[Syringomyelia secondary to adhesive arachnoiditis: clinical profiles and efficacy of shunt operations]

The authors report nine cases of syringomyelia secondary to adhesive arachnoiditis treated in our institute from 1982 to 1991. Neurological signs, radiological features, and results of surgical treatment were reviewed. Common initial manifestations in association with syringomyelia were spastic paraparesis in 8 patients (88.9%), regional sensory loss in 4 (44.4%), neurogenic bladder in 4 (44.4%), and somatic pain in 2 (22.2%). All the neurological symptoms or signs progressed gradually for years. All the patients were treated with various modes of shunt operations, including syringo-peritoneal shunt in seven patients, syringo-subarachnoid shunt in one, and ventriculo-peritoneal shunt in one, respectively. Three patients who failed to resolve their major complaints after the first surgery further received syringo-peritoneal shunts. Postsurgical follow-up periods ranged from 18 months to 10 years. Serial MR imaging revealed a significant reduction of the size of syringomyelia in 8 of 9 patients. However only 6 patients showed certain improvement of neurological deficits. Three patients who failed to improve clearly had a long (beyond 15 years) history of syringomyelia before the first surgical treatment. A total of 11 syringo-peritoneal shunts were done in 8 patients of whom 5 patients improved neurologically. It was noticed that 4 of 5 successful syringo-peritoneal shunts were placed in the caudal level of the syrinx. In conclusion, syringo-peritoneal shunt may be at present an optimal mode of surgical management for syringomyelia secondary to adhesive arachnoiditis. In addition, we would like to recommend that follow-up serial MR imaging be done for patients having adhesive arachnoiditis in order to detect syringomyelia as early as possible.

Acute effects of alcohol ingestion on blood pressure and erythrocyte sodium concentration

OBJECTIVE

To examine the acute effects of alcohol on blood pressure and erythrocyte cation concentrations in patients with essential hypertension.

DESIGN

An alcoholic drink or an isocaloric control drink was given during supper in random order on different days, and blood pressure and erythrocyte cation concentrations were measured before and 2 h after the meal.

METHODS

The subjects were 21 men with essential hypertension who habitually drank alcohol. Blood pressure was measured with a semi-automated sphygmomanometer, and erythrocyte cation concentrations were measured by flame photometry after haemolysis with distilled water.

RESULTS

Blood pressure decreased after both drinks, but the decrease was significantly larger after the alcoholic drink than after the control drink. There was a significant difference between the changes in erythrocyte sodium caused by the alcoholic and the control drink. Furthermore, there were significant positive correlations between the fall in blood pressures and the decrease in erythrocyte sodium concentration.

CONCLUSION

The predominant acute effect of alcohol ingestion in patients with hypertension is blood pressure reduction, and it may be associated with a decrease in intracellular sodium.

Purification from liver microsomes from untreated cynomolgus monkeys of cytochrome P450 closely related to human cytochrome P450 2B6

A cytochrome P450 (P450) (referred to as P450CMLa) was purified and characterized from hepatic microsomes from untreated cynomolgus monkeys (Macaca irus). The final preparation was electrophoretically homogeneous and its estimated minimum molecular mass was 49.5 kDa. The amino-terminal amino acid sequence of the protein (first 34 residues) closely resembled that of the protein encoded by the 2B6 cDNA from humans (94%). This protein was cross-reactive with antibodies raised against P450 2B1 (P450 b), P450 2B11 (P450 PBD-2), and P450GP-1, which were purified from hepatic microsomes from phenobarbital-pretreated rats, beagle dogs, and guinea pigs, respectively. Also, the antibody raised against P450CMLa was able to cross-react with P450 2B1, P450 2B11, and P450GP-1. P450CMLa was capable of catalyzing benzphetamine N-demethylation and testosterone 16 beta-hydroxylation in a reconstituted system. Anti-P450CMLa antibody inhibited the activity of testosterone 16 beta-hydroxylase but not the activities of testosterone 2 beta- and 6 beta-hydroxylases in liver microsomes from cynomolgus monkeys. The content of P450CMLa, as estimated by immunoblot analysis, was 70 pmol/mg (about 5% of total P450). The protein immunoreactive with the anti-P450CMLa antibody was also present in liver microsomes from Japanese monkeys, baboons, common marmosets, and common squirrel monkeys. In liver microsomes from common squirrel monkeys, the content of protein immunoreactive with the anti-P450CMLa antibody and the activity of testosterone 16 beta-hydroxylase were effectively increased by pretreatment with phenobarbital. The antibody against P450CMLa strongly inhibited the activity of testosterone 16 beta-hydroxylase in liver microsomes not only from untreated cynomolgus monkeys but also from phenobarbital- and pregnenolone 16 alpha-carbonitrile-pretreated common squirrel monkeys. These results indicated that the P450CMLa purified here is very similar to the forms of P450 classified into the 2B subfamily, in its amino-terminal amino acid sequence, catalytic activities, and immunochemical properties.

Vacuolated meningioma with secretory features: a case report

We report a case of meningioma with secretory features in a 47-year-old woman. The left frontal tumor mass had already eroded the overlying bone at the time of presentation. When respected, the mass showed a gelatinous appearance. Histologically, marked vacuolar change was seen in the stroma. Whorls, psammoma bodies, and pavement arrangement of nuclei were also noted. Periodic acid-Schiff stain revealed cytoplasmic granules, which were digested with diastase. Alcian blue diffusely stained the cytoplasm of the tumor cells. Electron microscopy showed numerous small vacuoles and cored vesicles in the cytoplasm. Glycogen granules were poorly observed. These features indicate the mild secretory nature of this vacuolated meningioma.

Cellular and cytokine responses of the human central nervous system to intracranial administration of tumor necrosis factor alpha for the treatment of malignant gliomas

To elucidate the role of tumor necrosis factor alpha (TNF alpha) as a biological response modifier, we studied cellular and cytokine responses of the central nervous system to TNF alpha administered intracranially in a phase I clinical trial for patients with malignant gliomas. Six patients received injections of TNF alpha (1.25 x 10(3)-10 x 10(3) U/injection) into the tumor cavities, and regional fluids (RF) and lumbar cerebrospinal fluids (CF) were serially sampled before and after the injections. Recruitment of neutrophils occurred, mostly peaking 8 h after TNF alpha injection, and fewer numbers of CD4+ T cells and monocytes/macrophages migrated, subsequently peaking at 24 h. The CF leukocytosis persisted for 48 h and was associated with an increased level of neutrophil chemotactic activity in the CF. This neutrophil chemotactic activity was attributed to interleukin-8 (IL-8) by HPLC. The level of IL-6 activity in the CF and RF consistently increased; beginning 2 h after TNF alpha injection and reaching the maximum between 8 h and 12 h. It returned to the basal level within 48 h. IL-1 beta was detected in the CF of three patients, its level peaking at 8 h. Prostaglandin E2 also increased after injection of TNF alpha, peaking between 4 h and 12 h and then gradually decreasing. Transforming growth factor beta was found in all cases tested and one patient showed a significant change after TNF alpha injection. IL-2 activity, interferon alpha (INF alpha) activity, IFN beta, and granulocyte/macrophage-colony-stimulating factor were not detected in the CF or RF. In conclusion, TNF alpha is biologically effective in inducing migration of immune cells and generating multiple cytokine responses in the human central nervous system.

[Diagnosis of intracranial occlusive vascular disease and evaluation of extracranial-intracranial (EC/IC) arterial bypass using three-dimensional magnetic resonance angiography]

The three-dimensional time-of-flight (TOF) magnetic resonance angiograms (MRA) were studied to evaluate its accuracy in the assessment of the intracranial carotid occlusive lesions, collateral circulation and also the patency of extracranial-intracranial (EC/IC) arterial bypass surgery. All occlusive lesions of the intracranial major arteries seen in conventional angiograms were revealed clearly with MRA. However MRA had its practical limitation in the evaluation of the leptomeningeal anastomosis (collateral circulation) probably due to the deterioration of contrast in its slow flow and saturation effect of the magnetization. In addition to that, MRA often exaggerated the severity of the stenotic lesions, mostly in severe cases. The post-operative state of collateral flow and the patency of EC/IC bypass could be evaluated as properly with MRA as with conventional angiography, although MRA was limited in spatial resolution and evaluation of flow direction. In conclusion, MRA was considered t be a reliable non-invasive modality as a screening examination for the evaluation of the carotid occlusive disease and as the follow-up study of the post-operative patients with EC/IC bypass surgery.

Atrioventricular (AV) reciprocating tachycardia utilizing left lateral AV bypass pathway with a long retrograde conduction time

A 52-year-old man had suffered from attacks of palpitation for 10 years. The frequency of the attacks had been increasing since June 1991. The electrocardiogram (ECG) at the time of attack showed a heart rate of 175 bpm and RP'/P'R > 1, indicating long RP' tachycardia. Electrophysiological examination of the heart revealed an accessory pathway in the left lateral position. During the tachycardia, PVCs from the right ventricular apex (RVA) captured the atria. On the basis of these findings the patient was diagnosed as having had atrioventricular (AV) reciprocating tachycardia (AVRT). Ventriculoatrial (VA) conduction indicated a decremental conduction curve by single premature stimulation from the RVA, and the atrial cycle length following PVC during tachycardia was prolonged (paradoxical delay). When verapamil was administered intravenously, tachycardia induced by the premature stimulation showed prolongation of the VA interval, associated with an increased tachycardia cycle length. Tachycardia in this patient was completely controlled by administration of verapamil.

Molecular cloning and sequence analysis of the cDNA for human mitochondrial short-chain enoyl-CoA hydratase

Short chain enoyl-CoA hydratase (SCEH) catalyzes the second step of the mitochondrial fatty acid beta-oxidation spiral. We isolated cDNA clones for human SCEH to facilitate investigation of the enzyme structure of the gene and to examine the genetic background of Reye's syndrome and sudden infant death. Oligo(dT)-primed and random primed human liver cDNA libraries in lambda gt11 were screened using the entire sequence of the rat SCEH cDNA as a probe. Three positive clones covered the full-length cDNA sequence with an open reading frame encoding a precursor polypeptide of 290 amino acid residues, and deduced relative molecular mass (31,280) with a putative N-terminal presequence of 29 residues, a 5'-untranslated sequence of 21 bp and a 3'-untranslated sequence of 391 bp. Comparison with the rat SCEH cDNA showed that the deduced amino acid sequence of the human SCEH precursor is 84% identical to that of the rat enzyme precursor. Northern blot analysis gave a single mRNA species of 1.6 kb in the human liver, fibroblast and muscle.

Velocity profile of human horizontal saccades

To assess saccadic trajectories, we evaluated the velocity profile using the 'skewness ratio' (the proportion of acceleration time to total saccadic duration) as a parameter. Horizontal cross-center saccades against target movements of 10 degrees, 20 degrees and 30 degrees were measured in 6 normal subjects using the magnetic search coil method. As the amplitude increased the period of the deceleration phase became prolonged: 10 degrees saccades were almost symmetrical and 30 degrees saccades were skewed to a ratio of about 0.3. A close relationship between duration and skewness ratio was found, and the skewness ratios of temporal saccades were smaller than nasal ones. This skewness ratio would be a useful parameter for assessing the velocity profile of human saccades.

Production and characterization of monoclonal antibodies specific for bovine oviductal glycoproteins

Four monoclonal antibodies (MAbs) were produced in rat cells against materials obtained from the bovine oviduct. The MAbs (1H10, 2A4, 2C5, and 1B12) reacted strongly with the oviductal epithelium of cows in the follicular phase. An immunohistochemical study demonstrated that each of the MAbs bound strongly to the supranuclear cytoplasm of epithelial cells of the oviduct, but not of the stromal cells. Antigens that reacted with the MAbs were characterized by immunoblotting analysis of proteins after fractionation by SDS-PAGE under reducing conditions of oviductal flushings obtained from cows at estrus. All MAbs strongly stained a band of protein with a molecular weight (MW) of 85-97 kD. MAb 1H10 also reacted with the minor band of a 55-kD protein. Similar antigens were not detected in uterine flushings, follicular fluid, and serum. No specific immunohistochemical reactivity with the MAbs was observed with other tissues from the reproductive tract and with nonreproductive tissues. The immunohistochemical reactions were completely eliminated by pretreatment of tissues with trypsin, but not with periodic acid, results that suggest that the antigenic determinants that react with the MAbs were proteinaceous rather than carbohydrate. We have thus established clones that produce 4 MAbs that are specific for oviduct-specific glycoproteins of the cow.

Intraocular pressure-dependent progression of visual field loss in advanced primary open-angle glaucoma: a 15-year follow-up

We studied the relationship between intraocular pressure (IOP) and progression of visual filed loss in 83 eyes of 83 patients with advanced primary open-angle glaucoma (loss of at least one quarter of the visual field on Goldmann perimetry). During the 15-year follow-up study, 71 eyes (86%) showed progression of visual field loss. The mean IOP was significantly lower in eyes that remained stable (13.4 +/- 1.3 mm Hg) than in those that showed progression of visual field loss (19.4 +/- 2.6 mm Hg). These results suggest that it is necessary to reduce IOP to below 15 mm Hg to prevent further progression of visual filed loss in advanced glaucoma.

Temporal modulation transfer function of vision by pattern visual evoked potentials in patients with optic neuritis

To reveal the impairment of the temporal modulation transfer function of vision in patients with optic neuritis, the pattern visual evoked potentials (P-VEPs) were recorded at reversal frequencies ranging from 4 to 24 per second, and the fast Fourier transform (FFT) of VEPs were investigated. In normal subjects, curves of the square root of the power of the FFTs of P-VEPs versus temporal frequency showed the maximum peak at 6 Hz (12 reversals/s). The specific distribution of the power spectrum could be found at each temporal frequency, and the amplitudes of higher harmonic components decreased while a single power spectrum peak became prominent as the temporal frequency increased. In patients with optic neuritis, an abnormality of the power spectrum of steady-state P-VEPs could by detected by estimating the 1st and 2nd harmonic components. The abnormality of the power spectrum of transient P-VEPs could be detected by estimating the higher harmonic components of the power spectrum.

Chronic hepatitis C in alcoholic patients: studies with various HCV assay procedures

Chronic hepatitis (CH) is one of the features of alcoholic liver disease (ALD). The role of hepatitis C virus (HCV) infection was investigated in 50 alcoholic patients with CH, employing various types of HCV antibody. All patients had a drinking history of more than 80 g/day of ethanol and the diagnosis of CH was made by liver histology within 2 weeks of abstinence. We assayed serum HCV using C100-3 antibody (Ortho EIA and RIA), the second generation (HCV-2nd) (DAINABOT EIA and PHA), and we also examined HCV-RNA by PCR. The positive rate of C100-3 antibody was 56% by EIA and 66% by RIA. The HCV-2nd was much higher; 80% and 82% by EIA and PHA, respectively. The HCV-RNA was positive in 82% of patients. The positive rate for either of the HCV markers was 92% (46/50). In patients positive for C100-3, serum aminotransferase levels were still elevated even after abstinence and most of them showed chronic active hepatitis by liver histology. Follow-up liver biopsies showed histological progression even after abstinence. On the other hand, in some patients positive only for HCV-2nd and/or HCV-RNA, serum aminotransferase levels were normalized and histological improvement was observed soon after abstinence. These results suggest that histological determined CH in alcoholics is attributed mainly to the infection of HCV, HCV plays an important role in the histological deterioration after abstinence, and that the presence of C100-3 antibody reflects the activity of liver disease caused by HCV.(ABSTRACT TRUNCATED AT 250 WORDS)

Regio- and stereoselective propranolol metabolism by 15 forms of purified cytochromes P-450 from rat liver

Regio- and stereoselectivity of cytochrome P-450-mediated propranolol metabolism (4-, 5- and 7-hydroxylations and N-desisopropylation) was studied using 15 purified cytochrome P-450 species. With each purified cytochrome P-450 species, the regioselectivity was distinct and different between the two optical isomers used as substrates. The stereoselectivity was different depending on the position of propranolol to be metabolized. The regio- and stereoselectivity was altered when substrate concentration was altered, suggesting that the kinetics of the reactions are different depending on the positions of propranolol to be metabolized. Furthermore, the selectivity and its manner of alterations with substrate concentrations were different among all cytochrome P-450 species used. Propranolol, with its multiple metabolic pathways and optical isomers, is an extremely interesting substrate for characterization of cytochrome P-450 species.

Intracerebral hemorrhage caused by a neoplastic aneurysm from small-cell lung carcinoma: case report

A neoplastic cerebral aneurysm from lung cancer is an extremely rare occurrence despite its high metastatic potential to the brain. We report a neoplastic cerebral aneurysm from small-cell lung carcinoma that caused an intracerebral hematoma. A 63-year-old man underwent an urgent craniotomy for a massive intracerebral hematoma. After evacuation of the hematoma, an anomalous artery was found on the wall and a biopsy was done. The histological examination revealed that the artery was filled with neoplastic cells, and a part of the vessel wall was distended, forming an aneurysm. The histological feature of the tumor cells was consistent with small-cell lung carcinoma, which was disclosed in the left hilus.

Schwannoma in the psoas muscle removed by the retroperitoneal approach

The case of a 56-year-old male with a schwannoma in the right psoas muscle is reported. The tumour was extirpated by the retroperitoneal approach, which afforded direct access to this lumbar paraspinal lesion.

New degradation product of spiradoline mesylate in aqueous solution: formation of an imidazolidine ring

A new degradation product of spiradoline mesylate was recognized in aqueous solution stored at 80 degrees C for 10 days. The structure of the degradation product was elucidated with spectroscopic data and a synthetic method as (1RS,3RS,8RS,10RS)-2-methyl-2,7-diazatricyclo - [6.4.0.0(3,7)]dodecane-10-spiro-2'-tetrahydrofurane by several two-dimensional NMR spectra. The fused imidazolidine ring system was synthesized from (5RS,7RS,8RS)-N-methyl-8-(7-pyrrolidino-1-oxa spiro-[4.5] decane)amine reacted with mercuric acetate. Because the degradation was promoted by bubbling air or oxygen gas into the solution or by adding alpha,alpha'-azobisisobutylonitrile for radical initiation, and the reaction was suppressed by bubbling nitrogen gas or deaerating, the reaction mechanism of the degradation was considered to be oxidation caused by an oxygen radical.

Sarcoidosis accompanied by pancreatic impairment

A 64-year-old male complained of weight loss and slight fever. Bilateral hilar lymphadenopathy and hepato-splenomegaly were observed. Serum ACE level was high, and liver function was impaired. Laparoscopy demonstrated small white nodules on the liver surface. A definite diagnosis of sarcoidosis was made by histological study of the specimen by liver biopsy and noncaseating epithelioid cell granulomas composed of giant cells and epithelioid cells were revealed. Various pancreatic enzymes were increased on admission, suggesting pancreatic impairment due to sarcoidosis. Corticosteroid therapy improved liver and pancreatic functions and decreased splenomegaly. He has been followed up for 4 years and 5 months.

A new focal pattern stimulator under direct observation of ocular fundus

A new focal pattern stimulator was developed. Since this system enables direct observation of ocular fundus during examination, it may be useful for the objective assessment of visual function in patients with various kinds of eye diseases.

Contrast sensitivity for the stationary and drifting vertical stripe patterns in patients with optic nerve disorders

Subjective contrast sensitivity for the stationary and horizontally drifting vertical stripe patterns was measured in normal subjects and in patients with glaucoma, optic neuritis and optic atrophy. Contrast sensitivity was also determined objectively using an eye movement reflex (optokinetic nystagmus) recorded by means of electro-oculography. The contrast sensitivity for the drifting stripe patterns in normal subjects was characterized by a depression of sensitivity at the high spatial frequency and an increased contrast sensitivity at the low spatial frequency in comparison with the results of stationary stripe patterns. The measurement of contrast sensitivity for the horizontally drifting vertical stripe patterns was found to be more sensitive for detection of minor damage to the optic nerve than that for the stationary patterns. The results of the subjective contrast sensitivity and the objective one determined using an eye movement reflex showed a good correlation.

Clinical and pathological features, and the mechanism of development in severe alcoholic hepatitis, especially in comparison with acute type fulminant hepatitis

Among the patients with alcoholic hepatitis, the patients with severe alcoholic hepatitis (SAH) were distinguished by clinical course, laboratory data and histological findings. The aim of this study was to clarify the clinicopathological features, pathological condition and pathogenesis of SAH. Twenty-four SAH patients were compared with 55 patients with acute type fulminant hepatitis (FH) and the other types of alcoholic liver disease. SAH showed a very poor prognosis with a survival rate of 25% and was complicated by multiple organ failure earlier than FH. IgA class lipid A antibody, endotoxin (Et) and tumor necrosis factor-alpha (TNF-alpha) levels in the blood well reflected the pathological condition and severity of SAH. The white blood cell count in the peripheral blood was thought to be the simplest indicator for the prediction of the prognosis of SAH. In conclusion, SAH involves hyper-endotoxemia due to dysfunction of the reticuloendothelial system in the liver, and cytokines including TNF-alpha and neutrophils play an important role in the severity of liver injury.

Neuroepithelial (colloid) cyst of the cerebellar vermis containing a xanthogranuloma

A case of a neuroepithelial cyst of the cerebellar vermis is presented. The cyst contained a viscous fluid and a xanthogranulomatous nodule. The fluid showed high signal on T1- and low signal on T2-weighted MR images. The xanthogranuloma showed mixed intensities with partial contrast enhancement. The correlation of the cyst contents and MR signals is discussed.

Stimulation of the hamster ventral lateral geniculate nucleus induces Fos-like immunoreactivity in suprachiasmatic nucleus cells

The suprachiasmatic nucleus (SCN) functions as a pacemaker for circadian rhythms in rodents. Its activity and, therefore, circadian rhythms, are synchronized by light information from both a direct retinal projection and an indirect projection from the thalamic intergeniculate leaflet (IGL) and ventral lateral geniculate nucleus (vLGN) (geniculohypothalamic tract; GHT). The GHT also appears to be important for synchronizing circadian rhythms to non-photic cues. Light can activate expression of several immediate-early genes in the SCN, including c-fos. We examined whether electrical stimulation of the IGL/vLGN region would induce Fos-like immunoreactivity (lir) in the hamster SCN. Electrical stimulation was given for one hour during the dark period of the lighting cycle. Stimulation at night of the IGL and adjacent LGN regions induced Fos-lir in cells in the SCN. Labeled cells were found in the dorsolateral part of the caudal SCN, and not in rostral or central regions of the SCN, nor in the ventral part of the caudal SCN. These results indicate that activation of cells contributing to the hamster GHT can induce Fos-lir in a restricted region of the caudal SCN.