Serum copper and zinc levels in epileptic children with valproate treatment

Valproate (VPA) induces zinc (Zn) deficiency in experimental animals, but whether VPA treatment induces deterioration of serum trace metal homeostasis in humans is uncertain. We measured serum copper (Cu) and Zn levels in epileptic children treated with VPA and/or other antiepileptic drugs (AEDs). Patients treated with VPA monotherapy had significantly lower levels of serum Cu (82.2 +/- 16.6 micrograms/dl) than normal controls (97.3 +/- 23.0 micrograms/dl). Patients treated with VPA in addition to some other AED also had significantly lower levels of serum Cu (84.8 +/- 20.0 micrograms/dl). Serum Cu concentrations in patients treated with AEDs except for VPA (87.7 +/- 19.1 micrograms/dl) were not statistically different from those of control subjects. In contrast to the reported results of animal experiments, serum Zn levels were not altered in patients with VPA treatment. Although none of our patients showed any symptoms of Cu deficiency, we should pay attention to potential Cu deficiency in patients with VPA treatment.

Glycogen storage disease type III with muscle involvement: reappraisal of phenotypic variability and prognosis

A review of the case histories of 19 Japanese patients with enzymatically proven glycogen storage disease (GSD) III who developed muscular symptoms at various ages illustrates the phenotypic variability of this disease. There seem to be 4 subgroups of GSD III with muscle involvement according to the clinical symptoms. The first group of patients is characterized by the childhood onset of muscle weakness and hepatic disorders. The second group of patients develops muscular symptoms in adult years while the liver symptoms start in childhood. The third group includes the patients whose muscle weakness started in adult years long after liver symptoms in childhood had disappeared. The fourth group shows only muscular symptoms as adults without any sign or history of liver dysfunction since childhood. The prognosis for each subgroup seems to be different; however, none of them appears to be better than that for GSD I, as has been suggested previously.

Changes in the ganglioside composition of human neuroblastoma cells under different growth conditions

The ganglioside composition of human neuroblastoma cells (LA-N-1 and LA-N-5) was studied in samples obtained from (1) original cells in tissue cultures, (2) tumors grown in nude mice inoculated with original cells and (3) cells in tissue cultures re-established from the mouse tumors. The amounts of "a" pathway gangliosides (GM2, GM1 and GD1a) and those of the "b" pathway (GD3, GD2, GD1b and GT1b) differed according to the culture conditions. The "b" pathway gangliosides were markedly increased in the tumors grown in nude mice. In contrast, the "a" pathway gangliosides were abundant in cultures of both original and re-established cells. We also measured the enzymatic activities of UDP-N-acetylgalactosamine: GM3, N-acetylgalactosaminyl transferase (EC 2.4.1.92) and of CMP-N-acetylneuraminic acid: GM3 sialyl transferase (EC 2.4.99.8) in neuroblastoma cells cultured under these conditions. These enzymes are thought to be the key enzymes involved in the synthesis of the "a" and "b" pathway gangliosides. Though there was no significant difference in the activity of N-acetylgalactosaminyl transferase between original cells and tumors in nude mice, re-established cells showed a definitely higher activity (3.5 times higher than in the original cells). On the other hand, tumors grown in nude mice had a markedly higher activity of sialyl transferase than that of original cells or re-established cells. These findings suggest that the culture conditions and/or the type of cell growth play some role in the synthesis and expression of gangliosides in neuroblastoma cells.

Neurohypophyseal function of an ectopic posterior lobe in patients with growth hormone deficiency

We studied the neurohypophyseal function of 20 patients with complete GH deficiency owing to pituitary stalk transection by means of the water deprivation and the hypertonic saline infusion test. In T1-weighted magnetic resonance images, high-signal intensity of the posterior lobe of the hypophysis was missing in all the patients. An ectopic posterior lobe was observed at the proximal stump of the transected stalk in 17 patients, whereas the 3 patients without ectopic posterior lobe had overt diabetes insipidus or intractable nocturnal enuresis. After water deprivation, 3 patients with large ectopic posterior lobes (length along the pituitary stalk axis exceeding 5 mm) showed urinary osmolality and plasma AVP levels as high as those of 13 patients with partial GH deficiency in whom magnetic resonance images revealed no abnormalities. On the other hand, 14 patients with small ectopic posterior lobes (length less than 5 mm) showed significantly lower urinary osmolality and plasma AVP levels than the patients with large ectopic posterior lobes (p less than 0.01 and p less than 0.01, respectively) and the patients with partial GH deficiency (p less than 0.01 and p less than 0.01, respectively). Urinary osmolality in the patients with small ectopic posterior lobes, however, was higher than that in 3 patients without ectopic posterior lobes (p less than 0.01). During the hypertonic saline infusion test, peak plasma AVP levels in the patients with small ectopic posterior lobes were significantly lower than those in the patients with partial GH deficiency (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Wilms tumour in a patient with growth hormone replacement therapy

Wilms tumour was found in a Japanese boy aged 5 years 9 months with isolated growth hormone (GH) deficiency and some congenital anomalies. He had received pituitary GH replacement therapy from the age of 2 years 1 month to 4 years 7 months and after a 1 year interval he received biosynthetic GH for 2 months until the tumour became clinically apparent. This was the sixth known patient with GH deficiency to develop a malignant neoplasm during or after GH replacement therapy and the first with a solid tumour in Japan since 1975, when treatment with pituitary GH for patients with GH deficiency was introduced.

Developmental changes of plasma ganglioside concentration during the neonatal period

We investigated the developmental changes of plasma ganglioside concentration during the neonatal period. The mean plasma ganglioside concentration at birth was 8.22 +/- 3.70 nmol lipid-bound sialic acid (LBSA)/ml, significantly lower than the value in adults (12.05 +/- 1.36 nmol LBSA/ml, P less than 0.02). However, it increased rapidly early in the neonatal period and reached its maximum level at 14 days of age (16.25 +/- 6.04 nmol LBSA/ml), which was higher than that of adults (P less than 0.05); then it decreased slowly to the adult level at one month of age. The mean plasma ganglioside concentration in preterm infants (gestational age less than 37 weeks) was 6.65 +/- 3.35 nmol LBSA/ml, somewhat lower than that of fullterm infants (gestational age greater than or equal to 37 weeks, 9.90 +/- 3.39 nmol LBSA/ml, P less than 0.02) at birth. After birth, it increased much more rapidly in preterm infants and there was no significant difference between these two groups at 5 days of age. Plasma ganglioside concentration at birth increased gradually in correlation with gestational age. Our investigations show that plasma ganglioside concentration may reflect the development and maturation of the central nervous system to some degree, at least early in the neonatal period.

Y chromosome specific DNA probe in the diagnosis of a patient with mos 45,X/46,XYnf

In a patient with mos 45,X/46,XYnf, the diagnosis was confirmed with a Y chromosome-specific DNA probe, Y-190. The patient was a phenotypic female without Turner syndrome stigmata other than short stature. She showed some evidence of virilization and high serum testosterone. Her peripheral blood karyotype was mos 45,X/46X, +mar. Although this marker chromosome resembled a Y chromosome, there was no quinacrine bright region on its long arm. Southern blot analysis of her peripheral blood mononuclear cell DNA with Y-190 as a probe showed strong hybridization with this probe. Gonadectomy was performed, and bilateral gonadoblastomas were found.

[Basilar bifurcation aneurysm associated with internal carotid artery occlusion. Report of two cases]

Two cases of subarachnoid hemorrhage caused by rupture of a basilar bifurcation aneurysm associated with occlusion of the internal carotid artery (ICA) at the neck are presented. Case 1, a 71-year-old female, was hospitalized in a coma. Angiography demonstrated occlusion of the bilateral ICA, collateral blood supply through the branches of the foramen rotundum or vidian artery from the maxillary arteries and right posterior communicating artery, and a saccular aneurysm at the basilar bifurcation. The patient died 1 month later following rerupture of the aneurysm. Case 2, a 64-year-old male, was hospitalized for drowsiness. Angiography showed occlusion of the right ICA, collateral blood supply through a tortuous artery (a vidian artery), and a large aneurysm at the basilar bifurcation. Posterior circulation supplied anteriorly through the right posterior communicating artery. The patient died 1 month later because of rerupture of the aneurysm. Laminar thrombosis of the right ICA and an anastomotic vessel, seemingly a branch of the foramen rotundum or a vidian artery, were demonstrated by autopsy. The combination of cerebral aneurysm and collateral circulation is extremely rare in cases of occlusion of the ICA. The two cases described here suggest that hemodynamic stress is an important factor in the formation of cerebral aneurysms.

Hypothalamic-pituitary function in growth hormone-deficient patients with pituitary stalk transection

We compared 1.5 T magnetic resonance (MR) image findings with hypothalamic-pituitary function in 11 patients with idiopathic pituitary dwarfism, each of whom had a history of perinatal abnormalities, and 1 patient with posttraumatic pituitary dwarfism. MR imaging revealed transection of the pituitary stalk in all patients and the formation of an ectopic posterior lobe at the proximal stump in 9 patients, none of whom had polydipsia or polyuria. Three patients without an ectopic posterior lobe had diabetes insipidus. The 5 patients who had small pituitary glands (less than 2 mm in height) had hypothyroidism with low serum TSH concentrations and low serum cortisol responses to insulin-induced hypoglycemia; however, 7 patients with normal-sized pituitary glands had normal thyroid and adrenal function. The serum GH response to GHRH did not correlate with the size of the pituitary gland. The patients with small pituitary glands had delayed or prolonged serum TSH responses to TRH and impaired serum LH and FSH responses to GnRH; 4 of the patients with normal-sized pituitary glands had normal serum TSH, LH, and FSH responses. Only 2 patients had high basal serum PRL concentrations. The endocrinological data suggest that reestablishment of the hypothalamo-hypophyseal portal circulation, which cannot be seen by MR imaging, may occur. We suggest that the primary cause of idiopathic pituitary dwarfism in many patients is injury to the pituitary stalk at birth.

Nocturnal urinary growth hormone excretion in children with short stature

Nocturnal urinary growth hormone levels in children with short and normal stature were measured by a sensitive enzyme immunoassay. Urinary GH excretion during sleep correlated positively with peak plasma GH values during pharmacological (r = 0.74, P less than 0.001) and sleep (r = 0.85, P less than 0.001) tests. The amounts of urinary GH excretion during sleep differed significantly from each other in the following groups: complete GH deficiency (mean +/- SEM: 0.1 +/- 0.1 ng/m2 of body surface area; range: less than 0.1-0.4), partial GH deficiency (1.6 +/- 0.3 ng/m2; 0.2-3.1), and short stature without GH deficiency (3.7 +/- 0.6 ng/m2; 0.7-11.5). No significant difference was found between short stature without GH deficiency and normal stature (5.0 +/- 0.5 ng/m2; 2.1-10.5). Measurement of nocturnal urinary GH excretion is a simple method for screening of GH excretion and may be helpful in the differentiation of the various etiologies of short stature in children.

Enhancement of transdermal delivery by superfluous thermodynamic potential. III. Percutaneous absorption of nifedipine in rats

The bioavailability of percutaneous nifedipine was studied in rats. To improve the transdermal delivery of nifedipine, concentration changes due to loss of a volatile component in the vehicle were utilized. The percutaneous absorption of nifedipine was enhanced from binary solvent systems of acetone and propylene glycol (PG) or isopropyl myristate (IPM), compared with the results from simple PG or IPM saturated with the drug. In contrast, no appreciable increases in the percutaneous absorption of nifedipine from PG or IPM above controls were observed for pretreatment of the dosing site with acetone. From a ternary vehicle of volatile/nonvolatile-hydrophile/nonvolatile-lipophile solvent system, i.e., acetone-PG-IPM, a very dramatic enhancement in the bioavailability of nifedipine was noted. In addition, a marked increase in the penetration of PG from the ternary solvent system was found, compared with the result from the binary solvent system of acetone and PG. Nifedipine solutions with the volatile component eventually caused precipitation at the dosing site and so reduced the plasma nifedipine concentration. The precipitation was inhibited or retarded when polymer additives were incorporated in the ternary solvent system, and the high plasma nifedipine concentrations were maintained. This effect was not diminished when the formulation was administered immediately after the evaporation of acetone. The area under the plasma nifedipine concentration-time curve from the ternary solvent system with a polymer additive was higher by about 75 times than that from PG saturated with the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Highly damage-resistant Mo mirror for high-power TEA CO(2) laser systems

A high-purity molybdenum (Mo) mirror was developed by an electron-beam melting method (e.b.m. Mo mirror). For the high-power TEA CO(2) laser, the e.b.m. Mo mirror has two to four times higher surface damage threshold than that of an Au-coated glass mirror and three times longer lifetime than that of a powder metallurgy Mo mirror (p.m. Mo mirror) when laser energy density lower than 60 J/cm(2) was irradiated with a 0.5-pps repetition rate. It was found that the difference between the e.b.m. Mo mirror and the p.m. Mo mirror at the laser-damage threshold was due to the fine surface without voids and the small amount of impurities.

[Growing aneurysm presenting with Weber's syndrome and obstructive hydrocephalus--a case report]

A case with two cerebral aneurysms, in which one at the origin of the left superior cerebellar artery (SCA) grew and presented with Weber's syndrome and obstructive hydrocephalus, is reported. The patient was a 69-year-old female, who had severe headache and vomited. On admission, neck stiffness was recognized. CT scan showed findings of subarachnoid hemorrhage. Angiograms demonstrated two saccular aneurysms at the right middle cerebral artery (MCA) bifurcation and at the origin of the left SCA. Craniotomy and neck clipping of the aneurysm at the right MCA was performed. After discharge, left oculomotor palsy appeared and gradually progressed. Severe headache and right hemiparesis suddenly occurred two years after the first attack. On the second admission, CT scan revealed high density on the brain surface and a well enhanced round lesion at the left ambient cistern. Left vertebral angiogram demonstrated increase in size of the aneurysm at the left SCA. The patient was discharged after conservative therapy. Drowsiness and urinary incontinence appeared, and she was admitted for the third time three years after the first admission. CT scan showed an enhancing mass lesion sized 25 X 30 mm beside the left midbrain and obstructive hydrocephalus. The aneurysm at the SCA no longer seen on the left vertebral angiogram. V-P shunt was performed. Both Weber's syndrome and obstructive hydrocephalus in this case indicate an aneurysmal natural history, in which aneurysm becomes gigantic and thrombosed spontaneously.

Basilar bifurcation aneurysm associated with bilateral internal carotid occlusion

A case of subarachnoid hemorrhage from ruptured aneurysm of the basilar bifurcation associated with occlusions of both internal carotid arteries at the neck is presented. Each internal carotid artery mainly received collateral flow at the cavernous portion from the internal maxillary artery through anastomotic artery of the foramen rotundum. Posterior circulation also supplied collateral blood flow via the right posterior communicating artery. This case report suggests that hemodynamic stress may be regarded as an important factor in the formation or development of cerebral aneurysm.

Tunable oscillation of a high-power argon excimer laser in the vacuum-ultraviolet spectral region

Successful oscillation of a tunable, high-power argon excimer laser is reported. The wavelength was tuned from 124.5 to 127.5 nm with a spectral width of 0.3 nm. The output power of 2.2 MW, obtained at the line center, is 3 orders of magnitude larger than the value reported previously by Wrobel et al. [Appl. Phys. Lett. 36, 113 (1980)]. The possibility of frequency conversion of the argon excimer laser radiation to other wavelengths by a stimulated Raman scattering process is discussed.

[Skull base metastasis of prostatic cancer presenting as exophthalmos--a case report]

A 72-year-old man was admitted to our hospital complaining of diplopia and right exophthalmos. Craniography and CT scan showed thickening of the right orbital roof and no intracranial lesion. Total acid phosphatase and prostatic acid phosphatase were high. Bone scintigraphy revealed high uptake at that lesion and the right pelvis. Unroofing of the right orbit and opening of the optic canal were performed in order to reduce intraorbital pressure. Microscopic examination revealed a metastatic lesion of prostatic cancer. Postoperatively, the patient was treated with "Honvan" and the course has been good.

[Meningioma and acoustic neurinoma occurring in two siblings of two different families]

The authors reported familial brain tumors in which meningioma and acoustic neurinoma occurred in two siblings of each two families with no evidence of the neurocutaneous syndromes, nor the familial cancer syndromes. Case A-1 is a 49-year-old female admitted to the hospital because of bilateral visual disturbance in July of 1976. A suprasellar mass was observed by CT scan. Right frontal craniotomy and removal of the tumor were done in July of 1976. Histological diagnosis was meningothelimatous meningioma. Case A-2 is a 47-year-old female, a younger sister of case A-1. Tinnitus, hearing disturbance, hemifacial sensory involvement of right side and impaired gait occurred at the end of 1981. Tomography revealed the dilatation of the right internal auditory canal. A multicystic mass was observed at the right cerebellopontine angle by CT scan. An operation was performed in May of 1982, and the tumor was diagnosed as Antoni A type neurinoma. Case B-1 is 23-year-old male who was admitted to the hospital in April of 1975, following the sudden onset of general convulsion. Left carotid angiogram showed the elevation of middle cerebral arteries and a tumor stain at the left temporal region. An operation was performed to remove the left sylvian tumor in April of 1975, and the tumor was diagnosed as transitional meningioma. Case B-2 is a 32-year-old female, an elder sister of case B-1. Bilateral tinnitus and hearing disturbance occurred in 1973. She complained left hemifacial sensory involvement and impaired gait in July of 1979. CT scan showed mass lesions with markedly contrast enhancement effect at the bilateral cerebellopontine angles. An operation was performed to remove the left tumor in November of 1979 and the right tumor in July of 1980. Histologically the both tumors were diagnosed as Schwannoma. The authors have collected reports of 117 families in which intracranial tumors occurred without evidence of the neurocutaneous syndromes and the familial cancer syndromes. Six out of 117 families showed histologically different kind of tumors, however the combination of meningioma and neurinoma could not be found. Consequently our cases of meningioma and neurinoma occurred in two siblings of two different families must be the first report.

Analysis of the dynamic characteristics of parasitic oscillation

An analysis of the dynamic characteristics of parasitic oscillation between target and pinhole of a beam expander was carried out using a simplified rate equation model. Suppression of parasitic oscillation was also investigated in view of the oscillation dynamics. Useful results were obtained quantitatively concerning the rise time of the amplifier gain and the distance between the target and the final amplifier of the laser fusion system.

Laser pumping by PFN power source

The use of a pulse forming network (PEN) as a main discharge power supply was tested in a electron-beam-controlled CO(2) laser amplifier in order to improve the utility efficiency of the energy in storage capacitors. The impedance of the pumping discharge through the laser gas was controlled by the accelerating voltage of the electron beam to match the PFN line impedance. In the matched condition all of the stored energy in the PFN was transffered to the laser gas at a constant electric field strength which was optimum for laser pumping.