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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 105 (1990), S. 30-34 
    ISSN: 0942-0940
    Keywords: Cerebral blood flow ; moyamoya disease ; internal carotid artery occlusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A study has been made of the cerebral blood flow (CBF) in moyamoya disease from the perspective of hemispheric cerebral blood flow and regional CBF (rCBF). The material includes 21 children between the ages of 5 and 15 years with moyamoya disease, and 19 adult moyamoya cases-all of which had virtually no neurological symptoms at the time of the study. CBF was measured using the133Xe intravenous injection method. Comparsion was made with the measurements from 16 normal children and 14 normal adults. Study was also made of the relationship between the angiographic stage of the disease and the CBF. With the exception of the more elderly patients, CBF was found to be significantly lower in the moyamoya cases than in normal subjects of the same age group. In all age groups, the distribution of rCBF showed a dominant posterior distribution, dissimilar to the dominant anterior distribution found in the normals. Among the juvenile moyamoya cases, there was a tendency toward decreasing hemispheric blood flow together with advancing disease-as determined angiographically. Moreover, with advancing stages of the disease, there was a continuing transition from the normal pattern of frontal dominance to one of occipital dominance. This dominance of posterior rCBF is thought to be a characteristic feature of moyamoya disease.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 105 (1990), S. 107-111 
    ISSN: 0942-0940
    Keywords: Cerebral blood flow ; moyamoya disease ; autoregulation CO2 response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to clarify the cerebrovascular response in Moyamoya disease, the autoregulation and CO2 response was investigated using the81mKr continuous cerebral blood flow (CBF) measurement technique. A total of 32 measurements were made over the anterior and posterior circulation in 16 Moyamoya patients (seven adults, nine children). CBF measurements were made during four loading trials (hypertension, hypotension, CO2 inhalation and hyperventilation). Study was then made of the vascular response of the frontal lobe, perfused by the internal carotid artery (ICA), and the occipital lobe and cerebellum, perfused by the vertebral artery (VA). Deficits of autoregulation were more severe among the juvenile cases in response to hypotension than to hypertension in both the ICA and VA regions, but the deficits were mild. The CO2 response to hypercapnea in the juvenile cases tended to be abnormal in both the ICA and VA regions. Both adult and juvenile patients showed deficits in the ICA region in response to hyperventilation, some of whom exhibited paradoxial responses. Notable differences in the severity of the deficits of the vascular response in adult and juvenile cases were seen, with the deficits in the response being more severe among the juvenile cases. Moreover, significant regional differences in the deficits were also found.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 112 (1991), S. 13-18 
    ISSN: 0942-0940
    Keywords: Cerebral ischaemia ; vertebral artery reconstruction ; vertebral to subclavian transposition ; vertebrobasilar insufficiency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary For vascular reconstruction in cases of atherosclerotic stenosis at the origin of the vertebral artery, we use vertebral to subclavian artery transposition. We discuss the advantages and effectiveness of such treatment based on a study of 32 cases. We have experienced neither surgical mortality nor morbidity and the outcome at the time of discharge has been favourable. Follow-up revealed no deaths, however, three cases exhibited symptoms of cerebral ischaemia. One had a supratentorial completed stroke, and the other two hat TIA or RIND, but without any notable lesion in the angiograms. There were no cases of cerebral infarction of the posterior fossa. We believe that this method should be the first choice for treatment of cases without lesions of the subclavian artery for the following reasons: serious operative complications have not been encountered, surgical invasion is minimal, temporary occlusion of the common carotid artery is unnecessary, the operation can be done by occluding only the vertebral artery, and unlike various bypass operations, anastomosis is required at only one location and is consequently technically uncomplicated. Following anastomosis the cerebral blood pathway is physiological.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Dissecting aneurysm ; vertebral aneurysm ; subarachnoid haemorrhage ; somatosensory evoked potentials ; auditory brain stem responses
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of repeated subarachnoid haemorrhage (SAH) caused by rupture of a dissecting intracranial vertebral aneurysm is reported. The clinical manifestations, angiographic findings, pre-operative assessment with neurophysiological monitoring, and surgery are presented. A review of the literature suggests that this type of intracranial aneurysm is being recognized with increasing frequency in SAH and fatality, and therefore exploration and treatment of vertebrobasilar (V-B) dissecting aneurysms is necessary. We emphasize that a balloon Matas test with monitoring of somatosensory evoked potentials (SEP), auditory brain stem responses (ABR), and its wedge pressure in occluding the vertebral artery before operation are objective assessments of treatment for dissecting intracranial vertebral aneurysm.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0533
    Keywords: Pituitary adenoma ; Plurihormonal adenoma ; Immunohistochemistry ; Acromegaly ; Rathke's cleft cyst
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of multiple large Rathke's cleft cyst within a pituitary adenoma presenting with acromegaly is reported. Rathke's cleft cyst within a pituitary adenoma is rare condition, and this is the first report of such a case presenting with acromegaly. An electron microscopic and an immunohistochemical analysis proved that the cyst within the pituitary adenoma of this case differs from cysts found in the embryonic stage of the pituitary gland.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-0533
    Keywords: c-myc protein ; Bromodeoxyuridine ; Pituitary adenoma ; Malignancy ; Labeling index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To clarify the relationship between the percentage of c-myc protein-labeled cells, the bromodeo-xyuridine (BrdUrd) labeling index (LI) and clinical malignancy in pituitary adenomas, we studied 31 cases of pituitary adenomas. Tumor invasiveness, recurrence, tumor size and the length of illness were evaluated from operative findings, magnetic resonance imaging findings, and the clinical course. Each pituitary adenoma was scored to represent the degree of clinical malignancy. An hour before excision of the tumor, we administered BrdUrd intravenously. Surgical materials were fixed in 70% alcohol and embedded in paraffin. Both hematoxylin and eosin staining and immunohistochemical staining were performed using a monoclonal antibody for both anti-BrdUrd and anti-c-myc protein. Among pituitary adenomas, there was a significantly low percentage of c-myc protein-labeled cells in cases with acromegaly. The percentage of c-myc protein-labeled cells in the pituitary adenomas tended to increase with increase with the total scores of clinical malignancy. The BrdUrd LI was lower than 1% in almost all cases of pituitary adenomas, and it showed no correlation with their clinical malignancy. In conclusion, determination of the percentage of c-myc protein-labeled cells in pituitary adenomas proved to be useful for evaluating their clinical malignancy.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Acta neuropathologica 77 (1988), S. 33-38 
    ISSN: 1432-0533
    Keywords: Rathke's cleft cyst ; Immunohistochemistry ; Pituitary hormones ; Intermediate filament ; Squamous metaplasia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary An immunohistochemical study was made of ten cases of asymptomatic and three cases of symptomatic Rathke's cleft cyst. The cysts in the asymptomatic cases had monolayer columnar or cuboidal epithelium. Within the epithelium, cells which were positive for at least one of the pituitary hormones were found. The rate of positive reactions for these six pituitary hormones was between 70% and 100%. In contrast, the cysts in the symptomatic cases had an epithelium which was partly stratified squamous and partly squamous epithelium, and none of the pituitary hormones were found in them. Therefore, when a Rathke's cleft cyst enlarges to the extent that clinical symptoms are produced, we consider that changes have already occurred in structure and function of the cyst epithelium. In addition, we believe there is a tendency for monolayer epithelia to undergo squamous metaplasia and for cells which are positive for pituitary hormones to change into non-granulated cells.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 112 (1991), S. 100-105 
    ISSN: 0942-0940
    Keywords: Progressing stroke ; cerebral infarction ; acute stage vascular operation ; bypass ; brain protecting substance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effectiveness of acute stage vascular reconstruction in cases of progressing stroke is reported. The clinical material consists of 28 cases of progressing stroke in the anterior circulation upon which vascular reconstruction was performed. Following admission, brain protective substances (500 ml mannitol, 500 mg vitamin E, 500 mg phenytoin) and dextran, were administered to the patients, and induced hypertension was also performed. Changes in symptoms were then observed and vascular reconstruction was carried out in cases where symptoms progressed. The vascular lesion was on the internal carotid artery in 8 cases and on the middle cerebral artery in 20 cases. Complete disappearance of neurological symptoms was obtained in 12 cases, whereas only mild neurological symptoms remained but a return to normal social life was possible in 11 other cases. Symptoms remained in three cases and there were two fatalities. In a long-term follow-up study, there were no cases of aggravation of symptoms due to ischaemic stroke. Moreover, the reconstruction was judged as effective on the basis of cerebral blood flow and metabolism. We concluded that acute vascular reconstruction for progressing stroke under the administration of brain protective substances is effective in preventing the progression of neurological symptoms.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Cerebral infarction ; brain swelling ; mannitol ; glycerol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Using our previously published “incomplete cerebral hemispheric infarction model in dogs” (produced by simultaneous ipsilateral occlusions of the anterior cerebral artery at the branching of the ethmoidal artery from its A1 portion, the A2 portion, the internal carotid artery, the posterior communicating artery, the posterior cerebral artery, and the anterior cerebellar artery), two, four, or six hours occlusion of blood flow was undertaken. Observations were then made on the degree of brain swelling following recirculation due to administration of mannitol or glycerol solutions. Furthermore, the leakage of Evans blue was investigated to determine the damage to the blood brain barrier. 1. In the animals given mannitol or glycerol, brain swelling was suppressed, following two hours occlusion. In the animals given mannitol, however, brain swelling was not suppressed after four or six hours occlusion. 2. After two hours occlusion in the animals given mannitol, leakage of Evans blue was slight compared with the untreated group. In the six hours occlusion groups, severe leakage of Evans blue was seen in both the untreated animals and the mannitol-treated animals. After two hours occlusion, in some animals which had been given glycerol, severe leakage of Evans blue was seen, even when there was little brain swelling.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 47 (1979), S. 37-44 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We review 36 patients with recurrent attacks before radical surgery during hospitalization and evaluate various factors which seem to contribute to the recurrence of haemorrhage.
    Type of Medium: Electronic Resource
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