Sympathetic skin response in diabetic children: do diabetic children have diabetic neuropathy?

BACKGROUND

Abnormal sympathetic skin response (SSR) has been reported in adult patients with diabetic neuropathy. In addition, other studies have revealed abnormal SSR in diabetic patients not having autonomic symptoms and autonomic dysfunctions. These findings have been only obtained from adult patients. There have been few reports on the autonomic functions in diabetic children. Accordingly, it is not clear whether the autonomic neuropathy occurs in diabetic children. The aim of the present study is to clear autonomic function in children with insulin-dependent diabetes mellitus by SSR.

METHODS

The SSR was measured in 28 normal healthy children and in eight patients with IDDM not having symptoms of dysautonomia. The SSR was elicited using 10 stimuli on programmed Nihonkoden Neuropack Sigma model machine. Following a single electrical stimulation, four SSR were recorded in both the palms and the soles simultaneously.

RESULTS

The SSR were simultaneously obtained in 100% of the two groups. The amplitudes in the palms and soles were not significantly different between the two groups. The mean and shortest latency in the soles were significantly longer in the IDDM group than in the control group (P < 0.01). None of the measurements of SSR revealed correlation with duration of diabetes and onset of illness.

CONCLUSIONS

Diabetic neuropathy may not have occurred in young patients having shorter duration of illness. Conversely, assuming that prolonged latency is abnormal, it may even have occurred in them. Follow up on these patients with prolonged latencies would be required.

Contingent negative variation in children with anorexia nervosa

BACKGROUND

Central catecholamines, particularly dopaminergic and noradrenergic systems, have affected the appetitive behavior in patients with anorexia nervosa (AN). The purpose of this study is to distinguish the characteristics of contingent negative variation (CNV) and postimperative negative variation (PINV), which may reflect the level of catecholamine in children with AN.

METHODS

Eight children with AN aged 10 to 15 years and 23 age-matched healthy children were recruited. Contingent negative variation was recorded from the frontal midline (Fz), central midline (Cz) and parietal midline (Pz) referenced to linked earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval of 2 s and an intertrial interval of 10 s. The imperative stimulus of each trial required a button press.

RESULTS

Children with AN had a diminished amplitude of the CNV. They had a significantly more attenuated early CNV and late CNV amplitude at Cz than normal children. No significant differences were observed between AN children and normal children in the amplitude of PINV at all three electrode sites. No difference could be found between the two groups in the frequencies of normal and abnormal duration of PINV.

CONCLUSION

These findings suggest that early CNV may be diminished by norepinephrine deficiency and late CNV may be attenuated by dopaminergic deficiency in children with AN. Reduced CNV may represent impaired cognitive processes which reflect impaired appetitive behavior in AN children.

Evidence for direct binding of intracellularly distributed ganglioside GM2 to isolated vimentin intermediate filaments in normal and Tay-Sachs disease human fibroblasts

Although some intracellularly distributed glycosphingolipids are reported to be associated with vimentin intermediate filaments or colchicine sensitive cytoskeleton, no direct evidence for such an association has yet been shown. In this report we demonstrated that the intracellularly distributed ganglioside GM2 directly binds to isolated vimentin intermediate filaments in normal and Tay-Sachs disease human fibroblasts. Indirect immunofluorescence microscopy using a GM2-specific monoclonal antibody demonstrated filamentously distributed GM2 in the cytoplasm. A double staining of Tay-Sachs fibroblasts with anti-GM2 and anti-vimentin monoclonal antibodies strongly suggested that the GM2 positive filaments are vimentin intermediate filaments. We then isolated vimentin, in the presence of a detergent and urea, from the normal human skin fibroblasts and murine mastocytoma cells. In a solid phase enzyme-linked immunosorbent assay, the isolated vimentin dose-dependently reacted with both anti-vimentin and anti-GM2 monoclonal antibodies but not with anti-GM3 or anti-GM1 monoclonal antibody. The molar ratio of GM2 to vimentin was approximately 20:1. The lipid fraction extracted from the purified vimentin preparation was immunostained with anti-GM2 on a thin-layer chromatography plate. Furthermore, only one band was detected at the molecular weight of 57 kDa, after electroblotting and simultaneous immunostaining with anti-GM2 and anti-vimentin monoclonal antibodies. These results clearly indicated that ganglioside GM2 directly binds to vimentin.

[Neurological sequelae caused by surgical procedures during adenoidectomy under anesthesia]

A five-year old boy with good risk was anesthetized with nitrous-oxide and halothane under orotracheal intubation for adenoidectomy and tubing of bilateral middle-ear cavities. Patient was on supine position with extension of neck. A mouth-gag was applied and the pharynx was packed with gauze. After long unskilled surgical procedures, severe neurological complications which were initiated with severe arrhythmias and followed by signs of paralysis of bilateral IX, X, XI, XII cranial nerves at their nuclei in medulla oblongata, were observed during the post-anesthetic period. The patient was saved with neurological sequelae of the cranial nerves and is alive after 6 years from the incident. The causes of this complications were discussed.

[A case of malignant lymphoma of the uterine cervix]

The case of an 85-year-old woman with a malignant lymphoma of the uterine cervix is reported, and the pertinent literature is reviewed. The patient was found to have vaginal bleeding and abnormal cytological smears. According to the Working Formulation, the histological diagnosis was a malignant lymphoma with diffuse, small, cleaved cells. As her condition was determined as being in FIGO's Stage I b, the patient was only given a hysterectomy, and she remains in complete remission 1 year after the initial diagnosis. This is the 21st reported case in Japan of a primary malignant lymphoma in the uterus. Such patients typically present vaginal bleeding and a cervical cytological examination is reliable way to achieve a diagnosis. From the small number of reports that exist, it appears that radiation therapy is proper curative method of procedure as some Stage I b patients who underwent surgery were found to have positive nodes.

[A case of Becker type congenital myotonia with myalgia]

We reported a case of Becker type congenital myotonia with myalgia. A 28 year-old woman admitted to our hospital because of right anterior chest pain and back pain. She was diagnosed as myotonic dystrophy by other university hospital when she was 16 years old. Physical examination revealed only myotonia and could not find muscle atrophy or cataracta which were usually found in myotonic dystrophy. The quadriceps muscle biopsy revealed complete absence of type IIB muscle fiber. We diagnosed her Becker type congenital myotonia by the clinical course and family history and the histopathological findings of quadriceps muscle. Myalgia which she complained seemed to have some connection with this disease. But we could not prove the pathogenesis of this myalgia.

[Venous pressure in the vertebral venous plexus and its role in cauda equina claudication]

The venous pressure in the ascending lumbar vein was measured by catheter and pressure transducer to document venous stasis in degenerative lumbar spinal canal stenosis. Measurement of the pressure in the ascending lumbar vein at rest revealed a progressive rise of the mean pressure from the control group to the lumbar intervertebral disc herniation group, and the lumbar spinal canal stenosis (LSCS) group in ascending order. Pressure curve tracings showed a plateau accompanying increased abdominal pressure during the Valsalva maneuver. Phase 3 was defined as the recovery period of decreasing pressure which began with the release of abdominal compression and terminated with the return to the initial pressure. The duration of phase 3 was prolonged in LSCS (p less than 0.01). It followed that the prolonged phase 3 documented the existence of venous stasis and its extent in LSCS. It is conceivable that increased venous pressure in the lumbar vertebral venous plexus participates in the pathogenesis of cauda equina claudication in LSCS.

A study of the clinical usefulness of dobutamine administered orally

Dobutamine 300 mg was administered orally to both healthy volunteers and to patients with circulatory failure. After the 300 mg dose of dobutamine, subjects were found to have a higher concentration of the drug in their plasma than the effective levels of 37.5 (SD 2.9) ng/ml (n = 5) normally seen during intravenous infusion of the clinically effective (5 micrograms/kg/min) dose. This increased concentration waned within 90 minutes. A clinical effect of dobutamine on the circulation was observed in both the healthy volunteers and the patients. An increase in the cardiac index of the patients continued longer than 90 minutes. An unidentified substance was noticed on chromatography measuring plasma dobutamine concentrations, which may have contributed to the increased cardiac index, although its chemical formula could not be determined. The results suggest that the oral administration of dobutamine may be expected to have a long-lasting and significant therapeutic effect on patients with chronic circulatory failure.

The molecular phylogenic tree of the genus Trichinella constructed from isozyme patterns

Six zymograms were compared for extracts of muscle-stage larvae of the seven Trichinella isolates, using isoelectric focusing in polyacrylamide gels. The isozyme patterns of acid phosphatase among them fell into four types. T. pseudospiralis from a raccoon and the Polar strain from a polar bear formed type 1 and type 2, respectively. The Iwasaki strain from a Japanese black bear and the Yamagata strain from a raccoon dog, both from Japan, were type 3. Type 4 consisted of three remaining strains, viz. the Polish strain from a wild pig, the USA strain from a pig, and the Thai strain from a human case, all of which have similar infectivity to pigs. The isozyme patterns of esterase 1, beta-N-acetylglucosaminidase, and peptidase were similar in types 2 and 3. Those of esterase D were common to types 2-4 but not to type 1. In the zymogram of mannosephosphate isomerase, types 2-4 but not type 1 had one common band, whereas in the other bands type 2 was markedly distinguished from types 3 and 4. In the present study, the molecular phylogenic tree was constructed for the first time on the basis of our present and previous electrophoretic data by the use of cluster analysis, and the evolutionary process was considered as follows: T. pseudospiralis (type 1) and T. spiralis (the common ancestor of types 2-4) were initially separated. Next, the common ancestor of the strains from wild carnivores (types 2 and 3) and type 4 were separated. Finally, the Polar strain (type 2) and the Japanese strain (type 3) were separated.

Early development of four Diphyllobothrium species in the final host

The early development of four Diphyllobothrium species, D. latum, D. dendriticum, D. ditremum, and D. vogeli, are described. D. latum sheds the entire larval body easily and shows a high shedding rate of 82.1% on average. On the other hand, D. dendriticum exhibits a different developmental pattern, with a low shedding rate of 8.7% in the hamster and a high shedding rate of 34.9% in the rat. D. ditremum is difficult to recover from hamsters but shows a high shedding rate of 42.9%. D. vogeli shows a constant recovery rate of 38.3% without shedding. The species specificity of these four diphyllobothriids is discussed briefly in relation to the early developmental pattern and the growth rate.

[Efficacy of paromomycin sulfate in the elimination of Diphyllobothrium species and Taenia saginata in clinical cases]

Recently it has been known that paromomycin sulfate had marked anthelmintic activity against some species of tapeworms. In this investigation, paromomycin sulfate was used for treating 6 cases of diphyllobothriasis and 1 case of Taenia saginata infection. Paromomycin sulfate was administered orally in a single dose or 2 divided doses of 40--60 mg/kg, being followed by a purge about 1.5 hours later. Strobila or fragments of proglottids were expelled from 5 cases, of which only 1 scolex was found in a case of infection with marine species of Diphyllobothrium. In 1 case of diphyllobothriasis no worm or worm-fragment was found in the stool even after the second challenge of treatment. Nevertheless follow-up examination for more than 1 month showed no evidence of remaining infection in all cases. Transient dizziness was observed in only 1 case, disappearing within about 30 minutes. Serum- and urine-examinations detected no abnormal signs in all cases excepting 1 case of diphyllobothriasis with suspected hepatitis. It was concluded that paromomycin sulfate is effective therapeutic agent for the treatment of taeniasis and diphyllobothriasis including marine species.

Neuromuscular effects of i.a. infusion of lignocaine in man

Neuromuscular effects of lignocaine during and after i.a. infusion were studied in healthy adult patients, using evoked electromyography. Supramaximal, paired stimuli were applied to the ulnar nerve with variable intervals between the two stimuli. The amplitude of the hypothenar muscle action potential to the second component of the paired stimulus (test response) was compared with that evoked by the first component (conditioning response). During and after i.a. infusion of lignocaine, there were marked decreases of the test response at intervals from 7 to 100 ms after the conditioning stimulus, although the decreases of the conditioning response were slight or negligible. The finding of decreased test responses coincided with the results obtained with tetanic stimulation such as pronounced fade and only slight post-tetanic potentiation. Differences between these findings and those found with muscle relaxants were compared, and it was concluded that the mechanism responsible for these results might be attributed to an effect of lignocaine on the motor nerve terminal.