[Periventricular hypodensity in communicating hydrocephalus studied by metrizamide CT cisternography (author's transl)].
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Biomedical subjects
Publications and source records attributed to Y Inaba.
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A method is described which has been found capable of detecting subarachnoid hemorrhage (SAH) up to 15 to 17 weeks after its occurrence. The episode of SAH was confirmed by bloody and/or xanthochromic cerebrospinal fluid (CSF) at the time of SAH onset. In this study, 47 samples of lumbar CSF from diagnostically confirmed SAH patients were used. The CSF cells were collected onto slides and stained with May-Gruenwald-Giemsa or Perl's reagent. Iron-positive cells were detected at 1 week, increased by 4 to 6 weeks to 8.5% of total nucleated cells, and decreased to 1% by 15 to 17 weeks. All 27 samples obtained at 2 to 9 weeks after SAH showed iron-positive cells. No iron-positive cells (false-negative samples) were noted in 25% (one of four) of samples obtained during the first week, and in 33% (one of three) of samples obtained 10 to 12 weeks and 15 to 17 weeks after SAH. Of the total samples (37) obtained within 17 weeks after SAH, 8.1% (three of 37) were false negative. No iron-positive cells were detected in samples obtained later than 21 weeks after the SAH episode (10 samples).
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We have studied the diagnostic value of computed tomography with metrizamide CSF enhancement in 37 infants. According to the method of injection, we called CT cisternography, CT ventriculography and CT cystography. These methods were useful for the morphologic and dynamic evaluation of the CSF pathways. We used them especially for the evaluation of hydrocephalus, skull base tumor, infantile subdural hematoma and its allied diseases, or congenital cystic lesion such as Dandy-Walker syndrome. The side effects in children are much less than those in adults.
Electron microscopy of negatively stained purified virus and of thin sections of infected cells and tissues showed Akabane virus being similar in morphology and morphogenesis to members of the family Bunyaviridae.
Twenty-three cases suspected of skull base tumors were examined by CT cisternography (CTC) with CT scanner (EMI 1010) from April, 1977 to March, 1978. The lesions in 20 cases were diagnosed as positive and confirmed by operation and/or autopsies. These include five acoustic neurinomas, six pituitary adenomas, two craniopharyngiomas, two skull base meningiomas, one arachnoid cyst and miscellaneous tumors. Isotonic Metrizamide solution four of 2-10 ml was injected via lumbar route. Patients were kept in 30 degrees Trendelenburg position for 60 minutes until the first scanning. Scannings were obtained 1, 3, 6, 24 and in some cases 48 hours after lumbar injection. No side effects except for headache, nausea, vomiting occurred. There were no convulsions. In diagnosing cerebellopontine angle tumors, the indirect signs such as asymmetrical ambient cisterns are of importance, when combined with direct signs, i.e. a shadow defect. Parasellar tumors are usually difficult to diagnose with conventional CT due to streak artifact caused by adjacent bony structure. In CTC the extrasellar extension of pituitary tumors were clearly visible. The size, shape, dimensions and the relationship to the adjacent structures of the craniopharyngiomas were easily demonstrated with CTC especially when a coronal view was added. In arachnoid cyst, CTC demonstrated the delayed turnover of Metrizamide between the cyst cavity and the adjacent subarachnoid space. In conclusion, CTC is an useful neuroradiological diagnostic adjunct because of minimal bony streak artifact and high spatial resolution. It would be expected that small tumors of even 2-3 mm in diameter might be diagnosed, from the fact that the middle cerebral artery in the suprasellar cistern is clearly visible as a shadow defect.
An attempt was made to attenuate the high virulent OBE-1 strain of Akabane virus by adaptation to low temperature. In it the virus was subjected to passage through HmLu-1 cell cultures at 30 degrees C. Cloning was carried out on the virus which had undergone 20 passages through these cultures to select a strain adapted to low temperature. Finally, ten clones were obtained. As a result, nine strains of clone in which virus replication was poor in HmLu-1 cell cultures at 40 degrees C were obtained. Of them, five strains of clone produced uniform plaques. Of these strains, one, or the TS-C2 strain, was selected. It was considerably lower both in peripheral infectivity to suckling mice and in intracerebral infectivity to 3-week-old mice than the OBE-1 strain. Calves and pregnant cows inoculated with the TS-C2 strain by the intracerebral, intravenous, or subcutaneous route were free from pyrexia, leukopenia, and viremia. Virus recovery was negative from various organs and fetuses. All the animals inoculated, however, were found to have neutralizing antibody produced. The results mentioned above suggested that the TS-C2 strain might have been so attenuated as to be available as a candidate strain for a live virus vaccine.
When various animals and routes of inoculation were examined for antibody response to Akabane disease live virus vaccine, the intracerebral (ic) inoculation of mice induced a better antibody response than the subcutaneous (sc) inoculation of calves, guinea pigs, hamsters, mice, or rats. Immunogenicity was compared among lots of this vaccine by performing ic inoculation of mice and sc inoculation of calves and guinea pigs. As a result, there was no distinct significant difference between any two lots of the vaccine, regardless of the animal species used. There was a tendency that the larger the dose of inoculation of the virus, the earlier the production of neutralizing (NT) antibody took place in calves inoculated with the vaccine, and the higher the antibody titer and the rate of taking a turn for positivity for antibody became in these calves. When calves immunized with the vaccine and cows in the field possessing NT antibody were given booster inoculation with the vaccine, the antibody titer showed a significant increase in almost all the calves and cows that exhibited an NT antibody titer of 4 or less at the time of booster inoculation. There were, however, no changes in antibody titer in such calves and cows as presenting an NT antibody titer of 8 or more. Calves and pregnant cows immunized with the vaccine were prevented from viremia and fetal infection when challenged by inoculation with virulent virus.
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Metrizamide CT cisternography (CTC) was performed for the evaluation of CSF dynamics and the diagnosis of skull-base tumors. Results of CTC in 52 cases examined for the study of CSF dynamics correlated well with those of isotope cisternography. However, the degree and duration of ventricular stasis of metrizamide and its transition into a periventricular low-density area in hydrocephalus were recognized more accurately in CTC. Twenty out of 23 cases with suspected skull-base tumor were diagnosed as positive and confirmed by operation. CTC was especially useful in parasellar, CP angle, and other posterior fossa tumors.
Delayed enhanced CT was performed in 53 cases and these findings are compared with those of delayed radioisotope scan and with operative and histopathologic findings. We have classified the results of enhancement into four types as follows: (1) immediate enhancement pattern due to rich vascular bed, typical in meningiomas; (2) delayed enhancement pattern due to exudation, often seen in cystic astrocytomas; (3) intermediate sustained pattern due to both mechanisms in glioblastoma multiforme; (4) no enhancement pattern as in diffuse astrocytomas. The results of delayed enhanced CT correlated well with those of radioisotope scan.
New fiberoptic scopes, originally designed for biliary tract operations, were used in 23 cases for removal of residual calculi at pyelolithotomy and for examination of the renal pelvis and ureter. The external diameters of the scopes are 6.6 mm. (CHF-X1) and 4.5 mm. (CHF-X2). Water irrigation and forceps manipulation can be performed simultaneously with the CHF-X1 scope but only irrigation can be done with the CHF-X2 scope. The scopes were reliable and allowed easy endoscopic forceps manipulation. Improvements for an ideal fibroptic nephroscope are discussed.
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