Hitoshi Fukuda

Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases.

BACKGROUND Until recently, it has been impossible to demonstrate vascular compression at the root entry or exit zone (REZ) of the trigeminal nerve and facial nerve in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) preoperatively, although surgical findings have revealed apparent neurovascular compression and its correction has resulted in a good outcome in most cases. Revealing the anatomic correlation between nerves and vessels at the REZ preoperatively would be useful to predict operative findings. METHODS To assess whether the vascular contact of the nerve at the REZ could be demonstrated preoperatively, high-resolution magnetic resonance tomographic angiography (MRTA) was performed in 21 patients with TN and 39 with HFS. Neuroradiological findings were compared with the operative findings in all patients. Contralateral asymptomatic nerves were evaluated as a control. RESULTS MRTA correctly identified offending vessels in 14 (67%) of the 21 TN and 34 (87%) of the 39 HFS patients. Failure to identify neurovascular contact was noted in the cases with compression by veins or small arteries, thickened arachnoid, or distal compression. Neurovascular contact was also observed in 15% of the asymptomatic nerves. The deformity of the nerve seemed to be a more important factor for determining operative indication. CONCLUSIONS MRTA could demonstrate offending vessels in TN and HFS at a high rate and was useful to predict operative findings. MRTA gave supportive evidence of surgical indications in patients with TN and HFS, although attention should be paid to the fact that MRTA did not necessarily detect all of the offending vessels.

A recurrent intradural cervical neurenteric cyst operated on using an anterior approach: a case report

The neurenteric cyst is an uncommon congenital lesion. In most reported cases, it has been operated on via a posterior approach using a laminectomy, despite the fact that the cyst is usually located ventral to the spinal cord. Reports have shown that early postoperative results have been good with the posterior approach, but very few studies of the long-term postoperative recurrence of neurenteric cysts have been conducted. Here, we report on a case of recurrent neurenteric cyst that was operated on using an anterior approach.A 42-year-old woman presented with a cervical neurenteric cyst that had recurred eight years after its partial removal via a posterior approach. The patient complained of pain on the lateral side of her upper arms, and an magnetic resonance imaging showed that the recurrent cyst was located ventral to the spinal cord and compressed the cord dorsally at the C4-6 level. The patient was operated on via an anterior approach using a vertebrotomy at the lower half of C5 and the upper half of C6. The cyst was attached to the spinal cord firmly and was subtotally removed, with the thickest portion adhering to the cord not being removed. The caudal end of the cyst was observed with the assistance of a rigid endoscope.A neurenteric cyst may recur after partial removal, and the patients condition may deteriorate during postoperative follow-up. The anterior surgical approach provides good visualization and facilitates safe removal of the lesion.

Permissive role of thyrotropin on thyroid radioiodine uptake during the recovery phase of subacute thyroiditis

Serial measurements of serum triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), and 4-hr thyroidal 131I uptake were carried out in nine patients with subacute thyroiditis. In the acute phase, suppressed TSH and 131I uptake were observed simultaneously with the elevations of T3 and T4. Thyrotropin-releasing hormone (TRH) failed to increase TSH in all patients studied. The mean value of an increment in serum TSH was only 1.8 muU/ml during the recovery phase when 131I uptake was normal or hypernormal. In addition, an elevated 131I uptake was not necessarily associated with an immediate increase in the serum T3 and T4. These observations suggest that the resumption of the iodide pump may be more important than an increment in TSH in producing normal or hypernormal 131I uptake during the recovery phase. There appears to be a dissociation between the reestablishment of 131I uptake and the resumption of the mechanism of hormonal synthesis and secretion in the thyroid.

Pituitary enlargement with target organ deficiency: hypothyroidism and hypogonadism

Three women with pituitary enlargements associated with preexisting target organ failures are reported. Two pituitary enlargements owing to primary hypothyroidism and one to primary hypogonadism were shown to be regressed on computed tomography after the replacement therapy. Clinically and pathologically, the differentiation of a pituitary hyperplasia from a pituitary adenoma is often very difficult. Moreover, the treatments for these conditions are quite different. Adequate medication can diminish a pituitary enlargement because of the feedback mechanism. Existence of the target organ deficiency should always be checked before the management of pituitary tumor.

The role of central serotoninergic and noradrenergic neurons in the regulation of nyctohemeral rhythm of plasma thyrotropin

A possible participation of central serotoninergic or noradrenergic neurons on nyctohemeral periodicity of plasma TSH concentration was studied in the rat. Control rats exhibited normal nyctohemeral fluctuations of plasma TSH characterized by high AM (09: 30) and low PM (18: 30) values (397 ± 45 vs. 207 ± 28 ng/ml, p < 0.01). The daily ip administration of p-chlorophenylalanine (p-CPA, 100 mg/kg body weight) for 7 days produced significant decreases in plasma TSH concentration and hypothalamic TRH content in the AM. However, these parameters in the PM were unaffected by p-CPA administration. An inhibition of serotoninergic activity thus abolished nyctohemeral periodicity in plasma TSH by lowering only AM values (AM: 253 ± 32 vs. PM: 236 ± 30 ng/ml, p > 0.1). On the other hand, intraventricular administration of 6-hydroxydopamine (6-OHDA, 250 μg/rat), a drug able to deplete noradrenaline and possibly dopamine, had no appreciable effect on AM-PM fluctuations of either plasma TSH or hypothalamic TRH content. The rate of elevation of plasma TSH after thyroidectomy was not significantly different in p-CPA or 6-OHDA treated rats compared to the respective controls, suggesting that there is no significant contribution of these biogenic amines to feedback control of TSH secretion by thyroid hormones. The present study suggests that the nyctohemeral periodicity of pituitary TSH secretion can be produced by cyclic activation of hypothalamus brought about by the increased input of serotoninergic neurons in response to the periodicity of certain environmental cues and that central noradrenergic or dopaminergic neurons are not involved in this system.

Effect of cold on plasma protein-thyroxine interaction in the guinea pig

Abstract In an attempt to study a possible alteration in the interaction of protein and thyroxine of animals exposed to cold, the uptake of labeled thyroxine by muscle was measured in the presence of plasma from control guinea pigs and those exposed to the cold. The uptake of labeled thyroxine was less in the presence of control plasma than in the presence of plasma obtained from animals exposed to the cold. The magnitude of this response to cold depends largely upon the severity of the cold. Plasma albumin decreased significantly in animals exposed to cold. TSH significantly augmented the uptake of labeled thyroxine by muscle in the presence of plasma, but ACTH was without effect in this system. Epinephrine and norepinephrine did not alter the uptake of labeled thyroxine by muscle in vitro in the presence of plasma. It is suggested that more free thyroxine is available to cells due to a lower binding affinity of plasma protein for thyroxine produced by a decrease of plasma albumin in animals exposed to cold. An increase of circulating TSH may play an additional role for an increase of free thyroxine in animals exposed to the cold, possibly by altering protein-thyroxine interaction.

A case of bromovalerylurea intoxication associated with acute hepatitis and pancreatitis

症例, 33才,男性,自殺目的でプロムワレリル尿素(Br薬)を約10g服用し半昏睡状態で入院.第2病日に覚醒したが重症肝炎(GOT6280, GPT5296IU/l,プロトロンビン時間16%)と膵炎(血清アミラーゼ1179IU/l,血清リパーゼ246IU/l)を合併していた.回復期肝生検では急性肝炎像を呈した. Br薬中毒により肝炎の報告は2例あるが膵炎や兩者の合併の報告はなく本例が第1例と思われた.

A case of multiple myeloma complicated by liver abscess perforating into the stomach

62才の男性が右季肋部痛にて来院.諸検査にて典型的な多発性骨髄腫(IgG-κ型)が確認された. MCP療法にて38°C台の発熱は下熱し小康を得たが,その後再度発熱し心窩部に圧痛が出現した.エコー, CT等により肝膿瘍と診断し,ドレナージを行ない黄白色の膿汁をえた.細菌培養は陰性,諸種抗生物質治療にも抵抗性で,入院後32病日,麻痺性イレウスの状態で死亡した.剖検にて,回盲部原発のアメーバ性大腸炎と,腹腔内と胃に穿破したアメ一バ性肝膿瘍と判明した.多発性骨髄腫に合併したアメーバ性肝膿瘍の報告は本邦初であり,アメーバ性肝膿瘍自体まれな疾患であるが,今後一種の日和見感染として常に念頭におくべき疾患と考えられ報告した.