Development of experimental meningeal gliomatosis models in rats

Experimental models of meningeal gliomatosis (MG) have been produced by intracisternal inoculation of rat C6 and 9L glioma cells into Wistar and Fischer 344 rats, respectively. Tumor growth was steady and rapid in both MG models when more than 10(6) tumor cells were implanted. The median survival time of the rats inoculated with tumor cells was inversely related to the number of the cells inoculated. The clinicopathological features observed in both MG models were similar to those seen in diffuse leptomeningeal involvement of gliomas in humans. The models may be useful for investigating the pathophysiology of MG and for the determination of the efficacy of chemotherapeutic agents in brain-tumor chemotherapy.

Treatment of prolactinoma based on the results of transsphenoidal operations

Ninety-eight patients (16 male, 82 female) with prolactinomas were treated by transsphenoidal operation. The postoperative course was closely related to the tumor size and the preoperative levels of serum prolactin. In 37 (74%) of 50 patients with microadenomas, the levels of serum prolactin returned to normal postoperatively. There were 48 patients with macroadenomas; 27 of these were expansive and 21 were invasive. In 9 (33%) of the 27 patients with expansive macroadenomas, the postoperative levels of prolactin returned to normal; this was not the case in any of the 21 patients with invasive macroadenomas. Of 81 premenopausal women, 35 (43%) resumed normal menstruation postoperatively. All patients with preoperative deficits in the visual field experienced postoperative improvement. There were no postoperative deaths or serious complications in this series. Our data indicate that microprolactinomas are highly curable by transsphenoidal operation alone. In women who plan to have children, prolactinomas should be removed immediately. On the other hand, in patients with macroprolactinomas who manifest high levels of serum prolactin, initial treatment with bromocriptine should be considered because there is little hope for surgical cure and postoperative bromocriptine treatment might be necessary.

[Mechanism and overcoming of resistance in ACNU-resistant sublines of rat brain tumors]

One of the most serious problems in chemotherapy of brain tumors is that tumor cells are able to acquire resistance to initially effective cytotoxic agents. In order to study the mechanism of such resistance to ACNU and the means to overcome it, two variant cell lines (C6/ACNU and 9L/ACNU) resistant to ACNU were selected in vivo. Uptake and retention of ACNU in these resistant cells were studied with [14C] ACNU. The results indicated that the resistance exhibited by both sublines of C6/ACNU and 9L/ACNU were due to both reduced uptake and retention of the drug. In an attempt to clarify the more detailed biochemical mechanism of resistance in these cells, we surveyed various membrane-modifying agents which potentiate the sensitivity of these resistant cells to ACNU. Among a number of membrane-modifying agents, calcium antagonists, especially nicardipine and verapamil, were found to cause retention of ACNU in the resistant cells and to enhance the effect of ACNU on these resistant cell lines. It might therefore be concluded that ACNU resistance can be overcome by membrane-modifying agents, such as nicardipine and verapamil.

Antitumor effect of bromocriptine on estrogen-induced rat prolactinomas: ultrastructural alterations of secretory granules

A quantitative analysis of ultrastructural alterations of secretory granules in correlation with prolactin (PRL) concentrations in estrogen-induced rat prolactinomas was performed to investigate the mechanism of the cytosuppressive action of bromocriptine (CB). The secretory granules of CB-treated adenomas increased in number but not in volume. The degree of exocytosis of the granules showed no significant decrease as reported previously, but rather an increase in adenomas treated with CB for 3 days. Radioimmunoassay revealed a decrease in PRL concentrations of adenoma tissues. and a marked reduction in serum PRL levels. These results suggest a low level of PRL in the secretory granules of the CB-treated pituitary adenomas.

[Development of experimental meningeal gliomatosis models using nude mice]

Experimental models of meningeal gliomatosis (MG) have been produced by intracisternal inoculation of human glioma cell lines into nude mice. The tumor growth was steady and fast in MG nude mice if 10(7) cells were implanted. Median survival time (MST) of nude mice inoculated with tumor cells was inversely related to the number of cells inoculated. There was a correlation between in vitro and in vivo (MG models) growth rate, which means that the cell kinetics in vitro are reflected in vivo. The clinicopathological features observed in nude mouse MG models were similar to those seen in diffuse leptomeningeal involvement of gliomas in humans. The models will be useful for investigating the pathophysiology of meningeal gliomatosis and the efficacy of chemotherapeutic agents.

[Cardiac myxoma metastatic to the brain]

A case of cardiac myxoma presenting as metastatic brain tumor are reported. The patient was a 44-year-old man. One year prior to this admission, he had suffered stroke, which was characterized by right hemiparesis and dysarthria. The computed tomographic (= CT) scan of the head at that time showed a low density on the left basal ganglia and the echocardiogram suggested a left atrial myxoma. At surgery, a polypoid myxoma attached to the atrial septum was totally removed. Right hemiparesis was improved and the patient was discharged. A few months later, the patient was evaluated for multiple cutaneous masses and diagnosed by biopsy as metastatic myxoma. The patient's condition remained unchanged until this admission. In March 1985, the patient had a tonic-clonic convulsion marching from right hand and developed right hemiplegia with drowsy. An echocardiogram failed to reveal recurrence of the cardiac myxoma. A CT scan revealed a 5-cm, relatively circumscribed, low density mass in the left fronto-parietal lobe, ring mottled enhancement after contrast administration and more enhancement in the delayed scanning of 45 min. Craniotomy showed a tender, friable tumor with a yellowish cyst fluid, but apparently not invading the brain parenchyma. After complete excision of the mass, there was rapid lessing in the hemiplegia and improvement in the level of consciousness. A contrast-enhancement CT scan performed 2 weeks after craniotomy revealed no evidence of residual tumor. Pathohistological examination showed spindle-shaped and stellate cells which formed clusters and contained large amounts of acid polysaccharides as demonstrated by the alcian blue method.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cortical somatosensory evoked potential associated with experimental chronic cord compression by epidural neoplasm in rabbits]

An experimental model of spinal cord compression was developed in rabbits by epidural neoplasms which were injected anterior to the T 13 vertebral body and grew into the spinal canal through the intervertebral foramina. With this experimental model, the neurological condition of the animals was monitored using a scale and changes of somatosensory evoked potentials (SEPs) were studied to evaluate the neurophysiological effect of experimental chronic cord compression. The animals were immobilized with pancuronium bromide and artificial respiration was maintained through a tracheostomy. SEPs were recorded by silver ball electrodes which were positioned epidurally over the somatosensory cortex through small burr holes. A subcutaneous needle placed at the nose served as a reference electrode. Right hind paw was stimulated via two percutaneous needles with 0.1 msec rectangular impulses sufficiently strong to produce motor responses, ranging from 10 to 20 volt in control rabbits. Electrical stimuli were delivered at a rate of 1 Hz. The intensity of electrical stimulation was raised up to 300 volt, when no consistent SEP was observed in the rabbit with spinal neoplasm. The SEP was summated by averaging 50 successive cortical transients with the analysis time of 200 and 500 msec. The cortical SEPs in the rabbit normally consisted of a positive-negative sequence, which we labelled P1, N1, P2, N2 and so on. Early peaks, P1 and N1, were observed constantly with average latencies of 30.1 and 53.3 msec respectively in normal rabbits. The variability of amplitudes seen even in control animals made them a less useful measure of function than latencies. Normal SEPs were preserved until the animals demonstrated moderate paraparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Meningeal gliomatosis model in nude mice]

The nude mouse has been proposed as a model animal for testing the chemosensitivity of human cancer cells, and encouraging results have been obtained. Murine brain tumor models were successfully prepared by direct inoculation of glioma cells into the cerebral hemisphere, an immunologically privileged area. However, the blood-brain barrier was destroyed mechanically by this manipulation. Accordingly, experimental models of MG were established by intracisternal inoculation of human glioma cells (ONS-6, -12, and -16). These cell lines were established by primary explant technique from our biopsy specimens. The outgrown cells were trypsinized and cultured in monolayers. Tumor cells (10(7) in 0.1 ml) were inoculated transcutaneously into the cisterna magna of BALB/c nu/nu mice using a 27-gauge needle. Tumor growth generally occur in no more than 10-20% of nude mice transplanted subcutaneously. Also, nude mice which were transplanted with these 10(7) glioma cells rejected the tumor. MG models which were inoculated with the same tumors intrathecally, however, all died within a month after inoculation. In in vitro studies, the doubling time (DT) of ONS-6, -12, and -16 were 30.5 h, 41.5 h and 60.9 h, respectively. Median survival time (MST) of MG models inoculated with ONS-6, -12, and -16 glioma cells were 8.5 days, 15.5 days and 18.5 days, respectively. These DTs were well correlated with the MST. Clinicopathological features observed in MG models were similar to those seen in diffuse leptomeningeal involvement of glioma in human beings. Tumor cells were disseminated in the diffuse arachnoid space, involving the cerebral hemisphere, spinal cord and throughout the cauda equina. Some tumor cells infiltrated the cerebral parenchyma and Virchow-Robin space. The models will be useful for investigating the pathophysiology of MG and the efficacy of chemotherapeutic agents.

Enhanced effect of reserpine upon growth-inhibitory action of ACNU on ACNU-resistant C6 glioma

Reserpine was found to enhance the cytotoxicity of ACNU on ACNU-resistant C6 glioma (C6/ACNU) cells in vitro. When reserpine was added along with ACNU to the C6/ACNU cells in vitro. When reserpine was added along with ACNU to the C6/ACNU culture in vitro at a concentration of 10 microM, the IC50 of ACNU for C6/ACNU cells decreased to the level of that for C6 cells and ACNU resistance was completely overcome in vitro. Furthermore, intracellular uptake of ACNU increased in both sensitive (C6) and resistant (C6/ACNU) glioma cells when 20 microM reserpine was added to the culture medium. Reserpine (20 microM) enhanced the cellular level of ACNU in C6 cells 1.5-fold and enhanced the level of ACNU in C6/ACNU cells 4-fold. The amount of ACNU incorporated into C6/ACNU cells reached the same level as that incorporated into C6 cells. The enhanced cytotoxicity of ACNU in vitro could be explained by the effective intracellular accumulation of ACNU resulting from the increase of intracellular uptake of ACNU in C6/ACNU cells by reserpine.

Successful combination chemotherapy (cisplatinum, vinblastine, and bleomycin) against peritoneal dissemination of intracranial germ cell tumor

We found combination chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB therapy) effective in the treatment of a patient with a pineal germ cell tumor with peritoneal dissemination. The metastatic complication may have been attributable to the ventriculoperitoneal shunt tube. After the first course of PVB therapy, the disseminated tumors were decreased in size; no residual tumors were detected after the third course by laparoscopic examination, computed tomographic scanning, or echogram. Our results suggest that combined PVB therapy is effective in the treatment of extraneural metastasis from intracranial germ cell tumors.

[Antitumor efficacy of activated macrophages against murine glioma cells]

A crucial manifestation of malignant gliomas is the regrowth of already-invaded neoplastic cells after surgical intervention. One possible approach for inhibiting such tumor growth is to utilize the tumoricidal potential of macrophages. In order to investigate the clinical application of this concept, peritoneal exudate cells (PEC) activated in vitro and in vivo by immunomodulating agents were tested for cytotoxic activity against murine glioma (203-glioma) cells. As immunomodulating agents, heat-killed Propionibacterium acnes (P. acnes), OK-432 and Concanavilin A supernatant (Con A sup) were used in these experiments. P. acnes was provided by Kowa Pharmaceutical Co., Tokyo, and OK-432 by Chugai Pharmaceutical Co., Ltd., Tokyo. Klinische Einheit (KE) units were used to express the strength of the preparation, with 1 KE equal to 0.1 mg of dried streptococci. Con A sup was produced by Con A pulsing of BALB/c splenocytes resuspended in complete medium. PEC harvested from mice to which 5% glycogen in saline had been inoculated intraperitoneally 6 d previously were activated in vitro by P. acnes (P. acnes-PEC), OK-432 (OK-432-PEC) and Con A sup (Con A-PEC). The cytotoxic activities of P. acnes-PEC, OK-432-PEC and Con A-PEC were approximately 25%, 65% and 60%, respectively. PEC were then collected from mice into which either 100 micrograms of P. acnes or 1 KE of OK-432 had been injected intraperitoneally several times. The antitumor effects of P. acnes-PEC and OK-432-PEC were about 35% and 50%, respectively. These activated PEC demonstrated cytotoxic activity against murine glioma in the tumor neutralization assay (Winn assay). Also, the antitumor efficacy of OK-432-PEC belonged mainly to adherent cells. Meningeal gliomatosis (MG) models were prepared for clinical studies. Viable 203-glioma cells (5 X 10(6) were injected percutaneously into the cisterna magna of C57BL/6 mice. The median survival time (MST) of the untreated group was 8.5 days. The MST of the groups treated by intraperitoneal and intracisternal administration of P. acnes were 26 and 33 days. This therapy significantly prolonged the survival time of these models, particularly by the intracisternal treatment. The differential cell count by Giemsa staining and latexphagocytic cell findings revealed that macrophages accounted for more than 90% of the P. acnes-PEC. These results may indicate that activated (PEC) macrophages were induced intracisternally by P. acnes and that activated macrophages induced intraperitoneally exerted antitumor effects in MG models.

Regional cerebral ischemia in the gerbil: measurement of regional cerebral blood flow by quantitative autoradiography

Alterations in the regional CBF after occlusion of the posterior communicating, middle cerebral, or common carotid artery were investigated in the gerbil with a quantitative autoradiographic technique using [14C]iodoantipyrine. Occlusion of the posterior communicating artery produced severe ischemia in the ipsilateral hippocampus, thalamus, and dorsal mesencephalon. Occlusion of the middle cerebral artery produced severe ischemia in the ipsilateral rostral and central cerebral cortex and lateral caudate-putamen. Occlusion of the common carotid artery produced ipsilateral hemispheric ischemia of variable degrees. The distribution and degree of cerebral ischemia produced by occlusion of one of these arteries correlated closely to the arterial territory and the extent of collateral blood supply. Since the areas affected after occlusion of the posterior communicating or middle cerebral artery differ, those models will be useful for the comparative investigation of the ischemia-related cerebral pathophysiology associated with different sites of primary lesion.

[Overcoming of ACNU resistance in a subline of rat glioma in vitro and in vivo by reserpine]

Reserpine was shown to enhance the cytotoxicity of ACNU in both C6 and C6/ACNU rat glioma cells in vitro and also to enhance the chemotherapeutic effect of ACNU in C6/ACNU-bearing rats (C6/ACNU meningeal gliomatosis rats), in which ACNU resistance could be partially overcome by reserpine. When reserpine was added to the culture at a concentration of 10 microM, the IC50 of ACNU for C6/ACNU cells decreased to the level of that for C6 cells. Intracellular uptake of ACNU in C6/ACNU cells increased and the efflux from the cells decreased when 20 microM reserpine was added to the culture. In in vivo experiments, combined ACNU (1 mg/kg) and reserpine (250 micrograms/kg) therapy by intrathecal injection of these drugs improved % ILS (increased life span) with statistical significance compared with that after treatment with ACNU alone. The probable explanation of the enhanced cytotoxic-effect of ACNU in ACNU-resistant glioma cells presented in in vitro and in vivo is increased intracellular ACNU concentration resulting from inhibition of the efflux of ACNU from the resistant cells.

[Surgery of high-flow arteriovenous malformation: with special reference to normal perfusion pressure breakthrough phenomenon]

Hemodynamic changes are of importance while removing large and high-flow arteriovenous malformations (AVM), because a phenomenon called "normal perfusion pressure breakthrough" may occur. In this report, we evaluated hemodynamic changes in 14 cases of high-flow AVM with cerebral angiogram and intraoperative monitoring of cortical-surface blood flow. The criteria we used for high-flow AVM are; nidus larger than 4 cm, a few large feeders, high-flow shunt in the nidus, and reduced circulation or dilated arteries in the adjacent brain tissue. For last 2 years, we experienced 14 cases of high-flow AVM which fulfilled the criteria, and 9 of these were operated on for total removal of AVM. Of those, 2 cases evolved postoperative local edema and hemorrhage and was thought to be due to "normal perfusion pressure breakthrough." Intraoperative monitoring of cortical-surface blood flow was useful to predict occurrence of "perfusion breakthrough", because blood flow in the adjacent brain tissue increased markedly with feeder clipping. Intraoperative barbiturate protection and postoperative controlled hypotension were thought to be useful for prevention of "normal perfusion pressure breakthrough", though the details of mechanisms are unknown.

Cytosuppressive effect of bromocriptine on human prolactinomas: stereological analysis of ultrastructural alterations with special reference to secretory granules

To ascertain the mechanisms of bromocriptine in lowering serum prolactin (PRL) levels and reducing the cell size of human prolactinomas, stereological analysis at electron microscope level was performed on six adenomas treated with bromocriptine (10 mg/day for 2 weeks) and four untreated adenomas. The bromocriptine treatment significantly decreased all the major organelles involved in PRL synthesis when expressed in absolute volume per single tumor cell, although it decreased only Golgi apparatus when expressed in relative volume within the cells. Secretory granules, lysosomes, and lipid droplets increased in relative volume but not in absolute volume in bromocriptine-treated adenomas. Consequently, bromocriptine decreased the volume of individual tumor cell to approximately 60% of that of untreated tumor cells. Unexpectedly, exocytosis of secretory granules increased significantly in the bromocriptine-treated adenomas in spite of a remarkable decrease in serum PRL levels. This appears to be contradictory to the current view that a decrease in serum PRL levels with a concurrent increase in the intracellular PRL levels caused by bromocriptine treatment results from the inhibition of exocytosis of secretory granules. The secretory granules of bromocriptine-treated adenomas may contain a small amount of PRL, as suggested by a culture study reporting degradation of PRL by bromocriptine.

[The anti-tumor efficacy of lymphokine-activated killer (LAK) cells induced in vitro from peripheral blood lymphocytes of patients with malignant glioma]

We studied whether lymphokine-activated killer (LAK) cells were capable of being induced in vitro from peripheral blood lymphocytes (PBL) of patients with malignant glioma, by using recombinant IL-2 (rIL-2). We then investigated whether they possessed anti-tumor efficacy against malignant gliomas (ONS-12, -20, -44). Human LAK cells were generated by placing 5 X 10(6) PBL into each well of 24-well plates (Corning) containing 2 ml of complete medium (CM) with 10 units of rIL-2 (TGP-3, provided by TAKEDA Chemical Industries, Ltd.). The CM consisted of RPMI 1640 with 0.1 mM nonessential amino acids, 1 microM sodium pyruvate, 5 X 10(-5) M 2-mercaptoethanol, 50 micrograms/ml gentamicin sulfate, 0.03% glutamine and 1% heat-inactivated human AB serum. The plates were incubated horizontally at 37 degrees C in a 5% CO2 atmosphere for 72-96 hours. The LAK cells were then harvested, washed three times with Hanks balanced solution, and resuspended in RPMI 1640 with 1% heat-inactivated human AB serum for the in vitro cytotoxicity assays. The anti-tumor cytotoxic activity of LAK cells was estimated in triplicate by 4-hr 51Cr release assays. The cytotoxic activity of the LAK cells against autogeneic ONS-44 glioma cells and PHA blasts was approximately 30% and a few %, respectively. The Natural Killer (NK) activity of the patient with ONS-44 glioma cells was equivalent to that of healthy subject.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lumbosacral lipoma: computed tomographic scan findings and surgical correction]

Display of the specific anatomic derangements by high-resolution computed tomographic (= CT) scan provides an important basis for planning corrective surgery of lumbosacral lipoma. In this paper, analysis of four infants and a child with lumbosacral lipoma revealed following discrepancy between the image by CT scan and operative finding. Most of lipoma showed a sharply outlined area of low density (approximately -100 H.U.) in the CT scan. Lipoma in the spinal cord parenchym represented intermingled fatty and neural tissue. There were also relatively high density areas in some cases and correspondingly, there were very fibrous lipomas, which could be identified by microscopic histological examination. Although there was a general correlation between the site of lumbosacral skin abnormality and underlying intraspinal lesion, some case does not match perfectly. In conclusion, a removal of the lumbosacral lipoma for the tethering effect always preferable to a total extirpation even though with technological advances in operative magnification and surgical instrumentation and a removal of the compressing lamina is necessary for adequate decompression.

[The in vitro antitumor effectiveness of murine lymphokine-activated killer (LAK) cells induced by recombinant IL-2]

We have studied the in vitro antitumor effectiveness of murine lymphokine-activated killer (LAK) cells induced by recombinant IL-2 (rIL-2). LAK cells were generated by placing 5 X 10(7) fresh C 57 BL/6 splenocytes (erythrocytes were lysed osmotically) in 10-cm (diameter) dishes (Falcon) containing 10 ml of complete medium (CM). The CM consisted of RPMI 1640 with 0.1 mM non-essential amino acids, 1 microM sodium pyruvate, 5 X 10(-5)M 2-mercaptoethanol, 50 micrograms/ml gentamicin sulfate, 0.03% glutamine, 10% heat-inactivated fetal calf serum (FCS) and 10 units/ml of rIL-2 (TGP-3, provided by TAKEDA Chemical Industries, Ltd). The dishes were incubated horizontally at 37 degrees C in a 5% CO2 atmosphere for 72-96 hr. The LAK cells were then harvested, washed three times, and resuspended in RPMI 1640 with 5% heat-inactivated FCS for the in vitro cytotoxicity assay. The antitumor cytotoxic activity of LAK cells was estimated in triplicate by 4 hr 51Cr release assays. The cytotoxic activity of LAK cells against syngeneic 203 glioma and normal syngeneic glioblasts was approximately 50% and a few %, respectively. The in vitro cytotoxicity of LAK cells against syngeneic EL-4 thymoma, allogeneic YAC-1 lymphoma and P-815 mastocytoma was 72%, 87% and 43%, respectively. Thus LAK cells have apparent tumor specificity in vitro and are easily generated. Fresh splenocytes of CBA/J mice were markedly lytic for natural killer (NK)-sensitive YAC-1 cells, but not for 203-glioma cells or NK-resistant P-815 cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth activity of tumors at different intracranial structures: immunohistochemical study with bromodeoxyuridine

To elucidate the environmental influence on the growth of a tumor, bromodeoxyuridine (BrdU) uptake in multiple tumor foci within the intracranial cavity was studied immunohistochemically with a monoclonal antibody. Walker 256 tumor implanted intracerebrally produced multifocal tumors presented as intraparenchymal solid tumor, tumor in the choroid plexus, and leptomeningeal dissemination. The BrdU-labeling indices, or the S-phase fractions (% of nuclei labeled by BrdU divided by the number of tumor cell nuclei scored; LI), of those tumors were 48.4 +/- 1.1, 59.1 +/- 1.3, and 27.9 +/- 5.9, respectively (mean +/- SEM). These differences in LI, or the tumor growth activity, are discussed in relation to the different environmental conditions in different host structures. These host structure-related modification of tumor growth would be important in evaluating the proliferative activity of tumors growing at various intracranial structures.

Effects of ACNU and radiotherapy on malignant glioma

A randomized clinical study of irradiation and irradiation combined with ACNU in the treatment of malignant gliomas was performed in order to determine if there was an enhancing therapeutic effect of ACNU given in addition to radiotherapy. An effect was defined as a reduction in tumor size, changes in neurological signs and performance status within 1 month after the completion of radiotherapy, or statistically improved survival times. Seventy-seven patients from 14 neurosurgical clinics were included in this validated study group. Radiotherapy with a total dose of 5000 to 6000 rads, given in 25 to 30 subdoses, was applied to the whole brain and to a generous field surrounding the tumor. Patients who were assigned to receive chemotherapy were given ACNU intravenously once or twice during radiotherapy at a dose of 100 mg/sq m of body surface area. The response rate (more than 50% reduction of the tumor size) was 13.5% in the group treated by radiotherapy alone and 47.5% in the group with radiotherapy and ACNU. The hematological toxicity was more severe in the group treated with radiotherapy and ACNU. Other toxicity was mild and acceptable. The survival rates of patients with astrocytoma grade III and glioblastoma multiforme at 36 months after the surgery were 48.9% and 0% for radiotherapy alone and 59.0% and 16.3% for radiotherapy plus ACNU, respectively. The differences between the survival curves were not significant at the p = 0.05 level. This study has demonstrated that, although the use of ACNU during radiotherapy suppressed malignant gliomas more than radiotherapy alone, the survival time was not extended significantly. It is necessary to continue to search for an effective chemotherapeutic regimen to prolong survival of patients with malignant gliomas.

[A case of multiple cerebral aneurysms caused by cardiac myxoma]

A case of neoplastic aneurysm caused by left atrial myxoma is reported. The patient was a 50-year-old woman who has been suffered from occasional vertigo and syncopal attack. She was admitted with a sudden loss of consciousness and cerebellar ataxia on December 1, 1983. Cerebral angiogram revealed multiple aneurysms in the periphery of both middle cerebral arteries and obstruction of the right superior cerebellar artery. Echocardiography displayed a cardiac myxoma in the left atrium. She suddenly died from recurrent cerebral embolism on January 7, 1984. The diagnosis was confirmed by the autopsy. The histopathological examination revealed that the wall of cerebral arteries were destroyed by the tumor cells of myxoma, and it caused cerebral aneurysms. We presented the detail of this case, and discussed about a mechanism and a treatment of neoplastic aneurysms.

Immunohistochemical investigation of cerebral ischemia during recirculation

Immunohistochemical methods for the determination of tubulin, creatine kinase BB-isoenzyme, and astroprotein-glial fibrillary acidic protein were used to investigate recovery of the ischemic lesion after temporary occlusion of a common carotid artery in the gerbil and the evolution of the postischemic lesion following reperfusion. One group of gerbils was followed from 15 minutes to one month after an ischemic period of 30 minutes, and another group was examined after 7 days following an ischemic period of 5 to 30 minutes. It was found that the postischemic lesion, visualized as loss of the immunohistochemical reaction for tubulin and creatine kinase BB-isoenzyme, evolved within 60 minutes after reperfusion in the hippocampus and cerebral cortex and within 3 hours in the caudoputamen and thalamus. Resolution of the preexisting ischemic lesion was possible only after an ischemic period of less than 10 minutes in the cerebral cortex and caudoputamen and less than 15 minutes in the thalamus. In the CA1-CA2 region of the hippocampus, the ischemic lesion already existed after an ischemic period of 5 minutes and was mostly irreversible. The immunohistochemical method of testing for different cellular and subcellular components was very useful for investigation of cerebral ischemia and may also be advantageous for investigation of other pathophysiological conditions of the nervous system.

[Immunohistochemical study of ethylnitrosourea-induced rat gliomas with vimentin and astroprotein (GFAP)]

Expression of two different types of intermediate filaments, vimentin filaments and glial filaments, was studied immunohistochemically in experimental rat gliomas. Although vimentin filaments are most commonly seen in mesenchymal cells, recent immunocytochemical study demonstrated that this type of filaments can be recognized also in glial cells during early cell differentiation and in tumor cells of epithelial origin. In the present communication, distribution of vimentin filaments in rat glial tumors was investigated and compared with that of glial filaments by using specific antiserum to each protein subunit, vimentin and astroprotein (GFAP). Ethylnitrosourea (50 mg/kg) was injected subcutaneously into 3 day-old Wistar rats. After four to ten months, brains of animals were removed, fixed in 95% ethanol and embedded in paraffin. Peroxidase-antiperoxidase method was carried out on 6 micron-thick sections. In normal portion of the brain, immunoreaction for vimentin was noted in ependymal cells and in vascular endothelial cells but not in astrocytes. This distribution contrasted with that of astroprotein (GFAP), which distributed in astrocytes but not in normal ependymal cells. These findings confirmed that the two antisera used in the present study do not crossreact to each other. In contrast to the absence of vimentin immunoreaction in normal astrocytes, a number of tumor cells showed positive reaction to the antiserum to vimentin. Mixed glioma with astrocytoma and oligodendroglioma had both astroprotein (GFAP)-positive and negative cells. Well developed cellular processes were noted in astroprotein (GFAP)-positive cells (astrocytoma cells). Weak immunoreaction for vimentin was noted in those cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of intraoperative cortical blood flow measurement by heat clearance method for monitoring cerebral ischaemia during therapeutic carotid ligation

Changes of regional cortical blood flow (rCBF) was monitored by the heat clearance method during the operation of cervical carotid ligation combined with superficial temporal artery and middle cerebral artery anastomosis for the treatment of inaccessible aneurysms of the internal carotid artery in eight patients. There were three types of rCBF responses upon closure of the internal carotid artery, with or without bypass blood flow. Based on the responses, the internal carotid artery was ligated abruptly or occluded gradually. The usefulness of the method for monitoring cerebral ischaemia for therapeutic carotid ligation is discussed.

Circulatory disturbance of the spinal cord with epidural neoplasm in rats

An experimental model of spinal epidural neoplasm was produced in rats by injecting Walker 256 carcinoma cell suspension anterior to the T12-13 vertebral body. With this model, spinal cord blood flow (SCBF) and its response to CO2 inhalation were estimated by the carbon-14-antipyrine autoradiography and the hydrogen clearance methods. In the early stages after tumor implantation, weakness, axonal swelling, and edema of the white matter were observed, while both SCBF and its response to CO2 inhalation remained normal. In the next stage, the tumor invaded the spinal canal and compressed the spinal cord epidurally. The edema of the white matter progressed, while the gray matter was morphologically intact. The SCBF and its response to CO2 inhalation were altered at both the compression area and caudally in the spinal cord. Changes in response to CO2 inhalation appeared earlier than the SCBF decrease. In the last stage, the SCBF decreased rapidly to the critical level, producing irreversible nervous tissue damage. Microangiographic studies revealed extensive obliteration of the spinal epidural venous plexus and patency of the larger nutritional vessels. From the data obtained, the progressive vascular pathophysiology related to spinal epidural neoplasm is as follows: 1) the vertebral venous plexus is compressed and obliterated in the early stages of the disease, and vasogenic edema appears in the spinal cord; 2) as the tumor grows, mechanical compression of the spinal cord is added and the circulatory disturbance increases; and 3) in the last stage, SCBF decreases rapidly to a critical flow level, and the loss of cord function becomes irreversible.

Effects of bromocriptine on prolactin-secreting pituitary adenomas. Mechanism of reduction in tumor size evaluated by light and electron microscopic, immunohistochemical, and morphometric analysis

Prolactin-secreting pituitary adenomas were studied to clarify the mechanism by which bromocriptine reduces tumor size. Patients examined consisted of three groups: Group I (four cases) received no medication, Group II (six cases) continued bromocriptine treatment (10 mg/day for 2 weeks) until the operation, and Group III (five cases) discontinued the treatment 1 week before the operation. Adenomas in Group II showed a variety of degenerative and necrotic changes of tumor cells in addition to marked decrease in volume of individual cell. Adenomas in Group III showed divergent structural changes. Irreversible changes seen in Group II became more pronounced with a marked increase in stromal tissue. Proliferative areas consisting of intermediate-sized cells were found in the scarce stromal tissue. The findings seem to indicate that the reduction in size of prolactinomas by bromocriptine treatment results from the reduction in size of individual tumor cell as well as from cell loss secondary to necrosis.

Prolactin secretion in acromegalic patients before and after selective adenomectomy

PRL secretion before and after transsphenoidal adenomectomy was studied in 13 patients with acromegaly. Six patient had elevated basal serum PRL levels before surgery, while 7 patients had normal levels. In every patient, the basal serum GH level decreased to less than 5.0 ng/ml after surgery. In the group (group A) with high basal serum PRL levels (mean +/- SD, 41.3 +/- 5.8 ng/ml) before surgery, the PRL levels decreased significantly (P less than 0.0002) to less than 10.0 ng/ml (4.8 +/- 3.6 ng/ml) after the operation. However, in the group (group B) with normal levels (10.8 +/- 4.4 ng/ml) before surgery, PRL levels changed little (7.8 +/- 3.1 ng/ml) after the operation. In group A, the increment of PRL after TRH injection decreased or disappeared (P less than 0.02; 4.1 +/- 2.4 ng/ml) after surgery compared with that before surgery (39.2 +/- 25.9 ng/ml). On the other hand, in group B, the increment of PRL after TRH injection was nearly unchanged (17.1 +/- 7.0 ng/ml) after surgery compared with that before surgery (19.3 +/- 8.0 ng/ml). The results indicate that PRL is secreted from the pituitary adenoma in acromegalic patients with hyperprolactinemia, while PRL secretion from the normal part of the pituitary gland is decreased.

[Nasopharyngeal paraganglioma extending to the middle cranial fossa]

A case report of a 15-year-old boy with a nasopharyngeal paraganglioma extended to middle cranial fossa is presented. We are reporting the fifteenth patient with a primary nasopharyngeal paraganglioma and reviewing the pertinent literature. The unusual initial presentation of oculomotor palsy and response to radiotherapy is described. The possible origin and radiosensitivity of this tumor discussed. Although the choice of therapy for this tumor remain controversial, the preferred treatment has been radiotherapy, in conjunction with surgical procedures for the mass of middle cranial fossa.

Bifrontal epidural hematoma after transsphenoidal operation: report of a case with a rare complication

We report a patient with a growth hormone-secreting adenoma who developed bifrontal epidural hematomas after a transsphenoidal operation. To our knowledge, this is the first report of such a complication.

[Extremely low-birth-weight infant with post-hemorrhagic hydrocephalus: surgical procedure and recognition by sonography]

In two infants admitted to the neonatal intensive care unit with birth-weight of less than 1,000 g, serial cranial real-time sonograms were obtained to determine the subependymal germinal matrix hemorrhage and follow up the post-hemorrhagic hydrocephalus, compared with computerized tomographic scan. This paper reports the results of the placement of a subcutaneous ventricular reservoir in these extremely low-birth-weight infants to resolve progressive post-hemorrhagic hydrocephalus and protect their cortical mantle until their risks of ventriculo-peritoneal shunting procedure are acceptable. In these infants, the hydrocephalus and increased intracranial pressure were controlled and following shunting procedure after their medical and anesthetic problems resolved.

Purification of astroprotein (astrocyte-specific cerebroprotein) by reversed-phase C-1 HPLC

A method for purification of astroprotein (an astrocyte-specific cerebroprotein) with HPLC is described. A linear gradient from 30 to 70% acetonitrile in 0.1% trifluoroacetic acid (pH 2.2) was applied to the reversed-phase C-1 (particle size 10 micron) column. Cerebroproteins from the crude extract from human glioma were clearly separated by this procedure. Highly purified astroprotein was homogeneous by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and has immunoreactivity to antiserum against astroprotein. Reversed-phase C-1 HPLC offers advantages over previously available preparative techniques in the higher purity and better separation time of the products.

Immunohistochemical study of metastatic brain tumors with astroprotein (GFAP), a glia-specific protein. Tissue architecture and the origin of blood vessels

Tissues from 12 metastatic tumors of the brain were studied immunohistochemically with an antiserum to a glia-specific protein, astroprotein (glial fibrillary acidic protein, GFAP). Emphasis was laid on demonstrating the tissue architecture of metastatic lesions incorporating brain-derived components (astrocytes and glial fibers). Of 12 samples, 11 manifested a number of irregular indentations at the tumor surface. These indentations, which contained astrocytic elements, extended into the tumor tissue in a tapering fashion. In seven cases, the deeper stromal portions of the tumor also contained astroprotein (GFAP)-positive elements. The presence of this glia-specific protein suggests that the stroma of the tumor tissue may in part be derived from preexisting brain tissue. This peculiar tissue architecture of the tumor supports the hypothesis that some of the blood vessels that are located in the stroma of the tumor tissue are also derived from the brain. These observations may be important in understanding the partial preservation of the blood-brain barrier in metastatic brain tumors and the mode of growth of the metastatic lesion, and in selecting the type of chemotherapy that will be most effective in controlling this central nervous system complication of systemic malignancies.

[Bilateral, symmetrical hemorrhagic infarction of the basal ganglia and thalamus following neonatal asphyxia]

With the advancement of perinatal intensive care, the occurrence of subependymal germinal matrix hemorrhage (= GMH) in low-birth-weight (premature) infants has became a major concern in perinatal medicine. The pathophysiology of the GMH has long been controversial. The introduction of computed tomographic (= CT) scanning to perinatal medicine has revealed various pathological events heretofore unknown in newborn infants having respiratory and circulatory distress. At our serving the entire Osaka Prefecture, infants suffering from birth asphyxia with severe perinatal brain damage were found to have CT findings distinguishable from those of GMH. We report three asphyxiated newborn infant who had hemorrhagic infarction in bilateral caudate nucleus, striatum and thalamus on the CT scan. Reports of similar findings are rare, and ours is the first serial observation of such CT scan image in newborn infants. The mechanism of development and pathology of this pathological condition have been variously argued as pathophysiology of GMH. The present study lacks postmortem examination, however, the findings in serial CT scans in three infants and review of the literatures related to the pathology of neonatal asphyxia indicate the following course. The thrombosis in the internal cerebral veins led to severe swelling of the brain, and hemorrhage occurred with the reduction in the swelling, eventually resulting in diffuse leukomalacia. Etat marbré (status marmoratus), mentioned earlier, is considered to represent a milder stage of this pathologic course.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypothalamic hamartoma: report of two cases

Two histologically confirmed hypothalamic hamartomas, one in a 7-year-old boy and another in a 10-year-old boy, are reported. One patient had precocious puberty, epileptic laughter, and abnormal behavior; the other had cerebral seizures. Partial removal of the tumors had no effect on precocious puberty; however, behavior improved in the first patient, and seizure control improved in the second patient.

Accumulation of amyloid in pituitary adenomas

The accumulation of amyloid in pituitary adenomas was examined in relation to the types of adenoma and the effect of bromocriptine treatment. Amyloid had accumulated in 34 of 48 adenomas (71%). The occurrence in prolactin-secreting adenomas and growth hormone-secreting adenomas was 79%, respectively, while that in non-functioning adenomas was 50%. Treatment with bromocriptine enhanced the occurrence and extent of the amyloid accumulation in prolactin- or growth hormone-secreting adenomas. Electron microscopy revealed the initial appearance of the amyloid fibrils in the smooth endoplasmic reticulum and a possible sequential process of their release from the cells. The presence of secretory granules in vesicles containing amyloid fibrils and their simultaneous release with amyloid fibrils suggested that degradation of secretory granules was involved in the formation of amyloid.

Normalization of thyroid stimulating hormone levels in acromegalic patients after selective adenomectomy

Changes in TSH secretion in six acromegalic patients were studied before and after transsphenoidal adenomectomy (Hardy's method) and compared to normal subjects and six patients with prolactinoma. Basal serum GH levels ranging from 5 to over 250 ng/ml before adenomectomy decreased to below 5 ng/ml after the operation, and the abnormal responses of GH to TRH observed initially in three of the six patients almost disappeared in the post-adenomectomy period. The response of serum TSH to TRH in acromegalic patients improved in each of the six patients after the operation. The TRH-stimulated TSH secretion in patients with prolactinoma of a size and grade similar to those in acromegalic patients was not so extremely low as that in the acromegalic subjects. As indicators of thyroid function, serum triiodothyronine (T3), thyroxine (T4), T3-uptake levels and free T4 indices did not change significantly after adenomectomy as compared with those before the operation in five of the six patients tested. Serum T3, T4 and T3-uptake levels and free T4 indices before adenomectomy were normal or subnormal in each patient except for a high serum T4 level and free T4 index before the operation in only one patient. Thus, it is difficult to conclude that the function of thyrotrophs was decreased by pressure upon the intact pituitary gland by the tumor, or that the thyroid gland also became hypertrophic secondary to the elevated GH, resulting in a large quantity of thyroid hormone being secreted, which caused a suppression of TSH secretion by negative feedback.(ABSTRACT TRUNCATED AT 250 WORDS)

[Meningeal gliomatosis: development of experimental models]

Experimental models of meningeal gliomatosis (MG) have been produced by intracisternal inoculation of C6 glioma and 9L glioma cells into Wistar and Fisher 344 rats, respectively. The tumor growth was steady and fast in both MG models if 10(6) cells were implanted. Median survival time(MST) of rats inoculated with tumor cells was inversely related to the number of cells inoculated. The clinicopathological features observed in both MG models were similar to those seen in diffuse leptomeningeal involvement of gliomas in human beings. The models will be useful for investigating the pathophysiology of meningeal gliomatosis and the efficacy of chemotherapeutic agents.

[Clinical studies of meningeal gliomatosis]

Ten (23%) patients out of 43 with malignant glioma developed meningeal gliomatosis during the follow up period of at least one year. The duration between the first surgery and diagnosis of meningeal gliomatosis ranged from one to 78 weeks (median 45 weeks). In younger age group less than 20 years old, 5 (56%) out of 9 patients had meningeal gliomatosis, and on the contrary the incidence was lower in older age group above 20 years old (5 of 34, 15%). Seven (22%) out of 32 male and 3 (27%) out of 11 female patients developed meningeal gliomatosis. The primary tumor location were frontal lobe in 4 cases (including one bifrontal tumor), temporal in 2, parieto-occipital in 1, thalamus in 1, midbrain in 1, and cerebellar hemisphere in 1, respectively. Histologically, 7 tumors were anaplastic astrocytoma, and 3 were glioblastoma. The characteristic neurological findings observed during the course of meningeal gliomatosis were abnormal mental status (80%), cranial nerve palsies (50%), paraplegia (60%), stiff neck (80%), seizure (50%), and respiratory disturbance (80%), CSF cytology was positive in all 9 patients tested. CT scan demonstrated hydrocephalus (70%), and diffuse contrast enhancement of ventricular wall (60%) and basal cistern (10%). In 2 cases, block and irregular filling defect were seen by myelography. Six patients were treated by irradiation to the whole brain and/or spine, and 5, by intrathecal chemotherapy with methotrexate, cytosine arabinoside and bleomycin. However, all patients died of the tumor one to 46 weeks (median 18 weeks) after the diagnosis of meningeal gliomatosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development of ACNU-resistant meningeal gliomatosis models: establishment of resistant rat glioma subline against ACNU]

Induction in vivo of resistance of C6 rat glioma and 9L rat glioma to ACNU [1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride] was studied and ACNU-resistant rat meningeal gliomatosis models were developed by using these resistant glioma sublines. Rapid acquisition of resistance to the agent was present at 2nd transplant generation in both glioma lines. Cellular resistance to ACNU remained unchanged in the absence of drug over 5 transplant generations in vivo in spite of the fact that the drug treatment was discontinued at the 5th generation after a complete resistance was induced. On the other hand, the degree of resistance of 9L resistant subline established by only once ACNU treatment was found to be decreased after 5 transplant generations in vitro. Degree of resistance at the cellular level was observed with each subline by in vitro technique and compared with each other. Each subline was found to have different degree of resistance: 9L resistant subline showed higher resistance than C6 resistant subline, and the differences in degree of resistance between 9L resistant subline and C6 resistant subline were approximately 750 and 20, respectively, when they were expressed as ratios of IC50 (drug concentration for 50% growth inhibition) for the resistant subline to the original one.