[Sleep apnea in multiple system atrophy]

Multiple system atrophy(MSA) characterized clinically by any combination of autonomic, extrapyramidal or cerebellar symptoms and signs. MSA patients frequently manifest a variety of sleep-related respiratory disturbances, which are life threatening problems. Above all, a common and serious complication is upper-airway obstructive sleep apnea associated with stridor, which is caused by vocal cord abductor paralysis(VCAP). For the early diagnosis of VCAP, it is important to perform laryngoscopy during sleep, because VCAP does not appear during awakefulness in the early stage of MSA. Polysomnographic study should be obtain to assess the severity of respiratory disturbances. Tracheostomy is reliable treatment for respiratory disturbances due to VCAP, while nasal continuous positive pressure may be a useful treatment for some patients.

Serum parathyroid hormone and calcitonin levels in racehorses with fracture

Serum parathyroid hormone (PTH) and calcitonin (CT) levels in fractured racehorses were measured by radioimmunoassay. Racehorses with fracture of large bone such as the radius, third metacarpus, third carpus, digital bone or tibia, showed normal PTH level and elevated CT level in the serum. Serum PTH level was slightly higher in racehorses with sesamoid bone fracture compared to that of healthy racehorses, but not statistically significant. Moreover, serum CT level of racehorses with sesamoid bone fracture was significantly higher than that of healthy racehorses. Racehorses with sesamoid bone fracture and large bone fracture might be in different conditions of calcium regulation.

Selective distribution of matrix metalloproteinase-3 (MMP-3) in Alzheimer's disease brain

A growing amount of evidence indicates that matrix metalloproteinases (MMPs) may play an important role in the pathogenesis of Alzheimer's disease (AD). Stromelysin-1 (MMP-3) plays a central role in activating latent-type MMPs, which are originally secreted as proenzymes. We examined MMP-3 immunoreactivity in the brains of patients who had suffered from Alzheimer's disease and in those of neurologically normal persons. The interstitium between myelinated axons and astrocytes in the white matter of all brain tissues, and senile plaques in the gray matter of the patients with AD were stained with a monoclonal antibody to MMP-3. Comparison of the number of senile plaques stained with the antibody against MMP-3 in the parietal cortex with that in the hippocampus showed that fewer plaques were stained in the hippocampus. The selective distribution of MMP-3 in the human brain suggests that MMP-3 might play an important role in the pathogenesis of AD, especially in the degradation of beta-amyloid protein.

Micturitional disturbance in pure autonomic failure

We obtained micturitional histories and performed urodynamic studies in six patients with pure autonomic failure. All patients had urinary symptoms. Urodynamic studies showed postmicturition residuals in two, small bladder capacities in two, detrusor hyperreflexia in four, low bladder compliance in two, detrusor-external sphincter dyssynergia in one, neurogenic sphincter electromyography in three, and denervation supersensitivity of the bladder in two. Micturitional disturbance is a common feature in pure autonomic failure because of peripheral and central types of abnormalities.

Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?

OBJECTIVES

Urinary dysfunction and orthostatic hypotension are the prominent autonomic features in multiple system atrophy (MSA). A detailed questionnaire was given and autonomic function tests were performed in 121 patients with MSA concerning both urinary and cardiovascular systems.

METHODS

Replies to the questionnaire on autonomic symptoms were obtained from 121 patients including three clinical variants; olivopontocerebellar atrophy (OPCA) type in 48, striatonigral degeneration (SND) type in 17, and Shy-Drager type in 56. Urodynamic studies comprised measurement of postmicturition residuals, EMG cystometry, and bethanechol injection. Cardiovascular tests included head up tilt test, measurement of supine plasma noradrenaline (norepinephrine,NA), measurement of R-R variability (CV R-R), and intravenous infusions of NA and isoproterenol.

RESULTS

Urinary symptoms (96%) were found to be more common than orthostatic symptoms (43%) (p<0.01) in patients with MSA, particularly with OPCA (p<0.01) and SND (p<0.01) types. In 53 patients with both urinary and orthostatic symptoms, patients who had urinary symptoms first (48%) were more common than those who had orthostatic symptoms first (29%), and there were patients who developed both symptoms simultaneously (23%). Post-micturition residuals were noted in 74% of the patients. EMG cystometry showed detrusor hyperreflexia in 56%, low compliance in 31%, atonic curve in 5%, detrusor-sphincter dyssynergia in 45%, and neurogenic sphincter EMG in 74%. The cystometric curve tended to change from hyperreflexia to low compliance, then atonic curve in repeated tests. Bethanechol injection showed denervation supersensitivity of the bladder in 19%. Cardiovascular tests showed orthostatic hypotension below -30 mm Hg in 41%, low CV R-R below 1.5 in 57%, supine plasma NA below 100 pg/ml in 28%, and denervation supersensitivity of the vessels (alpha in 73%; beta2 in 60%) and of the heart (beta1 in 62%).

CONCLUSION

It is likely that urinary dysfunction is more common and often an earlier manifestation than orthostatic hypotension in patients with MSA, although subclinical cardiovascular abnormalities appear in the early stage of the disease. The responsible sites seem to be central and peripheral for both dysfunctions.

IgG anti-GQ1b positive acute ataxia without ophthalmoplegia

IgG anti-GQ1b antibody was present in a patient with acute ataxia and areflexia without ophthalmoplegia or elementary sensory loss. Sensory nerve conduction studies and somatosensory evoked potentials were normal, but postural body sway analysis showed dysfunction of the proprioceptive afferent system. The clinical presentation and laboratory results for this patient resemble those of Miller Fisher syndrome, except for the lack of ophthalmoplegia. This case may represent part of an IgG anti-GQ1b syndrome.

Positron emission tomographic measurement of acetylcholinesterase activity reveals differential loss of ascending cholinergic systems in Parkinson's disease and progressive supranuclear palsy

We measured brain acetylcholinesterase activity in 16 patients with Parkinson's disease (PD), 12 patients with progressive supranuclear palsy (PSP), and 13 age-matched controls, using N-methyl-4-[11C]piperidyl acetate and positron emission tomography. Kinetic analysis was performed to calculate k3, an index of acetylcholinesterase activity. In PD patients, there was a significant reduction (-17%) of cerebral cortical k3 compared with normal controls, whereas there was only a nonsignificant reduction (-10%) of cortical k3 in PSP patients. However, there was a prominent reduction (-38%) of thalamic k3 in PSP patients compared with normal controls, whereas there was only a nonsignificant reduction (-13%) of thalamic k3 in PD patients. The results suggest that there is a loss of cholinergic innervation to the cerebral cortex in association with cholinergic innervation to the thalamus in PD, whereas there is a preferential loss of cholinergic innervation to the thalamus in PSP. When the thalamic to cerebral cortical k3 ratio was taken for each subject, PD and PSP were separated, suggesting that positron emission tomography measurement of acetylcholinesterase activity may be useful for differentiating the two similar disorders.

Special sensory ataxia in Miller Fisher syndrome detected by postural body sway analysis

To investigate whether ataxia in Miller Fisher syndrome (MFS) is caused by loss of proprioception or cerebellar dysfunction, we studied the power spectrum peak of the body sway frequency in 10 MFS patients, and compared the results with those of patients with cerebellar or sensory ataxia. The cerebellar patients had a peak at 2.4 Hz, whereas sensory ataxia patients had a 1-Hz peak. Nine of the MFS patients had a distinct 1-Hz peak. Clinical sensory loss or abnormal sensory nerve potentials were present in only 3 patients, whereas soleus H-reflexes were absent in all the MFS patients. MFS patients have dysfunction of the proprioceptive afferent system, and the special sensory ataxia may be caused by the selective involvement of muscle spindle afferents.

[Spinal myoclonus which appeared during the administration of alpha interferon]

We report a 42-year-old man who showed myoclonus in his right leg during alpha-interferon (alpha-IFN) treatment for HCV-RNA positive chronic hepatitis C. The myoclonus continuously persisted even during sleeping. Surface EMG recordings revealed fairly regular about 0.3 Hz periodic grouping discharges synchronized in the right lower extremities muscles. Jerk-locked back averaging method demonstrated a monophasic negative sharp wave associated with the myoclonus. This pre-myoclonus sharp wave was localized on the Cz and preceded the myoclonus by about 60 ms. T 2-weighted gradient-echo MRI images revealed a high-intensity lesion in the right leg motor cortex in the left hemisphere. The myoclonus vanished in association with the disappearance of the above MRI lesion one month after the termination of alpha-IFN therapy. Based on these, we conclude the alpha-IFN may induce the myoclonus in this patient.

Hemorrhagic enteritis associated with Clostridium perfringens type A in a dog

A female Shetland sheep dog died suddenly with hemorrhagic diarrhea and vomitting, and was examined pathologically and microbiologically. Gross pathological change was restricted to the intestinal tract. The intestine contained watery, blood-stained fluid. Histopathologically, the principal intestinal lesion was superficial mucosal hemorrhagic necrosis at the jejunoileum. Many Gram-positive bacilli were found adhering to the necrotic mucosal surface in parts of the intestinal tract. Clostridium perfringens in pure culture were isolated from jejunal contents by anaerobic culture. These results suggested that the typical lesion of this case coincided with canine hemorrhagic enteritis and enterotoxemia due to C. perfringens infection could be the cause of sudden death.

Two patterns of clinical recovery in Guillain-Barré syndrome with IgG anti-GM1 antibody

OBJECTIVE

To investigate the prognostic value of anti-GM1 antibody.

BACKGROUND

Whether anti-GM1 antibody is a marker of poor prognosis due to axonal degeneration in Guillain-Barré syndrome (GBS) is a matter of controversy.

METHODS

The clinical recovery of 41 consecutive GBS patients was analyzed.

RESULTS

The Hughes functional grading scores were similar at the peak, and 1, 3, and 6 months after onset for the groups of patients with (n=19) and without (n=22) immunoglobulin (Ig) G anti-GM1 antibodies. However, the anti-GM1-positive group included significantly higher proportions of patients with poor recovery (inability to walk independently at 6 months, 5 of 19 versus 0 of 22; p=0.01) and those with a markedly rapid recovery (improvement by two or more Hughes grades within a month, 9 of 19 versus 4 of 22; p=0.05). The positivity of IgG anti-GM1 antibody correlated well with the electrodiagnosis of the acute motor axonal neuropathy pattern but was not always associated with poor prognosis. Anti-GM1-positive patients showed two different patterns of clinical recovery-their conditions improved slower or faster than those of the anti-GM1-negative patients, most of whom had acute inflammatory demyelinating polyneuropathy.

CONCLUSIONS

Anti-GM1 antibody is not always a marker of poor prognosis and, besides axonal degeneration, early reversible effects other than demyelination could be part of the pathophysiology of Guillain-Barré syndrome with IgG anti-GM1 antibody.

D-penicillamine treatment for chronic sensory ataxic neuropathy associated with Sjögren's syndrome

Beneficial treatment has not been established for chronic sensory ataxic neuropathy associated with Sjögren's syndrome (CSAN-SS). We describe two patients with CSAN-SS who clinically improved in response to D-penicillamine treatment. Their neuropathic symptoms were lessened after D-penicillamine, and the results of electrophysiologic studies support the clinical improvement. D-Penicillamine can be considered a potentially beneficial agent in the treatment of CSAN-SS.

Brain muscarinic receptors in progressive supranuclear palsy and Parkinson's disease: a positron emission tomographic study

OBJECTIVES

To assess muscarinic acetylcholine receptors (mAChRs) in the brains of patients with progressive supranuclear palsy and Parkinson's disease, and to correlate the cholinergic system with cognitive function in progressive supranuclear palsy and Parkinson's disease.

METHODS

Positron emission tomography (PET) and [11C]N-methyl-4-piperidyl benzilate ([11C]NMPB) was used to measure mAChRs in the brain of seven patients with progressive supranuclear palsy, 12 patients with Parkinson's disease, and eight healthy controls. All of the patients with progressive supranuclear palsy were demented. The Parkinson's disease group consisted of 11 non-demented patients and one demented patient. The mini mental state examination (MMSE) was used to assess the severity of cognitive dysfunction in all of the subjects. The modified Wisconsin card sorting test (WCST) was used to evaluate frontal cognitive function in the non-demented patients with Parkinson's disease and controls.

RESULTS

The mean K3 value, an index of mAChR binding, was significantly higher for the frontal cortex in the patients with Parkinson's disease than in the controls (p<0.01). By contrast, the patients with progressive supranuclear palsy had no significant changes in the K3 values of any cerebral cortical regions. The mean score of the MMSE in the progressive supranuclear palsy group was significantly lower than that in the control group. Although there was no difference between the Parkinson's disease and control groups in the MMSE, the non-demented patients with Parkinson's disease showed significant frontal lobe dysfunction in the WCST.

CONCLUSIONS

The increased mAChR binding in the frontal cortex of the patients with Parkinson's disease may reflect denervation hypersensitivity caused by loss of the ascending cholinergic input to that region from the basal forebrain and may be related to frontal lobe dysfunction in Parkinson's disease. The cerebral cortical cholinergic system may not have a major role in cognitive dysfunction in progressive supranuclear palsy.

Expression of adult T cell leukemia-derived factor in human brain and peripheral nerve tissues

In both nonneurological and Alzheimer brains, we examined the localization of adult T cell leukemia-derived factor (ADF) by immunohistochemistry, that of its mRNA by in situ hybridization, and its semiquantitative mRNA analyses by RT-PCR. Anti-ADF antibody gave positive staining of white matter astrocytes and Schwann cells in the posterior root. Their intense and abundant staining was seen in Alzheimer brains. In situ hybridization for ADF mRNA showed identical signals in the white matter astrocytes. The evidence was also confirmed by RT-PCR analysis. These results suggest that redox regulation may play a role in Alzheimer pathology.

Demyelinating polyneuropathy with preferentially-proximal involvement

A 47-year-old man showed progressive, symmetrical weakness in the limbs for 6 months. There was muscle atrophy, fasciculations, and acute denervation without motor conduction abnormalities below the elbows or knees, and motor neuron disease had once been suspected. However, compound muscle action potentials (CMAPs) after proximal stimulation showed an amplitude reduction between axilla and Erb's point for the median and ulnar nerves on both sides. His weakness as well as the amplitude reduction improved after administration of prednisolone. Demyelinative conduction abnormalities can be limited to the proximal segments for at least several months in a conduction equivalent to chronic inflammatory demyelinating polyneuropathy (CIDP).

p53 mutation as a potential cellular factor for tumor development in enzootic bovine leukosis

Mutations of p53 in the lymphocytes from peripheral blood and from tumoral lymph nodes in six naturally occurring bovine leukemia virus (BLV)-infected cows were examined. A point mutation of the p53 gene was found in three of six (50%) BLV-infected cows. These p53 gene mutations resulted in amino acid substitutions of codons 144, 167 and 241. The BLV-infected cow in the tumor stage had abnormally proliferating monoclonal B-lymphocytes having the p53 mutation. However, the mutation was not found in somatic cells, except for tumor cells. These results show that p53 mutation plays an important role in the pathogenesis of BLV-induced neoplasms, and that the B-lymphocyte bearing p53 mutations may be a target cell for tumor formation of enzootic bovine leukosis.

Further analysis of the phenotype and distribution of tumor cells in sporadic B-cell and T-cell lymphomas in the lymph node and spleen of cattle

Immunohistologic studies were performed to identify the phenotype and distribution of neoplastic lymphocytes in the spleens of BLV-negative animals examined by PCR and diagnosed as having sporadic bovine leukosis. Tumor cells from three cases of sporadic bovine leukosis were identified as of B-cell lineage. Tumor cells from three additional cattle were identified as CD3+ CD4- CD8+, CD3+ CD4- CD8-, and CD3+ CD4- WC1+, respectively. The last case was diagnosed as a gamma/delta T-cell lymphoma. Differences in morphology proliferative characteristics were recognized between B- and T-cell type lymphomas. The tumor cells in B-cell type lymphoma were characterized as follows: medium or large in size, round or polymorphic nucleus with rough chromatin with some tumor cells containing a convoluted nucleus. These tumor cells of B-cell type lymphoma were present in the red pulp and periarteriolar lymphoid sheath. Tumor cells of the T-cell type lymphoma were uniformly smaller than B-cell type and present around arteries or replaced red pulp of the spleen.

Identification and mRNA developmental profiles of two ultraspiracle isoforms in the epidermis and wings of Manduca sexta

cDNAs were isolated from Manduca sexta that encode two isoforms of an ultraspiracle (USP) homologue MsUSP-1 and MsUSP-2 with different N-terminal A/B regions. The MsUSP-1 cDNA predicts a protein with 97% and 45% amino acid identities in the DNA- and ligand-binding domains respectively to the Drosophila USP and 89% overall identity with Bombyx mori CF1 (an USP homologue). Northern blot hybridizations with probes specific to MsUSP-1 and MsUSP-2 showed transcripts of an approximately equal size (4.5 kb), but with diverse developmental profiles in Manduca epidermis during the two final larval instars and the onset of the adult moult. The MsUSP-1 mRNA was expressed during the intermoult periods, with higher levels around the time of the larval ecdyses and at the onset of wandering behaviour. In contrast, the MsUSP-2 mRNA was up-regulated at times of high ecdysteroid titre during the larval moults, when the MsUSP-1 mRNA disappeared. Together, these conversely regulated isoform mRNAs contribute to the constitutive expression profile of total MsUSP mRNA.

[Muscarinic cholinergic receptor imaging of parkinsonian brain using 11C-NMPB and PET]

11C-NMPB is a useful ligand which is used to measure brain muscarinic cholinergic receptors (mAChRs) for its high affinity and high brain uptake. PET images of 11C-NMPB uptake had the highest accumulations in the cerebral cortex and striatum and the lowest in the cerebellum, both in patients with Parkinson's disease (PD) and normal subjects. 11C-NMPB uptake was homogeneous throughout the cerebral cortex in the normal subjects but greater in the frontal cortex of about one half of the PD patients as compared with other cerebral cortical areas. Quantitative analysis showed that the PD patients had high K3 values, an index of mAChR binding, in the frontal cortex. In PD, increased mAChR binding in the frontal cortex may be related to frontal lobe dysfunction. This technique should prove useful for detecting subclinical impairment of the central cholinergic system in PD.

Characterization of differentiation antigens expressed in bovine lymphosarcomas

To characterize the cell-surface antigens expressed in tumour cells derived from bovine leukosis and to determine their cell lineages, the immunophenotypes of the tumour cells from 13 bovine lymphosarcomas were examined with 13 monoclonal antibodies (mAbs). Of 13 cattle with lymphosarcomas, four were identified clinically as having the thymic-type sporadic bovine leukosis (SBL) and one as having the skin-type; two had enzootic bovine leukosis (EBL) and six were untypable. Flow cytometric analysis revealed that the tumour cells from nine cases were of T-cell lineage (BoCD5+, BoCD2+ or BoCD2-) and two were of B-cell lineage (MHC-II+, BoCD5+, IgM+); there were two bovine leukaemia virus-infected cattle (EBL). T-cell tumours appeared to originate from immature (BoCD4-, BoCD8-) T cells, but there was no significant relationship between clinical type (EBL, calf-, skin- and thymic-type) and tumour-cell immunophenotype.

The proto-oncogene c-myb is expressed in sporadic bovine lymphoma, but not in enzootic bovine leukosis

We examined bovine c-myb gene expression in six samples of sporadic bovine lymphomas (two calf, three thymic and one intermediate) and five of enzootic bovine leukosis. Tumor cells of the sporadic bovine lymphomas were of immature cell lineage (one B lymphoma and five T lymphomas). The c-myb mRNA was expressed in almost all the sporadic bovine lymphomas (except for one thymic form) including a BoCD8 single positive T lymphoma. On the contrary, c-myb was not expressed in mature B lymphomas of enzootic bovine leukosis. The results suggest that c-myb expression is closely associated with tumor cell differentiation of bovine lymphomas.

B-1a, B-1b and conventional B cell lymphoma from enzootic bovine leukosis

In order to characterize the phenotypes of tumor cells and to clarify from which B cell lineage the lymphomas were derived, ten cows with enzootic bovine leukosis were examined by means of immunohistologic staining and flow cytometry. The tumor cells expressed mainly major histocompatibility complex (MHC) class II+ (10/10), BoCD11b+ (9/10), IgG1+ (8/10), B-B2+ (8/10) BoCD5+ (7/10), and lambda light chain+ (7/10). Tumor cells from only one animal expressed sIgM+ (1/10). Tumor cells from all ten animals were negative for IgG2, BoCD3, BoCD4, BoCD8, WC1-N2, and IL-2R alpha. The phenotypes of these tumor cells were all slightly different, suggesting that bovine leukemia virus (BLV)-induced lymphoma expresses phenotypic diversity. Moreover, tumor cells from seven cattle coexpressed BoCD5 and BoCD11b (B-1a cells). On the other hand, tumor cells from two of them only expressed BoCD11b (B-1b cells), and those from one were negative for both BoCD5 and BoCD11b (conventional B cells). Therefore, we concluded that BLV-induced lymphoma cells can be derived from B-1a, B-1b and conventional B cells.

Immunohistological study on bovine lymph node using monoclonal antibodies to interleukin-2 receptor

Three monoclonal antibodies to IL-2R alpha (LCTB32, CACT116 and LCTB2) were used for immunohistologic staining of lymph nodes from normal young cattle and a calf suffering from phlegmon. In the normal cattle, a few IL-2R alpha positive cells were detected in the paracortex region. In the calf, IL-2R alpha was mostly expressed on follicle cells.

[A case of relapsing demyelinating multiple mononeuropathy with multifocal nerve enlargement]

We report a 23-year-old woman, who had a relapsing-remitting multiple mononeuropathy with multifocal nerve enlargement. The patient was characterized by asymmetrical, marked enlargement of multiple nerves in the arms (median and ulnar nerves) and neck (accessory nerve) bilaterally. Sequential nerve conduction studies revealed persistent demyelinative abnormalities, especially across the segment of nerve thickening. The MRI of the proximal arm confirmed the markedly enlarged median and ulnar nerves which showed high signal intensity on T2-weighted images and partial enhancement after administration of gadolinium. We consider that the patient had the clinical features of "multifocal pseudohypertrophic neuropathy" described by Adams et al, and that chronic demyelination and inflammation associated with impairment of the blood-nerve barrier might be underlying mechanisms.

Phenotypic analysis of neoplastic cells from calf, thymic, and intermediate forms of bovine leukosis

Immunohistochemistry and flow cytometric analysis were used with monoclonal antibodies to examine the phenotype of neoplastic cells from cattle with sporadic bovine leukosis (three cases of calf form, two cases of thymic form, and three cases of intermediate form). Three cases of calf form and two cases of intermediate form were positive for B cell lineage in immunohistologic examination and in flow cytometric analysis for B-B2+, sIgM+, and major histocompatibility class II+. Two cases of thymic form and one case of intermediate form were CD2+, CD5+, CD6+, and CD8+ in immunohistologic examination and in flow cytometric analysis. The results show that neoplastic cells develop from B and T cell lineages in sporadic bovine leukosis.

Immunohistologic studies on subpopulations of lymphocytes in cattle with enzootic bovine leukosis

The distribution of subpopulations of lymphocytes in lymph nodes and tumors from cattle with enzootic bovine leukosis (EBL) was examined by immunohistochemistry using a panel of monclonal antibodies against leukocyte differentiation molecules of EBL. The lesions in lymph nodes could be divided into three types based on the extent of infiltration and proliferation of neoplastic cells with provirus and differential expression of leukocyte differentiation molecules. The number of B-B2+, sIgM+ cells was reduced in frequency in follicles during the neoplastic cell proliferation. CD4- and CD8-positive alpha/beta T cells and gamma/delta T cells positive for WC1 (workshop cluster designation) were also reduced in frequency in areas infiltrated with neoplastic cells. Almost all neoplastic cells were B-B2- and IgM-positive. However, there were a few B-B2- and/or IgM-negative cells or cells stained faintly in all cases. WC1+ cells were not observed in tumor tissues. However, CD4+ and CD8+ cells were observed throughout tumor tissues, suggesting a role for these cells in tumor immunity.

Nucleotide sequence and the molecular evolution of a new A2 gene in the DQ subregion of the bovine major histocompatibility complex

cDNA clones encoding the bovine major histocompatibility complex (MHC) class II DQ alpha chain were isolated. One clone, MQ9, encoded a primary translated product of 255 amino acids, with a signal peptide of 23 amino acids and a mature polypeptide of 232 amino acids. A new A2 gene in the DQ subregion of the bovine genome was identified from a comparison of amino acid sequences encoded by class II A genes among several species and the construction of a phylogenetic tree. It was revealed that MQ9 is most closely related to the ovine DQA2 genes among sequences from various mammalian species. By contrast, the BoLA-DQA genes previously isolated are more closely related to ovine DQA1 than to the BoLA-DQA2 gene, and they represent BoLA-DQA1 genes. Thus, the presence of two BoLA A genes, which may be expressed and functional in the bovine, as well as in sheep was confirmed. A large number of amino acids unique to products of DQA2 genes of bovine and ovine origin were identified when the predicted amino acid sequences for both species were compared, and most of the DQA2-specific residues were located in the alpha 1 domain and were conserved with respect to products of DQA1 genes of ruminants. Thus, several characteristics of the bovine DQA genes were found to differ from those of human and rodent genes, despite similarities in gene structure and in nucleotide sequence.

Hypersensitivity of cortical muscarinic receptors in Parkinson's disease demonstrated by PET

The status of muscarinic receptors (mAChRs) is not clear in Parkinson's disease (PD). We measured mAChR binding in the brain of eight patients with PD and eight, age-matched, healthy controls by positron emission tomography (PET) and [11C]N-methyl-4-piperidyl benzilate ([11C]NMPB). PD patients were not demented according to DSM III criteria but showed significant frontal lobe dysfunction in the Modified Wisconsin Card Sorting Test. A mean K3 value, which is an index of mAChR binding calculated by a graphical method, was 20% higher in the frontal cortex of PD patients than controls (p < 0.05). Hypersensitivity of mAChRs in the frontal cortex of PD patients may be a response to a loss of ascending cholinergic input to that region, and may relate to frontal lobe dysfunction in PD.

Identification of a new bovine MHC class II DRB allele by nucleotide sequencing and an analysis of phylogenetic relationships

Three overlapping cDNA clones coding for the bovine major histocompatibility complex (MHC) class II DR beta chain were isolated. A clone NR1 encoded a primary translated product of 266 amino acids, 29 of which were deduced to form a signal peptide and 237 to form the mature polypeptide. The protein predicted from this cDNA appeared to have all the features expected of an expressed MHC class II molecule. Comparison of the sequences and construction of a phylogenetic tree revealed that NR1 represents a BoLA-DRB3 gene and not a BoLA-DRB1 or BoLA-DRB2 pseudogene. NR1 and ovine sequences exhibited the greatest overall similarity among sequences from various mammalian species, followed by the equivalent human sequences. Indeed, the bovine allele was more closely related to certain ovine alleles than to other bovine alleles. A large number of replacement substitutions were identified when beta 1 domains encoded by NR1 and each of the 36 distinct BoLA-DRB3 alleles were compared, and most of the allelic variations were found in regions that are commonly polymorphic in DRB sequences from different species and correspond to the predicted antigen-recognition site. Thus, the predicted structure of the unique NR1 allele for BoLA-DRB3 further confirms the overall conservation of the product of this locus, as previously established from studies in rodent and man.

An immunohistochemical study of an equine B-cell lymphoma

The tissues of an 8-year-old thoroughbred castrated male horse with equine lymphoma were examined immunohistochemically. Neoplastic masses were observed in the mediastinum, mesenteric lymph nodes, gastric mucosa and serosa, liver capsule, and spleen capsule with associated lymph nodes. Histopathologically, the neoplastic cells were seen to consist predominantly of a mixture of well differentiated small and large types. Immunohistochemically, the small lymphoid cells were MHC class IIlow+ and PanT- and the large lymphoid cells were MHC class IIhigh+ and PanT-. These findings revealed that the neoplastic cells were of B-lymphocyte lineage.

[Postural sway in patients with hereditary ataxia]

Instability of erect stance in patients with autosomal dominant hereditary ataxia was investigated by posturography. Postural sway on a force-measuring platform was measured quantitatively and sway frequencies were analyzed. Thirty patients from 27 families (15 men and 15 women, mean age of 53.1 years (SD 11.1)) were divided into two clinical groups. Twelve patients (group A) had "pure" cerebellar signs with no somatosensory afferent symptoms. Eighteen patients (group B) had sensory disturbances or diminished reflexes of the lower limbs, and a delayed latency of scalp P37 in somatosensory evoked potentials subsequent to tibial nerve stimulation. Postural sway of the patients of both groups was larger than that of normal subjects. Group A patients had a high antero-posterior/lateral sway ratio. Group B patients had increased sway with eyes closed. With respect to sway frequencies, group A patients had a power spectrum peak around 3 Hz. Group B patients had a power spectrum peak around 1 Hz, and twelve of them had another 3 Hz component. Atrophy of the anterior lobe of the cerebellum shown by MRI was more prominent in patients who had the 3 Hz power spectrum peak than in patients lacking the 3 Hz peak. Quantitative posturography was useful to detect disturbances of the anterior lobe of the cerebellum and the spinal ascending system in patients with autosomal dominant hereditary ataxia.

Cloning of cDNAs and the molecular evolution of a bovine MHC class II DRA gene

Two overlapping cDNA clones coding for bovine major histocompatibility complex (MHC) class II antigen DRA chain were isolated and characterized. The full-length cDNA clone, MR1, encoded a primary translated product of 253 amino acids, 24 of which were deduced to be a signal peptide and 229 which formed a mature polypeptide. The amino acid sequences deduced from this clone resembled those of class II A molecules from other species in both size and structure, but no potential consensus site of N-linked glycosylation comparable to those in the human, mouse, rat and swine proteins was found in the alpha 2 domain, as well as ovine and equine DRA molecules. Comparison of amino acid sequences encoded by class II A genes among several species and a dendrogram constructed from these data places the DRA gene and the DQA/DYA genes on two distinct branches of a phylogenetic tree, with bovine DRA and ovine DRA being most similar on the DRA branch.

Effects of trihexyphenidyl and L-dopa on brain muscarinic cholinergic receptor binding measured by positron emission tomography

The effects of pharmacological intervention on brain muscarinic cholinergic receptor (mAChR) binding were assessed in seven patients with Parkinson's disease by positron emission tomography and carbon-11 labelled N-methyl-4-piperidyl benzilate ([11C]NMPB). [11C]NMPB was injected twice, approximately 2 hours apart, in each patient, to assess the effect of single doses of 4 mg of trihexyphenidyl (n = 5) or 400 mg of L-dopa with 57 mg of benserazide (n = 2) on the binding parameter of mAChRs (K3). There was a mean 28% inhibition of K3 values in the brain in the presence of trihexyphenidyl, which was assumed to reflect mAChR occupancy. No significant change in K3 was observed in the presence of L-dopa. This study demonstrates the feasibility of measuring mAChR occupancy by an anticholinergic medication with PET.

Increased concentration of C4d complement protein in the cerebrospinal fluids in progressive supranuclear palsy

Plasma and CSF levels of C4d and the circulating immune complex (CIC) to C1q were measured in 27 patients with progressive supranuclear palsy (PSP), Parkinson's disease (PD) and cervical spondylosis (CS). There was no significant difference among groups in plasma C4d or in plasma or CSF CIC to C1q. However, the PSP group had significantly higher CSF levels of C4d than the PD and CS groups. Higher CSF C4d index in the PSP group was also shown compared with PD and CS groups. These results suggest that augmented complement activation in the wide areas of the central nervous system occurs in PSP. CSF levels of C4d or C4d index may serve as a basis for differentiating PSP from PD.

Concentration of neural thread protein in cerebrospinal fluid from progressive supranuclear palsy and Parkinson's disease

We measured the concentration of neural thread protein (NTP) in cerebrospinal fluid (CSF) by an automatized microparticle enzyme immunoassay from 11 progressive supranuclear palsy (PSP) patients and 11 Parkinson's disease (PD) patients and 7 patients with cervical spondylosis as controls. The mean levels did not differ significantly among the groups. In the PSP group, however, the levels correlated significantly with the severity of motor symptoms, signs and functional disability but not with dementia, while the opposite was true in the PD group. The elevated levels in PSP cases may reflect an increase with progression of the disease in such pathological structures as neurofibrillary tangles or neuropil threads, while in PD such levels may indicate associated Alzheimer-type pathology.

Morphogenesis of compound melanosomes in melanoma cells of a gray horse

A thoroughbred horse, gelding, gray color, aged 19 years old had cutaneous melanomas from the root to the middle of the tail, and throughout the connective tissues of the whole body. Histologically, the tumors were diagnosed as mature melanotic melanomas characteristically deposited with abundant melanin pigment. Examined with an electron microscope, melanosomes were electron opaque without internal structure (stage IV), or as mature granular and lamellar types. Most of them were fused with each other, and formed compound melanosomes, which was similar to internal melanin aggregates in shape. The internal melanin aggregates gradually disintegrated, and compound melanosomes grew spherical. The compound melanosomes changed into autophagosomes.

[Paramedian dorsal syndrome of mesencephalic tegmentum]

Two cases of brainstem infarction involving a unilateral side of the midbrain tegmentum showed a peculiar ocular symptom complex. The ocular syndrome consisted of (1) oculomotor palsy ipsilateral to the lesion, (2) monocular eyelid retraction and upward gaze palsy contralateral to the lesion, and (3) conjugate downward gaze and convergence palsy. By computed tomography and cerebral angiography, the lesion shared by the two cases was identified in the territory of median mesencephalic rami originating from the posterior cerebral artery. The lesion involved oculomotor nucleus on a side. Contralateral monocular symptoms and conjugate palsies could be attributed to a damage in their supranuclear tracts. Considering with two similar cases in the literature, it is strongly suggested that a unilateral ischemic lesion of the paramedian dorsal part of the midbrain tegmentum is responsible for this syndrome. Bilateral or unilateral eyelid retraction (Collier's sign) was considered to locate a lesion in the posterior commisure by Collier himself. The posterior commisure is, however, not involved in our two cases, and a paramedian lesion of the midbrain tegmentum deviated to a side may cause contralateral eyelid retraction. A combination of ophthalmoplegia ipsilateral to the lesion, upward or lateral (in the opposite direction to the lesion) gaze palsy, and hemiataxia on the contralateral side resembling our second case is sometimes erroneously called Nothnagel's syndrome. Nothnagel mentioned symptomatology of the quadrigeminal bodies for local diagnosis in his text in which he did not describe this combination of signs.

[HTLV-I associated myelopathy presenting with profound atrophy of unilateral lower limb]

A 63-year-old woman had suffered from progressive weakness and wasting of the right lower limb for seven years. In the lower limbs, there were profound muscular atrophy and weakness on the right, and mild weakness with spasticity on the left. Muscle strength of the upper limbs was normal. Sensory examination was normal except for paresthesias below the right knee. Anti-HTLV-I antibody titer was raised both in serum and in the CSF. Motor nerve conduction studies of the lower limbs showed small compound muscle action potentials and somewhat slow conduction velocities, more evident in the right side. F-wave was evoked only in the left tibial nerve and its latency was increased. Sensory nerve conduction studies were normal in the lower limbs. Somatosensory evoked potentials (SEPs) after tibial nerve stimulation at the ankles showed increased interpeak latencies between lumbar N20 and scalp P37. Nerve conduction studies in the upper limb were normal. Single fiber electromyography suggested anterior horn involvement not only in the lumbosacral cord but also in the cervical cord. Weakness and spasticity improved after oral administration of prednisolone. The SEPs findings and a favorable response to prednisolone excluded the possibility of amyotrophic lateral sclerosis. This case is a clinical variant of HTLV-I-associated myelopathy presenting profound atrophy of unilateral lower limb.

Dopamine D1 receptors in Parkinson's disease and striatonigral degeneration: a positron emission tomography study

Striatal dopamine D1 receptors were investigated in 11 patients with Parkinson's disease (PD), five patients with striatonigral degeneration (SND) and six age-matched controls by positron emission tomography and carbon-11 labelled SCH23390. The SND patients showed mean 12%, 21%, and 31% declines in the ratios of radioactivity in the caudate, anterior putamen, and posterior putamen compared with that in the occipital cortex. These ratios were not significantly altered in the PD patients. The results may explain the different therapeutic responses to levadopa between SND and PD patients, and this technique might prove useful for their differentiation.

Dopamine D1 receptors in Parkinson's disease and striatonigral degeneration: a positron emission tomography study

Striatal dopamine D1 receptors were investigated in 11 patients with Parkinson's disease (PD), five patients with striatonigral degeneration (SND) and six age-matched controls by positron emission tomography and carbon-11 labelled SCH23390. The SND patients showed mean 12%, 21%, and 31% declines in the ratios of radioactivity in the caudate, anterior putamen, and posterior putamen compared with that in the occipital cortex. These ratios were not significantly altered in the PD patients. The results may explain the different therapeutic responses to levadopa between SND and PD patients, and this technique might prove useful for their differentiation.

[Cobb syndrome and Klippel-Trenaunay-Weber syndrome]

We reported two patients with neurocutaneous angiomatosis. Patient 1, a 36-year-old woman of Cobb syndrome had cutaneous portwine angiomas in the high back and spinal arteriovenous malformations at the level of Th4-11. She had also atrophy and livedo reticularis presenting during standing position in the left lower extremity. Patient 2, a 47-year-old man of Klippel-Trenaunay-Weber syndrome had varices in the bilateral lower extremities, cutaneous portwine angiomas in the high back and bilateral lower extremities, and hypertrophy of the bilateral legs. Neuroradiological examination revealed abnormal vessels in the spinal canal at the level of C5 and Th4. These syndromes may have no essential difference because of the presence of neural and cutaneous angiomas at the corresponding level, venous system disorders and trophic changes (hypertrophy/atrophy).

[Analysis of relative cerebral perfusion in ischemic cerebral diseases by single photon emission computed tomography using N-isopropyl-p-[123I]iodoamphetamine]

Semiquantitative analysis of 123I-IMP SPECT enabled to evaluate relative regional cerebral perfusion and redistribution rates. Two parameters were calculated; the relative perfusion rate (RPR) is the ratio of radioactivity on a localized lesion divided by radioactivity on the visual cortex, the redistribution rate (RR) is the ratio of RPR in late images at 3 hrs divided by that in early images at 15 min postinjection. Total of 45 patients with ischemic cerebral diseases were studied. There were 29 males and 16 females with the age ranging from 37 yr to 80 yr. The RPRs were 81.3 +/- 5.1% in TIA (14 cases), 63.6 +/- 10.6% in RIND (8 cases), 64.6 +/- 8.5% in mild infarction (9 cases) and 40.2 +/- 13.8% in severe infarction (14 cases). RPR on the lesion of the severe infarction was extremely low compared to that of TIA, RIND and mild infarction. RPRs of lesions in the mild and severe infarction were reversely correlated to the size of LDA on X-ray CT (p less than 0.01). RPR was well correlated to clinical status of ischemic diseases. The RRs were 1.18 +/- 0.08 in TIA, 1.41 +/- 0.20 in RIND, 1.28 +/- 0.15 in mild infarction and 1.21 +/- 0.31 in severe infarction. The RR of RIND was significantly higher than those of other categorized groups (p less than 0.01). The RR may prove useful as a parameter reflecting tissue viability in cerebral ischemic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation for the training and behavior of dental treatment in our special patients center]

With a view to modifying the respective behaviors of patient, protector and operator so that a relationship of reliability can be established among them, we have adopted the training for dental treatment in the medical care system for handicapped children. We took this opportunity to classify the present handling methods at the practice of medical care into 4 groups (A, B-1, B-2, C) and to examine the training effect in each group and its features. [Method] On 145 patients having received treatment in the Dental Center for the Handicapped Children in our Hospital, number of patients by group, average age at the first examination, average training frequencies before and after treatment, average treating frequency, behavior in the training and relationship between each group and the disorder were examined for the card. [Results] 1) About 40% of the subjects for examination became capable of receiving treatment without any controlling appliance before the final treatment. 2) Average training frequency and average treating frequency had higher values of B-1 group than for other groups. 3) Behavioral estimation during the training revealed that A and B-1 groups showed better performance in mouth washing, brushing and cleaning by brushing than B-2 group, but the case was the contrary with oral use of three-way syringe and the vacuum. [Conclusion] Application of various behavior-modifying techniques to the training for dental treatment in children with psychosomatic disorder made its effect and features.

The inhibitory effects of cimetidine on elimination and distribution of propranolol in rats

We studied the effects of cimetidine on the pharmacokinetics, blood and tissue distribution and plasma protein binding of propranolol in rats. The plasma disappearance of propranolol after a 10 mg/kg intravenous injection and oral administration were fitted to a two compartment open model. In the cimetidine treated rats, the area under concentration curve after an intravenous injection (AUCiv) was increased by 64% and the plasma total body clearance (Cltot) and the rate constant at the terminal phase (beta) were decreased by 38% and 33% of those of the non-treated rats, respectively. The area under the concentration curve after oral administration (AUCpo) was increased by 62% and the plasma oral clearance (Clpo) was decreased by 39% by cimetidine treatment, whereas the bioavailability (F) was not changed. The hepatic blood flow rate (Qh) and the product of the plasma unbound fraction and the hepatic intrinsic clearance (fp x Clint,h) calculated from Cltot and Clpo were decreased by 30% and 39%, respectively. The blood-to-plasma concentration ratio (Rb) and the tissue-to-plasma concentration ratio (Kp) of propranolol were not affected by cimetidine treatment, while the binding constant (Kb) in plasma was decreased by 45%. The plasma unbound fractions (fp) of propranolol were increased by 25-70% in the in vivo plasma concentration range (0.1-1.0 microgram/ml) resulting in the decrease of tissue-to-plasma unbound concentration ratio (Kp,u) in lung, heart, spleen, brain and muscle. Cimetidine was shown to have the inhibitory effects on elimination and distribution of propranolol in rats.

Effects of nicotine on ambulatory activity in mice

Nicotine (0.5 and 1.0 mg/kg) administered subcutaneously to mice decreased the ambulatory activity recorded by an ambulo-meter in a dose-dependent manner from 5 to 60 min after the administration, and the higher dose (1.0 mg/kg) caused a long-lasting ataxia. To be noted was the initial increment of ambulation which usually preceded the ataxia-inducing effect with every dose of nicotine, and the lowest dose (0.10 mg/kg) employed herein induced only the increasing effect on ambulation recorded for the first 20 min after its administration. The ataxia-inducing effect of nicotine (1.0 mg/kg) was attenuated by the pretreatment with mecamylamine (0.4-2.0 mg/kg) in a dose-dependent manner, though the attenuating effect waned at a higher dose (4.0 mg/kg). In contrast, pretreatment with either hexamethonium (2.5 and 5.0 mg/kg) or atropine (1.0, 2.5 and 5.0 mg/kg) did not affect the ataxia-inducing effect of nicotine. Atropine when administered alone was found to markedly increase the ambulatory activity at the doses used for the pretreatment. Measurement of the time-dependent change of [3H]-nicotine level in brain tissue after its subcutaneous injection revealed that there is a good correlation between the brain levels of the alkaloid and the intensity of its ataxic effect rather than the initial increasing effect on ambulation. The results obtained herein suggest that nicotine exerts its ataxic effect centrally, but the site and type of the receptor stimulated by nicotine remains to be identified.