Determination of atrial size by esophageal echocardiography.

The sizes of both left atrial (LA) and right atrial (RA) cavities were assessed in 16 patients by esophageal echocardiography and biplane cineangiography. The changes in echocardiographic dimension and cineangiographic volume during 1 cardiac cycle showed excellent correlations in both atria. In the left atrium, the relation between the echocardiographic dimension and the cineangiographic volume was significant (r = 0.83) and was fitted by the following power function: LA volume (ml) = 0.94 X LA dimension (mm) 1.24. In the right atrium, the relation between the dimension and the volume was significant; RA volume (ml) = 0.015 X RA dimension (mm) 2.34 (r = 0.95). Thus, esophageal echocardiography is a useful method for evaluating LA and RA size and simultaneously observing of both atria.

Diagnosis and quantitative evaluation of secundum-type atrial septal defect by transesophageal Doppler echocardiography.

Transesophageal echocardiography (horizontal sector scan) was performed in 11 patients with secundum atrial septal defect (ASD). In all 11 patients, transesophageal echocardiography presented the definite visualization of the defect and a clear laminar shunt flow that showed its 2 peaks in late systole and late diastole. We estimated the size of ASD and a shunt volume across the defect by using transesophageal echocardiography. The defect size determined by transesophageal echocardiography was correlated with the surgical measurement (horizontal width, r = 0.92, p less than 0.001; vertical length, r = 0.85, p less than 0.01). A significant high correlation was shown between the shunt volume measured by transesophageal echocardiography and that by Fick's method (r = 0.87, p less than 0.01). There was no significant correlation between the pulmonary to systemic flow volume (ratio) and the mean shunt flow velocity across ASD, although a high linear correlation was observed between the pulmonary to systemic flow ratio and the defect size in horizontal direction (r = 0.82, p less than 0.01). Transesophageal echocardiography used for diagnosis and quantitative evaluation of ASD could be performed easily and satisfactorily within 10 minutes. Thus, transesophageal echocardiography is a useful method in evaluation of the defect size and the shunt flow volume of ASD. The mean shunt flow velocity was not a reliable index for estimating the shunt flow volume. The defect size might be a valuable determinant of left-to-right shunt volume in ASD.

Differences in glycoconjugates of adrenocorticotropic hormone-secretory granules between nonadenomatous pituitary cells and adenoma cells as detected by double labeling.

Lectin binding sites of adrenocorticotropic hormone (ACTH) secretory granules of human pituitary adenomas and of nonadenomatous pituitary tissue adjacent to adenomas were studied by postembedding immunocytochemical doublestaining on ultrathin sections followed by electron microscopy. The specific hormones produced by the secretory granules were identified by labeling one side of the section with anti-human pituitary hormone antibodies conjugated to gold particles. Simultaneously, the other side was labeled with horseradish peroxidase-lectin to reveal lectin binding sites. Specimens were obtained from four human ACTH-producing pituitary adenomas and from nonadenomatous pituitary tissue surrounding three other adenomas. The four ACTH-producing adenomas showed either weak or negative reactions with concanavalin A, whereas the nonadenomatous ACTH-producing pituitary cells reacted strongly with concanavalin A. Moreover, ACTH secretory granules were significantly larger in the nonadenomatous cells than in adenoma cells. Differences in biochemical structure and ultrastructure between nonadenomatous (normal) pituitary cells and adenoma cells secreting the same specific hormones were demonstrated, and the clinical implications of the results were discussed.

Influence of modes of ACNU administration on tissue and blood drug concentration in malignant brain tumors.

The water-soluble nitrosourea compound ACNU is also lipid-soluble at normal physiological pH levels. It lacks toxic effects on vision that nitrosoureas occasionally produce following intra-arterial administration. In 28 cases of both primary and secondary malignant brain tumors, ACNU was administered at surgery or angiography by three different modes: intravenous injection in Group I (10 cases), intra-arterial injection via the carotid artery in Group II (11 cases), and intra-arterial injection via the carotid artery after opening the blood-brain barrier (BBB) by means of mannitol in Group III (seven cases). Tumor tissue and blood samples were taken serially at various time intervals after ACNU injection, and ACNU was measured by high-performance liquid chromatography. The time-concentration curve for ACNU was calculated in each case by the two- and one-compartment open models for determination of ACNU levels in blood and tissue, respectively. Pharmacokinetic parameters including biological half-life, blood and tissue levels (0-t minutes and 0-infinity minutes), total plasma clearance, and distribution volume of the beta phase were compared. Statistical analysis of tissue ACNU levels at 0-t minutes revealed higher concentrations in Group III patients than in Groups II and I: levels in Group II were significantly higher than in Group I. Mean biological half-life was 30.3, 23.0, and 38.5 minutes in Groups I, II, and III, respectively. Levels of ACNU were significantly increased in tumor tissue as well as in peritumoral tissue in one Group III patient with multiple metastatic anaplastic adenocarcinoma. In this series, treatment of malignant brain tumor by intra-arterial administration of ACNU produced significantly higher tissue levels of ACNU than did the systemic intravenous route.

The use of an intraluminal shunt for bypass grafts of the cavernous internal carotid artery. Technical note.

The authors describe an indwelling intraluminal shunt for use during graft bypass procedures of the cavernous internal carotid artery. The clinical use of this shunt in a patient with meningioma invading the right cavernous sinus is described. This shunt has also been found applicable during carotid endarterectomy, and should prove to be a useful addition to the neurosurgical armamentarium for skull-base surgery.

Complete familial Currarino triad. Report of three cases in one family.

The Currarino triad is a unique complex of congenital caudal anomalies including anorectal malformation, sacral bone abnormality, and presacral mass. In this report, the authors describe three cases with the complete Currarino triad in a family. The authors treated a 30-year-old mother with an anterior sacral meningocele, her 1-year-old son with a combination of anterior sacral meningocele and dermoid cyst, and her 4-year-old daughter with an epidermoid cyst. These three patients had associated sacral agenesis and anorectal malformations. To the authors' knowledge, this is the first report describing radiological and operative findings of complete familial Currarino triad in which a mother and her two children were affected.

Intracranial germinoma with Down's syndrome: a case report and review of the literature.

BACKGROUND: Down's syndrome's association with malignancies such as leukemia is well known, but its association with brain tumor appears to be rare. We reviewed such rare cases of Down's syndrome and intracranial germ-cell tumor. CASE REPORT: A 10-year-old boy with Down's syndrome and intracranial germinoma located in the left basal ganglia is reported. The patient presented with right hemiparesis and was treated with a combination of surgery, chemotherapy with cisplatin and etoposide, and irradiation. CONCLUSIONS: We speculate that the percentage of germ-cell tumors is high among Down syndrome patients with brain tumors and that the most common site is the basal ganglia.

Juvenile parkinsonism treated with bilateral pallidotomies--case report.

A 47-year-old female diagnosed as having juvenile parkinsonism at age 38 years developed progressive motor fluctuation while receiving levodopa medication. She underwent right posteroventral pallidotomy which achieved only a transient effect on the wearing-off. An additional procedure on the left pallidum resulted in long-lasting relief of the parkinsonian symptoms.

[Neurosurgical endoscopy. Diagnostic and therapeutic indications]. / L'endoscopie neurochirurgicale. Indications diagnostiques et thérapeutiques.

An historical review of neurosurgical endoscopy is evocated. The characteristics of the endoscopic material are discussed: flexible or rigid?, length?, diameter?, irrigation?, free-hand manipulation or fixed arm? A rigid neurosurgical endoscope (STORZ) is described which characteristics are the following: 5 mm/3.7 mm ovale diameter, working length of 21 cm (allowing its use under stereotactic conditions), 5F working channel and articulated arm for solid immobilization in the desired position. All the indications of endoscopy are described and illustrated with a series of 48 patients. Indications for diagnosis are rare and summarised in exceptional help for conventional surgery. 80% of the usual indications of endoscopy were represented by third ventriculostomy. The endoscopic guidance brings safety and allows an increasing of the ventriculostomy's indications. Endoscopic fenestrations of arachnoid cyst are described with a particular interest on suprasellar cysts. The other indications are rare: unilateral hydrocephalus, biopsies of intraventricular tumors, puncture of colloid cysts.

[Clival chordoma in an infant; case report and review of the literature].

Skull base chordoma in infants is a very rare entity in spite of its congenital origin; only 11 clinical cases can be found in the literature so far. Here we report such a case and review the literature. The case is that of a 3.5-year old boy suffering from left abducent nerve palsy for 5 months. CT scan revealed an isodense mass lesion with bone destruction involving the clivus and left petrous apex, and was homogeneously enhanced on post-contrast study. MRI disclosed the clival tumor as a long T1 and long T2 mass. Angiogram showed no tumor stain. The tumor was preoperatively diagnosed as clival chordoma, and was partially removed via left transpetrosal-transtentorial approach. The tumor was found to extend into the subdural space through Dorrello's canal and compress the abducent nerve. Histological examination with H & E, PAS, mucicarmine, and reticulin stainings led us to a diagnosis of "typical chordoma". Electron microscopy demonstrated the mitochondria-endoplasmic reticulum complexes (MERC), glycogen granules, and vacuoles in the tumor cells. Postoperative irradiation (total dose 55 Gy) was performed. At present, 30 months after the operation, no evidence of tumor regrowth nor hypothalamus-pituitary deficiency is recognizable and the patient is free from left abducent nerve palsy. It is concluded that skull base chordoma in infants should be postoperatively irradiated in an appropriate manner.

[A case of microsurgically removed cavernous angioma in the midbrain].

The authors presented a case of microsurgically removed large cavernous angioma in the midbrain. A 46-year old woman was admitted to our service with bilateral nuclear oculomotor pareses and mild tetraparesis. MRI revealed a large round well-circumscribed high signal-intensity lesion on both T1 and T2 weighted image with low signal rim in the midbrain. This lesion was diagnosed preoperatively as a cavernous angioma. The operation was performed in three steps with intermittent hemorrhages by interhemispheric transcallosal-hippocampal commissure--velum interpositum-third ventricular approach and subsequent two infratentorial supracerebellar approaches and finally complete removal was performed. Histological examination of the surgical specimen revealed as a cavernous angioma having abnormal vessels with honeycomb appearance. The patient survived, although remains moderately disabled 6 months after the last operation.

[Immunochemotherapy of human gliomas transplanted into nude mice].

In the first part of this paper, various chemotherapies were performed against oligodendrogliomas subcutaneously transplanted in to nude mice. Vincristine (VCR), adriamycin, and 1000 rads irradiation were effective against this tumors. Concerning these two drugs, dose response effect was observed. And the effect of 1 mg/kg injection of VCR roughly corresponded to that of five weekly injections of 0.2 mg/kg. In the second part of this experiment, single or combined effects of VCR and immunotherapeutic agents including OK-432 (OK), PSK, and recombinant leucocytic interferon (IFN) were examined. Two glioma lines including oligodendroglioma and glioblastoma were used. Following results were obtained from this experiment: 1) Effect of OK and VCR against oligodendrogliomas were as follows: control less than OK local injection (Local) less than OK intraperitoneal injection (IP); VCR; OK (IP X 2) less than VCR + OK(IP) less than VCR + OK (IP X 2). Effects of OK and VCR were expressed in order of their effects against glioblastomas: control less than VCR less than OK (IP); OK(IP X 2); OK(Local) less than VCR + OK (IP); VCR + OK (IP X 2). Effects of PSK and VCR against glioblastomas were as follows: control; PSK (Local) less than VCR less than VCR + PSK (Local) less than VCR + PSK (IP). Effects of IFN and VCR against oligodendrogliomas were as follows: control; IFN (IP) less than VCR less than IFN (Local) less than VCR + IFN (IP); VCR + IFN (Local). Effects of IFN and VCR against glioblastomas were as follows: control less than IFN (IP) less than VCR; IFN (Local); VCR + IFN (IP).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of SPECT in cerebrovascular disease].

In 131 patients with cerebrovascular disease, regional cerebral blood flow was determined by 123I-IMP (N-isopropyl (123I)-iodoamphetamine) or 99mTc-HM-PAO (99mTc (d, l)-hexamethyl propyleneamine oxime) SPECT and findings were compared with those of X-CT or MRI. The perfusion deficit detected by SPECT was larger than the deficit by X-CT or MRI in every cases. The perfusion deficit area was more clearly demonstrated by SPECT than by X-CT or MRI in patients with acute cerebral infarction. The hypoperfusion area determined by 123I-IMP SPECT was wider than that by 99mTc-HM-PAO SPECT. The crossed cerebellar diaschisis was observed in 56 out of 131 cases (43%). The results of operation were quantitatively evaluated by 123I-IMP SPECT in 25 patients.

A case of myocardial damage following acute paracetamol poisoning.

A 24-year-old woman was admitted to our hospital with acute paracetamol poisoning, and severe hepatic injury. The peak blood level of GOT, GPT and LDH were 32,600 U, 119,200 U and 36,500 U respectively. Glucagon-insulin and glutathione were administered to save the liver function. On the third hospital day, hemodialysis was administered to treat acute renal failure. On the 16th hospital day, when the liver and renal functions recovered, severe pulmonary congestion occurred and right heart catheterization revealed high pulmonary pressure. Echocardiography showed left ventricular enlargement accompanied by a severe diffuse impairment of left ventricular wall motion. Multi-focal ventricular arrhythmia was frequent during this period. Hemodialysis and artificial respiration were carried out for the treatment of heart failure. Three months after admission, myocardial perfusion scintigram showed patchy reduction in the uptake of Tl-201 throughout the myocardium, and left ventriculography showed mild diffuse impairment of the LV wall motion (ejection fraction: 49%). In this case, acute heart failure appeared approximately 2 weeks after the severe hepatic injury. Apparently myocardial damage following paracetamol overdosage is caused not only by direct toxicity but by severe metabolic derangement.

Germinoma originating in the basal ganglia. Report of a case showing unusual appearance on MRI.

A case of germinoma originating in the basal ganglia is presented. Preoperative MRI showed an area of a reticulated core of mixed signal intensity with a surrounding rim of low signal intensity in the right basal ganglia on T2-weighted image. This finding was reported to be characteristic of cavernous angioma, but the tumor was histopathologically identified to be a germinoma with old hemorrhage. The pitfall of MRI in diagnosing brain tumors is discussed.