Functional magnetic resonance imaging-controlled neuronavigator-guided brain surgery: a case report.

The effectiveness of functional magnetic resonance imaging (f-MRI)-controlled and navigator-guided brain surgery for a patient with a recurrent astrocytoma is demonstrated. Preoperative f-MRI was performed in order to identify the motor area and ensure that the tumour was in the left prefrontal area. A more aggressive operation was planned for the recurrent tumour. The f-MRI data were input to the MKM navigation system and during the operation the contours of the tumour and motor area were visualised b y the microscope of the navigation system. The tumour and surrounding gliotic brain tissue were removed completely. The diagnosis was a grade III astrocytoma. The combination of the navigation system and f-MRI was useful for preoperative design of the surgical strategy, and tumour orientation during the operation, enabling aggressive surgery to be performed without functional deficits ensuing.

[A combination of low-dose carboplatin (CBDCA) and radiation therapy in head and neck cancer patients--response and hematologenic toxicity].

A combination of carboplatin (CBDCA) and radiation therapy was performed in patients with head and neck cancer. The intravenous administration of CBDCA at a weekly dose of 100 mg/body was combined with external irradiation at a dose of 1.8 Gy/day x 5/week during the same therapy period. We evaluated the effects of this method not only on survival and neoadjuvant chemotherapy in patients with advanced cancer but also on local control and prevention of distant metastases in patients with early cancer. The subjects consisted of 31 patients with head and neck cancer who visited the Department of Otolaryngology, Showa University Hospital, Kanto Rosai Hospital and Yokohama Rosai Hospital between March 1993 and March 1995. Squamous cell carcinoma was found in all but one patient who had adenocarcinoma in the parotid gland. The patients were 27 males and 4 females ranging between 40 and 81 years of age (mean, 59 years). Twenty-six patients had previously untreated tumor, while 5 patients had recurrent tumor. The clinical stage was Stage I in 6, Stage II in 10, Stage III in 5 and Stage IV in 10 patients. The original site of cancer was the larynx in 9, hypopharynx in 6, nasopharynx in 6 and elsewhere in 10 patients. The combined therapy was repeated for 2-9 courses (mean, about 5 courses). The total dose of CBDCA was 500 mg on average with a maximum of 900 mg. The total effective rate of the combined therapy was 93.3% with 12 cases of complete response (CR) and 16 cases of partial response (PR). The effective rate in patients with previously untreated tumor was 92% because one patient showed a minor response (MR) and one patient showed no change (NC). The effective rate in patients with recurrent tumor was 100%. Concerning the clinical stage, all patients with Stage I-III disease showed CR or PR, while MR was found in 1, NC in 1 and progressive disease (PD) in 1 of 10 patients with Stage IV disease, resulting in an effective rate of 71.4%. There were no CRs in Stage IV patients. Therapy was terminated due to side effects in 2 patients. Excellent safety was confirmed by laboratory data.

Surgical treatment of discrete subaortic stenosis in an adult.

We report on an adult patient with discrete-type subaortic stenosis. A 48-year-old man who had progressed asymptomatically since childhood despite heart murmur was transferred to our hospital. The patient was diagnosed as having severe aortic stenosis with a pressure gradient of 100 mmHg across the aortic valve, associated with a grade II aortic regurgitation. A conventional aortic valve replacement was scheduled. During surgery, the aortic valve was found to be tricuspid but incompetent as a result of shrinking and thickening of the left coronary cusp. A circumferential fibromuscular ridge was observed under the cusps, which corresponded to Kelly's type II discrete subaortic stenosis. Because of the small subaortic area and deformity of the cusp, we performed aortic valve replacement after excision of all cusps and the fibromuscular ridge. Early corrective surgery is recommended for discrete subaortic stenosis to prevention regurgitation progression.

[A new cell line derived from a nude mouse resembling human large cell lung cancer].

Tumor cells derived from a metastatic mediastinal lymph node of a thirty six year old man with large cell lung cancer were transplanted into the subcapsule of the kidney of a nude mouse. The growing tumor was transplanted into a nude mouse twice and, thereafter, cultured in vitro. After the twelfth passage in vitro, the cell (NUTIY) was transplanted into subcutaneous tissue of a nude mouse and formed a rapidly growing tumor, showing the histological pattern similar to the large cell lung cancer of the patient. However, the chromosomal analysis revealed only murine chromosomes for NUTIY and any transfected human genes were not found in the genes of NUTIY by means of Alu probe. H-ras oncogene of NUTIY was amplified 4 folds, but that of the primary lung cancer and the metastatic lymph node of the patient was on a level with normal cells. NUTIY might be a cancer cell which a murine cell had been transformed into by some carcinogen in vitro.

A case of multiple leiomyomatous lesions of the lung: an analysis of flow cytometry and hormone receptors.

A 36 year old woman was admitted to our department because of a chest X-ray which showed multiple developing shadows. She underwent bilateral exploratory thoracotomies and a total 5 tumors were resected and pathologically diagnosed as benign metastasizing leiomyoma, the largest of which was positive for the progesterone receptor and negative for the estrogen receptor. A histogram of this tumor using a flow cytometer showed a diploid pattern and 4.6 percent of the S phase which was not more than that of a leiomyoma of the uterus from another patient. Two months later, she underwent a hysterectomy and bilateral salpingo-oophorectomy for treatment of the positive progesterone receptor in the pulmonary lesions. The resected uterine myoma and normal myometrium showed positive estrogen and progesterone receptors. For the subsequent 28 months she has been free of any further symptoms. Benign metastasizing leiomyoma of the uterus is a rare disease and very interesting because of its histological benignity and hormonal dependency. However, according to the literature, it is often confused in entity due to the fact that normal lung tissue also possesses hormone receptors. Considering our data on hormone receptors, it is rational to think that multiple leiomyomatous lesions in the lung should only be diagnosed as benign metastasizing leiomyomas when they possess positive estrogen and progesterone receptors.

Adenoma and stone formation of the biliary tract in puppies that had choledochopancreatic anastomosis.

A canine model of anomalous choledochopancreatic ductal junction (APCDJ) was produced by choledochopancreatic end to side ductal anastomosis performed in 77 mongrel puppies weighing between 1.5 and 5 kg. Histopathological studies of the biliary tract showed that as the post-operative period became lengthened metaplasia and hyperplasia increased. In nine dogs that lived for over 5 years after the operation, papillomatous adenoma occurred in four (44%), and biliary stones in seven (78%). The histological changes seen in the biliary epithelium of our experimental canine model suggest that bile duct carcinoma may be due to the persistent return of pancreatic juice into the bile duct in patients with APCDJ.

[Non-destructive stress analysis of porcelain-fused-to-metal crown. 2. X-ray diffraction and radiograph stress measurement of various gold alloys for porcelain fusing].

Porcelain-fused-to-metal crowns though having a better aesthetic appearance, are admittedly inferior in strength, as compared with full cast crowns. We have used the X-ray stress measurement method that is the means of a non-destructive measurement, and this method is used to assess the residual stresses of various metals. X-ray diffraction examinations were made to evaluate the possibility of X-ray stress measurement of precious metals. Precious metal strips were then prepared to determine the change in the stress value during the porcelain firing process. The high compression stress produced by polishing was reduced by degassing. X-ray stress measurement of precious metals were successfully obtained.

Expression of Lewisa, Lewisb, Lewisx, Lewisy, siayl-Lewisa, and sialyl-Lewisx blood group antigens in human gastric carcinoma and in normal gastric tissue.

A panel of 6 mouse monoclonal antibodies detecting blood group antigens of the Lewis systems and their sialylated derivatives have been used to define the immunoanatomic distribution of these antigenic structures within the normal human gastric mucosa and in gastric cancer tissues. The reagents employed detect the following blood group specificities: Lewisa, Lewisb, Lewisx, Lewisy, sialylated Lewisa, and sialylated Lewisx. We have analyzed the presence of these antigens in histologically normal gastric mucosa and in gastric carcinoma from 61 patients by the immunoperoxidase method. In addition, we simultaneously examined the blood group and secretor status in 31 of the 61 individuals studied. Immunohistochemical analysis revealed that these antigenic systems are differentially expressed in cell types and cell layers of the normal gastric epithelium. Major differences were observed in surface epithelia and in deep glands including Brenner's gland of the gastroduodenal junction, mainly in the pronounced expression of Lewisa and Lewisb antigens in the former and the expression of Lewisx and Lewisy in the latter. In secretor individuals, Lewisb was the dominant antigen in the surface epithelium, and in nonsecretors, Lewisa was observed in the surface epithelium, Lewisx and Lewisy were both detected in the deep glands and in Brenner's glands regardless of the secretor status. The expression of sialylated derivatives in normal gastric tissues was considerably reduced but was consistent with the expression of their precursors in normal gastric epithelium. In gastric cancers, more pronounced expression of Lewisa and sialylated Lewisa was observed in secretor individuals and acted as a tumor-associated antigen. Comparison of the plasma level of sialylated Lewisa and its tissue expression demonstrated that the shedding of the antigen into interstitial stroma correlated with the detection of the antigen in serum. These studies confirmed the importance of blood group antigens as normal differentiation antigens. Examination of secretor status clarified the mechanism of Lewisa and Lewisb antigen expression in gastric surface epithelium. Alterations in the expression of these antigens and an increase of sialylated derivatives in gastric cancers demonstrated that these blood group antigens are useful tools for the analysis of histogenesis and organogenesis in the stomach and its neoplastic and nonneoplastic diseases.

Clinicopathologic and experimental studies on cases of abnormal pancreatico-choledocho-ductal junction.

An abnormal pancreatico-choledocho-ductal junction, in which free communication between the pancreatic duct and the common bile duct was present, was observed in 17 out of 120 cases (14.2%) of biliary tract carcinoma and in all of four cases of congenital biliary dilatation, but in noe of about 200 control patients without biliary tract disease. Outstanding findings in the pancreas, such as degeneration of the ductal epithelium and interlobular fibrosis, were found in 6 of 21 cases of abnormal junction. In an experimental study using 63 puppies given choledocho-pancreatic end-to-side ductal anastomosis, dilatation of the bile duct of varying degree occurred and mucosal hyperplasia of the biliary tract was observed in 12 of 25 anastomosed dogs for a duration of more than one month. Cell kinetics in biliary tract mucosa observed by the use of monoclonal antibody against bromodeoxyuridine (BrdU) was obviously elevated in dogs subject to long-term follow-up. As for pancreatic lesions, the incidence and histologic findings were similar to those of human studies, as follows: chronic pancreatitis in only a few animals, mild periductal parenchymatous change in 15 puppies and no significant change in 44 puppies. Therefore, an abnormal pancreatico-choledocho-ductal junction may be one of the significant factors producing biliary dilatation, biliary tract carcinoma and pancreatitis.

The essentials of data sources in eye epidemiology.

The extensive literature on eye epidemiology was selectively reviewed to provide a concise and comprehensive summary on the current status of available data sources. The topics being covered were epidemiologic data evaluation, data handling, card registration, computer analysis, geographic factors, socio-economic conditions, personal attributes, genetic backgrounds, twin analysis and laboratory procedures for host defense factors including humoral and cellular immunity. Also, the scope of this article encompassed such major practical issues as glaucoma, cataract and other blinding diseases as well as traffic and occupational hazards. Epidemiologic information thus obtainable through data searching may prove tobe instrumental in the identification of any potential preventive measures in ophthalmology and public health.

Elevation of serum immunoglobulin M (IgM) level in patients with brain tumors.

Sera of 43 brain tumor patients were analyzed along with various other control groups for serum immunoglobulin, cold and sheep cell hemagglutinin and a heterophile type antibody. Serum IgM and heterophile antibody (non-Forssman type) were found elevated in brain tumor and various acute viral meningoencephalitis groups. Serum IgA and IgG levels were essentially unchanged. IgM levels appear to be particularly stimulated by the meningioma class because the removal of tumor from the host was accompanied by its return to normal range. This system of IgM measurement may prove to be a valuable tool in preliminary diagnosis of brain tumors.

The mode of inhibition of herpes simplex and vesicular stomatitis ocular viral infections in the rabbit and hamster by an interferon inducer tilorone dihydrochloride.

Ocular viral infections are a major cause of loss of vision and their effective control by applications of chemical compounds has been extensively investigated. To achieve such a control, better understanding of virus-host-drug interactions become a necessity. Two models, hamster and rabbit cornea, were selected for assays of protection afforded by tilorone dihydrochloride against herpes simplex (HSV) and vesicular stomatitis viruses (VSV). To obtain basic biologic comparison between viral interference and interferon-induction by tilorone, the hamster cornea system was first studied to produce a mutual viral interference by double infection. Furthermore, its effect against ascending herpetic ocular infection into encephalitis was evaluated in the rabbit. This compound was reported to have promising results in improving manifestations such as corneal ulceration, uveitis and conjunctivitis.

Iridoplegia and aqueous flare due to acute herpetic keratouveitis.

Functional disturbances due to herpetic keratouveitis in rabbits were investigated. Measurements of pupillary reactivity and exudative processes in the anterior chamber with marked elevations of aquenous proteins and enzymes (LDH and GOT) were used to determine virus-induced pharmacodynamic changes by application of several autonomic and antiviral agents. Characteristic features included the earlier occurrence of hyperreactivity to Mecholyl and epinephrine and the later development of iridoplegia unreponsive to cocaine or atropine. An increase of aqueous proteins causing aqueous flare was suppressed by application of PPP. These patterns were compared with those of acute ocular responses to various types of injuries caused by fromalin, bacterial endotoxins and immunological sensitization with bovine albumin. This experimental herpetic keratouveitis in rabbits appeared similar to Wellings' ocular syndrome,which is suspected to be of herpetic etiology.

Pseudorabies virus - induced neural hyperreactivity following occular and skin infections in the rat.

The types of functional disturbances caused by a neurotropic virus was investigated by means of neurophysiological techniques. Two types of neurophysiologic lesions were produced in the superior cervical sympathetic ganglia and sural nerve in rats infected with two distinct strains of pseudorabies virus. The pruritus-producing strain following intraocular inoculation displayed spontaneous activity in the ganglia both in vivo and in vitro. This activity was susceptible to the actions of ATP, AMP, pyridoxine, pyridoxamine, serotonin and gamma-aminobutyric acid (GABA). Following intradermal inoculation, spontaneous activity and pruritus were seen along the sural nerve. The non- pruritus producing strain caused meningoencephalitis with impaired sympathetic synaptic conduction. The relationship of these pathopharmacologic findings to pathogenesis of syndromes naturally or experimentally occurring in viral infection was assessed.