[Prevention of cerebral vasospasm by cisternal irrigation].
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Biomedical subjects
Publications and source records attributed to N Kodama.
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Serum neuron-specific enolase (NSE) was determined by RIA in 102 lung cancer patients. Serum NSE was elevated (greater than 10 ng/ml) in 72% (21 of 29 cases) of small cell lung cancer (SCLC) patients, which was a significantly higher positive rate than those in normal adult controls (0%, 0/48), noncancerous lung disease (17%, 4/24), squamous cell carcinoma (19%, 6/31) and adenocarcinoma (16%, 4/25) (p less than 0.05, respectively). There were no NSE-positive cases in stage I-II lung cancer patients. In SCLC, cases of extensive disease had a significantly higher NSE-positive rate (100%, 8/8) than those of limited disease (62%, 13/21) (p less than 0.05), suggesting that NSE levels were related to the bulk of the tumor. There was an excellent correlation between serum NSE and clinical response. Raised NSE levels were identified significantly more frequently than those of CEA in SCLC before chemotherapy and on relapse (or progression) (p less than 0.025, p less than 0.005, respectively). Thus, serum NSE determinations may be more useful than those of CEA for the staging and monitoring of SCLC.
A surgical case of prolactinoma associated with craniopharyngioma is reported. A 47-year-old man was admitted to some neurosurgical clinic on October 12, 1982, because of visual disturbance, general fatigue and impotence. Laboratory study revealed hyperprolactinemia (360 ng/ml) and slight enlargement of sella turcica indicated the pituitary adenoma. Transsphenoidal surgery was performed to remove the tumor on November 20, 1982. Histopathological examination revealed chromophobe adenoma, and prolactin was stained in the tumor cells by means of immunoperoxidase staining. Though the clinical symptoms had been improved after surgery, visual disturbance became worse about one month later. At that time empty sella syndrome was suspected and the second operation (interhemispheric approach) was performed on January 21, 1983. No pathological changes were observed at all. On July 13, 1983, he was transferred to our clinic, because his visual acuity was deteriorating. At this time we reviewed the previous CT scan and noticed a suprasellar mass. It was supposed that the lesion had been overlooked and was the cause of the visual disturbance. On August 1, 1983, a bifrontal craniotomy was performed and the suprasellar tumor was removed. Pathological examination of the tumor revealed craniopharyngioma. So it was supposed that pituitary adenoma and craniopharyngioma had been coexisting since onset. Except for cases with von Recklinghausen's disease, multiple primary intracranial tumors of different cell types are relatively rare. A review of literature revealed 94 cases until 1986. The most frequent combination of multiple tumors was meningioma and glioma. But we could not find any case of pituitary adenoma associated with craniopharyngioma in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)
The present trial was designed to compare the effect of metoclopramide(MCP) + dexamethasone(DM) (Method A) with that of MCP + DM + lorazepam(Lor) (Method B) in the treatment of CDDP (cis-diamminedichloroplatinum)-induced nausea and vomiting in a randomized fashion. The results were collected by questionnaire given to 50 patients. The dosage of CDDP was 80-100 mg/m2. In addition, MMC and VDS, or VP-16 were used concurrently. Within 24 hours after the administration of CDDP, vomiting was not observed in 72% and 88% of the patients treated with Method A and Method B, respectively, and nausea was not noted in 48% and 68%, respectively. Marked malaise was observed in 36% of patients in the Method A group and in 12% in the Method B group. With respect to the extent of comfort, 16% of patients in the Method A group and 56% in the Method B group felt good. Sixteen percent in the Method A group and 56% in the Method B group were satisfied with the anti-emetic treatment. Thus, Method B was significantly superior to Method A with regard to the degree of comfort and treatment satisfaction.
A phase II study of epirubicin (EPI) was performed on 65 eligible lung cancer patients. EPI was administered intravenously at the dosage of 60 mg/m2 for non-small cell lung cancer (NSCLC) and 75 mg/m2 for small cell lung cancer (SCLC) at the interval of three to four weeks. The response rate of 57 measurable patients was 7.0% (predicted true response rate was 1.9-17.0%). In SCLC, the overall response rate was as low as 8.3% (2/24), but a better response rate, 20% (2/10), was observed in patients given no prior therapy. In NSCLC, the response rate was 6.1% (2/33) as a whole and 12.5% (2/16) in patients given no prior therapy. We were able to conclude that EPI was a moderately active agent in SCLC and marginally effective in NSCLC. Although the dose limiting factor was leukopenia, its incidence and degree seemed low as compared with adriamycin (ADM). As for alopecia or GI tract side effects, those associated with EPI appeared less acute than those produced by ADM. No cardiac toxicities were observed, partly because of the low cumulative maximum dose of 311 mg/m2 used in our study.
Successful surgical treatment of acoustic neurinoma in a case of hemodialyzed patient is reported. A 42-year-old female patient, who had been treated by hemodialysis, was diagnosed as having a C-P angle tumor by CT scan. She was refered to our clinic on June 24, 1983. Laboratory examinations on admission showed severe anemia and renal dysfunction. Every possible treatment was done in order to improve the laboratory data preoperatively. Another big problem in this case of hemodialyzed patient was brain edema and bleeding tendency. In order to cope with brain edema, intravenous administration of glycerol and slow hemodialysis for three days were performed preoperatively. These treatments were thought to be effective to reduce bleeding tendency also. During operation, however, heavy swelling of the cerebellum forced us to resect one third of the hemisphere to remove the tumor totally. In addition to this, postoperative mild bleeding in the cavity after tumor resection, subcortical hemorrhage around the shunt tube and oozing from the wound were observed. The patient was discharged from the hospital four months after surgery without any neurological deficit. The way of recovery, however, was not uneventful, because the patient developed various kinds of postoperative complications as mentioned above. In the postoperative managements, we felt almost as if we were treading on thin ice. Neurosurgical management in hemodialyzed patients is not yet very common. We should improve the postoperative management by adding new experience with similar cases.
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There are two major approaches to basilar top aneurysm: one is subtemporal by Drake, another is pterional by Yasargil. In either approach, however, it is hazardous and difficult to approach basilar top aneurysm with megadolichobasilar anomaly because strong retraction of brain, nerve and vessel is required. A successful case of ruptured basilar top aneurysm with megadolichobasilar anomaly treated directly through the third ventricle is reported. A 62-year-old woman was admitted with consciousness disturbance. Plain CT scan on admission demonstrated massive and diffuse subarachnoid hemorrhage and a clot in the third ventricle. The left vertebral angiography demonstrated a 5 X 5 mm basilar top aneurysm with megadolichobasilar anomaly 24 mm distant from dorsum sellae. The aneurysm was considered to be inaccessible by conventional approaches because of its high position. Therefore, we have applied a new approach mentioned below. Operation was performed 2 days after the onset, using a bifrontal craniotomy. Dissecting interhemispheric fissure, we approached the third ventricle via lamina terminalis. Evacuating the clot in the third ventricle, the basilar top aneurysm was visualized. After dissecting the neck of aneurysm and perforators, clipping was performed. The postoperative course was uneventful. Surgical key points and prospective view in approaching via lamina terminalis and through the third ventricle for a high position basilar top aneurysm are discussed.
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A case of chondromyxoid fibroma of the skull is reported. A 20-year-old boy visited our clinic on December, 1982 because of a recurrent forehead tumor. He had a 4 X 4 X 1.5 cm tumor on the right side of forehead and a 3 X 3 X 0.5 cm tumor on the left. Neurological examination showed no abnormalities. Skull X-ray film showed a large round radiolucent area with clear sclerotic margin in the frontal bone and right orbit. Right carotid angiogram showed marked posterior displacement of the anterior cerebral artery, but no tumor stain. Plain CT scan showed a mass with iso to low density area in the frontal region. It was markedly and irregularly enhanced with contrast media. Surgery was performed entirely in the epidural space, and the tumor was completely removed. The post-operative clinical course was uneventful. Histologically, the three components of chondroid, myxomatous and fibrous tissues in this tumor led to the diagnosis of "chondromyxoid fibroma."
The qualitative and quantitative changes in behavioral development in the prenatal and perinatal periods have been insufficiently studied. We observed the occurrence of spontaneous body movements in three strains of mice (ICR, C3H, and BALB) and the pulse counts measured by EMG activity gestation period normal for mice. During the prenatal period, fetal movements changed from simple movements to complex and coordinated movements. Differences in the timing of the development of these movements were not found in the three strains of mice. During the perinatal period, the three kinds of simple movement decreased. This decrease was affected by the onset of pulmonary respiration after delivery. The time span of spontaneous movement did not change during the perinatal period, while the pulse counts measured by EMG activity increased with age.
An autopsy case of intracranial multiple meningiomas associated with extracranial multiple neurinomas was presented. A 55-year-old woman, who had received surgical treatment for right parasagittal meningioma 20 years ago, gradually showed the sign of increased intracranial pressure and disturbance of the lower cranial nerves. Brain CT scan demonstrated numerous intracranial tumors. At autopsy 124 intracranial meningiomas, and neurinomas in her left cervical and right axillar portion were found. Meningiomas showed the transitional and fibroblastic type, histopathologically, and axillary and cervical tumors were the Antoni A type neurinomas. It is suggested that this case had a tendency of heterogenous and multiple origination of tumors.
A successful case of ruptured aneurysm of the persistent trigeminal artery (PTA) treated with direct operation is reported. Only 14 cases out of ever-reported 400 cases with persistent trigeminal artery have aneurysms developing from PTA itself or its junction. These aneurysms originate most frequently from the trunk portion of the PTA. In our case, aneurysms are found at the rt. internal carotid-PTA junction and the rt. IC-PC junction. Six out of 14 are associated with another intracranial aneurysms, indicating high multiplicity. Of 14 cases, only 2 including our case are treated by direct surgery. Since the internal carotid-PTA junction aneurysm is located in the cavernous sinus, special consideration is needed during the operation. Surgical keypoints in opening the cavernous sinus under normothermia and getting the landmark for orientation are described.
In this paper, a case with subdural tension pneumocephalus secondary to bifrontal craniotomy and VP shunt for ruptured Acom aneurysm is reported. In this patient, the mechanisms for entry of air into the subdural space and producing mass effect (Tension pneumocephalus) seem to be one way valve mechanism and negative pressure due to excess of CSF drainage owing to shunting system. Only 29 reported cases of tension pneumocephalus following surgery were found in an extensive review of the literature. We discussed about the clinical symptoms and signs, therapy, and especially about the mechanisms leading to this condition, and prevention for it.
A 49-year-old man who had been suffering from disturbance of hearing for 5 years suddenly developed severe headache, nausea, and vomiting. Computed tomography (CT) scans both with and without contrast medium enhancement, performed on the day of admission, showed a nearly round high-density area in the left cerebellopontine angle. A left transaxillary vertebral angiogram showed no aneurysm or arteriovenous malformation. Hemorrhage from a tumor in the left cerebellopontine angle was suspected. CT scan without contrast medium enhancement, performed on the 17th day after onset, showed only a small, ill-defined high-density area in the cerebellopontine angle. An operation was performed on the 20th day after onset. The tumor was totally extirpated together with a clot. Histologically the tumor was an acoustic neurinoma with hemorrhage and necrosis. The postoperative course was favorable. Massive hemorrhage from primary intracranial tumors, especially acoustic neurinomas, is discussed. Radical operation on the tumor should be performed as soon as possible.
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A 69 year-old male was admitted to our clinic with the chief complaint of hoarseness and difficulty in swallowing. These symptoms occurred about 5 months after penetrating neck injury. Neurological examination revealed right ninth to twelfth cranial nerves palsy and Horner's syndrome. Plain skull X-P demonstrated two broken pieces of glass below the right mastoid processus. The right carotid angiogram showed a 45 x 25 mm aneurysm originated from the right internal carotid artery just below the carotid canal. As the first operation, gradual occlusion of right internal carotid artery combined with the right STA-MCA anastomosis was performed. But two days after complete occlusion, left hemiparesis and pseudobulbar palsy appeared. Two months after such episode, aneurysm and the pieces of glass were removed. He discharged on foot with the improvement of the symptoms of lower cranial nerves. Villaret's syndrome caused by the traumatic aneurysm of extracranial internal carotid artery is rare. This case seems to be the first report in Japan.