Chronic multifocal demyelinating neuropathy associated with central nervous system demyelination

We have carried out a long-term study of lesions found in a man who had a demyelinating disease of both central and peripheral nervous systems. During the 10 years of his clinical course, he suffered from optic neuritis, multifocal myelitis, and chronic multifocal demyelinating neuropathy, with persistent conduction block. Our study revealed that both central and peripheral nervous system demyelination occurred repeatedly and simultaneously.

[A case of HTLV-1 associated myelopathy and adult T-cell leukemia, presenting unique muscle pathology including rimmed vacuole]

A 63-year-old man developed muscular atrophy and weakness in his four extremities since 1983, and was pointed out to have smoldering ATL by elevated HTLV-1 antibody titers in the serum (x 2,500) and CSF (x 32) in 1985. Neurological examinations revealed proximal muscular weakness and atrophy of four extremities, and mild spasticity of both legs. Deep tendon reflexes were hypoactive in both arms and hyperactive in both lower extremities with ankle clonus and bilateral positive Babinski and Chaddock reflexes. These findings were compatible with HAM. His gait, however, was markedly waddling, requiring support. Muscle biopsy at left biceps muscle revealed inflammatory change with rimmed vacuoles, small group atrophy, and marked type 1 fiber predominance. These findings on muscle biopsy are different from those of previously reported cases with HAM, showing some similarities to inclusion body myositis or distal myopathy with rimmed vacuole.

Urinary C-peptide as an index of unstable glycemic control in insulin-dependent diabetes mellitus (IDDM)

In order to investigate whether urinary C-peptide (UCP) excretion can be a useful index of insulin-dependent diabetes mellitus (IDDM) with unstable glycemic control, UCP was measured in nine IDDM patients with unstable glycemic control, nine IDDM patients with stable glycemic control, and 12 non-insulin-dependent diabetic (NIDDM) patients treated with insulin. The UCPs in overnight urine (U1) and fasting single void urine (U2) in IDDM patients with unstable glycemic control were significantly lower than those in IDDM patients with stable glycemic control (U1: 0.03 +/- 0.03 vs 0.24 +/- 0.20 nmol/mmol-Creatinine, U2: 0.02 +/- 0.01 vs 0.20 +/- 0.20 nmol/mmol-Cr, mean +/- SD, both P less than 0.01). The UCPs in U1 and U2 in both groups of IDDM were significantly lower than those in NIDDM (U1: 0.97 +/- 0.52, U2: 0.73 +/- 0.41 nmol/mmol-Cr, both P less than 0.01). The UCPs in U1 and U2 significantly correlated with incremental C-peptide response to intravenous glucagon injection and with glycemic stability assessed by the standard deviation of 10 previous fasting plasma glucose levels. These results suggest that UCP reflects their residual insulin secretory capacity and that UCP can be a useful index which distinguishes patients with unstable IDDM from those with stable diabetes mellitus.

Renal handling of glycated albumin in non-insulin-dependent diabetes mellitus with nephropathy

Renal handling of glycated albumin in diabetic nephropathy was examined by studies on renal selectivity for glycated albumin in 23 normal controls and 52 patients with non-insulin-dependent diabetes mellitus (NIDDM) with various degrees of nephropathy. The serum and urinary levels of glycated albumin were measured by enzyme-immunoassay with monoclonal antibody to glucitol-lysine residues in human glycated albumin. The diabetic patients were divided into 3 groups according to the albumin index (AI): patients with normoalbuminuria [AI less than or equal to 30 mg/g creatinine(Cr)], with microalbuminuria (30 less than AI less than or equal to 270 mg/g Cr), and with macroalbuminuria (AI greater than 270 mg/g Cr). The renal selectivity for glycated albumin was calculated from the ratio of the urinary to serum level of glycated albumin. In the controls, the renal selectivity was as high as 4.40 +/- 0.48, and significantly higher than those in patients with normo- (2.87 +/- 0.29), micro- (1.72 +/- 0.20) and macroalbuminuria (1.26 +/- 0.23). The renal selectivity was inversely correlated with the AI in diabetic patients (r = -0.58, P less than 0.01). These data indicate that glycated albumin was selectively excreted in the urine and that the renal selectivity in diabetic patients gradually decreased to a value of 1 with increase in albuminuria. When the patients with normoalbuminuria were divided into two subgroups with high and low albumin excretion, the renal selectivities for glycated albumin in both subgroups were still significantly lower than that in controls. These results suggested that early diabetic nephropathy which cannot be detected clinically by albuminuria can be diagnosed by measurement of renal selectivity for glycated albumin.

Two cases of neoplastic angioendotheliomatosis presenting with myelopathy

We describe two patients with autopsy-proven neoplastic angioendotheliomatosis (NAE) presenting only as a transverse myelopathy for 10 to 12 months, followed by disseminated intracranial manifestations. Postmortem examination disclosed a vasculocentric distribution of neoplastic cells in various organs that stained positively with B-lymphocyte-specific monoclonal antibody. These cases were unusual because they manifested as an isolated myelopathy for many months.

Reorganization of activity in the supplementary motor area associated with motor learning and functional recovery

The supplementary motor area (SMA) of primates has been implicated in the initiation and execution of limb movements. However, when a motor task was extensively overlearned, few SMA neurons, if any, were active before the movement onset. Subsequent lesions of the primary motor cortex gave rise to the appearance of premovement activity changes, indicating usedependent reorganization of the neuronal activity in SMA.

Simplification of a venous occlusion test

Chronological changes in plasma or serum concentrations of various fibrinolytic parameters, such as tissue-type plasminogen activator, plasminogen activator inhibitor, fibrinopeptide B beta 15-42 and FDP, were examined in 31 healthy volunteers before and after venous occlusion to determine a suitable time of venous stasis and a good parameter for use in a simplified venous occlusion test. After venous stasis for 5 min, a significant increase in the serum concentration of FDP (from 38.3 +/- 21.1 to 100.9 +/- 87.2 ng/ml (n = 24)) was observed, and the increase was parallel with changes in the plasma concentrations of other fibrinolytic parameters. The serum FDP level after 10 min VO was not significantly higher than that after 5 min VO. A significant decrease in ADP-induced platelet aggregation was observed after venous occlusion when measured by the impedance method, but not by the turbidimetric method. Therefore, as a simplified test, the change in the serum concentration of FDP after VO for 5 min was measured. The clinical significance of this simplified test was evaluated in fourteen patients with stenosis of cerebral artery. The mean percentage change in serum FDP concentration after venous stasis in the patients, 34.5 +/- 54.8%, was significantly less than that in normal subjects, 156.5 +/- 90.9%. Similar results were obtained on changes in plasma responses of other fibrinolytic parameters. Measurement of increase in serum FDP concentration after venous occlusion for 5 min should be useful as a screening tests for the hypofibrinolytic or thrombotic state due to vascular dysfunction.

Evaluation of brain-stem dysfunction following severe fluid-percussion head injury to the cat

The degree of brain-stem dysfunction associated with high-level fluid-percussion injury (3.0 to 3.8 atm) was investigated in anesthetized cats. Measurements were made of the animals' intracranial pressure (ICP) pressure-volume index (PVI), far-field brain-stem auditory evoked responses (BAER's), and cerebral blood flow (CBF). The animals were classified into two groups based on the severity of neuropathological damage to the brain stem after trauma: Group 1 had mild intraparenchymal and subarachnoid hemorrhages and Group 2 had severe intraparenchymal and subarachnoid hemorrhages. The ICP values in Group 1 were insignificantly lower than those in Group 2, while the PVI values in Group 2 were clearly lower (p less than 0.05). Immediately after the injury, peaks II, III, and IV of the BAER's demonstrated a transitory and marked suppression. One Group 1 and two Group 2 animals showed the disappearance of peak V. In Group 1, the latencies of peak II, III, and IV gradually increased until 60 to 150 minutes postinjury, then returned to 95% of baseline value at 8 hours; however, the animals in Group 2 showed poor recovery of latencies. Two hours after brain injury, the CBF decreased to 40% of the preinjury measurement in both groups (p less than 0.001). In contrast to Group 2, the CBF in Group 1 returned to 86.8% of the preinjury measurement by 8 hours following the injury. Changes in PVI, BAER, and CBF correlated well with the degree of brain-stem injury following severe head injury. These data indicate that high-level fluid-percussion injury (greater than 3.0 atm) is predominantly a model of brain-stem injury.

Two movement-related foci in the primate cingulate cortex observed in signal-triggered and self-paced forelimb movements

1. Single-unit activity in the cingulate cortex of the monkey was recorded during the performance of sensorially (visual, auditory, or tactile) triggered or self-paced forelimb key press movements. 2. Microelectrodes were inserted into the broad rostrocaudal expanse of the cingulate cortex, including the upper and lower banks of the cingulate sulcus and the hemispheric medial wall of the cingulate gyrus. 3. A total of 1,042 task-related neurons were examined, the majority of which were related to the execution of the key press movements. In greater than 60% of them, the movement-related activity preceded the activity in the distal flexor muscles. 4. The movement-related neurons were distributed, in two foci, in the posterior and anterior parts of the cingulate cortex, both including the upper and lower banks of the cingulate sulcus. The posterior focus was found to largely overlap the area projecting to the forelimb area of the primary motor cortex by the use of the horseradish peroxidase (HRP) method. 5. About 40% of the cingulate cortical neurons showed equimagnitude responses during the signal-triggered and self-paced movements. The neurons exhibiting a selective or differential response to the self-paced motor task were more frequently observed in the anterior than in the posterior cingulate cortex. 6. The long-lead type of changes in activity, ranging from 500 ms to 2 s, were observed mainly before the self-paced and, much less frequently, before the triggered movements. They were particularly abundant in the anterior cingulate cortex. 7. Only a few of the neurons showed activity time-locked to the onset of the sensory signals. 8. These observations indicate that the anterior and posterior parts of the cingulate cortex are distinct entities participating in the performance of limb movements, even if the movements are simple, such as those in this study.

[Analysis of pleural plaque found at lung cancer screening examination]

In the screening test of lung cancer, we found that there was a high prevalence of cases with pleural plaque recognized by chest X-ray film in inhabitants living in A town in Kumamoto Prefecture. We detected abnormal pleural plaque in 148 (41.5%) of 357 cases received lung cancer screening. These pleural plaques resulted in pleural thickening and calcification. Two or three mines of serpentine and an asbestos factory existed in this region from 1883 until 1970. Although twelve cases had a history of factory work, none had fibrous changes in the lung fields on chest X-ray films. It was considered that the pleural plaque probably resulted from exposure to low doses of asbestos in the atmosphere or contact with asbestos workers in their homes. The incidence of lung cancer in this region was not higher than that in other regions in Kumamoto Prefecture. There were no cases of malignant mesothelioma in our hospital during the past eleven years.

Relationship between molecular structures of sugars and their ability to stimulate the release of glucagon-like peptide-1 from canine ileal loops

The structure-activity relationship of sugars inducing secretion of glucagon-like peptide-1 from the gut was examined using intestinal loops prepared from the terminal portion of the ileum of dogs. The plasma glucagon-like peptide-1 concentration in a mesenteric vein draining only the looped region of the intestine was increased after infusion of 139 mmol/l solutions of D-glucose, D-galactose, D-glucuronic acid, 3-0-methyl-D-glucose, maltose, sucrose or maltitol into the intestinal lumen, but not after infusion of solutions of D-fructose, D-fucose, D-mannose, D-xylose or lactose. The increases in plasma glucagon-like peptide-1 concentration correlated with the corresponding increases in glucagon-like immunoreactivity induced by these sugars. The plasma glucose level of the regional mesenteric vein increased significantly from the basal level after instillation of D-glucose, but not after instillation of other sugars. It is suggested that cells of the gut have a glucose sensor for release of products of the glucagon gene and that this sensor has specific steric requirements. The sugars that induced glucagon-like peptide-1 release share the molecular features of electron density near C(6), an equatorial hydroxyl at C(2), and an axial hydroxyl at C(1), which could account for their recognition by the glucose sensor to initiate the releases of glucagon-like peptide-1 and glucagon-like immunoreactivity.

Metabolism of intravenously administered maltose in renal tubules in humans

To investigate how urinary excretion rates (UERs) of maltose and glucose are determined after intravenous maltose infusion, maltose and glucose solutions were infused at various rates and the relationships between UERs of maltose and glucose and their plasma concentrations were examined. Results showed the existence of a threshold plasma maltose concentration for the urinary excretions of maltose and glucose and the existence of a maximum rate of urinary glucose excretion after maltose infusion. Elevation of plasma glucose concentration by simultaneous glucose infusion increased urinary glucose excretion but did not increase urinary maltose excretion; the relationship between plasma total sugar concentration and urinary total sugar excretion was unchanged. Results suggest that maltose administered intravenously is hydrolyzed to glucose by maltase in renal tubules and reabsorbed as glucose competitively with glucose derived from plasma and that the maximum utilization of intravenously infused maltose is determined by the tubular glucose reabsorption capacity.

Role of protein kinase C in the regulation of glucagon gene expression by arginine

The cellular mechanism of glucagon gene expression in intact rat islets and their synthesis and release of glucagon were investigated. Arginine significantly increased the amounts of preproglucagon mRNA and glucagon in the islets and glucagon release. H-7, a specific inhibitor of protein kinase C (PKC), significantly inhibited these effects of arginine. However, H-8, a potent inhibitor of cyclic nucleotide-dependent protein kinases, did not affect the arginine-induced biosynthesis of glucagon or glucagon release. These results suggest that the regulation of glucagon gene expression by arginine is mediated by PKC, not by cyclic nucleotide-dependent protein kinases.

[Echo guided percutaneous needle biopsy for diagnosis of thoracic lesions]

Echo guided percutaneous needle biopsy was performed in 32 cases with thoracic lesions. A definitive diagnosis was made histopathologically in 11 (100%) of 11 malignancies, 4 (67%) of 6 benign tumors and 7 (47%) of 15 inflammatory lesions. Furthermore, using cytological specimens, definitive diagnosis was successfully made in 10 (91%) of 11 malignancies and 1 (17%) of 6 benign tumors. Such highly accurate diagnostic rates were due to 1) the accurate puncture of the lesions under real time sonographic guidance, 2) repeated biopsy in case in which sample was inadequate for cytological diagnosis, and 3) aggressive application of needle biopsy for histopathological diagnosis. Following this procedure, three patients suffered from a minor pneumothorax. To prevent pneumothorax, great care is necessary, especially in high risk cases, such as with a pneumatic pattern and thin lesion. One patient suffered from minor hemoptysis but recovered without any medication. No complications were noticed in cases of extrapulmonary lesions. We conclude that echo guided percutaneous needle biopsy is not only a complementary method for biopsy of mediastinal, peripheral pulmonary and chest wall lesions, but due to its simplicity and convenience, it should be a routine method for biopsy of thoracic lesions.

Serum levels of glycated albumin in non-diabetic and insulin-dependent diabetic children

The serum levels of glycated albumin (GA) in 83 non-diabetic children and 26 children with insulin-dependent diabetes mellitus (IDDM) were measured by high-performance liquid chromatography (HPLC). In non-diabetic children over one year, the GA levels were found to be uninfluenced by age, while the fructosamine (FRA) levels increased with age. The mean level of GA in IDDM children was 39.1 +/- 9.1%, which was significantly higher than in non-diabetic children with values of 16.1 +/- 1.1% (p less than 0.01). The GA levels of non-diabetic and IDDM children did not overlap, whereas their FRA levels did overlap. The GA levels correlated with HbAlc levels (r = 0.74, p less than 0.01) and FRA levels (r = 0.66, p less than 0.01) in IDDM children. The GA levels were more closely correlated than the FRA levels with the blood glucose two and three weeks previously. Thus, the GA level is a useful indicator of short-term control in diabetes mellitus.

Alterations of plasma immunoreactive glucagon-like peptide-1 behavior in non-insulin-dependent diabetics

The basal level of plasma immunoreactive glucagon-like peptide-1 (IR GLP-1) was significantly elevated in non-insulin-dependent diabetics (NIDD), and this elevation of IR GLP-1 was mainly due to an increase in the large component of IR GLP-1, corresponding to the pancreatic form. During the oral glucose-tolerance test (OGTT), the total plasma IR GLP-1 decreased in normal subjects but increased significantly in diabetic patients. Chromatographic analysis showed that IR GLP-1 consisted of several different molecular forms. OGTT caused a decrease in the pancreatic form but increased the intestinal form in normal subject, resulting into a net decrease in total plasma IR GLP-1. Whereas in NIDD the increase in the intestinal form was more prominent and the suppression of the pancreatic form was practically abolished to result in a net increase of total plasma IR GLP-1. This observation is consistent with the fact that in normal subjects the total change in IR GLP-1 was significantly correlated with both the total change of gut glucagon as well as that of pancreatic glucagon, but in diabetics the total change of GLP-1 only correlated to that of gut glucagon. The impaired suppression of pancreatic GLP-1 and enhanced release of intestinal GLP-1 could have some physiological importance in NIDD.