Quality of life of Japanese elderly oral cancer patients during the perioperative period.

Japan's aging society has an increasing incidence of oral cancer. This study investigated perioperative changes in quality of life (QoL) among 172 oral cancer patients (elderly ≥75 years vs non-elderly <75 years), pre-treatment, at treatment completion, and at 1, 3, and 6 months post-treatment, using the following Functional Assessment of Cancer Therapy - Head and Neck (FACT-H&N) subscales: physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional head- and neck-specific concerns (H&N). SWB (P=0.026), H&N (P=0.024), and total FACT-H&N (P=0.009) scores were significantly lower in the elderly group than in the non-elderly group at 6 months post-treatment, especially for mastication items (H&N1, P=0.047; H&N11, P=0.004), but not for swallowing items (H&N5 and H&N7, both P> 0.05). PWB (P= 0.004), EWB (P< 0.001), and FWB (P= 0.022) scores in the non-elderly group were significantly higher at 6 months post-treatment than before treatment. In the elderly group, no subscale showed a better score at 6 months post-treatment. Post-treatment QoL in elderly oral cancer patients did not improve, unlike in non-elderly patients.

Amphidiploidy recovers the viability of hybrids of European and east Asian water frogs.

Reciprocal diploid hybrids, artificially produced from crosses between Rana nigromaculata and Rana lessonae, die at the stage from neurula to tailbud. We found in a previous study that triploid hybrids having two R. nigromaculata genomes and one R. lessonae genome in R. nigromaculata cytoplasm grow into mature frogs, whereas triploid hybrids composed of the other combinations of genome and cytoplasm arrest before hatching. In this study, we made amphidiploid hybrids with two R. nigromaculata and two R. lessonae genomes in the cytoplasm of either species and examined their viability to discover the interaction between parental genomes in each cytoplasm. The amphidiploids with R. nigromaculata cytoplasm developed into mature frogs, whereas ones with R. lessonae cytoplasm arrested at almost the same embryo stage as the lethal triploid hybrids. These findings suggest that the arrest of the reciprocal diploid hybrids is not caused only by the incompatibility between the R. nigromaculata genome and the R. lessonae genome. Taking these together with the results of the triploid hybrids, we suppose that the lethality of the hybrids is mainly due to the incompatibility between the egg cytoplasm and foreign genome(s). With the R. nigromaculata cytoplasm, doubling the maternal genome can ease this incompatibility, but it cannot with the R. lessonae cytoplasm.

Parapharyngeal meningioma extending from the intracranial space.

A 50-year old woman with a giant parapharyngeal meningioma extending from the intracranial cavity was admitted to our hospital. The parapharyngeal tumor was biopsied using the transoral approach and a histological section diagnosis suggested meningioma. Thereafter, further examination by magnetic resonance images (MRI) and contrast enhanced CT scans revealed a diffuse meningioma en plaque in the posterior fossa. Invasion extended from the clival dura to the right sigmoid sinus. The extracranial extension of a meningioma is very rare but a few cases have been reported. In almost all of the reported cases, a large intracranial meningioma was simultaneously or previously verified by CT scans. Our case was special in that the intracranial mass was not voluminous but showed en plaque extension, and also because the pathway of the extracranial extension through the jugular foramen was clearly visualized by CT and MRI. Obliteration and invasion of the right sigmoid sinus and the internal jugular vein by tumor were also demonstrated.

Dysautoregulation in patients with ruptured aneurysms: cerebral blood flow measurements obtained during surgery by a temperature-controlled thermoelectrical method.

We used a temperature-controlled thermoelectrical method, induced hypotension, and CO2 inhalation to obtain cerebral blood flow (CBF) measurements during surgery for investigation of the state of brain vasoreactivity in subarachnoid hemorrhage patients. The study included 11 patients who underwent 12 operations for ruptured intracranial aneurysms. The CBF data were analyzed to investigate the neurological state, presence or nonpresence of vasospasm, timing of the operation, and outcome of each patient. Autoregulation disturbance, in terms of reaction to hypotension, was consistently seen in patients in poor neurological states, and this disturbance was correlated with poor outcome. This simple monitoring system, used during emergency operations for ruptured aneurysm, was useful in predicting outcome.

[A new technique for the removal of orbital tumors--combined fronto-orbital approach].

Advances in the surgical approach to the orbital fossa have resulted in an increase in the cure of tumors involving the optic nerve and the external ocular muscles. In the past 10 years we have encountered 12 cases with orbital fossa tumors, excluding ocular tumors and inflammatory disease case. After tumor removal surgery, new neurological deficits such as total ophthalmoplegia were caused in many cases, where surgery was performed by classical Krönlein's technique or Dandy's transfrontal approach. So we thought that a new method for tumor removal should be contrived to improve postoperative results. Recently we have had four cases with large orbital tumors (3 cavernous angiomas and one schwannoma). In order to protect visual acuity and external ocular muscle function, we have devised a modification of the frontal craniotomy technique, the "combined fronto-orbital approach". Using our new method, we have successfully removed these four orbital tumors and with good postoperative results. We have concluded that our new technique is superior to other transfrontal approaches on several points as follows: 1) Decreased avoidable compression against the orbital contents and a decrease in the risk of tearing the frontal lobe dura and the peri-orbital during fronto-orbital craniotomy. 2) Satisfactory external decompression and a wide operative field are obtained with simple and safe procedures. 3) Previously detaching the superior rectal muscle makes it easy to distinguish the orbital fossa pathoanatomy and to remove a tumor. 4) Good results are easily obtained in the reconstruction of the orbital roof and the orbital rim, especially in the prevention of postoperative bulbar pulsation and from cosmetic view point.

[A case of cerebellar neuroblastoma].

A three-year-old boy with a progressive history of headache, vomiting and ataxia in the course of 2 months, was admitted on August 1983, when he was lethargic. Neurological examination revealed dysphagia, scanning speech and tremor in the bilateral hand. CT scan showed a very large enhanced mass in the center of posterior fossa with central necrosis in it and the dilatation of whole ventricular system. Suboccipital craniectomy was immediately performed and the tumor that occupied the vermis and invaded into both cerebellar hemisphere was subtotally removed. Postoperative irradiation was well performed: 4140 rads to the whole brain and 3162 rads to the spinal cord. However, 5 months later, facial palsy in the left side and progressive ataxia became prominent. CT scan showed multiple enhanced masses in the left trigonum and right anterior horn of the lateral ventricles and in the left cerebellopontine angle. In spite of chemotherapy, the patient had a down-hill course, especially after the ventricular hemorrhage, and died on June 9th, 1984. Histologically, the tumor had a lobulated appearance with an aggregation of tumor cells encircled by vascular septae. The cells within lobules generally had vesicular nuclei, which were arranged in parallel row. Occasionally smaller hyperchromatic cells with scant cytoplasm were present along the vascular septae. Reticulin was present within the septa, but was not observed within the lobules. Scattered astrocytic cells and processes were identified within the lobules by the immunoperoxidase technique for GFAP. The fibrillary cytoplasmic processes within the lobules were stained by immunoperoxidase technique for neurofilament (68K).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of sex steroids on the growth of neuronal processes in neonatal rat hypothalamus-preoptic area and cerebral cortex in primary culture.

Dissociated cells of neonatal rat hypothalamus-preoptic area and cerebral cortex were grown in primary culture, and the effects of sex steroids on neurons were morphometrically studied. In cultures of the hypothalamus-preoptic area estradiol-17ß or testosterone propionate significantly increased the total neuronal process length as compared with control cultures given no steroids in the medium. Significant stimulatory effects were detected on 1, 2 and 3 days after plating, while, 5a-dihydrotestosterone failed to show any stimulatory influence. In contrast, none of these steroids was effective in cultures of cerebral cortical cells. Based on the number of processes arising from the soma, neurons were divided into unipolar, bipolar and multipolar neurons. Percentage of multipolar neurons of the hypothalamus-preoptic area was more in cultures treated with estradiol-17ß or testosterone propionate than the controls. Significant effect was not noted in cultures with 5α-dihydrotestosterone, while, in cultures of the cerebral cortical cells, effects on sprouting of these steroids were far less marked than in cultures of the hypothalamus-preoptic area. The present findings substantiate the importance of aromatization of androgen to exert its influence on neuronal process growth in cell culture.

[Diagnostic value of CT in atlanto-axial dislocation and the choice of treatment].

During the last three years we have experienced 20 cases of atlanto-axial dislocation (AAD) of various types. The series consists of 10 cases of traumatic anterior pure AAD, 2 traumatic anterior AAD with dens fracture, 2 os odontoideum, 1 rheumatic AAD, 1 Jefferson's fracture, and 3 "rotatory dislocation" (1 pure traumatic rotatory dislocation and 2 rotation deformity after Wackenheim). All patients were studied by plain X-ray, tomography, myelography with water soluble contrast media and computed tomography (CT) scanning. All of the operated patients and a part of the non-operated patients were also examined by CT myelography (met. CT) 3 hours after myelography. A special attention was paid to the shape of the spinal cord and the thecal sac at the level of dislocation, in several positions of the head such as hyperextension, neutral position, flexion, lateral bending and right or left rotation. A met. CT could clearly demonstrate that the thecal sac and the spinal cord were compressed by the dens and/or posterior arch of the atlas in traumatic pure anterior AAD. In all cases of ADD with dens fracture or os odontoideum, however, the spinal cord was compressed not by the dens but by the posterior margin of body of the axis. The fractured dens always moved with anterior arch of the atlas. This finding was most clearly documented by met. CT in flexion. In some cases of AAD accompanying rheumatic changes or narrowing of the spinal canal, a posterior decompression with postero-lateral fusion is indicated. A transoral anterior fusion in hyperextended position of C1 and C2 together with the fractured dens, followed by a Halo vest fixation, is the treatment of choice in traumatic AAD with dens fracture and os odontoideum. A posterior C1 and C2 fixation using Urlich's metal plate is also recommended for anterior pure AAD. CT scanning, especially met, CT, is by far the better than the conventional radiologic examinations to determine the indication, approach and mode of operation in AAD.

[Postoperative lumbar extradural arachnoid cyst. Report of two cases and review of the literature].

Two cases of postoperative extradural arachnoid cyst in the lumbar region were reported. The symptoms such as lumbago, sciatica and paresis of foot which were perfectly cured at discharge relapsed after several months of daily business. The two patients were readmitted and reexamined by myelography and computer assisted tomography. In the two patients a cystic pooling of metrizamide having a connection with the subarachnoid space was noted in the same way. At the second operation a small dural tear and an extradural arachnoid cyst were recognized similarly. Burres and coworkers reported that an extradural arachnoid cyst would easily grow through a small dural defect in the lumbar region, because the hydrostatic pressure is higher than that of the cervical level. Our two cases might well coincident with their theory. In consequence of the experience of the two postoperative extradural arachnoid cyst, we give emphasis that even though the dural tear would be small, especially in the lumbar region, it should not be overlooked and be closed carefully with fine sutures.

Comparative induction of somatic eye-color mutations and sex-linked recessive lethals in Drosophila melanogaster by tryptophan pyrolysates.

The mutagenicities of the products of pyrolysis of tryptophan, Trp-P-1 and Trp-P-2, on Drosophila melanogaster were examined by measuring the effects of these compounds in inducing recessive lethals and somatic eye-color mutations. Since negative results have already been obtained by the standard procedure in males, Trp-P-1 and Trp-P-2 (0.75 to 6 mg/ml) in sucrose solution were given to females for assay of recessive lethal mutations in X-chromosomes. These compounds caused a marginal increase above the control level in the mutation frequency. For the assay of effects on somatic eye-color mutations, Trp-P-1 (200 and 400 ppm) and Trp-P-2 (400 and 800 ppm) were fed to male larvae of a tester strain carrying a genetically unstable marker set of z and w+ on the X-chromosome. These compounds caused dose-dependent increases above the control level in somatic eye-color mutations in adults. It is concluded that, under the conditions used, the somatic eye-color mutation system was more sensitive than the recessive lethal system to the mutagenic effects of tryptophan pyrolysates.

[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.

[Artificial embolization with cyanoacrylate for the treatment of the extracranial arteriovenous malformation].

Two cases of the extracranial arteriovenous malformation (AVM) were treated by intra-arterial injection of cyanoacrylate (Aron alpha A). The first case was a 31-year-old man who had an AVM in the left temporal muscle. At operation, the feeders, the left anterior and posterior deep temporal arteries, were exposed and Aron alpha A was injected into these feeders. The pulsation of the AVM disappeared and the AVM became a hard mass. The mass was totally removed with remarkably little amount of bleeding. No complication was noted. The second case was a 23-year-old man who had an AVM in the scalp, and its feeder was the left occipital artery. The treatment was done in the same manner as in the first case. After operation the regional scalp became necrotic, but the epithelialization was completed in 3 weeks. No signs of recurrence of AVM were noted 20th and 21th month after operation in each of the cases. The recent literature were briefly reviewed.

[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.