[A case of acute cholinergic dysautonomia]

A 52-year-old man with hypohidrosis and selective parasympathetic peripheral autonomic nerve disturbances of acute onset is described. In April 1991, he noted a feeling of dryness in the eyes and the oral cavity, disturbance of taste, difficulty in micturition and a feeling of dryness at the distal extremities with acute onset, which were followed by alternating diarrhea and constipation. Clinical and laboratory autonomic examinations revealed decreased sweating in the distal extremities, decreased lacrimation and salivation, a decrease in the average urinary flow with residual urine and hypersensitive pupillary constriction to the instillation of methacholine. On the other hand, the results of upright tilt testing, the Valsalva test and cold pressor test were all normal, and the plasma noradrenaline level was also normal. Therefore, the diagnosis of acute cholinergic dysautonomia was made. He resumed his clerical work without medication 3 months after the onset. One year and 4 months after the onset, clinical and laboratory examinations showed that hypohidrosis in the distal lower extremities remained unchanged. We found ten patients of acute cholinergic dysautonomia in the literature, and concluded that our patient should be classified as a typical case of this disease. Clinical reports of acute cholinergic dysautonomia are relatively rare, and our patient is the oldest among the reported patients.

Asbestos fiber analysis in seven asbestosis cases

Asbestos bodies and fibers deposited in the lungs of seven asbestosis cases were counted after tissue digestion. The types and sizes of 100 asbestos fibers for each case were also analyzed. Asbestos bodies were counted with an optical microscope at 100x magnification, and asbestos fibers were counted with a transmission electron microscope (TEM) at 2000x magnification. Most asbestos fibers detected with TEM were longer than 3 microns (92.5%) and thicker than 0.1 microns (92.3%). Short fibers less than 2 microns--both chrysotile and amphiboles, as well as long, thin fibers less than 0.06 microns--would be missed at 2000x (TEM). An average of 1.37 (0.081-5.5) x 10(6) asbestos bodies and 164.8 (0.55-610) x 10(6) asbestos fibers per 5 g wet (0.88 g dry) lung tissue were found, and these values are higher than what was reported in mesothelioma cases without asbestosis that were reported previously. More than 13 (average = 266.2) asbestos bodies were found in a 4-micron-thick tissue section (average area = 3.24 cm2). One asbestos body in a section equaled approximately 5,000 per 5 g wet lung tissue. The intensity of fibrosis was minimal in one case, mild in four, moderate and severe in one each, and the intensity was correlated with the number of asbestos bodies and fibers. The fibrosis in the severe case may have been intensified by repeated infection. Crocidolite fibers were found most frequently (84.7%), were thin, and had a high aspect ratio by our counting rules. Crocidolite with a high aspect ratio may be most fibrogenic in the lung.

[A case of acute polyradiculoneuropathy with autonomic disturbances following rubella infection]

A 32-year-old man developed a rash on his body and extremities following acute fever of a few days duration, and also noticed pain and spontaneous tingling sensations in his lower extremities. Because severe pneumonia with dyspnea and low arterial blood oxygen concentration were found on examination, he was admitted and treated. After recovering from pneumonia in two months, he complained of abdominal symptoms, such as constipation, nausea and vomiting, spontaneous tingling sensations in the lower extremities, and orthostatic dizziness and fainting. On neurological examination, a mild to moderate muscle weakness was found in the distal muscles of both extremities. The ankle jerk was absent. Both superficial and deep sensations were moderately to severely decreased in the feet with positive Romberg's sign. Constipation and vomiting with nausea were noted. Clinical and laboratory examinations revealed marked orthostatic hypotension and hypohidrosis. Motor and sensory conduction studies indicated the presence of axonal degeneration and segmental demyelination and remyelination in the limbs nerves. CSF examination indicated that protein was 150 mg/dl and the cell count to be 18/mm3. Titer of antibody to rubella virus was significantly elevated. There were no other abnormalities to indicate the cause of motor, sensory and autonomic neuropathies. Therefore, the diagnosis of acute polyradiculoneuropathy with autonomic disturbances after rubella infection, which is rare in the literature, was made.

[A case of deletion of the short arm of chromosome 18 associated with chronic polymyositis]

A case of deletion of the short arm of chromosome 18 (18p- syndrome) associated with chronic polymyositis is described. The patient was a 37-year-old woman, who had psychomotor retardation in her early childhood. She started to notice a difficulty in raising both arms at 14 years of age and furthermore, she developed a gait disturbance due to weakness of the proximal muscles of the lower extremities from 34 years of age. Her parents were first cousins. On physical examination, she showed many dysmorphic features, such as short stature, round face, hypertelorism, low nasal bridge, small chin, high arched palate, abnormal dentition, short and webbed neck, and broad chest. Neurological examination revealed a low intelligence (IQ 47), severe proximal muscle weakness with moderate proximal muscle atrophy in all extremities, a waddling gait, and decreased or absent deep tendon reflexes of all extremities except for bilateral ankle jerks. Serum creatine kinase and myoglobin levels were slightly elevated. Needle EMG study showed fibrillation potentials at rest and polyphasic and low amplitude motor unit potentials of short duration on volitional activity in the affected muscles. Muscle biopsy demonstrated a variation in fiber size, necrotic fibers and mononuclear cell infiltration. These findings were compatible with those of chronic polymyositis. In addition, cytogenetic findings revealed 46.XX.18p- karyotype, although her parents had no chromosome abnormality. She had no immunological abnormality except for a positive rheumatoid factor and elevation of CD4/CD8 ratio on lymphocyte subset analysis in peripheral blood.(ABSTRACT TRUNCATED AT 250 WORDS)

A basic transthyretin variant (Glu61-->Lys) causes familial amyloidotic polyneuropathy: protein and DNA sequencing and PCR-induced mutation restriction analysis

A new mutation of transthyretin (TTR) has been identified in a patient with late-onset familial amyloidotic polyneuropathy (FAP) of Japanese origin. Peptide mapping by reverse-phase high performance liquid chromatography to compare the patient's TTR with normal TTR showed the presence of an abnormal peptide. Amino acid sequence analysis of the peptide (residues 49-61) showed a lysine-for-glutamic acid substitution at position 61. This substitution, verified by direct DNA sequencing, was the result of a guanine to adenine change on exon 3 of the TTR gene. A polymerase chain reaction-induced mutation restriction analysis (PCR-IMRA) system was established to rapidly detect the missense mutation. TTR-Lys61 is the first variant TTR with a replacement of the acidic with basic amino acid to be found in the amyloid precursor proteins of FAP.

Mutation of the myelin P0 gene in Charcot-Marie-tooth neuropathy type 1

We had previously reported that the myelin P0 gene was responsible for Charcot-Marie-Tooth neuropathy type 1B (CMT1B). In this study we found a different mutation of the P0 gene in a family of Charcot-Marie-Tooth neuropathy type 1 without a DNA duplication in chromosome 17p11.2. The mutation, a histidine substitution for arginine at amino acid position 98, is located in the extracellular domain of P0 like as the mutations in the three pedigrees with CMT1B. The extracellular domain forms an immunoglobulin domain responsible for the function of P0 as an adhesion molecule. Alterations in the tertiary structure of the extracellular domain of P0 would modify the function of P0, resulting in an impairment of peripheral myelin compaction.

Smaller number of large myelinated fibers and focal myelin thickening in mutant quails deficient in neurofilaments

The peripheral nervous system of a mutant of a Japanese quail deficient in neurofilaments (mutant) and of a normal Japanese quail (control) was morphometrically evaluated to characterize the morphological findings, especially those of the myelinated fibers of the mutant. In the proximal peroneal nerves, the frequency of the teased myelinated fibers showing the focal myelin thickening was higher in mutant than in control (P < 0.001) without obvious ongoing axonal degeneration and segmental demyelination. The total numbers of the myelinated fibers in the proximal and distal peroneal nerve, and in the tibial nerve branch to gastrocnemius muscle (pars medialis) were similar between control and mutant, although the number of the large myelinated fibers was less (P < 0.01) and the number of the small myelinated fibers was greater (P < 0.01) in mutant compared with control. The median diameters of neuronal cell bodies of the sacral dorsal root ganglia were similar in control and mutant. The percentages of light, dark and unclassified cells evaluated based on the histologic cytoplasmic features were also similar in control and mutant. Therefore, morphometric alterations were more pronounced in the peripheral myelinated nerve fibers compared with those in the cell bodies of the spinal dorsal root ganglia. We concluded that a smaller number of large myelinated fibers with a greater number of small myelinated fibers and the presence of focal myelin thickening are the main morphologic findings in this mutant, probably due to the arrest of radial growth or maturation of the axons of the myelinated fibers in the absence of ongoing myelinated fiber degeneration.

Sudomotor potential evoked by magnetic stimulation of the neck

We studied the sudomotor potential in the palm of the hand, evoked by magnetic stimulation of the neck, in 15 normal subjects and five patients with dysautonomia. The potentials consisted of two positive peaks (S1, S2), with mean (+/- SD) onset latencies of 408.5 +/- 31.8 and 619 +/- 61.4 msec. The sudomotor potential was clearly obtained only from the palm and was influenced by stimulus intensity, coil position, current direction in the coil, atropine or pilocarpine iontophoresis, and motor effort. With this method, we estimated the postganglionic sympathetic conduction time and the central reflex time, the mean values (+/- SD) of which were 408.5 +/- 31.8 and 323.3 +/- 45.2 msec. In three patients with severe dry skin, the sudomotor potential and the sympathetic skin response were not obtained. A patient with OPCA had a prolonged central reflex time, and a patient with alcoholic polyneuropathy showed a delayed sudomotor potential. Sudomotor potential is a noninvasive and useful method for evaluating sympathetic sudomotor function in patients with central and peripheral nervous system disorders.

Study on digestibility and energy availability of pulses (peanuts and kidney beans) in men

Four male Japanese students were fed a semisynthetic diet that included rice and whole eggs as protein sources for seven days (basal diet period), and in the following seven days (test diet periods), peanuts and then, kidney beans replaced part of the sugar in the basal diet. Urine and feces were collected throughout the periods and the contents of nitrogen, fat and energy in these excreta were determined. The results obtained were: 1) Digestibility of protein was 95.1 +/- 7.9% for peanuts and 84.8 +/- 3.7% for kidney beans. 2) Digestibility of fat was 83.5 +/- 8.5% for peanuts and 82.4 +/- 9.1% for kidney beans 3) The ratio of the total available energy to intake energy (Net Energy Availability) was 86.1 +/- 6.3% for peanuts and 84.8 +/- 3.1% for kidney beans.

[Japanese translation of profile of mood states (POMS)--interpretation of the fifty-six items of mood factors and their application in a manufacturing automotive parts factory]

As in Europe and the USA, POMS is now going to be widely used in the area of occupational health in Japan. However, the Japanese translation of POMS is still not well established. Therefore, in this study, we translated the POMS into Japanese, and using 261 medical students in their last three years of study, we analyzed whether the fifty-six items of the mood factors of POMS are correctly or differently interpreted compared with the classified mood states in the original POMS. The number of the items, differently interpreted at a higher frequency than 20% among the students, was about 20 on the average of three years. Many of the items fell under the heading of "depression-dejection" and "tension-anxiety". The number of items, differently interpreted at a lower frequency than 5% among the students, was about 15 on the average of three years. Many of these items belonged to "vigor". The Japanese translation of POMS was applied to 106 workers engaged in manufacturing automotive parts. Among male and female workers exposed to organic solvents, a positive correlation (P < 0.05) was found between the urinary hippuric acid level and the score of "anger-hostility". Negative correlations (P < 0.05-0.001) were found between the age and each score of "tension-anxiety", "depression-dejection", "anger-hostility", "fatigue" and "confusion". However, no significant difference in the score of any mood factors of POMS was found between the group of sixty-one workers exposed to organic solvents and the group of forty-five workers unexposed.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of asbestos fibers in lungs and mesotheliomatous tissues of baboons following long-term inhalation

Changes in the dimensions of inhaled asbestos fibers in the lung and translocation of intrapulmonary asbestos fibers into mesothelial tissues were investigated in 17 baboons (5 exposed to amosite, 4 to chrysotile, 5 to crocidolite, and 3 unexposed). The animals received different cumulative doses of asbestos by inhalation, followed by varying recovery periods (0-69 months). All asbestos types induced pulmonary asbestosis with severity directly related to the cumulative dose. There were a larger number of asbestos bodies in the lung of the amphibole-exposed animals than in those exposed to chrysotile. A tissue burden study, using transmission electron microscopy on 25-microns paraffin sections, ashed in a low-temperature asher, was performed. Intrapulmonary amosite fibers were shorter in geometric mean length compared with a standard amosite sample (UICC) (3.3 microns). In explanation, it was considered that long fibers might not be able to reach the lower respiratory tract and/or long fibers might be fragmented into shorter fibers. Further, in the amosite-exposed group, the mean length of intrapulmonary fibers increased with the extension of recovery period, suggesting that shorter fibers had been cleared from the lung. The chrysotile standard sample (UICC) had a shorter geometric mean length (1.1 microns) than amosite. The mean length of intrapulmonary chrysotile did not noticeably change with the extension of inhalation and recovery periods; however, the mean width decreased with the extension of these periods. This finding strongly suggested that separation of thick chrysotile fibers had occurred in the lung. The crocidolite standard sample (Transvaal) had a shorter geometric mean length (1.4 microns) than amosite.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute cerebellar ataxia with sympathotonic orthostatic hypotension following Epstein-Barr virus infection--a case report]

A 21-year-old man with acute cerebellar ataxia and sympathotonic orthostatic hypotension, following Epstein-Barr (EB) virus infection, was reported. He noticed unsteady gait 2 weeks after the development of cough, nausea and vomiting. On admission, he was unable to sit and walk due to truncal ataxia and orthostatic hypotension with marked tachycardia. Limb ataxia of moderate degree was also noted. The blood pressure was 112/42 mmHg, and the pulse rate was 64/min in supine position, and 5 minutes after standing, they were 82/42 mmHg and 128/min. In laboratory studies, no atypical lymphocytes were detected in the peripheral blood. However, the titers of antibodies, VCA-IgM, against EB virus, were x80 and x160 in serum, respectively. And the titer of VCA-IgM subsequently decreased to the normal level in two months. They were negative in the cerebrospinal fluid. The results of the autonomic function studies revealed dysfunctions of the sympathetic post-ganglionic nerves, especially of alpha-adrenergic system, with preservation of beta-adrenergic system. He recovered from cerebellar ataxia and from sympathotonic orthostatic hypotension 3 and 8 months after the onset, respectively, without residuals.

Cortical somatosensory potentials evoked by magnetic stimulation of thoracic and lumbar roots

We applied twin coil magnetic stimulation to thoracic and lumbar roots to evaluate the posterior column function in 50 normal subjects and 34 patients with neurologic disorders. In all nine patients with cervical myelopathy, there were abnormal somatosensory evoked potentials (SEPs) with stimulation of upper thoracic levels. In 14 patients with thoracic or lumbar myelopathy, there were normal SEPs with stimulation of spinal roots above the lesions and abnormal SEPs with stimulation below the lesions. In a patient with girdle sensation between T-3 and T-6, the peak latencies of P2 were significantly delayed with stimulation of T-2 and T-4, but peak latencies were normal with T-6, T-10, and L-3 stimulation. Ten patients with polyneuropathy had normal SEPs recorded with thoracic and lumbar root stimulation. SEPs by twin coil stimulation at thoracic and lumbar root levels are useful in detecting lesions of spinal cord or roots and for following their clinical course noninvasively.

Sulfhydryl drugs reduce neurotoxicity of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in the mouse

Striatal levels of dopamine and its metabolites 3-methoxy-4-hydroxy-phenylacetic acid (DOPAC) and homovanillic acid (HVA) decreased 7 days after subcutaneous injection of MPTP (20 mg/kg) to the mouse. Striatal GSH contents decreased and GSSG/GSH ratios increased one hour after subcutaneous administration of MPTP. Pretreatments of both cysteamine (200 mg/kg, s.c.) and dimercaprol (20 mg/kg, i.m.) reduced the MPTP-induced decreases in striatal dopamine, DOPAC and HVA, and also prevented the MPTP-induced decreases in GSH levels and increases in GSSG/GSH ratios. On the other hand, injection of cysteamine did not modify the MPTP-induced decreases in striatal levels of dopamine and its metabolites when it was done 2 hours after MPTP administration. Moreover, pretreatment of cysteamine did not affect striatal concentrations of MPP+ in MPTP-treated mice. These results suggest that sulfhydryl drugs such as cysteamine and dimercaprol may reduce neurotoxicity of MPTP probably via changes in redox cycle of glutathione in the brain.

Polyneuropathy due to ethylene oxide, propylene oxide, and butylene oxide

Axonal neuropathy occurs due to occupational ethylene oxide (EtO) exposure. The experimental model of human EtO neuropathy was established. In addition, the neurotoxic effects of propylene oxide (PpO) and butylene oxide (BtO) were demonstrated in rats. Although no human neuropathy due to PpO or BtO is reported, both chemicals must be considered to be neurotoxic, based on this study.

Axonal sprouting of motor nerve in acrylamide-intoxicated rats with progressive weakness

Quantitative morphologic studies on the motor axons in endplates of extensor digitorum longus muscle (EDL M) and soleus muscle, and on the myelinated fibers of the nerve to EDL M and other lower limb nerves were made on rats showing progressive weakness, intoxicated with acrylamide for 4 weeks (test), using silver staining. Terminal sproutings were significantly greater in frequencies in test compared with control in both muscles. In addition, morphologic changes in test consisted of a significant increase in the number of axon terminal branches and in the frequency of swellings of the preterminal, terminal, and ultraterminal axons and in an increase of myelinated fibers showing axonal degeneration in the nerve to EDL M. Such findings were in contrast with the previous report that cumulative doses of acrylamide inhibit sprouting of motor axons in endplates.

[Cutaneous thermal-cooling and -warming detection thresholds in distal extremities of normal subjects]

The cutaneous thermal-cooling and -warming detection thresholds were evaluated on the dorsal side of the right distal forearm and on the dorsum of the right foot in 134 normal subjects (66 men and 68 women) without sensory symptoms and signs, aged from 11 to 87 years by using a Thermal Threshold Tester (Vickers Medical International, England). The normative data for the clinical evaluation of the severity and the pathologic process of the sensory disturbance of the patients were obtained. The data obtained included 1) the mean of each threshold and 2) its upper limit value of 95% confidence interval for each decade. The mean of each threshold was significantly increased with aging (P less than 0.0001). Therefore, the cutaneous thermal-cooling and -warming detection thresholds of the patients with sensory disturbances should be compared with the normative data adjusted for the age of each subject obtained in this study. Based on the evaluation, repeated six times for three weeks, of each threshold of six volunteers (ages from 21 to 66), high reliability of each threshold (intraclass correlation coefficient from 0.78 to 0.96) was observed.

Inhibitory period following motor potentials evoked by magnetic cortical stimulation

Following motor potentials evoked (MEPs) by magnetic cortical stimulation, there is a transient suppression of muscle action potentials (inhibitory period). We recorded MEPs, the inhibitory period, V1 waves and F waves from the abductor pollicis brevis muscle in 20 normal subjects and in 17 patients with spastic hyperreflexia due to cerebral infarction. The duration of the inhibitory period increased in correspondence with increasing stimulus intensity and did not necessarily depend on the amplitude of the MEPs. The duration of the inhibitory period elicited by a twin coil, which can stimulate the motor cortex locally, was shorter than by a single coil. The mean duration of the inhibitory period was significantly shorter in patients with spastic hyperreflexia than in normal subjects, and it correlated with the amplitude of F waves. The effects of the inhibitory period on V1 waves were different from its effects on F waves in one patient with large V1 and F waves. The amplitudes of V1 waves recorded during the inhibitory period were approximately 30-50% of the maximal amplitude of V1 waves, but F waves were not smaller. The inhibitory period is probably caused primarily by central inhibitory mechanisms.

[The effect of the thyrotropin releasing hormone (TRH) on the motor speech disorder in spinocerebellar degeneration]

A prospective study regarding the effect of TRH on the motor speech disorder of three patients with spinocerebellar degeneration (SCD), the first with hereditary cortical cerebellar atrophy, the second and third with sporadic olivo-ponto-cerebellar atrophy, was performed. The effect was analyzed by using speech evaluation, such as the auditory impression, the questionnaire of the consciousness for verbal communication, the phonetic evaluation and the acoustic analysis. The results of the analysis and the mechanism of the improvement of the motor speech disorder are discussed. Only the first patient showed a remarkable improvement subjectively. In addition, the improvement of phonation and articulation was demonstrated quantitatively in the evaluation of the first patient. On the other hand, by phonation analysis using VISI-PITCH, it was seen that there were a decrease in the perturbation of the voice pitch and an increase in voice range in all three patients. Therefore, it was concluded that the improvement of phonation plays a major role in the improvement of the motor speech disorder. Such improvement of the phonation seems to have resulted from the improvement of coordination, mainly due to the normalization of the muscle tone of the larynx by TRH administration. Although a remarkable beneficial effect of TRH may be obtained in exceptional patients of SCD, the mechanism of such an effect of TRH should be more extensively studied using the quantitative clinical evaluation of phonation and articulation.

Overproduction of voltage-dependent Na+ channels in the developing brain of genetically seizure-susceptible E1 mice

We used E1 mice, a ddY mouse-derived, autosomal mutant strain and a model of hereditary sensory-precipitated epilepsy, to test the hypothesis that epileptic susceptibility may be associated with the activity of voltage-dependent ion channels. We examined the saxitoxin binding capacity of the receptor site 1 of the Na+ channel alpha-subunit, the expression activity of the Na+ channel mRNA, the veratridine-induced 22Na+ influx in the brain synaptosomes, and the regional distribution of Na+ channels in the brain. Compared with control ddY mice, in E1 mice which have not experienced seizures, the number of Na+ channels in the brain synaptosomes increased by approximately 20% starting at the fourth postnatal week through the adult stage as determined by [3H]saxitoxin binding assay. Northern blot hybridization analysis showed excess expression of Na+ channel mRNA (by 30-40%) coincidentally with Na+ channel increases. Regional analysis using the saxitoxin binding assay demonstrated approximately 1.3-fold denser distribution of Na+ channels in the cortex and cerebellum but not the hippocampus and midbrain including thalamus of E1 mice compared to ddY mice. Scatchard plot analysis for saxitoxin binding in the cortex of E1 mouse brains revealed higher maximum binding capacity (Bmax) values (ddY, 4.43 +/- 0.28 pmol/mg protein; E1, 5.43 +/- 0.25 pmol/mg protein) without a change in Kd (ddY, 1.05 +/- 0.03 nM; E1, 1.03 +/- 0.01 nM). Lastly, veratridine-evoked 22Na+ influx, sensitive to tetrodotoxin, was increased approximately 45% in the cortical synaptosomes in six-week-old E1 mice.(ABSTRACT TRUNCATED AT 250 WORDS)

Selective clean-up method using an immunoaffinity column following radioimmunoassay of prostaglandin F2 alpha in biological fluids

A selective clean-up method using an immunoaffinity column followed by radioimmunoassay (RIA) was developed for determining prostaglandin F2 alpha (PGF2 alpha) in human urine and plasma. Polyclonal antibody raised against PGF2 alpha, obtained from rabbits, was coupled to a tresyl-activated support based on a synthetic hydrophilic resin, TSKgel Tresyl-Toyopearl 650M, and used as the stationary phase for the immunoaffinity column. A human urine or plasma sample was introduced to this column, and PGF2 alpha was eluted with methanol-water (50:50, v/v) after the column had been washed. The eluate was subjected to competitive RIA for PGF2 alpha. The cross-reactivities of the RIA to a number of endogenous prostanoids, except PGD2, were negligible and the sensitivity was 4 pg/tube (p less than 0.05), giving a detection limit of 40 pg/ml when 1 ml of plasma or urine was available. The recoveries of plasma and urine samples were 98-108% and 96-106%, respectively, and their assay variances were 7-23%. The concentrations of endogenous PGF2 alpha in plasma and urine used here were estimated to be 72 and 98 pg/ml, respectively. This method should be very useful for various biological samples because of its good specificity, sensitivity, reliability and reproducibility.