In order to clarify the environmental factors which are involved in the development of the primordium of the pituitary gland such as cell-cell interactions, a three-dimensional reconstruction of this organ and its surrounding tissues was carried out. Pituitary material was obtained from human fetuses mainly during the period of organogenesis. Rathke's diverticulum was found to stretch rostrally from the stomodeal epithelium to the middle of the mesoderm, and already by the 5th week of fetal growth, it was clearly seen to be involved with the diencephalon. The area of contact between Rathke's pouch and the diencephalon gradually moved from the rostral to caudal regions and, after 13 weeks of development, had a position similar to that found in the newborn infant. Among the cells forming Rathke's pouch, it was found that the closer their relationship was to the diencephalon, the greater were their epithelial characteristics. When the relationship of such cells to the diencephalon was weaker, their differentiation to endocrine cells occurred earlier. Immunohistochemically, that portion of the pituitary primordium which has a close relationship with the diencephalon, later to become the pars intermedia, showed an adrenocorticotropic hormone (ACTH) immunoreactivity later than that of the pars anterior. On the other hand, in the 21st fetal week, nearly all of the cells of the pars intermedia were found to be ACTH-positive. This finding is thought to indicate a close connection between the physical contact between the brain (diencephalon) and the pituitary primordium and the development of the pars intermedia; the differentiation of ACTH cells. The surface of the epithelium of Rathke's cavity continues to increase at least until the 21st fetal week, so the growth of the epithelium of Rathke's pouch is thought to be heavily involved in the growth of the primordium of the pituitary gland in the early stages of development.

Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

SUMMARY Correlation with the size of the haematoma, neurological findings and prognosis was studied in 26 cases of hypertensive pontine haemorrhage, using CT. A good prognosis was found with no or mild disturbance of consciousness, normal pupils, and transverse diameter of the haematoma 20 mm or less. Most of the patients with poor prognosis became comatose within two hours of onset. Their pupils were dilated bilaterally, pin-point or anisocoric and the transverse diameter of the haematoma was over 20 mm.The prognosis in cases of pontine haemorrhage has been reported to be extremely poor,' but the widespread use of CT scanning has led to the discovery of small pontine haematomas which previously could not have been diagnosed. In such cases, the prognosis is not always unfavorable.2'4 We report the clinical symptoms, CT findings and prognosis of 26 patients with primary pontine haemorrhage. Materials and methodsAll cases of arteriovenous malformation and cryptic angioma were excluded leaving 26 cases of pontine haemorrhage brought to hospital within 24 hours of onset between July 1978 and April 1982 (table 1). Twenty were male and six were female, with ages ranging between 33 and 68 years (mean 50 years).Study was made of the symptoms at onset, level of consciousness on admission, pupillary and other cranial nerve findings and 10 mm thick slice CT findings in relation to the transverse and longitudinal diameters of the haematoma, the number of CT slices in which the haematoma was visible and the presence or absence of ventricular enlargement. Results(a) Clinical symptoms, therapy and prognosis The symptoms at onset were headache and vomiting in 10 patients, vertigo in seven, hemiparesis in six, loss of consciousness in five and unilateral sensory disturbance in two.

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated y-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage. A lthough hypertension is considered the cause L \ of bleeding in the majority of spontaneous A. \ . intracerebral hemorrhage cases, 1 -3 the existence of cases in which a hemorrhagic diathesis is the cause must be considered when deciding upon surgical therapy. Prior to November 1985, we performed computed tomography (CT)-guided stereotactic aspiration in 125 patients with intracerebral hematoma. 4 Among those patients, eight rebled subsequent to the surgery. When those patients in whom the rebleeding due to problems in postoperative care or the technique used for aspiration of the hematoma were excluded, there remained three patients with a history of liver disease.Those three patients drew our attention to the possible involvement of chronic liver disorders in spontaneous intracerebral hemorrhage and, specifically, to the possibility that patients might develop a tendency to bleed due to liver dysfunction. To clarify the degree to which such a tendency is involved in intracerebral hemorrhage, we studied alcohol consumption, liver function, and coagulation parameters in 117 patients admitted to our clinic with spontaneous intracerebral hemorrhage. Received August 13, 1987; accepted February 26, 1988. Subjects and MethodsBetween December 1985 and February 1987, we evaluated 202 patients with spontaneous intracerebral hemorrhage in whom diagnoses of aneurysm, arteriovenous malformation, or moyamoya disease had been excluded by cerebral angiography. Of those patients, 85 had been admitted to our clinic >24 hours after onset or had received incomplete examinations on admission. Therefore, only 117 patients met the criteria for this study. There were 68 men and 49 women. The men ranged in age from 30 to 77 (mean ± SD 54.9 ±9.9) years and the women from 33 to 84 (mean±SD 60.1 ±9.7) years. The sites of bleeding were the putamen in 66 patients, the thalamus in 38, the cerebellum in 6, the cerebral subcortex in 3, the caudate nucl...

In 296 cases with a single aneurysm of the anterior communicating artery (ACoA), fenestration or the presence of more than two ACoA's was observed in 17 cases (5.7%), and abnormal vessels of ACoA origin, such as a median artery of the corpus callosum, were observed in 13 cases (4.4%). As more than one anomaly was found in some of these cases, anomalies of the ACoA were found in total of 26 cases (8.8%). This occurrence rate was no higher than that observed in other cerebral aneurysm cases and in the control cases, which were reported previously. There was no significant increase of hypoplasia of the A1 portion if the ACoA aneurysm was complicated by other arterial anomalies.