[Sleep apnea in multiple system atrophy]

Multiple system atrophy(MSA) characterized clinically by any combination of autonomic, extrapyramidal or cerebellar symptoms and signs. MSA patients frequently manifest a variety of sleep-related respiratory disturbances, which are life threatening problems. Above all, a common and serious complication is upper-airway obstructive sleep apnea associated with stridor, which is caused by vocal cord abductor paralysis(VCAP). For the early diagnosis of VCAP, it is important to perform laryngoscopy during sleep, because VCAP does not appear during awakefulness in the early stage of MSA. Polysomnographic study should be obtain to assess the severity of respiratory disturbances. Tracheostomy is reliable treatment for respiratory disturbances due to VCAP, while nasal continuous positive pressure may be a useful treatment for some patients.

Serum parathyroid hormone and calcitonin levels in racehorses with fracture

Serum parathyroid hormone (PTH) and calcitonin (CT) levels in fractured racehorses were measured by radioimmunoassay. Racehorses with fracture of large bone such as the radius, third metacarpus, third carpus, digital bone or tibia, showed normal PTH level and elevated CT level in the serum. Serum PTH level was slightly higher in racehorses with sesamoid bone fracture compared to that of healthy racehorses, but not statistically significant. Moreover, serum CT level of racehorses with sesamoid bone fracture was significantly higher than that of healthy racehorses. Racehorses with sesamoid bone fracture and large bone fracture might be in different conditions of calcium regulation.

Selective distribution of matrix metalloproteinase-3 (MMP-3) in Alzheimer's disease brain

A growing amount of evidence indicates that matrix metalloproteinases (MMPs) may play an important role in the pathogenesis of Alzheimer's disease (AD). Stromelysin-1 (MMP-3) plays a central role in activating latent-type MMPs, which are originally secreted as proenzymes. We examined MMP-3 immunoreactivity in the brains of patients who had suffered from Alzheimer's disease and in those of neurologically normal persons. The interstitium between myelinated axons and astrocytes in the white matter of all brain tissues, and senile plaques in the gray matter of the patients with AD were stained with a monoclonal antibody to MMP-3. Comparison of the number of senile plaques stained with the antibody against MMP-3 in the parietal cortex with that in the hippocampus showed that fewer plaques were stained in the hippocampus. The selective distribution of MMP-3 in the human brain suggests that MMP-3 might play an important role in the pathogenesis of AD, especially in the degradation of beta-amyloid protein.

Micturitional disturbance in pure autonomic failure

We obtained micturitional histories and performed urodynamic studies in six patients with pure autonomic failure. All patients had urinary symptoms. Urodynamic studies showed postmicturition residuals in two, small bladder capacities in two, detrusor hyperreflexia in four, low bladder compliance in two, detrusor-external sphincter dyssynergia in one, neurogenic sphincter electromyography in three, and denervation supersensitivity of the bladder in two. Micturitional disturbance is a common feature in pure autonomic failure because of peripheral and central types of abnormalities.

Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?

OBJECTIVES

Urinary dysfunction and orthostatic hypotension are the prominent autonomic features in multiple system atrophy (MSA). A detailed questionnaire was given and autonomic function tests were performed in 121 patients with MSA concerning both urinary and cardiovascular systems.

METHODS

Replies to the questionnaire on autonomic symptoms were obtained from 121 patients including three clinical variants; olivopontocerebellar atrophy (OPCA) type in 48, striatonigral degeneration (SND) type in 17, and Shy-Drager type in 56. Urodynamic studies comprised measurement of postmicturition residuals, EMG cystometry, and bethanechol injection. Cardiovascular tests included head up tilt test, measurement of supine plasma noradrenaline (norepinephrine,NA), measurement of R-R variability (CV R-R), and intravenous infusions of NA and isoproterenol.

RESULTS

Urinary symptoms (96%) were found to be more common than orthostatic symptoms (43%) (p<0.01) in patients with MSA, particularly with OPCA (p<0.01) and SND (p<0.01) types. In 53 patients with both urinary and orthostatic symptoms, patients who had urinary symptoms first (48%) were more common than those who had orthostatic symptoms first (29%), and there were patients who developed both symptoms simultaneously (23%). Post-micturition residuals were noted in 74% of the patients. EMG cystometry showed detrusor hyperreflexia in 56%, low compliance in 31%, atonic curve in 5%, detrusor-sphincter dyssynergia in 45%, and neurogenic sphincter EMG in 74%. The cystometric curve tended to change from hyperreflexia to low compliance, then atonic curve in repeated tests. Bethanechol injection showed denervation supersensitivity of the bladder in 19%. Cardiovascular tests showed orthostatic hypotension below -30 mm Hg in 41%, low CV R-R below 1.5 in 57%, supine plasma NA below 100 pg/ml in 28%, and denervation supersensitivity of the vessels (alpha in 73%; beta2 in 60%) and of the heart (beta1 in 62%).

CONCLUSION

It is likely that urinary dysfunction is more common and often an earlier manifestation than orthostatic hypotension in patients with MSA, although subclinical cardiovascular abnormalities appear in the early stage of the disease. The responsible sites seem to be central and peripheral for both dysfunctions.

IgG anti-GQ1b positive acute ataxia without ophthalmoplegia

IgG anti-GQ1b antibody was present in a patient with acute ataxia and areflexia without ophthalmoplegia or elementary sensory loss. Sensory nerve conduction studies and somatosensory evoked potentials were normal, but postural body sway analysis showed dysfunction of the proprioceptive afferent system. The clinical presentation and laboratory results for this patient resemble those of Miller Fisher syndrome, except for the lack of ophthalmoplegia. This case may represent part of an IgG anti-GQ1b syndrome.

Positron emission tomographic measurement of acetylcholinesterase activity reveals differential loss of ascending cholinergic systems in Parkinson's disease and progressive supranuclear palsy

We measured brain acetylcholinesterase activity in 16 patients with Parkinson's disease (PD), 12 patients with progressive supranuclear palsy (PSP), and 13 age-matched controls, using N-methyl-4-[11C]piperidyl acetate and positron emission tomography. Kinetic analysis was performed to calculate k3, an index of acetylcholinesterase activity. In PD patients, there was a significant reduction (-17%) of cerebral cortical k3 compared with normal controls, whereas there was only a nonsignificant reduction (-10%) of cortical k3 in PSP patients. However, there was a prominent reduction (-38%) of thalamic k3 in PSP patients compared with normal controls, whereas there was only a nonsignificant reduction (-13%) of thalamic k3 in PD patients. The results suggest that there is a loss of cholinergic innervation to the cerebral cortex in association with cholinergic innervation to the thalamus in PD, whereas there is a preferential loss of cholinergic innervation to the thalamus in PSP. When the thalamic to cerebral cortical k3 ratio was taken for each subject, PD and PSP were separated, suggesting that positron emission tomography measurement of acetylcholinesterase activity may be useful for differentiating the two similar disorders.

Special sensory ataxia in Miller Fisher syndrome detected by postural body sway analysis

To investigate whether ataxia in Miller Fisher syndrome (MFS) is caused by loss of proprioception or cerebellar dysfunction, we studied the power spectrum peak of the body sway frequency in 10 MFS patients, and compared the results with those of patients with cerebellar or sensory ataxia. The cerebellar patients had a peak at 2.4 Hz, whereas sensory ataxia patients had a 1-Hz peak. Nine of the MFS patients had a distinct 1-Hz peak. Clinical sensory loss or abnormal sensory nerve potentials were present in only 3 patients, whereas soleus H-reflexes were absent in all the MFS patients. MFS patients have dysfunction of the proprioceptive afferent system, and the special sensory ataxia may be caused by the selective involvement of muscle spindle afferents.

[Spinal myoclonus which appeared during the administration of alpha interferon]

We report a 42-year-old man who showed myoclonus in his right leg during alpha-interferon (alpha-IFN) treatment for HCV-RNA positive chronic hepatitis C. The myoclonus continuously persisted even during sleeping. Surface EMG recordings revealed fairly regular about 0.3 Hz periodic grouping discharges synchronized in the right lower extremities muscles. Jerk-locked back averaging method demonstrated a monophasic negative sharp wave associated with the myoclonus. This pre-myoclonus sharp wave was localized on the Cz and preceded the myoclonus by about 60 ms. T 2-weighted gradient-echo MRI images revealed a high-intensity lesion in the right leg motor cortex in the left hemisphere. The myoclonus vanished in association with the disappearance of the above MRI lesion one month after the termination of alpha-IFN therapy. Based on these, we conclude the alpha-IFN may induce the myoclonus in this patient.

Hemorrhagic enteritis associated with Clostridium perfringens type A in a dog

A female Shetland sheep dog died suddenly with hemorrhagic diarrhea and vomitting, and was examined pathologically and microbiologically. Gross pathological change was restricted to the intestinal tract. The intestine contained watery, blood-stained fluid. Histopathologically, the principal intestinal lesion was superficial mucosal hemorrhagic necrosis at the jejunoileum. Many Gram-positive bacilli were found adhering to the necrotic mucosal surface in parts of the intestinal tract. Clostridium perfringens in pure culture were isolated from jejunal contents by anaerobic culture. These results suggested that the typical lesion of this case coincided with canine hemorrhagic enteritis and enterotoxemia due to C. perfringens infection could be the cause of sudden death.

Two patterns of clinical recovery in Guillain-Barré syndrome with IgG anti-GM1 antibody

OBJECTIVE

To investigate the prognostic value of anti-GM1 antibody.

BACKGROUND

Whether anti-GM1 antibody is a marker of poor prognosis due to axonal degeneration in Guillain-Barré syndrome (GBS) is a matter of controversy.

METHODS

The clinical recovery of 41 consecutive GBS patients was analyzed.

RESULTS

The Hughes functional grading scores were similar at the peak, and 1, 3, and 6 months after onset for the groups of patients with (n=19) and without (n=22) immunoglobulin (Ig) G anti-GM1 antibodies. However, the anti-GM1-positive group included significantly higher proportions of patients with poor recovery (inability to walk independently at 6 months, 5 of 19 versus 0 of 22; p=0.01) and those with a markedly rapid recovery (improvement by two or more Hughes grades within a month, 9 of 19 versus 4 of 22; p=0.05). The positivity of IgG anti-GM1 antibody correlated well with the electrodiagnosis of the acute motor axonal neuropathy pattern but was not always associated with poor prognosis. Anti-GM1-positive patients showed two different patterns of clinical recovery-their conditions improved slower or faster than those of the anti-GM1-negative patients, most of whom had acute inflammatory demyelinating polyneuropathy.

CONCLUSIONS

Anti-GM1 antibody is not always a marker of poor prognosis and, besides axonal degeneration, early reversible effects other than demyelination could be part of the pathophysiology of Guillain-Barré syndrome with IgG anti-GM1 antibody.

D-penicillamine treatment for chronic sensory ataxic neuropathy associated with Sjögren's syndrome

Beneficial treatment has not been established for chronic sensory ataxic neuropathy associated with Sjögren's syndrome (CSAN-SS). We describe two patients with CSAN-SS who clinically improved in response to D-penicillamine treatment. Their neuropathic symptoms were lessened after D-penicillamine, and the results of electrophysiologic studies support the clinical improvement. D-Penicillamine can be considered a potentially beneficial agent in the treatment of CSAN-SS.

Brain muscarinic receptors in progressive supranuclear palsy and Parkinson's disease: a positron emission tomographic study

OBJECTIVES

To assess muscarinic acetylcholine receptors (mAChRs) in the brains of patients with progressive supranuclear palsy and Parkinson's disease, and to correlate the cholinergic system with cognitive function in progressive supranuclear palsy and Parkinson's disease.

METHODS

Positron emission tomography (PET) and [11C]N-methyl-4-piperidyl benzilate ([11C]NMPB) was used to measure mAChRs in the brain of seven patients with progressive supranuclear palsy, 12 patients with Parkinson's disease, and eight healthy controls. All of the patients with progressive supranuclear palsy were demented. The Parkinson's disease group consisted of 11 non-demented patients and one demented patient. The mini mental state examination (MMSE) was used to assess the severity of cognitive dysfunction in all of the subjects. The modified Wisconsin card sorting test (WCST) was used to evaluate frontal cognitive function in the non-demented patients with Parkinson's disease and controls.

RESULTS

The mean K3 value, an index of mAChR binding, was significantly higher for the frontal cortex in the patients with Parkinson's disease than in the controls (p<0.01). By contrast, the patients with progressive supranuclear palsy had no significant changes in the K3 values of any cerebral cortical regions. The mean score of the MMSE in the progressive supranuclear palsy group was significantly lower than that in the control group. Although there was no difference between the Parkinson's disease and control groups in the MMSE, the non-demented patients with Parkinson's disease showed significant frontal lobe dysfunction in the WCST.

CONCLUSIONS

The increased mAChR binding in the frontal cortex of the patients with Parkinson's disease may reflect denervation hypersensitivity caused by loss of the ascending cholinergic input to that region from the basal forebrain and may be related to frontal lobe dysfunction in Parkinson's disease. The cerebral cortical cholinergic system may not have a major role in cognitive dysfunction in progressive supranuclear palsy.

Expression of adult T cell leukemia-derived factor in human brain and peripheral nerve tissues

In both nonneurological and Alzheimer brains, we examined the localization of adult T cell leukemia-derived factor (ADF) by immunohistochemistry, that of its mRNA by in situ hybridization, and its semiquantitative mRNA analyses by RT-PCR. Anti-ADF antibody gave positive staining of white matter astrocytes and Schwann cells in the posterior root. Their intense and abundant staining was seen in Alzheimer brains. In situ hybridization for ADF mRNA showed identical signals in the white matter astrocytes. The evidence was also confirmed by RT-PCR analysis. These results suggest that redox regulation may play a role in Alzheimer pathology.

Demyelinating polyneuropathy with preferentially-proximal involvement

A 47-year-old man showed progressive, symmetrical weakness in the limbs for 6 months. There was muscle atrophy, fasciculations, and acute denervation without motor conduction abnormalities below the elbows or knees, and motor neuron disease had once been suspected. However, compound muscle action potentials (CMAPs) after proximal stimulation showed an amplitude reduction between axilla and Erb's point for the median and ulnar nerves on both sides. His weakness as well as the amplitude reduction improved after administration of prednisolone. Demyelinative conduction abnormalities can be limited to the proximal segments for at least several months in a conduction equivalent to chronic inflammatory demyelinating polyneuropathy (CIDP).

p53 mutation as a potential cellular factor for tumor development in enzootic bovine leukosis

Mutations of p53 in the lymphocytes from peripheral blood and from tumoral lymph nodes in six naturally occurring bovine leukemia virus (BLV)-infected cows were examined. A point mutation of the p53 gene was found in three of six (50%) BLV-infected cows. These p53 gene mutations resulted in amino acid substitutions of codons 144, 167 and 241. The BLV-infected cow in the tumor stage had abnormally proliferating monoclonal B-lymphocytes having the p53 mutation. However, the mutation was not found in somatic cells, except for tumor cells. These results show that p53 mutation plays an important role in the pathogenesis of BLV-induced neoplasms, and that the B-lymphocyte bearing p53 mutations may be a target cell for tumor formation of enzootic bovine leukosis.

Further analysis of the phenotype and distribution of tumor cells in sporadic B-cell and T-cell lymphomas in the lymph node and spleen of cattle

Immunohistologic studies were performed to identify the phenotype and distribution of neoplastic lymphocytes in the spleens of BLV-negative animals examined by PCR and diagnosed as having sporadic bovine leukosis. Tumor cells from three cases of sporadic bovine leukosis were identified as of B-cell lineage. Tumor cells from three additional cattle were identified as CD3+ CD4- CD8+, CD3+ CD4- CD8-, and CD3+ CD4- WC1+, respectively. The last case was diagnosed as a gamma/delta T-cell lymphoma. Differences in morphology proliferative characteristics were recognized between B- and T-cell type lymphomas. The tumor cells in B-cell type lymphoma were characterized as follows: medium or large in size, round or polymorphic nucleus with rough chromatin with some tumor cells containing a convoluted nucleus. These tumor cells of B-cell type lymphoma were present in the red pulp and periarteriolar lymphoid sheath. Tumor cells of the T-cell type lymphoma were uniformly smaller than B-cell type and present around arteries or replaced red pulp of the spleen.

Identification and mRNA developmental profiles of two ultraspiracle isoforms in the epidermis and wings of Manduca sexta

cDNAs were isolated from Manduca sexta that encode two isoforms of an ultraspiracle (USP) homologue MsUSP-1 and MsUSP-2 with different N-terminal A/B regions. The MsUSP-1 cDNA predicts a protein with 97% and 45% amino acid identities in the DNA- and ligand-binding domains respectively to the Drosophila USP and 89% overall identity with Bombyx mori CF1 (an USP homologue). Northern blot hybridizations with probes specific to MsUSP-1 and MsUSP-2 showed transcripts of an approximately equal size (4.5 kb), but with diverse developmental profiles in Manduca epidermis during the two final larval instars and the onset of the adult moult. The MsUSP-1 mRNA was expressed during the intermoult periods, with higher levels around the time of the larval ecdyses and at the onset of wandering behaviour. In contrast, the MsUSP-2 mRNA was up-regulated at times of high ecdysteroid titre during the larval moults, when the MsUSP-1 mRNA disappeared. Together, these conversely regulated isoform mRNAs contribute to the constitutive expression profile of total MsUSP mRNA.

[Muscarinic cholinergic receptor imaging of parkinsonian brain using 11C-NMPB and PET]

11C-NMPB is a useful ligand which is used to measure brain muscarinic cholinergic receptors (mAChRs) for its high affinity and high brain uptake. PET images of 11C-NMPB uptake had the highest accumulations in the cerebral cortex and striatum and the lowest in the cerebellum, both in patients with Parkinson's disease (PD) and normal subjects. 11C-NMPB uptake was homogeneous throughout the cerebral cortex in the normal subjects but greater in the frontal cortex of about one half of the PD patients as compared with other cerebral cortical areas. Quantitative analysis showed that the PD patients had high K3 values, an index of mAChR binding, in the frontal cortex. In PD, increased mAChR binding in the frontal cortex may be related to frontal lobe dysfunction. This technique should prove useful for detecting subclinical impairment of the central cholinergic system in PD.

Characterization of differentiation antigens expressed in bovine lymphosarcomas

To characterize the cell-surface antigens expressed in tumour cells derived from bovine leukosis and to determine their cell lineages, the immunophenotypes of the tumour cells from 13 bovine lymphosarcomas were examined with 13 monoclonal antibodies (mAbs). Of 13 cattle with lymphosarcomas, four were identified clinically as having the thymic-type sporadic bovine leukosis (SBL) and one as having the skin-type; two had enzootic bovine leukosis (EBL) and six were untypable. Flow cytometric analysis revealed that the tumour cells from nine cases were of T-cell lineage (BoCD5+, BoCD2+ or BoCD2-) and two were of B-cell lineage (MHC-II+, BoCD5+, IgM+); there were two bovine leukaemia virus-infected cattle (EBL). T-cell tumours appeared to originate from immature (BoCD4-, BoCD8-) T cells, but there was no significant relationship between clinical type (EBL, calf-, skin- and thymic-type) and tumour-cell immunophenotype.

The proto-oncogene c-myb is expressed in sporadic bovine lymphoma, but not in enzootic bovine leukosis

We examined bovine c-myb gene expression in six samples of sporadic bovine lymphomas (two calf, three thymic and one intermediate) and five of enzootic bovine leukosis. Tumor cells of the sporadic bovine lymphomas were of immature cell lineage (one B lymphoma and five T lymphomas). The c-myb mRNA was expressed in almost all the sporadic bovine lymphomas (except for one thymic form) including a BoCD8 single positive T lymphoma. On the contrary, c-myb was not expressed in mature B lymphomas of enzootic bovine leukosis. The results suggest that c-myb expression is closely associated with tumor cell differentiation of bovine lymphomas.

B-1a, B-1b and conventional B cell lymphoma from enzootic bovine leukosis

In order to characterize the phenotypes of tumor cells and to clarify from which B cell lineage the lymphomas were derived, ten cows with enzootic bovine leukosis were examined by means of immunohistologic staining and flow cytometry. The tumor cells expressed mainly major histocompatibility complex (MHC) class II+ (10/10), BoCD11b+ (9/10), IgG1+ (8/10), B-B2+ (8/10) BoCD5+ (7/10), and lambda light chain+ (7/10). Tumor cells from only one animal expressed sIgM+ (1/10). Tumor cells from all ten animals were negative for IgG2, BoCD3, BoCD4, BoCD8, WC1-N2, and IL-2R alpha. The phenotypes of these tumor cells were all slightly different, suggesting that bovine leukemia virus (BLV)-induced lymphoma expresses phenotypic diversity. Moreover, tumor cells from seven cattle coexpressed BoCD5 and BoCD11b (B-1a cells). On the other hand, tumor cells from two of them only expressed BoCD11b (B-1b cells), and those from one were negative for both BoCD5 and BoCD11b (conventional B cells). Therefore, we concluded that BLV-induced lymphoma cells can be derived from B-1a, B-1b and conventional B cells.

Immunohistological study on bovine lymph node using monoclonal antibodies to interleukin-2 receptor

Three monoclonal antibodies to IL-2R alpha (LCTB32, CACT116 and LCTB2) were used for immunohistologic staining of lymph nodes from normal young cattle and a calf suffering from phlegmon. In the normal cattle, a few IL-2R alpha positive cells were detected in the paracortex region. In the calf, IL-2R alpha was mostly expressed on follicle cells.