Illustration of the stages of idiopathic macular holes by laser biomicroscopy

BACKGROUND

The determination of the developmental stage of macular holes is difficult to assess clinically. This may be the reason for the conflicting reports on the risk of vision loss in patients with macular holes and on the value of prophylactic surgery. We have developed a new method, laser biomicroscopy, which provides visualization and photographic record of vitreoretinal structures at the macula.

OBJECTIVE

To test the applicability of this method to the identification of macular holes stages.

METHODS

Laser biomicroscopy and slit-lamp biomicroscopy were used to examine 18 patients with macular holes, identify the lesions, and classify them according to the various stages of development of idiopathic macular holes as proposed by Gass.

RESULTS

Reflections considered to originate from the hyaloid membrane were observed more frequently by laser biomicroscopy than by conventional slit-lamp biomicroscopy. Two fellow eyes were diagnosed by laser biomicroscopy as having stage 1 lesions while slit-lamp biomicroscopy failed to yield a clear diagnosis. In four eyes with stage 3 holes the vitreoretinal separation was apparent only on laser biomicroscopy. Four cases were selected to illustrate the laser biomicroscopic findings in the different stages of macular hole development.

CONCLUSIONS

The ease of visualization of the macular lesions with laser biomicroscopy may facilitate the evaluation of the early stages of macular holes and reduce the incidence of misdiagnosis. Furthermore, photographs obtained by laser biomicroscopy may be a useful tool in studies of early stages of macular holes.

Amplification of DAT1 (human dopamine transporter gene) 3' variable region in the Japanese population

Amplification of the human dopamine transporter gene (DAT1) was performed by the polymerase chain reaction, and polymorphism of the VNTR locus was analyzed in a population sample of 176 randomly selected Japanese individuals. Genomic DNAs were extracted from whole blood, and the 3' untranslated region of the human DAT1 gene was amplified. The amplification products were distinguished by agarose gel electrophoresis, and visualized directly by ethidium bromide staining. In this way, four alleles were visualized directly and designated A, B, C, and D in decreasing order according to size. The relative frequencies of DAT1 allels A through D were 0.0171, 0.0625, 0.9119, and 0.0085, respectively. Evidence of significant deviations from the Hardy-Weinberg equilibrium was observed from these Japanese population data. The DAT1 locus was estimated to have a heterozygosity index of 13% and polymorphic information content of 0.16.

Usefulness of simulation of surgical approaches to cerebral aneurysms by helical scanning CT (HES-CT)

Using multiplanar reconstruction (MPR) CT imaging method, virtual views of various surgical approaches were compared preoperatively. With this technique, not only virtual surgical views of aneurysms and related vasculature, but also surgical views after virtual resection of skull base bone to a desirable extent are freely available. We operated four aneurysm cases after comparing various surgical approaches by this imaging method. It was found that these preoperative simulated images were very useful at surgery of complicated aneurysm cases.

Histological analysis of hepatocellular carcinoma treated by intraarterial combined immunochemotherapy

BACKGROUND/AIMS

We have previously reported the efficacy of intraarterial combined immunochemotherapy for 24 patients with unresectable hepatocellular carcinoma. This therapy consists of recombinant interleukin-2, OK-432, adriamycin, cyclophosphamide, and famotidine. We observed a complete response (CR) in 4, partial response (PR) in 3, minor response (MR) in 7, no change (NC) in 7, and progressive disease (PD) in 3. The response rate (CR+PR+MR) was 58.3%. The overall 2-year survival rate was 52%. The present study was designed to analyze the phenotype of tumor infiltrating lymphocytes and apoptosis-related antigen (Ley and Fas antigen) expression in tumor cells.

MATERIALS AND METHODS

The analysis of phenotype of tumor infiltrating lymphocytes and apoptosis-related antigen (Ley and Fas antigen) expression in tumor cells were performed by immunohistochemical stain using resected specimens.

RESULTS

Lymphocytes markedly infiltrated into the tumor lesions in treated patients compared with untreated patients. Phenotypes of tumor infiltrating lymphocytes were CD8+ and HLA-DR+. Ley-positive and Fas-positive tumor cells were observed as well. Furthermore, in the strong lymphocyte infiltrating area, the Fas antigen in tumor cells were strongly expressed.

CONCLUSION

In conclusion, the antitumor effect of intraarterial combined immunochemotherapy may be related with the activation of tumor infiltrating lymphocytes. These lymphocytes may kill tumor cells in an apoptotic fashion. Fas ligand expression of TILs should be determined in future.

A new model of subretinal neovascularization in the rabbit

PURPOSE

To establish a new model of subretinal neovascularization (SRN) in the rabbit by implanting basic fibroblast growth factor (bFGF)-impregnated gelatin microspheres beneath the retina.

METHODS

Basic fibroblast growth factor-impregnated gelatin microspheres were prepared by forming a polyion complex between gelatin and bFGF. The microspheres, containing 2.5 micrograms of bFGF, were injected into the subretinal space of rabbit eyes (n = 29). Control eyes (n = 10) received bFGF-free gelatin microspheres. Eyes were followed up for 3 days to 8 weeks by ophthalmoscopy, photography, fluorescein angiography, light microscopy, and transmission electron microscopy.

RESULTS

Twenty of 24 experimental eyes (83%) showed fluorescein leakage from SRN 2 weeks after implantation of the bFGF-impregnated microspheres. This leakage continued for 2 to 6 more weeks. In striking contrast, control eyes showed no fluorescein leakage. Histologic examination revealed SRN in all the experimental eyes but in none of the control eyes.

CONCLUSIONS

Subretinal implantation of bFGF-impregnated gelatin microspheres induces reproducible SRN in the rabbit.

Cardiac lesions and their reversibility after long term administration of methamphetamine

In order to clarify the effect of methamphetamine (MA) on myocardium, histological, immunohistochemical and electron microscopic changes in the myocardium of rats were examined following daily intraperitoneal administration of MA at a dose of 1 mg per kg body weight for 4, 8, and 12 weeks before sacrifice. Normal saline (NS) was similarly injected for the same period before sacrifice to constitute a control group. Light microscopic changes found in the myocardium of the MA-treated group included atrophy, hypertrophy, patchy cellular infiltration, eosinophilic degeneration and disarray, edema myolysis, fibrosis, and the appearance of vacuoles. Ultrastructurally, nuclei and normal mitochondria had various shapes and there were dilated T tubules and sarcoplasmic reticulum, the accumulation of glycogen granules and fat droplets. Intra- and extra-cellular edema and intramyocytic vacuoles were often found. Withdrawal of MA at the twelfth week in another group of rats evidenced gradual recovery of the myocardial changes, commencing at 3 weeks after withdrawal. Optimism is therefore generated about the possibility of the affected hearts in MA-abuse patients returning towards the normal state if they give up the drug.

Intracerebral infiltration by monoclonal plasmacytoid cells in Waldenstrom's macroglobulinemia--case report

A 68-year-old female presented with Waldenstrom's macroglobulinemia with infiltration into the cerebral parenchyma manifesting as increased confusion, memory loss, and disorientation. She had a past history of Waldenstrom's macroglobulinemia treated 3 years before. Magnetic resonance imaging showed a high intensity area on T2-weighted images in the left frontal lobe extending to the corpus callosum which was well enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Direct infiltration of neoplastic cells was confirmed by biopsy. Immunohistochemical examination showed that mature plasmacytoid cells in the cerebral parenchyma were immunoglobulin M and lambda light chain antigen positive, but immature lymphocytes in Virchow-Robin space were negative. Monoclonal proliferation was confirmed by southern blot analysis. She became symptom free and the size of the lesion was dramatically reduced after 40 Gy irradiation. She showed no evidence of recurrence 3 years after irradiation. As no effective chemotherapy regimen for Bing-Neel syndrome has been established, irradiation is worth considering when neuroimaging suggests intracranial infiltration of neoplastic cells.

[Clinical usefulness of 3-D CT endoscopic imaging of cerebral aneurysms]

Usefulness of endoscopic imaging of cerebral aneurysms is presented. 3D-luminal images were obtained using a new processing technique which extracts CT numbers in the boundary region between the vessel wall and contrast media filling in the vascular lumen. Clinical application of this technique to complicated large cerebral aneurysms showed that, with this 3D-CT endoscopic images and MRA, anatomical details of cerebral aneurysms such as the orifice of the aneurysm, intraluminal thrombus, and calcification of the wall could be clearly demonstrated. We operated on two large, complicated aneurysms after obtaining 3D-CT endoscopy images of the aneurysms. Such information was found to be very useful when operating on difficult and complicated cerebral aneurysms.

Proteoglycans in haemodialysis-related amyloidosis

Changes in extracellular matrices of articular tissue, intervertebral discs and systemic organs in patients with haemodialysis-related amyloidosis were investigated by immunohistochemical and biochemical examination of proteoglycans. Increased staining for chondroitin sulfate (CS) was detected in the amyloid deposits of all patients, ranging from early to advanced stages. Degenerative tissue changes around early-stage amyloid deposits in the intervertebral discs also showed positive staining for CS. Heparan sulfate (HS) was detected in amyloid deposits, especially in the synovial membrane. Biochemical analysis of connective tissues containing amyloid supported the immunohistochemical studies; CS was the major glycosaminoglycan species in these tissues, accounting for 55-81% of the total glycosaminoglycans. Although previous studies have stressed the importance of HS in amyloidogenesis, the present study showed that CS, which increased significantly in articular tissues associated with mechanical stress, also has a close relationship with amyloidogenesis.

Detection of D1S80 (pMCT118) locus polymorphism using semi-nested polymerase chain reaction in skeletal remains

We evaluated the usefulness of a semi-nested polymerase chain reaction (PCR) method for detecting D1S80 (pMCT118) locus polymorphisms of DNA extracted from old skeletal remains. The semi-nested PCR has been applied to the amplification of D1S80 nucleic acid sequences. For amplification of the locus D1S80, a pair of oligonucleotide primers have been used widely as described by Kasai et al. We have designed another set of primers for semi-nested PCR. This method resulted in D1S80-VNTR detection from low-titered DNA isolated from old skeletal remains. The first and second step PCR achieved amplification from as little as 10 ng and 10 pg of template DNA, respectively. Specificity and sensitivity of the amplification products was markedly improved by semi-nested PCR. In DNA extracted from biological samples, this method took about 5 hours to amplify the target DNA and 3 hours for electrophoretic separation. We demonstrated that this semi-nested PCR method was superior in sensitivity to conventional 1-step standard amplification for VNTR typing of the D1S80 locus.

Implantable biodegradable polymeric device in the treatment of experimental proliferative vitreoretinopathy

We investigated the use of a scleral plug of biodegradable polymer implanted at the pars plana to create a controlled drug-delivery system in the vitreous. We evaluated the efficacy of a plug containing doxorubicin hydrochloride to treat experimental proliferative vitreoretinopathy (PVR) in pigmented rabbits. An implantable device on the sclera, which imitates a scleral plug, containing 1% doxorubicin, was prepared with poly(lactic acid) (molecular weight, 20,000). The release of doxorubicin in phosphate-buffered saline was evaluated by spectro-photometry. After pars plana vitrectomy and plug implantation, concentrations of doxorubicin in the vitreous humor of the rabbits were measured by high performance liquid chromatography. The release profiles were evaluated during 5 weeks in vitro and 4 weeks in vivo. Cultured homologous fibroblasts were injected into the vitreous space to induce experimental PVR after gas compression of the vitreous. The scleral plugs were implanted at the pars plana in treatment animals (n = 11). Control rabbits (n = 11) were followed up without implantation after PVR induction. All eyes of the control group developed tractional retinal detachment at day 28, while the incidence of retinal detachment was decreased to 64% in the treated eyes. (P = 0.002). The implantation of the scleral plug effectively inhibited intravitreous proliferation of fibroblasts. This study demonstrated that the scleral plug of biodegradable polymers may have potential as a treatment modality for PVR.

Three-dimensional display of the bronchi using helical CT

The purpose of this study was to evaluate the clinical usefulness of three-dimensional (3D) images of the bronchi obtained using helical CT. Thirteen patients with lung cancer, one with tracheal diverticulum, and one with bronchial amyloidosis were examined. The CT scanner employed was the Toshiba Xforce. The helical CT scan cycle consisted of 20 continuous rotations, each requiring 1.5 sec, for a total scanning time of 30 sec. Scans were obtained using a 5-mm X-ray beam width, a 5-mm/1.5 sec couchtop sliding speed, and a 2-mm reconstruction interval. 3D images were reconstructed using a CEMAX VIPstation. The optimal lower and upper threshold CT values for 3D images of the bronchi were -650 and -100 HU, respectively, and 3D images clearly depicted endobronchial lesions. Cartilage crescents were also demonstrated, but longitudinal and circular mucosal folds could not be visualized. In conclusion, 3D images of the bronchi acquired using helical CT were useful in evaluating endobronchial lesions.

[Histopathological assessment of renal biopsy specimens of subjects with urine abnormality]

Between April 1985 and April 1992, 25,672 men (age 47 +/- 9 years, mean +/- SD) and 9,791 women (48 +/- 9 years) underwent mass urinalysis in the Center for Adult Complete Physical Examination in our hospital. The results revealed proteinuria in 6.3% of the men and 4.4% of the women and hematuria in 17.4% of the men and 37.8% of the women. Thirty-five subjects with asymptomatic persistent proteinuria and/or hematuria identified as a result of follow-up testing by the nephrologists at our hospital underwent renal biopsy. All of the biopsy specimens obtained were examined by light microscopy, fluorescence microscopy and electron microscopy. Histopathological findings in the biopsy specimens from these 35 subjects were as follows: One case (3%) of chronic pyelonephritis, 11 cases (31%) of IgA nephropathy, 4 cases (11%) of IgA nephropathy (severe type), 5 cases (14%) of membranous nephropathy, 4 cases (11%) of thin basement membrane disease (TMD), 7 cases (28%) of benign nephrosclerosis and 3 cases (9%) of minor glomerular abnormality. Light microscopy, fluorescence microscopy and electron microscopy for histopathological assessment of renal specimens, especially for the diagnosis of TDM, which was not uncommon, were indispensable tools in our study. Moreover, it is essential for proteinuria and hematuria to be tested simultaneously using the same standard method in all the urine specimens collected.

Biodegradable polymer microspheres for targeted drug delivery to the retinal pigment epithelium

The authors evaluated the feasibility of biodegradable polymer microspheres of poly (L-lactic acid) and poly(glycolic acid) to deliver a substance directly to the retinal pigment epithelial (RPE) cells. The microspheres encapsulated a fluorescent dye (rhodamine 6GX) that was used as a drug marker. The dye released from the microspheres was analyzed by spectrofluorophotometry in vitro. Microspheres were administered to cultured bovine RPE cells. Phagocytosis of the microspheres by RPE cells was studied by fluorescent microscopy and transmission electron microscopy. Intracellular release of the fluorescent dye was also evaluated after phagocytosis of the microspheres. A suspension of the microspheres was administered into the subretinal space via transvitreal approach with a glass micropipette in the rabbits in vivo. The release rate of the fluorescent dye was controllable by changing the molecular weight and the monomer composition of the copolymers in vitro. Microspheres were phagocytosed by RPE cells and the dye was released intracellularly during incubation. After subretinal delivery, the microspheres were degraded in the cytoplasm of the RPE, but the fragments were observed up to four weeks. The retinal architecture overlying the delivery site was well preserved. These results suggest that it is feasible to deliver substances directly to the RPE cells with the use of polymer microspheres without damaging the neural retinal structure. This drug delivery system may enable the functions of RPE cells to be modified pharmacologically.

[Surgical results of vitrectomy for idiopathic macular hole--factors affecting postoperative visual prognosis]

Pars plana vitrectomy was performed on 19 eyes with idiopathic full-thickness macular holes (6 eyes at stage 2, 8 eyes at stage 3, and 5 eyes at stage 4). Factors affecting postoperative visual prognosis were evaluated. Preoperatively a potential acuity meter (PAM) and laser interferometry were used to predict postoperative visual acuity. Resolution of the surrounding fluid cuff and flattening of the macular holes were obtained in 9 eyes (47%). Eight eyes (42%) gained an improvement in visual acuity of 2 lines or more. Most eyes with anatomical success showed functional improvement. Eyes with short duration of macular holes were considered to have better visual postoperative prognosis. The stage of macular holes, however, had no relationship with postoperative visual acuity. Preoperative measurement with laser interferometry was relatively well correlated with postoperative visual acuity (r = 0.54, p = 0.07), but the results of PAM and preoperative visual acuity had poor correlation.

[Prediction of postoperative visual acuity in retinal detachment with macular involvement]

We used laser interferometry (LI) and a potential acuity meter (PAM) to predict visual acuity after surgery for patients with rhegmatogenous retinal detachment with macular involvement. Thirty one eyes of 31 patients with retinal detachment were treated with scleral buckling procedures. Postoperative visual acuity was correlated with preoperative measurements of the LI and PAM, preoperative visual acuity by Landort's ring, and the estimated duration of macular detachment. The correlation between the duration of macular detachment and the postoperative visual acuity was not good (r = 0.55, p < 0.01). Although the preoperative visual acuity showed a relatively good correlation with postoperative visual acuity (r = 0.62, p < 0.01), the results of the LI and PAM provided a better correlation (LI; r = 0.73, PAM; r = 0.71). Our results suggest that the LI and PAM are useful to predict the visual acuity after retinal reattachment in patients with preoperative macular detachment.

Expression of HGF and TGF-beta 1 mRNA after partial hepatectomy in rats with liver cirrhosis

Hepatocyte growth factor (HGF) is a potent mitogen for the maturation of hepatocytes in vitro which plays a role in liver regeneration in vivo. In addition, transforming growth factor-beta 1 (TGF-beta 1) is also a potent regulator of liver regeneration. In attempting to clarify the mechanisms related to liver regeneration after partial hepatectomy, we investigated the expression of HGF and TGF-beta 1 in rats with liver cirrhosis (LC). A rat model of LC was prepared using carbon tetrachloride (CCl4). The expression of HGF mRNA in both the LC and control groups showed a similar time-course with the highest expression seen at 18h after a 70% hepatectomy. The expression of TGF-beta 1 mRNA peaked at 18h after partial hepatectomy in the LC group and at 48h in the control group. The 5-bromo-2'-deoxyuridine (BrdU) labeling index for the LC group at 24, 48, and 72 h after partial hepatectomy was 9.2%, 5.9%, and 1.8%, while for the control group it was 7.0%, 11.7%, and 6.8%, respectively. The BrdU labeling index in the LC group was thus suppressed earlier than that in the control group. We therefore postulate that regeneration of the remnant liver in the presence of LC accelerates immediately after partial hepatectomy, but the extent of regeneration is insufficient because of an early cessation due to an early expression of TGF-beta 1.

A new fluorescent imaging procedure in vivo for evaluation of the retinal microcirculation in rats

We investigated a new method for in vivo evaluation of the retinal microcirculation in rats using a cell-permeant fluorescent dye, acridine orange (AO), which stains cell nuclei and cytoplasm, and a scanning laser ophthalmoscope (SLO). AO, which binds and interacts with DNA and RNA, and thus stains cell nuclei and cytoplasm, was administered intravenously to rats. Fluorescein angiography was performed after administration of the AO, and fundus images were recorded on S-VHS videotape by means of an SLO. Argon laser was used as an exciter of the dye. The retinal vessels were stained with the dye, rendering the retinal microvasculature clearly visible. Cell nuclei and vessel walls were observed as greater fluorescence and lesser fluorescence, respectively. Leukocytes were also observed as highly fluorescent dots moving through the vessels. The results suggest that SLO visualization of AO uptake by cells may be a useful procedure for the evaluation of retinal microcirculation in vivo in rats.

[Long-term prognosis of intraocular lens implantation in diabetic patients]

We retrospectively studied 255 eyes of 190 diabetic patients who underwent cataract extraction with posterior chamber intraocular lens (IOL) implantation. One hundred forty-six eyes (57.3%) achieved the best visual acuity of 20/30 or better and 221 eyes (86.7%) achieved the acuity of 20/100 or better. Among 161 eyes that were followed up over 6 months, 26 eyes (16%) showed a progression of the retinopathy. Eight eyes developed proliferative retinopathy from non-proliferative retinopathy. The level of glycosylated hemoglobin of the progression group at the time of surgery was significantly higher than that of the non-progression group (8.0 +/- 2.4% vs 6.8 +/- 1.6%, p < 0.05). Sixty-five patients received IOL implantation in one eye. Of these patients, 10 eyes (15%) showed progression of the retinopathy. Seventy percent of the fellow eyes also showed the progression, where as 95% of the non-progression group did not show progression in the fellow eyes. The results suggested that the progression of diabetic retinopathy after IOL implantation was correlated with diabetic control at the time of surgery. Additionally, patients who developed the progression of the retinopathy in pseudophakic eyes frequently showed the progression in the fellow unoperated eyes.

[Hyperbaric oxygen treatment for macular edema after retinal vein occlusion--fluorescein angiographic findings and visual prognosis]

It has been reported that hyperbaric oxygen treatment improves visual function in patients with chronic macular edema associated with retinal vein occlusion. This study was designed to investigate relationship between visual prognosis and characteristics of macular edema. From fluorescein angiography performed prior to the therapy, areas of capillary closure and fluorescein leakages were quantitatively evaluated within 1 disc diameter from the fovea. In 27 eyes for which good angiograms were available, 19 eyes were classified as having mild ischemia 1 (area of capillary closure < 25%) and 8 eyes were classified as having severe ischemia (closure area < or = 25%). Of the 27 eyes, 14 showed visual improvement after the therapy. While only one eyes (13%) had visual improvement in the severe ischemic group, 11 eyes (58%) showed visual improvement in the mild ischemic group. The degree of fluorescein leakage before the therapy had no effect on visual outcome. The degree of macular ischemia was found to be a more significant factor influencing visual prognosis after the treatment than the degree of macular edema.

Quantitative evaluation of leukocyte dynamics in retinal microcirculation

PURPOSE

Leukocyte rheology may play a key role in microcirculation because leukocytes have unique properties, such as large cell volume, high cytoplasmic rigidity, and low deformability. However, only a few methods are available to study the dynamic behavior of leukocytes in retinal microcirculation. The authors developed a new method to analyze directly movements of leukocytes in the retinal vessels of primates.

METHODS

Acridine orange, which has been used as a nuclear stain in histochemistry and cytochemistry, was injected intravenously into cynomolgus monkeys for a vital staining of leukocytes. The fundus image was generated with the argon blue laser and a scanning laser ophthalmoscope. The images were recorded on a magnetic tape and evaluated with a personal computer-based image analysis system.

RESULTS

Each leukocyte was recognized as a single fluorescent dot moving in the retinal vessels. It was possible to analyze the spatial and temporal dynamics of individual leukocytes in the capillaries. Some leukocytes passed through the capillaries, plugging transiently under the physiological condition. Leukocytes that stayed in the same position for a few minutes may have stuck to the endothelium as a result of leukocyte-endothelial interactions. In the postcapillary vessels, leukocytes tended to be displaced from the center stream toward the vessel walls. The mean flow velocity of leukocytes in the perifoveal capillary was 0.92 +/- 0.32 mm/sec.

CONCLUSIONS

This study clearly demonstrated that rheologic behaviors of leukocytes in the retinal microcirculation can be studied through the vital staining with acridine orange in vivo. The authors' results suggest a potential role of leukocytes in retinal vascular flow disturbances. This study may open the door to the investigation of leukocyte hemodynamics in the retinal microcirculation in vivo.

Amplification and detection of the VNTR locus D4S95 in a Japanese population

The D4S95-VNTR locus was amplified and the polymorphism analysed in a population sample of 169 randomly selected Japanese individuals. A total of 14 alleles containing 850-1360 base pairs were distinguished by agarose gel electrophoresis. The distribution of alleles was symmetrical with respect to one peak at 1030 bp. The mean exclusion chance and discrimination power were calculated as 0.604 and 0.876 respectively.

Tolosa-Hunt syndrome with unusual clinical courses--two case reports

Two cases of Tolosa-Hunt syndrome with unusual clinical courses are described. The clinical onset of the first patient was typical, but was unresponsive to steroid hormone treatment. The symptoms resolved spontaneously after 1 year. Computed tomography (CT) and magnetic resonance (MR) imaging revealed enlargement of the affected cavernous sinus, which did not change after the symptoms resolved. The clinical presentation in the second patient included marked pupillary dilatation, a sign which is absent in the classical criteria. CT showed no abnormal findings, but MR imaging revealed a mass located in the medial side of the cavernous sinus extending to the lateral wall, which might have caused the pupillary dilatation. After steroid therapy the symptoms disappeared and MR imaging showed remarkable reduction of the mass in the cavernous sinus. Tolosa-Hunt syndrome usually responds promptly to steroid therapy and rarely manifests marked pupillary dilatation. Such variation in presentation adds to the difficulties in diagnosis and treatment of this disease of unknown etiology.

Renal lesion of type Ia glycogen storage disease: the glomerular size and renal localization of apolipoprotein

In order to investigate the glomerular size and renal localization of apolipoprotein in type Ia glycogen storage disease, a renal biopsy was performed in two proteinuric patients. Histopathological examination of the biopsy specimens revealed focal sclerotic glomerular sclerosis in both patients. The mean glomerular area was 21.6 +/- 11.6 x 10(3) microns 2, indicating enlargement of the glomeruli. Immunohistochemical staining of the specimens for apolipoprotein showed localization of apolipoprotein AI on the inner side of the glomerular capillary wall, and in proximal tubular epithelial cells. In one patient with a history of several episodes of hypoglycemia, treatment with corn starch improved the carbohydrate and lipid metabolic profile and reduced the daily urinary protein excretion from 2.23 to 0.5 g. These results suggest that focal sclerotic glomerular lesions associated with type Ia glycogen storage disease may be related to disorders of carbohydrate and lipid metabolism.