GABAergic inhibitory response of locus coeruleus neurons to caloric vestibular stimulation in rats

We examined the effects of caloric vestibular stimulation on the neuronal activity of the locus coeruleus (LC) in urethane-anesthetized rats. The middle ear cavity was irrigated with hot (44 degrees C) or cold (30 degrees C) water through a polyethylene tube. Most neurons (hot water: 76%, 55/72; cold water: 90%, 19/21) exhibited suppression of neuronal discharge in response to caloric stimulation. The suppression of LC neuronal discharge following caloric stimulation occurred with a long latency (approximately 80 s), and lasted a long period of time (approximately 3 min). Neither caloric stimulation of the auricle, nor irrigation of the middle ear with water at 37 degrees C, nor caloric stimulation of the middle ear after labyrinthectomy inhibited LC neuronal discharge. The caloric stimulation-induced LC neuronal inhibition was significantly attenuated by the intravenous injection of picrotoxin and by the iontophoretic application of bicuculline methiodide. These findings indicate that the predominant effect of caloric vestibular stimulation on LC neuronal discharge is inhibitory, and that the caloric stimulation-induced LC neuronal inhibition is mediated by GABAA receptors located on the membrane of LC neurons. It is suggested that the suppressed activity of noradrenergic LC neurons is involved in the vestibulo-autonomic reflex.

Effects of caloric vestibular stimulation on parietal and temporal blood flow in human brain: a consecutive technetium-99m-HMPAO spect study

The effects of caloric vestibular stimulation on regional cerebral blood flow (rCBF) of the parietal and temporal cortex were examined in 10 healthy volunteers. The consecutive 99mTe-hexamethyl-propyleneamine oxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) method with region of interest analysis was used. Changes in rCBF induced by caloric stimulation with cold air (25 degrees C) were evaluated in comparison with those induced by control stimulation with air at body temperature (37 degrees C). Caloric stimulation with cold air induced vertigo in 4 subjects, dizziness in 2, and no sensation of self-motion in the remaining 4 subjects, whereas, control stimulation did not induce the sensation of self-motion in any subject. Although both parietal and temporal rCBF were slightly decreased during caloric stimulation, a correlation could be established between the magnitude of left-right differences in change of parietal rCBF and the degree of self-motion perception induced by cold-air caloric stimulation, as compared to control stimulation. Left-right differences in change of parietal rCBF in subjects with vertigo during caloric stimulation were significantly higher than those in subjects without any sensation of self-motion. In contrast, there was no correlation between the magnitude of left-right difference in change of parietal rCBF and maximum slow phase eye velocity induced by caloric stimulation. These findings suggest that the parietal lobe is involved in the perception of vertigo due to vestibular stimulation, but not in the vestibulo-ocular reflex.

Case report: diabetic microangiopathic hemolytic anemia and thrombocytopenia with antiphospholipid syndrome

A 38 year-old man with a 12-year history of noninsulin-dependent diabetes mellitus with rapidly progressive diabetic complications presented with microangiopathic hemolytic anemia and thrombocytopenia. He had no disorders that could induce microangiopathic hemolytic anemia other than diabetic microangiopathy. In addition, there was a significant negative correlation between serum lactate dehydrogenase levels and peripheral platelet counts, which suggested that the hemolysis and thrombocytopenia occurred through the same mechanism. Activated partial thromboplastin time was slightly prolonged, and lupus anticoagulant and antiphospholipid immunoglobulin G antibodies were positive. Both the hemolysis and the thrombocytopenia spontaneously improved after the initiation of hemodialysis. This is a unique case of diabetic microangiopathic hemolytic anemia and thrombocytopenia in which antiphospholipid syndrome also may be involved.

[Three cases of Lermoyez's syndrome and its pathophysiology]

Two cases of bilateral Lermoyez's syndrome and one case of unilateral Lermoyez's syndrome are reported. The patients had recurrent episodes of vertigo with improvement of hearing or tinnitus, which is characteristic is Lermoyez's syndrome. In case 1, a 48-year-old female, dehydration with glycerol or furosemide induced nystagmus and improved bilateral hearing and the gain of the vestibulo-ocular reflex, while overhydration with drinking water impaired bilateral hearing with disappearance of nystagmus. These findings indicate that she had endolymphatic hydrops in both ears, suggesting that simultaneous changes in bilateral cochlear and vestibular function induce Lermoyez's syndrome. In case 3, a 52-year-old female, which we already reported, endolymphatic collapse in both ears may have changed bilateral inner ear function, resulting in Lermoyez's syndrome. On the other hand, patients 2, a 47-year-old male, experienced a vertigo attack with improvement of unilateral hearing after defibrinogenation therapy. In this case, slowly developing insufficiency of the inner ear blood supply may have caused the gradual hearing loss. It seemed that decreasing blood viscosity by defibrinogenation allowed blood to rush into the labyrinth, causing vertigo but at the same time improving hearing. We proposed that there are two types of Lermoyez's syndrome, bilateral (cases 1 and 3) and unilateral (case 2).

Sequence of alterations in subcellular organelles during the development of heart dysfunction in diabetes

Although changes in different subcellular organelles such as myofibrils, sarcoplasmic reticulum (SR), mitochondria and sarcolemma (SL), as well as in heart function have been reported to occur in chronic diabetes, their inter-relationships and functional significance are poorly understood. In order to gain information on this aspect, diabetes in rats was induced by an intravenous injection of streptozotocin and animals were assessed hemodynamically at 15-27 days. Ventricular tissue from several diabetic animals was pooled, subcellular organelles were isolated and their biochemical activities determined. Significant depressions in cardiac contractile and relaxation were observed to be associated with decreases in myofibrillar Ca(2+)-stimulated ATPase and SR Ca(2+)-pump activities at 21 days from the induction of diabetes. Likewise, the SL Na+-Ca2+ exchange and Ca(2+)-channel density were decreased at 21 days but the affinity of SL Ca(2+)-channels was increased in the diabetic heart. The SL Ca(2+)-pump and Na+-K+ ATPase activities were depressed at 18 and 24 days, respectively. Both alpha- and beta- adrenoceptor densities in SL were decreased at 27 days whereas no changes in mitochondrial function were observed at these early stages of diabetes. The SL low affinity Ca(2+)-binding was decreased while the low affinity Ca(2+)-ATPase activity was increased at 18 days following the induction of diabetes. These results indicate that SL defects precede those in SR, myofibrils or mitochondria and suggest that abnormalities in Ca(2+)-handling as well as interaction of Ca2+ with myofilaments in cardiomyocytes may lead to the development of heart dysfunction in chronic diabetes.

[A 32-year-old man who developed a posterior fossa mass 12 years after the radiation therapy for cerebellar arteriovenous malformation]

We report a 32-year-old man who developed cerebellar ataxia and a posterior fossa mass 12 years after the radiation therapy for a cerebellar arteriovenous malformation (AVM). The patient was well until 19 years of the age when he had an acute onset of vertigo and vomiting. A spinal tap was performed and the CSF was bloody. He was admitted to another hospital where an arteriovenous malformation was found in the cerebellum by angiography. Four years after the onset, he developed tingling sensation in the distribution of the second division of the right trigeminal nerve. He was admitted to the neurosurgery service of our hospital where the cerebellar AVM was confirmed. He was transferred to University of California where Bragg peak stereotaxic radiotherapy was successfully performed; this utilizes high energy alpha-ray produced by a cyclotron. Three years after the radiotherapy, marked reduction in the size of the AVM was confirmed by angiography. Twelve years after the onset of his initial symptom, he noted unsteadiness of gait. He was readmitted to our neurosurgery service where obstructive hydrocephalus was found. He was treated by ventriculoperitoneal shunting and placement of a Ommaya reservoir. After these therapy, he noted marked improvement in his gait and ataxia. However, in 1993, his unsteadiness of gait recurred, and he was again admitted to our neurosurgery service on June 20, 1993. On admission, T1-weighted MRI revealed a slightly low signal intensity mass lesion in the right cerebellar hemisphere compressing the brain stem; a spotty high signal intensity lesion and another small low intensity lesion were seen within the mass. Vertebro-basilar angiograms revealed upward displacement of the superior cerebellar arteries. No arteriovenous nidus was visualized. On July, 3rd, the cyst was surgically drained and the Ommaya reservoir was removed. Post-operative course was uneventful, however, he developed head tremor after the surgery. Neurologic examination on July 20, 1993 revealed an alert and well oriented man in no acute distress. General physical examination was unremarkable. Neurologic examination revealed no dementia; higher cerebral functions appeared intact. The optic discs were flat, and visual fields were intact. Ocular movements were full but convergence was restricted. Horizontal gaze nystagmus was noted more in the right lateral gaze. Pupils were intact. Facial sensation and facial muscles were intact. Hearing was normal. His voice was of nasal quality. Pharyngeal reflex was diminished. The tongue showed deviation to the left without atrophy. Head tremor at 5 c/s was noted. He was able to stand with support but was unable to walk. No muscle atrophy or weakness was noted. The finger-to-nose and the heel-to-knee tests showed dysmetria and decomposition more on the right. Rapid alternating movements were ataxic on the right. Muscle tone was diminished on the right. Muscle stretch reflexes were normally elicited and were symmetric. The plantar response was flexor bilaterally. Sensation was intact. On July 21, a posterior fossa exploration was performed. After the surgery, he was treated with 30 mg/day of alotinolol which showed no effect on his head tremor. He was then treated with gradually increasing doses of clonazepam; when he received 8 mg/day of clonazepam, his tremor showed marked improvement. He was discussed in a neurologic CPC on the nature of the posterior fossa lesion and his tremor. Opinions were divided between delayed radiation necrosis and a radiation-induced brain tumor. The chief discussant arrived at the conclusion that the patient had delayed radiation necrosis compressing the brain stem and cerebellar hemispheres. Regarding the nature of his tremor, he thought that his head tremor was of cerebellar type of postural tremor. Histologic examination of the biopsied specimen revealed accumulation of relatively fresh blood constituents in the deep area of the cerebellum forming a mass. Most of the

Effects of caloric vestibular stimulation on prepositus hypoglossi neurons in rats

In our previous study, we found that the majority of locus coeruleus (LC) neurons were inhibited by caloric stimulation and that the inhibition was mediated by gamma aminobutyric acid (GABAA) receptors. It has been reported that the nucleus prepositus hypoglossi (PrH) sends GABAergic inputs to the LC. In the present study, an attempt was made to determine whether PrH neurons contribute to the LC neuronal inhibition caused by caloric stimulation. We characterized the neuronal response in the PrH to caloric stimulation in rats. About three-fourths of PrH neurons showed various responses to both ipsi- and contralateral caloric stimulation, suggesting that PrH neurons receive bilateral vestibular inputs. However, these neurons were not activated by antidromic stimulation of the LC. The remaining one-fourth of the PrH neurons that were antidromically activated did not respond to caloric stimulation. Lesions in the PrH did not attenuate the LC neuronal inhibition caused by caloric stimulation. These findings suggest that the inhibition of LC neurons caused by caloric stimulation is not mediated by the PrH.

Influence of exercise and degenerative vertebral changes on BMD: a cross-sectional study in Japanese men

The effects of recreational exercise and milk intake on BMD were assessed in Japanese men using analysis of covariance with significant predictor variables, selected from age, height, body weight and body mass index (BMI), as covariates. The influence of degenerative vertebral changes on these effects was also evaluated. Recreational exercise was found to be positively associated with BMD at the lumbar spine and the femoral neck, whereas milk intake, a possible indicator of calcium intake in the Japanese, was positively associated with BMD at the radius and the lumbar spine. Not only vertebral BMD but also radial and femoral neck BMD was higher in the subjects with osteophytosis or sclerosis in the lumbar vertebrae. Neither exercise nor lumbar pain was significantly related to these vertebral changes. These data suggest a protective effect of regular recreational exercise and milk intake on bone health in Japanese men.

Neuropharmacological mechanisms of emesis. II. Effects of antiemetic drugs on cisplatin-induced pica in rats

The effects of diphenhydramine, domperidone, ondansetron, and diphenidol on cisplatin-induced pica (i.e., kaolin ingestion) in rats as the measure analogous to emesis in other species were examined. Ondansetron (2 mg/kg) and diphenidol (30 mg/kg) inhibited kaolin intake induced by cisplatin (10 mg/kg), but diphenhydramine and domperidone did not. Diphenhydramine and diphenidol have been shown to inhibit kaolin intake induced by double rotation, while domperidone and ondansetron did not, and kaolin intake induced by apomorphine was inhibited by domperidone and diphenidol, but not by diphenhydramine or ondansetron. These observations, together with the present findings, suggest that the emetic pathways through the inner ear (double rotation), chemoreceptor trigger zone (apomorphine) and visceral afferent (cisplatin), are pharmacologically independent and are mediated by histamine H1 receptors, dopamine D2 receptors and serotonin 5-HT3 receptors, respectively. It is conceivable that diphenidol may inhibit the emetic center itself, although the receptor on which it acts is not known.

[Seroepidemiology of human parvovirus B19 using recombinant VP1 + VP2 particle antigen]

Antibody prevalence to B19 virus in Japan was previously reported with 1973 and 1984 serum collections. Since then we have had two big epidemics of erythema infectiosum in Japan: 1986-87 and 1991-92. In an attempt to estimate how much those epidemics have affected seroprevalence to B19 virus infection, we studied seroepidemiology in three separate areas using a newly developed ELISA system consisting of recombinant VP1 + VP2 particle antigen. Total of 900 sera obtained in 1993 from healthy individuals living in northern, central and southwest parts of Japan were assayed for the presence of anti B19 IgG antibody. In the first, the new assay system was compared with our conventional assay system in which native B19 virus particles were used as antigen. Of 220 serum samples tested, 212 (96.4%) gave same results in both assays. Remaining 8 samples which gave variable results were those of near cut off values. We concluded that this new ELISA system can be recommended for seroepidemiological use. Antibody prevalence rates were 10% (0-4 y), 54% (5-9 y), 59% (10-14 y), 46% (15-19 Y), 38% (20-29 y), 48% (30-39 y), 64% (40-49y) and 76% (50 y-). No gender difference was observed. Comparison of antibody prevalences in 1973, 1984 and 1993 suggested that approximately 10% (about 8 million people) of the total population under 40 years of age acquired immunity to B19 virus during one epidemic period.

Molecular biological and quantitative abnormalities of ADP/ATP carrier protein in cardiomyopathic hamsters

The adenine nucleotide translocator or ADP/ATP carrier protein (AAC) is an integral protein present in the inner mitochondrial membrane, which performs the exchange of cytoplasmic and intramitochondrial ADP and ATP. The myocardial AAC content was studied in J-2-N cardiomyopathic hamsters. The AAC content was found to be significantly decreased in J-2-N hamsters. For molecular biological analysis, hamster AAC (T1 isoenzyme) cDNA was cloned by the plaque hybridization method. This AAC cDNA hybridized specifically with AAC mRNA, so RNA dot-blot hybridization was performed. The highest AAC mRNA level was observed in control hamsters followed by J-2-N hamsters with mild myocardial damage, J-2-N hamsters with severe myocardial damage and Bio 14-6 cardiomyopathic hamsters. These results suggest that a decreased AAC content may contribute to the pathogenesis of cardiomyopathy and that a decrease of AAC mRNA levels may explain the abnormalities of AAC in J-2-N cardiomyopathic hamsters.

Geographical heterogeneity between Far East and Europe in prevalence of ypm gene encoding the novel superantigen among Yersinia pseudotuberculosis strains

Yersinia pseudotuberculosis is known to produce a novel superantigen designated Y. pseudotuberculosis-derived mitogen. In the present study, we demonstrated that there was a distinct geographical heterogeneity between the Far East (higher prevalence) and Europe (lower prevalence) in the prevalence of the ypm gene encoding the superantigen among Y. pseudotuberculosis strains.

Effects of MK801 on Fos expression in the rat brainstem after unilateral labyrinthectomy

Unilateral labyrinthectomy (UL) causes ocular and postural asymmetries, which disappear over time in the processes of equilibrium recovery known as vestibular compensation. It has been reported that N-methyl-D-aspartate (NMDA) receptors are involved in vestibular compensation. In the present study, in order to elucidate the NMDA receptor-mediated neural circuit responsible for the development of vestibular compensation, we used Fos expression as a marker of neural activation and examined the effects of MK801, a specific antagonist of NMDA receptors, on UL-induced Fos expression in the rat brainstem. After UL, Fos-like immunoreactive (-LIR) neurons were observed in the ipsilateral medial vestibular nucleus (ipsi-MVe), the contralateral prepositus hypoglossal nucleus (contra-PrH) and the contralateral inferior olive beta subnucleus (contra-IOb). Fos-LIR neurons gradually disappeared in the processes of vestibular compensation. It is suggested that the activation of the ipsi-MVe, the contra-PrH and the contra-IOb neurons after UL are the initial event of vestibular compensation. Intraperitoneal injection of MK801 in the processes of vestibular compensation caused reappearance of UL-induced behavioral deficits. During the decompensation induced by MK801, Fos-LIR neurons appeared in the contra-MVe, the ipsi-PrH and the bilateral-IOB. It is suggested that the contra-MVe, the ipsi-PrH and the bilateral-IOb neurons are inhibited by glutamatergic synapses driving inhibitory neurons via NMDA receptors in the processes of vestibular compensation and that disinhibition of these nuclei induced by MK801 causes decompensation. However, MK801 caused neither Fos expression nor behavioral decompensation after vestibular compensation is accomplished. All these findings that the NMDA receptor-mediated inhibitory modulation in the central vestibular system plays an important role for the initial processes of the development of vestibular compensation.

Bufotenine reconsidered as a diagnostic indicator of psychiatric disorders

We have analyzed products of the serotonin-degradative pathway, in which both N-methylserotonin and bufotenine are formed in urine specimens of products with psychiatric disorders by three-dimensional HPLC with electrochemical detection. Bufotenine was detected in urine from all autistic patients with mental retardation and epilepsy (n = 18) and many autistic patients (32/47) with mental retardation. Bufotenine was detected in the urine of 15 of 18 patients with depression. Thirteen of 15 schizophrenic patients were also positive for bufotenine. N-methylserotonin was also detected in some cases of each disorder. Only two of 200 urine specimens from healthy controls were positive for bufotenine. Thus, the presence and levels of bufotenine might be useful and important markers of some psychiatric disorders.

Mesodermal defect in late phase of gastrulation by a targeted mutation of focal adhesion kinase, FAK

FAK is a unique non-receptor protein tyrosine kinase that was found in cellular focal adhesions. An increasing number of in vitro observations has suggested that FAK mediates signaling through integrins brought about by interactions with extracellular matrix (ECM). It is highly tyrosine-phosphorylated in v-src-transformed cells and during embryogenesis. To clarify the function of FAK in cell-ECM interactions, embryonic phenotype of its mutant was analysed. FAK-deficient embryos could implant and initiate gastrulation normally, but showed abnormalities in subsequent development. The abnormalities were characterized as a general deficiency in mesoderm, and the phenotype was quite similar to that caused by fibronectin-deficiency. The results suggest that FAK mediates fibronectin-integrin interactions uniquely at this stage of development, thereby playing an essential role in development of mesodermal cell lineages.

Neuropharmacological mechanisms of emesis. I. Effects of antiemetic drugs on motion- and apomorphine-induced pica in rats

The effects of diphenhydramine, domperidone, ondansetron, and diphenidol on motion- and apomorphine-induced pica (i.e., kaolin ingestion) in rats as the measure analogous to emesis in other species were examined. Diphenhydramine (10 and 20 mg/kg) and diphenidol (30 mg/kg) inhibited kaolin intake induced by 60-min double rotation, while domperidone and ondansetron did not. Kaolin intake induced by apomorphine (10 mg/kg) was inhibited by domperidone (2 mg/kg) and diphenidol (30 mg/kg), but not by diphenhydramine or ondansetron. These findings suggest that the emetic pathways through the inner ear (double rotation) and the chemoreceptor trigger zone (apomorphine) are pharmacologically independent and are mediated by histamine H1 receptors and dopamine D2 receptors, respectively. Diphenidol may inhibit a common locus of emesis.

Up-regulation of ferritin heavy chain mRNA expression in the rat skeletal muscle after denervation: detected by means of differential display

The differential display method was applied to identify gene expression, which is especially up-regulated in denervated skeletal muscle. Total RNA from normal and denervated rat facial muscles (muscles zygomaticus, levator nasolabialis and caninus) was isolated, amplified by polymerase chain reaction (PCR) using certain primers and separated by electrophoresis on a polyacrylamide gel. PCR products, the amounts of which were significantly higher in the operated side than in the control side, were cut out from the gel and sequenced. One of the cDNA fragments obtained in the present study showed 100% identity in nucleotide sequence to the rat ferritin heavy chain (FHC) mRNA. Northern blot analysis and in situ hybridization histochemistry confirmed that FHC mRNA expression was up-regulated after denervation and was distributed throughout whole muscle cell bodies. The biological damage attributed to superoxide and hydrogen peroxide is dependent on the presence of intracellular free iron. Intracellularly, most of the iron that is not metabolized is sequestered in ferritin as a crystalline core of ferric irons (Fe3+). These findings suggest that alterations in the ferritin subunit composition after denervation play an important role in iron metabolism in skeletal muscle cells, resulting in restriction of the biological tissue damage caused by reactive oxygen species.

Mouse Otx2 functions in the formation and patterning of rostral head

The anterior part of the vertebrate head expresses a group of homeo box genes in segmentally restricted patterns during embryogenesis. Among these, Otx2 expression covers the entire fore- and midbrains and takes place earliest. To examine its role in development of the rostral head, a mutation was introduced into this locus. The homozygous mutants did not develop structures anterior to rhombomere 3, indicating an essential role of Otx2 in the formation of the rostral head. In contrast, heterozygous mutants displayed craniofacial malformations designated as otocephaly; affected structures appeared to correspond to the most posterior and most anterior domains of Otx expression where Otx1 is not expressed. The homo- and heterozygous mutant phenotypes suggest Otx2 functions as a gap-like gene in the rostral head where Hox code is not present. The evolutionary significance of Otx2 mutant phenotypes was discussed for the innovation of the neurocranium and the jaw.

Reduced cell motility and enhanced focal adhesion contact formation in cells from FAK-deficient mice

The intracellular protein tyrosine kinase FAK (focal adhesion kinase) was originally identified gy its high level of tyrosine phosphorylation in v-src-transformed cells. FAK is also highly phosphorylated during early development. In cultured cells it is localized to focal adhesion contacts and becomes phosphorylated and activated in response to integrin-mediated binding of cells to the extracellular matrix, suggesting an important role in cell adhesion and/or migration. We have generated FAK-deficient mice by gene targeting to examine the role of FAK during development. Mutant embryos displayed a general defect of mesoderm development, and cells from these embryos had reduced mobility in vitro. Surprisingly, the number of focal adhesions was increased in FAK-deficient cells, suggesting that FAK may be involved in the turnover of focal adhesion contacts during cell migration.

Urinary excretion of type I collagen crosslinked N-telopeptides in healthy Japanese adults: age- and sex-related changes and reference limits

A new immunoassay for measuring urinary excretion of type I collagen crosslinked N-telopeptides (NTx) has been reported to be a specific and sensitive method for assessing bone resorption. We have studied factors affecting biological variations in urinary NTx excretion in a population of 452 healthy Japanese adults, comprising 238 men and 214 women, 20-79 years of age. Urinary NTx excretion increased significantly with age in women (> or = 25 years of age) (r = 0.55, p < 0.0001) and modestly correlated with lumbar bone mineral density (L-BMD) in both sexes (> or = 25 years of age) (r = 0.31, p < 0.0001 for men; r = 0.50, p < 0.0001 for women). Urinary NTx levels in women were significantly higher than in the corresponding male age groups after the fifth decade (p < 0.0001). None of the anthropometric variables (weight, height, and body mass index) showed a linear effect on the urinary NTx excretion independent of age and L-BMD. In women, menopause was reflected by a twofold increase in urinary NTx excretion, from a mean of 28-59 pmol bone collagen equivalents (BCE)/mumol creatinine, and this menopause-related increase persisted for the entire postmenopausal period. In postmenopausal women, the interindividual variations of urinary NTx excretion were much more marked than in men and in premenopausal women. Moreover, in the subgroups of pre- and postmenopausal women, urinary NTx excretion correlated with neither age nor L-BMD. These data show that the major biological factor that modifies urinary NTx level is menopause and suggest that the bone turnover rates in the elderly women are increased, on average, irrespective of bone mineral density.

[A clinical study of six cases of toxic shock-like syndrome by group A Streptococcus]

We have encountered six cases with toxic shock-like syndrome (TSLS) by Group A Streptococcus since 1978. Every patient had from the onset flu-like symptoms or high fever and immediately developed some of the following clinical signs: hypotension, acute renal failure, disseminated intravascular coagulation (DIC), and adult respiratory distress syndrome (ARDS). Three of the six patients died with rapid clinical courses and three survived. As for the surviving patients, early administration of antibiotics and anti-DIC therapy were effective. Streptococcus pyogenes were isolated from the blood in five of the patients, ascites from another, and necrotizing tissue in one patient. The serovars of the isolated strains were typed as T1/M1 in three, T8 in one, and T28 in another. The toxin-type of the strains were typed as B in four and B + C in one. Though there have been few reports of TSLS before 1992 in Japan, it is supposed that many TSLS cases may have potentially occurred.