Synthesis of novel ferrocenyl sugars and their antimalarial activities.

The synthesis of twelve types of novel ferrocenyl sugars and their biological properties towards the malaria parasite (P. falciparum) and mouse cancer cell (FM3A) are described.

Pulsed off-resonance magnetization transfer for brain tumor in patients.

We investigated the clinical applicability of pulsed off-resonance magnetization transfer (MT) technique in magnetic resonance (MR) imaging for the estimation of the histological feature of brain tumor. The parameters were optimized using bovine serum albumin (BSA) solutions and gels in 1.5-tesla MR system as follows: TR, 50 msec; TE, 5 msec; flip angle, 30 degree; offset frequency, 1000 Hz. MT effect was evaluated by measuring the MT ratio (MTR) and reconstructing calculated MTR color image. The MTRs of the BSA solutions and gels increased with increasing concentrations of protein, while the MTRs of the gels were remarkably higher than those of the solutions. The optimized sequence was performed in 20 healthy volunteers and 30 patients with brain tumors. In normal brains, the MTRs were significantly higher in white matter than in gray matter (p < 0.05). The MTR in brain tumor was significantly lower than that in normal brain tissue (p < 0.05) and the calculated MTR image produced contrast between brain tumor and normal brain tissue. There was a statistically significant difference in MTR between benign (0.30 +/- 0.05, n = 17) and malignant (0.26 +/- 0.04, n = 13) tumors (p < 0.05). The optimized MT technique is quite sensitive for estimating the degree of intermolecular interaction between macromolecules and water within the central nervous system.

[Clinical application of 31P-chemical shift image using 31P-volume coil to Moyamoya disease].

31P-MRS and 31P-Chemical Shift Image(CSI) using volume coil were applied to Moyamoya disease of 14 cases, data of which were compared with clinical manifestations and neuroimagings. In four asymptomatic cases, signal intensity of both total P and total ATP was almost equal in each voxel, but in other cases, both signal intensity of the lesion was relatively decreased, compared with non-lesion. Especially, signal intensity of total P and total ATP in ischemic lesion was significantly decreased. This showed that 31P-CSI is able to demonstrate cerebral ischemic lesion not detected by CT and MRI. We have reported on Moyamoya disease that 31P-MRS comparatively correlates to cerebral blood flow and 31P-CSI demonstrates ischemic lesion as not detected by CT and MRI less invasively.

2D-TOF MRA Follow-up Study of Percutaneous Transluminal Angioplasty for Severely Stenotic Cervical Internal Carotid Artery.

SUMMARY: Percutaneous transluminal angioplasty (PTA) for severe arteriosclerotic stenosis in the cervical internal carotid artery (ICA) was successfully carried out in 23 cases between December 1994 and August 1996. In order to analyze the condition of the cervical ICA in the early stage after PTA, 12 stenotic lesions of 11 cases were exposed to follow-up study of stenotic cervical ICA after PTA with magnetic resonance angiography (MRA) 1 to 150 days postoperatively. In six lesions, the diameter of the cervical ICA was dilated sequentially. In another four lesions, the diameter of the cervical ICA was decreased in the first three weeks and dilated over the next three weeks. Angiographically, these lesions had a small intimal flap at the balloon dilated portion, which was speculated to cause the turbulent flow in the first stage. In the remaining 2 lesions, restenotic changes in cervical ICAs were observed within three weeks after PTA. Follow-up angiography was performed over three months after PTA in five cases of this series and compared with MRA. Consequently, the diameters of the cervical ICA between angiography and MRA were closely correlated. The evaluation of the lesion after PTA of the cervical ICA demonstrated that MRA is beneficial, but within three weeks after PTA, caution should be paid for underestimation of the small intimal flap on MRA.

Relationship between Ricinus communis agglutinin-1 binding and nucleolar organizer regions in human gliomas.

Histochemical staining using lectins from Ricinus communis (RCA-1), Arachis hypogaea, and Canavalia ensiformis was investigated in 40 human gliomas, three central neurocytomas, one human neuroblastoma cell line (IMR-32), and two normal brain tissues. Staining was uniform in low-grade gliomas, but heterogeneous in high-grade gliomas, particularly with RCA-1. The correlation between RCA-1 reactivity and cellular proliferative potential was investigated in 10 high-grade gliomas using a combined staining technique: the silver colloid method for nucleolar organizer regions (Ag-NORs) and histochemistry with RCA-1. The mean number of Ag-NORs counted on a simple preparation was significantly greater in the nuclei of RCA-1-negative cells than in those of RCA-1-positive cells (p < 0.001). The staining intensity of inflammatory cells was obviously higher than that of neoplastic cells, and therefore inflammatory cells were easily discriminated from neoplastic cells. Combined RCA-1 histochemical and Ag-NOR silver colloid staining revealed heterogeneous expression of RCA-1 receptor in high-grade gliomas with changes in Ag-NOR number. This result seems to show that high-grade gliomas express heterogeneous cellular carbohydrate structure and proliferative potential even within the same tumor.

Clinical analysis of a series of vertebral aneurysm cases.

We reviewed 38 cases of aneurysms of the vertebral artery treated over the last 10 years: 26 (68%) located at the junction of the vertebral and posterior inferior cerebellar arteries, 10 (26%) at the vertebral artery, and 2 (5%) at the vertebrobasilar union. There were three distinct forms of aneurysms: 20 saccular (53%), 10 fusiform (26%), and 8 dissecting (21%). Among these 38 aneurysms, 33 (87%) had ruptured: 18 of the saccular aneurysms (90%), all 10 of the fusiform aneurysms (100%), and 5 of the dissecting aneurysms (63%). Computed tomography of the 28 ruptured aneurysms revealed diffuse subarachnoid hemorrhage in the basal cistern combined with intraventricular hemorrhage in 24 cases (86%). Magnetic resonance imaging was useful for differentiating between fusiform and dissecting aneurysms. Abnormalities such as a double lumen of the vertebral artery were demonstrated in four of the dissecting aneurysms. The overall surgical results were good for 22 of the 27 surgically treated cases (81%). New bleeding was observed in 8 (24%) of the 33 ruptured aneurysms. The rate of new bleeding was high (60%) in the patients with dissecting aneurysms, and occurred mostly in the acute stage. The incidence of vasospasm was 27%, and only two patients suffered permanent neurological deficits. These findings indicate that the rate of new bleeding tends to be high in patients with saccular and dissecting aneurysms, and thus, they should be treated as early as possible. A preoperative balloon occlusion test should be conducted if proximal occlusion of the vertebral artery is necessary, since proximal occlusion is not always safe, despite angiographic evidence of sufficient contralateral arterial flow.

[Peripheral aneurysms of the posterior inferior cerebellar artery; analysis of 15 cases].

Peripheral aneurysms of the posterior inferior cerebellar artery (PICA) are rare. The authors report 15 cases of peripheral PICA aneurysms. Twelve of the aneurysms were discovered after their rupture and two were discovered after rupture of concomitant AVM, and one was detected incidentally. As to the location of aneurysms, more than half of the aneurysms arose at the telovelotonsillar segment. One patient had 2 aneurysms on the same peripheral PICA, which were not obvious on preoperative angiography because the ruptured one was partially thrombosed. Another rare case with aneurysm located at the internal auditory meatus is also reported. The findings of CT were characteristic, namely hemorrhage in the fourth ventricle without obvious hemorrhage in the basal cisterns, or only within the cerebellar vermian cistern. This phenomenon strongly suggested the possibility of rupture of peripheral PICA aneurysms. As to the surgical results, 10 patients (71%) of the 14 patients had a good recovery, and 1 patient (7%) with nonrupture aneurysm had a fair result due to pre-existing pontine hemorrhage. Three patients (21%) died. Rebleeding occurred in 3 patients, but cerebral vasospasm occurred in only 1 patient. Consequently, as peripheral PICA aneurysms are likely to be missed, and rebleeding is an unfavorable factor, one should try to demonstrate aneurysms with angiography, by using various methods such as subtraction or magnification.

Intracranial cavernous angioma in the 1st year of life and a review of the literature.

Three cases of symptomatic cavernous angioma occurring in the 1st year of life are presented. All three patients were treated with radical extirpation. Postoperatively, two of them improved, but the third died due to cerebral herniation secondary to recurrence of bleeding of the lesion. The clinical characteristics of cavernous angioma in the 1st year of life are briefly discussed and a review of the literature presented, including 16 previous cases operated on directly.

[Visual impairment complicated with meningioma].

Among 106 patients of meningioma surgically experienced the past 10 years between 1981 and 1990, twelve of meningioma with progressive visual impairment were analyzed in relation to postoperative visual outcome. There were four males and eight females, and the age ranged from 33 to 61 years with the average 48 years. The distribution of tumor location was 6 cases in tuberculum sellae, 3 cases in the inner side of sphenoid ridge, and 3 cases in olfactory groove. The size of tumor in each case was 2 to 7 cm in diameter, and in 8 cases more than 3 cm. The duration of visual disturbance was between 3 months and 10 years with the average 3 years. For all cases, surgical removal of the tumor was performed totally by pterional and bifrontal approach. Consequently, 58.3% of 7 cases had improved vision postoperatively, 16.7% of 2 cases remained unchanged, and 25.0% of 3 cases were worse, including one case of malignant meningioma, Visual outcome was mainly affected by a duration of symptoms, a tumor size, a preoperative visual impairment, and in special, a situation of optic nerve where compression of tumor itself and adherence to the surrounding tissues took place. On operation, great care should be paid for a case of long-standing, severe visual disturbance as demonstrating hemianopsia with visual narrowing less than 50 degree by perimetry, and also for preservation of the feeding arteries of optic nerves.

[Pulmonary embolism complicated with stroke: analysis of 5 cases].

Though pulmonary embolism (PE) has been thought to be rare, the incidence seems to be increasing recently. During the past 10 years the authors have encountered 5 cases of PE among stroke patients. There were 2 males and 3 females, aged 51 to 71 years (mean age; 63 years). The mean time between admission and onset of PE was 23 days. As to the primary disease to be treated, 5 patients had subarachnoid hemorrhage and one had intracerebral hemorrhage. Generally, PE tends to be overlooked or misdiagnosed because of the fact that stroke patients are often in a state of unconsciousness. In our series, only one patient complained of dyspnea and the other 4 patients due to unexplained sudden tachycardia, tachypnea and hypoxemia were suspected to have PE. Deep venous thrombosis known as the risk factor leading to PE was presented in 3 patients. Especially in one patient, femoral venous catheterization was considered as a risk factor possibly leading to deep venous thrombosis. Regarding the diagnosis of PE, the roles of electrocardiogram and of chest x-ray film were small. In 3 patients, the elevation of the diaphragm was the only abnormal finding on chest X-ray. On the other hand, the lung scintigram with 99mTc-MAA was a useful method for definitive diagnosis of PE. In 3 patients, filling defects were demonstrated on the lung perfusion scintigrams. Consequently, we emphasize that PE must be kept in mind when tachycardia, tachypnea and hypoxemia appear suddenly. Prompt diagnosis and treatment are required.(ABSTRACT TRUNCATED AT 250 WORDS)

[Delayed effects of radiation of patients with germ-cell tumor, with special to cerebral blood flow].

Delayed effects of radiation therapy (RT) on twenty patients with germ-cell tumors, including 17 cases of germinoma, were evaluated with special reference to cerebral blood flow (CBF). All patients except for one of germinoma had craniotomy to verify the tumor histology, then RT followed with a total dose of 39.6 to 60 Gy for each patient. A follow-up study with CT scans and MRI proved not any recurrence of the tumors during the past 14-year period between June, 1975 and April, 1989. On the other hand, CBF was measured by 133Xe inhalation 1 to 14 years after RT. 40% of all patients were below critical values of CBF with higher frequency in the younger. Statistically, the post-irradiated changes of CBF were not related to a total administered dose, grading of brain atrophy, or physical mental developments, but closely related to irradiated volume dose (product of absorbed dose and field, rad.cm3) only for the age ranging from 8 to 15 years at RT. These results suggested that late effects of RT on CBF were more strongly depend upon absorbed dose and field of irradiation to brain in children than in adolescents.