[A case of chronic neutrophilic leukemia (author's transl)].
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Biomedical subjects
Publications and source records attributed to T Tsuchida.
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A very rare case of the choroid plexus carcinoma of the left lateral ventricle with metastasis to bone was reported. A two-month-old baby was suffering from irritability and vomiting. Her vital signs became progressively worse. On admission she showed an increased head circumference and meningeal irritation signs. An emergency tapping of the right lateral ventricle at the anterior fontanel revealed the bloody csf and an opening pressure of over 700 mm of water. All laboratory findings were negative. Cerebral angiograms showed only an internal hydrocephalus. CT scan and conray-ventriculography gave the finding of a tumor at the trigone of the left lateral ventricle. The tumor was removed "en bloc". Histological examination of the tumor revealed a choroid plexus carcinoma, which was considered met the criteria given by Russell and Rubinstein. The postoperative course was very complicated with metastasis to the right tibia, which was verified by needle biopsy. The patient died from a cachexia. This case was the youngest of all reported cases and very unique in the point of which the tumor metastasized to outside of the central neural axis.
Human sera collected from normal subjects and diabetic patients were electrophoresed in an urea-containing gel. The albumin fraction separated into several bands. In normal fasting serum the fast-migrating Bands 1 and 2 were observed and the slower-migrating Bands 4 and 5 did not appear. After glucose administration Band 1 disappeared and Bands 4 and 5 appeared for the first time. In diabetic serum Bands 4 and 5 did not appear before or after glucose administration and this abnormality resembles the pattern in C57BL/KsJ-db/db mice but not C57BL/6J-ob/ob mice.
The reports of perangiographic rupture of intracranial aneurysm are very few, but the actual incidence is doubtless higher than reported. We could find only 49 cases in the literature, all of which were recognized by extravasation of contrast media. Three of our own cases are documented; in all of them cerebral angiography was carried out soon after subarachnoid hemorrhages. The danger of cerebral angiography in patients with a recently hemorrhaged intracranial aneurysm is stressed.
Surgical treatment of hemifacial spasm associated with tortuous vertebrobasilar system was reported. A patient was 63-year-old female, who first experienced mild and intermittent muscle twitching around her left eye twenty years prior to admission. Five years later, the twitching extended to all the facial muscles on the left side. She was treated with facial nerve block, which resulted in facial palsy for about one year. Because of recurrence of the hemifacial spasm, she was admitted to the Neurosurgical Department of Bokuto Municipal Hospital on October 12, 1977. Neurological examination revealed no abnormalities except for left hemifacial spasm with slight muscular weakness. Electromyogram showed severe twitching and synkinesis of all the muscles of facial expression. Vertebral angiogram on the left side disclosed pronounced elongation of the vertebral and basilar arteries, which extended into the left cerebellopontine angle. Compression of the facial nerve root exit zone at the brainstem by the vertebral artery was considered to be the cause of the hemifacial spasm. Suboccipital craniectomy was carried out on November 29, 1977. The vertebral artery extended into the cerebellopontine angle, and adhered to the facial nerve. After mobilization of the vertebral artery from the facial nerve, a small prosthesis of non-absorbable spongy material (Teflon felt) was interposed between the vertebral artery and brainstem. Postoperatively, the hemifacial spasm disappeared, but the facial palsy, which had been observed preoperatively probably due to previous facial nerve block and long-standing hemifacial spasm, remained. The function of the acoustic nerve was preserved. Recently vascular compression of the facial nerve root exit zone has been reported as a major cause of hemifacial spasm, but such abnormal vessels are rarely demonstrated angiographically.
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We reported the case of a 40-year-old man who was hospitalized to our department on November 16, 1975 with a year history of neuralgia in the saddle region and vesicorectal dysfunction. Examination of CSF on lumbar puncture at L4-5 revealed xanthochromia with a protein content of 2,560 mg/dl. Myelography revealed a tortuous filling defect at the level of L2 coupled with complete blockade at L3 level. Selective spinal angiography of the left 12th intercostal artery demonstrated the enlarged Adamkiewicz's artery. This blood vessel was found to enter a diffuse uniform density, where no distinct blood vessels were visible. Within one second after the injection of contrast agent an efferent vein appeared from the right side of the density, ascended to the level of Th12 and then, upon turning, descended to the pelvic canal. These findings suggested a hemangioblastoma of the spinal cord. Laminectomy was performed at levels of L2 through L4 and a hemangioblastoma of the cauda equina was totally excised at L3 level. Although the postoperative course was complicated by a transient dysuria and hypesthesia at S1-S5 levels, complete cure was achieved in a month. In the present paper clinical features and neuroradiological examination of a hemangioblastoma of the spinal cord were described.
Spontaneous regression of sinus pericranii has not been reported in the literatures. The aurthors presented a very rare case of sinus pericranii, which was diagnosed as early as nine days after birth and completely disappeared in seven years. The patient was a nine-day-old boy from normal delivery in full term, who had a soft tumor simulating cephalhematoma in the right parietal region. The overlying scalp looked like a hemangioma bitemporally connecting with strikingly dilated scalp veins. Soft X-ray examination of the skull revealed a homogenous mass and a small bone defect beneath the mass. Venous blood was punctured from the tumor. By means of direct injection of contrast media into the tumor, the superior sagittal sinus as well as many extracranial varicositous veins were shown. No intracranial vascular anomaly. In a year the tumor spontaneously declined and in the following seven years it disappeared completely. Pathogenesis of this lesion was discussed with special reference to cephalhematoma and a possibility of spontaneous regression of sinus pericranii was stressed.
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Recurrence of an IC--PC aneurysm after a successful neck clipping (Heifetz' clip) is reported. This was caused by breaking of a clip blade at its proximal end. It is suggested that some structural weakness was present in the clip metal.
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This is a follow-up study of 96 patients with pineal tumors, except for one patient who was lost to follow-up. 60 of these tumors were verified histologically either at operation or at necropsy, 6 were diagnosed by epitheloid cells existing in the cerebrospinal fluid, and 30 were diagnosed by clinical and ventriculographic findings. In agreement with Russell and Rubinstein, we have classified the histologically verified tumors into 3 groups, as follows; 1. True Pinealoma Group (Pineocytoma, Pineoblastoma), 2. Germinoma-Teratoma Group, 3. Others (Glioma, Cyst). The following points need to be emphasized in the planning of management: 1. Pinealoma (Two cell pattern pinealoma) responds favorably to radiation therapy. 18 of 43 patients of pinealomas who were treated with irradiation are functioning normally in various life situations for more than 5 years. Among them, 5 cases of pinealomas treated with irradiation alone have more than 10 years survivals. 2. There is a limitation in the efficacy of irradiation therapy in cases of spinal cord implantation, infiltration in adjacent structures or subependymal infiltration along the ventricular cavity. 3. Only 2 of 67 patients with pinealomas had spinal cord metastasis. It seems undesirable to subject all patients to complete cerebrospinal axis irradiation. 4. Successful removal were performed in 4 patients with teratomas and are now alive for 9-21 years. None of them, however, are doing well clinically with many neurological deficits. 5. Since adenocarcinoma, teratocarcinoma, teratoblastoma and others are not sensitive to radiation therapy, only the palliative treatments are available. 6. Therefore, the most promising treatments for pineal tumors is that irradiation, plus shunting operation when required, is a first choice and after irradiation, radical removal should be tried in the case of teratoma diagnosed by clinical and ventriculographic findings.
Experience with Radio Isotope Myelography is reported here. 169Yb-DTPA as a tracer was intrathecally injected at lumbar region in twenty three patients with various spinal cord lesions. The first scanning is perfomed after comfirming by gamma-camera that the tracer reaches to the lesion, the second and the third scannings are done according to the ascending rate of the tracer. (I) Normal scintimyelogram (A) In normal case, the shape of the Radio Isotope Myelogram well corresponds the shape of anatomical subarachnoid space. (B) In normal adult cases, the tracer comes up to the cisterna magna in 20-25 minutes after the lumbar injection. Therefore, the scintimyelographic diagnosis should be made not only by the shape but also by the ascending rapidity of the tracer. (II) Abnormal scintimyelogram Abnormal scintimyelograms could be summarized as following three categories. (A) "Delay": It means delay of the ascending of the tracer. Besides, "Transient delay" found in a case of Arnord-Chiari's malformation was proposed. (B) "Partial block": It meas a defect at the level of the lesion. This "Partial block" were observed in cases of spinal cord angioma, cervical spondylosis and spinal cord tumor etc. (C) "Complete block": It means the stagnation of the tracer below the lesion. To sum up, Rario Isotope Myelography, especially in partial block, can more easily and more sensitively represent the maximum extent of the spinal cord lesion than other myelographic study or angiographic one. On the other hand, we can not qualitatively diagnose about the lesions by its indistinct border.