[MRI of the paranasal sinus mucopyocele]

Seven cases of the paranasal sinus mucopyocele were examined by MRI. All of the mucopyocele in our series were clearly demonstrated on MRI using long SE pulse sequence as high signal intensity. However, the degree of signal intensity was varied based on the contents of the mucopyocele. We can detect the mucopyocele as a three dimensional image by MRI, however, CT was necessary for evaluating the bone destruction caused by mucopyocele.

An ultrasonographic method for detection of Achilles tendon xanthomas in familial hypercholesterolemia

The diagnosis of familial hypercholesterolemia (FH) is frequently made on clinical grounds and detection of tendon xanthomas is crucial for that. In order to clarify whether ultrasonography (US) can be used as a reliable and practical method for detection of Achilles tendon xanthomas in FH, the Achilles tendon thickness in the sagittal section was examined by US in 15 patients with heterozygous FH and 34 normocholesterolemic subjects. US visualized clearly the anterior and posterior borders of the Achilles tendon. The Achilles tendon thickness determined by US correlated with that measured by conventional radiography (r = 0.99). The mean values +/- SD of the Achilles tendon thickness determined by US were 4.5 +/- 0.5 mm in the normal controls and 11.9 +/- 5.1 mm in the patients and the difference was significant (P less than 0.001). In 13 of 15 patients, US visualized thickened Achilles tendons with convex shape in the sagittal section. All the thickened Achilles tendons revealed by US were confirmed by radiography. The data indicate that US can detect Achilles tendons thickened by xanthomas. We conclude that US is a useful aid in the clinical diagnosis of FH.

[Operative approach to a dumbbell-shaped tumor in the anterior cranial fossa. A case of olfactory neuroblastoma]

We present a case of giant olfactory neuroblastoma with special reference to a new operative approach in cases of dumbbell-shaped tumor in the anterior cranial fossa. Our new approach is characterized as follows: resection of the bilateral orbital roof and frontal sinus en bloc, following bifrontal conventional craniotomy. Accordingly, retraction of the frontal lobe is minimized and it is possible to obtain, with ease, a good operative field extending to the region adjacent to the tuberculum sellae. Using this technique combined with the transsphenoidal approach, even in the case of marked extracranial downward extension of a dumbbell-shaped tumor, it should be possible to remove the tumor totally. This approach should open a way to a wide range of application.

TaqI polymorphism in the LDL receptor gene and a TaqI 1.5-kb band associated with familial hypercholesterolemia

The low density lipoprotein (LDL) receptor gene was analyzed in 67 unrelated healthy Japanese and 38 members of six consecutive families with familial hypercholesterolemia (FH) by Southern blot hybridization with TaqI, an LDL receptor cDNA fragment containing exons 1 to 8 being used as a probe. A new TaqI RFLP at the LDL receptor locus was detected with allele frequencies of 0.67 and 0.33. The data obtained with smaller cDNA subfragment probes revealed that the TaqI RFLP site is located within 1.1 kb of the 5' side of the EcoRI site of exon 5. The TaqI RFLP was in linkage disequilibrium with the PstI RFLP but showed no significant linkage disequilibrium with the RFLPs for AvaII, ApaLI/I15, PvuII, NcoI, and ApaLI/3'. Among the seven RFLPs at the LDL receptor locus, the TaqI RFLP was the only useful genetic marker in one of the six families with FH. Furthermore, the association of an additional TaqI 1.5-kb band with a mutant LDL receptor gene was observed in another family with FH in which the proband was homozygous for all of the seven RFLPs. The data obtained with various restriction enzymes and smaller cDNA subfragments probes suggested that a minor change in nucleotide sequences in the region including exons 5 to 8 is present in the mutant gene. These data suggest that the TaqI RFLP is a useful genetic marker at the LDL receptor locus and that TaqI serves for the analysis of some mutant LDL receptor genes, when used with small LDL receptor cDNA probes.

Spontaneous disappearance of middle fossa arachnoid cyst after head injury

A case of middle fossa arachnoid cyst is presented, which disappeared after head injury. Five days after the trauma, CT scan revealed subdural fluid collection in addition to an arachnoid cyst in the middle fossa on the same side. As the subdural fluid resorbed, the cyst became smaller and disappeared on the follow-up CT scans without surgical intervention.

Ultrastructural study of a cerebral gangliocytoma

A pure cerebral gangliocytoma leaving no sign or symptom of recurrence after surgical removal is reported, with special reference to its CT scan and the ultrastructural findings. Unusual, large, dense bodies having the size of 800-1200 m mu and radiating from a central core were identified on the ultrastructural study. Microcystic formations might have been produced by active secretory granules containing dense core vesicles. The literature concerning the dense core vesicle of ganglion cell tumors is reviewed.

[Ruptured cerebral aneurysm associated with aortitis syndrome: a case report]

In rare occasions, patients with aortitis syndrome have cerebral aneurysms and only seven cases have been reported so far. A case of aortitis syndrome complicated with basilar bifurcation aneurysm is reported. A 58-year-old woman, who had been hypertensive for 20 years and was diagnosed as pulseless disease 10 years ago, suddenly had severe headache and became unconscious on Feb. 17, 1983. Spinal tap performed 3 days after the onset demonstrated bloody cerebrospinal fluid. She was referred to our clinic 8 days following the ictus of subarachnoid hemorrhage. On admission, she was drowsy and had headache, neck stiffness, disorientation and left hemiparesis. Pulsation of the left common carotid and left radial artery was unpalpable. Angiography through the intraaortic catheter revealed occlusion of the left common and left subclavian arteries at their origin, confirming aortitis syndrome. Through the patent right vertebral artery, basilar artery was visualized and an aneurysm at the basilar bifurcation was noted. Seven cases reported in the literature were reviewed.

Traumatic mechanisms of head injury in child abuse

Child abuse is a complex sociophysical phenomenon in which a child may suffer physical and mental assault ranging from death to emotional deprivation. In this report, an effort is made to identify the pathogenetic mechanisms of head injury in child abuse and to describe the site of injury, incidence of head injury, and difficulties encountered in establishing a doctor-family relationship. During the years 1970 through 1979, 621 children were confirmed victims of child abuse and treated by the medical staff at the Children's Memorial Hospital in Chicago. Of these, there were 77 children (12%) who suffered associated head injuries ranging from cerebral concussion to irreversible brain damage and/or death. 85% of these head-injured children were under the age of 2 years. 62% were male and 38% female. In analyzing the type of injury which resulted in an associated head injury, we learned that 54% of all injuries were caused by direct blows to the head, face and other parts of the body, 35% were due to dropping, throwing or falling; only 8% were caused by 'shaking'. 55 injuries (48%) out of 115 trauma cases were thought to be caused by injury to head or face. 53 patients showed 113 external skin wounds such as ecchymoses of eyes, excoriations, bruises, contusion, hematoma, burns, etc. 46% of all external wounds were found over the head and face. This may probably indicate to us that a traumatic force causing injury to the brain is directed to the head and face. The traumatic mechanisms are analyzed and discussed to assess the behavioral derangement of the assault.

Periventricular white-matter cysts in a murine model of gram-negative ventriculitis

Hydrocephalic patients with shunt infections frequently develop multiple cerebrospinal-fluid-density cysts that cause midline shift and life-threatening intracranial hypertension and respond poorly, if at all, to shunt diversion of cerebrospinal fluid. These cysts have been considered to represent multiloculation of the ventricular system by ependymal adhesions and veils resulting from ventriculitis. Studies using an experimental model of E. coli meningitis/ventriculitis in the hy-3 mouse suggest these cysts: (1) develop by the coalescence of lakes of white-matter edema, (2) grow to large size entirely within the periventricular white matter, and (3) cause pseudoloculation of the ventricle by compression from without. The so-called intraventricular septa or "veils" are the ependyma displaced inward by subependymal cysts or sheets of residual pericystic white matter. This finding permits better interpretation of computed tomographic images depicting persistent enlargement of the so-called multiloculations despite functioning ventricular shunt catheters, the multiplicity of cysts, and the white-matter location of these cysts.

[A case report of superior sagittal sinus thrombosis--evaluation of computed tomographic findings in diagnosis and comprehension of this sinus thrombosis (author's transl)]

A case of superior sagittal sinus thrombosis was reported. A 23-year-old male was admitted to our clinic on August 16, 1978, because of generalized convulsive seizures. he had complained of severe headache and high fever for about 7 days before admission, and on admission he was in slightly drowsy state. At that time, bilateral choked discs and bilateral abducens pareses were found without any other neurological deficit. CT scan on his 1st hospital day revealed only slight compression of the ventricular system without any midline shift. On the 2nd hospital day, he developed sudden left hemiparesis, but his level of consciousness did not deteriorate as that of the previous day, demonstrating clear CSF by lumbar puncture. Right CAG on August 21 revealed delayed circulation, poor-filling of the cortical veins, and narrow superior sagittal sinus showing zigzag shaped margin. CT scan on August 22 showed multiple irregular high dense foci mainly in both parietal lobes and the shift to the left of the ventricular system. Besides, on enhanced CT scan, the so-called "empty triangle" sign was revealed with gyral enhancement. Although an increase of the shift of the ventricular system was demonstrated by the follow-up CT scans, he gradually improved and external decompression was necessitated no longer. He was discharged with slight weakness of the left upper limb after superior sagittal sinus showing good-filling on right CAG performed on September 27 and had been identified. As a result, it was confirmed that in case sinus thrombosis is doubted, follow-up study by CT scan would be significant for the choice of treatments as well as for its diagnosis at its each stage.

[Intracranial hemorrhage caused by metastatic brain tumors (author's transl)]

Metastatic brain tumors are known to produce the symptoms of stroke and intracranial high density areas are demonstrated by CT scan. But exact preoperative diagnosis is sometimes difficult. Recently, we have experienced three cases of metastatic brain tumors which began with the symptoms of vascular accident and were demonstrated as high density area by CT scan. Two of them are metastasis of lung cancer and another, hepatoma. Characteristic CT findings are as follow: 1) atypical location 2) non-homogeneous high density area extending from the margin of the tumor (sometimes ring-like appearance) 3) surrounding massive edema 4) positive contrast enhancement 5) multiple lesions Two of our cases were demonstrated the recurrence by CT scan which was performed at earlier postoperative stage. The dissemination of tumor cells in the hematoma was thought to be the main factor of it. We also discussed the operative procedures and the postoperative care.

Gyriform calcification after purulent meningitis

A 2-month-old baby developed bilateral frontoparietal gyriform calcification after purulent meningitis. Biopsy revealed severe cerebral cortical degeneration with many calcified foci. Another feature of interest was reabsorption of calcification over a period of 4.5 months.

[Flow cytometric studies of human brain tumors. Part I: Human malignant brain tumors (author's transl)]

This report concerns the distribution of the DNA content in cells obtained from seven nonneoplastic, human brain tissue specimens and from eight different kinds of malignant human brain tumors of 30 patients. Analysis was carried out by flow cytometry suing suspensions of single separated cells stained with propidium iodide as DNA-intercalating fluorochrome. Normal, non-stimulated lymphocytes served as diploid controls. An average of 91% of the cells from non-neoplastic brain tissue was diploid (2C) and these cells were presumable in G0 or G1 stage of the cell cycle. In specimens from malignant brain tumors the proportion of diploid cells in G0 or G1 stage varied between 35 and 89%. In these specimens polyploid (including triploid, tetraploid and hypertetraploid) cells were frequently observed. From the distribution of their DNA content the 14 specimens of glioblastomas were classified into 3 types. Specific patterns were noted in type III-b which was characterized by two peaks having the same heights. The cerebral metastasis displayed the greatest variations in ploidy and these tumors, on basis of their DNA distribution were divided into 3 types. As shown in the present study the cytofluorometric analysis of malignant brain tumors revealed characteristic features: 1) multiple DNA peaks, 2) wide ploid variations ranging from 2C to 8C, 3) variability of DNA content patterns and distribution, 4) relatively large portions of cells in S and G2 + M phase of the cell cycle, 5) presence of heteroploid and polyploid cells. Because flow cytometry has distinct advantages over other methods in permitting rapid analysis of large populations of cells with a high degree of reproducibility, results obtained with this technique may be of significant clinical importance.