Premature closure of the distal radial physis

Two cases of fracture of the radius treated by pinning resulted in severe wrist joint deformity due to premature closure of the epiphysial growth plate. Inappropriate pinning through the physis damaged the growth plate in both cases. They were treated by bone bridge resection with free fat interposition. The bone bar resection was effective in correcting the wrist joint deformity, and bone growth was expected without bone grafting.

Anatomical risk factors for Kienböck's disease

Contralateral unaffected wrists from 41 males with Kienböck's disease were compared with wrists from 66 normal males. From X-rays, various features of the lunate and radius were measured. In patients with Kienböck's disease, the lunate tended to be smaller and inclined more radially than in normal subjects and the radial inclination was flatter. Discriminant analysis showed that 85% of the unaffected contralateral wrists in patients with Kienböck's disease and 74% of the wrists in normal subjects were accurately discriminated to their respective groups. It may be possible to identify subjects who are at risk for Kienböck's disease prior to onset using discriminant analysis.

Effects of rHuEPO therapy on exercise capacity in hemodialysis patients with coronary artery disease

We investigated the effects of recombinant human erythropoietin (rHuEPO) therapy on exercise capacity by symptom-limited maximal treadmill exercise testing in 9 patients with coronary artery disease who were receiving maintenance hemodialysis. The initial hemoglobin concentration of 7.9 +/- 0.7 g/dl, (mean +/- S.D.) rose to 10.4 +/- 1.1 g/dl, (p < 0.01) after three months of rHuEPO therapy. The partial correction of renal anemia resulted in a significant increase in exercise duration (from 278 +/- 84 sec to 384 +/- 74 sec, p < 0.01) and maximum pressure-rate product (from 228.3 +/- 50.3 mmHg.bpm/10(2) to 262.8 +/- 40.4 mmHg.bpm/10(2), p < 0.01). The maximum exercise-induced ST segment depression significantly decreased after treatment (from 1.3 +/- 0.5 mm to 0.5 +/- 0.5 mm, p < 0.05). These results suggest that the improvement in maximum coronary oxygen supply exceeded the increased maximum myocardial oxygen requirements after the partial correction of renal anemia by rHuEPO therapy in hemodialysis patients with coronary artery disease.

[Posterolateral rotatory instability of the elbow--a case report and anatomical study of the lateral collateral ligament]

A 20-year-old woman was referred to our clinic complaining of recurrent subluxation of her right elbow. A posterolateral rotatory instability test revealed that she had insufficiency of the lateral collateral ligament. She was surgically treated; the ligament was reconstructed by using the palmaris longus tendon. A year after operation, she had no pain in her elbow, and regained full range of elbow motion. The function of the lateral collateral ligament is often overlooked. We, therefore, dissected 24 elbow joints and studied anatomically in order to confirm the origin and insertion of the lateral collateral ligament. The ligament originates from the lateral epicondyle, and runs distally in fan shape. It further inserts partly to the annular ligament and partly to the supinator crest. After complete sectioning of the ligament, the forearm was fixed in supination, then flexed with valgus moment. This maneuver elicited subluxation of the radio-humeral joint, which was similar to what we observed in the clinical case. From these observations, we have concluded that the ligament is important for stability of elbow joint as well as the medial collateral ligament.

Gene structure and expression of rice seed allergenic proteins belonging to the alpha-amylase/trypsin inhibitor family

Genomic and two novel cDNA clones for rice seed allergenic protein (RA) belonging to the alpha-amylase/trypsin inhibitor family were isolated and their nucleotide sequences determined. Ten cysteine residues deduced from nucleotide sequences were completely conserved among three cDNA clones including a clone, RA17, reported previously. One genomic clone, lambda 4, contained two RA genes, RAG1 and RAG2. Although RAG1 was cloned at the 5' portion only, two RA genes were arranged divergently. Nucleotide sequencing and DNA blotting analyses showed that RA are encoded by a multigene family consisting of at least four members. The transcriptional initiation site of RAG1 was localized at A, 26 bp upstream of the putative translational initiation codon, ATG, by the primer extension assay. The putative TATA box and CAAT box existed about 45 bp and 147 bp upstream of the transcription initiation site, respectively. A conserved sequence (ATGCAAAA) which was similar to the sequence (TGCAAAA) identified in rice glutelin promoters was observed in the 5' region of the two genes. In addition, RNA blotting analyses provided that RA genes specifically expressed in ripening seed and their transcripts accumulated maximally between 15 and 20 days after flowering.

Lipoma of the falciform ligament: US, CT, and MRI appearances

A case of lipoma of the falciform ligament was demonstrated using computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). US demonstrated a heterogeneous solid mass anteriorly in the upper portion of the abdomen. CT and MRI revealed a solitary, fatty mass with a small amount of soft tissue in it.

Long-standing extended dynamic splintage and release of an abnormal restraining structure in camptodactyly

62 patients with camptodactyly of the little finger have been reviewed, and only five cases failed to respond to conservative treatment. These cases are reported. One patient could straighten the deformed PIP joint with snapping, and the other two were resistant to conservative treatment and were found to have a restraining structure requiring release. These findings are in keeping with an imbalance between flexion and extension forces due to long-standing malposition of the extensor lateral bands. Operative treatment should be reversed for cases of failed conservative treatment, which should be started as early as possible.

[Three-phase bone scintigraphy of Kienböck disease]

Thirty-three joints in 31 patients of Kienböck disease were evaluated with three-phase bone scintigraphy. Follow-up studies were performed in 19 cases of them. The patients with increased ulnar blood flow on arterial phase and ample perfusion on venous phase in angiograms showed good clinical prognosis. This ample ulnar blood flow and perfusion might be essential for the recovery of this disease. Although staging was possible using static images alone, blood pool images provided more information about the present condition of lesions, such as hyperemic state and remodeling reactions. Blood pool image was indispensable for staging and analyzing lesions and evaluating post-operative course. Increased lunate perfusion in venous phase of angiograms and localized lunate uptake in blood pool images were the favorable signs, which were shown in most cases with good prognosis. It is concluded that three-phase bone scintigraphy gives useful informations for evaluating Kienböck disease which can not be obtained by conventional bone scintigraphy.

Differential effect of subspecies of lipoprotein containing apolipoprotein A-I on cholesterol efflux from cholesterol-loaded macrophages: functional correlation with lecithin: cholesterol acyltransferase

Two species of lipoprotein containing apoA-I, one containing only apoA-I (LpA-I), and the other containing apoA-I and apoA-II (LpA-I/A-II), were tested for their effects on macrophage foam cells. Rat macrophages were converted to foam cells by incubation with radiolabeled acetylated LDL. Incubation with LpA-I or LpA-I/A-II decreased the cellular cholesteryl esters (CE) mass. However, the free cholesterol (FC) mass was only reduced by LpA-I. All the radioactivity excreted into the medium was associated with LpA-I or LpA-I/A-II; 39% of the excreted radioactivity was esterified in LpA-I and 10% in LpA-I/A-II. Upon complete inactivation of lecithin: cholesterol acyltransferase (LCAT) activity with dithiobisnitrobenzoic acid, the cholesterol reducing capacity of LpA-I was weakened significantly. However, the CE mass reducing capacity of LpA-I/A-II was not affected. When LpA-I and LpA-I/A-II were combined, the cholesterol reducing capacity of the mixture was similar to that of LpA-I alone. However, LpA-I re-isolated from the medium showed a lower esterification rate than did the re-isolated LpA-I/A-II, thereby indicating that the cholesterol esterified in LpA-I was transferred to LpA-I/A-II. These results suggest that (i) the function of LpA-I is closely linked to the LCAT activity while that of LpA-I/A-II is not, and (ii) LpA-I in concert with LpA-I/A-II induces a series of extracellular events; LCAT-mediated esterification of excreted FC by LpA-I and a subsequent CE transfer to LpA-I/A-II. These mechanisms might be important for net cholesterol efflux from macrophage foam cells in physiological states.

Generation of plasma kinin by three types of protease isolated from Porphyromonas gingivalis 381

Three types of protease (A, B and C) isolated from the culture supernatant of Porphyromonas gingivalis 381 had peculiar activities on kinin generation from high molecular-weight kininogen in vitro. Protease C released bradykinin from the kininogen in a reaction mixture containing 2 mM dithiothreitol, but A and B did not. However, the activity of degrading bradykinin was much stronger in protease A and B than in C. These findings suggest that only protease C shows plasma kallikrein activity.

Recovery of impaired motor function of the upper extremity after stroke

Manual function score (MFS) of 174 hemiparetic stroke patients was examined every week for 8 weeks after starting the occupational therapy with programs based on MFS recovery profile, and the relation between the time since stroke onset (x) and MFS (y) was approximated by a hyperbolic function, y = A - B/x. The patients were classified into two groups, 125 cases (71.8%) with statistically significant fit of the function (fit group) and 49 without fit (non-fit). Using demographic and neurological variables of each patient, characteristics of the patients with regular recovery were analyzed. The results indicated that the gain of MFS during 8 weeks of the therapy was large in the fit group compared to the non-fit, and the regular recovery could be mostly expected in rather young patients, those with early start of the therapy, and those without ataxia, mental deterioration, and cortical lesions.

[Multivariate analysis of the clinical signs in late cortical cerebellar atrophy (LCCA) in Japan--compared with olivo-ponto-cerebellar atrophy (OPCA) and hereditary cortical cerebellar atrophy (HCCA)]

We investigated the clinical features of 179 patients with late cortical cerebellar atrophy (LCCA) comparing with 382 patients with olivo-ponto-cerebellar atrophy (OPCA) and 91 patients with hereditary cortical cerebellar atrophy (HCCA) using multivariate analysis. They had no significant difference in durations from onset. Disorders of finger-nose test were of more severity and disorders of heel-knee test were less involved in LCCA than in HCCA. Eye movements tended to be normal in LCCA. LCCA showed more depressive and euphoric character than OPCA and HCCA. Analysis of LCCA and OPCA demonstrated that LCCA revealed hypotonia in muscles, normal or weak reactions of muscle stretch reflexes. There existed 21.4 percent of cases which could not be discriminated by multivariate analysis using clinical signs in LCCA and OPCA. Multivariate analysis of LCCA and HCCA, which are very similar in clinical signs, showed 66.3 percent of discriminatory rate. Thus, we could diagnose them to a certain extent only by clinical signs.

Survey of a receptor protein in human erythrocytes for hemagglutinin of Porphyromonas gingivalis

The purpose of this study is to survey a receptor protein in human erythrocyte membrane for the hemagglutinin (HA) of Porphyromonas gingivalis. Human erythrocytes were modified by either chymotrypsin or P. gingivalis HA along with the disappearance of their hemagglutinating ability and the removal of the band 3 protein. By preparative electrophoresis, this protein was isolated and purified from human erythrocytes. The purified protein showed strong inhibitory activity for hemagglutination and the binding to P. gingivalis cells, whose binding sites were calculated to be approximately 9000, suggesting its binding to the active site of HA. Hemagglutinin purified from P. gingivalis by affinity absorption to sheep erythrocyte ghosts possessed strong trypsin-like activity, and both the HA and the enzyme activities were inhibited by arginine. Specific modification of arginyl residues in human erythrocytes by phenylglyoxal diminished the hemagglutinating ability. From the similarity of the inhibition profile and possible active sites between HA and the trypsin-like protease, it is suggested that hemagglutination may occur as a result of the primary reaction of the enzyme (protease) and the substrate. These results suggest that band 3 may be a key protein in human erythrocyte membrane for HA from P. gingivalis and its binding sites may be arginyl residues of the protein.

Lipoprotein-containing apolipoprotein A-I: sex-related quantitative and qualitative changes in this lipoprotein subspecies after ingestion of fat

We investigated the postprandial changes of two species of lipoproteins containing apolipoprotein (apo)A-I: lipoprotein containing apo A-I but no apo A-II (LpA-I), and lipoprotein containing apo A-I and apo A-II (LpA-I/A-II). These lipoproteins were isolated from 10 men and 11 women at 0, 4, and 6 h after they had eaten butter. In LpA-I, the concentrations of all lipids except triglyceride were increased at 4 and 6 h in the women. In the men all lipids were increased only at 4 h. The increase of apo A-I concentration was found at 6 h only in the women. In LpA-I/A-II, the concentrations of all lipids were increased at 4 h and only phospholipid (PL) was increased at 6 h in the women. In the men, free cholesterol and PL were increased at 4 and 6 h. The increases of apo A-I and apo A-II concentrations were found at 4 and 6 h only in the men. These results suggest that the postprandial changes are sex-related and may relate to the different incidence of atherosclerotic cardiovascular disorders.

Cleft hand, syndactyly and hypoplastic thumb

The clinical features of 58 patients with typical cleft hand were examined and compared with 86 patients with syndactyly between the long and ring fingers, 27 patients with syndactyly between the ring, little and other fingers, 53 patients with hypoplastic thumb and 100 patients with symbrachydactyly. The clinical findings of the typical cleft hand resembled those of syndactyly. There were two unusual cases of typical cleft hand associated with hypoplastic thumb, congenital heart anomalies and absence of the axial triradius. One of these also had cleft lip and palate. The critical embryonic period of the heart anomaly is early, while that of the cleft lip and palate is late. These findings suggest that an embryo with typical cleft hand and hypoplastic thumb results from impairments at two different times in the early embryonic period.

[Evaluation of complicated renal cyst: a comparison of CT and MR imaging]

We report 12 cases of renal cystic lesions that could not be diagnosed preoperatively. Sonography, computed tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in all cases. Angiography was not helpful in evaluating cystic lesions, because all cystic lesions were hypovascular or avascular within the cystic mass. CT was useful in depicting the fine structural abnormalities, and especially bolus-contrast CT study was useful in the differentiation of cystic renal cell carcinoma from simple renal cyst. However, there were 5 false positive cases. MR imaging is superior to CT in distinguishing a hemorrhagic cyst or multiloculated cystic mass. In conclusion, CT is currently the primary imaging modality for evaluating complicated renal cysts, and surgical exploration is warranted for the undiagnosed cystic lesion by CT. However, MR imaging also has an important role in detecting the benign complicated cyst. Therefore if complicated cyst is thought to be benign by MR imaging, parenchyma-sparing surgery should be considered preoperatively.

Nucleotide sequence of a cDNA clone encoding a major allergenic protein in rice seeds. Homology of the deduced amino acid sequence with members of alpha-amylase/trypsin inhibitor family

A cDNA clone of rice major allergenic protein (RAP) was isolated from a cDNA library of maturing rice seeds. The cDNA had an open reading frame (486 nucleotides) which coded a 162 amino acid residue polypeptide comprising a 27-residue signal peptide and a 135-residue mature protein of M(r) 14,764. The deduced amino acid sequence of RAP showed a considerable similarity to barley trypsin inhibitor [1983, J. Biol. Chem. 258, 7998-8003] and wheat alpha-amylase inhibitor [1981, Phytochemistry 20, 1781-1784].

The Sauvé-Kapandji procedure for chronic dislocation of the distal radio-ulnar joint with destruction of the articular surface

The Sauvé-Kapandji procedure has been performed in 15 non-rheumatoid patients with chronic distal radio-ulnar joint dislocation accompanied by joint damage or deformity. The clinical results were favourable; wrist pain improved in all patients, wrist flexion-extension was increased by more than 10 degrees in nine patients, grip strength of at least 80% of the contralateral wrist was achieved in 11 patients, and forearm rotation was more than 150 degrees in 12 patients. However, X-ray examination revealed an unstable proximal ulnar stump and radio-ulnar convergence in all patients similar to that associated with the Darrach procedure. Although the Sauvé-Kapandji procedure can preserve ulnar support of the wrist and is believed to yield more satisfactory results than the Darrach procedure, its extensive use is not recommended for non-rheumatoid distal radio-ulnar joint disorders, but it is recommended for chronic distal radio-ulnar joint dislocation with articular injury or deformity.

Somatosensory conduction delay in central and peripheral nervous system of diabetic patients

Fifty-four diabetic patients with or without clinical evidence of neuropathy and with no clinical evidence of CNS dysfunction were studied by somatosensory-evoked potentials after electrical stimulation of the median nerve at the wrist and recorded from the scalp electrode against a noncephalic reference. Peripheral conduction index, calculated as the distance from the wrist to the C7 spinous process divided by the P9 latency, was significantly decreased (P less than 0.01) in diabetic patients (69.81 +/- 6.47 m/s) compared with 28 age-matched nondiabetic subjects (76.85 +/- 5.65 m/s). The P11-P13 interpeak latency, representative of the transit time from the dorsal column at the level of the sensory input into the cervical cord to the brain stem along the somatosensory pathways (CCT1), and the P13-N19 interpeak latency, representative of the transit time from the brain stem to the somatosensory cortex (CCT2), were significantly increased in diabetic patients (CCT1, 2.51 +/- 0.63 ms; CCT2, 5.76 +/- 0.92 ms) compared with nondiabetic subjects (CCT1, 2.28 +/- 0.36 ms, P less than 0.05; CCT2, 5.18 +/- 0.51 ms, P less than 0.01). We conclude that, in diabetic patients, neurophysiological abnormalities may be present in two distinct parts of the CNS and the peripheral nervous system.

Carbohydrate binding specificity of monoclonal antibodies raised against lactose-protein Maillard adducts

Three hybridoma antibodies (L101, L104, and L117) specific for lactose-protein amino carbonyl products (Maillard adducts) were obtained by immunizing mice with the lactose-ovalbumin Maillard adduct and by screening with the lactose-bovine serum albumin (BSA) adduct. They reacted with the Maillard adducts of lactose with several different proteins, but not with the adducts of several other reducing sugars. L101 reacted well with the lactose-BSA adducts formed by 2- to 16-day incubation, whereas L104 and L117 reacted with the advanced stage reaction products but not with the adducts of 2-day incubation. The competitive inhibition of the antibody binding by several mono- and disaccharides showed that lactulose (4-O-beta-D-galactopylanosyl-D-fructose) was the best inhibitor for all three antibodies, and that L104 and L117 were inhibited by methyl-beta-D-galactoside more effectively than L101. These results suggested that different components produced during the progress of the Maillard reaction could be antigenic determinants, and that the carbohydrate moiety including the terminal galactosyl residue played an important role in the antibody binding to the lactose-protein Maillard adducts.

[Relation between Helicobacter pylori and intractable gastric ulcer--PAS positive intramucosal mucus as an index]

Helicobacter pylori (Hp) is considered to be one of the causes of gastric mucosal injury. Using biopsy specimens from the gastric mucosa of patients with gastritis or gastric ulcer, the intramucosal mucus was quantified by computer image analysis to evaluate its relationship with Hp. In gastric mucosa positive for Hp, the mucus content within the gastric mucosa was significantly decreased. Ammonia was administered based on its assumed role in decreasing the mucus content of the gastric mucosa, and resulted in a decrease in rats to whom it was administered. Based on these results, cases of intractable gastric ulcer were studied. In these intractable cases, Hp was present significantly more often than in other cases and the intramucosal mucus content was significantly lower. These findings suggest that Hp may be a factor in the resistance of gastric ulcer to treatment.

Changes in plasma and duodenal cholecystokinin concentrations after pancreatic duct occlusion in rats

The changes in plasma and duodenal cholecystokinin (CCK) concentrations after pancreatic duct occlusion were examined in rats. The rats were sacrificed 1, 3, 7, 10, 14, and 30 days after occlusion of the duct. Histological examination showed acute inflammation on days 1 and 3 after duct occlusion, interstitial fibrosis and regenerative changes on days 7, 10, and 14, and pancreatic atrophy on day 30. The plasma CCK concentration increased from 0.45 pM to 2.0 pM after the occlusion and then remained high throughout the observation period. In contrast to the stable increase in plasma CCK concentration, the CCK content in the duodenum increased on days 1 and 3, decreased on day 7, increased on day 10, reaching over the control level on day 14, and then returned to the control level on day 30. Administration of boiled and 10-fold concentrated rat pancreatic juice or human pancreatic secretory trypsin inhibitor for seven days after pancreatic duct occlusion reversed the decrease in duodenal CCK content. The major molecular forms of duodenal CCK were CCK-8, -33, and -58. These results indicate that (1) basal plasma CCK concentration did not reflect the duodenal CCK content, (2) duodenal CCK content was well correlated with a decrease in inflammation in the pancreas, and (3) a nonenzymatic component in the pancreatic juice reversed the decrease in duodenal CCK content and body weight caused by pancreatic duct occlusion.