Hirschsprung disease, unusual face, mental retardation, epilepsy, and congenital heart disease: Goldberg-Shprintzen syndrome

A 5-year-old girl with Hirschsprung disease, unusual facial appearance, psychomotor retardation, epilepsy, and congenital heart disease is reported. Patients with similar clinical features have been reported and they appear to exhibit the recently identified Goldberg-Shprintzen syndrome. It is believed that this girl also exhibits this new syndrome. Cranial computed tomography demonstrated abnormal findings that may suggest defective neuronal migration and/or dysgenesis of the brain. These findings were considered to cause psychomotor retardation and epilepsy in this patient.

Positron emission tomography of auditory sensation in deaf patients and patients with cochlear implants

The present study investigated the function of the auditory cortices in severely hearing-impaired or deaf patients and cochlear implant patients before and after auditory stimulation. Positron emission computed tomography (PET), which can detect brain activity by providing quantitative measurements of the metabolic rates of oxygen and glucose, was used. In patients with residual hearing, the activity of the auditory cortex measured by PET was almost normal. Among the totally deaf patients, the longer the duration of deafness, the lower the brain activity in the auditory cortex measured by PET. Patients who had been deaf for a long period showed remarkably reduced metabolic rates in the auditory cortices. However, following implantation of the cochlear device, the metabolic activity returned to near-normal levels. These findings suggest that activation of the speech comprehension mechanism of the higher brain system can be initiated by sound signals from the implant devices.

Efferent vestibular fibers to otolith organs in guinea pigs

The origins of efferent vestibular fibers to the otolith organs in guinea pigs, examined with the use of retrograde transport of HRP were: i) the bilateral lateral portions of the facial genu and ii) the ipsilateral reticular nucleus at the level of the facial nucleus. These origins are almost the same as those of the efferent fibers to the three semicircular canals which we have previously identified in cats; however, they differ in certain respects.

Mechanisms of alpha-Sialosyl cholesterol action to suppress both cyclic AMP production and DNA synthesis of rat glial cells

alpha-Sialosyl cholesterol (alpha-SC) that elicited morphological differentiation of rat astrocytes not only lowered intracellular cyclic AMP (cAMP) levels but also inhibited cAMP production induced by either alpha-isoproterenol, cholera toxin, or forskolin. The targets of alpha-SC in the cAMP production system of rat astrocytes were investigated to understand the mechanism of the alpha-SC action on cAMP production. cAMP production evoked by alpha-isoproterenol (1 microM) was entirely canceled by beta blockers such as propranolol and timolol (1 microM), but not by alpha-SC. Concentrations of alpha-SC greater than 15 microM were required for 50% inhibition of the activation by a beta agonist. Although alpha-SC inhibited in a dose-dependent manner the activities of membrane-associated adenylate cyclase that had been stimulated by either GTP gamma S of forskolin, alpha-SC inhibited neither GTP-binding activities nor GTPase activities of the membrane-associated G proteins. These findings suggest that alpha-SC suppresses adenylate cyclase directly, but not beta receptors or G proteins, and that it promotes the morphological differentiation of rat astrocytes through a mechanism regulating directly the cytoskeletal organization, regardless of intracellular cAMP level. alpha-SC (30 microM) suppressed 40% of DNA synthesis in the cell-free system, which contained the cytosolic extracts and the nucleus fraction prepared from rat astrocytoma C6 cells. Approximately 25% of alpha-SC incorporated in the astrocyte cytoplasm was transferred to the nuclei by 10 min after the addition.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multichannel cochlear implantation in a deaf child]

A multichannel cochlear implantation was performed in an 8-year-old child and the following results were obtained. The surgical procedures were not particularly difficult as compared to cochlear implantation for adults. Postoperative rehabilitation requires a longer time than in adult patients. Cochlear implants are useful not only for the recognition of environmental sound but also for the recognition of speech. Cooperation with the medical facility, as well teachers and family members, is essential.

[A case of spontaneous spinal epidural hematoma]

A 14-month-old girl with spontaneous spinal epidural hematoma and complete postoperative recovery was described. MRI proved to be a sensitive tool in identifying the nature and extent of this lesion. A review of literature was made with particular emphasis on the pediatric age group.

Considerations of cochlear implant surgery

Although cochlear implants have been reported to be easy to perform, some difficulties have been experienced in 4 of 21 operations. In order to make this surgery easier, the following points should be considered. Pre-operative CT and MRI must be performed in order to determine the condition of the cochlea. To determine the condition of the round window, exploratory tympanotomy is recommended in some cases. After insertion of the electrode in the cochlea, a radiograph should be taken during the operation to confirm that the electrode is correctly positioned.

[MRI findings of olivopontocerebellar atrophy and Machado-Joseph disease--diagnostic value of transverse pontine fibers]

Olivopontocerebellar atrophy (OPCA) and Machado-Hoseph disease (MJD) occasionally show similar clinical signs and symptoms, which makes differential diagnosis of OPCA and MJD difficult. In 1990, Savoiardo et al. reported that the transverse pontine fibers of OPCA patients had high signal intensity on T2 weighted MR images. To determine if the high signal intensity of the transverse pontine fibers is useful for the differential diagnosis of OPCA and MJD, we examined this abnormal intensity in patients diagnosed as OPCA or MJD. We observed the high intensity of transverse pontine fibers in all of the 18 OPCA patients. This finding, however, was not observed in any of the patients with the MJD. The high signal intensity of the transverse pontine fibers in T2 weighted images is characteristic of OPCA patients. Furthermore the atrophy of pontine tegmentum is characteristic of patients with MJD. These findings correlate well with pathological findings of OPCA and MJD, indicating the usefulness of these MRI findings for the differential diagnosis of OPCA and MJD.

Effect of somatostatin and its analogue on proliferation of human epidermoid carcinoma cells in vitro

Somatostatin (SS) and its analogue inhibit the growth of some human tumors in vivo. Surprisingly, we found that SS-14 and its analogue (SMS 201-995) exhibited unexpected proliferative effects on two lines of cells, A431 and KB human epidermoid carcinoma cells, in vitro. The level of intracellular cyclic AMP, an important second messenger that controls the growth of A431 cells, was unaffected in A431 cells by either SS-14 or SMS 201-995. In contrast, SS-14 (20 nM) and SMS 201-995 (10 nM) reduced the level of intracellular inositol 1,4,5-trisphosphate rapidly but transiently.

Effect of ascorbic acid on pituitary prolactin secretion in the non-ascorbate synthesizing Osteogenic Disorder Shionogi (ODS) rat

We examined the secretion of prolactin (PRL) in the hereditary scurvy-prone Osteogenic Disorder Shionogi (ODS) rat to investigate the role of ascorbic acid (AsA) in pituitary lactotroph and hypothalamic function. Plasma PRL concentrations of conscious AsA-deficient or control ODS rats were measured before and after the administration of metoclopramide (MCP), 5-hydroxy-L-tryptophan (5-HTP) or saline. The basal plasma PRL levels did not differ between the two groups. However, the AsA-deficient rats exhibited significantly larger changes in plasma prolactin concentration in response to MCP or 5-HTP than the control ODS rats. Thus, AsA deficiency enhanced the stimulated, but not the basal, secretion of PRL in ODS rats. Our findings suggest that AsA may have an inhibitory effect on PRL secretion.

CT of the pacchionian body

The CT appearances of the pacchionian body, confirmed at autopsy, are reported. The pacchionian body appears as a low density mass in the dural venous sinus, of almost the same density as the subarachnoid space.

Excretion of urinary epidermal growth factor in non-insulin dependent diabetes mellitus

Morning urine samples were assayed for human EGF (hEGF) in 137 non-insulin dependent diabetic patients with normal serum creatinine and beta 2-microglobulin levels. Serving as controls, 80 age- and sex-matched healthy subjects were also examined. A significant positive correlation between hEGF excretion and the level of hemoglobin A1C (HbA1c) was present in those patients with a HbA1c value exceeding 8% (r = 0.37; p = 0.003) but not in the overall patients. The urinary hEGF level did not correlate with the concentration of glucose in urine or plasma. The mean urinary hEGF level of diabetic patients was significantly lower than that of healthy subjects. The mean urinary hEGF level was significantly lower in the patients with a diabetic history that exceeded five years as compared with those with a history below five years. The mean urinary hEGF level was significantly lower in the patients with retinopathy vs. those without retinopathy. In the patients with HbA1c value below 8%, the mean urinary hEGF level was lower in the patients whose urinary albumin level exceeded 1.7 mg/mmol.creatinine as compared with those whose urinary albumin excretion was below 1.7 mg/mmol.creatinine. These findings suggest that urinary hEGF excretion may decrease with the progression of diabetic complications in the patients with well-controlled glycemia, and that inadequate glycemic control may lead to an increased excretion of urinary hEGF in the early disease stage.

Autonomic innervations in the middle ear and pharynx

Autonomic innervations of the mucosa in the middle ear and pharynx were investigated by retrograde labelling of the autonomic ganglia with horseradish peroxidase (HRP). Of the sympathetic ganglia, the superior cervical ganglion (SCG), middle cervical ganglion (MCG) and stellate ganglion (StG) were examined, and of the parasympathetic ganglia, the pterygopalatine ganglion (PpG) and the otic ganglion (OtG) were examined. Sympathetic innervation of the middle ear mucosa was accomplished by fibers originating in the ipsilateral SCG, but not by those originating in the MSG or StG. Parasympathetic innervation was by fibers originating in the ipsilateral PpG, but not by those originating in the OtG. The epipharynx received sympathetic innervation from the ipsilateral SCG, but not from the MCG or StG. Its parasympathetic innervation was from the PpG bilaterally, but not from the OtG. Sympathetic innervation of the mesopharynx was supplied by the SCG, MCG and StG, but no parasympathetic supply came from the PpG or the OtG. Sympathetic innervation was bilateral, but predominantly from the ipsilateral side. The hypopharynx resembled the mesopharynx, but had more innervation from the MCG and StG.

Auditory event-related potentials in patients with systemic lupus erythematosus

We studied auditory event-related potentials (ERPs) in 17 patients with systemic lupus erythematosus (SLE). Latencies of N100 and P200 components were normal in all patients, whereas the latencies of target P300 and nontarget P300 components were significantly prolonged in SLE patients with and without cognitive dysfunction. The P300 component of ERPs can be applied to evaluate the cognitive aspects of central nervous system manifestations in SLE patients.

T-cell receptors and collagen induced arthritis in H-2r mice

Mouse strains B10, B10.RIII, RIIIS/J and the F1 and backcross progeny arising from them were tested for susceptibility to porcine type II collagen-induced arthritis (PII-CIA). The clinically severe arthritis of rapid onset that is characteristic of PII-immunized B10.RIII mice developed predominantly in hybrid offspring that had inherited at least one copy of wild type T cell receptor (TCR) genes (V beta b genotype) from the B10 or B10.RIII parent. The results indicate that, in the development of PII-CIA, mice expressing the H-2r/r haplotype preferentially utilize TCR V beta genes that are normally encoded within the TCR V beta genomic deletion region of RIIIS mice (V beta c). After aggressive immunization with PII, the use of alternative TCR V beta genes, encoded outside of the RIIIS deletion region, produced a high IgG antibody response that was cross-reactive with mouse type II collagen (MII) and equivalent to that of B10.RIII mice, but only a very mild, late onset arthritis of 56% (27/48) incidence in RIIIS male mice and 28% (10/35) incidence in RIIIS female mice. In comparison, B10.RIII mice routinely developed early onset of PII-CIA of significantly higher incidence (100%; p < 0.005) and four-fold greater severity, even after milder immunization protocols. The data are compatible with the proposal that the clinically weak CIA response of RIIIs mice may be primarily antibody driven while the severe CIA of B10.RIII mice reflects the added inflammatory effects of collagen-reactive effector-T cells in the joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased content of epidermal growth factor in platelet lysates in non-insulin-dependent diabetes mellitus

We evaluated the content of EGF in platelet lysates obtained from 49 patients with non-insulin-dependent diabetes mellitus (NIDDM)(18 males, 31 females, age 58 +/- 13 years) and from 23 clinically healthy control subjects (11 males, 12 females, age 53 +/- 18 years). Platelets were collected from platelet-rich plasma and lysed. EGF was determined by radioimmunoassay. The immunoreactive EGF content in the platelet lysates in diabetic patients significantly exceeded that of control subjects (44.9 +/- 18.5 pg/mm3platelet vs. 34.2 +/- 7.8 pg/mm3platelet, mean +/- SD p < 0.008). In performing multiple regression analysis with ten clinical parameters, urinary albumin excretion (F = 16.1, r = 0.551, p < 0.001), duration of diabetes (F = 13.0, r = 0.511, p < 0.001) and the presence of diabetic proliferative retinopathy (F = 8.8, p < 0.01) were significantly associated with irEGF content in platelet lysates. These observations suggest that the amount of EGF in platelets may increase with the progression of diabetic complications. The mechanism for the increase of EGF in platelets remains to be clarified.

Primary non-Hodgkin malignant lymphoma of the breast. An immunohistochemical study of seven patients and literature review of 152 patients with breast lymphoma in Japan

BACKGROUND

The breast is rarely a primary site for extranodal malignant lymphoma. Most reported primary non-Hodgkin malignant lymphomas of the breast (PBL) are of B-cell phenotype.

METHODS

Histologic and immunohistochemical analyses of seven patients with PBL and a statistical analysis of 152 patients with PBL reported in the Japanese literature were performed.

RESULTS

Malignant lymphoma could not be predicted preoperatively with clinical and radiologic findings; breast carcinoma, fibroadenoma, and phyllodes tumor were the preoperative diagnoses. All patients were women; they ranged in age from 31 to 80 years (mean, 57.6 years). The right breast was involved initially in five patients. In four, only the breast was involved (Stage I), whereas in three, the ipsilateral axillary lymph nodes (Stage II) were involved at diagnosis. According to the Working Formulation, all patients belonged to the intermediate grade and were classified as having diffuse large cell (five patients) or mixed (two patients) lymphoma. Immunophenotypic analysis revealed that all patients had B-cell lymphoma. No patients had lymphoepithelial lesions, which is the characteristic feature in categorizing a lymphoma as a mucosa-associated lymphoid tissue (MALT) lymphoma. A statistical analysis of the patient reported in the Japanese literature has divided PBL into two types: a bilateral type that affects younger women and a unilateral type that has a broad age distribution, but preponderantly occurs in older women. The age and stage at diagnosis were significant prognostic factors in predicting the survival time, but the location and size of the tumor at initial presentation, histopathologic type, terminal leukemic manifestation, and treatment modality were not.

CONCLUSIONS

This study indicates that most PBL are diffuse large cell lymphoma of B-cell phenotype and that the age and stage at diagnosis are significant prognostic factors.

Thyroid storm associated with probable subclinical hypoadrenocorticism in an elderly woman

A 73-year-old woman was admitted to the hospital for severe persistent vomiting with fever, drowsiness, and weight loss. Elevated serum levels of thyroid hormones and the presence of a consciousness disorder with fever and vomiting led to the diagnosis of thyroid storm. A low normal concentration of serum cortisol, urinary 17-hydroxycorticosteroids and an elevated plasma level of corticotropin suggest that an inadequate adrenal reserve have been involved in the pathogenesis of the thyroid storm in this patient. She responded to the administration of intravenous methimazole and oral supersaturated potassium iodide solution.

Somatosensory event-related potentials following different stimulus conditions

We studied somatosensory event-related potentials (ERPs) in response to rare target, frequent nontarget and rare nontarget stimuli in 12 healthy subjects. Compared with the corresponding peaks following frequent stimuli, the responses elicited by rare target stimuli showed higher amplitudes for N70, P100 and N140 components and those evoked by rare nontarget stimuli showed higher amplitudes for N70 and N140 components. The P300 component following rare nontarget stimuli was shorter in latency and lower in amplitude than that elicited by target stimuli. ERP waveforms evoked by rare nontarget stimuli also showed obvious N240 and P300 components, which differed from those following frequent nontarget stimuli. These findings suggest that there are differences in signal processing in response to target, frequent nontarget and rare nontarget stimuli. The P300 component was distributed symmetrically and there was no significant hemispheric predominance with regard to any ERP component in response to either right or left side stimulation.

[A case report of postoperative recurrent hepatocellular carcinoma effectively treated with HCFU administration combined with TAE]

A 62-year-old man was found to have recurrent hepatocellular carcinoma (HCC) 2 cm in diameter in the left lobe in June 1990. After right lobectomy of the liver which contained the tumors of S6 2 cm and S8 3 cm in diameter 7 months before, the patient was treated with hepatic arterial embolization (TAE) combined with infusion of anti-cancer drug (ADM, CDDP) four times since June 1990. HCFU 300 mg per day was administered orally since June 1990. Since the 3rd TAE in December, 1990, the tumor stain in the left lobe disappeared for 10 months till October, 1991. No remarkable side effect of HCFU was noticed during this period. HCFU administration combined with TAE effectively prevented post-surgical recurrence of HCC in this case.

Hepatic accumulation and hepatotoxicity of luteoskyrin in mice

HPLC analysis revealed that luteoskyrin administered orally to male mice accumulated selectively in the liver, with minor distribution to the serum and kidneys. Elevation of serum GOT and GPT values was maximal 3 days after administration. In mice administered this mycotoxin intravenously, selective accumulation was also observed in the liver, and the half-life of hepatic luteoskyrin in males was significantly longer than that in females. Increment of serum transaminases was also marked in males with maximum accumulation at 24 h after administration. Histopathologically, cellular membrane damage was an early effect of luteoskyrin on cell necrosis, and these morphological changes were also marked in males. Luteoskyrin also elevated hepatic lipid peroxides, the maximum elevation being 8 h after injection; this increase was suppressed by alpha-tocopherol and Bi(NO3)3. HPLC-ECD analysis indicated that the level of 8-hydroxy-deoxyguanosine, one of the markers of hydroxy-radical-mediated modification of DNA guanine residues, was increased in hepatic DNA. These findings indicate that luteoskyrin has a high affinity for the liver, resulting in induction of lipid peroxidation, hepatocellular membrane damage, and elevation of serum transaminase activities. It is suggested that the hydroxy radicals derived from this anthraquinone contribute to these toxicological changes.

Interaction of sialosyl cholesterol with the cell surface of rat astrocytes and its biological activities

The interaction between sialosyl cholesterol (alpha- or beta-D-N-acetyl neuraminyl cholesterol, alpha- or beta-SC) and the plasma membrane of astrocytes was investigated by the use of 14C-labeled alpha- or beta-SC. Both alpha- and beta-SC were dose-dependently and time-dependently bound to rat astrocytes. The Scatchard plot analyses showed that rat astrocytes bound apparently 9.69 x 10(9) molecules of both alpha-SC/cell (apparent Kd = 2.29 x 10(-5) M) and beta-SC/cell (apparent Kd = 5.39 x 10(-5) M) at 37 degrees C. Both the binding of alpha-SC to astrocytes and the subsequent inhibition of DNA synthesis were decreased at the low temperature (4 degrees C), and also suppressed by serum proteins including albumin. One molecule of bovine serum albumin (BSA) bound 2.3 molecules of alpha-SC with the slightly lower Kd-value (8.03 x 10(-6) M) than that for the binding site on astrocytes. BSA not only suppressed the alpha-SC-binding to astrocytes but also increased its release from the cells to the culture media. Gangliosides such as GM1 and GM3 unaffected the alpha-SC-binding, promoted the small release of alpha-SC from the cell surface, and inhibited the morphological changes of astrocytes induced by alpha-SC. The mechanism of alpha-SC-binding to cultured astrocytes with reference to the effects of serum or gangliosides is discussed.

Terminal deletion of the short arm of chromosome 3

A boy with growth and mental retardation, flat occiput, high and broad forehead, blepharoptosis, narrow palpebral fissures, low set, malformed ears, short neck, anal atresia, deep sacral dimple is reported. High-resolution banding analysis showed terminal deletion of the short arm of chromosome 3 (46,XY,del(3)(p25.3)). Deletions of the short arm of chromosome 3 are relatively rare. The clinical features of the patient are compared with those of 19 previously reported cases.