IL-5 mRNA expression in blood lymphocytes from patients with Kimura's disease and parasite infection

Blood lymphocytes from patients with eosinophilia are known to produce interleukin-5 (IL-5) with appropriate stimulation in vitro. To determine whether blood lymphocytes from these patients produce IL-5 in vivo, we tested the IL-5 mRNA expression in blood lymphocytes immediately after separation by reverse-transcriptase polymerase chain reaction (RT-PCR) method. We found that lymphocytes from eosinophilic patients expressed IL-5 mRNA, but lymphocytes from normal volunteers did not express the lymphokine. These findings suggest that in patients with eosinophilia, peripheral blood lymphocytes produce IL-5 in vivo.

[The clinical manifestations of Sjögren's syndrome in children]

Sjögren's syndrome (SS) is thought to be uncommon in children. We studied the clinical manifestations and laboratory findings of 12 pediatric patients with SS, all of children did not have sicca symptoms but have lymphocytic infiltration of salivary glands, abnormal sialograms or abnormal results of scintigraphy compatible with typical SS. Seven cases had primary SS and five were secondary SS and had other autoimmune disorders (three cases with systemic lupus erythematosus, one case with dermatomyositis, and the other with mixed connective tissue disease). All patients were female. The mean age at onset of symptoms, including other autoimmune manifestations, was 12.2 years (range 9-15 years). The initial symptoms were some systemic manifestations (fever, exanthema, arthralgia, etc.) and various autoimmune phenomena (butterfly rash, Raynaud's phenomenon, proteinuria, weakness of muscles, etc.). On the other hand, no patients complained sicca symptoms. Laboratory studies in our patients revealed elevated levels of IgG (92%), antinuclear antibody (92%), rheumatoid factor (58%), anti-SS-A antibody (75%). These findings were similar to those found in adult patients with sicca symptoms previously reported in literature. From these studies, we suggest that lip biopsy, sialography and/or salivary gland's scintigraphy should be carried out in patients who had abnormal laboratory findings as mentioned above, irrespective of absence of sicca symptoms, in order to diagnose SS at early period.

[Study of peripheral neutrophil functions of patients with Wegener's granulomatosis]

Recently, the detection of anti-neutrophil cytoplasmic antibodies (ANCA) has gained worldwide acceptance as an important additional diagnostic tool of Wegener's granulomatosis (WG). A possible pathogenic role of ANCA has been suggested by the finding that the addition of purified IgG-ANCA to healthy neutrophils in vitro causes activation of these cells. But, investigation on neutrophil functions of patients with WG has been rare. To clarify this point, peripheral neutrophil functions (adherence, chemiluminescence and chemotaxis) of patients with active WG were examined. Adherence, chemiluminescence and chemotaxis of patients with WG were significantly suppressed when compared with control subjects. The effects of ANCA positive serum on neutrophil chemiluminescence were also examined. ANCA positive serum did not affect neutrophil chemiluminescence. These results indicate that the mechanism of WG is not simply due to neutrophil activation by ANCA.

[Anesthesia for bronchoscopy: application of laryngeal mask airway and "minidose midazolam anesthesia"]

Bronchoscopy distresses most of the patients. Therefore, we combines a small dose of midazolam (ca. 2 mg) with laryngeal mask airway. This method of anesthesia has the following features: (1) mild discomfort, (2) day care, (3) putting bronchoscope in or out easily, (4) mild effect on respiration and circulation, and (5) easy respiratory care. But improper cases for this method include non-fasting patients, those at high risk for regurgitation, and those with low pulmonary compliance. This is a very usefull anesthetic method for bronchoscopy.

Human arterial smooth muscle cell strains derived from patients with moyamoya disease: changes in biological characteristics and proliferative response during cellular aging in vitro

Moyamoya disease is a progressive cerebrovascular occlusive disease that occurs frequently in children. The etiology is unknown. We examined changes in biological characteristics and responsiveness to serum mitogens during the in vitro cellular aging of arterial smooth muscle cell strains derived from patients with moyamoya disease (HMSMC) and compared them with those of cells from age-matched control patients (HCSMC). HMSMC had a normal human diploid chromosome constitution. HMSMC and HCSMC had almost the same in vitro life span and the age-related patterns of biological parameters were essentially the same. However, the doubling time at the early passages was significantly longer in moyamoya SMC than control SMC, although there was no significant difference at the late passages. Furthermore, the poor responsiveness of moyamoya SMC to platelet-derived growth factor was retained throughout the life span in vitro. These results support the hypothesis that functional alterations in vascular cells are involved in the mechanism of development of intimal thickening in moyamoya disease.

Suppression of normal hematopoiesis in acute leukemia: effect of leukemic cells on bone marrow stromal cells and hematopoietic progenitor cells

Effects of leukemic cells (LC) on bone marrow stromal cells and myeloid progenitor cells (CFU-C) were studied in vitro, using LC lines with different lineage characteristics. LC and/or LC-conditioned medium (LC-CM) inhibited the growth of a stromal cell line, KM-101, and adherent cells of a long-term bone marrow culture (LTBMC) established from normal bone marrow. The inhibition was more prominent when LC were cocultured directly with KM-101 cells than when LC were cultured separate from the KM-101 cell layer via membrane filtration, or when LC-CM was added to KM-101 cells or LTBMC. LC-CM also exerted an inhibitory effect on the ability of LTBMC adherent cells to bind CFU-C. Furthermore, LC-CM inhibited the growth and survival of early and late CFU-C, but not the growth of LC. All these inhibitory effects were seen irrespective of the lineage characteristics of LC, but not seen with CM prepared from normal bone marrow immature granulocytes or peripheral blood lymphocytes. Neither tumor necrosis factor-alpha nor interferon-alpha was detected in these LC-CM. These findings suggest that LC suppress normal hematopoiesis through the release of undefined substance(s) inhibiting the growth and/or survival of stromal cells and hemopoietic progenitor cells as well as the function of stromal cells.

[Effects of acoustic overstimulation of 2F1-F2 distortion product in cochlear microphonics]

The cochlear microphonics (CM) response to two-tone stimuli was measured before and after exposure to 4 kHz pure tone at 100 dB SPL or 125 dB SPL. The 2f1-f2 distortion products in the CM (CM-DPs) were markedly suppressed by the sound exposure at either intensity, although the loss of CM output at the primary frequencies was limited to 4 dB or less. The suppression of CM-DPs was greater as the intensity of primary tones decreased, especially at primary intensities below 55 dB. These results show that the active transduction process in the cochlea was affected by acoustic overstimulation. This impairment of active transduction was postulated to be an initial process in developing noise induced temporary and/or permanent threshold shift.

Effect of endothelin-1 as growth factor on a human glioma cell line; its characteristic promotion of DNA synthesis

In addition to its powerful vasoconstrictive activity, endothelin-1 (ET-1) has been recognized to stimulate DNA synthesis in some cell lines. In this study, we confirmed the existence of ET-1 receptor in YKG-1 human glioma cells, and investigated its effect on DNA synthesis in YKG-1 for 6 consecutive days, comparing it with that of epidermal growth factor (EGF), platelet-derived growth factor (PDGF), and insulin-like growth factor-I (IGF-I). Scatchard analysis of the binding data revealed the presence of a single class of high-affinity binding molecule. The apparent dissociation constant (Kd) was 5.2 x 10(-9) M and the maximal binding capacity (B max) was 4.7 x 10(4) sites/cell. The percentage of non-cycling cells was initially more than 85%, and decreased to 55.40%, 24.22%, 11.50%, and 7.51% on days 1, 2, 4, and 6, respectively, after ET-1 stimulation. Although ET-1 reduces the fraction of non-cycling cells more slowly than other growth factors such as EGF, PDGF and IGF-I, it reaches the same level as the others by day 6. These results indicate that YKG-1 human glioma cells have ET-1 receptors and that ET-1 initiates a peculiar slow induction of DNA synthesis in these cells, suggesting that secondary factors might exist to accelerate the DNA synthesis in response to ET-1.

Effects of aging on amplitude-modulation following response

Phase spectral analysis as developed by Fridman (1982) was used to detect amplitude-modulation following response (AMFR). The threshold of AMFR was determined with greater sensitivity and accuracy by phase spectral analysis than by visual analysis. Using this method, a modulation frequency (MF) of 80 Hz was found optimal for detecting AMFR in young children (ranging in age from 2 to 4 years) during sleep, for whom there is no advantage in recording 40-Hz steady-state responses. To determine the optimal MF for detecting AMFR during sleep in children less than 2 years of age and age limitation for using 80-Hz MAFR in objective audiometry, AMFR as a function of MF was investigated during sleep in 25 children with normal hearing ranging from 4 months to 15 years of age, and 10 normal hearing adults. The stimulus was a 1000 Hz, 50 dBnHL sinusoidally amplitude modulated tone with a modulation depth of 95%. MF was varied from 20 to 200 Hz in 20 Hz steps. Response was determined by phase spectral analysis and the S/N ratio calculated by spectral amplitude at the modulation frequency and noise level around the modulation frequency using fast Fourier transform. Phase spectral analysis showed AMFR at MF of 80 Hz to be the most stable and reliable in all children during sleep among MFs from 20 to 200 Hz. Spectral amplitude analysis demonstrated 80-Hz AMFR to have a high S/N ratio in all children.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of aging on hearing results in tympanoplasty

The effects of aging on the preoperative and postoperative hearing results of tympanoplasty were assessed in 642 patients with chronic suppurative otitis media (COM) or cholesteatoma (CHL). Analysis focused on the correlation between hearing results and age for each disease and type of tympanoplasty. Data were evaluated by calculating the regression line, mainly using second order polynomial regression analysis. Averaged air and bone conduction thresholds (PTA) in patients were appreciably poorer in younger patients and increased with age, compared with physiological hearing impairment in old age (presbyacusis). Regression lines for PTA of air and bone conduction in patients and for normal data (air conduction) separated from each other after the age of 30 and hearing impairment gradually accelerated with age. Means of air-borne gap, however, were almost the same in each age group, though hearing thresholds in individual patients were distributed widely. This was more dominant in patients who had undergone type III or IV tympanoplasty than those with type I tympanoplasty, and in patients with COM than with CHL. Labyrinthine function thus appears to be gradually aggravated with age in patients with chronic inflammatory ear disease. Patients with chronic otitis media should be thus recommended to undergo tympanoplasty at an early age.

Neutrophil activating activity of tonsillar cells from patients with tonsillitis

The previous paper demonstrated that tonsillar cells cultured in vitro in the presence or absence of a streptococcal preparation, OK-432, produce factors that activate various neutrophil functions. In the present study, examination was made of the factor productivity of tonsillar cells from patients with chronic tonsillitis of varying severity, and palmoplantar pustulosis (PPP). Tonsillar cells from patients with severe tonsillitis and PPP incubated with culture medium alone produced a much greater amount of active factors compared with those from patients with mild tonsillitis. When tonsillar cells were incubated in the presence of OK-432, augmentation in factor production by the addition of OK-432 was less in former than latter cases, suggesting that factor production from tonsils correlates with the course of inflammation in this organ.

Three frequency component waveforms of auditory evoked brainstem response in spinocerebellar degeneration

Under adequate stimulus intensities, the power spectra of normal auditory evoked brainstem responses (ABRs) are composed of three major components: 0-350 Hz, 350-700 Hz and 700-1200 Hz. By means of a digital filter using fast Fourier transform, three ABR waveforms consisting of each frequency component of the power spectrum were obtained. The significance of these three component waveforms in the analysis of ABR abnormality was estimated in 30 patients with spinocerebellar degeneration (SCD). In conventional wave latency analysis, 9 out of 30 patients (30%) had abnormal ABRs, the main abnormality being prolonged interpeak latencies of waves I-III, I-V and the disappearance of wave V. On the other hand, component waveforms were abnormal in 82.5% of the cases. These results suggest that analysis of ABRs by the use of component waveforms is useful for detecting abnormality in the brainstem auditory pathway in SCD patients.

Phase spectral analysis of auditory brainstem response in cats

In order to apply the phase spectral analysis of auditory brainstem response (ABR) to the clinical diagnostic test, the phase spectra of ABRs were investigated under adequate stimulus intensity in normal cats and after the destruction of acoustic nerve and brainstem auditory pathways in cats. The results were as follows; i) In normal ABRs, the phase spectra were mainly composed of three frequency components at 0-300 Hz (component A), 300-900 Hz (component B) and 900-1500 Hz (component C). ii) A greater decrease of the component synchrony measure (CSM) occurred if ipsilateral destruction was performed in a peripheral lesion. Lesions of the auditory pathway were followed by a decrease of the CSM of component C in response to contralateral stimulation. These results suggest that the phase spectral analysis of ABRs has significant clinical value in the detection of brainstem lesions.

Quantitative assessment of influence of aging on optokinetic nystagmus

A quantitative assessment of the influence of aging on optokinetic nystagmus (OKN) was investigated using 50 normal adults in ages ranging from 30 to 70 years. In linear stimulus-induced OKN, a statistically significant difference was demonstrated in slow-phase OKN velocity only between the 30-59 year old age group and the 70-79-year-old age group, when OKN stimulus was more than 60 degrees/s. Step stimulus-induced OKN was investigated in the same age groups in order to compare aging effects upon slow-phase OKN velocity. No statistically significant difference was found in slow-phase OKN velocity between younger age groups and the oldest age group. There was no significant difference in fast-phase velocity among the age groups. Thus, step-induced OKN has a wider clinical application than linear stimulus-induced OKN.

Clinical advantages of electroneurography in patients with Bell's palsy within two weeks after onset

One of the advantages of applying ENoG to patients with Bell's palsy resides in its quantitative determinability for the axons which do not undergo wallerian degeneration. The relation between the ENoG value each day after onset and during the recovery process was investigated in 551 patients with Bell's palsy within 2 weeks after onset in order to consider the diagnostic value of ENoG. It was discovered that ENoG on patients with Bell's palsy makes it possible to reveal the extent of wallerian degeneration by 7 days after the onset of palsy. Accordingly, treatment of Bell's palsy should be administered within the above 7 days; as early as 8 days after onset, exact prognostic diagnosis and judgment of therapeutic effect from ENoG values were concluded to be practicable.

Recording of single fiber electromyography in patients with peripheral facial palsy

We determined muscle fiber density with single fiber electromyography (SFEMG) to discuss the condition of re-innervation after the recovery of facial movement in cases of peripheral facial palsy. Muscle fiber density was then compared with electroneurography (ENoG) which is thought to correlate with the severity of facial neuropathy in the early stage after the onset. The degree of neuropathy and subsequent recovery of innervation was also discussed. The subjects were 36 patients with peripheral facial palsy (30 patients with Bell's palsy and 6 with Hunt's syndrome), treated at our hospital, in whom ENoG could be recorded within 2 weeks after the onset. Muscle fiber density was determined after the recovery of facial movement. As a control, muscle fiber density was determined in 11 normal adults, and muscles on the healthy side in 23 patients with Bell's palsy. Muscle fiber density was 1.44 +/- 0.15 (mean +/- S.D.) in normal adults and 1.51 +/- 0.18 on the healthy side in patients, showing no significant difference. Data on the affected side were divided into 4 groups according to the minimum ENoG level within 2 weeks after onset and were compared with the normal group. In all cases with an ENoG level of 40% or more, muscle fiber densities were normal, and no significant differences were noted between the affected side and the healthy side. In cases with an ENoG level of less than 40%, muscle fiber density increased significantly with increasing severity of denervation. These findings suggest that collateral sprouting is absent in cases of peripheral facial palsy who show an ENoG level of 40% or more, or no wallerian degeneration.

Electrophysiological study on the pathology of synkinesis after facial nerve paralysis

By conducting electrophysiological tests on patients with facial nerve paralysis, the characteristics of synkinesis and the mechanisms of its manifestations were examined. The subjects were 114 patients of facial nerve paralysis on whom electroneurography (ENoG) and the blink reflex were conducted. As a result, it was indicated that synkinesis could be determined by the blink reflex, and that the frequency of synkinesis manifestation increased with severity of paralysis. From examination during the latent period, early component (SI) recognized in the cases of synkinesis was found to be the waveform which passed the fibers with a slow conducting speed. It was not related to the degree of degeneration of nerves for either the severe or light degeneration of nerves. From the above result it was concluded that synkinesis is generated as a misdirection of reproduced nerves.

ABR topographic mapping with digital filtering using fast Fourier transform

The power spectrum of normal ABR consists of three major parts: low (0-350 Hz: component A), middle (350-700 Hz: component B) and high (700-1200 Hz: component C) frequency components. With digital filtering using fast Fourier transform (FFT), three component waveforms of ABR were obtained and designated as component A, B and C. Component A has a positive peak which corresponds to wave V or the slow component of the original ABR. Component B has three positive peaks (B1-B3) which correspond to wave I, III and V, and component C has five positive peaks (C1-C5) which correspond to wave I-V. These three component waveforms of ABR were analyzed topographically in normal hearing adults and cats. In addition, changes in the topography of three component waveforms of ABR were studied in a series of experimentally induced lesions in the brainstem auditory pathway in cats. The following results were obtained: i) The highest voltage (HV) area of component B1 was detected on the ipsilateral side in normal adults and cats. The HV areas of component C1, C2 and C3 in normal adults and C1, C2 in normal cats were detected on the ipsilateral side. ii) There was a correlation between changes in component C and the lesion site of the auditory pathway. Component C appears to be the most sensitive indicator of the lesion site of the brainstem.

Diagnosis and treatment for Bell's palsy associated with diabetes mellitus

The method of detecting diabetes mellitus and estimating the diabetic control status in patients with Bell's palsy, and the effect of high-dose steroid therapy for Bell's palsy accompanied by diabetes were investigated. From October 1987, hemoglobin A1c (HbA1c) was introduced to detect diabetes in 288 out of 372 patients with Bell's palsy, as a screening test for DM. Thirty-six diabetics with complete facial palsy were treated by high dose steroid therapy as described by Stennert. Hemoglobin A1c was useful in diagnosing diabetes and in assessing the diabetic control. Many patients under diabetic therapy kept their diabetes under good control. In cases of complete palsy, high-dose steroid therapy, at a cure rate of 97.4%, was highly effective in treating diabetes-accompanied Bell's palsy.

Detectability of amplitude-modulation following response at different carrier frequencies

To assess the detectability of amplitude-modulation following response (AMFR) elicited at different carrier (CFs) and modulation frequencies (MFs) during sleep, as well as the usefulness of AMFR in evoked response audiometry, AMFR was examined in 10 adults with normal hearing while sleeping. The stimulus was a 50 dBnHL sinusoidally amplitude-modulated (SAM) tone with a modulation depth of 95%. The MF of the stimulus tone was varied from 20 to 120 Hz in 20 Hz steps and CFs were 500, 1000, 2000 and 4000 Hz. An SAM tone with a CF of 20,000 Hz was used for stimulation in 5 subjects to confirm that the response did not contain any artifact. Response was determined by phase spectral analysis. The component synchrony measure of AMFRs at MF of 40 Hz (40-Hz AMFR) was high at lower CFs, but 40-Hz AMFRs at higher CFs were unreliable. The detectability of 80-Hz AMFR was high for all CFs. It was confirmed that the response waveform was not contaminated by any electromagnetic artifact. Eighty-Hz AMFR detected by phase spectral analysis should thus be useful for predicting frequency-specific hearing thresholds during sleep.

Rebound positional nystagmus as a peripheral origin

Three cases of rebound positional nystagmus (RPN) are discussed in the present study. In all cases, spontaneous nystagmus was absent in the primary position, but positional nystagmus appeared in the side down position, and then nystagmus in the reversed direction appeared when the patient was returned to the primary position. The characteristics of RPN in the cases we studied were very similar to those of benign positional nystagmus. Tinnitus was accompanied with vertigo in Cases 2 and 3, and the glycerol tests were positive in Cases 1 and 3. There were no other abnormalities of ocular movements, neurological and neuroradiological examinations suggestive of central nervous system disorders indicating that RPN can be ascribed to peripheral lesions. A selective review of the literature is presented.

Quantitative analysis of oblique ocular movements

In the present study, oblique saccadic eye movements in the orthogonal and oblique directions were investigated in 10 normal subjects, and a computer program was used to accomplish quantitative assessment of oblique eye movements. Eye movements were recorded with direct-current electronystagmography (DC-ENG) and a 12-bit analog to digital converter was used to collect analog data of horizontal and vertical eye position, and stimulus signals at a sampling rate of 200 Hz. The oblique eye movement was displayed two-dimentionally on a high-resolution color graphic terminal for the evaluation of the trace of eye movements, and the peak velocity and the amplitude of the horizontal, vertical and oblique saccades were calculated. It was frequently found that the tracing line in the oblique saccadic eye movement was not completely straight, but loosely curved. The velocity of the vertical component of the oblique saccade was much lower than that of the horizontal component. This suggests that oblique saccades might be made by synchronized but independent vertical and horizontal pulse generators, and the system developed this time might be very useful for investigation of oblique eye movements in both the clinical and physiological field.

Acoustic neuroma presented as repeated hearing loss

Up to 15% of patients with acoustic neuroma may have a history of sudden hearing loss. Recovery from sudden hearing loss with acoustic neuroma is rare. In this paper, a case of bilateral acoustic neuromas presented as repeated sudden hearing loss with recovery on the left side after removal of right-sided tumor were reported. She experienced three episodes of sudden hearing loss, showing various types of audiograms and ABR on the left side. There was no relationship between the type of audiograms and ABR findings. Factor influencing ABR might be different from the cause of hearing impairment. Acoustic neuromas can be reliably identified by performing MRI properly. However, MRI showed negative scan and ABR finding was abnormal in the first episode of our case. ABR continues to be a sensitive diagnostic back-up test to MRI for the detection of acoustic neuromas. Even if the patient, who showed abnormal ABR findings suggesting retrocochlear pathology, showed normal MRI, acoustic neurinoma should not be ruled out and both ABR and MRI must be re-examined at regular intervals.

Facial nerve enhancement in Gd-MRI in patients with Bell's palsy

The diagnostic value of a contrast enhanced MRI in patients with Bell's palsy was investigated. It was a characteristic finding that the internal acoustic meatal segment of the facial nerve was enhanced only on the affected side. The signal intensity ratio of the geniculate ganglion and the tympanic segment was significantly higher on the affected side than on the normal side. The severity of the facial palsy and the results of physiological examinations showed no relation to the results of MRI scans. Gd enhanced MRI thus appears to provide some useful findings for estimating the affected region of Bell's palsy, whereas it is not considered to be valuable in the diagnosis of severity.