Mutations within the 5' nontranslated RNA of cell culture-adapted hepatitis A virus which enhance cap-independent translation in cultured African green monkey kidney cells

Mutations in the 5' nontranslated RNA (5'NTR) of an attenuated, cell culture-adapted hepatitis A virus (HAV), HM175/P16, enhance growth in cultured African green monkey kidney (BS-C-1) cells but not in fetal rhesus monkey kidney (FRhK-4) cells (S. P. Day, P. Murphy, E. A. Brown, and S. M. Lemon, J. Virol. 66: 6533-6540, 1992). To determine whether these mutations enhance cap-independent translation directed by the HAV internal ribosomal entry site (IRES), we compared the translational activities of the 5'NTRs of wild-type and HM175/P16 viruses in two stably transformed cell lines (BT7-H and FRhK-T7) which constitutively express cytoplasmic bacteriophage T7 RNA polymerase and which are derived from BS-C-1 and FRhK-4 cells, respectively. Translational activity was assessed by monitoring expression of a reporter protein, chloramphenicol acetyltransferase (CAT), following transfection with plasmid DNAs containing bicistronic T7 transcriptional units of the form luciferase-5'NTR-CAT. In both cell types, transcripts containing the 5'NTR of HM175/P16 expressed CAT at levels that were 50- to 100-fold lower than transcripts containing the IRES elements of Sabin type 1 poliovirus or encephalomyocarditis virus, confirming the low activity of the HAV IRES. However, in BT7-H cells, transcripts containing the 5'NTR of wild-type virus. This translational enhancement was due to additive effects of a UU deletion at nucleotides 203 and 204 and a U-to-G substitution at nucleotide 687 of HM175/P16. These mutations did not enhance translation in FRhK-T7 or Huh-T7 cells (a T7 polymerase-expressing cell line derived from human hepatoblastoma cells) or in vitro in rabbit reticulocyte lysates. These results demonstrate that mutations in the 5'NTR of a cell culture-adapted HAV enhance viral replication by facilitating cap-independent translation in a cell-type-specific fashion and support the concept that picornaviral host range is determined in part by differences in cellular translation initiation factors.

[Two cases of liver scar that was examined by biliary scintigraphy]

36-year-old-female admitted because of jaudice and ascites. T-bil was 18.5 mg/dl and transaminase, ALP, LDH and gamma-GTP was elevated. Ultrasonography (US) showed that right lobe was atrophy and left lobe was swelling. Plain computed tomography (CT) showed right lobe was low density. Magnetic resonance (MR) finding was T1-weighted image of right lobe was low intensity and T2-weighted image was high intensity. Angiography showed right lobe was more stained than left lobe. Histologically, right lobe was massive necrosis. These findings suggested that right lobe was liver scar. Biliary imaging showed right lobe was delayed. A 23-year-old-female admitted because of fever and abdominal tumor. Transaminase was normal, only gamma-GTP was elevated. US, plain CT, enhanced CT, MR imaging finding was as same as that of the first case. Similarily, biliary scintigraphy showed right lobe was delayed. Causes of the two liver scars was not clear, whereas liver scar detected after delivery was rare case.

[Fast two-compartment model analysis with 99mTc-GSA liver scintigraphy]

The use of numerical integration method (N. INT) was evaluated in determining parameters by two-compartment model analysis from liver scintigraphy. Among the 15 subjects, 14 had liver cirrhosis or chronic hepatitis, and one was normal. When using N.INT, the sum of two exponential functions on heart regression curve following intravenous injection of 99mTc-galactosyl human serum albumin (99mTc-GSA) was promptly calculated. The parameters obtained from N.INT, including transfer rate of 99mTc-GSA from extrahepatic blood to liver (k1), dissociation rate from liver to extrahepatic blood (k2), and excretion rate from liver to gallblader (k3), were significantly correlated with those obtained by the nonlinear least square method (NLS). k1/k2 was related with the maximum removal rate of 99mTc-GSA obtained from nonlinear five compartment model analysis (r2 = 0.705, n = 15) and also with the severity score of liver disease as classified by the First Department of Surgery, Mie University Medical School (r2 = 0.686, n = 13). In terms of the time required to obtain these parameters, including the blood retention rate of 99mTc-GSA at 15 min after injection (%ID15), N.INT was faster than the traditional method (NLS).

Human T-lymphotropic virus type II in Japan

Serum specimens were assayed for human T-lymphotropic virus type II(HTLV-II) infection in 1,500 individuals known to be seropositive for HTLV-I and 30,000 blood donors in Japan. All HTLV-I-positive individuals were negative for HTLV-II. However, one of the blood donors was clearly seropositive for HTLV-II. Further, the donor was shown to be positive for HTLV-IIb. Here we report at least one case with HTLV-II in Japan and discuss the origin of the infection.

Results of surgery for paralytic exotropia due to oculomotor palsy

In 138 cases of paralytic exotropia due to oculomotor palsy, transposition of the superior oblique muscle and resection of the medial rectus muscle were carried out. Surgery was performed with or without recession of the lateral rectus muscle. The long-term prognosis for 4 years or more was observed in 35 cases. We found that the same results could be obtained by selecting transposition of the superior oblique muscle in cases of complete palsy and resection of the medical rectus muscle in cases of incomplete palsy. There was no benefit in combining resection of the medial rectus muscle when performing the transposition of the superior oblique muscle. Regardless of which method was used, a combination with recession of the lateral rectus muscle greatly improved the effectiveness of the procedure.

Quantitative capillary reversed passive latex agglutination test for C-reactive protein (CRP) in the dog

A capillary reversed passive latex agglutination test (capillary RPLA) was developed which allows quantification of serum C-reactive protein (CRP) within approximately 15 min. The logarithmic regression line (calibration curve) obtained after measuring each CRP concentration three times in twofold dilutions of a standard canine serum containing 222 micrograms/ml of CRP was y = 6.394 + 0.030x (r = 0.995). Capillary RPLA permitted quantification of CRP in the range 6.9-222 micrograms/ml. The coefficients of variation ranged from 10.28% to 12.40%. The recovery rates (percentage recovery) of CRP by capillary RPLA were within the range 87% to 106%. On measuring the CRP concentrations in sera from 78 dogs by capillary RPLA, single radial immunodiffusion (SRID) and enzyme-linked immunosorbent assay (ELISA), close correlations were demonstrated between SRID and capillary RPLA (y = 7.250 + 1.109x, r = 0.978), between SRID and ELISA (y = 3.042 + 1.059x, r = 0.967), and between capillary RPLA and ELISA (y = 1.778 + 0.929x, r = 0.962). Capillary RPLA may be considered useful as a routine biochemical technique for measurement of serum CRP concentration in the dog.

Effects of ACE inhibition and beta-blockade on collagen remodelling in the heart of Bio 14.6 hamsters

1. The effects of angiotensin converting enzyme (ACE) inhibition and beta-blockade on collagen in the heart and on plasma catecholamines and tissue angiotensin (Ang) I and II were examined in Bio 14.6 Syrian hamsters. Male hamsters (76-79 days old) were given low-dose enalapril (3 mg/kg per day), high-dose enalapril (30 mg/kg per day), atenolol (50 mg/kg per day) or vehicle for 65 days. Age and sex matched healthy F1b hamsters were used as controls. Collagen concentration was determined by measuring hydroxyproline content and the relative proportion of type I, III, and V collagens was obtained by non-interrupted sodium dodecyl polyacrylamide gel electrophoresis (SDS-PAGE). Per cent collagen area (PCA) was measured by pixel counting in myocardial tissue by a personal computer. 2. Although heartweight (HW) and bodyweight (BW) in F1b controls were significantly higher compared with drug-treated groups and vehicles, the HW/BW ratio in cardiomyopathic Bio 14.6 hamsters tended to be high compared with F1b controls and was decreased by each drug treatment. 3. Collagen concentration, total collagen content and PCA in the heart of Bio 14.6 hamsters were significantly higher than F1b controls. Collagen concentration and total collagen content were significantly decreased in all drug-treated groups compared with vehicles. 4. The proportion of type I collagen tended to decrease while that of type III collagen tended to increase in all drug-treated groups compared with vehicles. Type V collagen in vehicle-treated group was significantly higher than in F1b controls, while it tended to decrease in all drug-treated groups compared with vehicles. 5. Plasma concentrations of catecholamines (adrenaline and noradrenaline) were decreased significantly by atenolol and high-dose enalapril, but not by low-dose enalapril. Tissue AngI remained unaltered in any of the drug-treated hamsters. Tissue AngII was decreased by the high-dose enalapril and beta-blockade, and tended to be decreased by low-dose enalapril treatment. 6. These results reveal that enalapril and atenolol produced similar beneficial effects on collagen remodelling in Bio 14.6 hamsters by decreasing the total amount of collagen, and also by changing collagen phenotypes through the inhibition of the renin-angiotensin system. Both drugs also improved myocardial morphological integrity.

Increased activity of plasma cholesteryl ester transfer protein in children with end-stage renal disease receiving continuous ambulatory peritoneal dialysis

The activity of cholesteryl ester transfer protein (CETP) was assayed in sera of children and adolescents on continuous ambulatory peritoneal dialysis (CAPD) by coincubating lipoprotein-deficient samples with exogenous donor and acceptor lipoproteins. Serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B and apolipoprotein B/apolipoprotein A1 ratio were increased, while the high-density lipoprotein cholesterol level was decreased. The CETP activity in children on CAPD exceeded that in either adults or control children, and was correlated with low-density lipoprotein cholesterol, apolipoprotein B, and total cholesterol/high-density lipoprotein cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol, and apolipoprotein B/apolipoprotein A1 ratios. The CETP activity in CAPD patients may be due to increased synthesis in response to a protein loss in the dialysis fluid and may exacerbate atherosclerosis.

[Experience with the Groshong port in a home TPN patient--a case report]

We experienced a home TPN patient using Groshong port. A 45-year-old woman, recurrent pancreatic head cancer, was treated with home TPN. The Groshong port was inserted via external jugular vein and stayed at home for 8 months with home TPN. Lipid emulsion was administered twice a week. After administration of lipid emulsion, 20 ml of saline was injected and catheter lock was performed with only saline. Heparin was not used for catheter lock. After 8 months' home TPN, patient died. We could not find any precipitate in the catheter and reservoir. A unique feature of Groshong port is a pressure-sensitive two-way valve at the intravascular end. The valve of this port opens outward during fluid infusion or bolus injection. During blood withdrawal, the valve opens inward and then closed after the procedure. Because the valve is designed to remain closed between -7 and 80 mmHg, it will not open spontaneously under normal central venous pressure conditions. This valve eliminates the need for heparin flusing. Catheter obstruction during prolonged TPN is a serious complication. Compound of heparin, lipid emulsion and electrolytes, especially calcium is now becoming one of the most important causes of catheter obstruction and catheter removal. We used the Groshong port to prevent catheter obstruction. After 8 months' use of this port, no precipitate was found in this port. We conclude that the Groshong port is useful for home TPN catheter because it can prevent catheter obstruction due to heparin-lipid-electrolytes compound.

Human esophageal carcinomas frequently express the tumor-rejection antigens of MAGE genes

The human genes MAGE-1 and -3 encode melanoma peptide antigens that are recognized by autologous cytotoxic T lymphocytes. Tumors expressing MAGE genes are potential targets for cancer immunotherapy, because MAGE genes are expressed only in tumor tissue and not in any normal tissue except testis and placenta. However, little is known about MAGE gene expression in human esophageal carcinoma. The purpose of this study was therefore to analyze MAGE gene status in human esophageal carcinoma. We studied the expression status of these genes in 42 surgical samples and in 12 cell lines of human esophageal carcinoma using the reverse transcription polymerase chain reaction (RT-PCR). Various clinicopathological factors were also analyzed. No MAGE gene expression was seen in any of the 42 normal esophageal tissue specimens. In contrast, tumor tissue expressed MAGE-1, -2, and -3 in 26, 18 and 24 specimens, respectively. Thirty-three of 42 tumors expressed at least one MAGE gene. Significant clinicopathologic differences between the tumors were not observed, regardless of the presence or absence of MAGE gene expression. In cell lines, MAGE-1, -2, and -3 gene expression was recognized in 5, 4 and 4 cell lines, respectively. This study demonstrates that MAGE genes are frequently expressed in clinical samples as well as in cell lines of esophageal carcinoma. The identification of MAGE genes, therefore, may open up a new modality of treatment, namely specific immunotherapy, for patients with esophageal carcinoma.

Protective immune responses induced by secretion of a chimeric soluble protein from a recombinant Mycobacterium bovis bacillus Calmette-Guérin vector candidate vaccine for human immunodeficiency virus type 1 in small animals

A recombinant Mycobacterium bovis bacillus Calmette-Guérin (BCG) vector-based vaccine that secretes the V3 principal neutralizing epitope of human immunodeficiency virus (HIV) could induce immune response to the epitope and prevent the viral infection. By using the Japanese consensus sequence of HIV-1, we successfully constructed chimeric protein secretion vectors by selecting an appropriate insertion site of a carrier protein and established the principal neutralizing determinant (PND)-peptide secretion system in BCG. The recombinant BCG (rBCG)-inoculated guinea pigs were initially screened by delayed-type hypersensitivity (DTH) skin reactions to the PND peptide, followed by passive transfer of the DTH by the systemic route. Further, immunization of mice with the rBCG resulted in induction of cytotoxic T lymphocytes. The guinea pig immune antisera showed elevated titers to the PND peptide and neutralized HIVMN, and administration of serum IgG from the vaccinated guinea pigs was effective in completely blocking the HIV infection in thymus/liver transplanted severe combined immunodeficiency (SCID)/hu or SCID/PBL mice. In addition, the immune serum IgG was shown to neutralize primary field isolates of HIV that match the neutralizing sequence motif by a peripheral blood mononuclear cell-based virus neutralization assay. The data support the idea that the antigen-secreting rBCG system can be used as a tool for development of HIV vaccines.

[Assessment of left ventricular contraction kinetics by ECG-gated myocardial SPECT with 99mTc-MIBI: a new attempt with multi-plane long axial tomography]

To investigate left ventricular (LV) contraction kinetics, we performed ECG gated myocardial tomography (gated-SPECT) with 99mTc-MIBI (99mTc methoxy-2-isobutyl isonitrile) at rest. Data were obtained from 32 views and R-R interval was divided into 16. To clarify whether myocardial count change during systole (%CC) reflected LV wall thickening (%WT), we compared septal and posterior %CC in short axis image with %WT which were obtained by echocardiography. And %CC correlated well with %WT (r = 0.86, p < 0.01). In order to assess myocardial contraction kinetics in various parts of LV, multi-plane long axial tomograms were constructed in 10 normal subjects and 9 patients with myocardial infarction (MI). By multi-plane long axial tomography, LV was divided into 17 segments. In each segment %CC was calculated from time activity curves of myocardial count of 99mTc-MIBI. And the disparity of the appearance of peak count in each segment was also observed. In normal subjects %CC was greatest at apex and they decreased from apex to cardiac base. Besides %CC at lateral segments was greater than that in septal segments. Normal range of %CC was determined segment by segment. In normal subjects the intervals from ECG R-wave to peak count were not different in each segment. But in patients with MI they distributed in wide range and prolonged intervals were observed in segments with rest perfusion defect (infarcted segment). In patients with MI decreased %CC was observed in 91% of infarcted segments, in 83% of the segments with exercise induced ischemia and in 89% of the segments with 123I-BMIPP defects. These results indicated decreased %CC represented viable but compromised myocardium as well as necrotic myocardium. In gated-SPECT we obtained useful informations in addition to myocardial perfusion. But it took more than 30 minutes to perform. More experience will be necessary to ascertain the value of this technique.

The expression of tumor-rejection antigen "MAGE" genes in human gastric carcinoma

BACKGROUND & AIMS

The genes MAGE-1 and MAGE-3 both encode melanoma peptide antigens recognized by major histocompatibility complex-restricted cytotoxic T lymphocytes. The antigens may be a target for immunotherapy. There is, however, little information on the expression of these genes in gastric carcinomas. Therefore, the expression of MAGE genes in gastric carcinomas was evaluated.

METHODS

The expression of MAGE-1, MAGE-2, and MAGE-3 genes in tumors and corresponding normal tissue specimens was studied using a reverse-transcription polymerase chain reaction. The results were analyzed according to clinicopathologic factors of the tumor.

RESULTS

In the 68 gastric carcinomas studied, MAGE-1, MAGE-2, and MAGE-3 messenger RNA were detected in 41%, 31%, and 38%, respectively. Fifty percent of the gastric carcinomas expressed at least one of the MAGE genes. Messenger RNA for the three MAGE proteins was not detected in normal gastric tissue. MAGE gene expression in gastric carcinomas was not associated with a significant clincopathology of the tumor. However, gene expression was lower in mucinous carcinomas (3 of 10).

CONCLUSIONS

MAGE-1, MAGE-2, and MAGE-3 are expressed in a high percentage of gastric carcinomas. These tumor rejection antigens may provide tumor-specific targets for immunotherapy.

Desmoplastic fibroma. Aggressive curettage as a surgical alternative for treatment

In this article, the authors present 5 patients with desmoplastic fibroma and review the literature. Four patients had aggressive curettage with bone graft, and 1 had aggressive curettage alone. Although the literature reports that many patients have recurrence after curettage, there have been no recurrences in these 5 patients during followup periods ranging from 5 years 6 months to 9 years. Although wide excision has been recommended in the literature, treatment with aggressive curettage achieved clinical and radiographic control of the lesions for at least an intermediate duration of followup.

Endothelin induced collagen remodeling in experimental pulmonary hypertension

To investigate pathophysiological roles of endothelin-1 (ET-1) in collagen remodeling in pulmonary hypertension, we measured: (a) mRNA expression, concentration, localization of ET-1; (b) changes in types and content of collagen in the lung; (c) and confirmed direct effects of ET-1 on type V collagen metabolism in vascular smooth muscle cells. Monocrotaline-treated rats showed pulmonary hypertension with medial hypertrophy and perivascular fibrosis of pulmonary arteries. At the progressive stage of pulmonary hypertension, both ET-1 levels and its mRNA expression in the lung increased. Total collagen in the lung rose markedly with a higher rate of increase in type V collagen. ET-1, which exists in vascular smooth muscle cells, other perivascular cells and endothelium, stimulated type V collagen production. Our results suggest that local production of ET-1 in the lung contributes to progression of pulmonary hypertension through changes in phenotypes and content of collagen.

Serial lectin affinity chromatography demonstrates altered asparagine-linked sugar chain structures of gamma-glutamyltransferase in human renal cell carcinoma

Differences between human renal cortex and human renal cell carcinoma (RCC) in asparagine (Asn)-linked sugar chain structures of gamma-glutamyltransferase (GGT) were investigated by using a serial lectin affinity chromatographic technique. The relative amounts of GGT which passed through the concanavalin A (Con A) column but bound to the phytohaemagglutinin E column, were significantly decreased in RCC, but there were significant increases in the relative amounts of GGT which bound weakly to the Con A column and passed through the pea lectin (PSA) column, and bound strongly to the Con A column and bound to the wheat germ agglutinin column in RCC compared with those of the normal renal cortex. A significant correlation was observed in RCC between nuclear grade and relative amount of GGT which bound weakly to the Con A column and passed through the PSA column. The findings indicate that Asn-linked sugar chain structures are altered in RCC and suggest that studies of qualitative differences of sugar chain structures of GGT might lead to a useful diagnostic tool for human RCC.

[CT findings of primary retroperitoneal cystic tumors: special emphasis on the distinction benignancy from malignancy]

We describe the CT findings of primary retroperitoneal cystic tumors in 20 patients (cystic lymphangioma, 9; cystic teratoma, 3; cystic neurinoma, 4; mucinous cystadenocarcinoma, 3; synovial sarcoma, 1). CT findings were retrospectively reviewed and the findings correlated with the pathological findings to determine malignant or benign cystic tumors. Definite criteria for malignancy were invasion to surrounding organ and the presence of distant metastasis. However, the sensitivity of these criteria was very low (25%). Enhancement of an intracystic solid component was a reliable criterion (p < 0.05) for malignancy (sensitivity 75%, specificity 81%, accuracy 80%). Either unilocular cystic appearance or the presence of a "neck" (between the cystic mass and paraaortic region) strongly suggested the possibility of benignancy (specificity 100%). The "neck" was thought to be morphologically specific for cystic lymphangioma.

Alteration of transglutaminase activity in rat and human spinal cord after neuronal degeneration

We measured the activity of transglutaminase (TG), a Ca(2+)-dependent enzyme and a biochemical marker of cell degeneration, in the adult rat spinal cord after unilateral occlusion of a branch of the dorsal spinal artery, and compared it to the enzyme activity in the tissue on the contralateral side without ischemic damage. The affected half of the spinal cord showed a significant rise in intrinsic (endogenous) TG activity one day after ischemic insult while no apparent morphological changes were observed in the tissue. However, the enzymic activity on the affected side gradually decreased to reach the level in the non-affected tissue, accompanying severe degeneration of neuronal cells at 7 days after the surgery, then it declined to nearly half the level in the intact tissue 30 days after the operation. We also determined the TG activity in transverse sections of the human spinal cord obtained at autopsy from 5 amyotrophic lateral sclerosis (ALS) and 9 non-ALS patients. TG activity in thoracic and lumbar cords was markedly low in ALS patients not only in ventral and lateral regions but also in the dorsal portion. These findings imply that the reduced TG activity in the ALS spinal cord is one of the characteristic features of the disease reflecting exhaustion of the enzyme in the tissue resulting from degeneration of the spinal neurons through cross-linkage of soluble intraneuronal cytoplasmic proteins.

Growth, development and nutritional status in Japanese children under 2 years on continuous ambulatory peritoneal dialysis

We examined the growth, development and nutritional status over a period of 10 years of 15 young children (< 2 years old) on continuous ambulatory peritoneal dialysis (CAPD). There were 6 males and 9 females with a mean age of 12.5 months, mean weight of 6.3 kg, mean height of 66.2 cm at the start of CAPD and a mean duration of therapy of 2.6 years. Height, weight, head circumference, development quotient (DQ), blood chemistry and dietary intake were assessed over a period of 10 years. The patients' mean height standard deviation score (SDS) did not change significantly (from -2.51 to -2.74) during CAPD therapy. The mean growth velocity index (GVI) during CAPD was 76.5% and correlated positively with energy intake but not with protein intake. The mean DQ was low (67.0%) at the start of CAPD and 69.3% at the end of CAPD. DQ did not correlate with energy intake, GVI, head circumference SDS or with the weight/height ratio; however, 2 patients with low DQ (< 60%) had a low energy intakes. Although most patients had a low DQ, the IQ at 5-6 years of age was normal in all patients except 1 without cerebral disease. Our study showed minimal growth (delta SDS) and mental developmental (IQ) delays during CAPD therapy, but an adequate nutritional intake must be assured to obtain the above results.

School adjustment of children with end-stage renal disease

We examined adjustment to school of children with end-stage renal disease (ESRD) and the psychological condition of their mothers; 30 children on continuous ambulatory peritoneal dialysis (CAPD), 35 children with a transplant and 33 healthy children were studied. A factorial ANOVA statistic found that the mean scores for non-academic problems (psychological factors) differed significantly across the three groups, being highest in CAPD children and lowest in healthy children. No significant differences between CAPD and transplant children were found for school maladjustment with academic problems, although the prevalence differed significantly across the groups, being highest in transplant children and lowest in healthy children. The mothers of children with ESRD were prone to feel various anxieties and dependency.

Effect of a hematopoietic-promoting factor derived from porcine kidney on megakaryocyte colony formation by murine bone marrow cells

We investigated the effect of a hematopoietic-promoting factor (HPF) purified from porcine kidney on murine megakaryocyte colony formation. Murine bone marrow cells were cultured in agar in Iscove's modified Dulbecco's medium supplemented with 10% fetal calf serum in the presence of interleukin-3 (IL-3) as a source of megakaryocyte colony-stimulating factor. HPF alone exerted only a slight effect on megakaryocyte colony formation, and the combination of HPF with IL-3 enhanced colony formation compared with IL-3 alone. At days 11 and 13, 1.9-fold and 1.7-fold enhancements were observed, respectively. When erythropoietin (Epo) was added to the combinations of IL-3 plus HPF or IL-3 plus HPF plus SCF megakaryocyte colonies were enhanced compared with the cultures without Epo. As the result of determination the ploidy distribution, more than 20% of the megakaryocytes in IL-3 plus HPF showed 32N and above ploidy, but the number of 8N and under megakaryocytes was the same as those stimulated with IL-3 alone. These results suggest that HPF stimulates both the proliferation of megakaryocyte colony-forming units and the maturation of megakaryocytes in the presence of IL-3.

[Familial amyloidosis of the Finnish type (FAP) with extraocular muscle involvement]

Among 17 patients with amyloid polyneuropathy type IV in a Japanese family, we found a 72-year-old woman, who showed extraocular symptoms approximately 10 years after the onset of the disease. she developed weakness of the right facial muscles and dysarthria at age 57. She had atrophy and disturbance of movement of the tongue, along with difficulty in swallowing at age 62. At the age of 66, she felt diplopia when she looked toward the left, followed by difficulty of ocular movement. These manifestations progressed and at age 72, she was found to have mild ptopsis, mild to moderate disturbance of almost all extraocular muscles, moderate to severe disturbance of facial, masseter, pharyngeal, tongue and neck muscles. She also had slight weakness and atrophy of the limb and truncal muscles together with slight loss of pain and vibratory sensations in the distal parts of the limbs. FAP IV has sometimes been called cranial amyloidosis, but motor disturbance is limited to the middle and lower cranial nerve territories in the majority of the reported cases, and manifestations of the extraocular muscles are quite rare. According to the present investigation of the world literature, this is the second case of FAP IV with extraocular muscle involvement.