[Emergency manual aspiration for severe hypertensive cerebellar hemorrhage]

We treated 16 patients with hypertensive cerebellar hemorrhage and coma, or deep coma. Their ages ranged from 44 to 79 years (mean age: 66.3 years). Manual aspiration was performed in 9 patients and suboccipital craniectomy was performed in 7 patients. The difference in outcome between the manual aspiration group and the suboccipital craniectomy group with severe hypertensive cerebellar hemorrhage was then evaluated. Manual aspiration was performed for 4 patients in coma, and 5 in deep coma, with a mean age of 69.0 years. The average size of the hematoma was 48.7mm and the mean volume was 31. 7ml on CT scan. The mean interval from admission to operation was about 60 minutes. The mean aspiration rate was 79.6% and 7 patients (77.8%) had a good response to drainage. The suboccipital craniectomy patients included 5 in coma, and 2 in deep coma, with a mean age of 63.4 years. The average size of the hematoma was 51.1 mm and the mean volume was 33.1 ml on CT scan. The mean interval from admission to operation was about 112 minutes and the mean evacuation rate was 86.4%. The results were as follows: 1) After manual aspiration, 5 patients (55.6%) had a good outcome and 2 patients (40%) with deep coma showed good recovery. In contrast, after suboccipital craniectomy only 2 patients (28.6%) had a good outcome and all of the deep coma patients showed poor recovery. 2) The outcome may be most strongly influenced by the duration from admission to operation. 3) All patients with a hematoma volume of over 30 ml had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid cholesteryl ester hydrolase activity of mononuclear leukocytes in patients with non-insulin-dependent diabetes mellitus: studies before and after treatment of diabetes

The change of acid cholesteryl ester hydrolase activity in mononuclear leukocyte following treatment of diabetes mellitus was studied in 21 patients with non-insulin-dependent diabetes mellitus (NIDDM). Enzyme activity before treatment in the patients was significantly lower than that in 14 age-matched healthy subjects (1.20 +/- 0.15; mean +/- S.E. vs. 2.20 +/- 0.17 nmol/mg protein/h, P less than 0.01). Enzyme activity before treatment in the patients was significantly increased (P less than 0.05) after 4-8 weeks of treatment. However, enzyme activity of 1.43 +/- 0.14 nmol/mg protein/h observed after treatment in the patients was significantly lower (P less than 0.01) than that in the healthy subjects. There was a significant negative correlation between enzyme activity before treatment and the increase in enzyme activity following treatment (rs = -0.555, P less than 0.01, n = 21). These results indicate that low level of enzyme activity may be insufficiently improved by the treatment of diabetes, and the risk for the development of atherosclerosis as viewed from the enzyme activity may persist even after the treatment in NIDDM.

Radiation-induced osteosarcoma of the calvaria--case report

The authors report a case of radiation-induced calvarial osteosarcoma. A 58-year-old female received subtotal removal of the pituitary adenoma and 5000 rads postoperative irradiation. Seven years later, an osteoblastic osteosarcoma occurred in the frontotemporal region. She received total tumor removal and chemotherapy. However, computed tomography subsequently revealed multiple small lesions at the margin of the bone flap. A chest x-ray film demonstrated lung metastasis. Local recurrence and lung metastasis require careful attention in radiation-induced osteosarcoma patients.

Monitoring of severe head-injured patients with transcranial Doppler (TCD) ultrasonography

Intracranial haemodynamics were studied in 36 patients with severe head injury and experimental animals with acute intracranial hypertension by the use of TCD ultrasound. The mean flow velocity (FV) in the basal cerebral arteries commonly decreased on the side of the haematoma depending on intracranial pressure (ICP) elevation and cerebral perfusion pressure (CPP) reduction in focal brain injury. The FV decreased bilaterally and there was no difference between the right and left sides in diffuse brain injury without a clear relationship between the FV and CPP. The FV of the middle cerebral artery and blood flow in the internal carotid artery exhibited flow patterns which changed correlatively depending on CPP reduction in experimental animals. Monitoring with TCD ultrasound is valuable in evaluating compression ischaemia in focal brain injury. But many complicated factors are considerable in diffuse brain injury.

Coexisting diffuse axonal injury (DAI) and outcome of severe head injury

The importance of coexisting diffuse axonal injury (DAI) and outcome were studied in 107 patients with diffuse and focal brain injury. Comprehensive neuropathological study was undertaken in 26 fatal patients. There was a clear rank order of the mortality rate in the lesion type. The rank order of good recovery and moderate disability was also similar to the inverse of the mortality ranking. The pathological "marker" of DAI, macroscopic lesions in the corpus callosum and dorsolateral quadrant of the upper brainstem and histological evidence of axonal retraction balls, were commonly found not only in patients with diffuse brain injury but also in focal brain injury. The type of intracranial lesion in severe head injury is thus an important factor in determining outcomes and DAI of varying severity is the common subjacent lesion in the fatal patients.

[A case of pituitary adenoma and hyperplasia with primary hypothyroidism]

A 23 year-old woman was admitted to our hospital, complaining of sterility and obesity. Her serum TSH and Prolactin were abnormally high, and her serum T3, T4 were low. Contrast-enhanced computerized tomographic (CT) scan revealed a round mass in the sella and suprasellar region. A transsphenoidal operation was then performed. The intrasellar mass was composed of a soft liquid-like part and a solid part. Only the soft liquid-like part of the mass was removed. Histological examination showed the typical appearance of chromophobe adenoma, Reticulin stain of the specimen revealed no reticular network. The remnant of the mass was considered to be hyperplasia because the size of the mass decreased on serial CT scan after thyroid hormonal replacement. Sometimes it may be difficult to distinguish between hyperplasia and adenoma. The application of reticulin stains is considered to be useful for differentiation between hyperplasia and adenoma.

[Concentration of thrombin antithrombin III complex and plasmin alpha 2-plasmin inhibitor complex in nephrotic syndrome]

Plasma concentration of fibrinogen (Fbg), plasminogen (PLG), antithrombin III (AT III), alpha 2-plasmin inhibitor (alpha 2-PI), thrombin antithrombin III complex (TAT) and plasmin alpha 2-plasmin inhibitor complex (PIC) were evaluated in 23 nephrotic patients with proteinuria more than 3.5 g/day, including 4 cases with clinical evidence of thromboembolism. Among patients without thromboembolism, concentration of PLG and AT III was in the normal range but that of Fbg and alpha 2-PI was significantly elevated (p less than 0.01 for Fbg and p less than 0.001 for alpha 2-PI respectively). Also there was a positive relationship between AT III and serum albumin (p less than 0.05). Two fifth of these patients had an had an increased level of TAT, and also had a higher level of PIC compared with normal control (p less than 0.01). There was a positive relationship between TAT and PIC, TAT and Fbg (p less than 0.05), PIC and Fbg (p less than 0.01). TAT and PIC levels were markedly elevated in the patients with thromboembolism. From aforementioned data, it was suggested that patients with nephrotic syndrome would be in the prethrombotic state and the increased level of Fbg is one of the major risk factors of thromboembolic complications in these patients. Furthermore measurement of TAT and PIC are the useful means for the diagnosis of these complications.

[A case of bacterial aneurysm following Hardy's operation]

Intracranial mycotic aneurysm of extravascular origin is reported. A 64 year-old male developed headache and visual disturbance. Computed Tomography (CT) revealed high density mass lesion with contrast enhancement in the intra- and suprasellar lesion. He was then admitted to our hospital under the diagnosis of pituitary adenoma. But he suddenly complained of headache and loss of vision during hospitalization. An emergency operation using the transsphenoidal approach was performed. The pathological diagnosis was craniopharyngioma. Postoperative radiation therapy was carried out using a tumor dose of 50Gy. Two months after the operation, he suffered from rhinorrhea and high fever. He was admitted again and treated with high doses of antibiotics. Two weeks after admission, he suddenly lost consciousness. A CT scan revealed an aneurysm of the anterior temporal artery. Immediately, removal of the hematoma and resection of the aneurysm were performed. Microscopic examination showed that inflammatory cells had infiltrated the aneurysmal wall, and lymphocytes and plasma cells had gathered around the microabscess. This rare case is discussed with other related cases in the literature.

[Histopathological study of wound healing process of rat tongue and femur by excimer laser irradiation--possibility of cutting of vital tissue by laser irradiation]

The possibilities of bone and soft tissue ablation without thermal damage by 248 nm KrF excimer laser irradiation were examined. A defect was made on the rat tongue by laser at pulse width: 15 nsec, power density: 12 W/cm2, pulse repetition rate: 20 Hz and irradiated time: 60 seconds. The same size defect was made by stainless steel surgical knife for control. The tongues were examined histopathologically at timed sequence from 1 hour to 7 days after operation. The rat femur was cut by laser at pulse width: 15 nsec, power density: 2.6 kW/cm2, pulse repetition rate: 30 Hz and irradiated time: 3 minutes. The femur was amputated by dental diamond disc for control. The femurs were examined histopathologically at timed sequence from 1 hour to 16 weeks after operation. The rat tongue was easily excised with little thermal injury by laser irradiation, and its healing process is almost the same as that of the control. The laser irradiation had no hemostatic effect. The femur could be amputated by laser irradiation but its wound healing was prolonged. The laser ablation stump showed massive necrosis probably due to the thermal injury and these necrotic bones likely disturbed the wound repair. The degree of the thermal injury by the excimer laser irradiation might depend on the irradiation condition because the condition of bone amputation was stronger than that of tongue excision.

Acid cholesteryl ester hydrolase activity of mononuclear leukocyte in type 2 (non-insulin-dependent) diabetic patients

Acid cholesteryl ester hydrolase activity of mononuclear leukocytes was measured in 52 Type 2 (non-insulin-dependent) diabetic patients. Enzyme activity was significantly lower in the diabetic patients than in 14 age-matched control subjects (0.89 +/- 0.08 (mean +/- S.E.) vs. 2.20 +/- 0.17 nmol/mg protein/hr, p less than 0.01). In diabetic patients undergoing diet treatment only, the enzyme activity was significantly lower in poorly controlled patients than in well controlled patients (0.43 +/- 0.03 vs. 1.15 +/- 0.24 nmol/mg protein/hr, p less than 0.01). In the diabetic patients, there was a significant negative correlation between the enzyme activity and serum total cholesterol or low density lipoprotein cholesterol level (r = -0.361, p less than 0.01, n = 52 or r = -0.630, p less than 0.01, n = 28). These results suggest that a low level of acid cholesteryl ester hydrolase activity in mononuclear leukocyte might play an important role in the progression of atherosclerosis in Type 2 diabetes.

[Familial gingival fibromatosis: report of a case]

One family of familial gingival fibromatosis was presented. Case 1 is an 11 years old girl. Gingival fibromatosis was noted by delayed eruption of permanent teeth. Fibromatosis was seen in whole gingiva and lower 1/2 to 1/3 of the tooth crowns was covered. Gingivectomy was performed. Case 2 was 42 years old man, who was father of case 1. Firstly gingival swelling was noted at the age of 10 years. He had operations of gingivectomy at the age of 28 years. It recurred and fibromatosis was seen in whole gingiva and lower 1/2 to 1/3 of the tooth crowns was covered. Cytogenetically no abnormality was seen in the chromosomes of both cases. Reported cases of familial and non-familial gingival fibromatosis in Japan were reviewed.

Nonamyloidotic nephrotic syndrome in Waldenström's macroglobulinemia

Severe nephrotic syndrome developed in an 83-year-old Japanese man with Waldenström's macroglobulinemia. Treatment with corticoid remarkably improved the proteinuria. Autopsy disclosed no deposit of amyloid in the kidneys but a slight infiltration of atypical lymphocytes. A considerable number of glomeruli showed mesangial cell proliferation and global or segmental thickening of the basement membrane with occasional double tracks. Immunofluorescent studies revealed deposits of IgM but not IgG, IgA and C3 along the basement membrane in most glomeruli. Electron microscopy disclosed the splitting glomerular basement membrane and scattered electron-dense deposits.

[Effects of Er:YAG laser irradiation on human extracted teeth]

The ablation effects of the Erbium:YAG laser (wave length: 2.94 microns) on the human extracted teeth were examined histopathologically. The enamel surface of the human extracted tooth was irradiated by the laser at 500 mJ, 1 pps or 3 pps: 3, 15, 30, 50 and 100 shots. After observation under a dissecting microscope, the teeth were placed in a demineralizing solution of 0.1 M lactate buffer with 6% hydroxyethyl cellulose (pH 4.5) in order to evaluate the acid resistance of the enamel adjacent to the ablated area. After 4 days, the degree of demineralization of the surrounding enamel was assessed by contact microradiography. The result showed that every irradiated tooth had a clear-cut defect, and almost all the teeth had acquired acid resistance at the enamel surrounding the ablated portion. The other experiment was carried out to estimate the effects of the Er:YAG laser through a contact probe. The enamel, dentin and cementum of the extracted teeth were irradiated at 39 mJ or 74 mJ, 10 pps; 10 shots. The teeth were observed under a dissecting microscope. The result clearly indicated that the Er:YAG laser guided by the contact probe could also produce a defect in the dental hard tissue. The above-mentioned findings suggested that the Er:YAG laser could pave the way for the cavity preparation with acid-resistant cavity margin.

[The groping phenomena in a case of Alzheimer type dementia]

We reported a case of senile dementia, Alzheimer type, with groping in response to a visual stimulus ("visual groping"). T.S. was a right-handed woman, 69 years old. In the beginning she displayed "visual groping" of the right hand, besides aphasia, lowered registration and Casteigne's "Motor neglect" of the right upper extremity. As the disease progressed, "visual groping" of the left hand developed, followed by "forced grasping" of the left hand. When the patient was 62 years old, she first showed decreased volition and lowered registration. Later poor finger movement and lessened speech were marked. At the age of 69, she was admitted to our hospital with aphasia and reduced registration. The patient showed preservation in naming and drawing tests. She also displayed a "visual groping" phenomenon of the right hand. This phenomenon was revealed when an examiner displayed something about 50 cm in front of the patient, and then she extended the upper extremity gropingly. We considered this phenomenon as "groping in response to a visual stimulus" of Denny-Brown. At the same time, the motor or praxic disorder of this patient consisted of paucity of movement. When she was told to imitate, her right upper extremity was hardly utilized, although later movements could be realized by her practice. When she was told to pour water from one glass into another, she used her left hand, although she used her right hand for spontaneous actions. So we considered this dyspraxia as a motor neglect of Casteigne.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine and exocrine pancreatic functions following partial pancreatectomy + partial hepatectomy

Comparative studies were performed on changes in endocrine and exocrine responses of the pancreas after partial hepatectomy, partial pancreatectomy or combination of these procedures in rats, in order to clarify the effect of the combined operation on the remnant pancreatic parenchyma. Three days after partial (60%) pancreatectomy with partial (70%) hepatectomy, endocrine function was better preserved than after partial pancreatectomy alone, suggesting that hypersecretion of insulin initiated by partial hepatectomy may ameliorate the defective glucose-induced insulin secretion following partial pancreatectomy. Further, exocrine function in terms of amylase output was relatively well maintained 3 days after partial pancreatectomy + partial hepatectomy as compared with partial pan after partial pancreatectomy + partial hepatectomy as compared with partial pancreatectomy alone.

Analyses of risk factors of ischemic heart disease in diabetics--multivariate analyses

In order to confirm the principal risk factor of ischemic heart disease (IHD) in diabetes, multivariate analyses were performed. ST depression in electrocardiogram (ST-ECG) and 18 other clinical-laboratory findings (sex, age, duration of diabetes, blood pressure, cholesterol, HDL-cholesterol, triglyceride, etc.) were measured in 70 non-insulin dependent diabetes mellitus patients. ST-ECG findings were divided into five ranges as an index of the severity of IHD, based on the assumption that the degree of ST-ECG would provide a reasonable correlation to the grade of IHD. In partial correlation analysis, the degree of ST-ECG was significantly correlated both to the level of triglyceride (r = 0.455, p less than 0.001) and to blood pressure (r = 0.392, p less than 0.01), but not to the other 16 variables. Three selected variables (blood pressure, triglyceride and atherogenic index) were sufficient to provide a satisfactory discrimination between patients with and without IHD. Five selected variables (sex, blood pressure, triglyceride, atherogenic index and weight index) were sufficient for evaluation of regression. These results suggest that the high level of triglyceride and hypertension are essential risk factors of IHD in diabetes. It is noticeable that the high level of triglyceride is one of the independent risk factors of IHD in diabetes; it does not depend on the degree of control of hyperglycemia or on the other variables.