[Brain tumor in children--with special consideration on the relationship of treatment to survival (author's transl)].
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Biomedical subjects
Publications and source records attributed to S Endo.
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Butoctamide hydrogen succinate (BAHS), related to an organic compound naturally occurring in the central nervous system (CNS), has been shown to increase REM sleep in chronically prepared cats. In the present study, we confirmed that BAHS increases REM sleep in healthy humans, the subjects were six males whose mean age was 21 years and the experiment covered eight consecutive nights. Identical capsules containing either a placebo (linolenic acid) or 600 mg BAHS were administered 1 h prior to recording, which was started at 11 p.m. There was little change in total sleep time, sleep efficiency index, sleep latency, REM sleep latency, or the number of REM sleep periods during the drug- as compared to the baseline periods. There were, however, significant increases in REM sleep and decreases in sleep stages 1 and 2. The night's sleep was divided into three equal portions and analysis of the percentage of sleep stages in each showed that REM sleep markedly increased in the middle third while stages 3 and 4 increased in the last third. A carryover effect of BAHS was recognized during the withdrawal period. The maximum percentage of BAHS-induced REM sleep was 34%. REM density during the drug periods tended to decrease. These results suggest that BAHS may be an efficacious hypnotic in that it increases REM sleep which is suppressed by other clinically used hypnotics.
In a 4-month-old female with agenesis of the corpus callosum, seizures resembling infantile spasms were observed succeeding tonic-clonic seizures. Interictal EEG revealed hypsarrhythmia with an asynchronous pattern. Overnight sleep polygraphy was performed before, during and after ACTH therapy. The results were as follows: 1) Clinical seizures were observed only before ACTH therapy. The clinical seizures and the ictal discharges without any apparent clinical seizures occurred in all stages of wakefulness, REM sleep and NREM sleep. 2) The clinical seizures first began with the tonic-clonic seizures and were followed by seizures resembling infantile spasms. The seizures resembling infantile spasms did not appear singly. The ictal discharges in the tonic-clonic seizures appeared only in one hemisphere and, moreover, asynchronously on many occasions. The polygram of a seizure resembling infantile spasms was just like that of infantile spasms. 3) Before ACTH therapy, decrease of REM sleep time and lack of slow wave sleep were found. Decrease of REM sleep time, lightening of sleep and prolongation of awake time were observed during ACTH therapy as compared with those before the therapy. It was indicated that the seizures resembling infantile spasms in the present case differed considerably from infantile spasms. In addition, it was suggested that the asynchrony of hypsarrhythmia and the asymmetry of ictal discharges were not attributable to agenesis of the corpus callosum but dysfunction of a lower area than the corpus callosum.
Some simple technical devices for radiotherapy planning using computed tomography are reported, including (a) a wide, flat-topped plywood couch, (b) a poultice patch to mark the treatment area, (c) a Plexiglas scan level marker, and (d) reference anteroposterior radiographs using a conventional X-ray TV system.
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Two cases of traumatic cerebral aneurysm associated with widening skull fracture are reported. Cases of traumatic aneurysms in infants are particularly rare, and there have been no reported cases associated with widening skull fracture.
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Two cases revealed only small bulging at ICPC junction on carotid angiogram after subarachnoid hemorrhage were reported. One case was treated conservatively and other was operated. The diagnosis and operative indication of these cases were discussed. The authors think that all of these cases, whether these bulging are classified angiographically as aneurysm or junctional dilatation, should be operated positively when CT scan shows high density area due to subarachnoid hemorrhage around them and there are no other findings inducing subarachnoid hemorrhage on angiograms.
A case of giant pituitary adenoma was reported. The patient was a 47-year-old man with visual disturbance. CT scan revealed the huge tumor, about 6 cm in diameter, at the midportion over the sella turcica, extending to the frontal, temporal, posterior and hypothalamic region. Total resection of the tumor was successfully carried out and the difficult post-operative complications were overcome. In this paper we mainly discussed the operative procedure for giant pituitary region tumor, which usually involve the main cerebral arteries, i.e., A1 and A2 portion of the anterior cerebral artery (ACA), anterior communicating artery (ACOMA) and intracranial internal carotid artery (ICA). We used to expose the internal carotid artery at the neck for the temporary occlusion prior to craniotomy. Prolongation of the temporary occlusion time is achieved by intravenous administration of 800 ml-20% mannitol solution. After bifrontal craniotomy, we approach the tumor interhemispherically and expose the A2 portion of ACA. Then anterior communicating artery, A1 portion of ACA and ICA are exposed as the tumor is extirpated. Under the bifrontal craniotomy, as we separate bilateral Sylvian fissure and interhemisphere, we can get the wide operative field and we can also approach the tumor from various direction. Therefore, even the tumor is huge, it is possible to remove the tumor without brain damage, vessel and cranial nerve injury.
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Vasoconstriction of the external carotid arteries, which has not been previously reported, was investigated angiographically in 23 patients who had intracranial vasospasm after aneurysm rupture. In about 50% of these patients vasoconstrictive change in the external carotid arteries was also found. These changes were not seen in control cases without intracranial vasospasm. Pathogenesis of the vasoconstriction of the external carotid arteries was discussed with particular emphasis on the relationship with sympathetic nerves.
The authors report a case of infratentorial arteriovenous malformation that regressed spontaneously within 25 months without bleeding episodes or surgical intervention. The patient's clinical symptoms, left-sided tinnitus, cranial bruit, and right homonymous hemianopsia, disappeared completely over the same period.
The influence of hormone therapy on sleep states, pulse, respiration and seizure activities of infantile spasms was examined by means of overnight sleep polygraphy. Also the correlation between the changes of these parameters and the prognosis was investigated. The results were as follows: 1) In all cases, the awake time of TIB during hormone therapy was longer than before hormone therapy. The reduction of REM sleep time of SPT and lowering of REM density were remarkable during hormone therapy in cases with delayed psychomotor development as compared with cases with a considerable degree of psychomotor development. During hormone therapy, the NREM sleep time of SPT was shortened in cases with ACTH therapy, and prolonged in case with hydrocortisone therapy. 2) During hormone therapy, the pulse rate increased significantly in cases with a considerable degree of psychomotor development, but decreased significantly in cases with delayed psychomotor development. The change of respiratory rate by hormone therapy was not remarkable in all cases. 3) In cases with hypsarhythmic EEG records, the number of spikes decreased drastically by hormone therapy. In the case with EEG record of focal spikes, the number of spikes increased by hormone therapy. From the results mentioned above, the mechanism for effectiveness of hormone therapy and correlation between the administration of hormone therapy and prognosis was discussed.