[Steroid treatment in neurosurgical practice--with special reference to the serum beta-methasone level and clinical effect (author's transl)].
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Biomedical subjects
Publications and source records attributed to T Kusunoki.
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The brain of the hagfish, Eptatretus burgeri, was investigated by enzyme histochemical methods to locate roughly the areas which have somatic, visceral, and correlative functions. From the results of previous investigations, it seems that, as a rule, AChE is found in the correlation areas and in a part of the visceral and somatic areas, whereas SDH and MAO are detected in the somatic and visceral areas, respectively. Therefore, the activities of these three enzymes can be used to indicate the functional areas. In addition, G6PD is used to detect areas related to the pentose cycle. Areas with remarkable AChE activity are layer 4 (neuropil), layer 3 (perikarya), layer 5 (perikarya and neuropil), the primordium hippocampi of Jansen (neuropil and a small number of perikarya), the median sagittal lamina of the habenula (neuropil and perikarya), some cells in the pars dorsalis thalami of Jansen (neuropil), the nucleus tuberculi posterior of Jansen (neuropil), and the hypophysis. Activity of SDH, MAO, and G6PD appears in the neuropil. Regions showing activity of both SDH and MAO are the olfactory nerves and glomeruli, the septal area, layer 1 and 4 including the neostriatum of Crosby and Schnitzlein, the primordium hippocampi of Jansen, the preotic area, the habenula, and the caudal part of the medial hypothalamus, this last being the circumference of the hypothalamic ventricle. Furthermore, the anterior part of the amygdala of Crosby and Schnitzlein shows SDH activity. Activity of G6PD is distributed in the same regions showing activity of SDH and MAO, with the exception of the primordium hippocampi of Jansen. Finally, (1) two groups of continuous areas of AChE activity are found conspicuously in the telencephalon; one group consists of layers 3, 4, and 5, and the other consists of the ventral part of the primordium hippocampi, the lateral part of the pars ventralis thalami, and the nucleus tuberculi posterior. These two groups may play a correlative role between the visceral and somatic areas and the cholinergic mechanisms. (2) It seems that the forebrain, especially in the hypothalamus, is poorly differentiated. Furthermore, (3) a comparison with other nonmammalian brains is made from the viewpoint of the chemoarchitectonics.
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CT scans were used to evaluate the development of the hydrocephalus, periventricular hypodensity (PVH) and the degree of the brain damage on 33 patients with the normal pressure hydrocephalus (NPH), following the subarachnoid hemorrhage (SAH), and the following conclusion can be drawn from our study. 1) NPH occurs in 33 cases out of 156 cases of subarachnoid hemorrhage (21%), and there was a relatively high incidence of normal pressure hydrocephalus following rupture of the anterior communicating artery aneurysm. 2) Factors causing NPH may be the arterial vasospasms and subarachnoid blood clot of the basal cistern verified by CT. 3) According to the repeated CT and lumbar tap after SAH, PVH, and, hydrocephalus usually become apparent around 7-10 days and most prominent around 3-4 weeks after SAH except for acute hydrocephalus appeared immediately after severe SAH. 4) The results were compared with CT findings and clinical response to shunting. The clinical improvements were achieved in cases (85%), in which CT showed PVH, small brain damage in the frontal lobe due to vasospasms or intracerebral hematoma, and no cortical atrophy. 5) Repeated CT can give better informations on the development of hydrocephalus in cases of SAH and can provide the indication for a shunt.
Eighteen subjects, who were diagnosed as idiopathic normal pressure hydrocephalus in our outer patient clinic, were undergone with CT scan, metrizamide CT cisternography (CTC), radioisotope cisternography (RIC), and they were classified into 3 groups in accordance with ischemic score which had been proposed by Hachinski. Ventriculoperitoneal shunt was performed in 17 subjects, but improvement of the symptoms were obtained only in five. Dementia, gait disturbance and urinary incontinence were common features among the ones who had clinical improvement after shunt and the ones who had not, but systemic arterial hypertension and focal ischemic signs were more frequently found in formers than in latters. The subjects with low ischemic score were classified into Group 1, and the one with high ischemic score were classified into Group 2 and the other one with moderate score were into Group 3. The subjects who had clinical improvement postoperatively were exclusively found in Group 2 and 3. If the degree of ischemic score has good correlation with actual existence of cerebral ischemic lesions, we might suspect from our data that systemic arterial hypertension and ischemic lesion of the cerebrum might be basic pathologies which develop an idiopathic normal pressure hydrocephalus.
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The existence of an infrared sensory neuron group with ascending fibers which directly reach the optic tectum in Crotaline snakes was confirmed with three methods. (1) With the retrograde horseradish peroxidase (HRP) method, labeled neurons were not found within the nucleus descendens lateralis nervi trigemini (DLV), but in an unnamed cell group located immediately ventral to the DLV of the contralateral side at the transitional portion between the nucleus oralis (DVo) and the nucleus interpolaris (DVi). This unnamed cell group, which was seen only in the Crotalinae, was provisionally called the 'new nucleus'. (2) Normal brain series of 15 species were stained by the methods of Bodian-Otsuka, Klüver-Barrera and Nissl staining to compare the cytoarchitecture of the medulla oblongata. The 'new nucleus' was found only in species belonging to the Crotalinae. This nucleus was situated in fiber tracts which appeared to correspond to the lemniscus spinalis and tractus spino-cerebellaris of the reptilian medulla oblongata, and contained medium-sized multipolar or fusiform neurons. (3) In an electrophysiological study 16 single units responding unimodally to an infrared stimulus were recorded. Three of these recording sites were determined with Pontamine sky blue marking to be near or within the 'new nucleus'.
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The sixth case of hydranencephaly in a twin is reported. The patient is an 11-year-old girl, and her twin was stillborn and macerated. Intrauterine disseminated intravascular coagulation may be the cause of hydranencephaly in this patient.
In a case of Engelmann's disease in an 11-year-old Japanese boy the muscular changes were studied in detail. Muscle weakness was maximal about the pelvic girdle. Muscle biopsy showed the selective atrophy of type II fibres, and no degenerative change could be seen histologically, histochemically, or electron-microscopically. Although the distribution of muscular weakness in Engelmann's disease is similar to that of a progressive muscular dystrophy, the disease does not seem to be a myopathy.
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Six patients aged between 1 to 11 years (4 females and 2 males) developed Stokes-Adams attacks with complete heart block due to acute nonspecific myocarditis. Transvenous pacing was instituted in 2 patients, but in the other 4 patients the ECG returned to normal by isoproterenol. All ECGs in complete heart block showed QRS complexes of right bundle branch block with left posterior hemiblock pattern, except for 1 which showed QRS complexes of complete left bundle branch block pattern. The ECG improved sequentially in order and left anterior hemiblock pattern of QRS complexes remained to the last during the convalescent period. Normal atrioventricular conduction returned by 2 to 24 hours in all but 1 patient who was dead and 1 of the 2 patients with shock. In another patient bifascicular block has persisted.
Cerebrospinal fluid flow dynamics of 15 patients with occlusive cerebrovascular diseases was studied using RI cisternography (RIC) and Metrizamide CT cisternography (CTC) and these methods were compared. RIC demonstrated RI retention in 9 patients, which was noticed in all chronic stage patients (over one month after apopletic episode). Five patients had subarachnoid block in affected cerebral hemisphere. Ventricular reflux, however, was present in only one patient. Metrizamide CTC (170 mgI/ml) showed ventricular reflux or stasis in 11 of 16 patients. Seven patients revaaled asymmetrical metrizamide filling of Sylvian fissures at 3 or 6 hours after intrathecal injection of Metrizamide. Asymmetrical demonstration of Sylvian fissure after 3 hours in 3 patients corresponded with the finding of subarachnoid block at the same side on RIC. The clinical values of CTC were emphasized on the basis of this investigation. Ventricular reflux or stasis, which indicated one of the important findings on cerebrospinal fluid flow disturbance, was easily and clearly detected. Asymmetrical metrizamide filling of Sylvian fissures at 3 hours after injection was compatible with subarachnoid block on RIC.
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