Mechanisms of vasodilation induced by vasoactive intestinal polypeptide in rabbit mesenteric artery

Vasoactive intestinal polypeptide (VIP; over 10(-13) M) inhibited the norepinephrine (NE)-induced contraction evoked from the rabbit mesenteric artery. Increased concentrations of VIP (over 10(-9) M) inhibited the contractions induced by caffeine and 39 mM [K]o. However, VIP (below 10(-7) M) had no effect on the membrane potential and resistance of muscle cells. In Ca-free solution, VIP (10(-10) M) inhibited the NE-induced contraction, but the second application of NE after removal of VIP enlarged the amplitude of contraction over that in the control. Yet when 10(-9) M VIP was applied, both the first and second contractions were consistently smaller than those observed by application of 10(-10) M VIP. In Na- and Ca-free solution, repetitive applications of NE generated contractions longer than those observed in Ca-free solution. When VIP (10(-10) M) was applied once (3 min), the contraction was inhibited only once during repetitive applications of NE. VIP (over 10(-9) M) dose dependently inhibited the NE-induced contraction and had a long-lasting inhibition after washout of the tissue. In saponin-treated skinned muscles, VIP (10(-7) M) had no effect on the Ca-induced contraction or on the Ca store sites. VIP (over 10(-8) M) was about 10 times more potent than equimolar concentrations of isoproterenol in increasing the content of adenosine 3', 5'-cyclic monophosphate (cAMP). These results indicate that VIP (10(-10) M) selectively inhibits the Ca release activated by NE, and high concentrations (over 10(-9) M) would expectedly increase the Ca extrusion from cells following increase in the levels of cAMP.

Giant cell tumor of the skull

Two cases of giant cell tumor of the skull are reported. The first patient had a radical operation for a giant cell tumor of the temporal base followed by radiation therapy. The second patient had a partial removal of a giant cell tumor of the occipital bone followed by radiation therapy. The pertinent literature on giant cell tumors originating from the cranial bones other than the sphenoid bone is reviewed.

The presynaptic regulation of noradrenaline release differs in mesenteric arteries of the rabbit and guinea-pig

Prejunctional control mechanisms of neuromuscular transmission in mesenteric arteries of the guinea-pig and rabbit were compared by examining excitatory junction potentials (e.j.p.s). The various agents used did not modify the membrane potential or resistance of smooth muscle cells of either tissue at the concentrations used in the present experiments. In the rabbit mesenteric artery, 10(-7) M-phentolamine and yohimbine had almost no effect on the amplitude of e.j.p.s or on facilitation. In the guinea-pig mesenteric artery, phentolamine enlarged and yohimbine reduced the amplitude of the first e.j.p. but both agents markedly enlarged the amplitude of e.j.p.s evoked by repetitive perivascular nerve stimulation at frequencies over 0.1 Hz. In the rabbit mesenteric artery, isoprenaline and dibutyryl cyclic AMP inhibited the e.j.p.s and the facilitation evoked by repetitive stimulation, while in the guniea-pig mesenteric artery, isoprenaline enhanced the amplitude of e.j.p.s and the facilitation process. In the rabbit mesenteric artery, ATP inhibited the amplitude of e.j.p.s with no change in facilitation and adenosine inhibited mainly the facilitation process evoked by repetitive perivascular nerve stimulation. In the guinea-pig mesenteric artery, these agents had no effect on e.j.p.s or facilitation. In both the rabbit and guinea-pig, indomethacin enlarged the amplitude and prolonged the duration of e.j.p.s. Prostaglandin E2 and F2 alpha inhibited the amplitude of e.j.p.s. Enlarged amplitudes of the e.j.p.s following pre-treatment with indomethacin were inhibited by treatment with PGE2 or ATP. In the rabbit mesenteric artery, 8-phenyltheophylline (an antagonist of P1 subtype of purinergic receptor) had no effect on the e.j.p.s, but these agents did reverse the inhibitory action of 2-chloroadenosine (an agonist of P1 subtype of purinergic receptor) or adenosine on facilitation of e.j.p.s. Theophylline did not have any direct effect on e.j.p.s nor did it reverse the effects of adenosine or 2-chloroadenosine. In the rabbit mesenteric artery, ATP and adenyl-imidophosphate showed much the same potency in inhibiting the amplitude of e.j.p.s. Therefore, the ATP action on nerve terminals is not due to a high energy requiring mechanism. From these results we conclude that the control mechanisms related to noradrenaline (NA) release in nerve terminals differ in the guinea-pig and rabbit mesenteric arteries.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of nifedipine derivatives on smooth muscle cells and neuromuscular transmission in the rabbit mesenteric artery

The effects of nifedipine and its derivatives, nisoldipine, nimodipine and nitrendipine, on smooth muscle cells and neuromuscular transmission were investigated in the rabbit mesenteric artery. These agents in concentrations of up to 2 X 10(-7) M modified neither the membrane potential nor the membrane resistance, yet did inhibit the spike potential evoked by direct muscle stimulation in the presence of TTX or by perivascular nerve stimulation. The inhibitory action of nitrendipine was weaker than that of the other derivatives. These agents had no effect on the miniature excitatory junction potentials (m.e.j.ps) and e.j.ps evoked by the first stimuli and after completion of the facilitation in a train stimulation. Nifedipine and its derivatives had no effect on the K-induced depolarization but did have a marked effect on the K-induced contraction. Nisoldipine showed the highest inhibitory potency for the K-induced contraction [IC50 was 1.2 X 10(-9) M for the 128 mM (K)o-induced contraction]. Noradrenaline depolarized the membrane (greater than 5 X 10(-7 M) and produced contraction (greater than 3 X 10(-7) M). The contraction evoked by high concentrations of noradrenaline was inhibited by these agents to a greater extent than that evoked by low concentrations. The contraction evoked by perivascular nerve or direct muscle stimulation was partly inhibited by nifedipine and its derivatives. The contraction elicited by Na-free solution was inhibited by these agents but the noradrenaline- or caffeine-induced contraction in Ca-free solution was not. These results indicate that in smooth muscle cells of the rabbit mesenteric artery, nifedipine and its derivatives inhibit the voltage dependent Ca-influx which occurs during the spike potential and in response to K-, electrically- or noradrenaline-induced depolarization. These derivatives appear to have no effect on the adrenoceptor operated Ca increase in myoplasm which occurs in the absence of depolarization at low noradrenaline concentrations. The derivatives act as Ca antagonists with a quantitative difference in potency, i.e. the strongest action was observed with nisoldipine and the weakest with nitrendipine.

Effects of adrenoceptor agonists and antagonists on smooth muscle cells and neuromuscular transmission in the guinea-pig renal artery and vein

In the guinea-pig renal artery and vein, the membrane potential was -66.8 mV and -46.8 mV, the length constant 0.54 mm and 0.43 mm, and the time constant 240 ms and 98 ms, respectively. The maximum slope of the depolarization produced by a 10 fold increase [K]o was 46 mV in the renal artery and 39 mV in the renal vein. Noradrenaline (NA over 5 X 10(-7)M in the artery and over 10(-7)M in the vein) depolarized the membrane and slightly reduced the membrane resistance, assessed from relative changes in the amplitude of electrotonic potential. The action of NA was suppressed by prazosin in the artery but by yohimbine in the vein, i.e. the alpha 1-adrenoceptor is present in the extrajunctional muscle membrane in the renal artery while the alpha 2-adrenoceptor is present in the renal vein. Dopamine and isoprenaline did not modify the membrane properties. In the renal artery, repetitive perivascular nerve stimulation (0.1 ms, 50 Hz, 5 shocks) evoked excitatory junction potential (e.j.p.). Applications of guanethidine (10(-6) M) or tetrodotoxin (3 X 10(-7) M) abolished the generation of the e.j.p.. Low concentrations of phentolamine (5 X 10(-7) M), prazosin (10(-7) M) and yohimbine (5 X 10(-7) M) enhanced the e.j.p. amplitude, while high concentrations of phentolamine (10(-5) M) and prazosin (greater than 10(-5) M) reduced the amplitude of e.j.p.s. NA, dopamine and clonidine consistently suppressed the amplitude of e.j.ps, at any given concentration over 10(-7) M. Spontaneous generated miniature e.j.ps (m.e.j.ps) were recorded on rare occasions. Phentolamine and yohimbine both at 5 x 10(-7) M and prazosin 10(-7) M increased the appearance of m.e.j.ps. 5 In the renal vein, repetitive nerve stimulation failed to generate the e.j.p. Sympathetic innervation to this tissue seems to be sparse. 6 Specificity of innervation and adrenoceptors present on smooth muscle cells in both the renal artery and vein are discussed, and the presynaptic regulation ofNA release is compared with findings in other vascular tissues.

Actions of isosorbide dinitrate on smooth muscle cells of rabbit vascular tissues

To investigate the mechanism of the anti-anginal actions of isosorbide dinitrate (ISDN), the effects of this agent on smooth muscle cells of intact and skinned preparations of the rabbit mesenteric artery and vein, and of the coronary artery were studied. ISDN (less than 10(-5) M) had no effect on the membrane potential or resistance of smooth muscle cells of the mesenteric artery and vein under resting conditions, nor when the membrane was depolarized by the presence of various concentrations of [K]o or noradrenaline (NA). The amplitude of spike evoked by outward current pulse after pretreatment with 10 mM tetraethylammonium (TEA) in the mesenteric artery was slightly inhibited by application of 10(-5) M ISDN. The K-induced and NA-induced contractions in the mesenteric artery were not affected by 10(-5) M ISDN, while those evoked in the mesenteric vein were inhibited in concentrations above 10(-6) M. The amplitude and facilitation of excitatory junction potentials evoked by perivascular nerve stimulation in the mesenteric artery were not affected by 10(-5) M ISDN. In skinned muscles, the free calcium concentration (pCa)-tension relationships observed in the mesenteric artery and vein were not affected by 10(-5) M ISDN. This agent had no effect on Ca accumulation into and Ca release from the stores in muscle cells of the mesenteric artery and vein, in skinned preparations. In the rabbit coronary artery, the membrane potential, resistance and spike evoked in the presence of 10 mM TEA were not affected by application of 10(-5) M ISDN. The contraction evoked by excess concentrations of [K]o was not affected. The contraction evoked by a low concentration of acetylcholine (3 X 10(-7) M) but by high concentrations (greater than 10(-6) M) was slightly inhibited by 10(-5) M ISDN. A tonic contraction induced in 39 mM [K]o was reduced by 10(-5) M nitroglycerine but not by 10(-5) M ISDN. Thus in rabbit vascular tissues, ISDN mainly acts on the venous system in vitro. The induced vasodilatation may lead to a reduction in the venous return and hence, reduce oxygen consumption in the cardiac muscles. This effect of ISDN may relate to the anti-anginal actions.

Effects of prostaglandin I2 and carbocyclic thromboxane A2 on smooth muscle cells and neuromuscular transmission in the guinea-pig mesenteric artery

1 In the guinea-pig mesenteric arteries neither prostacyclin (PGI(2)) nor carbocyclic thromboxane A(2) (cTxA(2)) affected membrane potential in concentrations below 1 x 10(-6) M. Increasing the concentration to 3 x 10(-6) M either slightly hyperpolarized or depolarized the membrane with little change in membrane resistance.2 At a concentration of 1 x 10(-7) M, the amplitude of the first e.j.p. and the enlarged amplitudes of the subsequent e.j.ps evoked by trains of stimuli were reduced consistently by PGI(2) or cTxA(2). Facilitation was unaffected by either agent.3 The inhibitory actions of PGI(2) were partly overcome by increased concentrations of 5 mM [Ca](o) and were accelerated by a reduced concentration of 1.25 mM [Ca](o).4 The amplitude of the contraction evoked by perivascular nerve stimulation was inhibited to a greater extent by PGI(2) than by cTxA(2) at concentrations below 1 x 10(-6) M.5 The contraction evoked by 5 x 10(-6) M noradrenaline (NA) or excess concentrations of 20.2 mM [K](o) was enhanced by 1 x 10(-8) M - 1 x 10(-6) M cTxA(2) and suppressed by 1 x 10(-8) M - 1 x 10(-6) M PGI(2). The minimum concentration of cTxA(2) required to produce the contraction was 1 x 10(-8) M.6 These results indicate that transmission at the neuromuscular junction was inhibited consistently by PGI(2) or cTxA(2), presumably due to inhibition of NA release by suppression of the Ca influx at the nerve terminals. Whereas PGI(2) inhibited, cTxA(2) enhanced the mechanical response by a direct action on the smooth muscle cells.

Modulation of noradrenergic transmission in the guinea-pig mesenteric artery: an electrophysiological study

We carried out electrophysiological experiments on guinea-pig mesenteric arteries in an attempt to clarify the modification of noradrenaline (NA) release from noradrenergic nerve terminals by the action of prejunctional adrenoceptors. NA (10(-7)-10(-5) M) suppressed the amplitude of the first excitatory junction potential (e.j.p.(f], the facilitation process, and the e.j.p. after facilitation was completed (e.j.p.(s]with no change in the post-junctional membrane properties of smooth muscles. These actions of NA on e.j.p.s were antagonized by high concentrations of extracellular Ca, [Ca]o, but not in a simple competitive manner. NA (10(-7) M) suppressed the appearance but not the amplitude of the miniature e.j.p.s. These effects of NA on transmission indicate that NA acts on prejunctional nerve terminals and suppresses the release of NA from nerve terminals rather than producing a desensitization of post-junctional adrenoceptors. Prazosin and phentolamine (10(-6) M) did suppress the NA-induced contraction (greater than 10(-6) M) but did not suppress the contraction evoked by perivascular nerve stimulation, below a frequency of 1.0 Hz. At a dose of 10(-7) M, yohimbine, clonidine, prazosin and phentolamine had no effect on the muscle membrane potential and resistance. Yet on the e.j.p.(f), yohimbine and clonidine caused suppression, phentolamine enhancement and prazosin had no effect. On the e.j.p.(s), yohimbine and phentolamine caused enhancement, clonidine suppression and prazosin had no effect. These results indicate that at least three different adrenoceptors are distributed on the neuromuscular junction in this tissue, i.e. alpha 1-extrajunctional, alpha 2-prejunctional, and an unknown subtype of intrajunctional adrenoceptors. Furthermore, the feedback mechanism on NA release is mediated by suppression of the influx of Ca. Nonselective and non-specific actions of alpha-adrenoceptor agonists and antagonists were also elucidated.

[Secondary empty sella syndrome: report of three cases and review of the literature]

Three cases of the secondary empty sella syndrome were reported. Case 1. A 57-year-old female was admitted to our clinic because of recurrent visual disturbance. Fourteen years previously a pituitary adenoma was diagnosed and two courses of radiation therapy was given elsewhere, the total dosage being unknown. Pneumoencephalography revealed air collection in the sellar cavity. Exploratory craniotomy demonstrated an empty sella with downward migration of the optic nerve and chiasm. Case 2. A 40-year-old female was readmitted to our clinic for possible recurrent pituitary adenoma. Three years previously she underwent transsphenoidal surgery and postoperative radiation therapy with a tumor dose of 6,400 rad. She had headache and visual disturbance. Pneumoencephalography showed air extension into the sellar cavity. Case 3. A 50-year-old female was readmitted to our clinic because of general prostration and headache. Ten years previously she received transsphenoidal surgery and postoperative radiation therapy with a tumor dose of 6,650 rad for a pituitary adenoma. Endocrine evaluation revealed a hypopituitarism. Pneumoencephalography showed air extension into the sellar cavity. The etiology of secondary empty sella has not been clarified yet, although the primary empty sella has been considered to result from incomplete development of the diaphragma sellae. We consider that the most important factor should be present in the diaphragma itself. It is conceivable that the diaphragma sellae becomes weak due to 1) compression by the tumor, 2) mechanical injury during operation, 3) radiation effect. Then, these preceding factors might bring about herniation of the optic nerve and chiasm with the diaphragma sellae into the sellar cavity. Therefore, we propose that early diagnosis of pituitary tumor should be important, and that careful packing of the sellar floor at transsphenoidal surgery should be essential to prevent occurrence of the secondary empty sella syndrome.

Intracranial double teratomas

A case of double teratomas located in the pineal region and the fourth ventricle is presented. A simultaneous occurrence from nonmetastatic, separate origins seems rare in cases of mature teratomas. Computerized tomographic scans led to detection of another asymptomatic teratoma. Surgical treatment produced good results.

[A case of hemangioma calcificans (author's transl)]

A 32-year-old male, who had had temporal lobe seizure for the past 10 years, was admitted to the neurosurgical institute of Tenri Hospital on March 10, 1981. Physical examination on admission revealed some memory disturbance, neuroasthenic tendency and a purplish nevus in the left foot. Plain x-ray series of the skull showed several nodular calcified lesions in the medial aspect of the left temporal lobe. Electroencephalography showed sporadic negative spikes and irregular slow waves dominant in the left anterior quadrant of the head. CT scan showed a high-density area in the left hippocampal gyrus with slight enhancement by contrast medium. Under stereotactic consideration, a left temporal osteoplastic craniotomy and total removal of the mass were performed on March 20, 1981. The histological examination proved it to be calcified cavernous hemangioma or hemangioma calcificans after Penfield and Ward (1948). Postoperative course was uneventful; even 4 weeks after surgery, electroencephalogram became normalized, and memory and anxiety scores became better. At present, in spite of decreased anticonvulsant, the patient has had no more seizure since surgery, and has returned to his business without any complaint. The authors have emphasized the necessity of active operation for hemangioma calcificans even for the one located in the depth of the dominant cerebral hemisphere. Stereotactic consideration can make the surgical risk minimize. CT scan especially with its contour plot of the images is helpful precisely to locate the lesion. For the nevus in the left foot, the biopsy was refused by the patient, which might have connection with the intracerebral cavernous angioma.

[Three cases of arachnoid cysts associated with chronic subdural hematoma (author's transl)]

The association of arachnoid cyst of the middle cranial fossa and subdural hematoma has been emphasized previously but is not common knowledge. We present three cases of arachnoid cyst of the middle cranial fossa and associated chronic subdural hematoma. The importance of computed tomography for the diagnosis of arachnoid cyst associated with the hematoma is emphasized. Pathogenesis of arachnoid cyst and the hematoma remain uncertain. However histological findings suggested that subdural CSF collection might be important to develop hemorrhagic outer membrane of the chronic subdural hematoma.

Modulation on neuromuscular transmission by endogenous and exogenous prostaglandins in the guinea-pig mesenteric artery

1. At concentrations of 2.8 x 10(-8)-2.8 x 10(-6) M, prostaglandins (PGs; PGE(1), PGE(2) and PGF(2alpha)) had no effect on membrane potential and resistance of smooth muscles of the guinea-pig mesenteric artery. PGs (2.8 x 10(-8) M) suppressed the contraction evoked by perivascular nerve stimulation, but did not suppress the contraction evoked by direct muscle stimulation.2. PGs (2.8 x 10(-8) M) suppressed the e.j.p.s evoked by repetitive perivascular nerve stimulation but preserved the facilitation process of e.j.p.s evoked by any given stimulus frequency (0.1-1.0 Hz).3. The relationships between e.j.p. amplitudes and [Ca](o) plotted on log scales in the presence or absence of PGE(2) were not parallel. High concentrations of [Ca](o) prevented the inhibitory actions of PGs on the amplitude of e.j.p.s.4. PGE(2) did not suppress the activity of nerve fibres contributing to the generation of e.j.p.5. Indomethacin (10(-6) M) enhanced the amplitude of e.j.p.s and the frequency of miniature e.j.p.s with no change in the membrane potential and resistance of smooth muscles; these actions of indomethacin were suppressed by PGE(2) (2.8 x 10(-8) M).6. Phentolamine (10(-7) M) enlarged and yohimbine (10(-7) M) reduced the amplitude of the first e.j.p. evoked by a train stimulation, but the maximum amplitude of e.j.p., after the facilitation was completed, was in both cases much larger than that observed in the control. The enhancement of the transmission process was also suppressed by PGs (2.8 x 10(-8) M).7. The results indicate that in the guinea-pig mesenteric artery, PGs mainly suppress chemical transmitter release from nerve terminals due to interactions with Ca influx, but not due to interaction with presynaptic alpha-adrenoceptors. Endogenous PG may act as a regulator substance in neuromuscular transmission.

Synergistic effect of chlorpromazine and alkanals on the human red blood cells

The hemolysis of human red cells in the presence of chlorpromazine and 2-methylpropanal, or propanal, has been studied by a spectrophotometric method. A strong synergistic effect was observed concomitant to the quenching of photon emission. The synergistic effect is consistent with the view that triplet excited species generated from a hemoprotein-catalyzed aerobic oxidation of aldehydes promotes "in situ" the photooxidation of chlorpromazine leading to products which have shown hemolytic effects. This view is supported by protection, albeit weak, offered by energy acceptors such as eosin and the 9,10-dibromoanthracene-2-sulfonate ion.

[Two cases of the diencephalic syndrome were reported with hormonal studies (author's transl)]

Two cases of the diencephalic syndrome were reported with hormonal studies. The first case was initially admitted at her age of 4 years and 10 months old. Progressive visual disturbance and horizontal nystagmus had developed one year prior to the admission. Her weight gain had stopped since 10 months old. Partial removal of the hypothalamic pilocytic astrocytoma and 5,000 rad of lineac radiotherapy brought satisfactory effects on her previous symptoms. She was readmitted, however, at her age of 8 years and 10 monts old because of precocious puberty. Her breast development was in Tanner's grade 2, and her bone maturation was equivalent to one of 11 years old. Hormonal studies showed decreased urine 17-OHCS and 17-KS, elevated serum LH, E1 and E2. The CT scan disclosed some enhanced area in the vicinity of the optic chiasm, which had not changed for the last one year. The second case was admitted at his age of 10 years and 9 months old because of progressive marked emaciation of 6 months' duration. Parinaud's sign was only positive neurological finding. The CT verified enhanced areas in the pineal and chiasm. Cytological study of CSF gave the diagnosis of germinoma. Hormonal studies showed decreased urine 17-OHCS and 17-KS, decreased T3, T4, ACTH, and increased PRL as well as increased HGH. Local lineac irradiation by 5,500 rads was given, during which the enhanced area in CT disappeared and his weight gain started. Increased HGH became normalized but paradoxical response of HGH to GTT remained same.

[Case report of acute central cervical cord injury with C7 laminar fracture and extradural hematoma (author's transl)]

A 57-year-old epileptic male with an acute central cervical cord injury was reported, who fell down from 2.5 meter height to a dry river bed presumably during a convulsive seizure. Upon physical examination at the time of admission, 4 hours post trauma, there were severe neck pain with limited neck motion, sensory level at C4 bilaterally, no motion at all in the upper extremities, and minimal motion in the lower extremities as well as apparent urinary retention. Plain cervical spine series showed moderate posterior osteophytes at C4--C5 and C5--C6, although the film of lateral view did not visualize a part of C7 well. After 4 days' clinical observation, a myelography was done at lateral cervical approach between C1 and C2, which showed a complete block at C3. Urgent laminectomy C3 through C7 showed a fracture of the C7 spinous process extending to the bilateral lamina and an extradural hematoma from C3 to C7 with thickness of 3 to 5 mm. Neither pial incision nor dorsal myelotomy was performed because of no remarkable swelling of the cord. Post-operative course was uneventful, the patient recovering first the motion in the lower extremities, urinary retention, and motion in the upper extremities. At 10 months' follow-up after the operation, he could take care of himself in dressing, eating and toileting, although he had had residual motor disturbance in his hands and fingers especially in fine finger movements. It was keenly felt important to visualize C7-T1 in roentgenograms of lateral cervical view in cases of acute cervical injury, for which swimmer view and/or tomogram might be necessary. Queckenstedt's test was criticized as a dangerous maneuver in such case but C1--C2 myelography is considered safer and more informative. Literature on the acute central cervical cord injury were reviewed.

Extradural nasal and orbital extension of glioblastoma multiforme without previous surgical intervention

A case of extradural nasal and orbital extension of a glioblastoma multiforme in the absence of previous surgical intervention is presented. Such penetration by a glioma is rare due to the natural resistance of the dura mater.

[Electron-microscopic study of the arachnoid cyst (author's transl)]

The primary arachnoid cyst developed on the left middle cranial fossa of 5 year-old girl was examined with electron-microscope and discussed its pathogenesis. The cyst wall was mainly composed of two distinct layers, one was compact arranged flattened cells and others loosely arranged of collagen fibers and fibroblast. Various junctions were observed between those cells. Those features were similar to that was seen in normal arachnoid membrane. However, the abundant attenuated cell processes, whole formation and psammoma body were observed in cyst wall. Those finding suggested the cyst was congenital arachnoid malformation, resulting from abnormal proliferation of developing arachnoid cells.

[A case of intracranial germinoma with multiple remote metastases (author's transl)]

A case of suprasellar germinoma with multiple remote metastases was reported including its autopsy findings. Several series of radiation therapy and prolonged steroid administration were considered to be causes of immunosuppression bringing about such metastases. A 29-year-old man had undergone a suprasellar germinoma removal and 5,200 rad of postoperative local irradiation at a university hospital 5 months prior to the admission to our clinic. A walnut-sized left cerebellopontine angle mass was subtotally extirpated by us, which proved to be germinoma. Total dosis of 5,5550 rad with lineac was applied locally to the operated site. Since the second surgery, several nodules had been seen in the lumbosacral region, scalp and left cervical region, which were individually treated with lineac and beta-tron by 5,000, 6,000 and 4,750 rad. The patient had been on steroid substitution therapy for hypopituitarism since the first operation. Eventually the patient expired 9 months after the second operation. Autopsy findings included multiple metastases to the spinal arachnoid, dura, extradural space, spines, scalp, thoracic cage, lymph nodes, heart, lungs, liver, kidney, adrenal and pancreas. Nine cases including ours were reviewed as remote metastases of the tumors in the pineal region and of so-called ectopic pinealomas. The cases of only subarachnoid seeding of these were excluded in this study.

Spinal epidural meningioma in childhood

A spinal epidural meningioma in a 14-year-old boy is presented and the literature reviewed. He had several café-au-lait spots and had previously had a subcutaneous lipoma removed from the mid-lumbosacral region.

[A case of Maffucci's syndrome with intracranial chondroma (author's transl)]

A rare case of Maffucci's syndrome with intracranial chondroma was reported and the literature reviewed. A 16-year-old female high-school student was reffered to our service with 2 month history of diplopia and headache. She had been noticed to have multiple subcutaneous blueish nodules in the lower extremities and multiple body deformities in the four extremities since 6 months old. A biopsy of a skin lesion revealed cavernous hemangioma with calcified thrombi. Another biopsy from the deformed right femur showed it to be enchondroma. Skull series, carotid and vertebral arteriographies, and CT scan revealed a left parasellar mass, which had brought her sensory impairment of the left V1 and the left abducens palsy. The biopsy of the extradural mass in the medial portion of the left middle fossa proved it to be chondroma identical with the right femur lesion. So far as one year postoperative follow-up, she has been doing well with the postoperative sequela of mild left oculomotor paresis, having no evidence of malignant degeneration.

[Diagnosis of abnormal spine motion with cineradiography (author's transl)]

For the past one year, 13 patients were studied 20 times with cineradiography to diagnose abnormal spine motion, which was quite informative compared to usual plain spine X-ray pictures. The direct radiation dosis was only 2.35 rem/min on taking cineradiography at the speed of 60 frames/sec. The camera used was Cardoskop-U and the X-ray generator was Pandoros Optimatic, both of which were of Siemens make. It was keenly recognized that cineradiography was useful to diagnose 1) solidity of spine fusion, 2) effect of spinal traction, 3) efficacy of immobilizing apparatus for spine and 4) abnormal spine motion on dynamic way.

Arteriovenous malformations in the posterior fossa

We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Enlarged anterior spinal artery as collateral circulation

✓The authors report and discuss two cases in which collateral circulation could be angiographically demonstrated passing through the anterior spinal artery. Case 1 proved to have occlusions of the left internal carotid artery and both vertebral arteries. The basilar artery was visualized via the anterior spinal, the primitive trigeminal, and primitive otic arteries. The presence of multiple vascular malformations and an abnormal anterior spinal artery suggested that the latter had been functioning as collateral circulation since an embryonic stage. In Case 2, both internal carotids and both vertebral arteries were occluded by arteriosclerotic changes. It was assumed that the deleted anterior spinal artery visualized angiographically had developed into a collateral circulation with increasing age.