Bone mass changes of tibial and vertebral bones in young and adult rats with collagen-induced arthritis

To study the effect of arthritis on bone mass, bone mineral density (BMD) of cancellous and cortical bone in the tibial metaphysis and diaphysis in 2- and 7-month-old rats with collagen-induced arthritis (CIA) was serially measured using peripheral quantitative computed tomography (pQCT). BMD in the fourth lumbar vertebra in 7-month-old CIA rats was also measured by pQCT. The fourth lumbar vertebral body, distal femur, and proximal tibia in 7-month-old CIA rats were analyzed histomorphometrically. Changes in BMD differed between 2-month-old (young) and 7-month-old (adult) CIA rats. Although the BMD for the proximal tibia (2 mm and 5 mm distal from the growth cartilage) in young CIA rats decreased compared with that in control rats, the values exceeded the initial value during the arthritis course. On the other hand, bone loss in adult CIA rats occurred predominantly in the cancellous bone of the periarticular region of the tibia (2 mm distal from the growth cartilage), in which the enhancement of bone resorption and reduced bone formation were observed histomorphometrically. No remarkable changes were demonstrated in BMD or histomorphometrical analysis for the lumbar vertebra during the experimental course. These results suggest that bone loss in adult CIA rats resembles the osteoporosis that develops during the early stage of human rheumatoid arthritis. We conclude that adult CIA rats are more appropriate than young CIA rats as an experimental model of secondary osteoporosis due to rheumatoid arthritis.

[Globus pharyngeus and bone mineral density]

While globus pharyngeus is a common disorder, the cause of this anomaly remains unclear. Gastroesophageal reflux, cricopharyngeal spasm, and many other etiologies have been considered as possible causes. Some researchers believe that the disorder is probably multifactorial in origin. Patients with globus pharyngeus are usually female, and the majority of them are menopausal. These middle aged females often have a reduced bone mineral density. This study was undertaken to determine whether males and females with globus pharyngeus have a reduced bone mineral density. We studied 12 men and 17 women with globus pharyngeus who came to Tokai University, Isehara Kyodo Hospital and the Hagino E.N.T. Clinic between February 1992 and February 1994 and compared them to a control group of 12 males and 15 females. Each patient met the criteria for 'primary globus pharyngeus' (Bradley 1987) as determined by endoscopy and none of the patients showed any signs of inflammation, tumors, or gastroesophageal reflux. The second midcarpal bone mineral density of each subject was measured using a computed X-ray densitometer and analyzed using microdensitometry. Compared with control group, patients with globus pharyngeus had a lower bone mineral density in their second midcarpal bone. The sigma GS/D was significantly lower in the globus pharyngeus patients than in the control group (p < 0.01) and significantly lower in the female patients than in the female control group (p < 0.01). The GSmax was significantly lower in the patients than in the control group (p < 0.01) and significantly lower in the female patients than in the female control group (p < 0.01). The GSmin was significantly lower in the patients than in the control group (p < 0.01), significantly lower in the female patients than in the female control group (p < 0.01), and significantly lower in the male patients than in the male control group (p < 0.05). In conclusion, globus pharyngeus appears to be related to a decrease in bone mineral density.

Study on sensitivity and specificity of diagnostic criteria for early rheumatoid arthritis

Abstract Sensitivity and specificity were compared among the American College of Rheumatology (ACR) 1987 classification criteria, the Yamasaki diagnostic criteria, and the Japan Rheumatism Association (JRA) diagnostic criteria for early rheumatoid arthritis (RA). The study included 90 patients who consulted our department for the first time within 1 year after onset and were suspected of having RA (final diagnosis: RA 45 cases, non-RA 45 cases). We investigated whether physical and laboratory findings at the first examination met these three sets of criteria to determine the sensitivity and specificity of each set of diagnostic criteria. Moreover, the sensitivity and specificity of each item in the diagnostic criteria set were similarly determined. The sensitivity of the ACR 1987 classification criteria, the Yamasaki diagnostic criteria, and the JRA diagnostic criteria for early RA were 71.1%, 88.9%, and 95.6%, respectively, and their specificities were 100%, 93.3%, and 77.8%, respectively. In a study on each diagnostic item, observation for 1 week was considered to be sufficient for morning stiffness, swelling in three joint areas, and symmetrical swelling, while observation for a more prolonged period seemed to be necessary for swelling of the finger and hand joints. The Yamasaki diagnostic criteria are appropriate for the diagnosis of early RA, while the JRA diagnostic criteria are suitable for screening.

Ventricular enlargement in schizophrenia spectrum patients with prodromal symptoms of obsessive-compulsive disorder

We hypothesized that male patients with schizophrenia spectrum disorders who have prodromal symptoms of obsessive-compulsive disorder (OCD) have ventricular enlargement compared with non-psychotic OCD patients, and that the difference in the ventricular size would offer a clue to the early detection of schizophrenia spectrum disorders. The ventricle-brain ratios (VBRs) in eight male patients with schizophrenia or schizotypal personality disorder (SPD) who had prodromal symptoms of OCD were compared with eight male patients with non-psychotic OCD and 14 normal male comparison subjects using three-dimensional magnetic resonance imaging (MRI). The VBR of the schizophrenia spectrum group was significantly larger than those of the OCD group or comparison subjects. Even the minimum VBR in the schizophrenia spectrum group was larger than the maximum VBR in the OCD group. These results may suggest the usefulness of three-dimensional MRI for early detection of patients with schizophrenia spectrum disorders who manifest OCD symptoms early in the course of the illness.

Clinicoradiologic study of cervical laminoplasty with posterolateral fusion or bone graft

STUDY DESIGN

A retrospective study of cervical expansive laminoplasty for cervical myelopathy from a clinicoradiologic perspective.

OBJECTIVE

To clarify the correlation among sagittal curvature of the cervical spine, cervical range of motion, sagittal plane translation, spinal cord atrophy, and myelopathic symptoms in patients who have undergone laminoplasty.

SUMMARY OF BACKGROUND DATA

Laminoplasties were developed to diminish the undesirable effects of laminectomy, which include postoperative kyphotic changes and instability. However, the superiority of laminoplasty over laminectomy remains controversial.

METHODS

Fifty-one patients with cervical spondylotic myelopathy or ossification of the cervical posterior longitudinal ligament who underwent laminoplasty were radiologically assessed before and after surgery. The index of the sagittal curvature, intervertebral range of motion, listhesis, and the transverse area of the spinal cord at the site of maximal compression were measured to evaluate interrelations among those parameters and myelopathic symptoms.

RESULTS

There were no patients with kyphotic curvature before surgery. The postoperative curvature tended to be less lordotic. This tendency did not adversely affect postoperative symptoms. The intervertebral range of motion was significantly decreased except at C1-C2. The final C4-C5 range of motion and the postoperative myelopathic symptoms were negatively correlated. A significant correlation was observed between the postoperative spinal cord atrophy and the final myelopathic symptoms.

CONCLUSIONS

The decrease in the lordotic curvature index and the decrease in the intervertebral range of motion after laminoplasty did not cause neurologic deterioration. In the C4-C5 intervertebral segment with a high incidence of listhesis, the restriction of the C4-C5 range of motion improved the clinical myelopathic symptoms. The radiologic prognostic factors were the postoperative restriction of intervertebral range of motion in preoperatively unstable segments and the anatomic reversibility of spinal cord insult.

Anomalies of ossification in the posterolateral femoral condyle: assessment by MRI

BACKGROUND

Anomalies of ossification in the lower femoral epiphysis are often radiographically indistinguishable from juvenile osteochondritis dissecans.

OBJECTIVE

To clarify the MRI characteristics of the anomalies of ossification in the posterolateral femoral condyle that distinguish it from juvenile osteochondritis dissecans.

MATERIALS AND METHODS

We retrospectively examined the medical records, plain radiographs (n = 4), MRI (n = 4) and follow-up MRI (n = 2) of four boys (age 8-11 years) with anomalies of ossification in the posterolateral femoral condyle.

RESULTS

Plain radiography showed symmetrical marginal irregularity of the posterolateral femoral condyles of both knees. These lesions were asymptomatic, and the areas of irregular radiographic appearances reduced in size or disappeared without treatment within a mean observation period of 3.5 months. MRI showed a clearly demarcated low-intensity islet with the same signal intensity as subchondral bone (which was considered to be an accessory ossification nucleus) in a high-signal area in which the signal intensity was equal to that of normal articular cartilage. The areas observed as radiolucent zones on plain radiography were visualised at the same signal intensity as articular cartilage, and were continuous with articular cartilage on MRI; thus they were regarded as uncalcified cartilage. These MR findings are different from MR images of osteochondritis dissecans.

CONCLUSIONS

MRI is considered to be the most effective non-invasive diagnostic method for these two conditions.

Effects of weight bearing on the tidemark and osteochondral junction of articular cartilage: histomorphometric analyses of 7 normal femoral heads

To study the effect of weight bearing on the tidemark and osteochondral junction, we compared the morphology of these two boundaries in weight-bearing and less weight-bearing regions of normal human femoral heads. We measured the irregularities of the boundaries in the two regions using an X-Y digitizer connected to a computer in histological whole sections of femoral heads in 7 subjects without joint diseases. The irregularity of the tidemark was small, showing no difference between the two regions. However, the irregularity of the osteochondral junction in the weight-bearing region was greater than in the less weight-bearing region, which was confirmed by three-dimensional reconstructed images. Our findings suggest that mechanical stresses greatly influence the morphology of the osteochondral junction compared to the influence of such stresses on the tidemark, and that the marked irregularity of the osteochondral junction in the weight-bearing region is a reactive phenomenon against mechanical fragility due to simple contact between calcified cartilage and subchondral bone without fibrous connections.

Anterior-posterior knee laxity increased by exercise. Quantitative evaluation of physiologic changes

To quantify physiologic changes in anterior-posterior laxity of the normal knee caused acutely by exercise, we evaluated the exercise level and the duration of exercise needed to cause changes in laxity, the magnitude of changes in laxity, and the time needed for laxity to return to the level before exercise, by continuously applying a fixed exercise load. After a 20-minute run at 7 km/hr, anterior laxity with a displacement force of 133 N increased by about one third, and the compliance increased by one half with anterior drawer between 0 and 67 N. These changes were maintained at a similar level during exercise. The levels before exercise were restored gradually over 1 hour after exercise. As the muscle strength showed no changes during exercise, we consider these changes in laxity are not associated with a decrease in muscle strength. Furthermore, since the changes in knee laxity after triathlon (in which the knee is subjected to prolonged excessive exercise) are similar to those after running at 7 km/hr, we believe that the magnitude of changes in laxity after exercise is fixed, regardless of the level of the exercise load. Moreover, the threshold of exercise that causes the maximum change is low.

Treatment of obstructive sleep apnea syndrome with a Kampo-formula, San'o-shashin-to: a case report

The following describes a 76-year-old male with obstructive sleep apnea syndrome successfully treated with a Kampo-formula, San'o-shashin-to (Formula medicamentorum tres ad dispellendi cordis). Polysomnography, performed before and after administration of San'o-shashin-to, revealed that the apnea index decreased from 11.1 events/hour to 4.1 events/hour, and that the apnea plus hypopnea index decreased from 18.4 events/hour to 10.7 events/hour. The patient was normo-weight (body mass index: 20.4 kg/m2), and events of sleep apnea and hypopnea were mostly noted during a non-rapid eye movement sleep. It is possible that San'o-shashin-to has some alleviating effects on the upper airway resistance during sleep.

Effect of ED-71 on modeling of bone in distraction osteogenesis

We investigated the effect of 2-beta-(3-hydroxypropoxy)-1alpha,25-dihydroxyvitamin D3 (ED-71) on the modeling of bone in distraction osteogenesis. The tibiae of 30 rabbits were lengthened by 10 mm in 10 days. Following osteotomy, ED-71 (0.05 microg/kg) was administered subcutaneously twice a week to the ED-71 group until necropsy. The bone mineral content (BMC) of the lengthened callus was measured by dual-energy X-ray absorptiometry (DXA). Five rabbits per group were killed at 1, 3, and 8 weeks after completion of lengthening, and the lengthened callus was examined histologically and histomorphometrically. Bone volume of the lengthened callus was measured by peripheral quantitative computed tomography (pQCT) at 8 weeks after the completion of lengthening. At all timepoints the BMC in the ED-71 group was significantly higher than that in the untreated group. The mineral apposition rate and bone formation rate were higher in the ED-71 group than in the untreated group at 1 and 3 weeks after the completion of lengthening on the coronal section. In cross sections, the cortical area and width in the ED-71 group showed significantly higher values than in the untreated group at 8 weeks after the completion of lengthening. Both the endosteal osteoid surface and endosteal eroded surface showed no differences between groups. However, the endosteal mineral apposition rate and endosteal bone formation rate were significantly higher in the ED-71 group. At 8 weeks after completion of lengthening, the intracortical area and intracortical BMC were significantly greater in the ED-71 group than in the untreated group, but no significant difference was noted in intracortical BMD. These findings indicate that ED-71 increases callus volume during the early period after the completion of lengthening, resulting in thick cortical bone formation.

Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan

A survey of all fractures in patients > or =35 years of age for hip, distal radius, and proximal humerus was performed in Tottori Prefecture, Japan. Hip fracture survey was done for the years 1986-1988, and also 1992-1994. A distal radius and proximal humerus fracture survey was done for the years 1986-1988, 1992, and 1995. The age- and gender-specific incidence rates of these three types of fracture among Japanese were substantially lower than those of whites living in North America or northern Europe. The age-adjusted incidence rates of hip fracture (per 100,000 person-years) were 40.7 and 114.1 in 1986 and 57.1 and 145.2 in 1994 for men and women, respectively, showing a significant increase with time for women. Upon examination of individual fracture types, there was no significant increase in cervical fractures, whereas a significant increase was observed in trochanteric fractures for women. The age-adjusted incidence rates of distal radius fractures for women were 164.9 in 1986 and 211.4 in 1995, showing a significant increase with time; however, no increase was observed among men. Incidence of proximal humerus fractures was 10.3 and 42.0 in 1986 and 17.1 and 47.9 in 1995 for men and women, respectively, and these increases were significant for both genders.

Bone metabolic changes in Antarctic wintering team members

Bone mass, bone metabolic markers, and calcium regulation hormones were measured in members of an Antarctic wintering team who stayed at the Japanese Antarctic station, Syowa (latitude: south 69 degrees 00', longitude: east 39 degrees 35') for 1 year. Subjects included 31 healthy Japanese males, aged 24-51 years (mean age 34.5 years) at the beginning of this study, ingesting 488 IU/day of vitamin D and 550.9 mg/day of calcium per person. The long-term coefficient of variation (CV) of the equipment used in the assessments of bone mass was 0.67% in single X-ray absorptiometry (SXA), 0.17% in the speed of sound (SOS) by quantitative ultrasound method (QUS), and 0.63% in broadband ultrasound attenuation (BUA) by QUS. The seasonal changes in the calcaneal bone mineral density (BMD) by SXA were not significant, whereas the SOS measured by QUS decreased during the measurement period (0.55%, p < 0.001), and BUA increased (1.9%, p < 0.01). Bone-specific alkaline phosphatase and osteocalcin levels increased significantly during summer (p < 0.001) and urinary calcium level decreased significantly during winter (p < 0.05). Urinary pyridinoline and deoxypyridinoline levels decreased significantly at the end of winter (p < 0.001). Serum 1,25(OH)2D3 level did not change significantly, whereas serum 25(OH)D3 level decreased significantly during winter (p < 0.001). Serum parathyroid hormone (PTH) level significantly increased at the end of winter (p < 0.01), although both PTH level and 25(OH)D3 level remained within the normal range. We concluded that the 25(OH)D3 level in subjects who stayed in Antarctica for 1 year decreased significantly with the reduction in duration of sunshine, but there were no clear changes in bone mass.

The change of bone mineral density in secondary osteoporosis and vertebral fracture incidence

Causes of secondary osteoporosis are diverse, and bone changes in this condition have been elucidated less than those in primary osteoporosis. In this study, bone mineral density (BMD) was measured in the lumbar spine, distal and proximal sites of the radius, and calcaneus in representative disorders that cause secondary osteoporosis to evaluate its changes. Also, the incidence of nontraumatic vertebral fracture was examined. The subjects were 80 patients with rheumatoid arthritis, 50 patients undergoing glucocorticoid (steroid) therapy, 20 patients with chronic hepatitis, 24 patients with liver cirrhosis, 14 patients with primary biliary cirrhosis (PBC), 26 patients with diabetes mellitus, and 20 postgastrectomy patients; all were ambulatory female outpatients. Two hundred females with primary osteoporosis were examined as a control group. The reproducibility of the measurement of the BMD was satisfactory at about 3% by all methods of measurement employed. Concerning changes in BMD, periarticular trabecular bone density was most markedly reduced in the rheumatoid arthritis group. The patients receiving steroid therapy showed the greatest decreases in the trabecular bone mineral density at the distal 4% of the radius and lumbar spinal BMD. In addition, the threshold of vertebral fracture was higher in those undergoing steroid therapy than in those with primary osteoporosis. The patients with PBC showed the greatest decreases in BMD among patients with chronic liver disorders, and no decrease in BMD was noted in the chronic hepatitis group. BMD was reduced only in the radius in the patients with diabetic mellitus, and it was generally reduced in the postgastrectomy patients. BMD of the calcaneus was not reduced in any group.

Effects of D2 dopamine receptor agonist and antagonist on brain activity in the rat assessed by functional magnetic resonance imaging

The effects of D2 dopamine receptor agonist, bromocriptine (BROMO), and antagonist, haloperidol (HPD), on brain activity were investigated in rats by functional magnetic resonance imaging. T2*-weighted signal intensity was increased in the hypothalamus at 120 min after acute administration of BROMO, and in the ventral posterior and dorsomedial nuclei of the thalamus from 30 to 120 min. In contrast, the signal intensity was decreased in the caudate-putamen at 30 min after acute administration of HPD, in the hypothalamus from 30 to 60 min, and in the perirhinal cortex at 30 min. After chronic (2 weeks) HPD treatment, acute administration of HPD decreased signal intensity in the caudate-putamen at 60 min, in the hypothalamus at 30 min, the perirhinal cortex from 2 to 120 min, the dorsomedial and ventral posterior nuclei of the thalamus from 2 to 120 min, and the medial nucleus of the amygdala from 60 to 120 min. These results suggest that (1) the D2 receptor agonist increased the activity of the thalamic nuclei and the hypothalamus, while the D2 receptor antagonist suppressed brain activity in the regions where D2 receptors were present, (2) the suppression of brain activity in the thalamic nuclei and the perirhinal cortex by acute HPD administration was enhanced by chronic HPD treatment, and (3) the effects of antipsychotic drugs on the thalamus, amygdala, and perirhinal cortex may be related to their therapeutic efficacy, since clinical improvement in schizophrenic patients appears several days after the start of HPD treatment.

Radial and lumbar bone mineral density after wrist synovectomy in rheumatoid arthritis. A minimum 2-year follow-up in 10 unilaterally operated patients

Bone mineral density (BMD) of both radii and lumbar vertebrae was measured by single-photon absorptiometry and dual X-ray absorptiometry, respectively, before and 2.1-4.8 years after a unilateral wrist synovectomy in 10 patients with rheumatoid arthritis. Radial BMD on the operated side significantly increased after synovectomy, while that on the non-operated side did not change. Lumbar BMD significantly decreased after the operation. The grip strength of the operated side increased significantly after synovectomy, while there were no changes in the grip strength on the non-operated side. These findings suggest that wrist synovectomy results in pain relief and improves use, thereby increasing the BMD of the operated radius.

[Association of bone mineral density with vitamin D receptor gene polymorphism--changes in radial bone mineral density with long-term follow-up: longitudinal study]

Recent studies have shown that genetic effects on bone mineral density (BMD) and bone turnover are related to vitamin D receptor (VDR) gene polymorphism. However, discordant studies have been published and it is still not clear whether VDR genotypes influence bone mass accretion and/or postmenopausal bone loss. To assess allelic influence of the VDR gene on BMD, we determined changes in 1/6-radial-BMD by several repeat measurements in the same subjects for about ten years and analyzed VDR polymorphism of BsmI restriction enzyme in 53 normal healthy Japanese women (age: 50.3 +/- 4.7 years, mean +/- SD). Twenty-seven (age: 53.2 +/- 4.7 years) of the subjects were post-menopausal (POST group). Among these 53 subjects, the distribution of bb, Bb and BB genotypes was 64.2%, 34% and 1.9%, respectively. The genotype frequencies in this study were very similar to those in previous reports concerning other Japanese women. There was no difference between the b group (women with bb genotype) and B group (women with BB or Bb genotype) in age, body weight, height, body mass index (BMI), years since menopause, serum osteocalcin and serum alkaline phosphatase values. In the POST group, BMD of the B group at menopause was lower than that of the b group (p < 0.05). About ten years after menopause, BMD did not differ significantly between these groups because the decrease in BMD in the b group was larger than that in the B group. Regarding changes in BMD in the POST group for four years after menopause, BMD of the b group was significantly decreased compared with the B group (p < 0.01). Our findings suggest that the differences in BMD by VDR genotype were larger among pre- and pri-menopausal women and seemed to decrease with years after menopause. It is suggested that there are other factors influencing BMD and postmenopausal bone loss in elderly women.

Bone responses at various skeletal sites to human parathyroid hormone in ovariectomized rats: effects of long-term administration, withdrawal, and readministration

This study was undertaken to examine bone responses to human parathyroid hormone (hPTH) at various skeletal sites. Forty 6-month-old female Wistar rats were divided into four groups, and bilateral ovariectomy (ovx) was performed in three of the four groups (n=30). The other group (n=10) received sham surgery (sham). Four weeks after the ovx, hPTH(1-34) administration was started. The ovx rats received 5 microg/kg per day of PTH (PTH-5; n=10), 10 microg/kg per day of PTH (PTH-10; n=10), or vehicle (PTH-v; n=10), three times a week for 24 weeks. Thereafter, PTH was withdrawn for 16 weeks followed by readministration at the same dosage for 8 weeks. The bone mineral content (BMC) at the whole skeleton and the bone mineral density (BMD) at the lumbar vertebrae, caudal vertebrae, distal femur, diaphysis of the femur, proximal tibia, and skull were longitudinally measured by dual-energy x-ray absorptiometry (DXA) at 4-week intervals during the experimental period. Thirteen rats that died during the experimental period were excluded from the analysis. As a result, the whole skeleton showed an increase in BMC during the PTH administration, whereas no withdrawal or readministration effects were observed. The metaphysis showed a highly sensitive bone response, while the lumbar vertebrae and diaphysis showed a moderate magnitude of changes in bone mass during the PTH administration. The skull and the caudal vertebrae did not show sensitive responses to PTH. After withdrawal, the BMD was markedly decreased at the sites that showed marked increases in BMD after PTH administration. The PTH readministration increased the BMD again at the sites that showed sensitive responses after the initial administration. Strength tests were also performed when the readministration was completed. The ultimate loads for the femur and vertebral body in the PTH-treated groups were significantly higher than those in the vehicle-treated group. In conclusion, the response to PTH in ovx rats varied among skeletal sites; withdrawal-related decreases were marked at the sites showing marked increases in bone mass related to PTH administration, and PTH readministration may be sufficiently effective.

A case of subwakefulness syndrome

We report a patient, a 30-year-old male Japanese-Brazilian migrant construction worker, suffering from excessive daytime sleepiness for at least 6 months. Electroencephalogram recordings during his waking states showed that 10-Hz and 60-microV alpha activity was present prominently in the occipital regions. From the multiple sleep latency test, it was found that stages 1-2 NREM sleep episodes appeared repetitively without any REM episodes, and that the mean sleep latency was 10.2 min. These findings support the diagnosis that this patient suffers from subwakefulness syndrome.

Trifocal distraction osteogenesis for segmental mandibular defect: a technical innovation

Distraction osteogenesis in the mandible is a promising method, not only for correction of mandibular hypoplasia such as hemifacial microsomia, but also for reconstruction of segmental bone defects in the mandible. The authors report a case in which a mandibular segmental defect, about 60 mm in length, was reconstructed by distraction osteogenesis. The patient was a 45-year-old man who had been treated for an oral floor cancer. After preoperative chemotherapy and irradiation therapy, the mandible had been resected from the second incisor on the right side to the first molar on the left side, and had been reconstructed with a titanium plate and a vascularized rectus-abdominis compound flap. However, an infection developed around the titanium plate and this plate had to be removed. Therefore, trifocal distraction using an original three-dimensional distractor was performed, at the rate of 1 mm per day (0.5 mm in the morning and 0.5 mm in the evening). During the distraction period, the skin flap was pushed out from the bone defect. Although small free bone transplants were needed for complete continuity, the segmental bone defect was almost filled by the regenerated bone with the lengthened gingiva. Radiographic observation showed successful new bone formation in the lengthened area.

Hypofrontality does not occur with 6-hydroxydopamine lesions of the medial prefrontal cortex in rat brain

This study examined the effect of lesions of dopamine (DA) nerve terminals the medial prefrontal cortex on local cerebral glucose utilization (LCGU) and dopamine metabolism in the rat brain. Bilateral 6-hydroxydopamine lesions were stereotaxically placed in the medial prefrontal cortex. Twenty-eight days after the lesion, concentrations of DA and its metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), were determined in eight brain regions with a high-performance liquid chromatographic assay. LCGU was assessed by [14C]2-deoxy-D-glucose autoradiography. The lesion produced a striking reduction in DA (to 6% of the control value), and a moderate reduction in DOPAC and HVA in the medial prefrontal cortex. The ratio of DOPAC to DA in the medial prefrontal cortex was significantly elevated in the 6-OHDA lesioned animals. In contrast to DA depletion, LCGU in the medial prefrontal cortex of the lesioned rats was unaltered when compared with the control. These findings suggest that decreased energy metabolism in the frontal cortex, i.e., hypofrontality, does not occur with decreased DA innervation of that site.

Autophosphorylation of insulin receptor in a patient with Werner's syndrome associated with insulin resistant diabetes mellitus

The tissue sensitivity to insulin was evaluated using the hyperinsulinemic euglycemic clamp technique in a 44-year old male with Werner's syndrome associated with diabetes mellitus. In addition, the autophosphorylation of insulin receptors and the number of autophosphorylated insulin receptors were measured in his erythrocytes by a new enzyme-linked immunosorbent assay. He had an increased serum insulin level (30.5 microU/ml) in addition to hyperglycemia (226 mg/dl), suggesting that he had insulin-resistant diabetes mellitus. A clamp study revealed that his insulin-stimulated glucose disposal rate (2.80 mg/kg/min) was comparable to that in noninsulin-dependent diabetes mellitus (4.14 +/- 1.94 (SD) mg/kg/min, n = 23). The number of autophosphorylated insulin receptors per 300 microliters of erythrocytes was also identical to that in normal control subjects. In addition, the autophosphorylation of insulin receptors determined at six different insulin concentrations was within the normal range, even when it was expressed as per 300 microliters of erythrocytes as well as per unit receptor. These results demonstrate that insulin resistance in the patient with Werner's syndrome is caused by a defect that cannot be detected by means employed in this study, and suggest that the defect is present at the steps distal to the autophosphorylation of tyrosine kinase of insulin receptors.

Comparative study of dopamine metabolism with local cerebral glucose utilization in rat brain following the administration of haloperidol decanoate

The effects of haloperidol decanoate on dopamine (DA) metabolism in discrete regions of rat brain were investigated and compared with changes in local cerebral glucose utilization (LCGU). The concentration of DA and its metabolite, homovanillic acid, and the alpha-methyl-p-tyrosine (alpha-MT)-induced decline of DA were measured in 6 brain regions by a high-performance liquid chromatographic assay. LCGU in 26 brain regions were examined by [14C]2-deoxy-D-glucose autoradiography. At 24-hr after intramuscular injection of haloperidol decanoate (60 mg eq/kg to haloperidol), the concentration of homovanillic acid in the prefrontal cortex, caudate-putamen, accumbens nucleus, lateral amygdala, and medial thalamus showed significant increase compared with control values. On day 21, the increase in these regions was significantly attenuated with no significant difference from the controls. Furthermore, chronic haloperidol rats showed alpha-MT-induced decline of DA to a similar extent in the control rats. LCGU on day 21 showed significant decrease in the parietal cortex, and a tendency toward decrease in the prefrontal cortex, lateral amygdala and medial thalamus compared with the controls. There was no significant change in LCGU in the caudate-putamen or accumbens nucleus. Chronic haloperidol would thus appear to affect energy metabolism mainly in the cortico-thalamo-limbic circuits, and this may not correspond well to presynaptic DA metabolism.

Enzyme-linked immunosorbent assay method for human autophosphorylated insulin receptor. Applicability to insulin-resistant states

The insulin receptors from erythrocytes of 50 patients with non-insulin-dependent diabetes mellitus were tested for their ability to autophosphorylate. The assay was performed by a new enzyme-linked immunosorbent assay system that used monoclonal anti-insulin receptor antibodies absorbed to microtiter plates as a first antibody and polyclonal antiphosphotyrosine antibody as a labeled second antibody. By this assay, 3 patients were identified with defects in their insulin receptor kinase, although their defects appeared heterogeneous. Patient 1 had 85% less maximal autophosphorylation with a normal ED50 (1.6 x 10(-9) M insulin). Patient 2, who had polycystic ovary disease, had a 49.2% decrease in maximal autophosphorylation of insulin receptors, and the ED50 was shifted to the right (5.6 x 10(-8) M). Patient 3 with acanthosis nigricans had a normal maximal autophosphorylation, but the ED50 shifted to the right (2.9 x 10(-8) M). The mechanisms for the diversity detected in this assay is not known, but this technique has sufficient specificity and sensitivity to be used to screen for insulin-resistant patients who have a lack of kinase activity.

Bone mineral density of the radius in patients with ossification of the cervical posterior longitudinal ligament. A longitudinal study

Radial bone mineral density (BMD) in the distal one sixth and distal one third of the left radius was measured by single-photon absorptiometry (SPA) in patients with ossification of the cervical posterior longitudinal ligament (OPLL). Twenty-three OPLL patients (15 men and 8 women) with mean initial age of 60.1 years were studied longitudinally for mean follow-up period of 3.9 years. Based on roentgenologic findings, the patients were divided into two groups, those with advancing OPLL and those with non-advancing OPLL. The final value of distal 1/6th BMD in the advancing group was significantly lower than its initial value, but no change of the value of the distal 1/3rd BMD was observed in either group. The final value of distal 1/6th BMD/distal 1/3rd BMD ratio in the advancing group was significantly decreased compared with its initial value. These results suggest that, in the advancing OPLL group, trabecular bone mass decreased while cortical bone mass remained unchanged.

Changes in local cerebral glucose utilization and dopamine metabolism in the rat brain following acute administration of haloperidol

The effects of acute administration of haloperidol on local cerebral glucose utilization (LCGU) in 26 discrete regions of the rat brain were examined by the quantitative autoradiographic [14C] 2-deoxy-D-glucose technique and compared with the changes in dopamine (DA) metabolism in 13 brain regions examined by a high performance liquid chromatographic assay. A moderate dose (0.25 mg/kg) of acute haloperidol significantly reduced LCGU in a few brain regions; a high dose (1.0 mg/kg) reduced LCGU in 11 regions including the prefrontal cortex, thalamus and other subcortical structures, but not in the caudate putamen or accumbens nucleus. However, the levels of DA metabolite in the caudate-putamen, accumbens nucleus, prefrontal cortex, and medial thalamus were strikingly elevated with both doses of haloperidol. Thus, the changes in LCGU did not parallel presynaptic DA metabolism in terms of direction or distribution, and they might represent mainly the activities of postsynaptic sites.

Effect of ovariectomy on bone response to in vivo external loading

This study was undertaken to find whether the bone response to increased external loading (EL) of the tibia in rats is affected by estrogen depletion. Female Sprague-Dawley rats 6 months were randomly assigned to four groups of 10 each: sham ovariectomy without loading (Shm-XL), ovariectomy without loading (OVX-XL), sham ovariectomy with external loading (Shm-EL), and ovariectomy with external loading (OVX-EL). In vivo external loading by a four-point bending device was initiated 4 weeks after surgery. The right lower leg of each EL rat was loaded at 31.4 +/- 0.2 N for 36 cycles at 2 Hz every other day for 21 days (11 loading days). Mean in vivo induced strain was 1305 microstrain (mu epsilon) for Shm-EL rats and 1280 mu epsilon for OVX-EL rats. With external loading of the tibia, periosteal bone formation rose equally in Shm and OVX rats. Woven bone was present around the tibia or fibula in 60% of the loaded rats and none of the control rats. No loading response occurred either at the endocortical surface or in the cancellous bone of the proximal tibial metaphysis. After OVX, cancellous bone area in the proximal metaphysis declined and formation surface rose compared to Shm rats. Although periosteal and endocortical bone formation rose after OVX, no cortical bone loss occurred. We conclude that ovariectomy and attendant loss of endogenous estrogen do not change the cortical bone response to an external load of about 1300 mu epsilon in rats. However, these results may not predict the cortical bone response to loading in animals with Haversian remodeling that display estrogen-related loss of cortical bone.

[Insulin receptor Arg1131-->Gln: a novel mutation in the catalytic loop of insulin receptor observed in insulin resistant diabetes]

A novel mutation Arg1131-->Gln in the catalytic loop of insulin receptor (IR) associated with insulin resistant diabetes was detected. A 56-year-old male with hyperinsulinemia (fasting IRI 92 microU/ml) showed moderate impairment in glucose tolerance (HbAlc 7.0%, fructosamine 258 mumol/l, fasting glucose 119 mg/dl, maximum value of blood glucose during 75 g OGTT 220 mg/dl). While insulin binding to erythrocytes IR was normal, the insulin-induced autophosphorylation of the patient's erythrocytes IR in vivo showed marked decrease, suggesting this patient had some defect in the kinase domain (exon 17-21) of IR. PCR-SSCP analysis of kinase domain with a genomic DNA obtained from the patient's leucocytes indicated the presence of some mutations in exon 19. Sequencing analysis in M13 revealed a heterozygous mutation at a position 1131 (CGG-->CAG) substituting Gln for Arg. Four people of patient's family analyzed are revealed to have an identical missense mutation at the same position with the patient.

[Osteoporosis in rheumatoid arthritis]

Rheumatoid arthritis may be associated with generalized, as well as, juxta-articular osteoporosis. To assess the skeletal distribution of bone loss, bone mass was measured in women with rheumatoid arthritis, using single photon absorptiometry and dual energy X-ray absorptiometry. Bone loss was more rapid in the distal metaphyseal region of the radius than in the diaphyseal region. Bone loss in the legs was correlated with gait disturbance and bone loss in the third lumbar vertebra was recognized only in the patients treated with corticosteroids for more than 1 year. These results indicate that rheumatoid arthritis was not universally associated with generalized osteoporosis. Patients treated with corticosteroids are likely to be at risk from generalized osteoporosis.

Radial bone mineral changes in pre- and postmenopausal healthy Japanese women: cross-sectional and longitudinal studies

Healthy premenopausal and postmenopausal Japanese women were evaluated by longitudinal and cross-sectional studies to assess changes in radial bone mineral density. A total of 300 healthy Japanese women were enrolled in the cross-sectional study, and 126 of them were chosen for the longitudinal study. In the cross-sectional study significantly lower bone mineral density was found in the women over 50 years old. In the longitudinal study, premenopausal women aged 45-54 years showed rate of change of -0.61%/year at the distal radius and 0.49%/year at the radial shaft. The perimenopausal changes were -1.95 and -0.93%/year and the postmenopausal changes were -1.88 and -1.37%/year at the distal radius and at the radial shaft, respectively, in the women aged 45-54 years. These rates of premenopausal and postmenopausal change were similar to those reported for whites in the United States. The strength of the relationship between the rate of change in radial bone mineral density and the anthropometric values, biochemical data, and menopausal status was evaluated by multiple linear regression analysis. Menopausal status had the greatest influence on the rate of change in radial bone mineral density. It is concluded that menopausal status was the most important variable related to bone loss in our longitudinal study and the rate of bone loss was greatest during the early postmenopausal period in healthy Japanese women.

The incidence of fractures of the proximal femur and the distal radius in Tottori prefecture, Japan

We report the incidence of proximal femur and distal radius fractures in Tottori prefecture, Japan. In 1986 and 1987, 573 proximal femoral fractures and 1576 distal radial fractures were registered in this district. The age- and sex-specific incidence rates of these two fractures are lower among Japanese than among European or North American whites, according to previous reports. Thus, it was concluded that the incidence rates of these two fractures are lower in Japanese than in Caucasians.

Fracture incidence and bone mineral density of the distal radius in Japanese children

The incidence of fractures of the distal radius in Japanese persons under 20 years of age was determined, and the bone mineral density of the radius was measured in 236 healthy Japanese children. The peak incidence of fractures occurred at 13 years of age (807 per 100,000) in boys and at 11 (300 per 100,000) in girls. Bone mineral density increased with age, but the rate of increase was not equal at the metaphysis and the diaphysis in the parapubertal period. The metaphyseal/diaphyseal ratio of bone mineral density was lowest at the age of 12-13 years in boys and 11 years in girls. The age at the peak incidence of fractures thus coincided with the age at which the metaphyseal/diaphyseal density ratio was lowest. Thus, it is suggested that low bone mineral density at the metaphysis may be the cause of the high incidence of these fractures in adolescence.

[A clinical study evaluating bone mineral mass in the radius during skeletal growth--single photon absorptiometry]

Using 125-I single photon absorptiometry, bone mineral measurements were performed on 206 healthy Japanese children (2 to 19 years of age). Bone mineral content (BMC), bone width (BW) and BMC/BW values were determined for the radius at distal 1/6 site (metaphysis) and distal 1/3 site (diaphysis). BMC/BW values at both sites correlated well with body height and weight. Bone mass in the diaphysis (distal 1/3 site) increased linearly during the 2-19 years of skeletal growth, but bone mass in the metaphysis (1/6 site) increased steeply during the pubertal period. In children receiving glucocorticoid therapy, bone mass was reduced in proportion to the duration of drug administration. In children under anticonvulsant therapy, the yearly increase in bone mass was significantly low especially in those patients with poor physical activity levels. Bone mineral decrease in the radius occurred in the children with hypopituitalism, hypothyroidism (cretinism), hyperthyroidism and Turner's syndrome.

[Osteoporotic changes in rheumatoid arthritis]

Bone mineral density (BMD) in the distal 1/6 and 1/3 sites of the radius was measured by single photon absorptiometry in 58 female patients with rheumatoid arthritis, not treated with corticosteroids. Half of the patients showed lower values of BMD than those (mean--1SD) of age-matched controls. BMD decreased more significantly with advancement of destructive changes of radiocarpal joint in postmenopausal patients. There was a significant inverse correlation between BMD and duration of the disease. Decreasing rate of BMD was much higher in postmenopausal patients than in premenopausal patients. These results indicated rheumatoid arthritis was not universally associated with osteoporosis. Osteoporosis occurred much more frequently in postmenopausal patients with a long duration of the disease showing marked joint destruction. In premenopausal patients, bone loss was most common in the region of affected joints. But, bone loss in postmenopausal patients occurred not only in the periarticular bone but in the diaphyseal bone.

Computed tomography in patients with Ehlers-Danlos syndrome

Three patients with Ehlers-Danlos syndrome were reported. Unusual findings on computed tomography were seen in two of the three patients. One case showed peculiar and marked dilatation of the 4th ventricle, supracerebellar cistern and lateral ventricle. The other case presented disproportionate enlargement of the anterior horn of the lateral ventricle. These CT findings in the two patients suggest that developmental abnormalities may constitute a structural defect.