Pituitary-adrenocortical response to metoclopramide in patients with acromegaly and prolactinoma: a clinical evaluation of catecholamine-mediated adrenocorticotropin secretion.

We have demonstrated that metoclopramide stimulates cortisol secretion at least in part by a stress-mediated effect in normal men. To examine further the effect of the drug on the hypothalamo-pituitary adrenal system, we studied the cortisol response to 20 mg metoclopramide in patients with acromegaly, prolactinomas, and functional hyperprolactinemia and compared the results with the responses to insulin-induced hypoglycemia. In some patients, the effects of metoclopramide on CRH-induced ACTH and cortisol increase were studied to determine whether a change in dopaminergic (catecholaminergic) activity altered CRH stimulation of pituitary-adrenal function. No cortisol response to 20 mg metoclopramide occurred in 13 tests on 8 of 9 patients with prolactinoma or acromegaly with hyperprolactinemia, whereas both acromegalic patients without hyperprolactinemia had a response. All of the patients had a normal cortisol response to insulin-induced hypoglycemia. Pretreatment with metoclopramide enhanced the CRH-induced cortisol increase from 30-120 min after CRH in normal men, but only at 15 and 30 min in 5 agromegalic patients. The results suggest that metoclopramide acts in the hypothalamus to release ACTH through a dopamine antagonist-mediated (catecholaminergic) mechanism, and that metoclopramide may act additively with CRH to stimulate ACTH secretion in normal men. The absence of a metoclopramide-induced cortisol response in patients with acromegaly or prolactinomas and the absence of a normal cortisol response to metoclopramide-CRH in acromegalic patients could be due to endogenous catecholamine deficiency in these patients.

Ruptured dissecting aneurysm of the vertebral artery revealed by repeat angiography.

A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.

[Neurosurgical management of dialyzed patients].

Cerebrovascular disease is a lethal complication for patients with renal failure because of the hemostatic disturbance and equivocality about management of the central nervous system. Appropriate management of the renal failure in neurosurgical patients was considered on the basis of experience. Hemodialysis (HD), which is the most common dialysis method, has a serious disadvantage: the elevation of intracranial pressure during dialysis due to the "disequilibrium syndrome." It is important to stabilize the serum osmolarity during dialysis in order to prevent the disequilibrium syndrome. From this point of view, continuous ambulatory peritoneal dialysis (CAPD) has great advantages; serum osmolarity is not rapidly changed and no anticoagulants are required during dialysis. CAPD is recommended as the first method of choice in neurosurgical management of renal failure patients. However, if a patient has to be maintained with HD because of a history of laparotomy or peritonitis, it is essential to keep the serum osmolarity as stable as possible using the extracorporeal ultrafiltration method, hypernatremic HD, bicarbonate HD, and intravenous administration of glycerol.

[Clinical significance of beta 2-microglobulin and carcinoembryonic antigen in intracranial tumors].

Beta 2-microglobulin (beta 2-MG) levels were determined in serum, cerebrospinal fluid (CSF), and tumor cyst fluid obtained from patients with a variety of intracranial tumors. In addition, a simultaneous determination of the carcinoembryonic antigen (CEA) was carried out in some patients. The beta 2-MG levels were elevated in 11/101 intracranial tumors, including glioma (4/34), non-glial tumors (1/18), malignant lymphoma (2/18), and metastatic brain tumors (4/31). There were no significant differences in the beta 2-MG levels of serum among the different patient groups. On the other hand, the beta 2-MG levels in CSF were significantly higher in patients with malignant lymphoma and metastatic brain tumors than in those with glioma and non-glial tumors. Fifteen (83.3%) of 18 patients with malignant lymphoma and 6(25.0%) of 24 patients with metastatic brain tumors showed increased the levels of beta 2-MG in CSF. The beta 2-MG levels in the tumor cyst fluid of 11 intracranial tumors exceeded normal serum levels in all but two patients. When the CEA levels in the serum and CSF were measured simultaneously, meaningful differences between malignant lymphoma and metastatic brain tumors were clearly observed. The highest incidence and highest levels of the CEA in serum and CSF were only noted in patients with metastatic brain tumors. Conversely, the serum CEA was slightly raised in 11.8% of malignant lymphoma and the levels of CEA in CSF were within normal range in all these patients. Serial determination of CSF beta 2-MG in patients with malignant lymphoma correlated well with their clinical findings.(ABSTRACT TRUNCATED AT 250 WORDS)

[Three-dimensional analysis of arteriography in human posterior circulation (preliminary report)].

In earlier articles it was suggested that there is a relation between vertigo and the posterior circulation. This study was designed to ascertain the course of the branches of the vertebral artery and the basilar artery, as well as the principal blood vessels of the vestibular nucleus by using radiographic three-dimensional observation. We studied 27 human brains (17 males, 10 females) fixed with the arterial embalming method at the Department of Anatomy of Kawasaki Medical School. The results were as follows: 1. Many variations in the course of the anterior inferior cerebellar artery and the posterior inferior cerebellar artery were observed, but the most frequent pattern, observed in 56% of our subjects, was the anterior inferior cerebellar arteries originating from the basilar artery and the posterior inferior cerebellar arteries from the vertebral artery. 2. Measurement of the inside diameter of both vertebral arteries showed the diameter of the left side to be thicker than that of the right side. 3. Perforating branches in the brain stem consisted of the pontine branches from the basilar artery and small branches from the anterior inferior cerebellar artery. Moreover, the transverse section showed a large number of them to originate from the ventral part of the brain stem.

Contents of lecithin and choline in crude drugs.

The determination of lecithin and choline in crude drugs was established by a combination of high performance liquid chromatography (HPLC) with electrochemical detector (ECD) and enzyme reaction. Lecithin in crude drugs extracted with a mixture of chloroform-methanol (2:1) at room temperature was hydrolyzed by phospholipase D. The hydrolyzate was injected to HPLC, and choline was separated from impurities by reverse phase column. The choline was converted to betaine and hydrogen peroxide by passing through column packed with immobilized choline oxidase. This hydrogen peroxide was detected by ECD. The peak area of hydrogen peroxide derived from lecithin was proportional to the concentration of lecithin from 0.10 to 1.52 microgram/ml. Choline in crude drugs was extracted with ethanol under reflux and determined under the same HPLC conditions as lecithin. The peak area of hydrogen peroxide derived from choline was proportional to the concentration of choline from 0.01 to 0.45 microgram/ml. The contents of lecithin and choline in 31 kinds of crude drugs were determined by these established methods. The results showed that Cervi Parvum Cornu, Kokurozin, Foenigraeci Semen and Psoraleae Semen contained more lecithin than other crude drugs, while Angelicae Radix, Foenigraeci Semen, Psoraleae Semen, and especially Hippocampus were found to contain more choline than other crude drugs.

The cerebral circulation in cases of carotid cavernous fistula. Findings of single photon emission computed tomography.

Ten patients with carotid cavernous fistula (CCF) were reviewed. Single photon emission computed tomography (SPECT) for regional cerebral blood flow (rCBF) study was performed in six patients with fast flow shunt. Five of these six patients with fast flow shunt angiographically demonstrated cortical venous drainage, and two of these patients suffered intracerebral hemorrhage. The rCBF decreased in the region demonstrating the cortical venous drainage in five patients, and in one patient the angiography demonstrated arterial steal and the rCBF decreased in a part of the ipsilateral cerebral hemisphere. SPECT proved to be useful in assessing the cerebral circulation in cases of CCF.

Provocation of a paradoxical growth hormone response to corticotropin-releasing hormone by pretreatment with metoclopramide in patients with acromegaly and normal subjects.

Two of 7 patients with acromegaly and one of 7 normal subjects exhibited a paradoxical rise in growth hormone (GH) to human corticotropin-releasing hormone (CRH) when pretreated with metoclopramide, although CRH alone did not induce an increase in GH. In one of these two patients with acromegaly, the GH increase to metoclopramide alone also reached the criteria of a paradoxical response. These two acromegalic patients showed a GH increase to metoclopramide pretreatment before and up to two months after surgery. In another acromegalic patient, whose GH level remained high 5 months after surgery, metoclopramide induced an increase in GH level, while in a patient who had an above-normal GH level 18 months after surgery, the resumption of physiological GH secretion after surgery was evidenced by a postoperative absence of a GH response to metoclopramide. It is suggested from these results that the GH response to metoclopramide and the metoclopramide-provoked GH response to CRH in patients with acromegaly result from the secretion of GH from nonadenomatous cells of the pituitary.