CT findings in patients with gliomas, surviving more than 10 years

After reviewing the latest CT scans of 23 mostly low grade glioma patients who survived more than 10 years after treatment, it was suggested that loss of the original tumour bulk and frequently the presence of porencephalic cavity replacing the original tumour, with a smooth lining which is not contrast-enhanced is essential to assume a clinical "cure" in the case of intrinsic cerebral gliomas. In the case of gliomas growing within the ventricle or subarachnoid space, tissue with calcium deposit but without contrast-enhancement was noted, although the number of cases was limited.

[An arachnoid cyst in the left lateral ventricle]

Generally arachnoid cysts are congenital in origin and found over the cerebral convexity, in the major fissures, and in the folded portions of the brain wherever the arachnoid membrane extends. Including other central nervous system (CNS) cysts, the location of these cysts has implications as to their origin, for examples, intracerebral cysts generally are ependymal cysts, while extracerebral cysts are mostly arachnoid cysts. An 8-month-old boy was admitted to our department because of enlarged head and developmental retardation. Computerized tomographic scan (CT) revealed remarkable hydrocephalus and a relatively high-dense, round lesion between the lateral ventricles. During surgery the cyst was found to arise from the left ventricular floor. Histologically the cyst wall was arachnoid membrane.

[Immunohistochemical study of ischemic neuronal damage with antiserum to tubulin, a microtubular protein]

The limitation of conventional histological methods to demonstrate ischemic change of neurons in early phase has been a major drawback in histopathological and pathophysiological studies of cerebral ischemia. Cellular metabolism is disturbed immediately after cessation of the regional circulation and rapid alterations in macromolecular and ultrastructural integrity in neurons may take place before any evidence of histopathological changes could be detectable. To demonstrate ischemic change of neurons more sensitively on a histological level, we applied immunohistochemical method using antiserum to tubulin, a protein of microtubules. As this organelle has been implicated in several important cellular functions such as control of cell shape, intracytoplasmic transport of materials or synaptic transduction, immunohistochemical alterations in microtubules may indicate structural as well as functional damage of neurons. In order to study the ischemic change in neurons, the posterior communicating artery of a gerbil brain was occluded by the method previously reported by us, and the hippocampus, which is one of the most vulnerable structures of the brain to ischemia, was observed. Five or 30 minutes after occlusion, animals were sacrificed by decapitation. Brains were removed, cut coronary vessels and fixed in ethanol-acetic acid (95:5). Tubulin used for this study was extracted from normal gerbil brains and specific antiserum was raised in goats Peroxidase-antiperoxidase method was performed on paraffin sections. Immunohistochemical distribution of tubulin in a normal gerbil brain demonstrated by the present method was in good accordance with the reported electronmicroscopical distribution of microtubules.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sellar fibrosarcoma following radiotherapy for prolactinoma]

A 51-year-old house woman visited the Department of Neurosurgery, Osaka University Hospital for examination of the head injury on Oct. 7, 1975. Neurological examination was normal. Endocrinological examination showed galactorrhea. The patient had a past history of premature menopause. Plain skull films revealed enlargement of sella turcica and CT scan showed sellar tumor with suprasellar expansion which was enhanced by contrast medium. The serum prolactin (PRL) level was 3,290 ng/ml. Diagnosis of PRL secreting pituitary adenoma (prolactinoma) was made. Though surgical removal of the tumor was recommended, it was refused by the patient. Therefore, careful observation was continued as an out-patient until May 1979 when she noticed a temporal hemianopsia of her left eye. She was admitted and had partial removal of the tumor via frontal route and subsequent irradiation (total dose of 5,000 rad by Lineac). The tumor was verified to be a prolactinoma by the immunohistochemical staining. Postoperative course was uneventful and she lead a normal life. In Oct. 1981, severe faceache began and she was readmitted. Sella was destructed extensively and CT scan revealed a hugh sellar tumor with multi-directional extrasellar extension which was less enhanced than that of the first study. The serum PRL level was 588 ng/ml and the regrowth of prolactinoma was suspected. High dose bromocriptine (40 mg/day) therapy was started. The serum PRL level rapidly fell to the negligible value, however, shrinkage of the tumor was not observed. On Jan. 20, 1982, suddenly she developed a left hemiparesis and her level of consciousness gradually deteriorated. On Mar. 11, 1982, the second operation was performed and a solid firm tumor in the base of the skull was partially removed. The tumor was histologically verified to be a fibrosarcoma. After the second operation bromocriptine therapy was discontinued, however expected elevation of the serum PRL level was not recognized. She died on Apr. 4, 1982.

[Enhanced effect of reserpine on growth-inhibitory action of ACNU on ACNU resistance C6 glioma]

Reserpine was found to enhance the effect of ACNU on ACNU-resistant C6 glioma (C6/ACNU). When reserpine was added to the culture medium at the concentration of 10 microM, the IC50 of ACNU for C6/ACNU was decreased to the level of that for C6. Intracellular uptake of ACNU increased in both resistant and sensitive cells when 10 microM reserpine was added to the culture medium. This phenomenon is more remarkable in C6/ACNU than in C6.

[Local blood flow and capillary permeability in the experimental meningeal carcinomatosis]

Local blood flow and capillary permeability of the rats with meningeal carcinomatosis were studied with macroautoradiography, and relationship between blood flow, permeability and effects of chemotherapy is discussed. Experimental meningeal carcinomatosis was induced in the Wistar rats by inoculating Walker 256 tumor into cisterna magna. One to 12 days after inoculation, rats were used for measurements of blood flow (by 14C- iodoantipyrine) and capillary permeability (by 14C-alpha-aminoisobutyric acid). Images of autoradiography and corresponding histological appearances were analyzed. In the early stage of tumor growth (2 to 3 days after inoculation), a few layers of tumor cells were identified in the ambient cistern. Blood flow in the vicinity of the tumor cell layer was noted, but no increase in capillary permeability was found. In the middle stage of tumor growth (3 to 5 days after inoculation), 10 to 20 layers of the tumor cell was noted in the ambient cistern. Blood flow in the tumor was evident and capillary permeability began to increase. In the late stage of tumor growth (6 to 12 days after inoculation), a mass of the tumor cells was noted in the ambient cistern. In this stage, blood flow in the tumor was similar to that of cerebral gray matter and capillary permeability increased markedly. Brain adjacent to the tumor also showed increase in capillary permeability. The result correlated well to the previous result of experimental chemotherapy. Form those data, lipid soluble drugs which cross blood-brain barrier readily are recommended for the early stage of meningeal carcinomatosis, and water soluble drugs which has limitations to cross blood-brain barrier can not be recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

[Meningeal gliomatosis models as a chemosensitivity assay system]

Experimental models of meningeal gliomatosis (MG) have been produced by intracisternal inoculation of C6 and 9L glioma cells into Wistar and Fisher 344 rats, respectively. Chemotherapy of these models and in vitro chemosensitivity assay for these cell lines were studied with ACNU, BCNU and VM-26. In vitro chemosensitivity assay revealed that 9L cells were sensitive to all of the anticancer drugs above, and that C6 cells were resistant to ACNU and BCNU, but not to VM-26. In vivo experiment, the survival time of the rats inoculated with 9L glioma cells (9LMG) was prolonged by both ACNU and BCNU but not by VM-26. None of these drugs were effective against the rats inoculated with C6 glioma cells (C6MG). It is concluded that the result of in vitro chemosensitivity assay is not always correlative with that of in vivo. This implies that an in vivo chemosensitivity assay system including MG models is indispensable in researching into chemotherapy of brain tumor.

[Primary culture of human functioning pituitary adenoma in monolayer and collagen gel culture]

Human functioning pituitary adenomas (3 acromegalies, 3 prolactinomas) obtained at transsphenoidal hypophysectomy were dispersively embedded inside collagen gels and subjected to the conventional monolayer culture in Eagle's MEM medium containing fetal bovine serum. Basal secretion of growth hormone (GH) and prolactin (PRL) in the media of monolayer and collagen gel cultures were measured by radioimmunoassay (RIA) for 5 weeks. GH secretion in the culture media was initially high in all cases with acromegaly in both monolayer and collagen gel cultures. GH secretion in monolayer culture declined rapidly almost as a straight line on a semilogarithmic scale until 5 weeks, when GH level decreased around 10 ng/ml. GH secretion in collagen gel culture was preserved more than in monolayer culture, but declined slowly up to about 500 ng/ml within 5 weeks. PRL secretion in monolayer culture initially declined rapidly until 1 week, but after then remained constant or decreased slowly. In the other hand, PRL secretion in collagen gel culture remained almost constant for up to 5 weeks. It is concluded that this new culture method may provide suitable conditions for maintenance of the adenomas cells in vitro.

Effects of methylprednisolone on peritumoral brain edema. A quantitative autoradiographic study

Peritumoral brain edema was produced by intracerebral transplantation of Walker 256 tumor in rats. Local cerebral blood flow (LCBF), local cerebral glucose utilization (LCGU), and capillary permeability were studied in untreated and methylprednisolone-treated rats by quantitative autoradiography. In the untreated group, LCBF and LCGU were widely depressed in the cortex and deep structures of the hemisphere ipsilateral to the tumor. In the methylprednisolone-treated animals, LCBF and LCGU were significantly better than in the untreated animals. Capillary permeability was highly increased in the viable part of the tumor in the untreated animals. In the methylprednisolone-treated group, capillary permeability of the tumor was significantly lower than that in the untreated group. These results may suggest that increase in capillary permeability of the tumor is the major source for edema fluid production, and that methylprednisolone improves brain edema by decreasing capillary permeability of the tumor. Decrease in edema fluid formation may result in restoration of blood flow and glucose metabolism in the adjacent brain tissue, and may improve clinical symptoms and signs.

[Germ cell tumor in the basal ganglia with elevated serum and CSF alpha-fetoprotein levels]

Intracranial germ cell tumors usually locate either in the pineal region or in the suprasellar region or both. Primary occurrence of germ cell tumor in the basal ganglia is rare. To our knowledge, only 17 cases have been reported in the literatures, and all the patients were Japanese. None of these patients presented elevated serum and CSF AFP levels in the literatures. We are reporting a patient with a germ cell tumor which developed in the left basal ganglia and showed high serum and CSF alpha-fetoprotein (AFP) levels. The patient was a 12-year-old boy who had been completely well until five months prior to the first admission when he developed weakness of right extremities. On admission he showed a right hemiparesis of mild degree and right hypesthesia. CT-scans demonstrated a homogeneous high density area over the caudate head and the putamen on the left side. The anterior limb of the left internal capsule and a part of the posterior limb were also involved. The lesion was moderately enhanced by the contrast medium. Stereotaxic biopsy of the lesion was uncontributory and he was discharged for follow up. Five months later, CT-scans demonstrated the enlargement of the high density area with perifocal edema. Then we performed a craniotomy, and the tumor which was soft and dark red in colour was biopsied at the wall of the anterior horn of the left lateral ventricle. Histopathology of the specimen showed germinoma of two-cell pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of the blood-brain barrier in experimental metastatic brain tumors

An experimental model for blood-borne cerebral metastases was developed by introducing Walker 256 carcinoma cells selectively into the intracranial internal carotid artery of rats. This model was used to study the regional capillary permeability of rat brain and metastatic brain tumors of various sizes with the aid of 14C alpha-aminoisobutyric acid (AIB) quantitative autoradiography. The regional capillary permeability varied with the anatomical location and size of the tumor. Intraparenchymal tumors less than 1 mm in diameter showed no increased permeability to AIB. As the tumors enlarged over 1 mm in diameter, the permeability in the intraparenchymal tumors increased proportionally, but remained less than one-third of capillary permeability of subcutaneously transplanted tumors. Capillary permeability in the peripheral invasive part and necrotic center was less than in the viable part of large tumors. Capillary permeability in metastatic tumors of the choroid plexus and meninges was significantly higher than in tumors of the brain parenchyma. The results suggest that the uptake of chemotherapeutic agents that do not cross the blood-brain barrier easily varies with the anatomical location and size of the metastatic tumors.

[Effects of methylprednisolone on tumor-induced brain edema]

Local cerebral blood flow (LCBF), local cerebral glucose utilization (LCGU) and capillary permeability were studied in rats with tumor-induced brain edema. Moreover, effects of methylprednisolone on these physiological parameters were studied to analyse a possible role of steroid on treatment of peritumoral brain edema. A cubic millimeter pellet of Walker 256 tumor was transplanted to the left sensorimotor cortex of the rat brain. Animals were randomly divided into two groups. One group was treated with methylprednisolone (15 mg/kg/day) for 5 days starting at 5 days after tumor inoculation, and the other group received no treatment. These rats were used for autoradiographic study at 10 days after tumor inoculation. Local CBF, LCGU and capillary permeability were measured with 14C-iodoantipyrine, 14C-deoxyglucose and 14C-alphaaminoisobutyric acid, respectively. In the untreated group, LCBF and LCGU were widely depressed in the cortex and deep structures of the hemisphere ipsilateral to the tumor. Of the methylprednisolone treated animals LCBF and LCGU were significantly better than that of untreated animals. Capillary permeability of the untreated animals were highly increased in the viable part of the tumor. Some increase was also noted in the peripheral edge of the tumor and adjacent brain. In the methylprednisolone treated groups, capillary permeability was significantly lower than that in untreated group. The data suggest that methylprednisolone decreases capillary permeability in the viable part of the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Biphasic occurrence of delayed ischemia after early aneurysm surgery. Case report

An unusual case of delayed ischemia following rupture of an aneurysm of the left internal carotid artery is reported. Symptoms occurred twice after clipping the aneurysm and removing most of the subarachnoid blood on the left side the day after subarachnoid hemorrhage (SAH). Initial ischemia due to vasospasm occurred on the left side of the brain on the 8th day after SAH and responded favorably to induced hypervolemia. After complete recovery, a second episode due to vasospasm occurred on the 16th day after SAH on the right side of the brain from which the subarachnoid blood had not been removed. This caused a massive lesion and permanent severe neurological deficits. This case suggests that removal of subarachnoid blood may affect the severity and time course of vasospasm, and emphasizes the necessity of extensive removal of subarachnoid blood for prevention of severe delayed ischemic symptoms.

[Intracranial hypertension]

Intracranial hypertension is caused by various pathologic processes. From oncologic point of view, they are 1) intracranial space-occupying lesions, especially malignant tumors, 2) leptomeningeal tumors, 3) hemorrhage in the brain tumors, 4) intracranial hemorrhage due to hemorrhagic diathesis related to the malignant tumors, and 5) cerebral thrombosis or embolism due to increased blood coagulability secondary to malignancy. In the increase of intracranial pressure, brain edema or disturbance of cerebrospinal fluid (CSF) circulation due to the presence of brain tumors play more important role than the tumor bulk itself. CT scan is useful for demonstrating the process causing the intracranial hypertension. Therapeutic measures in all patients with increased intracranial pressure are initiated promptly to restore the cardiopulmonary dysfunction if any. Hyperventilation and intravenous infusion of hyperosmolar agents such as mannitol and glycerol have an immediate effect in reducing intracranial pressure when brain edema plays role in increasing it. Steroids are also very effective in reducing brain edema; the effect is less immediate but long lasting. CSF drainage or shunt operation is necessary when dilated ventricular system plays role in the intracranial hypertension. The radical treatment of the intracranial hypertension is a removal of the tumor causing it; however, if not indicated, the second choice is the internal or external decompressions. Postoperative radiotherapy and chemotherapy are also indicated for the malignant brain tumors.

Distribution of bleomycin in ethylnitrosourea-induced gliomas in rats

We used a microbioassay to study the distribution of bleomycin in rat brain tumors induced in newborn Sprague-Dawley rats with 1-ethyl-1-nitrosourea (ENU, 50 mg/kg s.c.). Upon suspected successful tumor induction bleomycin (0.1 g/kg i.v.) was administered, and 2 hr later bleomycin concentrations in major organs and tumor tissues were bioassayed using Bacillus subtilis PCI 219 IMC. To determine their histology, the tumors were stained by the immunofluorescence- or immunoperoxidase method using antiserum to astroprotein in addition to the conventional staining methods. There were 11 gliomas each of the brain and spinal cord, 14 schwannomas of the trigeminal nerve and 4 adenomas of the pituitary gland; they developed within 8 (gliomas), 7.3 (schwannomas) and 15 (adenomas) months on average after ENU treatment. The bleomycin concentration and the tumor:plasma concentration ratio were 7.69 +/- 2.84 micrograms/g and 0.13 +/- 0.05 (brain gliomas), 7.10 +/- 3.15 micrograms/g and 0.27 +/- 0.12 (spinal cord gliomas), 5.40 +/- 1.41 micrograms/g and 0.23 +/- 0.05 (schwannomas), 4.83 +/- 1.05 micrograms/g and 0.21 +/- 0.08 (adenomas). Normal brain- and spinal cord tissues scarcely contained bleomycin.

Quantitative autoradiographic measurements of blood-brain barrier permeability in the rat glioma model

Quantitative autoradiographic technique was applied in measuring blood-brain barrier (BBB) permeability of autochthonous gliomas in rats. In small tumors (less than 2 mm in diameter), no increase in BBB permeability was noted. As the tumor grew and neovascularization occurred, BBB permeability increased in the center of the tumor, and it was suggested that the BBB was partly disrupted in the neovascularized vessels. In the fully grown tumors, BBB permeability was markedly increased in the viable part of the tumor to levels similar to the choroid plexus. Yet, the BBB was partly preserved at the periphery of the tumor and in the brain adjacent to the tumor. The heterogeneity of the BBB phenomenon according to the stage of tumor growth may be a major obstacle for uptake of chemotherapeutic drugs that do not cross the BBB easily.

[Combined effect of intravenous hyperalimentation and chemotherapy on experimental meningioma]

Combination effects of intravenous hyperalimentation (IVH) and chemotherapy were studied in rats with meningeal carcinomatosis. Sprague-Dawley rats were inoculated intracisternally with 1 X 10(4) Walker 256 carcinosarcoma cells. Animals were divided into five groups of 10 to 12 animals per group: 1) no treatment; 2) cyclophosphamide 30 mg/kg i.v. at 5 days after tumor inoculation (Day 5); 3) IVH (Day 5 to Day 10); 4) cyclophosphamide (Day 5) and IVH (Day 5 to Day 10); and 5) cyclophosphamide (Day 5) and IVH (Day 10 to Day 15). The group of IVH alone reduced survival time significantly (p less than 0.001) compared with no treatment group. Cyclophosphamide alone increased survival time significantly (p less than 0.001) in comparison with no treatment group. Combination of cyclophosphamide (Day 5) and IVH (Day 5 to Day 10) did not prolong survival time compared with cyclophosphamide alone. However, IVH (Day 10 to 15) in combination with cyclophosphamide (Day 5) prolonged survival time significantly (p less than 0.001) in comparison with cyclophosphamide alone. Mean body weight was reduced maximally at 5 to 10 days after cyclophosphamide injection. However, no reduction of body weight was noted while animals were on IVH. The present data appears to indicate that IVH may reduce the side effects of cyclophosphamide and may prolong the survival time.

[Local cerebral glucose utilization in the ethylnitrosourea-induced rat glioma]

Local cerebral glucose utilization (LCGU) of anesthetized rats bearing ethylnitrosourea (ENU)-induced gliomas was studied with 14C-deoxyglucose autoradiography. Single subcutaneous injection of ethylnitrosourea (50 mg/kg) was made to the newborn rats, and animals were used for experiment at 150 to 300 days after birth. Under ketamine anesthesia, 14C-deoxyglucose was injected through a venous catheter, and timed arterial sampling was made. Brains were removed at 45 min after injection, and prepared for macro-autoradiography. LCGU values were measured by the equation developed by Sokoloff et al. In the microtumors (less than 2 mm in diameter), mean LCGU value was 30 mumol/100 g/min, which was significantly (p less than 0.01) lower than mean value of normal cortex (63 mumol/100 g/min). In the macrotumors (greater than 2 mm in diameter). LCGU values in the tumor were separated to high part (mean; 49 mumol/100 g/min) and low part (mean; 38 mumol/100 g/min), which were still lower than mean cortical value and higher than mean white matter value (corpus callosum; 26 mumol/100 g/min). No LCGU changes were noted in the brain tissue adjacent to the microtumors. Whereas, macrotumor significantly reduced LCGU in the adjacent cortex. The present data may indicate that glucose metabolism of the ENU induced glioma and edematous peritumoral brain tissue is lower than that of normal cortex.

Cellular level of purine compounds in ischemic gerbil brain by high performance liquid chromatography

The cellular level of AtP and related compounds in ischemic gerbil brain was investigated by high performance liquid chromatography (HPLC). Brain samples were obtained in situ following ligation of the common carotid artery. AMP and ADP peaks in the brain extracts in the ischemic group became much larger whereas the ATP peak decreased dramatically. The most striking finding was an extensive increase of adenosine: 50-100 fold. The levels of inosine and hypoxanthine also increased greatly in typical symptomatic gerbil.

Regional blood flow and capillary permeability in the ethylnitrosourea-induced rat glioma

Regional cerebral blood flow and capillary permeability of rat brains bearing ethylnitrosourea-induced gliomas of various size were investigated with 14C-antipyrine autoradiography and Evans blue staining. In the small tumors (less than 2 mm in diameter), blood flow was uniformly reduced when compared to the adjacent brain. Even in tiny tumors (0.3 to 0.4 mm in diameter), reduction in blood flow was evident. In the medium (2 to 4 mm in diameter) and large (greater than 4 mm in diameter) tumors, the blood flow increased or decreased depending on the part of the tumor examined. The necrotic center and peripheral edge had low blood flows, whereas the viable portion adjacent to the necrotic center had high blood flows. Blood flow in the brain tissue adjacent to medium and large tumors was lower than control brain tissue, probably due to local edema. Leakage of intravenous Evans blue in the tissue was only evident in the large tumors with central necrosis. The present findings suggest that neovascularization of the tumor may occur when the tumor reaches a certain size, and leaky new vessels may be the cause of brain edema associated with tumor.

[Changes of blood-brain barrier in the ethylnitrosourea induced rat glioma (author's transl)]

Capillary permeability of rat brains bearing ethylnitrosourea induced rat glioma was measured with quantitative autoradiography. In the small tumors (less than 2mm in diameter), no changes in capillary permeability was noted. When tumors became larger and neovascularization of the tumor occurred, increase in capillary permeability was evident. This change was more prominent in the center of the tumor than in the periphery. In the large tumors, the capillary permeability was markedly increases, and the value was similar to that in the choroid plexus. This indicates that blood-brain barrier(BBB) completely disappeared in the large tumors. This BBB change may be the main cause of tumor induced brain edema. The data also provide the information about pharmacokinetics of water soluble drugs in the brain tumors.

[Regional blood flow in the ethylnitrosourea induced rat glioma (author's transl)]

Regional cerebral blood flow of rat brains bearing ethylnitrosourea induced glioma of various size was investigated with 14C-antipyrine autoradiography. In the small tumors (less than 2 mm in diameter), blood flow was uniformly reduced when compared to the adjacent brain. Even in tiny tumors (0.3-0.4 mm in diameter), reduction in blood flow was evident. In the medium (2-4 mm in diameter) and large (greater than 4 mm in diameter) tumors, the blood flow increased in the viable center of the tumor and decreased in the necrosis and peripheral edge. High blood flow in the viable center may be attributable to the neovascularization of the tumor. Blood flow in the brain tissue adjacent to medium and large tumors was lower than control brain tissue probably due to local edema. This reduction in blood flow may be partly attributable to the appearances of the focal neurologic deficits. The result obtained may provide some information about growth regulation of glioma and also pharmacokinetic delivery of chemotherapeutic drugs to the malignant brain tumors.

Alteration of blood-CSF barrier by tumor invasion into the meninges

Cyclophosphamide and 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) were found to have an equivalent cytostatic effect in rats with subcutaneous transplants of Walker 256 carcinosarcoma. Rats with meningeal carcinomatosis received a single intravenous dose of cyclophosphamide (30 mg/kg) or ACNU (15 mg/kg) at various times after intracisternal inoculation of 1 X 10(4) Walker 256 carcinosarcoma cells. Cyclophosphamide, administered 1 day after tumor inoculation, failed to prevent tumor growth in the subarachnoid space. The survival time of these rats was prolonged only 10% to 14% compared to the controls, while ACNU produced a maximum increased survival time of 180%. If administered 2, 3, 4, and 5 days after tumor inoculation, both drugs were effective; cyclophosphamide yielded a maximum increase in median survival time of 109%, 94%, 90%, and 52%, and ACNU 127%, 139%, 240%, and 100%, respectively. These results indicate that the blood-cerebrospinal fluid (CSF) barrier was circumvented in the early stage of subarachnoid tumor growth, although some areas remained where the infiltrating tumor cells were protected from systemically administered drugs by the intact barrier.

Primary fibrosarcoma of the skull

The case of a 61-year-old woman with fibrosarcoma of the skull is discussed. Despite surgical treatment and irradiation, she died 23 months after diagnosis. Primary fibrosarcoma of the skull is rare but must be considered in the differentiation of the osteolytic lesions of the skull.

Combination chemotherapy with 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride and bleomycin in meningeal carcinomatosis in rats

Combination chemotherapy with 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) and bleomycin (BLM) was evaluated using an experimental model of meningeal carcinomatosis induced in Sprague-Dawley rats by intracisternal inoculation of 1 X 10(4) Walker 256 tumor cells. Tumor-bearing animals were treated by i.v. administration of cyclophosphamide, BLM, ACNU, or a combination thereof, starting on Day 5 after tumor inoculation. BLM, 5 mg/kg on Day 5 as well as 5 mg/kg/day on Days 5, 7, 9, 11, and 13, was ineffective. Cyclophosphamide, 30 mg/kg, or ACNU, 15 or 30 mg/kg, on Day 5 increased the median survival time by 52, 70, and 82%, respectively. The combination of ACNU, 15 mg/kg, and cyclophosphamide, 15 mg/kg, increased median survival time by 73%, while the combination of ACNU, 15 mg/kg, and BLM, 5 mg/kg, resulted in a maximal increase of median survival time of 200% when the agents were given on Day 5. The combination of ACNU, 15 mg/kg on Day 5, and BLM, 5 mg/kg/day on Days 5, 7, 9, 11, and 13, increased median survival time by over 360% and cured 60% of the animals. These results point to the therapeutic advantage inherent in ACNU and BLM combination therapy.

Levels of astroprotein (an astrocyte-specific cerebroprotein) in cerebrospinal fluid of patients with brain tumors. An attempt at immunochemical diagnosis of gliomas

Levels of astroprotein (an astrocyte-specific protein found in the cerebrum) were measured by radioimmunoassay in the cerebrospinal fluid (CSF) of 120 patients with intracranial diseases and eight control subjects. The astroprotein level was elevated (above 25 ng/ml) in 13 of 30 cases (43.3%) of glial tumors, nine of 57 cases (15.8%) of nongliomatous intracranial tumors, seven of 33 cases (21.2%) of non-neoplastic intracranial diseases, but in none of the eight control cases. In glioblastoma patients, CSF astroprotein was elevated in eight of 12 cases (66.7%), in three of them to a remarkable degree (above 500 ng/ml). The possible role of this test is briefly discussed, and the mechanism of increase of the astroprotein levels in the CSF considered.

Edema and circulatory disturbance in the spinal cord compressed by epidural neoplasms in rabbits

An experimental model of spinal cord compression by epidural neoplasms was produced in rabbits by injecting a VX2 tumor-cell suspension anterior to the T-13 vertebral body. With this experimental model, edema and circulatory disturbance of the spinal cord compressed by epidural tumors were studied. The characteristic histopathological findings in the compressed spinal cord were edema and axonal swelling in the white matter. Water content and uptake of intravenously injected 99mTc pertechnetate in the compressed spinal cord were significantly greater than in the spinal cord distant from the tumor, and increased in proportion to the degree of neurological loss. Microangiography and fluorescein angiography demonstrated stenosis or obstruction of the epidural venous plexus and impairment of venous drainage in the compressed spinal cord at the early stage of neurological symptoms. It is suggested that venous stasis and subsequent vasogenic edema in the spinal cord play an important role in the symptomatology of metastatic epidural spinal cord compression.

[Radioisotope ventriculography for functional evaluation of the Ommaya Reservoir (author's transl)]

Thirty nine patients with diagnosis of meningeal leukemia, meningeal lymphoma and leukemia having high risk of meningeal involvement were treated with intraventricular administration of chemotherapeutic drugs via Ommaya reservoir. In all of those patients, radioisotope ventriculography was always performed with ytterbium-169 diethyltriamine pentaacetic acid (169Yb-DTPA) at 1 week after placement of the Ommaya reservoir. In the patients who had normal cerebrospinal (CSF) flow, majority of the radioactivity injected moved to cisterna magna and basal cistern at 4 hours after injection and to subarachnoid space of the cortical surface at 24 hours. Two cases of ventricular catheter occlusion were diagnosed by this method. Two cases of catheter tip misplacement were suspected with computed tomography and confirmed with radioisotope ventriculography. One of the misplacement cases developed focal leukoencephalopathy possibly due to high concentration of methotrexate (MTX) in the brain adjacent to the ventricular cathter. Two cases showed delayed CSF circulation, and the doses of MTX were decreased to be half of the ordinary dose (12 mg/M2 once a week) during initial phase of the treatment. The dose was increased after successful treatment of meningeal dissemination and restoration of the normal CSF flow. Radioisotope ventriculography might be quite useful for detection of the flow of materials placed into Ommaya reservoir. Routine use of this procedure may be helpful to prevent reservoir- and drug-related complications.

[The anti-tumor effect of ACNU and X-irradiation on mouse glioma (author's transl)]

Anti-tumor activities of ACNU and X-irradiation on methylcholanthrene induced glioma in C57BL mice were studied in vitro and in vivo. In vitro experiments using cultured glioma cells (MGB cells), the synchronization of cell cycle was done by excess addition of thymidine, and the anti-tumor cell effect were investigated by mean of determinations of DNA synthesis, mitotic index and the number of the living cells following the treatments. As the results, it appeared obvious that ACNU was most effective on MGB cells in S phase and X-irradiation in M phase. As to the combined therapy of ACNU and X-irradiation, the anti-tumor effect was most remarkable when the cells were treated by X-irradiation in the G2, M phase, which were hervested by addition of ACNU 44 hours before irradiation. However simultaneous treatment of ACNU and X-irradiation on the cells in G1 phase was not so remarkable. In vivo experiments the anti-tumor effect of ACNU and X-irradiation on subcutaneously or intracranially transplanted glioma in mice was investigated. Either ACNU 10 mg/kg or local X-irradiation 1240 rads showed inhibitory effect on the tumor growth and prolonged the survival time of the tumor bearing mice. The combination therapy was more effective than ACNU or X-irradiation alone, particularly combination therapy of ACNU and repeated small doses irradiation of X-ray was remarkably effective. Evidence obtained indicates that the combination therapy of ACNU and X-irradiation have synnergistic anti-tumor effect on experimental mouse glioma.