In vivo effect of prednisolone on release of leukotriene B4 from neutrophils from asthmatic patients

We examined the release of leukotriene B4 from calcium ionophore A23187-stimulated neutrophils from asthmatic patients treated with or without intravenous prednisolone during an asthmatic attack. The mean level of LTB4 in the supernatant of stimulated neutrophils from patients treated with intravenous prednisolone was significantly lower than that in the supernatant of stimulated neutrophils from those without prednisolone treatment. Preincubation with prednisolone caused a dose-dependent inhibition of LTB4 release from calcium ionophore A23187-stimulated neutrophils. These findings suggest that intravenous prednisolone inhibits the release of LTB4 from neutrophils in vivo.

Sporothrix schenckii isolated from a cat in Japan

A yeast-like fungus isolated from a granulomatous and ulcerative skin lesion in a mongrel cat was mycologically examined. The isolate was identified as Sporothrix schenckii from the morphological findings and its pathogenicity in a mouse, confirming the first case of feline sporotrichosis in Japan. Fortunately, no transmission to humans occurred in this case, however the risk of humans contracting Sporothrix schenckii infection increases with the increase in the number of animals with sporotrichosis. Consequently when handling such animals protective clothing such as gloves should be worn to reduce the risk of transmission of the fungus through open wounds.

Priming effect of platelet activating factor on leukotriene C4 from stimulated eosinophils of asthmatic patients

BACKGROUND

Eosinophils from asthmatic patients are known to release greater amounts of leukotrienes than normal eosinophils when stimulated by the calcium ionophore A23187. The effect of platelet activating factor (PAF) in priming eosinophils was investigated.

METHODS

Eosinophils were obtained from 18 asthmatic patients and 18 healthy donors. Cells separated by the Percoll gradients were incubated with PAF (C-18) for 30 minutes and then stimulated with the calcium ionophore A23187 (2.5 microM) for 15 minutes. The amount of leukotriene C4 (LTC4) in supernatants was measured using a combination of high pressure liquid chromatography and radioimmunoassay.

RESULTS

The mean (SD) amount of LTC4 released by eosinophils from asthmatic patients upon stimulation with the calcium ionophore A23187 alone was 27.9 (9.9) ng/10(6) cells (n = 6). The amount of LTC4 released following stimulation with the calcium ionophore A23187 after pretreatment with PAF (1, 5, and 10 microM) was 57.2 (8.9), 75.1 (14.3), and 52.6 (10.7) ng/10(6) cells (n = 6), respectively. Trace amounts of LTC4 (0.9 (0.02) ng/10(6) cells, n = 6) were detected in the supernatant of the cells after stimulation by PAF alone (5 microM). The amount of LTC4 released upon stimulation by calcium ionophore A23187 alone in eosinophils from healthy donors was 10.3 (3.7) ng/10(6) cells (n = 4). The amounts of LTC4 released upon stimulation with calcium ionophore A23187 after pretreatment with PAF at concentrations of 1, 5, and 10 microM were 11.9 (3.5), 17.8 (5.6), and 12.7 (5.1) ng/10(6) cells (n = 4), respectively. Trace amounts of LTC4 (0.6 (0.02) ng/10(6) cells, n = 4) were detected in the supernatant of the cells upon stimulation with PAF alone (5 microM). The amounts of LTC4 released upon stimulation with calcium ionophore A23187 after pretreatment with lyso-PAF at concentrations of 1, 5, and 10 microM (n = 4 or 6) were 30.8 (5.2), 22.9 (5.1), and 27.3 (4.3) ng/10(6) cells (n = 6) from the eosinophils of asthmatic patients and 13.7 (3.3), 15.2 (4.9), and 14.7 (3.8) ng/10(6) cells (n = 4) from the eosinophils of healthy donors.

CONCLUSIONS

The results indicated that PAF enhanced LTC4 formation by eosinophils obtained from asthmatic patients stimulated with the calcium ionophore A23187, but not those obtained from normal subjects.

In vivo effect of prednisolone on release of leukotriene C4 in eosinophils obtained from asthmatic patients

We investigated the release of leukotriene C4 from eosinophils of asthmatic patients who were treated with or without intravenous prednisolone. The mean level of LTC4 in the supernatant of A23187-stimulated eosinophils obtained from asthmatic patients during an attack was significantly lower with intravenous prednisolone than without prednisolone treatment. Findings suggest that intravenous prednisolone inhibits the release of LTC4 from the eosinophils of asthmatic patients by acting on these cells in vivo.

Molecular design and biological activity of potent and selective protein kinase inhibitors related to balanol

BACKGROUND

The protein kinase C (PKC) family of serine/threonine-specific protein kinases is involved in many cellular processes, and the unregulated activation of PKC has been implicated in carcinogenesis. PKC inhibitors thus have significant potential as chemotherapeutic agents. Recently, the fungal metabolite balanol was shown to be an exceptionally potent inhibitor of PKC. We previously developed a practical and efficient total synthesis of balanol. We set out to use this synthetic molecule, and several synthetic analogs, to probe the mechanism of PKC inhibition and to determine the effect of balanol on the activity of other protein kinases.

RESULTS

As well as inhibiting PKC, balanol is a potent inhibitor of cyclic AMP-dependent protein kinase (PKA), another protein serine/threonine kinase. Balanol does not, however, inhibit the Src or epidermal growth factor receptor protein tyrosine kinases. The inhibition of both PKC and PKA by balanol can be overcome by high concentrations of ATP, and molecular modeling studies suggest that balanol may function as an ATP structural analog. Although balanol discriminates rather poorly between PKC and PKA, only minor modifications to its molecular structure are required to furnish compounds that are highly specific inhibitors of PKA.

CONCLUSIONS

A number of balanol analogs have been designed and synthesized that, unlike balanol itself, exhibit dramatic selectivity between PKA and PKC. Thus, despite the substantial homology between the catalytic domains of PKA and PKC, there is enough difference to allow for the development of potent and selective inhibitors acting in this region. These inhibitors should be useful tools for analyzing signal transduction pathways and may also aid in the development of drugs with significant therapeutic potential.

[A hemodialysis patient with HTLV-1-associated myelopathy (HAM)]

We report here a case of maintenance hemodialysis with HTLV-1 associated myelopathy (HAM). A 53-year-old female hemodialysis patient was admitted to Teikyo University Ichihara hospital because of paralytic ileus. She had a history of blood transfusion and had been under dialysis treatment for 8 years. She had experienced gait disturbance and sensory disturbance in her lower extremities for 8 years. Neurological examination revealed myelopathy and neuropathy. Laboratory data revealed that serum anti-HTLV-1-antibody was over 1260 x (PA) and liquor HTLV-1-antibody was over 160 x (PA). Her liquor revealed a cell count of 4/3 cmm, protein 22 mg/dl, glucose 45 mg/dl, chloride 125 mEq/l and no atypical cells. To the best of our knowledge this is a rare case in Japan. Our findings suggest that HAM should be taken into consideration when we diagnose a maintenance hemodialysis patient showing neuropathy and myelopathy.

[Secondary hyperparathyroidism and tertiary hyperparathyroidism chronic renal failure, uremia]

The bone histology of renal osteodystrophy is classified into osteitis fibrosa, osteomalacia, those of mixed, osteoporosis and low turnover bone. Osteitis fibrosa is the most frequent skeletal abnormality and is caused by various degrees of hyperparathyroidism. The main factors inducing hyperparathyroidism which is a well known complication in patients with renal failure include (a) phosphorus retention: 1) hypocalcemia and 2) decreased levels of 1 alpha, 25(OH)2 Vitamin D3, (b) reduced number of 1 alpha, 25(OH)2 Vitamin D3 receptors in parathyroid tissue, (c) skeletal resistance to set-point for calcium-regulated parathyroid hormone secretion. Serum or plasma levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, calcitonin and tartrate resistant acid phosphatase are measured to evaluate hyperparathyroidism and metabolic bone disease. Dietary phosphorus restriction in chronic renal insufficiency prevents secondary hyperparathyroidism and renal osteodystrophy. Other treatment of phosphorus binders, Vitamin D metabolites or analogues, carcitonin and bisphosphonate are useful for the management of renal bone disease.

[An adult case of hemolytic uremic syndrome (HUS) after pathogenic Escherichia coli (E. coli) infection]

In recent years, it has been revealed that verocytotoxin-producing E. coli (VTEC) infection is one of the leading causes of HUS and the molecular aspects of its pathophysiology have also been studied extensively. We report a case of a 56-year-old man who developed HUS after E. coli (O 26 strain) infection with diarrhea. The characteristic laboratory findings in this case included hypergammaglobulinemia, hypocomplementemia and a high level of immune complex in addition to the common findings of HUS. The light microscopic findings of the first renal biopsy performed before treatment revealed extensive interstitial changes with remarkable mononuclear cell infiltrations as well as mild mesangial proliferation with crescent formation. Subendothelial electron-dense deposits within the glomerular capillary walls and mesangial area were also detected by electron microscopic examination. The diagnostic possibilities of infectious endocarditis and collagen diseases, such as Sjögren syndrome, were reasonably ruled out by the appropriate examinations. After 2-month prednisolone therapy, proteinuria and deteriorated renal functions as well as the abnormal immunological parameters described above were remarkably improved. The second renal biopsy after treatments showed clearly diminished subendothelial deposits and interstitial mononuclear cell infiltrations. This case report might provide information on the unique features of renal interstitial damage and immunological abnormalities in VTEC-induced adult HUS.

Peripheral neuropathy associated with dialysis amyloidosis

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A high-level and regulatable production system for recombinant glycoproteins using a human interferon-alpha promoter-based expression vector

A novel expression vector for human cells, pIFP, which expresses a cloned gene under the control of the human interferon-alpha-encoding gene (IFN-alpha) promoter (pIFN) was constructed. As a model of glycoprotein production, a human erythropoietin-encoding cDNA (EPO) inserted downstream from pIFN in pIFP was introduced into human B-cell leukemia-derived BALL-1 cells, and EPO-producing cells were established. Upon stimulation with Sendai virus, the cells produced human EPO at high levels. The highest production level and the highest inducibility were 872 IU/ml and 67-fold, respectively. Simultaneously, the transformed cells also produced IFN-alpha and tumor necrosis factor-alpha (TNF-alpha), as the parental BALL-1 cells did. Comparing the amounts of the substances produced, activity of the exogenous pIFN introduced seemed much higher than that of the endogenous one. Further, the transformed cells could be obtained in a large quantity by being applied to the 'in vivo cell proliferation method (hamster method)'. Human EPO produced by the transformed cells had a molecular mass range of 35 to 42 kDa, similar to that of EPO produced by CHO cells. The processing of EPO seemed to occur properly. The combination of the human pIFN, BALL-1 cells and the hamster method provides us with a useful production system for bioactive glycoproteins of human origin.

Peripheral anterior inferior cerebellar artery aneurysms

Two cases of peripheral anterior inferior cerebellar artery (AICA) aneurysms are reported. The first case was a 60-year-old man who showed frequent attacks of subarachnoid hemorrhage (SAH) and hearing disturbance. His aneurysm was obliterated by trapping the AICA and his neurologic status was unchanged compared with preoperatively. The second case had SAH without cranial nerve involvement; this aneurysm was obliterated by neck clipping. He was discharged without neurologic deficit. Peripheral AICA aneurysm has already been reported in 48 cases including arteriovenous malformation-associated cases. This aneurysm may show cranial nerve involvement (seventh and eighth) without SAH as in the case of internal carotid-posterior communicating artery aneurysms. We review the clinical signs of these cases and discuss them from the point of view of anatomic variations of the AICA and internal auditory artery.

[Glucocorticoid therapy in renal diseases--its indication and therapeutic schedule]

Glucocorticoid therapy is used to treat renal diseases because of the two pharmacological actions, i.e anti-inflammatory and Immunosuppressive ones. Indications for steroid therapy in renal diseases are mainly primary and secondary nephritis and the nephrotic syndrome. These include minimal change nephrotic syndrome, membranous nephropathy, membranoproliferative glomerulonephritis, focal glomerular sclerosis, rapidly progressive glomerulonephritis, IgA nephropathy (in part), lupus nephritis, acute interstitial nephritis and so on. There are two routes of steroid administration, orally or intravenously, to treat nephritis and the nephrotic syndrome. The standard therapeutic regimen is the oral administration of prednisolone (PSL), which usually consists of initial high dose therapy (40-60 mg/day), subsequent withdrawal of steroids and maintenance therapy. As for intravenous administration, high dose injection of methylprednisolone (usually 1000 mg on three successive days) is utilized and followed by high dose oral PSL.

Striatal grafts in infarct striatopallidum increase GABA release, reorganize GABAA receptor and improve water-maze learning in the rat

We grafted fetal striatal cells in ischemic rat models, and investigated graft survival/growth, GABA release, GABAA receptor reorganization and functional recovery. One hour intraluminal occlusion of the middle cerebral artery (MCA) induced ischemic infarct in the lateral part of the striatum and adjacent cortex. In ischemic rats, the acquisition of Morris' water-maze learning was significantly slower than that of control rats. In these animals GABA level in the globus pallidus, detected by microdialysis, was about the half of that of controls. However, after the grafts of fetal striatal cells in the striatopallidum, the acquisition was improved, thus no difference was observed in the time course of learning curves in control and grafted animals. GABA level recovered to almost normal level by the graft. It further increased by the treatment of a GABA uptake blocker (nipecotic acids) in the perfusion. In the grafts, GABAA receptor organization detected by autoradiography using [3H] labeled SR95531 was restored for more than 1 year after the graft. Data suggest that fetal striatal cell grafts in infarct striatum may partially reconstruct striatopallidal GABA projection and reorganize GABAA receptor. This might be a basis of improvement of function.

Metabolism of L-amino acids in a marine bacterium isolated from mackerel intestines in relation to eicosapentaenoic acid biosynthesis

Metabolism of glucose and L-amino acids in an obligately aerobic marine bacterium isolated from Pacific mackerel intestines was investigated for the mechanism and pathway of eicosapentaenoic acid (EPA) biosynthesis. This bacterium could not uptake glucose but the cell-free extract of this bacterium had the enzymatic activities of L-alanine oxidase (EC 1.4.3.2), L-alanine dehydrogenase (EC 1.4.1.1). L-serine dehydratase (EC 4.2.1.13), and malate dehydrogenase (EC 1.1.1.40), and of seven enzymes involved in the TCA cycle of the usual aerobes. On the other hand, the carbon-13 concentration in cellular fatty acids of the bacterium, especially that in their methyl carbon atoms in contrast to their carbonyl carbons, increased drastically when the bacterium was grown in the presence of 13CH3COONa. These results indicate that: (i) the TCA cycle works in this bacterium, (ii) glucose is not utilized and pyruvic acid is in vivo synthesized from L-alanine, L-serine, and malic acid, and (iii) EPA and other cellular fatty acids are in vivo synthesized from acetyl coenzyme A by the usual de novo synthesis route.

[Appearance of hallucinations and one-and-a-half syndrome after resection of a cavernous angioma located in the fourth ventricle floor]

A patient is described who simultaneously suffered from hallucinations and one-and-a-half syndrome following surgical resection of a cavernous angioma located on the fourth ventricle floor. A 30-year-old male was admitted having a 10 year history of progressive weakness and hypesthesia of the right extremities. Neurological examination revealed right hemiparesis and hemihypesthesia. A computerized tomography (CT) scan showed a well circumscribed mixed-density area at the left portion of the pontine tegmentum. Magnetic resonance imaging (MRI) indicated a mixed intensity core surrounded by hypointense regions on T2-weighted images. A red mulberry-like tumor was found, during surgical procedures, on the mid-and left-portion of the fourth ventricle floor. The tumor was totally resected and the histological diagnosis was cavernous angioma. Visual hallucinations occurred several times following surgery, being subsequently described as images of moving worms, a dump truck next to the bed, and a bed falling from the ceiling. The patient soon understood these objects were not real. He simultaneously exhibited left lateral gaze palsy associated with left internuclear ophthalmoplegia i.e., one-and-a-half syndrome. Three months after surgery the visual hallucinations disappeared but the one-and-a-half syndrome was incompletely resolved. According to the neurological signs and the MRI results, the lesion site was considered to extend from the left lower pons to the midbrain. Previously reported operations of cavernous angioma of the fourth ventricle floor are also described.

Striatal grafts in the ischemic striatum improve pallidal GABA release and passive avoidance

Fetal striatal cells were grafted into the ischemic striatum of rats and pallidal GABA release, and behavioral improvement were investigated. Intraluminal occlusion of the middle cerebral artery (MCA) for 1 h induced ischemic infarcts in the lateral striatum and the adjacent cortex. In ischemic rats, the performance of a passive avoidance task was disturbed, and the pallidal GABA level detected by microdialysis decreased to about a half of control. After the graft, the deficit in the passive avoidance was partially alleviated and the GABA level recovered moderately and increased further by the infusion of an uptake blocker. The data indicate that fetal striatal cell grafts in the ischemic striatum partially restored both chemical and behavioral deficits.

[The molecular basis for the steroid hormone actions in the kidney]

Steroid hormones such as mineralo- and glucocorticoids act as important regulators for the kidney to maintain the body fluid homeostasis. During the past 40 years, numerous investigations have been dedicated to the elucidation of precise mechanisms of steroid hormone actions in their target tissues including the kidney. Now it is well recognized that cellular actions of steroid hormones can be accomplished by two step processes, namely a specific receptor binding in the cytosol and/or the nucleus and a new protein synthesis through a gene transcription. The efforts for the isolation and purification of steroid hormone receptors have been also made and followed by the great successes of molecular techniques in the cDNA cloning and determination of amino acid sequences for them in recent years. The revealed high homology of the functional domains of receptors has renewed the issues of how tissue specificities of steroid hormone actions are determined. The identification of steroid-induced proteins and cellular steroid hormone metabolites would be also important issues to be studied.

[Impairment of acid-base balance in renal failure]

It is very critical for the living organism to maintain homeostasis of body fluid volume and its electrolyte composition by renal regulation, including acid-base balance. In renal failure, impaired acid-base balance is inescapable because of disturbed urinary acidification, one of the major renal functions. Among all types of acid-base imbalance, metabolic acidosis is a major one in renal failure. For better understanding of this issue, several fundamental items for the renal mechanisms of urinary acidification must be discussed first, and the pathophysiological features and their relevant treatment for acid-base imbalances in renal failure, next. Moreover, some comments on the practical aspects, in long-term dialyze uremic patients, is also provided.

Takayasu arteritis in Japan

Takayasu arteritis is a disease on which many investigations have been conducted to determine its causes, clinical features and treatment, since 1908 when it was reported by Dr. Takayasu. The first nationwide epidemiological survey on Takayasu arteritis was conducted over 3 years from 1973 through 1975 by a research group on "aortitis syndrome", a disease specified by the Ministry of Health and Welfare. Another nationwide survey on this disease over a period of 3 years was carried out from 1982 through 1984 by a research group focusing on "systemic vascular lesion", another disease specified by the Ministry of Health and Welfare. The present study reports on the combined results of these two nationwide epidemiological surveys.

[Clinical significance of thrombocytopenia associated with hemorrhagic cerebrovascular diseases]

We investigated the clinical significance of thrombocytopenia (platelet counts less than 10 x 10(4)/mm3) associated with hemorrhagic cerebrovascular disease. This study was conducted in 96 patients suffering from hemorrhagic cerebrovascular diseases. We divided the clinical course into 3 stages: acute (from the 1st to 7th day), subacute (8th-21st day) and chronic (after the 22nd day). The average age of the patients with thrombocytopenia (TCP) was 60.6 years old. TCP was more frequent in men (81.3%) than in women (18.7%). TCP developed in 18.6% (8/43) of patients with subarachnoid hemorrhage (SAH) and in 15.1% (8/53) of those with intracerebral hemorrhage (ICH). Among the patients with SAH, four were in the acute stage, three in the subacute stage and two in the chronic stage. TCP due to SAH was more likely to develop in the acute and/or subacute stage. TCP due to SAH showed two peak appearances: the first was within 24 hours (n = 3), and the second was around 10 days after onset (n = 3). The cause of TCP in its late peak appearance was presumed to be the consumption of platelets due to microembolism induced by vasospasm and/or hemodilution therapy. Among patients with ICH, five cases were in the acute stage, three in the subacute stage and two in the chronic stage. TCP due to ICH was more likely to develop in the acute stage. Fifty percent (4/8) of the patients with ICH had TCP on admission. This data suggested that TCP was possibly a cause or an inducer for ICH.(ABSTRACT TRUNCATED AT 250 WORDS)

A study of oral adsorbent in chronic renal failure

In order to examine the effect on the progression of chronic renal failure (CRF), we have applied an oral adsorbent (AST-120) composed of spherical porous carbon particles to patients with chronic renal failure undergoing conservative therapy. Its effect was observed in improvement of uremic symptoms, improvement of slope in linear regression of reciprocal of serum creatinine vs. time plots and delayed initiation of hemodialysis, compared to control patients, together with reduced uremic peak 2a in HPLC analysis of serum and lower levels of beta 2 microglobulin in AST-120 group than in control. The improvements of uremic symptoms, creatinine and 2a levels were confirmed in double blind study where background of patients were evenly randomized between AST-120 and placebo groups and no improvement was observed in placebo group. The result leads us to conclude that the oral adsorbent therapy is expected as an useful therapy for retardation of progression of CRF.

[Intracranial hematoma associated with acquired immunodeficiency syndrome (AIDS): case report]

The authors report a case of intracranial hematoma associated with AIDS. A male aged 21 had been treated with infusion of factor VIII to control hemophilia A. He fell down and hit his right occipital region. Immediately after the impact, he became comatose. When he was hospitalized 30 minutes after the injury, a herniation sign was recognized. CT scan revealed right acute subdural hematoma that showed mixed density. This hematoma was successfully removed with HITT (hematoma irrigation with trephination therapy) and he recovered almost completely. However he died when the intracerebral hematoma bled suddenly on the 20th day after surgery. We assumed the hematoma was related to vasculitis induced by AIDS. Three points in this case impressed us. First, HITT is very useful for treating acute subdural hematoma associated with AIDS. Second, the patient's condition may deteriorate suddenly through intracerebral hematoma originating from AIDS-related vasculitis, although the coagulation factors are well maintained. Third, a manual for management of cases of AIDS is necessary to avoid confusion among the medical staff.

[Clinical evaluation of protocol for the craniomandibular disorders. 2. Craniomandibular disorders according to new classification]

The purpose of this study is to clarify the actual state in the patients with extensive pathological states of craniomandibular disorders (CMDs). 100 patients, with their ages ranging from 11 to 77 years old, were selected for the study and they were divided into 5 groups according to classification of Japanese Society for Temporomandibular Joint. The following results were obtained: 1. By classification type, the ratio was 88, 16, 8 and 2% for Type III, Type I, Type IV and Type II. Type V was not found. 2. 22% of patients were male and 78% were female. The ratio of male and female was 1:4. 3. By age group, the ratio was 34, 23, 18, 12, 11, 1 and 1% for twenties, tens, thirties, fifties, forties, sixties and seventies. CMDs was found highly in younger ages (tens and twenties). 4. The ratio diagnosed Type III was 86.9, 97.0, 88.8 and 83.3% for tens, twenties, thirties and forties. Type III was found high ratio in all ages. 5. In all patients, right TMJ with disorder 37%, left TMJ with disorder 34%, bilateral TMJ with disorder 29%. There were no difference between right and left. 6. As can be seen from the above, young individuals with CMDs were clearly high ratio and many CMDs were diagnosed Type III through all the ages. Therefore, the results of our study suggest that young CMDs patients could be increasing gradually and complicating a pathological state.

[Clinical evaluation of protocol for the craniomandibular disorders. 3. Questionnaire for the craniomandibular disorders]

The purpose of this study is to clarify the effectiveness of questionnaire which is included in the protocol designed for screening the patients with extensive pathological states of craniomandibular disorders. 100 patients, with their ages ranging from 11 to 77 years old, were selected for the study and they were classified under various disorder classification which is based on the criteria of Japanese society for Temporomandibular Joint. Statistical analysis was performed to find the relationship between the different pathological states and the results of the questionnaire. The following results were obtained: 1. The ratio of appearance on TMJ pain was as follows: Type I (100%), Type II (0%), Type III (43.8-75.0%) and Type IV (75.0%). 2. The ratio of appearance on TMJ pain on chewing was as follows: Type I (50.0%), Type II (100%), Type III (20.0-100%) and type IV (37.5%). 3. The ratio of appearance on TMJ pain on maximum opening was as follows: Type I (100%), Type II (100%), Type III (50.0-100%) and Type IV (75.0%). 4. The ratio of appearance on TMJ noise was as follows: Type I (0%), Type II (0%), Type III (40.9-81.3%) and Type IV (50.0%). 5. The ratio of appearance on the fatigue by mastication was as follows: Type I (0%), Type II (50.0%), Type III (40.0-100%) and Type IV (75.0%). 6. The ratio of appearance on bruxism was as follows: Type I (0%), Type II (0%), Type III (10.4-40.0%) and Type IV (25.0%). 7. The ratio of appearance on the stiff of jaw on awakening was as follows: Type I (50.0%), Type II (0%), Type III (20.8-70.0%) and Type IV (37.5%). 8. The ratio of appearance on the unilateral chewing was as follows: Type I (50.0%), Type II (0%), Type III (20.0-50.0%) and Type IV (62.5%). 9. There were significances among those types about each items on the questionnaire, it can be suggested that the questionnaire for screening about craniomandibular disorders was effective.

[Clinical Evaluation of protocol for the craniomandibular disorders. 1. Protocol of our department]

Craniomandibular disorders are conditions encompassing various types of dysfunction of the stomatognathic system. To define the very nature of morbidity, both differential and pathological diagnosis are absolutely necessary. At present, each medical institution in this country has its own protocol for evaluating and treating craniomandibular disorders. This makes it difficult to exchange and compare data between institutions. In this paper, a protocol worked out by our department after a series of clinical tests and study is presented, and its merits and unresolved problems are discussed.