Nerve lipid abnormalities in human diabetic neuropathy: a correlative study

To study endoneurial lipid composition in human diabetic neuropathy, we biopsied sural nerves from 3 middleaged men with adult-onset diabetes mellitus. Magnitude of electrophysiological abnormalities and myelinated fiber loss paralleled the clinical severity of neuropathy in all cases. Cholesterol ester concentration was elevated to about 800% of normal in diabetic nerves. Reduction in total endoneurial lipid concentration correlated best with decrease in myelin volume as calculated from measured fiber diameters. Cholesterol, cerebroside, and most phospholipids were reduced in keeping with the severity of fiber loss in each nerve. The phosphatidylinositol-phosphatidylserine fraction was most reduced in the least affected nerves. Cerebroside nonhydroxy fatty acids in diabetic nerves were of shorter chain length and more saturated than normal. It is not yet clear whether the abnormalities of phosphatidylinositol-phosphatidylserine and cerebroside fatty acids are of pathogenetic importance or whether these changes may be the nonspecific consequence of axonal degeneration.

Antiserum-mediated demyelination in vivo: a sequential study using intraneural injection of experimental allergic neuritis serum

Primary segmental demyelination accompanied by mononuclear phagocytes was induced by injection of antiserum into rat peripheral nerve, and the morphologic sequence of events was studied. Antisera were obtained from rabbits with experimental allergic neuritis (EAN) produced by the inoculation of emulsified bovine peripheral nerves in complete Freund's adjuvant. Sera were injected directly into rat sciatic nerve to circumvent the blood-nerve barrier. Recipient rats developed sensorimotor paralysis on the side injected with experimental allergic neuritis sera. Intense focal demyelinative lesions resulted from injection of experimental allergic neuritis sera. Control sera obtained from rabbits inoculated with bovine serum albumin in complete Freund's adjuvant did not produce paralysis or demyelination. The earliest change was damage to Schwann cells, seen 20 minutes after antiserum injection. Within a few hours lamellar splitting and vacuolation of myelin began to paranodal regions and Schmidt-Lanterman clefts and there were infiltrating polymorphonuclear cells. By 8 hours without the detectable presence of monocytes or macrophages, myelin vesiculation became advanced and widespread. By 15 hours, endoneurial edema had reached its maximum. Macrophages were found in association with myelinated nerve fibers. From that time through the next 5 days, demyelination progressed to complete denudation of axons by macrophage phagocytosis of myelin. Activated cytoplasm of Schwann cells reinvested demyelinated axons, often in concert with persisting phagocytic macrophages. Peripheral nerve demyelination thus transferred evolved rapidly, and myelin destruction occurred prior to the appearance of monocytes or macrophages. Demyelinating activity was lost after absorption by purified peripheral nerve myelin but not by liver or kidney and was heat-labile and complement dependent (T. Saida, K. Saida, D. H. Silberberg, and M. J. Brown: Nature 272: 639, 1978).

Comparison of the Developmental Test of Visual-Motor Integration and the Bender-Gestalt test

The Developmental Test of Visual-motor Integration (Beery) and the Bender-Gestalt test (Bender) were administered to 44 second-grade children. Developmental age scores (Koppitz scoring) and age equivalents (Beery) were compared. The correlation of .43 between Bender (Koppitz scoring) and Beery scores was moderate but statistically significant. A t test for dependent groups indicated a significant difference between the means on the Bender and Beery tests. These results confirm that neither test should be utilized as the sole indicator of visual-motor perception.

G gamma delta beta thalassaemia and g gamma HPFH (Hb Kenya type): comparison of 2 new cases

Two new cases of G gamma delta beta thalassaemia and G gamma HPFH (Hb Kenya type) have been characterised in detail and compared with regard to haematological data, globin chains biosynthesis, and intracellular distribution of Hb F. The similarities and differences between these two conditions are discussed in relation to the possible underlying defects at the molecular level and to the control of the gamma delta beta gene complex in general.

A small cluster of Hodgkin's disease

Nine cases of Hodgkin's disease and one of acute lymphoblastic leukaemia occurred in 1972-5 in an area of less than 1 km. Clinical, social, and drug histories provided no relevant information, and definite patient-to-patient contacts before the onset of disease were not established. There was a higher incidence of malignant neoplasms in first-degree relatives of the patients than in those of a small control group living in the same area. There was no apparent reason for this cluster of cases, but geographical, climatic, and entomological studies are being carried out.

An index of cardiac output derived from the cardiopneumogram

The cardiopneumogram has been reinvestigated as an index of stroke volume and cardiac output in anaesthetized dogs. Using a water-filled oesophageal balloon to calibrate the system good correlations have been found between the values derived from dye dilution and the indices obtained from the cardiopneumogram.

Microdissection of peripheral nerve: collagen and lipid distribution with morphological correlation

Peripheral nerve is a complex tissue composed of endoneurial fascicles surrounded by perineurium and epineurium. We separated endoneurium from peri- and epineurium in human sural nerves by "endoneurial plucking", a method of microdissection. Endoneurial contents (axons, myelin sheaths, Schwann cells, vessels, and interstitial collagen) were cleanly separated in high yield from enveloping connective tissue, by both microscopic and biochemical criteria. Most of the nerve sulfatide and unesterified sterol was found in the endoneurial fraction while most of the collagen was in the peri-epineurial fraction. This microdissection method should prove useful in biochemical investigations of peripheral nerve.

Painful diabetic neuropathy. A morphometric study

We investigated three diabetic patients whose neuropathy was characterized by pain, hypesthesia, and autonomic dysfunction, with preservation of epicritic sensation and muscle-stretch reflexes. Two sural nerves were studied qualitatively and quantitatively, using teased fiber, light, and electron microscopical techniques. The most striking alterations were encountered in unmyelinated and small myelinated fibers. Unmyelinated nerve fiber sprouting was evident. The clinical features, which suggested small-fiber involvement, correlated with the pathological findings in biopsied cutaneous nerve. The balance of evidence indicates that the painful small-fiber neuropathy of diabetes is an axonal disorder.

A double-blind trial of perhexiline maleate in the prophylaxis of angina pectoris

Perhexiline maleate, which has no beta adreno-receptor-blocking activity, has been suggested as an effective prophylactic agent for angina pectoris. The effects of perhexilline were compared with those of placebo by a double-blind crossover trial in seven patients with moderate to severe angina pectoris. Attack rates and glyceryl trinitrate consumption were significantly lower during the perhexilline phase than during the placebo phase of treatment. There was also a mild fall in resting heart rate. Three patients who had failed to respond to beta adrenoreceptor-blocking drugs, and one who had suffered reccurrence of symptoms after coronary artery surgery responded favourably to perhexiline. It thus appears that perhexiline maleate is an effective and potentially valuable agent in this condition.

Structural rearrangements associated with the Ph1 chromosome in chronic granulocytic leukaemia

Four cases of C.G.L. in which banding of the Ph1 chromosome was performed were found to have variation from the usual 9/22 translocation pattern. All 4 cases showed a rearrangement involving at least 3 chromosomes, 2 of which were a9 and a22. One of these cases had in addition an XYY karyotype in the bone marrow.

Evidence for a significant contribution from central effects of angiotensin in the development of acute renal hypertension in the greyhound

1. The importance of central vasomotor effects of endogenously generated angiotensin in the acute hypertensive response to renal artery constriction has been investigated in the anaesthetized greyhound. 2. When the central cardiovascular action of angiotensin was abolished by thermocoagulation of the areas postrema, the hypertensive response to renal artery constriction was reduced by half while the increase in plasma renin activity was unchanged. 3. It is concluded that central vasomotor effects of angiotensin play a significant role in renin-dependent hypertension.

Congenital side-to-side tracheoesophageal fistula in the adult

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