The authors report their experience with the surgical therapy of middle cerebral artery (MCA) aneurysms in 413 cases, and describe their technique. After the M1 portion of the MCA is identified, the Sylvian fissure is opened. During the administration of 20% mannitol, temporary occluding clips are applied to the feeding and draining vessels of the aneurysm. The aneurysm is freed from all surrounding tissue, and the aneurysm neck is treated by ligation, clipping, or wrapping. Analysis of surgical results in 91 cases operated on after the surgical approach had become standardized indicates that more than 94% of patients have returned to useful social lives by the time of follow-up evaluation. Twenty-four percent of these patients were operated on within 48 hours after subarachnoid hemorrhage.

Cerebral Arteries↗

PubMed1984

[CT-guided stereotaxic brain tumor biopsy].

CT-guided stereotaxic biopsy was performed on 13 cases of the brain tumor using Leksell's CT stereotaxic system under control of Hitachi W-3 scanner. Trepanation was put on near to the coronal suture, and biopsy needle was inserted parallel to sagittal plane in two cases. The course of the needle was showed by the sagittal reconstructive CT. In 11 cases, biopsy needle was inserted parallel to the CT slice. Trepanation was put on frontal area in nine cases of frontal tumor, and on posterior temporal area in four cases of occipital or thalamic tumor. The course of needle was showed on one CT slice. Stepwise biopsies were performed using spiral biopsy needle. Minimal bleeding occurred after biopsy in one case, however, was stopped by induced hypotension. Post-operative CT revealed no hematomas in all of the cases. There was no case with postoperative worsening of the symptoms. Ommaya's reservoir was implanted in three cases with cyst. Comparison of tissue sample with CT findings is possible in our CT-guided stereotaxic method, because all the course of biopsy track was confirmed by the CT.

Adult↗

PubMed1984

[Experimental study of cerebral protective effect on cerebral ischemia of various antioxidants and other agents. With special reference to the combined treatment of mannitol, vitamin E, dexamethasone and perfluorochemicals].

We have previously reported that the combined administration of mannitol and perfluorochemical blood substitutes is evidently effective in protecting the brain from cerebral ischemia. This experimental study was designed to develop more effective method in suppressing brain infarction than the combined treatment of mannitol and PFC. Using the "Canine model of complete ischemic brain regulated with a perfusion method" in which it is possible to control the degree of blood flow to a cerebral hemisphere via a perfusion pump, the effect of eight agents including six kinds as the free radical scavenger on cerebral ischemia was investigated. Eight agents were mannitol, vitamin E (Vit. E), dimethyl sulfoxide (DMSO), vitamin C, glycerol, nizofenone (Y-9179), dexamethasone (Dexa.) and suloctidil (MY-103). After pretreatment with each agent, blood flow was reduced via the pump to 1/10 of the normal state and 1 hour later, return to the normal state was allowed. Subsequent changes in EEG were observed and the effects of the drugs evaluated. In the control group, no recovery of electrical activity was seen, but in six groups among eight treated groups, i.e., treated with mannitol, Vit. E, DMSO, MY-103, Y-9179 and Dexa, gradual emergence of slow waves was observed. And more favorable effects were found when the combined administration of mannitol, Vit. E and Dexa was made in the same experimental schedule as compared with the single administration of each of these drugs. Furthermore in the animals administered with PFC in combination with mannitol, Vit. E and Dexa, flattening of electrical activity could not be seen throughout the period of severe ischemia. Moreover, the power of electrical activity recovered nearly to the preischemic state immediately after recirculation. Although the possible mechanisms are not yet completely clarified, the present results are thought to indicate that this new combination therapy utilizing PFC with mannitol, Vit. E and Dexa may be useful in the treatment of cerebral ischemia.

Animals↗

PubMed1984

Inhibition of aminoacyl-transfer RNA formation by low-molecular substances from melanoma extract.

Two partially purified fractions of the ethanol precipitate (70-95%) of the water extract of Harding-Passey mouse melanoma, which inhibit protein and DNA syntheses of B-16 melanoma cells in culture, also inhibit protein synthesis in various cell-free systems. By examining their inhibitory effects on limited reactions of protein synthesis, it was found that one of them (ME II) inhibits protein synthesis by blocking aminoacyl-tRNA formation, while the other (ME IV) does not. This inhibition of aminoacyl-tRNA formation was not limited to specific amino acids. Since the amino acid-dependent pyrophosphate (PPi)-ATP exchange reaction catalyzed by aminoacyl-tRNA synthetases was not inhibited, it was concluded that some factor(s) in ME II inhibits amino acid transfer from aminoacyl-AMP to tRNA. ME II contains more than 20 proteins from 10,000 to 90,000 daltons. EDTA treatment of this fraction caused the release of low-molecular substances with inhibitory activity from the proteins. The molecular weights of the active substances are less than 5,000 daltons. The active low-molecular substances are apparently not peptides or nucleotides.

Adenosine Triphosphate↗

PubMed1984

[Mutant strains susceptible for epilepsy or convulsions].

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Animals↗

PubMed1984

[Hypoglycemic effects of the blended Chinese traditional medicines in genetically and chemically diabetic mice].

The selective sensitivities to the blended Chinese traditional medicines (Kampo Hozai) applied for diabetes mellitus were pharmacologically studied utilizing the diabetic models: genetically diabetic KK-CAy mice and alloxan diabetic mice. The hypoglycemic response to sulfonylurea (tolbutamide) was observed in the KK-CAy mice as well as that to metformin, giving evidence which supported the difference of diabetic features between KK-CAy mice and alloxan diabetic mice. The hypoglycemic potencies of the blended medicines were determined in alloxan diabetics: Chikuyosekkoto greater than Byakkoka-Ninjinto not equal to Bakumondoto much greater than Hachimigan not equal to Ninjinto greater than Goreisan. A similar order of potency was shown in the fasted KK-CAy mice. In the nonfasted KK-CAy mice, Hachimigan selectively had the more marked hypoglycemic effect. In conclusion, it is compatible that the effects of Kampo Hozai may be classified into plural types of action mechanism by utilizing etiologically different diabetic models.

Alloxan↗

PubMed1984

[Protective effect of mannitol in cerebral infarction--CT findings and physiological observation in experimental cerebral infarction in dogs].

Sequential changes of low density area in CT scan and sequential changes of neurons in light microscopical study following occlusion were investigated. Similar observations were also made with the administration of 20% mannitol (2g/kg) prior to occlusion to determine the effect in preventing cerebral infarction. In these experiments we used our previously published "complete cerebral hemispheric infarction model in dogs" which was produced by ipsilateral occlusion of the A1 and A2 segment of anterior cerebral artery, ophthalmic artery, internal carotid artery, middle cerebral artery and the junction of the posterior communicating artery and posterior cerebral artery. Sequential changes in CT findings of 4 untreated control animals showed a low density area 3 hours after the occlusion in each animals. After 6 hours, these areas became more distinct. On the other hand in 3 mannitol treated animals, the low density area was not distinct 6 hours after the occlusion. In light microscopical study of 5 untreated control animals, no normal neurons were seen 4 hours after occlusion, and shrinkage and swelling was seen in roughly 80% of the neurons 6 hours after the occlusion. However, in 2 mannitol treated animals, 30% normal neurons were seen 4 hours after occlusion, and shrinkage and swelling was seen only 10-20% 6 hours after the occlusion.

Animals↗

PubMed1984

[Surgical treatment of middle cerebral artery aneurysms].

A review of 413 cases of middle cerebral artery aneurysms out of the means of 1621 cases which were operated upon by one of the authors (J. Suzuki), is made with regard to their surgical management. At operation, the patient is placed in the supine position with the head fixed neutral and chin slightly up. Small craniotomy is performed by means of a small semi-circular skin incision just behind the hair line. After exposure of the internal carotid artery, the arachnoid overlying the Sylvian fissure is cut distally in order to expose the middle cerebral artery. The most important principle for aneurysm surgery is to secure the afferent artery prior to aneurysm exposure. In our approach, the M1 portion runs horizontally so that we can secure the parent artery after evacuation of liquor at the chiasma and then dissect the aneurysm. We usually put the temporary clips on the afferent and efferent arteries of aneurysm, that is the M1 and M2's during dissection of the aneurysm. In order to prolong the time of temporary arterial occlusion, 20% mannitol solution is administered intravenously just prior to dural incision under normotensive and normothermic anesthesia. Under such condition, it is possible to occlude the middle cerebral artery for 40 minutes. On the treatment of aneurysm, it is important to expose the whole aneurysm. If only neck portion is exposed and treated, kinking or stenosis of the parent artery can occur due to adhesion, and a second aneurysm or small artery hidden behind can easily overlooked. Therefore, exposure of the entire aneurysm is necessary. Subsequently, ligation should be carried out, then neck clipping performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Arteries↗

PubMed1984

[Primary intracranial yolk sac tumor developing in the frontal lobe from the inside of the sphenoidal ridge].

A case of primary intracranial yolk sac tumor, the first known case growing in the frontal lobe, is compared with similar cases of suprasellar region. The case, 18-year-old female, suffered from headache, vomiting and visual disturbance for one month prior to the hospitalization. Plain CT scan demonstrated suppressed left anterior horn and normal density area in front of it. After injection of contrast medium, the area was enhanced distinctly. The left carotid angiography displayed a hypervascular mass in the suprasellar region and tumor stain was also seen in the capillary phase. Bilateral frontal craniectomy was performed and the tumor was almost totally removed macroscopically. The tumor situated in the left frontal lobe infiltrated into the optic nerve and a part of anterior cerebral artery. Histologically the tumor was diagnosed as yolk sac tumor according to Teilum's classification. There were stellate cells arranged in loose vacuolated network which formed cystic cavities and a complicated network of honeycomb with communicating cavities and extracellular PAS-positive hyaline globules. Glomerular-like structures (Schiller-Duval body) was also seen. Immunoperoxidase study clearly demonstrated the presence of intracytoplasmic alphafetoprotein granules in the tumor tissue. In radioimmunoassay, the level of the serum alphafetoprotein measured was two folds higher than that of the normal range, postoperatively. Although irradiation (local 3000 rads, whole 3000 rads) combined with chemotherapy (ACNU, Futraful), PSK had almost no effect. The effect of other chemotherapy (Cis-platin, VBL, Bleomycin) was indicated by the diminish size of the tumor. Five months after the onset, she was discharged with almost no neurological findings other than left visual loss. Pathological findings and clinical treatments were also discussed in detail.

Adolescent↗

PubMed1984

[An experimental study on the protective effect of nizofenone in cerebral ischemia].

Using the "canine model of complete ischemic brain regulated with a perfusion method" in which it is possible to control the degree of blood flow to a cerebral hemisphere via a perfusion pump, the protective effects of nizofenone against cerebral ischemia was investigated. After pre-treatment with nizofenone, blood flow was reduced via the pump to 1/10 of the normal state and 1 hour later, return to the normal state was allowed. Subsequent changes in EEG activity were observed and the effect of nizofenone evaluated. In the control group, no recovery of EEG was seen following recirculation, but in the group treated with nizofenone, gradual emergence of slow waves was observed. And the degree of recovery of EEG was better in the group administered a large dosage than in those given a low dosage. Our study suggested that within the dose ranges tested, nizofenone ameliorated ischemic brain damage in a dose dependent fashion. But the application of this experimental results to the human clinical situation requires that particular note should be paid to the dangers of transient fall of blood pressure at higher dosages.

Animals↗

PubMed1984