Acromegaly and hyperthyroidism associated with McCune-Albright syndrome

A 36-year-old man is described having McCune-Albright syndrome, acromegaly likely due to somatotroph hyperplasia and hyperthyroidism due to adenomatous goiter. Sexual precocity was not noted. The sella was narrow in size and no mass was seen. The decline of elevated GH by hyperglycemia and increase by GHRH-44(NH2) may support somatotroph hyperplasia, but plasma GHRH-44(NH2) levels were not elevated. A mass in the right lobe and enlargement of the left lobe of the thyroid were noted. Thyroid hormone levels in serum and thyroidal radioiodine uptake values were elevated, while TSH measurements in serum were low. The radioiodine scan showed a cold nodule in the right lobe and a hot area in the left of the thyroid. Thyroidal radioiodine was not suppressed following T3 given orally. These findings are compatible with functioning glands autonomously as the mechanism for the endocrinopathies associated with the McCune-Albright syndrome.

Laserthermia on head and neck malignancies--experimental and clinical studies

In recent years, remarkable progress has been made in thermotherapy. However, there is little information on localized laser hyperthermia (laserthermia) or on conventional hyperthermia technique applied to head and neck cancers. We have developed a ceramic probe to insert into tumor tissue and irradiate the Nd:YAG laser omnidirectionally. This probe can heat a spherical range of 1.5 cm to 43 degrees C. This paper concerns experimental and clinical studies on the effectiveness of laserthermia using our technique in the tumor of head and neck regions. The results obtained were as follows: histological findings and biochemical studies of arachidonic acid metabolites on normal rabbit tongue after laserthermia showed very slight effect and relatively short duration of the concomitant inflammation. The combination of laserthermia and CDDP chemotherapy was found to give a much better cytocidal effect on the tumor tissue in nude mice implanted with human thyroid cancer cells. In a clinical study on 21 cases with head and neck cancers, four cases showed complete and 13 cases showed partial remission after combined treatments of laserthermia and radiochemotherapy. Both basic experimental and clinical results have indicated a role for laserthermia in the treatment of head and neck cancer. Possible uses include the treatment of early cancer as well as advanced or recurrent cancer, where its therapeutic effect may be increased by combination with radiotherapy or chemotherapy.

[A case of basilar artery fenestration with recurrent attacks of vertebrobasilar insufficiency]

Fenestration of basilar artery is an uncommon vascular anomaly that is usually an incidental product on autopsy or angiography. None of the cases in the literature had clinical symptoms associated with this anomaly except for subarachnoid hemorrhage when accompanied with saccular aneurysm. We report a rare case of the basilar artery fenestration associated with clinical symptoms without any aneurysm. A 71-years-old male, who had been treated for labile hypertension and had had recurrent attacks of vertigo, nausea, sometimes diplopia or unsteady gait, for 5 years, was referred to our hospital on Sept. 13, 1985. One day prior to admission, he suddenly felt diplopia and vertigo and unsteady gait. His family noticed he was dysarthric. On admission, he was alert and normotensive. He complained of dysesthesia on the right half of the perioral region and his right fingers. A neurological examination showed a mild weakness and hyperactive deep tendon reflexes on his right leg. His motor coordination was almost normal, but he was unsteady when he stood on one foot with his eyes closed. Laboratory examinations were normal except for an elevated serum uric acid level. A chest x-ray film showed a sclerotic change of aorta and mild cardiomegaly. Left ventricular hypertrophy was observed on his ECG. His CT scans showed multiple lacunae and mild brain atrophy. On cerebral angiography, his basilar artery (BA) had a fenestration almost in its total length that divided the BA, like a duplication, into two components with a smaller diameter than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

A possible relationship between cord blood transferrin and birth length in infants

Cord blood levels of transferrin (Tf) and insulin-like growth factor I (IGF-1) were measured in 33 normal and 12 preterm infants. Tf was measured by the single radial immunodiffusion technique, while IGF-1 was measured by specific RIA. Tf levels in normal term infants (195 +/- 27 mg/dl) were significantly below normal adult levels (261 +/- 12 mg/dl). Tf levels in preterm infants (159 +/- 30 mg/dl) were lower than those in normal term infants. Tf levels showed a positive correlation with birth length, weight, gestational age and albumin levels in all infants. There was no correlation between Tf and IGF-1 levels in term and preterm infants.

Transferrin receptor on rat Kupffer cells in primary culture

Kupffer cells may play a role in the turnover of iron in acute viral hepatitis. The transferrin receptor of rat Kupffer cells in primary culture was therefore investigated in this study. Daily specific bindings on 125I-diferric transferrin (Tf) to rat Kupffer cells in primary culture from day 3 to day 6 of culture were 1.64 +/- 0.08%, 4.16 +/- 0.05%, 4.34 +/- 0.07% and 2.63 +/- 0.07%, respectively. The specificity of the Tf binding sites was examined by competition studies showing that galactose (30 mmol x l-1) and ovalbumin (90 mumol x l-1) did not compete for the binding sites, but human lactoferrin (50 mumol x l-1) competed for the binding sites by about 30%. The affinity and capacity of Tf receptor on rat Kupffer cells in 5-day culture were analyzed according to the method of Scatchard. A single class of 125I-diferric Tf binding sites with an affinity constant of 1.65 x 10(7) l x l-1) and a capacity of 6.86 x 10(6) sites/cell was found. After zymosan (500 micrograms/ml) preincubation for 30 min, the binding capacity increased about 1.7-fold, and this increase depended upon the increase of the affinity of Tf receptor. These data suggest that Kupffer cells in the activated state accelerate the removal of elevated serum iron.

[A TRH analog (DN-1417). Effects on the levels of monoamines and the metabolites in the various brain regions in rats]

The effects of a TRH (thyrotropin-releasing hormone) analog, DN-1417 (gamma-butyrolactone-gamma-carbonyl-L-histidyl-L-prolinamide citrate), on the levels of norepinephrine (NE), dopamine (DA), serotonin (5-HT) and the metabolites in the various brain regions of rats were determined by means of high performance liquid chromatography with electrochemical detection. DN-1417 (20 mg/kg, i.p.) produced marked decreases in the levels of NE, DA and 5-HT, especially in the nucleus accumbens, striatum and hypothalamus. The maximum effect was observed at 15 min after the administration. DA metabolites, 3,4-dihydroxyphenylacetic acid and homovanillic acid, increased significantly in the nucleus accumbens, striatum and hypothalamus, whereas 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindoleacetic acid remained unchanged. 3-Methoxytyramine increased significantly in the nucleus accumbens and striatum. Two week chronic administration of DN-1417 (20 mg/kg, i.p.) increased the levels of DA and NE in the nucleus accumbens and DA in the striatum. These results suggest that DN-1417 stimulates the turnover of the cerebral monoamines, especially the release of DA from the nucleus accumbens and striatum in the mesolimbic and nigro-striatal DAergic systems.

Effect of middle cerebral artery compression on pial artery pressure, blood flow, and electrophysiological function of cerebral cortex of cat

In 20 cats, the left middle cerebral artery was gradually compressed with a microdriven vascular occluder implanted by a transorbital approach. Pial artery pressure, cortical blood flow, segmental vascular resistance, electrocorticogram, and cortical steady potentials were measured in the territory of the left middle cerebral artery and correlated with the degree of vascular stenosis. Pial artery pressure began to decrease when the lumen of the middle cerebral artery was reduced to 200 micrometers. Cortical blood flow and EEG power declined when pial artery pressure fell below 35-40 mm Hg; cortical steady potential started to shift toward negativity at a pressure below 25-30 mm Hg; and both hemodynamic and electrophysiological changes were maximal at a pressure below 10 mm Hg. When the vascular occlusion was released within 5 min after the onset of ischemia, a pial artery pressure of only 18 mm Hg was necessary to restore normal blood flow. After 1-h occlusion, normalization of flow occurred at a pressure of 30 mm Hg. Since this pressure is still substantially below normal pial artery pressure, no-reflow does not seem to be of significance in this experimental situation.

Pial arterial pressure in cats following middle cerebral artery occlusion. II. Relationship to regional disturbance of energy metabolism

Focal cerebral ischemia was produced in 16 cats by occluding the left middle cerebral artery (MCA) for 120 min. Cortical blood flow and pial artery pressure were determined prior to vascular occlusion and after 15, 60 and 120 min. At the end of the experiments (after 120 min MCA occlusion) heads were frozen in situ with liquid nitrogen. Cooled brains were cut into 0.5 cm thick slices. From these slices twenty-micron sections passing through the territory of the MCA were prepared in a cryostat and used in the pictorial presentation of glucose and ATP. NADH-fluorescence was recorded from the tissue slice, immersed in liquid nitrogen. In addition, tissue samples were taken from regions of interest and used for quantitative determination of biochemical substrates. In all but two animals permanent MCA occlusion led to disturbances in the energy-producing metabolism, as indicated by reduction in glucose and ATP, and increase in lactate. The regions exhibiting bright NADH-fluorescence were much smaller than those in which ATP was absent. In 6 animals NADH-fluorescence was not increased but even decreased in areas with disturbed energy-producing metabolism. A close correlation was obtained after comparing cortical blood flow measured 15 min after MCA occlusion with the area of ATP-depletion at the end of the experiments. However, the size of ATP-depletion did not correlate with flow measured 60 or 120 min after MCA occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of internal carotid dolichoectasia]

A 50-year-old woman noticed right motor and sensory paralysis in the morning of December 15, 1978, which improved gradually to be able to walk during 20 days. She had recurrence of incomplete paralysis of right extremities with speech disturbance and admitted to our department on April 7. Neurological examination revealed right hemiparesis. Plain skull rentogenorgram showed a calcification extending posteriorly from the left anterior clinoid process. CT scan showed a mass lesion located at the left frontal lobe to the ambient cistern. The mass lesion showed high density, but its midportion was isodensity. The left carotid angiogram demonstrated abnormally curved, tortuous and dilated internal carotid artery at the intracavernous portion (C3) to bifurcation (C1). The cerebral circulation time was greatly delayed, which regained about 6 seconds for the visualization of the distal portion of the middle cerebral artery. On the basis of the above, we considered that the first right hemiparesis was due to emboli produced in the dolichoectasia and the following progressive stroke was attributable to the low perfusion demonstrated by a great delay of circulation time. The operation was performed to trap the dolichoectasia after STA-MCA anastomosis. However, trapping procedure was very difficult because of hardness of the distal portion of the involved artery. Therefore, surgery was concluded with STA-MCA anastomosis and only proximal internal carotid clipping. The postoperative angiography demonstrated well functional anastomosis and obliteration of dolichoectasia. She discharged on improvement of her condition on the 23rd day after operation. CT scan performed 6 months after operations showed the mass lesion to have become definitely reduced in size. The application of bypass surgery to the internal carotid dolichoectasia was reported with review of the literatures.

A possible role of lipid peroxidation in cellular damages caused by cerebral ischemia and the protective effect of alpha-tocopherol administration

Incomplete global cerebral ischemia was induced by clamping the bilateral common carotid arteries of spontaneously hypertensive rats (SHR) and blood reperfusion was allowed by declamping the arteries after indicated times. To investigate the possible role of lipid peroxidation which causes irreversible ischemic cell injury during ischemia and subsequent reperfusion, cerebral energy metabolism, brain edema, neurological signs and cerebral and serum lipid peroxides were examined. The effect of alpha-tocopherol administration on these parameters was also studied from the standpoint of its action as a free radical scavenger. During ischemia up to 5 hours, cerebral ATP decreased and lactate increased rapidly, and concomitantly neurological signs, such as eye closure and jumping seizures, and slowly progressing brain edema were observed. The level of lipid peroxides in the brain and serum remained practically unchanged during ischemia, although an increasing tendency was noted. When blood reperfusion was allowed 3 hours after ischemia, tissue ATP level was restored only partially (67.4% of normal), but lactate returned to the normal level. The reperfusion resulted in a rapid rise in the lipid peroxide level both in cerebral tissue and serum and also caused a more severe expression of neurological signs. Intravenous injection of alpha-tocopherol (20 mg/kg body weight) 30 minutes prior to ligation of the carotid arteries significantly suppressed the rise in lipid peroxides both in the brain and serum, improved the severely expressed neurological signs, and promoted resynthesis of ATP. These improvements in the parameters were observed only after the reperfusion was made following ischemia for 3 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Pial arterial pressure in cats following middle cerebral artery occlusion. 1. Relationship to blood flow, regulation of blood flow and electrophysiological function

In lightly anesthetized cats, the left middle cerebral artery was occluded using a transorbital approach. Pial arterial pressure was measured with a feedback-controlled micropressure recording system in the territory of the occluded artery, and compared with changes of cortical blood flow, cortical steady potential and cortical EEG activity. After middle cerebral artery occlusion pial artery pressure fell from 56.2 +/- 1.6 to 7.8 +/- 0.4 mm Hg; during the following two hours it again slowly rose to about 15 mm Hg. Cortical heat conductance, as a measure of blood flow, decreased from 15.1 +/- 0.2 to 11.9 +/- 0.2 X 10(-4) cal X cm-1 X sec-1 X degrees C-1, and remained at this level throughout the observation period. Cortical steady potential shifted by 9.1 +/- 0.7 mV towards negativity, and EEG amplitude was reduced by about 50%. Pial arterial pressure correlated with blood flow, cortical steady potential and EEG amplitude, but not with EEG frequency. Autoregulation and CO2 reactivity of blood flow were disturbed after middle cerebral artery occlusion. Calculation of extra- and intracortical vascular resistances revealed that this disturbance was entirely due to intracortical vasoparalysis whereas the collateral vessels supplying the ischemic territory continued to react to both pressure and CO2 changes. Maintained vascular reactivity of collateral vessels, therefore, is a decisive factor for the efficiency of therapeutic blood flow improvement after acute middle cerebral artery occlusion.

Regional cerebral blood flow, sensory evoked potentials, and intracranial pressure in dogs with MCA occlusion by embolization or trapping

Regional cerebral blood flow (rCBF), sensory evoked potentials (SEP), and intracranial pressure (ICP) were investigated in dogs with focal cerebral ischemia produced by a silicone cylinder embolus in the middle cerebral artery (MCA) trunk as compared to that produced by trapping the same vessel. These variables were measured at intervals of 1 hour for a period of 6 hours after MCA occlusion. In the embolized animals, rCBF decreased most extensively at the basal ganglia, from a control level of 53.9 +/- 3.9 (mean +/- SE) to 21.5 +/- 2.7 ml/100 gm/min at the 6th hour. Sensory evoked potentials decreased progressively from the resting level of 100% to 53.0% +/- 7.2% at the 3rd hour. Intracranial pressure, measured by epidural pressure on the occluded side, increased rapidly during the first 3 hours, from 10.6 +/- 0.3 to about 30 cm H2O. In the animals with trapping, the decreases in rCBF and declines of SEP were significantly less than those in the embolized animals, and no evident brain swelling was observed. This study demonstrates that MCA trunk occlusion by silicone cylinder embolization produces a more marked decrease in deep CBF, with diminution of SEP and increase in ICP, than that produced by trapping.

Comparison of middle cerebral artery trunk occlusion by silicone cylinder embolization and by trapping

The authors produced occlusion of the middle cerebral artery (MCA) trunk in dogs by two methods: silicone cylinder embolization and trapping. Comparative analyses of the clinicopathological features in these models, extending from the acute to chronic stage, were performed. Within 24 hours after embolization, the brain exhibited swelling without macroscopic infarction. Microangiograms revealed impaired filling in the deep areas of the brain with midline shift. At 4 to 7 days after embolization, the animals showed major neurological deficits, evident deep cerebral infarction, and poorly perfused areas in the deep cerebrum with prominent midline shift. At 3 to 4 weeks after embolization, the neurological deficits improved and the affected regions showed cavities or localized lesions. Microangiograms demonstrated hypervascular areas with abnormal vessels in the affected cerebrum. On the other hand, trapping of the MCA trunk produced mild neurological deficits, although there was no evidence of macroscopic lesions or impairment of filling. This study shows that silicone cylinder embolization in the MCA trunk produces a reliable and reproducible deep cerebral infarction in dogs.

Experimental microsurgical embolectomy after middle cerebral artery embolization in the dog

The effects of microsurgical embolectomy were investigated clinicopathophysiologically in 60 dogs after occlusion of the middle cerebral artery (MCA) trunk with a silicone cylinder embolus. One group of animals served as a control (non-embolectomized group), and in the other two groups the embolus was removed 3 or 6 hours after occlusion (3-hour or 6-hour embolectomy group). In the non-embolectomized animals, major neurological deficits with deep cerebral infarction were observed. Regional cerebral blood flow (CBF) in the basal ganglia decreased most prominently. Sensory evoked potentials also declined to about 50% of the control level 3 hours after embolization. In the 3-hour embolectomy group, mild neurological deficits with minimal infarctions were found. One hour after embolectomy, CBF was restored to the original level in all regions, and the sensory evoked potentials surpassed the control level. In the 6-hour embolectomy group, most animals exhibited major neurological deficits and severe brain swelling with hemorrhagic infarction. This study suggests that early microsurgical embolectomy of the MCA trunk restores blood flow in the perforating arteries and prevents deep cerebral infarction.