Spondylo-epi-metaphyseal dysplasia with normal stature: a case followed from infancy to skeletal maturity

Spondylo-epi-metaphyseal dysplasia is a rare skeletal dysplasia showing radiographic abnormalities in the epiphyses and metaphyses of the long and short tubular bones, and in the spine. There are very few reports of a case followed throughout the entire growth period. Here we report the case of a Japanese girl followed from 1 month old to skeletal maturity at 16 years old. She developed progressive kyphoscoliosis at 7 years old, and underwent a surgical correction of the spine at 14 years old. The diagnosis of spondylo-epi-metaphyseal dysplasia was made from examining all the follow-up radiographs showing abnormalities in the spine, long bones and hands involving epiphyses and metaphyses. She had normal stature--a rare finding in this condition.

New brittle bone disorder: report of a family with six affected individuals

We report on a family in which four females and two males in three generations had a previously undescribed brittle bone disorder that was dominantly transmitted through a maternal line. The cardinal manifestations of the disorder comprised dolichocephaly with frontal bossing, hypoplasia of the midface, postpubertal prognathism, micromelic short stature, coarse trabeculae of the entire skeleton, and bone fragility of variable degrees. Mild spondylar modification and iliac hypoplasia were other hallmarks that were recognized in childhood. The proband, a 19-year-old male, was most severely affected with multiple wormian bones in the calvaria, repetitive fractures, intractable bowing of the legs and forearms, and pseudofractures of the long bones with metaphyseal narrowing. His male cousin was next severely affected with angular deformity restricted to the forearm. The four females were much less affected without angular deformity. The mode of inheritance was thus consistent with either an autosomal dominant trait with sex-influence or an X-linked semidominant trait. Histological bone examination in the proband showed atrophy and fibrous degeneration of the lamellar trabeculae and disorganized chondro-osseous junction, which implied that the disorder involved both intramembranous and enchondral ossifications.

Risk factors of myelopathy at the atlantoaxial level in spondyloepiphyseal dysplasia congenita

Spondyloepiphyseal dysplasia congenita (SEDC) can be accompanied by hypoplasia of the odontoid and/or lax ligaments which may lead to spinal cord compression. Since an early diagnosis of myelopathy is essential for rational treatment, identification of the high-risk factors is imperative. Sixteen patients were retrospectively reviewed, 10 male and 6 female, and their average age at the time of examination was 18 (range 3-37) years. Myelopathy was seen in 6 individuals. Five were associated with atlantoaxial subluxation, and the critical value of space available for the spinal cord at the level of the atlas was 10 mm or less. Their height was less than -7SD of average Japanese of the same age, and all were associated with severe coxa vara. Although SEDC itself is a risk factor, marked short stature of less than -7SD and severe coxa vara are particularly high-risk factors for cord compression at the level of the atlas.

[A case of neutropenic enterocolitis in high dose chemotherapy with peripheral blood stem cell transplantation for relapsed testicular tumor]

High dose chemotherapy with peripheral blood stem cell transplantation (PBSCT) is safe and useful for the treatment of refractory or relapsed testicular tumors, but is sometimes accompanied by serious complications. We report a case of relapsed testicular tumor complicated by neutropenic enterocolitis during high dose chemotherapy with PBSCT.

Effect of TKS159, a novel 5-hydroxytryptamine4 agonist, on gastric contractile activity in conscious dogs

A novel 5-hydroxytryptamine (5-HT)4 receptor agonist, TKS159, ¿4-amino-5-chloro-2-methoxy-N-[(2S,4S)-1-ethyl-2- hydroxymethyl-4-pyrrolidinyl] benzamide), has recently been developed as a gastroprokinetic drug. Cisapride is already used clinically to increase gastric contractions. The stimulatory effects of TKS159 and cisapride on gastric contractions were examined using force transducers chronically implanted on the vagally denervated pouch (Heidenhain pouch) and the vagally innervated main stomach in conscious dogs. Contractile activity was analysed by computer and expressed as a motor index. Intravenous administration of TKS159 or cisapride significantly increased the motor index in both the main stomach and the Heidenhain pouch during the fed and fasted states. Pharmacological characterization in the fasted state revealed that the contraction-stimulating activity of TKS159 and cisapride on the stomach was significantly inhibited by atropine, hexamethonium and a 5-HT4 receptor antagonist, SDZ 205-557. Granisetron (a 5-HT3 receptor antagonist) significantly inhibited cisapride-induced, but not TKS159-induced gastric contractions. The plasma motilin concentration was significantly increased after cisapride, but not after TKS159 injection. In conclusion, TKS159 has a contractile-stimulating effect on both the innervated and the denervated stomach. It is likely that a cholinergic pathway and 5-HT4 receptors are involved in producing the contractions, although other mechanisms cannot be excluded. Cisapride has almost the same characteristics, but the present findings suggest the involvement of motilin and 5-HT3 receptors in the effects of cisapride.

An exocytotic mutant of Paramecium caudatum: membrane fusion without secretory contents release

This is a detailed characterization of a secretory mutant incapable of releasing secretory contents despite normal exocytotic membrane fusion performance. Trichocyst non-discharge strain tnd1 of Paramecium caudatum and its wildtype (wt) both show a transient cortical [Ca2+]i increase and exocytotic membrane fusion in response to the polyamine secretagogue, aminoethyldextran (AED), or to caffeine. tnd1 cells frequently display spontaneous Ca2+ signals parallelled by spontaneous exocytotic membrane fusion. This remains undetected, unless the trichocyst matrix is shown to be freely accessible to the inert, non-membrane permeable fluorochrome, F2FITC, from the outside. In these tnd1 cells, spontaneous and AED- or caffeine-induced membrane fusion, always without contents expulsion by decondensation (i.e. several-fold stretching), is ascertained by electron microscopy. Exocytotic openings, with condensed trichocysts retained, may persist for hours without impairing cells. Trichocyst decondensation normally requires micromolar [Ca2+]e, but an increase to 10 mM has no effect on tnd1 trichocyst expansion in vivo or in vitro (when isolated and exposed to ionophore A23187 + Ca2+). Paracrystalline packing of the major secretory components (trichynins) does occur, despite incomplete proteolytic precursor processing (according to SDS-PAGE). However, 45Ca(2+)-binding by secretory components is considerably reduced--the likely cause of the non-discharge phenotype. Our findings imply significant untriggered membrane fusion in a system normally following the triggered pathway and clear separation of exocytotic membrane fusion from any later Ca(2+)-dependent steps of the secretory cycle.

Stature and severity in multiple epiphyseal dysplasia

We investigated the stature and radiological findings in 15 patients with multiple epiphyseal dysplasia (MED). They were divided into normal-stature and short-stature groups according to their body height after 4 or 5 years of age. Their stature was not related to the involvement of the spine or epiphyses of long tubular bones except for the distal radius. Proximal phalanges and metacarpi were shorter in the short-stature group than in the normal-stature group, indicating that stature in MED had some relationship to the involvement of the wrist and hand. However, some patients in the normal-stature group showed involvement of distal radial epiphyses, and some patients in the short-stature group did not have stubby fingers. There are thus no clear-cut criteria to differentiate between the severe Fairbank type and the milder Ribbing type of MED.

2-Deoxyglucose inhibits chemotherapeutic drug-induced apoptosis in human monocytic leukemia U937 cells with inhibition of c-Jun N-terminal kinase 1/stress-activated protein kinase activation

Human monocytic leukemia U937 cells undergo apoptosis when treated with antitumor drugs, such as etoposide, camptothecin and mitomycin C. The molecular mechanism of the drug-induced apoptosis is not well understood. In this study, we found that 2-deoxyglucose (2DG), an analog of D-glucose and an inducer of glucose-regulated stress, inhibited anticancer drug-induced but not tumor necrosis factor-alpha-induced apoptosis of U937 cells. 2DG did not reduce initial cellular damage caused by etoposide, an inhibitor of topoisomerase II, suggesting that 2DG affected subsequent cellular responses involved in apoptosis. 2DG inhibited the etoposide-induced activation of c-Jun N-terminal kinase 1/stress-activated protein kinase (JNK1/SAPK) and the subsequent activation of CPP32, both of which are positive regulators for etoposide-induced apoptosis of U937 cells. Our results indicate that 2DG inhibits apoptosis by blocking the signals from cellular DNA damage for JNK1/SAPK activation.

An evaluation of motor function in transverse colon transplants after total gastrectomy

The motor activity of the isolated colon is understood less than that of any other part of the gastrointestinal viscus. Thus, the aim of the present study was to evaluate the motor activity of the interposed transverse colon following total gastrectomy through a study of 21 patients. Manometric studies were carried out with a 5-lumen, open-tipped catheter in the resting state, in response to dry swallows, and swallowing distilled water and a liquid meal. Contractile waves in the interposed colon grafts were divided into three types, namely, high-amplitude propagated contractions (HAPCs), low-amplitude propagated contractions (LAPCs), and low-amplitude nonpropagated contractions (LANPCs). No retrograde contractions were observed during the entire recording. Motor activity in the interposed colon increased to a greater extent after swallowing distilled water or liquid meals than during the resting period or after dry swallows; however, there was no significant difference between the effect of distilled water and liquid meals. The motor activity of the interposed colon was lower in patients with symptoms than in asymptomatic patients. These results suggest that the volume, rather than the composition, of the lumen contents is an important factor for inducing interposed colon graft contractions, and that contractions of the interposed colon can help to propel the contents of the colon into the duodenum and clear any duodenal juice if reflux should occur.

Motilin controls cyclic release of insulin through vagal cholinergic muscarinic pathways in fasted dogs

The effect of motilin on insulin release has not been studied in the interdigestive state. Adult mongrel dogs were chronically implanted with force transducers in the stomach and duodenum to monitor contractile activity, and the plasma motilin and insulin concentrations were measured by a specific radioimmunoassay and enzyme immunoassay, respectively. The concentration of insulin in plasma was found to fluctuate in close association with that of motilin and phase III of the interdigestive migrating contractions in the stomach. This spontaneous release of insulin was mimicked by intravenous infusion of motilin at a dose of 0.3 microgram.kg-1.h-1. Exogenous motilin (0.01-0.3 microgram/kg) dose dependently stimulated insulin release, which was abolished by atropine, hexamethonium, ondansetron, and truncal vagotomy. Phentolamine significantly enhanced, whereas propranolol inhibited, motilin-induced insulin release. In a perifusion system using islet cells from the canine pancreas, motilin did not affect insulin release. In conclusion, motilin stimulates insulin release through vagal cholinergic, muscarinic receptors on pancreatic beta-cells, and the effect appears to be modulated by adrenergic nerves.

Benign form of congenital angulation of long bones associated with shortening of soft tissues

We report a benign form of congenital angulation of long bones associated with shortening of soft tissues. The patients were three males and four females including two siblings. The average age at first examination was 6 months (range, 1-17 months) and that at the time of follow-up was 7 years (range, 13 months-11 years). The characteristics were short-limb type short stature, congenital multiple angulation deformities of the long bones of both upper and lower extremities, with almost the same angulation directions for all the patients and improvement of the deformities with age. There was also accelerated skeletal maturation, lack of epi-metaphyseal lesions, skin dimples, limitation of the ankle joint dorsiflexion, and inconspicuousness of skin creases on the flexor side of the elbow and knee. This phenotype is not consistent with any of the bent bone dysplasia group. Caffey's report [Caffey J (1947). Am J Dis Child 74:543-5621 included two different subtypes of bent bones, round bowing and sharp angulation, and the latter are similar to this report. However, Caffey's cases lack limitation of ankle dorsiflexion and reduced skin creases. An autosomal recessive mode of inheritance could be present in this subtype.

Enchondromatosis with features of dysspondyloenchondromatosis and Maffucci syndrome

We report a girl with multiple enchondromatosis, unequal leg length, short stature, congenital scoliosis, lymphangioma, and cutaneous hemangiomata. The skeletal findings were consistent with the clinical and radiological features of dysspondyloenchondromatosis except that short stature was not apparent in the neonatal period. Dysspondyloenchondromatosis is a rare disorder, one of the several types of multiple enchondromatosis with spinal abnormalities. In previous reports of this condition the association of vascular lesions usually found in Maffucci syndrome has not been described.

Synthesis and pharmacological properties of ureidomethylcarbamoylphenylketone derivatives. A new potent and subtype-selective nonpeptide CCK-B/gastrin receptor antagonist, S-0509

A novel series of CCK-B/gastrin receptor antagonists-ureidomethylcarbamoylphenylketone derivatives-were designed, synthesized, and evaluated for activity. Structure-activity relationship studies revealed the importance of a carboxylic acid at substituent R2 and tert-butoxycarbonyl group at R1 in structure A. Compound 7a (S-0509) showed remarkable affinity for the CCK-B/gastrin receptor and a subtype selectivity profile in vitro. Administration (id) of 7a led to excellent inhibition of gastric acid secretion induced by pentagastrin in anesthetized rats with an ED50 value of 0.014 mg/kg. Furthermore, 7a proved to have poor blood-brain permeability by its small effect on enhancement of morphine analgesia. Thus, S-0509 has an increase in selectivity for the peripheral effects of gastrin antagonism from the central effects of CCK-B antagonism.

Potent and subtype-selective CCK-B/gastrin receptor antagonists: 2,4-dioxo-1,5-benzodiazepines with a plane of symmetry

A series of CCK-B/gastrin receptor antagonists, 2,4-dioxo-1,5-benzodiazepine derivatives with a plane of symmetry, were designed, synthesized, and evaluated for antagonistic activity. Structure-activity relationship studies revealed that carbonylmethyl groups at both N-1 and N-5 positions and hydrophilic groups, such as the carboxyl group on the benzene ring attached to the ureido group at the C-3 position, brought about potent affinity and subtype selectivity for CCK-B/gastrin receptors. Several compounds showed excellent in vivo inhibition of gastric acid secretion induced by pentagastrin in anesthetized rats.

Congenital deficiency of the fibula with ipsilateral iliac horn and absence of the kidney

Congenital deficiency of the fibula is sometimes accompanied by femoral hypoplasia, genu valgum, patellar a/hypoplasia or dislocation, tibial bowing, foot deformity, and toe deficiency in the affected limb. 'Iliac horns' are bony projections extending posterolaterally from the ilium and considered to be pathognomonic of nail-patella syndrome. We report a 5-year-old Japanese girl with congenital complete deficiency of the left fibula, ipsilateral iliac horn and absence of the left kidney.

A new method to measure gastric emptying in conscious dogs: a validity study and effects of EM523 and L-NNA

A new method for measurement of gastric emptying without the use of radioisotope markers has been developed in dogs. A test meal was given after measurement of its freeze-dried weight, and 1-ml duodenal samples were collected through an indwelling tube at 15-min intervals, and their absolute weight was measured. The duodenum was continuously perfused with phenolsulfonphthalein to determine the recovery of each sample. Three different calorie or fat-enriched meals were administered with 100 ml saline containing polyethylene glycol as a liquid marker. The results showed that increasing the calorie load of, and adding fat to, the test meal proportionally delayed gastric emptying of the solid phase. Utilizing this method, it was found that EM523, an erythromycin derivative, accelerated the gastric emptying of solids, whereas N(omega)-nitro-L-arginine (L-NNA) markedly delayed the gastric emptying of both solids and liquids. In conclusion, this freeze-drying method is a reliable technique for measuring the gastric emptying of the solid phase in dogs.

Long-term observations of uterine contractions in nonpregnant dogs

Uterine contractile activity in nonpregnant conscious dogs was investigated based on 2- to 6-mo-long continuous recording by means of a chronically implanted force transducer. We found that nonpregnant uterine contractile activity could be classified into six major patterns: sporadic contractions, weak and strong tonic contractions, weak and strong phasic contractions, and phasic contraction bursts. The contractile patterns during proestrus and estrus were the most active, with strong phasic and tonic contractions and phasic contraction bursts. The phasic and tonic contractions were inhibited dose-dependently by a beta 2 adrenergic agonist, ritodrine, and reproduced by an alpha 2 adrenergic agonist, clonidine. In contrast, the cholinergic inhibitors atropine and hexamethonium did not affect the spontaneous occurrence of these contractions, although bethanechol evoked uterine contractions. Oxytocin and prostaglandin F2 alpha-induced contractions were phasic during estrus, whereas they showed tonic increases with phasic contractions during proestrus, diestrus, and anestrus, and these contractions did not resemble the spontaneous contractions. In conclusion, the nonpregnant uterus contracts continuously in harmony with the estrous cycle phases, and its contractile activity is enhanced by alpha adrenergic receptors and inhibited by beta 2 adrenergic receptors.

Muscarinic control of phase III contractions and motilin release in dogs

The role of muscarinic receptor subtype(s) in the control of gastric phase III contractions and motilin release was determined in dogs. Pirenzepine (226 nmol/kg/h) shortened the phase III cycle, causing an early increase in plasma motilin concentrations. Both AF-DX116BS and 4-DAMP inhibited the occurrence of spontaneous and motilin-induced phase III contractions, and 4-DAMP also inhibited the spontaneous increase in plasma motilin concentration. Only 4-DAMP inhibited carbachol-induced motilin release in perifused duodenal mucosal cells. In conclusion, M1 receptors are involved in the indirect inhibition of motilin release. Motilin-induced contractions are mediated mainly by M3 receptors and partly by M2 receptors, and M3 receptors are present in motilin-producing cells.

Congenital dislocation of the knee reduced spontaneously or with minimal treatment

Six cases of congenital dislocation of the knee (CDK) reduced spontaneously or with minimal treatment were investigated. Reduction was achieved from 4 days to 3 months after birth. Clinical results were good, although in four cases, hyperextension < or = 20 degrees persisted. In view of the perinatal complications and associated anomalies, CDK reduced with no or minimal treatment is supposed to be a category of congenital postural deformity. We believe that it is advisable to wait 1 month for spontaneous reduction of CDK in cases not associated with clubfoot, arthrogryposis multiplex congenita, and Larsen's syndrome.

Exogenous motilin stimulates endogenous release of motilin through cholinergic muscarinic pathways in the dog

BACKGROUND & AIMS

Exogenous motilin is believed to stimulate endogenous release of motilin, but this has not been studied in detail. The aim of this study was to investigate whether and by what mechanism exogenous motilin stimulates endogenous release of motilin in the dog.

METHODS

Gastric and duodenal contractile activity in conscious dogs was monitored by chronically implanted force transducers. Plasma canine motilin (c-motilin) concentrations in response to exogenous porcine motilin (p-motilin) were determined by specific radioimmunoassay for c-motilin. The release of motilin from motilin cells obtained from canine duodenal mucosa was studied in vitro using a perifusion system.

RESULTS

In vitro, c-motilin release was stimulated by carbachol but not by p-motilin, and the carbachol-induced c-motilin release was inhibited by atropine. In vivo, exogenous p-motilin stimulated endogenous c-motilin release and gastric and duodenal phase III-like contractions; this motilin-induced motilin release was inhibited by atropine, hexamethonium, and a 5-hydroxy-tryptamine 3 receptor antagonist.

CONCLUSIONS

In the dog, exogenous motilin stimulates endogenous motilin release through muscarinic receptors on motilin-producing cells via preganglionic pathways involving 5-hydroxytryptamine 3 receptors.

Fragile bone syndrome associated with craniognathic fibro-osseous lesions and abnormal modeling of the tubular bones: report of two cases and review of the literature

OBJECTIVE

To report examples of disorders characterized by bone fragility, calvarial and/or gnathic fibro-osseous lesions, and metadiaphyseal undermodeling of the tubular bones.

DESIGN

The clinical, radiological, and pathological features of two patients are described and the literature reviewed.

PATIENTS

The patients comprised a 10-year-old boy and a 48-year-old woman. The former exhibited multiple fractures starting in early childhood and calvarial masses which developed in late childhood; the latter showed a mandibular mass.

RESULTS

Calvarial doughnut lesions, osteopenia with coarse bony trabeculae, and undermodeling of the lower limbs were radiologically demonstrated in the first patient, while multiple sclerotic foci in the maxilla and mandible, spontaneous bowing of the right femur, and minimal undermodeling of the tibiae were demonstrated in the second. Bone biopsy of the iliac crest in the first patient revealed histologically normal bony trabeculae. Bone histomorphometry suggested an increased osteoid surface. Osteoid volume was also slightly increased. The pathological findings of the mass in the jaw in the latter patient were consistent with it being a fibro-osseous lesion. The literature review revealed several patients whose features overlapped with those of our patients.

CONCLUSION

These patients may represent a group of fragile bone syndromes which differ from osteogenesis imperfecta.

Sodalite, Na4Si3Al3O12Cl: structure and ionic mobility at high temperatures by neutron diffraction

Crystal data: Na4Si3Al3O12Cl, cubic, space group P43n, Z = 2, F(000) = 233.06 fm, μ n = 0.06 cm−1, lattice parameter ao  (Å) [T] (K) at eight temperatures: 8.882 (1) [295]; 8.902 (2) [500]; 8.912 (1) [600]; 8.923 (1) [700] 8.951 (2) [800]; 8.971(1) [900]; 8.988 (1) [1000]; 9.037 (1) [1200]. The crystal structure has been determined at six temperatures (295 ≤ T ≤ 1200 K) based on neutron diffraction data with (sin θ/λ) < 0.80 Å−1. Besides conventional parameters, the least-squares refinement model included thermal tensor parameters up to fourth-order for sodium and chlorine (295 ≤ T ≤ 1200 K) and up to third-order for oxygen (T ≥ 700 K), together with the 1:1 coupled site occupancy factors of sodium and chlorine (T = 1200 K). The indices-of-fit, wR(F 2), are in the range 0.015–0.028 with observation-to-parameter ratios from 7.0 to 8.6. Bond lengths and angles in the aluminosilicate framework have average e.s.d.'s less than 0.002 Å and 0.08°. Between 295 and 1200 K, the observed Si—O (Al—O) bond lengths differ by −0.015 Å (−0.012 Å); corrections for librating rigid SiO4 (AlO4) groups change the difference to +0.004 Å (+0.006 Å), compared with the 295 K value of 1.620 Å (1.741 Å). The unique Si—O—Al angle increases from 138.24° (295 K) to 146.87° (1200 K), while the Si and Al valence angles are virtually unchanged. Between 295 and 1200 K the [Na4Cl] clusters expand with increases in the Na—Cl bond lengths of 0.200 Å, with simultaneous increases in Na—O bond lengths of 0.145 Å and decreases in the shortest Na...O contact distances of 0.126 Å. The thermal expansion of sodalite is attributed to the increasing amplitudes of coupled translational motion of the Na+ ions and the librational motion of the [Al/ SiO4] tetrahedra, leading to the untwisting of the aluminosilicate framework. Maps of the probability density functions for Na+ and Cl− indicate ionic diffusion paths along (111) directions. There is a finite probability of finding the Na+ ion within the plane of the next-nearest O atoms, suggesting that Na+ jumps from an occupied to an unoccupied site in the next-nearest cage through the six-membered ring of [Al/SiO4] tetrahedra.

Scoliosis in cerebral gigantism, Sotos syndrome. A case report

STUDY DESIGN

This retrospective study reviewed five patients with scoliosis associated with cerebral gigantism (Sotos syndrome).

OBJECTIVE

To clarify the clinical characteristics and progression of scoliosis in patients with cerebral gigantism. SUMMARY OF BACKGROUND DATA. Little has been reported about spinal deformity in this syndrome.

METHODS

The records and radiographs of five patients were reviewed.

RESULTS

Scoliosis was first noticed at the age of 5 years in one case and at 6-16 months in the others. Their curve patterns were not consistent. Cobb's angles increased rapidly by 4 years of age and after 8 years of age despite attempts at bracing.

CONCLUSIONS

Excessive growth in infancy and growth-spurt period after 8 years of age may be related to the rapid progression of scoliosis in the same period.

[Primary pulmonary cryptococcosis treated by thoracoscopic resection]

A 37-year-old man was admitted to the hospital because of an abnormal shadow in the right lower field on a chest roentgenogram. The lesion was calcified and was therefore suspected to be benign. Thoracoscopic resention was performed. The pathological diagnosis was cryptococcosis of the lung. The lesion was completely resected, so no antifungal drug was given. The patient was doing well as of 12 months after the operation.