[Radiology of trigeminal neuralgia--with special reference to CT findings]

CT findings in ninety-nine patients with trigeminal neuralgia were reviewed. Brain tumors including three trigeminal neurinomas, three meningiomas, one epidermoid, one acoustic neurinoma, were found in eight cases as a cause of symptomatic trigeminal neuralgia. Among seventy-nine patients with idiopathic trigeminal neuralgia, four cases had vascular decompression surgery because of the tortuous, ectatic or anomalous vertebrobasilar artery. Among the other seventy-five non-surgical cases, seventeen cases showed the tortuous and/or ectatic vertebrobasilar artery on CT, and this group of patients showed slightly higher recurrence rate of trigeminal neuralgia after nerve block or medication compared with other non-surgical patients. CT is thought to be a useful screening imaging modality for evaluation of patients with trigeminal neuralgia, and angiography is required for precise evaluation of the compressing vessels when surgical treatment is contemplated.

[Stellate ganglion block therapy against progressive facial hemiatrophy]

A typical case with progressive facial hemiatrophy was treated with a new therapeutic trial, stellate ganglion block. The present case, a Japanese girl, suffered from progressive atrophy involving the soft tissue of the left buccal region, with onset at the age of 6 following a minor local trauma. She visited our hospital at the age of 9, and as soon as the diagnosis was made, left stellate ganglion block was initiated. Local injection of lidocaine was performed 53 times over the period of 1 year and 4 months. During this period of therapy and the subsequent follow-up period of 4 years, the state of atrophy remained unchanged and nonprogressive. Stellate ganglion block as a therapy against progressive facial hemiatrophy was considered to be worth further evaluation, although it was impossible to judge, based solely on our experience, whether the arrest of progression was attributable to the therapy. The rationale of this therapy was also discussed. It was based upon the assumption that atrophy may result from irritation of the cervical sympathetic nerve, one of the most popular theories regarding the pathomechanism of progressive facial hemiatrophy.

[Computed tomographic diagnosis of postoperative maxillary cyst (POMC)--a comparison with conventional tomography]

We reviewed the computed tomographic (CT) findings of postoperative maxillary cyst (POMC) in 64 patients with 79 lesions, and evaluated its diagnostic efficacy. Typical CT finding of POMC was an expansile and homogeneous soft tissue mass with bone erosion. Thin-walled capsule and bony septation were also demonstrated in 72% and 35% of the lesions, respectively. A comparison between conventional tomography and CT has been made in the same subjects for evaluation of the detectability and extension diagnosis of POMC. CT proved to be superior to conventional tomography in diagnosing the presence and the extent of POMC. We conclude that conventional tomography is not necessary in diagnosis of POMC, when full examination of the paranasal sinus is performed by CT.

[Diagnostic imaging of gallbladder carcinomas with special reference to ultrasonographic findings. Retrospective review with emphasis on diagnostic problems in preoperatively undiagnosed gallbladder carcinomas]

The diagnostic images of twenty surgically-resected gallbladder carcinomas were retrospectively reviewed for correlations with macroscopic findings. Among them, nine cases were correctly diagnosed preoperatively; 11 were not. Macroscopically, all correctly diagnosed lesions were elevated type carcinomas. Preoperatively undiagnosed lesions were comprised by 9 superficial and 2 elevated types of carcinomas. None of these 11 undiagnosed carcinomas could be identified on retrospective review of the ultrasonographic findings. Thorough evaluation of the gallbladder wall was prevented by gallstones and/or emphysema in 6 cases, and by contraction of the gallbladder in 4 cases. There was no definite evidence of wall thickening in one case of diffuse superficial carcinoma involving the muscle layer. As for lesion detectability, computed tomography was inferior to ultrasonography, though the former demonstrated localized wall thickening of the gallbladder in the majority of cases of elevated type carcinomas. Intravenous cholangiographic findings were non-specific.

Decreased leukocyte ferrochelatase activity in erythropoietic protoporphyria

We studied the porphyrin metabolism of a 7-year-old Japanese boy with erythropoietic protoporphyria (EPP) and his family members. Leukocyte ferrochelatase activity was markedly decreased in this patient, being approximately 12% of the mean value of normal controls (4 aged-matched healthy boys). In contrast, leukocyte delta-aminolevulinic acid (ALA) synthase activity was normal. The free protoporphyrin content of erythrocytes was greatly increased (4.3 mg/100 ml RBC), while erythrocyte ALA dehydratase and porphobilinogen (PBG) deaminase activities were 1.7- and 2.2-fold of respective control values. A survey of his family revealed that 12 of 19 members probably had manifest EPP or were EPP carriers. These results suggest that, in EPP, there might be an inherited impairement of ferrochelatase activity which gives rise to an elevation of erythroblast ALA dehydratase and PBG deaminase activities to compensate for a resultant decrease in heme production.

[A histological study of striated muscle and nerve fiber in the human caused by a high voltage electric current]

A case of an electrocution is reported, involving a 37-year-old man who while engaged in an electrical work, received an electric shock by touching an electric wire of 11,000 volts. Both of his arms had to be amputated. A piece of muscle tissue was removed from the amputated arm to be examined by light and electron microscopy. Under light microscopy, the muscle tissue, after myoglobin staining, showed a particular pattern that closely resembled the pattern on the skin of a python. Thus the author has named the pattern seen in this case as the "Python-pattern". The electron microscopy inspection revealed on myoglobin staining excessive stretching and fragmentation of the myofibrils where the myoglobin staining was negative in the slide.

Clinical, histological, and immunohistological studies of postoperative erythroderma

We report 7 cases of acute fatal illness characterized by fever, diffuse erythematous rash, and progressive leukopenia occurring 10 days after surgical operation. The outcome was uniformly fatal. The biopsy findings consisted of eosinophilic individual necrosis of epidermal cells, satellite cell necrosis, basal liquefaction degeneration, and scanty cell infiltration into the dermis. T lymphocytes were found in the epidermis but Langerhans cells disappeared. These findings are compatible with acute graft-vs-host disease following blood transfusion. Explanations based upon drug allergy, infection, toxic shock syndrome, or toxic epidermal necrolysis seem less reasonable.

Histopathological study of alobar holoprosencephaly. 1. Abnormal laminar architecture of the telencephalic cortex

Abnormal architecture of the telencephalic cortex was studied in six autopsy specimens of alobar holoprosencephaly by histopathological, electron microscopic and immunohistochemical methods. Several common abnormalities are described and their significance discussed. In all of the specimens, the cortices showed excessive thickness and abnormal lamination with a middle cellular layer and an external sparse layer, indicating disturbance of neuronal migration. Neurons of the external sparse layer were segmented into irregularly arranged groups, suggesting disturbance of tissue organization. In three specimens, the internal pyramidal layer contained numerous abnormal glomerular structures which consisted of fine dendrites and axons.

Acute necrotizing encephalopathy with widespread edematous lesions of symmetrical distribution

A 67-year-old Japanese woman with liver cirrhosis was affected by an unusual acute progressive encephalopathy, presenting mental confusion and slurred speech as its initial symptoms. She died in profound coma, following the entire course of 17 days. Autopsy disclosed bilateral symmetrical, widespread, edematous and necrotic lesions, their centers being located in the basal ganglia, diencephalon and midbrain, and their peripheries expanding into the cerebral white matter, cerebellum, pons and medulla. Diapedesis of erythrocytes and serum plasma was conspicuous, in contrast to paucity of capillary proliferation. Although the lesions were somewhat similar to those of Wernicke's and Leigh's encephalopathies, they were considered to be representative of a more acute metabolic disorder distinct from the latter conditions.

Evaluation of the significance of "redistribution" in I-123 IMP SPECT in cerebrovascular disorders--a comparative study with PET

We evaluated the significance of redistribution in 123I-IMP SPECT study using PET. Twelve lesions in ten patients were selected. These lesions were classified into the following three groups; ischemia, infarction of subacute phase and infarction of chronic phase. All lesions with ischemia or subacute infarction showed good or moderate redistribution. Three of four lesions with chronic infarction showed no redistribution. The mean values of rCBF and rCMRO2 were highest in the lesions with good redistribution, but there was no differences in rOEF with the degree of redistribution. In conclusion, the tissue with good redistribution is not always viable and it was impossible to predict a region with increased rOEF by redistribution alone.

Histopathological study of alobar holoprosencephaly. 2. Marginal glioneural heterotopia and other gliomesenchymal abnormalities

Abnormalities of glial and mesenchymal elements were studied in six autopsy specimens of alobar holoprosencephaly by histopathological and immunohistochemical methods. Marginal glioneural heterotopia was observed in all of the specimens. It was most prominent in the prosencephalic base around the optic chiasm, and extensive in five specimens. The floor of the third ventricle was intermingled with excessive mesenchymal elements, and in three specimens the ventricular cavity was plugged by heterotopic nodules. In the cerebellum, dysplastic nodules were observed in two specimens. In the telencephalon, the marginal and subventricular layers were thickened. The pathological significance of these findings is discussed with their possible relationship to the pathomechanism of holoprosencephaly.

Establishment of a human megakaryoblastic cell line (T-33) from chronic myelogenous leukemia in megakaryoblastic crisis

A megakaryoblastic cell line, termed T-33, was established from the peripheral blood of a patient with Philadelphia chromosome-positive chronic myelogenous leukemia in megakaryoblastic crisis. T-33 cells have been maintained in RPMI 1640 medium containing 10% fetal calf serum in a single cell suspension with a doubling time of 24-36 h for over 2 years. Giemsa-banded karyotypes were female hyperdiploid with a modal chromosomal number of 51, all cells including Philadelphia chromosome. The cells showed strong positivity for periodic acid-Schiff and alpha-naphthyl acetate esterase, and weak for alpha-naphthyl butyrate esterase, but were negative for myeloperoxidase. Flow cytometric analysis of cell surface markers showed the existence of HLA-DR, MY-7, MY-9, and a platelet antigen (Yukb), and no markers for T- or B-lymphocytes. Most of the cells fixed with acetone were positive for Factor VIII, platelet glycoprotein IIb-IIIa, IIIa (Yukb), and Ib, but negative for glycophorin A and hemoglobin. Ultrastructural platelet peroxidase was demonstrated in 2-3% of cells and the percentage of positive cells increased up to 20% after the treatment with 12-O-tetradecanoylphorbol-13-acetate. The cells contained small dense granules negative for platelet peroxidase, their number increasing threefold after 12-O-tetradecanoylphorbol-13-acetate treatment. Such treated cells frequently showed a complex of the demarcation membrane in the cytoplasm. T-33 responded thrombin to exhibit calcium influx. This cell line may be useful for the study of the early stage of megakaryocytic differentiation in human megakaryopoiesis.

[Traumatic occlusion of the bilateral vertebral arteries associated with fracture of the cervical spine--a case report]

A case of traumatic occlusion of the bilateral vertebral arteries associated with fracture of the cervical spine is reported. A 34-year-old man, having no previously noted medical problems, fell to the bottom of a bathtub with a depth of 80 cm, and hit the vertex fronto-parietal region of his head. He was transferred to our hospital 6 hours after his fall with a crush fracture of the cervical spine at the C6 level. On admission he was alert, but having pain in the vertex region, dysarthria, blurred vision and hemiparesis. Roentgenograms confirmed a crush fracture of the C6 vertebral body. Computed tomograms of the brain revealed a high density of basilar artery. Cervical traction with a Halo brace was then carried out. Twelve hours after the trauma, left oculomotor and right facial palsy appeared followed by bilateral oculomotor palsy and respiratory difficulty. At the 14th hour, he displayed bilateral Babinski's signs and tetraparesis. Tetraparesis became complete with right-side Horner's syndrome at 16 hours. Cerebral arteriograms performed 20 hours after the trauma showed a complete occlusion of the right vertebral artery and an incomplete occlusion of the left vertebral artery at the C6-7 intervertebral disk space. Conscious level deteriorated to a 200 level on the Japan coma scale 28 hours after the trauma and to a 300 level after 32 hours. Computed tomograms revealed a marked low density on the cerebellum and brain stem 38 hours after the accident. He expired on the 22nd day after the trauma.(ABSTRACT TRUNCATED AT 250 WORDS)