[Emergency operation for the ruptured intracranial aneurysms -Within 5 days after subarachnoid hemorrhage- (author's transl)].
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Biomedical subjects
Publications and source records attributed to Y Tokuriki.
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Fifteen cases of brain tumors of supratentorial location were studied by RI cisternography; Cisternographical patterns of decreased or absent radioactivity were classified into five groups as follows: Pattern I: Sharply circumscribed and localized decrease in radioactivity; Pattern II:Ill-defined and focal decrease in radioactivity; Pattern III: Areal decrease in radioactivity involving one whole or two lobes; Pattern IV: Hemispherical decrease in radioactivity and Pattern V: Total decrease in radioactivity in the head. Each pattern appears to correspond well with topographical features of brain tumors and their related pathology, such as extracerebral tumors (pattern I), intracerebral but superficially located tumors (pattern II), extracerebral tumors with surrounding edema or large intracerebral tumors (pattern III), extracerebral or intracerebral tumors with increased intracranial pressure (pattern IV), and extremely increased intracranial pressure regardless the site of tumor (pattern V). In consideration of these patterns, RI cisternography would be a more useful supplementary method in diagnosis of brain tumors to detect the area involved, to differentiate an intracerebral from an extracerebral tumor, and to find a recurrence of the tumormfurthermore, it is helpful to know the therapeutical effects of surgery and radiotherapy. RI cisternography is a simple, relatively noninvasive method which can be used more widely.
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In contrast to 169Yb-DTPA the usage of 111In-DTPA, a new radiopharmaceutical, is not as yet popular for RI cisternography. This report deals with a comparative study of these two radiopharmaceuticals for RI cisternography. For the past one year 301 RI cisternography. For the past one year 301 RI cisternographies were performed in 160 cases at the Neurosurgical Survice of Shizuoka Rosai Hospital. Among those 169Yb-DTPA was used in 137 occasions, 111In-DTPA in 53, and both 169Yb-DTPA and 111In-DTPA in 30. The results of this study were as follow. 1. 111In-DTPA was chemically stable in intrathecal administration. 2. A reactive fever was minimal with 111In-DTPA if any. 3. There was no adverse reaction, such as aseptic meningitis, following 111In-DTPA cisternographies. 4. The effective half-life of 111In-DTPA was 16 hours, and that of 169Yb-DTPA 22 hours in this series. This means the men were exposed to radioactivity less with 111In-DTPA than with 169Yb-DTPA. 5. However, there was no difference in diagnostic value between these two radiopharmaceuticals, even 48 hours after intrathecal administration. From this study 111In-DTPA appears to be more suitable for RI cisternography than 169Yb-DTPA.
The significance of bone scintigraphy using 99mTc-polyphosphate or 99mTc-diphosphate in the diagnosis of eosinophilic granuloma was discussed on the basis of our experience with four cases. The summary is following: 1. On diagnostic procedure of eosinophilic granuloma, it was found that abnormal RI accumulation in the bone scintigram was more marked than that in the ordinary brain scintigram. 2. The bone scintigram of eosinophilic granuloma showed more accurately the extent of skull involvement of cellular infiltration than the plain skull X-rays or brain scintigram. Accordingly, the bone scintigram was helpful for neurosurgeon in planning the operative procedure and determining the extent of removal of the involved skull. 3. The plain skull X-rays show the size of skull defect, and the brain scintigram reveals the size of the size of granuloma per se, as well as soft tissue involvements. We can conjecture the stage of the diseases by comparison between the findings of bone scintigram and those of above procedures: plain skull X-rays and brain scintigram. Viz, the bone scintigram showed more extensive areas of RI accumulation including the surrounding cellular infiltration in the acute stage, but the same size of the lesions shown by the ordinary brain scintigram and plain skull X-rays is chronic stage. Furthermore, we discussed the possibility of the differential diagnosis between eosinophilic granuloma and other neoplastic bone diseases, such as intracranial metastatic tumors and multiple myelomas etc., by further experience with the bone scintigram.