The levels of urinary epinephrine during daytime REM sleep deprivation

Urinary excretion of epinephrine during REM sleep deprivation in the daytime was examined in an attempt to determine whether epinephrine excretion during sleep is related to the structure of disturbed sleep. Six healthy males were subjected to two experimental conditions: 1) day sleep without interruption, as a control condition, and 2) day sleep with REM sleep deprivation. Under both conditions, epinephrine excretion levels of five of the subjects were found to be distributed along a basal regression line, expressing the relationship of epinephrine excretion and percent of waking time, as calculated in a previous study. The epinephrine levels of the one remaining subject exceeded the values predicted by the regression line. His sleep structure was not only distorted under REM deprivation conditions but also under control conditions as well. These results suggest that the basal regression line is useful for observing the existence of sleep disturbance; indeed, a subject with epinephrine excretion levels much higher than those predicted by the regression line was found to have spontaneously disturbed sleep. More study is needed to clarify the relationship between high epinephrine levels and disturbed sleep.

[Clinical analysis of 270 cases of microsurgical lumbar discectomy]

Since 1983, the authors encountered 270 cases of lumbar disc hernia, which were operated on with the microsurgery. In the present study, the operative procedures were described and the results, especially the results of the reoperations were examined. Good results were obtained in 252 patients (93%). In nine patients, some kind of lumbago continued, which required other treatments, such as epidural block (3.3%). Reoperations were performed in nine patients (3.3%). In lumbar discectomy, extent of removal of the bony structures and the disc material seemed important. In "microlumbar discectomy", which was advocated by Williams, only the flavectomy with no bony structure removal was performed. In this procedure, discectomy is limited to the protruded disc material. On the contrary, some authors, who also adopt microsurgical lumbar discectomy as Wilson and Hudgins do, perform subtotal removal of the disc material with removal of some bony structures. In the present series, microsurgical lumbar discectomy following the procedures advocated by Wilson et al was performed. Reoperations after lumbar discectomy have been reported after all kinds of operations. In the present series, the rate of reoperation was 3.3%. As to the reasons for reoperations, true recurrence of disc hernia was the most prevalent. The hernias recurred at the same level and on the same side. Adhesion or fibrosis around the nerve root also played an important role. From the results of the present study, microsurgical lumbar discectomy with good illumination and high magnification has proved to bring satisfactory results. Recurrence, however, can occur after this procedure, so further inventions are required to ensure more satisfactory results.

Complete remission of metastatic teratoma from malignant testicular tumor using salvage chemotherapy with VP-16 (etoposide), CDDP, and ACNU--case report

A 26-year-old male with an intracranial teratoma, metastasizing from a testicular yolk sac tumor refractory to cis-diamminedichloroplatinum (CDDP), vinblastin, and bleomycin (PVB) therapy, was successfully treated with a combination of etoposide (VP-16), CDDP, and ACNU (salvage chemotherapy). Emergency surgery for subcortical hemorrhage discovered the metastasis, diagnosed as a yolk sac tumor. CDDP chemotherapy failed to prevent recurrence, and total removal was impossible due to subdural invasion. He underwent radiation therapy and salvage chemotherapy. A third operation found only scar tissue. Maintenance salvage chemotherapy was continued. He was doing well 30 months after the first operation.

Giant pseudoaneurysm of the extracranial vertebral artery successfully treated using intraoperative balloon catheters

Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.

Inhibition of cholesterol absorption and synthesis in rats by sesamin

The effects of sesamin, a lignan from sesame oil, on various aspects of cholesterol metabolism were examined in rats maintained on various dietary regimens. When given at a dietary level of 0.5% for 4 weeks, sesamin reduced the concentration of serum and liver cholesterol significantly irrespective of the presence or absence of cholesterol in the diet, except for one experiment in which the purified diet free of cholesterol was given. On feeding sesamin, there was a decrease in lymphatic absorption of cholesterol accompanying an increase in fecal excretion of neutral, but not acidic, steroids, particularly when the cholesterol-enriched diet was given. Sesamin inhibited micellar solubility of cholesterol, but not bile acids, whereas it neither bound taurocholate nor affected the absorption of fatty acids. Only a marginal proportion (ca. 0.15%) of sesamin administered intragastrically was recovered in the lymph. There was a significant reduction in the activity of liver microsomal 3-hydroxy-3-methylglutaryl coenzyme A reductase after feeding sesamin, although the activity of hepatic cholesterol 7 alpha-hydroxylase, drug metabolizing enzymes, and alcohol dehydrogenase remained uninfluenced. Although the weight and phospholipid concentration of the liver increased unequivocally on feeding sesamin, the histological examination by microscopy showed no abnormality, and the activity of serum GOT and GPT remained unchanged. Since sesamin lowered both serum and liver cholesterol levels by inhibiting absorption and synthesis of cholesterol simultaneously, it deserves further study as a possible hypocholesterolemic agent of natural origin.

[Clinical evaluation of lumbar disc hernia in the teenagers]

Lumbar disc herniation is a rare occurrence in teenagers. There are several questions as to its pathogenesis, relationship to trauma, and clinical manifestations compared with those in adults. In the present paper, we described nine cases of teen-age lumbar disc herniation, which accounts for about 3.3% of all the operated lumbar disc herniations in our clinic. In the discussion, 687 cases of teen-age lumbar disc herniation were analyzed from the world literature. The clinical signs and symptoms in teenagers showed no distinct difference from those in adults. Laségue's sign was found in nearly all the patients. Although direct or indirect trauma to the lumbar region may play an important role in causing disc herniation in teenagers, a more important factor seems to be the degeneration of the disc material, which begins in children earlier than usually suspected. Although surgical therapy has been advocated by many authors, it must be followed up for a long term before the efficacy of such treatment for teenagers can be confidently ascertained.

Tubular adenoma of the gallbladder with squamoid spindle cell metaplasia. Report of three cases with immunohistochemical study

Three cases of tubular adenoma of the gallbladder with squamoid spindle cell metaplasia are reported. Two of the three patients, who were middle-aged Japanese, had a solitary polyp in the gallbladder, and the other had three polyps. All the lesions were detected incidentally by ultrasonography. The polyps were pedunculated with a fine or frail stalk, and ranged from 0.5 to 3.9 cm in diameter. Histologically, they were tubular adenomas accompanied by scattered foci composed of a compact collection of short-spindle or oval cells with mild atypia. These cells did not retain intercellular bridges, and lacked intracellular keratinization. Immunohistochemically, the spindle cells stained positively for high-molecular-weight cytokeratin (EAB 903, a marker of squamous cell differentiation), whereas adenoma cells lining the tubules were negative for this antigen. Therefore, the spindle cell component is considered to represent squamoid metaplasia of adenoma cells.

Malignant eccrine tumor--a case report and a classification of tumors of eccrine sweat apparatus

A case of malignant eccrine tumor and its histological findings were reported. In this case, we considered basal cell carcinoma or malignant melanoma clinically; however, the histological features matched those of malignant eccrine tumor. It has been said that it is very difficult to determine the origin of tumors of sweat apparatus; to contribute to this ongoing dialogue, the classification of tumors of eccrine sweat apparatus was also discussed.

Efficient tumor suppression by glioma-specific murine cytotoxic T lymphocytes transfected with interferon-gamma gene

We have recently shown that exogenous expression of the mouse interferon-gamma (IFN-gamma) gene augmented the cell-killing potential of a line of cytotoxic T lymphocytes (CTLs) specific against a murine glioma line (203-glioma). In the present work, we further investigated the in vivo antitumor effects of the E gamma-6 and E gamma-9 sublines of this CTL line transfected with the IFN-gamma gene. Using the Winn assay to test the neutralization of subcutaneous gliomas, we determined that these CTL sublines were more effective than the E-4 parent CTL line and that suppression of the tumor growth was dependent on the number of effector cells (CTLs). Moreover, intravenous injection of E gamma-9 cells was more effective in suppressing the tumor growth than intravenous injection of E-4 cells. These results suggest that transfection of antitumor effector cells with the IFN-gamma gene could improve the efficacy of adoptive immunotherapy against cancer.

[Histological and immunohistochemical studies on nevocellular nevi in the dermis. With special reference to the histogenesis of nevus cells]

The author has performed study on the histogenesis of the nevus cells in the nevocellular nevi. In the study, specimens of the intradermal nevi in 124 cases were evaluated histologically and immunohistochemically and the following results were obtained: 1) Findings of hematoxylin eosin staining It was observed that three types of cells, including type A cells (epidermoid type cells), type B cells (lymphoid type cells), type C cells (neuroid type cells) were found to run through an intermediate stage from the upper part to the lower part of the nevocellular structure, although they disclosed different histological structures. In 39 (31.5%) of the 124 cases, Meissner's corpuscle-like cells were confirmed. 2) Findings of immunohistochemical staining i. Of the type A, type B and type C cells, the S-100 alpha protein stain was essentially negative. Meissner's corpuscle-like cells were selectively positive by this stain. ii. Although no particular difference was noted in the staining of S-100 protein between the type A and type B cells, a somewhat greater proportion of positive cells was noted in type C cells. In the Meissner's corpuscle-like cells, a notably higher positive conversion of cells was observed as compared to those of the three other types of cells. iii. Type A, type B and type C cells compared more or less similarly for the positive ratio of neuron-specific enolase but the ratio was unusually high in the Meissner's corpuscle-like cells. 3) Findings from routine electron microscopic staining i. Similar to the light microscopic findings, the nevus cells were found to change in shape uninterruptedly from the upper layer to the lower layer of the dermis. Unusually marked changes were noted both in the number and shape of the melanosome and premelanosome in the cytoplasm. ii. In the Meissner's corpuscle-like cells both melanosomes and premelanosomes were missing but a finding suggestive of a neuroid structure was affirmed. As noted above, the results of the histological, immunohistological and electron microscopic studies were in support of the general findings suggestive of a gradual shift of the nevus cells from the upper layer to the lower layer in the dermis, which prompted the author to support the so-called "neural crest origin hypothesis".

Exogenous expression of mouse interferon gamma cDNA in mouse neuroblastoma C1300 cells results in reduced tumorigenicity by augmented anti-tumor immunity

To examine the influence of interferon gamma (IFN-gamma) on tumorigenicity, we established constitutively IFN-gamma-producing cell lines from a malignant mouse neuroblastoma, C1300, by retroviral transfer of a mouse IFN-gamma cDNA. The gene-transferred cells generally showed an enhanced high-level expression of the major histocompatibility complex class I antigens at the cell surface and the transcription levels, irrespective of their IFN-gamma-producing potential. Although in vitro cell growth of these cells was unaffected by the IFN-gamma production, their s.c. tumor growth in syngeneic A/J mice was dependent upon levels of IFN-gamma production; tumors induced by a low-producer line grew well at a rate similar to those induced by the parental one, but tumor growth of a high-producer line was strongly suppressed. This apparent tumor suppression was abolished by simultaneous i.p. injection of anti-Lyt2.2 and/or anti-IFN-gamma monoclonal antibodies, and subsequently large tumors of the high producer were generated. Anti-asialoganglioside GM1 antibodies allowed the high-producer line to induce a substantial but only transient tumor growth, whereas other antibodies, such as anti-Lyt2.1, anti-IFN-beta, and anti-activated macrophage, had no such effect. The mice immunized with the high-producer line were resistant to tumor growth of the parental cells but permitted another kind of A/J tumor line, Sa-1, to induce remarkable tumors. These results indicate that the reduced tumorigenicity of the IFN-gamma high-producer line was due to the augmented specific anti-tumor immunity, in which cytotoxic T lymphocytes seemed to play a decisive role, probably as a result of the immunomodulatory effects of the IFN-gamma derived from the tumor.

Primary malignant melanoma of the penis--a case report and a review of the literature

A 50-year-old man had a primary malignant melanoma of the penis associated with granuloma telangiectaticum in the pigmented lesion. The patient had an operation for phimosis at the age of 20 and after the operation, he noticed a pigmented lesion at the operation site. We examined the literature and found 16 cases of primary malignant melanoma of the penis in Japan.

[A novel experimental approach to immunotherapy against malignant brain tumor with the mouse IFN-gamma gene transfer]

To investigate the effect of interferon-gamma (IFN-gamma) on the immunotherapy, we used the autocrinically stimulated system in which a mouse IFN-gamma cDNA was transferred by infection with a chimeric retrovirus containing the IFN-gamma gene. First, we established a tumor specific CTL clone (E-4) against 203-glioma cells (a 20-methylcholanthrene induced mouse ependymoblastoma line of C57BL/6 mouse origin), and then transferred murine IFN-gamma cDNA into E-4 by using retroviral vector (pSVX(Mu gamma delta A]. Out of five gene-transferred subclones, E gamma-4, E gamma-5, E gamma-6, E gamma-7 and E gamma-9, two subclones (E gamma-6 and E gamma-9) constitutively produced 8- to 10-fold amounts of IFN-gamma as compared with the parental E-4. Moreover, these two subclones exhibited two to three times higher killing activity against 203-glioma than the parental cells. The enhancement of the killing activities was abrogated by an adequate addition of anti-IFN-gamma antibody. No alteration was seen after the gene transfer in cell surface phenotypes, Thy-1+, Lyt-1-, Lyt-2+3+ and asialo-GM1-. Fluorescence-activated cell sorter (FACS) analysis showed that the surface expression of major histocompatibility complex (MHC) Class I antigen, H-2Kb, of parental E-4 was augmented remarkably, and it was not altered by the IFN-gamma gene transfer, but the Class II antigen, I-Ab, was slightly enhanced on the two IFN-gamma-producing sublines. Since it is considered that in the vicinity of the constitutively IFN-gamma-producing CTL cells, tumor cells are exposed to a high concentration of IFN-gamma and may be stimulated to induce or enhance the expression of surface antigens including MHC antigens as well as tumor associated antigens in relation to immune recognition. The 203-glioma cells pretreated with IFN-gamma were more efficiently killed by both the parental E-4 and the gene-transferred sublines. It was thus suggested that the specific tumor killing activity of the gene-transferred CTLs was augmented by the constitutive production of IFN-gamma derived from the exogenous gene. As the next step, a mouse IFN-gamma cDNA was transferred into a neuroblastoma line C1300 of A/JAx mouse origin. Two infected subclones C gamma 3 and C gamma 22, were obtained as a low and a high producers, respectively. Both IFN-gamma gene transferred cells remained unchanged as regards in vitro cell growth, morphological appearance and differentiation antigen expression such as neurofilaments after the IFN-gamma gene transfer. On the other hand, expression of MHC Class I antigens of both subcloned lines was extremely augmented at the surface expression level as well as at the transcription level, re

Augmentation of tumor targeting in a line of glioma-specific mouse cytotoxic T-lymphocytes by retroviral expression of mouse gamma-interferon complementary DNA

As an initial approach to experiments directed toward effective adoptive immunotherapy for cancer using lymphokine genes, we transferred retrovirally a complementary DNA encoding mouse gamma-interferon (IFN-gamma) into a specific cytotoxic T-lymphocyte clone, designated E-4, against 203 glioma cells (a 20-methylcholanthrene-induced mouse glioma line) and confirmed the efficacy of IFN-gamma production from the exogenous gene on augmentation of tumor targeting. Of five, two gene-transferred subclones constitutively produced 8 to 10 times the amount of IFN-gamma as compared with the parental E-4. Correspondingly, these two subclones exhibited 2 to 3 times higher killing activity against 203 glioma than the parental cells; the enhancement of the killing activities was abrogated by an adequate addition of anti-IFN-gamma antibody. No alteration was seen after the gene transfer in cell surface phenotypes, Thy-1+, Lyt-1-, Lyt-2+,3+, and asialo-GM1-. The surface expression of a major histocompatibility complex Class I antigen, H-2Kb, was not altered remarkably, but the Class II antigen, I-Ab, was partially and slightly enhanced on the two IFN-gamma-producing sublines mentioned above on fluorescence-activated cell sorter analysis. Since it is considered that in the vicinity of the constitutively IFN-gamma producing cytotoxic T-lymphocyte cells tumor cells are exposed to a high concentration of IFN-gamma, the cells may be stimulated to induce or enhance the expression of surface antigens including major histocompatibility complex antigens as well as tumor-associated antigens relevant to immune recognition. The 203 glioma cells pretreated with IFN-gamma were more efficiently killed by both the parental E-4 and the gene-transferred sublines. Taken together, the results suggested that the augmented specific tumor-killing activity of our gene-transferred cytotoxic T-lymphocytes was ascribed to the constitutive production of IFN-gamma derived from the exogenous gene.

The relationship between waking time and urinary epinephrine in bed-rested humans under conditions involving minimal stress

The correlation between urinary excretion of epinephrine and percent of waking time during time allotted for sleep was evaluated for both daytime and nighttime bed-rest under minimally stressful conditions. The experiment was performed on 6 male subjects. Polysomnographic recordings were made throughout each 8-h bed-rest period, and free epinephrine excretion was measured at intervals of 2.5 h. Epinephrine excretion showed a strongly positive correlation with percent of waking time during bed-rest in the daytime and at night (average correlation coefficient: day: r = 0.89, P less than 0.001; night: r = 0.68, P less than 0.001). The possibility that levels of epinephrine excretion could be used as an indicator of sleep disturbance is discussed.

Immunohistochemical study of the cells infiltrating human renal allografts by the ABC and the IGSS method using monoclonal antibodies

Sixty renal allograft tissues obtained from 29 patients were stained with hematoxylin and eosin. These tissues were histologically classified into 4 patterns according to the distribution pattern of the infiltrating cells: normal, focal, focal-diffuse, and diffuse types. Clinical signs of acute rejection were observed in 88% of the patients with the diffuse type infiltration, and 83% of those with the focal-diffuse type infiltration but in only 13% of those with the focal type infiltration. Twenty-four renal allografts were analyzed by the ABC and the IGSS methods using monoclonal antibodies. The number of T cells (Leu 1) accounted for about 80% of the total number of infiltrating cells; 2-8% of the cells were B cells (Leu 12); about 10% were NK/K cells (Leu 7); and 4-6% were monocytes/macrophages (Leu M3). As to helper/inducer T cell (Leu3a) and killer/suppressor T cell (Leu2a), which are T lymphocyte subsets, there were more Leu3a- than Leu2a-positive cells in focal type tissue, but there were more Leu2a- than Leu3a-positive cells in focal-diffuse and diffuse type tissue. In most cases that developed clinical signs of acute rejection, there were more Leu2a- than Leu3a-positive cells. The Leu3a/Leu2a ratio in most of the AZA-administered cases dropped immediately after the transplantation and maintained a low value, but in the CSA-administered cases it decreased gradually post-transplant.

[Measurement and clinical significance of the posterior cranial fossa volume of patients with hemifacial spasm]

The etiology of hemifacial spasm had long been obscure until 1962 when Gardner proved that this hyperdysfunction of the facial nerve was caused by mechanical compression of the facial nerve by vascular structures in the posterior cranial fossa. In 1977, Jannetta proposed a specific location at the root entry zone of the facial nerve; this area has consequently been considered to be especially vulnerable to minor trauma such as vascular compression. In patients with hemifacial spasm, the posterior cranial fossa cavity is commonly found to be small or shallow on plain craniogram; this anatomical change in the skull is regarded as pathognomonic for the facial nerve hyperdysfunction. To make a quantitative analysis of the posterior cranial fossa volume in these patients, the following method was used. In the preliminary study, a dry human skull with an artificial "tentorium" made of thick paper was prepared to decide the fundamental plane for volume measurement by CT scan. This plane included attachments of posterior clinoid ligaments, superior petrosal veins and lateral sinuses. When this fundamental plane was projected to the lateral view on CT scan, it appeared to be almost identical to the line connecting the tip of posterior clinoid process to the internal occipital protuberance (the fundamental line). A horizontal CT scan for an intracranial volume measurement was performed in a parallel fashion to this fundamental line, with a 5 mm slice for the infratentorial and a 10 mm slice for the supratentorial area. The intracranial area of each horizontal slice was calculated by computed planimeter.(ABSTRACT TRUNCATED AT 250 WORDS)

Intrahepatic calculi associated with cholangiocarcinoma

A unique case of hepatolithiasis associated with cholangiocarcinoma is described. The intrahepatic calculi consisted mainly of cholesterol rather than calcium bilirubinate. A bacteriological study of the intrahepatic and gallbladder bile was negative, though bacterial infection of the bile duct has been considered a main factor responsible for formation of intrahepatic calculi.

[Importance of intraoperative monitoring of ABR and compound action potential of the eighth cranial nerve during microvascular decompression surgery]

An intraoperative recording of a direct compound action potential of the 8th cranial nerve with pre, intra and postoperative monitorings of auditory brainstem evoked response (ABR) was carried out for the purpose of clarifying mechanism and prevention of postoperative hearing dysfunction following microvascular decompression surgery as a treatment for hyperdysfunction syndrome of cranial nerves. In 221 patients with hemifacial spasm and tic douloureux out of 510 patients operated on by microvascular decompression surgery, ABR was monitored before, during and after surgery and furthermore, in the recent 94 patients among them, an intraoperative direct recording of a compound action potential of the acoustic nerve was performed simultaneously. Among these 94 patients, postoperative mild hearing dysfunction was encountered in 11 patients and severe reduction of hearing acuity in 2. As a result of our studies of monitoring action potential of the 8th cranial nerve and ABR, the following conclusions were drawn. When a latency of component V of ABR was delayed by more than 1.5-2.0 msec during surgery, and delay of latency of main negative peak (N1) of an action potential of the acoustic nerve exceeded by more than 1.0 msec, the occurrence rate of postoperative hearing dysfunction became positively high. There were two different types of changes in both ABR and action potentials; one type was a delay of an action potential in combination with that of ABR latencies and the other one was merely a delay in ABR components without following a remarkable change in action potentials. The former change might due to be an insult of whole neural pathways of the 8th cranial nerve including a cochlear nucleus and the latter change may due to be functional changes of the structures proximal to the cochlear nucleus. The delay of latencies in ABR and action potentials could be imposed either by a traction of the 8th cranial nerve or by a compression of the region of cochlear nucleus by a blain spatula as well as a vascular insufficiency of the tiny vessels which supplied these neural structures. To avoid the surgical insult to the acoustic nerve itself and more proximal neural pathways, the traction of any neural structures by a brain spatula should be lasted less than 5 minutes with more than 2 minutes intervals when judged from the results of our monitoring studies and the pressure of the compression on the cerebellar cortex is much preferable to be less than 20 mmHg for the safety throughout whole surgical procedures.

[Three cases of Eagle's syndrome]

Recently microvascular decompression surgery has been performed for trigeminal neuralgia or glossopharyngeal neuralgia with remarkable success. In differential diagnosis of such neuralgia, a lot of atypical facial pain must be taken into consideration, one of which is so-called Eagle's syndrome. This syndrome is characterized by elongated styloid process or calcified stylohyoid ligament compressing the Vth and/or IXth cranial nerve. In the present paper we report three cases of Eagle's syndrome and discuss the mechanism, differential diagnosis and surgical treatment of the facial pain in this syndrome. The first case was a 40-year-old man. He complained of continuous dull pain on the right face. Sometimes he also suffered from radiating pain into the orbit and maxillary region. A-P and lateral projection of plain skull film showed elongated styloid process measuring about 4.5 cm in length. This process curved medially and was palpable in the tonsillar fossa. Above mentioned radiating pain was released by the injection of local anesthesic agent into the tonsillar fossa. From these findings, diagnosis of Eagle's syndrome was made. He was performed partial styloidectomy by transoral approach with complete relief of the facial pain. The second case was a 49-year-old woman. She complained of continuous or periodic pain that radiating from the right subauricular area to the right neck. Lateral view of plain skull film showed elongation of her right styloid process measuring about 4 cm in length. In the right tonsillar fossa, the elongated styloid process was palpable, compression of which induced radiating pain. By injection of anesthesic material into the right tonsillar fossa the pain disappeared temporarilly.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of a large thoracic epidural hourglass neurinoma, incidentally detected on routine chest roentgenogram--with respect to the surgical approach]

In case of the advanced extension into the thoracic cavity, it has been difficult to remove a large thoracic spinal hourglass tumor by conventional laminectomy, even adding costotransversectomy, due to high risk of injuring diverse important vessels and other organs by blind manipulation. A case of a large thoracic spinal hourglass neurinoma with advanced extension into the mediastinum is presented. A 49-year-old female was admitted for the further examination of the left mediastinal tumor, incidentally detected on routine chest roentgenogram, which was suspected as the part of spinal hourglass tumor. Her neurological examination was normal except hyperreflexia of bilateral lower extremities. Plain chest roentgenogram showed a left mediastinal mass behind the aortic arch and the descending aorta, which slightly enlarged in size, compared with its previous size in the chest film taken 3 years ago. Thoracic spine tomogram showed the destruction of the left pedicle of T4, the absorption of posterior aspect of the T4 vertebral body and the dilatation of the left intervertebral foramen between T4-T5. Myelogram showed the complete block of dye column at T4. Metrizamide CT scan revealed the large extradural hourglass tumor, which compressed the dural theca anterolaterally and extended through the dilated left T4-T5 intervertebral foramen into the left mediastinum and attached to the descending aorta. Two stage operation, the first for the removal of the left mediastinal tumor by transthoracic approach and the second for intraspinal canal tumor by posterior approach, was performed with success for this large thoracic spinal hourglass tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Simultaneous detection of B-cells and T-cells by a double immunohistochemical technique using immunogold-silver staining and the avidin-biotin-peroxidase complex method

A new double immunohistochemical technique for the simultaneous detection of B-cells and T-cells was investigated, using tissue preparations obtained from human axillary lymph nodes and rejected renal allografts. The specimens were immunostained first for the demonstration of B-cells, by the immunogold-silver staining (IGSS) method using Leu-12 monoclonal antibody, and then for T-cells by the avidin-biotin-peroxidase complex (ABC) method using Leu-1 monoclonal antibody. With the present methods, both B-cells and T-cells were clearly detected and distinctively identified without cross-linking of antibodies or double reaction of enzymes.

Ventriculoperitoneal shunt malfunction during pregnancy. Case report

Malfunction of a ventriculoperitoneal shunt is reported in a 25-year-old woman at 32 weeks of gestation. Pregnancies and delivery in women with cerebrospinal fluid shunts are rarely reported, and malfunction of a shunt system during pregnancy is extremely unusual.

[Synchronized hemifacial spasm induced by sound stimulation]

A 42-year-old woman whose hemifacial spasm develops not only involuntarily but also synchronously to the sound stimulation to the left ear is presented. She had about 10 years history of left hemifacial spasm which occurred only involuntarily, and she was treated successfully by microvascular decompression method on June 1982. She had been uneventful and free from facial spasm until around January 1983, about 7 months after the first surgery, when her hemifacial spasm recurred and interestingly enough, this spasm started to occur not only involuntary but also synchronously to stimulation of the sound. On her electromyography (EMG) of the face, high amplitude discharge were noted sporadically during her facial muscle twitching, but more constant and regular high amplitude discharge on EMG were also evoked invariably and synchronously with the sound stimulation which was induced by 90 dB click sound and once this sound stimulation discontinued her facial muscle twitching ceased and abnormal discharge of EMG which appeared with sound stimulation disappeared instantly. On March 18, 1983, her left posterior fossa was explored and another angled artery was found compressing the facial nerve just at the root entry zone, more proximally than the previous site where the nerve was found compressed and decompressed at the first surgery. After complete replacement of this offending artery from the nerve, her facial spasm disappeared completely and was never evoked by the sound stimulation. Her postoperative EMG revealed no abnormal discharges at all after the sound stimulation by click sound in the ear.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cervical dural ectasia in von Recklinghausen's disease]

A case of cervical dural ectasia in von Recklinghausen's disease is reported. A 36-year-old female was admitted to our hospital with complaints of hypesthesia in the extremities and gait disturbance. Plain cervical x-ray films showed dilated interpediculate distance and increased A-P diameter of the cervical spinal canal. Myelography showed abnormally dilated subarachnoid space at C4-C7 level. Metrizamide CT scan also revealed abnormally dilated subarachnoid space, which was at the ventral site of the spinal cord. No tumors, arachnoid cysts, syringomyelia were noticed. From the above-mentioned radiological findings, dural ectasia in von Recklinghausen's disease was suggested. In the discussion, it was emphasized to consider dural ectasia in the differential diagnosis of the dilated spinal canal.

Relationship between sleep efficiency and urinary excretion of catecholamines in bed-rested humans

The relationship between urinary excretion of catecholamines during sleep and sleep disturbance was examined in four healthy subjects who were confined to bed for approximately 1 week under an entrained condition. Polysomnographic recordings were made throughout the period of continuous bed rest. Free epinephrine and norepinephrine excretion were measured. Sleep efficiency, i.e., percentage of total sleep time over an allotted sleep period, was an indicator of sleep disturbance. All subjects showed a negative correlation between sleep efficiency and epinephrine excretion (average correlation coefficient -0.79, p less than 0.004). Norepinephrine excretion correlated negatively with sleep efficiency in only one subject, and the group average correlation coefficient of -0.28 was not significant. Circadian variations were observed in sleep efficiency and catecholamine excretion. Although epinephrine excretion was influenced by psychophysiological stress arising from the experimental conditions of forced bed rest, the correlation between sleep efficiency and epinephrine excretion remained stable and negative. The urinary excretion of epinephrine could be an effective indicator of sleep disturbance.

Effects of L-carnitine on exercise tolerance in patients with stable angina pectoris

The effects of L-carnitine (900 mg, p.o. daily) on exercise performance were studied in 12 patients with stable effort angina using a multistage treadmill exercise test. Exercise tests were performed at the end of the placebo period and after 4 and 12 weeks of carnitine therapy. While 12 patients experienced angina during treadmill tests in the placebo period, 2 patients were free of angina after treatment with carnitine. The mean exercise time was 11.4 +/- 0.7 min (mean +/- SE) in the placebo period. This increased significantly to 12.2 +/- 0.5 min (p less than 0.05) after 4 weeks and 12.8 +/- 0.5 min (p less than 0.01) after 12 weeks of treatment with carnitine. The time required for 1 mm ST depression to occur was 6.4 +/- 0.9 min in the placebo period. This increased significantly to 7.6 +/- 0.9 min (p less than 0.01) after 4 weeks and 8.8 +/- 1.0 min after 12 weeks of treatment with carnitine. There was significantly less ST segment depression during the same exercise load after 12 weeks of treatment as compared with that in the placebo period (p less than 0.05). The heart rate and the pressure rate product at the same work load showed no significant difference among the 3 testing periods. The results of this study suggest that L-carnitine may improve exercise tolerance in patients with effort angina.

Determination of pemoline in plasma, plasma water, mixed saliva, and urine by high-performance liquid chromatography

A new determination method of pemoline in plasma, plasma water, mixed saliva, and urine using high-performance liquid chromatography was developed. The detection limit of pemoline using 0.2 ml of the sample was 0.02 microgram/ml in plasma, plasma water, saliva, and urine. The recoveries of pemoline added to plasma, saliva, and urine (each 6 micrograms/ml) were more than 98%. The coefficients of variation of within-run and between-run precisions for 5 concentrations of pemoline in plasma were less than 5 and 6%, respectively. The elimination half-lives of pemoline obtained from the plasma concentration-time curves after a single oral administration of pemoline in two subjects were 6.7 and 10.3 h. Mean values of the ratio between saliva and plasma total concentration in two subjects were 0.55 and 0.64, and mean values of plasma protein binding percent were 35.7 and 25.2%, respectively. The saliva concentrations were in proportion to the plasma unbound pemoline concentrations at simultaneous samplings, and the ratios between saliva and plasma unbound concentration were about 0.9 in two subjects. Usefulness of saliva in the estimation of plasma protein-unbound pemoline concentration was noted.

Hemangioma calcificans with circumscribed brain atrophy

A case of hemangioma calcificans is presented. On CT scan, the tumor shows no mass effect but is accompanied by circumscribed low density which is deemed to indicate brain atrophy and an enlarged subarachnoid space. A case of this tumor surrounded by peritumoral brain atrophy has not been reported before.