[Endocrinological and metabolic disorders in the patients with massive bowel resection in the newborn period]

Massive (70%) resection of the small bowel was performed in seven newborn infants. Follow-up study was undertaken in four of these patients and the growth and endocrinological status were evaluated. Body weight and height of three patients were below 50th percentile. On glucose tolerance test, peak IRI was low and insulinogenic indices were below normal range. These findings suggest that there are some mechanisms which suppress the secretion of insulin. Pituitary and thyroid function were within normal limits but secondary sexual manifestation was not seen in a fifteen year old boy. Hyperoxaluria was seen in three children, and one had kidney stone with some impairment of renal function.

Proximal renal tubular acidosis associated with glycogen storage disease, type 9

A 2 1/2-year-old Japanese boy with glycogen storage disease, type 9, developed proximal renal tubular acidosis (RTA). The RTA significantly improved in response to cornstarch therapy, implying a direct causal relationship between subtle metabolic derangements in glycogen storage disease, type 9, and proximal RTA.

An improved method of high-voltage isoelectric focusing on cellulose acetate membranes

An apparatus and the procedure for cellulose acetate isoelectric focusing were refined and optimized for routine use in clinical laboratories. The space in the electrophoretic chamber was minimized to maintain high humidity during the run. The water content of the thin cellulose acetate membranes in the chamber was well controlled during isoelectric focusing and the effect of atmospheric carbon dioxide was also excluded. The temperature of the membranes was kept below 2 degrees C, even under conditions of high electric field strength for faster isoelectric focusing of high-molecular-weight proteins. No special training was required for technicians in clinical laboratories to obtain reproducible isoelectric profiles of human serum proteins.

Re-evaluation of normal human urinary proteins fractionated by one-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis

Proteins in normal human urine were clearly fractionated into 26 bands with molecular weights from 14,000 to 230,000 by means of one-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) coupled with silver staining. The main band contained uromucoid, and the second main band had albumin. However, when urine samples from healthy persons were electrophoresed in the absence of SDS using polyacrylamide gel or agarose gel, or a cellulose acetate membrane, albumin but not uromucoid, frequently formed the main protein band. It is suggested that this is due to the complexing of uromucoid subunits to form a large molecule which cannot penetrate into the gel. In order to correctly fractionate all the proteins contained in normal human urine, it was concluded that it was best to treat a urine sample with SDS with pre-condensation, fractionate it by SDS-PAGE and stain fractionated proteins by a highly sensitive method such as silver staining.

Hypodermic needles: an unusual tracheobronchial foreign body

Case reports of foreign bodies in the upper aerodigestive regions and descriptions of the various methods used to retrieve them have been recorded in the medical literature since ancient times. Sharp, penetrating foreign bodies are most dangerous and may cause acute complications if they perforate the air and food passages. Recently, the authors encountered nine cases of hypodermic needles in the tracheobronchial tree. Seven of the nine needles were removed endoscopically without complications and two were expelled by the patients.

Effects of prenatal nicotine exposure on neuronal development: selective actions on central and peripheral catecholaminergic pathways

The effects of prenatal nicotine exposure on development of catecholaminergic pathways were examined through measurements of transmitter turnover and levels in both the central and peripheral nervous system. Administration of nicotine (3 mg/kg SC, twice daily) to pregnant rats on gestational days 3 through 20 resulted in growth retardation which did not spare the brain and which did not resolve until after weaning. Nicotine exposure produced an elevation in transmitter turnover in central noradrenergic pathways with a regional selectivity reflecting the timetable of cellular development: the most profound effects were seen in late-developing regions (cerebellum), intermediate effects were found in earlier-developing areas (cerebral cortex) and the least effect was obtained where maturation occurs earliest (midbrain + brainstem). Dopaminergic pathways were much less vulnerable than was the noradrenergic system. Effects on the peripheral sympathetic nervous system also were targeted toward specific neuronal populations: renal, cardiac and adrenal pathways were activated by prenatal nicotine exposure, whereas sympathetic innervation of the lung showed reduced activity. All the peripheral effects appeared only after the second postnatal week. These results indicate that prenatal nicotine exposure produces profound alterations in transmitter disposition which are targeted toward specific neuronal populations and which may depend upon generalized effects on cellular development of specific brain regions. Because altered peripheral nerve activity was seen only after the onset of central control of sympathetic tone, actions on central regulation may play a role in the relatively more profound effects in the autonomic nervous system.

Light and electron microscopic studies of a case with simultaneous Mondini and Michel deformities of the inner ears

We performed light and electron microscopic studies on the temporal bones of a patient with genetic aplastic deafness, in which the right ear had a Mondini-type defect and the left ear a Michel-type anomaly. The round window of each ear was absent. The stapedial foot plate of the right ear was depressed at its central part and was covered by thin membrane. The course of the internal auditory meatus of the left ear was deviated ventrally. There was total aplasia of the cochlea in the left ear, while that of the right ear showed only three-quarters of a turn. In this ear, three sites of spherical bulging were found and were believed to represent outer hair cells. Other structures of the normal cochlear duct were not present. The modiolus of the left ear was round and dome-shaped, contained sparse nerve fibers and a primitive spiral ganglion. The saccule, utricle and semicircular canals of each ear were missing, so that a common cavity of the vestibular system was present. Several otoliths could be seen under the surface of the membrane covering the common cavity. No sensory cells or their related tissues could be found in either ear.

Effects of maternal nicotine injections on brain development in the rat: ornithine decarboxylase activity, nucleic acids and proteins in discrete brain regions

Fetal exposure to nicotine via maternal cigarette smoking produces intrauterine growth retardation and postnatal behavioral abnormalities. In this study, biochemical characteristics of brain development were compared in normal rats and in rats whose mothers received chronic nicotine injections throughout pregnancy. Nicotine exposure produced a persistent elevation of fetal ornithine decarboxylase activity preferentially in brain; in keeping with this selectivity, there was no evidence of the sparing of brain growth which ordinarily accompanies non-specific toxic insult. After birth, DNA synthesis was suppressed throughout the brain and there was a subsequent rebound during the phase of "catch-up" growth. Evidence was also obtained for regional selectivity of the adverse effects of maternal nicotine injections: the effects on DNA synthesis and levels were most profound in cerebellum (a region which matures postnatally) and growth-impairment was least evident in midbrain & brainstem, an early-maturing region. The maternal nicotine group also displayed desynchronization of the ontogenetic patterns of DNA, RNA and proteins in every brain region. These data indicate that maternally-injected nicotine compromises early biochemical events which delineate brain cell replication and differentiation; these alterations are eventually translated into abnormalities in development of specific brain regions.

Epithelial linings of the human semicircular canal. A scanning and transmission electron microscopic study

We have used scanning and transmission electron microscopy to examine adult human semicircular canals taken at autopsy and an operation. Our findings can be summarized as follows. In the semicircular circular canals obtained at autopsy from a 30-year-old male, non-sensory ciliated cells having 50-60 cilia were seen sporadically in the canal side of the ampulla of the horizontal canal. A labyrinthine specimen taken at operation demonstrated folding of the cell membrane at the base of columnar cells lining the wall of that part of the canal close to the ampulla. Distal to this site, canal wall cells became progressively flattened and their intracytoplasmic organelles were seen to be progressively less abundant. These cells were found to be layered, facing the endolymphatic space. Dense filaments and fibrocytes were present outside these cells, between which were interposed single-layered basement membranes. Since the capillary network present was found to be sparse, we believe that the portion of the canal studied does not produce endolymph but plays a role in the maintenance of the composition of endolymph and perilymph.

Proximal renal tubular acidosis in a child with type 1 glycogen storage disease

A 6 1/2-year-old Japanese girl with type 1 glycogen storage disease developed a profound metabolic acidosis refractory to bicarbonate renal tubular acidosis and hyperphosphaturia. There was no evidence of distal tubular dysfunction.

Salivary testosterone concentration and testicular volume in male infants

In order to investigate the changes in testicular volumes (TV) and salivary testosterone concentrations (ST) in normal male infants aged from birth to one year, TV in 158 and ST in 61 infants were measured cross-sectionally during this period. ST of normal male adolescents in Tanner's public hair stage from P2 to P5 (n = 20) were also measured as the control. To clarify the relationship between remarkable height increase and testosterone (T) during early male infancy, longitudinal follow-up of 10 male infants (4 from birth to 4 months, 6 from birth to 7 months) were also carried out by simultaneous measurement of ST and crown-heel length. Maximum TV (ml) was observed at 1-4 months (1.7 +/- 0.6) (mean +/- SD) and was significantly higher than the values at birth (0.5 +/- 0.1, P less than 0.01) and at 6-12 months of age (1.4 +/- 0.4, P less than 0.01). Maximum St (ng/dl) was also observed at 1-4 months, with the mean value being 3.4 +/- 1.5, which was significantly higher than 1.9 +/- 0.8 at 6-12 months (P less than 0.01). The ST at four month was not significantly different from that at Tanner's pubic hair stage P2. The longitudinal study showed that the rise in ST was concomitant with the maximum increase in crown-heel length at 1-4 months. The fluctuations in ST and height increase were also apparently synchronous during the first year.

Tuberous sclerosis: report of two cases studied by computer-assisted cranial tomography within one week after birth

Two neonates with tuberous sclerosis are reported. The patients presented convulsive seizures 30 mins or 5 days after birth. Computer-assisted cranial tomography (CT) on admission showed typical paraventricular calcifications in Case 1 and a calcified mass in Case 2. In addition to the CT findings, the diagnosis was made on the basis of the depigmented skin, and the mother with tuberous sclerosis in Case 1 and the pathological findings after surgery in Case 2. The importance of CT as a diagnostic procedure for this disease within 1 wk after birth is emphasized.

Multiple metaphyseal lesions in a child with a syndrome of progressive muscle cramps, alopecia and stunted growth (Satoyoshi disease)

An 11-year-old Japanese girl with a syndrome of progressive muscle cramps, alopecia and stunted growth (Satoyoshi disease) is described. Unique bone lesions in the syndrome are demonstrated and defined as multiple metaphyseal bone disease.

Factors affecting the cholesterol dissolution ability of human bile

Bile samples were obtained from 13 patients with cholesterol gallstones at laparotomy. Control bile samples were obtained from 15 patients with gastric cancer or gastric ulcer. One mixed stone was cut in half and serial thin sections, 10 micrometers in thickness, were prepared from the cut surface. The solubility of cholesterol in these gallstone sections after immersion in the bile samples was observed microscopically after 1, 3, 5 and 24 hr. Of 15 control bile samples, 9 showed a marked cholesterol dissolution after 1 hr, and 6 showed it after 3 and 5 hr. Three out of 13 bile samples from the patients with cholesterol stones dissolved the gallstone section after 1 hr, and 7 after 3 and 5 hr. The dissolution was not observed in the remaining 3 bile samples. Cholesterol and total bile acid concentrations of the control bile were significantly higher than those of the bile from the cholesterol gallstone patients (p less than 0.05 and p less than 0.02, respectively). Correlative studies of the composition of bile and its ability to dissolve cholesterol revealed that bile samples with a high total bile acid concentration possessed a higher dissolution ability, even when the ratios of total bile acid to cholesterol were almost the same in control and cholesterol gallstone bile. On the basis of these findings, it may be concluded that the solubility of cholesterol in bile cannot simply be explained in terms of relative concentrations of cholesterol, phospholipids and total bile acid, because the absolute concentration of total bile acid also plays a significant role for the dissolution ability.

An unusual form of vitamin D-dependent rickets in a child: alopecia and marked end-organ hyposensitivity to biologically active vitamin D

A 12-yr-old female patient with an unusual form of vitamin D dependency and alopecia is described. She was a product of consanguineous mating and developed signs and symptoms suggesting vitamin D dependency early in life. Neither 150 microgram/day (6 microgram/kg.day) 1 alpha-hydroxyvitamin D3 nor 5 microgram/day (0.2 microgram/kg.day) 1,25-dihydroxyvitamin D3 proved to have an effect on her abnormal serum chemistry. Seven million international units per day (about 2 x 10(5) IU/kg.day) of native vitamin D restored her serum chemistry to normal and brought about marked improvement on skeletal radiographs, when her serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and 24,25-di-hydroxyvitamin D were 4250, 4.8, and 35 ng/ml, respectively. Even with the high serum levels of vitamin D metabolites, her intestinal 47Ca absorption rate remained in the lower normal range and urinary calcium excretion was decidedly low. Association of hypoparathyroidism was ruled out. These results suggest that the patient has extreme and-organ (intestine) hyposensitivity, probably of congenital origin, to the biologically active metabolites of vitamin D.

Modification of the anterior commissure technique of partial laryngectomy

The anterior commissure technique of partial laryngectomy is useful for treating "horseshoe" lesions of the larynx. As originally described, a McNaught keel is used after the excision to maintain an open glottic chink and to prevent webbing. After three weeks, this keel is removed as a surgical procedure. During the past four years, we have treated 12 patients using 0.020-gauge Silastic sheeting to replace the McNaught keel. The Silastic sheet is anchored above and below the glottis with externally tied 2-0 proline stutures. Two to three weeks later, a direct laryngoscopy is performed and the stent is removed. This modification avoids a second surgical procedure, decreases the hospital stay, and allows for inspection of the glottis.

Electrophoretic analysis of the protein in palatine saliva

The protein in palatine saliva was investigated and compared with that in parotid saliva by means of SDS electrophoretic method. It was found that palatine saliva contains a large amount of high molecular weight protein (higher than 300,000) which is identified as mucin-rich glycoprotein and sialoglycoprotein, while no such protein is present in parotid saliva. The protein composition of palatine saliva has qualitatively smaller individual difference when compared to that of parotid saliva. We suggest that the high molecular weight protein which is specific to palatine saliva probably contributes to the rentention of complete maxillary dentures.

Biological activity of 1-alpha-hydroxy vitamin D3 in vitamin D dependency

The biological activity of 1(OH) vitamin D3 was evaluated in 2 cases of vitamin D dependency. For the improvement of serum chemistry and increment of urinary excretion of calcium 1(OH) vitamin D3 was 500--1000 times more active than vitamin D2. The administration of 0.05 microg/kg/day and 0.1 microg/kg/day of 1(OH) vitamin D3 were equally effective to keep the serum chemistry within normal limits. However, urinary excretion of calcium increased to an abnormal height on 0.1 microg/kg/day of 1(OH) vitamin D3. On the other hand, administration of 0.05 microg/kg/day of 1(OH) vitamin D3 kept both serum level and urinary excretion of calcium normal. It is suggested that 0.05 microg/kg/day is close to the optimum requirement of 1(OH) vitamin D3 in vitamin D dependency and this should correspond to the essential requirement of 1(OH) vitamin D3 in man.