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Objective : To investigate the effect of muscle-tone-reducing procedures (MTRPs), i.e. partial nerve block by lidocaine (PNB) and surgical release of muscle attachment to bone (SRMAB), on incessant involuntary head movements in athetotic patients. Methods : Pre/post-MTRP changes in neck-muscle activities, glabella movement and maximum isometric forces of the head were measured in six athetotic patients with severe spondylotic myelopathy resulting from incessant involuntary head movements. Results : Pre/post-MTRP changes in neck-muscle activities resembled those after gamma-block. In four patients, PNB reduced the maximum isometric force by no more than 40% of pre-PNB force, while decreasing the amount of involuntary head movements to 37–65% of the pre-PNB value in the frontal plane. MRSAB reduced the force by less than 40% of pre-SRMAB force in 4 MRSAB tested patients, while decreasing the amount of involuntary head movements to 12–45% of the pre-SRMAB value in all 6 patients. Conclusion : MTRPs reduced involuntary head movements significantly while preserving voluntary muscle forces relatively well. PNB and SRMAB procedures have in common the effect of reducing gain in the myotatic reflex pathway by decreasing the excitatory inflows to alpha-motoneurons via muscle spindle Ia-afferents, which resulted from blocking mainly gamma-efferent conduction by PNB, and reducing background tension in muscle spindles by SRMAB.

Vascular endothelial growth factor (VEGF) is known to be a mediator of angiogenesis and vascular permeability. A cystic component and hemorrhage are often found in pituitary adenomas. In the present study we assess the VEGF expression based on immunohistochemical examinations in 48 pituitary adenomas. All the adenomas showed some VEGF immunoreactivity mainly in the cytoplasm of tumor cells. Of the 48 adenoma-cases, 16 cases had a strong VEGF immunoreactivity, 26 cases had a moderate one, and 6 cases had a weak one. On the MR images, a cystic component was found in 16 cases (33.3%), and a hemorrhage was found in 18 cases (37.5%). The VEGF immunoreactivity had a significant relationship with the cystic component but neither the hemorrhage, size, recurrence, or HE classification. These findings suggest that VEGF might play a potential role in the pathogenesis of cystic formation in pituitary adenomas.

To find out the distribution of nerve endings in the dural sheath of cervical nerve roots and to study the mechanism of cervical radicular pain.2069 20 microm serial sections were made from 39 cervical root-dorsal root ganglion specimens obtained from 18 postmortems. By using optical microscope and Suzuki silver impregnation method and Klüver-Brrera method, we examined the morphology, quantity and distribution of the nerve ending in the nerve sheath of the root, dorsal root ganglion (DRG) and the spinal nerve of these sections.There were several kinds of nerve endings such as free nerve endings in the nerve sheath of the root, the dorsal root ganglion, and the spinal nerve. Free nerve endings were distributed in the proximal and distal portions of DRG sheath more extensive than that in other parts of the dural root-sheaths.The free nerve endings in the dural root-sheaths especially those in the DRG sheath are thought to play an important role in cervical radicular pain.

To clarify the influence of intubation maneuver with or without premedication for intracranial hemorrhage with unconsciousness.Between May 1995 and May 2000, we analyzed retrospectively 46 patients who had received intubation for unconsciousness and were found non-traumatic intracranial hemorrhage by head computer tomography at the Trauma and Critical Care Center, National Defense Medical College. They were divided into two groups, Drug group in which drugs were used before intubation and Control group which were intubated without drugs. Physical findings on admission, head CT findings, Glasgow Outcome Score(GOS) at discharge were analyzed between the groups.There were no significant differences for background of subjects between the groups. In the Drug group, diazepam, pentazocine, lidocaine, nifedipine and nicardipine were used before intubation. GOS in the Control group was significantly greater than in the Drug group(p0.01).In case of intubation for unconscious patients who may suffer intracranial hemorrhage, using premedication leads to favorable outcome.

We herein describe thallium-201 single photon emission tomography (T1-201 SPECT) findings in three cases with intracranial angioma. One of the lesions which was associated with chronic encapsulated intracerebral hematoma showed moderate accumulation of T1-201, but, others demonstrated no accumulation. The usefulness and limitations of T1-201 SPECT in differential diagnosis of intracranial mass lesions are discussed.

A 58-year-old female presented with a rare case of intracranial solitary fibrous tumor (SFT) manifesting as progressive ataxic gait and hearing loss on the left persisting for 6 months with recent symptoms of increased intracranial pressure. Computed tomography demonstrated a large isodense irregular-shaped mass in the left posterior cranial fossa. T2-weighted magnetic resonance imaging showed two components appearing as very low intensity and high intensity. Extreme-lateral suboccipital craniotomy was performed. Gross total resection was achieved except for some dural attachment in the jugular foramen. All symptoms and signs subsided after surgery. Histological, immunohistochemical, and electron microscopic examinations led to a diagnosis of SFT. The strongly hypointense areas on the T2-weighted images were hypocellular region characterized by disorganized spindle cells and thick bands of collagen. The hyperintense areas on the T2-weighted images were hypercellular region mimicking hemangiopericytoma. Strong immunoreactivity for CD34 was also helpful in the diagnosis. Electron microscopy revealed absence of pinocytic vesicles and dense laminae which are characteristic of hemangiopericytoma. The magnetic resonance imaging appearance of SFT seems to be pathognomonic.

A 28-year-old woman was hospitalized in drowsy state with signs of increased intracranial pressure. CT scans revealed diffuse increased density with marked enhancement in the subarachnoid space, as well as ventricular dilatation. V-P shunt operation was performed to control intracranial pressure. Repeated cytological examinations of CSF couldn't determine the tumor origin. CT scan of thoracic spine showed a cystic tumor in its dorsal aspect. T2-weighted MRI revealed multiple spotty low intensity, specific to melanin granules, throughout the whole spine. Her thoracic spine was explored, and the intradural tumor was partially removed. Histopathological examination revealed the tumor cell which had dark nucleus with conspicuous nucleolus and cytoplasmic granules. These findings were compatible with malignant melanoma. Her general condition were deteriorated progressively and she died about 5 months after her admission. Postmortum examination showed diffuse leptomeningeal invasion of dark tumor throughout the entire central nervous system, and metastasis to peritoneum and omentum via V-P shunt system. Histopathological examination proved the tumor to be malignant melanoma. Electrone microscopic examination also revealed melanosome in the cytoplasm. Primary intracranial malignant melanoma is divided in two groups, nodular type and leptomeningeal type. In the latter type, early diagnosis is very difficult, just as in our case, because only a little tissue specimen can be obtained. In a case of leptomenigeal carcinomatosis, possibility of primary malignant melanoma, though rare, should always be kept in mind, and specific staining such as Fontana-Masson's staining should be tried.

In order to assess effects on conductivity of the spinal nerve roots which were compressed due to lumbar disc herniation (LDH) and spinal canal stenosis (SCS) at the lumbosacral vertebrae, spinal nerve root potentials (SRP) were recorded epidurally at multiple levels upon stimulation of the tibial and peronea nerves. Subjects were five normal volunteers and fifteen clinical cases (10 LDH and 5 SCS). Simultaneous recording of evoked EMGs was used to identify afferent and efferent components of SRPs. The shortest latency SRP consisted of orthodromic group I afferent and antidromic alpha-efferent potentials. The potential on liminal M-wave stimulation was regarded as representing exclusively group I volley and that on maximal M-wave stimulation as predominantly alpha-efferents. A centrifugally conducting nerve potential for H-reflex could be also recorded. Conduction blockage in the lumbar spinal roots of the clinical cases could be recognized as increased positivity and desynchronization. Quantitative assessment of these signs was devised in comparison to the control data. The present method revealed at least one of these signs in all clinical cases, and was found useful to determine the levels at which surgical decompression is indicated, supplementing radiological examination.

A 45 year old woman presented with swelling and pain on joint movement of her knees, although joint movement was relatively well maintained. Five years previously the patient had been diagnosed as having pustulosis palmoplantaris by a dermatologist. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) had no effect, but treatment with 5 mg/day prednisolone caused remission of both the joint pain and swelling and the pustulosis palmoplantaris. There were no sternocostoclavicular lesions at any time during treatment. Clinical findings in this patient were different from previous reports and she was diagnosed as having palmoplantar pustulotic arthro-osteitis affecting the peripheral joints.

Synovial osteochondromatosis of the foot is a rare disorder. We present the first report of synovial osteochondromatosis of the intermetatarsal/tarsometatarsal joints. When a mass develops in the sole of the foot and heterotopic ossifications are revealed radiographically, synovial osteochondromatosis should be considered in the differential diagnosis.

Characteristics features of the histopathological findings of the ossification of the posterior longitudinal ligament (OPLL) of the cervical spine are as follows: 1. In the segmental type of OPLL, the ossification of fibers usually initiates near the posterior border of the vertebral body and in those fibers which attach to the edge of the vertebral body. 2. At the axial ossifying point, degeneration of fibers occurs and enchondral ossification process follows, while in other part of the ossifying area, different types of ossification processes may also occur. 3. In association with OPLL, especially in the hyperostotic type, other paraspinal soft tissues may exhibit proliferation of the cartilage cells with or without ossification, implying the presence of ossifying tendency of the whole body. Of these tissues, the periosteum, the annulus fibrosus and/or the dura mater demonstrate proliferating changes in direct contact with OPLL, and the involvement of the periosteum precedes the other changes including OPLL, suggesting some influence from the vertebral side over the ossifying process of the paraspinal soft tissues.