Heterogeneity of antigen-specific CD4+ T cell clones from a patient with Schistosomiasis mansoni

Two subsets of differentiated murine helper T cells, Th1 and Th2, based on secretion products in response to antigen have been described (Cher & Mosmann 1987, Coffman et al. 1988, Lopez et al. 1988, Paliard et al. 1988, Patel et al. 1988, Mosmann & Coffman 1989). To analyse immunological function of antigen-specific CD4+T cells in human schistosomiasis, we produced schistosomal egg antigen-specific T cell clones from a former patient. We identified four different types of CD4+ T cell clones by analysis of cytokine production. Two of the four types of the clones corresponded to murine Th1 or Th2 subsets; a third type was of the Th0 subset (Th1 + 2) and a fourth type produced IL-5 dissociated from IL-4. Analysis of the antigen(s) recognized by these T cell clones showed that all of the clones proliferated in response to soluble egg antigen(s) (SEA) found within a pl fraction whose pH was 5.2. T cell Western blot analysis of the stimulatory pl fraction demonstrated that the apparent Mr of the relevant antigens recognized by the clones were 38 kDa for the Th2 homologue, and 45-55 kDa for the Th1 homologue.

A comparison of the developing dopamine neuron phenotype in cultures of embryonic rat mesencephalon and hypothalamus

Development of the dopamine (DA) neuron phenotype was monitored in cultures of embryonic rat mesencephalon (MES) and hypothalamus (HYP) maintained for 1 to 21 days in vitro (DIV) in the absence of glial support cells. Cell counts following immunohistochemistry for tyrosine hydroxylase (TH) demonstrated that the number of DA neurons declined by 85% in MES cultures yet increased 5-fold in cultures of HYP, so that by 21 DIV equal numbers of DA neurons were present in these culture systems. After 21 DIV MES DA neurons exhibited a multipolar morphology, with numerous branching processes. HYP DA neurons were primarily fusiform in shape with fewer processes and process branch points. Double-label immunohistochemistry for TH and microtubule-associated protein 2 identified the majority of TH-positive processes in either culture system as dendrites. Individual MES but not HYP DA neurons were also found to generate axons. Western analysis showed that between 1 and 21 DIV the concentration of TH protein increased 2-fold in MES and 4-fold in HYP cultures. After 21 DIV the concentration of TH protein in MES cultures was twice that found in cultures of HYP. In the period between 1 and 21 DIV levels of tetrahydrobiopterin (BH4) increased by 6-fold in MES and 20-fold in HYP cultures. After 21 DIV BH4 content was 3-fold higher in HYP than in MES cultures. The abundance of the mRNA encoding for GTP cyclohydrolase I, the rate-limiting enzyme in BH4 biosynthesis, was similar in MES and HYP cultures despite this difference in BH4 levels. In contrast, TH mRNA was 4-fold more abundant in MES than in HYP cultures. Treatment of MES cultures with the DA neuron toxin 1-methyl-4-phenylpyridinium decreased DA cell numbers, TH protein content and BH4 levels, demonstrating that BH4 is localized primarily to DA neurons. Similar treatment of HYP cultures did not effect any of these parameters. Steady-state levels of DA and the rate of DA synthesis were both 3-fold higher in MES than in HYP cultures. A 95% decline in BH4 content produced by inhibiting BH4 biosynthesis resulted in 64% and 84% declines in the rate of MES and HYP DA synthesis, respectively. Overall, these observations indicate that, with the exception of the capacity to synthesize DA, DA neurons in MES and HYP cultures share few common properties.

Haemodynamic and haematologic effects of Acanthaster planci venom in dogs

This study was designed to examine haemodynamic and haematologic effects of the crown-of-thorns starfish venom (Acanthaster planci venom: APV) in dogs. Severe systemic hypotension, thrombocytopenia and leukopenia were induced by APV (1.0 mg protein/kg i.v.), followed by gradual return to the baseline level within 60 min. Hypotension was presumably caused by two factors: an early decrease in systemic vascular resistance and the large reduction in cardiac output due to reduced ventricular filling. Indomethacin, a cyclooxygenase inhibitor, remarkably suppressed systemic hypotension induced by APV. The peak reduction in systemic pressure was associated with concomitant rise of plasma 6-keto-PGF1 alpha, a major stable metabolite of prostacyclin. Thus, the hypotensive effect of APV may be caused primarily by prostacyclin and/or some vasodilating prostaglandins. In contrast, thrombocytopenia and leukopenia were not affected by cyclooxygenase inhibitor, 5-lipoxygenase inhibitor or platelet activating factor (PAF) receptor antagonist. When APV was administered repeatedly, tachyphylaxis was developed in haemodynamic effects, but not in haematologic effects. These findings suggest that APV-induced hypotensive effects may occur mainly through endogenous production of vasodilating prostaglandins including prostacyclin, although APV-induced thrombocytopenia and leukopenia may be caused by other mechanism(s) unrelated to arachidonate metabolites and/or PAF.

[Pathomechanism of juvenile muscular atrophy of unilateral upper extremity (Hirayama's disease)--extensibility and asymmetry of the cervical posterior dural wall]

We performed myelography in chin-up position during neck flexion in 20 patients with juvenile muscular atrophy of unilateral upper extremity, and we also performed CT-myelography in rotational position during neck flexion in 15 of them. In this disease, in which posterior lower cervical dural wall shifts anteriorly and compresses the spinal cord during neck flexion, we found that the anterior dural shift and cord compression became lessened by making chin-up without changing the position of neck flexion. By measuring the posterior dural length from foramen magnum to C6 vertebra on the profile of myelogram in neutral and neck flexion posture, we found that the posterior lower cervical dural wall of this disease was less extensible during neck flexion than that of control cases. On CT-myelogram the spinal cord compression of muscularly atrophic side increased by the neck rotation to the non-atrophic side during neck flexion, which is the position of maximum extension of posterior dural wall. The spinal cord compression decreased by the rotation to the atrophic side. We think that the low extensibility and asymmetry of posterior lower cervical dural wall may be the cause of this disease and its laterality may be relevant to unilaterality of this disease. These findings could also explain the efficacy of cervical immobilization by using cervical coller.

Confirmation of mutant alpha 1 Na,K-ATPase gene and transcript in Dahl salt-sensitive/JR rats

As the sole renal Na,K-ATPase isozyme, the alpha 1 Na,K-ATPase accounts for all active transport of Na+ throughout the nephron. This role in renal Na+ reabsorption and the primacy of the kidney in hypertension pathogenesis make it a logical candidate gene for salt-sensitive genetic hypertension. An adenine (A)1079-->thymine (T) transversion, resulting in the substitution of glutamine276 with leucine and associated with decreased net 86Rb+ (K+) influx, was identified in Dahl salt-sensitive/JR rat kidney alpha 1 Na,K-ATPase cDNA. However, because a Taq polymerase chain reaction amplification-based reanalysis did not detect the mutant T1079 but rather only the wild-type A1079 alpha 1 Na,K-ATPase allele in Dahl salt-sensitive rat genomic DNA, we reexamined alpha 1 Na,K-ATPase sequences using Taq polymerase error-independent amplification-based analyses of genomic DNA (by polymerase allele-specific amplification and ligase chain reaction analysis) and kidney RNA (by mRNA-specific thermostable reverse transcriptase-polymerase chain reaction analysis). We also performed modified 3' mismatched correction analysis of genomic DNA using an exonuclease-positive thermostable DNA polymerase. All the confirmatory test results were concordant, confirming the A1079-->T transversion in the Dahl salt-sensitive alpha 1 Na,K-ATPase allele and its transcript, as well as the wild-type A1079 sequence in the Dahl salt-resistant alpha 1 Na,K-ATPase allele and its transcript. Documentation of a consistent Taq polymerase error that selectively substituted A at T1079 (sense strand) was obtained from Taq polymerase chain reaction amplification and subsequent cycle sequencing of reconfirmed known Dahl salt-sensitive/JR rat mutant T1079 alpha 1 cDNA M13 subclones. This Taq polymerase error results in the reversion of mutant sequence back to the wild-type alpha 1 Na,K-ATPase sequence. This identifies a site- and nucleotide-specific Taq polymerase misincorporation, suggesting that a structural basis might underlie a predisposition to nonrandom Taq polymerase errors.

Acute effects of methylmercury on hepatic and renal glutathione metabolisms in mice

Because of its high affinity to the sulfhydryl group, the in vivo fate of methylmercury (MeHg) is closely related to the glutathione (GSH) metabolism. Here, to examine the possible effects of MeHg on the GSH metabolism, C57BL female mice were challenged by this heavy metal at a marginal dose level to induce slight renal dysfunction. Liver and blood GSH levels decreased by 16% and 20%, respectively, 24 h after MeHg (160 mumol/kg) administration, whereas kidney and plasma levels drastically increased. The GSH half-lives obtained using L-buthionine-(S,R)-sulfoximine were shortened by 17% in the liver, but lengthened by 28% in the kidney. The accelerated secretion of GSH from the liver and/or blood cells might have caused increased plasma levels of the tripeptide, which in turn could increase the supply of the constituent amino acids for GSH synthesis to the kidney. Furthermore, renal gamma-glutamylcysteine synthetase activity, a rate-determining enzyme in GSH biosynthesis, was found to be enhanced in the MeHg-treated group. The marked increase in the renal GSH levels induced by MeHg could be due to the increased synthesis and the decreased efflux of the tripeptide in this tissue. The MeHg-induced alterations of GSH metabolism described here might reflect one of the defense mechanisms of bioorganisms against the challenge by MeHg.

[Involuntary movements caused by thalamic lesion]

We described two types of involuntary movement accompanied with a well-located thalmaic lesion shown by MR imaging in five patients. All patients had the involuntary movements of an upper limb contralateral to the thalamic lesion. Two patients (1 and 2) had choreoathetosis that became most prominent when their index finger approached their nose, where irregular and dysynchronous oscillation occasionally superimposed. This choreoathetosis was differentiated from pseudoathetosis caused by disturbance of proprioceptive sensations. The MRI lesion was located at the middle level of thalamus including nucleus centromedianus. The other three patients (3, 4 and 5) had a regular and rhythmic oscillation in their forearm. The oscillation began to appear after their index finger reached their nose on finger-to-nose test. We considered the oscillation as a postural tremor based on its rhythmicity and regularity. Patient 4 had additional tremor in movement. Their postural tremor continued while the arm kept the position. Surface electromyogram showed the reciprocal discharges between the forearm extensor and flexor muscles with a frequency of 3 to 4 Hz. This tremor was not accentuated during limb movement toward the nose nor was coarse, and was distinguished from intention tremor described by Charcot and Dejerine. This tremor was also different from hyperkinesis volitionnelle and movement oppositionist. The "rubral tremor" differed from the tremor shown in our cases for a lack of resting tremor. The responsible lesion shown by MRI located at caudal posterior thalamus including pulvinar in patient 3, or located at the upper level of thalamus in patient 4 and case 5 that was more rostral than the lesion of the choreoathetosis cases. In cases of cerebrovascular accidents, both types of involuntary movement appeared after several months from the stroke. This delayed appearance suggests that these involuntary movements were the result not only of functional disturbance of thalamus, but of secondary repairing mechanism occurring at the lesion.

A new cancer-associated antigen defined by a monoclonal antibody against a synthetic carbohydrate chain

Carbohydrate antigens can be designed by referring to previously defined carbohydrate structures. We have generated a novel monoclonal antibody (MAb) (F1 alpha-75) against an artificially designed antigen (F1 alpha), using organic-synthetic chemistry methods and hybridoma technology. F1 alpha (Gal beta 1-->4GlcNAc beta 1-->6GalNAc alpha 1-->Ser/Thr) belongs to core type 6 of O-linked glycans, which has not been previously reported in human cancers. To produce antibodies against F1 alpha, a glycolipid was synthesized which carries the carbohydrate portion of F1 alpha on a ceramide foundation (Gal beta 1-->4GlcNAc beta 1-->6GalNAc alpha 1-->Cer). The MAbs we obtained (F1 alpha-75, F1 alpha-87) specifically recognized F1 alpha and had only a very weak or no cross-reactivity with other glycolipids similar to F1 alpha. We investigated the expression of F1 alpha in human tissues, including 110 gastric cancers, 73 colon cancers and 42 pancreatic cancers. F1 alpha was found in human cancerous tissues but not in normal adult tissues. The rate of positive staining with F1 alpha-75 was 80.0% for gastric cancer, 52.4% for pancreatic cancer and 38.4% for colon cancer. F1 alpha-75 also reacted with the tissues neighboring gastric and pancreatic tumors but not intensely. Among fetal tissues, F1 alpha-75 reacted with the pyloric glands of the stomach, the centro-acinar cells of the pancreas, the convoluted tubules of the kidney and the terminal bronchioles of the lung.

Astasia without abasia due to peripheral neuropathy

OBJECTIVE

To describe an unusual symptom characterized by an inability to stand still despite the ability to walk in eight patients with paraparesis due to peripheral neuropathy.

DESIGN

Case series during the past 18 years.

SETTING

Referral center.

PATIENTS

Six patients with acute or subacute polyneuropathies recovering from flaccid paralysis of the lower limbs and two patients with chronic progressive polyneuropathy for more than 10 years were studied. Weakness around the ankle joints was profound, while muscle strength around the hip joints was well recovered or preserved.

MAIN OUTCOME MEASURES

Standing and walking were recorded and reviewed on videotape or motion pictures. Spectral content of postural sway was analyzed in three recent cases.

RESULTS

The symptom was transient in acute or subacute cases and was continual in chronic cases. The patients were compelled to take a series of steps forward and backward while standing until they initiated locomotion. They swayed rapidly around the hip joints before stepping. The anteroposterior component of postural sway in three patients had frequency peaks around 1 Hz.

CONCLUSION

We have termed this symptom astasia without abasia, or stilts phenomenon, in which maintenance of the body mass depends on a moving base of support. Both an abnormal pattern of postural movements and defective somatosensory feedback for postural stabilization may be responsible for the symptom.

Fine antigen specificity of human gamma delta T cell lines (V gamma 9+) established by repetitive stimulation with a serotype (KTH-1) of a gram-positive bacterium, Streptococcus sanguis

We have established human gamma delta T cell lines specific for Streptococcus sanguis (S. sanguis) KTH-1 present in normal oral cavity flora. The CD4-CD8-CD3+V gamma 9+V delta 1-CD45RO+ CD25+ T cell lines showed a proliferative response to the streptococcal antigen (Ag) in the presence of autologous antigen-presenting cells without apparent evidence of HLA restriction. The proliferative response of the gamma delta T cell lines was completely blocked by anti-TcR gamma delta monoclonal antibody (mAb) and anti-HLA class I mAb (W6/32), whereas anti-HLA classical class Ia mAb (B-H9; anti-HLA-A,B,C), anti-HLA class II mAb (anti-DR, anti-DQ, and anti-DP) and anti-CD4 mAb did not have any inhibitory effects. Surprisingly, the gamma delta T cell lines showed the proliferative response against the original bacterial Ag KTH-1 exclusively, and exhibited no cross-reactivity with nominal Ag such as purified protein derivative of tuberculin, tetanus toxoid and Mycobacterium tuberculosis, or the same species but different strain of S. sanguis, American Type Culture Collection (ATCC) standard strain (10556), or even with the same strain but different serotype of S. sanguis, KTH-3. Moreover, cytokine production of the gamma delta T cell lines was similar to the Th1 pattern [interferon-gamma, tumor necrosis factor (TNF)-alpha and TNF-beta]. They also produced interleukin-8 that functions as one of chemoattractants for polymorphonuclear cells. Using direct sequencing technique of the polymerase chain reaction products, we found that junctional diversity of the T cell receptor (TcR) used by the parental KTH-1 specific gamma delta T cell line and its subclones is rather limited. It is suggested that gamma delta T cells with canonical TcR could preferentially respond to KTH-1 Ag. Thus, in addition to a broad or cross-reactivity of gamma delta T cells against phylogenetically conserved stress/heat-shock protein, which is well characterized by others, some peripheral blood gamma delta T cells could recognize and kill exogenous agents with fine antigenic specificity to protect the body against them.

Micturitional disturbance in human T-lymphotropic virus type-1-associated myelopathy

We reported the findings of micturitional histories and urodynamic studies in five patients with human T-lymphotropic virus type-1-associated myelopathy. Histories showed that all patients had obstructive as well as irritative micturitional symptoms, and four of their micturitional symptoms appeared from the onset of the disease. Urodynamic studies showed that four of them had residual urine (average 170 ml), all had detrusor hyperreflexia, two had detrusor-sphincter dyssynergia, and none had neurogenic changes in external urethral sphincter electromyography. Our findings of supranuclear type of voiding dysfunctions seemed to be in accordance with the known pathological lesions of this disease.

Effects of an N-methyl-D-aspartate antagonist and a GABAergic antagonist on entorhinal tetanic responses during the early stages of amygdala kindling in rats

Changes in synaptic potentials during each train stimulation (tetanic responses) have been suggested to intimately relate to the development of kindling. We examined the effects of an NMDA antagonist, carboxypiperazinephosphonate (CPP), and a GABAergic antagonist, picrotoxin, on entorhinal tetanic responses evoked by train stimuli (10 Hz, 100 pulses) at the developmental stage (seizure stage; 0-2) of amygdala kindling in conscious rats, to clarify the significance of facilitation in tetanic responses and the roles of NMDA and GABA receptors in the development of kindling. Facilitation of tetanic responses was noted as a progressive increase in both amplitude and duration of negative potentials in the tetanic responses, especially during the later half of train pulses (51-100). The negative potential area (mV x ms) of the averaged tetanic responses was used as an estimate of the magnitudes of excitatory synaptic activity in the tetanic responses, and correlated significantly (P < 0.001) with the duration of afterdischarges (AD). CPP (10 mg/kg) reversibly blocked AD in association with a significant decrease (P < 0.05) in the negative potential area. The CPP-sensitive component consisted of a slow negative potential with a duration longer than 60 ms and was greater in the later tetanic responses (51-100) than the earlier ones (1-50). Picrotoxin (2-3 mg/kg), which did not produce convulsions, significantly (P < 0.005) increased the negative potential area in the tetanic responses in association with a reversible decrease in the AD threshold. Although positive potentials ascribable to inhibitory synaptic activity were often negligible in the tetanic responses in controls, picrotoxin further decreased the positive potentials of tetanic responses, if any.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between a newly established pancreatic cystadenocarcinoma cell-line, ocup-1 and cells derived from pancreatic ductal carcinoma

The prognosis of pancreatic cystadenocarcinoma is known to be relatively favorable, unlike poor prognosis of the majority of pancreatic cancers. However, little is known about the pathogenesis and mode of progression of this cancer. We report on a newly established pancreatic cystadenocarcinoma cell line, OCUP-1. Its characteristics were compared to those of cells derived from pancreatic ductal cell carcinoma. OCUP-1 was established by successive culture of cancer cells obtained during an operation for pancreatic cystadenocarcinoma. This cell line demonstrated mono-layered proliferation and a doubling time of 80.3 h, which was 2.1 to 5.3 times longer than that of six ductal cell carcinoma-derived cell lines. Cell cycle time agreed with the doubling time. Tumors could be produced in all nude mice by inoculating cells from the 6 different ductal cell carcinoma derived cell lines without pre-treatment. However, with OCUP-1 cell line inoculation, the nude mice had to be pre-treated with asialo-GM1 - an inhibitor of natural killer cell activity - for tumors to be produced. Although the newly established OCUP-1 cell line demonstrated low proliferative activity, its genetic characteristics (point mutation at codon 12) were similar to those of other cells derived from ductal cell carcinomas. The OCUP-1 cell line may be used to investigate the pathogenesis and progression of pancreatic cystadenocarcinomas.

Reverse Shapiro's syndrome. A case of agenesis of corpus callosum associated with periodic hyperthermia

OBJECTIVE

Investigation of the mechanism of the idiopathic periodic hyperthermia associated with agenesis of the corpus callosum.

SETTING

Tertiary care referral center.

PATIENT

Fourteen-year-old girl who was the first case of reverse Shapiro's syndrome (ie, agenesis of the corpus callosum associated with periodic hyperthermia, as opposed to hypothermia as described in the original report by Shapiro et al).

INTERVENTION

Magnetic resonance imaging scans, endocrinological examinations for hypothalamus, electroencephalograms, and levodopa therapy.

MAIN OUTCOME MEASURE

Body temperature.

RESULT

No neurologic or physical abnormalities were noted beside the callosal agenesis. Neuroimaging examinations could not reveal any structural abnormality of the diencephalon. Endocrinological examinations and electroencephalograms were found to be normal. The hyperthermia returned to normal by a small dose of levodopa, but a larger dose reversed the hyperthermia to hypothermia.

CONCLUSIONS

These observations suggest that the hyperthermia observed in this case may have been caused by the dopaminergic denervation of the hypothalamic thermoregulatory center, resulting in the supersensitivity of its dopaminergic receptors.

A case of cerebral aneurysm associated with complex partial seizures

We report a 20-month-old girl with an unruptured aneurysm of the middle cerebral artery. The initial sign was complex partial seizures. Magnetic resonance angiography showed an aneurysm of the right middle cerebral artery. Cerebral angiography confirmed the presence of a saccular aneurysm. After 3 months, the aneurysm spontaneously thrombosed without neurological deficit. The seizures were controlled by anti-convulsants. The aneurysm was probably near the focus of the complex partial seizures. This is a rare case of a childhood cerebral artery aneurysm that first manifested itself by complex partial seizures.

Mechanism of methylmercury efflux from cultured astrocytes

To study the mechanism of methylmercury (MeHg) efflux from the central nervous system cells, cultured astroglia obtained from neonatal rats were incubated with 10 microM MeHg-cysteine (CySH) for 30 min. After being washed four times, cells were incubated in Hg-free medium, and the release of MeHg from the cells was monitored. The amount of MeHg released in the medium approached a plateau level (ca. 31% of the loaded amount) at 4 hr. Treatment of the cells with a CySH precursor, 2-oxothiazolidine-4-carboxylic acid (OTC), resulted in a significant increase of cellular levels of CySH and glutathione (GSH). OTC also increased 1.5-fold the MeHg efflux from the loaded cells. Another GSH enhancer, GSH isopropyl ester, also stimulated MeHg export from the cells. Ion-exchange column chromatography using DEAE-Sephadex revealed that the MeHg metabolite thus released was exclusively MeHg-GSH conjugate, both with and without OTC. Since the MeHg efflux was suppressed significantly by the presence of probenecid, the efflux occurred via the probenecid-sensitive organic acid transport system. Even though the cellular GSH levels were depleted drastically by treatment with L-buthionine-(S,R)-sulfoximine (BSO), a considerable level (90% of the control) of Hg efflux was detected. Since neither GSH- nor CySH-MeHg was detected in the culture medium of the BSO-treated cells, GSH depletion may trigger some other secretion system(s) in the cells. These results suggest that conjugation with GSH is the major pathway for MeHg efflux in rat astroglia, and that elevation in the cellular GSH level would possibly be a logical therapy for MeHg poisoning, promoting the accelerated elimination of MeHg from the critical tissues.

Regulation of tetrahydrobiopterin biosynthesis in cultured dopamine neurons by depolarization and cAMP

Primary cultures containing embryonic rat brain mesencephalic or hypothalamic dopamine neurons were used to examine the effects of membrane depolarization and elevations of cAMP levels on tetrahydrobiopterin cofactor content. Initial studies showed that 24-h incubations with 8-bromo-cAMP or isobutyl methylxanthine increased cofactor levels in either culture system, whereas the stimulatory effects of forskolin or depolarization of membrane potential were only observed in cultures of hypothalamus. 8-Bromo-cAMP was found to increase cofactor content in a concentration-dependent manner, with increases observed up to 5 mM. The time course of the effect of 8-bromo-cAMP was biphasic. Over the short term, an increase of 50% in cofactor content at 2 and 5 h was detected. Over the long term, by 24-48 h, cofactor levels increased by between 100% and 300%. Studies of cofactor turnover indicated that the long-term increase was due to stimulation of tetrahydrobiopterin biosynthesis with no alteration in degradation rate. Inhibitors of gene transcription and translation prevented the long- but not short-term increase in cofactor content. Levels of GTP cyclohydrolase I mRNA were increased 7-10-fold following 5 h of incubation with 8-bromo-cAMP. Tetrahydrobiopterin biosynthesis within cultured dopamine neurons of the hypothalamus and mesencephalon thus appears to be regulated by a cAMP-dependent mechanism involving enhanced gene expression of enzyme(s) involved in cofactor biosynthesis.

Spinocerebellar degenerations in Japan: a nationwide epidemiological and clinical study

A nationwide survey of patients in Japan with spinocerebellar degenerations (SCD), including SDS and SND, was conducted from 1988 to 1989. The survey consisted of two parts. The first revealed that the estimated total number of patients with SCD in Japan was 5,050 (range: 4,100-6,000) with an estimated prevalence of 4.53 per 100,000 in 1987. The second part investigated the neurological and functional status of patients with SCD. The percentages of those belonging to each subtype of SCD were: OPCA; 34.4%, LCCA; 15.2%, MHCA; 12.6%, HHCA; 7.5%, SDS; 7.0%, HSP; 3.9%, DRPLA; 2.5%, FA; 2.4%, MJD; 2.0% and SND; 1.5%. Compared with European epidemiological studies Japan had a higher proportion of non-hereditary types of SCD. Various clinical features of SCD subtypes were compared grouped by pathological lesion and heredity. HHCA and LCCA: cerebellar ataxia predominated in all stages, and neurological signs other than cerebellar ataxia were rare. MHCA, DRPLA and MJD: in the early phase ataxia was the most common symptom in MHCA, the AC form of DRPLA and MJD, but ataxia was less common and chorea or epilepsy were often observed in ME and PH forms of DRPLA. Other frequently observed clinical features were parkinsonian rigidity in MHCA, abnormal movements and posture in DRPLA and MJD, and disturbances of eye movements in MHCA, the AC form of DRPLA and MJD. OPCA, SDS and SND: dominant clinical features were cerebellar ataxia in OPCA, autonomic disturbance in SDS, and parkinsonian rigidity in SND. FA and HSP: both were rare in Japan. Clinical features related to supra-supinal lesions were frequently observed in FA. Functional status of SCD: the severity of illness was significantly associated with the level of independence in each item of ADL. Activities not requiring dynamic balance were performed independently for a longer period than those requiring dynamic balance. Among SCD subtypes, functional prognosis was poorest in non-hereditary, multi-systemic types (OPCA, SDS and SND) followed by hereditary multi-systemic types (MHCA, DRPLA and MJD), and better in spinal types (FA and HSP) and cerebellar types (HHCA and LCCA).

[Four cases of phrenic nerve paralysis following surgery of thoracic esophageal carcinoma]

Four cases of phrenic nerve paralysis (two cases in right side, two cases in bilateral side) were experienced after surgery of thoracic esophageal carcinoma with extended lymph node dissection in neck and upper mediastinum. In all of the four patients, phrenic nerve paralysis was indicated by difficulties in weaning the patients from respirator, and respiratory management was requiring so many effort that the periods under respirator were prolonged from 12 to 41 days, but all patients recovered from phrenic nerve paralysis with conservative therapy and discharged. Vital capacity of the four patients at more than one year after surgery reached more than 75% in three patients and about 65% in one patient in comparison with the preoperative vital capacity, respectively. Therefore, long term result of respiratory function of these patients was not worse than that of patients without phrenic nerve paralysis. Since phrenic nerve is located nearly at the range of lymph node dissection in neck and upper mediastinum, dissection in that range is considered to have relation to injury of the phrenic nerve, but the nerve was not thought to be transected in view of the clinical course of the four patients. Although phrenic nerve paralysis has not been reported as the complication of surgery of esophageal carcinoma, in our department from 1987 it was found in 1.9% of patients who underwent surgery of thoracic esophageal carcinoma and in 16% of patients who underwent extended lymph node dissection. These results suggest the importance of care for the phrenic nerve during surgery of esophageal carcinoma with extended lymph node dissection.

Loss of insulin receptor immunoreactivity from the substantia nigra pars compacta neurons in Parkinson's disease

Immunohistochemistry using both a newly developed polyclonal, and a commercially available monoclonal, anti-insulin receptor antibody was done on the midbrain from cases of idiopathic Parkinson's disease (PD), Alzheimer's disease, amyotrophic lateral sclerosis, vascular parkinsonism and non-neurological controls. Both antibodies gave identical patterns of neuronal staining. The neurons of the oculomotor nucleus were immunopositive in all the brains. However, the neurons in the pars compacta of the substantia nigra, paranigral nucleus, parabrachial pigmental nucleus, tegmental pedunculopontine nucleus, supratrocheal nucleus, cuneiform nucleus, subcuneiform nucleus and lemniscus medialis, which were positive in other diseases and in non-neurological controls, were not stained by these antibodies in PD brains. These results suggest that, in PD, a dysfunction of the insulin/insulin receptor system may precede death of the dopaminergic neurons.

[Strategic lymph node dissection for thoracic and abdominal esophageal carcinoma in relation to nodal metastasis and location of carcinoma--analysis of subgroups carcinoma location]

The range of lymph node dissection in 226 cases of thoracic and abdominal esophageal carcinoma was investigated with reference to the relation between nodal metastasis and location of carcinoma. Subgroups of Iu (the upper third), Im (the middle third) and E (the lower third of thoracic esophagus plus abdominal esophagus) were defined as localized Iu (n = 10) and IuIm (n = 7); ImIu (n = 21), localized Im (n = 66), ImE (n = 34) and extensive Im (n = 6); and EIm (n = 23) and localized E (n = 59). In cases of Iu, dissection of cervical and upper mediastinal nodes including subaortic nodes was important, because of the high incidence of metastasis to right recurrent nerve nodes and left paratracheal nodes. Dissection of middle mediastinal nodes was also necessary in the IuIm group. Nodal metastases in cases of Im covered in a wide range, but there were some differences in distribution of nodal involvement in the three subgroups. Cervical and upper mediastinal (including subaortic) nodes in the ImIu group, upper mediastinal (excluding subaortic) nodes in the localized Im group and celiac-axis nodes in ImE group were found to have a high incidence of metastasis, while right recurrent nerve nodes and middle and lower mediastinal and upper gastric nodes commonly showed a high metastatic rate in all subgroups. Dissection was found to be essential for this range of lymph nodes, especially, for right recurrent nerve nodes and upper gastric nodes regarded as being affected by metastasis at the early stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic significance of hst-1 gene amplification in primary esophageal carcinomas and its relationship to other prognostic factors

We studied hst-1 gene amplification in 50 primary human esophageal carcinomas using Southern blot analysis. We found 3- to 9-fold amplification of the hst-1 gene in 15 out of 50 (30.0%) DNA samples from primary tumors. There was no evidence of a correlation between hst-1 gene amplification and several prognostic factors other than the histological type; hst-1 gene amplification was more common in well differentiated squamous cell carcinoma. Survival rates for patients bearing tumors with and without hst-1 gene amplification were calculated by the Kaplan-Meier method and evaluated by the log-rank test. The survival curves for the two groups were almost identical. These results suggest that amplification of the hst-1 gene is a poor indicator of the prognosis of patients who have undergone surgery for primary esophageal carcinoma.