前頭葉皮質下切離法（T-トミー）の症候學的觀察

Prefrontal Subcorticotomy (T-Tomy) from Symptomatologlocal Point of View.

第1章　緒言

　腦性小兒麻痺，不隨意運動症及び癲癇症等一連の難症に對する外科的療法として我教室竹林助教授は曩に前頭葉皮質下切離法即ちTトミー（Prefrontal Subcorticotomy；T-Tomy）を提唱し，その術式^1）基礎的研究及び效果の概要に就ては既に數次に捗り發表され，^{2）．3），4）}その手術症例は今日250例を算するに到つた。余等は術後遠隔成績をとる爲經過觀察濟の122例即ち全症例の半數を整理吟味し，爰にT-Tomyの效果に關する全貌を凡そ把握する事が出來た。依つてその概括を症候學的觀察と題して述べ諸彦の御批判を乞う事とした。

　全122例中男子79例，女子43例で手術施行最高年齡は61歳最低4歳である。

At present ca. 200 cases have been operated upon with Prefiontal Subcorticotomy (Ttomy; Ta-kebayashi), among which half were examined as follows, at least for 6 mouth duration after the operation.

Soon after the T-tomy of one side the patient seems tranquilized, shows musclar soreness of the contralateral extremities with apparent hyperemia and rise of skin temperature etc,

Hypersalivation, athetotic movements and extra-pyramidal symptoms (area 6-symptoms i.e. Spasm, rigor, forced grasping, massive movements, fanning sign og Babinski, Clonus, negative Mayer and Hoff-man reflex etc.) are apt to disappear as well pyr-amidal symptoms- (area 4-symptoms i.e. Babinski, Chaddock, Gonda, Gordon, stiffness and contracture of muscles) soon or later.

T-tomy causes no bad changes detectable by men-tal test except for a change toward extraversion, sometimes childish patterns of behavior, T-tomy offers profound relief for extrapyramidal, basal gan-glionic or diencephalic syndromes i.e., involuntary movements as athetosis or tremor, which usually ex-ceeds through psychic stress ; improvement of hyper-salivation, hemiplegic aphasy, which can be reached by no other method.

As to postoperative side reactions, i.e., nausea, vo mlitting, incontinence, Aphasia anmésique litre, con-vulsion etc., we have no reason to be anxious as they recover soon or later.

Patients operated upon become more cheerful, ac-tive in every motion and positive in daily life under extraversed mental condition with no intellectual change (Horimi M.D Prof. etc.) but with benefited muscle movements.

They gain usually weight gnd show much benefited metabolism resp. biological,oxydation from various points of clinical findings i.e., basal metabolism (Mo-tomura, Kawfshima, Yoshida) cholinesterase (Kohzu) intermediatemetabolism of protein, fat, lipoid, carbo-hydrate, organic and anorganic salts (Ohji M.D. etc. 1st Int. Cl.) etc.

In short T-tomy causes good functional change for vegetative nervous system and is likely to say "indirect approach to the veg. nervous centrum".