[Small cell lung cancer presenting as a metastatic conjunctival tumor]

A 65-year-old man complaining of a left medial ocular angle mass and hemoptysis was admitted to our hospital. Chest radiography revealed a right hilar mass and bronchoscopy revealed widespread cancerous invasion of the carina, both main bronchi, right upper lobe bronchus, truncus intermedius, and middle lobe bronchus. Histological examination of a biopsied specimen revealed small cell carcinoma. Brain CT scan, abdominal CT scan, and bone scintigram showed solitary brain, multiple liver, and multiple bone metastases. Partial response was obtained with three courses of combined chemotherapy with carboplatin and etoposide, and the ocular tumor until it was almost invisible to the unaided eye. However, complete response could not be obtained with additional two courses of combined chemotherapy, and the patient was discharged. Seven months after the first admission, he was readmitted with dyspnea and an enlarged (6 mm in diameter) left ocular mass. Histological examination of the resected mass revealed a small cell carcinoma that had metastasized to the conjunctival substantia propria. He died of respiratory failure one month after readmission. Metastasis to the eye from primary lung cancer is uncommon and patients such as this are extremely rare. Although some cases of uveal or orbital metastasis from lung cancer have been reported, we can find no other report of conjunctival metastasis from lung cancer.

Potentiation of the toxicity of tumor necrosis factor by tumors in mice

Tumor necrosis factor-alpha (TNF-alpha) was reported to be important in the induction of septic shock. After i.v. injection of recombinant TNF-alpha (rTNF-alpha), BALB/c mice bearing Meth A fibrosarcoma (Meth A), but not normal mice, died of shock. Tumor cells are known to release many biological components. In this study, we examined the role of the tumor in the toxicity of rTNF-alpha in mice. Meth A cells maintained i.p. in mice were cultured for 24 hr in vitro. Conditioned medium (CM) obtained from the Meth A cells was given i.v. to mice, and 2 to 7 days later, i.v. injection of rTNF-alpha induced death in the animals. rTNF-alpha treatment 4 days after Meth A CM gave the maximum effect. rTNF-alpha did not induce death in mice treated with CM from spleen cells. However, after the Meth A cells were passaged 2 or 3 times in in vitro culture, the CM did not potentiate the toxicity of rTNF-alpha in mice. rTNF-alpha induced symptoms of disseminated intravascular coagulation (DIC) on coagulation parameters in the blood, and high plasma tissue factor (TF) activity in Meth A CM-treated mice and Meth A tumor-bearing mice. These results suggest that factor(s) are released from tumor cells activated by interaction with host cells, and injection of rTNF-alpha and the factor(s) results in the induction of DIC syndrome leading to host death.

Diabetes mellitus, internal thoracic artery grafting, and risk of an elevated hemidiaphragm after coronary artery bypass surgery

The elevated hemidiaphragm after coronary artery bypass grafting (CABG) that occurs in some patients is associated with internal thoracic artery (ITA) grafting as well as with the use of topical cardiac hypothermia. An increased incidence of elevated hemidiaphragm after CABG surgery in diabetic patients was observed. To determine the incidence and risk factors of elevated hemidiaphragm after CABG surgery and the relationship to preoperative diabetes, 200 consecutive patients undergoing CABG were studied; 29 (14.5%) had hemidiaphragm elevation postoperatively (25 on the left, 1 on the right, 3 bilateral). In the remaining 171 there was no hemidiaphragm elevation. Factors analyzed were age, gender, preoperative diabetes, duration of cardiopulmonary bypass (CPB) and aortic cross-clamping, minimum esophageal temperature during CPB, and use of the ITA graft. Univariate analysis showed a significant association between elevated hemidiaphragm and diabetes (P < 0.05), left ITA grafting (P < 0.01), and age (P < 0.05). Right ITA was not used for any patient. Multivariate analysis ruled out age, whereas preoperative diabetes and the use of the ITA remained the independent factors associated with elevated hemidiaphragm (odds ratio, 3.41; 95% confidence interval 1.41 to 8.18, and 2.86; 1.01 to 8.06, respectively). The relative risk of an elevated hemidiaphragm was 9.75 in diabetic patients with the ITA graft, as compared with nondiabetic patients without this graft. All 3 patients with bilateral diaphragm paralysis and a patient with a right hemidiaphragm elevation were diabetic. In conclusion, both diabetes and use of the ITA graft appear to be important risk factors for the development of elevated hemidiaphragm following CABG.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of thymic cyst showing elevated CEA, SLX and CA125 levels in the cystic fluid associated with non-invasive thymoma]

A 66-year-old woman, who had complained of left ptosis and been diagnosed as having myasthenia gravis (ocular type) 9 years previously, was admitted to our hospital for further examination of an abnormal mass shadow on chest X-ray film. Chest computerized tomography (CT) revealed a cystic tumor in the anterior mediastinum and thoracotomy was performed to make a definitive diagnosis. The tumor could be removed completely and was diagnosed histologically as a thymic cyst with thymoma. The cyst was 32 x 30 x 28 mm in size and contained about 10 ml of brown turbid fluid. The levels of CEA (61.3 ng/ml), SLX (24,000 U/ml) and CA125 (1300 U/ml) were markedly increased in the cystic fluid, while those in serum were not elevated. Immunohistochemical staining demonstrated the epithelial cells lining the cyst to contain SLX. The findings suggest that SLX was produced in the epithelial cells of the cyst. However, neither CEA nor CA125 was positive in the epithelial cells. From our review of reported cases of thymic cyst showing elevated levels of tumor markers in the cystic fluid, the main mechanism of marked elevation of tumor markers seems to be condensation in the cystic fluid rather than increased production in epithelial cells lining the cyst. Cases of thymic cyst with thymoma are extremely rare, but our case was concluded to be incidentally associated with non-invasive thymoma.

The effect of droloxifene on the insulin-like growth factor-I-stimulated growth of breast cancer cells

Insulin-like growth factor-I (IGF-I) is an important mitogen in breast cancer. We studied here the effects of a new antiestrogen drug, droloxifene (DROL, (E)-alpha-[p-[2-(dimethylamino) ethoxy]-phenyl]-alpha'-ethyl-3-stilbenol) and tamoxifen (TAM) on the IGF-I-stimulated growth of estrogen receptor (ER) positive breast cancer cells, MCF-7 and their mechanism of action. IGF-I secretion from MCF-7 was increased by the addition of estrogen. Externally added IGF-I stimulated the growth of MCF-7 but not ER negative breast cancer cells, MDA-MB-231. DROL and TAM inhibited the IGF-I-stimulated growth of MCF-7. A 2 hr treatment with both drugs did not block IGF-I binding to the receptors in MCF-7. However, a 4 day treatment with DROL decreased the number of IGF-I receptors without altering the binding affinity in MCF-7. These results suggest that DROL can exert its antitumor activity against ER positive breast cancer not only by blocking the E2 binding to the ER, but also by counteracting the mitogenic effect of IGF-I.

Role of hypothalamic histamine in stimulating the corticosterone release in rats

Intracerebroventricular injection of alpha-fluoromethylhistidine caused a significant decrease of the histamine content of the hypothalamus as well as of plasma adrenocorticotropic hormone and corticosterone concentrations. A high correlation was observed between the histamine content of the hypothalamus and the plasma corticosterone concentration. When the histamine content of the hypothalamus decreased, the plasma concentration of corticosterone diminished. Almost the same result was obtained when the posterior hypothalamus was lesioned electrically. The increases in plasma adrenocorticotropic hormone and corticosterone concentrations, induced by intracerebroventricular injection of histamine in sham-operated rats, were abolished after hypothalamic lesioning. When electrical stimulations were applied to the posterior hypothalamus, plasma adrenocorticotropic hormone and corticosterone concentrations increased significantly and, at the same time, evoked potentials were recorded on the adrenal nerve. An increase in plasma corticosterone concentration, induced by hypothalamic stimulation, was also observed even after hypophysectomy, suggesting that another corticosterone-secreting pathway exists apart from the hypophysis-adrenocortex system. The increase in plasma adrenocorticotropic hormone and corticosterone concentrations was inhibited not only by pyrilamine and cimetidine, but also by (R)-alpha-methyl-histamine, and H3 agonist. In addition, the effect of this latter product was inhibited by thioperamide, an H3 antagonist. These results indicate that hypothalamic histamine plays an important role in the stimulation of the corticosterone release in rats.

Changes in plasma adrenocorticotropic hormone and cortisol levels induced by intracerebroventricular injection of histamine and its related compounds in dogs

Changes in plasma adrenocorticotropic hormone (ACTH) and cortisol levels induced by intracerebroventricular injection of histamine (H(i)) were studied in dogs. Intracerebroventricular administration of Hi at doses of 5 and 10 micrograms/kg caused a significant increase in plasma ACTH, while more rapid and more marked increase in plasma cortisol was noticed after Hi injection at doses of 2-10 micrograms/kg. Similar results were obtained when 2-methylhistamine was injected; remarkable increases in both plasma ACTH and cortisol levels were observed at doses of 25 and 50 micrograms/kg. However, no such effect was elicited by 4-methylhistamine even at a dose of 50 micrograms/kg. The rate of plasma cortisol increase induced by either Hi or 2-methylhistamine was significantly faster than that of plasma ACTH. Simultaneous application of pyrilamine (intracerebroventricularly) with H(i) resulted in the significant inhibition of H(i)-induced hormone secretions, but in similar administration neither ACTH nor cortisol were affected by cimetidine. In hypophysectomized dogs, a significant increase in plasma cortisol level was also observed after H(i) injection at a dose of 5 micrograms/kg. Intravenous infusion of hexamethonium continued before and after H(i) injection failed to inhibit the increase in plasma ACTH and cortisol levels induced by H(i). From these findings, it can be concluded that intracerebroventricular injection of H(i) caused an increase in plasma ACTH and cortisol levels via H1-receptor, and it is suggested that to some extent, the cortisol release elicited by H(i) is certainly produced without participation of ACTH.

Organization of the multiple polymorphic sites of the D19S11 locus within a 650-kb cosmid contig

The D19S11 locus has been previously described as consisting of a complex set of six nonallelic polymorphic sites detected with a combination of four restriction enzymes and three probes that were subcloned from a single cosmid. These probes also hybridized to additional nonvariant fragments on Southern blots of human genomic DNA. In the course of establishing a contig map of human chromosome 19, a set of cosmids that were positive for at least one of the probes defining this locus was identified. These cosmids, along with additional cosmids, were assembled using a combination of strategies, including fluorescence in situ hybridization studies using G1 interphase nuclei and sperm pronuclei as chromatin targets, into a single overlapping set of cosmids that spans approximately 650 kb. Cosmids that are positive for the MEL gene probe are localized at the centromeric end of the spanning path, with some cosmids being positive for both the MEL gene probe and one of the D19S11 probes. The EcoRI fragments with homology to the various probes have been identified; some cosmids have homology to all three D19S11 probes. The positions for five of the six polymorphic sites were localized within a 40-kb region, with four sites within 15 kb.

Effects of intracerebroventricular injection of histamine and related compounds on corticosterone release in rats

1. The effects of intracerebroventricular (i.c.v.) injection of histamine and related compounds on plasma adrenocorticotrophic hormone (ACTH) and corticosterone concentrations were studied in conscious rats. 2. Histamine at doses of 5-20 micrograms kg-1 rapidly increased plasma ACTH and corticosterone concentrations almost simultaneously, and subsequent courses were also similar to each other. However, in the case of CRF-41 (i.v.), the plasma ACTH concentration first increased followed by an increase in plasma corticosterone concentration. Even in hypophysectomized rats, a significant increase in plasma corticosterone concentration was induced by histamine at doses of 20 and 50 micrograms kg-1. 3. Histamine at doses of 10 and 20 micrograms kg-1 elicited an increase in the amplitude of adrenal nerve activity, and electrical stimulation to the adrenal nerves resulted in an increase in plasma corticosterone concentration. 4. Both H1-agonist (2-methylhistamine) and H2-agonists (4-methylhistamine and impromidine) also induced similar effects to those of histamine. Pretreatment with pyrilamine caused an inhibition of histamine-induced increase in plasma ACTH and corticosterone concentrations, while both cimetidine and ranitidine failed to inhibit this effect. However, both H2-blockers were effective in inhibiting the 4-methylhistamine-induced elevation of plasma ACTH and corticosterone concentrations. 5. Neither (R)-alpha-methylhistamine nor thioperamide had a significant effect, indicating that the H3-receptor is not involved in the histamine-induced increase in plasma ACTH and corticosterone concentrations. 6. From these findings, it was concluded that (1) electrical signals transmitted from the brain to the adrenal gland through the neurones may be involved in the rapid corticosterone release induced by histamine, and (2) not only H1- but also H2-receptors are implicated in histamine-induced hormone secretions in rats, though the contribution of the H2-receptor is less important than that of the H1-receptor.

The effect of a new calcium antagonist, TA3090 (clentiazem), on experimental transient focal cerebral ischemia in cats

BACKGROUND AND PURPOSE

TA3090 (Clentiazem) has been shown to have cerebrovascular protective properties in three experimental studies. An in vivo investigation was undertaken to determine its effects on pial arteries and cerebral blood flow and its therapeutic value in transient focal cerebral ischemia.

METHODS

This experiment was divided into two protocols. In the first, 200 or 400 micrograms/kg per hour TA3090 was administered continuously for 3 hours in cats without ischemic insult (n = 6 for each group). The effects on pial arteries and cerebral blood flow were estimated. In the second protocol, 400 micrograms/kg per hour TA3090 (treated group, n = 14) or physiological saline (control group, n = 10) was administered 5 minutes before 1 hour of middle cerebral artery occlusion in cats. The effects on the pial arteries and cerebral blood flow were observed continuously, followed by autoradiography for a quantitative measurement of cerebral blood flow 5 hours after middle cerebral artery recirculation. The volumes of the cerebral edema and infarct were estimated by planimetry from cerebral preparations made for histological examination.

RESULTS

Pial arteries dilated by up to approximately 10% in the 400-micrograms group and 3% in the 200-micrograms group 30 minutes after administration of TA3090. Increases in cerebral blood flow of about 10% in the 400-micrograms group and 2% in the 200-micrograms group were demonstrated with laser Doppler flowmetry. In the second protocol, dilatation of pial arteries was significantly smaller during and after the ischemic insult in the treated group compared with the control group (p < 0.01). Cerebral blood flow decreased less significantly during ischemia (p < 0.01 at the end of ischemia) and increased less significantly after ischemia (p < 0.01 at the end) in the treated group compared with the control group. Autoradiography showed a more remarkable increase in cerebral blood flow due to luxury perfusion in the cerebral cortex, which was mainly perfused by the middle cerebral artery on the affected side in the control group (p < 0.01). Cerebral blood flow in the cerebral cortex, thalamus, and caudate nucleus on the contralateral side of the treated group increased by about 20% more than that of the control group (p < 0.05). Cerebral edema and infarction were much smaller in the treated group than in the control group (p < 0.01).

CONCLUSIONS

1) TA3090 dilates pial arteries and increases cerebral blood flow in normal brain regions in a dose-response fashion; 2) in ischemic regions compared with those in untreated animals, TA3090 results in a lesser reduction of cerebral blood flow during ischemia and in a lesser degree of hyperemia during reperfusion; 3) TA3090 is associated with less pial artery dilatation during ischemia, presumably due to improved collateral flow; and 4) the improved hemodynamic state with TA3090 is associated with significant reduction of cerebral edema and infarct size.

The effect of acetylcholinesterase inhibitor (SDZ ENA 713) for r-CBF and focal cerebral ischaemia

The purpose of the present study was to examine the effect of Acetylcholinesterase inhibitor (AChEI) on r-CBF (group A) and its protecting effect on focal ischaemic cell damage (group B). The pial arterial diameter and the r-CBF were measured with a width analyzer and with a laser Doppler flowmeter through a cat cranial window on the ectosylvian gyrus. The ischaemic area was measured histologically. We used intravenous injection of AChEI([-])(S)-N-ethyl-3-[(1-dimethyl- amino)ethyl]-N-methyl-phenylcarbamate, SDZENA 713, Sands Pharmacy) to block AChE. Twenty minutes after injection AChEI (0.6 mg/kg) the pial arteriole dilated 108.5 +/- 1.8% and the r-CBF increased 115.4 +/- 2.6%. The pial arteriole dilated maximally to 137.6 +/- 6.5% at 120 minutes after injection and the r-CBF increased maximally to 137.1 +/- 19.5% at 60 minutes after injection. The protecting effect was evaluated using cats and 1 hour of occlusion of the middle cerebral artery (MCA). Twenty minutes after injection of AChEI, the pial arteriole dilated to 116.7 +/- 2.4% and the r-CBF increased to 111.9 +/- 2.6% significantly. During MCA occlusion the r-CBF decreased to 24.7-41.4% in group B and 25.1-32.6% in sham group (group C). The pial arteriole dilated 145.0-184.0% in group C and 150.7-171.6% in group B during MCA occlusion and 30 minutes after reperfusion the pial arteriole returned to 120.0 +/- 3.3% in group C and 123.4 +/- 11.3% in group B. There were no significant changes in the r-CBF and the vessel diameter between group B and C during the 2 hours after reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Experimental study of acute spinal cord injury: a study of spinal blood flow]

It is well known that the worsening of neurological findings after spinal cord injury is due to the secondary progression of pathological changes which may be caused by spinal cord blood flow disturbance. We measured spinal blood flow of 5mm rostrally and caudally distant portions from the injured point, using the laser Doppler flowmeter experimentally. Forty rats were used. Ten of these were used as a control group. And thirty animals were injured at the level of the tenth thoracic cord with a 50g epidural one minute compression method and measured continuously from 30 minutes before the injury to 6 hours after the injury. Twenty two surviving animals were evaluated. In the control group, spinal blood flow was stable. But in the injured group, spinal blood flow dropped by 30.6 + 9.8% on the rostral side and 37.3 + 17.6% on the caudal side in comparison with the resting value soon after the injury. Although the flow improved to 89.3 + 11.1 and 71.3 + 17.8% respectively 15 minutes later, it dropped again gradually and reached 42.8 + 14.1 and 66.2 + 16.4% respectively 6 hours after the injury had been inflicted. Lastly, in the animals, carbon perfusion was performed through the left ventricle. The normal figured vasculature in the preparation of the injured and measured portion was calculated with a microcomputer imaging analyzer and compared with control groups. The number of the normal vessels was significantly more abundant on the caudal side than on the rostral side (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Experimental study of acute spinal cord injury: a histopathological study]

The microscopic appearance of a rat spinal cord which was acutely compressed by aneurysmal clip for one minute, was investigated 15 minutes, 30 minutes, 1 hour, 3 hours and 6 hours after the injury. Although the resulting small hemorrhagic lesion involved primarily only the central gray matter of the injured portion 15 minutes after compression injury, hemorrhage, necrosis and edema in the central gray matter enlarged progressively until 3 hours after injury. Petechial hemorrhage, necrosis and edema were observed in the surrounding area one hour after spinal compression. Then these pathological changes extended rostrally and caudally, but their extension was more significantly remarkable in the rostral side than in the caudal side 3 hours after compression. It was observed that leukocytes begin to infiltrate into the injured capillary walls and plug up the capillary lumen 30 minutes after the injury. Three hours following the injury, leukocytes (lymphocyte, macrophage) extravasated into the surrounding spinal tissue. From these histopathological observations, we reached the following conclusions. A. Secondary injuries play an important role in grave impairment of neurological function of the spinal cord following acute trauma. B. Pathological findings (hemorrhage necrosis and edema) extend more prominently to the rostral side, because the direction of spinal blood flow may be rostral in the thoracic spinal cord. C. Severe disturbance of intraspinal capillary blood flow leading to grave spinal damage may be evoked, because leukocytes infiltrate into the capillary around the injured area and plug up the their lumen about 30 minutes after the injury.

[A case of pulmonary tuberculosis complicated with drug toxicosis--value of shosaikoto and hochuekito as anti-allergic agents]

A clinical course of pulmonary tuberculosis was reported about adverse reaction of anti-tuberculous chemotherapy. A fifty-eight-year-old male patient was complicated with agranulocytosis induced by RFP, hepatic dysfunction and systemic eruption induced by INH, and high fever induced by SM. Adjuvant therapy with Shosaikoto and Hocheukito suppressed INH induced hepato-dermatological toxicosis moderately and suppressed SM induced high fever completely. By these anti-allergic therapy, combined chemotherapy with SM, EB, PAS and PZA became possible during more than six months, and chemotherapeutic effect was marked. This case report suggested possibility and significance of those Kampo agents against serious allergic reaction complicated with the chemotherapy for pulmonary tuberculosis.

[Purine catabolites and pial arteriolar diameter in transient cerebral ischemia]

In transient cerebral ischemia, extracellular purine catabolites and pial arteriolar diameter were measured continuously. Ischemia during one hour was induced by unilateral occlusion of left middle cerebral artery in feline. Extracellular purine catabolites were sampled by in vivo brain microdialysis technique from the gray matter at ectosylvian gyrus. These catabolites were analyzed by HPLC system. Simultaneously, reactivity of pial arteriole was observed and its diameter was measured through the cranial window using intravital microscope and width analyzer. Extracellular concentrations of adenosine, inosine, hypoxanthine and xanthine were found to be 0.80 +/- 0.16 microM, 2.01 +/- 0.95 microM, 4.01 +/- 2.73 microM and 3.93 +/- 2.39 microM, respectively. During ischemia, the concentration of adenosine increased 8.7-fold and arteriolar diameter was 170% of the resting state. These findings in extracellular adenosine concentration and pial arteriolar diameter during ischemia support a role of adenosine in regulation of cerebral blood flow. After reperfusion, arteriolar diameter had returned to 120% of the resting state. But 50 min after reperfusion, pial arteriole began to dilate again coincident with the peak of xanthine concentration. These results suggest that free radicals were produced and could affect pial arterioles 50 min after reperfusion.

Antiallergic effect of epinastine (WAL 801 CL) on immediate hypersensitivity reactions: (II). Antagonistic effect of epinastine on chemical mediators, mainly antihistaminic and anti-PAF effects

Anti-histamine and anti-PAF effects of epinastine were tested in rats, guinea pigs and rabbits. Epinastine showed a potent histamine H1-blocking effect, but the potency was slightly less than that of ketotifen in histamine-induced contraction of guinea pig ileum and histamine-induced cutaneous reactions in rats. In histamine-induced dye leakage into the nasal cavity tested in rats, the drug was slightly more potent than ketotifen and azelastine. Epinastine as well as ketotifen suppressed rabbit platelet aggregation induced by PAF at higher concentrations compared with WEB 2086, a specific PAF-antagonist. In the bronchospasm induced by PAF in guinea pigs, epinastine was more effective than ketotifen in inhibiting the bronchoconstriction, while it showed no remarkable effect on the hypotension induced by PAF. Epinastine caused a potent antagonistic effect on LTC4-induced contraction of isolated guinea pig trachea. In conclusion, the potent anti-histamine, anti-PAF and anti-LT effects of epinastine may significantly contribute to its antiallergic activity.

[The focal brain ischemia with disturbance of venous drainage]

The focal brain ischemia with disturbance of cerebral venous drainage often lead to brain edema and hemorrhagic infarction and make mortality and morbidity worse. So we tried to make sure of this fact using a middle cerebral artery (MCA) occlusion model in adult cat. The MCA was exposed by the transorbital approach and temporally obstructed by Zen's clip. We divided the animals into two groups of eight cats. One group is only MCA occlusion group (sham group) and the other in MCA occlusion with disturbance of venous drainage (VRD group). We ligated bilateral external jugular vein (EJV) and internal jugular vein (IJV) and injected embolic sources from the left EJV to obstruct the venous system of cat brain. The pressure of superior sagittal sinus was increased up to 18.7 +/- 5.3 mmHg by this method. A cranial window was made above the ectosylvian gyrus, which has poor anastomosis. The reactivity of pial arteriole and regional cerebral blood flow (rCBF) were observed through the window. And histological brain examination was also performed. The result was that the reactivity of pial arterioles was severely disturbed in VRD group. The area of cerebral infarction and edema were also significantly expanded in VRD group. Considering from these facts, when the venous drainage was disturbed, cerebral perfusion pressure relatively decrease. Because of the decrease in cerebral perfusion pressure, cerebral infarction and edema probably expand to the area so called penumbra.

[The hemodynamics of intracranial aneurysm by transcranial Doppler arteriography]

The use of an ultrasonic transcranial Doppler arteriography (TCDA) technique for noninvasive diagnosis of cerebral aneurysm is described. Twenty one patients with intracranial aneurysm previously diagnosed by conventional angiography were evaluated with Trans-Scan (EME). Mapping image was used as a guide to identify parent artery and aneurysm. In four patients, we could not record aneurysmal blood flow because of their poor or non existent acoustic window. Good images were recorded in 17 patients. The location of aneurysms were A-com (1 case), Distal ACA (2 cases), IC (7 cases), MCA (3 cases), Basilar (1 case) and IC fusiform (3 cases). Two types of Doppler spectra were obtained from the aneurysmal blood flow. One was characterized by a high density zone along the base line and the other was characterized by a homogeneous high density zone. In both types, Doppler sound was characterized by low frequency sound. The low frequency sound reflects the turbulent flow in the aneurysm. The pattern of Doppler spectra obtained from ordinary arteries was characterized by a high density zone along the descending limb of the envelope. Doppler sound is characterized by high frequency sound. A homogeneous spectral pattern was obtained in both aneurysms and ordinary arteries. But it was possible to differentiate them by Doppler sound. Consequently to be able to hear Doppler sound is very important. We were able to detect fourteen of seventeen aneurysms (A-com 1/1, Distal ACA 1/2, IC 7/7, MCA 2/3, Basilar 1/1, and IC fusiform 2/3). The rate of detection was 82 percent. Aneurysm size ranged from 5mm x 4mm to 16mm x 18mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Perfusion pressure breakthrough threshold of cerebral autoregulation in the chronically ischemic brain: an experimental study in cats

A study was designed to investigate hyperperfusion syndrome after the restoration of normal cerebral blood flow in a chronically cerebral ischemic state resulting from high-flow arteriovenous malformations or severe carotid stenosis. A fistula between the left distal common carotid artery and the jugular vein was created and the left vertebral artery was simultaneously occluded in 44 cats to produce a chronic cerebral ischemic state. For control experiments, 10 cats underwent occlusion of the left common carotid and vertebral arteries. Six weeks later, pial arterial behavior, disruption of the blood-brain barrier (BBB), and cerebral histological changes were investigated using three experimental methods. In the first, in which a fistula was occluded under normal conditions, pial arteries contracted to some 80% of the resting state; however, no BBB disruption or histological changes were observed. In the second experiment, in which a 20-minute occlusion of the left middle cerebral artery was performed in the cats with a patent fistula, a 30% to 40% dilated state of the pial arteries continued after recirculation, and BBB disruption-induced cerebral edema and infarction were observed. These findings were more prominent in the cats that underwent occlusion of the fistula. On the other hand, in the control group, the pial arteries returned to resting size within 40 minutes, and no BBB disruption or histological changes were observed. In the third experiment, in which moderate hypertension was induced for 1 hour, the pial arteries dilated much more remarkably; BBB disruption and cerebral edema were revealed to be more extensive in the cases of fistula occlusion than within those with a patent fistula. In the control group, however, the pial arteries contracted 10% during hypertension, while BBB disruption and histological changes were not evident. The results indicate that the perfusion pressure breakthrough threshold in the chronically ischemic brain may not be reduced by the restoration of normal blood flow, but may be decreased by the addition of new ischemic insults or hypertension.

[A case of vitello intestinal cyst]

A case of vitello intestinal cyst was reported. A 16-month-old girl was referred to our clinic with a complaint of a cystic mass in the region of the navel. With a diagnosis of urachal cyst, resection of the cyst was performed. Histopathologically, the cyst wall consisted of fibrous and fat tissue, and a small polypoid tumor which was found on the inner surface of the cyst was covered by intestinal epithelia. Pancreatic and gastric mucosal elements were observed in the submucosal layer. The histopathological diagnosis was vitello intestinal cyst. Serum amylase level elevated preoperatively normalized after removal of the cyst. We collected 11 cases of vitello intestinal cyst reported in Japan including the present case. Ectopic pancreatic tissue is considered a characteristic of vitello intestinal cyst and that serum or fluid amylase level may be useful for differential diagnosis of the disease.

[Experimental study on brain reversibility following temporary regional cerebral ischemia; from the point of view of vessel behavior and histological changes]

Using a middle cerebral artery occlusion model in adult cats, we investigated the ischemic time threshold for inflicting damage on cerebral vessel behavior and brain tissue. With the transorbital approach, a middle cerebral artery (MCA) was exposed and temporarily obstructed by a Zen's clip. Animals were divided into ten groups (each group: N = 8) according to the ischemic time of 10, 20, 30 minutes, 1, 2, 4, 6, 8, 12, 24 hours. Five hours after the recanalization, Evans' blue dye was injected intravenously and after further 30 minutes, the brain was fixed with transaortal perfusion for histological examinations. A cranial window was made above the ectosylvian gyrus which has poor anastomosis. The pial vessel behavior was observed through the cranial window and evaluated using an intravital microscope and a videoangiometer. Considering the correlation between functional change of vessel behavior and pathological change in the brain, the threshold time of ischemia inflicting irreversible damage was estimated. In the 30 minute ischemia group, deterioration of vessel behavior began to be observed as well as extravasation of Evans' blue dye. As the ischemic duration became longer, infarction and hemorrhage, which showed close correlation, increased. When the duration of ischemia was 6 hours, the infarcted area was significantly larger than that of the 4-hour ischemia group. Intracranial pressure (ICP) markedly increased as soon as recanalization took place. We think this phenomenon is due mainly to swelling. About three hours after recanalization, ICP further increased due to severe vasogenic edema in addition to the brain swelling.(ABSTRACT TRUNCATED AT 250 WORDS)