[Dynamic aspect of brain edema in cases of acute carbon-monoxide poisoning (author's transl)]

Eleven cases of acute carbon-monoxide poisoning in various stages were observed with the computerized tomography for 17 times and analysed their correlation between intracranial lesion and their clinical courses. Five of 11 cases revealed characterististic pathologic findings in CT scan, however complete recovery of consciousness was observed in only 4 of 6 cases with normal CT findings. In early stage of acute carbon-monoxide poisoning, CT scans showed typical diffuse subcortical low absorption with no obvious ventricular dilatation. The entity of this typical finding was supposed to be the so called "vasogenic edema" attributed to increased extracellular fluid caused by increased permeability of vessels due to hypoxic process of the poisoning. While this diffuse subcortical edema was subsiding gradually in about 2 weeks, progressive brain atrophy was supervening and resulted finally in severe dilatation of the ventricular system. In spite of two exceptional cases of vegetative state with normal CT scan in early stage seemed suggestive of poor prognosis in most of cases. Pathogenesis of subcortical brain edema and the effect of hyperbaric therapy in the cases of acute carbon monoxide poisoning were also discussed.

[Clinical evaluation on glucocorticoid administration in neurosurgical patients (author's transl)]

Anterior pituitary function tests (ITT, TRH test and LH-RH test) were performed on 10 patients with intracranial lesions other than hypothalamo-pituitary tumors. These lesions were 8 brain tumors and 2 aneurysms. Relatively high doses of glucocorticoid were administered in pre- and post-operative period to all the cases. Preoperative study showed a slightly low response of GH and FSH in one case and a low TSH response in 2 cases. ACTH, LH and PRL were normal in all the cases. Postoperative study was performed about 10 days after ceasing of glucocorticoid. Postoperative data revealed that anterior pituitary function tests did not show any significant changes after surgeries in all the patients.

[Wallenberg's syndrome with sleep-induced dyspnea--a case study]

One case with Wallenberg's syndrome followed by the neck clipping of the posterior inferior cerebellar aneurysm was reported. The patient was 49 years old female with the subarachnoid hemorrhage, who had previously no history of the cardiovascular disease. The vertebral angiogram revealed a saccular aneurysm of the left vertebral artery at the origin of the posterior inferior cerebellar artery. The preoperative neurological examination were normal, except for the slight degree of the meningeal irritation. The surgical intervention was successfully performed on 39th day after the subarachnoid hemorrhage. Postoperative course was eventful, presenting the typical Wallenberg's syndrome, which was complicated the accompanying signs. The troublesome accompanying signs were chiefly automatic respiratory dysfunction (sleep-induced dyspnea), autonomic dysfunction (Horner's syndrome, perspiration, hypertension), and restless confusion. The postoperative vertebral angiogram showed the obliteration of the aneurysm and the sufficient circulation of the vertebrobasilar system, especially the posterior inferior cerebellar artery. The mechanism of "sleep-induced dyspnea" was discussed in detail from the literatures. In addition to the above mentioned, it should be stressed that the recognition of "sleep-induced dyspnea" and the other accompanying signs are important for the treatment of the patient with the brain stem lesion.

Endocrinological evaluation of sellar and suprasellar tumor cases (the eighth report)--on growth hormone secretion of acromegalic patients before treatment (author's transl)

Serum GH levels were measured in 14 acromegalic patients in ITT, TRH test, LH-RH test, arginine test, OGTT, exercise test, CPZ test and PEG. More than 50% increase of serum GH level was observed in 3 of 13 ITT, 8 of 14 TRH test, 6 of 14 LH-RH test, 2 of 12 arginine test, 2 of 9 OGTT and 2 of 7 PEG. Only 2 out of 7 cases showed more than 50% decrease of serum GH level in CPZ test. Striking GH responses were observed in TRH and LH-RH test. Five of 14 cases showed more than 100% increase of serum GH level in TRH test but they did not have a significant response to LH-RH. Four of 14 cases also had more than 100% increase in LH-RH test with no significant response to TRH. The rest of the cases (5 cases) did not have marked response to either TRH or LH-RH. According to these results, serum GH responses of acromegalic patients could be devided into 30 types, 1) TRH responding type, 2) LH-RH responding type, 3) no response type.

[Endocrinological evaluation of sellar and suprasellar tumor cases (the seventh report)--endcrinological study on four cases of pituitary adenoma with intratumoral hemorrhage (author's transl)]

Four cases of pituitary adenoma with intratumoral hemorrhage were studied endocrinologically. 1) It would be suggested that ACTH and TSH secretion of these cases was strongly impaired but LH, FSH and PRL secretion was fairly preserved immediately after hemorrhagic episode. 2) Two of these four cases revealed normal TSH secretion and normal thyroid function following the period of excessive TSH secretion and impaired thyroid function.

[Endocrinological evaluation of sellar and suprasellar tumor cases (the sixth report)-on pituitary hormone secretion of acromegalic patients before treatment (author's transl)]

1) Pituitary hormone secretion of 14 acromegalic patients was studied before treatment. Incidence of hyporeactive response was 0%, 43%, 29%, 71% and 9% in ACTH, LH, FSH, TSH and PRL respectively. 2) Relatively higher incidence of hyporeactive TSH response in TRH test seems to be characteristic in acromegalic patients. 3) Six of 13 acromegalic patients examined on blood PRL level revealed relatively high blood PRL level over 50ng/ml.

[Endocrinological evaluation of sellar and suprasellar tumor cases (the fifth report) - on pituitary function of 5 cases of ectopic pinealoma in the Chiasmal Region (author's transl)]

The anterior pituitary hormone secretion of 5 patients with ectopic pinealoma in the chiasmal region was studied. 1) GH response in ITT was hyporeactive in all cases. Two of 4 cases showed hyporeactive ACTH secretion in Metyrapone test. Two of 5 cases decreased TSH secretion in TRH test. Prolaction secretion was normal in all 5 cases. All 5 cases showed hyporeactive FHS response. LH secretion was negligible in 2 of 5 cases, but other 3 cases showed abnormal LH response in LH0RH test with abnormally high basal level and no response to LH-RH. 2) In 3 cases with abnormal LH response blood HCG was determined and identified by radio-immuno-assay using HCG-beta-subunit antiserum. 3) Precocious puberty was recognized in 2 boys with identified blood HCG. 4) Abnormally high blood LH levels in those 3 cases were significantly decreased after lineac irraiation.

Uptake of bleomycin by human brain tumours

The uptake of bleomycin (BLM) by various types of brain tumours after intravenous or intrathecal administration was investigated by bioassay in 67 patients. The correlation between the BLM distribution and the type and characteristics of brain tumours was studied.

[Endocrinological evaluation of sellar and suprasellar tumor cases (author's transl)]

1) Pituitary function of 9 cases of tuberculum sellae meningioma was examined, before and after surgery (3 weeks, 1 year and 2 years after surgery). 2) In all cases ACTH, LH, FSH and prolactin responses were normal throughout pre- and postoperative courses. 3) GH and TSH were normoreactive in almost all cases preoperatively. Postoperatively GH and TSH were hyporeactive 3 weeks after surgery, but recovered to normal 1 or 2 years after surgery.

[Endocrinological evaluation of seller and suprasellar tumor cases (the third report)-on secreting chromophobe adenoma (author's transl)]

1) Nine of 25 cases of chromophobe adenoma revealed abnormally high plasma prolactin level. The plasma prolactin level of these 9 cases ranged from 5300 to 15000 ng/ml, and those of other 16 cases ranged from negligible to 53 ng/ml. 2) Five cases with abnormally high plasma prolactin level had a poor clinical course. 3) Quantitative determination on PEG according to our own method showed that tumor size of these patients with abnormally high plasma prolactin level was larger than that of relatively lower plasma prolactin level. 4) Three of all 25 cases of chromophobe adenoma were histologically diagnosed as pleomorphic. Each of those three cases showed abnormally high plasma prolactin level.

[Endocrinological evaluation of sellar and suprasellar tumor cases (the 2nd report);--on postoperative pituitary function (author's transl)]

Fifty-six cases of sellar and suprasellar tumors were examined endocrinologically before and 3 weeks after surgery. 1) Hyporeactive cases of GH & ACTH were more frequently found in pituitary adenoma (100% and 23% respectively than in craniopharyngioma (86% and 14% respectively) before surgery. 2) GH secretion was impaired 3 weeks after surgery in all the cases. 3) ACTH secretion impaired preoperatively in 5 cases of pituitary adenoma improved in 3 cases 3 weeks after surgery. 4) Hyporeactivity of LH, FSH and TSH was found more frequently after surgery than before. 5) Almost all the cases of tuberculum sellae meningioma were endocrinologically normal before surgery. 6) ACTH, LH, FSH and prolactin secretion in cases of tuberculum sellae meningioma was not impaired after surgery, but TSH secretion in these cases became hyporeative in 4 of 5 cases after surgery.

Uptake of tritiated methotrexate by mouse brain tumors after intravenous or intrathecal administration

✓ Malignant gliomas were induced in strain ddN mice by intracerebral implantation of a 20-methylcholanthrene pellet. The uptake and distribution of tritiated methotrexate (MTX-3H) in the tumor were investigated by radioactive assay and radioautography after single intravenous or intrathecal injections. By either route, a large amount of MTX-3H was taken up by gliomas, and a significantly higher concentration was observed in tumor than in the brain tissue. At 24 hours after intrathecal administration, the uptake of MTX-3H by gliomas exceeded that achieved after intravenous injection, although the drug dosage in the latter was 10 times that in the former.

Response of cereborspinal fluid pressure to hyperbaric oxygenation

The response of cerebrospinal fluid pressure (CSFP) to hyperbaric oxygenation (OHP) was investigated in 13 patients with acute cerebral damage and in dogs with or without experimentally produced cerebral damage. To elucidate the mechanism of the CSFP response, continuous measurements of carotid blood flow, arterial blood pressure, central venous pressure, and superior sagittal sinus pressure and CSFP were made before, during and after OHP. There was considerable variation in the response of CSFP to OHP in the patients, but three main patterns emerged; type I (nine cases), CSFP decreased at the beginning and rose again at the end of OHP, type II (two cases), CSFP fell with OHP and remained significantly lower than pretreatment level after it, and type III (two cases), CSFP showed little change with OHP. An animal without cerebral damage commonly showed a type I response of CSFP to OHP; the changes of CSFP at the beginning and end of OHP are mainly due to the changes of the cerebral blood flow. There may be two different actions of OHP on cerebral oedema, one decreasing cerebral oedema and another (mainly affecting the normal brain) producing cerebral oedema. Information obtained from the response of CSFP to OHP may be useful in judging the severity and pathophysiological state of cerebral damage.

Intrathecal chemotherapy. Selection of cytostatic agents

Selection of cytostatic agents for intrathecal administration is the subject of this paper.Both the toxic side effects-destruction of blood-brain barrier and change of body weight-and the cytostatic effects on intracranially transplanted Yoshida ascites sarcoma were investigated of intrathecal administration of various cytostatic agents. As a result, it may be concluded that Methotrexate and Endoxan and lower dose of mitomycin C are suitable drugs for intrathecal chemotherapy.Based on these findings, clinical cases of malignant brain tumours were treated with intrathecal chemotherapy.Grateful acknowledgement is made to Professor Dennosuke Jinnai for his constant interest and guidance in this investigation.