[A case of cerebral cryptococcosis, with special reference to computerized tomography findings]

A case of cryptococcosis simulating brain tumor was reviewed. A 66-year-old female was admitted to our hospital with chief complaint of vertigo, gait disturbance and dysarthria. These symptoms started about one year before admission and worsened. Vomiting and urinary incontinence appeared. Neurological examination revealed left cerebellar ataxia and dysarthria. In plain CT (computerized tomography) irregular ill-defined low density area was noted in the cerebellar vermis and bilateral cerebellar hemispheres. And slight ventricular dilatation was found. Irregular shape of ring-like enhancement corresponding to capsule and patchy or mottled enhancement inside the tumor were seen. Suboccipital craniectomy was performed and yellowish necrotic tumor with hard capsule was removed. Histological diagnosis was not neoplasm or tuberculoma. Postoperatively liver function progressively worsened. She died due to disseminated intravascular coagulation. Autopsy revealed typical liver cirrhosis without malignant change. 3.0 X 2.5 cm sized, slightly hard, yellowish lesion was found on upper part of cerebellar hemispheres. This had extremely necrotic tissue and a great number of cryptococcus neoformans were found. And other intracranial lesion was not confirmed. Finding of pulmonary cryptococcosis was not gained. Our case is very rare because of solitary cerebellar abscess and absence of meningitic episode or pulmonary cryptococcosis. There are three types of inflammation in cerebral cryptococcosis. The commonest manifestation is the meningitic type, the second mode is granulomatous lesion and the third and the least presentation is intracranial abscess formation. CT reveals various findings according to clinical stage. CT findings are those of meningitis, meningoencephalitis, granuloma and abscess. Cryptococcal granuloma or abscess often simulates brain abscess, glioma and metastatic brain tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Rat pituitary adenoma and hyperplasia induced by caffeine administration

The effect of caffeine by oral administration on female Wistar rats was studied for 12 months. High concentrations (2000 micrograms/mL) of caffeine caused a decrease in body weight and an increase in the weight of the pituitary gland in these rats. Increased pituitary weight was caused by the growth of a pituitary adenoma or hyperplasia. Pituitary adenomas and instances of hyperplasia were found in 27 of the 40 rats in the caffeine group, compared to 9 of the 30 rats in the control group. The histologic classification used was microadenoma, papillary (or sinusoidal) macroadenoma, and diffuse macroadenomas. These adenomas appeared to be endocrinologically nonfunctioning.

Choriocarcinoma arising from the pituitary fossa with extracranial metastasis: a review of the literature

Since Askanazy's first report on a case of primary intracranial choriocarcinoma in 1906, more than 60 cases have been reported so far. We add to that a case of intrasellar choriocarcinoma with suprasellar extension: A 12-year-old girl showed cranial nerve palsies, hypopituitarism, and abnormally high titers of human chorionic gonadotropin (HCG) in blood and in cerebrospinal fluid (CSF). She died 3 months after surgery. At autopsy, an intra- and suprasellar choriocarcinoma, which penetrated through the clivus into the cerebellopontine angle and metastasized remotely to the lungs, was confirmed. This rare case is presented with a thorough review of the literature.

The Nd:YAG laser in neurological surgery

The Nd:YAG laser has been applied in microneuro-surgery and has been found to be quite effective in removing had and hemorrhagic tumors such as meningiomas, tumors of the deep skull base, or tumors deep in the ventricle. Another indication for the use of the Nd:YAG laser is to open the thick sellar floor in transsphenoidal operations.

[Investigations on physiological values of blood in industrial workers. Report 3. Serum colloid reaction and enzyme activity values]

The purpose of this study is establish the physiological values of serum colloid reaction and serum enzyme activities representing the liver function. 1,732 industrial workers (1,035 males aged 35-65 yr, and 697 females aged 35-60 yr) were examined by the serum zinc sulfate turbidity test (ZTT) and serum thymol turbidity test (TTT) according to the standard method of "The Japanese society of gastroenterology," serum alkaline phosphatase (ALP) by Kind-King method, serum gamma-glutamyl transpeptidase (gamma-GTP) by the modified Orlowski method, and serum glutamic oxaloacetic transaminase (GOT) and serum glutamic pyruvic transaminase (GPT) by UV method. Then frequency distributions, geometric means, several percentile values of these six laboratory data and correlations among the values were determined. The results are as follows: 1) Frequency distributions of serum ZTT, TTT, ALP, gamma-GTP, GOT, and GPT almost fitted to the log-normal distribution. 2) Geometric means and 0-95th percentile or 5-95th percentile values in bracket were 6.6 (3.7-11.7) Kunkel unit for ZTT in male, 8.2 (5.1-13.0) Kunkel unit for ZTT in female, 0.6 (0-2.8) Kunkel unit for TTT in male, 0.8 (0-2.8) Kunkel unit for TTT in female, 6.6 (4.1-10.4) King-Armstrong unit for ALP in male, 5.5 (3.2-8.9 for 49 year or less, 4.6-10.3 for 50 yr or more) King-Armstrong unit for ALP in female, 15.8 (0-45) mU/ml for gamma-GTP in male, 8.4 (0-17 for 44 yr or less, and 0-20 for 45 yr or more) mU/ml for gamma-GTP in female, 21.4 (0-39) Karmen unit for GOT in male, 20.8 (0-35) Karmen unit for GOT in female, 13.9 (0-29) Karmen unit for GPT in male, and 12.7 (0-32) Karmen unit for GPT in female. 3) Serum ZTT and TTT levels were higher in female than in male. Both ALP and gamma-GTP levels were higher in male than in female, and have become high according to aging in female. Serum level of GPT was higher in male than in female. 4) There were significant positive correlations between serum ZTT and serum TTT levels, and also between serum GOT and serum GPT levels.

[Investigations on physiological values of blood in industrial workers. Report 2. Serum lipid values]

In order to establish the physiological values of serum lipids in healthy workers, 1,728 workers aged 35 years and over (1,035 males and 693 females) were examined after the over-night fast. Serum total cholesterol and serum triglycerides were measured by enzyme method. High density lipoprotein-cholesterols were measured by precipitation method (heparin-Mn2+) and beta-lipoprotein also by precipitation method (heparin-Ca2+). Ratios of total cholesterols to HDL-cholesterols and beta-lipoproteins to HDL-cholesterols were calculated. The results obtained are as follows: (1) Frequency distributions of 4 sorts of lipid values and 2 indices fitted approximately to the log-normal distribution. (2) High positive correlation coefficients were found between three lipid measurements, i.e. total cholesterol, triglyceride and beta-lipoprotein, in both men and women. High positive correlation coefficient was found between two ratios, total cholesterol/HDL-cholesterol and beta-lipoprotein/HDL-cholesterol. (3) Geometric means and, 5-95th percentile values in bracket were 184.5 (135-253) mg/dl for total cholesterol in men, 185.4 (139-247) mg/dl for total cholesterol in women, 84.9 (38-188) mg/dl for triglyceride in men, 71.3 (40-126) mg/dl for triglyceride in women, 47.9 (28-81) mg/dl for HDL-cholesterol in men, 51.5 (33-80) mg/dl for HDL-cholesterol in women, 348.3 (211-577) mg/dl for beta-lipoprotein in men, 306.9 (193-489) mg/dl for beta-lipoprotein in women, 3.9 (2.3-6.6) for total cholesterol/HDL-cholesterol in men, 3.6 (2.3-5.7) for total cholesterol/HDL-cholesterol in women, 7.3 (3.6-14.6) for beta-lipoprotein/HDL cholesterol in men, and 6.0 (3.1-11.7) for beta-lipoprotein/HDL-cholesterol in women. (4) Group average values of total cholesterol, triglyceride, beta-lipoprotein, total cholesterol/HDL-cholesterol and beta-lipoprotein/HDL-cholesterol tended to increase with age in women. These differences by age were statistically significant. (5) Mean values of HDL-cholesterol were higher in women than in men in all age groups.

Long-term prognosis of behavior therapy in practice

A prognosis study was carried out on 30 cases of patients treated with behavior therapy. The treatments, which took more than three years before the study, averaged four years and eight months. The results are as follows: (1) The improvement achieved by therapy was maintained or further improved in 29 cases during the post-therapeutic period of more than three years. (2) The prognosis largely depended on the grade of improvement at the end of therapy. A complete disappearance of symptoms at the end of therapy did not necessarily mean that it was a fair prognosis. (3) There was no relation between the prognosis and the length of history of illness or the situation of therapy terminated. (4) The impression is that long-term prognoses are different depending on the main symptoms.

Changes of behavior, fear and thought in the treatment by response prevention--a case study of obsessive compulsive disorder

A 15-year-old boy with compulsive hand washing and fear of contamination was treated by response prevention. Each series of the response prevention was experimentally divided into four periods: total response prevention, partial response prevention, free hand washing under noticed observation, and free from prevention and free from observation periods. After nine repeats of the series he became free of the symptoms. Temporal increase of fear and appearance of "freezing" phenomenon were observed in the total response prevention periods. Besides decrease in fear and hand washing, there was observed a change of his thought on symptoms with progress of the treatment. Based on these observations and results, the mechanism of treatment of response prevention was discussed.

Bioenergetics in clinical medicine. VIII. Adminstration of coenzyme Q10 to patients with essential hypertension

Coenzyme Q10 has been administered to five patients having essential hypertension and deficiencies of activity of succinate dehydrogenase-co-enzyme Q10 reductase in leucocyte preparations ranging from 20-40%. For a 74-year old male, the systolic pressure was reduced (p less than 0.001), the diastolic pressure was reduced (p less than 0.05), the specific activity of the coenzyme Q10-enzyme was increased (p less than 0.001), and the deficiency of coenzyme Q10 activity was negated (p less than 0.01). Four patients receiving CoQ10 for 3-5 months showed reductions (p less than 0.05 to p less than 0.001) of diastolic pressure, and 3 of these 4 showed reductions (p less than 0.05 to p less than 0.01) of diastolic pressure. Initial deficiencies of enzyme activity were reduced (p less than 0.01 to 0.05) in two patients. Three other patients did not show the high level of deficiency on treatment as initially observed. These effects of CoQ10 on the reduction of systolic and diastolic blood pressures, increase in CoQ10-enzyme activity, and reduction of CoQ10-deficiency are presumably due to improved bioenergetics through correction of a deficiency of coenzyme Q10.

Features of lysosomal proteolytic enzyme activity in infarcted myocardium

Myocardial infarction was produced in dogs to investigate the behavior of cardiac lysosomal enzymes; acid protease and beta-glucuronidase activities were measured in whole myocardial homogenate and 30,000 X g supernatant fractions. Total activity of acid protease in the whole homogenate of the myocardium increased after 1 hr of infarction and showed maximal value after 6 hr, while in the 30,000 X g supernatant fraction the activity began to increase after 3 hr and reached the maximal level by 24 hr. Total beta-glucuronidase activity in the whole homogenate decreased during the initial 3 hr after myocardial infarction and markedly increased after 12 hr. The activity in the 30,000 X g supernatant fraction showed corresponding changes. These findings that the increase in whole homogenate activity preceded that in the 30,000 X g supernatant fraction may support the hypothesis that lysosomal enzymes may be newly synthesized and then solubilized in the infarcted myocardium.

Relationship between energy liberation and utilization in ischemic cardiac muscle

Mitochondrial respiration, succinate dehydrogenase coenzyme Q reductase, and myosin B were investigated in ischemic myocardium from experimental myocardial infarction in dogs. Respiratory control ratio of mitochondria was impaired by ischemia at 60 min after coronary ligation, and oxygen consumption was inhibited 120 min later. Enzyme activity of succinate dehydrogenase coenzyme Q reductase was decreased at 6 hr after coronary ligation. Calcium ion sensitivity of myosin B declined 12 hr after coronary ligation. However, adenosine triphosphatase activity of myosin A from infarcted myocardium was not different from that of the intact one. These results suggest that interaction in the sequence of enzyme complexes was first impaired in ischemic myocardium and that deterioration of enzyme activity was then manifested.

A clinical study of the effect of coenzyme Q on congestive heart failure

Expecting activation of myocardial energy liberation, coenzyme Q was applied as a treatment to 55 patients suffering from congestive heart failure. Daily doses of 50 to 100 mg of coenzyme Q7 were injected intravenously in 21 cases for 3 to 35 days. Daily doses of 60 mg of coenzyme Q7 were administered perorally in 17 cases for 14 to 196 days. Daily doses of 30 mg of coenzyme Q10 were administered perorally in 17 cases for 7 to 182 days. Clinical effects were evaluated within 4 weeks by the criteria using a scoring method of severity of congestive heart failure which was devised by the authors. In summary a certain effect was found in 20 cases and a mild effect was observed in 29 cases. No significant changes were observed in heart rate and blood pressure. Exanthema appeared in 2 patients of the group of coenzyme Q7 intravenous injection. In conclusion the therapeutic effect of coenzyme Q was thought to be mild but stable in supplement to digitalis therapy in cases of congestive heart failure.

Bioenergetics in clinical medicine. Studies on coenzyme Q10 and essential hypertension

The specific activities (S.A.) of the succinate dehydrogenase-coenzyme Q10 (CoQ10) reductase of a control group of 65 Japanese adults and 59 patients having essential hypertension were determined. The mean S.A. of the hypertensive group was significantly lower (p less than 0.001) and the mean % deficiency of enzyme activity was significantly higher (p less than 0.001) than the values for the control group. These data on Japanese in Osaka agree with data on Americans in Dallas. Some patients showed no CoQ10-deficiency, and others showed definite deficiencies. Emphasizing the CoQ10-enzyme for patient selection, CoQ10 was administered to hypertensive patients. Four individuals showed significant but partial reductions of blood pressure. Monitoring the CoQ10-enzyme before, during, and after administration of CoQ10 indicated responses. The maintenance of high blood pressure could be primarily due to contraction of the arterial wall. Contraction or relaxation of an arterial wall is dependent upon bioenergetics, which also provide the energy for biosynthesis of angiotensin II, renin, aldosterone, and the energy for sodium and potassium transport. A clinical benefit from administration of CoQ10 to patients with essential hypertension could be based upon correcting a deficiency in bioenergetics, and point to possible combination treatments with a form of CoQ and anti-hypertensive drugs.

Highly Sensitive Light-induced Memory Effect with Amorphous Se-SnO(2) Heterojunction

The light-induced memory effect in amorphous selenium films is studied by fabricating them into a sort of heterojunction (Se-SnO(2)) so as to be able to apply the bias voltage together with the laser beam irradiation for memory. Under the reverse bias voltage, a region of high electric field is formed in the selenium film near the junction. Remarkable enhancement in the photo-induced image spot is achieved if an appropriate bias voltage is applied simultaneously, indicating the sensitization of the memory effect due to the photocurrent induced by the high electric field in the selenium film.