[Imaging and pathological studies on the esophageal dysfunction in patients with myotonic dystrophy]

The purpose of this study is to clarify a correlation between the esophageal dysfunction and suffocation after meals in patients with myotonic dystrophy (MD) and to find how to prevent such accidents. Using imaging methods, we examined eight patients with MD (six of them had difficulty in swallowing), four patients with other neuromuscular diseases (Fukuyama-type congenital muscular dystrophy, congenital myopathy, Machado-Joseph disease, and Duchenne's muscular dystrophy), and two healthy control subjects. We also investigated material from an autopsy of another patient with MD who died of suffocation. In all patients with MD, fluoroscopy and computed tomography showed dilatation of the esophagus, particularly in the proximal third, and residual contrast media in the esophagus 15 to 40 minutes after swallowing. In histologic studies, morphologic changes were confined to the esophageal striated muscle in a patient with MD. These results indicate that regurgitation from the esophagus to the trachea happens more than 40 minutes after swallowing in patients with MD and that histological alterations of striated muscle are primary causes of the esophageal dysfunction. From these findings, we propose that patients with MD should not lie down at least 40 minutes after meals whether they complain of difficulty in swallowing or not.

[A patient with Guillain-Barré syndrome in association with Campylobacter jejuni enteritis (PEN19:LIO7) in a patient with HLA-B52 antigen]

We report a 15-year-old boy with Guillain-Barré syndrome (GBS) in association with Campylobacter jejuni enteritis. A neurologic examination revealed distal-dominant weakness and areflexia. Compound muscle action potentials were markedly reduced in amplitude, but the decrease in motor conduction velocities was slight. C. jejuni was isolated from his stool culture and the serotype belonged to PEN19:LIO7. Thin-layer chromatography-immunostaining showed that his serum IgG reacted strongly with GM1 and weakly with GD1b. The patient had HLA-B52 antigen, whose epitope is very similar to that of B35 antigen.

Phagocytosis of collagen by fibroblasts incident to experimental tooth movement

The upper molars of adult Wistar rats were moved lingually by a wire spring for 5 and 9 days. Collagen-containing fibroblasts in the pressure zone caused by the tooth movement were investigated morphologically (forms characterized by type A and type B compartments) and cytochemically (location of acid and alkaline phosphatase activity). The following results were obtained: The distribution of collagen-containing fibroblasts with type A or type B compartments could not be distinguished clearly in either 5-day or 9-day specimens; Acid phosphatase activity was recognized in the Golgi apparatus, lysosomes, and elliptical bodies associated with type B compartments; Alkaline phosphatase activity was positive in the plasma membrane of collagen-containing profiles and in both intracellular and extracellular collagen fibrils. These results suggest that fibroblasts are capable of phagocytosing collagen fibrils in all areas of the cytoplasmic membrane and that digestion of collagen fibrils in fibroblasts may be associated with acid and alkaline phosphatase.