Rhythmic slow wave observed on nocturnal sleep encephalogram in children with idiopathic nocturnal enuresis.

All-night sleep polygraphs, except the first night, were recorded for 15 patients with idiopathic nocturnal enuresis and 10 normal controls. Relations between sleep and the mechanism by which nocturnal enuresis is caused, with special emphasis on the occurrence of rhythmic slow waves (RSW), was studied. The following results were obtained. (a) There was no significant difference between the two groups in the proportions of the electroencephalographic (EEG) sleep stages, under the same conditions. (b) Nocturnal enuresis occurred with almost the same frequency in all sleep stages except stage 1 sleep and was higher in the second and third cycles. (c) Immediately before a nocturnal enuretic event, 6-7 Hz RSW continued for as long as 15-40 s in NREM sleep, or 3-5 Hz RSW was observed in REM sleep. (d) RSW was observed in enuretics and controls, and decreased with increase in age. However, RSW occurred more often, and age-related decrease was delayed in enuretic children. (e) RSW was induced by stimuli such as changes in sleep stages or body movement. During RSW, the variance of heart rate and respiration tended to be low. These results and the similarity between RSW and diffuse rhythmic theta suggest that RSW may be an expression of the process of maintaining a given sleep stage in children. These results may also be caused by the immaturity of the sleep mechanism in enuretic children. The long-lasting RSW on the sleep EEG was considered to be a sign of the onset of nocturnal enuresis.

Cystic meningioma in a 10-month-old infant: Case report.

The authors report a case of cystic meningioma in a 10-month-old boy diagnosed by metrizamide ventriculography and computerized tomography. Intracranial meningioma in infants under 1 year old is extremely rare. This case is only the 16th case reported in the world literature; the other 15 cases are reviewed.

Expression and role of cadherins in astrocytic tumors.

Cadherins are Ca(2+)-dependent cell adhesion molecules that play an important role in tissue formation and morphogenesis in multicellular organisms. In recent years, there have been reports of cadherin involvement in tumor invasion and metastasis. Twenty-two surgical specimens and some cultured cells were studied by immunohistochemical staining. No significant difference was observed in the patients with anaplastic astrocytoma, whereas decreased expression of N-cadherin was detected at the time of recurrence in those with glioblastoma. In these groups, cerebrospinal fluid dissemination was found, and contralateral cerebral metastases and extracranial metastases were observed. We conclude that decreased N-cadherin expression at the immunohistochemically demonstrated time of recurrence correlates with tumor invasion and dissemination of cerebrospinal fluid.

Immunohistochemical detection of carbohydrate determinant 19-9 (CA 19-9) in intracranial epidermoid and dermoid cysts.

We evaluated carbohydrate antigen (CA) 19-9 levels of intracranial dermoid and epidermoid cyst in serum and intratumoral tissue. The preoperative serum levels were mildly to moderately higher than their normal ranges in four of seven patients. In four patients with high serum CA 19-9 levels, they returned to normal ranges in three who had the cyst resected totally and remained slightly high in one with residual cyst. Immunohistochemical studies using anti-CA 19-9 antibody demonstrated positively stained capsule and keratinous tissue. Serum CA 19-9 levels of intracranial dermoid or epidermoid cysts with more teratomatous components may be elevated above normal levels.

Primary central nervous system T-cell lymphoma. Case report.

A 46-year-old male presented with a rare primary non-Hodgkin's lymphoma of the central nervous system of T-cell lineage, localized primarily in the right parietal region. There was no evidence of acquired immunodeficiency syndrome. Biopsy of the tumor allowed immunohistochemical confirmation of the diagnosis. Irradiation and chemotherapy were given, and the patient has remained well for 24 months. The clinical manifestations, management, and outcome of T-cell lymphoma are very similar to those of B-cell lymphoma.

Magnetic resonance imaging and quantitative analysis of contents of epidermoid and dermoid cysts.

The intracapsular cholesterol, protein, and calcium contents of epidermoid and dermoid cysts from seven patients were compared with the signal intensities on T1-weighted spin-echo magnetic resonance (MR) images. All specimens had a paste-like consistency when resected. Epidermoid and dermoid cysts demonstrated a wide range of cholesterol and calcium contents, and epidermoid cysts were not always rich in cholesterol. Five patients had cysts with lower signal intensity than white matter, which contained more than 18.3 mg/g wet weight of protein. One of these patients had the highest cholesterol content of all seven patients (22.25 mg/g wet weight) and another had the highest calcium content (0.75 mg/g wet weight). Two patients had cysts with higher signal intensity than white matter, with protein contents of lower than 4.3 mg/g wet weight. High protein content (> 18.3 mg/g wet weight) may decrease signal intensity on T1-weighted MR images, while low protein content (< 4.3 mg/g wet weight) may increase signal intensity in epidermoid and dermoid cysts with high viscosity (paste-like consistency) contents.

[A study of cefoperazone levels in the cerebrospinal fluid of patients with hydrocephalus].

Eleven neurosurgical patients without intracranial infection were given 4 g cefoperazone (CPZ) intravenously for 30 minutes. Ventricular drainage was performed in 10 cases, and 1 case with cisternal drainage. Eight of 11 cases showed moderate to severe ventricular dilatation. Serum and ventricular cerebrospinal fluid (CSF) concentrations of CPZ were measured for 8 hours after injection. Average peak serum concentration of CPZ was 476 micrograms/ml and the half-life was 150 minutes. Patients with obstructive hydrocephalus showed relative good penetration of CPZ in CSF (2.74 approximately 5.29 micrograms/ml). Especially, those who had severe dilatation of ventricles demonstrated sequential increased concentration (5.48 approximately 6.25 micrograms/ml at 8 hours). In poor risk patient and intracerebral hemorrhage with ventricular hemorrhage cases, who had normal range of CSF cell counts and protein, CPZ level was low, less than 2 micrograms/ml. In cases with severe subarachnoid hemorrhage, sufficient concentration (11 micrograms/ml) of CPZ was observed in cisternal CSF. The CPZ concentrations in CSF after 4 g administration did not seem to exceed comparing to 2 g dosing.

[An infant autopsy case of ependymoblastoma with high serum alpha fetoprotein (author's transl)].

This report is concerned with a 55-day-old female hospitalized because of intraventricular hemorrhage from a tumor in the pineal region. Examination of serum alpha fetoprotein showed 7400 ng/ml. The patient expired because of frequent intraventricular hemorrhage and progressive hydrocephalus. Autopsy demonstrated the tumor was ependymoblastoma. No teratomatous component was noticed in the histological examination. High serum alpha fetoprotein in relation to tumor histology was briefly discussed.

[Scanning electron microscopy of human cultured gliomas (author's transl)].

Tumor tissues of glioblastoma multiforme, astrocytoma and medulloblastoma, maintained up to 21--28 days by gelfoam organ culture technique, were examined by scanning electron microscopy (SEM). Glioblastoma multiform has irregular cell surface and many cytoplasmic folds. Astrocytoma has many fibrils. The fibrils have smooth surface and are coiling. Fibrils of piloid astrocytoma are smooth and cylindrical. The focal thickness of fibrils are associated with so-called Rosenthal fiber. Capillary of astrocytoma has irregular surface and marked tortuosity. Medulloblastoma is composed of non-fibrillated round tumor cells. The tumor cells touch each other with short cell processes. These findings seemed to correspond to the malignancy of original tumor. Comparative observation of medulloblastoma maintained by monolayer cell culture with one maintained by organ culture, using light microscopy and scanning electron microscopy, was done. And medulloblastoma in monolayer culture was proliferated to two types of cells. One is epitheloid cell with taper cell processes, and the other is stellate cell with fine processes. In most organ culture, feature of cells corresponded to those observed in original surgical material by light microscopy.

[Clinicopathological study on malignant glioma--with special reference to GFAP].

In surgical specimens of 91 cases of malignant glial tumor, the correlation between the clinical malignancy of the tumors and the presence of GFA protein in the surgical specimen was examined. In anaplastic astrocytomas, 20 of 27 cases revealed positive staining of GFAP. In the cases of glioblastoma multiforme 27 of 35 cases showed GFAP positive staining. On the other hand, in medulloblastomas, all 29 cases were negative. In anaplastic astrocytomas and glioblastoma multiforms, the difference between the survival curves of GFAP positive groups and negative groups were examined. Between two groups, there was no statistical differences. In this study, the presence of GFAP was not proportional to the degree of tumor differentiation, and the GFAP staining of the tumor tissue was not a valuable examination showing the prognosis of the patient.

[Clinico-pathological study of meningiomas in childhood--with special reference to malignant meningiomas].

Six cases of meningiomas which accounted for 3.6% out of 167 intracranial tumors in children were studied with clinico-pathological method. Four meningiomas located in the convexity, two meningiomas developed within the lateral ventricle. CT scan with contrast material showed homogeneous enhanced tumors in four cases. Heterogeneous enhanced tumors were observed in two malignant meningiomas. There was evidence of recurrence in three cases. Two of in these cases were malignant meningiomas. Three patients received postoperative radiotherapy. One case of malignant meningiomas died seven years after the first operation. Five cases are still alive. Macroscopically three cases had cyst formation. Four convexity meningiomas were attached to the dura matter. Three malignant meningiomas were ill-defined and invaded the normal brain tissue. One case of malignant meningiomas invaded the skull. Six meningiomas were classified histologically into two fibrous, one transitional and three malignant meningiomas according to the World Health Organization (WHO) classification of brain tumors. All cases were examined for glial fibrillary acidic protein (GFAP) using the immunohistochemical method. Two cases of malignant meningiomas demonstrated the positive reaction to GFAP. Four cases were negative. These findings suggest that malignant meningiomas grow invasively into the surrounding normal brain tissue.

[Ultrastructure of human oligodendroglioma].

Ten cases of human oligodendroglioma were examined with electron microscope. The materials were specimens derived through surgical operations. Results were as follow. The shape of tumor cells are various, round, oval, polygonal and irregular. The majority of tumor cells have round or ovoid nuclei, some have irregular nuclei or nuclear indentation. Chromatin distributions tend to clump. In the cytoplasm, there are commonly ribosomes, rough surfaced endoplasmic reticulums, mitochondria, microtubules and lysosome. Glial filament is rare or almost absent. Crystalline structures are seen in 3 cases. Cellular junctions, though immature, are seen in 4 cases. Perinuclear halo in the light microscopy was explained to be a fixation artifact in 10% formol. The samples, which were fixed in 2.5% cold glutaraldehyde and post-fixed in 1% osmium tetraoxide, did not show perinclear halo under the light and electron microscope. The specimen, which were fixed in 10% formol, were examined with electron microscope. Plasma membrane of the tumor cell was partly destroyed, intracytoplasmic organelles and matrix were also broken, and the cytoplasm was empty. It is confirmed in this study that empty cytoplasm represents the peculiar perinuclear halo in the light microscopy.

[Clinicopathological study of oligodendroglioma with special reference to immunohistochemical investigation].

The present study was undertaken to evaluate the utility of pathologic features and specific immunohistochemical studies in estimating the prognosis of oligodendroglioma. The pathological diagnosis of an oligodendroglioma was made on HE stained-sections according to WHO classification. Sixteen oligodendrogliomas, twelve mixed oligoastrocytomas and ten anaplastic oligodendrogliomas were immunotested by the peroxidase-antiperoxidase (PAP) method with anti-GFAP serum, anti-S-100 serum and anti-MBP (Myelin basic protein) serum and by the avidin biotin peroxidase-complex (ABC) method with anti-vimentin serum and ant-Leu 7 monoclonal antibody. GFAP positive cells were interpreted as reactive astrocytes, neoplastic astrocytes and neoplastic oligodendrocytes, S-100 positive cells were interpreted as reactive astrocytes and neoplastic astrocytes. Leu 7 positive cells were found in only one case of anaplastic oligodendroglioma. Anti-Leu 7 could not be considered as a specific marker for oligodendroglioma. Of the anaplastic oligodendroglioma 60% displayed MBP positively and 70% displayed vimentin positively. NSE positive cells were found in a few anaplastic oligodendrogliomas. The present study has not so far uncovered any marker that is restricted to oligodendrogliomas. However GFAP may be useful to assess the extent of reactive astrocytes and neoplastic astrocytes in the oligodendroglioma or mixed oligoastrocytoma. MBP and vimentin will help to determine the malignancy of oligodendroglioma.

[An intracranial collision tumor composed of intrasellar gangliocytoma and pituitary adenoma].

The authors report a rare case of collision tumor composed of intrasellar gangliocytoma and pituitary adenoma. The patient was a 56-year-old woman, who had a mild acromegalic feature and slightly elevated plasma GH level. But she had no abnormal neurological findings. Transsphenoidal microsurgery was performed and an intrasellar tumor was totally removed. After the operation, plasma GH level decreased to within normal level. She was discharged with no neurological deficit. Histological examination showed two components. One of them was gangliocytoma composed of many large, and often binucleated cells with Nissl substance. The other had the appearance of chromophobe adenoma. In this part, some of the cells showed positive stain for GH. The clinical and histological features of this lesion are discussed and compared with 31 other cases of intrasellar ganglioglioma or gangliocytoma.

[Glial fibrillary acidic protein and neurofilament protein in medulloblastoma].

Medulloblastoma is the most common primitive neuroectodermal tumor (PNET) with the potential to differentiate along glial or neuronal lines. Thirty cases of medulloblastoma were tested by the peroxidase-antiperoxidase (PAP) method with anti-GFAP serum (DAKO) and by the avidin-biotin peroxidase complex (ABC) method with 68kd subunit of anti-NF antibody. All the cases were classified into three subtypes based on these immunohistochemical findings and were analyzed in relation to clinico-pathological features. Fifteen of thirty medulloblastomas contained GFAP positive cells, seventeen showed cells reacting to NF. The reactions for both proteins were present in eight medulloblastomas (PNET-BD, bipotential differentiation). Seventeen medulloblastomas reacted to only one protein (PNET-MD, monopotential differentiation). No reaction for either was found in five cases (PNET-NOS, not otherwise specified). The two year survival rate was 12.5% for PNET-BD compared to 49.2% for PNET-MD and 53.3% for PNET-NOS. Nine variables, i.e. age, tumor stage, metastatic stage, operation, radiotherapy, chemotherapy, histology, GFAP and NF, were analyzed using Cox's proportional hazard model. This revealed that the significant factors were tumor stage (p = 0.0002), GFAP (p = 0.0008) and operation (p less than 0.05). In conclusion, GFAP is the most important histological factor for prognosis and medulloblastoma without glial differentiation has a much better prognosis than one with glial differentiation.

[Treatment of malignant brain tumors with slowly releasing anticancer drug-polymer composites].

The purpose of this study is to present the methodology and results of a clinical trial of local chemotherapy of malignant brain tumors based on slowly-releasing anticancer drug-polymer composites. The slowly releasing drugs were prepared by combining and mutually dispersing anticancer agents with glassified monomers containing 10% polymetacrylic methyl acid and then this compound was frozen at -78 degrees C and exposed to 1 X 10(6) rad of gamma rays from cobalt 60. Thus we prepared a compound of polymers and anticancer agents. We used needle-shaped capsules of this compound. These capsules release the drug very slowly over 40 days. We administered locally to the malignant brain tumors with either slowly releasing mitomycin, slowly releasing adriamycin, slowly releasing ACNU or slowly releasing 5 Fu drugs. The following techniques were employed in implantation these capsules. Implantation into the remaining tumor wall at the time of excision. Implantation into the tumor by CT-guided stereotactic method. We implanted these drugs into tumor of 55 cases, thereafter we conducted both radiation and chemotherapy with ACNU in most patients. This method has the following advantages: It is possible to be employed to different types of anticancer agents. Both dosage and releasing time can be adjusted. It is possible to administer these capsules postoperatively by the stereotactic method. The clinical study consists of 55 patients, 20 cases of anaplastic astrocytoma, 23 cases of glioblastoma multiforme, 5 cases of oligodendroglioma, 3 cases of medulloblastoma and 4 cases of others. Survival rate estimated by Kaplan-Meier method was 47% in glioblastoma at 12 months and 91% in anaplastic astrocytoma at 18 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinicopathological study of supratentorial tumors with multipotential differentiation in childhood. Primitive neuroectodermal tumor].

Three cases of supratentorial tumor in childhood were studied clinico-pathologically in an attempt to clarify its histological character. Case 1: A 3-year-old boy. Carotid angiogram revealed avascular lesion in the left parietal lobe. Twice operations and radiotherapy were performed. Ten months after the second operation, he died. Surgical specimen at the first operation was composed mainly of round tumor cells. The tumor tissue contained many collagen fibers. At the periphery of this tissue, medulloblastomatous areas consisting of closely aggregated hyperchromatic small round cells were found. There were perivascular rosettes and Homer Wright rosettes. In part, tubular and papillary arrangement of cells was also present. Astrocytomatous and oligodendrogliomatous structures were also present. Surgical specimens at the second operation showed the predominance of sarcomatous areas consisting of spindle-shaped cells with abundant argyrophilic fibers. Case 2: A 10-year-old girl. CT scan revealed a heterogeneous enhanced mass with a cyst and calcification in the right parietal lobe. Operation and radiotherapy were performed. Twelve months after operation, she is still alive. Most of the surgical specimens showed sarcomatous structure with abundant argyrophilic fibers. In these tissues, there were medulloblastomatous and ependymomatous features. Papillary arrangement of cells was also present. In part, there was oligodendrogliomatous structure. Case 3: A 2-year-old girl. CT scan revealed a heterogeneous enhanced mass in the right frontal lobe. The tumor tissue was composed of an aggregation of undifferentiated small round cells with Homer Wright rosettes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinico-pathological features of intracranial germ cell tumors with dissemination or metastasis in childhood].

Recently reports of the cases with intracranial germ cell tumor associated with dissemination to the central nervous system are increased since the introduction of CT scan. The authors experienced 8 cases with the dissemination among 19 cases of intracranial germ cell tumor in childhood, and discussed their clinico-pathological features. Before the CT scan era, the authors experienced only one case with dissemination, who was a 11 years-old boy (Case 1) and revealed two cell pattern pinealoma disseminating on the subependymal layer of all ventricles and in the basal cisterns at autopsy. Since the introduction of CT scan, 4 cases were found, who showed periventricular dissemination already at the first admission. Among them three cases revealed tumors in the pineal or suprasellar region and also dissemination of tumors on the wall of the lateral ventricles. The other one (Case 3) did not reveal any tumor at pineal or suprasellar region, but disseminated tumors on the wall of the third and lateral ventricles. Histological appearances of all 4 cases were two cell pattern pinealoma by examination of surgical or CSF materials. Only one case (Case 5) was found spinal dissemination later. All 4 cases were good prognosis. The authors considered that there might be diffuse primary ependymal germ cell tumor besides diffuse metastatic one. In the CT scan era, there were three cases who showed dissemination or metastasis along their clinical courses, but had not showed at the first administration. One (Case 6) of 3 cases showed a tumor at the right thalamus at the first administration. Five years later, the tumor metastasized to the cervical cord and he died.(ABSTRACT TRUNCATED AT 250 WORDS)

[The relationship between cell proliferation activity and secretory activity in pituitary adenoma--a review of 63 cases].

Determination of the cell proliferation activity of neoplasm is useful in making a prognosis. Immunohistochemical detection using MIB-1 monoclonal antibody has recently allowed us to assess tumor cell proliferation easily, because it can be performed on paraffin-embedded specimens and the results have been demonstrated to be positively correlated with the results of PCNA staining. In this study, surgical specimens of 63 pituitary adenomas were examined by immunohistochemical staining with MIB-1 monoclonal antibody. Twenty-nine cases were non-functioning pituitary adenomas, 20 were prolactin (PRL)-producing pituitary adenomas, and 14 were growth hormone (GH)-producing pituitary adenomas. The MIB-1 positive rates of the pituitary adenomas ranged from 0% to 6.46%. In the non-functioning pituitary adenomas, the MIB-1 positive rates ranged from 0% to 4.55% (mean : 0.76%), in the PRL-producing pituitary adenomas the MIB-1 positive rates ranged 0% to 6.46% (mean : 0.91%), and in the GH-producing pituitary adenomas the MIB-1 positive rates ranged 0% to 1.28% (mean: 0.58%). There were no significant differences between these values according to the results of the Wilcoxon signed-rank test. Although the size of the non-functioning pituitary adenomas was not correlated with their MIB-1 positive rate, tumor size was closely correlated with the interval between the onset of the initial symptoms and the date of surgery. In the PRL-producing pituitary adenomas, the MIB-1 positive rate was not correlated with serum PRL levels as an index of secretory activity, but was correlated with the PRL staining positive rate. Preoperative bromocriptine therapy proved effective in reducing tumor size and serum PRL levels, but had no effect on the MIB-1 positive rate. In the GH-producing pituitary adenomas, the MIB-1 positive rate was not correlated with serum GH levels as an index of secretory activity, but was closely correlated with the GH staining positive rate. All three groups included both invasive and noninvasive tumor types, but there were no close statistical correlations between the three tumor types.