[The effect of a water-cooled vest on heat intolerance in a patient with anhidrosis due to familial amyloidosis of Finnish type]

The patient was a 70-year-old male with familial amyloidosis of Finnish type who complained of heat intolerance due to anhidrosis during outdoor activities in summer. A water-cooled TM-2 vest was tried for this patient to reduce his body heat during exercises. Following the morning activities including jogging in August his body temperature rose up to 38.0 degrees C without wearing the partly frozen vest. However, when he wore it, his temperature rose up to only 37.2 degrees C after the exercises, which was 0.8 degree C lower than when he did not wear the vest. Headache and tachycardia during and following the morning activities did not appear by wearing the vest. In the heat loading test, in which the room temperature was raised from 28.0 degrees C to 38.0 degrees C for 15 minutes and kept at 38.0 degrees C for 60 minutes with 60% humidity, the rises of his skin and esophageal temperatures with wearing the partly frozen vest for the last 60 minutes were 1.2 degrees C and 0.4 degree C lower, respectively, than his skin and esophageal temperatures without wearing it. Concomitantly, the increase of heart rate was suppressed in the same test condition. Wet vest in running water showed the similar effects. Therefore, we concluded that the use of water-cooled TM-2 vest was effective in alleviating the symptoms and signs of his heat intolerance.

[A late onset familial amyloidotic polyneuropathy (FAP) with a novel variant transthyretin characterized by a basic-for-acidic amino acid substitution (Glu61-->Lys)]

A 64-year-old man has suffered from intractable diarrhea since January 1990. He noticed numbness and weakness in the distal portion of four extremities in the following several months. His symptoms were gradually progressive. In June 1992, neurological examination revealed mild muscular atrophy and weakness in the proximal and distal portions of four extremities. There were paresthesia and severe impairment of superficial sensations in the lower limbs, lower half of the trunk and upper limbs. All deep tendon reflexes were reduced or absent. Autonomic dysfunctions such as orthostatic hypotension, impotence and diarrhea were evident. On sural nerve biopsy, myelinated fibers showing axonal degeneration were predominantly seen, and densities of both myelinated and unmyelinated fibers were markedly decreased. No amyloid deposits were found in the endoneurium. Amyloid deposition was identified in the gastric mucosa by Congo red staining and immunostaining with anti-transthyretin (TTR) antibody. Edman degradation showed one amino acid substitution of Lys for Glu at position 61 in the TTR-peptides from the serum. Direct DNA sequencing revealed a new point mutation in the 61st codon of TTR gene. The same point mutation of TTR gene was identified in the DNAs from his 67-year-old brother and 63-year-old sister and one of the paternal cousins, a 64-year-old woman, although their clinical symptoms and signs were negative. Clinical features such as late onset of the symptoms and signs and presence of carriers in their sixties in this family are unique and atypical as compared with those of more frequent Val30-->Met FAP families. A variant TTR, characterized by a Glu61-->Lys substitution (a basic-for-acidic amino acid substitution) found in this family, has not been reported in the literature. In the case of the examination of the patients with autonomic and sensory symptoms and signs of unknown etiology, amyloidotic polyneuropathies, including FAP even in the absence of the family history, should be differentiated. When FAP is highly suspected, the combination of family study and DNA analysis of a possible variant TTR is indispensable for the establishment of the diagnosis.

Spontaneous intraventricular hemorrhage caused by lateral ventricular meningioma--case report

A 39-year-old female presented with acute intraventricular hemorrhage manifesting as sudden onset of headache associated with gradually progressing somnolence and left oculomotor nerve paresis. Intraventricular hemorrhage occurred from a meningioma of the lateral ventricle. Computed tomography and magnetic resonance (MR) imaging revealed intraventricular hemorrhage and a mass in the right trigone. The tumor was totally removed. Her postoperative course was uneventful except for left homonymous hemianopia. The histological diagnosis was fibroblastic meningioma. The MR imaging was highly suggestive of hemorrhage from the tumor periphery.

Two components of metabotropic glutamate responses in acutely dissociated CA3 pyramidal neurons of the rat

The excitatory and inhibitory actions of metabotropic glutamate receptor (mGluR) agonists were investigated in acutely dissociated rat hippocampal CA3 pyramidal neurons, using the conventional whole-cell and nystatin-perforated patch recording configurations under the voltage-clamp condition. With the conventional whole-cell recording, glutamate (Glu) and quisqualic acid (QA) induced only ionotropic inward currents accompanied by increased membrane conductance at a holding potential (VH) of -45 mV. The response was reversibly blocked in the presence of D-2-amino-5-phosphonopentanoic acid (D-AP5) and 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), the antagonists of N-methyl-D-aspartate (NMDA) receptor and non-NMDA receptor, respectively. With nystatin-perforated patch recording, mGlu responses insensitive to both D-AP5 and CNQX were observed. Fifty-five % of the cells responded by a slow inward current accompanied by conductance decrease (ImGlui) at a VH of -44 mV. One % of the neurons showed an outward current with conductance increase (ImGluo), and 34% of the neurons showed ImGluo followed by ImGlui. The onset of ImGluo occurred approximately 900 ms after the response to 30 mM K+. The time to peak of ImGluo were 32- to 79-times longer than those of ionotropic responses. ImGlui appeared at lower concentrations than ionotropic Glu responses, whereas ImGluo appeared at similar concentrations as ionotropic responses. The rank order of affinity was QA > Glu > (+/-)-1-aminocyclopentane-trans-1, 3-dicarboxylic acid (tACPD) for both ImGlui and ImGluo. Half-maximal effective concentrations (EC50) and the threshold concentrations for the three agonists were four- to tenfold lower for ImGlui than for ImGluo. The current-voltage relationship showed that the reversal potentials of ImGlui and ImGluo shifted 55 and 59 mV, respectively, for a tenfold change in extracellular K+ concentration, indicating that K+ is the charge carrier of both mGlu responses. During ImGlui, both the leakage current and muscarine-sensitive voltage-dependent K+ current (M current) were suppressed. ImGluo induced by 10(-4) M tACPD was abolished by 3.10(-7) M charybdotoxin and 10(-6) M ryanodine. These results show that there are two components of mGlu responses in CA3 pyramidal neurons and that ImGlui and ImGluo show different pharmacological properties.

[Familial amyotrophic lateral sclerosis showing variable clinical courses with (Leu84-->Val) mutation of Cu/Zn superoxide dismutase]

A family with autosomal-dominant amyotrophic lateral sclerosis with histopathological confirmation on autopsy was described. A 42-year-old female proband showed the signs and symptoms only in the lower limbs characteristic of lower motor neuron involvement at the onset. ALS had been diagnosed in other five members in three generations of her family. The mean +/- SD age of onset of the disease was 42.5 +/- 9.3 years with a range of 30 to 51 years. The mean +/- SD duration of the disease (n = 5, excluding the proband) was 56 +/- 70 months with a range of 7 to 180 months. Molecular genetic studies showed a T-to-G transversion that results in the substitution of valine for leucine84 in exon 4 of the Cu/Zn superoxide dismutase (SOD) gene on chromosome 21 in a proband. This mutation is identical to that found in the Japanese family with autosomal-dominant ALS characterized by short duration of the disease, within 1.5 years, in all the affected family members. Therefore, the clinical phenotype, especially the duration of the disease seems to be highly variable even in the families with the identical mutation of the Cu/Zn SOD gene.

[Familial amyloidosis, Finnish type with marked anhidrosis]

Familial amyloidosis, Finnish type (FAF), is a gelsolin-related systemic amyloidosis that has an autosomal-dominant inheritance pattern and is clinically characterized by progressive cranial neuropathy, corneal lattice dystrophy and skin changes such as cutis laxa, blepharochalasis, and lichen amyloidosis. A 70-year-old Japanese male proband, who was believed to be originally from Fukuoka Prefecture, showed signs and symptoms characteristic of FAF. In addition, he complained of progressive anhidrosis and heat intolerance during the daytime in summer. On examination, perspiration was absent on the almost entire body surface. Molecular genetic studies showed a G-to-A transversion that resulted in the substitution of asparagine for aspartic acid 187 in the gelsolin gene, a mutation found in most patients with FAF. Skin biopsy revealed marked deposition of amyloid, which was positive with anti-gelsolin antibody staining, around eccrine sweat glands and ducts, and around sebaceous glands, outside the basal lamina; slight to mild deposition around small vessels and small nerve fascicles; and very slight deposition in the perineurium and endoneurium. Morphometric evaluation of the nerve terminals and axons of eccrine sweat glands revealed a significant decrease in the number of nerve terminals per transverse profile of the sweat gland. Compared with controls, nerve terminals were further from the secretory epithelial cell owing to deposition of amyloid outside its basal lamina. The proband's sister had almost identical, although much less severe, clinical signs and symptoms with the same mutation of the gelsolin gene. Autonomic signs and symptoms in FAF are reported to be less frequent and less severe than those in familial amyloid polyneuropathy of Andrade type. Findings in our proband suggest that perspiration may be markedly decreased in FAF owing to marked deposition of amyloid around the eccrine sweat gland which causes degeneration of the nerve terminals and disturbs access of the neurotransmitter to the secretory epithelial cell.

[A family of hereditary motor and sensory neuropathy type I with a mutation (Arg98-->His) in myelin Po--report on a second Japanese family]

A 46-year-old housewife had complaints of insidiously progressive muscle weakness and paresthesia in the distal lower limbs. On neurological examination, a slight to moderate degree of muscle weakness with slight atrophy was observed in the bilateral intrinsic hand muscles. A severe degree of muscle weakness with moderate atrophy was observed in tibialis anterior, gastrocnemius and soleus muscles. Muscle stretch reflexes were decreased in the upper limbs and absent in the lower limbs, without pathologic reflexes. She had a steppage gait. Vibratory sensation was slightly decreased in the hands and moderately decreased in the feet. Touch, pain and temperature sensations were also moderately decreased only in the feet. On laboratory examination, glycosuria (5.6g/dl) was noted. Fasting blood sugar was 226mg/dl with an elevated hemoglobin A1C level (12.7%). The right median motor and sensory nerve conduction velocities were 14.8 and 20.3 m/sec, respectively, with a markedly prolonged distal latency. No muscle action potential was obtained from stimulation of the right tibial nerve. Also, no nerve action potential was elicited from stimulation of the right sural nerve. A fascicular biopsy of the right sural nerve revealed the presence of both demyelinated and remyelinated axons, and an onion-bulb formation with a marked decrease in the density of the myelinated fibers. Based on the neurological examination and nerve conduction studies of the family members, a younger sister, younger brother and an elder daughter of the proband were found to be affected by demyelinating polyneuropathy. Diabetes mellitus was not found among the family members with laboratory evidences of demyelinating polyneuropathy. Based on the family history, an uncle on the mother's side of the proband, the proband's grandmother and a younger daughter of a proband's brother were considered to be affected. The uncle and grandmother had diabetes mellitus. Therefore, we concluded that this family had HMSN type I with autosomal dominant inheritance. In the studies on fluorescence in situ hybridization, and restriction fragment length polymorphism of the genomic DNA of the proband, a DNA duplication in the 17p11.2-12 region was not observed. However, the direct sequencing analysis of DNA fragments from genomic DNA encoding the Po gene of the proband revealed a substitution of histidine for arginine at the codon 98 in the extramembranous domain of Po. She was heterozygous for the mutant allele and normal allele. Alterations in the tertiary structure of the extramembranous domain of Po may result in an impairment of the peripheral myelin compaction. This is the second Japanese family with the same mutation (Arg98-->His) of myelin Po as reported previously by us, and this type of case is rare in the literature. Therefore, the mutation at the codon 98 may play a critical role in the development of the myelin abnormality in HMSN type IB.

[Application of neurobehavioral tests in a manufacturing automotive parts factory]

Three neurobehavioral tests and a profile of mood states (POMS) test, which are included in the WHO neurobehavioral core test battery, were applied to 106 workers engaged in manufacturing automotive parts, especially for the purpose of determining the presence or absence of a significant difference in the score between a group of sixty-one workers chronically exposed to organic solvents and a group of forty-five workers unexposed. The scores of both pursuit-aiming and digit-symbol substitution tests were lower (P < 0.02 and P < 0.01, respectively, in analysis of covariance) in the group of exposed workers than in the group of unexposed workers. Furthermore, in the group of exposed workers, the pursuit-aiming and digit-symbol substitution scores showed a positive correlation (P < 0.05 and P < 0.01, respectively) to the fatigue score in the POMS test. On the other hand, the score of the digit span test showed no significant difference between the two groups. No significant correlation was found between the urinary hippuric acid level and the score of each of the three neurobehavioral tests. Therefore, among the exposed workers, the perceptual motor function evaluated in pursuit-aiming and digit-symbol tests seems to be affected. The neurobehavioral tests administered in this study are limited in number and in function, however, the comparison of their scores between the exposed and unexposed workers may suggest the presence of adversive effects of chronic exposure to organic solvents.

Effect of sleep stage on somatosensory evoked potentials by median nerve stimulation

The effects of sleep stage on early cortical somatosensory evoked potentials (SEPs) and short-latency components elicited by median nerve stimulation were studied in 12 normal volunteers. The latency of P13 in the awake stage was not significantly different from that in any sleep stage. The latencies of N16, N20 and P20 were significantly prolonged while the amplitude of N20 was decreased during the non-rapid eye movement (NREM) sleep stage. P22, P23 and N24 components showed double peaks (P23a, P23b, N24a, N24b) during the NREM sleep stage in 6 subjects, while N24 showed a single peak and only P22 and P23 showed double peaks in 5 other subjects. The latencies and morphologies of SEPs during rapid eye movement sleep stage were almost the same as those during the awake stage. These findings suggest that NREM sleep affects the latency, amplitude and morphology of N16 and early cortical components.

[Clinical analysis of elderly patients with malignant lymphoma]

An epidemiological study on 173 consecutive elderly malignant lymphoma patients age 65 years or over was performed and the clinical outcome of chemotherapy is reported. Of there, 131 patients (75.7%) had non-Hodgkin's lymphoma (NHL) and 21 patients had Hodgkin's disease (HD). As for clinical staging, 58.9% of patients were in stage 3 or 4. The initial sites were nodal in 61.8% of the patients the most common sites of involvement in superficial lymph nodes being cervical, inguinal and axillar. The most frequent site of extranodal involvement was the gastrointestinal tract. The cases were treated with CHOP/COPP, BACOP or COP-BLAM combination chemotherapy. The clinical efficacy of these modalities was similar, with complete remission rates being about 50%. However, the total response rate (CR+partial remission) by the COP-BLAM regimen were 88.1%. The median survival time of cases achieving CR, was longer than 47 months. The most frequent cause of death was infection, especially pneumonia and septicemia. Many elderly ML patients were found and diagnosed when the disease developed to an advanced stage. Therefore it is necessary to make efforts to find early ML patients by screening apparently healthy elderly people. Improvement of the complete remission rate should be obtained if vigorous and intensive chemotherapy is carried out with careful supportive therapy concerning the general condition and complications in patients.

The effect of MS-818, a pyrimidine compound, on the regeneration of peripheral nerve fibers of mice after a crush injury

One of the pyrimidine compounds, 2-piperadino-6-methyl-5-oxo-5,6- dihydro(7H)pyrrolo[3,4-d]pyrimidine (MS-818), has neurotropic effects in vitro. Therefore, we studied the effect of MS-818 on the regeneration of the peroneal nerve in C57BL/6J mice after a crush injury. Two test groups, which received a daily intraperitoneal injection of 5 mg/kg or 10 mg/kg MS-818, respectively, were compared with controls, which received daily intraperitoneal injections of physiological saline, over a 14-day period. The maximum foot-width ratio (crushed side/uncrushed side) was obtained on days 1, 8 and 14 after the crush injury, and the various morphometric parameters were evaluated at both 5 and 10 mm distal to the proximal portion of the crush site. The significant effects of MS-818 included a larger maximum foot width (P < 0.04) and a greater number of unmyelinated axons per nerve at both levels (P < 0.003) in both test groups than in controls. MS-818 had no significant effects on body weight, the increase of total transverse fascicular area after the crush injury, the total number of myelinated fibers with their size distributions, or the number of nuclei of Schwann cells and macrophages. Therefore, we conclude that MS-818 promotes axonal sprouting and elongation after a crush injury in mice.

Asbestos fiber analysis in nine lung cancer cases with high asbestos exposure

We examined the types and sizes of 100 asbestos fibers in lung tissue obtained from 9 lung-cancer cases (5 autopsy and 4 surgical) with more than 10(4) asbestos bodies per 5 g of wet lung tissue, asbestos bodies in histological sections, and the history of occupational asbestos exposure. Evaluation of asbestos fibers by transmission electron microscopy (2,000 x magnification) revealed that most fibers were longer than 3 microns (96%) and were thicker than 0.1 micron (93%). The analytical conditions we used enabled us to identify 99.7% of all asbestos fibers as being amphibole asbestos. Crocidolite fiber, which was found most frequently (73.1%), was the predominant type of fiber found in 8 of the 9 cases; crocidolite was followed by amosite (21.7%), which was the predominant type found in the remaining case. Crocidolite fibers were thin and had a high aspect ratio (mean diameter = 0.23 micron, mean aspect ratio [length/diameter] = 85.5). Amosite fibers were long, and they also had a high aspect ratio (mean length = 21.8 microns, mean aspect ratio = 66.4). It has been suggested that such fibers with a high aspect ratio are strongly carcinogenic to pulmonary parenchyma. Review of our previous and present data with respect to the ratio of amosite to crocidolite fibers in groups of subjects who had various diseases revealed that this ratio was relatively constant in some occupations. The more predominant fibers found were crocidolite in insulation workers and amosite in railroad workers. The ratio of amosite to crocidolite fibers should be considered in tissue-burden studies.

[The effect of MS-430, a synthetized pyrimidine compound, on regeneration of nerve fibers of rats after crush injury--a morphometric study]

One of the synthetized pyrimidine compounds, 2-piperidino-7-methyl-6-oxo-5,6-dihydro-(7H) pyrrolo [2,3-d] pyrimidine maleate (MS-430), has neurotropic effects in vitro. Therefore, we studied the effect of MS-430 on regeneration of the myelinated fibers of the peroneal and sural nerve of Sprague-Dawley rats after crush injury in two tests, intraperitoneally administered daily 1.0 mg/kg (test 1, n = 7) and 7.5 mg/kg (test 2, n = 8) of MS-430, respectively. We then compared the effects with the control rats (n = 7) administered similarly as in the tests with physiological saline for 14 days from the day after crushing. Twenty-four hours after completion of the administration, the sural nerves at 7.5 mm and 15 mm distal to the crushed site, and the peroneal nerve at 15 mm distal to the crushed site were removed from each rat used in the two tests and from the controls, and then embedded into epoxy resin. In the sural nerve, the total number of regenerated myelinated fibers per nerve in test 2 was greater (P < 0.05) than in the controls at 7.5 mm distal to the crushed site. However, it was similar among the three groups at 15 mm distal to the crushed site. In the case of the peroneal nerve, it was greater in both tests 1 and 2 than in the controls, however the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Idiopathic acquired generalized anhidrosis with normal numbers of eccrine gland nerve terminals and unmyelinated axons. A case report]

A 37-year-old man with acquired generalized anhidrosis but without other autonomic or somatic abnormalities (idiopathic acquired generalized anhidrosis) is described with special reference to histologic and morphometric findings of the eccrine gland and its nerve terminals and unmyelinated axons. The patient was admitted to our hospital in August 1989 with complaints of heat intolerance and anhidrosis of the face, trunk, and both limbs. General physical and neurological examinations revealed no abnormalities except generalized anhidrosis. Sweating tests revealed anhidrosis of most surfaces of the body except the axillae, mammary areolae, forearms, hands, popliteal fossae, and plantar surfaces. Sympathetic skin responses were absent in the axillae, and were decreased on the palms. Iontophoretically applied pilocarpine revealed a complete absence of active eccrine glands on the dorsal surface of the right foot. No other abnormalities were revealed by autonomic function tests. Light and electron microscopic studies of the eccrine glands of the distal and lateral aspects of the left leg were performed in this patient and six control subjects. Infiltration of mononuclear inflammatory cells around the duct and secretory coil of a limited number of eccrine glands on multiple sections was found only in this patient. Electron microscopic morphometric evaluation of the eccrine glands, associated nerve terminals and unmyelinated axons of this patient revealed no definite alterations when compared with those of the six control subjects. Therefore, we concluded that the nerves innervating the eccrine glands were not affected in this patient and suspect that either the cholinergic receptors or the function of secretory cells of the eccrine glands were involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Smaller axon and unaltered numbers of microtubules per axon in relation to number of myelin lamellae of myelinated fibers in the mutant quail deficient in neurofilaments

To characterize the morphological features of the myelinated fibers in the mutant quails deficient in neurofilaments (NF), caused by a nonsense mutation in the NF-L gene, the morphological parameters of the axon and myelin sheath, and their relationships in the peroneal nerve were evaluated. In the mutant, the axonal area was smaller than in the control (P > 0.01), reflecting the lack of large diameter axons. There was no significant difference in the mean number of myelin lamellae and of their spacings between controls and mutants. Therefore, it was decided to analyze the alteration of axonal parameters in relation to the number of myelin lamellae. In the regression analysis, the number of microtubules (MT) per square micrometer of the axonal area was greater in the mutant than in the control (P < 0.05); however, the number of MT per axon was similar in controls and mutants with the same given number of myelin lamellae. The number of MT+NF per axon was smaller in the mutant than in the control only for myelinated fibers with more than 25 myelin lamellae (P > 0.05). These findings indicate that there was a less significant effect of NF deficiency on the smaller than on the larger myelinated fibers. There was no compensatory increase in the numbers of MT per axon of the myelinated fibers in the mutant as found previously in the unmyelinated fibers of the mutant.

[Plasma concentration of cytosine arabinoside (Ara-C) in the elderly patients with hematological malignancy treated by Ara-C or cytarabine ocfosfate (SPAC)]

Plasma concentration of cytosine arabinoside (Ara-C) was determined in elderly patients with myelodysplastic syndromes or acute myelocytic leukemia who were treated with subcutaneous injection of Ara-C (Ara-C s.c.; 10 mg/m2/12 hr, 14-21 days), continuous drip infusion of Ara-C (Ara-C d.i.v.; 20 mg/m2/day, 24 hr 14 days) and/or oral administration of cytarabine ocfosfate (SPAC) (SPAC p.o.; 100 mg-300 mg/body/day, 14 days) by radioimmunoassay. In the Ara-C s.c. patients, the peak plasma level (Cmax) of Ara-C was 103 ng/ml and the time to reach Cmax was 15 min. The elimination half-like (t1/2) was 25 min and no accumulation was detected after 14 days of consecutive Ara-C s.c. administrations. In the SPAC p.o. patients, Cmax of Ara-C was 3-8 ng/ml and it took 3-5 days to reach Cmax. The plasma concentration level of Ara-C remains almost at the Cmax level during the SPAC p.o. administration and it remained higher than 0.32 ng/ml for as long as 15 days after the end of administration. In a Ara-C d.i.v. patient, plasma level of Ara-C was detected 4-7 ng/ml during the administration (day 7 through day 14). In all patients bone marrow suppression was observed after chemotherapy regardless of regimen, and there was no significant difference between nadir peripheral cell blood counts of Ara-C s.c. patients and SPAC p.o. patients.

Sympathetic skin responses evoked by magnetic stimulation of the neck

We studied sympathetic skin responses (SSRs) following magnetic stimulation of the neck in 40 normal subjects and 54 patients with neurological diseases and active sweat gland densities (ASGDs) at the foot induced by pilocarpine in 39 patients. SSRs at the hand following magnetic stimulation showed the lowest coefficients of variability of the latencies and amplitudes in eight consecutive responses compared with SSRs following other types of stimuli (electrical and auditory stimulation, and deep inspiration) in 12 normal subjects. Fourteen of 38 patients with neuropathies (37%) showed the presence of SSRs after magnetic stimulation, but not after median nerve stimulation, although SSRs to magnetic stimulation corresponded with those to nerve stimulation in all patients with multiple sclerosis or multiple system atrophy. These results suggest that the absence of SSRs after nerve stimulation in patients with neuropathies may be due to abnormalities of the peripheral sensory afferent fibers. ASGDs significantly correlated with SSRs at the foot following magnetic stimulation, but not with those following nerve stimulation in patients with neuropathies. Magnetic stimulation of the neck is the highly reproducible method of evoking SSRs because this technique is able to produce strong sensory afferent inputs proximally. Furthermore, SSRs following magnetic stimulation, little influenced by sensory afferent fiber involvement, are very useful for evaluating the postganglionic sympathetic function in patients with neuropathies.

Asbestos body formation in the human lung: distinctions, by type and size

The fraction of fibers coated in a total of 3,800 asbestos fibers from 38 patients with disease related to asbestos (100 fibers per patient) was determined, according to asbestos fiber type and size parameters. Among the 3,800 fibers, 638 (16.8%) were coated and 3,162 were uncoated. All fibers were analyzed at 2,000 x magnification (lower limit of detection: 2 microns for length and 0.06 microns for diameter). The diameter of the totally coated fibers (28.4% of total bodies; 181/638) was not measured. The percentage of coated fibers varied with the asbestos type; it was 27.1% (335/1235) for amosite fibers, 16.0% (228/1423) for crocidolite, 6.6% (60/908) for tremolite or actinolite, 6.5% (14/214) for anthophyllite, and 5% (1/20) for chrysotile fibers. Most coated fibers were longer than 10 microns and had an aspect ratio (length/diameter) of more than 20. Approximately 60% of coated fibers had an aspect ratio of more than 100. The longer the fiber, the greater the percentage of coated fibers, regardless of diameter. The increase in the percentage associated with length was more marked in fibers with a smaller diameter; the percentage of coated fibers was, therefore, greater in fibers 30 microns or less in diameter. However, in fibers longer than 30 microns, the relationship to percentage of coated fibers was not as clear, and the diameter was less important. Accordingly, the fibers with high aspect ratios, particularly long fibers, tended to show asbestos body formation. The percentage of long fibers was highest in amosite, and the percentage of fibers with an aspect ratio of more than 100 was highest in amosite and crocidolite.(ABSTRACT TRUNCATED AT 250 WORDS)

Naloxone suppresses the rising phase of fever induced by interferon-alpha

Interferon-alpha (IFN-alpha, 2.0 x 10(4) units) was bilaterally microinjected into the medial preoptic area and anterior hypothalamus in conscious rats treated 10 min prior with an opioid receptor antagonist, naloxone (NLX, 2 mg/kg, IM) or a prostaglandin synthetase inhibitor, acetaminophen (ACAP, 25 mg/kg, IM). The IFN-alpha-induced rise of rectal temperature (Tre) was suppressed from 20 to 60 min in NLX pretreated rats and from 30 to 180 min in ACAP pretreated rats. The rate of rise in Tre during the initial 20 min observed in NLX pretreated rats was significantly smaller than that in ACAP or saline pretreated rats. ACAP suppressed the fever when it was given 50 or 100 min after injection of IFN-alpha. In contrast, NLX did not affect the fever when given 25 or 50 min after IFN-alpha. The results suggest that an opioid that its involvement may last only in the early phase of the fever, but not after the plateau has been reached.

Differential up-regulation of voltage-dependent Na+ channels induced by phenytoin in brains of genetically seizure-susceptible (E1) and control (ddY) mice

We investigated the effect of in vivo administration of an antiepileptic drug, phenytoin, on the saxitoxin binding capacity of receptor site 1 of the Na+ channel alpha-subunit, and the expression activity of the channel messenger RNA in epileptic El mouse brains, as compared with parental ddY mice. Subchronic treatment with phenytoin (25 mg/kg per day) for 14 days increased the [3H]saxitoxin binding to brain-derived synaptic membranes of both El and control ddY mice in a time dependent manner. This increase plateaued at 21 +/- 4% in El mice and 28 +/- 3% in ddY control mice after administration of phenytoin for seven days. After cessation of treatment with phenytoin, [3H]saxitoxin binding capacity returned to the basal level within two weeks in both ddY and El brains. Scatchard plot analysis revealed that the phenytoin treatment caused a 20-30% increase in maximum binding capacity of [3H]saxitoxin binding without any change in equilibrium dissociation constant in the brain cortical synaptic membranes of both epileptic El and control ddY mice. A single injection of phenytoin (25 mg/kg) elevated the level of Na+ channel messenger RNA within 1 h in ddY mouse brains. The increase in Na+ channel messenger RNA reached a peak (about 80% increase) after 5 h of phenytoin administration in a concentration-dependent manner (6.25-50 mg/kg). On the other hand, in El mouse brains, Na+ channel messenger RNA was not elevated until more than 5 h after phenytoin injection, and was increased by only about 33%.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with bilateral recurrent nerve palsy and primary alveolar hypoventilation--comparative studies of the histological findings of the two sural nerve biopsies with 9 years interval]

A 27-year-old man noticed a tingling sensation in his fingers and toes in early 1982, at the age of 18 years, and his symptom gradually progressed in the following several months. In December 1982, based on neurological and laboratory examinations including the first sural nerve biopsy on the right side, a diagnosis of axonal sensory neuropathy of unknown etiology was made. During the following years, muscle weakness in the distal limbs and hoarseness developed and progressed, and the sensory impairments became gradually evident. On the second neurological examination in July 1991, he showed soft palate palsy and bilateral recurrent nerve palsy. The intrinsic muscles of hands and feet were atrophic, and pes cavus was noted bilaterally. There was mild to moderate weakness in the distal muscles of both limbs. Ankle jerk was absent and other tendon reflexes were decreased in both limbs. A mild to moderate decrease of both superficial and deep sensations with mild paresthesia was noted in both hands and feet. Routine laboratory findings were unremarkable. In blood gas analysis, hypercapnea and respiratory acidosis were found. Spirometry showed an increase of residual volume, and alveolar CO2-pulmonary ventilation response test suggested the presence of primary alveolar hypoventilation caused by hypofunction of the medullary respiratory center. In nerve conduction studies, motor nerve conduction velocities were moderately reduced in bilateral median and ulnar nerves. Distal latencies of M-waves were prolonged in bilateral median nerves. Temporal dispersion of M-wave was found in the left tibial nerve. The amplitudes of sensory action potentials were moderately reduced in bilateral median and sural nerves.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with acute bilateral optic neuritis with normal findings on pattern-reversal visual evoked potential study]

A 35-year-old man with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with acute bilateral optic neuritis is described. At age 33, he noticed a tingling sensation in his toes followed by weakness in the lower limbs. He was admitted to our hospital because he became unable to walk without support. His motor and sensory symptoms gradually resolved during 7 months admission only with physical rehabilitation. At age 35, in July 1988, he noticed a tingling sensation in his toes and fingers, which reached to the knees and elbows in October 1988, when he developed weakness in the lower limbs. Motor and sensory symptoms were almost stationary thereafter and in March 1989, he experienced bilateral blurred vision of acute onset without ocular pain. He was readmitted to our hospital in April 1989. The neurological examination revealed decreased visual acuity of both eyes without any abnormality of the optic disks, mild weakness on flexion and extension of toes, an absence of Achilles reflex, and distal impairment of pain and touch sensations in the upper limbs, and of pain, touch and vibration sensations in the lower limbs. After laboratory examinations, CSF protein was elevated (122 mg/dl), and sensory nerve conduction velocity of the right median nerve was decreased (37.1 m/sec). The sural nerve action potential was not elicited on electrical stimulation. Central scotoma was found in both eyes by the visual field examination. P100 latency was seen to be normal by repeated pattern-reversal visual evoked potential (VEP) studies. CT and MRI of the brain were unremarkable.(ABSTRACT TRUNCATED AT 250 WORDS)

Greater number of microtubules per axon of unmyelinated fibers of mutant quails deficient in neurofilaments: possible compensation for the absence of neurofilaments

Morphometric evaluations were performed on the peroneal nerve from mutant quails deficient in neurofilaments (NF) to elucidate the effect of an absence of NF on unmyelinated axons. The diameter frequency distribution of unmyelinated axons was similar between controls and mutants. The mean transverse axonal area, axonal circumference and circularity index of the unmyelinated axons were also similar in controls and mutants. However, the number of microtubules (MT) per axon was greater (P < 0.01) in the mutants than in the controls. The regression analysis relating the number of MT per axon to the diameter of unmyelinated axons indicated a greater number of MT in the mutants than in the controls (P < 0.05-0.01). A significantly greater number of MT per axon in the mutants may suggest a compensatory increase of MT in the absence of NF. This may conserve the size and transverse circular profile of the unmyelinated axons which are probably maintained by both MT and NF in the controls. The number of MT may be increased at the expense of the soluble fraction of tubulin.

[Comparative studies on the evaluation of vibratory perception thresholds using three different instruments, vibratron II, TM-31A and SMV-5--reliability, correlation with age and interrelationship]

Vibratory perception thresholds of 40 (13 males and 27 females) subjects without sensory disturbances were evaluated using three different instruments, Vibratron II, TM-31A and SMV-5, successively three times every third or fourth day to compare their reliability, correlation with age and interrelationship. The intraclass correlation coefficients of the threshold, obtained at the palmar distal phalanx of the index finger of the predominant hand by using Vibratron II and SMV-5 were 0.77 and 0.88, respectively, and those at the radial styloid process on the same side by using TM-31A and SMV-5 were 0.62 and 0.84, respectively. There was a similarity of the intraclass correlation coefficients in the measurement at both sites between the subjects of ages < or = 40 and those of ages > 40, when different instruments were used. However, the thresholds were lower among the subjects of ages < or = 40 than among those of ages > 40. A significantly positive correlation was found between the threshold and the age at both sites when using different instruments. A significantly positive correlation was also found between the thresholds obtained by Vibratron II and SMV-5 at the palmar distal phalanx and between those obtained by TM-31A and SMV-5 at the radial styloid process. The above data indicate that each instrument is applicable not only for diagnosing and evaluating the vibratory sensation disturbances, but also for the follow-up study and evaluation of the efficacy of the specific treatment for the patients with sensory disturbances. They are likewise applicable for the screening and diagnosis of peripheral neuropathy in the occupational and environmental medicines. However, the reliability was lowest in the evaluation by TM-31A, and the correlation coefficient was smallest in the relationship between the age and the threshold obtained by TM-31A.