Neurosurgical trauma in Japan.

According to the statistics compiled by the Institute for Traffic Accident Research and Data Analysis, the total number of head trauma patients has stayed virtually the same for the last 10 years in Japan, although a fraction of people suffering minor head trauma has shown a trend to increase. The Japan Society of Neurotraumatology is in the process of establishing a guideline for head trauma management. No major difference is noted in surgical procedures selected by neurosurgeons in Japan as compared to those in other countries. It appears, however, that the ventriculostomy may be less frequently employed to control elevated intracranial pressure, and the jugular bulb venous oximetry is far more frequently employed to detect cerebral deoxygenation in Japan. There appear to be two obvious differences in selection of pharmacological therapies among neurosurgeons in Japan and those in other countries; neurosurgeons in Japan prefer glycerol to mannitol for osmotic control of intracranial pressure, and barbiturate to morphine as sedatives. Two drugs are currently available in Japan for promoting the recovery from disturbance of consciousness after head trauma: cytidine diphosphate choline (CDP)-choline (Nicholin, Takeda Chemical Industries, Ltd., Osaka) and protirelin tartrate (Hirtonin; thyrotropinreleasing hormone (TRH) analogue, Takeda). Another TRH analogue, NS-3 (montirelin hydrate), is currently submitted to the Ministry of Health and Welfare for approval. A multi-institutional controlled study to examine the efficacy of therapeutic hypothermia for head trauma management is now in progress in Japan. The Japan Neurotrauma Data Bank System was inaugurated 2 years ago, enabling joint statistical processing at 10 major neurotrauma centers. Utilizing such a system, more detailed analysis of head trauma management will be possible, and clinical trials will be conducted systematically and more promptly in future.

Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis.

BACKGROUND: Insulin resistance contributes to the pathogenesis of atherosclerotic cardiovascular disease and, thus, has an important impact on the mortality of uraemic patients. Haemodialysis (HD) is known to improve insulin resistance observed in uraemia. However, it is not known whether continuous ambulatory peritoneal dialysis (CAPD) alleviates insulin resistance in adult uraemic patients. The objective of this study was to compare the effect of two different dialysis modalities, HD and CAPD, on insulin resistance in adult uraemic patients and to identify the possible predictive factors for changes in insulin resistance. METHODS: Insulin resistance was examined in 19 non-diabetic patients with end-stage renal disease (ESRD) before and after dialysis therapy (HD, n=10; CAPD, n=9), as well as in 10 healthy controls using the hyperinsulinaemic euglycaemic glucose clamp technique. The glucose disposal rate (GDR mg/kg/min) was used as an index of insulin sensitivity during the clamp technique. We also determined which of various biochemical parameters might be associated with change in insulin resistance by carrying out multiple logistic regression analysis. RESULTS: GDR was significantly lower (6.44+/-1.76) in ESRD subjects than in normal subjects (9.90+/-2.01). HD and CAPD therapies significantly normalized GDR from 6.53+/-1.84 to 9.74+/-2.88 and from 6.35+/-1.65 to 8.18+/-1.76 respectively. Multiple logistic regression analysis showed that changes in BUN, haematocrit and plasma bicarbonate were significant predictive factors for the change in insulin resistance. CONCLUSION: CAPD therapy, in spite of its possible adverse effects in patients with atherosclerotic disease, has been shown to improve insulin resistance in adult uraemic patients, similarly to HD therapy.

The relationship between drinking status and serial changes of pancreatographic findings in patients with suspected early chronic alcoholic pancreatitis.

Twenty-two patients (mean age, 48.5 years) suspected of early chronic alcoholic pancreatitis, who had ductal changes mainly in the side branches, were followed by serial endoscopic retrograde pancreatography (ERP). Follow-up ranged from 1.1 to 11.9 years (mean, 5.4). Serial ERP revealed deterioration in six patients (27%), five of whom had outflow disturbance of the main pancreatic duct. On the other hand, five patients presented slight progressive changes restricted to the side branches and the remaining 11 patients showed no change. None of the 12 patients who abstained from drinking showed a deterioration of their pancreatogram. The deterioration of clinical symptoms was less frequently seen in patients with abstinence (5/12) than in those who continued drinking (10/10). This study suggests that a ductal abnormality mainly in the side branches may be an early sign of chronic alcoholic pancreatitis. Outflow disturbance of the main pancreatic duct might play an important role in the progression of the pancreatogram to an advanced stage. Abstinence is associated with a high probability of stabilization of both clinical symptoms and ductal changes.

[Early detection of hepatobiliary cancer in mass health screening].

Mass health screening (MHS) for detecting early cancer of hepatobiliary diseases is not common. However, as high risk factors for developing hepatocellular carcinoma (HCC) has been established in Japan, MHS for HCC is available, especially in high endemic areas of hepatitis C. Intrahepatic bile duct cancer often occur in patients with Thorotrastosis. Cohort study for detection of early cancer of intrahepatic bile duct has been conducting by the Japanese Government. Early detection of bile duct cancer in health screening is very rare. It will be helpful for perform MHS to clarify the high risk factors for bile duct cancers.

Comparative study of CA242 and CA19-9 in chronic pancreatitis.

CA242 has been proved to be useful in the diagnosis of pancreatic cancer. The aim of the present study was to clarify the mechanisms contributing to the high specificity of CA242 as compared with CA19-9 resulting from scarce serum elevation of this antigen in patients with chronic pancreatitis by correlating serum levels and endoscopic retrograde choledocho-pancreatography (ERCP) findings and by immunohistochemical analysis. Serum CA19-9 levels were significantly elevated in patients with calcification and with main pancreatic duct (MPD) stenosis or obstruction. On the other hand, serum CA242 levels showed no significant elevation in patients with such factors. Even though such pathological conditions were considered to lead to the stagnation of pancreatic juice, serum CA242 levels seemed to be less affected than serum CA19-9 levels. Immunohistochemical studies of chronic pancreatitis tissues revealed that CA242 was expressed less frequently and less intensely than CA19-9, and the difference in expression was more prominent in the centroacinar cells and terminal ductules. From the results of the present study, it is conceivable that CA242 is less influenced by the stagnation of the pancreatic juice than CA19-9 because of the low levels of expression in ductal systems, which results in the release of this antigen into the circulation in lower amounts than that of CA19-9.

Mandibular reconstruction using computer-generated three-dimensional solid models.

In mandibular reconstruction, it is necessary to know the exact, three-dimensional extent of the mandible and its defect; the bone graft must be the exact size and dimension of the defect, to assure a precise three-dimensional configuration of the mandible. Previously, the bone graft had to be reshaped during the operation by trial and error, often a time-consuming procedure. The operative procedure has been simulated in advance using three-dimensional, solid models, which has shortened the operating time required.

Dynamic changes in cytochrome oxidase activity in the rat somatosensory cortex following thalamocortical deafferentation.

The changes in cytochrome oxidase (CYO) activity in the primary somatosensory cortex (SI) induced by unilateral lesions restricted to the posterior ventrobasal region of the thalamus were investigated by histochemical techniques and photometric semi-quantitation in the rat. The CYO activity decreased rapidly and dramatically in layer IV of the lesioned side, reaching its lowest level within 2 weeks, and remained depressed at 8 weeks post-lesion. Segmentations normally seen in layer IV corresponding to barrels remained absent. While less marked decreases were also noted in other layers, obvious recovery was subsequently observed, attaining levels comparable to those on the intact size at 6 or 8 weeks post-lesion. The persistent decrease in layer IV appears to reflect a reduced thalamocortical activation of the dendritic profiles and neuronal perikarya. The recovery in other layers may represent an increase in the resting level of the initially depressed neuronal activity near to the original levels. The persistent reduction of function in the inhibitory surround, which is normally activated by thalamocortical input, may contribute to the increase in CYO activity.

Thalamic neuronal hyperactivity following transection of the spinothalamic tract in the cat: involvement of N-methyl-D-aspartate receptor.

Single neuron activities responding to peripheral stimuli with short latencies were recorded within the thalamic nucleus ventralis posterolateralis (VPL) after transection of the spinothalamic tract (STT) in the cat under alpha-chloralose anesthesia. The VPL neurons showed spontaneous and evoked hyperactivity after STT transection, which was revealed at 1-2 weeks. The spontaneous hyperactivity further progressed until 3-4 weeks. These hyperactivities were observed in core-area neurons as well as neurons found in the shell area, suggesting that some, if not many, of the N-methyl-D-aspartate (NMDA) receptor antagonist (MK-801, 4-16 mg; i.v.) attenuated both the spontaneous and evoked hyperactivity observed after STT transection. No such effects were demonstrated in sham-operated animals. These findings suggest that VPL neurons become hyperactive after STT transection through recruitment of NMDA receptors. The hyperactivity of VPL neurons may represent an important background process in the production of deafferentation pain induced by lesions involving the STT.

T-cell non-Hodgkin's lymphoma of the lung.

We report a case of primary T-cell non-Hodgkin's lymphoma of the lung. A definite diagnosis was made histologically at open lung biopsy. Atypical cells in the biopsy specimen reacted with monoclonal T-cell markers. Transbronchial lung biopsy and bronchoalveolar lavage fluid were useful in the diagnosis. Primary T-cell lymphoma of the lung is rare and is reviewed in this report.

Craniofacial fibrous dysplasia showing marked involution postoperatively.

There have been few reports in the literature concerning the long-term prognosis of fibrous dysplasia. We reported here a boy with craniofacial fibrous dysplasia, which showed marked involution at the end of his puberty.

Pancreatic angiography using balloon catheter occlusion and a vasoconstrictor.

When a vasoconstrictor (noradrenaline) was injected during occlusion of the common hepatic artery with a balloon catheter, the vasoconstrictor flowed only into the proper hepatic artery and constricted it. The balloon was immediately deflated and contrast medium injected into the common hepatic artery. The flow of the contrast medium into the gastroduodenal artery was then increased, clearly visualizing the entire pancreatic-duodenal arcade.

Deep-brain stimulation in a persistent vegetative state: follow-up results and criteria for selection of candidates.

Eight cases of a persistent vegetative state caused by brain damage were treated by chronic deep-brain stimulation (stimulation target: the mesencephalic reticular formation and/or non-specific thalamic nucleus) over a period of more than 6 months. Three of the patients are currently able to communicate and to express their demands by voice and one other patient has recovered very close to this state. These four cases showed changeable spectrograms with desynchronization on continuous EEG recording and all components of the BSR and SER could be recorded except for prolonged latency of both N20 (SER) and the V wave (BSR) 2 months after the initial coma. Following chronic deep-brain stimulation, EEG and behavioural arousal responses were observed with increased r-CBF, r-CMRO2 and r-CMRGL in the whole brain tissue. After 3-6 months of chronic deep brain stimulation, the prolonged coma scale rose in four of the eight cases and three cases emerged from the persistent vegetative state. Transmitter substances and their metabolites were also found to be increased in the CSF after chronic deep-brain stimulation. Based on these findings, chronic deep-brain stimulation represents a useful kind of treatment that can lead to emergence from a persistent vegetative state, if the candidate is selected by electrophysiological studies 2 months after the initial insult and if the stimulation is applied for more than 6-8 months using a high-safety chronic deep-brain stimulating instrument.

[Roentgenographic manifestations of peripheral bronchogenic carcinomas].

Peripheral bronchogenic carcinomas in early clinical stage are discovered by plain chest roentgenogram, and good prognosis will be expected by surgical resection. 20 bronchogenic carcinomas (18 adenocarcinomas, one squamous cell carcinoma, and one large cell carcinoma) in 19 patients were examined. 9 cases presented noduler lesion on the plain chest roentgenogram, and the other presented 7 focal patchy shadow and 4 band-like shadow. Thin-section CT could demonstrated indented pleura (95%), notch (95%), convergence of peripheral vessels (70%), irregular border (75%). In adenocarcinomas, thin-section CT demonstrated airbronchogram or airbronchiologram (61%), multiple small cavitation (61%), and heterogeneous density (56%). CT-pathologic correlation proved thin-section CT could demonstrate tumor's internal texture and fine detail of tumor-lung interface. Small peripheral lung cancer in early stage could be discovered by plain chest roentgenogram, and thin-section CT was useful for the diagnosis of small peripheral bronchogenic carcinomas, especially adenocarcinomas.

Spinal cord responses to feline transcranial brain stimulation: evidence for involvement of cerebellar pathways.

The physiological characteristics of spinal cord responses recorded from the spinal epidural space of the cat to transcranial brain stimulation were studied, in comparison with the spinal cord responses to direct stimulation of the motor cortex or cerebellum. The conduction velocity of the initial wave of the responses to transcranial brain stimulation (122.3 +/- 16.3 m/sec mean +/- SD, n = 5) was much faster than the conduction velocity of the initial wave of the responses to motor cortex stimulation (68.3 +/- 14.7, n = 5) and similar to the conduction velocity of the initial wave of the responses to cerebellar stimulation (120.2 +/- 16.2, n = 5). Furthermore, the conduction velocity of any component in the subsequent polyphasic waves at any intensity was not similar to the conduction velocity of the initial wave of the responses to motor cortex stimulation. All components of the responses to motor cortex stimulation disappeared after intercollicular transection. In contrast, the initial wave of the responses to cerebellar stimulation and transcranial brain stimulation remained unaffected by intercollicular transection. The initial wave caused by anodal transcranial brain stimulation was eliminated by ablation of the cerebellum. However, cathodal transcranial brain stimulation sometimes can produce an initial wave that can be eliminated only by transection at the medullospinal junction. The initial wave of the responses to cerebellar stimulation was largest in amplitude when the vicinity of the dentate nucleus was stimulated. These results suggest that responses to activation of the cerebellum, rather than corticospinal neurons arising from the motor cortex, represent a major component of the spinal cord responses to transcranial brain stimulation in cats. The data obtained indicate that it is difficult to activate the motor cortex selectively by transcranial brain stimulation in cats.

[Delayed radiation necrosis of the temporal lobe following radiation therapy of maxillary carcinoma].

A case of delayed radiation necrosis following radiation therapy for maxillary carcinoma was reported. The diagnosis of this case for the radiation necrosis was clinically suggestive and established by the pathological findings of autopsy. This 66 year-old man had been treated by the partial resection for the right maxillary carcinoma with chemotherapy (pepleomycin 110 mg, adriamycin 20 mg). Pre- and postoperatively total dose of 5040 rads were irradiated with cobalt therapy during 42 days at a dose of 180 rads and 5 times in a week through two ports at 8 x 8 cm field including right orbital region. Three years 7 months after radiation therapy he complained of disorientation, recent memory disturbance and slight left hemiparesis. On enhanced CT irregular ring enhanced mass lesion was seen in left temporal lobe inside the radiation field with extensive low density over temporal lobe on plain CT. MR imaging demonstrated that T 1-weighted spin echo images with a 50-msec repetition time (TR) and 22-msec echo time (TE) had irregular low signal intensity and extensive high signal intensity combined with partially low intensity in the central area on T2 weighted spin echo images with 2300 msec TR and 100 msec TR. There were not appeared vascular obstruction and stenosis on right carotid angiogram. He improved remarkably on clinical symptoms and CT by treating of dexamethasone and osmotic diuretics, but died of pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in serum levels of Forssman-like antibody in patients with gastric cancer.

Because Forssman antigen, one of the most well-known heteroantigens, has been noted in certain cancerous tissues, it would seem that the serum levels of the Forssman antibody of patients with these cancers would be low, owing to the absorption of the naturally occurring antibody by the Forssman antigen-containing cancerous tissues. This hypothesis was tested by researchers assessing the serum hemolysin titers of 174 patients with cancer (gastric cancer, 100; colonic cancer, 40; and other cancers, 45) and of 856 age-matched, sex-matched, and blood type-matched healthy individuals against the serum levels of sheep red blood cells. Serum levels of the hemolysin of patients with gastric cancer tend to be lower than those of patients with other types of cancer and also lower than those of age-matched and sex-matched controls. The decrease was especially prominent in patients with moderately differentiated adenocarcinoma of the stomach. Preoperative and postoperative serum samples of 40 patients with gastric cancer were analyzed therefore to determine the effect of surgically removing the cancer on the serum level of the hemolysin. The results showed that the serum levels of the hemolysin antibody increased in all 40 patients after the successful surgical removal of the cancer. However, in patients with recurrence of the cancer, the serum levels of hemolysin decreased again in 11 of 11 patients. These results indicate that the serum levels of the Forssman-like hemolysin could be used as an index of recurrence in patients with gastric cancer after surgical removal of the cancer.

Preoperative determination of the level of spinal cord lesions from the killed end potential.

To determine preoperatively the level of lesions in acute cervical cord injury, the killed end potential of the spinal cord was recorded with a pair of electrodes placed in the spinal epidural space, one initially being placed rostrally to the lesions for obtaining recordings and the other placed caudally to the lesions for stimulation. The level associated with the largest killed end potential was clearly determined without much difficulty, with sequential recordings on stepwise withdrawal of the recording electrode, in four of five cases investigated. In two cases subjected to surgery, the recording electrode left in place at the level associated with the largest killed end potential was found to be located at, or a few millimeters below, the center of the lesions. This demonstrates the preoperative localizing value of the killed end potential for determining the level of lesions responsible for myelopathy.

Corticospinal direct response in humans: identification of the motor cortex during intracranial surgery under general anaesthesia.

The corticospinal direct (D) response to stimulation of the motor cortex exposed for intracranial surgery was recorded in 20 cases from wire electrodes inserted into the spinal epidural space. The D response was obtained from stimulation of restricted areas of the cerebral cortex, that is, the hand, trunk and thigh areas of the motor cortex. The D response was resistant to anaesthesia and unaffected by muscle relaxants. Thus, recordings of the D response are useful for identifying the location of the motor cortex during intracranial surgery under general anaesthesia.

Meningeal chondrosarcomatous tumor associated with meningocytic differentiation.

Most meningeal chondrosarcomatous tumors have been regarded as identical to similar tumors occurring elsewhere in the body. The neoplasm reported here, however, clearly demonstrated transitions between usual meningiomas and chondrosarcomatous tumors. The present case thus provides evidence in support of Cushing's and Eisenhardt's proposal that some meningeal chondrosarcomatous tumors are derived from meningeal cells and are histogenetically related to meningiomas.