Hajime Handa

Immunohistochemical analysis of infiltrating lymphocytes in central nervous system tumors

To investigate cell-mediated immune responses to central nervous system tumors, we immunohistochemically analyzed 32 operative specimens, including 19 primary tumors, 5 recurrent tumors, and 8 metastases, for the presence of infiltrating T lymphocytes. In 1 patient, an additional sample of normal brain was studied. Using monoclonal antibodies against T lymphocyte surface markers with a peroxidase technique on frozen sections, we determined that a mild lymphocytic response was present in 3 of 7 primary glial tumors, 1 of 4 recurrent glial tumors, and in 3 of 9 primary meningiomas. The predominant subset was Leu 2, or suppressor/cytotoxic. In contrast, 5 of 7 intracranial metastatic tumors and 1 extracranial metastasis showed marked infiltration with an overall Leu 3, or helper/inducer, predominance. The remainder of the specimens, including 1 recurrent meningioma, 3 neurinomas, and the normal brain sample, were free of infiltrates. Permanent sections revealed an overall pattern of lymphocytic infiltration similar to that of frozen sections. Although additional studies such as electron microscopy are required to establish definitively the lymphocytic nature of the infiltrates, these results support the concept of the ability of the body to mount a cell-mediated response against central nervous system tumors and imply a differential response to primary and secondary tumors.

Endovascular coil embolization of a recurrent giant internal carotid artery aneurysm via the posterior communicating artery after cervical carotid ligation: Case report

The case of a 29-year-old man with a giant fusiform aneurysm of the left internal carotid artery (ICA) is presented. The aneurysm, treated by cervical ICA ligation and extracranial-intracranial bypass, recurred 4 years later owing to recruitment of the posterior communicating artery (PCoA). Because of the previous bypass surgery a direct surgical approach was excluded. After an initial failure with balloon embolization, the aneurysm was embolized successfully with occlusive platinum microcoils through the microcatheter navigated into the aneurysm via the enlarged PCoA. Endovascular coil embolization may be useful in the treatment of cerebral aneurysms not amenable to direct surgery or balloon embolization.

Congenital subclavian steal syndrome with anomaly of the aortic arch

A case of congenital subclavian steal syndrome associated with an anomalous right-sided aorta is reported. A 41-year-old man complaining of vertigo and a loss of consciousness was admitted. Physical examination revealed a blood pressure differential between the arms that was 20 mm Hg less in the left. Aortography showed a right aortic arch from which arose the right subclavian and both common carotid arteries. The left subclavian artery did not opacify. Right vertebral angiography showed retrograde filling of the left vertebral. A left carotid-subclavian bypass was performed. Postoperatively, the patient is symptom free with equalized blood pressure.

Revascularization in the Acute Stage of the MCA Occlusion

Thromboembolectomy of the middle cerebral artery (MCA) was successfully performed by Welch in 1954 and a considerable number of patients underwent this procedure thereafter, with or without refinement of microsurgical techniques.2,9,15,17,18 The procedure lags, however, somewhat behind the superficial temporal artery-middle cerebral artery (STA-MCA) bypass pioneered by Yasargil and Donaghy in 1967.17 The purpose of this report is to present our experience with thromboembolectomy of the MCA in the acute stage on two cases and to reappraise the procedure.

Cerebral Hemodynamics and Functional Prognosis in Hydrocephalus

The functional outcome of cerebral hemodynamics in the chronic stage of juvenile hydrocephalus was determined using single photon emission computed tomography (SPECT). Five patients including three with aqueductal stenosis, one with post-meningitic hydrocephalus, and one case with hydrocephalus having developed after repair of a huge occipital encephalocele. Early images of cerebral blood flow (CBF) were obtained 25 minutes after intravenous injection of 123-I-Iodoamphetamine (IMP), and late images were scanned 3 hours later. Cerebral blood volume (CBV) was also measured using 99mTc in three patients. Twenty cases with adult communicating hydrocephalus were also investigated from the point of view of shunt effectiveness. Although there was no remarkable change in the cerebrovascular bed in the juvenile cases, CBF of the remnant brain parenchyma was good irrespective of the degree of ventricular dilatation. There was a periventricular-reduced IMP uptake in each case, however it somehow matched the ventricular span. Functional outcome one to 23 years after the initial shunt operation was good in every case, despite multiple shunt revisions. Redistribution on late images had no bearing on clinical states. In adult cases, 8 patients with effective shunting demonstrated a relatively localized periventricular low perfusion, with preoperative increased cerebrospinal fluid (CSF) pressure. On the contrary, 12 patients with no improvement with or without shunting showed disproportionately widespread periventricular-reduced IMP uptake, despite low CSF pressure. The present study indicates that periventricular hemodynamics may play an important role in cerebral function compromised by hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative Hemodynamic Study by Doppler Ultrasonic Flowmeter in the Extracranial-Intracranial Arterial Bypass

With recent advances in technology of Doppler flowmeters, it is now possible to detect the direction of blood flow and visualize the flow patterns in vessels in spectrographic display.3,4,7,8 In the present study, the flow patterns were analyzed intraoperatively in the donor and recipient arteries just before and just after the extracranial-intracranial bypass in 9 cases.

Brachial plexus injury with cough attack: case report.

Cough attacks elicited by movement of the neck and right arm are reported in a patient who had sustained several shoulder injuries and who had an anterior scalenectomy. The coughing was accompanied by weakness in the right upper limb. At exploration, the phrenic nerve was found adhered to the brachial plexus. The cough attacks disappeared, and the weakness of the right upper limb improved somewhat after lysis of the adhesions between the phrenic nerve and the plexus and after external neurolysis of the upper, middle, and lower trunks. Postoperatively, the patient could elevate his right arm without coughing.

Mechanism of Vascular Welding by Low Power Nd-YAG Laser Irradiation

The temperature at the anastomotic site during Nd-YAG laser irradiation was measured. Histological specimen of the anastomosed vessel was examined photomicroseopically. The mechanism of vascular welding by laser beaming is postulated based on the results obtained from the experiment. A transient dissolution of the tissue protein first takes place owing mainly to the thermal effect rendered by the laser beam in the localized minute adjacency of the vessel ends to be anastomosed, and prompt and firm fusion of the tissue protein then ensued as the temperature around the anastomosis is lowered. The advantages of Nd-YAG laser anastomosis is briefly discussed.