Time evolution of collisionless shock in counterstreaming laser-produced plasmas.

We investigated the time evolution of a strong collisionless shock in counterstreaming plasmas produced using a high-power laser pulse. The counterstreaming plasmas were generated by irradiating a CH double-plane target with the laser. In self-emission streaked optical pyrometry data, steepening of the self-emission profile as the two-plasma interaction evolved indicated shock formation. The shock thickness was less than the mean free path of the counterstreaming ions. Two-dimensional snapshots of the self-emission and shadowgrams also showed very thin shock structures. The Mach numbers estimated from the flow velocity and the brightness temperatures are very high.

A groundbreaking new suturing device: the Excalibur.

BACKGROUND: Laparoscopic knot tying can be stressful. We reported two simple techniques, known as the Thumbs up! knot and the Tornado knot. We have further refined these procedures with the development of a new needle holder, called the Excalibur suturing needle holder. MATERIALS: This forceps differ from most conventional forceps in that the hinge is designed to stick out. The large hinge is stored out of the way when the forceps are closed, to prevent the thread accidentally catching. RESULTS: The thread is hooked on the projected hinge, which resembles the heel of a high-heel shoe. By using this forceps, the laparoscopic knot tying becomes easier for not only well experienced but also less experienced surgeons. CONCLUSIONS: The Excalibur, with its high heel, can complete knots with simple straight-line motion, making knot tying easier. This forceps will help reduce the stresses associated with intra-corporeal knot tying.

Prolongation of liver allograft survival after interleukin-10 gene transduction 24-48 hours before donation.

BACKGROUND: Interleukin- (IL) 10 may be a potent regulator for controlling of allograft rejection. A single administration of IL-10 is not effective for controlling graft rejection. Gene transfer is an attractive vehicle for prolonging the expression of short-lived proteins. METHODS: Donor or recipient livers were transduced with 1 x 10(10) p.f.u. of replication-deficient adenovirus vectors harboring human IL-10 cDNA (AdCMVhIL-10) via the ileocecal vein before or after rat orthotopic liver transplantation. RESULTS: DA allografts given AdCMVhIL-10 24-48 hr before donation survived for more than 56 days in Lewis recipients, although DA allografts given the adenovirus vector 7 days or 6 hr before, and 3 days after transplantation were rejected within 30 days in recipients. Serum levels of human IL-10 in gene-transferred rats were maximum from day 2 to 7. The serum level of human IL-10 then decreased gradually, and human IL-10 was not detected by ELISA 30 days after gene-transduction. In gene-transduced long-term surviving liver allografts, IL-10 was expressed, and the expression of IL-4 was also up-regulated on posttransplant day 3, despite the expression of Th1 cytokines (IL-2 and interferon-gamma), although in rejected liver allografts, IL-2 and interferon-gamma were expressed without expression of IL-4 and IL-10. CONCLUSIONS: The prolongation of survival of IL-10 cDNA transferred liver allografts might be due to inhibition of the early phase of alloimmune-response by over expression of IL-10, despite the expression of IL-2 and interferon-gamma.

Alteration of neurotensin receptors in MPTP-treated mice.

We examined the sequential changes in neurotensin receptors in the striatum and substantia nigra of mouse brains lesioned with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) by receptor autoradiography, in comparison with the alterations in dopamine uptake sites. The mice received four intraperitoneal injections of MPTP (10 mg/kg) at 1-h intervals and then the brains were analyzed at 6 h and 1, 3, 7, and 21 days after the treatments. [3H]Neurotensin and [3H]mazindol were used to label neurotensin receptors and dopamine uptake sites, respectively. [3H]Neurotensin binding was significantly decreased in the striatum from 6 h to 21 days after MPTP treatment. In the substantia nigra, pars reticulata also showed a significant decrease in [3H]neurotensin binding from 3 to 21 days post-MPTP treatment. However, no significant change in [3H]neurotensin binding was observed in the pars compacta even after 21 days. On the other hand, [3H]mazindol binding was markedly decreased in the striatum and substantia nigra from 6 h to 21 days after MPTP treatment. These results indicate that neurotoxin MPTP can produce a severe decrease in neurotensin receptors and dopamine uptake sites in the striatum and substantia nigra of mice. Thus, our findings provide evidence that the dysfunction in neurotensin receptors may be involved in the degenerative processes causing Parkinson's disease.

Presence of adrenomedullin-like immunoreactivity in the human cerebrospinal fluid.

The presence of adrenomedullin-like immunoreactivity in the cerebrospinal fluid was studied by radioimmunoassay in 13 subjects with various neurological diseases. The concentrations of adrenomedullin-like immunoreactivity in the cerebrospinal fluid were 9.4 +/- 3.1 pmol/l (mean +/- SD, n = 13). Reverse-phase high performance liquid chromatography of the extract of the pooled cerebrospinal fluid showed that approximately 40% of the adrenomedullin-like immunoreactivity was chromatographically identical to human adrenomedullin (1-52). This is the first report that demonstrates the presence of adrenomedullin-like immunoreactivity in the human cerebrospinal fluid.

Differential vulnerability of dopamine receptors in the mouse brain treated with MPTP.

We investigated the chronological changes of dopamine D1 and D2 receptors and dopamine uptake sites in the striatum and substantia nigra of mouse brain treated with 1-methyl-4-phenyl-1,2,3, 6-tetrahydropyridine (MPTP) by quantitative autoradiography using [3H]SCH23390, [3H]raclopride and [3H]mazindol, respectively. The mice received i.p. injections of MPTP (10 mg/kg) four times at intervals of 60 min, the brains were analyzed at 6 h and 1, 3, 7 and 21 days after the last the injection. Dopamine D2 receptor binding activity was significantly decreased in the substantia nigra from 7 to 21 days after MPTP administration, whereas such binding activity was significantly increased in the medial part of the striatum at 21 days. There was no alteration of dopamine D1 receptor binding activity in either the striatum or the substantia nigra for the 21 days. The number of dopamine uptake sites gradually decreased in the striatum and the substantia nigra, starting at 6 h after MPTP administration, and the lowest levels of binding activity were observed at 3 and 7 days in the striatum (18% of the control values in the medial part and 30% in the lateral part) and at 1 day in the substantia nigra (20% of the control values). These results indicate that severe functional damage to the dopamine uptake sites occurs in the striatum and the substantia nigra, starting at an early stage after MPTP treatment. Our findings also demonstrate the compensatory up-regulation in dopamine D2 receptors, but not dopamine D1 receptors, in the striatum after MPTP treatment. Furthermore, our results support the existence of dopamine D2 receptors, but not dopamine D1 receptors, on the nigral neurons. The present findings suggest that there are differential vulnerabilities to MPTP toxicity in the nigrostriatal dopaminergic receptor systems of mouse brain.

Temporal changes of dopaminergic and glutamatergic receptors in 6-hydroxydopamine-treated rat brain.

Quantitative receptor autoradiography was used to examine the sequential patterns of changes in dopaminergic and glutamatergic receptors in the brain of rats lesioned with 6-hydroxydopamine. The animals were unilaterally lesioned in the medial forebrain bundle and the brains were analyzed at 1, 2, 4 and 8 weeks of postlesion. Degeneration of the nigrostriatal pathway caused a significant increase in dopamine D(2) receptors in the ipsilateral striatum from 1 to 8 weeks of postlesion. In the ipsilateral substantia nigra (SN), a significant decrease in dopamine D(2) receptors was also observed from 1 to 8 weeks of postlesion. On the other hand, dopamine D(1) receptors were increased in the ipsilateral ventromedial striatum from 2 to 4 weeks of postlesion. In the ipsilateral SN, a transient increase in dopamine D(1) receptors was observed only 1 week after lesioning. However, other regions in both ipsilateral and contralateral sides showed no significant change in dopamine D(1) and D(2) receptors during postlesion except for a transient change in a few regions. N-Methyl-D-aspartate (NMDA) receptors showed no significant changes in all brain regions studied during the postlesion. In contrast, a transient increase in excitatory amino acid transport sites was observed only in the frontal cortex and ventromedial striatum of the ipsilateral side at 2 weeks of postlesion. However, glycine receptors showed a significant change in any brain areas of both ipsilateral and contralateral sides after lesioning. The change in the brain areas of contralateral side was more pronounced than that of ipsilateral side for glycine receptors. In addition, dopamine uptake sites showed a severe damage in the ipsilateral striatum from 1 to 8 weeks after lesioning. In the contralateral side, in contrast, no significant change in dopamine uptake sites was found in the striatum during the postlesion. These results indicate that unilateral injection of 6-hydroxydopamine in the medial forebrain bundle can cause a significant increase in dopamine D(1) and D(2) receptors in the striatum. The increase in dopamine D(2) receptors was more pronounced than that in dopamine D(1) receptors in the striatum after 6-hydroxydopamine treatment. In contrast, dopamine uptake sites showed a severe damage in the striatum during the postlesion. Furthermore, our results support the existence of dopamine D(2) receptors on the neurons of SN, but not dopamine D(1) receptors. For glutamatergic receptor system, the present study suggests that the changes in glycine receptors may be more susceptible to degeneration of nigrostriatal pathway than NMDA receptors and excitatory amino acid transport sites. Thus, our findings are of interest in relation of degeneration of the nigrostriatal pathway that occurs in Parkinson's disease

Sequential changes of dopaminergic receptors in the rat brain after 6-hydroxydopamine lesions of the medial forebrain bundle.

We investigated the sequential patterns of changes in dopamine uptake sites, D1 and D2 receptors in the brain of animals lesioned with 6-hydroxydopamine using quantitative receptor autoradiography. The rats were unilaterally lesioned in the medial forebrain bundle and the brains were analyzed at 1, 2, 4 and 8 weeks postlesion. Degeneration of the nigrostriatal pathway caused a significant loss of dopamine uptake sites in the ipsilateral striatum, substantia nigra (SN) and ventral tegmental area (VTA) in the lesioned animals. Dopamine D1 receptors were significantly increased in the ventromedial part of striatum of the ipsilateral side from 2 to 4 weeks postlesion. In the ipsilateral SN, a transient increase in dopamine D1 receptors was observed only 1 week after lesioning. However, the frontal cortex, parietal cortex and dorsolateral part of the striatum showed no significant change in dopamine D1 receptors throughout the experiments. On the other hand, dopamine D2 receptors were decreased increased in the ipsilateral SN and VTA from 1 week to 8 weeks postlesion. In the ipsilateral striatum, dopamine D2 receptors were increased in the dorsolateral part from 2 weeks to 8 weeks and in the ventromedial part from 2 weeks to 4 weeks. However, the frontal cortex and parietal cortex showed no significant change in dopamine D2 receptors during postlesion. In the contralateral side, most of regions examined showed no significant change in dopamine uptake sites, dopamine D1 receptors and dopamine D2 receptors during postlesion except for a transient change in a few regions. These results demonstrate that 6-hydroxydopamine can cause a severe functional damage in dopamine uptake sites in the striatum, SN and VTA. Our findings also suggest that the up-regulation in dopamine D2 receptors is more pronounced than that in dopamine D1 receptors in the brain after 6-hydroxydopamine treatment. Furthermore, our results support the existence of dopamine D2 receptors on the neurons of SN and VTA. Thus, our findings provide insights into the pathogenesis of Parkinson's disease.

PET study of cerebral glucose metabolism and fluorodopa uptake in patients with corticobasal degeneration.

We measured cerebral glucose utilization and fluorodopa metabolism in the brain of patients with corticobasal degeneration using position emission tomography. The clinical pictures are distinctive, comprising features referable to both cerebral cortical and basal ganglionic dysfunctions. Brain images of glucose metabolism can demonstrate specific abnormalities with a marked asymmetry in the parietal cortex (the primary motor and sensory cortex and the lateral parietal cortex), the thalamus, the caudate nucleus and the putamen of the dominantly affected hemisphere related to clinical symptoms in six patients. [18F]dopa uptake also reduced in an asymmetric pattern, both the caudate nucleus and the putamen in four patients. This unique combination study measuring both cerebral glucose utilization and fluorodopa metabolism in the nigrostriatal system can provide efficient information about the dysfunctions which are correlated with individual clinical symptoms.

Brain 6-[18F]fluorodopa metabolism in early and late onset of Parkinson's disease studied by positron emission tomography.

We measured 6-[18F]fluorodopa (FDOPA) uptake in the caudate nucleus and the putamen of 20 patients with early and late onset of Parkinson's disease (EOPD and LOPD) and 20 normal control subjects using positron emission tomography. The mean influx rate constant values (Ki) were significantly reduced in the caudate nucleus and the putamen of the patients with EOPD and LOPD compared with age-matched control groups (p < 0.01), respectively. There were significant negative correlations between Ki values in the caudate nucleus (r = -0.67, p = 0.0024) and the putamen (r = -0.67, p = 0.0014), and duration of disease in the LOPD group compared with the EOPD group. Similar negative relationships between Ki values and clinical stages by Hoehn and Yahr and degrees of main clinical symptoms (bradykinesia, tremor and rigidity) were more markedly seen in the LOPD group than in the EOPD group. The present results suggest that the function of presynaptic dopaminergic terminals correlates well with clinical disease severity and degrees of main symptoms in the LOPD group, but not in the EOPD group. We speculate that compensatory up-regulatory function in the postsynaptic dopaminergic receptors may modify disease severity and the degrees of main clinical symptoms of EOPD.

PET study of striatal fluorodopa uptake and dopamine D2 receptor binding in a patient with juvenile parkinsonism.

We studied pre-synaptic and post-synaptic function in the striatum of a patient with juvenile parkinsonism (JP) using positron emission tomography (PET). [18F]6-fluorodopa (18FDOPA), 11C-YM-09151-2 and [18F]fluoro-2-deoxy-d-glucose (18FDG) were used to measure fluorodopa uptake, dopamine D2 receptor binding and glucose metabolism, respectively. In this patient, 18FDOPA accumulation was decreased markedly in the caudate nucleus and the putamen bilaterally. In the images of 11C-YM-09151-2 and 18FDG, in contrast, no conspicuous changes were observed in the striatum. Thus our PET studies using 18FDOPA, 11C-YM-09151-2 and 18FDG provide a useful approach for assisting the diagnosis of JP, because the present findings are different from the results in patients with dopa-responsive dystonia and hereditary progressive dystonia with marked diurnal fluctuation. Furthermore, our findings are of particular interest in relation to the pathogenesis of JP.Copyright Lippincott-Raven Publishers

Alterations of second messenger systems in the rat brain after 6-hydroxydopamine lesions of the medial forebrain bundle.

We studied the sequential changes in second messenger systems in the striatum and substantia nigra (SN) after 6-hydroxydopamine lesions of the medial forebrain bundle in rats. The animals were unilaterally lesioned in the medial forebrain bundle and the brains were analyzed at 1, 2, 4 and 8 weeks postlesion. [3H]Phorbol-12, 13-dibutyrate (PDBu), [3H]forskolin and [3H]rolipram were used to label protein kinase C (PKC), adenylyl cyclase and calcium/calmodulin-independent cyclic-AMP phosphodiesterase, respectively. The degeneration of nigrostriatal pathway produced a significant increase in [3H]PDBu binding in the ventromedial part of the ipsilateral striatum from 2 to 8 weeks postlesion. In the contralateral side, [3H]PDBu binding showed a transient increase in the SN only 4 weeks after lesioning. [3H]Forskolin binding showed a significant increase in the ipsilateral and contralateral striatum from 2 to 4 weeks postlesion. In the ipsilateral SN, a significant increase in [3H]forskolin binding was observed at 4 weeks after lesioning. However, no significant change in [3H]forskolin binding was observed in the contralateral SN during postlesion. On the other hand, [(3)H]rolipram binding showed no conspicuous alteration in the brain during postlesion. These results demonstrate that rats made hemiparkinsonism by unilateral 6-hydroxydopamine injection have a significant increase in [3H]PDBu and [3H]forskolin binding in the striatum and/or SN, whereas no significant change in [3H]rolipram binding is observed in these areas during postlesion. Our findings also suggest that the increase in [3H]forskolin binding is more pronounced than that in [3H]PDBu binding in the brain after unilateral 6-hydroxydopamine injection. Thus, our studies may provide valuable information concerning degeneration of the nigrostriatal pathway such as Parkinson's disease.

Biochemical and immunohistological changes in the brain of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mouse.

We investigated neurochemically and neuropathologically the utility of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice as a model of Parkinson's disease. The changes in dopamine D1 and D2 receptors and dopamine uptake sites were determined by quantitative autoradiography using [3H]SCH23390, [3H]raclopride and [3H]mazindol, respectively. Dopamine and 3,4-dihydroxyphenyl acetic acid (DOPAC) contents in the striatum were measured by high-performance liquid chromatography. The distribution of nigral neurons and reactive astrocytes was determined by immunohistochemical staining with antibody against tyrosine hydroxylase (TH) and glial fibrillary acidic protein (GFAP). The mice received four intraperitoneal injections of MPTP (10 mg/kg) at 1-h intervals and then the brains were analyzed at 3 and 7 days after the treatments. No significant change in dopamine D1 receptors was observed in the striatum and substantia nigra after acute treatment with MPTP. Dopamine D2 receptors were reduced significantly in the substantia nigra only 7 days after the MPTP treatment, whereas striatum showed no significant change in the binding throughout the experiments. In contrast, dopamine uptake sites were reduced markedly in the striatum and substantia nigra 3 and 7 days after the MPTP treatment. Dopamine and DOPAC content were also reduced in the striatum 3 and 7 days after the MPTP treatment. An immunohistochemical study indicated a loss of the number of TH-positive neurons in the substantia nigra 7 days after the MPTP treatment. In contrast, numerous GFAP-positive astrocytes were evident in the striatum 7 days after the MPTP treatment. These results provide valuable information for the pathogenesis of acute stage of Parkinson's disease.

Safety and growth suppressive effect of intra-hepatic arterial injection of AdCMV-p53 combined with CDDP to rat liver metastatic tumors.

Surgical resection is thought to be the best treatment for liver carcinoma, including hepatocellular carcinoma and metastatic liver carcinoma if there are a small number of tumors. Liver carcinoma is one of the main causes of death from cancer worldwide. The prognosis of liver carcinoma is still poor. Mutation of p53, which is well known as a tumor suppressor gene, is observed in many cases of advanced liver carcinoma. Cancer gene therapy using p53, which transduces the wild-type p53 gene in the tumor, is a promising new strategy for treating liver carcinoma. Selective and less invasive gene delivery to the liver tumor is necessary for clinical liver tumor gene therapy. The first purpose of the current study was to determine the best way to deliver the gene of interest to the liver tumor selectively. The second purpose was to study the tumor suppressive effect of intrahepatic arterial injection of an adenovirus vector with the p53 gene (AdCMV-p53), followed by administration of CDDP and noting its side effects. We injected AdCMV-LacZ via hepatic arteries of rats bearing RCN-9 colon cancer metastasis in the liver. Injection via the hepatic artery resulted in more successful gene transduction to the liver tumor in a tumor-selective manner than did injection via the portal vein. At 48 hrs after arterial injection of AdCMV-p53, CDDP (3 mg/kg) was administered in the peritoneal cavity of each rat. The use of CDDP with arterial injection of AdCMV-p53 resulted in more extensive apoptosis in the rat liver tumors without any deterioration in liver function. In conclusion, hepatic arterial injection of an adenovirus vector is better than portal vein injection for gene transduction efficiency, and causes no liver function disorder even when the injection is combined with CDDP.

PET study in a patient with spinocerebellar degeneration before and after long-term administration of thyrotropin releasing hormone.

We studied the chronic effect of thyrotropin releasing hormone (TRH) in a patient with spinocerebellar degeneration by measuring cerebral metabolic rate for glucose (CMRG1c) using 2-[18F]fluoro-2-deoxy-D-glucose (18FDG) and positron emission tomography (PET). A 56-year-old female, who had suffered from progressive ataxia for 2 years, was treated by intravenous administration of 2 mg TRH for 3 weeks, and CMRG1c of the brain was measured before and after treatment. CMRG1c was markedly decreased in the cerebellum and there was no significant difference before and after the treatment, i.e. mean CMRG1c values were 4.92 and 4.90 mg/100 g/min, and the ratios of the cerebellum versus the frontal cortex were 0.50 and 0.51, respectively. The degree of disequilibrium of her body examined with stabilography became better by the 19th day and further improved by the 26th day after the start of TRH treatment. Based on the present study we conclude that long-term administration of TRH did not improve CMRG1c in the cerebellum, but evidently improved the sway of gravity center by stabilography. We speculate that the chronic effect of TRH was not necessarily due to an improvement of cerebellar function, because TRH receptors are widely distributed throughout the central nervous system.

[Progressive cerebellar ataxia and distal amyotrophy of Charcot-Marie-Tooth type with hyperglutamataemia:two sibling cases].

We reported two sibling cases of progressive cerebellar ataxia accompanied with muscular atrophy of Charcot-Marie-Tooth (CMT) type. Autosomal recessive inheritance was suggested because of the parental consanguinity and other family history. The first symptom was ataxic gait in their teens, and speech disturbance appeared later. Subsequently weakness and muscular atrophy developed in the four limbs in their thirties or forties. These symptoms slowly progressed. Neurological examinations revealed weakness, muscular atrophy, and disturbance of superficial and deep sensation in the distal parts of all limbs. Deep tendon reflexes were absent in the four limbs. There were no pyramidal tract signs, nor dementia. Sural nerve biopsy demonstrated the axonal degeneration without any findings suggesting hypertrophic neuritis. MRI study revealed marked cerebellar atrophy. Although plasma amino acid analysis showed elevated glutamate levels in both cases, activities of glutamate dehydrogenase in leukocytes was not reduced. Here, we propose a new disease entity of hereditary cerebellar ataxia and sensorimotor neuropathy associated with elevated plasma glutamate levels. Abnormal glutamate metabolism may be related to the pathogenesis of this disease.

[A case of hypertensive intracerebral hemorrhage associated with cerebral arteriovenous malformation and aneurysm (author's transl)].

A 45-year-old man suddenly developed right hemiparesis and aphasia during work and lost conciousness next day, when he was admitted to us. Lumbar puncture showed bloody C.S.F. with the initial pressure of 220 mm H2O. Physical examination revealed hypertension and arteriosclerosis. Cerebral angiogram revealed an arteriovenous malformation in the left frontoparietal-parasagittal region and a saccular aneurysm at the left internal carotid-posterior communicating artery junction. In addition, the existence of putaminal hematoma was suspected on account of the displacement of the left anterior cerebral artery and the left lenticulostriate arteries. On the fourth day after admission his consciousness returned and the right hemiparesis gradually improved. One month later the disappearance of the displacement of the anterior cerebral artery was demonstrated by cerebral angiogram. A frontoparietal craniotomy was done and no hematoma was found around the arteriovenous malformation and the basis of the aneurysm did not adhere to the temporal lobe. Taking these findings into consideration, it is presumed that the hematoma in putaminal region was due to neither arteriovenous malformation nor aneurysm but was a hypertensive intracerebral hemorrhage.

[Intracranial neurinoma of jugular foramen--report of a case and reference, its clinical manifestations (author's transl)].

This is the 28th case report of jugular foramen neurinoma in the world. A 24-year-old man was admitted to our hospital with complaints of dizziness and impaired balance. Neurological examination revealed IX, XI and XII cranial nerves and cerebellar involvements, e.g., Brun's-Cushing nystagmus, curtain sign on the left, weakness of the left sternocleidomastoid muscle and deviation of the tongue to the left, accompanied with atrophy. Choked discs and other signs of increased intracranial pressure were not recognized. There were no cerebellar symptoms except impaired balance and nystagmus. Lateral view of vertebral angiography showed that the posterior inferior cerebellar artery was displaced backward and upward, the basilar artery was imposed to the clivus, and the superior cerebellar artery was elevated. A-P view of vertebral angiography showed that the posterior inferior cerebellar artery was displaced to the left. Enlargement of the left jugular foramen was revealed especially by tomograms of horizontal section at the level of 0.3 cm below the external acoustic meatus and 0.5 cm behind the external acoustic meatus. The jugular foramen margins were smooth and somewhat sclerotic. We confirmed the diagnosis of the jugular foramen neurinoma on the left. Suboccipital craniectomy confirmed a huge tumor which covered the left jugular foramen and the bulk of which was in the cisterna magna. These findings were supposed to explain that the patient did not show increased intracranial pressure. The tumor was encapsuled with smooth and thin capsule. This tumor was totally removed and the postoperative course was uneventful. Histological diagnosis was neurinoma. We consider that this tumor arose on the IXth or XIth cranial nerve.

[Surgery of acoustic neurinoma in a hemodialyzed patient].

Successful surgical treatment of acoustic neurinoma in a case of hemodialyzed patient is reported. A 42-year-old female patient, who had been treated by hemodialysis, was diagnosed as having a C-P angle tumor by CT scan. She was refered to our clinic on June 24, 1983. Laboratory examinations on admission showed severe anemia and renal dysfunction. Every possible treatment was done in order to improve the laboratory data preoperatively. Another big problem in this case of hemodialyzed patient was brain edema and bleeding tendency. In order to cope with brain edema, intravenous administration of glycerol and slow hemodialysis for three days were performed preoperatively. These treatments were thought to be effective to reduce bleeding tendency also. During operation, however, heavy swelling of the cerebellum forced us to resect one third of the hemisphere to remove the tumor totally. In addition to this, postoperative mild bleeding in the cavity after tumor resection, subcortical hemorrhage around the shunt tube and oozing from the wound were observed. The patient was discharged from the hospital four months after surgery without any neurological deficit. The way of recovery, however, was not uneventful, because the patient developed various kinds of postoperative complications as mentioned above. In the postoperative managements, we felt almost as if we were treading on thin ice. Neurosurgical management in hemodialyzed patients is not yet very common. We should improve the postoperative management by adding new experience with similar cases.

[A case of chondromyxoid fibroma of the frontal bone].

A case of chondromyxoid fibroma of the skull is reported. A 20-year-old boy visited our clinic on December, 1982 because of a recurrent forehead tumor. He had a 4 X 4 X 1.5 cm tumor on the right side of forehead and a 3 X 3 X 0.5 cm tumor on the left. Neurological examination showed no abnormalities. Skull X-ray film showed a large round radiolucent area with clear sclerotic margin in the frontal bone and right orbit. Right carotid angiogram showed marked posterior displacement of the anterior cerebral artery, but no tumor stain. Plain CT scan showed a mass with iso to low density area in the frontal region. It was markedly and irregularly enhanced with contrast media. Surgery was performed entirely in the epidural space, and the tumor was completely removed. The post-operative clinical course was uneventful. Histologically, the three components of chondroid, myxomatous and fibrous tissues in this tumor led to the diagnosis of "chondromyxoid fibroma."