Serum copper and zinc levels in epileptic children with valproate treatment

Valproate (VPA) induces zinc (Zn) deficiency in experimental animals, but whether VPA treatment induces deterioration of serum trace metal homeostasis in humans is uncertain. We measured serum copper (Cu) and Zn levels in epileptic children treated with VPA and/or other antiepileptic drugs (AEDs). Patients treated with VPA monotherapy had significantly lower levels of serum Cu (82.2 +/- 16.6 micrograms/dl) than normal controls (97.3 +/- 23.0 micrograms/dl). Patients treated with VPA in addition to some other AED also had significantly lower levels of serum Cu (84.8 +/- 20.0 micrograms/dl). Serum Cu concentrations in patients treated with AEDs except for VPA (87.7 +/- 19.1 micrograms/dl) were not statistically different from those of control subjects. In contrast to the reported results of animal experiments, serum Zn levels were not altered in patients with VPA treatment. Although none of our patients showed any symptoms of Cu deficiency, we should pay attention to potential Cu deficiency in patients with VPA treatment.

[Methicillin-resistant Staphylococcus aureus (MRSA) isolated in hospitals in Fukuoka City area]

Bacteriological and clinical studies were carried out on 280 strains of Staphylococcus aureus isolated in hospitals in Fukuoka city area from September 1990 to March 1991. Of all S. aureus strains studied 116 (41.4%) were methicillin-resistant. The proportion of MRSA in S. aureus isolates from outpatients was 10% (11/109), 69.2% (90/130) in those from inpatients. The average age of patients with isolated MRSA was 70.5 +/- 16.9 years and that of patients with isolated MSSA, 44.2 +/- 29.3. MRSA strains were recovered mainly from sputum and pus. The isolation rate did not vary significantly with hospitals of different size (number of beds). Of all MRSA strains 48 (41.3%) produced coagulase type VII. As for drug susceptibility, MRSA strains with coagulase type VII were more sensitive to clindamycin and more resistant to minocyclin compared to MRSA with other coagulase types.

Continuous, generalized, high-voltage fast activity and FIRDA in two children

The EEG pattern of continuous, generalized, high-voltage fast rhythms without any reaction to eye-opening/closure, photic stimulation, or the sleep-awaking cycle was previously reported to be characteristic of infantile neuroaxonal dystrophy (INAD). However, we have observed such fast activity in one child with INAD and one with Menkes' kinky-hair syndrome. They both exhibited severe psychomotor disturbance, and their EEGs also included "frontal intermittent rhythmic delta activity (FIRDA)," a nonspecific EEG finding suggestive of organic encephalopathy. Since the continuous, generalized, high-voltage fast activity had features suggestive of spindles in both children, this EEG pattern is thought to actually represent "extreme spindles," and nonspecifically to indicate widespread organic brain damage.

Analysis of human herpesvirus 6 glycoproteins recognized by monoclonal antibody OHV1

A virus-specific glycoprotein (gp) from human herpes-virus 6 (HHV-6) was studied using the anti-HHV-6 monoclonal antibody OHV1. Immunoprecipitation with extracts from infected cells revealed that the antibody recognized four glycosylated proteins (gps) with Mrs of 106K, 102K, 65K and 63K under reducing conditions. However, only two gps, of 106K (gp106) and 102K, were detected under non-reducing conditions. Pulse-chase experiments revealed that gp65 and gp63 were cleavage products of gp106 and gp102. When infected cells were treated with tunicamycin, none of these gps was detected. With endo-beta-N-acetylglucosaminidase H (endo H) and endo-beta-N-acetylglucosaminidase F (endo F) treatment, gp106 and gp102 disappeared. Moreover, gp65 and gp63 were not affected by endo H treatment but were sensitive to endo F treatment. These data suggest that sugar residues of gp106 and gp102 are high-mannose type N-linked oligosaccharides, whereas those of gp65 and gp63 are complex type N-linked oligosaccharides.

Morphological characteristics of the scalp far-field potentials evoked by median nerve stimulation in infants and children

We investigated the somatosensory evoked potentials (SEPs) produced by median nerve stimulation in normal infants, children and adults, focussing upon the wave forms of the scalp far-field potentials (FFPs). In adolescents and adults, 3 or 4 positive FFPs preceded the widespread N18 component on the scalp, corresponding to P9, P11, P13 and P14 (or P13-14). In infants and children, however, the scalp FFPs often included 5 positive waves, the initial three of which were characteristically sharp and brief. This distinctive wave form, with 5 positive FFPs, was correlated with an Erb's potential having a bipeaked negative phase. We studied the temporal relationship of the 5 positive FFPs to the Erb's potential and the cervical SEPs and concluded that the initial 3 brief positive waves were produced by overlapping of a bipeaked "P9" and bipeaked "P11." Both "P9" and "P11" are stationary waves that are thought to originate in the first-order afferents, so they probably reflect the bipeaked appearance of the compound nerve action potential.

Changes in blood volume and potassium concentration during exercise in rats

We measured the changes in circulating blood volume (BV), plasma sodium ([Na+]), and plasma potassium ([K+]) concentrations continuously, during and after exercise in euhydrated and dehydrated rats. Rats ran on a treadmill for 15 min at 600, 900, and 1,200 m/h, and the recovery period lasted 45 min. The BV decreased immediately after onset of exercise, and reached a plateau value in about 5 min of exercise. With 1,200 m/h exercise, a further decrease in blood volume was observed in both groups. The decline in BV was reversely related to the exercise intensity in both groups although the decrease was less in the dehydration group. During and after exercise, there were no significant changes in plasma [Na+] at any speed in either group. Plasma [K+] increased sharply at the onset of exercise and the magnitude of the increase was directly related to the exercise intensity. However, at all three exercise intensities the change in plasma [K+] in the dehydrated group was only about 60% of that measured in the euhydrated control group. These findings suggest that dehydration reduces the wash-out of K+ from the interstitial space of the exercising muscle.

"Floating" labyrinth. Pathophysiology and treatment of perilymph fistula

Collapse of the membranous labyrinth of the pars superior is a morphological change observed in 50% of animals with experimentally produced perilymph fistula, although the extent and degree of the collapse may vary greatly. The moderately collapsed membranous labyrinth may drift with CSF and/or perilymph pressure changes and this may stimulate sensory cells of the utricle and/or semicircular canals if the sensory cells are intact and the collapsed wall is in contact with the otolithic membrane and/or cupula. This condition is termed "floating" labyrinth. Caloric irregularity is often observed in electronystagmograms recorded from animals with experimental perilymph fistula. This is also observed in patients with perilymph fistula. Partial destruction of the vestibular organs using argon laser was performed in a patient with perilymph fistula who was incapacitated because of persistent positional vertigo after closure of the oval window fistula. Irradiation of the argon laser beam was directed to the macula utriculi, utriculoampullary nerve and singular nerve. The hearing of the patient was maintained, and vertigo disappeared after laser labyrinthectomy.

Anomalous multifocal ossification of the os calcis--case report

A three-month-old female baby was diagnosed by roentgenograms as having bilateral multifocal ossification of the os calcis. Five ossification centers in the bilateral calcaneus were recognized. However, at one year of age the roentgenograms showed only three ossification centers, with cleft separating on both sides the anterior third from the posterior two-thirds of the bone. At two years of age, the three ossification centers had coalesced into a single composite ossification center and the cleft at the calcaneus disappeared.

RELATIONSHIP BETWEEN BLADDER TRIGONE AND BLADDER NECK INDUCED BY TRACTION OF AN INDWELLING BALLOON CATHETER WITH A SPRING BALANCE AND PARAMETERS OF CYSTOMETROGRAM

Sensation of the bladder trigone and bladder neck induced by traction of an indwelling balloon catheter with a spring balance and cystometry was evaluated in 393 males and 106 females. Male patients with an average age of 56.9 +/- 15.9 (mean +/- standard deviation) years old (range 17 to 88 years) were divided into 7 groups as follows: 19 patients without any micturitional disturbance, uregency and chronic prostatitis (11 patients), benign prostate hypertrophy (BPH) (131 patients), cervical or thoracic cord compression disorders (67 patients), lumbar vertebral disorders (114 patients), other peripheral nerve disorders associated with diabetes mellitus, post operative status of rectum cancer and others (27 patients) and brain diseases (24 patients). Female patients with an average age of 55.2 +/- 15.5 years old (range 17 to 88 years) were divided into 6 groups as follows: 24 patients without any neurological problems, urgency (7 patients), cervical or thoracic cord compression disorders (11 patients), lumbar vertebral disorders (37 patients), other peripheral nerve disorders (18 patients) and brain diseases (9 patients). The observed sensation, first desire to void (FDV) and maximum cystometric capacity (MCC) were evaluated statistically in relation to clinical factors (e.g. disease group, generation and patterns of cystometrogram). The correlation between the sensation and FDV or MCC in these patients were assessed by linear regression analysis. Sensation of normal males was 334.2 +/- 159.7 g on the average and correlated well with FDV (r = 0.88, y = 375x - 189.4). Sensation of normal females was 373.3 +/- 199.5 g on the average. However, there was no correlation (r = 0.35) between sensation and FDV in females. In males, the means of sensation obtained in patients with other peripheral nerve disorders (557.3 +/- 314.5 g) was significantly larger than the means of normal subjects (p less than 0.001), and patients with uregency and chronic prostatitis (236.4 +/- 148.3 g, p less than 0.01), BPH (424.1 +/- 215.6 g, p less than 0.001), cervical or thoracic cord compression disorders (349.0 +/- 229.5 g p less than 0.001), lumbar vertebral disorders (349.7 +/- 201.7 g, p less than 0.001) or brain diseases (490.6 +/- 305.0 g, p less than 0.05). Furthermore, the differences in the means of sensation between BPH and lumbar vertebral disorders (p less than 0.05) or brain diseases (p less than 0.05) were statistically significant.(ABSTRACT TRUNCATED AT 400 WORDS)

Expression of brome mosaic virus-encoded replicase genes in transgenic tobacco plants

We introduced replicase genes of brome mosaic virus (BMV) to Nicotiana tabacum cv. Petit Habana (SR1) using two different types of transformation vectors containing cDNAs of BMV RNA 1 and RNA 2. One type (V type) contains cDNA from which complete viral RNAs are transcribed. These RNAs can function as templates for viral replicase. The other type (M type) contains cDNA from which viral RNAs without their 3' non-coding regions are transcribed; these RNAs can only function as mRNA. Viral replicase expressed from the integrated cDNAs in both V and M type transgenic plants can complement an infection by BMV RNA 3.

Inner ear morphology of experimental perilymphatic fistula

The inner ear pathology of experimental perilymphatic fistula (EPLF) is described. EPLF was produced by injecting artificial perilymph into the subarachnoid space, or by suctioning 4 microL of perilymph through one of the round window membranes of the guinea pig. The animals were either killed immediately, or were kept alive for 3 weeks to 3 months. The conventional celloidin embedding method was employed for morphologic study. Vestibular function of the animals was tested by observing spontaneous nystagmus and positional nystagmus after the experiment. The caloric test was also performed. Various pathologic changes of the membranous labyrinth were observed. In the cochlea these included rupture or collapse of Reissner's membrane, bulging of Reissner's membrane, loss of hair cells, and compression of the organ of Corti. Pathology of the otolithic organs and semicircular canals mainly consisted of collapse of the membranous labyrinth. Clinical symptoms in patients with perilymphatic fistula (PLF) are explained, based on our experimental findings. Electronystagmography (ENG) of EPLF animals showed either no caloric response or, with a longer duration, caloric irregularity. Prolonged unsteadiness in patients may be due to "floating" labyrinth.

[A case of transitional cell carcinoma of renal pelvis with an extremely high serum carcinoembryonic antigen (CEA) level]

A case of urothelial tumor with extremely high serum carcinoembryonic antigen (CEA) levels is described. A 68-year-old female presented with macroscopic hematuria and left flank pain. Laboratory examination revealed an extremely high serum level of CEA (194 ng/ml) and elevated levels of serum CA 19-9 (235 U/ml) and squamous cell carcinoma (SCC)-Antigen (10.7 ng/ml), while urine CEA remained within normal limits. No abnormal findings were recognized in gastrointestinal and respiratory systems, but left renal pelvic tumor (T4N2M0) was discovered. Nephroureterectomy with regional lymph node dissection was done. The pathologic anatomy was infiltrating non-papillary transitional cell carcinoma (TCC, G2 = G3, pT4N2M0). More than 30% of the tumor cells were positive for CEA by ABC-peroxidase staining. Levels of tumor markers remained higher than normal after the operation and were normalized after M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. However, 6 months after the operation, levels of tumor markers rose again and lung metastases appeared. She died 10 months after the operation.

Regional cerebral blood flow in relation to MRI and EEG findings in tuberous sclerosis

To identify the focus of paroxysmal neuronal activity causing epilepsy in tuberous sclerosis (TS), the regional cerebral blood flow (r-CBF) in 19 patients with TS was assessed using single-photon emission computed tomography (SPECT) with I-123 iodoamphetamine (IMP), in correlation with serial interictal EEGs and organic changes observed on magnetic resonance imaging (MRI). There was a general irregularity of cortical IMP uptake and retention in TS, and two-thirds of the cerebral regions exhibiting high intensity in T2-weighted MRI images (cortical tubers) showed a decrease in r-CBF. In addition to in tubers, decreased r-CBF was observed in regions in which MRI was considered to indicate destruction of the normal cortex, atrophy or vascular abnormalities, although these areas did not consistently show epileptic changes in serial EEGs. Among the cortical regions which consistently showed epileptic foci in serial EEGs, none showed abnormal r-CBF without lesions on MRI. We conclude that IMP-SPECT is useful for visualizing the epileptogenic laterality in cases with bilateral MRI lesions and EEG epileptic changes, and to differentiate epileptogenic foci from electrophysiological propagated areas. However, regarding the severity of epilepsy, the MRI findings showed a better correlation than the IMP-SPECT findings did.

Chronic mumps virus encephalitis

A previously well 4-year-old girl developed frequent seizures and mental deterioration after mumps parotitis. Direct IgG antibody capture enzyme-linked immunosorbent assay revealed a high titer of anti-mumps viral antibodies in the cerebrospinal fluid. Chronic mumps encephalitis was diagnosed. Her mental state and seizures improved markedly with inosine pranobex therapy.

[Exposure of workers to electric and magnetic fields from radiofrequency dielectric heaters to process polyvinyl chloride material]

Exposure of workers to electric and magnetic fields from radiofrequency dielectric heaters (RF heaters) to process polyvinyl chloride material was surveyed. Measurements of electric and magnetic field strengths were made in 10 workers operating 7 RF heaters at 3 plants in Japan. Six of the RF heaters are of the sewing machine type and the other is of the shuttle tray type. In all the RF heaters surveyed the nominal frequency of the radiofrequency generator was 40 MHz, and therefore electric and magnetic field from these are assumed to oscillate at the same frequency. The power output ranged from 0.83 W to 1.8 W for the sewing machine type and was 2.4 W for this shuttle tray type. Measurements were made at about 5 cm from the surface of the hand, eye, chest, waist, knee and foot of each worker. The meter readings were converted to equivalent plane wave power density and corrected for duty cycle (0.073 to 0.27). It was found that all the workers surveyed were exposed to electric and magnetic field strengths greater than the TLV recommended by ACGIH (1 mW/cm2). For the hand, eye, chest, waist, knee and foot of the worker, 95%, 63%, 32%, 47% and 36% and 27% of the measured field strengths exceeded the TLV, respectively. Especially for the sewing machine type RF heaters, electric fields at the hand and eye were extremely strong. Thus, for the hand, 100%, 75% and 38% of the measured electric field strengths exceeded the TLV, ten times the TLV, and one hundred times the TLV, respectively, and for the eye, 88% and 25% exceeded the TLV and ten times the TLV, respectively. No correlation was observed between power output of the RF heaters and measured electric and magnetic field strengths at any anatomical site of the worker.

[Selective vulnerability of peptide-containing neurons in cerebral ischemia; immunohistochemical study]

Histochemical changes in peptidergic and catecholaminergic neurons during ischemia were investigated in the cerebral neocortex of the gerbil. Catecholaminergic fibers were observed by catecholamine histofluorescence with glyoxylic acid solution, and peptidergic neuron systems such as vasoactive intestinal polypeptide (VIP), somatostatin (SOM), and neuropeptide Y (NPY) were observed by immunohistochemistry. Two hours after unilateral occlusion of the internal carotid artery, catecholaminergic fibers disappeared in the neocortex on the occlusion side, while peptidergic nerve fibers except for NPY fibers were intact after 2 hours of ischemia. NPY fibers had decreased in number on the occlusion side 2 hours after ischemia. VIP-, SOM-, and NPY-immunoreactive neurons showed a decrease of 60% six hours after ischemia, and these neurons completely disappeared in the cerebral neocortex 24 hours after ischemia. These results suggest that catecholaminergic neuron system is more vulnerable than the peptidergic one in ischemic event.

[Autoantibodies related to interferon therapy in chronic hepatitis B may affect the therapeutic response to interferon]

We have evaluated the problem of autoantibodies such as antinuclear antibodies (ANA), smooth muscle antibody (SMA) and antibodies to thyroid microsomal (TMA) and to thyroglobulin (TGA) related to interferon therapy in 27 patients with chronic hepatitis B. Anti-interferon antibody was also studied by Western blot method. Eight patients had ANA and 2 had SMA during interferon therapy. However, 6 of the 8 patients were ANA positive and one of the 2 was SMA positive prior to interferon treatment. No patients developed TMA, TGA or anti-interferon antibody. Eight (29.6%) of the 27 patients had clearance of both DNA polymerase and HBeAg and persistent normalization in alanine aminotransferase levels with interferon therapy. Seven of the 8 responders developed none of the autoantibodies related to interferon therapy. These results suggest that the presence of ANA or SMA during treatment may affect the therapeutic response to interferon.

2',5' Oligoadenylate synthetase activity in peripheral blood mononuclear cells and serum during interferon treatment of chronic non-A, non-B hepatitis

The 2'-5' oligoadenylate synthetase (2-5 AS) activity of peripheral blood mononuclear cells and serum was measured in 23 patients with chronic non-A, non-B hepatitis during interferon therapy, 16 of whom were found to have antibody to hepatitis C virus (anti-HCV). Patients received a daily dose of either 1 million, 3 million or 6 million units of human interferon-alpha or -beta for 4 to 6 weeks. Before treatment, the 2-5 AS activity was not significantly different from that in normal control subjects or patients with chronic hepatitis B. However, during treatment the 2-5 AS activity increased 2- to 41-fold from the initial level. Alanine aminotransferase (ALT) levels normalized promptly after the start of treatment in 15 (65.2%) of the 23 patients, but remained elevated in the remaining 8 (34.8%). Six (40%) of the 15 patients showed consistently normal ALT levels for 6 to 30 months after the end of treatment. There was no significant difference between the responders and non-responders in the pattern of change of 2-5 AS activity, but pretreatment activity levels in peripheral blood mononuclear cells were significantly higher (P less than 0.001) in the patients whose ALT levels did not normalize during treatment. The frequency of patients with a positive anti-HCV was significantly higher (P less than 0.05) in the group in which ALT levels normalized. Therefore, these findings suggest that the pretreatment 2-5 AS activity and the detection of anti-HCV may be useful parameters for predicting the response to interferon therapy.

Clip electrode method for recording eye movements in experimental animals

Both the guinea pig and squirrel monkey were used in this study. An animal model for inner ear disease was established, and each animal was subjected to vestibular function tests consisting of spontaneous nystagmus recording, positional testing, caloric testing, and optokinetic stimulation testing. Recordings of nystagmus in the guinea pig and squirrel monkey were successfully obtained by using newly devised clip electrodes. A variety of nystagmic patterns in animal models following experimentally created perilymphatic fistula and labyrinthectomy are presented in this study.

Immunosuppressive dose of azathioprine inhibits replication of human cytomegalovirus in vitro

Azathioprine (Aza) was found to have anti-human cytomegalovirus (HCMV) activity in vitro at concentrations used for immunosuppression therapy. The dose of Aza for 50% plaque reduction was 0.592 micrograms ml for HCMV in human embryonic lung (HEL) cells, but those of Aza for 50% plaque reduction for herpes simplex virus (HSV) and varicella-zoster virus were more than 20 micrograms/ml. The dose of Aza for 50% reduction of the HCMV yield in infected cells was 0.25 micrograms/ml, while that for 50% reduction of the HSV yield in infected cells was more than 50 micrograms/ml. The dose of Aza for 50% growth inhibition of HEL cells was 30 micrograms/ml, and 50.7 and 120 times greater than the doses for 50% reduction of the plaque formation and the yield of HCMV, respectively. Thus Aza was found to have a strong anti-HCMV activity at concentrations used for immunosuppression. When HCMV infected cells were treated with cyclosporine (CsA: 0.2 microgram/ml) and prednisolone (Pred: 0.3 microgram/ml) simultaneously with Aza, the doses of Aza for 50% reduction of plaque formation and the yield of HCMV were 0.73 and 0.32 micrograms/ml, respectively. Thus an inhibitory effect of Aza was also observed in HCMV-infected cells treated with CsA and Pred at their concentrations used for immunosuppression. Maintenance of an anti-HCMV dose of Aza in combination with CsA and Pred might establish not only satisfactory immunosuppression but also suppression of HCMV infection in transplant recipients.

Somatosensory evoked potentials after posterior tibial nerve stimulation in focal spinal cord diseases

We investigated the somatosensory evoked potentials (SEPs) produced by posterior tibial nerve (PTN) stimulation in 8 infants and children with focal spinal cord disorders. The spinal responses of the PTN-SEPs were considered to assist in the localization of spinal lesions because their abnormalities were consistent with the neurologic and/or radiologic findings in all 6 examinations that revealed abnormal spinal SEPs. The cortical responses correlated significantly with proprioception in the lower limbs because proprioception was only disturbed when the cortical SEPs were absent (3 examinations). When both the spinal and cortical responses were abnormal, the spinal lesion probably involved the dorsal column so extensively that it completely interrupted the afferent impulses. In contrast, when SEP studies demonstrated abnormal spinal and normal cortical SEPs (3 examinations), the dorsal column involvement was probably less severe; therefore, both the spinal and cortical responses provided useful information regarding afferent conduction in the dorsal column. PTN-SEPs appear to have the potential to be of value in the diagnosis of focal spinal disease, especially in infants and young children who cannot cooperate with detailed neurologic examinations.