Protein S Tokushima: An Abnormal Protein S Found in a Japanese Family with Thrombosis

An abnormal protein S (PS) was found in a Japanese family with a high incidence of thrombosis. The proband is a woman who was born in Tokushima Prefecture. She had superior sagittal sinus thrombosis, thrombophlebitis of the left leg, and thrombosis of the placenta. She had a normal plasma level of free PS antigen but decreased PS activity. Her mother and aunt also had thrombophlebitis of the leg, and together with four other family members also showed a normal level but decreased activity of PS. This suggests that hereditary dysfunction of PS is inherited in this family as an autosomal dominant trait. The proband’s PS appears to have a slightly higher molecular weight than normal PS both in the intact and modified form, suggesting that it has a molecular defect on the carboxyl-terminal side of the thrombin-sensitive site. This abnormal PS with apparently unique characteristics was named PS Tokushima.

Type I Congenital Plasminogen Deficiency Is not a Risk Factor for Thrombosis

The risk of thrombosis in type I congenital plasminogen (PLG) deficiency has been suggested, but is still not confirmed. We studied 40 members of two unrelated families with this disease, and found that 21 were heterozygotes of type I congenital PLG deficiency. Three of them had thrombosis, but the other 18 had no thrombosis. The percentages of family members with no history of thrombosis up to a given age among subjects with type I congenital PLG deficiency and healthy controls were analyzed by the Kaplan-Meier method. No significant difference between the two groups was observed by the generalized Wilcoxon test (p = 0.23). These results suggest that there is no significant correlation between type I congenital PLG deficiency and thrombosis.

Familial idiopathic basal ganglia calcification: Histopathologic features of an autopsied patient with an SLC20A2 mutation

Idiopathic basal ganglia calcification (IBGC), or Fahr's disease, is a neurological disorder characterized by widespread calcification in the brain. Recently, several causative genes have been identified, but the histopathologic features of the brain lesions and expression of the gene products remain unclear. Here, we report the clinical and autopsy features of a 62-year-old Japanese man with familial IBGC, in whom an SLC20A2 mutation was identified. The patient developed mild cognitive impairment and parkinsonism. A brain CT scan demonstrated abnormal calcification in the bilateral basal ganglia, thalami and cerebellum. An MRI study at this point revealed glioblastoma, and the patient died 6 months later. At autopsy, symmetric calcification in the basal ganglia, thalami, cerebellar white matter and deeper layers of the cerebral cortex was evident. The calcification was observed in the tunica media of small arteries, arterioles and capillaries, but not in veins. Immunohistochemistry using an antibody against type III sodium-dependent phosphate transporter 2 (PiT-2), the SLC20A2 product, demonstrated that astrocytic processes were labeled in several regions in control brains, whereas in the patient, reactivity in astrocytes was apparently weak. Immunoblotting demonstrated a marked decrease of PiT-2 in the patient. There are few autopsy reports of IBGC patients with confirmation of the genetic background. The autopsy features seem informative for better understanding the histogenesis of IBGC lesions.

M2 macrophage/microglial cells induce activation of Stat3 in primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is one of the most aggressive malignant lymphomas with a median survival of less than 20~40 months. Interest in signal transducer and activator of transcription 3 (Stat3) has increased during the past decade because Stat3 activation was found to contribute to tumor progression by inducing angiogenesis, immunosuppression, and metastasis. We previously demonstrated a significant correlation between Stat3 activation in tumor cells and infiltrating anti-inflammatory (M2) macrophages. Here, we focused on the phenotypes of infiltrating macrophages/microglial cells and Stat3 activation in PCNSL cells. The correlation of Stat3 activation or density of M2 macrophage infiltration with patient prognosis was also evaluated. We performed immunostaining for CD68, CD163, CD204, and pStat3 using paraffin-embedded PCNSL specimens obtained from 43 patients. CD163 and CD204 served as markers of the M2 phenotype. Dense infiltration of CD68(+) macrophages was found in all samples. High numbers of CD163(+) and CD204(+) M2 macrophages/microglial cells were observed in 29 and 25 cases, respectively. Stat3 activation in lymphoma cells was enhanced in the patients who showed denser infiltration of CD163(+) macrophages/microglial cells in tumor tissues. In vitro co-culture experiment to investigate cell-cell interactions between macrophages and lymphoma cells found that Stat3 in lymphoma cells was strongly activated by co-culture with macrophages. Numbers of CD68(+), CD163(+), and CD204(+) tumor-associated macrophages/microglial cells (TAMs) and Stat3 activation in lymphoma cells were not correlated with prognosis. However, because Stat3 involvement in tumor development was demonstrated in several malignant tumors, our present finding that cell-cell interactions of M2 macrophage/microglial cells with lymphoma cells induced Stat3 activation may provide novel insights into PCNSL pathogenesis.

Chordoid glioma of the third ventricle: a report of two cases, one with ultrastructural findings

Chordoid glioma, which generally occurs in adults, is a rare CNS tumor arising in the anterior part of the third ventricle. We report two cases of chordoid glioma of the third ventricle in a 42-year-old woman and a 51-year-old man, respectively. Both tumors showed essentially the same histological and immunohistochemical features; the tumors were composed of cords and nests of epithelioid, GFAP-immunoreactive cells in a mucinous stroma with lymphoplasmacytic infiltrates at the tumor periphery. Ultrastructural examination in one case revealed that the tumor cells were characterized by the presence of hemidesmosomes and associated focal basal lamina formation, intermediate junctions, microvilli and cilia, and intercellular microrosettes with microvilli. Of interest was that small blood vessels with fenestrated endothelial cells were present in the stroma. In the brain, the presence of fenestrated endothelial cells is a feature of the circumventricular organs (except the subcommissural organ), among which the organum vasculosum of the lamina terminalis is located in the anterior part of the third ventricular floor that is lined by specialized ependymal cells known as tanycytes. These findings further strengthen the hypothesis that chordoid glioma may represent a peculiar clinicopathological subtype of ependymoma (chordoid ependymoma) originating from the lamina terminalis area.

Severe tension pneumocephalus caused by opening of the frontal sinus by head injury 7 years after initial craniotomy--case report

A 46-year-old man presented with severe tension pneumocephalus triggered by mild head injury 7 years after craniotomy. He had a history of subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm, coating of the aneurysm performed via a craniotomy, and a ventriculoperitoneal (VP) shunt inserted. He fell from bed in a rehabilitation hospital. Eight hours after the injury, he became comatose and suffered general convulsion. He was then transferred to our hospital. Radiography and computed tomography (CT) revealed a large amount of intracranial air and a widely opened frontal sinus. On the day of admission, the shunt tube was ligated. Surgery was performed to repair the dura mater and close the frontal sinus. Postoperative CT revealed reduction in the amount of air and frontal sinus obstruction. The patient had a good postoperative course without meningitis. Tension pneumocephalus may occur as a complication several years after a craniotomy because of the chronic lowering of intracranial pressure induced by a VP shunt. Complete frontal sinus repair is important during the initial craniotomy.

[A case of orbital osteoma--summary of the case reports in Japan, and the usefulness of the microsurgical drilling procedure in surgical treatment of orbital osteoma]

A 57-year-old woman was admitted with a 3-month history of diplopia and exophthalmos in the right eye. Plain skull X-P and axial CT demonstrated two bony tumors. One involved her right orbit, frontal sinus and ethmoidal sinus, and the other was located in the left occipital bone. The right intraorbital tumor was removed almost totally via the superomedial orbital approach by means of microsurgical drilling. Histopathological examination revealed mature osteoma. The microsurgical drilling procedure was helpful in obtaining an optimal result from surgical treatment of the orbital osteoma.

Sclerosed hemangioma of the liver

We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the differential diagnoses of hepatic lesion with delayed enhancement.

Long-term treatment with haloperidol decreases the mRNA levels of complexin I, but not complexin II, in rat prefrontal cortex, nucleus accumbens and ventral tegmental area

The effect of long-term treatment with haloperidol on gene expression of the presynaptic protein complexins was investigated in the discrete brain regions of rats, using reverse transcription-polymerase chain reaction. Four-week-treatment with haloperidol decanoate (25 mg eq/kg) produced a significant decrease in the mRNA levels of complexin I in the medial prefrontal cortex, nucleus accumbens and ventral tegmental area, but not in the striatum and substantia nigra. No significant changes in complexin II mRNA levels were observed in any brain region examined here. The reduced expression of complexin I may be associated with the haloperidol-induced depolarization block of mesocorticolimbic dopamine neurons.

Effect of atypical antipsychotics on phencyclidine-induced expression of arc in rat brain

The effect of atypical antipsychotics on the immediate-early gene, arc (activity-regulated cytoskeleton-associated gene), expression was investigated in phencyclidine (PCP)-treated rats using RT-PCR. Administration of PCP (10 mg/kg) increased arc mRNA levels in the prefrontal cortex, nucleus accumbens and posterior cingulate cortex. Pretreatment with clozapine (20 mg/kg), olanzapine (10 mg/kg) and risperidone (2 mg/kg), but not haloperidol (2 mg/kg), prevented PCP-induced arc expression in the prefrontal cortex and nucleus accumbens. Pretreatment of haloperidol increased the striatal arc mRNA levels. Clozapine, olanzapine and haloperidol inhibited the PCP-induced arc expression in the posterior cingulate cortex. These results suggest that the effects of antipsychotic drugs on PCP-induced arc expression in the prefrontal cortex and nucleus accumbens are useful for distinguishing atypical antipsychotic properties of the drugs.

Effects of atypical antipsychotic drugs vs. haloperidol on expression of heat shock protein in the discrete brain regions of phencyclidine-treated rats

Haloperidol augmented a trend of an increase in the heat shock protein (hsp70) mRNA levels induced by phencyclidine (PCP) in rat medial prefrontal cortex, nucleus accumbens and striatum, while the atypical antipsychotic drugs such as clozapine, olanzapine and risperidone decreased it. When administered alone, clozapine, but not haloperidol, decreased hsp70 mRNA levels. Haloperidol and the atypical antipsychotic drugs may thus have differential effects on hsp70 expression in some brain regions of PCP-treated rats.

Quantification of dopamine D3 receptor mRNA level associated with the development of amphetamine-induced behavioral sensitization in the rat brain

We hypothesized that changes in expression of dopamine (DA) D3 receptor gene in the rat brain would correlate with the behavioral sensitization induced by amphetamine (AMPH). In order to test this hypothesis, we measured D3 receptor mRNA levels in the striatum, nucleus accumbens and prefrontal cortex, in individual rats following AMPH treatment (2.5 mg/kg s.c., for 5 consecutive days) using a ribonuclease protection assay method. We observed similar levels of D3 receptor mRNA in saline and AMPH treated animals in each brain region examined. These results suggest behavioral sensitization to AMPH is not mediated through postsynaptic transcriptional regulation of D3 receptor.

Effect of chronic haloperidol treatment on synaptic protein mRNAs in the rat brain

Chronic haloperidol treatment caused significant decreases in the levels of synaptotagmin I and IV, synaptobrevin II, syntaxin 1A and Rab 3A mRNAs in the nucleus accumbens but not in the prefrontal cortex medial field, striatum, substantia nigra and ventral tegmental area. No significant changes in SNAP 25 and synaptophysin mRNA levels were observed in any brain region examined. The reduced expression of synaptic proteins may be related to haloperidol-induced depolarization block of mesolimbic dopamine neurons.

[A case of bilateral infraoptic course of ACA associated with multiple cerebral artery aneurysms]

Infraoptic course of anterior cerebral artery (ACA) is a rare cerebral vascular anomaly frequently associated with intracranial aneurysm. A 58-year-old woman suffered, subarachnoid hemorrhage due to aneurysmal rupture. Carotid angiography revealed multiple aneurysms and bilateral infraoptic course of ACA. Usual A1 segments were not visualized on both sides. These findings were also confirmed by craniotomy. Only 46 cases have been reported including ours. In this paper, we reviewed previously reported cases and the cause of aneurysm formation was discussed.

[Intracranial aneurysms in autosomal dominant polycystic kidney disease detected by MR angiography: screening and treatment]

The association of intracranial aneurysm with ADPKD is well-known, and patients with ADPKD are at increased risk of subarachnoid hemorrhage from rupture of intracranial aneurysms. We prospectively performed three-dimensional time-of-flight magnetic resonance angiography (MRA) in 30 nonselective adult patients with ADPKD. Sixteen were women and 14 were men with a mean age of 51 yr (range 24 to 79 yr). The diagnosis of ADPKD was made on the basis of abdominal ultrasound or computed tomographic studies. Three patients were on maintenance hemodialysis, 8 patients were nondialysed patients with chronic renal failure (serum creatinine > or = mg/dl) and 25 patients had hypertension (BP > or = 140/90 mmHg). None of these patients have a previous diagnosis of intracranial aneurysm. Unruptured intracranial aneurysms were suspected in 5 patients by MRA, and 8 aneurysms were confirmed in 4 (13.3%) of 30 patients by conventional arteriography. These aneurysms were 3 approximately 10 mm in diameter and 3 aneurysms (3 approximately 4 mm in diameter) were newly detected by cerebral arteriography. After informed consent was obtained, neck clipping of the intracranial aneurysms were performed successfully in all the patients. These results suggest that the prevalence of intracranial aneurysms is about 13% in ADPKD, and that MRA is useful in screening for occult intracranial aneurysms in patients with ADPKD.

Gliomatosis cerebri with good prognosis

A 52-year-old man was admitted to our clinic with severe headache and bilateral papilledema. Magnetic resonance (MR) images on admission demonstrated diffuse swelling of the cerebral cortex without formation of a tumor mass. Biopsy revealed diffuse infiltration with neoplastic glial cells. After radiation and chemotherapy, the MR images returned to normal. The morphological and neurological features of the present case met the criteria for gliomatosis cerebri. However, this patient showed an unusually good response to radiation and chemotherapy.

Effectiveness of revascularization surgery evaluated by proton magnetic resonance spectroscopy and single photon emission computed tomography

Proton magnetic resonance spectroscopy (MRS) and single photon emission computed tomography (SPECT) were used to evaluate chronic ischemic regions in 26 stroke patients before and 1, 3, and 6 months after revascularization surgery. The volume of interest for proton MRS was placed in an area including part of the frontal and temporal opercula, insular cortex, and basal ganglia. Twenty healthy volunteers served as controls for proton MRS. Patients were divided into three groups according to the preoperative proton MRS. Group A (n = 12) had significantly lower N-acetylaspartate/choline (NAA/Cho) and N-acetylaspartate/creatine (NAA/Cr) ratios on the operative side compared to those on the contralateral side, and also lower than those in normal subjects. In seven patients in Group A, postoperative serial proton MRS demonstrated no recovery of these ratios on the operative side. However, proton MRS of the other five patients indicated gradual improvement in these ratios on the operative side at 3 to 6 months after surgery, and SPECT indicated an increase in cerebral blood flow on the operative side in four of these five patients. In Group B (n = 9), proton MRS and SPECT showed no laterality before revascularization and no remarkable change during the postoperative course. In Group C (n = 5), NAA/Cho or NAA/Cr decreased on the contralateral side preoperatively. Two patients showed fluctuating values of NAA/Cho or NAA/Cr during the postoperative period. Serial proton MRS and SPECT studies may be useful for the evaluation of revascularization surgery on ischemic regions. The efficacy of revascularization surgery on the metabolism may appear gradually within 3-6 months.

Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: report of three cases

Embolization of three surgically difficult cerebral aneurysms was performed using our newly developed non-adhesive embolic material, EVAL mixture (ethylene vinyl alcohol copolymer). Conventional embolic materials such as detachable balloons or microcoils were not used because of a large or irregular aneurysmal neck. After temporary occlusion of the parent artery with a superselective balloon catheter, the EVAL mixture was slowly injected through a microcatheter placed in the aneurysm or parent artery. The locations of the aneurysms were anterior communicating artery, basilar artery-posterior cerebral artery and basilar artery-anterior inferior cerebellar artery (BA-AICA). One aneurysmal occlusion and 2 parent artery occlusions were performed. Patients had no persistent deficits. The patient with the BA-AICA aneurysm associated with an arteriovenous malformation died of rupture of the residual AVM due to haemodynamic change 2 weeks after embolization. In selected and limited cases, embolization of surgically difficult cerebral aneurysms using EVAL mixture was more effective and safer than embolization using conventional embolic materials such as balloons and microcoils.

Potentiation of phencyclidine-induced dopamine release in the rat striatum by the blockade of dopamine D2 receptor

Local perfusion with phencyclidine (PCP) increased extracellular dopamine levels in the rat striatum in a dose-dependent manner, as measured by in vivo microdialysis. While pretreatment with SCH 23390, a selective dopamine D1 receptor antagonist, had no significant effect on PCP-induced increases in extracellular dopamine levels, pretreatment with YM-09151-2 (cis-N-(1- benzyl-2-methylpyrrolidin-3-yl)-5-chloro-2-methoxy-4-methylamin obenzamide), a selective dopamine D2 receptor antagonist, markedly potentiated the effect of PCP. These results suggest that the blockade of dopamine D2 presynaptic autoreceptors strongly potentiates the PCP-induced dopamine release in the striatum.

[Two cases with metastatic intracerebral alveolar soft part sarcoma]

The alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor which usually occurs in the lower extremity of young girls. The incidence of metastasis is said to be highest in the lung (38%), and second highest in the bone and brain (33%). This report describes two cases of metastatic intracerebral alveolar soft part sarcoma, originating in the lower extremity. A female patient noticed a painless swelling in her right leg at the age of 11, and 10 years later she underwent total removal of the tumor. The diagnosis was alveolar soft part sarcoma. At 37 she was admitted to our service with a diagnosis of cerebral metastasis in the left frontal lobe. Since then she has undergone surgical removal 4 times for recurrent cerebral metastasis and twice for lung metastasis. Now she is 55 years old and doing well except for mild left hemiparesis. She survives without cerebral or general metastasis 44 years following the onset of the sarcoma in her right leg and 18 years following the onset of the metastatic brain tumor. A 30-year-old man, who noticed a painless swelling in his left thigh in January 1991, underwent total removal of the tumor and the diagnosis was alveolar soft part sarcoma. He was admitted to our service with no neurological deficits in October 1992, but a CT scan showed a metastatic brain tumor in the left parieto-occipital region. Total removal of this metastatic brain tumor was successfully performed in November 1992. However, he died because of multiple brain and lung metastasis in February, 1994.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of phencyclidine on the basal and high potassium evoked extracellular GABA levels in the striatum of freely-moving rats: an in vivo microdialysis study

The effect of phencyclidine (PCP) on the gamma-aminobutyric acid-ergic (GABAergic) transmission in the striatum of freely-moving rats was investigated using an in vivo microdialysis. The high potassium (100 mM) increased the extracellular GABA level to 4000% of the basal level. Although the basal GABA level in the striatal dialysate did not show either calcium dependency or tetrodotoxin (TTX) sensitivity, the high potassium evoked GABA level was reduced by 82% under calcium-free conditions (with 12.5 mM magnesium) and by 54% in the presence of 10 microM TTX. The systemic administration of PCP (7.5 mg/kg) or the local perfusion of PCP (100 microM and 1 mM) significantly inhibited the high potassium evoked GABA release in the rat striatum. The local perfusion of MK-801 (10 microM and 100 microM), a more potent and selective N-methyl-D-aspartate (NMDA) receptor antagonist, also inhibited the high potassium evoked striatal GABA release. These drugs did not show any significant effect on the basal extracellular GABA level. NMDA (1 mM) either partly or completely blocked the effect of PCP (1 mM) or MK-801 (100 microM) on the high potassium evoked striatal GABA release. On the other hand, nomifensine (100 microM), a dopamine uptake blocker, did not show any effect on the high potassium evoked GABA release. These results suggest that PCP inhibited the striatal GABAergic neuronal transmission through its antagonism of the NMDA receptor.

Involvement of dopamine D1 receptors in phencyclidine-induced behavioral stimulation in rats

The effects of dopamine receptor antagonists on phencyclidine (PCP)-induced behaviors were examined in rats. Acute administration with PCP (7.5 mg/kg i.p.) produced various behavioral changes, such as increases of spontaneous activity, head-weaving, sniffing, rearing, back-pedaling, and ataxia. To determine which dopamine receptor subtypes were involved in mediating the PCP-induced behaviors, SCH 23390 (0.05 and 0.5 mg/kg), sulpiride (20 and 100 mg/kg), or haloperidol (0.05 and 0.5 mg/kg) were pretreated 30 min before PCP treatment (7.5 mg/kg). A higher dose of SCH 23390 significantly reduced the increase of spontaneous activity induced by PCP. Both doses of sulpiride did not affect the PCP-induced behaviors. A higher dose of haloperidol decreased the PCP-induced spontaneous activity, whereas a lower dose of haloperidol enhanced the activity. Ketanserin (0.5 and 5 mg/kg) did not alter any PCP-induced behaviors. These results suggest that the D1, but not D2, dopamine receptor subtype may be involved in the PCP-induced behavioral abnormality.

Effect of phencyclidine on dopamine release in the rat prefrontal cortex; an in vivo microdialysis study

The effect of phencyclidine (PCP) on the extracellular dopamine levels in the rat prefrontal cortex was investigated using an in vivo brain dialysis technique. PCP increased extracellular dopamine levels in the prefrontal cortex of freely-moving rats after the systemic (7.5 mg/kg i.p.) or the local injection (100 microM and 500 microM). The local injection of MK-801, which is a more selective and potent NMDA receptor antagonist than PCP also increased the extracellular dopamine levels (from 10 microM to 100 microM). These results suggest that part of the effect of PCP is attributable to its antagonist effect on the NMDA receptor.

Effect of phencyclidine on endogenous excitatory amino acid release from the rat anterior cingulate cortex--an in vivo microdialysis study

The effect of systemically administered phencyclidine (PCP) on the extracellular concentration of aspartate (Asp) and glutamate (Glu) in the rat anterior cingulate cortex was investigated using in vivo microdialysis. PCP significantly reduced the K(+)-evoked release of Asp and Glu, while it had no effect on the basal efflux of Asp and Glu. These results suggest that PCP might inhibit excitatory amino acid (EAA) release through an N-methyl-D-aspartate (NMDA) receptor-mediated mechanism.

Protein S Tokushima: an abnormal protein S found in a Japanese family with thrombosis

An abnormal protein S (PS) was found in a Japanese family with a high incidence of thrombosis. The proband is a woman who was born in Tokushima Prefecture. She had superior sagittal sinus thrombosis, thrombophlebitis of the left leg, and thrombosis of the placenta. She had a normal plasma level of free PS antigen but decreased PS activity. Her mother and aunt also had thrombophlebitis of the leg, and together with four other family members also showed a normal level but decreased activity of PS. This suggests that hereditary dysfunction of PS is inherited in this family as an autosomal dominant trait. The proband's PS appears to have a slightly higher molecular weight than normal PS both in the intact and modified form, suggesting that it has a molecular defect on the carboxyl-terminal side of the thrombin-sensitive site. This abnormal PS with apparently unique characteristics was named PS Tokushima.

Prognosis of primary malignant lymphoma of the central nervous system--a retrospective study of 32 cases

A retrospective analysis of 32 patients with primary malignant lymphoma of the central nervous system (CNS) diagnosed between 1976 and 1989 investigated treatment results and recurrence patterns. All patients showed either complete or partial regression of the tumor after initial treatment, mainly radiation therapy with adjuvant chemotherapy. The mean dose of whole-brain irradiation was 40.9 Gy and that of booster was 14.4 Gy. Most patients had tumor recurrence. The median time to recurrence from completion of the treatment was 5 months. The 1- and 5-year survival rates were 50.0 and 17.7%, respectively, and the overall median survival time was 11 months. Most tumors had multiple recurrences at the primary site and other regions of the CNS, and tended to recur in the periventricular region and the cerebrospinal fluid space. Spinal metastasis occurred in five cases. The importance of good control of the primary lesion and active maintenance therapy for the whole CNS is emphasized.

Type I congenital plasminogen deficiency is not a risk factor for thrombosis

The risk of thrombosis in type I congenital plasminogen (PLG) deficiency has been suggested, but is still not confirmed. We studied 40 members of two unrelated families with this disease, and found that 21 were heterozygotes of type I congenital PLG deficiency. Three of them had thrombosis, but the other 18 had no thrombosis. The percentages of family members with no history of thrombosis up to a given age among subjects with type I congenital PLG deficiency and healthy controls were analyzed by the Kaplan-Meier method. No significant difference between the two groups was observed by the generalized Wilcoxon test (p = 0.23). These results suggest that there is no significant correlation between type I congenital PLG deficiency and thrombosis.

Effects of antineoplastic agents and hyperthermia on cytotoxicity toward chronically hypoxic glioma cells

The effects of hyperthermia and antineoplastic agents on the cytotoxicity to normally oxygenated and chronically hypoxic glioma cells were investigated in vitro. Exposure to temperatures above 43.0 degrees C was less cytotoxic to hypoxic cells which predominantly accumulated in the G0/G1 phase fraction. On the other hand, mitomycin C (MMC) and adriamycin (ADM) were preferentially cytotoxic to hypoxic cells not only at 37 degrees C but also at elevated temperatures (42 degrees C and 43 degrees C). These two agents showed marked synergistic effects with hyperthermia under both oxygenated and hypoxic conditions. In contrast, bleomycin (BLM), cis-diamminedichloroplatinum(II) (CDDP), and vincristine (VCR) were preferentially cytotoxic to oxygenated cells at both 37 degrees C and elevated temperatures. CDDP showed cytotoxic synergism with hyperthermia that appeared to be oxygen-dependent. A nitrosourea derivative, 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU), showed no major preferential toxicity under either oxygenated or hypoxic conditions. This study suggests that hyperthermia in combination with MMC or ADM would have a greater cytotoxic effect on hypoxic cell subpopulations of malignant gliomas.

[Surgical treatment of hypertensive cerebellar hemorrhage; stereotactic aspiration surgery vs suboccipital craniectomy]

Patients with severe types of hypertensive cerebellar hemorrhage have been treated usually by suboccipital craniectomy and hematoma evacuation. However, since 1981, we have treated such patients with stereotactic aspiration surgery. The purpose of this study was to evaluate the prognosis of patients treated by stereotactic aspiration surgery for cerebellar hemorrhage in comparison with those who underwent suboccipital craniectomy. Between May 1976 and December 1989, 246 patients with hypertensive cerebellar hemorrhage were admitted to our university hospital and affiliated hospitals. The patients were classified into four categories according to the grading of hypertensive cerebellar hemorrhage proposed by Matsumoto in 1982; benign, moderate, severe, and fulminant. Then we decided the most appropriate therapy according to this grading. Fifty-nine patients (24.0%) underwent suboccipital craniectomy and 38 (15.4%) underwent stereotactic aspiration surgery. There was no significant difference in the postoperative outcome between suboccipital craniectomy and stereotactic aspiration surgery in the overall study. However prognosis of the fulminant type was significantly better with stereotactic aspiration surgery than with suboccipital craniectomy. Possible reasons for this include: 1) All patients of this type who underwent aspiration surgery had this procedure within 12 hours after the onset of cerebellar hemorrhage. 2) The hematoma volume of most patients of this type who had aspiration surgery was under 30ml. 3) The age of all patients of this type with aspiration surgery was under 70 years old. In conclusion, we suggest that aspiration surgery for hypertensive cerebellar hemorrhage is indicated for all patients with moderate, severe and fulminant types of hemorrhage.

Coexistence of intracranial and spinal meningiomas--report of two cases

The authors report two rare cases of multiple meningiomas in both the intracranial and spinal regions. A 64-year-old female presented with a right sphenoidal ridge meningioma and a cervical extramedullary meningioma. Tumor histology was transitional and vacuolated types, respectively. The tumors were removed successfully in two stages, craniotomy then laminectomy 3 months later. A 62-year-old female presented with a right sphenoidal ridge meningioma (meningotheliomatous type) which was totally removed. An extramedullary spinal meningioma became symptomatic 33 months later, which was also removed totally. The meningiomas in the first case had different subtypes, but immunohistochemical characteristics including microcyst formation were similar. The second case had meningiomas of the same subtype with similar characteristics, but different fibrous septum development. Multiple meningiomas, even in different compartments of the central nervous system, may have common characteristics.

[Simultaneous supra- and infratentorial hypertensive intracerebral hemorrhage]

Multiple intracerebral hemorrhage may occur as rebleeding at the site of the previous lesion or in other places. However, multiple intracerebral hemorrhage occurring simultaneously in the supra-and infratentorial regions is rare. We experienced 9 such cases between May 1976 and December 1989. The clinical symptoms, CT findings and outcome of our cases and of 4 cases which were previously reported in the literature are reviewed in this paper. Out of 13 cases, 11 patients had cerebellar hemorrhage, and the others had pontine hemorrhage in the infratentorium. Among the supratentorial lesions, 11 involved hemorrhage in the putamen or the thalamus, and the others were in the subcortical region. There were no characteristic initial symptoms or neurological signs which suggested that hemorrhage had occurred in both the supra-and infratentorial regions. The only methods by which we could recognize this exceptional situation were the CT scan and MRI scan. The outcome in those patients whose initial neurological grading (NG) was 1 to 3 was good with conservative therapy or surgical treatment. On the other hand, the outcome in patients whose initial NG was 4 or 5 was very poor no matter what treatment was used. As far as surgical treatment is concerned, we believe that hematoma evacuation is necessary when the cerebellar hematoma is bigger than the supratentorial hematoma.

Auditory brainstem response during systemic hyperthermia

The relationship between the brain temperature and the latency of ABR was evaluated in a dog model of systemic hyperthermia induced by heating of the blood during extracorporeal circulation. The latency of ABR was shortened and the amplitude was reduced with the elevation of brain temperature. The shortening of the latency was more notable in wave 4 than in wave 1, and this is considered to have been due to greater changes in the conduction velocity in the central nervous system than in peripheral nerves. The latency of ABR, from which the brain temperature can be estimated, is considered to be clinically useful as an index of brain temperature during systemic hyperthermia.

[Somatosensory evoked potential and brain temperature in the Mongolian gerbil during whole body hyperthermia]

Somatosensory evoked potentials (SEP) have been applied to many men and several animals with cerebral ischemia. But in the Mongolian gerbil, one of the most common models of cerebral infarction, the wave form and the latency of SEP have been studied by few authors. In this report, we studied the effects of hyperthermia on SEP in the gerbil. Six gerbils weighting 40 to 50g were anesthetized and heated with ultra-red ray. Brain and rectal temperatures were continuously monitored. The brain temperature changed from 35 degrees C to 42 degrees C during heating, then returned to 37 degrees C with cooling. Typical SEP peaks have been labelled according to their positive or negative character and their sequential latency determination. The latency of the major positive voltage deflection, P1, was 9.97 +/- 9.94 ms at 37 degrees C. The negative deflection before P1 has been labelled as N0 and the negative waves after P1 and N1 and N2. Peak latency of SEP was significantly reduced gradually during hyperthermia, and increased gradually with recooling. The correlation between the latency of SEP and the brain temperature was very close. Our results emphasize the importance of measurement of SEP during hyperthermia as a monitor of the brain temperature and during experiment for maintenance of the body temperature at 37 degrees C.

[A case of juvenile hemifacial spasm, successfully treated by microvascular decompression]

A 16-year-old girl had an episode of intermittent involuntary spasm of the right inferior orbicularis oculi muscle at the age of 12. In the following years the right orbicularis oris muscle and platysma were unilaterally and progressively involved in the spasms and with increasing frequency. Medical treatment with minor transquilizer was not effective. She was referred to our department at the age of 16. CT and MRI revealed no abnormality. Angiographical study revealed that the right PICA (posterior inferior cerebellar artery) was tourtously coming off from a relatively high portion of the right vertebral artery. The trunk of the right AICA (anterior inferior cerebellar artery) was not able to be identified. Although the onset of this condition was unusually early, the clinical course and symptoms of hemifacial spasm were so clearly typical that she underwent microvascular decompression surgery on July 26, 1988, at the age of 16. During the operation an upward looping PICA was found crossing and tightly compressing the exit zone of the right facial nerve. The offending artery seemed to be elastic without significant atherosclerotic change. The arterial loop was carefully dissected and replaced with two pieces of sponge prosthesis between the artery and the surface of brain stem. Her hemifacial spasm completely disappeared post-operatively. No recurrence has been noted for over one year in the follow-up observation. Hemifacial spasm is subacutely or chronically a progressive disorder of facial involuntary movement. The arterial compression in the exit zone of the facial nerve is said to be the cause of the disorder and microvascular decompression has been indicated for it since a little before the beginning of this decade.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of ganglioglioma with choked disc]

A case of ganglioglioma associated with choked disc is reported. A 19-year-old girl was admitted to our hospital because of blurred vision. Neurologically, the patient had nothing but choked disc. The CT showed a large cystic mass with calcification in the left parieto-occipital lobe. The MRI revealed that the cyst was delineated by a membrane and that its dorsal side was solid, showing enhancement by Gd-DTPA. Cerebral angiography showed no tumor stain. Left parieto-temporo-occipital craniotomy was performed and the tumor was removed subtotally. Histopathological examination demonstrated the typical pattern of ganglioglioma. The most common symptom of ganglioglioma is convulsions. Symptoms of increased intracranial pressure have been reported sporadically in the literature. It was clinically noted that the cause of the increased intracranial pressure in this patient was enlargement of the cyst associated with ganglioglioma.

[Effect of human interleukin-1 on cartilage metabolism]

This study was undertaken to elucidate the effect of human interleukin-1 (IL-1) on the cartilage metabolism, with H235SO4 and 3H-proline as the respective indices for the metabolism of proteoglycan and collagen. We examined in vitro the 35S and 3H rates of incorporation after IL-1 was added to free chondrocytes incubated from human and porcine joint cartilage. As a result, IL-1 suppressed dose-dependently the secretion of both 35S and 3H into the supernatant of the medium containing free human or porcine chondrocytes. There was no difference between the control and the IL-1 group in the elution pattern of proteoglycan on the column-chromatogram. These results indicated that human IL-1 did not affect the molecular weight of the proteoglycan produced by human and porcine chondrocytes.

Spinal cord glioblastoma multiforme with intracranial dissemination--case report

A case of spinal cord glioblastoma multiforme with intracranial dissemination is reported. A 23-year-old female was admitted to a local hospital complaining of lumbago. Myelography revealed an intramedullary thoracic tumor. The tumor was partially removed through a laminectomy at Th11-L1. The histological diagnosis was glioblastoma multiforme, and focal irradiation (total 50 Gy) was given. Eight months after the operation, symptoms of increased intracranial pressure appeared. Computed tomographic (CT) scans showed marked hydrocephalus, and multiple tumors at anterior horns of bilateral lateral ventricles. A ventriculoperitoneal shunt and an Ommaya reservoir into the left lateral ventricle were emplaced. Three months later, she was transferred to our hospital. CT scans showed enhanced lesions in the fourth ventricle, anterior horn of the left lateral ventricle, septum pellucidum, and pituitary gland. Suboccipital craniectomy was performed, and the mass around the fourth ventricle was partially removed. Histological examination of the tumor specimens showed glioblastoma multiforme. Postoperatively, she received whole brain irradiation (total 50 Gy), and intrathecal injection of beta-interferon via the Ommaya reservoir. However, she died of respiratory insufficiency. It is considered that the spinal cord glioblastoma multiforme disseminated into the intracranial space.

Intracranial and intraspinal dissemination from pineal yolk sac tumor treated by PVB therapy--case report

A 15-year-old male was admitted because of diplopia and persistent headache. Postcontrast computed tomography (CT) revealed a homogeneously enhanced large mass, 3 x 4 cm in size, in the pineal region and moderate obstructive hydrocephalus. A right ventriculoperitoneal shunt was installed. At that time, the serum alpha-fetoprotein (AFP) level increased to 23,036 ng/ml, but the level of serum beta-subunit of human chorionic gonadotropin was less than 0.2 ng/ml. These data indicated the tumor to be a pure yolk sac tumor. Following cisplatin-vinblastine-bleomycin (PVB) therapy and whole-brain irradiation (50 Gy), the tumor disappeared on CT, although the AFP level did not return to normal. Eight months after the completion of initial therapy, he had lumbago. Spinal magnetic resonance imaging revealed a metastatic mass at the L5-S2 levels, which was subtotally removed and histologically diagnosed as yolk sac tumor. Postoperative local irradiation (30 Gy) was performed. Seven months after the operation, spinal dissemination at the Th7 level occurred and, 1 month later, intracranial dissemination in the left cerebellopontine angle was detected. He died 25 months after the first admission. PVB therapy did not prevent spinal dissemination in this case.

Computed tomography controlled aspiration surgery for hypertensive intracerebral hemorrhage. Experience of more than 400 cases

To overcome the disadvantages of conventional surgery, we developed our own method of computed tomography controlled stereotactic aspiration surgery for hypertensive intracerebral hemorrhage. A new ultrasonic surgical aspirator was also developed to facilitate aspiration of a dense clot in the acute stage. Between 1980 and 1988, 437 patients with hypertensive intracerebral hemorrhage underwent aspiration surgery. Computed tomography controlled stereotactic aspiration surgery can be performed in hematomas of any site or any stage with minimal tissue damage, even in aged patients. Aspiration surgery led to a favorable clinical experience and outcome, especially in the acute stage.

[Multifocal gliomas in cerebral hemisphere associated with von Recklinghausen's disease: case report]

A case of intracerebral multifocal gliomas with von Recklinghausen's disease is reported. A 12-year-old boy was admitted to our hospital with an episode of convulsive attacks which were uncontrolled by anticonvulsants. CT scan and MRI revealed small well circumscribed tumors in the left frontal cortex and left parietal subcortex. Both of the tumors revealed low density in plain CT scan and low intensity in T1 weighted MRI. The vascularity of these tumors was poor in cerebral angiography. In other words these tumors were of a similar nature. The histology of the frontal tumor, which was totally removed surgically, showed typical pilocytic astrocytoma. The other tumor in the left parietal subcortex must also be included in the category of low grade glioma. In the sixth month after the operation, we could find neither recurrence of the frontal glioma nor enlargement of the parietal tumor, on CT and MRI findings. Immunohistochemically, the outer portion of the Rosenthal fiber in this tumor was positive for GFAP and S-100 protein, but the inner portion was negative, because the GFAP and S-100 protein there had degenerated. The cytoplasm of this tumor's cell was abundant with mitochondria and Golgi's bodies compared to the fibrillary astrocytoma. This case may be the first case of multifocal gliomas in the same cerebral hemisphere. We suggest that multifocal gliomas grow naturally, and over the years, tumors combine with each other and finally constitute a large type diffuse glioma.

[Anti-tumor effect of hyperthermia plus hematoporphyrin derivative on malignant brain tumor]

Photoradiation therapy using the photosensitizing agent, hematoporphyrin derivative (HpD), and laser light has been currently employed as a new modality for the treatment of cancer. At present, however, the application of this therapy is limited to superficial tumors because of difficulties in achieving light penetration, whereas 13.56 MHz radiofrequency (RF) used in hyperthermia is capable to penetrate into deeper regions and elevate the temperature of brain tumors. In the present studies, the author evaluated an anti-tumor effect of hyperthermic treatment with HpD administration on experimental malignant brain tumors both in vitro and in vivo and, moreover, investigated the histological changes of subcutaneous tumors following water bath heating and the uptake of HpD into the brain and subcutaneous tumors. In vitro, C-6 and Rous sarcoma virus-induced mouse glioma cells (RSV glioma cells) were incubated in the medium containing HpD (0-125 micrograms/ml) for 24 hours. Hyperthermia was performed either in a water bath or by 13.56 MHz RF heating in the range of 37-43 degrees C. All procedures were carried out in the dark. The anti-tumor effect was evaluated by counting the viable glioma cells. HpD itself showed a growth inhibitory effect on C-6 and RSV glioma cells dose-dependently, while synergistic effect was observed in combination with hyperthermia. C-6 cells were more sensitive to this treatment than RSV glioma cells. The degree of response depended on the heating time and the temperature. In both cells, the effect of heating by water bath and 13.56 MHz RF was similar at each temperature.(ABSTRACT TRUNCATED AT 250 WORDS)