Computed tomography in congenital ocular motor apraxia

Unusual computed tomographic findings were observed in four patients with congenital ocular motor apraxia (COMA). These (CT) findings were characteristic in the posterior cranial fossa, with a dilated or deformed shape and size of the fourth ventricle, particularly its upper portion. One case revealed partial agenesis of the cerebellar vermis. It was suggested that the four patients subjected to CT showed abnormal topography of the cerebellar vermis or the brain stem. We postulate that these CT findings in COMA may have an important role in its pathogenesis.

[Effect of bestatin on immuno-suppressive acidic protein in patients with stomach cancer]

Serum immuno-suppressive acidic protein (IAP) levels increased with the invasion of cancer in to the gastric wall, the progress of lymph nodes metastasis, and also with the increase of tumor diameter of the gastric mucosa. The immunopotentiator, Bestatin was administered for 7 days to 28 patients with gastric cancer before any other therapeutic treatment. high IAP levels (over 500 micrograms/ml) in patients with stage IV cancer were remarkably improved with this treatment.

Intranuclear defect in beta-globin mRNA accumulation due to a premature translation termination codon

We have analyzed a cloned beta O-thalassemia (beta O-thal) gene from a patient doubly heterozygous for hemoglobin Lepore and beta O-thalassemia. Studies of 3H-uridine incorporation into beta-globin mRNA in this patient's erythroblasts suggested an intranuclear defect in both beta and Lepore (delta beta) mRNA synthesis, as did S1 nuclease analysis of nuclear RNA. However, the nucleotide sequence of the beta O-thal gene revealed only a single base change in codon 39 (CAG----UAG), which created a premature translation termination codon. The 5' flanking sequence, including transcription promotor boxes and the mRNA initiation (CAP) site, were normal. The unexpected effect of this mutation on intranuclear beta-mRNA synthesis in vivo was studied by insertion of the cloned gene into a plasmid expression vector and transfection into tissue culture (COS-1) cells. beta-Globin mRNA produced by the transfected cells was assessed by S1 nuclease analysis. The beta O-39 thalassemia gene generated five- to tenfold less beta-mRNA than a normal beta-gene in both nuclear and cytoplasmic RNA, simulating the results observed in vivo. Moreover, the small amount of beta O-39 mRNA produced was as stable as normal beta-mRNA during an actinomycin D chase, ruling out rapid cytoplasmic turnover as a cause of the reduced accumulation. Cotransfection of the beta O-39 thalassemia gene with a mutant tyrosine suppressor tRNA gene resulted in restoration of the beta O-39 mRNA accumulation to near-normal levels. On the basis of these results, we suggest that the low levels of beta-mRNA known to exist in the common form of beta O-thalassemia, beta O-39 thalassemia, result from a lesion in transcription, or early posttranscriptional processes; the defect appears to be corrected by restoration of proper translational potential to the mutant mRNA, at least in a gene transfer-expression system in tissue-culture cells.

Fibroblasts from patients with myotonic muscular dystrophy: cholesterol requirement for proliferation and sensitivity to polyene antibiotics

The genetic defect in myotonic muscular dystrophy (MMD) remains obscure. From the evidence that drugs blocking cholesterol biosynthesis induce myotonia and increased serum concentrations of deoxycholic acids are common among patients with MMD, evidence of the abnormal sterol metabolism in MMD fibroblasts was sought by comparing them with fibroblasts from control individuals and patients with Duchenne muscular dystrophy (DMD). Although early-onset type MMD and DMD fibroblasts have lower maximal cell densities than fibroblasts from age-matched control individuals do in medium containing 10% fetal bovine serum, we could not reveal any abnormalities in exogeneous cholesterol requirements for proliferation of MMD fibroblasts. This suggests that the sterol biosynthetic pathway in MMD fibroblasts is grossly intact. Furthermore, no difference were observed in sensitivities to polyene antibiotics, which bind to membrane sterols and presumably damage the cell membrane.

Methylation of erythrocyte membrane phospholipid in patients with early-onset myotonic dystrophy

Methylation of erythrocyte membranes was compared in 10 patients with myotonic dystrophy (MyD) and sex- and age-matched healthy controls. The incorporation of 3H-methyl groups into phosphatidylcholine (PC) increased with age in the controls. In all 5 patients with early-onset MyD, 3H-methyl incorporation into PC was significantly higher than in sex- and age-matched controls. In contrast, 5 patients with adult form MyD showed incorporation rates into PC that were not significantly different from the controls. Our findings may confirm the presence of differences in the methylation of cellular membranes in MyD patients with the adult- and early-onset forms of the disease.

Intracranial hemorrhage in the full-term neonate and young infant: correlation of the location and outcome

The cranial computed tomography (CT) and outcome for 13 full-term neonates and 12 young infants with intracranial hemorrhage (ICH) were studied. The full-term neonates had perinatal asphyxia or neurological signs such as seizures. All infants were breast-fed and showed bleeding diathesis. In the full-term neonates there was a high incidence of intraventricular hemorrhage (IVH) and hemorrhage around the falx. The location of the hemorrhage on CT and brain pathology suggested that the original site of IVH might be the choroid plexus vessels in the lateral ventricle or in the subependymal layer. On the other hand, the sites of ICH in infants were multifocal compared with those in full-term neonates. Subdural hemorrhage (SDH) was seen more frequently and IVH less frequently in infants than in full-term neonates. The cases with SDH frequently showed accompanying cerebral infarction followed by porencephaly. Thus, SDH with cerebral low density on CT may predict a poor prognosis.

Computed tomography in Krabbe's disease: comparison with neuropathology

We report computed tomography (CT) appearance of two patients with Krabbe's disease. The most common findings included severe brain atrophy: an enlarged frontal extracerebral space, dilatation of ventricles, enlarged cisterns and enlarged cortical sulci. There was low attenuation in the corpus medullaris of the cerebellum, and symmetrical focal hypodensity in the central periventricular white matter. CT at the terminal stage (16 months) showed marked cerebral atrophy including flattening of the heads of caudate nuclei and widening of the third ventricles confirmed by a neuropathological study. There was relatively less low density on the white matter of Krabbe's disease compared with that of other leukodystrophies. These CT findings may be useful in the diagnosis. The relative lack of low density in the white matter of Krabbe's disease might be related to severe gliosis and reduced total lipid contents.

[Histopathological evaluation of minute stomach cancer]

We histologically examined 17 lesions from minute gastric cancer (less than 5 mm in diameter). Flat or IIb type was frequently seen in minute cancer (47%); the depressed type was predominant in ordinary early gastric cancer (72%). Differentiated adenocarcinoma was noted more often in minute cancer (88%) than in ordinary early gastric cancer (61%) or advanced cancer (45%). Differentiated type minute cancer was frequently associated with severe atrophic gastritis (93%) and intestinal metaplasia (73%). There was no evidence for the preexistence of chronic peptic ulcer, because no fibrosis was present in the gastric wall beneath the minute cancerous lesions.

Cerebral blood flow velocities in postasphyxial term neonates

Blood flow velocities of the anterior cerebral artery and right radial artery were studied in 15 postasphyxial term neonates using a continuous waveform bidirectional Doppler Pulsatility index (PI) values of most mild asphyxic infants were within the normal range. However, the infants with anoxic encephalopathy showed high or low PI values. The minimal flow velocities of the right radial artery (RRA) showed markedly retrograde flow velocity shortly after birth in comparison with those of the controls. The high PI values may be mainly due to a marked decrease of diastolic flow velocity representing retrograde flow in RRA. The low PI values indicated the poor prognosis in the postasphyxial infants. In low PI cases the cerebrovascular autoregulation may be presumed to be impaired, and arterioles to be markedly dilated.

Low serum cholic acid concentration of Duchenne muscular dystrophy

Serum bile acids of 15 patients with Duchenne muscular dystrophy (DMD) were analyzed by gas-liquid chromatography. The serum cholic acid values were unusually low (0.16 +/- 0.13 microM), even less than 0.01 microgram/ml in 4, compared with controls (1.47 +/- 0.17 microM). HDL-cholesterol was within normal limits. The low concentration of serum cholic acid may be causative of abnormal calcium mobilization in DMD. The intracellular calcium mobilization seems to be affected by serum cholic acid as indicated by the enhanced rate of loss of intracellular calcium from the muscle exposed to cholic acid, which acts as a calcium-ionophore and reversibly forms soluble complexes with calcium ions.

Postnatal changes of cerebral blood flow velocity in normal term neonates

Postnatal changes of cerebral blood flow velocity were studied in 43 healthy term neonates using a continuous waveform bidirectional Doppler flowmeter and an ultrasonograph with a pulsed Doppler unit. Pulsatility Index (PI) values of anterior cerebral artery were high within 6 hours after birth, and then decreased in the neonates born by means of both vaginal delivery and caesarean section. These postnatal changes of PI observed with the continuous waveform bidirectional Doppler flowmeter were identical with those with pulsed Doppler technique. The sequential measurement of right radial artery blood flow showed a marked decrease of diastolic flow velocity, which may be due to transient postnatal patent ductus arteriosus. Therefore, this postnatal transient patent ductus arteriosus may be one of the pathogenetic factors for high PI values shortly after birth.

Acute hemiplegia with lacunar infarct after varicella infection in childhood

We report 4 cases of acute hemiplegia and a small low-density lesion on computerized tomography (CT) after varicella infection. In 3 of them, CT in the acute hemiplegic stage, and later, reveals the development of lacunar infarct around the internal capsule. Focal low density may be caused by occlusive vascular lesions of the penetrating arteries. Varicella infection may play an important role as one of the causes of acute hemiplegia in childhood producing lacunar infarct, as well as delayed hemiplegia, reported previously in herpes zoster ophthalmicus.

Abnormalities of bile acids in serum and bile from patients with myotonic muscular dystrophy

1. Serum bile acids in seven patients with adult type myotonic dystrophy and 22 normal persons were quantitatively analysed by gas-liquid chromatography and gas chromatography-mass spectrometry for cholesterol, gamma-glutamyltransferase and bilirubin. There was no bile obstruction in any patient. 2. Dexoycholic acid values in all mothers of patients with congenital type myotonic dystrophy were three times (2.1 mumol/l) that of the control (0.7 mumol/l). 3. Uncommon bile acids were detected in the patients' sera. One of them appeared to be dihydroxymono-oxocholanic acid, having a longer side chain. Another one appeared to be dihydroxycholanic acid, with a steroid-nucleus structure similar to chenodeoxycholic acid and with a longer side chain. 4. Biliary bile acids from three patients and one normal person were also analysed, and this revealed a remarkable decrease in ursodeoxycholic acid in the patients. 5. The presence of bile acid abnormality in patients with myotonic muscular dystrophy is proposed.

[Pharmacological study on hydrocortisone 17-butyrate 21-propionate (author's transl)]

The topical and systemic anti-inflammatory activities of hydrocortisone 17-butyrate 21-propionate (HBP) were studied. The systemic anti-inflammatory activities of HBP and reference steroids were examined for their effects on dinitrochlorobenzene dermatitis, carrageenin edema, cotton pellet granuloma and adjuvant arthritis in rats and by the delayed allergic edema test in mice. The topical anti-inflammatory activities of these steroids were examined for their effects on croton oil dermatitis, croton oil ear edema, carrageenin edema and cotton pellet granuloma in rats. Furthermore, effects of these steroids on liver glycogen deposition in mice, thymolysis, and decrease of serum corticosterone level in rats were examined. Systemically administered HBP was less potent than betamethasone 17-valerate (BV), but was almost equal to hydrocortisone 17-butyrate (HB) in anti-inflammatory activity, and its effects on liver glycogen deposition, thymolysis, and the decrease of serum corticosterone level. However, the topical anti-inflammatory activity of HBP was more potent than that of BV and HB, although in the same experiment, thymolytic activity of HBP was less potent than that of BV, but was almost equal to HB. The inhibitory effect of HBP on hypotonic induced hemolysis was weaker than that of BV, but was stronger than that of HB in vitro. The affinity of HBP was higher than that of BV and HB to polymorphonuclear leucocytes used as the inflammatory cells in vitro. On the other hand no marked difference was observed in the affinity to erythrocytes used as the non-inflammatory cells in vitro. These results suggest that HBP is a useful drug which has superior topical anti-inflammatory activity, but has a weak systemic effect.

[Studies on antigenicity, phototoxicity and other specific toxicities of hydrocortisone 17-butyrate 21-propionate (HBP) (author's transl)]

The present experiments were undertaken to determine the antigenicity and other toxicities of HBP; such as phototoxicity, photosensitivity, ulcerogenicity, adrogenic-myotropic, estrogenic and progestational activities, and mutagenicity. No antibody formation and delayed type skin reaction of HBP were seen in rabbits. Active systemic anaphylaxis was not observed in guinea pigs challenged by HBP. In the phototoxicity and photosensitivity test, 0.1% HBP ointment, 0.1% HBP cream and 10% HBP acetone solution did not show any skin reaction with or without irradiation of ultraviolet light. Repeated subcutaneous administration of HBP irritated the gastric and intestinal mucosa dose dependently in rats as hydrocortisone 17-butyrate and betamethasone 17-valerate (BV). HBP had neither androgenic-myotropic nor estrogenic activity, but antiestrogenic activity was observed. The progestational activity of HBP in immature rabbit pretreated with estrone was less potent than BV. In the mutagenicity test os HBP investigated by the reverse mutation according to the method by Ames, no significant increase in the number of revertants was observed in the presence or absence of S9 mixture.

[Studies of D-penicillamine (4) : effects on antibody formation (author's transl)]

The value of D-penicillamine (D-PA) in the treatment of rheumatoid arthritis is now well established, however, the mode of action remains obscure. We studied the effects of D-PA on the primary and secondary homocytotropic antibody formation with various doses, timing, quantity of antigen stimuli and stress loading in mice. Homocytotropic antibody was assayed by rat PCA (IgE) or mouse PCA (IgG1), and the effects were compared with those of the other antirheumatic drugs such as aurothiomalate and chloroquine diphosphate and the immunosuppressive agents such as hydrocortisone and cyclophosphamide. The antibody formation was slightly suppressed by D-PA under various conditions induced by different quantities of antigen stimuli, while the effects of the other antirheumatic drugs and the immunosuppressive agents on the primary and secondary responses differed from that of D-PA. Stress loading applied with oral consecutive administration of saline for 3 weeks or by restraint with adhesive plaster from 3 days before the primary immunization reduced the antibody formation. D-PA restored the reduced IgE antibody formation after the secondary immunization and also weight of the spleen. These observations suggest that D-PA acts as an immunomodulating agent as the spleen weight and IgE antibody formation were recovered under conditions of induced stress.

Mortality and survival for Down syndrome in Japan

Mortality and survival data for 1,052 Japanese patients with Down syndrome who were born between 1966 and 1975 were analyzed. The survival rate at age 10 was estimated to be about 86%. Mortality in each age group for Down syndrome was elevated over that of the general population. In the survival rate at age 10, there was no significant difference between males and females, but the difference between cases with and without congenital heart disease was highly significant. Using data from this study-for mortality up to age 10-and from the study of institutionalized cases for mortality over age 10, a hypothetical life table was constructed; it shows that the life expectancy at birth for cases with Down syndrome is nearly 50 years.