[Dystrophia myotonica (Steinert disease)--a frequently misdiagnosed disease]

Dystrophia myotonica (Steinert's disease) is the most common hereditary disease of the neuromuscular system in adults. Its mode of inheritance is autosomal dominant. The gene responsible for its is located on chromosome 19 in the linkage domain of the loci for the apolipoproteins C2, C1 und E and of the creatine kinase of skeletal muscle (CKMM). Myotonic dystrophy is categorized in an adult and in a congenital form. In the adult form, the characteristic findings are muscular atrophy in certain regions of the body (face, neck and distally in the extremities) and myotonia. Cataract, intraocular hypotension, gonadal atrophy, conduction abnormalities in the heart and hearing deficiencies appear quite often in the course of the disease. In the congenital form, general muscle weekness (particularly pronounced in the face) is the leading finding, combined with retarded loco motor and mental development. A decisive criterion for the diagnosis of this form is the occurrence of myotonic dystrophy in the patient's mother. Electromyographic investigation is indicated when a suspicion of myotonic dystrophy cannot be ascertained on the basis of clinical and genetic findings. Myotonic runs in the EMG will then corroborate the suspicion. Recent electrophysiological investigations have indicated that at least three different types of channels for the passage of ions through the membrane of the skeletal muscle cells show abnormal behaviour, i.e. the channel for Cl-, Na+ and K+. These findings corroborate the hypothesis that the abnormality responsible for myotonic dystrophy is situated in the membrane systems. A pharmacological treatment of the muscular dystrophy has not yet been developed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development of a secondary malignant tumor in patients with Hodgkin's disease]

Six out of 204 patients with Hodgkin's disease developed second malignant tumours 25, 30, 61, 65, 68 and 130 months following their treatment. The length of follow-up ranged between 24-233 months with a mean value of 95.8 months. Half of the tumours appeared within the volume irradiated. Five patients received radio- and polychemotherapy, only but one radiotherapy alone. The location of tumours found was as follows: 1 melanoma of the skin, 1 adenocarcinoma of the nasopharynx, 1 cancer of the rectum, 1 renal cell cancer as well as two cancers of the lung. Four patients are living following treatment of their secondary tumour. Until now no case of acute leukaemia could be observed.

The effect of pirenzepine on the functions of human platelets

Despite the very high chemical similarity of pirenzepine (P) to the selected tricyclic antidepressive drugs (TCAD) (imipramine, desimipramine, nortriptyline and amitriptyline), P has a distinctly different effect on platelets, in particular, on serotonin uptake and platelet aggregation. Using two groups of nine healthy volunteers, mean age 27.7 and 27.5 years, respectively, assessment of the two indicators in vitro helped us to eliminate the possibility of a drug induced defect of the two thrombocyte functions, i.e. their aggregation and serotonin uptake. There is therefore, no reason to fear the danger of decreased hemocoagulation in ulcer patients treated with P for gastrointestinal hemorrhage. The results obtained in vivo using two tests which showed the level of platelet activation associated with release of a specific platelet protein (beta-thromboglobulin in platelet-poor plasma) and malondialdehyde in thrombocyte-rich plasma ruled out any changes, specifically their increase, and have disproved any kind of stimulating activity of P on thrombocyte reactivity.

The metabolic effects of acute and chronic administration of gastrozepin

The structure of gastrozepin (G) resembles that of tricyclic antidepressants and antihistaminic and antiserotonic cyproheptadine which are compounds with known metabolic effects. The object of this study was to test the potential action of G on the metabolism of basic nutrients, insulin and selected hormonal parameters after parenteral administration (10 and 20 mg G) and after chronic oral administration (50 mg G) during antiulcer therapy. Investigations carried out in two groups of 7 and 9 healthy volunteers, respectively, and on one group of seven patients with ulcer disease, revealed no changes in any of the blood parameters studied, nor in the excretion of catecholamines or 17-OH steroids in the urine. Our observations practically rule out any metabotropic activity of G, thereby differentiating it from tricyclic antidepressants and cyproheptadine. Isolated significant differences from the basal value seen after G and saline, can be attributed to other than pharmacological or specific mechanisms such as stress associated with the first examination, effect of fasting, individual response of the subjects, and so on.

Muscular infiltration of the limbs in Hodgkin's disease. Report of three cases

Three cases of muscular infiltration by Hodgkin's disease appearing on the limbs are reported. Diagnosis was based on various imaging methods (angiography, computed tomography and ultrasonography) followed by histologic verification in two cases. The pathomechanism of muscular manifestation remains unclear, haematogenous dissemination as well as progression from lymph nodes via lymphatics may be considered. Clinical symptoms were misleading in two cases. Radiotherapy was found effective in management of muscular infiltration.

Nasopharyngeal lymphoid hyperplasia following treatment of patients with Hodgkin's disease

Nasopharyngeal tomography was performed in 64 patients following treatment of Hodgkin's disease. Symmetric soft tissue mass involving roof and lateral walls of the nasopharynx was revealed in 33 cases, of which 24 underwent biopsies from the nasopharynx. Histology of biopsy specimens detected characteristic lymphoid hyperplasia. Its frequency was found to be influenced by the mode of previous treatment. Its occurrence was more frequent amongst those having received total nodal irradiation (TNI) as to those with extended fields irradiation (EFI), the difference proved to be statistically significant. This finding supports our hypothesis that nasopharyngeal lymphoid hyperplasia is a compensatory mechanism evoked by damage of lymphoid tissue due to previous therapy. Nasopharyngeal biopsy or a close follow-up is proposed, depending on the shape of nasopharyngeal mass and the condition of cervical lymph node area.

Plasma beta-endorphin immunoreactivity (PL-beta-ED-ir) in patients with ulcer disease and its management by acute and chronic administration of gastrozepin

The initial level of PL-beta-ED-ir was significantly lowered in a group of 14 patients with gastroduodenal ulcer disease as compared with healthy volunteers (P less than 0.05). Immediately after i.m. administration of 20 mg gastrozepin (G) the PL-beta-ED-ir level increased but not significantly. Given orally over two weeks, G (50 mg/day) led to a more than doubling of the initial level (P less than 0.05). Controls showed no significant changes. A further meaningful change represented the time relationship of PL-beta-ED-ir during 5-hour observation to i.m. administration of 20 mg G before the start and after the end of the 2-week oral therapy. The placebo character of the above findings rules out the absence of any deviations of PL-beta-ED-ir in the diseased and healthy group after i.m. injection of saline. The study deals with the findings in relation to the pathophysiology of ulcer disease, and with a potential interference of G in the interrelation of the cholinergic and endogenous opiate systems.

Clinical value of immunohistochemistry with AF-antibody in the diagnosis of familial amyloid neuropathy

Peripheral polyneuropathy associated with recurrent diarrhoea and orthostatic hypotension was observed in two unrelated German kinships and two sporadic cases. Congo red staining and polarization microscopy of biopsy specimens revealed amyloid deposits. Immunohistochemical investigation using the indirect immunoperoxidase staining with antisera to several purified amyloid fibril proteins showed a positive reaction with an antiserum to the prealbumin-related AF-amyloid in the families and one of the sporadic cases and with an antiserum to the immunoglobulin light chain amyloid (A lambda) in the other sporadic case. Therefore, the amyloid of the families and one of the sporadic cases was identified as the prealbumin-related AF amyloid, while the amyloid of the other sporadic case was of immunoglobulin origin. It is concluded that immunohistochemistry with antisera to the different amyloid proteins is useful in the differential diagnosis of amyloid neuropathy.

Changes in the circadian rhythm of serum iron induced by a 5-day sleep deprivation

The effect of 5 days of sleep deprivation on the circadian rhythm of serum iron was studied in a group of six healthy male volunteers. The results were compared with a control group of five individuals, whose normal sleep cycle was preserved, but whose daily regimen was otherwise identical with the sleep deprivation group. Their biorhythm was processed mathematically using cosinor analysis. Sleep deprivation markedly reduced the mean level of iron, diminished the absolute and relative amplitude of oscillations, disturbed the shape of the daily course of serum iron and gradually decreased the computative acrophase, i.e., shortened the period of rhythm. Forty-eight hours of recovery resulted only in a partial normalization of all the observed changes. The potential mechanisms of the observed changes are discussed.

Johns Hopkins University, Baltimore, Maryland

The STEM can be used in one of three modes: 1) to image individual atoms; 2) to measure mass or molecular weight; 3) to collect electron energy loss spectra or x-ray fluorescence data. Heavy atom imaging is used to identify chemical groups in a molecule or macromolecules in an assembly. Specific labels have been developed for bases in nucleic acids. These permit localization of bound proteins on single strand nucleic acids. Pt(gly-L-met)Cl is a specific label for methionine residues of proteins as shown with the SLS aggregate of collagen. Lysine can be labeled as well if first methyl (methyl-thio-acetimidate) is coupled. This labeling procedure permits the localization of individual histones within a nucleosome. Mass determination can be used to answer crucial questions about biological assemblies. This is demonstrated by examples from muscle structure.

A new type of distal myopathy in two brothers

Two brothers are described with a distal myopathy different from the known hereditary distal myopathies. Early adult onset, beginning in the distal leg muscles with marked elevation of creatine kinase (CK) activity (20 to 30-fold) were the characteristic features. The parents of the patients had no symptoms or signs of myopathy. Their serum CK-activity was in the normal range. There was parental consanguinity, so the distal myopathy in these brothers is probably an autosomal recessive inheritance.

Effects of sleep deprivation on the activity of selected metabolic enzymes in skeletal muscle

The effect of 120-h sleep deprivation on the activity of selected enzymes of energy metabolism in skeletal muscle was studied in seven healthy volunteers. The results showed a significant decrease in the activity of malate dehydrogenase, citrate synthase, glycerol-3-phosphate dehydrogenase and lactate dehydrogenase. Triosephosphate dehydrogenase, hexokinase, and hydroxyacyl-CoA-dehydrogenase activities showed an insignificant decrease. The findings are indicative of (1) decreased aerobic oxidation capacity; (2) reduced function of reducing-equivalent carriers from cytosol across the mitochondrial membrane; (3) relative accentuation of the non-aerobic glycolytic pathway; (4) a prediabetic type of muscle metabolism.

[Glycogenosis caused by amylo-1,6-glucosidase deficiency. Myopathy as a lead finding in adults]

Glycogen storage disease due to amylo-1,6-glucosidase deficiency was diagnosed in a 21-year-old patient. The enzyme defect was demonstrated by biochemical analysis of muscle tissue, the glycogen content of which was typically increased. Investigation of the patient's kindred showed that his 25-year-old sister was also affected. This report sets out to show that in adolescence and in adult life myopathy may be the leading symptom of the disease. Besides the clinical symptoms of muscle weakness and stiffness, an increase in serum creatine kinase usually is found. While an increase in the glycogen content of skeletal muscle has been known since the first description of this glycogen storage disease, it was believed that the glycogen deposits do not cause a clinically relevant disturbance of muscle function. A review of the literature and our own observations show that this assumption has to be at least partially revised. In patients with unclear myopathy who had hepatomegaly during childhood the possibility of glycogenosis due to amylo-1,6-glucosidase deficiency should be considered, especially if symptoms of hypoglycemia are reported. In the patient as well as in his sister marked kyphoscoliosis was present. Whether there is a connection between skeletal deformity and enzyme defect cannot be determined as the patients were available for further studies.