Morphometry of intramuscular nerves in amyotrophic lateral sclerosis

Morphometric analysis of 90 intramuscular nerves from the biopsied biceps muscles of 16 cases of amyotrophic lateral sclerosis (ALS) were done and compared with controls. In all fascicles (large and small) of ALS, the total number and the numbers of large and small myelinated fibers were significantly reduced to 52, 16, and 64% of controls, respectively. A histogram of the largest fascicles revealed a unimodal distribution and a shift to the left, showing a single peak at 1 micron diameter. The results indicate proximal and distal involvement of the most remote portions of the nerves to the muscle in ALS and support previous suggestions of a neuronopathy.

HLA haplotype-linked high immune responsiveness against HTLV-I in HTLV-I-associated myelopathy: comparison with adult T-cell leukemia/lymphoma

HLA haplotypes of 27 patients with human T-lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM) and 12 patients with adult T-cell leukemia/lymphoma (ATLL) were examined by analyzing HLA types of the patients and their family members. Either A11Bw54Cw1DR4DQw3, A24Bw54Cw1DR4DQ-, A24B7Cw7DR1DQw1, or A24Bw52Cw-DR2DQw1 and the related haplotypes were found in 70% of cases with HAM. None of these "HAM-associated" haplotypes was found in patients with ATLL. HLA haplotypes made up of HLA components of A26Bw62Cw3DR5DQw3 and one particular haplotype of Aw33B44Cw-DRw6DQw1 were associated with the ATLL haplotypes. These "ATLL-associated" haplotypes were also found in the patients with HAM who had no previous history of blood transfusion. The in vitro cultures of peripheral blood lymphocytes with HTLV-I virion antigens revealed that the response with HAM peripheral blood lymphocytes was remarkably higher than that with ATLL peripheral blood lymphocytes. Based on this HTLV-I-specific immune responsiveness, we can segregate the high responders in HAM (14 of 16 cases) and the low responders in ATLL (6 of 7 cases). The existence of high and low responders was also confirmed by the normal healthy individuals, whose responses were segregated with HAM-associated and ATLL-associated haplotypes. These results suggested that two ethnic groups in southern Kyushu may get the two different diseases, HAM and ATLL, because of their different immunogenetic backgrounds. The high immune response to HTLV-I seems to be an important genetic factor in the development of HAM.

Sural nerve morphology in asymptomatic uremia

This study evaluates morphologically the sural nerves of two patients with acute and another pair with chronic uremia, both of whom had neither clinical nor electrophysiologic evidence of neuropathy. Morphometric changes indicative of myelin repair were noted in the chronic uremic case who had a shorter duration of renal failure but required dialysis. Also, changes suggestive of axonal degeneration were found in the case who had chronic uremia of long duration. Both cases of acute uremia did not reveal significant abnormalities. Structural changes in the sural nerves may precede clinical and nerve conduction derangements in uremia, specifically in chronic cases.

Immunological studies of HTLV-I associated myelopathy

We report the immunological studies of 50 cases with a chronic progressive myelopathy associated with elevated antibodies to human T-cell lymphotropic virus type I (HTLV-I) and adult T-cell leukemia-like cells (HAM). These are as follows: (1) T-cell activation; (2) increase of the OKT4/OKT8 ratio, due mostly to increased inducer/helper T cells and/or decreased suppressor/cytotoxic T cells; (3) decrease of natural killer cell numbers and activity; and (4) increase of immunoglobulins (IgG, IgA). Our results provide evidence that autoimmune events may participate in the pathogenesis of HAM and may be relevant in the hypothesis of common immune mechanisms between HAM and HTLV-I positive tropical spastic paraparesis.

Waardenburg syndrome: a variant with neurological involvement

A case of a variant of Waardenburg syndrome is reported. A 13-year-old boy with features of Waardenburg syndrome consisting of facial anomalies, heterochromia of the iris and fundus, and congenital sensorineural deafness had a marked mental and motor retardation and developed severe gait disturbance associated with neurological abnormalities including dystonia, muscular stiffness and peripheral neuropathy. Sural nerve biopsy revealed 'onion bulb' formation.

[HTLV-I-associated myelopathy]

Following our proposal of a new clinical entity, HTLV-I-associated myelopathy (HAM), at least 270 cases have now been diagnosed in Japan. The geographical distribution resembles that of adult T-cell leukemia-lymphoma. Our laboratory has now identified 85 cases (27 males and 58 females aged 18-75 [mean 52] yrs. with age at onset 6-75 [mean 37] yrs.). The illness duration ranged from 4 mos. to 55 yrs. (mean 15.6 yrs.). Of the 85 cases, 81 lived in Kagoshima, where about 16% of the population have HTLV-I antibodies. Previously, we recognized a subgroup of cases who had frequent histories of blood transfusion, and from our recent data, 18 (21%) had the same history. The group with no history of transfusion was younger at onset of HAM (33 [SD 18] yrs. vs 49 [12] yrs.; p less than 0.05). From the latter, we have also recognized another subgroup consisting of 6 young cases (under 15 yrs.) whose mothers were positive for HTLV-I antibody titer. This group has been labeled mother-to-child or vertical transmission. Notably, the progression of symptoms was slower in the vertically transmitted group when compared to the group with a history of transfusion. We also reported the effectiveness of corticosteroids in 4 HAM cases and from the present data, 65 cases have been followed up for treatment response. Based on a 14-grade disability scoring, excellent response was noted in 20%, good in 37%, fair in 34% and no response in 9% of the total 65 cases. Compared with the vertically transmitted group, the group a history of blood transfusion appeared to have a better response to corticosteroids.

Normal sural nerve morphometry in acute uraemia

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Leber's hereditary optic neuropathy: mitochondrial and biochemical studies on muscle biopsies

Two patients with Leber's hereditary optic neuropathy underwent morphological and biochemical investigations of muscle biopsy samples from the biceps brachii. Although clinically there was no muscle weakness or atrophy, specific histochemical and electron microscopic examinations showed mild but distinct myopathic changes, including abnormal oxidative enzyme activities, aggregates of enlarged mitochondria in the subsarcolemmal regions, and disruptions of myofilaments. Biochemical analyses of mitochondria isolated from muscle samples did not show and deficiency in respiratory-chain enzyme complexes or defect in content of cytochromes. Leber's hereditary optic neuropathy is assumed to be a multisystem disorder involving skeletal muscle also.

[Clinical and myopathological findings in polymyositis]

The present report analyzed a clinical and myopathological findings of 60 patients defined for the diagnosis of polymyositis. Patients were classified in four groups according to the system Walton and Adams. Forty five per cent were classified as Group I, 28.3 per cent as Group II, 15.0 per cent as Group III and 11.7 per cent as Group IV. Seven patients were associated with a malignant neoplasm and all of them were over fifty. The primary growth was carcinoma of the lung in 2, of the prostate, ovarium, stomach in one case each, and in one case a chronic myelogenous leukemia and in one case a malignant lymphoma. The female to male ratio was 2:1. Though cases were seen in all age groups, the largest number was in the sixth decade. The presenting symptoms and signs were essentially similar to those reported before. Proximal lower and upper limb weakness was the most frequent symptoms (91.7 and 83.3 per cent respectively). Other characteristic symptoms were skin changes, muscle pain, arthralgia and Raynaud's phenomenon. The CK was measured at the time of presentation in 58 of the 60 cases. Normal values were found in 18.3 per cent of cases. In general, muscle biopsy was performed in the first stage of the disease. A diagnostically abnormal biopsy was 55 cases (92 per cent), but 8 per cent of cases had normal biopsy. The characteristic changes in the biopsies from 60 cases were muscle fiber necrosis, inflammatory infiltration, fibrosis, basophilia and increase of internal nuclei. We could not get a significant difference between the two groups. However all of the cases of Group IV had muscle fiber necrosis, inflammatory infiltration and fibrosis.

Clinical electrophysiologic studies of HTLV-I-associated myelopathy

Six patients with human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM) were studied by electrophysiologic methods. Upper-limb short-latency somatosensory evoked potentials showed slight delay of the N9-N20 interpeak latency in one of 12 limbs, while the lower-limb short-latency somatosensory evoked potentials showed prolonged N20-P40 interpeak latency in eight of 12 limbs. Frequent polyphasic potentials and occasional giant spikes were observed in the distal extremities. F-wave conduction velocity was delayed in some patients. Results of the other nerve conduction studies were unremarkable. Our data provide a valuable extension of the clinical examination of HAM and offer encouragement for a more extensive electrophysiologic study of this entity, especially in the spinal cord.

Chronic progressive myelopathy associated with elevated antibodies to human T-lymphotropic virus type I and adult T-cell leukemialike cells

Six adult patients had a chronic progressive myelopathy that possessed the following features: high antibody titers to human T-lymphotropic virus type I (HTLV-I) in serum and cerebrospinal fluid (CSF); predominantly upper motor neuron disorder, symmetrical, with mild sensory and bladder disturbances; and presence of adult T-cell leukemia-like cells in both peripheral blood and CSF. We refer to this entity as HTLV-I-associated myelopathy (HAM). Electrophoretic studies of immunoglobulin G in CSF using Western blot analysis characteristically demonstrated p24 and p32 bands. Rates of intra-blood-brain barrier synthesis were determined and found increased in the patients with HAM. Corticosteroid treatment produced clinical improvement in all of 4 patients. A retrospective survey of CSF samples was carried out in 287 patients with neurological disorders, and 6 additional patients with HAM were identified.

Canine storage disease characterized by hereditary progressive neurogenic muscular atrophy: breeding experiments and clinical manifestation

Progressive neurogenic muscular atrophy due to storage of a compound lipid in the lower motor neurons was diagnosed in 3 English Pointers that were littermates. Using 2 clinically normal littermates of these 3 affected dogs and 2 clinically normal dogs of the 2nd litter from the parents of the original 3 affected dogs as the initial breeding stock, a breeding experiment was performed, resulting in a breeding line of 26 dogs, 4 of which had the disease and 6 of which died before 3 months of age. Results indicated that the disease may have an autosomal recessive mode of inheritance. The clinical manifestation and electrophysiologic findings indicated lower motor neuron involvement in the affected dogs produced by breeding consistent with findings in the original 3 affected dogs. Upper motor neurons or the sensory system was not involved. The disease appeared to be distinct from other canine storage diseases previously reported.

Cardiac involvement in congenital myopathy

We examined cardiac changes in 8 patients (4 men and 4 women, age 21-43 years) with congenital myopathy proven by skeletal muscle biopsy. Of 8 patients, 4 showed cardiac changes, including 1 with cytoplasmic body myopathy (patient 1), 2 with minimal change myopathy (patients 2 and 3) and 1 with nemaline myopathy (patient 4). Patients 1 and 2 showed left ventricular dilatation with severe global hypokinesis of left ventricular wall. These clinical features were quite similar to those of dilated cardiomyopathy and the patients were in NYHA class 3 or 4. Patient 3 had severe mitral regurgitation with mitral valve prolapse. This patient also had a persistent left superior vena cava and hypoplasia of the aorta, and her cardiac function was in NYHA class 3. Patient 4 showed moderate global left ventricular hypokinesis but the left ventricle was not dilated. This patient also had sino-atrial block and type A Wolff-Parkinson-White syndrome. His cardiac function was NYHA class 1. In conclusion, various types of congenital myopathy are associated with cardiac changes which can result in severe congestive heart failure.

Neutral oligosaccharides in the urine of a patient with glycogen storage disease type II

Neutral oligosaccharides were isolated from urine of an adult patient with glycogen storage disease type II, a deficiency of lysosomal acid alpha-glucosidase, by chromatography on columns of activated charcoal, Dowex 50 X 2 and Dowex 1 X 2. Total neutral oligosaccharides in the urine of the patient were increased about 5-fold as compared with those in normal controls. The most accumulated oligosaccharide was separated by Bio-Gel P-2 column chromatography, and finally purified by paper chromatography. Based on various studies, including carbohydrate analysis, chemical ionization mass spectrometry, fast atom bombardment mass spectrometry, degradation by glucoamylase and isopullulanase, and methylation analysis, the structure of this oligosaccharide was deduced to be Glc alpha 1----6Glc alpha 1----4Glc alpha 1----4Glc. This oligosaccharide appears to be accumulated in urine of the patient with acid alpha-glucosidase deficiency as an end product of the hydrolysis of glycogen.

Schwartz-Jampel syndrome associated with von Willebrand's disease

We report a very rare case of Schwartz-Jampel syndrome associated with von Willebrand's disease. This association might be coincidental because of the different modes of inheritance of the two disorders. However, we speculate that there might be some link between the two disorders, for example in the locus of the affected gene.

Morphometric analysis of intramuscular nerves

Intramuscular nerves were obtained at autopsy from five adult controls and were morphometrically analyzed. The number of myelinated fibers was directly proportional to the diameter of the fascicles. The fascicles were grouped into six sizes according to diameter. For each group, the normal range of distribution of the number of myelinated fibers could be estimated. Fiber size distribution and myelinated fiber density were also calculated. A unimodal fiber size distribution was observed for the small fascicles (less than 50 microns in diameter), and a bimodal pattern was observed for the large fascicles. Total myelinated fiber density was high in the small fascicles, and it decreased as the fascicles became larger in size, approaching the values observed in the large peripheral nerves. This study will be helpful in objectively evaluating morphological changes of intramuscular nerves in adult neuromuscular disorders.

High CSF lactate and pyruvate content in Kearns-Sayre syndrome

We studied lactate and pyruvate concentrations in CSF and blood of a patient with Kearns-Sayre syndrome (KSS), 3 patients with ocular myopathy and 11 normal control subjects. We found significant elevation of lactate and pyruvate in the CSF of the patient with KSS, suggesting a disorder of CNS lactate-pyruvate metabolism.

Mitochondrial encephalomyopathy with lactate-pyruvate elevation and brain infarctions

We studied a patient with somatic growth failure with easy fatigability, myopathy with mitochondrial abnormality, increased lactate and pyruvate in blood and CSF, mental retardation, seizure, myoclonus, deafness, cerebellar ataxia, and blindness with macular degeneration and optic atrophy. Pathologic findings included multiple brain infarctions and massive calcification in the basal ganglia. Biochemical studies of isolated mitochondria revealed decreased oxygen consumption in skeletal muscle, diaphragm, and brain, suggesting an abnormality in the respiratory chain.