Decreased reactivity to PPD among HTLV-I carriers in relation to virus and hematologic status

Data on human T-cell lymphotropic-virus-type-I (HTLV-I) status and hematology from 528 individuals were analyzed for associations with low reactivity to the purified protein derivative (PPD) of Mycobacterium tuberculosis recall antigen. Subjects were classified as HTLV-I carriers with abnormal lymphocytes (Ably), carriers without Ably, and seronegatives. All carriers had a significant 2.6-fold risk of being low responders to PPD compared with the seronegatives, carriers with Ably having the highest relative risk. Carriers with HTLV-I-antibody titer > or = 1:256, or with other detectable markers of virus status such as antibody to tax and proviral DNA, had increased risk for low response to PPD similar to the estimate for HTLV-I seropositivity alone, compared with the seronegatives. Subjects with a low lymphocyte count had 3.5 times the risk for being low responders to PPD, compared with subjects with high counts. Similarly, subjects with a low monocyte count had 2.0 times the risk for low reactivity of those with a moderate to high count. Results were not confounded by age, sex, smoking or alcohol drinking. Using multiple logistic regression, only HTLV-I seropositivity and low lymphocyte and monocyte counts were predictive of low reactivity to PPD. Analysis indicates that suppression of delayed-type hypersensitivity is associated with HTLV-I infection per se, and not with viral replication or load. Furthermore, this effect may occur in part via changes in the number and function of lymphocytes and monocytes. Such a mechanism may involve altered cytokine production in carriers and concomitant changes in cell populations involved in delayed-type hypersensitivity.

Study on self-recording audiogram of sudden deafness

Self-recording audiograms of sudden deafness in 54 patients were studied for the relationship between type of Jerger's classification, hearing loss at the initial examination, and prognosis of hearing loss. Type I of Jerger's classification was shown in patients with slight to profound hearing loss, whereas Type II + IV was shown more frequently in cases with profound hearing loss. Many patients of Types I and II were among those who recovered completely or markedly, while patients of Type II + IV were found more frequently among those who recovered or had unchanged hearing.

Clinical study of audiograms in the initial stage and fixed stage of sudden deafness

Audiograms in the initial stage and the fixed stage of sudden deafness were analyzed in 79 cases using the following 5 criteria; i) the onset is sudden and time of onset definite, ii) hearing loss at 1 kH is more than 35 dB, iii) the course of hearing recovery is clear, iv) unaffected ear has normal hearing, and v) the first examination and treatment is within 15 days after onset. Consequently, at least in cases receiving treatment within 6-15 days after onset, it was considered that the prognosis of hearing recovery could be established rather than the pattern of hearing loss than by the period of treatment after onset.

Delta-crystallin enhancer binding protein delta EF1 is a zinc finger-homeodomain protein implicated in postgastrulation embryogenesis

We investigated nuclear factors that bind to delta 1-crystallin enhancer core and regulate lens-specific transcription. A nuclear factor delta EF1, which binds to the essential element of the delta 1-crystallin enhancer core, was molecularly cloned from the chicken by a southwestern method. The protein organization of delta EF1 deduced from the cDNA sequence indicated that it has heterogeneous domains for DNA-binding, two widely separated zinc fingers and a homeodomain, analogous to Drosophila ZFH-1 protein. The C-terminal zinc fingers were found to be responsible for binding to the delta 1-crystallin enhancer core sequence. delta EF1 had proline-rich and acidic domains common to various transcriptional activators. During embryogenesis, delta EF1 expression was observed in the postgastrulation period in mesodermal tissues; initially, in the notochord, followed by somites, nephrotomes and other components. The expression level changed dynamically in a tissue, possibly reflecting the differentiation states of the constituent cells. Besides mesoderm, delta EF1 was expressed in the nervous system and the lens, but other ectodermal tissues and endoderm remained very low in delta EF1 expression. Cotransfection experiments indicated that this factor acts as a repressor of delta 1-crystallin enhancer. Possession of heterogeneous DNA-binding domains and its dynamic change of expression in embryogenesis strongly suggest that delta EF1 acts in multiple ways depending on the cell type and the gene under its regulation.

[Clinical views of cases with discontinuity of the ossicular chain]

It is well known that reconstruction for discontinuity of the ossicular chain, without inflammatory disease, has a good prognosis. Eleven cases of congenital ossicular chain malformation without ossicular fixation and 6 cases of ossicular chain injury due to the head trauma or an earpick , were treated surgically. The method of reconstruction and the prognoses, according to short-term and long-term follow up, were studied in these 17 cases. The following results were obtained: 1) In almost all cases, the pure tone audiograms were flat or slightly rising types, and the mean air conductive hearing loss was about 60 dB. Only 2 cases showed the falling type with conductive hearing loss. Connective tissue was observed at the incudo-stapedial joint intraoperatively in these two cases. 2) Mean hearing improvement was in 31.8 dB in the low frequency region (125, 250, 500 Hz), 22.7 dB in the middle frequency region (500, 1000, 2000 Hz), and 12.9 dB in the high frequency region (2000, 4000, 8000 Hz), within 3 weeks after operation, in all 17 cases. 3) No clear changes in hearing level were seen postoperatively, for the four periods evaluated; 1-3 weeks, 1-3 months, 4-6 months and over 7 months in all cases. 4) The cases in whom the reconstruction was performed between the incus and stapes, especially the foot plate of the stapes, showed poor hearing recovery. 5) There was no relation between hearing recovery and the prostheses used in reconstructions. However, it was thought that pieces of the patient's own cartilage or bone should be used whenever possible.

[Intracavitary suction for treating giant bulla]

Examination was made of 9 consecutive patients who underwent intracavitary suction for giant bulla. A second operation was required for one patient who had multiple giant bullae. In the other 8 patients, improvement of pulmonary function and symptoms was obtained immediately following the operation. This was particularly more apparent in patients with poor pulmonary function. The following results were obtained. Functional recovery was evident from the early postoperative phase. A one-stage operation was possible. Reduction in postoperative drainage time was realized by bronchial occlusion. The present operation is particularly applicable to compromised patients. Computed tomography scanning is essential for evaluation of the drainage site. For giant bulla with some septation and multivesicular, the present mode of treatment would not be indicated.

[Indications of G-CSF in patients with drug-induced agranulocytosis]

Bone marrow findings at the onset of disease were analyzed in five patients with drug-induced agranulocytosis to detect simple indices for a determination of the indications G-CSF therapy. Two patients showed severe marrow hypoplasia, extremely low ME ratio and complete absence of myelocytes or more mature neutrophils in their bone marrow. In these cases, the periods for recovery to 500 or more peripheral neutrophils per microliter were 5 and 9 days in a G-CSF-treated patient and a non-treated patient, respectively. On the other hand, the bone marrow of other three patients revealed normal or slightly high cellularity, moderately low ME ratio and appearance of myelocytes and more mature neutrophils. In the latter cases, the periods for recovery to 500 or more peripheral neutrophils were 3 days in all cases, regardless of whether G-CSF was administered or not. These findings suggest that G-CSF should be administered to drug-induced agranulocytic patients with severe marrow hypoplasia, extremely low ME ratio and absence of marrow neutrophilic cells.

Blindness due to non-ketotic hyperglycinemia: report of a 38-year-old, the oldest case to date

We report a 38-year-old woman with a mild form of hyperglycinemia complicated with optic nerve atrophy and convulsion. She was normal at birth and showed normal mental and physical development. After the age of 13, her visual acuity rapidly decreased. At the age of 33, she had numerous episodes of tonic seizures lasting for 1-2 minutes. She had optic atrophy, but no intellectual impairment. Glycine levels of the plasma, urine and cerebrospinal fluid were markedly increased, but the CSF/serum glycine ratio was slightly higher than the normal range. Although there is one case of retinal impairment of hyperglycinemia in the literature, this is the first report of blindness with hyperglycinemia in a 38-year-old woman.

[A case of intrapleural rupture of pulmonary arteriovenous fistula]

The hemothorax due to rupture of arteriovenous fistula is very rare and only 6 cases of this complication have been reported in Japanese literature. 44-year-old male complained of chest pain and dyspnea. A chest roentgenogram revealed right pleural effusion and an abnormal pulmonary shadow. By further examination including pulmonary angiography, the rupture of pulmonary arteriovenous fistula into right pleural cavity was diagnosed. Partial resection of the right lung containing arteriovenous fistula was successfully performed and postoperative course was uneventful.

[Role of glomerular mesangial cells in the regulation of glomerular endothelial cell growth]

Because of difficulties of propagating and cultivating glomerular endothelial cells (GEN), the role of glomerular mesangial cells (GMC) in the regulation of GEN growth is still unknown. We cloned individually GEN and GMC from the same adult bovine kidneys, and a direct coculture system was established to examine the interactions between GEN and GMC. When cocultured with GMC which was growth arrested by mitomycin C, the GEN growth was inhibited by 63% after 8 days of the beginning of coculture. No inhibitory activity was detected when media conditioned by individual culture of GMC. In contrast, media conditioned by GEN cocultured with GMC inhibited bromodeoxyuridine (BrdU) uptake of GEN detected by flow cytometry. Addition of anti-transforming growth factor (TGF)-beta antibody to media conditioned by coculture blocked the inhibitory actions of conditioned media on GEN growth. Western blotting analysis of conditioned media by coculture revealed an existence of TGF-beta in the media. These results indicate that latent TGF-beta is produced by these cells and activated in coculture of GEN and GMC.

[Long-term maintenance of platelets by IFN alpha-2b in a case of chronic idiopathic thrombocytopenic purpura refractory to prednisolone therapy]

A 63-year-old female with chronic idiopathic thrombocytopenic purpura refractory to prednisolone therapy was treated with interferon alpha-2b (IFN alpha-2b). Initially, the patient received 2 courses of short-course therapy in which 1.5 million IU and IFN alpha-2b was subcutaneously injected 3 times a week every other day for 4 weeks. During the first course, the platelet count rose from 1.0 x 10(4)/microliters to 12.4 x 10(4)/microliters 3 weeks after the beginning of the therapy, but the effect was transient. In the second course the platelet-increasing effect was lower than that in the first course. Then, intermittent injections of 3 million IU of IFN alpha-2b once a week were subsequently begun. Consequently, the patient's platelet count has been maintained at 5 to 9 x 10(4)/microliters for more than 19 months since the beginning of intermittent IFN alpha-2b therapy.

[Minitracheotomy]

Twenty-four consecutive patients undergoing minitracheotomy were reviewed. Postoperative sputum retention was the major indication. In one case the procedure was not possible. Nineteen patients made an uneventful recovery, and decanulation was done in 17. In four patients minitracheotomy treatment was discontinued because formal tracheotomy was performed subsequently. This method is much simpler, less invasive, and more advantageous than formal tracheotomy. It can also be used for the patients after median sternotomy. On the other hand, in the patients with misswallowing because of recurrent nerve palsy etc., conventional tracheotomy should be performed.

Sensitivity of polymerase chain reaction assay for Rickettsia tsutsugamushi in patients' blood samples

We developed a nested polymerase chain reaction (PCR) method to detect Rickettsia tsutsugamushi (R. tsutsugamushi) DNA and determined its sensitivity. Primers were selected from the DNA sequence of the 58-kDa group-specific antigen gene of the Karp strain. The target sequence of rickettsial DNA was detectable as the band corresponding to 88 bp in 1.0 microgram of the DNA extracted from BS-C-1 cells infected with R. tsutsugamushi. Rickettsia-specific bands were observed not only for the homologous Karp strain, but also for four heterologous strains: two other reference strains (Gilliam and Kato) and two prototype strains prevalent in Miyazaki district (Irie and Hirano). The minimum copy number detectable by this method was estimated to be five rickettsiae. All of nine peripheral blood mononuclear cell samples from patients with tsutsugamushi disease who were seen 2-11 days after disease onset tested positive for rickettsial DNA. The PCR assay method presented here could be a specific diagnostic tool for tsutsugamushi disease, especially in its early acute stage.

[Progressing cases from low tone sudden deafness to Menière's disease--cochlear impairment in the so-called pre-Menière's disease period]

Among 80 patients with low tone sudden deafness (LTSD) who visited our department over the past 15 years, there were 6 cases (7.5%) who subsequently progressed to Menière's disease. The clinical and audiological processes of the 6 patients were studied in detail and the following results were obtained. (1) In these 6 patients, the time between onset of LTSD and the diagnosis of Menière's disease ranged from 4 months at the shortest to 6 years and 8 months at the longest, 2 years and 9 months on average. (2) Two pattern types were seen in the change from LTSD to Menière's disease: changing within a short period of time after recurrence of an LTSD-like attack, and changing after more than one year without recurrent attack. (3) The monoattack-nonrecovered type of LTSD and the recurrent type of LTSD within three months after the onset (short-term prognosis) frequently progressed to Menière's disease. (4) There were no close relationships between subjective symptoms and audiological features in the pre-Menière's disease period (from the onset of LTSD to the recurrence of vertigo with cochlear symptoms). (5) The 6 patients showed various audiogram shapes at the time of progression to Meniere's disease; 3 cases with the slightly rising type, 1 with the high frequency-impaired type, and 2 with the moderate, gradual and flat type. (6) Of the 6 patients, 3 had good hearing during long term observation. At least 2 patients seemed to have the mild type of Menière's disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Review of pharmacologic treatment of tinnitus

Recent research on the pharmacologic treatment of tinnitus is reviewed, emphasizing studies in which controls have been used. Several double-blind cross-over studies have found that lidocaine can reduce tinnitus in about 50 to 75 percent of subjects. Unfortunately, it cannot be used clinically because it must be administered intravenously and its effects are very brief. Other drugs have been much less successful. A few controlled studies have found success rates between 33 and 56 percent using oxazepam, clonazepam, sodium amylobarbitone, flunarizine, and eperisone hydrochloride. None of these studies have been replicated, however. Closely controlled studies using specified etiologic subgroups with subjective and objective psychophysical measurements are needed.

High HTLV-I proviral DNA level associated with abnormal lymphocytes in peripheral blood from asymptomatic carriers

The level of proviral DNA in peripheral blood mononuclear cells from a representative group of asymptomatic HTLV-I carriers in Miyazaki district, an HTLV-I endemic area in Japan, was determined by a single-cycle polymerase chain reaction method (PCR). Of 217 subjects, 26% had a high level of proviral DNA, 43% a medium level, 18% a low level, and 13% an undetectable level. In the high-DNA group, 60% had at least 0.6% abnormal lymphocytes on peripheral blood smears, significantly higher than in those with low DNA levels (19%). This association was present for men of all ages and for women under 55. Men were more than twice as likely to have abnormal lymphocytes as well as high levels of proviral DNA. These differences may reflect different host responses to the virus by sex or by the time or route of infection. This study supports the utility of PCR for molecular screening in epidemiologic studies of the natural history of HTLV-I, and may lead to the identification of those carriers who are at greatest risk of developing HTLV-I-induced malignancy.

Comparison of the properties of ribonucleases in human liver tissue and serum

Two ribonucleases (RNases) with acidic pH optima were partially purified, one from normal human liver tissue and the other from serum. The properties of the two enzymes were studied and compared. Liver RNase was partially purified about 700-fold by acid fractionation, phosphocellulose column chromatography, Sephadex G-75 gel filtration, and polyguanylate affinity column chromatography. Serum RNase was purified about 1200-fold by phosphocellulose column chromatography and Sephadex G-75 gel filtration. The two RNases showed a similar optimal pH and molecular mass, and similar behaviour towards metal ions, but they differed in their substrate specificity. Liver RNase displayed a higher activity towards polyuridylate (poly(U)) than towards polycytidylate (poly(C)), while serum RNase hydrolysed poly(C) more rapidly than poly(U). These findings suggest that liver RNase is not the primary source of the serum RNase with an acidic pH optimum.

Prevalences of hepatitis B surface antigen carriers and liver damages in the general population of Hisayama, Japan

The prevalences of hepatitis B surface antigen (HBsAg) carriers and liver damages were studied in 2,411 residents aged 40 and over and living in Hisayama, Japan in 1983. Hepatitis B virus (HBV) associated markers were all measured by radioimmunoassay. HBsAg carriers were found in 2.3 per cent of the residents. Hepatitis B e antigen and antibody to hepatitis B e antigen were positive in 8.9 per cent and 80.4 per cent, respectively, of HBsAg carriers. The prevalences of liver damages in HBsAg carriers were compared with 1095 who had none of HBV markers (neither anti-HBc nor anti-HBs). The prevalences of abnormal aminotransferase level in sera were not different between HBsAg carriers and those who had none of HBV markers. A history of jaundice and/or hepatitis was evident in 32.3 per cent of male carriers and 24.0 per cent of female ones, being significantly more than those without HBV markers (13.1 per cent and 5.8 per cent, p less than 0.05 and p less than 0.005, respectively). These results indicate that, among HBsAg carriers aged 40 and over, few have active clinical signs of hepatitis, although about 20 per cent of them have histories of symptomatic hepatitis due to hepatitis B.

Exposure to hepatitis B virus in the general population of Hisayama, Japan: significance of isolated antibody to hepatitis B surface antigen in general population

Cross-sectional survey on the prevalence of hepatitis B serological markers was performed in 2,411 residents who accounted for 74.4% of the population aged 40 and over and living in Hisayama Town, Japan, in 1983. Overall prevalences were 40.7% for both anti-HBs and anti-HBc, 6.1% for isolated anti-HBs and 5.4% for isolated anti-HBc. The condition with isolated anti-HBs was different from those with isolated anti-HBc and both anti-HBc and anti-HBs as follows. The titer of anti-HBs in isolated anti-HBs positive samples was significantly lower than that in both anti-HBs and anti-HBc positive ones (46.2 +/- 5.4 vs. 83.2 +/- 2.8, mean +/- SE, p less than 0.001). The presence of isolated anti-HBs was neither significantly more frequent in males nor related to the risk of liver damages in contrast with that of anti-HBc with or without anti-HBs. These findings suggest that isolated anti-HBs pattern with the absence of anti-HBc in general population was not due to prior HBV infection, but due to natural immunization with HBsAg.

[Study of tinnitus masking by self-recording audiometer]

The tinnitus masking test, in which the minimum masking levels of tinnitus by various pure tones and band noises are measured and used to produce tinnitus masking curves, is one of the methods for evaluating the character of tinnitus. At present, the tinnitus masking test is usually performed using a pure tone audiometer. In this study, tinnitus masking curves were produced using a self-recording audiometer (Bekesy audiometer) in 22 cases of tinnitus, and the basic nature of the tinnitus masking curves from the self-recording audiometer was investigated and compared with those from a pure tone audiometer. The results showed no changes in the masking level, and the amplitudes of the tinnitus masking curves from the self-recording audiometer were observed to be at the tinnitus pitches. The amplitude of the tinnitus masking curve showed a negative correlation with tinnitus loudness as measured by the loudness balance test for tinnitus, that is, the amplitude tended to decrease as the tinnitus became louder. This suggests that the loudness of the masking tone influences the tinnitus masking phenomenon.

Successful graft of HTLV-I-transformed human T-cells (MT-2) in severe combined immunodeficiency mice treated with anti-asialo GM-1 antibody

To develop an experimental model of adult T-cell leukemia/lymphoma in small animals, severe combined immunodeficiency (SCID) mice treated with anti-asialo GM-1 antibody were inoculated with MT-2 cells, a cell line transformed by the human T-cell leukemia virus (HTLV-I). Three mice injected with 4 x 10(7) cells subcutaneously or intramuscularly developed tumors at or near inoculation sites. Immunofluorescent antibody (IFA) staining for HTLV-I structural protein, p19, revealed the specific antigen in the cytoplasm of most cells from tumors and the DNA signals of HTLV-I proviral DNA were also positive in cellular DNA by polymerase chain reaction assay with HTLV-I tax gene primers, SK43/SK44. The MT-2 cells did not invade in mouse organs.

Familial primary biliary cirrhosis associated with impaired concanavalin A-induced lymphocyte transformation in relatives. Two family studies

The familial occurrences of biochemical and immunological abnormalities and histocompatibility antigens were studied in 18 healthy first-degree relatives of patients with primary biliary cirrhosis (PBC) in two families. In each of these two families, there were two members who suffered from PBC. All relatives had normal serum aspartate aminotransferase, alkaline phosphatase, bilirubin, total cholesterol, and immunoglobulins except the two, who had a mild elevation of alkaline phosphatase without cholestasis. Autoantibodies were present in some relatives; five (28%) for antithyroglobulin antibody and antithyroid microsomal antibody, one (6%) for antimitochondrial and antinuclear antibody, and one (6%) for rheumatoid factor. Abnormalities of T or B lymphocytes in peripheral blood were detected in two (11%) relatives. Impairment of concanavalin A-induced lymphocyte transformation determined by ethidium bromide fluoroassay was found in seven (39%) relatives, although an abnormal response for phytohemagglutinin was detected in none of the relatives. The HLA haplotypes were not necessarily associated with positive autoantibodies or impaired concanavalin A-induced lymphocyte transformation in these families. These findings suggest that impairment of concanavalin A-inducible lymphocytes (mainly suppressor T cells) is one of the contributing factors in the development of PBC.

[Review of the evaluation criteria for low tone sudden deafness]

Low tone sudden deafness (LTSD) has the three following features; obscure origin, acute or sudden onset and sensorineural hearing loss limited to low frequencies without vertigo. Twenty LTSD patients with total hearing levels at low frequencies (125 Hz, 250 Hz, 500 Hz) from 70 dB to 95 dB (Group A) and 19 LTSD patients (typical LTSD) with levels above 100 dB (Group B) were studied. All patients visited our department within one week after onset. All presented over the past 3 years and were followed up for two years or more after initial examination. The clinical parameters such as incidence, subjective symptoms, the configuration of the audiogram and the prognoses of patients in the two groups were investigated comparatively. The following results were obtained. (1) Patients in their twenties were more frequently affected in group A, but patients aged 20 to 50 were equally affected in group B. (2) Females were more frequently affected in both groups, remarkably so in group B. (3) Hearing disorders frequently occurred after an upper respiratory tract infection and stress in both groups. (4) Fullness of the ear, tinnitus and hearing disturbance were common chief complaint and subjective symptoms in both groups. (5) The configuration of the audiogram seemed to be variable within each group and between the two groups. (6) The ratios of recurrent type to monoattack type were almost the same and the patients had good prognoses in both groups. From the results mentioned above, both groups were considered to belong to the same category of LTSD.(ABSTRACT TRUNCATED AT 250 WORDS)

Marked reduction of cerebral oxygen metabolism in patients with advanced cirrhosis: a positron emission tomography study

Regional cerebral blood flow (rCBF), cerebral metabolic rate of oxygen (rCMRO2), and oxygen extraction fraction (rOEF) were measured using positron emission tomography (PET) in four patients with cirrhosis (two males and two females, aged 57 to 69 years) in comparison with those in five age-matched controls with previous transient global amnesia. PET studies were carried out when the patients were fully alert and oriented after the episodes of encephalopathy. In the patients, rCBF tended to be lower, while rCMRO2 was significantly lowered in almost all hemisphere cortices, more markedly in the frontal cortex. Our results suggest that the brain oxygen metabolism is diffusely impaired in patients with advanced cirrhosis, and the frontal cortex seems to be more susceptible to the systemic metabolic derangements induced by chronic liver disease.