(+)-Syringaresinol-di-O-beta-D-glucoside, a phenolic compound from Acanthopanax senticosus Harms, suppresses proinflammatory mediators in SW982 human synovial sarcoma cells by inhibiting activating protein-1 and/or nuclear factor-kappaB activities.

(+)-Syringaresinol-di-O-beta-D-glucoside (SR), syringin, and isofraxidin isolated from the stem bark of Acanthopanax senticosus Harms are its major constituents. The present work was undertaken to analyze effects of these compounds on inflammatory functions in SW982 human synovial sarcoma cell system. When cells were exposed to SR, syringin, or isofraxidin, only isofraxidin had significant inhibitory effects on cell growth, although a slight inhibition was observed at the highest concentration of SR. SR suppressed the production of IL-6 at lower concentrations than syringin and isofraxidin. SR and syringin significantly suppressed the production of prostaglandin E(2), while isofraxidin suppressed only slightly. SR was more potent than syringin and isofraxidin at inhibiting the expression of IL-1beta, IL-6, cyclooxygenase (COX)-2 and matrix metalloproteinases (MMP)-1 mRNA, but was less potent than syringin at inhibiting the expression of MMP-2. We further demonstrated that SR significantly reduced MMP-1 promoter luciferase activity and DNA-binding activity of transcriptional factors AP-1 and NF-kappaB. Taken together, these results suggest that SR, an active component of the stem bark of A. senticosus, modulates the inflammatory process involved in arthritis by suppressing various gene expression through inhibiting AP-1 and/or NF-kappaB activities.

Bilateral intranigral NMDA infusion suppresses neuronal injury without affecting the duration of kainic acid-induced seizures in rats.

The substantia nigra pars reticulata (SNpr) is recognized as an important modulator of seizures within the limbic system. We have investigated the effects of N-methyl-D-aspartate (NMDA) infusion into SNpr upon seizure-related neuronal injury (assessed by expression of the 72-kDa heat shock protein - HSP 72) induced by systemic kainic acid (KA) in rats. Three to four days following implantation of guide cannulae for drug administration into SNpr, KA (7 mg/kg) was injected intravenously to induce seizures. Bilateral intranigral infusion of NMDA (20 nmol) 15 min prior to KA injection, suppressed the expression of HSP 72 in the hippocampal CA1 region without affecting seizure duration. These results support the involvement of NMDA receptors within SNpr in modulating neuronal injury following KA-induced limbic seizures.

Deep prepiriform cortex modulates kainate-induced hippocampal injury.

As seizure propagation within limbic structures is mediated in part by a small area of deep prepiriform cortex (area tempestas), we investigated the role of area tempestas in modulating hippocampal injury induced by systemic kainate administration. Injury was quantitated by counting the numbers of neurons that stained for the 72,000 mol. wt heat shock protein and with acid-fuchsin dye. Status epilepticus induced these markers of neuronal injury in the CA1 and CA3a regions of the hippocampus, thalamus, piriform cortex and the amygdaloid complex. Microinjection of 2-amino-7-phosphonoheptanoic acid, a competitive antagonist of the N-methyl-D-aspartate subclass of the glutamate receptor, into area tempestas prior to systemic administration of kainate attenuated both heat shock protein induction and acid-fuchsin labeling in CA1 and CA3a pyramidal neurons without reducing the duration of electrographic seizures. Injections of bicuculline, a GABA antagonist, into area tempestas produced hippocampal damage when given with subcytotoxic doses of intravenous kainate. Thus, area tempestas may be a uniquely sensitive anatomical structure involved not just in seizure propagation but also in modulating the extent and pattern of damage induced in hippocampal neurons as a result of prolonged, systemically induced seizures. These effects are due in part to excitatory and inhibitory projections to neurons in area tempestas.

Distribution of HSP72 induction and neuronal death following limbic seizures.

A small area of deep prepiriform cortex is uniquely susceptible to convulsant and anticonvulsant drugs in the rat. We have studied the pattern of expression of the non-constitutive stress protein (HSP72) following seizures induced by unilateral microinjection of bicuculline into this area. HSP was seen first in ipsilateral dorsal medial thalamus, amygdala and associated piriform cortex, and with more sustained seizures was seen bilaterally in these structures as well as in other projection sites. Neuronal cell death, as assessed by acid-fuchsin staining, occurred in the same brain regions. Frank necrosis was found in the ipsilateral piriform cortex with prolonged seizures. Behaviorally, the seizures induced are characteristic of involvement of the limbic system and, therefore, may be a model of human complex partial seizures.

Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament.

Multi-level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well-documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi-level spondylosis and OPLL. They consisted of 19 patients with cervical spondylosis, 12 with OPLL, and 14 with combined lesions of both cervical spondylosis and OPLL. There were 32 men and 13 women. The mean age was 55 years, ranging from 35 to 70 years. In all of our 45 patients, anterior vertebrectomy, discectomy, removal of posterior osteophytes and OPLL, and interbody fusion were done for progressive myelopathy refractory to conservative treatment. In 2 of 45 patients, 5 vertebral bodies were resected; in 3 patients, 4 vertebral bodies were resected; in 12 patients, 3 vertebral bodies were resected, in 19 patients, 2 vertebral bodies were resected; and in 9 patients, 1 vertebral body was resected. Thirty-nine of 45 patients (87%) had good results. Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion.

Papilledema and spinal cord tumors.

Two cases of cervical schwannoma associated with papilledema and dementia are described and the pertinent literature is reviewed. It is very important to conduct complete spinal surveys when patients suffer dementia and papilledema and the cerebrospinal fluid protein is elevated.

Arteriovenous malformations of the lateral ventricle.

Nine cases with arteriovenous malformations (AVM's) predominantly involving the lateral ventricle are presented. All the AVM's were small, but caused intraventricular hemorrhage in eight cases. Only two patients had an intracerebral hemorrhage large enough to warrant evacuation. Eight patients were under the age of 40 years at the onset of their disease. Computerized tomography demonstrated intraventricular hemorrhage in eight patients, and after intravenous administration of contrast medium a small area of enhancement with dilated subependymal draining veins was seen in seven. The lateral ventricles were of normal size in seven cases, and only two patients required a shunting procedure. Angiography demonstrated that the lesion was an AVM in eight patients, and did not visualize the lesion in the ninth. One patient suffered a recurrent intraventricular hemorrhage when the AVM was demonstrated, although repeated angiography had failed to disclose a vascular lesion at his first intraventricular hemorrhage 14 months before. All nine lesions were resected by microsurgical techniques, and the results were excellent in eight patients. Of four caudate lesions, three were resected through a frontal transcortical approach and the other was operated on through an anterior transcallosal approach; the results were excellent in three of these patients. Only one (Case 4) was left with neurological deficits; he had confusion and disorientation following a right frontal transcortical approach. Even in the dominant hemisphere, lesions in the head of the caudate nucleus could be safely resected by an anterior transcallosal approach. Two choroidal lesions located in the temporal horn and trigone on the dominant side were resected through a middle temporal gyrus approach, and three thalamic lesions through a posterior transcallosal approach, all with excellent results. In all cases the brain opening required was about the width of the retractor (maximum 2.0 cm, average 1.5 cm).

Foreign-body granuloma simulating recurrence of falx meningioma. Case report.

The authors report a case of foreign-body granuloma that developed 1 1/2 years after total removal of a falx meningioma. Prior to surgery, it was thought to be a recurrence of tumor.

Intracerebral hemorrhage remote from the site of the initial neurosurgical procedure.

Four cases of intracerebral hemorrhage remote from the site of the initial neurosurgical procedure are presented. Two of the four patients had preoperative hypertension. Possible mechanisms are discussed, and labile hypertension and unstable blood pressure during the perisurgical period may be contributory. Clinical awareness of this rare but potential complication is essential to early diagnosis and treatment. Difficulty in awakening from anesthesia and the development of new neurological deficits not attributable to the operative site are the most important keys to early diagnosis. Computed tomography is the diagnostic method of choice.

Cerebral chromoblastomycosis complicated by meningitis and multiple fungal aneurysms after resection of a granuloma. Case report.

Cerebral chromoblastomycosis is a rare intracranial lesion. This lesion was found in a 23-year-old man, who presented with right proptosis and fainting attacks. Computerized tomography revealed a moderately enhanced irregular mass in the right frontal region. Angiography disclosed that the mass was avascular. At surgery, a hard elastic avascular tumor was totally removed piecemeal. Histological diagnosis was a granuloma of fungal origin. Characteristic brown pigments in the hyphae of fungus in the granuloma strongly suggested that the fungus was chromoblastomycosis. The postoperative course was complicated by meningitis and rupture of fungal aneurysms. The patient remained vegetative and died 2 1/2 years later. The literature on such fungal aneurysms is briefly reviewed; no previous case of fungal aneurysms associated with cerebral chromoblastomycosis could be found.

[Computed tomographic metrizamide myelography in Chiari malformation in adult--special reference to the diagnostic values of reconstruction CT].

Three adult patients with a clinical diagnosis of Chiari malformation were examined by computed tomography after intrathecal injection of metrizamide via the lumbar route. In all patients Chiari malformation was demonstrated as a soft tissue oval mass at the level of C1-C2 vertebral body that was intradural and posterior to the medulla and the upper cervical spinal cord. These findings were more accurately visualized in saggital and in frontal reconstructed CTs. In one patient the spinal cord was measurably enlarged at the upper thoracic level. A delayed scan was obtained in another case at 24 hours after the injection and the syrinx was remained opacified whereas the density of cerebrospinal fluid and parenchyma decreased. In the third patient no abnormality of the cord was demonstrated either in CT or myelography. High resolution CT, especially reconstruction-CT appears to be more reliable than myelography and should be the examination of choice in the diagnosis of Chiari malformation.

[Familial narrow spinal canal (lumbar canal stenosis with narrow cervical canal): case reports of three brothers].

We reported three brothers with lumbar canal stenosis out of six brothers. The three brothers had undergone laminectomy of the lumbar spine. Two of the three who were operated had to undergo emergency operation because of acute onset of paraplegia and micturition disturbance. At surgery we found thick and hypertrophic lamina at stenotic portion of the lumbar spine in case 1 and case 2 and pseudospondylolysthesis in case 3. These three brothers were also found to have narrow cervical canal. Two of them underwent decompressive procedure for cervical spine after lumbar surgery and the rest had already undergone anterior fusion of cervical spine at another hospital. A sister of the six brothers was also demonstrated to have narrow cervical canal. These cases suggested that there is hereditary influence on the pathogenesis of the developmental lumbar canal stenosis. We could find only two reports on familial lumbar canal stenosis in English literature. Our familial cases are considered interesting in the following points. 1) Two of three cases necessitated emergency operation and no mass lesion such as herniated disc, tumor or vascular anomaly was found at surgery. 2) All three cases had narrow cervical canal in association with lumbar canal stenosis.

[Total myelography with metrizamide through the lumbar route (author's transl)].

Total myelography with metrizamide at a concentration of 270 mgI/ml was carried out via lumbar puncture in 170 consecutive patients. Good opacification and/or diagnostic value was obtained in the lumbar, thoracic and cervical region at 88.8%, 77.6% and 72.4% respectively. Unsatisfactory results were mostly due to the poor technique of physicians and x-ray technicians. Also it was inadequate to perform this study in some lesions, such as ruptured arterio-venous malformation and occification of posterior longitudinal ligament. Several cases with previous oil myelography showed poor results, because the remaining of Myodil disturbed a good spreading of the newly injected media. It was requested to evacuate oily contrast media prior to metrizamide myelography. One of the most important clues to a successful myleography was to make dilusion of contrast media as little as possible, and the use of high concentration of metrizamide (250-270 mgI/ml) seemed to be tolerated. It was also important to avoid excessive movement of the patient and the rapid transit of the contrast media to the level of interest. It was recommended to study the entire spinal subarachnoid space as a whole. In sixty-three patients out of 170, one or more abnormal myelographical findings were detected at unexpected level. Immediately after the examination the patients were encouraged to drink a large quantity of diuretic beverages such as tee, juice or coffee for the purpose of reducing side effects. As Potts and coworkers and Eldevik and associates reported, it was recognized that the overhydration could reduce the severe side effects after the metrizamide myelography.

Intratumoral hemorrhage after a ventriculoperitoneal shunting procedure.

Ventriculoperitoneal shunting has been accepted as a safe and useful preliminary procedure that lowers the mortality and morbidity of definitive surgery for tumors causing obstructive hydrocephalus. We are reporting four patients with intratumoral hemorrhage as a complication of shunting. The hemorrhage was massive and fatal in two patients, one with an unverified pineal tumor and the other with a malignant astrocytoma of the thalamus. The hemorrhage was small and limited in the other two patients, one with a glioblastoma of the thalamus and the other with a cerebellar astrocytoma. On the basis of this experience, we conclude that the possibility of intratumoral hemorrhage should be taken into consideration when planning the preoperative management of obstructive hydrocephalus caused by brain tumors. It is possible that ventricular decompression may result in rapid motion and distortion of the intracranial structures and a sudden imbalance between intracranial and intratumoral pressures, leading to vascular insufficiency, congestion, and then hemorrhage within the tumor.

Aneurysm of distal anterior cerebral artery associated with azygos anterior cerebral artery.

An aneurysm arising from the distal anterior cerebral artery distal to the bifurcation of the azygos anterior cerebral artery is reported. A review of the literature emphasizes the rarity of this lesion.