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The Symposium on Brain Edema has been organized by the
Osterreichische Arbeitsgemeinschaft fur Neuropathologie and by the
Problem Commission for Neuropathology of the World Federa tion of
Neurology. We would like to express our thanks to Dr. L. van
Bogaert, president of the W.F.N., for his great interest in the
design of this conference and for his energetic support. One of the
aims ofthe Problem Commission for Neuropathology has been to
contribute to the advances in various problems which are becoming
ripe for elucidation by experts in different fields. The idea of
the Symposium on Brain Edema has as its background a compelling
necessity to elucidate this subject which is clinically so
important and neuropathologic ally so poorly understood. It was
hoped that this could be achieved by a multidisciplinary approach
involving a variety of aspects to be discussed and correlated.
Brain edema, being an abnormal cerebral condition, belongs
basically to the sphere of neuropathology, but to be successful in
our endeavors we had to apply neuropathology in its most modern and
widest terms. By this we understand that such neuropathology
includes the study of all abnormal phenomena in the nervous tissue
related to the structural alterations, and by "structural" we mean
not only tissual or cellular ones but also changes on
ultrastructural and molecular levels. Thus we needed close and
integrated coopera tion of experts in fields such as
neurohistology, histochemistry, electron microscopy,
neurochemistry, and neurophysiology.
The first International Symposium on Brain Edema was organized by
Dr. Klatzo and Dr. Seitelberger and held in Vienna in 1965. The
second Symposium was held in Mainz in 1972 and organized by Dr. H.
J. Reulen and Dr. K. Schiirmann, the third in Montreal in 1976 by
Dr. H. M. Pap- pius, the fourth in Berlin in 1979 by Dr. J.
Cervos-Navarro, and the fifth in Groningen in 1982 by Dr. K. G. Go.
This volume contains the papers presented at the 6th International
Sym- posium on Brain Edema, held in Tokyo, Japan, November 7-10,
1984. The invited lectures by Dr. I. Klatzo, Dr. A. Hirano, Dr. S.
I. Rapoport, Dr. B. K. Siesj6, Dr. H. M. Pappi us, Dr. K. A.
Hossmann, and Dr. D. M. Long are included as special chapters. On
behalf of the organizing committee, I wish to express my deep ap-
preciation to all the participants for their contribution toward
making this meeting so fruitful and significant. Moreover, the
great success of this Sym- posium depended on the high quality of
the invited lectures and presen- tations by experts in various
fields, as well as on the free and enthusiastic discussion. I was
deeply impressed with the papers presented by all the authors, who
endeavored to elucidate their subjects. The editors have made only
minor corrections and rearrangements, since prompt publi- cation
was considered to be important.
The Maturation Phenomenon, described by Ito et al. in 1975 [3) on
the basis of his to logical observations in the hippocampus as well
as other portions of the cerebral hemisphere, refers to the hours
or days of delay in the development of pathological changes in
various parameters of ischemic injury following the restoration of
blood flow to the ischemic brain. There is a direct relationship
between the intensity of ischemic insult and the speed and rate of
maturation of ischemic injury, a lesser intensity being associated
with slower and less severe development of the lesions. The delayed
neuronal death of CAl pyramidal cells of the hippocampus [8) is a
classic example. In the cerebral cortex, with increasing intensity
of the ischemic insult, the maturation phenomenon of ischemic
injuries intensifies, seamlessly, from less exten sive to more
extensive disseminated selective neuronal necrosis (DSNN), and then
further to cerebral infarction upon reaching a critical threshold
[1,2,4,6,7). We also have found that following ischemic insults
just under the threshold level required to induce infarction, only
disseminated selective neuronal necrosis (DSNN) progresses, while
following ischemic insults at the threshold level, initially only
DSNN develops, followed by the evolution of a gradually enlarging
infarcted focus [5, 7). The reporting of this phenomenon boosted
research in the field, as it became evi dent that ischemic damage
is not a sudden event, but a process potentially susceptible to
therapeutic intervention.
Many nerve cells of the brain which are not killed outright may
suffer delayed death or recovery after ischemic insult. This fact
has led to the concept of "maturation phenomenon" of neuronal
injuries. Since the 1st International Symposium on Maturation
Phenomenon in 1990, new developments, particularly in molecular
biology, have been rapidly bringing new information about molecular
nature and mechanisms of cell death. This book contains the
presentations of the 2nd International Symposium held in Tokyo in
April 1996. The latest developments in maturation phenomenon and
the present status of investigation are described and further
stimulation of research in this field is provided.
The topic "Cerebrovascular Transport Mechanisms" was chosen by the
General Couneil of the International Society of Neuropathology as
one of the four main symposia at the IX International Congress of
Neuropathology, September 1982 in Vienna. The chairmen of the
symposium were asked to structure a program which would cover the
reeent devel- opments in this field and which could serve as a
background for free communications, relevant to this topic,
submitted by the participants of the Congress. Cerebrovascular
transport mechanisms refleet the main function of the blood-brain
barrier in providing optimaI, homeostatically regulated,
biochemical environment for the brain. It is obvious that
disturbanees of this function may play a significant role in patho-
physiology of various brain disorders. Since the elucidation of the
complex blood-brain barrier phenomenon, consisting of various
"barrier systems", necessarily requires applica- tion of
multidisciplinary approaches, the program of this symposium was
structured by evaluation of ultrastructural, cytochemical,
physiological, biochemical, pathophysiological and therapeutic
aspects of the blood-brain barrier by invited, recognized experts
in respec- tive areas. As aresult, this volume of the proceedings
of the symposium attempts to summarize much of today's knowledge on
cerebrovascular transport mechanisms in health and disease, and is
supplemented by the abstracts of free communications dealing with
the most reeent research in this field. We hope that this volume
wil1 serve both as an introduction and a reference book, and that
it wil1 stimulate further research.
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