[Taste disturbance after tonsillectomy]

There are some patients, though few in number, who complain of taste disturbance after tonsillectomy. Actual measurement of the distance between the lingual branch of the glossopharyngeal nerve, which controls taste in the posterior portion of the tongue, and the lower pole of the palatine tonsil, using a cadaver, showed the distance to be only 2-4 mm, thereby suggesting the danger of direct or indirect disturbance of this nerve by tonsillectomy. Among the 3,583 outpatients complaining of taste disturbance whom we have treated at our taste disorder clinic in the last 15 years, 11 (0.31%) were found to be suffering from taste disorder triggered by tonsillectomy. Among these 11 causes, the causes of taste disturbance have been identified in 8 cases. In three cases, the taste disturbance was caused by direct or indirect damage to the lingual branch of the glossopharyngeal nerve, whereas in another two cases, the disturbance was attributable to medication following tonsillectomy. In the remaining three cases, the diagnosis was a taste disturbance initiated by tonsillectomy but actually caused by a lack of dietary zinc. It is therefore important that patients be informed of the risk of post-operative taste disorder following tonsillectomy, at the time informed consent for tonsillectomy is obtained. It is equally important to measure the taste threshold values for each taste nerve and the serum zinc value as part of the pre-operational examination, and to ask the patients what drugs, if any, they take habitually.

[A case of hemifacial hyperhidrosis on the opposite side of the pancoast tumor]

An 82-year-old man was referred to our pain clinic for the relief of pain arising from Pancoast tumor on the right side. The pain was controlled well by cervical epidural morphine, but one month after admission, he complained of unilateral hyperhidrosis on the face, head and neck on the left side. Massive sweating occurred only during the sleep. At this stage Horner's sign on the right side was recognized. Cervical epidural block diminished sweating. Massive sweating was observed until his death two months after admission. We speculate that paralysis of the right cervical sympathetic system caused by invasion of Pancoast tumor elicited sympathicotonia of the opposite side, resulting in left hemifacial hyperhidrosis, which was exaggerated during the sleep when the activity of perspiration center increased. We recommend that the presence of hemifacial sweating should be closely evaluated, because it can be caused not only by irritation of the ipsilateral sympathetic nervous system, but also by the paralysis of the contralateral sympathetic nervous system due to malignant tumors or other diseases in the neck and upper mediastinum.

[Techno-Stress; techno-centered and techno-phobia]

The "Techno-Stress" is a sociological new concept, hypothesized by Craig Brod and it includes clinically "Techno-Centered" and "Techno-Phobia". Based on 34 cases with mental disorders or psychosomatic diseases, we evaluated symptomatically these categories from standpoint of computer operating works. Fourteen cases represented severe problems in human relationship and they adapted excessively to computer operation. This group was thought as "Techno-Centered" and 50% of them were diagnosed as narcissistic, obsessive and schizophreniform personality. Twenty cases with maladaptation to computer operation were characterized as strict or avoidant personality and this group was evaluated as "Techno-Phobia". The "Techno-Phobia" was thought as simple adjustment disorder caused by new technology, on the other hand, the cases of "Techno-Centered" were seemed to be well-adapted to social skill only superficially, but psychological disturbance should be severer than "Techno-Phobia".

Use of near infrared reflectance spectroscopy in the screening for biliary atresia

Early diagnosis is crucial for treatment and prognosis of biliary atresia (BA). We used near infrared reflectance spectroscopy (NIRS) for screening of BA. Fecal samples were collected from 200 healthy infants and 16 infants for whom either BA or neonatal hepatitis was diagnosed. Diagnoses were made retrospectively by other diagnostic methods, including laparotomy. The samples (0.5 g each) were manually homogenized. Reflected light from the surface of feces was measured by NIRS. Absorbance peak spectra for fecal fat and conjugated bilirubin were determined before the study, and proved to be 730, 1158, and 1210 nm, respectively. Two cutoff points were set in the second-derivative spectrum: the first (> -0.005) at 730 nm for conjugated bilirubin, and the second (< 1.0) at 1,158:1,210 nm for fat (to include all patients with BA). The sensitivity of NIRS in the diagnosis of BA was 100%, and the specificity was 95.2%. The authors conclude that NIRS is a simple, rapid, noninvasive, and precise technique for the early diagnosis of BA.

Recombinant and native zymogen forms of human complement factor D

We have expressed a full-length cDNA clone encoding human factor D by using a baculovirus expression system. The purified recombinant protein reacted with Ab against native factor D, but was hemolytically inactive and slightly larger than factor D. These results suggested that the recombinant protein was the elusive zymogen of factor D. Amino acid sequencing demonstrated that the recombinant factor D consisted of two proenzyme forms with respective activation peptides, AAPPRGR and APPRGR. Catalytic amounts of trypsin converted recombinant profactor D to its enzymatically active form, exhibiting SDS-PAGE mobility and specific hemolytic activity similar to those of native factor D. About 90% of trypsin-activated recombinant profactor D had the same NH2-terminus as factor D. Human thrombin, kallikrein, and plasmin could also activate recombinant profactor D, but relatively high concentrations of these enzymes were required and the specific hemolytic activity of the "activated" profactor D was about one-third that of native factor D. Trypsin-activatable profactor D was also purified from the urine of a patient with Fanconi's syndrome. This native profactor D represented less than 1.0% of the total antigenic factor D in the patient's urine and had a Gly-Arg dipeptide as the activation peptide. Apparently, urine profactor D was produced by cleavage of pre-profactor D at Arg-(-3) by a serine protease with trypsin-like specificity, which probably is different from the putative leader peptidase that produces the recombinant profactor D. Urine profactor D was inhibited by diisopropyl fluorophosphate although the recombinant proenzyme was resistant to this inhibitor.

Recombinant and native zymogen forms of human complement factor D

We have expressed a full-length cDNA clone encoding human factor D by using a baculovirus expression system. The purified recombinant protein reacted with Ab against native factor D, but was hemolytically inactive and slightly larger than factor D. These results suggested that the recombinant protein was the elusive zymogen of factor D. Amino acid sequencing demonstrated that the recombinant factor D consisted of two proenzyme forms with respective activation peptides, AAPPRGR and APPRGR. Catalytic amounts of trypsin converted recombinant profactor D to its enzymatically active form, exhibiting SDS-PAGE mobility and specific hemolytic activity similar to those of native factor D. About 90% of trypsin-activated recombinant profactor D had the same NH2-terminus as factor D. Human thrombin, kallikrein, and plasmin could also activate recombinant profactor D, but relatively high concentrations of these enzymes were required and the specific hemolytic activity of the "activated" profactor D was about one-third that of native factor D. Trypsin-activatable profactor D was also purified from the urine of a patient with Fanconi's syndrome. This native profactor D represented less than 1.0% of the total antigenic factor D in the patient's urine and had a Gly-Arg dipeptide as the activation peptide. Apparently, urine profactor D was produced by cleavage of pre-profactor D at Arg-(-3) by a serine protease with trypsin-like specificity, which probably is different from the putative leader peptidase that produces the recombinant profactor D. Urine profactor D was inhibited by diisopropyl fluorophosphate although the recombinant proenzyme was resistant to this inhibitor.

Catheter ablation of atrioventricular accessory pathway with decremental properties connecting to the tricuspid annulus

A 65-year-old male with Wolff-Parkinson-White syndrome presented with atrial fibrillation. The patient was found at the electrophysiological study to have two accessory pathways, a Kent fiber and an atrioventricular accessory pathway with decremental properties. The latter pathway conducted exclusively in the antegrade conduction and the ventricular insertion site was the tricuspid annulus. Both accessory pathways were successfully abolished by radiofrequency catheter ablations at the tricuspid annulus. We propose that an atrioventricular accessory pathway with decremental conduction may have various forms concerning not only sites of origin, but also sites of insertion.

Interactions between respiratory, cardiac and stepping rhythms in decerebrated cats: functional hierarchical structures of biological oscillators

Interactions are described of central origin between respiratory, cardiac and stepping rhythms during fictive locomotion in paralyzed, vagotomized, and decerebrated cats. Fictive locomotion was induced by tonic electrical stimulation of the mesencephalic locomotor region (MLR). The coherence between heart beat fluctuation, the efferent discharges of the phrenic, and the lateral gastrocnemius nerves was used to evaluate the strength of the coupling between those three rhythms. The heart beat rhythm was modulated by the centrally generated respiratory and stepping rhythms. The central respiratory rhythm was modulated by the centrally generated stepping rhythm. Based on the present findings, we have proposed a new model concerning the functional hierarchical structures of the three biological oscillators.

Preliminary crystallographic studies on human complement pro-factor D

The recombinant zymogen of the human complement protein factor D has been crystallized. Crystals were grown by vapor diffusion using polyethylene glycol 6000 as precipitant. Two crystal forms obtained at pH 5.4 belong to space group P2(1). The crystals grow to dimensions of 0.6 mm x 0.3 mm x 0.3 mm in three days, are stable in the X-ray beam, and diffract to 2.4 A.

Effect of mode of delivery, parity and umbilical blood gas on first meconium passage in full-term healthy neonates

The various physiologic factors which might influence the time of first meconium passage were studied in 62 healthy full-term newborn infants. Thirty-two babies were born vaginally and 30 by elective cesarean section. Infants born vaginally were more acidotic and passed first stool earlier compared to those born by cesarean section. The same applies to vaginally delivered babies when comparing babies born to primipara and others. Acidosis is a presumed mechanism, and a role of gastrointestinal hormones is suggested to be the possible mediator of increased motility in these babies.

The histology of lumbar intervertebral disc herniation. The significance of small blood vessels in the extruded tissue

Six hundred surgical cases of lumbar intervertebral disc herniation were evaluated histologically for the presence of blood vessels. These patients ranged in age from 12 to 77 years. Blood vessels were observed in 57 of 101 cases of complete prolapse type of herniated disc (56.4%), 12 of 32 cases of incomplete prolapse type of herniated disc (37.5%), and 53 of 467 cases of protrusion type of intervertebral disc herniation (11.3%). The presence of blood vessels in intervertebral discs was also investigated in postmortem specimens. Blood vessels were observed in 293 of 616 intervertebral discs (T10-L5), in individuals older than 40 years of age from 100 postmortem spines. The specimen age range was 16-89 years. Most of the blood vessels seen in the extruded tissue, exposed to the epidural space in cases of complete and incomplete prolapse type of herniation, are thought to have been newly formed after herniation occurred. As invasion of the intervertebral disc by blood vessels was found to occur with the advance of age, it is possible that such blood vessels become extruded with the intervertebral disc tissue. The intervertebral disc may herniate posteriorly in three basic patterns. The first pattern is "protrusion type of herniated disc." In protrusion hernia type there is abnormal posterior bulging of the anulus fibrosus. The disc pathology is predominantly nucleus pulposus, and the peripheral layer of the anulus fibrosus remains attached to the vertebral body bony rim, however.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of auranofin, a chrysotherapy agent, in urine by HPLC with a postcolumn reaction and visible detection

Auranofin [(2,3,4,6-tetra-O-acetyl-1-thio-beta-D-glucopyranosato-S) (triethylphosphine)gold(I): AF] is a unique orally active chrysotherapy agent. A HPLC method has been developed for determining AF in urine. The proposed method comprises initial chromatographic separation of AF followed by on-line decomposition by potassium iodide with a released mercapto group undergoing a color-developing reaction with 5,5'-dithiobis(2-nitrobenzoic acid). An aliquot (100 microliters) of a urine sample was chromatographed on a YMC AM-302 octadecylsilica column (4.6 mm i.d. x 15 cm, ambient) with a water-methanol (35:65) eluent delivered at a flow rate of 1 ml/min. A reagent solution for a postcolumn reaction comprised of 50 microM 5,5'-dithiobis(2-nitrobenzoic acid), 0.3 M potassium iodide and a 50 mM phosphate buffer (pH 7.4), was delivered at a flow rate of 0.5 ml/min. The postcolumn reactor consisted of a poly(tetrafluoroethylene) tube (0.5 mm i.d. x 5 m) at 60 degrees C. Detection wavelength was 412 nm. The identity of the AF peak was confirmed by a 3-dimensional chromatogram as well as by atomic absorption spectrophotometric analysis of gold in the column effluent. Under the conditions described above, a linear relationship was obtained between peak height and AF concentration in the range 0.1 to 10 microM, with a correlation coefficient of 0.999. The detection limit was 50 nM (S/N = 3 at 0.005 AUFS) and the reproducibility was within 4% for 5 determinations. The AF concentrations in the urine of a rabbit given AF intraperitoneally were determined.

Indium 111-labeled platelets accumulation over abdominal aortic graft with chronic disseminated intravascular coagulation--a case history

The authors describe a seventy-six-year-old man with aortic graft, which became the focus of chronic disseminated intravascular coagulation (DIC). The patient had abdominal aortic aneurysm (AAA) and the size had increased up to 38 mm in diameter. The AAA was excised and replaced by Dacron graft. Ten months later, the DIC became chronic with renal dysfunction. Indium 111-labeled platelets scintigraphy showed increased accumulation of radioactivity over the graft. In the treatment of chronic DIC, low-dose subcutaneous heparin injection (5,000-10,000/day) was effective, and he was discharged. In this case there was also suspicion of lung cancer and recurrent aortic aneurysm, which were a more reasonable cause of chronic DIC. This case suggests that an aortic graft prosthesis may be a cause of localized chronic DIC and that indium 111-labeled platelets scintigraphy is useful for the detection of localized chronic DIC. Moreover, subcutaneous heparin administration may be effective for chronic DIC in patients with an abdominal aortic graft prosthesis.

[Treatment of hyperhidrosis with caudal epidural alcohol block in a patient with cervical cord injury]

A 44-year-old man complained of intermittent and excessive sweating of head and neck throughout the day, followed by severe lower abdominal spasms. He had been suffering from complete paraplegia with neurogenic bladder for 16 years, due to C7 spinal cord injury. In the last 16 years he had four episodes of hyperhidrosis, and these were treated by subarachnoid phenol block. The patient was referred to our clinic this time because of the dry tap during attempted subarachnoid phenol block. We tried several test blocks, lumbar epidural block, inferior mesenteric plexus block, celiac plexus block and caudal epidural block in order to clarify the afferent route of this reflex, because as a cause of this reflex sweating, no physical abnormality was detected. With caudal epidural block abnormal sweating disappeared completely. This finding led us to conclude that the somatic sacral nerves from bladder were afferent routes. We injected 20 ml of 75% alcohol into the caudal epidural space to destroy sacral nerves 5 times in 4 weeks. In a follow up examination, 5 months after his discharge, except minimal complaints about mild lower abdominal spasms, there were no complications from alcohol injection.

Heart beat fluctuation during fictive locomotion in decerebrate cats: locomotor-cardiac coupling of central origin

Fictive locomotion was evoked by stimulation of the mesencephalic locomotor region (MLR) in immobilized, vagotomized and decerebrate cats. The coherence between heart beat fluctuation and efferent discharges of the hindlimb nerve was used to evaluate the strength of the coupling between the cardiac and locomotor rhythms during MLR-elicited fictive locomotion. This study demonstrated that there was a locomotor-cardiac coupling of central origin.

[A 24-year-old man presenting Garcin syndrome and paraplegia]

We report a 24-year-old man who presented unilateral multiple cranial nerve involvements followed by progressive paraplegia. The patient expired after developing DIC and pneumonia. Post-mortem examination revealed Ewing's sarcoma originated in the pubic bone with extensive metastases including the clivus which was responsible for his cranial nerve lesions. The patient was well until 24 years of age when he noted an onset of pain and a mass in the pubic region. The histology of the biopsy specimen of the tumor suggested Ewing's sarcoma. He was treated with chemotherapy and local radiation. A year after, he noted an onset of nuchal pain, difficulty in tongue movement, dysarthria, deafness in the left ear, and diplopia. On admission to our hospital in July 1990, neurological examination revealed an alert and intelligent Japanese male in no acute distress. The olfactory to the trigeminal nerves appeared intact. He showed complete abducens nerve palsy, facial weakness, mild deafness, and weakness of the soft palate, the sternocleidomastoid muscle and the tongue, all on the left side. The remainder of the neurological examination was unremarkable except for dysesthesia along the left C8 and Th1 dermatoms. Radiological examination revealed a 10 x 10 cm sclerotic mass in the public bone and a high signal mass lesion between the clivus and the pons in the T2-weighted MRI. His clinical course was complicated by acute paraplegia with anesthesia below the Th4 dermatom, DIC, and respiratory distress due to plural effusion. Post-mortem examination revealed a necrotic and hemorrhagic tumor in the pubic bone. The histology was consistent with Ewing's sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Complement activation by lipopolysaccharides purified from gram-negative bacteria isolated from infected root canals

The purpose of the present study was to investigate the complement activation by lipopolysaccharides purified from Porphyromonas (Bacteroides) endodontalis, Veillonella parvula, and Fusobacterium nucleatum isolated from infected root canals. The rate of consumption of the C3T component of the complement increased remarkably when lipopolysaccharides of more than 10 micrograms were added.

[Two cases of Churg-Strauss syndrome with bilateral wide-spread pulmonary infiltrates]

We report two cases of Churg-Strauss syndrome. The first case was a 25-year-old woman with a one year history of bronchial asthma, who developed fever, skin eruptions, abdominal pain and mononeuritis multiplex. During treatment with prednisolone 40 mg per day, chest X-ray films showed bilateral wide-spread infiltrates. When the dosage of prednisolone was increased to 80 mg per day, these infiltrates disappeared. Skin and lung biopsy specimens demonstrated allergic vasculitis and eosinophilic pneumonia. There was no response to high-dose methylprednisolone pulse therapy for persistent severe abdominal pain and mononeuritis multiplex. Pericardial and pleural effusions with eosinophilia recurred eight months later. The second case was a 31-year-old man with a six year history of bronchial asthma, who developed fever, skin eruptions, myalgia and mononeuritis multiplex. One year later, during treatment with prednisolone 15 mg per day, bronchial asthma with eosinophilia relapsed and chest X-ray films showed bilateral patchy infiltrates. Skin biopsy specimens demonstrated eosinophilic infiltrates and necrotizing vasculitis, while lung biopsy specimens demonstrated eosinophilic infiltrates and small granulomas. With additional administration of cyclophosphamide, he has had no evidence of active disease for six years. In both cases, the neurological symptoms persisted despite treatment with high doses of steroids, and during tapering of prednisolone, vasculitis syndrome relapsed. Therefore, long-term careful surveillance is necessary in this disease.

Transinterosseous transfer of a peroneal island flap for reconstruction of prepatellar skin defect: report of two patients

We describe the use of a peroneal vascular transinterosseous island flap for the resurfacing of a prepatellar skin defect in 2 patients. Being a fasciocutaneous flap, the peroneal flap is thin, and the location of perforators is easily and safely detected with a Doppler flowmeter. When used as a vascular island flap, either a distal pedicle or a proximal pedicle can be used. The peroneal flap can be used as either a free flap or a vascularized fibular and fasciocutaneous flap. It may, therefore, be applied to compound skin, subcutaneous tissue, and bone defects in the lower extremities. A peroneal vascular transinterosseous island flap can reach a prepatellar skin defect, whereas the peroneal island flap with conventional proximal pedicle cannot.

[Occlusion-reperfusion model of cerebral ischemia in Fischer 344 rats]

The effect of transient cerebral ischemia (from 15 to 180 min) by bilateral carotid arterial occlusion on postischemic mortality rate and the signs of nervous disorder in Fischer 344 rat was studied. Total mortality rate was 40 to 60% during 72 hr of reperfusion following 2 hr ischemia. Postischemic mortality rate did not vary distinctly with 10, 20 and 40 weeks-old.

Selective inhibition of complex I by N-methylisoquinolinium ion and N-methyl-1,2,3,4-tetrahydroisoquinoline in isolated mitochondria prepared from mouse brain

1,2,3,4-Tetrahydroisoquinoline (TIQ), which is structurally similar to MPTP, has been found in human brain and has been reported to inhibit the mitochondrial respiration as does 1-methyl-4-phenylpyridinium ion (MPP+). However, the potency of inhibition by TIQ is less than that of MPP+. In this study, we report the effects of N-methyl-1,2,3,4-tetrahydroisoquinoline (N-Me-TIQ) and N-methylisoquinolinium ion (N-Me-IQ+) on the mitochondrial electron transport system using mitochondria prepared from mouse brains. Five mM N-Me-TIQ and 500 microM N-Me-IQ+ inhibited complex I activity to 54% and 63% of the control, respectively. The IC50 of N-Me-TIQ and N-Me-IQ+ were approximately 6.5 mM and 650 microM, respectively. Neither substance inhibited complex II, III and IV activities. Kinetic analyses of N-Me-IQ+ on complex I activity revealed uncompetitive inhibition against NADH and non-competitive inhibition against ubiquinone. These inhibitory characteristics were the same to those of MPP+ and the inhibitory potency of N-Me-IQ+ on complex I activity was stronger than that of MPP+.