[Clinical study of voiding disorders in patients with cerebrovascular accidents].

Cystometry and urethral pressure profile were determined in 41 patients (29 males and 12 females) with voiding disorders resulting from cerebrovascular accidents within one year after the episode. By clinical symptoms, they were classified into 3 groups, urge incontinence (14 patients, 34%), pollakisuria (10 patients, 24%) and dysuria (17 patients, 41%). Cystometrogram were classified into 3 types, hyperactive bladder (31 patients, 76%), normal bladder (5 patients, 12%) and hypoactive bladder (5 patients, 12%). All patients in both groups of incontinence and pollakisuria showed hyperactive bladder except one normal bladder, while in the group of dysuria 3 types of cystometrograms were observed. Bladder capacity in incontinence group showed tendency to be smaller than that in dysuria group who had hyperactive bladder. Maximum urethral pressure in incontinence group was significantly lower than that in pollakisuria group and dysuria group who had hyperactive bladder. Ten patients with cerebral cortical lesions (80%) showed hyperactive bladder and 60% of them showed incontinence. In patients with cerebral lesions who had hyperactive bladder, the maximum urethral pressure of patients with incontinence showed tendency to be lower than that of patients with pollakisuria and dysuria. The majority of 7 patients with thalamic lesions showed hyperactive bladder and normal urethral pressure, and had dysuria. Two patients with pontine lesions showed hypoactive bladder. These findings suggested that urge incontinence resulting from cerebrovascular accidents was due not only to hyperactive bladder but also to lower urethral pressure.

[Familial primary intracranial malignant lymphoma].

A 76-year-old female developed depression and loss of appetite. On admission, in June of 1987, she was disoriented. Computed tomography (CT) revealed enhanced masses without perifocal edema in the cerebellar vermis and left occipital lobe. The cerebellar tumor was subtotally removed through a suboccipital craniectomy. Histological examination disclosed malignant lymphoma of the diffuse, large cell type. The patient underwent postoperative irradiation, and no other tumors were detected by whole-body CT or gallium scans. Her 51-year-old son had been admitted to another hospital in April of 1987, with complaints of depression and change in mental status. Neurological examination revealed right hemiparesis, and CT demonstrated an enhanced left frontal paraventricular mass and severe perifocal edema. The histological diagnosis was malignant lymphoma, and the patient received postoperative irradiation and chemotherapy. A few cases of familial extracranial malignant lymphoma have been described. However, to the authors' knowledge, this is the first reported occurrence of familial primary intracranial malignant lymphoma.

[A giant cell glioblastoma--a case report].

Discussed is an 8-year-old girl with a history of convulsive seizures. A sharply demarcated tumor, measuring 3 X 4 cm, was located in the right frontal lobe. The mass grey and cystic in the center, and microscopic specimen demonstrated bizarre, irregular, giant cell with a long vesicular nuclei and spindle-shaped cell. A perivascular pseudo-rosette formation also was seen, and silver impregnation revealed reticulin network and extracellular collagen fibers. The pathological entity of an intracranial giant celled glioblastoma remains controversial. This entity is considered a giant celled glioblastoma by some and a monstrocellular sarcoma by others. In this that the authors experienced, a CT scan showed a ring that formed a high density area and low density in the center at the right frontal lobe. Also reviewed and discussed are the historical aspects of a giant celled glioblastoma and radiologic problems that have been encountered.

[Primary intrasellar germinoma with amenorrhea--a case report].

A 22-year-old woman with a history of headaches and secondary amenorrhea is reported. Her physical examination showed a visual acuity loss. An endocrine evaluation revealed hypopituitarism and an elevated level of serum prolactin. Polytomography demonstrated an enlarged sella with a double floor. A computerized tomography (CT) scan revealed an enhancing lesion within the sella turcica with an extension into the suprasellar cistern. A lumbar puncture was performed and the cerebrospinal fluid was found to contain no tumor cells. The patient subsequently underwent a trassphenoidal exploration of the sella and an intrasellar tumor removal. A histological analysis of the surgical specimen revealed a germinoma. A total dose of 3500 rads with lineac was applied to the whole brain postoperatively. Her vision is now normal. The pathogenesis of an intracranial germinoma is briefly discussed, and a review of the literature discloses 48 previous reports of germinoma.

[Diffuse metastatic leptomeningeal carcinomatosis (DMLC)].

Diffuse metastatic leptomeningeal carcinomatosis (DMLC) due to systemic cancer has been diagnosed clinically in 7 patients. The primary sites involved were the stomach, the lung, and the breast. In all patients, there was progressive clinical deterioration, the average survival after diagnosis being 18 weeks. Also, leptomeningeal metastases was found to be present in 7 or 47 (14.9%) patients with metastatic brain tumors at the National Kanazawa Hospital. The clinical diagnosis was confirmed by the presence of malignant cells in the cerebrospinal fluid, which showed a decrease in glucose and an increase in the protein content. Ommaya reservoirs were placed in two patients. Treatment consisted of intrathecal injections of either Methotrexate (MTX) alone or MTX and Cytosine arabinoside and venous injections of ACNU in combination with radiation therapy of the brain and the spine.

[Brain metastases of colorectal cancer--a case report].

Metastatic brain tumors from colorectal cancers are relatively rate. In previous reports, the incidence, ranged from 1.9 to 3.5 percent of all metastatic brain tumors. We reported 2 cases of metastatic brain tumors from colorectal cancers. Metastasis to the lung and liver were not found in 2 cases at the time of the diagnosis of the single brain metastasis. The CEA levels in the serum were highly elevated in these 2 cases. On a contrast-enhanced CT scan, tumors were equally demonstrated as high density and cystic, with a ring-like mass with surrounding brain edema. Brain metastases of colorectal cancer were discussed with a review of the literature.

An ultrastructural study of mineralization in craniopharyngiomas.

In eight cases of adamantinomatous craniopharyngioma examined ultrastructurally special attention was paid to the process of mineralization. The tumors were usually composed of neoplastic epithelial cells and fibrous connective tissue stroma. Islands of keratinized cells were frequently observed in the epithelial cell zone. In most of the degenerated keratinized cells cytoplasmic organelles had disappeared except for tonofibrils and membrane-bound round vesicles were seen among the numerous tonofibrils. Needle-shaped crystals were deposited within some vesicles. The accumulation of crystals in the vesicles and the coalescence of calcified vesicles and calcified adjacent tonofibrils resulted in the formation of a large calcified body. Mineralized precipitates were confirmed as calcium and phosphorus by means of an energy dispersive X-ray microanalyzer; the precipitates were composed of hydroxyapatite which was substantiated crystallographically with an X-ray diffractometer. These findings suggest that membrane-bound vesicles derived from degenerated keratinized cells play an important role in the initial process of calcification. The tonofibrils may also serve to orient apatite crystal precipitation.

[Extracranial recurrence of sphenoidal ridge meningioma--a case report].

A 46-year-old woman with right sphenoidal ridge meningioma (alar type), which recurred in the orbit and the pterygomaxillary fossa three years after total removal, is presented. Histologically the first examination showed transitional type meningioma. She noticed right exophthalmos, ophthalmoplegia, visual disturbance and swelling of the right side of the face three years later. Microscopically, the tumor showed malignant meningioma. Electron microscopic examination of the specimen disclosed the nucleoli lying on the nuclear membrane, interdigitation with desmosomes, polymorphous mitochondria, free ribosomes, glycogen granules and an enlarged Golgi apparatus. In conclusion, this patient had a transitional type of meningioma when it first presented, but developed malignant histological features invasion at extracranial sites three years later.

[The surgical treatment of primary empty sella].

Two cases of the primary empty sella complaining of intractable headache for many years are reported. Case 1. A 73-year-old female was admitted on August 23, 1983 because of intractable headache. Plain skull radiograph showed slightly enlarged sella with deepening of the floor. Metrizamide CT scan demonstrated the sella cavity filled with metrizamide extensively. Operation was done performing intrasellar intradural plugging via transsphenoidal route (Hardy's technique). Postoperatively headache was improved. Case 2. A 43-year-old female was admitted on July 24, 1984 after many years of intractable headache. Craniogram demonstrated deep sella of slightly increased volume and unaltered dorsum sellae. On metrizamide CT scan, contrast medium occupied greater parts of the sellar cavity. Extradural intrasellar plugging (Guiot's technique) was performed. Postoperative course was uneventful. Surgical procedure on the primary empty sella relieved headache by decreasing intrasellar pressure and alleviating pulsatile pressure on the dulla. Operation via transsphenoidal method was the suitable procedure because of less trauma on the optic nerve and advantageous plugging of the sellar cavity. Guiot's technique with extradural intrasellar plugging may be more preferable because of accompanying no postoperative cerebrospinal fluid rhinorrhea.

[Malignant meningioma with extracranial metastasis].

We report case of malignant meningioma involving the lumbar vertebra (3rd and 4th). A 53-year-old man who developed occipitalgia in April 1977 was operated under the diagnosis of posterior fossa tumor in August 1977. The tumor was totally removed macroscopically Simpson grade 2. The histological diagnosis was malignant meningioma, He complained of lumbago and right leg pain since June 1981. Destruction and tumor stain of the 3rd and 4th lumbar vertebrae were recognized on CT scans. In May 1982, surgical decompression and spinal fixation were attempted. The surgical specimen was verified as a malignant meningioma. Therefore, he underwent irradiation therapy to the lumbar spine (total dose 50 Gray). He presented with occipitalgia in March 1983. CT scan detected tumor recurrence in the suboccipital region. The recurrent tumor was totally removed immediately. The histological feature was malignant meningioma. The mode and site of metastasizing meningioma are discussed with a review of the literature.

Repair of cerebrospinal fluid rhinorrhoea with pedicled dural flap.

Four cases of persistent cerebrospinal fluid rhinorrhoea through the ethmoid sinus are presented. Using the operative microscope, the margin of the dural defect was easily identified, and a pedicled dural flap supplied by branches of a meningeal artery was successfully sutured to the dural margin in a watertight fashion without increasing pre-existing neurological deficits. To prevent intracranial infection, the watertight closure with a predicled dural flap is presumably more complete and reasonable than are various grafts without vascular circulation.

Delayed hypersensitivity reactions in guinea-pigs using cotton pellets; demonstration of macrophage migration inhibition activity in the cell free exudate.

Subcutaneous implantation of cotton pellets containing PPD into CFA sensitised guinea-pigs produced a reaction of having many characteristics of the delayed hypersensitivity (DH) reaction, together with less conspicuous features of a non-immunological response. The time course of the cellular response in the reaction showed a slow onset, attaining maximum levels between 18 and 24 hr. Mononuclear cells dominated the reaction from 18 to 48 hr. In animals treated with ALS the reaction diminished to the level of a non-immunological reaction. The model made it possible to detect macrophage migration inhibition factor (MIF) activity in the skin exudates. From 6--48 hr high molecular weight antigen-dependent MIF activity was found associated with immunoglobulin. At 18 hr, two types of low molecular weight MIF activity were demonstrated. One was antigen-dependent and the other was antigen-independent. Treatment of sensitised guinea-pigs with ALS abolished the appearance of these factors, suggesting that they might be related to cell-mediated immunity. At 48 hr, the low molecular weight antigen-dependent MIF activity was still evident whereas the low molecular weight antigen-independent activity was not detected. High molecular weight antigen-independent MIF activity was also found at 18 hr. No MIF activity was demonstrated in any of the control exudates.

Characterization of two different factors chemotactic for cancer cells from tumor tissue.

Two different factors chemotactic for cancer cells were extracted in pseudoglobulin fraction of rat ascites hepatoma transplanted tissue. After chromatography on Sephadex G-50 and CM-sephadex, these factors were separated by gel filtration on Sephadex G-100. The factor a was further fractionated by immunoadsorbent chromatography with goat antirat gamma-globulin antibody and then with rabbit antirat hemoglobin antibody; it was a protein with a molecular weight of about 78,000, resembling a chemotactic factor previously reported, and its activity was thermolabile. The previously undescribed factor b was also a protein with a molecular weight of about 14,000 and its activity was thermostable. Intradermal injection of these factors at low concentrations induced an extravascular migration of circulating tumor cells and formation of metastatic secondary tumors; and little difference in the in vivo effect between these factors was observed. It was thus assumed that the combined action of these two factors may be involved in malignant invasion.