Mortality of inhabitants in an area polluted by cadmium: 15 year follow up

OBJECTIVE

To assess the influence of environmental exposure to cadmium (Cd) on long term outcome of inhabitants living in an area polluted by Cd.

METHODS

A follow up study for 15 years (from 1974-5 to 1991) was carried out on 2408 inhabitants (amounting to 95% of the target population, 1079 men and 1329 women) of the Kakehashi River basin in Ishikawa Prefecture, Japan. These inhabitants had been the subjects of the health impact survey in 1974-5 to evaluate (by measurement of urinary retinol binding protein (RBP)) renal dysfunction induced by Cd. Analysis of mortality was performed by dividing subjects into a urinary RBP positive (> or = 4 mg/l) group and RBP negative (< 4 mg/l) group.

RESULTS

After adjustment for age with Cox's proportional hazard model, RBP > or = 4 mg/l showed a significant relation to mortality in both sexes. At this time, the mortality risk ratio of the RBP positive to negative group was 1.71 in the men and 1.42 in the women. When the SMRs according to causes of deaths in the RBP positive group were compared with those of the RBP negative group or the overall Japanese population increases of SMR for cardiovascular diseases, especially heart failure, and renal diseases were found in both sexes.

CONCLUSION

These results suggest that the prognosis of the exposed inhabitants with renal tubular dysfunction is unfavourable, and these increases of mortality are due to heart failure and renal diseases.

Effects of alcohol ingestion on vestibular function in postural control

In order to define the acute effects of a moderate quantity of alcohol on balance, related to the vestibular function, vestibulo-ocular reflex (VOR) test, caloric test and dynamic posturography (EquiTest) were performed. Ten healthy male volunteers aged 19-27 average 22.8) years old imbibed 1.5 ml whisky (alcohol content 43%) per kilogram of body weight within 5 min. Blood alcohol level (BAL) was measured before administration and then after 30, 90, and 150 min. Equilibrium examinations were performed immediately after each blood sample was taken. At the highest alcohol level, significant reductions were found in VOR gain, in the maximum slow-phase velocity of the caloric test and in the equilibrium score of the sensory organization test in condition 5, when compared with those before drinking. In some typical cases, the subjects' response in all tests were most disturbed at the time when the highest alcohol level was measured. From our results, we conclude that a moderate quantity of alcohol affects not only the oculomotor system but also the vestibular system. Furthermore, it was suggested that one of the reasons for postural instability after drinking alcohol may be reduced vestibular function.

Influence of a cold front upon the onset of Meniére's disease in Toyama, Japan

In order to clarify the influence of a cold front (CF) upon the onset of Meniére's disease (MD), major CFs were defined by meteorological observations, and the influence of CFs on MD was evaluated by using the time n method. From our preliminary study it was seen that the onset of MD had its highest incidence exactly on days where a CF passed by. Out of the patients with MD, sudden deafness (SD) and Bell's palsy (BP) who visited our neurotological clinic of the Toyama Medical and Pharmaceutical University from 1987 to 1992, 67 MD patients, 70 SD patients and 70 BP patients could clearly define the date of the onset of their disease, and were therefore selected for this epidemiological study. Thirty-six our of the 67 MD patients had the first attack on the day when a CF passed by or on the next day. The results obtained from these studies were as follows. i) The onset of MD was influenced by the passing of a CF, and this influence was more specific in MD than in SD or BP. ii) In the 36 CF influence MD patients, the majority were over the forty years, and their hearing level was worse than that of the other 31 MD patients during the observation periods.

Epidemiological study of severe cases of Meniére's disease in Japan

In order to clarify the characteristics of severe cases of Meniére's disease (MD), we analyzed various epidemiological factors such as sex ratio, past history, complication, cause of onset of vertiginous attacks, etc., in a series of 958 patients with definite MD. Data were obtained from the three Japan-wide surveys of MD conducted by the Meniére's Disease Research Committee of Japan (1975-76) and the Vestibular Disorders Research Committee of Japan (1982-84 & 1990). Following the ideas proposed by the members of the Vestibular Disorder Research Committee of Japan, we divided severe cases into three categories according to the following criteria i) bilateral MD cases (BMD), ii) unilateral MD cases with prolonged disabled vertigo (UPDV), iii) unilateral MD cases with profound hearing loss (UPHL). About 40% of the subjects were classified as severe cases (UPDV: 23%; BMD: 9%; UPHL: 6%). The ratio of otitis media in past history was statistically different between severe cases and non-severe patients (p < 0.05), suggesting that otitis media in the past may contribute to the severity of Meniére's disease.

Epidemiological and clinical characteristics of Menière's disease in Japan

From 1975 to 1990, nationwide surveys on Menière's disease were performed three times by the Research Committee of Menière's disease (1975-76) and the Research Committee of Peripheral Vestibular Disorders (1982-84 and 1990) in Japan. Nine hundred and fifty-eight definite Menière cases, 520 in the 1st, 230 in the 2nd and 148 in the 3rd survey, were sampled by the members of the Committees. The epidemiological and clinical characteristics of Menière's disease were analyzed and compared with such control cases as other vertiginous patients, ENT patients without vertigo, and healthy subjects. In Menière's disease, the male to female ratio has changed from even to female predominance over the 15 years the study ran. The age distribution at onset peaked in the forties for males and thirties for females. Significant epidemiological results are summarized as follows: Definite Menière's disease has a higher incidence in married persons and in people with a nervous and precise character, whereas the incidence is lower in obese people. Physical and mental fatigue induced the onset of attacks. Menière's disease happened in day time in many cases, especially during the afternoon. As these epidemiological findings were commonly observed in all the surveys, the results are considered to be universal epidemiological characteristics of Menière's disease in Japan. In the same period, regional investigations were performed by Toyama Medical Association and our University. The male to female ratio in Toyama indicated a more significant female predominance than in the nationwide surveys. The prevalence of Menière's disease in Toyama Prefecture has been almost constant in all surveys, about 17/100,000 since 1974.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary guidelines for reporting treatment results in Menière's disease conducted by the Committee of the Japanese Society for Equilibrium Research, 1993

In order to draft guidelines for reporting treatment results in Menière's disease (MD) in Japan, 17 committee members elected from the Japanese Society for Equilibrium Research (JSER) have met for about two years. The preliminary guidelines obtained from their discussions are summarized as follows. i) Evaluations of symptoms: Only definitive vertiginous spells with spontaneous nystagmus should be evaluated (AAOO, 1972). The parameter for the assessment of hearing levels should be evaluated using four-frequency pure-tone averages (PTA) at 250 Hz, 500 Hz, 1 kHz and 2 kHz. ii) Evaluation period: Valid results for the evaluation should be based on observations at least six months before treatment and over at least 12 months after initiation of therapy. iii) Evaluation criteria The formula expressing the effects of treatment on vertiginous spells should adopt a numeric vertigo score, which is shown in the AAO-HNS (1985) guidelines. If the duration of pre-treatment evaluation period is less than 6 months, the divisor is replaced by the average of definitive spells per month for the period of observation. iv) Global judgment: For a global judgment, patients and doctors should jointly evaluate the treatment results from the standpoints of their subjective and objective symptoms respectively.

Synthesis and structure-activity relationships of new (5R,8S,10R)-ergoline derivatives with antihypertensive or dopaminergic activity

A series of new (5R,8S,10R)-ergoline derivatives was synthesized, and their antihypertensive and dopaminergic activities were evaluated in conscious spontaneously hypertensive rats and in rats with unilateral 6-hydroxydopamine-induced lesions of the substantia nigra, respectively. (5R,8S,10R)-6-Methyl-8- ergolinemethanols, prepared from the corresponding ergolinecarboxylates, were converted to the tosylates, which were treated with various five-membered heterocycles containing nitrogen atoms to afford the new ergolines. (5R,8S,10R)-8-(1-Imidazolylmethyl)-6-methylergoline (5a, BAM-2101) and (5R,8S,10R)-2-bromo-6-methyl-8-(1,2,4-triazol-1-ylmethyl) ergoline (7c, BAM-2202) exhibited potent antihypertensive activities. The maximum falls of systolic blood pressure after oral administration of 5a and 7c at 3 mg/kg were 95 and 132 mmHg, respectively, while those of cianergoline, bromocriptine mesylate, hydralazine, and nifedipine at the same dose were 40, 37, 47, and 49 mmHg, respectively. The durations of significant antihypertensive effects of these compounds except nifedipine were more than 7 h. None of the ergolines exhibited potent dopaminergic activity. Structure-activity relationships are discussed.

Visual otolith-ocular reflex in normal subjects. A preliminary report

The influence of the otolith-ocular reflex (OOR) induced by the linear (along Y-axis) acceleration was evaluated 12 healthy subjects. The elicited maximum eye velocity (MV) was comparatively analyzed under three stimulus conditions; (1) sinusoidal linear acceleration with eyes covered, (2) sinusoidal optokinetic stimulus and (3) sinusoidal linear acceleration with eyes open (visual-vestibular interaction). By the linear acceleration level of 78 cm2, i.e. 0.08 G, the MV of the optokinetic response (OKR) showed no change in spite of the existence of the OOR.

Synthesis and structure-activity relationships of new (5R,8R,10R)-ergoline derivatives with antihypertensive or dopaminergic activity

A series of new (5R,8R,10R)-ergoline derivatives was synthesized, and their antihypertensive and dopaminergic activities were tested in conscious spontaneously hypertensive rats and in rats with unilateral 6-hydroxydopamine-induced lesions of the substantia nigra. (5R,8R,10R)-6-Alkyl-8-ergolinemethanols, prepared from the corresponding ergolinecarboxylates, were converted to the tosylates, which were treated with various five-membered heterocycles containing nitrogen atoms to afford the new ergolines. (5R,8R,10R)-8-(1,2,4-Triazol-1-ylmethyl)-6-methylergoline (4s, maleate: BAM-1110) exhibited potent dopaminergic activity, about 18-fold greater than that of bromocriptine mesylate. (5R,8R,10R)-8-(1,2,4-Triazol-1-ylmethyl)-6-propylergoline (8b, fumarate: BAM-1602) showed extremely potent dopaminergic activity, being about 220 and 1.15 times more active than bromocriptine mesylate and pergolide mesylate, respectively. Several compounds exhibited potent antihypertensive activity. Structure-activity relationships for antihypertensive and dopaminergic activities are discussed.

Sudden deafness from vertebrobasilar artery disorder

Two cases are presented of sudden deafness with vertigo and/or dizziness, a 19-year-old male and a 54-year-old female. Their onset condition was considered to be caused by vascular disorders in the area of the vertebrobasilar artery, but they showed no signs of the central nervous system disorders. Case 1 suffered right sudden deafness just after a super selective embolization for the peripheral area of the right vertebral artery, and case 2, just after the accidental cutting of the left vertebral artery during the procedure of neurovascular decompression surgery. The neurotologic findings in these cases were almost the same and the common characteristics were (1) irreversible total deafness of the affected ear, (2) canal paresis in caloric test, (3) retrolabyrinthine disorder of the vestibular system detected by the galvanic test, and (4) no obvious findings of central nervous system disorders, such as eye movement disorder or ataxy. These findings indicate that the sudden deafness was attributable to localized embolism in the inner ear artery caused by thrombosis in the area of the vertebrobasilar artery.

Plain radiological findings in Ménière's disease

In order to investigate the characteristics of plain radiography of Ménière's disease, the degree of the pneumatization and the distance between the sigmoid plate and the bony wall of the vestibule in Schüller's view were examined in patients with unilateral and bilateral Ménière's disease, non-Ménière vertiginous disease and healthy subjects. There was no difference of the degree of pneumatization and the distance among the patients with Ménière's disease, the non-Ménière inner ear disease group and in healthy subjects. The distance of the unaffected ear was significantly shorter in patients showing a shorter distance of the affected ear. There was no relationship between the distance and age of onset of the disease, and duration of the disease. Therefore, it is concluded that the dysfunction of endolymphatic sac does not always reflect poor mastoid pneumatization and/or shorter distance in the plain radiography and that other etiological mechanisms such as autoimmune disease should be considered in some patients having evidence of endolymphatic hydrops.

Optokinetic nystagmus elicited by a random dot pattern and a wide interval stripe pattern in normal subjects

In optokinetic stimulus in practical living conditions, not only the central fovea but also the peripheral retina are strongly stimulated. In order to investigate the influence of this stimulus on the peripheral retina in optokinetic nystagmus (OKN), we tested OKN elicited by a pattern of numerous random dots (ROKN) in 30 normal subjects and compared the results with those of OKN elicited by a wide interval stripe pattern. The most significant difference between the two response patterns was the correlation between slow phase velocity and slow and fast phase amplitude. In ROKN, the nystagmus amplitude was highly correlated with slow phase velocity. On the other hand, in SOKN there were two types of correlation between slow phase velocity and nystagmus amplitude. One indicated low correlation, which was extremely predominant, and the other, high correlation as in ROKN. This tendency was more marked in the fast phase amplitude. Although it is generally accepted that OKN fast phase in SOKN is controlled by voluntary saccade, our results indicate that ROKN is more strongly controlled by reflective resetting eye movements, which is similar to the nystagmus fast phase in vestibular nystagmus.

[Six cases of anesthesia mumps]

Six cases of acute transient enlargement of the parotid gland under general anesthesia, so called anesthesia mumps, are reported. Patient 1 was placed in the left lateral position and the left parotid gland was subsequently observed to be diffusely enlarged. With five patients in the prone position, bilateral parotid gland enlargement was observed. Patient 1 complained of parotid swelling. Patient 4 suffered from slight tenderness of the right parotid gland. However, the others had no subjective symptoms. All cases of parotid swelling resolved spontaneously within 7 days. Changes in serum amylase during parotid enlargement were almost within normal range. Mechanical compression by sheet amadou may have produced the swelling in the patient who was placed in a lateral position. In the prone position, changes in the autonomic nervous system during surgical procedures and anesthesia, vascular congestion resulting from the surgical position, an overactive pharyngeal reflex stimulated by endotracheal intubation and mechanical ventilation are discussed as possible causes. Evaluation of the occurrence and clinical course of anesthesia mumps provided useful diagnostic and management data.

Glycoconjugates in the vestibular organs as revealed by the silver methenamine method

The glycoconjugates in the vestibular organs of the guinea pig were studied after staining by the silver methenamine method and by the periodic acid-Schiff (PAS) reaction. The organic matrix of otoconia, otolithic membranes and cupulae were stained to the same degree by the PAS reaction. In contrast, the mineralizing and non-mineralizing matrices were clearly distinguished by the silver methenamine method. The otoconia were surrounded by an intensely stained organic matrix, while the otolithic membranes and cupulae were moderately stained. This histochemical difference suggests that the positively stained organic matrix of otoconia is not identical to the otolithic membranes and cupulae in terms of its biochemical composition. The strongly stained material may play an important role in turnover of calcium in otoconia. The contact areas between type I hair cell and nerve calyx were contained silver methenamine-positive material which is probably involved in adhesion of these cell membranes.

Nasal septal neurinoma

A case of nasal septal neurinoma is presented. The patient was a 71-year-old male who complained of nasal obstruction and epistaxis. Results of the physical examination showed a giant mass filling the nasal cavity and the nasopharynx. A biopsy taken from its tissue surface showed histological features of neurofibroma. The lesion was completely resected with the patient under general anesthesia. The tumor completely occupied the right nasal cavity and the nasopharynx, partially penetrated the nasal septum and extended to the left nasal cavity. After the operation, the final pathological diagnosis was not neurofibroma but neurinoma in which Antoni type A and type B cells were mixed. The postoperative course was uneventful, and no recurrence has been observed to date.

Changes in auditory evoked responses during intravenous lidocaine

Auditory evoked responses in 21 cases with tinnitus were recorded before and after the administration of intravenous lidocaine. A dosage of 1 mg/kg body weight was diluted with 20% glucose (20 ml) and administered intravenously over a one-min period. The loudness of tinnitus was evaluated during electrocochleography (ECochG) or auditory brain-stem response (ABR) recordings using a score between 0 and 11. The stimulus sound was a tone burst in a frequency that corresponded to the pitch of tinnitus. AP latency on ECochG and the inter peak latency (IPL) of wave I-III and wave III-V on ABR were prolonged momentarily and tinnitus was reduced. These findings reveal that the sites of action for lidocaine are both the inner ear and the brain-stem.

Electrocochleography in syphilitic hearing loss

Syphilitic labyrinthitis presents such symptoms as hearing loss, tinnitus, vertigo and/or dizziness, and is well known as one of the endolymphatic hydropic diseases. In order to elucidate the relationship between syphilitic hydrops and ECochG findings, we performed ECochG in patients with syphilis following our previously reported study of patients with Meniere's disease. Twenty-two patients who have been serologically and clinically diagnosed as having syphilitic labyrinthitis were examined with ECochG between December, 1982 and November, 1991. Of the 27 ears tested with ECochG, 2 showed no response due to severe hearing loss, and increased SP (SP/AP ratio > 0.37) was observed in 14 (56.0%) out of the remaining 25 ears. The SP/AP ratio of patients with syphilitic labyrinthitis was not significantly different from that of the patients with Meniere's disease or delayed endolymphatic hydrops, while it was significantly higher than that of the patients with sudden deafness and other types of sensorineural hearing loss. We conclude that the electrocochleographic features of endolymphatic syphilitic lesions resemble those in Meniere's disease.

Quantitative evaluation of the function of looking at visual target in optokinetic nystagmus

A new method is presented to qualitatively evaluate the function of OKN which certainly looks at a visual target. Optokinetic stimulation was given to a test subject by projecting stripes with a 5 degrees visual angle width at 30 degrees intervals, which was accelerated by 1 degree/s2 up to 100 degrees/s. The correlation between slow phase and fast phase was computed with our program. Two correlations were mixed in a normal response, one indicated low correlation and the other high correlation. As normal subjects look at wide interval visual targets one by one regardless of the target velocity, low correlation type OKN beats are considered to be those which certainly look at the visual target. In order to quantitatively analyze this type of OKN, approximate regression lines of the low correlation type, [y = ax + b (x: slow phase velocity, y: fast phase amplitude or velocity)], were computed by the minimum square method. In normal subjects, value a indicates low and value b high velocity and their normal limits are determined. The results of cases with central disequilibrium indicate that this analysis provides information of pathological OKN different from that of such conventional parameters as slow phase velocity and number of nystagmus beats.

Neurotological findings in patients with acute mumps deafness

We report the neurotological findings in 4 cases of acute stage hearing loss due to mumps. In 2 of the cases, the less severe hearing loss which occurred in the opposite ear was shown to have improved after therapy. If patients with mumps suffer from a mild hearing loss which recovers quickly, the temporary auditory problem might go undiagnosed; thus the incidence of mumps deafness might well be higher than that reported in the literature. Two of our patients complained of dizziness. In the caloric test, a reduced response of the ear with poorer hearing was found in 3 cases, and a normal caloric response was revealed in the fourth. In the galvanic body sway test (GBST), 3 cases showed a normal response bilaterally and one case presented a normal response bilaterally in the first test, no response in the right side in the second test, and recovery of response in the third test. These findings suggest that an inner ear disorder might occur in combination with a retrolabyrinthine disorder in mumps deafness, with the former lasting longer and the latter improving earlier.

Vestibular nerve disorder in patients suffering from sudden deafness with vertigo and/or vestibular dysfunction

Vestibular nerve disorder (VND) in cases suffering from sudden deafness with vertigo was studied. Between 1987 and 1991, we observed 46 patients suffering from sudden deafness with or without vertigo, who had undergone the caloric test and galvanic body sway test (GBST). Twenty-seven patients had vertigo and canal paresis (CP) upon the caloric test, 6 vertigo without CP and 13 CP without vertigo. VND was detected in 12 of the 46 patients. All those with VND had vertigo and CP upon the caloric test, 12/27 (44%). The degree of hearing loss in those with VND was significantly (p < 0.05) more severe and their recovery of hearing loss was poorer than in patients without VND. These results indicate that VND is a common finding in cases of sudden deafness with vertigo especially in those with severe hearing loss.

Evaluation of vestibular function by dynamic posturography and other equilibrium examinations

We evaluated the significance of dynamic posturography (EquiTest) in vestibular function assessment by comparing it with our routine equilibrium examinations comprised of nystagmographic data and other postural tests. Fifty-two patients with unilateral peripheral vestibular disorders were examined. Differences in test results between pendular rotation test and dynamic posturography were found in 23 out of 52 (44%) patients with unilateral peripheral vestibular disorders. In 5 patients, no abnormality of vestibular function could be detected by means of a three-test battery (spontaneous and positional nystagmus and pendular rotation test) used for evaluating vestibular compensation. In spite of these results, the patients complained of vertigo of dizziness and showed abnormal results in dynamic posturography. Dynamic posturography was superior to other postural tests in the detection of pathology corresponding with the patients' complaints. From these results, dynamic posturography (EquiTest) appeared to provide new information about such conditions of vestibular patients which other equilibrium examinations have not heretofore been able to detect.

A case of Bickerstaff's encephalitis. With special reference to neurotological findings

The case of a 60-year old male with prodromal common cold symptoms and progression of brain stem involvement with no cardiac or respiratory complications is described. This conformed to the criteria of Bickerstaff's encephalitis. Neurotological examinations, including the OKN test, the caloric test, and the GBST were performed from onset to recovery of the disease. The results of these tests closely reflected the central nervous system disorders each time, but there was a discrepancy in the results of the two test batteries of equilibrium function, the caloric test and the GBST. The caloric test showed bilateral canal paresis while the GBST showed normal responses. These results suggested that the involved area of the vestibular nucleus was localized to the superior portions. Form our clinical observations, we can conclude that neurotological examinations provide more vital information for localized diagnosis and follow-up of the brain stem lesion in Bickerstaff's encephalitis.

Effect of transdermally administered scopolamine on the vestibular system in humans

In order to elucidate the effect of scopolamine on the vestibular system in humans, various experimentally-induced forms of nystagmus, i.e. caloric nystagmus, rotational nystagmus, optokinetic nystagmus, visual-vestibular interaction and optokinetic after nystagmus, were evaluated before and after the administration of two pieces of Scopoderm-TTS or placebo patches retro-auricularly. Scopolamine reduced the responses of both the caloric and optokinetic after nystagmus compared with the placebo. The possible action site of this drug is discussed.

The contribution of proprioception to posture control in normal subjects

In order to investigate the contribution of proprioceptive input to maintaining an upright position, stabilometry via 100-Hz vibratory stimulation applied to the Achilles tendon was studied and analyzed with respect to area, length and power spectra according to the method of fast Fourier transform (FFT). Twenty-one young medical students were analyzed in this study. When vibration was applied, the body sway was significantly greater than that of control in area and length with both eyes open and closed. There was a significant increase of total power in both the lateral (X) and antero-posterior (Y) directions with the eyes closed. With the eyes open, an increase was found only in the antero-posterior direction. The frequency band indicating the maximum spectrum did not shift. Significant increases in power spectra were found in the frequency range of more than 2 Hz in both two directions with the eyes closed. It was concluded that a vibration given to the Achilles tendon provoked a pronounced high frequency body sway especially in the antero-posterior direction when visual information was nullified, and that proprioceptive information may have a minor role compared with visual information.

Otoconia in young and elderly persons: a temporal bone study

Using serially sectioned human temporal bones, the volumes of otoconia masses were compared between young children and elderly people. The latter group had significantly less otoconia volume than the former group, both in the macula utriculi and macula sacculi. The ratio between macula utriculi and macula sacculi was 100:70 in the young group, whereas it was 100:35 in the elderly group. Thus, the macula sacculi in the elderly group showed the severest otoconia reduction.