Immunohistochemical analyses of cell cycle-related proteins, apoptosis, and proliferation in pituitary adenomas.

To analyze the cell cycle regulatory mechanisms in the growth of pituitary adenomas, we investigated immunohistochemically the expression of the cell cycle-related proteins cyclin A and p27 in 48 pituitary adenomas. The frequency of apoptosis and the proliferative potential were also examined. The percentage of apoptotic cells was evaluated by immunohistochemical analysis using the anti-single-strand DNA antibody. The proliferative potential was assessed using the anti-Ki-67 antibody. The mean cyclin A labeling index (LI) for the non-recurrent group was 1.03% and for the recurrent group 2.31%. A positive linear correlation between cyclin A LI and Ki-67 LI was found. The mean p27 LI for the non-recurrent group was 67.4% and for the recurrent group 47.0%. There were significant differences in cyclin A LI and p27 LI between the non-recurrent group and the recurrent group. The mean apoptotic rate for the non-recurrent group was 0.87% and for the recurrent group 1.05%. There was no significant difference. Multivariate regression analysis revealed that high cyclin A LI and high Ki-67 LI were significant factors for shorter progression-free survival. The results suggest that the cyclin A LI is a useful prognostic factor in pituitary adenomas. (J Histochem Cytochem 49:1193-1194, 2001)

[A case of familial cerebral cavernous angioma and review of Japanese cases].

We present one pedigree of familial cerebral cavernous angioma (FCCA). Case 1 was a 52-year-old male with right hemiplegia. When he was 37 years old, a left occipital lesion was excised and histologically diagnosed as cavernous angioma. MR image showed many cavernous angiomas in the right temporal lobe, the right paraventriclar white matter, the right frontal lobe, the left basal ganglia, and the left parietal lobe. Stereotactic radiosurgery was undertaken for all the lesions. Although the size of each lesion was unchanged, neither hemorrhage nor neurological deterioration were recognized after radiosurgery. Case 2 was a 24-year-old male, a son of the patient in case 1. He has manifested tonic-clonic type epilepsy since the age of 2. MR image showed cavernous angiomas in the pons, the right frontal, and the left intra-Sylvian regions, and many paraventricular cysts with rims indication of previous hemorrhages. Two de novo lesions were observed on subsequent annual MR screening. Surgical excision for the left intra-Sylvian lesion and stereotactic radiosurgery for all lesions were undertaken. Histological diagnosis was cavernous angioma. In the literature, there were 17 pedigrees and 37 cases of FCCA in Japan. The incidence of both multiple lesions and hemorrhage were less than in found in Spanish or French cases. Stereotactic radiosurgery is considered an useful treatment for FCCA, because lesions are multiple and de novo lesions occur.

Evaluation of pleomorphic xanthoastrocytoma by use of positron emission tomography with.

We present a case of pleomorphic xanthoastrocytoma (PXA) in a patient with temporal lobe seizures. Imaging sequences included MR, and results of positron emission tomography (PET) with [18F]-fluorodeoxyglucose (FDG) and [11C]-methionine (Met) tracers revealed a hypermetabolic region equivalent or nearly equivalent to normal cerebral cortex, suggesting that the tumor might have malignant potential. Histopathologic findings indicated low-grade glioma. The mechanism for glucose hypermetabolic activity of PXA is not clear; however, the positive findings obtained from FDG-PET may not always indicate the degree of malignancy associated with PXA.

Simultaneous bilateral thalamic hemorrhage: case report.

A 60-year-old man presented with an extremely rare case of simultaneous hypertensive bilateral thalamic hemorrhage manifesting as left hemiparesis with headache followed by deterioration in consciousness and tetraparesis. CT scan confirmed the bilateral thalamic hemorrhages 17 hours after onset. Magnetic resonance imaging showed the bilateral thalamic lesions had similar signal intensities, consistent with the simultaneous onset, and had no evidence of hemorrhagic reason. Conservative treatment achieved some neurological improvement, but he died of pneumonia six months after onset. The prognosis of a patient with bilateral hemorrhages is worse than would be indicated by the size of the hemorrhages.

Meningioma associated with acute subdural hematoma--case report.

A 48-year-old woman presented with sudden left hemiplegia with headache, which deteriorated two days later. CT scan showed repeated intratumoral and subdural hemorrhages. Magnetic resonance imaging showed a parasagittal tumor infiltrating into the superior sagittal sinus, with intratumoral hemorrhage and acute subdural hematoma in the interhemispheric fissure. The intratumoral hematoma had several different intensities, which indicated repeated hemorrhages. The subdural hematoma and the tumor were removed via frontoparietal craniotomy. The histological diagnosis was fibrous-type meningioma with a high Ki-67 labeling index (6.7). As there were tumor cells within the subdural hematoma, it seemed to have resulted from tumoral hemorrhage. A high index of cell proliferation may indicate some mechanism responsible for hemorrhage in malignant tumor.

PET for diagnosis of malignant lymphoma of the scalp: comparison of [11C]methyl-L-methionine and [18F]fluoro-2-deoxyglucose.

A 43-year-old woman was admitted with a tumor mass in her forehead. Two months previously, a lump in her breast had been diagnosed as mastopathy. Palpation revealed an elastically hard immobile tumor mass in her forehead. MRI detected a tumoral lesion of generally uniform contrast involving frontal subcutaneous, cranial, and intracranial regions. PET demonstrated more intensive and wider accumulation of [11C]methyl-L-methionine (Met) than of [18F]fluoro-2-deoxyglucose (FDG). Biopsy of the forehead mass was performed, which was diagnosed as B-cell-type malignant lymphoma. The tumor mass in the forehead then shrank spontaneously, as confirmed by palpation and MRI. The tumor mass in the left breast was totally extirpated and histologically diagnosed as B-cell-type malignant lymphoma, like the tumor mass in the forehead. Postoperatively, chemotherapy (VEPA) was performed. Although FDG accumulation had not been detected, postchemotherapy PET demonstrated slight Met accumulation, suggesting the presence of a residual tumor. PET served well to detect the lesion and evaluate therapeutic efficacy in malignant lymphoma. Met-PET was more sensitive to malignant lymphoma than FDG-PET.

Parkinsonism due to chronic subdural hematoma.

A 75-year-old male presented with bilateral parkinsonism due to chronic subdural hematoma. The hematoma was removed through a small craniotomy. The parkinsonism rapidly improved following operation, suggesting a strong relationship between the hematoma and parkinsonism. We recommend surgical intervention in such cases.

Local multicystic encephalopathy: case report.

A case of local multicystic encephalopathy is presented. CT scan showed a low-density area with a string-like structure of iso-density in the left frontal lobe. Angiogram demonstrated no abnormality. Magnetic resonance imaging (MRI) demonstrated multiple cystic lesions, and we diagnosed the case as local multicystic encephalopathy. This disease generally occurs diffusely, and local occurrence is very rare. MRI was very useful for diagnosis and delineating the details.

Spontaneous spinal subarachnoid hematoma--case report.

BACKGROUND: Spinal subarachnoid hemorrhage is unusual, and rarely results in spinal subarachnoid hematoma because the cerebrospinal fluid tends to dilute the blood and prevent the formation of clots. We describe a patient with spinal subarachnoid hematoma of unusual spontaneous origin. CASE: A 66-year-old female presented with sudden onset of intense back pain with paraplegia. Magnetic resonance imaging demonstrated a mass lesion between T2 and T6, compressing the spinal cord anteriorly. Emergency osteoplastic laminotomy exposed a hematoma in the subarachnoid space from T2 to T6, but no source of the hemorrhage was found. The patient was able to walk by herself about 20 days after the operation. CONCLUSION: The outcome is significantly influenced by the duration between onset and operation, preoperative neurologic status, and rapidity of symptom progression. Therefore, we emphasize the importance of early diagnosis, and rapid and complete operative removal of spinal subarachnoid hematoma in order to achieve the best outcome.

Migration of a subduroperitoneal shunt catheter into the subdural space--case report.

An 82-year-old male with intractable bilateral chronic subdural hematomas was treated by emplacement of bilateral subduroperitoneal shunts on the left in 1990 and on the right in 1991. Chronic subdural hematoma recurred in 1992 due to an unusual migration of a shunt catheter into the subdural space. This migration was probably due to inadequate fixation of the shunt. Shunt replacement and fixation with an anchoring wing has resulted in no further complications for 2 years.

Persistent primitive hypoglossal artery aneurysms--report of two cases.

The authors present two patients with subarachnoid hemorrhage caused by ruptured intracranial saccular aneurysms of the persistent primitive hypoglossal artery. A standard unilateral suboccipital approach in one patient resulted in incomplete neck clipping since the operative field was restricted by a protruding jugular tubercle. Successful aneurysmal neck clipping was achieved in the second patient via a unilateral-transcondylar-suboccipital approach with resection of the jugular tubercle and rim of the foramen magnum.

Endarterectomy for persistent primitive hypoglossal artery--case report.

Persistent primitive hypoglossal artery, an anastomosis between the carotid artery and the vertebrobasilar system, is found in about 0.05% of cerebral angiograms. Though usually asymptomatic, it may occasionally cause ischemic disease. A 62-year-old male presented with left hemiparesis. Right carotid angiograms demonstrated a primitive hypoglossal artery originating from the internal carotid artery at the 2nd cervical spine. This artery supplied almost all blood to the basilar artery system. A marked stenosis extended from the origin of the internal carotid artery to the primitive hypoglossal artery. An endarterectomy of the internal carotid and primitive hypoglossal arteries was performed using a special internal shunt 46 days after the onset. Sudden arterial bleeding from the incised part of the internal carotid artery occurred 12 days after the operation. The carotid artery was resutured. The rupture of the carotid artery appeared to be caused by an infection of Pseudomonas aeruginosa, which was detected by culture of the chronic ear discharge. Rupture of the vessel wall due to infection is an important complication after endarterectomy. This is the second reported endarterectomy of the primitive hypoglossal artery.

The role of leukotriene B4 in neutrophil infiltration in experimentally-induced inflammation of rat tooth pulp.

Inflammation was induced in rat dental pulp by applying bacterial lipopolysaccharide (LPS). Extirpated tissue samples from inflamed pulps were incubated in vitro in a Krebs buffer containing Ca2+ ionophore A23187, and leukotriene (LT) B4 released into the medium was determined by radio-immunoassay. Production of LTB4 could be detected three to 24 h after the application of LPS and showed a maximum at 12 h. Histologically, marked infiltration of neutrophils, but not other leukocytes, was characteristically observed in the LPS-applied pulps, and the temporal change in neutrophil infiltration was almost parallel, but somewhat more delayed than LTB4 production. When BW755C, a dual inhibitor of cyclo-oxygenase and lipoxygenase, was given to the animals before the application of LPS, both the production of LTB4 and the number of infiltrated neutrophils were significantly decreased, whereas administration of indomethacin had no effect. These results suggest that LTB4 may be involved in neutrophil infiltration in pulpal inflammation. It was also suggested that a major early source of LTB4 in experimental pulpitis was leukocytes, primary neutrophils, because the synthesis of LTB4 in the inflammed pulp was diminished by depletion of circulating leukocytes with cyclophosphamide prior to the application of LPS.

[Response properties of the neurons in the cervical cord to stimulation of the inferior alveolar nerve in the cat].

The purpose of this study was to investigate the neuronal mechanisms of the clinical symptoms of unusual muscle stiffness and/or pain in the neck and shoulder sometimes observed in patients suffering from chronic pulpal or periodontal diseases. Physiological properties of the neurons responding to the inferior alveolar nerve stimulation (inferior alveolar nerve driven-neurons: IANDNs) were studied by recording single unit activities in the upper cervical cord in cats anesthetized with alpha-chloralose. The results were as follows: (1) IANDNs were widely distributed from the dorsal horn to the ventral horn in the gray matter of the cervical cord (C2 and C3). (2) IANDNs were subdivided into two types of neurons based on the latencies of the spike responses: fast-type (F-type) (n = 60) and slow-type (S-type) (n = 101). (3) Two possible pathways from the inferior alveolar nerve to the cervical spinal cord participating in these spike responses were assumed: one was through the trigeminal spinal nucleus and the other through Probst's tract by way of the trigeminal mesencephalic nucleus. These results suggest that the impulses originating from dental inflammatory loci might drive IANDNs in C2 or C3 and that their activities may evoke contraction of the neck muscles, resulting in their stiffness and cervical back pain.

[Measurement of cerebral blood flow by single photon emission computed tomography in cases of internal carotid artery occlusion].

Cerebral blood flow (CBF) was measured with 133xenon inhalation and single photon emission computed tomography in 33 cases of internal carotid artery occlusion, in the resting state and 25 minutes after acetazolamide (Diamox) administration. The patient population consisted of 24 males and nine females with a mean age of 57 years, who presented with transient ischemic attacks or stroke. Acetazolamide inhibits carbonic anhydrase, and CBF increases as a result of dilatation of cerebral arteries due to CO2 accumulation. The mean CBF was 46 ml/100/g/min on the affected hemisphere and 56 ml/100/g/min on the unaffected hemisphere. The mean CBF value obtained by the same method in 10 normal volunteers was 55 ml/100/g/min. Thus, in the patients, CBF decreased on the affected side. The average increase in CBF after acetazolamide administration was 9% on the affected side and 17% on the unaffected side. The average increase in 10 normal volunteers was 32%. The reduced cerebral arterial reactivity to acetazolamide administration was bilateral in the patient group, which suggests that the cerebral arteries were dilated in order to maintain normal CBF. Extra-intracranial (EC-IC) bypass surgery was performed in nine patients. Preoperatively, the mean CBF was 48 ml/100 g/min on the affected side and 57 ml/100 g/min on the unaffected side; the postoperative CBF was 48 ml/100 g/min on the affected side and 56 ml/100 g/min on the unaffected side. Thus, there was no notable change in CBF on either side after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of arachidonic acid metabolites in increases in vascular permeability in experimental dental pulpal inflammation in the rat.

Pulp was experimentally inflamed by applying bacterial lipopolysaccharide (LPS). Changes in arachidonic acid (AA) metabolites were determined by measuring the conversion of exogenously added AA in pulp homogenates. The inflamed pulp produced 12-hydroxy-eicosatetraenoic acid (12-HETE), 6-keto-prostaglandin (PG) F1 alpha greater than PGE2, thromboxane B2 and 11-HETE, which was further identified with high-performance liquid chromatography. The LPS treatment caused a 2.0-fold increase in 12-HETE production at 1 h, a 3.8-fold increase in 6-keto-PGF1 alpha production at 12 h and increases in PGE2 and 11-HETE production of 8.8- and 5.5-fold, respectively, at 24 h. Vascular permeability in the inflamed pulp was measured by quantifying the amount of an extravasated dye; it increased markedly from 6 h and reached a peak at 12 h after the LPS application. When indomethacin (0.3-30 mg/kg, s.c.) was given before LPS, both the production of 6-keto-PGF1 alpha and PGE2 and the increase in vascular permeability were inhibited dose dependently. Exogenously applied PGE2 and PGI2 methyl ester reduced the inhibition of the increase in vascular permeability caused by indomethacin. Thus PGE2 and PGI2 may be involved in increases in vascular permeability in pulpal inflammation.

Arachidonic-acid metabolism in normal and experimentally-inflamed rat dental pulp.

Pulp homogenates were incubated with [14C]-arachidonic acid and the metabolites separated by thin-layer chromatography. The main products of normal pulp were 6-keto-prostaglandin (PG) F1 alpha and 12-hydroxy-eicosatetraenoic acid (12-HETE), further identified by high performance-liquid chromatography. Thromboxane (TX) B2, and PGD2, E2 and F2 alpha were also detected at less than 30 per cent of 6-keto-PGF1 alpha. When the pulp was inflamed by applying bacterial lipopolysaccharide, production of all these metabolites increased; in particular, PGE2 was increased 9.3-fold compared with normal, and 6-keto-PGF1 alpha and HETE 3.8- and 2.0-fold, respectively. An unidentified product, slightly more polar than 12-HETE, was also markedly produced by the inflamed pulp. Thus arachidonic-acid metabolites including lipoxygenase products may be involved in the development of pulpal inflammation.