[Cerebral malformations associated with probable intrauterine infection]

An autopsy case with various cerebral malformations was studied and discussed on the pathogenesis. The patient was a 17-year-old female who developed tonic seizures around the age of 1 month and was treated under a diagnosis of infantile spasms. A CT scanning revealed agenesis of corpus callosum, subtentorial arachnoid cyst and brain atrophy. Neuropathologically multiple malformations were observed in the brain, polymicrogyria, pachygyria, cerebral gray matter heterotopia, partial agenesis of corpus callosum, hypoplasia of cerebellar vermis and arachnoid cyst. The most remarkable finding was chronic inflammation represented by infiltration of lymphocytes and foamy macrophages, fibrosis and vascular hyalinization in the arachnoid membrane as well as in the choroid plexus of the third ventricle. Proliferation of astrocytes with intracytoplasmic eosinophilic inclusions was also found in the areas of polymicrogyria and heterotopia. The infratentorial cyst was walled by scarring cerebellar tissue with a focal inflammation which was probably caused by an encephaloclastic process. The diversity in these cerebral malformations suggests that etiology might be polyphasic in time and infectious in nature during the intrauterine period of cerebral development.

[A case of hyperammonemia in chronic renal failure successfully treated with the infusion of NaHCO3]

The present report describes a rare of a 77-year-old woman who developed encephalopathy and metabolic acidosis associated with hyperammonemia, at the introduction of hemodialysis by chronic renal failure. With the intravenous infusion of HCO3-, levels of acidosis and hyperammonemia decreased rapidly. Concomitantly the disturbance of consciousness was improved. Results of plasma amino acid patterns of pre and post infusion of HCO3- showed improvement of the metabolism of the urea cycle, increased urea synthesis and decreased plasma ammonium levels. The role of the hepatic urea cycle has been considered to be exclusively the elimination of potentially toxic ammonia. In the conventional view, the acid base balance of the body obtains stabilized homeostasis by the function of the principal organs, lungs and kidneys. But, it has been recently shown that urea cycle is an important factor in the maintenance of pH homeostasis, due to regulated metabolism of HCO3-. Both HCO3- and NH4+ are converted to urea indicating the urea cycle's involvement in acid base homeostasis. 2HCO3- + 2NH4+-->urea+CO2+3H2O In this case, with the infusion of HCO3, the metabolism of the urea-cycle was improved and plasma ammonium levels were decreased. This indicates that HCO3- is an important factor for the metabolism of ammonia.

[Alteration of inositol 1,4,5-trisphosphate receptor binding after 6-hour hemispheric ischemia in the gerbil brain]

Inositol 1,4,5-trisphosphate (IP3) has recently been known to play vital roles as one of the second messengers to control intracellular metabolism of calcium ion. Therefore, alterations of IP3 receptor binding and local cerebral blood flow (1CBF) were evaluated at 6 hours after occlusion of the right common carotid artery in the gerbil brain. The autoradiographic method developed in our laboratory enabled us to measure both parameters in the same brain. Animals attaining more than 5 in their ischemic scores, which were assessed at 1 hour after the occlusion, were utilized. LCBF was measured by the 14C-iodoantipyrine method at the end of the experiment. After frozen brains were cut into serial slices on a cryostat, the IP3 receptor binding was evaluated in vitro by using 3H-inositol 1,4,5-trisphosphate as the ligand. LCBF fell below 10 ml/100 g/min in most of the cerebral regions on the occluded side. In contrast a significant reduction in IP3 binding was noted only in the hippocampus CA1 on the occluded side. The IP3 binding tended to decrease when the values of 1CBF were reduced below 20 ml/100 g/min in this region. These findings suggest that the selective alteration of IP3 receptor binding in the hippocampus CA1 may be closely associated with the selective vulnerability of this region to ischemia.

Immobilization stress induces alterations of second-messenger systems in the gerbil brain

The effects of immobilization stress on the cerebral second messenger (adenylate cyclase and phosphoinositide) were investigated autoradiographically in mongolian gerbils. After 10 min (10-min stress group, n = 7), or after 6 h (6-h stress group, n = 7) of fixation on a flat board while supine, in vitro autoradiography was performed using [3H]forskolin (3H-FK) and [3H]phorbol-12,13-dibutyrate (3H-PDBu) as specific ligands to identify the distribution of adenylate cyclase and protein kinase C, respectively. In another group of 7 gerbils (control group), the same autoradiographic procedure was performed immediately after the animals were removed from the cage. In the 10-min stress group, FK binding was significantly decreased in the hypothalamus and amygdala, but significantly increased in the basal ganglia including the caudate-putamen and globus pallidus. FK binding in the 6-h stress group tended to increase throughout the brain, rising significantly in the basal ganglia. PDBu binding in either stress group did not change significantly compared to the control group in any region except the hippocampal CA3 region of the 6-h stress group. Under immobilization stress, the adenylate cyclase system may undergo time-dependent and regionally specific changes, while the phosphoinositide system remains relatively stable.

Case report: the effect of a Chinese herbal medicine, BG-104 in two HIV positive hemophiliacs

The BG-104, a Chinese herbal medicine, has been reported to restore decreased plasma superoxide scavenging activity. This report showed in vivo effect of BG-104 on two patients with hemophilia A infected with human immunodeficiency virus by infusions of the concentrated Factor VIII. Both patients, showed a peripheral CD4+ T-lymphocytopenia for more than half a year. BG-104 was administered daily and follow-up observations were continued for 3 years. The number of CD4+ T-lymphocytes remained relatively constant during BG-104 treatment without disease progression.

Inhibition of nitric oxide synthesis impairs autoregulation of local cerebral blood flow in the rat

The effect of intravenous administration of NG-monomethyl-L-arginine (L-NMMA, 30 mg kg-1), a specific inhibitor of nitric oxide (NO) synthesis, on the autoregulation of local cerebral blood flow (LCBF) was examined in the rat using the [14C]iodoantipyrine autoradiographic method. LCBF was significantly lower in various superficial regions such as the cerebral cortices and cerebellar cortex and in several deep brain regions in animals with haemorrhagic hypotension induced after L-NMMA infusion (the L-NMMA + HEM group) compared with animals without haemorrhagic hypotension after L-NMMA infusion (the L-NMMA group). The present findings suggest that NO synthesis may play a crucial role in the autoregulation of LCBF in response to a reduction in blood pressure in the cerebral cortices, cerebellar cortex and several deep brain regions.

[Hematologic response to low dose natural interferon-alpha in a case of CML with myelo-megakaryoblastic crisis]

A 59-year-old female with splenomegaly was admitted in November, 1989. Her WBC was 7,900/microliters with 51% myeloblasts and 10% megakaryoblasts. Analysis of the surface markers showed that 56.5% were CD13 positive and 66.8% carried platelet GpIIb/IIIa. The Ph1 chromosome was 100% positive. VPM therapy was started but proved ineffective, as was subsequent MCNU therapy. The patient was given intramuscular human lymphoblastoid interferon-alpha (1.2 million IU daily) for more than 20 months. She had improved to the accelerated phase after INF-alpha therapy for 13 months. Thus there appears to be a relationship between INF-alpha and myelo-megakaryoblastic crisis.

Reduction in second-messenger ligand binding sites after brain ischemia--autoradiographic Bmax and Kd determinations using digital image analysis

Changes in forskolin (FK) and phorbol 12,13-dibutyrate (PDBu) binding were evaluated in relation to local cerebral blood flow (CBF) after 6-h unilateral carotid artery occlusion in the gerbil striatum employing a quantitative autoradiographic method, which permitted these three parameters to be measured in the same brain. CBF was measured by the [14C]iodoantipyrine method at the end of the experiment. [3H]FK and [3H]PDBu were utilized as specific ligands to assess the activity of adenylate cyclase (AC) and protein kinase C (PKC), respectively. A saturation study was undertaken to measure the Kd (dissociation constant) and Bmax (maximal binding capacity) of each ligand by digital image processing of sequential autoradiograms employing pixel-by-pixel Scatchard analysis. The Bmax values of FK and PDBu were significantly decreased on the ischemic side, but the reduction in Bmax of FK was greater than that of PDBu. The K4 of each ligand remained unchanged. The FK binding underwent a progressive decline as CBF fell below 30 ml/100 g/min. The PDBu binding showed only a gradual decline in parallel with the CBF reduction. These findings suggest that a reduction in CBF below 30 ml/100 g/min for 6 h may induce a remarkable suppression of the AC system with less significant inhibition of the PKC system in the striatum.

[Experimental study on the effect of ursodeoxycholic acid in liver transplantation]

We investigated the effects of combination of cyclosporine A (CsA) and ursodeoxycholic acid (UDCA) in order to reduce hepatopathy caused by host-versus-graft-reaction (HVG reaction). DA/S1c rats were used as donors, and LEW/Sea rats were used as recipients in orthotopic liver transplantation. The liver transplanted rats were divided to four groups as follows; group A was control that was not given CsA nor UDCA, group B was given CsA alone, group C was given UDCA alone and group D was given combination of CsA and UDCA. These groups were compared and evaluated in case of same dose of CsA that was administered with or without UDCA. The survival periods of group D were significantly longer than those of group B. Blood biochemical levels in group D were significantly lower than those of group B. Histological study of the liver graft of group D showed that destruction of hepatic structure was mild in comparison to that of group B. It was demonstrated that the combination of low dose of CsA and UDCA could prevent hepatopathy due to HVG reaction. These results suggested that addition of UDCA to CsA would be able to reduce the dose of CsA in clinical liver transplantation.

Alteration of second-messenger ligand binding following 2-hr hemispheric ischemia in the gerbil brain

The alterations of second-messenger ligand binding and cerebral blood flow (CBF) were evaluated in the gerbil brain after 2-h unilateral common carotid artery occlusion. [3H]Forskolin (FK) and [3H]phorbol-12,13-dibutyrate (PDBu) were used as specific ligands for adenylate cyclase (AC) and protein kinase C (PKC) activity estimation, respectively. CBF was determined at the end of the experiment by the [14C]iodoantipyrine method. A quantitative autoradiographic method permitted simultaneous measurement of the three parameters in the same brain. The levels in the caudate-putamen, globus pallidus, and hippocampus were analyzed. The animals were divided into three groups: Group 1 with severe ischemia (CBF in the lateral nuclei of the thalamus (CBFt) less than 50 ml/100 g/min), Group 2 with mild ischemia (CBFt greater than or equal to 50 ml/100 g/min), and the Sham Group. The PDBu binding revealed a statistically significant increase in the caudate-putamen, lateral nuclei of the thalamus and hippocampus (CA1 and CA3 regions and dentate gyrus) on the ischemic side in Group 1 as compared to that in Group 2 and the Sham Group. In contrast, the FK binding did not show any significant changes in any of the regions. These data and our previous findings for 6-h ischemia suggest that (1) PKC translocation to the cell membrane may occur at the early ischemic phase in particular regions including the caudate-putamen, lateral nuclei of the thalamus and hippocampus, with the translocated PKC gradually diminishing during the subsequent ischemic period; and (2) the suppression of the AC system observed in 6-h ischemia may not appear in the early ischemic phase.

[A case of endometrioid carcinoma arising from endometriosis of the rectum]

A very rare case with rectal endometriosis heterotopic transformed into carcinoma is reported. A 44-year-old female patient underwent colostomy due to ileus. Postoperative examinations revealed submucosal tumors all around the rectum. Low anterior resection and the closure of the colostomy were performed. Thickening in the muscular layer and serosa were observed in the resected specimen, but the mucosal surface was maintained. Histopathological observation revealed glands of the endometrium and connective fibers with glandular adenocarcinoma in the periphery. Transformation of the benign endometrial tissues into carcinoma and squamous metaplasia were observed. A diagnosis of endometrial carcinoma in the rectum was made.

[CT findings of six cases with intracranial tuberculosis in National Higashi-Saitama Hospital]

We have experienced 6 cases of intracranial tuberculosis since 1985. 2 cases were diagnosed as intracranial tuberculoma without tuberculous meningitis, and 4 cases were diagnosed as tuberculous meningitis. Brain CT showed intracranial tuberculomas in three of them, and showed cerebral infarcts in two cases, and showed hydrocephalus in two cases. Brain CT on intracranial tuberculosis showed various findings. In two cases with tuberculous meningitis, brain CT showed many tuberculomas with ringed or nodular enhancement appeared after adequate chemotherapy had been started. About 1 year later, a few tuberculomas were found with homogeneous enhancement and were enlarged while the chemotherapy was continued. But later they were reduced in size. The above facts may suggest that intracranial tuberculoma could appear and be enlarged on cranial CT in spite of adequate anti-tuberculous chemotherapy during a course of tuberculous meningitis. They also suggest that the continuation of adequate chemotherapy might be necessary to the treatment of intracranial tuberculomas.

Development of the human pontine nuclei: a morphometric study

The morphometric development of the pontine nuclei in the human fetus from 16 to 40 gestational weeks, in a 2-month-old infant and in a 63-year-old adult were examined employing a serial celloidin section method and computer assisted electronic planimeter. The results of our study can be summarized as follows: (1) the development of the human pontine nuclei accelerated in volume after 32 gestational weeks and continued after birth, (2) neuron numbers remained relatively constant after 27 gestational weeks. It was difficult to clearly distinguish neurons from glia before 27 gestational weeks. The total estimated neuronal numbers were not indicative of the gestational stages in infants 27 gestational weeks and older, (3) individual neurons appeared to continue to develop after 32 gestational weeks in accordance with size, distribution and circularity ratio, (4) many islet-shaped groups of large neurons appeared and were scattered throughout the pontine nuclei after 32 gestational weeks.

[Paradoxical expansion of intracranial tuberculomas during chemotherapy]

A 45-year-old female patient was admitted to a hospital because of tuberculous meningitis in July, 1986. She was treated with chemotherapy (oral isoniazid, rifampicin, ethambutol and an intramuscular injection of streptomycin). Her consciousness was worsened at first, but later she improved aside from some disabilities (incontinence, gait disturbance, disorientation and dementia). She was transferred to National Higashisaitama Hospital in November, 1986. Since then we have continued the chemotherapy, and she has improved gradually. Initially her cranial computerized tomography (CT) revealed no intracranial tuberculoma and showed mild enhancement of basal cistern. About 4 months later, her CT showed many tuberculomas with ringed or nodular enhancement. About 13 months later almost all tuberculomas disappeared. But a few were found with homogeneous enhancement and were enlarged in spite of adequate chemotherapy. These tuberculomas were enlarged while the chemotherapy was continued, but later they were reduced in size. About 3 and a half years later, these tuberculomas disappeared without any calcifications. The above facts may suggest that intracranial tuberculoma could appear and be enlarged on cranial CT in spite of adequate chemotherapy during a course of tuberculous meningitis. They also suggest that continuation of adequate chemotherapy might improve tuberculomas.

Investigation of the existence and biological role of L-arginine/nitric oxide pathway in human platelets by spin-trapping/EPR studies

The aim of the present study was to apply spin trapping/EPR spectroscopy to investigate the existence and biological role of the L-arginine/nitric oxide pathway in human platelet aggregation. Three different spin traps were used: two nitroso, 3,5-dibromo-4-nitrosobenzenesulfonate (DBNBS) and 2-methyl-2-nitrosopropane (MNP), and a nitrone, 5,5-dimethyl-1-pyrroline N-oxide (DMPO). The effect of spin-trap concentration on the collagen-induced human platelet aggregation was compared to the anti-aggregatory effect caused by L-arginine. The results show that the nitroso spin traps (DBNBS and MNP) are more effective than L-arginine in preventing platelet aggregation. DMPO has virtually no effect on the collagen-induced aggregation except at a high concentration (300 mM). Furthermore, activation of platelets with a low concentration of collagen (17 micrograms/ml) and in the presence of DBNBS or MNP yields several EPR-detectable spin adducts. Some of the observed spin adducts do not correspond to those originating from the interaction of a free radical, nitric oxide (NO.) gas, with the spin traps [Arroyo, C.M. & Kohno, M. (1991) Free Radical Res. Commun. 14, 145-155]. Only one adduct of DBNBS, with a relative intensity of 0.1, observed in the washed-platelet experiment and in the presence of superoxide dismutase, is similar to the EPR spectrum obtained following a reaction of pure NO. gas with DBNBS. This suggests that the EPR spectrum of the DBNBS adduct consisting of a triplet may originate from the production of NO. by these cells. Additional DBNBS and MNP spin adducts were generated during platelet activation in the presence of Ca2+ and of a cytosol-depleted L-arginine preparation from washed platelets to which L-arginine was subsequently added. The formation of these DBNBS and MNP spin adducts were inhibited by N omega-methyl-L-arginine (MeArg, 100 microM), suggesting that these originated from a product of NO synthase. Furthermore, the formation of DBNBS and MNP spin adducts in platelet suspensions was enhanced by the presence of superoxide dismutase; however, their formation was prevented by the endothelial-derived relaxing factor (EDRF) inhibitors methylene blue and hemoglobin. The results from the MeArg and EDRF inhibitor experiments support the existence of the L-arginine/NO pathway in platelets. In addition, the prevention of spin-adduct formation by EDRF inhibitors, suggests that the mechanisms of EDRF formation and the L-arginine/NO pathway in endothelial cells and platelets are similar.(ABSTRACT TRUNCATED AT 400 WORDS)

[A case of cat scratch disease complicated by reversible encephalopathy]

We described a eight-year-old girl with encephalopathy due to cat scratch disease. Cat scratch disease is a common cause of benign, self-limited, regional adenopathy seen among young people. Encephalopathy is uncommon but is a serious complication of cat scratch disease. Cat scratch disease with associated encephalopathy was described by Stevens in 1952. Since then there have been reports of only 39 cases in the English literature. As far as we know, this case is the first case in Japan. In cases of a rapidly progressive encephalopathy, the diagnosis of cat scratch disease should be considered.

[A case of delayed myeloneuropathy due to malathion intoxication]

We report a patient with serious organophosphorus-induced delayed neurotoxicity due to malathion. The patient was a 49-year-old male with a history of habitual alcohol drinking, who ingested approximately 100 ml of 50% malathion [S-1,2-bis(ethoxycarbonyl)-ethyl-0,0-dimethyl phosphorodithioate solution], with a large amount of alcohol in a suicide attempt. Following recovery from an acute cholinergic phase 36 hours after ingestion, respiratory muscle weakness, consciousness disturbance and diffuse weakness of the limb muscles occurred, necessitating mechanical ventilation. On the 7th hospital day, glove and stocking type sensory disturbance was observed and weakness of the limbs had progressed to distal dominant flaccid quadriparalysis with moderate muscle atrophy. Two months after onset, neurogenic bladder and spinal automatism became obvious. After 7 months, spasticity of the lower limbs developed, while the weakness of the upper limbs improved. Sural nerve biopsy showed axonal degeneration, loss of large myelinated fibers and increases in Schwann cell clusters. These findings were similar to those seen in patient with triorthocresyl phosphate (TOCP) intoxication. The symptoms of this patient seemed to correspond to Senanayake's "intermediate syndrome". The final clinical features and sural nerve biopsy findings were in close agreement with those in patients with serious organophosphorus compounds induced delayed neurotoxicity due to TOCP intoxication. However, this patient exhibited more severe neuropathy than seen in previously reported cases of organophosphorus compounds induced delayed neurotoxicity caused by less toxic organophosphorus compounds, such as Dipterex. This suggests that alcohol might have been an etiological factor in damage of nervous tissue in this rare case. This is the first case of organophosphorus compounds induced delayed neurotoxicity due to malathion to be reported in Japan.

[A case of transverse myelopathy caused by acupuncture]

A 54-year-old man received insertion of an acupuncture needle into the region extending from the posterior neck to the back on two occasions for the treatment of shoulder stiffness. Two weeks after the second acupuncture, he developed fever, dysarthria and mictionary disturbance, finally reaching the condition of tetraplegia. He was immediately admitted to an emergency room in our hospital, and was diagnosed as sepsis with DIC, ARDS, heart failure, renal failure, liver failure, and myelitis. After one month, he recovered with transverse myelopathy as a residual deficit. Neurological findings showed transverse myelopathy below the level of Th2 at that time. Cervical CT revealed an irregular low density at the periphery of the cervical vertebra from the C2 to C4 level. Cervical MRI revealed an irregular swelling of his spinal cord from the C2 to C7 level. We explained the mechanism of transverse myelopathy in this case as follows. After the acupuncture, he suffered a focal infection of the region of needle insertion, and then the infection expanded to the cervical vertebra, thus causing osteomyelitis, sepsis, and finally cervical myelitis. Direct injury of the spinal cord and nerve roots as a complication of acupuncture was previously reported, but indirect injury of the spinal cord due to myelitis had not been reported except our present case. Careful attentions should be paid to the complications of acupuncture.

[A case of acute polyradiculoneuritis associated with autonomic involvement of the pupils]

Acute polyradiculoneuritis relapses rarely, and autonomic nerve involvement is less frequent than motor cranial nerve involvement. An 11-year-old boy exhibited acute relapsing polyradiculoneuritis associated with two types of autonomic dysfunction of pupils 6 months after the onset of the disease. Parasympathetic dysfunction of pupils with ocular palsies preceded neuropathy of limbs at the onset. Thereafter, sympathetic dysfunction of pupils without ocular palsies was revealed by pupillography at the 2nd attack of limb palsies.

Differences in the induction of urate deposition of specific-pathogen-free chicks inoculated with avian nephritis virus passaged by five different methods

The G-4260 strain of avian nephritis virus (ANV) was passaged using five different methods as follows: method 1, passage three times in chorioallantoic membrane (CAM) of 11-day-old embryonated eggs (CAM3); method 2, passage twice in CAM and further passage once in yolk sac (YS) of 6-day-old embryonated eggs (CAM2-YS1); method 3, passage 11 times in CAM (CAM11); method 4, passage 10 times in CAM and further passage twice in YS (CAM10-YS2); method 5, passage as in Method 4 and then passage three times in chicken kidney cell culture (CAM10-YS2-CK3). CAM11 and CAM10-YS2 were each inoculated orally into 25 one-day-old specific-pathogen-free (SPF) chicks. Seven chicks in the CAM11-inoculated group and six chicks in the CAM10-YS2-inoculated group died or were killed because they were moribund; all had either nephrosis or urate deposition. CAM3, CAM2-YS1, CAM10-YS2, and CAM10-YS2-CK3 were each inoculated intraperitoneally into 15 one-day-old SPF chicks. No chicks inoculated with CAM3 or CAM2-YS1 died, but wo chicks inoculated with CAM10-YS2 and three inoculated with CAM10-YS2-CK3 died with urate deposition. At 14 postinoculation, plasma urate values of the CAM10-YS2- and CAM10-YS2-CK3-inoculated chicks were significantly higher than those of CAM3- and CAM2-YS1-inoculated chicks and control chicks (P less than 0.01). However, interstitial nephritis was observed in most of the ANV-inoculated birds.

[Crossed cerebellar diaschisis demonstrated by SPECT in hemiplegic children]

Crossed cerebellar diaschisis (CCD) in twenty five children with hemiplegia were studied using single photon emission computed tomography (SPECT) with N-isopropyl-p-I-123-iodoamphetamine. Seven of twenty-five patients had cerebral palsy, and the others were impaired by acquired brain injury between ten months and fourteen years of age. CCD was demonstrated in five patients (20%), who were impaired by acquired brain injury after seven years of age. CCD could never be detected in patients with cerebral palsy. Ipsilateral cerebellar diaschisis was also demonstrated in two patients with cerebral palsy and three with early acquired brain injury before three years of age. It is suggested that diaschisis presents itself as a different form in a contralateral and ipsilateral cerebellum before three years of age from a form which presents after seven years of age.

[Clinical significance of gastrointestinal decontamination under protected environment]

Many infections are caused by the patient's own oro-intestinal microbial flora under a protected environment. Thirty-eight patients with acute leukemia and two patients with blast crisis of chronic myelocytic leukemia were treated under a protected environment with or without prophylactic antibiotics. Antibiotics used for decontamination were vancomycin (V), polymyxin B (P) and nystatin (N). The number of patients in the VPN, PN and the no antibiotic group were 13, 13 and 14, respectively. While the intestinal microbial flora was almost completely eliminated in VPN group, the number of bacteria decreased slightly in PN group. The mean number of pharyngeal and anorectal bacterial species decreased most markedly in the VPN group, but there were no significant differences among the three groups. The number of febrile days was significantly lower in the VPN and PN group than the no antibiotics group with neutrophil counts of less than 100 microliters. The average number of episodes of infection per patient was lowest in VPN group and highest in the no antibiotic group. These data indicate that VPN administration is effective for eliminating intestinal bacterial flora and resultantly protecting endogenous infections.

Brain perfusion in acute encephalitis: relationship to prognosis studied using SPECT

Single photon emission computed tomography (SPECT) and cranial computed tomography were sequentially examined in 2 patients with acute encephalitis. Radiographic computed tomography revealed focal low-density areas within a few days of the onset of symptoms in both patients. In SPECT, 1 patient exhibited hyperperfusion in the corresponding area, while the other had a normal scan. The outcome of the former was poor, while the latter recovered fully. Abnormal brain perfusion, thus, coincided with a poor prognosis. SPECT may be used to promptly evaluate the focal change of acute encephalitis.

[Low-dose danazol therapy in idiopathic thrombocytopenic purpura]

Danazol was administered orally at a dosage of 50 mg/day to 17 patients (11 females and 6 males) with idiopathic thrombocytopenic purpura refractory to steroids and/or splenectomy. The patients had not been treated with conventional dosages of danazol. The drug was suspended in four patients because of adverse effects of danazol. In 13 patients (8 females and 5 males, mean age 44 y. o.) who received the danazol therapy for more than 6 months, there were no patients with an excellent response, and one patient had a good response to the therapy. The rest of the patients did not respond to danazol.

[Clinical characteristics of the lung diseases due to Mycobacterium avium and Mycobacterium intracellulare classified by DNA probe test]

Clinical characteristics of the lung diseases due to M. avium and M. intracellulare classified by DNA probe test were investigated. Between M. avium and M. intracellulare, there was no significant differences in the samples' backgrounds and the clinical characteristics except for their prognoses. The prognosis of the lung diseases due to M. intracellulare was better than those due to M. avium, and M. avium was revealed to be highly susceptible to Cyclocerine than M. intracellulare. No remarkable difference was found in the susceptibility to other antituberculous drugs.

Cytochrome c oxidase deficiency with acute onset and rapid recovery

A 7-year-old girl with cytochrome c oxidase deficiency who had no neurologic deficits in infancy suddenly developed ophthalmoplegia, ptosis, and respiratory arrest. She recovered almost completely 80 days after onset, suggesting that acute onset and rapid remission are observed in patients with cytochrome c oxidase deficiency. It is also possible that early initiation of therapy in cytochrome c oxidase deficiency with coenzyme Q10 may hasten and enhance the therapeutic effect.

[Single photon emission computed tomography of the brain in Sturge-Weber syndrome using N-isopropyl-p-[123I] iodoamphetamine--a comparative study with X-ray computed tomography]

Single photon emission computed tomography (SPECT) of the brain using N-isopropyl-p-[123I] iodoamphetamine (123I-IMP) was performed in 11 children with port wine stain on the face or head, aged 1.0-14.2 years at investigation. Four cases without neurologic symptoms had no specific abnormality on SPECT and X-ray computed tomography (CT). In 4 cases of so-called Sturge-Weber syndrome with developmental quotients (DQ) or intelligence quotients (IQ) more than 80 and the neurologic symptoms consisting of seizures and hemiplegia, SPECT showed localized reduction of IMP accumulation, and CT exhibited calcification, atrophy and enhancement in 2 cases of 3 with contrast medium infusion in the same areas. In 3 cases with DQ of 50-60 and severer neurologic symptoms, SPECT showed diffuse reduction or defect of IMP accumulation in the ipsilateral hemisphere, and CT exhibited remarkable atrophy, calcifications and enhancement in 2 cases with contrast medium infusion in the same hemisphere. In one case with severe neurologic symptoms, SPECT performed at an early stage showed high IMP accumulation in the ipsilateral hemisphere.

[Acute renal failure following dehydration and hemolytic crisis due to pneumonia in a case of PNH]

A 41-year-old female, who had been diagnosed as having paroxysmal nocturnal hemoglobinuria (PNH) in 1985, was admitted to our hospital with cough, fever, diarrhea, vomiting and palpitation in April 1988. The chest X-ray showed pneumonia in her right lung. In the peripheral blood, red blood cell count was 1.64 x 10(6)/microliters, hemoglobin 4.7 g/dl and reticulocytes 19%. The levels of serum LDH, indirect bilirubin and creatinine were high. Pneumonia improved by the administration of antibiotics, however, anemia and renal failure deteriorated. After washed red blood cell transfusions totalling 2,000 ml and six times of hemodialysis, renal function returned to normal. This patient with PNH appeared to have developed acute renal failure by dehydration and hemolytic crisis due to pneumonia.

[Development of the human facial nucleus: a morphometric study]

The development of the human facial nucleus was studied using complete serial sections of the brains of 8 fetuses at 21, 23, 27, 30, 33, 34, 35, and 40 weeks of gestation, a 2-month-old infant and a 63-year-old adult. Morphometric analysis adopting a microscope, an electronic planimeter and a computer revealed the following three points as to the development of the human facial nucleus. (1) The size of neurons, the amount of Nissl body, the length of processes and neuropil increased gradually after 30 weeks of gestation. (2) The facial nucleus was divided cytoarchitectonically into dorsal, medial, intermediate, ventromedial, ventrolateral and lateral subnuclei at 21 weeks of gestation onwards. The mean neuronal size of the medial subnucleus was smaller than that of other subnuclei. (3) The number of neurons was practically the same regardless of age. At 21 and 33 weeks of gestation, 10% of total neurons was degenerated.

Clinical study of epileptic children with frequent seizures

The subjects were 98 children with an average age of 5.8 years. The frequent seizures were categorized into the following three modes: (1) seizures occur more than five times a day; (2) 1-4 seizures occur every day for one week or more; (3) 1-4 seizures a day occur weekly for one month or more. The incidence of each mode was as follows: (1) 15.3%; (2) 16.3%; (3) 17.3%; (1) + (2) 43.9%; etc. We observed frequently the cases of tonic-clonic seizures in mode (1), infantile spasms (IS) in mode (2), simple partial seizures (SPS) in mode (3), and minor seizures, IS, and Lennox-Gastaut syndrome (LGS) in mode (1) + (2). Abnormal CT findings were observed in 37.8%. Of all the patients, 33.7% indicated a developmental quotient (DQ) or intelligence quotient (IQ) above 80, and 31.6% showed a DQ or IQ under 30. Of 96 patients followed for the past one year or more, 32.3%, consisting mainly of the cases with absence seizures and IS, had been seizure-free for at least one year; 60.4% including the cases with LGS, SPS, etc., still had seizures.

A clinical study of patients with idiopathic thrombocytopenic purpura

Fifty patients with chronic idiopathic thrombocytopenic purpura (ITP) were initially treated with corticosteroids. Seven patients had an excellent response (normal platelet count after therapy), 17, 18, and 8 had a good response (normal platelet count during therapy), fair response (improved platelet count during therapy) and poor response (no improvement), respectively. Nine patients, who had a fair or poor response to the corticosteroids, were splenectomized. Five of the 9 had an excellent response to splenectomy. The other four patients were then treated with azathioprine. Three of the four responded well to the immunosuppressive therapy. The effectiveness of three main therapies for chronic ITP was confirmed in the present study. Especially, it indicated that splenectomy can be considered for relatively young patients who show a fair to good response to corticosteroids. Of the 6 patients with acute ITP, 5 had an excellent response to corticosteroids, and 1 recovered without therapy.

[Autotransplantation of parathyroid glands in thyroid carcinoma surgery and their postoperative function]

Total removal and subsequent autotransplantation of parathyroid glands were carried out in operations for thyroid carcinoma in 25 cases. For the purpose of fine dissection of paratracheal lymph nodes, before thyroidectomy more than 2 parathyroid glands were found and transplanted into greater pectoralis muscle. The patients who underwent surgery were studied for more than one year following operation to determine the short term and long term outcomes of the procedure. None of the patients received prophylactic calcium supplement therapy except for hypocalcemic symptoms. In thirteen patients, the parathyroid function was almost completely restored within 3 weeks without any postoperative substitution therapy, with an obvious surge in the plasma PTH level on 5P.O.D. The serum Ca level started to elevate on 7P.O.D. and recovered to 97.4% of the preoperative value 3 weeks after transplantation. As for the 12 patients who exhibited hypocalcemic symptoms, Ca lactate and hydroxycholecalciferol were administered for only 24.7 and 17.0 days, respectively. Serum levels of Ca and P, as well as the index of bone mineral content, were all within the extremely excellent range even one year after operation. None of the patients was on a substitution regimen. These results suggest that autotransplantation is a valuable alternative for the preservation of the parathyroid function in operations for thyroid carcinoma.

Myrocin C, a new diterpene antitumor antibiotic from Myrothecium verrucaria. II. Physico-chemical properties and structure determination

The structure of a new antitumor antibiotic, myrocin C, from a strain of Myrothecium verrucaria was characterized as a pentacyclic pimarane diterpene composed of a gamma-lactol group and a unique cyclopropane ring on the basis of its physico-chemical properties and spectroscopic data as well as a single-crystal X-ray diffraction analysis of its monoacetyl derivative.

Multiple functioning paraganglioma associated with polycythemia

Multiple retroperitoneal functioning paraganglioma complicated by polycythemia is reported in the case of a girl who, at the age of 13 years complained of headache, palpitation, and faintness preoperatively. In the retroperitoneal cavity, there were 21 paragangliomas larger than 1 cm in diameter. All were removed surgically in two sections, the first in 1979 and the second in 1983. Bilateral adrenals were macroscopically normal, and her symptoms disappeared. Now the recurrence of retroperitoneal paraganglioma is likely, although there have been no symptoms for 8 years, since the first operation. It is difficult to conclude that the tumors were benign or malignant in this case. Though complication of polycythemia had been diagnosed before the operation, the symptom continued even with the serum erythropoietin level kept in the normal range. Association of polycythemia with paraganglioma is extremely rare, and it is also rare to find more than 10 paragangliomas. Only a limited number of reports have been made on each case in the literature.

Evidence that calpains and elastase do not produce the von Willebrand factor fragments present in normal plasma and IIA von Willebrand disease

Recent evidence suggests that proteolysis plays an important role in some forms of inherited and acquired von Willebrand disease (vWD). Because calpains and one or more enzymes released from polymorphonuclear leukocytes are known to proteolyze von Willebrand factor (vWF) in vitro with resultant loss of large multimers similar to that seen in IIA vWD, they have been suggested as being responsible for the proteolysis in vivo. Using monoclonal epitope mapping, we have examined the proteolysis of the vWF subunit by porcine calcium-activated neutral proteases (calpains) and human leukocyte elastase to determine whether they produce the vWF proteolytic cleavage products seen in normal individuals and IIA vWD. Purified vWF was digested with porcine calpains I and II. We found no difference in the size, location, and quantity of the fragments produced by calpain I v calpain II. New fragments were detected of approximately 200, 170, 150, and 125 Kd. There was no evidence for generation of the native 140 and 176 Kd fragments. Some loss of the native fragments was seen, which suggests that they were further cleaved. Epitope mapping of the 170- and 150-Kd calpain-cleaved fragments revealed them to be from different parts of the molecule than the regions from which the native 176- and 140-Kd fragments derived. This was further supported by determination of the amino-terminal sequence of the calpain-cleaved 170- and 150-Kd fragments. Digestion of vWF with human leukocyte elastase produced new fragments at 210/205, 190, 170/165, 145/140, and 130/125 Kd. No generation of native fragments was detected. Monoclonal epitope mapping of the 145/140-Kd elastase-cleaved band proved that it derived from the carboxyl-terminal portion of the vWF molecule, whereas the native 140-Kd fragment is derived from the amino-terminal end. Neither calpains nor human leukocyte elastase produced the proteolyzed fragments present in normal and IIA vWD and, therefore, probably do not cause the loss of large multimers that is seen in that disorder.

[Immunohistochemical demonstration of cytokeratin in thyroid neoplasms and its clinical implications]

Formalin fixed paraffin sections of previously resected surgical specimens and ethanol fixed stamped samples of newly obtained specimens from patients with thyroid neoplastic lesions were investigated for the presence of cytokeratin by the help of avidin-biotin peroxidase complex (ABC) method using anticytokeratin monoclonal antibody PKK-1. The result showed that PKK-1 reacted only to a large cell variant of anaplastic carcinoma of the thyroid and not to a small cell type. Therefore this method appears not to be useful for differentiation between small cell carcinoma and lymphoma. The differentiation between papillary carcinoma and follicularly growing tumor was possible by this method because the former reacted to PKK-1 at a high rate, whereas most of the latter were negative to it. Freshly prepared stamped samples showed a better reaction to the monoclonal antibody, and thus this technique appears to be applicable to an aspiration biopsy cytology.

Neuron-specific enolase in comatose children

Sequential examination of neuron-specific enolase in cerebrospinal fluid and serum was performed in 20 comatose children with acute encephalitis, acute encephalopathy, or Reye's syndrome. Neuron-specific enolase activities corresponded to the degree of brain damage. As neuron-specific enolase levels increased to greater than 80 ng/mL, patients had more severe impairment or died. Neuron-specific enolase may be a useful marker for evaluating the degree of neuronal damage and prognosis.

Platelet volume and intraplatelet adenine nucleotides in various hematologic disorders

By recent advanced techniques, blood platelets have proved to be varied in size and metabolism in various hematologic disorders. We examined platelet volume and intraplatelet adenine nucleotides in 36 patients with various hematologic disorders in order to clarify the quantitative platelet abnormalities. Platelet volumes were smaller in patients with acute leukemia and aplastic anemia, and larger in patients with immune thrombocytopenic purpura (ITP). The amount of intraplatelet ADP was decreased and ATP/ADP ratio was increased in acute leukemia, aplastic anemia and myeloproliferative disorders (MPD), which strongly suggested the presence of storage pool deficiency in these patients. Intraplatelet ADP per volume was decreased in acute leukemia, aplastic anemia and MPD, and ATP per volume was decreased in aplastic anemia. ATP content was increased in ITP in proportion to the increased platelet volume. These parameters were examined in 36 patients with the following hematologic disorders: 7 acute leukemia treated with cytotoxic chemotherapy, 5 aplastic anemia, 3 paroxysmal nocturnal hemoglobinuria (PNH), 9 immune thrombocytopenic purpura (ITP), 5 hypersplenism and 7 myeloproliferative disorders (MPD).