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Summary Background & aims The associations between dietary magnesium intake and stroke and coronary heart disease (CHD) incidences are inconsistent and not established in Asian. We aimed to determine the association between dietary magnesium intake and the risk of stroke and CHD in a Japanese population. Subjects/Methods We studied 85,293 Japanese subjects by questionnaire at baseline (age 45–74 years, without cardiovascular disease or cancer in 1995 and 1998 for Cohorts I and II, respectively). The participants were followed until the end of 2009 and 2010 in Cohorts I and II, respectively. Dietary magnesium intake was estimated from a self-administered 138-item food-frequency questionnaire. Results After 1,305,738 person-years of follow-up, 4110 strokes and 1283 cases of CHD were documented. The multivariable-adjusted hazard ratios (HRs, 95% confidence intervals, 95%CIs) of CHD for the fourth and fifth quintiles of dietary magnesium intake were 0.70 (0.50–0.99) and 0.66 (0.44–0.97) in men (P for trend = 0.036), respectively, and third quintile of dietary magnesium intake was 0.61 (0.39–0.96) in women (P for trend = 0.241), compared with the lowest quintile in men and women. We observed no decreased risks of incident stroke in men or women with higher dietary magnesium intakes. Conclusions Higher dietary magnesium intake was associated with a reduced risk of CHD in Japanese men.

A finding between dietary pattern and cancer may provide visions beyond the assessment of individual foods or nutrients. We examined the influence of dietary pattern with colorectal cancer (CRC) among a Japanese population.A total of 93,062 subjects (43,591 men, 49,471 women) who participated in the Japan Public Health Center-based Prospective Study were followed from 1995-1998 to the end of 2012, during which 2482 cases of CRC (1514 men, 968 women) were newly identified. Dietary data was obtained from a validated food-frequency questionnaire between 1995 and 1998.Three dietary pattern was derived from principal components factor: prudent, westernized, and traditional pattern. After controlled for potential confounders, the prudent pattern showed a decreased association of CRC risk in men (HR for highest quintile vs lowest: 0.85; 95% CI: 0.72-1.00; P trend0.05), slightly more strongly with distal colon cancer (P trend0.05); but an increased risk of rectal cancer in women (P trend0.05). The westernized pattern showed a significant positive linear trend for colon (P trend0.05) and distal cancer (P trend0.05) in women. There was no apparent association of traditional Japanese dietary pattern on the overall or any specific sites risk of CRC.A prudent dietary pattern showed an inverse association with CRC risk in men, and a westernized pattern was related with a higher risk of colon and distal cancer in women.

Aims Coping strategies may be significantly associated with health outcomes. This is the first study to investigate the association between baseline coping strategies and cardiovascular disease (CVD) incidence and mortality in a general population cohort. Methods and results The Japan Public Health Center-based prospective Study asked questions on coping in its third follow-up survey (2000–04). Analyses on CVD incidence and mortality included 57 017 subjects aged 50–79 without a history of CVD and who provided complete answers on approach- and avoidance-oriented coping behaviours and strategies. Cox regression models, adjusted for confounders, were used to determine hazard ratios (HRs) according to coping style. Mean follow-up time was 7.9 years for incidence and 8.0 years for mortality. The premorbid use of an approach-oriented coping strategy was inversely associated with incidence of stroke (HR = 0.85; 95% CI, 0.73–1.00) and CVD mortality (HR = 0.74; 95% CI, 0.55–0.99). Stroke subtype analyses revealed an inverse association between the approach-oriented coping strategy and incidence of ischaemic stroke (HR = 0.79; 95% CI, 0.64–0.98) and a positive association between the combined coping strategy and incidence of intra-parenchymal haemorrhage (HR = 2.03; 95% CI, 1.01–4.10). Utilizing an avoidance coping strategy was associated with increased mortality from ischaemic heart disease (IHD) only in hypertensive individuals (HR = 3.46; 95% CI, 1.07–11.18). The coping behaviours fantasizing and positive reappraisal were associated with increased risk of CVD incidence (HR = 1.24; 95% CI, 1.03–1.50) and reduced risk of IHD mortality (HR = 0.63; 95% CI, 0.40–0.99), respectively. Conclusion An approach-oriented coping strategy, i.e. proactively dealing with sources of stress, may be associated with significantly reduced stroke incidence and CVD mortality in a Japanese population-based cohort.

Background and aims Higher intake of fish or n-3 polyunsaturated fatty acids (PUFAs) has been associated with reduced risk of coronary heart disease (CHD). However, it is unclear whether increased blood levels of n-3 PUFAs are associated with reduced risk of CHD in the Japanese population. Methods The relationship between circulating levels of n-3 PUFAs (eicosapentaenoic acid + docosapentaenoic acid + docosahexaenoic acid) and risk of CHD was examined in a nested case-control study among participants in the Japan Public Health Center (JPHC)-based Study Cohort. Plasma n-3 PUFA phospholipid levels were measured at baseline by gas chromatography in 209 cases with CHD and 418 controls matched for sex, age, date of blood draw, time elapsed since last meal before blood collection, and study location. The CHD cases (n = 209) comprised 168 cases of myocardial infarction and 41 of sudden cardiac death, otherwise classified as 157 non-fatal and 52 fatal coronary events, respectively. Mean duration of follow-up was 13.5 years. Results Multivariate conditional logistic analysis showed no significant association between n-3 PUFAs and risk of total CHD. The odds ratio (OR) for the highest versus lowest quartiles of plasma n-3 PUFAs was 0.79 (95% confidence interval [95% CI]: 0.41–1.51, p for trend = 0.51). Subtype analysis of CHD revealed that the multivariate ORs for the highest versus lowest quartiles for n-3 PUFAs were 0.91 (95% CI: 0.43–1.89, p for trend = 0.90) for myocardial infarction, 0.08 (95% CI: 0.01–0.88, p for trend = 0.04) for sudden cardiac death, 0.89 (95% CI: 0.42–1.89, p for trend = 0.97) for nonfatal coronary events, and 0.12 (95% CI: 0.02–0.75, p for trend = 0.03) for fatal coronary events. Conclusions Plasma n-3 PUFA levels were not associated with risk of total CHD but were inversely associated with risks of sudden cardiac death and fatal coronary events among middle-aged Japanese individuals.

Seafood/fish intake has been regarded as a protective factor for coronary heart disease (CHD), while smoking is a strong risk factor. To examine whether associations between smoking and risk of CHD are modified by seafood/fish intake, we studied 72,012 Japanese men and women aged 45-74 years who completed 2 food frequency questionnaires, 5 years apart, during the period 1995-2009. After 878,163 person-years of follow-up, 584 incident cases of CHD (101 fatal and 483 nonfatal), including 516 myocardial infarctions, were documented. There was a clear dose-response association between smoking and CHD risk among subjects with a low seafood/fish intake (

We examined the association between green tea consumption and mortality due to all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale population-based cohort study in Japan.We studied 90,914 Japanese (aged between 40 and 69 years) recruited between 1990 and 1994. After 18.7 years of follow-up, 12,874 deaths were reported. The association between green tea consumption and risk of all causes and major causes of mortality was assessed using the Cox proportional hazards regression model with adjustment for potential confounders.Hazard ratios for all-cause mortality among men who consumed green tea compared with those who drank less than 1 cup/day were 0.96 (0.89-1.03) for 1-2 cups/day, 0.88 (0.82-0.95) for 3-4 cups/day, and 0.87 (0.81-0.94) for more than 5 cups/day (P for trend.001). Corresponding hazard ratios for women were 0.90 (0.81-1.00), 0.87 (0.79-0.96), and 0.83 (0.75-0.91; P for trend.001). Green tea was inversely associated with mortality from heart disease in both men and women and mortality from cerebrovascular disease and respiratory disease in men. No association was found between green tea and total cancer mortality.This prospective study suggests that the consumption of green tea may reduce the risk of all-cause mortality and the three leading causes of death in Japan.

The effect of whole-body hyperthermia on the development of peritumoral brain oedema and intracranial pressure was studied in cats with intracerebral transplanted tumour. Whole-body hyperthermia was achieved by means of extracorporeal circulation. The temperature within the brain tumour tissue was increased to 41.8 +/- 0.15 degrees C (mean +/- SD) for 2 h. Measurements of brain water content revealed that hyperthermia worsened the degree of peritumoral brain oedema. Microscopical observation demonstrated that extravasation of horseradish peroxidase, indicating disruption of the blood-brain barrier in the oedematous region, was more severe in animals exposed to hyperthermia than in non-treated animals. Intracranial pressure significantly increased from 13.5 +/- 5.26 mmHg to 25.8 +/- 6.16 mmHg (p0.05) during hyperthermia, although it was controlled at 20.7 +/- 2.60 mmHg by continuous infusion of glycerol. The results suggest that whole-body hyperthermia acting on a brain-bearing tumour caused an increase in intracranial pressure due to worsening of the degree of peritumoral vasogenic type of brain oedema. We emphasize that whole-body hyperthermia may be performed with careful monitoring of intracranial pressure for patients who have brain tumour.

The possible effects of repeated night-time exposure to an extremely low frequency magnetic field (ELF-MF) on melatonin were investigated in nine healthy male subjects aged 23-37 yr. The 16-week experiment consisted of 3 weeks of pre-exposure, 11 weeks of night-time exposure to MF generated from a nonheated electric sheet (ES), and 2 weeks of post-exposure recovery observation. The average MF intensity (rms, mainly 50 Hz AC) on the surface of the sheet was 0.7 microT at the head, 8.3 microT at the waist, and 3.5 microT at the feet of the subject. For each of the urine samples collected 5 times a day on scheduled sampling days, the urinary excretion rate (ng/h) of melatonin was determined, and 24 h rhythms were extracted for each subject and each experimental period (pre-exposure, first half and latter half exposure, and post-exposure periods) by the method of complex cosine curve fitting. Although estimates of the peak height, acrophase, and total daily amount of melatonin were characterized by significant variations among individual subjects, they did not reveal any statistically significant difference between exposure periods and nonexposure periods. Thus, the present study indicates that any profound effect of the MF originating from an ES on nocturnal melatonin production and its circadian rhythm is unlikely.

The production of amyloid beta protein precursor (APP), which is a potent inhibitor of matrix metalloproteinases and serine proteinases, in human astrocytic tumors (n = 17) and normal brain tissues (n = 3) was investigated. We found proteinase inhibitory activity at around 120 kD by trypsin reverse zymography in the culture media of explant cultures of anaplastic astrocytomas and glioblastomas, but not in those of astrocytomas and normal brain tissues. Immunohistochemistry using a monoclonal antibody against human APP demonstrated that APP was detectable mainly in tumor and endothelial cells. Semiquantative analysis of western blotting revealed that immunoreactivity for APP in the culture media of tumor explant cultures appeared to be increased associated with the malignancy of astrocytic tumors. These findings suggest that APP production may be related to the malignant progression of human astrocytic tumors.

The temporal increase of plasma corticosterone (CORT) levels at 3 or 4 days after a single oral administration of trimethyltin (TMT) was suppressed by intracerebroventricular administration of the interleukin-1 receptor antagonist (IL-1ra). On the other hand, glutamate receptor antagonist (MK801) did not affect the TMT-induced CORT level increase. These results indicate that this transient activation of the hypothalamo-pituitary-adrenocortical axis in TMT-treated rats may be in part attributable to the neuroendocrine effects of IL-1 produced by microglia.

Production of tissue inhibitor of metalloproteinases-1 (TIMP-1), a specific inhibitor of matrix metalloproteinases, was investigated in human astrocytic tumors (n = 15) and normal brain tissues (n = 3). Enzyme immunoassay indicated that TIMP-1 levels in the culture media of tumor explants were significantly higher in glioblastomas as compared with anaplastic astrocytomas, astrocytomas, and normal brain tissues. Immunohistochemistry using a monoclonal antibody against TIMP-1 demonstrated that TIMP-1 was detectable mainly in tumor cells, especially in glioblastoma. These results suggest that increased expression of TIMP-1 is associated with the malignant progression of astrocytic tumors.

A 65-year-old male and an 80-year-old female presented with unusual simultaneous bilateral hypertensive intracerebral hemorrhages in the putamina and thalami, respectively. The hematomas were demonstrated by computed tomography performed within a few hours of onset. The patients underwent conservative therapy. The male patient died 4 days after the onset and the female finally became vegetative. The majority of patients with bilateral intracerebral hemorrhages generally have a poor outcome due to the development of severe disturbed consciousness, tetraparesis, and pseudobulbar palsy, even if the hematomas are not so large. The indication of surgery for this type of hemorrhage may be confined to patients with small hematomas who can be expected to have a good functional outcome after removal of the larger hematoma.

A detailed immunohistochemical and electron microscopic study of a case of clear cell (glycogen-rich) meningioma is presented. The neoplasm recurred three times and the patient died of the disease. The specimens obtained at all three operations showed similar basic histologic patterns. The tumor was comprised mainly of a syncytial, sheet-like proliferation of polygonal cells with clear cytoplasm containing abundant glycogen. The immunohistochemical features included epithelial membrane antigen- and vimentin-positive cytoplasm. The ultrastructural examination revealed distinctive meningocytic cells which contained large amounts of glycogen granules. In addition, the presence of numerous blocky, collagen conglomerations were a conspicuous feature of this tumor. The collagen deposits exhibited intensive immunopositivity for types I, III, IV and VI collagen, and their fine structure suggested the production of the extracellular matrix substance from the contiguous meningothelial cells with well developed Golgi complexes and frequent vesicles near the cell membrane. Proliferating cell nuclear antigen cell kinetics study revealed high labeling index of this neoplasm. The findings for this clear cell (glycogen-rich) meningioma may be useful in the differential diagnosis and treatment of this distinctive subtype of meningioma.

A 62-year-old male presented with a rare brain metastasis from malignant mesothelioma manifesting as headache and progressive left hemiparesis. He had previously undergone pleurectomy for malignant mesothelioma. Chest x-ray films showed no recurrence of mesothelioma. Computed tomography and magnetic resonance imaging revealed a homogeneously enhanced nodular mass adjacent to the falx in the right frontal lobe. The tumor was totally removed and diagnosed histologically as brain metastasis from malignant mesothelioma. Following surgery, left hemiparesis improved gradually. Brain metastasis from malignant mesothelioma is usually discovered in the terminal stage or at autopsy. Surgical removal and radiotherapy should be considered for isolated lesions.

An 11-year-old boy was admitted with a painless lump in the right frontal area as his chief complaint. On admission, physical and neurological examinations were normal except for the localized lump constituting the frontal lesion. Skull roentgenogram showed an osteoblastic and osteolytic mass with radiating bony spicules "sunray appearance" around the coronal suture. CT scans demonstrated it more clearly. The initial surgery was performed in July 1993. Pathological specimen showed osteosarcoma of the skull. The patient was transferred to our hospital for chemotherapy. The regimen consisted of intravenous high dose methotrexate 9,000 mg given for 6 hours with leucovorin rescue in a single course. Following 4 courses of high dose methotrexate, he underwent residual tumor resection. Two courses of intraarterial carboplatin 150 mg and methotrexate 200 mg were also given. Histologically, the lesion showed complete remission of the tumor, and no viable tumor cells were seen. Two additional courses of high dose methotrexate were given. The patient is doing well without evidence of recurrence. This case indicates that the chemotherapy with systemic high dose methotrexate and intraarterial carboplatin and methotrexate is effective for skull osteosarcoma.

Serum samples were collected in Hiroshima and Nagasaki, Japan, from 1970 to 1972 for 208 persons who in 1973-1983 developed stomach cancer; for 77 who in 1973-1983 developed lung cancer; and for controls matched for age, sex, city, and season of blood collection. Average serum levels of selenium and zinc were slightly (5%) but not significantly lower among the cancer cases than among controls. Smoking-adjusted risks of lung cancer were elevated only among those in the lowest quartiles of serum selenium [odds ratio (OR) = 1.8] and zinc (OR = 1.3); the trends in risk of this cancer with decreasing serum levels were neither linear nor significant. Little or no excess risk of stomach cancer was observed among those with lowest levels of selenium (OR = 1.0) or zinc (OR = 1.2). These exploratory findings add to limited data available from other reports showing slightly increased risks of lung cancer associated with low blood levels of selenium, but suggest little association with either lung or stomach cancer across normal selenium or zinc ranges in this Japanese population.

Eight chordomas were studied by using specific antibodies against cytokeratin, vimentin, desmin, type II collagen, S-100 protein, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP). One chondrosarcoma was included as a representative of chondroid tumors. All chordomas were positively stained for epithelial markers (cytokeratin and EMA), whereas the chondrosarcoma was not. All chordomas and the chondrosarcoma expressed vimentin, type II collagen and S-100 protein. Oncofetal antigens (CEA and AFP) and desmin were found in five (63%) chordomas, whereas these antigens were not found in the chondrosarcoma. Ultrastructurally the chordoma cells showed junctional complexes, microvillous projections and basal lamina-like structures alongside the tumor cells, whereas the tumor cells of the chondrosarcoma had neither junctions and microvillous projections, nor basement membrane. The present study demonstrates the utility of these tumor markers and ultrastructural features in the differential diagnosis of chordomas and tumors with similar histologic patterns such as chondrosarcomas.

Possible individual variations in the sympathetic nervous system response to sound stimuli were investigated using the auditory evoked plethysmogram response (AEPGR). This study consists of the following 3 experiments; (EXP1) the sound level-response relationships between white noise at 50, 70, and 90 dB (A) and AEPGRmax as defined below, (EXP2) individual variations of AEPGRmax to white noise at 90 dB (A), and (EXP3) the relationship between the AEPGR pattern and the urinary catecholamine (CA) excretion rate during sleep on the preceding night. The subjects were 35 young persons in (EXP1), and 79 young (18-28 yrs. old) and 35 old (60-83 yrs. old) persons in (EXP2) and (EXP3), respectively. The results were: (1) a good sound level-response relationship between the sound levels of 50, 70, and 90 dB (A) and AEPGRmax was obtained on average; (2) an AEPGRmax of more than 100% in response to the 90 dB (A) white noise was found in about 10% of the subjects, whereas it was below 100% in 90% of them. The time prior to the maximum response in the former case varied from 4.6 to 22.2 sec, which was quite a contrast to that of 3.0-9.0 sec in the latter case; (3) The NE (norepinephrine), E (epinephrine) and DA (dopamine) excretion rates were shown to be significantly higher in the former group in (2) than in the other groups, regardless of adjustment for age, blood pressure and/or ECG findings. Thus, it is suggested that the cardiac response to E secreted from the adrenals due to white noise stimuli was predominant in the former group in (2). Therefore, this response pattern was called the AEPGR "beta type", whereas the other group was designated the "alpha type", since its AEPGR appeared to reflect only vasoconstriction. The suggested individual differences in AEPGR associated with increased night-rest catecholamine secretion were also discussed in relation to their possible relevance to chronic stress, neuroticism and other conditions.

Using stored serum samples collected during from 1970 to 1972 and/or 1977 to 1979 from a fixed population in Hiroshima and Nagasaki, Japan, serum ferritin, transferrin, and ceruloplasmin levels were determined immunologically for persons in whom stomach (233 cases) or lung cancer (84 cases) subsequently developed as well as for their controls. An elevated stomach cancer risk was associated with low antecedent serum ferritin levels, with more than a threefold excess among those in the lowest compared with the highest ferritin quintile. The risk did not vary with the time between blood collection and stomach cancer onset, remaining high among those with low ferritin levels 5 or more years before cancer diagnosis. Achlorhydria, diagnosed in a sample of the population about 10 years before the 1970-to-1972 blood collection and up to 25 years before cancer, was an independent marker of stomach cancer risk. In combination, low serum ferritin and achlorhydria were associated with a tenfold increase in the subsequent risk. No effect of transferrin or ceruloplasmin, independent of ferritin, was observed in the gastric cancer risk, and the risk of lung cancer was not related to these three serum proteins. These prospective findings indicate that biologic markers of an increased risk of stomach cancer can be detected long before cancer onset.

Eight cases of central neurocytomas were studied by immunohistochemistry and electron microscopy. Seven tumors were located in the lateral ventricles and one in the subependymal region. All but one patient had a favorable postoperative course. The tumors were composed of small uniform cells possessing amitotic round nuclei with frequent perinuclear halos, a few Homer Wright rosettes and no ganglion cells; an appearance resembling that of oligodendroglioma. Immunohistochemical studies disclosed neuron-specific enolase and Leu-7 positivity in all tumors, S-100 protein-positive cells were found in six, while glial fibrillary acidic protein--and vimentin-positive cells were confined to the blood vessels. Myelin basic protein as well as neurofilament were not detected in the tumors. Synaptophysin-positive areas were seen in one tumor. Ultrastructural examination showed distinctive neuronal tumor cells which had a cytoplasm with sparse dense-core vesicles and thin cell processes containing parallel microtubules. They were classified into three different types of tumor cells according to the extent of differentiation. The most consistent finding for histological diagnosis was the presence of typical or abortive synapses with clear and dense-core vesicles. Additionally, synaptophysin may be a specific marker for some central neurocytomas.

Five male Wistar rats were treated with methyl-mercury chloride (MMC) and compared with five agematched control rats. A dose of 10 mg/kg was given three times. The chronic effects of the MMC administration on the urinary output of catecholamines [norepinephrine (NE), epinephrine (E) and dopamine (DA)] were measured for 50 days. On the 69th day after MMC administration, the rats were examined for insulin-induced hypoglycemic stress. On the 90th day, the animals were decapitated and various organs were weighed and serum thyroid hormones [thyroid stimulating hormone (TSH) and total and free thyroxine (T4)] were measured. Decreases in DA excretion and DA response to stress were observed in the MMC-treated group. Inflammation of the kidney was also found, suggesting MMC-induced damage to the renal tubular region, the apparent site of renal DA synthesis. The MMC group and the control group showed differential NE and E response patterns. The lowered baseline excretion of NE appeared to continue even 70 days after MMC administration, while the difference in E excretion between the two groups disappeared 1 month after MMC administration. Both NE and E showed normal responsiveness to hypoglycemic stress induced by insulin. All serum TSH and total and free T4 baseline levels showed slight increases, and the thyroid gland weights in the MMC group were slightly heavier. These findings suggest a rather hyperthyroid state after the initial acute phase suppression, as suggested by the previous examinations. Thus, these findings suggest long-lasting effects of methylmercury administration, especially on renal DA synthesis. Baseline urinary excretion of NE and thyroid function could also be affected for a long time.

In cases of herpes simplex encephalitis, a low density lesion in the temporal lobe is a common CT finding, whereas hemorrhagic lesion is rarely observed on CT in this disorder despite the frequent occurrence on pathologic studies. Two cases of hemorrhagic lesion observed on CT in herpes simplex encephalitis are reported, and atypical CT findings of herpes simplex encephalitis is discussed.

Thirty male Wistar rats, weighing 200 to 300 g, were used for this study. During a 3- to 4-min period, 300 micrograms of 6-OHDA was injected stereotactically into the right lateral ventricle. The same amount of saline was injected into the ventricle for the control group. Seven days after this procedure, the right common carotid was occluded with a clip and 4 to 6 ml of blood was removed from the external jugular vein to reduce the blood pressure. The clip was removed in 2 hr, and blood flow was maintained for 1 hr. The SG of cerebral tissue was measured according to the method of Marmarou et al. The disruption of BBB was examined by Evans blue injection, and the brain tissue was also examined by electron microscopy. Rats with 6-OHDA treatment had brain edema although the control group had no edema. We suggest that the depletion of brain NA could cause a disturbance in cerebral microvascular tone and could make cerebral blood vessels more vulnerable to the decreased CBF when followed by restoration of the blood flow.

SummaryTwenty-four hour urines were obtained from groups of male and female volunteers recruited from urban populations in developed and developing countries (UK, USA, Japan and Nigeria) and from an agriculture-based Polynesian population (Tokelau Islands). The urines were collected on typical working days, with minimal disturbance to subjects' normal routines. High-performance liquid chromatography was used to determine catecholamine concentrations in each urine, providing a basis for calculation of total 24-hour excretion. Mean 24-hour excretion of noradrenaline and adrenaline was low in the Polynesians compared to the modern, urban groups, and low in women compared to men. Discussion of the results includes assessment of the possible influences of artefact, physical characteristics of the population samples, physical environment and social and psychological factors.

Cerebrospinal fluid flow (CSF) was studied using isotope cisternography in 52 patients with increased intracranial pressure (ICP), all of whom showed acute transient rises of ICP, i.e., plateau waves, in their continuous ICP recordings. The patients were assigned to two groups. Group I was comprised of 23 patients without hydrocephalus and high ICP resulting from brain tumors, benign intracranial hypertension, and superior sagittal sinus thrombosis. Group II included 29 patients with either communicating hydrocephalus or high ICP resulting from rupture of intracranial aneurysm. Plateau waves were frequently observed in patients with baseline pressures ranging from 21 to 40 mmHg in both groups. The isotope cisternographic pattern in the Group I patients showed a large accumulation of radioactivity over the cerebral convexities, while that in the Group II patients revealed a complete obstruction of the subarachnoid space over both cerebral convexities. The isotope clearance from the intracranial CSF showed a marked delay in both groups of patients with one exception. The results suggest that, in the limited range of increased ICP caused by delayed CSF absorption, plateau waves are most evident regardless of the isotope cisternographic pattern.

Eighteen patients were studied for cerebral blood perfusion abnormalities using N-isopropyl I-123 p-iodoamphetamine (IMP) and rotating dual gamma camera emission computed tomography (ECT). All were stroke patients, 10 with cerebral vasospasm after an aneurysmal rupture, 3 with an occlusion of the middle cerebral artery, 2 with an occlusion of the internal carotid artery (IC), one with an IC stenosis, one with Moyamoya disease and one with RIND. Four patients had extracranial-intracranial (EC-IC) bypass operations. In three of them, CBF studies were done before and after bypass surgery. An arterial line was placed in the left radial artery and connected to a Harvard pump. IMP (1.5-3 mCi) was injected into an arm vein while at the same time an arterial blood sample was withdrawn at a constant speed for 5 minutes. Scanning was started 35 minutes after IMP injection. After a scan, multiple transverse, coronal and sagittal section images were reconstructed with a minicomputer. We determined the values of regional CBF in the regions of interest using an image. Transmission computed tomography (CT) studies were performed on the same day. In eight patients, CBF study by 133Xe inhalation method (NOVO cerebrograph) was done. ECT showed diffuse low perfusion in two patients and focal low perfusion in 16 patients while CT showed abnormalities in 9 patients (50%). ECT abnormalities were more extensive than CT abnormalities. The values of rCBF in the superficial brain determined by ECT were similar to those examined by the inhalation method (ISI). Significant increase in rCBF was observed after the bypass operations.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of intracranial malignant melanoma associated with nevus of Ota is presented. A 77-year-old man was admitted to the department of neurosurgery, Fukui Medical School on June, 1985 because of developing disturbed consciousness. The physical examination on admission revealed pigmented lesion diagnostic of the nevus of Ota, anisocoria (R greater than L) and left hemiparesis. Computed tomographic (CT) scans demonstrated a high density mass in the left temporal lobe and the mass was homogenously enhanced after the injection of contrast agent. Left common carotid angiogram showed elevation of the middle cerebral artery and a slight vascular blush. Subtotal removal of the dark-colored tumor within the left temporal lobe and biopsy of the nevus were performed. Histopathological examination of the tumor revealed malignant melanoma and that of the skin biopsy was consistent with a nevus of Ota. Postoperatively DTIC, ACNU and vincristine were administered intravenously but the patient died three weeks after operation. At autopsy, widespread black pigmentation of the leptomeninges, communicating with the pigmented tumor in the left temporal lobe, covered the base of the brain and spinal cord. No melanoma was found outside the central nervous system. Primary intracranial melanoma associated with nevus of Ota is rare and only 6 cases have been reported in the literature. In this paper, primary intracranial melanoma associated with nevus of Ota and some other subjects are discussed.

Intracranial meningioma cells and hemangiopericytoma cells were cultured in vitro for immunohistological and ultrastructural study. Anti-vimentin, desmin, actin, alpha-actinin and laminin monoclonal antibodies were applied for immunohistological examination. Three dimension culture cells in collagen gel were examined by electron microscopy for ultrastructural studies. Cultured meningioma cells and hemangiopericytoma cells were positive for anti-vimentin stain, while desmin, actin, alpha-actinin were positive in only hemangiopericytoma cells. The culture morphology of these two cells was same in light microscopic study except for the whorl formation in meningioma cells. Reconstruction of intercellular junctions such as desmosomes and junctional complexes were common in cultured meningioma cells but seldom in hemangiopericytoma cells. Hemangiopericytoma cells continued to have prominent intracytoplasmic intermediate filaments and microfilaments forming dense bodies in culture. These results suggest that intracranial hemangiopericytoma has something in common with smooth muscle cell and fibroblast cells which forms the vascular and perivascular tissues, and it is distinguishable from meningioma.

The intracranial pressure, systemic blood pressure, respiratory pattern and heart rate were studied polygraphically in five patients with plateau waves in continuous intracranial pressure recording. Three brain-tumor patients and two benign intracranial hypertension patients were included. The intracranial pressure was recorded through an indwelling ventricular catheter attached to a pressure transducer. The systemic blood pressure was recorded through an intraarterial catheter placed in the femoral artery. The recordings were made from 18 to 40 hours and a total of 770 plateau waves were examined in this study. The systemic blood pressure showed little or no change in spite of a marked rise in intracranial pressure. The respiratory alterations were always noted during the plateau waves. This respiratory changes during the plateau waves were assigned into three patterns. The first was the suppressed respiratory pattern during the entire course of the plateau waves (Type I): the second was the pattern characterized by the initial suppression followed by the late hyperventilation (Type II); and the third was the hyperventilation pattern during the entire course of the plateau waves (Type III). The pattern of Type I was noticed in 65% of the observed plateau waves, the pattern of Type II in 23%, and the pattern of Type III in 12%. The heart rate decreased in most plateau waves, but there was little change in the heart rate in some plateau waves.(ABSTRACT TRUNCATED AT 250 WORDS)

Two cases of trigeminal neuralgia caused by arteriovenous malformation (AVM) located in cerebellopontine angle (CP angle) are presented. A 61-year-old woman has been suffered from the left 2nd and 3rd division trigeminal neuralgia, and gasserian ganglion rhizotomy did not relieve the pain. Ten days before admission the patient suddenly got right hemiparesis and left cerebellar ataxia. Bleeding of the left CP angle was noticed by computerized tomography (CT) scan and angiogram revealed AVM of the left CP angle. A 48-year-old man had right facial neuralgia for 4 years along and he received percutaneous retrogasserian glycerol rhizotomy twice, but the pain was not aleviated. Superior petrosal sinus was enhanced on conventional CT scan, and air contrast CT cisternography disclosed network shaped structure at the CP angle, which was revealed as AVM by vertebral angiography. The patient was completely relieved from the neuralgia after removal of the AVM. AVM of the CP angle that causes the trigeminal neuralgia is rare and the gasserian ganglion rhizotomy is little effective in aleviating the pain. Bleeding from AVM causes severe neurological deficits. Removal of AVM is important not only for pain relief but also for protecting bleeding. Air contrast CT cisternography is one of the safety and convenient methods to detect the AVM and other vascular anormalies resulting in trigeminal neuralgia.

The intracranial pressure, systemic blood pressure and compressed spectral array in EEG monitoring were studied in three patients with typical plateau waves in continuous intracranial pressure recordings. Two patients with brain-tumor and one patient with aqueductal stenosis were included. The intracranial pressure was recorded through an indwelling ventricular catheter attached to a pressure transducer. The systemic blood pressure was recorded through an intraarterial catheter placed in the femoral artery or the dorsalis pedis artery. To obtain continuous and compressed spectral array in the EEG, Berg-Fourier Analyzer by the OET-Biomedica Company of Italy was used. Simultaneous recordings of the intracranial pressure, systemic blood pressure and EEG spectral analysis were made for 180 minutes in each patient. During the plateau waves, the systemic blood pressure did not rise in spite of a marked increase in intracranial pressure, resulting in a marked decrease in the cerebral perfusion pressure. The patients, however, showed no clinical symptoms resulting from ischemia of the brain, such as vasopressor response and impairment of consciousness, but complained only headache. The spectrograms in these patients were characterized by a constant and predominant activity in the alpha or high frequencies. This structural aspect was retained throughout the continuation of plateau waves. The power of low frequencies only appeared transiently. The results suggest that some mechanisms producing and maintaining the fast and/or alpha wave activity may participate in the recurrent appearance of plateau waves.

Noise has been measured usually for a particular source or place and not for each individual exposed. It has been thought to be of great significance if individual noise exposure is recorded in various kinds of noise environment and auditory effects of noise on each individual can be discussed. The present study, having each of examinees carry 10-Channel Noise Exposure Meter with him, intended to know about dose or equivalent sound level (Leq) of individual nois exposure for a whole day and for each of eight time-zones in a day. The examinees were 12 male married workers in a factory manufacturing electronic machines in Kawasaki City, Kanagawa Prefecture, Japan. They were divided into two groups; those who were working in a noisy workshop (Group N, 8 workers) and those who were working in a less noisy workshop (Group N-N 4 workers). Time-zones were categorized as follows: (a) time from rising to leaving home for the place of work, (b) commuting time in the forenoon, (c) working time in the forenoon, (d) noon recess time, (e) working time in the afternoon, (f) commuting time in the afternoon, (g) time from returning home to going to bed, and (h) sleeping time. Leq (c) and Leq (b) were highest and Leq (h) was lowest for Group N among the eight Leq values in the day, while Leq (b) and Leq (f) were highest for Group N-N. Statistically significant differences of Leq for each time-zone between the two groups were found in Leq (c), Leq (d) and Leq (e), whose energy average sound levels for Group N and Group N-N were 84.2 and 59.4 dB, 72.7 and 61.4 dB, and 85.5 and 61.4 dBrespectively. Energy average equivalent sound levels of Leq (24) were 81.0 dB for Group N and 66.7 dB for Group N-N. Leq (24) for Group N were primarily determined by the noise exposure in the working time (c and e), while those for Group N-N by that in the commuting time (b and f). Practical disadvantages in the course of individual application of 10-Channel Noise Exposure Meter were also pointed out. It was shown that it is possible individually to measure the noise exposure dose for each time-zone in a day or daily noise exposure pattern, and the noise exposure dose over 24-hour. It may be recommended that many typical noise exposure patterns and 24-hour noise exposure doses for each of the groups classified by sex, age, kind of job, kind of commuting methods, kind of residential area of residential area and so forth should be surveyed further, which will be useful for estimating the auditory effects of noise on a population. Also, the relationships between Leq and such effects as annoyance or interference with daily activities should be examined to ease the measurement of noise.

Surgically excised intracranial hemangiopericytomas from three patients were cultured in vitro and they were examined by immunohistochemistry and electron microscopy to trace the origin of intracranial hemangiopericytomas compared to meningiomas. In all of the three hemangiopericytoma cell cultures, the matrix stained positively for vimentin and desmin. Two stained positive for actin and laminin. Cultured meningioma cells were positive in vimentin staining but negative in others. Hemangiopericytomas continued to have prominent intracytoplasmic intermediate filaments, microfilaments forming dense bodies and pinocytotic vesicles. Reconstruction of only a few cell junctions of zonula adherens type after subcultivation were observed in hemangiopericytoma, while there were neither whorl formations nor cell junctions found, such as desmosomes and junctional complexes, which are common in cultured meningioma cells. These results suggest that intracranial hemangiopericytoma has something in common with muscle cell, endothelial cell and fibroblast which form the vascular and perivascular tissues, and it is distinguishable from meningioma.

A case is reported in which an aneurysm on the anterior communicating artery calcified during the time course of 17 years. A ring-like calcification was demonstrated in plain skull films as well as CT scans. Carotid angiograms showed that the aneurysm grew a little bit bigger for 17 years. The aneurysm was coated because of the calcified aneurysm.

A sign of descending tentorial herniation (DTH) on computed tomography (CT) in 48 patients with putamenal hemorrhage was examined in the acute stage. Correlation between the DTH sign and prognosis for survival was studied in two groups; a conservative group and an operative group. Patients were grouped according to the presence or absence of DTH sign on CT. Grade 0: no herniation sign; Grade I: an encroachment upon the lateral aspect of the suprasellar cistern (impending herniation); Grade II: widening of the crural and ambient cistern on the same side as hematoma (actual herniation); Grade III: effacement of the cisternal space at the tentorial level (advanced stage of herniation). Twenty-one patients (44%) with Grade 0 DTH sign showed a good prognosis in both conservative and operative groups. Six patients (13%) with Grade I DTH sign also showed a good prognosis in both the conservative and the operative groups except one patient with anisocoria. There were 14 patients (29%) with Grade II DTH sign. Three of them who were treated conservatively showed only mild impairment of consciousness at the initial phase, but became worse 3-4 hours later. In the remaining patients who showed severe impairment of consciousness from the beginning of the illness, prognosis was poor except for patients with hematoma evacuation. Seven patients (15%) with Grade III DTH sign had poor prognosis both in the conservative and the operative groups. It is suggested that, in the acute stage of patients with putamenal hemorrhage, operative procedure should rapidly be performed not only for the clinical herniation sign but also for the DTH sign on CT even if the patients showed no clinical sign and only impairment of consciousness.

A 33-year-old male was admitted to the Department of Neurosurgery, Fukui Medical School with a complaint of headache. There were no neurological deficits on admission. Craniogram demonstrated a so-called "phantom sella". A computed tomography revealed a high density mass lesion and the mass was enhanced well, that mainly extended from the sella to the left middle cranial fossa. The left carotid angiogram revealed an avascular mass lesion extending from the sella to the left middle cranial fossa. Pituitary function tests revealed an extremely high serum prolactin (PRL) levels (70, 100 ng/ml). PRL response to TRH was delayed in peak and the high level continued. Serum PRL levels elevated to 90, 800 ng/ml at 180 min after injection of TRH. A biphasic response was demonstrated in response to CB-154 suppression test to PRL secretion, that is, CB-154 stimulated PRL release initially (up to 90 min) and suppressed thereafter. Serum PRL levels (178, 400 ng/ml) reached to peak about 90 min after CB-154 administration. Response of growth hormone (GH) and adrenocorticotropic hormone (ACTH) to insulin were also impaired. Craniotomy was performed. The tumor was partially removed and was diagnosed as a prolactinoma histologically. Tumor tissue removed was subjected to the monolayer culture and electron microscopic study. Their observations demonstrated hyperactive PRL secretion of the individual cells. A total dose of 5,000 rads was irradiated postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

A 29-year-old man with Cockayne's syndrome (CS), presenting reversible ischemic neurological deficit is reported. In his past history, hearing disturbance developed at 6 years old and visual disturbance at 12 years old. His parents have consanguinious marriage. He came to our hospital complaining of right-sided hemiparesis and speech disturbance. He was 115.8 cm tall and his weight 20 kg. The characteristic manifestation of CS, i. e., dwarfism, mental retardadation, cachectic feature, retinal atrophy, neural deafness and calcification of bilateral basal ganglia were all noticed. A CT scan on admission revealed marked brain atrophy as well as the intracranial calcifications, while no lesions compatible with his neurological findings were detected. Cerebral ischemic state was mostly suspected. Following up with conservative therapy by the use of fibrinolytic agent, his neurological deteriorations disappeared on the 4th hospital day. Cerebral angiograms showed stenotic lesions of both C1-C2 portion of the left internal carotid artery and the right middle cerebral artery, and the aneurysm in the right internal carotid artery. Such atherosclerotic vascular change as observed in the cerebral angiograms in this case have progressed rapidly for his age. In this case, diabetes mellitus and hyperlipoproteinemia such as increased total cholesterol, increased triglyceride, decreased HDL and increased apoprotein B and C II were complicated for the risk factor of the atherosclerosis. It's controversial that early progress of atherosclerosis is due to ideopathic original feature of CS or to the secondary change from these complications.(ABSTRACT TRUNCATED AT 250 WORDS)