[Spinal epidural arteriovenous malformation fed by bilateral internal iliac arteries]

A rare case of a spinal epidural AVM fed by bilateral internal iliac arteries is reported. The patient was a 50 years old female with symptoms of slowly progressive paraparesis and sensory disturbance below L-2 associated with sphincter disorders. Myelography disclosed a serpiginous filling defect at the lumbar region. Selective internal iliac arteriograms disclosed an AVM fed by bilateral lateral sacral arteries. The nidus was excised totally, then a gradual improvement of those symptoms followed. Reviewing the literature, only 9 cases of spinal AVM of this type have been reported. In the majority of these cases, symptoms progressed slowly from the lower sacral level up to a level close to the end of the drainer. These symptoms were considered to be caused by steal phenomenon as well as by venous congestion due to arterialized intradural draining veins.

[Cerebral venous thrombosis associated with the use of oral contraceptives]

The entity of cerebrovascular diseases associated with the use of oral contraceptives is well known but quite rare in Japan in contrast to Western countries. We recently encountered a 38 years old female with cerebral venous thrombosis considered to be caused by oral contraception. This patient took oral contraceptives for 17 days following therapeutic abortion, and was transferred to our hospital because of disturbed consciousness. CT scans disclosed a right temporo-occipital subcortical hemorrhagic infarction and bilateral thalamic infarction. Cerebral angiograms showed non-filling of cortical veins in the same area. The internal cerebral vein, vein of Galen and right transverse sinus were not visualized either. The hematoma and necrotic tissue were removed to avoid farther neurological deterioration. The brain was swollen and hyperemic, and thrombosed cortical veins were clearly recognized at operation. Twelve cases, including ours, of cerebrovascular diseases associated with oral contraception were reported up to now in Japan, and only 3 of them were diagnosed objectively as venous or sinus thrombosis. The average age of these 12 cases was 34 years old and many of them experienced abortion or therapeutic abortion. There was no relationship between the dose of estrogen and the onset of cerebrovascular diseases. We believe that the onset of this pathological state is based on gynecological hypercoagulable state, and the oral contraception may play a role of a trigger. Oral contraception should be contraindicated in patients with gynecological hypercoagulable state, hypertension and/or smoking habit.

Beneficial effect of donor-specific blood transfusions (DST) on living-related kidney allograft survival

The survival rate of 19 patients who underwent living-related kidney transplantation after donor-specific blood transfusions (DST) was compared with that of 32 historical controls receiving transplants without DST. The graft survival rate of the DST group was 82% after two and three years. The graft survival rate of the DST group was significantly better than the 53% rate after two years obtained with the 32 historical controls (p less than 0.05). We tested sera from 16 DST-treated recipients to study the beneficial effect of DST on kidney allograft survival using the mixed lymphocyte culture (MLC) serum inhibition test. The results demonstrated that MLC inhibitory factors were induced in the serum of the recipient after completion of DST. This inhibition of MLC was observed by treatment of responder lymphocytes with serum obtained three weeks after DST plus rabbit complement. The inhibitory effect was also specific for responder cells in anti-donor MLC. Regarding the correlation with rejection episodes, these MLC inhibitory factors were often observed in the non-rejection group (p less than 0.05). The data suggest that such factors may be anti-idiotypic antibodies and be associated with prolonged graft survival.

[The effects of TSH, cholera toxin and Graves' IgG on cAMP production in cultured human thyroid adenoma cells in monolayer]

Monolayer cultures of human thyroid cells derived from thyroid adenoma were utilized for the assay of thyroid stimulating substances such as thyrotropin (TSH), cholera toxin and thyroid stimulating immunoglobulin (TSI) in patients with Graves' disease. Adenoma cells were treated with 0.1% collagenase or 2000 unit/ml dispase to thyrocytes. The cells were cultured in MEM containing 10% fetal calf serum under an atmosphere of 5% CO2 in air. Within 24 hours, the cells attached themselves to the plastic surface and formed a monolayer. Cyclic AMP responses to TSH, cholera toxin or Graves' IgG were tested in a medium (PBS) containing 0.5 mM IBMX. The cyclic AMP responses to TSH were generally maximal on the 3rd day of culture and declined thereafter. The response was dose-dependent, and 10 microU/ml of TSH produced a significant increase of cellular cyclic AMP. The response by 1 microU/ml of TSH was 28 approximately 57 fold above the basal. The response was also a function of the incubation period. The maximal response was attained after 1 h incubation. When the cultures were washed after exposure to TSH, the cellular cyclic AMP levels rapidly declined, suggesting that removal of receptor-bound TSH results in a prompt cessation of cyclic AMP production. The thyroid cells in monolayer also responded to cholera toxin. The response was dose-dependent, and cholera toxin as low as 1 ng/ml was able to increase cyclic AMP production. In contrast to the observations in TSH, the cyclic AMP responses induced by cholera were hardly affected by washing the cultures after exposure to cholera toxin. Treatment of the cells with cholera toxin for only 3 min resulted in a continuous stimulation of cyclic AMP production for more than 4 hours. Confirming recent observations by others, most of Graves' IgG stimulated cyclic AMP production in a dose-dependent manner, but some of them inhibited the response at high concentrations. IgG derived from normal subjects did not increase cellular cyclic AMP. The time course in the cyclic AMP responses induced by Graves' IgG was variable among the IgG preparations from different patients. In some patients, the maximal responses were attained after 4 hours of incubation. A significant difference was noted between TSH and Graves' IgG in the stimulation of cyclic AMP production after washing the cultures. When the cultures were treated with Graves' IgG for 30 min, washed and then incubated without Graves' IgG, cellular cyclic AMP levels remained at the levels which were almost equivalent to those observed in the continuous presence of the IgGs.(ABSTRACT TRUNCATED AT 400 WORDS)

Accessory cerebral ventricle of the occipital lobe. Morphogenesis and clinical and pathological appearance

Small separated accessory ventricles in the occipital lobe were observed in 21.3% of 404 patients, as seen by computerized tomogram. There was no significant preponderance in regard to sex or laterality. The accessory ventricles were clinically not significant. As seen at autopsy, accessory ventricles were found in the subcalcarine white matter, posterior to the occipital horn of the lateral ventricle, in 29.5% of 200 "normal" brains. Again, there were no significant sex and laterality differences. Accessory ventricles were never found in brains of fetuses or newborn babies. The youngest child in whom an accessory ventricle was found was 1 month old. No accessory ventricles were larger than 1 cm in diameter; they were slit-like, triangular or oval in shape. Histologically, they showed subtotal loss of the ependymal layer, subependymal gliosis, and/or fibrosis, and, in some cases, hyalinofibrotic capillary degeneration. Electron microscopy of the remaining ependymal cells in the accessory ventricle showed marked atrophy. Accessory ventricles are formed at the tip of the occipital horn postnatally through the expansion of the deep calcarine fissure, increase in brain volume in the region, and subsequent fusion of the mediolateral ventricular walls.

[Psychiatric symptoms of patients with chronic subdural hematoma]

Thirty-two cases with chronic subdural hematoma in adults were analyzed from two standpoints; one is the characteristics of pre- and post-operative psychiatric symptoms, the other is the common factors in patients with post-operative psychiatric symptoms. The average age of subjects was 55.4 years, and psychiatric symptoms were noticed in 18 cases (56%). Main pre-operative psychiatric symptoms were disorders of intellectual capacity including memory and orientation disturbance and were able to be classified into amnestic syndrome and dementia according to DSM-3. Outcome in amnestic group was good in contrast to that in dementia group mostly complicated by post-operative psychiatric symptoms. Post-operative psychiatric symptoms were seen in 6 cases. The average age of these cases was 68.2 years which was higher than that of asymptomatic group. And these were classified as dementia according to DSM-3. Common factors in these 6 cases were as follows: Accompanied by marked pre-operative psychiatric symptoms. High age. Complicated by post-operative subdural fluid collection with certain mass effects. Long period from head injury to operation. Accompanied by other complications such as cirrhosis of liver and hypertension. Subdural fluid collection following surgery is a problem under discussion. We obtained favorable results by subdural-peritoneal shunt.

Meningioma of the fourth ventricle: a case report

A rare case of meningioma located in the 4th ventricle is reported. The mass was successfully removed. The authors also review 14 reported cases of this type of tumor.

[Intracranial arachnoid cyst and porencephaly of the middle fossa--its clinical and neuroradiological study]

We reported four cases with well demarkated low density area in the middle cranial fossa, which was not enhanced with contrast medium and had the same absorption coefficient as the CSF. The operations and histological examinations revealed that two cases were arachnoid cysts and the others were porencephalic cysts. The clinicoradiological differential clues are listed below. 1) The porencephaly has intimate relation with focal neurological signs. 2) The thinning and bulging of the temporal bone are not a specific finding of an arachnoid cyst. Hemicranial atrophy, elevation of minor sphenoid wing and dilatation of paranasal sinuses in addition to focal bulging and thinning are indicative of porencephalic cyst. 3) Hemiatrophy of the brain and dilatation of the lateral ventricle on CT as well as the absorption coefficient of the brain surface facing the cyst are important finding of the porencephaly in differentiation. 4) The investigation of CSF dynamic is by no means helpful in differentiation between arachnoid cyst and porencephaly except intraarachnoid cyst. 5) The horizontal portion of the middle cerebral artery is not elevated in both two porencephalic cases. One of them showed a slight shift of anterior cerebral artery toward the affected side. An obstruction of the vessel is an important finding in porencephaly. 6) The electroencephalography can clearly demonstrate a porencephalic cyst as a localized slow focus, whereas it is not so remarkable in an arachnoid cyst.

[Computed tomography in hypertensive cerebellar hemorrhage (author's transl)]

Fourteen cases of cerebellar hemorrhage were analysed from the point of CT-scan, and the following results were obtained. 1. The number of cases of cerebellar hemorrhage forms 4.4% of that of total intracranial hemorrhage. 2. Most of the cerebellar hematomas extend upward. Downward extension is rare. 3. In acute dead cases hematomas are 5 cm or more in diameter and lie over bilateral hemistpheres with the extension to third or fourth ventricles in CT-scans. 4. Slowly progressive cases are deteriorated by the secondary hydrocephalus. 5. In mild cases hematomas are 3cm or less in diameter on CT-scans and the hematoma evacuation is not indicated for these cases. 6. The shunt operation alone is sufficient for the life saving of the slowly progressive cases, but the hematoma evacuation is indicated in these cases if the functional prognosis is taken into consideration. 7. Immediate hematoma evacuation together with the ventricular drainage is considered to be effective for the life saving of the acute fulminant cases.

Effects of age and sex on microsomal heme oxygenase and cytochrome P-450 content in liver of rats

Effects of age and sex on microsomal heme oxygenase activity and cytochrome P-450 content were investigated in Wister rats. Heme oxygenase activity declined with an increase in age, namely, its activity in 100 days old (young) rats was 58% in male and 72% in female rats as compared with respective 30 days old (immature) rats, and in 300 days old (old) rats it was 32% in male and 39% in female rats. In male rats, cytochrome P-450 content based on 100 g body weight decreased only in old rats as compared with immature rats, whereas a significant reduction was observed in female rats in the content based on mg microsomal protein as well as based on 100 g body weight in young and old animals. In littermate rats at the age of 56 days which obtained by in breeding in our laboratory, sex difference was apparent in heme oxygenase activity and cytochrome P-450 content, and further a good reciprocal correlation between that activity and content (r = 0.9730 in male, and r = -0.852 in female) was observed.

Age changes in the human kidney of the different races

Comparative study has been made histologically and micrometrically on the senile changes of the kidney between Caucasians and Japanese. In both races, weight loss of the kidney, decrease in number of the parenchymal cells and tendency to increase in size of the cells were considered to be main characteristics of the senile changes, but in the process of the senile changes some differences were noticed between the two races. The race differences may be partly due to the difference in the process of sclerotic changes of the intrarenal arteries. These differences have been discussed with special consideration to the nutritional conditions of the two races.