A novel action of epidermal growth factor in rat granulosa cells: its potentiation of gonadotrophin action.

It is well known that epidermal growth factor (EGF) induces down-regulation of LH receptors and desensitization to gonadotrophin stimulation in gonadal cells, including granulosa cells. In a previous study we showed that EGF receptor levels in rat granulosa cells were increased up to fourfold after 96 h of culture with human GH in the presence of FSH, and the present study has evaluated the action of EGF on these cells. The induced EGF receptors were identical in size to the pre-existing receptors as assessed by affinity labelling with 125I-EGF. After 48 h in culture, various amounts of EGF (0.5-10 ng) were added and the cells were cultured for a further 48 h. The addition of EGF caused down-regulation of LH receptors in cells expressing high levels of EGF receptors. However, this down-regulation was less than that in control cells. After the cells were washed, cAMP synthesis in response to human chorionic gonadotrophin (hCG) increased by two to three times the control value and this increase was closely correlated with an increase in EGF receptor content. However, stimulation with cholera toxin or forskolin showed no such augmentation, indicating that it may not be due to quantitative alterations in G proteins and their effector systems. Induction of EGF potentiation required long-term exposure to EGF, for at least more than 24 h. In addition, progesterone synthesis was sensitive to stimulation with lower doses of hCG. These findings indicate that the activation of hGH-induced EGF receptors may potentiate gonadotrophin action in granulosa cells.

Spontaneous regression of intracranial arteriovenous malformation on PET.

We report a case of spontaneous regression of intracranial arteriovenous malformation (AVM) detected by PET in a 57-yr-old woman who had suffered repeated ruptures of the AVM at 28, 30 and 31 yr of age associated with pregnancy. The rupture at this hospitalization was the most critical, and after repeated ruptures for 1 mo, the AVM regressed spontaneously. The decreased cerebral blood volume (CBV) in the AVM indicated regression. The flow-to-volume (CBF/ CBV) ratios surrounding the AVM increased. The metabolic rate for oxygen (CMRO2) did not correlate with her improved neurological status, and an imbalance between CBF and CMRO2 was recognized.

Cerebral hemodynamics and metabolism of severe diffuse brain injury measured by PET.

Cerebral hemodynamics and metabolism in three patients with severe diffuse brain injury were measured 10 days after onset using PET. In this study, regional cerebral blood flow (rCBF), oxygen extraction fraction (rOEF), cerebral blood volume (rCBV), cerebral metabolic rate for oxygen (rCMRO2), cerebral metabolic rate for glucose (rCMRglc) and cerebral metabolic ratio (rCMRO2/rCMRglc) were measured. The Glasgow Coma Scale scores on admission were 4, 5 and 5, respectively, and CT on admission showed typical findings of diffuse brain injury. As a result, PET revealed misery perfusion and hyperglycolysis in Patient 1 and matching low perfusion and low glucose metabolism in Patients 2 and 3. Although Patient 1 died, Patients 2 and 3 had good recoveries. We speculate that a long-lasting anaerobic state, indicated by a high OEF value and low metabolic ratio, is an important undesirable factor related to the outcome.

Human growth hormone augmentation of epidermal growth factor binding sites on rat granulosa cells.

The effect of human GH (hGH) on the regulation of epidermal growth factor (EGF) receptor was investigated during differentiation of FSH-treated rat granulosa cells, which has been reported to be mediated by a cAMP-dependent mechanism. By measuring the binding of [125I]iodo-EGF to the intact cells, FSH was shown to cause increases in the number of EGF binding sites after culture for 72 h. When granulosa cells were cultured with hGH, the number of FSH-induced EGF binding sites was augmented, with a half-maximal effect at about 10 micrograms hGH/l and a maximal stimulatory concentration of 100 micrograms/l. The stimulatory effect of hGH was absolutely dependent on insulin which by itself showed stimulatory effects on EGF binding sites. Scatchard analysis of EGF binding sites indicated that treatment with hGH increased the number of EGF binding sites (17,200 sites/cell after treatment with FSH; 31,700 sites/cell after FSH plus hGH), but did not alter the binding affinity. The augmentation was observed after culturing for 48 h and increased progressively with time, reaching 280% of the level after FSH treatment by 120 h. Although progesterone synthesis was increased by hGH, the markers of cell differentiation such as cAMP synthesis and LH binding sites were suppressed, indicating hGH inhibition of the cAMP-mediated signal. The action of hGH on the EGF binding sites was not accompanied by cell proliferation. These findings indicate that hGH has a novel action on the regulation of rat granulosa cell EGF binding sites and that the granulosa cell may possess both cAMP-dependent and -independent mechanisms for expression of EGF binding sites.

A modified fluid percussion device.

This report examines a modified fluid percussion device with specific improvements made to address deficiencies found in previously reported devices. These improvements include the use of a cylindrical saline reservoir made of stainless steel, placement of the reservoir in a 15-degree head-up position for the easy release of air bubbles, placement of the fluid flushing outlet and the pressure transducer close to the piston on the same plane, with both perpendicular to the direction of the piston, and adjustable reservoir volume to vary the waveform of the pressure pulse, and a metallic central injury screw secured to the animal's skull over the exposed dura. Using this device, midline fluid percussion (MFP) and lateral fluid percussion (LFP) injuries were performed in 70 rats. Histopathologic findings included diffuse axonal injury in the MFP model and cortical contusion in the LFP model. Survival rate was 41.4% in MFP animals and 100% in LFM animals when the device settings were 178 mm3 of the cylindrical reservoir and 50 degrees-60 degrees in height of the pendulum. Our results suggest that this modified fluid percussion device may offer significant improvements over previously reported fluid percussion models for use in experimental head injury.

Spontaneous reduction in size of prolactin-producing adenoma after delivery. Case report.

The authors describe the case of a pregnant woman with a large prolactin-producing pituitary adenoma that regressed after delivery. The patient's neurological signs and symptoms spontaneously disappeared soon after delivery without treatment. Reduction in tumor size was confirmed on computerized tomography scans. It is hypothesized that the growth rate of a prolactinoma may be accelerated by estrogen.

Acute brain edema in fatal head injury: analysis by dynamic CT scanning.

Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p less than 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.

Basic fibroblast growth factor messenger RNA is expressed strongly at the acute stage of cerebral contusion.

Basic fibroblast growth factor (bFGF) has a neurotrophic effect both in vitro and in vivo, and is considered to play an important role in the maintenance of neuronal functions in the normal brain. Neural damage in brain contusion progresses after the primary injury of trauma because of cerebral hemodynamic and metabolic impairment including intracranial hemorrhage and/or brain swelling. Northern blot analysis of bFGF mRNA was performed in rats after cerebral contusion produced by our modified fluid percussion device. Expression of bFGF mRNA increased significantly on the second day after trauma. A possible role of bFGF is functioning to protect the critical neurons from secondary neural damage in cerebral contusion.

Estrogen receptors in brain tumors.

We examined the cytosolic estrogen receptor (ER) level in tumor tissue from 77 patients: 36 meningiomas, 20 gliomas (12 glioblastomas, 2 cerebellar astrocytomas, 2 ependymomas, and 4 medulloblastomas), 8 neurinomas, 7 pituitary adenomas (2 prolactin-producing adenomas, 1 growth hormone-producing adenoma, and 4 nonfunctioning adenomas), and 6 metastatic brain tumors (1 from breast cancer, 4 from lung cancers, and 1 from colon cancer). Nuclear ER levels were assayed in 11 meningiomas and 2 glioblastomas. ER was determined by the dextran-coated charcoal method and calculated by Scatchard analysis. Cytosolic ER was detected in 100% of the pituitary adenomas, 50% of the meningiomas, 50% of the metastatic brain tumors, 25% of the neurinomas, and 15% of the gliomas. In gliomas, only medulloblastomas had ER activity. Nuclear ER was found in three premenopausal women with meningioma. The dissociation constant of the ER complex was, in each case, less than 10(-9) M. These observations suggest that some brain tumors may be responsive to estrogen via the cellular ER.

Rapidly growing aneurysm.

A rare case of rapidly growing intracranial aneurysm is reported. The enlarged aneurysmal wall was extirpated and studied histologically. The cause of the rapid growth of the aneurysm is discussed.

Value of high-resolution computed tomography in diagnosis of petrous bone fracture.

High-resolution computed tomography (CT) was performed on 31 patients clinically suspected of having petrous bone fracture. The location of the fracture was demonstrated accurately in 28 patients (90.3%), whereas it could be diagnosed by plain skull film in only 17 patients (54.8%). The anatomic location of fractures demonstrated by high-resolution CT clearly corresponded to the clinical symptoms and signs. We have classified petrous bone fracture into five types according to the anatomic levels demonstrated on CT images. The findings indicate that high-resolution CT is extremely useful for diagnosing petrous bone fracture.

Immunocytochemical demonstration of carcinoembryonic antigen in cerebrospinal fluid with carcinomatous meningitis from rectal cancer.

The case presented illustrates the application of the immunoperoxidase technique to cerebrospinal fluid (CSF) cytology. The cytologic findings in a Papanicolaou-stained slide of the CSF permitted the diagnosis of a metastatic carcinoma. Positive reactions to carcinoembryonic antigen (CEA) were demonstrated in the tumor cells in the CSF sample as well as in the paraffin-embedded section of the primary rectal cancer. Rising CEA levels were also detected in both CSF and serum. The determination of cancer-associated antigens, such as CEA in the CSF specimen, may be useful in establishing the presence of metastatic tumor in the CSF.

Meningitis with Acinetobacter calcoaceticus in cerebrospinal fluid. A case report.

A case of meningitis due to Acinetobacter calcoaceticus occurred after neurosurgery. The cerebrospinal fluid cytology showed intracellular diplococci that strongly resembled Neisseria meningitidis. However, subsequent bacteriologic studies revealed a bacterium identical to A. calcoaceticus. It is of practical importance for cytology laboratories to recognize this diplococcal form of organism.

Spontaneous epidural hematoma from a hepatocellular carcinoma metastasis to the skull--case report.

A rare case of acute epidural hematoma originating from a hepatocellular carcinoma metastasis to the skull in a 52-year-old male is reported. The skull metastasis and epidural hematoma were completely removed, but he died of large liver tumor. Histological examination of the removed tumor showed many sinusoid-like blood vessels, which probably lead to hemorrhage and formation of epidural hematoma.

[Hematomas of the lenticular nucleus and pons in a hypertensive patient]. / Hématomes du noyau lenticulaire et du pont chez un hypertendu.

Secondary pontine hemorrhages are not rare in intracranial hypertension caused by a supratentorial mass lesion. Cerebral herniation and caudal dislocation of the brainstem account for the secondary pontine hemorrhages. In the present case, two unrelated hemorrhages were demonstrated by an early CT. Neurological findings and CT thus suggest that this is a rare case in which supratentorial and infratentorial hypertensive intracerebral hemorrhages occurred simultaneously.

[Extravasation of contrast media demonstrated during cerebral angiography in the giant aneurysm of the brain].

The authors report a case of giant aneurysm in which extravasation of contrast medium was demonstrated during cerebral angiography and confirmed by computed tomography. A 33-year-old man suddenly lost consciousness and vomited frequently. Three hours later, he was admitted to our hospital in semicomatose state with left hemiplegia. Within two hours after admission, plain CT scan, enhanced CT scan, left carotid angiography and post-angiographic CT scan were performed. CT scan showed marked subarachnoid hemorrhage, left temporal intracerebral hematoma and oval mass which was remarkably enhanced in the left Sylvian fissure. First left carotid angiogram demonstrated a giant aneurysm of the middle cerebral artery which was measured 4.5 cm in maximum diameter. Second left carotid angiogram demonstrated an extravasation of contrast medium around the aneurysm. The patient immediately underwent CT scan, which showed enlargement of intracerebral hematoma and intraventricular high density area as added lesion. By regulation of window level, the presence of contrast medium due to intra-angiographic rupture of the aneurysm was confirmed. The patient expired fifteen hours after admission. At autopsy, the thrombus in the aneurysmal sac was hardly present and the wall of the sac was made mainly of collagen fibers. From the following two points this case was very interesting. However this aneurysm was very large, the thrombus in the aneurysmal sac was hardly present. Extravasation of contrast medium was clearly demonstrated during cerebral angiography with confirmation by computed tomography in the giant aneurysm.

[Bifrontal cystic tumor--a form of suprasellar germinoma (author's transl)].

Twenty year old boy was admitted because of a recent history of generalized seizures and papilledema. Neurological examination was essentially negative except papilledema in the both optic fundi. A history of polydipsia or polyuria was not obtained. CT scan showed bifrontal cystic lesions and cyst walls were partly enhanced. Midline frontal nodules around the foramen of Monro were also revealed by enhancement. Operation was performed and biopsy specimen showed typical histology of germinoma with a small focus of squamous epithels. Postoperatively, the patient's urinary output increased temporalily up to 5,000 ml per day under steroid administration. Shortly after irradiation, cysts decreased in size and all enhanced lesions disappeared completely. The patient is fully working without disturbance one and half year after the onset. Close relationship of germinoma and teratoma was briefly reviewed in literature.

[Three cases of pituitary abscess].

We report three cases of pituitary abscess. Three patients, all females, had suffered headache and complained of general fatigue. In each case magnetic resonance imaging (MRI) revealed a sellar mass with suprasellar extension. T1-weighted images revealed an isointense or slightly hypointense lesion with thin ring-enhancement following gadolinium injection. No inflammatory signs were found in two cases. In one case, a gradual change in clinical symptoms and MRI findings was noted: the hypophyseal hemorrhagic lesion detected on MRI changed into a cystic lesion with thin ring-enhancement. Transsphenoidal surgery was performed in all three cases. In each case, however, no organism was cultured and no tumor component was found. It is difficult to diagnose pituitary abscess prior to surgery if no inflammatory signs are present. Diagnosis of this condition requires careful radiological evaluation. Findings of a suprasellar round cystic mass with thin ring-enhancement on MRI associated with thickened stalk, hyperprolactinemia, and diabetes insipidus may be suggestive of a pituitary abscess.

[Artificial embolization with cyanoacrylate for the treatment of the extracranial arteriovenous malformation].

Two cases of the extracranial arteriovenous malformation (AVM) were treated by intra-arterial injection of cyanoacrylate (Aron alpha A). The first case was a 31-year-old man who had an AVM in the left temporal muscle. At operation, the feeders, the left anterior and posterior deep temporal arteries, were exposed and Aron alpha A was injected into these feeders. The pulsation of the AVM disappeared and the AVM became a hard mass. The mass was totally removed with remarkably little amount of bleeding. No complication was noted. The second case was a 23-year-old man who had an AVM in the scalp, and its feeder was the left occipital artery. The treatment was done in the same manner as in the first case. After operation the regional scalp became necrotic, but the epithelialization was completed in 3 weeks. No signs of recurrence of AVM were noted 20th and 21th month after operation in each of the cases. The recent literature were briefly reviewed.

["Disproportionately large, communicating fourth ventricle" due to membranous obstruction of Magendie's foramen].

A case of disproportionately large, communicating fourth ventricle (DLCFV) with the entire ventricular system dilated symmetrically due to membranous obstruction of Magendie's foramen is reported. A 20-year-old female complained of headache and nausea. Slight papilledema was found in both eyes. CT scan and MRI showed that the entire ventricular system was dilated symmetrically, but we could not locate the cause of this disease, for example, tumor, arachnoid cyst, cerebellar malformation and so on. Although cinemode-MRI showed CSF pulsation as if CSF flowed through Magendie's foramen, we were not convinced that CSF flowed through it. We speculated that something obstructed CSF flow at Magendie's or Luschka's foramen, so surgery was performed by suboccipital craniectomy. As expected, a membranous obstruction was found at Magendie's foramen. After excision of the membrane, all symptoms improved. Postoperative cinemode-MRI clearly demonstrated CSF flow through Magendie's foramen. Ventriculoperitoneal shunting is generally effective for DLCFV, but we do not consider it the optimal treatment. The cause of DLCFV must be confirmed by suboccipital craniectomy if evidence of NPH, mass lesion or cerebellar malformation cannot be found anywhere especially around Magendie's foramen.