Magnetic resonance imaging findings in Japanese encephalitis. White matter lesions

Ten patients with Japanese encephalitis diagnosed by serological criteria underwent magnetic resonance imaging (MRI) in axial and coronal sections. In 6, a second MRI study was done. The MRI findings were compared with the clinical outcome. Four patients died within several months of onset, 2 had sequelae such as hemiparesis and dementia, and the remaining 4 had no sequelae. In 9 of 10 patients, either diffuse or patchy white matter lesions were observed bilaterally, together with abnormalities in areas such as the thalamus, basal ganglia, and brainstem. For 3 patients who died or remained demented, the second MRI revealed extensive, diffuse white matter abnormalities. This study indicates that Japanese encephalitis can produce white matter involvement, although gray matter structures such as the thalamus, basal ganglia, and brainstem are more severely affected. The severity of these MRI lesions correlated with the clinical outcome.

Production and secretion of adrenomedullin from vascular smooth muscle cells: augmented production by tumor necrosis factor-alpha

In this study, we demonstrate production and secretion of adrenomedullin (AM) from cultured vascular smooth muscle cells (VSMCs). In addition to endothelial cells (ECs), we found immunoreactive (ir-) AM in culture media of rat and bovine VSMCs in the survey for AM-producing cells. Although the secretion level of ir-AM was at most 1/6 that of rat ECs, all the examined VSMCs were shown to produce AM. By gel filtration, reverse phase high-performance liquid chromatography, and biological characterization, ir-AM in the culture medium was identified to be rat AM of 50 residues. By RNA blot analysis, a positive band of AM mRNA was detected in cultured VSMC at an intensity 3-4 fold higher than that in adrenal gland. Gene expression and production of AM were markedly augmented by tumor necrosis factor-alpha. Based on these data as well as the presence of AM specific receptors on VSMCs, AM secreted from VSMC is deduced to function as an autocrine or paracrine regulator in vascular cell communication.

Cruciate retained and excised total knee arthroplasty. A comparative study in patients with bilateral total knee arthroplasty

A comparative study of posterior cruciate ligament retention and excision was conducted in patients who underwent bilateral total knee arthroplasty using the total condylar modifier prosthesis. The posterior cruciate ligament was excised in one knee and was retained in the other knee in 28 patients. Postoperative results were assessed using the Hospital for Special Surgery Knee Evaluation Score. In addition, stair activity was tested to determine whether there was preferential dependence on one of the two knees. There was no significant difference between the posterior cruciate ligament retained or excised knees in terms of postoperative Hospital for Special Surgery Knee Evaluation Score. Patients who ascended and descended stairs with one leg at a time tended to prefer the posterior cruciate ligament retention side. Those who could use each leg in sequence to go up and down stairs, however, did not show preferential dependence on either knee.

Differentiation of herpes simplex virus 1 and 2 in cerebrospinal fluid of patients with HSV encephalitis and meningitis by stringent hybridization of PCR-amplified DNAs

Differentiation of herpes simplex virus (HSV) types 1 and 2 in cerebrospinal fluid of 17 patients with serologically diagnosed HSV encephalitis and meningitis or acute limbic encephalitis was determined by stringent hybridization of polymerase chain reaction--amplified DNAs. Ten of 17 patients were positive; six with HSV 1 isolates and four with HSV 2 isolates. We detected HSV type 1 in two cases of meningitis, although meningitis is generally thought to be caused by type 2. Additionally, HSV type 2 was found in one case of acute adult encephalitis, which is generally due to HSV type 1. HSV DNAs could be detected for over 1 month after onset, although our patients included several prolonged and recurrent cases. HSV DNA genomes were not detected in three cases of acute limbic encephalitis. Our study indicates that this method can be used for type differentiation in HSV CNS infections.

Tosulfloxacin versus norfloxacin for prevention of infections in chemotherapy-induced neutropenic patients

We conducted a non-randomized, prospective study comparing the efficacy of tosulfloxacin with that of norfloxacin in preventing bacterial infection during chemotherapy-induced neutropenic episode. Fifty-one patients with hematological malignancies were included, and a total of 108 episodes of neutropenia were studied. There was no significant difference between the two groups in the incidence of fever, in the time-to-event analysis of febrile episodes nor in the incidence of gram-positive bacteremia despite the broader spectrum of tosulfloxacin. The incidence of gram-negative bacteremia was lower in patients treated with the quinolones as a prophylactic than in the historical controls given polymyxin B. Especially the incidence of bacteremia due to Pseudomonas aeruginosa was significantly less when tosulfloxacin was used. A possible synergistic effect of sulfamethoxazole-trimethoprim in preventing the febrile episode was also observed.

[Hepatitis B virus antibody positive spastic paraparesis]

We present here thirteen patients (5 men and 8 women, aged 31 to 73, mean 55 years) with spastic paraparesis who showed clinical features similar to those of HTLV-1 associated myelopathy without HTLV-1 antibody, but with positive antibody to hepatitis B virus (HBV). All of these patients showed slowly progressive difficulty in walking. Five patients had previous histories of blood transfusion, of these one with history of B hepatitis. Neurologically, muscle weakness, spasticity and exaggerated deep tendon reflexes in the lower extremities were common to all the patients. Seven patients showed Babinski's reflex. Disturbance of micturition was noted in 3 patients. None showed organic changes of the spine on magnetic resonance image (MRI). None was serologically positive for syphilis and had cryoglobulin and hypergammaglobulinemia. Elevated levels of the liver enzymes were noted in two patients. All patients were positive for hepatitis B surface antibody (HBs-Ab) (EIA) but negative for hepatitis B surface antigen (HBs-Ag) (EIA). Five patients were seropositive for hepatitis C virus (HCV) (PHA). In 3 of them, reverse transcriptase polymerase chain reaction was performed but failed to detect HCV-RNA. All patients underwent spinal tap, and showed normal cell count and protein concentration in their cerebrospinal fluid (CSF). Atypical cells were not observed in all the patients. The CSFs from three patients were tested for HBs-Ag and HBs-Ab. HBs-Ag was negative in all three patients, but HBs-Ab was positive in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonequilibrium air clathrate hydrates in Antarctic ice: a paleopiezomdter for polar ice caps

"Craigite," the mixed-air clathrate hydrate found in polar ice caps below the depth of air-bubble stability, is a clathrate mixed crystal of approximate composition (N2O2).6H2O. Recent observations on the Byrd Station Antarctic core show that the air hydrate is present at a depth of 727 m, well above the predicted depth for the onset of hydrate stability. We propose that the air hydrate occurs some 100 m above the equilibrium phase boundary at Byrd Station because of "piezometry"--i.e., that the anomalous depth of hydrate occurrence is a relic of a previous greater equilibrium depth along the flow trajectory, followed by vertical advection of ice through the local phase-boundary depth. Flowline trajectories in the ice based on numerical models show that the required vertical displacement does indeed occur just upstream of Byrd Station. Air-hydrate piezometry can thus be used as a general parameter to study the details of ice flow in polar ice caps and the metastable persistence of the clathrate phase in regions of upwelling blue ice.

The effects of orally administered Y-25130, a selective serotonin3-receptor antagonist, on chemotherapeutic agent-induced emesis

The antiemetic effects of orally administered Y-25130, a potent and selective 5-HT3-receptor antagonist, were compared with those of ondansetron, granisetron, metoclopramide and domperidone. Y-25130 (0.1-1.0 mg/kg) dose-dependently prolonged the latency to the first vomiting and decreased the number of vomitings induced by cisplatin in dogs. The antiemetic effect of Y-25130 against cisplatin-induced vomiting was more potent than that of metoclopramide and ondansetron, but it showed little difference from that of granisetron. The emesis induced by the combined treatment of doxorubicin and cyclophosphamide was also inhibited by Y-25130 (0.1-1 mg/kg) in ferrets. The antiemetic effect of Y-25130 was more potent than that of metoclopramide, almost the same as that of granisetron and less potent than that of ondansetron. Because of a notable difference of potency ranking between Y-25130 and ondansetron in these two tests, a third test was performed to evaluate the inhibitory effect of Y-25130 in ferrets on cisplatin-induced emesis in comparison with that of ondansetron. The antiemetic effect of Y-25130 on cisplatin-induced emesis in ferrets was very similar to that of ondansetron. Domperidone did not inhibit these cytotoxic agents-induced emeses. These results suggest that Y-25130 is an orally active antiemetic compound against cisplatin and doxorubicin/cyclophosphamide-induced emeses; and its the antiemetic potency is similar to those of granisetron and ondansetron, but superior to those of metoclopramide and domperidone.

[Myokymia]

Myokymia is one of the involuntary movements, which is characterized by undulatory muscle spasm, similar to the worm's crawl. Sometimes muscle pain, itchy sensation, dysautonomia and other symptoms are associated with it. Cases showing normal neurological findings are rare. Myokymia is caused by various diseases, such as, multiple sclerosis, hypothyroidism, Guillan-Barre syndrome and so on. Generally myokymia is classified into two types, i.e. limb myokymia and facial myokymia according to the site. On the other hand, myokymia with hyperhidrosis is known as Issacs syndrome. There are many opinions about the pathogenesis and mechanism in the myoneural junction, peripheral nerve or spinal cord, however these are not established. Further investigation of myokymia is expected.

Murine chromosomal location of four class III POU transcription factors

A family of mouse genes encoding class III POU transcription factors consists of four members: Oct-6, Brn-2, Brn-1, and Brn-4. In accordance with mouse nomenclature, these loci have been designated Otf-6, Otf-7, Otf-8, and Otf-9, respectively. While the four genes share a highly conserved class III POU domain, the remaining regions are considerably diverged from each other. The POU domains of these transcription factors recognize the octamer-motif sequence and possess a similar DNA-binding specificity. Chromosomal mapping has demonstrated that the four genes are unlinked: Otf-6 is located on the distal region of chromosome 4, Otf-7 on the proximal region of chromosome 4, Otf-8 on chromosome 1, and Otf-9 on the X chromosome.

A mouse homologue of the Drosophila tumour-suppressor gene l(2)gl controlled by Hox-C8 in vivo

The homeobox is a 183-base-pair DNA sequence originally found in Drosophila segmentation and homeotic genes. In Drosophila, homeotic genes are clustered in the Antennapedia and Bithorax complexes, collectively called the homeotic gene complex (HOM-C). In the mouse genome, about 40 homeobox genes (Hox) are clustered in four chromosomal regions (Hox A to D). The Hox genes are arranged in the same order and have the same anteroposterior pattern of expression as their structural homologue in the HOM-C, suggesting that they control mouse pattern formation in the same way that HOM-C members do in Drosophila. Homeobox gene products are believed to be transcription factors that regulate expression of target genes. A few candidate target genes have been identified in Drosophila by various approaches but the Hox gene targets are poorly understood, mostly because of limitations in the available approaches. Here we identify several candidate Hox gene targets, including a mouse homologue of the Drosophila tumour-suppressor gene l(2)gl, by immunopurification of DNA sequences bound to a Hox protein in native chromatin.

[Treatment of sepsis by extracorporeal elimination of endotoxin using fiber-immobilized polymyxin B]

To remove endotoxin directly from the blood, an affinity adsorbent (PMX) has been developed. PMX is composed of a ligand of polymyxin B and a carrier of polystyrene fibers. We treated 16 patients, suffering from septic shock or multiple organ failure by PMX-F hemoperfusion. The pretreatment level of endotoxin decreased significantly from 80pg/ml to 21pg/ml on average 2 hours after the hemoperfusion. The hyperdynamic status in the cardiac index and the decreased systemic vascular resistance, which are characteristic to endotoxin shock, were normalized after the treatment. In septic shock patients with systolic pressure under 10mmHg, the systolic pressure increased significantly from pretreatment level. Nine of the sixteen patients remained alive for two weeks after the therapy, and seven out of the nine patients discharged alive. Hemoperfusion with PMX is likely to become an effective treatment for sepsis and septic shock.

[Familial cases of spastic paraparesis, mental disturbance and thinning of the corpus callosum]

We reported a family in which two brothers and one sister out of five siblings were affected by a neurological disease showing the following clinical manifestations: 1) intellectual disturbance with relative preservation of memory and orientation probably developed on child food, 2) spastic paraparesis beginning at the age of about 20 years, 3) mild peripheral neuropathy and cerebellar sign. Their clinical courses were stereotyped, and so much the worse in elder patients. Two of them were investigated in detail. Laboratory findings including chromosomal analysis, amino acid analysis and thyroid function were normal. HTLV-1 antibody was negative. Several lymphocytes lysosomal enzymes including beta-hexosaminidase and arylsulfatase A and serum very long fatty acids were also within normal range. CT and MRI showed characteristic thinning of corpus callosum, dominant in anterior portion. However, changes in intensity of white matter in T2 weighted image were not so prominent. In the older patient, more mentally deteriorated, were demonstrated hypoperfusion in the fronto-parietal lobes by SPECT and slow wave bursts dominant in the same region by EEG. Therefore, we considered that the change of corpus callosum was hypoplasia, but not atrophy, and it may provoke dysfunction of relevant nervous system. Family cases of such clinical feature were rare. We could confirm only three families in literatures, all of them were Japanese.

Crosslinking of proteins in acetylcholine receptor-rich membranes from Torpedo californica: relation of 43-kD protein and Torpedo dystrophin to acetylcholine receptor

We examined the spatial relation of 43-kD protein and Torpedo dystrophin, which are cytoplasmic peripheral membrane proteins in the nicotinic acetylcholine receptor (AChR)-rich membranes, to AChR. We used three kinds of the heterobifunctional crosslinking reagents to crosslink proteins in the AChR-rich membranes. Products crosslinked by SMPB (14.5 A span) including 43-kD protein and Torpedo dystrophin appeared at the tops of the stacking gels at the concentrations of 8.89 x 10(-5)M to 8.89 x 10(-3)M SMPB. High molecular weight materials (crosslinked products) increased with increasing concentrations of the crosslinker. On the other hand, band intensity of alpha, beta, and delta subunits of AChR remained unchanged up to a concentration of 2.67 x 10(-3)M SMPB, while the band of gamma subunit diminished at the same concentrations as did that of the 43-kD protein. Torpedo dystrophin was also crosslinked at the same concentrations as were effective for the 43-kD protein and gamma subunit. On the basis of these results, we conclude that the 43-kD protein is intimately associated with the gamma subunit of AChR and Torpedo dystrophin.

[A relationship between the annual onset day of Japanese cedar pollinosis and pollen dispersion]

A statistical analysis of the annual day of onset of Japanese cedar pollinosis was carried out on a total of 305 patients seen at the out-patient clinic for allergic diseases in the Department of Otorhinolaryngology of Kyoto Prefectural University of Medicine between 1989 and 1991 (3 years). The day of onset varied among individuals and was distributed over a period of about one month, in patient number statistics, however, a clear single peak was seen for all 3 years. The day of onset in most patients showed tendency to peak after January 1, i.e., when the maximum temperature integral is approximately 450 degrees C, on warm days where the maximum temperature exceeds 15 degrees C, on days where there is little rain, and on days when there is a strong southerly wind. This peak onset day is about 3 weeks after first day of pollen count, or 3 or 4 days before the first dispersion peak, which corresponds to the day on which pollen dispersion begins in earnest. Furthermore, it was found that there was a drastic increase in the attack rate (from 10% to more than 50%) in pollinosis patients about 1 week before the peak day of onset. By the first dispersion peak, 70-80% of the patients had experienced an attack. The results of the present study may be useful in pollen forecasting and in treating early pollinosis in the dispersion season.

Neurotoxin-binding activity in the supernatant fraction of the electric organ from Torpedo californica

We found neurotoxin-binding activities in the supernatant fraction obtained by ultracentrifugation of a homogenate of the electric organ dissected from the electric ray, Torpedo californica. While about half of the activity was estimated as due to acetylcholine receptors in dispersed microparticles, the remainder was unassigned. A part of the latter, detected with alpha-bungarotoxin, eluted ahead of the alpha-bungarotoxin-acetylcholine receptor complex on a Sepharose CL-6B column in the presence of 1% Triton X-100. Another component eluted after this complex. Although these activities were immunologically related to AChR, they were different from AChR in their size and reactivity with Concanavalin A. We are currently seeking to characterize these toxin-binding components at present. The existence of such activities is interesting since they may possibly function in regulating signal transduction at the neuromuscular junction.

Detailed structural analysis of asparagine-linked oligosaccharides of the nicotinic acetylcholine receptor from Torpedo californica

The structures of the major oligosaccharide moieties of the nicotinic acetylcholine receptor (AcChoR) protein from Torpedo californica have been reported [Nomoto, H., Takahashi, N., Nagaki, Y., Endo, S., Arata, Y. and Hayashi, K. (1986) Eur. J. Biochem. 157, 233-242] to be high-mannose types. Here we report detailed analyses of the structures of the remaining oligosaccharides in this receptor. The sialylated oligosaccharides released by glycopeptidase (almond) digestion were separated according to the number of sialic acid residues using high-performance anion-exchange chromatography with pulsed amperometric detection. After removal of sialic acid from each fraction, the resulting neutral oligosaccharides were separately pyridylaminated and were analyzed by a combination of sequential exoglycosidase digestion and HPLC, then identified on a two-dimensional sugar map. The structures of two desialylated pyridylamino-oligosaccharides were further analyzed by high-resolution proton NMR. Each oligosaccharide was composed of species containing varying numbers of sialic acids. The desialylated complex-type oligosaccharides of AcChoR consisted of ten, eight and one different biantennary, triantennary and tetraantennary oligosaccharide, respectively. The biantennary oligosaccharides were divided into two groups; oligosaccharides with fucose at the proximal N-acetylglucosamine (six varieties) and oligosaccharides without fucose (four varieties). Each group consisted of species differing in the number of terminal galactose residues. The major component of the biantennary oligosaccharides had two galactose residues at the non-reducing termini. The terminal alpha-galactose residue(s) linked to C3 of beta-galactose were found in the fucose-containing biantennary oligosaccharides (two varieties). The triantennary oligosaccharides were also divided into two groups; oligosaccharides with (four varieties) and without (four varieties) besecting N-acetylglucosamine. These groups were composed of species differing in the number of terminal galactose residues. The major component of the triantennary oligosaccharides was fully galactosylated with three galactose residues. An unusual group, Gal beta 1-3GlcNAc, was present in low levels in the triantennary oligosaccharides. In contrast, the tetraantennary oligosaccharide was composed of only one species, which is fully galactosylated with four galactose residues.

Detection of varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid of patients with herpes zoster meningitis

In three of five patients with herpes zoster meningitis, varicella-zoster virus (VZV) DNA was detected by the polymerase chain reaction (PCR) in the initial samples of cerebrospinal fluid. DNA fragments of group A or B, following classification of VZV strains by the size of the variable region IV of VZV genome, were found at the 7th, 10th and 24th illness day in the three positive cases: one of these cases did not have skin lesions. These results suggest that the detection of VZV DNA by PCR is useful for the diagnosis of herpes zoster meningitis, as well as for its molecular epidemiology.

Relapsing acute disseminated encephalomyelitis associated with chronic Epstein-Barr virus infection: MRI findings

A 25-year-old women had a fever, left cervical lymphadenopathy, neurological symptoms and signs, CSF pleocytosis and persistent high serum antibodies to the Epstein-Barr virus (EBV); she had a recurrence 1 year later. She was thought to have relapsing acute disseminated encephalomyelitis associated with chronic EBV infection. MRI revealed abnormalities, mainly in the right basal ganglia and left midbrain. At the time of the recurrence, further abnormalities appeared in the opposite basal ganglia and right cerebral white matter.

[A patient with lambda type light-chain disease associated with Crow-Fukase syndrome and autoimmune thrombocytopenia]

A 67-year-old woman, who presented polyneuropathy, pleural effusion, ascites and sclerosing changes in the ribs, was admitted to our hospital on June 17, 1987. On admission, cerebrospinal examination showed a marked protein-cell dissociation and a delay in nerve conduction velocity. Bence-Jones protein was detected in urine, and the immunohistochemical study of biopsied bone marrow of the rib revealed lambda-chain positive plasmacytoma. Serum immunoelectrophoresis, however, showed no monoclonal gamma-globulinemia. From the findings described above, she was diagnosed as having Crow-Fukase syndrome associated with lambda-type light chain disease. Even with a therapy by prednisolone, platelet counts progressively declined to 10,000/ml3. Bone marrow aspiration showed normal number of megakaryocytes. Since platelet-associated IgG was increased to 452 ng/1.0 x 10(8) plt, a diagnosis of autoimmune thrombocytopenia was considered. Melphalan and cyclophosphamide to plasmacytoma resulted in a marked improvement of platelets. In addition, the level of platelet-associated IgG returned to normal range. Polyneuropathy, however, didn't respond to those therapies. It was suggested that both Crow-Fukase syndrome and thrombocytopenia were closely concerned with plasmacytoma but developed in a different manner.

[HIV infection of CD4-CD8+ T-cell line derived from patients with HAM]

This studies have attempted human immunodeficiency virus (HIV) infection in four CD4+ or CD8+ T-cell lines derived from HTLV-I associated myelopathy virus (HAM) patients. Not only CD4+ cell line but also CD8+ cell line could be infected with HIV and CD4+ cell line showed a higher susceptibility than CD8+ cell line on HIV infection. HIV antigen in early stage after HIV inoculation was detected by using enzyme-linked immunosorbent assay (ELISA) rather than indirect immunofluorescence assay (IFA). HTLV-I producing CD4+ and CD8+ cell lines became to express two viral antigens (HTLV-I and HIV) after HIV inoculation. The results indicated that CD4-CD8+ T-cell line from patient with HAM can be infected with HIV. So that, we have found that other epitopes except for CD4 antigen may be associated with HIV infection.

[Primary pulmonary artery sarcoma showing multiple HDA on the brain CT--an autopsy case report]

A 67-year-old female suddenly developed a speech disturbance and right hemiplegia. She was diagnosed as having cerebral infarction. Then 2 months later, she had a fever and disturbance of consciousness. She died of respiratory insufficiency. The brain CT showed multiple high density areas with niveau. The autopsy revealed primary pulmonary artery sarcoma and multiple metastasis to the brain, the small intestine, etc. Primary pulmonary artery sarcoma is a very rare tumor which can occur in the pulmonary trunk of a person from any age groups. This case is a very rare one with cerebral metastasis.

The antiemetic profile of Y-25130, a new selective 5-HT3 receptor antagonist

Y-25130( (+/-)N-(1-azabicyclo[2.2.2]oct-3-yl)-6-chloro-4-methyl-3-oxo-3,4-dihydro - 2H-1,4-benzoxazine-8-carboxamide hydrochloride) is a potent and selective 5-HT3 receptor antagonist free of dopamine receptor blocking activity. This compound was effective against emesis induced in animals by cytotoxic drugs or by total body X-radiation. When given prophylactically, the doses required to completely inhibit cisplatin-induced emesis in dogs and doxorubicin and cyclophosphamide-induced emesis in ferrets were 0.1 and 0.3 mg/kg i.v., respectively. Y-25130, at the dose of 0.3 mg/kg i.v., almost completely inhibited X-radiation-induced emesis in ferrets. When given during emesis, the doses required to completely inhibit cisplatin-induced emesis in dogs and doxorubicin- and cyclophosphamide-induced emesis in ferrets were 0.1 and 0.3 mg/kg i.v., respectively. The i.v. dose of 0.3 mg/kg of Y-25130 was enough to almost completely inhibit cisplatin-induced emesis in dogs for 24 h. From these results, it is suggested that Y-25130 may become an effective antiemetic drug against emesis induced by anticancer therapy.

Experimental haemarthrosis in rhesus monkeys: morphometric, biochemical and metabolic analyses

The effects of a single episode of massive haemarthrosis in rhesus monkeys were studied. Autologous whole blood was injected into a femorotibial joint of 16 anaesthetized monkeys, equally divided into four groups and killed 7 days, 2, 3 and 6 months post-injection (PI). Synovial membrane and femoral articular cartilage were analysed morphometrically and articular cartilage was further analysed biochemically and metabolically. At 7 days PI, morphometric evaluation revealed a significant increase (P less than 0.05) in synovial membrane cellularity and synovial intimal thickness of injected joints versus control joints. This change was no longer evident 2 months PI. There was also an overall (n = 16) significant increase (P less than 0.05) in femoral articular cartilage cellularity in injected joints. The average chondrocyte lacuna area of injected joints was not statistically different from the control joints. Biochemical analyses of femoral articular cartilage revealed a significant decrease in hexosamine concentration (P less than 0.05) of injected joints. There was no significant difference between the injected and control joints in hydroxyproline or total protein concentration. Metabolic analyses revealed a significant increase (P less than 0.05) in cartilage collagenous protein production by injected joints compared with control joints. There were no significant differences in cartilage or secreted total protein production between injected and control joints. There were also no significant differences in cartilage or secreted proteoglycan production between joints. Morphometric evaluation of articular tissues following massive haemarthrosis has quantified a temporary hyperplastic reaction. A significant decrease in cartilage hexosamine concentration in haemarthrotic joints suggests this is a crucial biochemical event in the pathogenesis of blood-induced cartilage destruction.

[A case of leptomeningeal carcinomatosis: demonstration of CA19-9 and CEA positive malignant cells in the CSF and particular elevation of CA19-9 level in the CSF]

A 44-year-old male was admitted for diplopia, headache and gait disturbance. Neurological examination revealed the meningeal irritation sign, the Vth, VII, VIth, IXth and the Xth nerve palsies and cerebellar ataxia of all four limbs. Laboratory studies carried out on the day of admission demonstrated the elevation of serum levels of both tumor markers, carbohydrate 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The estimated serum concentrations of CA19-9 and CEA were 39.4 U/ml and 81.1 ng/ml, respectively. The cerebrospinal fluid (CSF) contained 9 cells/mm3 which consisted of the mixture of malignant cells with appearance strongly suggestive of poorly differentiated adenocarcinoma and of hemosiderinphagocytizing macrophages. Detection of both CA19-9 and CEA in the tumor cells in the CSF was undertaken by the avidin biotinylated peroxidase complex method by use of monoclonal antibodies against each marker. As the results the following findings were obtained. Namely, although all the tumor cells isolated from the CSF were found to contain both tumor markers, CA19-9 and CEA, there was found a difference in the concentration ratio in CSF vs serum between the markers. The estimated concentration of CA19-9 (61.4 U/ml) in CSF was approximately 1.6 times higher than that in serum. On the other hand, the CSF concentration of CEA remained constantly very low (1.1 ng/ml) as compared with that in the serum throughout the whole course of the disease. In response to intrathecal administration of cytarabine and brain irradiation, the CSF cytological findings became normal and concomitant decrease in the concentration of CA19-9 was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuroimaging findings (ultrasonography, CT, MRI) in 3 infants with congenital rubella syndrome

Neuroimaging observations of three infants with congenital rubella syndrome are reported. We have observed congenital rubella syndrome lesions in the subependymal area, the basal ganglia and the deep white matter. Cranial ultrasonography defines subependymal cysts, calcification and possible vascular changes in the basal ganglia while MRI is the most sensitive to minor atrophic changes and white matter lesions. Although CT defines calcification, it is less sensitive than MRI to white matter changes and does not demonstrate subependymal cysts.

CT and MR imaging of acute cerebellar ataxia

An adult female showed mild cerebellar ataxia and CSF pleocytosis following an acute infection of the upper respiratory tract, and was diagnosed as having acute cerebellar ataxia (ACA). CT and MR appearances in the acute stage revealed moderate swelling of the cerebellum and bilaterally increased signal intensity in the cerebellar cortex.

A case of Marfan's syndrome phenotype associated with neurogenic muscle atrophy

A 23 year-old man was admitted because of weakness and atrophy in both tights. He was 184 cm in height with arachnodactyly and had a mild dilatation of the ascending aorta which was detected by cardiac echogram and chest CT scan. A laboratory examination revealed normal serum values for mucopolysaccarides and amino acids, and 46XY chromosomes. These findings indicate a Marfan's syndrome phenotype. A neurological finding showed a proximal dominant muscle atrophy and increased deep tendon reflexes. The EMG revealed a polyphasic action potential, and a subsequent muscle biopsy demonstrated a small group atrophy and atrophy of Type II fibers. Neuroradiological studies of brain and spinal cord indicated no substantial abnormalities. Only 4 cases of Marfanoid habit accompanied by primary nervous system disturbances have been reported and these had variable complications or severe neurological deficits. The present case, which involved mild neurogenic muscle atrophy and brisk deep tendon reflexes without complications except myopia, was unique.

GM1 ganglioside reduces edema and monoaminergic neuronal changes following experimental focal ischemia in rat brain

Seventy-two hours following a middle cerebral artery occlusion, the associated increase in water content on the ischemic side was significantly reduced by the exogenous administration of monosialoganglioside GM1 (30 mg/kg, i.p.). The levels of dopamine and serotonin on the ischemic side were approximately 50% and 80% of those on the contralateral non-ischemic side, respectively. Treatment with GM1 (5 times during the first 48 h after occlusion) produced a significant reduction in the levels of dopamine and serotonin loss. The present findings are compatible with the observed protective action of the exogenously administered GM1 following ischemic brain injury.

Energy consumption in paraplegic ambulation using the reciprocating gait orthosis and electric stimulation of the thigh muscles

The energy consumption of six thoracic paraplegic persons ambulating in the reciprocating gait orthosis (RGO) with and without functional electric stimulation (FES) of their thigh muscles was determined as a function of walking speed. Plots of Kcal/kg-min and Kcal/kg-m vs walking speed in the RGO and RGO & FES were experimentally determined in this study and compared with the energy cost of walking in the long leg brace (LLB), the hip guidance orthosis (HGO), and an FES walking aid from data available in the literature. The RGO powered with electric stimulation of the thigh muscles required the lowest energy expenditure in Kcal/kg-m across the full range of walking speeds. The RGO, HGO, LLB, and FES walking orthoses ranked second, third, fourth, and fifth respectively. The lowest energy costs in Kcal/kg-min were associated with the RGO & FES, followed by the RGO, HGO, LLB, and FES for walking speeds below .28m/sec. At walking speeds higher than .28m/sec the HGO demonstrates lower energy cost followed by the RGO & FES, RGO, FES, and LLB. At the end of a 30-m walk, patients using the RGO & FES had a mean heart rate (HR) which was 12 beats/min less than the mean HR when using the RGO without FES, 31 beats/min less than the HR when using the LLB, and 42 beats/min less than the HR when using FES only. It was concluded that the FES-powered RGO combines the advantages of a passive mechanical orthosis with those of FES to provide substantial improvements in energy cost which may provide paraplegic persons with a mode of independent ambulation superior to the wheelchair.

Factors affecting postoperative flexion in total knee arthroplasty

In the review of 67 cases with total condylar (TC) prostheses, 59 with TC posterior stabilizers, 70 with TC prostheses modified with flat posterior tibial plateau, and 35 with porous-coated arthroplasty (PCA) prostheses, multiple cross-examinations of various factors for postoperative flexion were performed. Follow up was 2 to 9 years. In nearly all cases, no further improvement of flexion was noted after 1 year following surgery. The most influential factor for good postoperative flexion was intense physical therapy, leading to good suprapatellar pouch reconstitution. Residual flexion contracture was more frequent when the posterior cruciate ligament (PCL) was retained in the cases with significant preoperative flexion contracture. However, retention of PCL or preoperative ACL condition did not bear any significance to the ultimate flexion.

The effects of prenatal protein-energy malnutrition on ossification of fetal rat bones: a biochemical study

In fetal rats whose dams were fed a low-protein diet, 35S sulfate uptake into the growth plate of the long bone and rib was higher than in the control group. The elution pattern of guanidine-HCl extract in gel chromatography revealed that the malnourished group had more high molecular weight proteoglycans in the dissociative condition and a larger aggregated portion in the associative condition than did the control group; however, the same chondroitin-sulfate chain size existed. Calcium content did not differ in both groups. Aggregated proteoglycan or a high molecular weight proteoglycan that existed in the malnourished group probably played an inhibitory role in calcification. Prenatal protein-energy malnutrition may delay the change of proteoglycan character, which could affect mineralization of fetal bones.

Full flexion after total knee replacement in rheumatoid arthritis

The results of the Y-S total knee replacement are reported in 152 patients with rheumatoid arthritis (227 knees). The follow up was from 2 to 4 years (average 2.7 years). The good range of motion generally achieved was attributed to the use of a calibrated distractor for soft tissue balancing, a tibial prosthesis with a flattened plateau and extensive postoperative rehabilitation. Fourteen patients (27 knees) were able to squat fully after operation. A good range of motion before operation was related to a good range after operation. The range and overall results did not differ in patients with rheumatoid arthritis or osteoarthritis. The knees which recovered full flexion were no different from those with less than full flexion as far as stability and radiographic findings were concerned.

Electromyogram power spectra frequencies associated with motor unit recruitment strategies

The isolated contributions of motor unit recruitment and firing rate variations to the median frequency of the electromyogram's power density spectrum were determined. Orderly stimulation of the cat gastrocnemius motor units via nerve electrodes gave rise to linearly increasing median frequency regardless of the action potential firing rate of the active motor units. Increase in the discharge rate of all the motor units resulted in nearly constant median frequency. It was concluded that the increasing average conduction velocity during motor unit recruitment is the major contributor to variations in the electromyogram median frequency. The possibility of using the median frequency as the index to identify the recruitment control strategies employed by various muscles during increasing force contraction is suggested.

A follow-up study by CT and MRI in 3 cases of Japanese encephalitis

A follow-up study by CT and MRI in 3 cases of Japanese encephalitis (JE) was performed. Neurologically dementia, forced laughing, tetraplegia and parkinsonism were observed as sequelae. In the CT and MR scans about 3 years after the onset of JE, low-density areas (LDAs) or abnormal signal intensities had remained in the thalamus and basal ganglia. The abnormalities were also found in the brain stem. When the main lesions shown by CT and MRI were compared with those of the acute stage, T2-weighted MRI clearly revealed multiple small areas with high signal intensities, although those in the acute stage had shown diffuse abnormal signals. These findings may be useful in helping to identify JE a long time after the onset.

[Neuroleptic properties of Y-20024, a new benzofurancarboxamide derivative]

N-[(1-butyl-2-pyrrolidinyl)methyl]-2-methyl-5-sulfamoyl-2,3- dihydrobenzofuran-7-carboxamide hydrochloride (Y-20024) was synthesized in our laboratories in anticipation of developing a new psychotropic drug. In the present study, the pharmacological properties of Y-20024 were compared with those of sulpiride (SPR) and haloperidol (HPD). Administered orally, Y-20024 was 10 times stronger than SPR in inhibiting apomorphine (0.5 mg/kg, s.c.)-induced hyperactivity in mice; administered intravenously or intracerebroventricularly, it was 2 times or one third as strong, respectively. Y-20024 was almost equipotent to SPR in antagonizing apomorphine (0.1 mg/kg, s.c.)-induced vomiting in dogs. Combined with methamphetamine (5 mg/kg, i.p.), Y-20024 and SPR induced mortality dose-dependently in rats, but HPD did not. The mammotropic activity of Y-20024 administered orally once a day for 5 days was almost equipotent to that of SPR. From these results, Y-20024, pharmacologically similar to SPR, but superior in bioavailability and penetration through the blood brain barrier, may have potential usefulness as an antipsychotic drug.

The RGO Generation II: muscle stimulation powered orthosis as a practical walking system for thoracic paraplegics

The RGO Generation II reciprocating gait orthosis was jointly developed by Louisiana State University Medical Center and Durr-Fillauer Medical, Inc, to overcome four problems encountered with the existing model: 1) The high energy cost of locomotion; 2) the great arm strength required for patients to stand up from the seated position without assistance; 3) difficulty (especially for patients with hamstring contracture) in remaining standing owing to failure of the knee latch to lock except in full extension; and 4) problems in balancing when ambulating on an incline. The RGO Generation II employs concurrent electrostimulation of the rectus femoris and hamstrings to assist in rising and balancing and a ratchet-type latching device to improve safety and stability in standing. Alternating stimulation of the rectus femoris and contralateral hamstrings are used for locomotion. Testing in six patients with thoracic paraplegia demonstrated an average 30+% reduction in energy expenditure at a walking speed of .05 m/s and a 15+% reduction at .37 m/s; improved mobility and better balance on inclines; and unassisted rising in all patients. Walking range was increased from an average of 100 m to an average of 800 m. More research is needed to provide stair-climbing ability and to further reduce energy expenditure.