Characteristics of auditory P300 in children: application of single trial analysis

As, especially in children, cognitive function might vary from one stimulus to the other, even when the same target stimuli are presented in the oddball paradigm, we applied the single trial analysis adopting discrete Fourier transformation followed by inverse discrete Fourier transformation to the auditory P300 for the first time in children. In 9 children, age 9-13 years, a positive peak was clearly identified in approximately a quarter of the processed single sweep responses to target stimuli (single sweep P300), whereas it was observed less frequently for non-target stimuli. In 2 children of age 6 years, it was difficult to discriminate single sweep P300 from background EEG activities even in the processed data. As for the former group, the detection ratio of P300 in single sweep target responses ranged from 10.0 to 40.0%, and its mean latency and amplitude ranged from 311 to 348 ms and from 31.7 to 41.5 microV, respectively. There was a significant correlation between average data and single sweep data in terms of the P300 latency. However, the amplitude of P300 in the average data bore no relation to the detection ratio, mean amplitude or variability of latency among single sweep P300s. As compared with adult data previously reported, the detection ratio of single sweep P300 was lower and the P300 amplitude was higher in childhood. P300 in children, at least past puberty, can be analyzed by using the single trial method, which is expected to provide more information about the development of human higher brain functions, especially cognitive function.

Electrogastrography in neonates

We recorded the electrical signals from bipolar electrodes placed on the abdomen of 7 adults and 10 newborn infants. Data were analyzed by visual inspection and by a wave analysis computer program with a fast Fourier transform. Waves of 3 cycles/min were recorded in adults, and similar 3 cycles/min waves were recorded in infants as well. The percentage of time of 3 cycles/min waves was lower in neonates (13.8% +/- 10.8%) than in adults (57.9% +/- 27.8%) (p < 0.01). Only an electrocardiogram superimposing the flat baseline was recorded in the remaining recording time. Spectral analysis confirmed the validity of the visual analysis, showing clear peaks at 0.05 Hz only when 3 cycles/min waves were visually present and motion artifact was absent. The electrode positions where percentage of time of 3 cycles/min waves was greatest were different for newborns and adults. There was no significant difference in the mean amplitude of the waves between groups. These facts indicate that the electrogastrogram of neonates is different from that of adults in terms of best electrode positions and percentage of time of 3 cycles/min waves.

Infantile spasms: localized cerebral lesions on SPECT

Ten infantile spasms (IS) patients had single photon emission computed tomography (SPECT) with [99mTc]HMPAO, EEG, and magnetic resonance imaging (MRI) studies. SPECT showed localized cerebral hypoperfusion in 7 infants (4 unifocal; 3 multifocal) always involving the temporal regions either unilaterally or bilaterally. EEGs obtained in near time of the SPECT studies showed focal abnormalities in all 7 infants with hypoperfusion on SPECT, with complete correspondence of the abnormalities in 5. MRI showed localized cerebral lesions in only 3 of the 10 infants, all of whom had corresponding areas of hypoperfusion on SPECT. Our study indicates that localized cerebral abnormalities (especially of the temporal lobes) may often be associated with IS and that such patients may have localized cerebral hypoperfusion on SPECT even when the MRI is normal.

Serial EEG and sleep polygraphic studies on lissencephaly (agyria-pachygyria)

We carried out serial EEG studies on 12 cases of lissencephaly (6 of agyria and 6 of pachygyria), polysomnograms being recorded in 8 of the 12 cases. Fourteen Hz sleep spindles appeared from early infancy in all cases. They were poorly observed after the age of 1 year, and 5-11 Hz high-amplitude rhythmic activity (HARA) of more than 300 microV appeared predominantly in place of the 14 Hz spindles. Both the 14 Hz spindles and HARA showed asymmetry, but the dominant cerebral area for both types of waves was much the same. Four of the 6 agyria cases showed hypsarrhythmia within the first 6 months after birth, 3 of the 4 cases showing asymmetric hypsarrhythmia at first. Their hypsarrhythmia consisted of very high-voltage 5-7 Hz slow sharp waves and delta waves. The EEG abnormalities transformed from hypsarrhythmia to focal spikes in the 6 pachygyria cases. The polygraphic study on 8 cases revealed that the proportion of REM sleep decreased in 3 cases and the REMs/min values decreased in 7. Infantile spasms occurred in 4 of the 8 cases. The REM/min values decreased in all of these 4 cases, and, furthermore, the proportion of REM sleep decreased in 3 of the 4 cases. These findings suggest that lissencephaly involves a disorder of the brainstem, and that the combination of brainstem lesions and severe cerebral dysplasia is important for the manifestation of infantile spasms in lissencephaly.

Activation of hydrogen peroxide by copper (II) complexes with some histidine-containing peptides and their SOD-like activities

The reactivities of copper(II) complexes with histidine-containing oligopeptides towards active oxygen species such as hydrogen peroxide (H2O2) and superoxide ion (O2-) were investigated by electron spin resonance (ESR)-spin trapping and thiobarbituric acid (TBA) methods. At physiological pH values, Cu(II) complexes with oligopeptides containing histidyl residue at the N-terminal could more easily activate H2O2 to yield hydroxyl radical (.OH) than other Cu(II)-oligopeptide complexes containing histidyl residue in the second or third position. Further, it was suggested that since all Cu(II)-oligopeptide complexes examined could scavenge O2-, these complexes have SOD-like activities.

[Neurophysiologic studies on patients with migration disorder]

Neurophysiologic studies on six patients (five lissencephaly and one schizencephaly) with migration disorder were performed in order to evaluate the CNS function by multimodality evoked potentials. All cases revealed abnormalities in SSEP, four cases lost components below P 3 or had low voltage of P 3 indicating brainstem dysfunction in the somatosensory pathway. Two cases lost component below N 1 indicating sensory cortical dysfunction. Three cases revealed ABR abnormalities including a low amplitude of wave V, and one case revealed a prolonged peak latency of wave I and a low amplitude of all components. Two cases revealed abnormalities of poor cortical components in SEP, two cases in VEP, and three cases in MLR. Five cases had normal findings in P-SEP and three cases in VEP. The result of this study demonstrates that patients with migration disorder are frequently associated with cortical, brainstem and peripheral dysfunctions and has heterogeneity in pathophysiology.

Epidemiological characteristics on human immunodeficiency virus infection and acquired immunodeficiency syndrome in Japan

The first case of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in Japan was diagnosed in a homosexual male in 1985. The Ministry of Health and Welfare formed the AIDS Surveillance Committee, which published HIV seropositive and AIDS data at 2-month intervals. Excluding persons infected through blood products there were 971 HIV seropositives by April 1993, and 204 reported cases of AIDS. One of the epidemiological characteristics of HIV infection and AIDS in Japan is the rapid increase of cases of transmission through heterosexual contact since 1991. Before this, homosexual transmission was the commonest reported mode of transmission. Sporadic cases of mother-to-child transmission and some cases due to injecting drug use were also reported. It is predicted that heterosexual contact will be the primary mode of transmission of HIV in the future. Virtually all the diagnosed AIDS cases so far have been reported to this surveillance network, and it will be an important task of the network to monitor the HIV seropositive cases.

A novel saturation transfer contrast method for 3D time-of-flight magnetic resonance angiography: a slice-selective off-resonance sinc pulse (SORS) technique

Saturation transfer contrast (STC) techniques have been employed to decrease the signal intensity of observed water by saturating a broad proton component. The STC pulse, generally spatially nonselective, reduces the signal of brain background tissues as well as inflowing blood in 3D time-of-flight (TOF) angiography. We present a novel technique, a slice-selective off-resonance sinc pulse (SORS), which is employed to enhance inflowing blood and to suppress the signal of stationary background tissues. The STC effects of the SORS and other spatially nonselective methods influencing inflowing blood is discussed in detail. Angiograms using the SORS method are also presented to demonstrate improved vessel conspicuity. In addition, the SORS method is applicable to imagers with a whole-body RF transmitter system.

Partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura

OBJECTIVE

The purpose of this study was to assess the effectiveness of partial splenic embolization in the treatment of chronic idiopathic thrombocytopenic purpura.

SUBJECTS AND METHODS

Twenty-six patients with chronic idiopathic thrombocytopenic purpura underwent partial splenic embolization and were followed up for 6-61 months. The condition was refractory to steroids in 20 of 26 patients. The other six patients, in whom a response to steroids was shown, could not be withdrawn from steroid therapy because their platelet counts decreased with any decrease in steroid dose. Five of 26 patients underwent splenectomy after partial splenic embolization, and the other patients were followed up without medical treatment until platelet counts decreased below 3 x 10(10)/l. The therapeutic effect of partial splenic embolization was defined on the basis of the platelet count at the last follow-up after partial splenic embolization: complete response, greater than 10 x 10(10)/l; partial response, 5 x 10(10)/l to 10 x 10(10)/l; and no response, less than 5 x 10(10)/l without medication.

RESULTS

Partial splenic embolization brought a complete response in seven (33%) of 21 patients, a partial response in eight (38%), and no response in six (29%). In four of five patients, who later underwent splenectomy, response to partial splenic embolization was coincident with the response to splenectomy. No serious complications occurred, but minor complications such as abdominal pain, fever, and nausea were observed in most patients.

CONCLUSION

This study suggests that partial splenic embolization might be useful as an alternative to splenectomy in the treatment of chronic idiopathic thrombocytopenic purpura.

Invasive growth patterns of hepatic hilar ductal carcinoma. A histologic analysis of 18 surgical cases

BACKGROUND

Postoperative recurrence of hepatic hilar ductal carcinoma usually occurs in a localized region around the surgical margin, such as the bile duct. This study was aimed at assessing the invasive patterns of the hepatic hilar ductal carcinoma by histologically examining surgical specimens obtained by extended liver resection, especially the involvement of intrahepatic duct.

METHODS

Eighteen resected specimens of hepatic hilar ductal carcinoma were histologically investigated. Multiple sections vertical to the extrahepatic and intrahepatic bile duct were made at a 5-mm interval. The extension of carcinoma was evaluated on each of three layers (mucosal, extramucosal-intramural, and extramural), and routes of the invasion were examined.

RESULTS

Extramucosal extent toward the hepatic side was observed in 14 patients (77.8%) and that toward the duodenal side in 8 patients (44.4%) (P < 0.05). The distance of extramucosal tumor extent was also significantly longer (P < 0.05) in the hepatic side than in the duodenal side. Histologic tumor margin was usually identified in the extramural layer. Two patients had discontinuous extramucosal invasion. The lymphatic invasions were observed most frequently, followed by perineural invasion, and venous invasion was rare. In the extramucosal invasion of the liver, the left dominant carcinomas had extended toward the left, whereas those right dominant had extended toward the right (P < 0.05). Well differentiated differentiated tubular adenocarcinomas extended to the liver more extensively than moderately and poorly differentiated ones, but not significantly.

CONCLUSIONS

The authors examined the extramucosal invasion of hepatic hilar ductal carcinoma. This invasion extended more frequently and further to the hepatic side than to the duodenal side, usually by the route of the extramural layer.

[Primary spinal intramedullary malignant lymphoma: case report]

We report a case of primary spinal intramedullary malignant lymphoma. A 48-year-old man suffered from numbness and weakness of the left leg for 8 months. He was admitted to the hospital with progressive paraplegia and sudden onset of urinary retention. MRI revealed a low intensity mass on T1-weighted image with diffuse enhancement by Gd-DTPA in the thoracic spinal cord. An intramedullary spinal cord tumor was suspected and an urgent laminectomy (C7-Th5) was performed for decompression and confirmation. In the operation, the spinal cord was seen to be diffusely swollen, but no apparent tumor was identified either in color or consistency, and only biopsy was performed. The pathological diagnosis was malignant lymphoma (diffuse medium size-cell type). Investigations excluded the presence of lymphoma in other sites in the central nervous system and in the extraneural organs. We diagnosed a primary spinal intramedullary malignant lymphoma. Postoperative irradiation and chemotherapy were performed. After the irradiation with 16Gy to the tumor and 30Gy to the whole spinal axis, the tumor disappeared on MRI. One month later MRI demonstrated two markedly enhanced lesions in the right frontal lobe white mantle and the corpus callosum. He died of progressive respiratory disturbance 15 months after the beginning of his illness. Primary involvement of the spinal cord in malignant lymphoma is rare. Only 12 cases have been reported. The number of cases of malignant lymphoma in the central nervous system has gradually increased and it must be taken into consideration when diagnosing spinal cord tumors. We are looking forward to developing curative means including chemotherapy and radiotherapy.

Localization and quantitation of active renin in monkey kidney by radioinhibitor binding and in vitro autoradiography

We developed an in vitro autoradiographic method to localize and quantify active renin in primate tissues. Active renin in monkey kidney sections was labeled with the primate specific renin inhibitor, 3H-CGP29287, and quantitated with autoradiography and computerized densitometry. Microscopic emulsion autoradiography was carried out to clarify the detailed localization of the binding. Non-specific binding to aspartyl proteases other than renin was blocked using 1 mumol/L of N-acetyl-pepstatin. To assess the usefulness of this procedure, binding of 3H-CGP29287 was examined both by film and emulsion autoradiography in the kidneys of monkeys (Macaca fuscata) that were given chronically either an angiotensin converting enzyme inhibitor (trandolapril), an angiotensin II receptor antagonist (E4177), or vehicle. 3H-CGP29287 was found to bind very selectively to the juxtaglomerular apparatus (JGA) under control conditions. In monkeys treated with trandolapril or E4177, 3H-CGP29287 binding was increased in proportion to the increase in renal renin concentration determined enzymatically; in these kidneys, emulsion autoradiography revealed radioinhibitor binding extending far from the JGA. The potency of a series of unlabeled renin inhibitor in competing for 3H-CGP29287 binding in the autoradiographic system closely paralleled their potencies, as determined in inhibiting renin by an enzymatic assay. This technique permits specific labeling of the catalytic site of renin in the monkey kidney sections.

Theoretical consideration on polarized photometric detection

Previously, we developed a novel detector, a polarized photometric detector for optically active compounds, where two polarizers are set on either side of the UV-visible absorbance detector flow cell. In this paper, we present theoretical considerations on this method with several equations. If the inclined angle of the second polarizer is defined as alpha (left when alpha > 0 degree), the following equation is obtained: delta Abs = 2 log e.tan alpha.beta, where delta Abs is the change in absorbance and beta (magnitude of beta << alpha) is the angle of rotation of light passing through the cell containing the optically active compound. This equation suggests that delta Abs is proportional to the analyte concentration and that the dextro- and laevorotatory compounds are detected as positive and negative absorbance changes, respectively. The theoretical maximum signal to noise (S/N) ratio is obtained when alpha = 45 degrees (= 0.8 rad) and the smallest detection limit is 5 x 10(-5) degrees (S/N = 3) when the path length of the flow cell is 10 mm. This detector was successfully used in flow injection analysis (FIA) as well as HPLC for optically active compounds.

[Infantile spasms with localized cerebral lesion detected by 99mTcHMPAO-SPECT]

We experienced a 6-month-old girl with infantile spasms who had localized cerebral lesion detected by 99mTcHMPAO-SPECT. She was born vaginally after a full term uncomplicated delivery with a birth weight of 3,100 g. She developed emprosthotonic spasms with series formation and EEG showed asymmetric periodic hypsarrhythmia which was predominant in the right hemisphere. While MRI could not detected any focal lesion, 99mTcHMPAO-SPECT disclosed hypoperfusion at the right anterior temporal and frontal areas. Although vitamin B6, clonazepam and sodium valproate were administered with no remarkable benefit, the treatment with ACTH-Z or carbamazepine resulted in cessation of spasms and improvement of the EEG findings. Consequently, the study with 99mTcHMPAO-SPECT was useful to clarify the pathology of infantile spasms, and we concluded that a patient with localized cerebral lesions should be given carbamazepine.

Increase in production of hepatocyte growth factor by human embryonic lung fibroblasts in the process of aging in culture

It was determined whether human hepatocyte growth factor (hHGF)-producing ability would change in the human embryonic lung fibroblast cell strains (MRC-5 and IMR-90) until the cells senesced in culture. The effects of phorbol 12-myristate 13-acetate (PMA), dexamethasone, and transforming growth factor-beta 1 (TGF-beta 1) on hHGF production were also studied in these cell strains. For stimulation of DNA synthesis of adult rat hepatocytes in primary culture, hHGF secreted by MRC-5 cells at 39.9 and 69.8 population doubling levels (PDLs) showed almost the same activity as recombinant hHGF. Secretion of hHGF by MRC-5 cells increased about threefold between 37.3 and 67.8 PDLs. IMR-90 cells also showed about a threefold increase in hHGF secretion with increased passage from 37.8 to 66.0 PDL. Both cell strains showed almost the same ratio of hHGF amount in the cell extracts to that secreted into the medium around 40 and 70 PDLs. Northern blot analysis showed that the transcriptional level of the hHGF gene in MRC-5 cells increased about three-fold from 42.0 to 73.6 PDL in culture. These findings indicated that hHGF production increased in both cell strains with aging in culture. Production of hHGF in both cell strains was remarkably stimulated by treatment with 10 nM PMA. On the other hand, hHGF production in both cell strains was slightly suppressed by treatment with 1 microM dexamethasone. TGF-beta at a concentration of 5 ng/ml prominently inhibited hHGF production in both cell strains. The response of both cell strains to these regulators for hHGF production was almost the same around 40 and 70 PDLs in culture.

[Hypotensive action of human renin inhibitor KRI-1314 in the common marmoset]

The possibility of using KRI-1314, a new cyclohexylnorstatine derivative, as an antihypertensive drug was examined using common marmosets. KRI-1314 strongly inhibited plasma renin activity (PRA) in both humans and marmosets, with a 50% inhibitory concentration of 4.7 x 10(-9) and 6.9 x 10(-9) M, respectively. In anesthetized marmosets, the increase in both blood pressure and PRA induced by bolus intravenous injection of RH-renin (0.15 microgram/kg) was suppressed by constant intravenous infusion of KRI-1314 (0.01 and 0.1 mg/kg/min) in a dose-dependent manner. In the sustained hypertension induced by continuous intravenous infusion of RH-renin (0.1 microgram/kg/min), a dose-dependent hypotensive response was produced by bolus intravenous injection of KRI-1314 (0.03-3 mg/kg). In the sodium-depleted model, whose PRA was increased by a two-week low-sodium diet coupled with furosemide loading, both intravenous injection (0.1-3 mg/kg) and oral administration (10 and 30 mg/kg) of KRI-1314 to anesthetized and conscious animals, respectively, lowered blood pressure dose-dependently with PRA suppression. The hypotensive activity of orally administered KRI-1314 (30 mg/kg) was almost equal to that of orally administered captopril (1 mg/kg). KRI-1314 did not affect heart rate in any of the experiments. These results indicate that the potent human renin inhibitor KRI-1314 may become an orally effective drug for treating renin-dependent hypertension.

Anti-atherosclerotic and plasma lipid lowering effects of the novel calcium blocker with alpha 1-adrenoceptor antagonistic activity, monatepil, in high cholesterol diet-fed Japanese Macaca fuscata monkeys

1. The preventive effects of atherosclerosis and hyperlipidemia of monatepil ([(+-)-N-(6,11-dihydrodibenzo [b,e]thiepin-11-yl)-4-(4-fluorophenyl)-1-piperazine-butanamide+ + +]monomaleate , AJ-2615, CAS 103377-41-9), a new antihypertensive drug with potent calcium antagonistic and alpha 1-adrenoceptor blocking activities, were investigated in Japanese monkeys (Macaca fuscata) fed with a cholesterol-rich diet (2% cholesterol + 6% corn oil) and compared with those of prazosin. 2. The dose of monatepil selected (30 mg/kg/d, p.o., 6 months) was the plasma concentration dose level of antihypertensive therapy and that of prazosin (2 mg/kg twice daily, p.o., 6 months) was the dose where hypolipidemic effect in cholesterol-fed monkeys has been reported. 3. In the cholesterol diet control group (n = 7), plasma levels of total cholesterol and low-density lipoprotein (LDL) significantly increased and that of high-density lipoprotein-cholesterol (HDL-C) decreased compared with the normal diet group (n = 5). In the monatepil group (n = 5), these changes were significantly suppressed. In the prazosin group (n = 5), these changes were also inhibited but the inhibitory effect was weaker than in the monatepil group. 4. The cholesterol content and sudanophilic area in the aorta indicating atheromatous lesions in the cholesterol-diet fed control group were significantly higher than those in the normal diet control group. In the monatepil group, these changes were significantly suppressed whereas in the prazosin group these changes were partially inhibited. 5. In the histological study, aortic lesions characterized by aggregations of foam cells were observed in the cholesterol-diet control group, while there was little change in the monatepil group. The anti-atherogenic effect of prazosin was weaker than that of monatepil. 6. Coronary atheromatous lesions were found in 4 out of the 7 animals in the cholesterol-diet control group and 3 out of the 5 animals in prazosin group. In contrast, no coronary atheromatous lesion was found in the monatepil group. 7. The treatment with monatepil did not influence food consumption, body weight, physical signs or blood biochemistry. 8. The anti-atherosclerotic and plasma lipid-lowering effects of monatepil may in part be attributable to its calcium antagonistic, alpha 1-adrenoceptor blocking, and anti-lipid peroxidation activities. 9. In conclusion, monatepil is a new class of antihypertensive agent that possesses anti-atherogenic properties and the ability to reduce plasma lipid levels, a main risk factor for atherosclerosis.

Generator mechanism of pain-related evoked potentials following CO2 laser stimulation of the hand: scalp topography and effect of predictive warning signal

In order to clarify the generator mechanism of pain-related evoked potentials (pain EPs), we studied the scalp topography of the pain EPs following CO2 laser stimulation of hand dorsum by using balanced sternovertebral electrodes as the noncephalic reference in 11 normal volunteers. We also examined the effects of predictive warning signal (light-emitting diode) on the pain EPs. In both the warned and unwarned conditions, all of the 22 hand stimulations showed a large negative component (N2) at the peak latency of about 213 ms followed by a large positive component (P2) at the peak latency of about 329 ms. A preceding small negative component (N1) at the peak latency of about 148 ms was detected in 12 of the 22 hand stimulations in the warned condition and in 13 of the 22 hand stimulations in the unwarned condition. P2 was significantly larger and occurred earlier in the warned condition than in the unwarned condition, whereas other components did not differ between the two conditions, suggesting that an increased attention of the subject to the stimulus influenced the generator mechanism of the P2 component. With regards to the scalp topography, N2 was maximal at Cz and widespread transversely to both sides, whereas P2 was maximal at Cz or Pz and spread more posteriorly than N2. These findings suggest that P2 is generated by a different mechanism from N2 and is most likely associated with pain-related cognitive function. N1 was localized to the contralateral central and midtemporal areas, confirming that the nociceptive inputs are perceived in the sensory cortex in humans. The question as to whether the N1 component is generated in the hand area of the primary somatosensory cortex or in the secondary somatosensory cortex, or in both areas, remains to be solved.

A sensitive method of non-radioactive in situ hybridization for mRNA localization within human renal biopsy specimens: use of digoxigenin labeled oligonucleotides

A sensitive method of non-radioactive in situ hybridization using digoxigenin-labeled oligonucleotides is described for the detection of mRNA within human renal biopsy specimens. Although non-radioactive in situ hybridization typically has the drawback of low sensitivity, we increased the sensitivity of this method, providing a practical alternative to the use of radiolabelled probes. The four main points are: 1) assessment of the efficiency of labeling, 2) optimization of the probe concentration for hybridization, 3) requirement of deproteinization of tissues with HCl and proteinase K, and 4) the use of a four-layer immunoperoxidase staining system. This technique was found to clearly localize individual mRNA positive cells within cryostat tissue sections. A variety of controls including sense probes, excess unlabeled anti-sense probes, and RNase-treatment demonstrated the specificity of the technique. This improved method is a powerful technique for detecting mRNA within human renal tissue and will be most useful in the study of gene expression in the pathogenesis of renal diseases.

Erythromycin does not directly affect neutrophil functions

To determine whether erythromycin could affect neutrophil functions, we measured N-formyl-methionyl-leucyl-phenylalanine (FMLP)-induced chemotaxis and superoxide generation of neutrophils in the presence of erythromycin at various concentrations. Erythromycin had no effect on either of them. We further confirmed that intracellular free calcium concentration ([Ca2+]i) was not influenced by FMLP stimulation in the presence of erythromycin. Our results indicate that erythromycin has no direct effects on neutrophil functions in vitro, although it is reported that erythromycin inhibits the local migration of neutrophils in the small airways of subjects with asthma.

[MRI measurements of the brain stem and cerebellum in high functioning autistic children]

To determine involvements of the brain stem and/or cerebellum in autism, we compared midsagittal magnetic resonance images of the brains of high functioning autistic children with those of normal controls. We found that the midbrain and medulla oblongata were significantly smaller in these autistic children than in the control children. The pons area did not differ between the two groups, nor was there any difference in the cerebellar vermis area. The ratio of the brain stem and cerebellum to the posterior fossa area did not differ significantly between the high functioning autistic and the control children. The development of the cerebellar vermis area was delayed in autistic children as compared with that in the control children. Thus, it was suggested that significant anatomical changes in the midbrain and medulla oblongata existed in the autistic children.

Effect of transscleral Nd:YAG laser cyclophotocoagulation: research for a new manner of treatment

Twenty-six eyes of 24 patients with advanced glaucoma refractory to conventional therapy were treated with noncontact neodymium: YAG laser cyclophotocoagulation and were followed for a minimum of 6 months postoperatively. The mean baseline intraocular pressure (IOP) was 34.2 +/- 2.0 mm Hg. Nine to 10 evenly spaced pulses per quadrant were circumferentially applied 2.0-2.5 mm posterior to the limbus. Eight to 35 pulses (mean, 19 pulses) were delivered per treatment with an energy per pulse of 3.9-5.7 J (mean, 4.7 J), and the total energy per treatment was 35.6-164.9 J (mean 91.1 J). Twelve eyes of 11 patients (46%) required 2 or more treatments (mean, 1.7). The mean final IOP was 17.0 +/- 2.1 mm Hg, and the mean percent decrease in IOP was 41.7 +/- 6.5%. Statistical analyses revealed that the IOP reached its lowest point about 1 week after treatment and remained that level through 6 months of follow-up. There were significant correlations between the percent pressure decrease and preoperative IOP, the number of administered pulses and the total energy at the last procedure. Based on these results, we introduce intentional multiple treatments as a new manner of treatment to avoid phthisis bulbi. An initial treatment is performed circumferentially for 180 degrees and if sufficient pressure reduction is not obtained, an additional treatment 180 degrees should be employed 1 week after the most recent procedure, whether initial or not.