Nutritional intake of elite Japanese track-and-field athletes

Mean daily intakes of energy and nutrients were surveyed from 3-day food records for 62 elite Japanese track-and-field athletes (28 males and 34 females) selected to participate in the 1994 Asian Championship games held in Hiroshima, Japan. Mean energy intakes of male and female athletes were 3,141 kcal (+/-592) and 2,508 kcal (+/-537), respectively. Based on the Japanese Recommended Dietary Allowances (JRDAs), long-distance and middle-distance runners had significantly higher energy and macronutrient intakes than did sprinters, jumpers, and throwers. There was no significant difference in micronutrient intake among the different types of athletes. However, of the sprinters, jumpers, and throwers, 15 males (54%) and 22 females (65%) consumed less than the JRDA for at least one micronutrient (i.e., vitamin or mineral). For some athletes, nutritional counseling that provides strategies for increasing food intake is recommended to optimize nutrient intake.

Postoperative residual tumor growth of meningioma can be predicted by MIB-1 immunohistochemistry

BACKGROUND

Meningiomas are benign tumors that can be cured by surgical removal. However, tumors located deeply within or close to vital structures cannot be removed completely and require repeated surgery. This study was designed to clarify whether immunohistochemical study using MIB-1 monoclonal antibody is useful for determining the rate of regrowth for this tumor.

METHODS

Tumor volume doubling time (Td) was measured by using computed tomography or magnetic resonance imaging neuroimages during 29 different follow-up periods after surgery. MIB-1 monoclonal antibody was used to stain Ki-67 proliferating cell antigen in surgical specimens, and the MIB-1 staining index (SI) was determined independently of neuroimaging analysis. These two values and other clinical parameters were analyzed statistically.

RESULTS

The Td values varied from 19-6830 days (median, 350 days); the Td values were <365 days in 15 cases, 365-730 days in 8 cases, and >730 days in 6 cases. There was no significant correlation between age and Td value, but all 6 patients whose Td values were >2 years were age >50. There was a strong inverse correlation between log(Td) and MIB-1 SI (P < 0.001). In three cases, more than three surgical procedures were performed for tumor recurrence. The MIB-1 values did not increase at the time of the first recurrence but increased at later recurrences. The calculated Td values also were not shortened until the second recurrence.

CONCLUSIONS

Using the MIB-1 SI makes it possible to predict the regrowth potential of a tumor after initial surgery.

Genetic engineering of the unsaturation of fatty acids in membrane lipids alters the tolerance of Synechocystis to salt stress

The role of unsaturated fatty acids in membrane lipids in the tolerance of the photosynthetic machinery to salt stress was studied by comparing the desA-/desD- mutant of Synechocystis sp. PCC 6803, which contained monounsaturated fatty acids, with the wild-type strain, which contained a full complement of polyunsaturated fatty acids. In darkness, the loss of oxygen-evolving photosystem II activity in the presence of 0.5 M NaCl or 0.5 M LiCl was much more rapid in desA-/desD- cells than in wild-type cells. Oxygen-evolving activity that had been lost during incubation with 0.5 M NaCl in darkness returned when cells were transferred to conditions that allowed photosynthesis or respiration. Recovery was much greater in wild-type than in desA-/desD- cells, and it was prevented by lincomycin. Thus, the unsaturation of fatty acids is important in the tolerance of the photosynthetic machinery to salt stress. It appears also that the activity and synthesis of the Na+/H+ antiporter system might be suppressed under high-salt conditions and that this effect can be reversed, in part, by the unsaturation of fatty acids in membrane lipids.

Low p27 expression correlates with poor prognosis for patients with oral tongue squamous cell carcinoma

BACKGROUND

p27, a cyclin-dependent kinase inhibitor, regulates progression from G1 to S phase. There have been a few clinical reports of low p27 expression associated with poor survival among patients with cancer; however, there have been no reports of such an association in cases of head and neck cancer. The authors investigated whether p27 expression in patients with oral tongue squamous cell carcinoma was associated with their prognosis.

METHODS

Ninety-four patients with oral tongue squamous cell carcinoma were analyzed. The authors performed p27 immunohistochemistry on all patients and Western blot analysis on 19 available patients. Cox proportional hazards regression analysis that included gender, history of smoking and alcohol usage, presence of multiple primary cancers, stage, histologic grade, and p27 status was used to identify the multivariate predictive value of prognostic factors.

RESULTS

Twenty-six patients had high p27 expression (> or =50% tumor cell nuclei positive), and 68 patients had low p27 expression (<50%) by immunohistochemistry. In those with low p27 expression, N(+) and advanced T (T3 or T4) were significantly higher than in those with high p27 expression (P = 0.02 and 0.04). The 5-year survival rate in the low p27 group was 44%, whereas that in the high p27 group was 68%, indicating a significant difference (P = 0.04). p27 expression was inferred from Western blot analysis, and an arbitrary quantity (<1, 1-5, or > or =5) from the ratio of tumor to normal tissue density was used to characterize, resulting in 8 (42%), 3 (16%), and 8 (42%) patients in the low (<1-fold), intermediate (1-5-fold), and high (> or =5-fold) groups, respectively. Results of immunohistochemical analysis for p27 were significantly correlated with those of Western blot analysis (P = 0.02). Multivariate analysis revealed that low intensity of p27 expression and advanced stage (Stage III or IV) were predictors of reduced survival (P = 0.02 and 0.001).

CONCLUSIONS

Low p27 expression was associated with increasing lymph node metastasis and stage of tumor and resulted in a poor prognosis for patients with oral tongue squamous cell carcinoma. p27 is apparently a significant predictor of survival.

Spontaneous regression of a residual pineal tumor after resection of a cerebellar vermian germinoma

A case of multiple intracranial germ cell tumor in which a pineal tumor regressed spontaneously after resection of the cerebellar mass is reported. Immunohistochemical staining of the cerebellar mass showed that most of the infiltrating lymphocytes were positive for CD3 and CD8. The anti-Ki-67 monoclonal antibody MIB-1 staining of the resected tumor revealed a high MIB-1 positivity ratio (36.1%) among the large tumor cells, and TUNEL staining demonstrated that positivity in up to 6% of the tumor cells. Possible mechanisms responsible for this spontaneous regression including immunological responses and apoptosis induced by T lymphocytes are discussed.

Novel characteristic for distinguishing Lactococcus lactis subsp. lactis from subsp. cremoris

Lactococcus lactis strains were examined for their ability to produce gamma-aminobutyric acid (GABA). Results showed that strains of L. lactis subsp. lactis were able to produce this acid, whereas L. lactis subsp. cremoris were not. GABA production thus represents another effective characteristic for distinguishing L. lactis subsp. lactis from L. lactis subsp. cremoris.

[Efficacy of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans in diagnosis of pulmonary nodules]

To evaluate the value of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans, we performed FDG-PET scans in 23 patients with indeterminate pulmonary nodules less than 3 cm in size and analyzed these scans qualitatively and semiquantitatively. Histologic specimens were obtained by thoracoscopic excisional biopsy in 16 patients, CT-guided needle aspiration cytology in three, and bronchoscopic brushing cytology in four. Pathological diagnoses were lung cancer in 16 patients, benign inflammation in six, and malignant lymphoma in one. Sensitivity, specificity and accuracy of the FDG-PET scans were 88% (15/17), 67% (4/6) and 83% (19/23), respectively. There were two false-positive cases (organizing pneumonia and cryptococcosis) and two false-negative ones (slow-growing adenocarcinoma and malignant lymphoma). Although a few false-positive cases of granulomatous disease were yielded, the FDG-PET scans were highly sensitive in the detection of lung cancer. We conclude that the FDG-PET scanning in a useful diagnostic imaging modailty in the management of indeterminate pulmonary nodules.

Control of epilepsy associated with cerebral arteriovenous malformations after radiosurgery

OBJECTIVE

To investigate the effect of radiosurgery for symptomatic epilepsy associated with cerebral arteriovenous malformations (AVMs).

METHODS

Thirty five patients with unruptured epileptogenic AVMs were studied with a mean follow up of 43.0 months. The duration of epilepsy before radiosurgery ranged from 2 months to 21 years (mean 2.8 years). Fifteen patients showed partial seizures; eight of these had associated secondary generalisation. The remaining 20 patients showed only generalised seizures without preceding focal seizures.

RESULTS

At the final follow up examination, 28 patients remained seizure free, whereas seizures continued in seven. Variables significantly associated with continuity of seizures after radiosurgery were the number of seizures before therapy (p<0.01) and duration of epilepsy (p<0.05). According to Engel's classification, the 10 patients with intractable seizures before treatment included five with grade I, four with grade III, and one with grade IV. The frequency of seizures began to decrease several months after radiosurgery; much shorter than the time required for morphological change in the AVMs.

CONCLUSIONS

Radiosurgery seems to be beneficial for seizure control in patients with unruptured epileptogenic AVM.

Serum and bronchoalveolar fluid KL-6 levels in patients with pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis (PAP) is a disease characterized by the filling of alveolar spaces with periodic acid-Schiff-positive proteinaceous material and by the hypertrophy of type II pneumocytes in the alveolar interstitium. To examine if KL-6, a mucinlike glycoprotein, is useful for the diagnosis of PAP and the estimation of its activity, serum KL-6 levels in patients with PAP were measured by an enzyme-linked immunosorbent assay and compared with those of patients with other lung diseases. Furthermore, to estimate the origin of KL-6 in some patients, measurements of KL-6 levels in bronchoalveolar lavage (BAL) fluid and immunohistochemical staining of the lung tissues with a monoclonal antibody to KL-6 antigen were performed. Serum KL-6 levels in patients with PAP were extremely high and were significantly higher than those in patients with interstitial lung diseases in which elevation of serum KL-6 has been recognized. BAL-fluid KL-6 levels in patients with PAP were higher than serum levels. Both serum and BAL-fluid KL-6 levels in patients with PAP correlated well with the disease activity. Immunohistochemically, positive staining was observed in proliferating type II pneumocytes. These results suggest the usefulness of KL-6 measurement in the diagnosis and estimation of disease activity of PAP.

[A study of neuroleptic malignant syndrome in the presenium and senium]

Recently, with the increase in elderly population, we have had more opportunities to administer neuroleptics to elderly patients for hallucinatory delusional state, delirium, psychomotor excitement, wandering etc. However, little is known about the characteristics of the neuroleptic malignant syndrome (NMS) in elderly patients, which is the most serious side effect of neuroleptics. In this paper, we present the clinical course of five NMS patients in the presenium and senium. Case 1 was 72-year-old male who was diagnosed as having dementia of Alzheimer's type (with late onset). He showed nocturnal wandering, insomnia, and irritability. Tiapride 60 mg per day had been administered previously. Just after the addition of oxypertine 10 mg per day, NMS occurred, and he died of pneumonia a week later. Case 2 was 75-year-old male who was diagnosed as having vascular dementia. He showed insomnia, hyperactivity and wandering. He had been given levomepromazine (LPZ) 10 mg per day over a long period of time. At first, he had daily episodic fever, however, serum CPK levels did not increase at that time. A month later, all the symptoms of NMS appeared and then the patient's condition suddenly deteriorated and he died three days later. Case 3 was a 64-year-old male who was diagnosed as having dementia of Alzheimer's type (with early onset). He showed insomnia, irritability and violence. Tiapride 50-125 mg per day was administered along with oxypertine 50-115 mg per day. Almost two months later, NMS occurred. He had daily episodic fever at first, extrapyramidal symptoms and autonomic instabilities gradually increased. Soon after symptoms of NMS were completed. In this case, NMS seemed to be induced by bacterial pneumonia after long term administration of LPZ 5 mg per day. Case 4 was a 75-year-old female who was diagnosed as having dementia of Alzheimer's type (with late onset). She showed hallucinatory delusional state. Although she had autonomic instabilities just after adminstration of haloperidol 1-2 mg per day, NMS itself occurred after discontinuing the neuroleptic. Case 5 was a 61-year-old female who was diagnosed as having schizophrenia at the age of forty. She was given various neuroleptics over a period of time. The neuroimaging in SPECT showed her cerebral cortex was generally hypoactive. She had a tendency to have autonomic instabilities after the administration of relatively high potential neuroleptics. Risperidone 3-6 mg per day was administered, and almost a month later, autonomic instabilities increased and she was diagnosed as having NMS. All the patients would be able to have brain dysfunction, which suggested that such patients may be liable to NMS. In our patients, NMS occurred after the additional administration of oxypertine 10 mg per day or after long time administration of LPZ 5 mg per day. It was suggested that NMS could occur after the administration of low dose and relatively low potential neuroleptics in elderly patients. Our 3 of 5 patients showed the delayed type of NMS, which might be relatively more frequent in senior and presenior patients than in younger patients. In case 3, NMS was induced by the somatic disease (bacterial pneumonia), however in other cases, NMS was not always induced by somatic disease. Our 4 of 5 patients experienced some of the symptoms of NMS--episodic fever, extrapyramidal symptoms and autonomic instabilities--before the onset of NMS. Such symptoms may be "pre-steps" to NMS. Once NMS occurred, the patient's systemic condition tended to deteriorate acutely. Due to the fact that our 2 of 5 patients died, it was suggested that the prognosis of the NMS patients in presenium and senium tends to be much worse. It is important to find the "pre-steps" to NMS and treat them as soon as possible for better prognosis.

Reliability and validity of a questionnaire for assessment of energy expenditure and physical activity in epidemiological studies

A self-administered physical activity questionnaire (PA-questionnaire) was developed to assess daily energy expenditure and weekly physical activity in epidemiological studies. The Calorie Counter method (CC-method) was administered to 49 male and 32 female volunteers aged 18-64 years, on 7 consecutive days; after the measurement, the subjects were asked to complete the PA-questionnaire (validation study). The PA-questionnaire was completed by 95 males and 119 females (aged 35-73 years) twice with one-year interval (reliability study). The validation study showed that the mean daily energy expenditure estimated by the PA-questionnaire was slightly and significantly (4.5%) lower than that determined by the CC-method for males (p < 0.05); while no significant difference was observed for females (p > 0.05), mean weekly physical activities were similar between the PA-questionnaire and CC-method in males and females. Daily energy expenditures by the two methods strongly correlated with each other: r = 0.56 (p < 0.001) in males and r = 0.67 (p < 0.001) in females. Weekly physical activities by the two methods also strongly correlated with each other: r = 0.68 (p < 0.001) in males and r = 0.69 (p < 0.001) in females. The reliability study indicated that the Pearson's correlation coefficients between two assessments of daily energy expenditure and weekly physical activity over one-year ranged from 0.37 to 0.62 (p < 0.001). These data indicate that the PA-questionnaire has adequate levels of validity and test-retest reliability in assessment of daily energy expenditure and weekly physical activity in epidemiological studies.

[Clinical experience of autologous blood transfusion and fibrin glue in neurosurgery]

Clinical experience of autologous blood preservation on 83 patients and transfusion on 43 patients were reported. When drawing blood, 14 patients whose hemoglobin level was below 13 g/dl (body weight < 70 kg) or 14 g/dl (body weight > 70 kg) received subcutaneous recombinant human erythropoietin injection (s.c.) to facilitate erythropoiesis, according to the internal standard protocol. Hemoglobin levels of all the patients recovered to more than 10 g/dl by the time they were admitted to the hospital, which value would not interfere with general neurosurgical procedures. The injection of erythropoietin did not cause any side effects. Autologous blood transfusion was performed in 43 patients but, in 3 patients, additional homologous transfusion was required because of excessive bleeding. Except in cases with meningioma, postoperative hemoglobin values were identical with preoperative values, indicating that autologous blood transfusion was enough to replace intraoperative blood loss. Autologous fibrin glue was applied in 74 patients. In 70 cases including 55 with skull base surgery, the glue was applied to ensure dural closure. The incidence of cerebrospinal fluid leakage was 16.4% (5 patients) in skull base surgery. This incidence was identical to or less than that in previous reports. The glue was also effective in transposing and fixing offending vessels in 4 cases which received microvascular decompression. As a conclusion, procedures for autologous blood preservation and transfusion were safely performed in neurosurgical cases. Review of the literature was also presented to discuss the advantages and problems to be solved in the future.

Endothelin-1 is a paracrine growth factor that modulates melanogenesis of human melanocytes and participates in their responses to ultraviolet radiation

Endothelin (ET)-1, alpha-melanocyte stimulating hormone (alpha-melanotropin; alpha-MSH), and basic fibroblast growth factor (bFGF) are keratinocyte-derived factors that interact synergistically to stimulate human melanocyte proliferation. ET-1 has a dose-dependent mitogenic effect on human melanocytes and a biphasic effect on melanogenesis: a stimulatory effect at subnanomolar concentrations, and an inhibitory effect at concentrations equal to or higher than 1 nM. Human melanocytes express ET B receptors. Brief treatment of melanocytes with ET-1 caused up-regulation of alpha-MSH receptor mRNA but did not alter ET B receptor mRNA level. ET-1 modulates the response of human melanocytes to UV rays (UVRs). Treatment of melanocytes with 10 nM ET-1 immediately after exposure to UVRs enabled them to overcome the G1 growth arrest. However, ET-1 did not inhibit p53 accumulation or p21(Waf-1/SDI-1/Cip-1) overexpression, nor did it reverse the hypophosphorylated state of pRb or the reduction in Bcl2 level in irradiated melanocytes. These results substantiate the role of ET-1 as a paracrine regulator that modulates the response of human melanocytes to UVRs.

Cardiovascular fitness, physical activity and selected coronary heart disease risk factors in adults

BACKGROUND

The aim was to investigate the associations between cardiovascular fitness and physical activity, and their relationship to selected coronary heart disease (CHD) risk factors.

METHODS

This was a cross-sectional study for one week. All participants were Japanese living in the City of Toyota, Japan. Two hundred and twenty-two healthy Japanese (104 men and 118 women), with ages between 20 and 62 years old. Cardiovascular fitness (VO2max) was measured by a progressive submaximal bicycle ergometry test. Physical activity was estimated by an accelerometers attached to the subject's waist for one week, CHD risk factors included blood pressure, fasting levels of blood lipids, and apolipoprotein concentrations.

RESULTS

Cardiovascular fitness and physical activity were positively related (r = 0.41 in men and 0.65 in women). For both genders, Pearson coefficients as well as age-adjusted partial correlations indicated that fitness was more closely linked to CHD risk factors than activity was. Also, CHD risk factors were analyzed by three groups of fitness and activity levels in both genders, which indicates that subjects who are physically fitter and/or more active tend to have better CHD risk profiles.

CONCLUSIONS

As favorable CHD risk profile was related to cardiovascular fitness, but not to physical activity in both genders, it can be concluded that fitness may be a more important independent predictor for CHD risk factors than activity measured by accelerometer over one week.

Effect of guarana on exercise in normal and epinephrine-induced glycogenolytic mice

The tonic action of water Guarana extract, (Paullinia cupana MART.), was investigated in normal, exercised, and epinephrine-induced glycogenolytic mice. A water extract of Guarana (GW) (500 mg/kg) increased the blood glucose level (p < 0.001) and decreased the liver glycogen contents of mice 60 min after oral maltose administration (p < 0.05). GW also significantly suppressed exercise-induced hypoglycemia (60 min: p < 0.05). However, GW did not affect the blood glucose in epinephrine-induced glycogenolytic and exercise mice. These findings indicate that the suppressive mechanism of hypoglycemia might be due to the promotion of glycogen resolution.

Production of gamma-aminobutyric acid by cheese starters during cheese ripening

Nine mixed-strain starters were examined for their abilities to produce gamma-aminobutyric acid. Six commercial starters were found to produce gamma-aminobutyric acid in a skim milk culture. The bacterium that produced gamma-aminobutyric acid was isolated from the mixed-strain starters, identified as citrate-utilizing Lactococcus lactis ssp. lactis (formerly L. lactis ssp. lactis biovar diacetylactis) and designated as strain 01-7. A cell extract showed glutamate decarboxylase activity, for which the optimum pH was 4.7. In pH-controlled cultivation, gamma-aminobutyric acid was generated at pH 5.0 but not above pH 5.5. Cheeses were prepared experimentally using strain 01-7 to determine the relationship between the pH values and the production of gamma-aminobutyric acid during cheese ripening. gamma-Aminobutyric acid increased linearly in the experimental cheeses as the pH of the cheese decreased. Based on these results, gamma-aminobutyric acid was concluded to be produced by the cheese starters during ripening.

Basal ganglia arteriovenous malformation presenting as "writer's cramp"

A 12-year-old girl with a 3-year history of writer's cramp in association with a basal ganglia arteriovenous malformation (AVM) is reported. The lesion was localized to the left globus pallidus and putamen, extending to the adjacent white matter of the frontal lobe. Our experience confirms a common anatomical basis of symptomatic focal dystonia: disruption of the pathways within and adjacent to these structures. Appropriate imaging should be carried out in patients with unexplained movement disorders.

Clinical evaluation of a leucocyte-depleting blood cardioplegia filter (BC1B) for elective open-heart surgery

Activation of leucocytes during extracorporeal circulation has attracted attention in recent years as a cause of reperfusion injury in open-heart surgery patients. In the present study, 40 adult patients undergoing elective open-heart surgery were randomized into two groups: 20 using the Pall BC1B leucocyte-depleting filter for blood cardioplegia (group 1) and the other 20 without the filter (group 2). In order to determine if the filter was effective in protecting the myocardium, CPK-MB and troponin-T (TnT) were measured. In addition, efforts were also made to determine appropriate sites at which the BC1B blood cardioplegia filter should be positioned. There were no significant differences between the two groups in terms of conditions of perfusion. No adverse effects were seen in either group. The total leucocyte reduction rate through the filter was 98.1% with the passage of 2 liters of blood through the filter. A pressure drop of 4.4 +/- 3.2 mmHg was observed through the filter during use. Statistically significant differences were noted between the two groups in CPK-MB (p = 0.031) and TnT (p = 0.004). Findings obtained in previous studies demonstrate that the various advantages of leucocyte reduction, shown in experimental studies, can be translated into clinical advantages. In conclusion, based on the results in this clinical study showing significant difference in CPK-MB and TnT which are known effective indicators for myocardial injury, between leucoreduced and non-leucoreduced group, the Pall BC1B leucocyte-depleting filter for blood cardioplegia has been shown to be effective in alleviating reperfusion injury in open-heart surgery patients.

[Neonatal intracranial tumor highly suspected of teratoma in the lateral ventricle consisting of multiple cysts: case report]

Neonatal intracranial teratoma is rare and early attempts at surgical treatment are not usually successful. We describe an exceptionally rare case of neonatal intracranial tumor in the lateral ventricle composed of multiple cysts with little mass content which was highly suspected of teratoma and treated successfully by microsurgery. A 55-day-old male was admitted to our hospital with complaints of convulsive seizure. Examination found no obvious neurological deficit except mild enlargement and bulging of anterior fontanel. There were no abnormal laboratory findings. Computerized tomography with contrast medium revealed an 8 cm multicystic lesion with little mass content in the right lateral ventricle and hydrocephalus. Magnetic resonance imaging showed the cystic content as slightly higher in intensity than CSF on the T1-weighted image and of higher intensity than CSF on the T2-weighted image. The cyst wall was enhanced on T1-weighted image with gadolinium. The aqueduct was obstructed by compression due to the intraventricular cyst. A right occipitoparietal craniotomy was performed, which disclosed a hair in the cyst wall, two huge cysts, and independence of the intracystic lesion from the lateral ventricle. The tumor was removed except for a small part adjacent to the pineal region, from which the tumor had presumably originated. Mature teratoma was highly suspected on the basis of the hair in the cyst wall and histological examination of the specimen, which revealed hamartomatous tissues derived from two germ cell layers. After surgery, his hydrocephalus was improved and convulsive seizures were reduced remarkably. He was discharged ten days later and is being followed up. Reoperation will be performed if regrowth of the residual tumor occurs.

Diminished reproduction, failure to thrive, and altered immunologic function in a colony of T-cell receptor transgenic mice: possible role of Citrobacter rodentium

Citrobacter rodentium from an undetermined source was detected in a breeding colony of T-cell receptor transgenic mice housed in a conventional mouse facility in which murine hepatitis virus had been endemic and Helicobacter spp. had been detected. Citrobacter rodentium, isolated from blood, spleen, and colon, correlated with a significant increase in mortality and morbidity in this breeding colony. Transgenic mice of all ages were affected by chronic debilitation, loss in reproductive efficiency, rectal prolapse, and acute death, resulting in the near loss of these noncommercially available strains. Several alterations in immunologic parameters were observed, including outgrowth of an unusual population of cells in the spleen and blood, reduction in ascites production, loss of the capacity of peritoneal exudate cells to serve as feeders for the cloning of long-term T-cell lines, and inhibition of antigen-specific cytotoxic T-cell activity. These altered immune functions also were apparent in commercially-derived nontransgenic mice cohoused with the infected colony and in overtly healthy transgenic and nontransgenic littermates. Citrobacter rodentium and murine hepatitis virus were eliminated ultimately on rederivation of the affected strains by embryo transfer. However, the rapid decrease in the health of the colony necessitated more immediate action. To reduce mortality and allow breeding to continue during rederivation of the transgenic lines, animals were treated with enrofloxacin and moved to a barrier facility. Antibiotic therapy significantly reduced morbidity and mortality, markedly increased litter size and frequency, and resulted in the normalization of many of the immunologic assays. The involvement of C. rodentium in altering viability of the colony and perturbing immunologic assays is suggested by correlation of the onset of the syndrome with the appearance of Citrobacter sp. and its resolution with the elimination of Citrobacter sp. from the colony. Whether infection with Citrobacter alone is causative or whether superinfection of murine hepatitis virus- and Helicobacter-infected mice is required remains to be determined.

Motor activity rhythm in dementia with delirium

Using an actigraph, the activity patterns in 13 demented patients with delirium were examined. We analyzed the data of the eight patients, wearing the actigraphs for more than 10 days. They were classified into four types: type A, nocturnal delirium type; type B, wandering type; type C, hypobulia type; and type D, lying down type. The day to day activity variation was most prominent in type A and seemingly the least in type B. The dominant period of activity rhythm was nearly 24 h in all cases. Additional 12-h period was observed in type C. Actigraphs might become useful in making therapeutic decisions regarding demented patients with delirium.

Study on surgical treatment of intractable childhood epilepsy

We studied the clinical details of 14 children with intractable epilepsies, all of whom underwent epilepsy surgery before age 18 years. All 14 suffered catastrophic seizures, which were resistant to the full range of available medical treatments. The ages at operation ranged from 4 years 7 months to 17 years 2 months, with a mean of 9 years 11 months. In nine patients, the age at onset of epilepsy was less than 2 years. The seizure disorders were classified as temporal lobe epilepsy in two patients, extratemporal lobe epilepsy in 10, and symptomatic generalized epilepsy in two. Eight patients had a hemicorporeal deficit (hemiparesis or hemiplegia) preoperatively. All 14 patients showed localized magnetic resonance imaging (MRI), single photon emission computer tomography (SPECT) and/or positron emission tomography (PET) abnormalities, providing crucial information regarding the epileptic focus. As to the surgical outcomes, four patients became seizure-free and the other 10 showed significant improvement during a mean follow-up period of 2 years 5 months. As to etiology, cortical dysplasia was identified in seven patients. Epilepsy surgery should be considered for intractable childhood epilepsy based on individual clinical characteristics, including seizure status, cognitive development, and evidence indicating location of the seizure focus, rather than age.