Successfully operated case of posterior fossa tuberculoma in childhood (author's transl)

A case of intracerebellar tuberculoma is described in which a tuberculoma was removed successfully through the administration of antituberculous agents, and a full recovery was obtained. The patient was a 3-year-old boy who had been receiving antituberculous agents for about 4 months because of acute inflammation followed by osteomyelitis of his right big toe, which was suspected to be tuberculous, and because of pulmonary tuberculosis diagnosed in a chest roentgenogram taken about 1 month after osteomyelitis was cured. While his osteomyelitis was being treated, disturbance in his gait, due to progressive spastic paraparesis, was not iced, and thereafter left cerebellar symptoms with impairment of equilibrium appeared additionally. Then, he was reffered to our clinic for further neurosurgical examination, and was admitted on November 1, 1974 after right carotid and vertebral angiography was performed via the right axillar artery, in which findings suggesting left cerebellar tumor and internal hydrocephalus were obtained. After he was admitted to our clinic, a diagnosis of tumor of the left cerebellum and internal hydrocephalus was more precisely confirmed by pneumoventriculography. Suboccipital craniectomy was then carried out and the tumor, weighing 60 gm, was completely removed from the left cerbellar hemisphere. The tumor was confirmed as tuberculoma not only by histological findings but also by the vertification of tuberculous bacilli in it. Though, moderate fever lasted for about 2 weeks postoperatively, no obvious meningitic signs or new neurological deficits were noted. The patient showed marked improvement especially in his gait disturbance, and was discharged ambulatory 40 days after the operation, and has since been asymptomatic except for slight ataxic gait. The antituberculous agents have been continuously administered postoperatively.     

Data on the pathogenesis of solitary juvenile bone cysts (author's transl)

On the basis of the histologic analysis of 45 solitary (juvenile) bone-cysts the author reveals new aspects of the pathogenesis. I. Data on sex-age-localisation are referred to. II. Due to the hemosiderosis regularly manifesting itself in the loose connective tissue layer lining the cyst and owing to the similarity to the liquified hematomas to be found elsewhere in the organism, as well as on the basis of the specific blood-supply conditions of the spongiosa of the increasing metaphysis the author presumes the intramedullary hemorrhage--possibly occurring also without fracture--to be the primary change. III. In the lining layer of the cyst, as well as in the adjacent bony tissue the author frequently observed capillary stase and to a considerable degree lymphedemas (resorption insufficiency). On the basis of these data the author presumes that the following mechanism might be hold responsible for the persisting of the cyst: The congestive (anoxic) wall of the capillary gets permeable for the proteins. Hence the fluid of high protein content, filling the cyst is constantly replaced. It is emphasized that solely the lymphatic vessels are apt to convey proteins. On the basis, however, of the histologic phenomena (lymphedema) observed, the pericystic lymphatic system is in the stage of relative insufficiency.     

Aortic coarctation. Treatment under one year (author's transl)

Fifteen patients operated upon for aortic coarctation under one year are reported. Nine of them survived. The E.C.G. was very useful as far as the surgical prognosis is concerned. Dead patients showed either right or biventricular hypertrophy, with alteration of the repolarisation. On the other hand 50% of survivors had left ventricular hypertrophy. In six of the operated patients a plasty between subclavian artery and aortic arch was performed. The remaining patients were treated by end-to-end anastomosis.     

Occult temporal arteritis--a case report (author's transl)

A 57-year-old female patient with ischaemic papilloedema developed vascular pseudopapillitis of the opposite eye three months later. Temporal arteritis was diagnosed by means of a biopsy of the temporal arteries. Such cases of occult temporal arteritis are characterized by the absence of typical general symptoms and pathological laboratory findings, or, alternatively, these symptoms appear only much later than the ischaemic alteration to the fundus. Hence, one should consider occult temporal arteritis when confronted with any ischaemic process of the optic nerve, and also in the case of occlusion of the central retinal artery, expecially in cases with a simultaneous rise in the blood-sedimentation rate, since high doses of steroids, when given in time, may prevent total loss of sight.