Gakuji Gondo

Collagen gel matrix assay as an in vitro chemosensitivity test for malignant astrocytic tumors

BackgroundThe efficacy of individual chemotherapy based on chemosensitivity has scarcely been studied.MethodsWe examined the chemosensitivites for four anticancer agents – 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3 (2-chloroethyl)-3-nitrosourea hydrochloride (ACNU), carboplatin, cisplatin, and etoposide – of 43 malignant astrocytic tumors (21 anaplastic astrocytomas and 22 glioblastomas) by using a collagen gel matrix assay, and we also determined the survival periods of the tumor-bearing patients. The chemosensitivity was evaluated in terms of the growth inhibition rate, using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide (MTT) method.ResultsFor the anaplastic astrocytomas, the mean growth inhibitory rate was 33.2% with cisplatin, 37.2% with carboplatin, 28.0% with ACNU, and 24.8% with etoposide. For the glioblastomas, these rates were 36.9%, 42.3%, 23.2%, and 34.8%, respectively. The median overall and progression-free survivals of anaplastic astrocytoma-bearing patients who had undergone chemotherapy with two anticancer drugs, both of which showed significant anticancer activity (growth inhibitory rate >30%) were significantly longer than those of the patients who had been treated with two drugs, one or both of which did not show significant anticancer activity. On the other hand, there was no significant difference in the overall or the progression-free survivals in the two corresponding groups of glioblastoma-bearing patients.ConclusionThe collagen gel matrix assay is clinically useful to determine in vitro chemosensitivity that reflects in vivo chemosensitivity. Individual chemotherapy for malignant astrocytic tumors, based on chemosensitivity data, could contribute to longer survival, particularly in anaplastic astrocytoma-bearing patients.

Thermosensitive Determination of Patency in Lumboperitoneal Shunts: Technical note

Surface cooling and thermistor recording over shunt tubing was used in 23 studies of cerebrospinal fluid shunt patency in 19 patients with lumboperitoneal shunts and normal-pressure hydrocephalus. Shunt patency was shown by downward reflection of the recording trace similar to that obtained for ventriculoperitoneal shunts. Obstruction was demonstrated by a flat-line recording or an upward deflection.

Sciatic Neuralgia Caused by May-Thurner Syndrome

BACKGROUND Sciatic neuralgia (SN) is a type of pain commonly associated with lumbosacral radiculopathy. May-Thurner syndrome (MTS) is a disease characterized by venous congestion in the left common iliac vein (LCIV) due to right common iliac artery compression. A case of MTS with SN as the first presenting symptom is described. CASE DESCRIPTION A 53-year-old man gradually developed left SN; however, radiologic examination showed no causal findings. Conservative medical treatment did not result in satisfactory pain relief. During the follow-up period, edema and brownish skin pigmentation were noted on the left crural region. Follow-up magnetic resonance imaging of lumbar spine revealed vascular enlargement around the spine and compression of the LCIV by the right common iliac artery. Furthermore, the left S1 nerve root was compressed by enlarged veins, which was thought to be the cause of the left S1 radiculopathy and SN. After the stenosed part of the LCIV was expanded, the pain and edema in the left leg disappeared. CONCLUSIONS This is the first report of SN associated with MTS. MTS should be considered as one of the differential diagnoses of SN. Thus, symptoms such as pain, edema, and skin hyperpigmentation on the left leg should be closely noted.

Nonneoplastic Intramedullary Spinal Cord Lesions

In spite of the development of recent imaging technology, it is sometimes difficult to make a diagnosis of intramedullary spinal cord neoplasm. The purpose of this study is to investigate the differentiation of these lesions from nonneoplastic ones. Twelve patients with nonneoplastic intramedullary spinal cord lesions, excluding syringomyelia, who underwent surgery for either partial removal or biopsy were reviewed. Eight lesions were located in the cervical cord, 3 were in the thoracic cord, and 1 was in the thoracolumbar cord. Signs and symptoms were usually referable to the location of the cord lesions, which was not helpful in distinguishing them from intramedullary spinal cord neoplasms. On T1-weighted magnetic resonance imaging, most of signal intensities were iso- or low intense, whereas T2-weighted images showed high signal in all cases. The extent of enhancement with gadolinium (Gd)-DTPA varied from mildly homogeneous to irregular enhancement; however, all lesions showed an ill-defined boundary. Minimal or no spinal cord expansion in spite of the extent of the enhanced mass was the most consistent finding in most of the cases. The pathology of the surgical specimens demonstrated demyelinating lesions in 2 patients, granulomatous disease in 2 patients, vascular disease in 3 patients, inflammatory disease in 3 patients, and other conditions in 2 patients. Even with the advent of diagnostic techniques, it is still sometimes difficult to distinguish nonneoplastic intramedullary spinal cord lesions preoperatively from intramedullary spinal cord neoplasms.