Klippel-Feil syndrome with conductive deafness and histological findings of removed stapes

The Klippel-Feil syndrome is usually associated with sensorineural hearing impairment, but rarely is it associated with conductive or mixed deafness. A 22-year-old female presented with fusion of the cervical vertebrae, torticollis, scoliosis, pterygium colli, the Sprengel deformity with an omovertebral bone, concavity of the thorax and conductive hearing impairment of the right ear. Tympanotomy disclosed an atrophic long process of incus and a fixation of the stapes footplate, and stapedectomy was performed with immediate postoperative improvement of hearing. However, she developed a sudden hearing loss with dizziness soon after she had physical exercise on the 15th postoperative day, and revision surgery revealed a perilymph fistula of the oval window. Histological investigations of the removed stapes showed no specific osseous changes but hyperostosis of the posterior edge of the footplate. The literature is reviewed and the etiology of the conductive deafness and the perilymph fistula is discussed.

Neuropathological findings of an autopsy case of adult beta-galactosidase and neuraminidase deficiency

An autopsy case of a Japanese male with familial beta-galactosidase and neuraminidase deficiency is reported. The clinical picture was characterized by adult onset, a gargoyle-like face, cerebellar ataxia, myoclonus, convulsions, retinal degeneration and cortical blindness. Histopathologically, most neurons seemed to have become degenerated in the whole cerebral cortex. Moreover, the calcarine cortex appeared spongy with depopulation of nerve cells. Stuffed neurons or neuronal storage changes were found throughout the brain, especially in the motor nuclei of the spinal cord and brain stem. The inclusions in the stuffed neurons revealed various profiles on the electron microscope. They were composed of membranous lamellar and/or multilamellar structures, often accompanying vacuoles and reminiscent of lipofuscin-like profiles.

Hemodynamic effects of salbutamol, an oral long-acting beta-stimulant, in patients with congestive heart failure

As the efficacy of oral long-acting sympathomimetic drugs is not yet well established, we investigated the hemodynamic effects of orally administered salbutamol in eight heart failure patients. Cardiac index, heart rate, blood pressure, and left ventricular filling pressure were monitored for 6 hours after a single oral administration of 4 to 8 mg salbutamol and placebo. In patients who had received salbutamol, a 40% increase in the cardiac index (+0.75 L/min/m2, p less than 0.01) was noted 1 hour post administration; a 44% increase (peak effect) occurred at 2 hours (+0.84 L/min/m2, p less than 0.05); and a significant increase persisted for 6 hours. Changes in heart rate showed a similar time course; however, the increase was less pronounced (+27% at 2 hours). The changes in blood pressure were slight and none of the eight patients developed ventricular arrhythmia or other complications. After placebo administration, no consistent changes in the hemodynamic parameters were noted. The present study suggests that, due to its sustained positive action on cardiac output, the oral administration of salbutamol may be efficacious in ambulatory patients with low cardiac output due to heart failure.

[Left ventricular hypertrophy in hypertensive and athlete's hearts: echocardiographic and vectorcardiographic characteristics]

The difference in the patterns of left ventricular hypertrophy (LVH) between the athlete's heart (Judo player: Judo-Ath group) and the hypertensive heart (HT group) was studied using vectorcardiography and echocardiography. The both groups were classified into two types based on the pattern of a QRS loop vector in the horizontal plane, respectively. One type (type II) satisfied the vectorcardiographic criteria of LVH by Upshaw, and the other (type I) did not satisfy it. The subjects composed of 12 Ath-I, 18 Ath-II, 10 HT-I and 16 HT-II. In the Ath-I, the characteristic vectorcardiogram was demonstrated in the horizontal plane, where an increased amplitude of an initial QRS vector was in the right and anterior direction. A mean ratio of the thickness of the interventricular septum to left ventricular posterior wall (IVSTd/PWTd) was 1.20 (p less than 0.001) in their echocardiograms. In HT-I, on the other hand, a decreased amplitude of an initial anterior vector and an increased amplitude of a posterior vector were observed in the horizontal plane. IVSTd and PWTd did not increase in these patients. These results indicated that an increased amplitude of an initial QRS vector in Ath-I is a reflection of the increased IVSTd. In type II, both IVSTd and PWTd were symmetrically increased. Concerning a spatial maximum QRS magnitude and left ventricular mass (LV mass), there was a significant correlation between the two only in HT-II (r = 0.75, p less than 0.01). It was concluded that there was some vectorcardiographic and echocardiographic differences between the left ventricular hypertrophic patterns of the athlete's heart and the hypertensive heart.

Rearrangement of repeated DNA sequences during development of macronucleus in Tetrahymena thermophila

Three clones of non-repetitive sequences and six clones containing repetitive sequences were obtained from micronuclear DNA of Tetrahymena thermophila. All the non-repetitive and three repetitive sequences had the same organization in micro- and macronuclear DNAs as revealed by blot hybridization. On the other hand, the remaining three clones with repetitive sequences had apparently different organization in the two nuclear DNAs. All these repetitive sequences showed a smear on the blot in addition to a number of discrete bands when micronuclear DNA was digested with EcoR I. In macronuclear DNAs, these sequences invariably became one or two bands and the smear disappeared. We conclude that, when a macronucleus develops from a micronucleus, the non-repetitive sequences amplify by more than 20 times with relatively few rearrangement, whereas some selected portions of repeated and/or repeat-contiguous sequences are amplified with rather extensive reorganization.

Effects of serum, tissue extract, conditioned medium, and culture substrata on neurite appearance from spinal cord explants of chick embryo

The effects of serum, tissue extracts, conditioned medium, (CM), and culture substrata on neurite appearance from spinal cord explants of 6- to 8-day-old chick embryos were investigated. In Eagle's minimum essential medium (MEM) with no supplement neurites from explants did not appear on collagen coating but on polyornithine coating (PORN). It is concluded that cell-to-substratum interaction is important in neurite appearance. CM, serum and tissue extract potentiated neurite appearance, but their activities were highly dependent on the coating. The amount of collagen was also crucial. On collagen, neurite appearance was observed only when promoting substances were present. CM and serum contained at least two components; one affected neurite appearance after deposition on collagen and the other affected neurite appearance when present in the culture medium. The former was included also in tissue extracts. Both of adsorbable and non-adsorbable components from any origin were necessary for effective induction of neurite appearance. Heat treatment and dialysis differentiated these active components. On PORN, CM highly potentiated neurite appearance. The activity of the CM was reproduced by its low molecular weight fraction. Serum also promoted neurite appearance, but to a lesser extent than CM. The effect of tissue extract was not remarkable.

Surface contraction waves in amphibian eggs

Circular waves of change in brightness, known as ‘surface contraction waves’ (SCW-1 and SCW-2), propagate over the animal surface of amphibian eggs at each cycle of cleavage. Movement of carbon particles attached to the egg surface indicated that SCW-1 involves expansion of the egg surface, whereas SCW-2 accompanies surface contraction. Stiffness of the cortex as measured by applying negative pressure through a micropipette increased concomitantly with the passage of SCW-2. Measurement of stiffness at two loci on the egg surface with two sets of pipettes confirmed the spatio-temporal coincidence of the wave of stiffness and SCW-2. The stiffness showed either no change or even a slight decrease on passage of SCW-1. Thus SCW-2 is a genuine wave of ‘contraction’, but SCW-1 can more properly be called a ‘surface relaxation wave’.

Cloning and determination of the transcription termination site of ribosomal RNA gene of the mouse

A Eco RI 6.6 kb DNA fragment containing the 3'-end of 28S ribosomal RNA gene of the mouse was detected by Southern blot hybridization, and cloned in a lambda-phage vector. The site of transcription termination and the processed 3'-end of 28S RNA were determined on the cloned fragment and the surrounding nucleotide sequence determined. The 3'-terminal nucleotides of mouse 28S RNA are similar to those of yeast, Drosophila and Xenopus although the homology was lost drastically beyond the 3'-end of 28S RNA. 45S precursor RNA terminated at 30 nucleotides downstream from the 3'-end of 28S RNA gene. A structure of a dyad symmetry with a loop was found immediately prior to the termination site of 45S RNA. The rDNA termination site thus shares some common features with termination sites recognized by other RNA polymerases.

Assessment of postoperative hearing in 528 middle ear and mastoid surgery cases in Tokai University Hospital

The postoperative hearing results in cases of tympanoplasty, radical mastoidectomy, modified radical mastoidectomy and tympanoplasty combined with modified radical mastoidectomy on 528 ears, performed in the Tokai University Hospital between 1975 and 1980 were assessed. The assessment was based on pure-tone audiograms taken 3 months to 5 years after the operation. Out of 528 cases 70.5% gained better postoperative hearing, 6% showed no change of hearing and 23.5% showed deterioration of hearing. Auditory success of those who attained social hearing, air-bone gap closure to within 20dB or gained hearing of 20 dB or more was 53.4%. The results in cholesteatoma cases were poorer than those of non-cholesteatoma cases. In 44% of the cases, ossiculoplasty was performed, and the most successful ossiculoplasty results were obtained when the malleus was repositioned to the head of the stapes. Fairly good results were achieved when an artificial prosthesis, such as a Teflon-piston, Gelfoam-wire or platinum-piston, was used. The least successful results were found when the incus was transpositioned. In the non-ossiculoplasty group, type I tympanoplasty produced 59.5% auditory success whereas 37.3% auditory success was achieved in radical mastoidectomy. Better auditory success rates were obtained when the bony bridge was preserved than when it was removed. The results were identical in cases where the mastoid cavity was obliterated or when it was kept open. A new technique, "scutumplasty", was used for reconstructing the scutum. Revision surgery was required in only 3.4% of the cases.

[A correlative study of M-mode echocardiograms and pathological findings in mitral ring calcification]

Correlation between pathologically proved mitral ring calcification (MRC) and M-mode echocardiographic findings was examined. Subjects for this study were 36 aged autopsy cases of MRC (14 men, 22 women) with a mean age of 78.9 years. Echocardiographic diagnosis of MRC was based upon the following criteria; a dense echo that moves parallel to the endocardium of the left ventricular posterior wall, immediately posterior to the mitral leaflet and its abrupt termination during a sweep of the beam to the left atrium and left ventricle. The length along the mitral ring and its maximal cross-sectional diameter of MRC were measured pathologically. Extension of MRC to the mitral commissures was also evaluated. The following results were obtained; (1) The larger was the size of MRC measured pathologically, the more it was easily diagnosed by echocardiography. (2) The width of MRC in the echocardiogram correlated well with the pathologically measured maximal cross-sectional diameter of MRC (r = 0.67, p less than 0.01). (3) Sensitivity in the diagnosis of MRC was better in the echocardiograms (58.3%) than in the plain chest X-ray films (38.9%) (p less than 0.05). The length of MRC equal to or greater than 30 mm was diagnosed in all by the echocardiograms. In contrast, only 78.6% of these were diagnosed by plain X-ray films. (4) When cases with MRC were divided into 2 groups according to the mitral diastolic descent rate (MDDR), the decreased group (MDDR less than 35 mm) had a significantly longer length of MRC (32.4 +/- 15.5 mm) than the non-decreased group (16.6 +/- 20.9 mm) (p less than 0.05). Extension of MRC to the mitral commissures was more frequently observed in the group with decreased MDDR than in non-decreased group (p less than 0.005). From these observations, it was suggested that mechanical restriction of the movement of the anterior mitral; leaflet due to involvement of the commissures by MRC may be a contributing factor for decreased MDDR. (5) Identification of echoes from the posterior mitral leaflet and the left ventricular posterior wall was difficult in cases with positive MRC echoes.

Effect of indole on adenylate energy charge and mitochondrial phosphorylative activity of rat liver

1. Luminal perfusion of 5.0 mM indole (0.5 ml/min) in small intestine lowered hepatic adenylate energy charge [(ATP + ADP/2)/(ATP + ADP + AMP)] from 0.85 to 0.80. 2. Liver perfusion of indole (0.5, 5.0 mM) also lowered adenylate energy charge. 3. In liver perfusion experiments, both ketone body ratio (beta-hydroxybutyrate/acetoacetate) and oxygen concentration of the effluent fluid were decreased by infusion of 0.5 mM indole, but they were increased by 5.0 mM indole. 4. In the isolated liver mitochondria system, indole uncoupled oxidative phosphorylation at lower concentrations than 2.0 mM. However, higher concentrations of indole inhibited the electron transport system.

Energy-dependent lysosomal wrapping mechanism (LWM) during autophagolysosome formation

The relation of lysosomes to autophagy, in particular the lysosomal wrapping mechanism (LWM) is investigated ultracytochemically from the viewpoint of demonstrations of energy dependency of the LWM. An induction of the LWM was made in mouse subcutaneous histiocytes by subcutaneous administration of ovalbumin. Prior administration of the inhibitor of glycolysis (2-deoxyglucose) alone and of the oxidative phosphorylation (sodium azide or 2,4-dinitrophenol) alone did not prevent the occurrence of the LWM following ovalbumin administration, but a prior administration of a mixture of 2-deoxyglucose and 2,4-dinitrophenol or 2-deoxyglucose and sodium azide prevented the occurrence of the LWM. These results suggest that in order for the LWM to take place ATP is required as an energy source.

[Study on anterior-pituitary function during pregnancy and puerperium by radioimmunoassay of human FSH-subunits (author's transl)]

In order to observe the anterior pituitary function of pregnant women in terms of FSH secretion, specific and sensitive radioimmunoassays for human FSH-alpha and -beta subunits were utilized for this study. Blood levels of hFSH-alpha during pregnancy increase acutely and the values of the subunits are as follows: 428.0 +/- 92.64 ng/ml (mean +/- SE., 5-10 weeks of gestation), 962.8 +/- 132.5 ng/ml (11-20 weeks), 1889.0 +/- 137.60 ng/ml (21-30 weeks), 2959 +/- 323.40 ng/ml (31-40 weeks). After child delivery, serum levels of hFSH-alpha decreased to 22.92 ng/ml. In contrast, blood levels of hFSH-beta were not altered significantly through gestation. hFSH-beta subunits: 1.97 +/- 0.74 ng/ml (5-10 weeks of gestation), 2.66 +/- 0.52 ng/ml (11-20 weeks), 2.27 +/- 0.52 ng/ml (21-30 weeks), 2.07 +/- 0.37 ng/ml (31-40 weeks), respectively.

beta-Galactosidase-neuraminidase deficiency in adults: deficiency of a freeze-labile neuraminidase in leukocytes and fibroblasts

4-methylumbelliferyl neuraminidase activity was studied in fibroblasts, leukocytes, and frozen tissues from adult patients with beta-galactosidase-neuraminidase deficiency and specific clinical manifestations. This enzyme was almost completely deficient in fibroblasts, but the residual activity was relatively high (20% of the control mean) in the leukocytes from the patients. The frozen liver from one patient showed the enzyme activity as high as controls. This enzyme consisted of two components, freeze-labile and freeze-stable, and it was demonstrated that only the labile enzyme was deficient in fibroblasts and leukocytes. The apparently normal activity of neuraminidase in frozen autopsy tissues of a patient may be explained by the loss of the labile component in control tissues after a long-term freezing. The neuraminidase activity was variable in parents and no definite conclusion was drawn on the hereditary nature of the disease.

[Study on human pituitary gonadotropin synthesis and release during gestation by two steps LH-RF stimulation (author's transl)]

The pituitary gonadotropin response of synthesis and release to two step-stimulation at 60 minutes interval by 100 micrograms of luteinizing hormone-releasing factor was studied by radioimmunoassay of hLH-beta, hLH and hFSH in pregnant women. The immunological affinity of hLH-beta antiserum was 7.9% with hCG-beta, 3.4% with hLH-alpha and 0.41% with LER 907 as compared to 100% with hLH-beta. Serum mean levels of hLH in non pregnant women were 248.5 ng/ml serum before the first injection of LH-RF. The first injection caused an increase in the serum hLH level to 2185.0 ng/ml serum. After the second injection of the hormone, serum hLH levels increased further than the first peak, indicating the "self-stimulating" or "priming" effect of the first LH-RF on the second peak. Serum mean values of hLH-beta in normal menstrual women were 2.60 ng/ml before the first injection. The hLH-beta response to the second injection was significantly greater than to the first. The first peak of hLH-beta was 4.30 ng/ml serum and the second peak was 5.07 ng/ml serum. The FSH response to the second injection of LH-RF was not significantly peaked from that after the first injection. The value of the serum mean levels of hLH-beta during pregnancy were between 0.57 and 0.81 ng/ml and showed no significant increase through two LH-RF stimulations, suggesting that pituitary gonadotropins synthesis and release were depressed during gestation. Thus LH-RF two step stimulation was useful to clarify anterior pituitary function in both synthesis and release of gonadotropin.