Endoscopic ventriculo-cystomy for non-communicating hydrocephalus secondary to quadrigeminal cistern arachnoid cyst.

INTRODUCTION: Intracranial arachnoid cysts are developmental, anomalous collections of cerebrospinal fluid (CSF), and occasionally cause symptoms when large enough to obliterate the CSF outflow pathway and give rise to non-communicating hydrocephalus. The treatment of choice for symptomatic arachnoid cysts has been surgical excision or fenestration of the cyst, but less invasive endoscopic fenestration has been attempted with favorable preliminary results. CASE REPORT: We report a case of non-communicating hydrocephalus caused by a quadrigeminal cistern arachnoid cyst in a 35-year-old woman who presented with worsening headaches. She was successfully treated by endoscopic third ventriculostomy and fenestration of the cyst (ventriculo-cistomy). DISCUSSION: Endoscopic fenestration of symptomatic arachnoid cysts can be as effective as open surgery in terms of short-term efficacy, and it is certainly less invasive than open surgery. However, its long-term outcome remains unknown, and these rare cases require careful clinical and radiological follow-up.

Spontaneous thrombosis of intracavernous internal carotid artery aneurysm and parent artery occlusion in patients with positive balloon test occlusion--two case reports.

Two patients with giant intracavernous internal carotid artery (ICA) aneurysms were intolerant to balloon test occlusion of the ICA, and later developed spontaneous thrombosis of the aneurysm and the parent ICA without ischemic sequelae. Case 1: A 60-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. An unsuccessful extracranial-to-intracranial bypass graft operation was complicated by transient postoperative ophthalmoplegia. The patient did not tolerate balloon test occlusion of the right ICA after attempted bypass surgery, and was treated conservatively. The patient presented with acute onset of headache 3 years later. Case 2: A 50-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. The patient was managed conservatively after a positive balloon test occlusion of the right ICA. The patient suffered transient hypopituitarism and acute onset of headache 2 years later. Spontaneous thrombosis of the aneurysms and occlusion of the parent ICA were found in both patients. Neither had major hemispheric infarcts, but the first patient had asymptomatic infarcts, which were presumed to be thromboembolic in nature. Patients with intracavernous ICA aneurysms who have positive balloon test occlusions appear to develop tolerance to spontaneous and gradual occlusion of the ICA without significant sequelae. However, these patients have an increased risk of developing embolic infarctions. The role for anticoagulation and repeat hemodynamic tests remains unclear.

Primary osteosarcoma of the sphenoid bone with extensive periosteal extension--case report.

A 28-year-old male presented with a primary osteosarcoma of the sphenoid bone with extensive periosteal extension manifesting as severe headache and right exophthalmos. Computed tomography (CT) and magnetic resonance imaging revealed an anterior middle cranial fossa tumor extending into both the orbit and the extracranial space. However, roentgenography and CT with bone windows showed no marked osteolytic changes of the sphenoid bone. Total removal of the tumor was performed via the orbitozygomatic approach. Surgery revealed that the tumor had extended periosteally without macroscopic bone destruction, but no obvious abnormalities of the skull. The histological diagnosis was osteosarcoma. The patient was treated with chemotherapy and radiation therapy, but died of tumor recurrence 10 months after the surgery.

Neurite growth capability of rat fetal neuronal cells against matured CNS myelin in vitro.

Reconstruction of neurocircuits by transplanted cells is expected to become an effective therapy for brain damage. In order to establish the transplantation therapy, it is necessary to find transplantable cells capable of reconstructing the lesioned neurocircuitry. We have reported that the younger neuronal cells such as neural stem cells are useful transplant materials because of their vigorous capacity for forming abundant neurites. On the other hand, it was reported that myelin-associated neurite growth inhibitor prevents neurite regeneration. In this study, we used rat fetal neuronal cells to examine the neurite growth capacity in the presence of mature CNS myelin. Crude CNS myelin was prepared from the brains of adult Wistar rats using previously described procedures. Testing wells were precoated with poly-L-lysine and additionally by over-night drying of a suspension containing 0, 5, 10, 15, or 20 microg/cm2 of the crude myelin protein. On embryonic days 10, 12, 15, and 17 (E10, E12, E15, and E17) embryos were surgically removed, mesencephalic neural plates were dissected out from the E10 embryos, and midbrain cells were taken from the E12, E15, and E17 embryos. The neural plates and midbrain cells were placed on the myelin-coated wells. After 24 h of culture (72 h in the case of neural plates), the number of surviving cells and the length of the neurites were examined immunocytochemically using anti-neurofilament (NF) antibody. Neurite length was measured by image analyzer Luzex-F. The mesencephalic neural plate was able to grow neurites even on 20 microg/cm2 central myelin. Almost the same number of midbrain cells attached themselves to the wells without myelin in every culture obtained from various stages of embryos. The number of cells attached on the myelin-coated wells decreased with the concentration of myelin. The number of NF-positive cells was higher in cultures of materials obtained from older embryos than in cultures obtained from younger embryos. The younger cells grew longer neurites than the older cells in the myelin noncoated wells. Neurite growth was inhibited strongly when the concentration of the central myelin was 10 microg/cm2 or greater, but on the 5 microg/cm2 myelin, the younger the cells were, the longer neurites they had. When the length of the longest neurites in one field of the image analyzer was further examined in the same way, the younger the cells were, the longer their axons grew on 0 and 5 microg/cm2 myelin. Thus, CNS myelin was seen to be a significant inhibitor of the recovery of injured neural tissue of the adult CNS. Younger cells grew longer neurites than older cells on CNS myelin, and so it was suggested that neural stem cells or younger neurons may serve as tissue for transplantation therapy.

Glomus jugulare tumor presenting with intracerebellar hemorrhage.

What is believed to be the first case of a glomus jugulare tumor presenting with intracerebellar hemorrhage is described. A 25-year-old normotensive man suddenly suffered from severe headache, nausea, vomiting, vertigo, and ataxia due to an intracerebellar hemorrhage. Magnetic resonance imaging and angiography revealed a highly vascular jugulare foramen tumor extending into the intracranial space adjacent to the hematoma. Total removal of the tumor was performed successfully via the combined pre- and retrosigmoid approach, and the histologic diagnosis was a glomus jugulare tumor. We concluded that one of the numerous draining veins on the surface of intracranial tumor, which were observed during the operation, was the origin of the intracerebellar hemorrhage.

Differentiation and angiogenesis of central nervous system stem cells implanted with mesenchyme into ischemic rat brain.

After cerebral infarction, necrosis in neural tissues is not usually repaired or reconstructed by the injured brain. We therefore examined the effects on postinfarction repair of implanting central nervous system (CNS) stem cells together with mesenchyme, because CNS stem cells can be expected to adapt and survive in the adult brain. Cerebral infarction was induced by the Koizumi-Longa method, using the adult male spontaneous hypertensive rat model. Reperfusion was performed an hour after middle cerebral artery occlusion. The rat mesencephalic neural plate at the early somite stage (embryonic day 10.5) together with the adjacent ventral mesenchymal tissues was dissected out under the microscope and immediately implanted into the ischemic rat striatum. One month later, the cognitive function was evaluated by the Morris water maze method. Histologic and immunohistochemical examinations of the graft were made with hematoxylin-eosin (H&E), neurofilament-200, and tyrosine hydroxylase (TH) stains. In the water maze study, mean latency times required to reach an escape platform in the implanted animals with surviving grafts were found to be shorter than in those without grafts, but longer than in normal animals. In the spatial probe trial, the number of animals seen to cross the area in the pool where the platform had been located was greater in the implanted rats with surviving grafts than in other groups. Multiple vascularization in the grafted area was observed histologically in H&E-stained tissues, and neurofilament-200-positive cells were recognized in the graft. TH staining revealed within the graft many immunoreactive neuron-like cell bodies with long dendrites. It was suggested that grafted CNS stem cells with mesenchyme may survive and differentiate into mature CNS tissue within the adult ischemic rat brain, constructing vessels in and around the grafts, and may therefore have the potential to be effective in the recovery of the cognitive function of the rat model.

A rapid serological detection method for squamous cell carcinoma.

OBJECTIVE: We conjugated the squamous cell carcinoma (CA)-associated antibody (anti-YM antibody) with gelatin particles. We found that these particles reacted specifically with the tumor-associated antigen (YM antigen) in serum samples from patients with squamous cell CA of the uterine cervix and various organs (GPA reaction). METHODS: 1) We performed immunohistochemical studies of the YM antigen in dysplasia and invasive squamous cell CA of the uterine cervix; 2) We measured the GPA reaction in various malignant and non-malignant gynecologic diseases. RESULTS: 1) Immunohistochemical localization of the YM antigen was over 75% in cases of dysplasia and invasive squamous cell CA of the uterine cervix, and was 21% in normal squamous epithelium of the uterine cervix. 2) The GPA reaction in gynecologic diseases was positive in 57.1% of the dysplasia cases; in CIS cases, 69.2%; in cervical CA, 83.0%; in corpus CA, 25.0%; in leiomyoma 16.7%; and in pregnant serum samples, 66.7%, 3) GPA reactions in non-ob-gyn cases were positive in 68.8% of the cases of squamous cell CA of the head and neck; 66.7% in cases of squamous cell CA of the lung; and 25.0% in adenoCA of the lungs whereas the sera of patients with benign tumors and of healthy persons were free of the YM antigen. CONCLUSION: We concluded that this newly developed GPA-reaction measurement is a simple and reliable serologic test for detecting the initial stage of squamous cell CA of various organs and for monitoring its postoperative status.

[Phase II study of paclitaxel (BMS-181339) in patients with ovarian cancer by 3-hour intravenous infusion].

A phase II study of Paclitaxel in patients with ovarian cancer by 3-hour intravenous infusion was undertaken by a cooperative study group of 30 institutes. Of 66 cases enrolled, 57 cases were evaluable for efficacy, and 63 cases were evaluable for safety. In spite of the fact that all cases for efficacy evaluation were previously treated with chemotherapy including platinum-based drugs, 2 cases of complete response (CR) and 15 cases of partial response (PR) were observed, with a response rate of 29.8% (The 95% confidence interval of response rate was 18.4-43.4%). Paclitaxel also showed 28.2% (11/39) response rate in patients refractory to treatment by platinum-based drugs. Histologically, the response rates were 28.9% (11/38) in serous adenocarcinoma, 40.0% (2/5) in clear cell adenocarcinoma and 25.0% (1/4) in mucinous adenocarcinoma. As the major laboratory abnormalities, leukopenia, neutropenia and decrease in hemoglobin were observed with incidence rates of 98.4% (62/63), 95.2% (59/62) and 85.7% (54/63), respectively. However, these abnormalities were clinically manageable by either withdrawal of medication, administration of antibiotics, G-CSF or metachysis etc. In addition, thrombocytopenia, elevation in GOT and GPT were seen with moderate incidence. Peripheral neuropathy was a major adverse symptom with an incidence of 79.4% (50/63), followed by alopecia, myalgia, arthralgia and fever. However, the majority of these adverse reactions were less than grade 3. From these findings, we confirmed that 3-hour intravenous infusion of Paclitaxel was a clinically useful chemotherapeutic agent in patients with ovarian cancer.

Immunohistochemical expression of glutathione S-transferase pi (GST-pi) and chemotherapy response in malignant ovarian tumors.

OBJECTIVES: To clarify the relationship between the expression of GST-pi and the therapeutic effects of high-dose combination chemotherapy with support by autologous bone-marrow transplantation (ABMT). METHODS: Expression of GST-pi in tissue specimen were analyzed by indirect immunoperoxidase methods using anti-GST-pi polyclonal antibody. RESULTS: (1) Eighteen of 36 cases (50%) tested prior to administration of any chemotherapeutic agents were found to be positive in terms of immunohistochemical expression of GST-pi in the cancer cells. (2) The rate of GST-pi expression was elevated following administration of cisplatin, adriamycin, and cyclophosphamide, which suggests that administration of such anti-cancer agents is capable of inducing expression of GST-pi in cancer cells. (3) GST-pi negative patients exhibit better survival rates than do GST-pi positive patients (Kaplan Meier method: p < 0.001). CONCLUSIONS: Analysis of GST-pi obtained at primary surgery can serve as a valid marker in anticipating chemotherapeutic effects and long-term prognoses.

Suppression of plasma glutathione peroxidase activity by ifosfamide.

Plasma glutathione peroxidase (GPx) is synthesized predominantly in the kidneys. Plasma-GPx activities were measured in 12 patients with gynecological malignancies before and after chemotherapy. The patients were treated with cisplatin alone (P); with VP16 and cisplatin (EP); with cyclophosphamide, doxorubicin, and cisplatin (CAP); or with ifosfamide, doxorubicin, and cisplatin (IAP). The protein levels of the enzyme were semi-quantitatively determined by immuno-blot analysis. Plasma GPx activity was decreased by an average of 61% (p < 0.01) in patients treated with IAP, while no significant decreases were observed in patients treated with any drug combinations without ifosfamide. Immuno-blot analysis of plasma samples from a patient treated with IAP revealed no differences in the protein levels of plasma GPx either before or after IAP administration, although the plasma GPx activity decreased 83%, from 0.173 to 0.029 units/ml. The results indicate that the decrease in plasma GPx activity was not due to impaired production of the enzyme in the kidneys, and that ifosfamide is responsible for inhibition of the enzyme activity. Since GPx is an enzyme of major importance in detoxification of lipid peroxides in the brain, CNS toxicity induced by ifosfamide might be related to severe suppression of plasma GPx activity.

[Retrospective analysis of relationship between progression and regression of dysplasia and existence of HPV DNA by in situ hybridization].

We investigated the relationship between the progression and regression of cervical dysplasia and the existence of HPV DNA. The materials we analyzed were 80 biopsied specimens obtained from 22 cases of dysplasia which were followed-up for a long time at our out-patient clinic, and 47 specimens of squamous cell carcinoma. Detection of HPV DNA was done by in situ hybridization with biotinylated HPV DNA probes types 6/11, 16/18 and 31/33/35. The analysis of several specimens obtained at long term follow-up showed that the dysplasia-progression group had a higher incidence and more frequent detection of HPV DNA than the regression group. In the progression group, HPV 16/18 were detected more frequently than HPV 31/33/35 at the dysplasia lesion, but HPV 6/11 was detected in neither the dysplasia nor the squamous cell carcinoma. Fourteen of the 47 cases of squamous cell carcinoma (29.8%) were positive for HPV DNA, and 13 of them (92.9%) were detected in the lesions of dysplasia adjacent to carcinoma in situ or invasive cancer. Comparison of the detection rate for HPV DNA was done in the 3 dysplastic areas, i.e. the dysplastic areas in the dysplasia progression group (A), dysplasia regression group (B) and in the area adjacent to squamous cell carcinoma (C). The detection rates for HPV DNA were 43.5% in A, 27.7% in C and 15.0% in B. From these results we drew the following conclusions: 1) The continuous existence of HPV DNA, especially type 16/18 in the dysplasia lesions, may progress from lesions to carcinoma in situ or invasive cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-up laparoscopy in patients with ovarian cancer.

Between 1982 and 1990, two hundred and fourteen consecutive laparoscopies were performed on 75 patients with epithelial ovarian cancer when the disease appeared to be clinically in complete remission according to simultaneous CT scan or ultrasonography. Evaluation were based on macroscopic findings through the laparoscope, by cytologic examination of ascitic and peritoneal washings and by intraperitoneal biopsy. The results were positive in 34 laparoscopies for 19 patients, suspicious in 15 laparoscopies for 13 patients and negative in 164 laparoscopies. the intraperitoneal recurrence rate after negative second-look laparoscopy was 14.0% as a whole, and 4.5% in cases with more than two consecutive negative evaluations. Serum CA-125 levels exhibited and elevation in 28 of 34 positive laparoscopies before treatment and remained within the normal range in 22 (78.6%) of the 28 cases after treatment despite positive follow-up laparoscopies. The repeated laparoscopies offer the advantage of lowering the false negative rate. This will enable early detection of intraperitoneal recurrence, better prognoses and reduction of unnecessary laparotomies.

[Maternal drinking and smoking and the risk of birth defects].

Maternal drinking or smoking and the risk of birth defects was studied in a case-control study, performed on 1,789 babies, born between 1990 and 1992 in the Tokai University hospital, and their mothers. The findings were as follows: The proportion of maternal drinking before or during pregnancy was higher in the mothers of children with birth defects (odds ratio 2.2; 95% confidence intervals 0.5-8.9). However, this difference was not statistically significant. Maternal smoking, defined as 11 or more cigarettes per day before pregnancy, was 13.5% in the mothers of children with birth defects, compared to 6.7% in the mothers of controls (odds ratio 2.2; 95% CI 0.6-7.4). This difference was not statistically significant. A total of 78 classified deformities were reported in the 52 children with birth defects, of which 24.4% were associated with maternal drinking and 16.7% were associated with maternal smoking, respectively. A significant association was found between premature birth and mothers who reported drinking during pregnancy (odds ratio 3.3 95% CI 1.1-10.9). The frequency of spontaneous abortion was higher among mothers who reported both drinking and smoking during pregnancy. In addition the frequency of complications during pregnancy was higher. Analysis of factors related to birth defects showed that the risk for birth defective infants was higher for mothers above 35 years of age than for those under 35 (p < 0.05). This study supports an association between maternal drinking during pregnancy and infant birth defects, but does not implicate maternal smoking because the number of mothers who smoked during pregnancy was too small to be of significance.

[Immunohistochemical studies on a new antigens associated with squamous cell cancer in oncogenesis of uterine cervical cancer].

We examined the localization of squamous cell cancer associated antigens (SCCAA) in dysplasia, cancer in situ (CIS) and microinvasive SCC of the uterine cervix, since detection of SCCAA in these subjects is highly effective for early diagnosis. Anti-squamous cell cancer associated antibody (Anti SCCAAb IgG) was prepared by immunizing rabbits with specific components at around PI 6.1 that were originally purified from SCC of maxillary sinus. In this study, the following results were obtained by the immunoperoxidase method. (1) Eleven out of 15(73%) cases of dysplasia, 20 out of 26(77%) cases of CIS, 21 out of 24(88%) cases of Stage I, 13 out of 14(93%) cases of Stage II and 9 out of 10(90%) cases of Stage III-IV in the clinical stages of SCC showed positive staining, while controls of unrelated SCC were almost negative. (2) The SCCAA positive ratio was 2 out of 2 cases of small cell nonkeratinized type, 86% in large cell nonkeratinized type and 94% in Keratinized type of SCC. (3) The SCCAA was demonstrated on all the layers of stratified squamous epithelium in a lesion of CIS and some layers migrated to adjacent nonneoplastic lesion with lateral invasion in middle layer. These results suggest that the demonstration of SCCAA may be useful in diagnosing the malignant transformation of squamous epithelium in the early stage of SCC.

[Previous cytology in patients with carcinoma of the cervix].

The cytologic history of 317 patients with uterine cancer, in a mass survey using mobile units, was reviewed. They included 152 cases of carcinoma in situ of the cervix, 151 cases of invasive epidermoid carcinoma of the cervix, 11 cases of adenocarcinoma of the cervix, one case of verrucous squamous cell carcinoma and 2 cases of adenocarcinoma of the endometrium. There was no history of cytology in 17.1% of CIS or in 29.8% of invasive epidermoid carcinoma in the preceding 3 years (same order in the following); in the preceding 5 years the figures were 24.3% and 23.6% respectively. Suspicious or positive cytology noted more than once were 22.2% and 21.7% in the preceding 3 years, and 24.3% and 23.6% of the cases in the preceding 5 years. At least 2 negative Papanicolaou smears were 19.1% and 20.5% in the preceding 3 years, and 28.3% and 28.5% of the cases in the preceding 5 years. The yearly rate of suspicious and/or positive cytology in the preceding 5 years fluctuated between 13.5% and 30.4% in CIS, and between 9.1% and 23.0% in invasive epidermoid carcinoma. They showed no significant rise or trend. Verrucous squamous cell carcinoma as well as adenocarcinoma of the cervix and of the endometrium not infrequently showed successive negative cytology.

[Studies on the prevalence and incidence rate of epithelial neoplasia of the uterine cervix by mass survey using mobile units].

In this paper, we analyzed the results obtained in a mass survey using mobile units. The survey covered 276,846 women of whrom 78,018 (24.6%) were women who were being screened for the first time and the other 208,828 had been screened previously. 1) The total detection rate was 0.04% for invasive cancer, 0.03% for carcinoma in situ and 0.06% for severe dysplasia of the uterine cervix. The prevalence rate for 1,000 women was calculated as 0.40, 0.30 and 0.63 respectively. 2) The detection rate for invasive cancer, carcinoma in situ and severe dysplasia was 0.08%, 0.07% and 0.08% respectively for women who were being screened for the first time and 0.03%, 0.02% and 0.06% respectively for repeats. Through the latter results, the incidence rate for 100,000 women was calculated as 30 for invasive cancer, 20 for carcinoma in situ and 60 for severe dysplasia. 3) The detection rate for invasive cancer and severe dysplasia increased abruptly above 60 years and that for carcinoma in situ at 65 years old and over. 4) The detection rate for invasive cancer, carcinoma in situ and severe dysplasia in previously screened women showed little fluctuation by age group.

Colposcopy in the management of cervical dysplasia.

A follow-up study was carried out on 27 patients with high dysplasia and 133 patients with mild dysplasia for at least 1 year, using mainly cytodiagnosis and colposcopy. Advanced cases were identified in 25.9% of the first group and 8.3% in the latter group. It was demonstrated that these advanced cases could be found without fail from colposcopic findings combined with cytodiagnosis.

Enzyme histochemical and ultrastructural studies in human adrenal glands of normal and anencephalic fetuses.

In order to confirm the functional status of adrenal gland in human anencephalic fetuses, an enzyme histochemical and ultrastructural approach was used to study the adrenocortical cells of normal and anencephalic human fetuses. In the adrenal gland of the anencephalic fetuses (32nd, 34th and 36th week of gestation), enzyme histochemical activities of alkaline phosphatase and acid phosphatase was weaker than those in normal human fetuses (20th and 26th week of gestation). Ultrastructurally, a large number of lipid droplets, rough endoplasmic reticulum, tubular or vesicular profiles of smooth endoplasmic reticulum and mitochondria with poorly developed cristae were noted in the cytoplasm. In addition, Golgi complexes and microvilli were very poorly developed. Based on these findings, functional aspects of the adrenal gland in anencephalic fetuses were discussed.