Antitumor effect of combination of hyperthermotherapy and 5-aminolevulinic acid (ALA)

BACKGROUND

5-Aminolevulinic acid (ALA) is a precursor of heme. ALA is used as a photosensitive substance in photodynamic diagnosis (PDD) and photodynamic therapy (PDT) because heme metabolism is abnormal in tumor cells and a photosensitive metabolite of heme synthesis from ALA, protoporphyrin IX (PpIX), specifically accumulates in tumors. We investigated the enhancement of the antitumor effect by combination of ALA and hyperthermotherapy (HT) using a transplanted tumor model with Lewis lung carcinoma cells (3LL) in mice.

MATERIALS AND METHODS

Animals were divided into four test groups: control (untreated), HT, and HT plus ALA (100 or 300 mg/kg) groups, and HT by bathing at 43°C for 20 min was performed at five days after transplantation. ALA was administered once at the above doses three hours before HT by intraperitoneal injection.

RESULTS

The tumor sizes at five days after HT were 5.2- and 2.6-times greater than those at the time of HT in the control and HT groups, respectively. In contrast, PpIX accumulation in the tumor region was noted three hours after ALA administration, the HT+ALA group given at 100 or 300 mg/kg of ALA inhibited tumor growth to 1.3- and 1.1-times increases in the tumor size.

CONCLUSION

Therefore, ALA administration markedly enhanced the tumor growth-inhibitory effect of HT.

[Usefulness of time-resolved projection MRA on evaluation of hemodynamics in cerebral occlusive diseases]

The usefulness for evaluation of cerebral hemodynamics using time-resolved projection MRA was studied in normal volunteers and patients of cerebrovascular diseases. Six normal volunteers and ten patients with cerebrovascular occlusive diseases including 6 of IC occlusion and 4 of post EC/IC bypass surgery underwent time-resolved projection MRA on a 1.5 T clinical MRI system. Projection angiograms are acquired with 2 D-fast SPGR sequence with a time resolution of approximately one image per second, 40 images being acquired consecutively before and after bolus injection Gd-DTPA. And all images were calculated by complex subtraction from the background mask in a work station. In normal volunteers, the quality of images of time-resolved projection MRA was satisfactory. The arteries from internal carotid artery through M 2 segment of middle cerebral artery and all major venous systems were well portrayed. In 4 cases of IC occlusion who were assessed the collateral flow through the anterior communicating artery and posterior communicating artery, there were delayed to demonstrate the ipsilateral MCA. However, in 2 cases of IC occlusion that were assessed the collateral flow through leptomeningeal anastomosis, ipsilateral MCA and collateral circulation were not demonstrated. In all patients of post EC/IC bypass surgery, the patency of EC/IC bypass could be evaluated as properly with time-resolved projection MRA as 3 D-TOF MRA. Although the temporal and spatial resolutions are insufficient, time-resolved projection MRA was powerful non-invasive method to evaluate the cerebral hemodynamics via the basal communicating arteries in IC occlusion and identify the patency of EC/IC bypass.

[A case of adult moyamoya disease progressed after vascular reconstructive surgery]

We report an adult onset patient with moyamoya disease showing acute progress after contralateral vascular reconstructive surgery. A 47-year-old female developed cerebral infarction in the left corona radiata. A magnetic resonance (MR) angiography and a cerebral angiogram revealed severe stenosis extending from the terminal portion of left internal carotid artery (ICA) to the M1 portion. The right ICA showed slight stenosis. We performed direct bypass surgery (STA-MCA anastomosis) on the affected left side. MR angiography 1 month after surgery revealed the progressive stenosis of the C1 portion of the right ICA. While measurement of cerebral blood flow (CBF) showed a slight impairment of vascular reactivity to acetazolamide loading in the region of the right MCA, we continued without vascular reconstructive surgery for the right side because there was no ischemic attack. The patient had a transient sensory disturbance of the left upper extremity 16 months after surgery. MR angiography and a cerebral angiogram revealed more progressive stenosis extending from the right ICA to the M1 portion. CBF study showed a low CBF at rest and a negative response to acetazolamide loading in the region of the right MCA. Direct bypass surgery was performed on the right hemisphere. Follow-up study revealed an increment of rest CBF and improvement of vascular reactivity. We underlined the necessity for careful postoperation observation of progressive contralateral arterial stenosis using MR angiography and CBF study in adult onset patients with moyamoya disease.

[Evaluation of hemodynamics in cerebral infarction using MRI with FAIR sequence]

In comparison with 99mTc-ECD SPECT, the usefulness for evaluation of cerebral blood flow by the perfusion images using MRI with FAIR sequence was studied in ischemic stroke patients. Among 27 cases, 15 patients showed lacunar infarctions and 12 patients showed cortical infarctions determined by T2 weighted MR images. FAIR images were obtained as single images at the slice position running through the basal ganglia or corona radiata. The inversion times(TI) were varied, ranging from 800 to 1,400 msec. In 15 patients without definite low perfusions in the SPECT study, FAIR images showed sequentially proxymal arterial branches in early phase and distal arterial branches or capillary beds in the cortical tissues in a late phase as the TI was elongated. Nine of the 12 patients with low cerebral perfusions in the SPECT study showed perfusion defects in FAIR imaging. Five of the 12 patients with a small low cerebral perfusion area in the SPECT study showed a delay of the depiction of cortical arteries along with TI elongation. In 3 patients, ischemic lesions demonstrated by the SPECT study was not shown in the MRI study because of motion artifacts. In conclusion, FAIR imagings are considered to be useful in the evaluation of cerebral flow dynamics in the ischemic stroke patients.

Transvenous embolization of carotid-cavernous sinus fistula associated with a primitive trigeminal artery--case report

A 58-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. The fistula was treated by introducing detachable coils through the transvenous approach, as the detachable balloon was not available. Follow-up angiography performed 14 days after the embolization revealed complete disappearance of the carotid-cavernous sinus fistula due to thrombosis, which was presumably accelerated by the coils. Transvenous coil embolization should be considered as an alternative treatment for high-flow carotid-cavernous sinus fistula, but only if transarterial balloon embolization is not successful or unavailable.

Changes in visibility of intracranial arteries on MRA with normal ageing

We investigated age-related changes in the visibility of intracranial arteries on magnetic resonance angiography (MRA) and the influence of risk factors for stroke. We studied 230 adult patients without specific neurological deficits. MRA was performed using the three-dimensional time-of-flight technique with a spoiled gradient-recalled acquisition sequence. We classified internal carotid artery (IC) and the horizontal (M1) and distal (beyond M2) middle cerebral segments into 4 grades. Linear regression revealed a significant negative relation between age and the quality of demonstration on MRA. For IC and M1, the score was significantly lower in subjects with risk factors than in those without. The distal MCA was poorly seen in patients without a history of hypertension or lacunar infarcts. A marked correlation was observed between visibility and age patients with no history of hypertension, diabetes mellitus and hyperlipidaemia. We suggest that atherosclerotic change and decline in flow velocity with normal ageing are factors leading to decreased visibility on MRA.

Diagnostic use of isotropic diffusion-weighted MRI in patients with ischaemic stroke: detection of the lesion responsible for the clinical deficit

We examined the diagnostic use of isotropic diffusion-weighted (DW) MRI in 140 consecutive patients suspected of or diagnosed as having an ischaemic stroke. Isotropic DW imaging could demonstrate the lesion responsible for the clinical deficit in patients with multiple cerebral infarcts at an early stage, even small lesions without a perifocal oedema or mass effect. Accurate diagnosis by DW images may, however, be difficult about 2 weeks after the onset of stroke.

Development of the local medical service network system. Integration of medical service with the network system between university hospital and other medical institutions

Although every medical institution always make efforts to provide best services for the patients, it tends to be insufficient to send the patient's information and share them with other medical institutions. It is partly because in the Japanese medical care system there is no obligation to inform patients' medical information to other medical institutions. To provide effective and cost-effective medical service, we made a local network system between university hospital and other medical institutions. The system contributes to clarify the role of medical institutions and the continuity of medical service. For the next step, we must construct the home-care information service network towards the total service for the patients.

[Changes in visualization of cerebral MR angiography with normal aging]

MR angiograms from 200 neurologically normal subjects aged 30 to 79 years were analyzed to assess the influence of aging and hypertension on the degree of the--visualization of the cerebral arteries. The degree of MR visualization of the cerebral arteries, including the IC, M 1, and distal MCA, was evaluated on a 4-degree scale. IC and M 1 differ in appearance. The MR gradings of each cerebral arteries showed a significant (p < 0.001) negative correlation with age. Hypertension, which is a risk factors for arteriosclerosis, significantly reduced MR grade. The degree of visualization of M 1 and the distal MCA decreased significantly with age in the normotensive group. Therefore, the decrease visualization of the cerebral arteries appears to involve not only cerebral arteriosclerosis but other factors associated with aging.

Magnetic resonance angiography in patients with acute stroke treated by local thrombolysis

Although magnetic resonance angiography (MRA) is accepted for showing chronic intracranial stenotic or occlusive lesions, the method has not been practically examined in patients with acute cerebral ischaemia. We carried out three-dimensional time-of-flight MRA in six patients with acute ischaemia treated by local thrombolysis, and compared the findings with those of digital subtraction angiography (DSA). In all patients, MRA before thrombolysis clearly demonstrated the occluded arteries, which corresponded precisely to those shown by DSA. In four patients with complete recanalisation of the occluded vessels after thrombolysis, the recanalisation could be demonstrated by postoperative MRA. In one patient with reocclusion of the recanalised artery, repeat MRA also demonstrated the reocclusion, confirmed by DSA. These results suggest that MRA may be helpful for noninvasive investigation before and after thrombolysis.

[Functional MRI of higher brain function with gradient echo on clinical MR unit]

MR imaging of brain function has been successfully performed at 1.5 T clinical MR unit. In the early studies, functional MRI were performed with simple stimulation such as visual and motor. Recently, many investigators have attempted to demonstrate the specific brain localization of higher brain functions such as memory, imagination, language and so on. In this study, we attempted the functional MRI for motor and word imagination with gradient echo sequences on clinical MR unit. In our experiences, motor cortex was activated on motor imagination task and Broca area was activated on word imagination task, respectively. We demonstrated the higher brain functions were able to be demonstrated on clinical MR unit with gradient echo sequences.

Analysis of Ki-ras codon 12 mutations in the duodenal juice of patients with pancreatic cancer

BACKGROUND & AIMS

Point mutations of the Ki-ras gene at codon 12 have been frequently identified in pure pancreatic juice of patients with pancreatic cancer in studies examining pancreatic cancer tissues. The aim of this study was to examine mutations of the Ki-ras codon 12 in the duodenal juice collected from patients with various pancreatic disorders.

METHODS

The duodenal juice was collected through a Dreiling tube installed in the duodenum during a secretin test. Analysis of the Ki-ras mutations was performed using the enriched polymerase chain reaction--single-strand conformation polymorphism technique.

RESULTS

Point mutations were detected in 12 of 19 patients with pancreatic cancer; of the 12 patients, 10 had ductal tubular adenocarcinoma and 2 intraductal papillary adenocarcinoma. Mutational patterns included GAT (n = 4), GTT (n = 3), CGT (n = 1), and double mutations of GTT and GAT (n = 3) and GAT and CGT (n = 1). In 41 patients with benign pancreatic disorders, a point mutation was detected in only 1 patient with chronic pancreatitis.

CONCLUSIONS

Analysis of the Ki-ras codon 12 mutations in the duodenal juice is useful in the diagnosis of pancreatic cancer.

[Familial amyloidosis of the Finnish type (FAP) with extraocular muscle involvement]

Among 17 patients with amyloid polyneuropathy type IV in a Japanese family, we found a 72-year-old woman, who showed extraocular symptoms approximately 10 years after the onset of the disease. she developed weakness of the right facial muscles and dysarthria at age 57. She had atrophy and disturbance of movement of the tongue, along with difficulty in swallowing at age 62. At the age of 66, she felt diplopia when she looked toward the left, followed by difficulty of ocular movement. These manifestations progressed and at age 72, she was found to have mild ptopsis, mild to moderate disturbance of almost all extraocular muscles, moderate to severe disturbance of facial, masseter, pharyngeal, tongue and neck muscles. She also had slight weakness and atrophy of the limb and truncal muscles together with slight loss of pain and vibratory sensations in the distal parts of the limbs. FAP IV has sometimes been called cranial amyloidosis, but motor disturbance is limited to the middle and lower cranial nerve territories in the majority of the reported cases, and manifestations of the extraocular muscles are quite rare. According to the present investigation of the world literature, this is the second case of FAP IV with extraocular muscle involvement.

Primary spinal chondrosarcoma localized in the cervical spinal canal and intervertebral foramen--case report

A 48-year-old male presented with a very rare case of spinal chondrosarcoma localized in the cervical spinal canal and intervertebral foramen, but without marked destruction of the vertebral column. Spinal chondrosarcoma is characterized by radiological evidence of destruction of the surrounding bone structure and mottled calcification. Magnetic resonance imaging was useful in the diagnosis and determination of the extent of this spinal chondrosarcoma. However, preoperative differential diagnosis of the tumor was not possible based on neuroimaging evidence.

Grades of exophthalmos and thyrotropin-binding inhibitory immunoglobulin in patients with myasthenia gravis

Exophthalmos and thyrotropin-inhibitory immunoglobulin (TBII) were examined in myasthenia gravis (MG) patients with normal thyroid function. Exophthalmos was found in 7 of 31 (22.6%) MG patients, and TBII was detected in 4 of 21 (19.0%) MG patients. The grades of exophthalmos did not decrease after extraocular muscle weakness was improved by treatment. Patients with MG whose diplopia was Tensilon unresponsive were only found among those with exophthalmos. TBII was more frequently detected in MG patients with exophthalmos than in those without. The present study revealed that exophthalmos is not rare in MG patients, even if they do not show any signs of Graves' disease other than exophthalmos and their thyroid functions are within the normal limit. The presence of TBII in MG patients may relate to the development of exophthalmos, and exophthalmos itself might enhance ocular symptoms of MG.

Successful total removal of intramedullary hemangioblastoma from the medulla oblongata

The case of a large solid hemangioblastoma embedded wholly in the medulla oblongata is reported. Preoperative magnetic resonance imaging provided precise indications of the anatomical location and radiologic features of the tumor, which facilitated its total removal by microsurgery. Short-latency somatosensory evoked potentials were monitored throughout the operation.

Usefulness of multiangle MRI in aortic arch dissection

A multiangle scan technique was used in combination with usual spin echo and cine MR techniques to study a patient with aortic arch dissection. The intimal flap was seen with each technique and the jet into the entry site was observed with cine MR technique. Exact short axis images of aortic arch were obtained only with multiangle scan. Retrograde dissection and involvement of left subclavian artery were detected clearly on the short axis images.

Analysis of blood flow patterns in aortic aneurysm by cine magnetic resonance imaging--a review of case material

Cine magnetic resonance imaging (MRI) (0.5-T) using rephased gradient echo technique was performed in 5 normal volunteers and 14 patients with aortic aneurysm to study the patterns of blood flow in aortic aneurysm. In the transaxial section, blood flow in normal aorta appeared as homogeneous and high intensity during systole. Blood flow in aneurysm appeared as inhomogeneous flow enhancement with flow void. In the sagittal scan, the homogeneous flow enhancement in normal aorta was also observed during systole, and its apex of flow enhancement was "taper." The blood flow patterns in aneurysm were classified as "irregular," "zonal," "eddy," and "obscure," depending on the contrast of flow enhancement and flow void. Their apexes were "taper" or "round." When the size of aneurysm became larger, the flow pattern in aneurysm tended to become "eddy" or "obscure" and the flow enhancement became "round." Though the exact mechanism of abnormal flow patterns in aneurysm remains to be determined, cine MRI gives helpful information in assessing blood flow dynamics in aneurysm.

Foramen magnum decompression for syringomyelia associated with basilar impression and Chiari I malformation--report of three cases

Anterior or posterior decompression of the foramen magnum was performed in three patients with syringomyelia associated with basilar impression and Chiari I malformation. The operative results were evaluated using the pre- and postoperative magnetic resonance (MR) images. Two patients with combined anterior and posterior cervicomedullary compression due to basilar impression and tonsillar descent received suboccipital craniectomy, upper cervical laminectomy, and dural plasty without any intradural manipulations via the posterior approach. One patient with prominent anterior cervicomedullary compression due to basilar impression and a sharp clivoaxial angle was operated on by the transoral anterior approach. Postoperatively, all patients showed a sustained shrinkage of the syrinx and rounding of the flattened cerebellar tonsils. Two patients showed upward movement of the herniated tonsils. All patients had improved symptoms during 2-4 years follow-up. Treatment of syringomyelia associated with basilar impression and Chiari I malformation requires more efficient decompressive procedures at the foramen magnum based on neurological and MR findings.

Intracranial nonspecific inflammatory granuloma

A case of nonspecific inflammatory granuloma arising from the dura mater near the hypoglossal canal is reported. A 38-year-old woman developed an isolated left hypoglossal nerve palsy. Computed tomography and magnetic resonance imaging demonstrated an enhanced tumorous lesion at the inner orifice of the left hypoglossal canal. Skull x-ray was normal, and cerebral angiography showed no vascular abnormalities. Examination of the cerebrospinal fluid showed mild pleocytosis with a predominance of lymphocytes. Systemic examination revealed no abnormalities. The tumor was removed completely and pathologic investigation revealed that it was an inflammatory granuloma. The patient's history and laboratory data, however, failed to suggest the underlying disease, and histopathologic examination did not indicate any special type of granuloma. Therefore, the lesion was diagnosed as a nonspecific inflammatory granuloma.

[Changes in various serum protein levels between acute and convalescent phases in patients with respiratory infections]

We determined serum levels of alpha 1-antitrypsin, alpha 1-acid glycoprotein, ceruloplasmin, haptoglobin, alpha 2-HS glycoprotein, C3 and fibronectin in 22 patients with acute pneumonia, 10 patients with mycoplasma pneumonia and 8 patients with exacerbation of chronic bronchitis at both acute and convalescent phases to clarify whether levels of these proteins change with inflammation. Serum levels of alpha 1-antitrypsin, alpha 1-acid glycoprotein, ceruloplasmin, haptoglobin and C3 in the patients in the acute phase were significantly higher than that in the patients in the convalescent phase. The serum level of fibronectin in the patients in the acute phase was significantly lower than that in the patients in convalescent phase. The serum level of alpha 2HS glycoprotein remained unchanged.

[Clinical studies and sputum levels of ceftriaxone once daily administration in respiratory tract infection]

Ceftriaxone (CTRX), a new cephalosporin, was investigated by once daily administration for its clinical efficacy and safety on respiratory tract infections. The results obtained are summarized as follows: 1. Clinical responses to CTRX of a total of 39 cases with respiratory tract infections were excellent in 12 cases, good in 23, fair in 3, poor in 1 with an efficacy rate of 89.7%. Against acute bronchitis, lung abscess, bronchiectasis, chronic bronchitis and obstructive pneumonia, efficacy rates were 100%. 2. Serum levels and urinary excretion rates of CTRX were investigated in 2 cases after intravenous drip infusion of the drug at doses of 1 g and 2 g, respectively. Although urinary excretion rate tended to decrease with the deterioration of renal functions, prolongation of serum half-life was slight in those patients with normal liver function. In 1 case, it remained at 1.9 micrograms/ml at 12 hours and in another at 0.9 microgram/ml at 22 hours in sputum. According to the results, it appears that once daily administration of CTRX is effective and well tolerated in patients with acute respiratory infections.

Uncommon type of meningiomas with conspicuous plasmo-lymphocytic infiltration. An immunohistochemical and histochemical study

Two cases of meningioma revealing conspicuous plasmo-lymphocytic tissue and hyalinized fibrous tissue components are reported. Histopathological examination of the plasmo-lymphocytic infiltration was performed. Both lesions showed polyclonality of plasma cells as revealed by positive reactions for IgG and paraimmunoglobulin kappa- and lambda-light chains, and amyloid infiltration into the fibrous stroma and blood vessel walls. The histochemical and immunohistochemical characteristics of the lesion in relation to its etiology are briefly discussed.

[A case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography]

One case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography is reported. A 44-year-old female slipped and hit her head without loss of consciousness, one month ago. Recently she complained of headaches and visited the department of Neurosurgery, Washokai Sadamoto Hospital on May 21, 1985. There were no physical and neurological signs on examination. Plain CT scans showed a crescent-shaped high density area in the left frontal region with a slight mass sign. She was diagnosed as having a possible chronic subdural hematoma and further examination was recommended. Biplane ultrafast overlapping cerebral computed angiotomograms clearly demonstrated a so-called avascular area delineated by enhanced superficial cerebral vessels with contrast medium. Furthermore, a marked high density mass measuring 8 mm X 10 mm X 6 mm in diameters was simultaneously demonstrated around the right anterior clinoid process on the same image, suggesting a cerebral aneurysm. Right carotid angiograms showed a right internal carotid-posterior communicating junction aneurysm. The irrigation of the left chronic subdural hematoma was carried out on May 24 and the neck clipping of the right IC-PC junction aneurysm was done two weeks later. During the operation, there were no findings suggesting a previous subarachnoid hemorrhage from the aneurysm, but a bleb was found on the aneurysm. The post-operative course was uneventful. Since the introduction of the CT scanner, chronic subdural hematomas are usually operated without cerebral angiograms.(ABSTRACT TRUNCATED AT 250 WORDS)

Screening and treatment of unruptured cerebral aneurysms

Thirty outpatients with unruptured cerebral aneurysms screened by computed angiotomography have been analysed and followed up in our clinic since 1979. Seventeen were men and the age range was 41 to 74 years old (mean 57.7 years). Patients had no or only mild neurological symptoms, such as headache, sensorimotor or speech impairment and others, which were scarcely related to the unruptured aneurysms themselves. It is important to realize that these first aneurysms which remain unruptured, have a primary significance to the individual in the protective aspect of an initial subarachnoid haemorrhage. Operation was successfully performed in fifteen patients. Transient aggravation of previous diseases, e.g. cerebral infarction, occurred in three after operation. Follow-up studies of fifteen patients without operation revealed no change in eight and some worsening or death due to other or previous diseases in six. One died of aneurysmal rupture in the 5th month after its detection. Because of the low operative risk, we advocate the operative treatment of unruptured aneurysms, following careful selection of the indicated patients.

Computed angiotomography of unruptured cerebral aneurysms

Twenty-seven unruptured cerebral aneurysms in 25 patients were detected by computed angiotomography. A comparison of the computed angiotomographic features in common aneurysm sites with plain CT and conventional arteriography was carried out. An isodense, round cisternal defect and a calcification or high-density mass in the basal cisterns on plain CT are important findings suggestive of unruptured aneurysms larger than 7 mm in diameter. The identification of the aneurysm, as well as of the afferent and efferent arteries on computed angiotomography is essential for the direct diagnosis of smaller unruptured aneurysms related to the circle of Willis. This is possible in a number of cases when the aneurysms are relatively large. It appears that the aneurysm size must be larger than 3 mm in diameter to permit its recognition on the basis of angiotomography and the avoidance of false-positive findings.

Monoclonal antibody 9.3 and anti-CD11 antibodies define reciprocal subsets of lymphocytes

We have previously described antibody 9.3 which recognizes a 44-kDa polypeptide designated Tp44 expressed on 70-80% of peripheral blood T cells, including nearly all CD4+ cells and some CD8+ cells. Whereas the 9.3+ population contains helper cells, cytotoxic T cell precursors and cytotoxic T cell effectors, the 9.3- population has been reported in several models to contain precursors for suppressor cells. In this report, we demonstrate that 9.3- lymphocytes express CD11, an antigen which is also present on monocytes and granulocytes. Among lymphoid cells, Tp44 and CD11 represent markers that identify reciprocal, nonoverlapping subsets, each of which contains both CD8+ cells and CD4+ cells. With Tp44 and CD11, and CD4 and CD8, the development and function of T cells can thus be examined within the framework of two distinct systems of reciprocally expressed antigens.

[A case of Burkitt's lymphoma with total ophthalmoplegia]

Burkitt's lymphoma was first reported by Burkitt in 1958 as a sarcoma involving the jaw in African children with characteristic symptoms. Forty three Japanese cases have been reported since the first description by Oboshi et al. in 1969. We report a case of Burkitt's lymphoma with left total ophthalmoplegia. A 73-year-old Japanese female was admitted in Sadamoto Hospital on July 11, 1983 with a two-week history of headache, ptosis and double vision. The patient was exposed to the atomic bomb in Hiroshima and had ten-year history of hypertension. On admission, physical examination showed hypertension and neurological examination revealed only left total ophthalmoplegia (such as left ptosis, external ophthalmoplegia, mydriasis and deficit of light reflex). Plain X-ray film and enhanced CT scan showed no remarkable abnormalities. Laboratory examinations revealed high serum levels of GOT(51 K.U.) and LDH (1300 U.). Left carotid and right retrograde branchial angiograms showed no remarkable abnormal findings. While the patient was treated only conservatively, left abducent and trochleal nerve palsy appeared on August 5, 1983. On plain and enhanced CT scans at the time, abnormal density mass with bone destruction of the left sphenoidal sinus was demonstrated. Biopsy specimen from the left sphenoidal sinus showed lymphosarcomatous cells. Peripheral blood and bone marrow smears showed lymphoma cells which are compatible with L3-Burkitt's type according to FAB leukemia classification. The patient was diagnosed as leukemic transformation of Burkitt's lymphoma and treated with CHOP; Cyclophosphamide (C), Hydroxydaunorubicin(H), Vincristine (O), and Prednisolone (P).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of SM-4300 against bacterial infections in the field of internal medicine]

A new drug of human intact immunoglobulin, SM-4300 was applied to the acute respiratory infections in the field of internal medicine. SM-4300 was administered intravenously for 1 or 3 days at a daily dose of 2.5 g to 4 patients suffering from respiratory infections. We have obtained the results as follows. Clinical effects of SM-4300 were good in 2 cases, fair in 1 case, unknown in 1 case, and no side effects were observed.

Fast overlapping scans in cerebral computed angiotomography

Three to four overlapping cerebral CT scans were obtained after the injection of a single bolus of contrast medium. The rapid sequential dynamic scanning was carried out with table increments, while there was peak iodine density in the carotid artery. The demonstration of cerebral vessel lesions (aneurysms, moyamoya disease, arteriovenous malformations, arterial narrowing, etc.) is easier and safer with this method as compared with the conventional multiple injection technique.

Occlusion of the great vein of Galen associated with a huge meningioma in the pineal region. Case report

The authors report a case in which the great vein of Galen was occluded during removal of a huge meningioma in the pineal region. The patient recovered satisfactorily without any serious neurological deficits after the operation. Preoperative angiography had shown marked stenosis of the great vein of Galen and anastomoses between the deep and the superficial venous systems. Occlusion of the great vein of Galen may be well tolerated in particular cases if this vein is already compromised.

Coronal computerized angiotomography for the diagnosis of isodense chronic subdural hematoma

The authors demonstrate the value of coronal computerized angiotomography for the diagnosis of and screening for isodense chronic subdural hematoma. Specific features of coronal computerized angiotomograms include 1) thick lines of high density with slight convexity; 2) lines of high density parallel with the inner table of the skull; or 3) high-density dotted lines away from the inner table. These high-density lines or dots represent the superficial cerebral veins and cortical branches of the middle cerebral artery, which have been displaced by the hematoma. When these characteristic features are revealed on noninvasive coronal computerized angiotomography, cerebral angiography may be unnecessary.

Suppression of the responsiveness of lymphocytes from cancer patients triggered by co-culture with autologous tumor-derived cells

The question as to whether or not cancer patients have "tumor antigen"-induced suppressor T cells is of considerable interest and importance. As an approach to that question, the effect of addition of autologous irradiated tumor-derived cells (TDC) on the mixed lymphocyte response (MLR) of patients' lymphocytes (Ly) and of healthy donor Ly was tested. The rationale for these experiments was based on the fact that circulating antigen-responsive blood lymphocytes can be reactivated in vitro by exposure to the appropriate antigen. Thus, if there are circulating tumor "antigen"-reactive suppressor Ly, exposure to TDC as a source of the antigen should reactivate those cells. Reactivation of suppressor cells might result in diminished responsiveness to other stimuli such as alloantigens in the mixed leukocyte culture. We found that the addition of TDC to Ly cultures produced four distinct patterns of reaction. In 26 of the 74 different patient-tumor assays, the addition of autologous TDC to the patient cultures inhibited MLR, but the addition of the same TDC to cultures of Ly from healthy donors had no effect or increased their responsiveness (Specific Suppression). In 21 cases, the addition of autologous TDC to the patient cultures suppressed the MLR and the addition of the same TDC to control cultures suppressed the response of some but not all the healthy donors (Selective Suppression). In four cases, the addition of TDC to the cultures suppressed the MLR of the patients and all of the control donors (Nonspecific Suppression). In 23 cases, the addition of autologous TDC resulted in no suppression of the patient MLR or of any of the simultaneously tested normal donors (No Suppression). When TDC of patients with noninvasive bladder cancer were added to their own Ly cultures, only four of 11 produced specific or selective suppression compared to 11 of 12 when TDC came from patients with superficially invasive cancer. These data provide indirect evidence to support the hypothesis that human tumors induce circulating suppressor cells that may be reactivated in vitro by co-culture with TDC.

Suppression of the responsiveness of lymphocytes from cancer patients triggered by co-culture with autologous tumor-derived cells

The question as to whether or not cancer patients have "tumor antigen"-induced suppressor T cells is of considerable interest and importance. As an approach to that question, the effect of addition of autologous irradiated tumor-derived cells (TDC) on the mixed lymphocyte response (MLR) of patients' lymphocytes (Ly) and of healthy donor Ly was tested. The rationale for these experiments was based on the fact that circulating antigen-responsive blood lymphocytes can be reactivated in vitro by exposure to the appropriate antigen. Thus, if there are circulating tumor "antigen"-reactive suppressor Ly, exposure to TDC as a source of the antigen should reactivate those cells. Reactivation of suppressor cells might result in diminished responsiveness to other stimuli such as alloantigens in the mixed leukocyte culture. We found that the addition of TDC to Ly cultures produced four distinct patterns of reaction. In 26 of the 74 different patient-tumor assays, the addition of autologous TDC to the patient cultures inhibited MLR, but the addition of the same TDC to cultures of Ly from healthy donors had no effect or increased their responsiveness (Specific Suppression). In 21 cases, the addition of autologous TDC to the patient cultures suppressed the MLR and the addition of the same TDC to control cultures suppressed the response of some but not all the healthy donors (Selective Suppression). In four cases, the addition of TDC to the cultures suppressed the MLR of the patients and all of the control donors (Nonspecific Suppression). In 23 cases, the addition of autologous TDC resulted in no suppression of the patient MLR or of any of the simultaneously tested normal donors (No Suppression). When TDC of patients with noninvasive bladder cancer were added to their own Ly cultures, only four of 11 produced specific or selective suppression compared to 11 of 12 when TDC came from patients with superficially invasive cancer. These data provide indirect evidence to support the hypothesis that human tumors induce circulating suppressor cells that may be reactivated in vitro by co-culture with TDC.

The cell surface phenotype of a naturally occurring human suppressor T-cell of restricted specificity: definition by monoclonal antibodies

A series of murine monoclonal antibodies was used to characterize the surface phenotype of a naturally occurring E+ B14-specific suppressor cell present in the blood of a patient with recurrent superficial bladder carcinomas. This suppressor T cell is different from the few naturally occurring suppressors of MLC reported by others in that its function does not require HLA-D compatibility with the cells being suppressed. This patient's T cells had decreased proportions of T3+, 10.2+, 9.3+, and T4+ cells, a normal proportion of T8+ cells, and a markedly increased proportion of Ia-positive cells. The MLC-suppressor assay was used to test the functional activity of cell populations selectively depleted by treatment with monoclonal antibodies and C or enriched by panning. The B14-specific suppressor T cells in this patient expressed T cell markers recognized by monoclonal antibodies 9.6, T3, and the T cell subset marker identified by OKT8 (T8+) but not the subset marker identified by OKT4 (T4-). Ia antigens were present on a substantial portion of these suppressor T cells. Thus, this unique, naturally occurring suppressor T cell has a phenotype similar to that of other T suppressor cells in humans, adding validity to the concept of functionally distinct T cell compartments in human blood.

The cell surface phenotype of a naturally occurring human suppressor T-cell of restricted specificity: definition by monoclonal antibodies

A series of murine monoclonal antibodies was used to characterize the surface phenotype of a naturally occurring E+ B14-specific suppressor cell present in the blood of a patient with recurrent superficial bladder carcinomas. This suppressor T cell is different from the few naturally occurring suppressors of MLC reported by others in that its function does not require HLA-D compatibility with the cells being suppressed. This patient's T cells had decreased proportions of T3+, 10.2+, 9.3+, and T4+ cells, a normal proportion of T8+ cells, and a markedly increased proportion of Ia-positive cells. The MLC-suppressor assay was used to test the functional activity of cell populations selectively depleted by treatment with monoclonal antibodies and C or enriched by panning. The B14-specific suppressor T cells in this patient expressed T cell markers recognized by monoclonal antibodies 9.6, T3, and the T cell subset marker identified by OKT8 (T8+) but not the subset marker identified by OKT4 (T4-). Ia antigens were present on a substantial portion of these suppressor T cells. Thus, this unique, naturally occurring suppressor T cell has a phenotype similar to that of other T suppressor cells in humans, adding validity to the concept of functionally distinct T cell compartments in human blood.

Normal anatomy of cerebral vessels by computed angiotomography in the coronal, Towne, and semisagittal planes

This report presents a detailed analysis of the normal cerebrovascular anatomy on the modified coronal, Towne (half-axial), and semisagittal computed tomographic (CT) images. Direct multiplane CT scans were obtained from fresh cadavers injected with gelatinous iodine solution. The modified coronal plane is optimal for delineation of the internal carotid bifurcations and the anterior and the middle cerebral arteries, and for identification of the lenticulostriate arteries and the angiographic sylvian point. The Towne plane is optimal for delineation of the vertebrobasilar arterial system. Thorough knowledge of the normal appearance of cerebral blood vessels in biplane or multiplane computed angiotomography is a prerequisite for understanding the spatial relationships of the abnormal cerebrovascular anatomy.

Delineation of unruptured cerebral aneurysms by computerized angiotomography

Unruptured aneurysms were diagnosed in 15 of 86 patients with cerebral aneurysms during 2 years beginning in April, 1979. One patient with severe head injury was excluded from the series. Fifteen aneurysms in the other 14 patients were first detected by computerized angiotomography. Six aneurysms were located in the middle cerebral artery, three in the upper half of the basilar artery, two in the anterior communicating artery, two in the posterior cerebral artery, and two at the internal carotid-posterior communicating artery junction (both in the same patient). Three were smaller than 5 mm, eight were between 6 and 10 mm, and four were larger than 10 mm. The noncontrast computerized tomography (CT) findings associated with 15 aneurysms were as follows: five showed defects in the basal cistern of Sylvian fissure, four were calcified or high-density masses, and in the six instances there was no evidence of an aneurysm. Unruptured aneurysms may be suggested by a well demarcated, round, isodense mass which forms a defect in the basal cistern of Sylvian fissure on a plain CT image, and are highly and homogeneously enhanced by computerized angiotomography. A carotid artery blood iodine level of 15 mg/ml is required to obtain clear images. The authors conclude that computerized angiotomography is useful in the delineation of unruptured aneurysms.

Minimum dose contrast bolus in computed angiotomography of the brain

We have carried out basic investigations of an intravenous minimum dose bolus (MinDB) injection method for cerebral computed angiotomography by comparing blood iodine concentrations with high resolution computed tomography (CT) images of cerebral blood vessels. With the GECT/T 8800 scanner, a MinDB injection of 1 ml/kg of 60% Conray at a rate of 2 ml/s made it possible to increase the blood iodine concentration in the carotid artery to more than 15 mg/ml for about 20 s. Computed tomography performed during this period enabled us to obtain clear images of the circle of Willis, including other main cerebral arteries, deep veins, and cortical and lenticulostriate arteries. Cerebral computed angiotomography using this method should be useful for noninvasive screening or detection of cerebrovascular lesions themselves, such as cerebral aneurysms, cerebrovascular obstructions, arteriovenous malformations, and moyamoya disease, and should also be useful for determining the anatomical relationship between the cerebral blood vessels and other parenchymal or space occupying lesions.

[Traumatic interhemispheric subdural hematoma--report of a case and analysis of 7 cases]

A case of traumatic interhemispheric subdural hematoma is reported and 7 cases, including ours, reported in literature are analyzed. A 43-year-old jogger hit his forehead in the traffic accident. After medical care for the wound at the near hospital, he walked to home without any neurological deficits. On the following day, he complained of headache, nausea and slight gait disturbance, so the visited us 5 days after head trauma. On the biplane computed tomograms, interhemispheric subdural hematoma was detected. A distinct avascular space in this portion was found on the right carotid angiograms. Treated conservatively with repeated computed tomography, he recovered completely well about a month after head trauma. Analyzing 7 cases, following comments were obtained; Age distribution was between 23 to 74 and all were male. The mechanism of the hematoma formation in such region remained still unclear, but seemed to be caused partially due to rotational cerebral injuries. Characteristic clinical symptom was hemiparesis, predominantly crural or crural monoparesis. This symptom was found in four of seven cases on the same side of the hematoma, that was supposed due to the compression of the contralateral blood flow the distal anterior cerebral artery. Neuroradiologically, on the angiograms, the internal branches of callosomarginal arteries turned away from the middle parallel to the pericallosal artery stayed in the middle and between them, a distinct avascular space was found. On the biplane computed tomograms, semilunar high density area was identified along the midline, bounded medially by the falx cerebri, laterally by the convex border against the brain parenchyma, inferiorly by the tentorium. Although the anteroposterior extension of the hematoma was recognized on the axial plane, the superoinferior extension, especially in relation to the tentorium, was well shown on the coronal plane. On the electroencephalogram, no characteristic findings were obtained. Abnormalities blood coagulation were found in a case. Five cases were operated on and 2 cases treated conservatively, and the outcome was good in all. The following diseases had to be differentiated: hematomas due to the rupture of peripheral anterior cerebral artery aneurysms, including traumatic ones, blood coagulopathy or medication of anticoagulants. Tumors such as parasagittal or falx meningiomas, subdural abscesses localized in the interhemisphere, infarctions of distal anterior cerebral artery.