[Penetrating transorbital intracranial foreign body]

About a month prior to admission to our hospital, a 25-year-old man had a quarrel with his friend and was stabbed in his left eye with a cracked bottle of beer. He underwent emergency operation for the injured left eye. Subsequently he was admitted to an ophthalmological ward in our hospital for plastic surgery of an artificial eye. An intracranial foreign body was pointed out, and he was soon transferred to our neurosurgical ward. Plain x-ray films and tomograms of the skull and CT scan showed a foreign body at medial portion of the left superior orbital fissure. Carotid angiography revealed no significant implication of the cerebral vessels. As there was a strong suspicion of cerebral contusion or liquorrhea, a pterional craniotomy was so designed as to do removal of thie foreign body and repair of the dura mater in one stage. The post-operative couse was uneventful without liquorrhea or miningitis. It was emphasized that pterional approach used by Hamby (1970) for surgery of malignant exophthalmos was useful and felicitious in this case. It was additionally reported that cerebrospinal orbitorrhea observed in this case was rare and it might be the third case in the literature.

Changes in peripheral nerve fibres distal to a constriction

Continued constriction of the tibial nerve of the rabbit by a ligature was accompanied by a reduction in maximal motor conduction velocity distal to the ligature, and by a reduction in axonal and total fibre diameter. From the presence of paranodal demyelination and distal fibre degeneration in severely affected nerves, it is suggested that in some instances the change in axonal calibre was part of a progressive distal atrophy which could lead to secondary demyelination and ultimately to "dying-back" of the affected axons.

Bile reflux: a possible cause of stomach ulcer in nontreated mutant mice of W/WV genotype

The chronic antral ulcer developed spontaneously in (WB X C57BL/6)F1-W/WV mice. Natural history of the ulcer was investigated to make clear the mechanisms involved in the development of ulcer in this mutant mouse. Although no histopathologic abnormalities of the stomach were detected at the fifth day after birth, erosions developed at the tenth day and the severity of the ulcerative lesions advanced with age. Antral pH of the W/WV mice was higher than that of the congenic +/+ mice, and the content of gastrin in the glandular stomach of the former was lower than that of the latter. Therefore, hyperacidity cannot be the cause of the ulcer in the W/WV mice. Bilirubin was demonstrable in the stomach contents of the suckling W/WV mice. After subcutaneous injection of [35S]sulfobromophthalein, the 35S radio-activity in the stomach contents of the 10-day-old W/WV mice was about 40 times as great as that observed in the +/+ littermates. As the peak of the bile reflux occurred shortly before the development of obvious ulcer that penetrated beyond the muscularis mucosae, the bile reflux could be a cause rather than a result of the ulcer.

Electrocochleographic study of Ménière's disease

Auditory nerve action potential (AP), cochlear microphonics (CM), and summating potential (SP) were recorded from 32 patients with Ménière's disease. Patients were classified into three groups according to the degree of their hearing impairment. The group of patients that had a mild to moderate hearing loss and whose hearing was reversible showed notably satisfactory responses for AP, CM, and negative SP (-SP), and also showed a high incidence of positive SP (+SP). Low responses for AP and CM with an increase of detection thresholds and a high -SP/AP ratio were obtained from patients with moderate hearing impairment, whose hearing fluctuated slightly. These electrocochleographic findings were suggestive of the pathophysiologic differences at the various stages of Ménière's disease.

[Canine parvovirus infection in a group of beagles (author's transl)]

An outbreak of canine parvovirus infection in a group of 26 beagles was described. The disease characterized by acute intestinal involvement was highly contagious but fatality was low (1/26). Transient leukopenia was recorded in some animals. All the convalescent sera were positive in agar gel diffusion test using feline panleukopenia virus antigen. Histopathological examination on fetal dog revealed regressive change associated with formation of amphophilic intranuclear inclusion bodies in the enterocytes of the Lieberkühn's crypt and regressive change in the lymphoid tissues. Pathologic picture exhibited strikingly resemblance with that of feline panleukopenia.

Anticomplement immunofluorescence for the titration of antibody to varicella-zoster virus

Anticomplement immunofluorescence (ACIF) was tested for its use for the titration of antibody against varicella-zoster virus (VZV). ACIF antibody responses of patients with VZV infection were specific for VZV antigen and heterotypic responses to herpes simplex virus type-1 and cytomegalovirus antigens were not observed. Comparative studies of ACIF, membrane immunofluorescence (MIF) and indirect immunofluorescence (IF), using acetone-fixed antigen, were carried out with nonimmune sera and convalescent sera of patients who had recovered from varicella, herpes zoster and Rumsey Hunt disease. Nonspecific staining occurred with some nonimmune sera at a 1:4 dilution in the MIF and IF tests, after freezing and thawing of the serum, but not in the ACIF test. The antibody titers in convalescent sera agreed well in these three methods and the highest titer was obtained by MIF. The titers in ACIF and IF were similar but the ACIF antibody decreased earlier than the IF antibody during convalescence. On the other hand there was a discrepancy between the titers of ACIF and those of MIF and IF antibody in the sera of healthy adults, all sera with titers higher than 10 in the MIF and IF tests had titers below 10 in the ACIF test. The average titer of ACIF antibody declined to less than 10 with increasing age (13 to more than 20 years), whereas the MIF antibody increased during the same period of life.

Electrocochleographic study of patients with cerebral vascular lesions

Electrocochleographies were performed on three patients with deafness resulting from cerebral vascular lesions. Recording was made by the transtympanic needle electrode technique. In a patient who had anterior-inferior cerebellar artery aneurysm that showed fluctuating hearing loss, auditory nerve action potential (AP), cochlear microphonics (CM), and summating potential fluctuate in amplitude in concert with episodes of ischemic hearing loss. This indicates the pathophysiology of reversible impairment of the cochlear nerve and of sensory epithelium of the inner ear caused by disturbance of blood flow into the inner ear. It was also conjectured that the cochlea is hardly impaired in the case with normal AP and CM responses despite the increased threshold in pure-tone audiometry and that the cochlea undergoes irreversible organic changes in the patient who has no AP or CM response in tests after a long period.

Time-dependent changes in open-loop gains of baroreflex systems after massive hemorrhage

To quantify the effects of massive hemorrhage (5 ml/kg body weight) on the individual arterial baroreflex systems in the dog, changes in the open-loop gains of the intact arterial pressure control system (Gintact), the carotid sinus baroreflex system (GCS), and the vagally mediated and aortic arch baroreflex systems (GV) were measured repeatedly from the response to quick mild hemorrhage (2 ml/kg body weight) before and after massive hemorrhage. Fifteen mongrel adult dogs were divided into 3 groups. i.e., the control, vago-aortic nerve-severed, and carotid sinus-denervated groups. The dogs anesthetized with Nembutal (35 mg/kg body weight) were bled by 2 ml/kg body weight within 2 sec through a catheter inserted into the abdominal aorta. The arterial pressure change after mild hemorrhage was monitored via a catheter placed in the aortic arch. The open-loop gain of the baroreflex system was assessed as (delta API/delta APS--1), where delta API and delta APS are the immediate and steady-state falls in arterial pressure following mild hemorrhage. The mean values of Gintact, GCS, and GV before massive hemorrhage were 7.8, 2.0, and 1.8, respectively. Since Gintact is not a simple summation of GCS and GV, it is speculated that the carotid sinus baroreflex system interacts in a facilitatory way with the vagally mediated and aortic arch baroreflex systems. After massive hemorrhage, Gintact changed along a time course of parabolic form, whereas GCS did not change and GV decreased. These results suggest that the time-dependent change of Gintact after massive hemorrhage depends on the change in the open-loop gain of the baroreflex system making a facilitatory interaction.

Inhibition of gastrin secretion by pirenzepine (LS 519) in treatment of gastric ulcer

The effects of pirenzepine on the serum gastrin levels in the basal state and in response to a liquid test meal were investigated in nine patients with gastric ulcer. Single-dose administration of the drug caused a significant decrease in the basal gastrin level and significant inhibition of the serum gastrin response. When measured 12 h after the end of drug treatment for 7 days, the serum gastrin levels in the basal state and in response to a test meal tended to be high, but the differences were not statistically significant.

Carcinoembryonic antigen in gastric juice as an aid in diagnosis of early gastric cancer

The levels of carcinoembryonic antigen (CEA) in the serum and gastric juice of 58 patients with gastric cancer were determined by radioimmunoassay. The level of serum CEA was not a satisfactory indicator of gastric cancer: it was elevated in only 19.4% of the cases of advanced and unresectable cancer and 4.5% of cases of early cancer examined. However, the CEA level in the gastric juice was significantly higher in patients with gastric cancer than in normal subjects or patients with benign gastric diseases: increased CEA concentrations and outputs in the gastric juice were observed in 54.5% and 40.1%, respectively, of the patients with early gastric cancer, and in 52.9% and 50.0%, respectively, of the patients with advanced gastric cancer. The gross type of gastric cancer had no influence on the gastric CEA level, but the CEA level in the gastric juice tended to be high when the tumors were large, or when they had little or no glandular structure or high mucus-secreting activity.

[A reevaluation of the glucagon provocative test for pheochromocytoma--on the in vitro release of catecholamine from the adrenal medulla or pheochromocytoma tissue, and on the effect of intravenous glucagon on urinary catecholamine excretion and blood pressure (author's transl)]

The effects of glucagon on the adrenergic system have been studied in experimental and clinical conditions. 1. in vitro studies: In the first experiment a continuous flow incubation system was developed in which the secretory response to these drugs was characterized by a serial fluorimetric assay of catecholamines in the effluent medium. Pig adrenal medulla or human pheochromocytoma were studied. There was an initial massive release of catecholamines which declined to basal levels (0.02 micrograms/mg) after 1.5 hours. When 10(-4) glucagon was infused for 10 minutes following 2 hours of preincubation, both adrenaline and nonadrenaline outputs rose abruptly to concentrations of 0.08 micrograms/mg and 0.07 micrograms/mg respectively. In the second experiment the effect of these drugs on the in vitro release of catecholamines from the isolated in vitro chromaffin granules of the pig adrenal medulla were studied. The results were the same as in the previous experiment. 2. clinical studies: The effects of glucagon were studied on the blood pressure and urinary catecholamine levels of healthy control subjects, of patients suffering from essential hypertension, thyroid disease, diabetes mellitus and acromegaly. Glucagon induced a slight but constant increase in blood pressure. By contrast no significant urinary catecholaline elevation was evoked. There was no difference in the effect of intravenous glucagon between normal subjects and patients suffering from the above-mentioned disorders.

Anisocoria in inner ear lesions

In experiments using rabbits, the pupil on the side of irritative inner ear lesion showed dilatation, and that on the side of paretic lesion showed constriction. In the clinical observation of patients with unilateral inner ear diseases (134 cases), anisocoria was recognized in 54.5%. In 68.5% of these, anisocoria was induced after applying a drop of neosynephrine. The size of the pupil on the healthy side was smaller in 65.8% than the pupil on the healthy side. Anisocoria in inner ear lesions is believed to be due to vestibulo-sympathetic imbalance through the superior cervical sympathetic ganglion.

Morphometrical analysis of the peripheral nerve lesions in experimental diabetes rats

Morphometrical analysis of the peripheral nerve lesions in experimental diabetes rats was undertaken to elucidate their relationship to glucose intolerance and nerve conduction velocity. Motor nerve conduction velocity of the rat's tail and nerve fiber density in the cross sectional view of the peroneal nerves significantly reduced in the diabetes rats without insulin treatment. With the teased nerve fiber methods, degenerated nerve fibers frequently appeared and shortening of internodal length was estimated in the diabetes rats by quantification. The slowing of nerve conduction, blood glucose levels on the oral glucose tolerance test and the incidence of degenerated nerve fibers were well correlated with one another. Daily insulin treatment caused a significant decrease in degenerated nerve fibers in the diabetes rats. The reduction of nerve fiber density was also related to glucose intolerance. However, there was neither the relationship between nerve fiber density and incidence of degenerated nerve fibers, nor the relationship between nerve fiber density and nerve conduction velocity.

Cyclophosphamide eliminates suppressor T cells in age-associated central regulation of delayed hypersensitivity in mice

Effect of treatment of mice with cyclophosphamide (CY) on the delayed hypersensitivity (DH) response was investigated in C57BL/6 mice. DH to methylated human serum albumin (MHSA) could be enhanced with CY in young mice but not in aged ones. DH enhancement with CY appeared to be due to elimination of suppressor T cells involved in DH. Effector T cells were also sensitive to CY, the damaging effect of CY on these latter cells was, however, transient suggesting the rapid recovery of effector T cells. The overshooting recovery of the effector T cells required the presence of the thymus. It is more probably that there are at least two distinct subpopulations of T cells in DH, effector T cells, and suppressor T cells. The distinction is already apparent in the thymus stage. The suppressor T cells, categorized as a central regulator, seem to be antigen nonspecific and regulate the more effectively the DH in young mice, thus physiological role of these cells in age-associated immune alterations is implicated.

A case of mesenchymoma in the oral cavity clinically resembling a large pleomorphic adenoma

A report is made of a 52-year-old male whose main complaint was a painless tumor at the right side of the palate resulting in speech disturbance. He was diagnosed as a case of what Stout called benign mesenchymoma. Some discussion is also made of the tumor pathology in terms of genetic factors, predirective sites, age range, sex differences and therapy.

[Cystic craniopharyngioma extending down into the upper cervical spinal canal (author's transl)]

A case of craniopharyngioma with a large cyst extending through the posterior fossa down into the upper cervical spinal canal was reported. The patient is a 14-year-old female who was operated on for the first time in 1970, because of a suprasellar calcified mass. Histological examination verified craniopharyngioma of adamantinomatous type. Since then, she had been operated three times because of deterioration of visual acuity. She was admitted for the fifth time in January, 1977, complaining of severe neck pain radiating bilaterally to the shoulders. Radiological examination demonstrated, besides the suprasellar tumor, a huge mass extending along the clivus down to the level of C3 of spinal canal. Anteroposterior diameter of bony spinal canal evidently enlarged in upper cervical region. Interpedicular distance also widened markedly in the same region. Laminae of C1-C3 vertebrae were abnormally stretched and the spinal cord was compressed posteriorly by the tumor. Suboccipital craniectomy verified a cystic tumor in the region of foramen magnum and cervical spinal canal. The medulla oblongata was pushed backward by the tumor. The cystic tumor was evacuated and the capsule of the tumor was partly resected, which was histologically verified as craniopharyngioma of squamous type. The patient was relieved from the neck pain after operation and discharged in April 1977.

[Normal pressure hydrocephalus. Part 2. The evaluation of severity of cerebral dysfunction by measurement of "barrier ratio" and regional cerebral blood flow (author's transl)]

In the previous study, quantitative analysis of RI ventriculography was reported in fifty-three cases with chronic communicating hydrocephalus. In this study, according to the same criteria as that of previous report, fifty-three cases were divided into two groups, namely NPH group (twenty-seven cases) and control group, which were considered as mere chronic communicating hydrocephalus without and NPH chalacteristics. (twenty-six cases). Results of "barrier ratio (B.R.)" measurement and regional cerebral blood flow study in these cases are as follows: 1) "Barrier ratio" using of 99mTcO4-: Concerning about B.R. of 99mTcO4- there was no significant difference between NPH and control group. However it tends to be that shunt surgery is not so effective in NPH cases in which B.R. shows abnormally low value. 2) rCBF by 133Xe clearance method: Regional cerebral blood flow was diffusely decreased in NPH patients, especially in its frontal area, suggesting the frontal area would be more severely damaged in NPH cases. These findings leads us to the conclusion that whether the shunt surgery might be effective or not depends on severity of cerebral dysfunction and the cerebral dysfunction is clearly evaluated by RI technique mentioned above.