[Medulloblastoma with extracranial metastases--a case report (author's transl)]

A case of medulloblastoma with extracranial metastases was reported. A 20-year-old woman was operated on for cerebellar medulloblastoma twice during the past 5 years and a half. Two years after the second operation, she revealed the metastases to the cervical, axillar and inguinal lymphnodes, and to the skeletal system, such as the skull, scapula, humerus, sternum, spine, pelvis and femur. The cause of extracranial metastases in the very core in this case. While the tumor was located deep in the cerebellar hemisphere at the first operation, it spread over the cerebellar surface at the after the second operation, so that the tumor cells became infiltrative to the dura mater. Thus through lymphatic and circulatory system extracranial metastases occurred. The location of the tumor seems important in this case.

Occlusive arteriopathy and brain tumor

Four cases with the association of occlusive arteriopathy and brain tumor are presented. A clinical analysis of these cases and cases reported in the literature revealed that occlusive arteriopathy at the base of the brain was often associated with a slowly growing basal tumor in children. Possible causes of occlusive arteriopathy in these cases were compression of the circle of Willis by a slowly growing basal tumor, secondary artial occlusive changes by radiation therapy for a basal tumor, or vasculopathy associated with neurocutaneous syndrome. Symptoms of sudden onset or episodic nature suggest the presence of occlusive arteriopathy rather than the mass effect of a tumor. Cerebral angiography is mandatory whenever computerized tomography (CT), performed to rule out recurrence of a basal tumor, shows an ischemic lesion with low-density areas without any evidence of mass effect of the tumor. Cerebral angiography is also necessary when a basal tumor is suspected in children, particularly in cases associated with neurocutaneous syndrome and a basal tumor. Care should be taken not to scarify the abnormal vascular network at the base of the brain at the time of operation, because it is considered to be functioning as collateral circulation. The potential hazards of radiotherapy to radiation-induced occlusive changes of the circle of Willis must be considered in treating a benign basal brain tumor in children. Even in adults, repeated large doses of irradiation could cause occlusive arteriopathy.

Microvascular responses to norepinephrine and vasopressin during halothane anesthesia in the rat

This experiment was designed to determine the microvascular responses to the two known naturally occurring vasoconstrictors, norepinephrine (NE) and vasopressin, at known levels of central vasomotor activity before, during and after halothane anesthesia. The responses to topical application of NE and vasopressin were studied in the microvasculature of the mesentery and cremaster muscle, using microscopic methods. Neural (CNS) stimulation was accomplished through electrodes chronically implanted in vasoactive sites of the forebrain and midbrain. The increase in blood pressure in response to CNS stimulation was decreased during halothane anesthesia (32.4 +/- 5.4 per cent before and 24.7 +/- 6.1 per cent during; P less than 0.001). There was no significant change in the steady-state diameter of the microvasculature under study during or after halothane anesthesia. Marked abatement of arteriolar vasoconstriction in response to CNS stimulation was seen prior to halothane. However, the same target vessel showed increased constriction in response to topically applied NE (from 32.3 +/- 4.7 to 53.2 +/- 7.8 per cent; P less than 0.01) during halothane anesthesia. By contrast, the response to vasopressin decreased (from 42.4 +/- 5.7 to 1.0 +/- 6 per cent; P less than 0.001) with halothane. The precise mechanism(s) underlying the described hypersensitivity to NE and hyposensitivity to vasopressin in the same vascular structure during halothane anesthesia remains undetermined.

[A case of binasal quadrantanopsia due to opto-chiasmal arachnoiditis (author's transl)]

A case of binasal quadrantanopsia due to chiasmal arachnoiditis was reported. The patient was a 28-year-old man who complained of blurring of vision for 12 months. Visual acuity of the right eye was 20 cm/numerus digitorum and the left 0.7X contact lens. Visual field revealed binasal lower quadrantanopsia. Pneumoencephalogram showed poor filling in the chiasmatic cistern, but the angiogram and CT scan showed no parasellar mass lesion. Then optochiasmal arachnoiditis was diagnosed and a right frontal craniotomy was performed. The arachnoid around the post-fixed chiasm was thickened and adhered to the bilateral rectal gyri. Proximal parts of A--1 segments of bilateral anterior cerebral arteries were displaced medially and downward, compressing the both lateral aspects of the chiasm. Compression of the optic chiasm by the anterior cerebral arteries was relieved after removed of the arachnoid. Despite of the slight improvement of visual acuity, visual fields were not changed postoperatively. The authors briefly discussed the mechanism of binasal hemianopsia in our case and reviewed recent literatures.

Involvement of calcium in cyclic nucleotide metabolism in human vascular smooth muscle

When cyclic nucleotide phosphodiesterase was purified from isolated smooth muscle layer of human aorta by DEAE-cellulose column chromatography, separated cyclic GMP phosphodiesterase activity was markedly stimulated in the presence of 10-20 micrometer of Ca2+ by a protein modulator which has similar physicochemical properties to troponin C. Synthetic compound, N-(6-aminohexl)-5-chloro-1-naphthalensulfonamide, which produced relaxations of arteries contracted by prostaglandin F2alpha or KCl was found to inhibit selectively this Ca2+-dependent cyclic GMP phosphodiesterase. This compound produced inhibition of superprecipitation of myosin B system obtained from mouse skeletal muscle and also inhibited adenosine triphosphatase activity of myosin B. Our data suggest that calcium is involved through a protein modulator in cyclic nucleotide metabolism of vascular smooth muscle and that the calcium-dependent protein modulator probably participates in the regulation of contractile response of vascular smooth muscle by affecting actomyosin ATPase activity.

Cyclic 3':5'-nucleotide phosphodiesterase determined in various human tissues by DEAE-cellulose chromatography

Tissue extracts from human heart, lung, liver, kidney, skeletal muscle and cerebrum displayed at least 3 distinct cyclic 3':5'-nucleotide phosphodieterase (EC 3.1.4.17) activity peaks (FI, FII, FIII) on DEAE-cellulose chromatography and various properties of these forms were compared in each tissue. FI eluted at about 0.08 M sodium acetate, hydrolyzed cyclic GMP more rapidly than it did cyclic AMP, and cyclic GMP hydrolysis by FI in most tissues was enhanced by a protein activator in the presence of CaCl2. As only high concentrations of cyclic AMP inhibited cyclic GMP hydrolytic activity of FI, the enzyme probably has a low affinity for cyclic AMP. FII eluted at about 0.2 M sodium acetate, hydrolyzed both nucleotides at equal rates, and substrate affinities were relatively low. Cyclic GMP hydrolysis by FII was also stimulated by addition of a protein activator in the presence of CaCl2 and cyclic AMP hydrolysis in this fraction was accelerated by a micromolar fraction of cyclic GMP. FII eluted at about 0.35 M hydrolyzed cyclic AMP preferentially and was insensitive to protein activator. These two cyclic nucleotides act as mutual inhibitors of the hydrolysis in this fraction. Ratio of the cyclic GMP to cyclic AMP hydrolysis was in the order FI, FII, FIII. Four activity peaks were eluted from the cerebral extract and enzymes from this tissue exhibited much the same properties as observed in the other tissues examined herein.

Experimental hydrocephalus of the rat, produced by cisternal injection of kaolin-solution (author's transl)

Experimental hydrocephalus was produced in rats in high percentage, by direct injection of kaolin-solution into the cisterna magna under a operating microscope. Rats with hydrocephalus showed retarded development of the body. The skull enlarged round and became so thin, that the cortical vessels were observed through the skull. The brain showed marked internal hydrocephalus, retaining cerebrospinal fluid passage in the ventricular system, but there was an obstruction at the ambient cistern and the basal cistern. Review of the literature dealing with the methods to produce acquired hydrocephalus showed that this is the first report of experimental hydrocephalus of the rat produced by injecting kaolin-solution.

Effect of anti-thyroid agents, methimazole and propylthiouracil, on brain noradrenaline content

1 Methimazole (1-methyl-2-mercaptoimidazole, MMI) and propylthiouracil (6-propyl-2-thiouracil, PTU) which are used in the therapy of hyperthyroidism were found to reduce brain noradrenaline (NA) content. Endogenous NA levels in rat brain were reduced from 1 to 6 h after intraperitoneal injection of MMI by doses in excess of 25 mg/kg and by PTU at a dose of 50 mg/kg. However, endogenous NA in the rat heart was only slightly reduced after 50 mg/kg of MMI, and was not affected by PTU (50 mg/kg). 2 Both MMI and PTU effectively inhibited the in vivo conversion of [3H]-dopamine into [3H]-noradrenaline ([3H]-NA) in the brain of rats after a single intraperitoneal injection of doses above 10 mg/kg (MMI) and 25 mg/kg (PTU). This inhibition by MMI and PTU was dose-dependent over the range of 10 mg/kg to 50 mg/kg, was highest after 2-3 h and continued for at least 6 h after their injection; The conversion rates returned to normal after 24 hours. 3 The results suggest that the reduction of brain NA by these drugs is, at least in part, due to the inhibition of brain dopamine beta-hydroxylase.

[Intracranial invasion of ethmoid cancer --a report of two cases (author's transl)]

Two cases of intracranial invasion of the ethmoid cancer were reported. With additional six cases reported in Japan, the precise clinical course and pathophysiological findings of the disease were reviewed, and the following several points became clear; 1) The incidence of the ethmoid cancer was rare. 2) These were divided into main groups according to the onset of intracranial signs, such as the frontal lobe symptoms and I-VII cranial nerve involvement. The first group showed the intracranial symptoms early, and the second group late. 3) The tumor invaded the cranial cavity along the perineural sheeth of each cranial nerve mainly. 4) It was very difficult to identify the paranasal sinus of origin after invading the cranial cavity. 5) The prognosis was extremely poor. All cases were died within one and half year.

Neurenteric cyst with meningomyelocele. Case report

✓ A case is reported of lumbosacral meningomyelocele with a neurenteric cyst and superficial presentation of the mucosa. Development and inversion of the cyst is discussed.