such as development of a CNS neoplasm. AGP has a marked heterogeneity due to its high content of glycoside chains. We report here, from analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and high performance liquid chromatography (HPLC) -anion exchange chromatography, that CSF-AGP from glioma patients had lower molecular weight, less sialic acid content, and lower negative electrical charge than serum-AGP. AGP was distributed into 4 fractions by concanavalin A (Con A) crossed affino-immunoelectrophoresis (CAIE) . One of the AGP fractions on Con A-CAIE of CSF from patients with gliomas had a stronger interaction with Con A than any other AGP fractions of CSF-AGP and serum-AGP. AGP strongly bound with Con A was elevated in glioma patient-CSF and that which interacted only weakly or not at all with Con A was increased in normal sera. Also, wheat germ agglutinin (WGA) -CAIE divided serum-AGP and glioma patient-CSF-AGP into two fractions. One of these two fractions indicated a strong interaction between AGP and WGA, and the other was suitable for AGP which interacted very little or not at all with WGA. The former fraction was not present in the WGA-CAIE of normal CSF. Furthermore, these two fractions were fused by desialilation into one fraction at a position between the two fractions. We believed that these results might indicate the alteration of protein glycosilation by neoplasmic changes. Consequently, further analysis of the heterogeneities of AGP could make CSF-AGP a reliable marker for diagnosis and prognosis-estimation of gliomas.

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A simple method has been devised to facilitate ultraviolet (UV) spectrophotometric assay of monoamine oxidase (MAO) activity towards serotonin (5-HT) as a substrate. Validation of the methodology is described in this report. Mitochondria were obtained from the cortex of the hog kidney, of which 1 part was suspended in 3 parts of 0.25 M sucrose-phosphate buffer and used as the enzyme source (Mt, 26 mg protein/ml) . The reaction mixture was comprised of phosphate buffer (pH 7.0, 10 mM), 5-HT hydrochloride (10 mM), and semicarbazone acetate (5 mM) in a final volume of 5 ml; fixed amounts of Mt for the time-course study, or varied amounts of Mt for the enzyme amountreaction rate study were included as needed. Varied concentrations of harmaline (HM) or pargyline (PG) were added to another mixture with a fixed amount of Mt for inhibition studies. The mixtures were reacted at 37°C and the resulting semicarbazone of 5-hydroxyindole acetaldehyde was extratced into ethyl acetate for UV scanning. The UV extinction (λ_max 274 nm) increased linearly with the time-course or the Mt amounts, suggesting the usefulness of the UV measure-ment for monitoring MAO activity. Inhibition of MAO activity was stronger with HM (PI₅₀= 6.8) and weaker with PG (pI₅₀=3.8), suggesting that 5-HT was the substrate for both the A-type and the B-type of MAO. In a comparison study with benzylamine (BZ) as a substrate, the UV spectra (A_max 280 nm) similar to that from the authentic benzaldehyde were recorded and inhibition was produced only by PG (pI₅₀=5.8) . These results agree with the substrate-selectivity and inhibitor-susceptibility findings reported by us on the MAO activity in slices of hog kidney cortex measured by Warburg's manometry, and reported by others with different materials and methods. The usefulness of this method for assaying MAO activities towards 5-HT has thus been verified.

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Research findings increasingly support the view that eosinophils are important in the pathogenesis of asthma. Because eosinophils are under the control of cytokines, we measured eosinophil viability enhancing activity (EVEA) in bronchoalveolar lavage (BAL) fluids from patients who had symptomatic asthma (n=40), asymptomatic asthma (n=9), and patients with diseases other than asthma (n=3) . The BAL fluids from 15 symptomatic asthmatics showed increased EVEA. High levels of EVEA in four BAL fluid samples were almost completely blocked by an anti-interleukin (IL) -5 monoclonal antibody, and the remaining activity was blocked by anti-granulocyte-macrophage colony-stimulat-ing factor (GM-CSF) and/or an anti-IL-3 antibody. These findings suggest that EVEA in asthma is mediated mainly by IL-5, with lesser contributions from GM-CSF and IL-3. To determine when each eosinophil active cytokine appeared, we measured EVEA in BAL fluid samples from patients who had allergic rhinitis and had undergone segmental bronchoprovocation (SBP) with ragweed extract. Twenty-four hours after SBP, EVEA in BAL fluid was mostly due to IL-5; 48 hours after SBP, EVEA was mainly due to IL-5 with lesser contributions from GM-CSF, and IL-3. Thus, IL-5 is the predominant eosino-phil-active cytokine in asthma and may play a key role in the pathophysiology of eosinophil-associated airway inflammation.

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The vestibular pathology of a perilymph fistula produced either by injecting an artificial perilymph into the subarachnoid space or by suctioning the perilymph through the round window was studied in animal models. Vestibular changes observed were the collapse of the otolithic organs or the semicircular ducts, which were demonstrated by computer graphics from serially sectioned specimens. Collapse of the utricular wall was common. In some animals, part of the utricular wall collapsed onto the otolithic membrane of the parts interna. When changes were severe, the whole macula utriculi was covered by the collapsed wall. The trabecular mesh was torn in the utricle and semi-circular canals. Collapse was irreversible. However, no otolithic membrane, sensory epithelium or nerve fibers were involved. Collapse of the ampullary wall, saccule and cochlea were also evident. The mechanism of the collapse is explained by the finding of the rupture of the Reissner's membrane. Withdrawal of the endolymph from the cochlea possibly caused the collapse of the vestibular membranous labyrinth. The sensory cells of the macula utriculi being stimulated by the collapsed utricular wall onto the otolithic membrane could explain the persistent dizziness of patients with preilymph fistula.

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The Interscalar septum (ISS) between the apical and middle turns was dissected out of the human cochlea and morphologically studied. The ISS is a thin bony plate, in which run the radiating arterioles to the middle turn and the venules from the lower spiral ligament of the apical turn. The radiating arterioles are located within the fairly large perivascular space. Melanocytes with irregular or granular shapes adhere to the wall of the radiating arterioles. These cells also adhere to the wall of the perivascular space without touching the arteriole wall. Strands, which are possibly remnants of atrophied blood vessels are observed within the space. An avascular channel is also observed. Indian ink injected into the modiolus reaches the upper spiral ligament via the perivascular space of the radiating arteriole. It is possible that cerebrospinal fluid reaches the cochlear lateral wall through the same space to participate in formation of the perilymph.

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To evaluate the feasibility of preoperative chemotherapy, 38 consecutive, previously untreated patients with loco-regional advanced gastric carci-noma received preoperative 5-Fu or 5′-DFUR by oral administration. Clinically, 18 patients indicated a macroscopic response. Histopathologically, 11 cases had no effect, 23 were slightly affected, 3 had moderate effects, and one had an excellent effect. The overall five-year survival rate was 41%. According to clinical staging by TNM classification, five-year survival rates were 78% in stage II, 46% in stage III and 15% in stage IV. The overall five-year survival rate of cases with a positive histopathological effect was 51 %, while the survival rate of cases with a negative histopathological effect was 14%. Especially in the cases of stages II and III, the prognosis for positive-histopathological-effect cases was significantly better than that for negative-histopathological-effect cases. On the other hand, the existence of a macroscopic change did not significantly affect the survival of a patient. Consequently, mild preoperative chemotherapy is useful for resectable gastric cancer cases with a positive histo-pathological effect.

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A 17-year-old boy, an assistant truck driver who consumed whiskey and smoked developed rapidly progressive glomerulonephritis and renal failure, but no lung hemorrhage. The disease was associated with antiglomerular basement membrane antibodies in the serum, linear deposits of IgG along the glomerular basement membrane, and diffuse epithelial crescents on renal biopsy. Past history revealed heavy smoking and involuntary indeliberate inhaling of gasoline which may have affected the structure of the glomerular basement membrane (GBM) . Despite extensive treatment by steroid and cyclophosphamide, renal function rapidly deteriorated, and hemodialysis was finally introduced. His HLA type showed DR2 and DR5 which are strongly linked to Goodpasture's syndrome. All of these factors can possibly cause the development of anti-glomerular basement membrane disease.

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