[A new method of gait analysis in Duchenne muscular dystrophy]

We assessed gait in Duchenne muscular dystrophy (DMD) mainly by determining alteration of foot pressure using a new gait analyzing procedure. DMD patients showed a characteristic foot pressure pattern according to their degree of dysfunction. In stage I disease, the observed pattern was the same as that of normal controls. In stage II, the period during which the center of foot pressure was seen in the front part of the foot was prolonged. This change became more marked in stage III. In stage IV, the center of foot pressure began at the head of the ossis metatarsalis primi and moved back and toward the lateral side. Thereafter, the center of foot pressure again moved forward along the outside of the foot. These changes were considered to be the result of talipes equinus and waddling gait, which are commonly demonstrated in patients with DMD.

Oscillatory variations of cutaneous blood flow in newborns using a laser Doppler flowmeter

Oscillatory variations of cutaneous blood flow were studied using laser Doppler flowmetry in 20 newborns. Simultaneous monitoring of cardiorespiratory state was also performed. The frequency and amplitude of oscillatory curve varied, even on identical skin regions in each infant. When their respiration and heart rate were irregular, the frequencies of oscillatory curves were significantly higher and with a larger amplitude than when cardiorespiratory function was regular. The frequencies of oscillatory curves at two symmetrical points of an individual were not different, but a significant difference in the oscillatory cycle was recognized at two asymmetrical points. Distributions of peak-to-peak time periods of oscillatory curves were studied in nine healthy and four sick newborns. Seven of nine healthy newborns had more than two peaks in their distributions, while only one peak with a narrowly-spread distribution was observed in the four sick newborns with almost exclusively periodic breathing throughout monitoring. In conclusion, we speculate that cardiorespiratory state and some neurogenic control affects the variations observed. In addition, the narrowly-spread distribution of each time period appeared to be an important indicator of morbidity.

[Diurnal sleep apnea in myotonic dystrophy]

We investigated diurnal sleep apnea in myotonic dystrophy with respiratory inductive plethysmography. Five of eight patients met criteria for sleep apnea syndrome and had central apnea mainly. In a case showing periodic breathing with apnea like Cheyne-Stokes type breathing, the duration of apnea and breath was even and the tidal volume went waxing and waning regularly. In the other four cases, central apneas were observed in sequence, but the duration of apnea and the tidal volume changed variously. Large breaths between apneas elevated arterial oxygen saturation rather than stable breaths without apnea. We suspected that hypoxemia, which exacerbated by involvement of respiratory muscles, supine position and sleep, initiated the hyperventilation between apneas. And then the saturation of oxygen raised by hyperventilation would cause central sleep apnea.

Immunological activities of monoclonal IgG1 antibody against Trypanosoma gambiense

The present paper deals with the immune reaction between a monoclonal IgG1 antibody and Trypanosoma gambiense. The aggregation of trypanosomes, immune adherence to macrophages and protection against infection are associated with the antibody. IgG1-mediated clumping of trypanosomes is readily dissociated by the addition of complement. Dissociation of the clumped trypanosomes in the equivalence area released approximately fifty percent of previously bound surface antigens. These antigens were capable of binding again to new IgG1 antibody. Complement deposition rendered bivalent IgG1 antibody in the immune complex functionally univalent. Such an event in the presence of complement is of great advantage to the infected host in killing pathogens in vivo, as it allows more antibodies to attach to surface antigens and subsequently to initiate complement activity.

Diversity of complement-mediated immune reaction to Trypanosoma gambiense

Intact and papain-treated Trypanosoma gambiense clone populations, each expressing special antigens on their cell surfaces, were mixed with rabbit antiserum in the presence of complement. Two distinct types of immune reaction between trypanosomes and antisera were observed: clumping followed by dissociation (CD) and inhibition of aggregation (IA). Special antigens on the cell surface of trypanosomes exposed after papain digestion are implicated in both types of immune reaction. IA was considered to be more effective as an immunological response which would allow the infected host to clear the pathogen without any obstruction of capillaries and impairment of blood flow caused by clumping masses of trypanosomes.

[Pathogenesis of juvenile muscular atrophy of unilateral upper extremity in reference to venous congestion of epidural space]

MRI and dynamic CT studies were performed in a young male with juvenile muscular atrophy of unilateral upper extremity (JM) with onset at age 15 and clinical course of 2 years. The mechanism of development of congestion in vertebral venous plexus was considered. Dynamic CT of the head in the neck flexion showed rapid reflux of blood from the intervertebral veins into the posterior internal vertebral venous plexus at the C5-C6 level and consequent congestion. It is speculated that in this patient some mechanism associated with head anteflexion led to a reflux into the valveless posterior internal vertebral venous plexus and congestion as well. Furthermore, it could be considered that anterior shift of the dural sac at the time of head anteflexion plays an important role in the development of this internal vertebral venous plexus congestion in JM.

Immune mechanism facilitating clearance of Trypanosoma gambiense by IgG3 antibody from infected host

The aggregation of trypansomes, immune adherence to macrophage and protection against infection of Trypanosoma gambiense are associated with IgG3 antibody. IgG3-mediated clumping trypanosomes are readily dissociated by the aid of complement to become free. Dissociation of the clumped trypanosomes in the equivalence area released approximately fifty percent of previous bound surface antigens. These antigens were capable of binding again to new IgG3 antibody. Experiments indicated that complement deposition altered functionally bivalent IgG3 antibody in the immune complex into a univalent one. Such event in the presence of complement is of great advantage to the infected host in killing pathogens in vivo, as it allows more antibodies to attach to surface antigens and subsequently initiate complement activity.

[A case of Japanese encephalitis demonstrating characteristic changes in MRI]

A 40-year-old woman developed high fever and headache. Five days later, she was admitted because of consciousness disturbance and tremulous movements in upper extremities. The paired sera showed more than fourfold elevation in complement fixation titer to Japanese encephalitis virus. She was diagnosed as Japanese encephalitis from the clinical features and serological tests. Magnetic resonance imaging (MRI), which was performed about seven months after the onset, revealed abnormal intensity areas bilaterally in the thalamus, hippocampus, substantia nigra, globus pallidus and white matter around the lateral ventricle. Eight months after the onset, she was left with bradykinesia, disturbance of rightening reflex, emotional lability and impairment of recent memory with a long period of amnesia, including not only her illness and subsequent events but also about several years before her illness. The characteristic memory dysfunction seems to be due to disorder of bilateral hippocampus, where MRI revealed abnormal intensity areas. And disorder of medial thalamic nucleus would be related to emotional liability. The relation between the clinical features and MRI findings is also discussed.

Isolation and characterization of thermostable chitinases from Bacillus licheniformis X-7u

Four kinds of thermostable chitinase were isolated from the cell-free culture broth of Bacillus licheniformis X-7u by successive column chromatographies on Butyl-Toyopearl, Q-Sepharose, and Sephacryl S-200. We named the enzymes chitinases I(89 kDa), II(76 kDa), III(66 kDa) and IV(59 kDa). Chitinases II, III and IV possessed extremely high optimum temperatures (70-80 degrees C), showing remarkable heat stability. Chitinases II, III and IV produced (GlcNAc)2 and GlcNAc from colloidal chitin and chitinase I predominantly produced (GlcNAc)2. The action pattern of chitinase I on PN-(GlcNAc)4 also showed a stronger propensity to cleave off the (GlcNAc)2 unit from the non-reducing end than the other three chitinases. Chitinases II, III and IV catalyzed a transglycosylation reaction that converted (GlcNAc)4 into (GlcNAc)6.

Seroepidemiological study for HBV markers and anti-delta in Kenya

An HBV carrier rate of 3.0% in outpatients and 1.4% in school children, was found in a sero-epidemiological survey in Muranga District, Kenya. The prevalence of anti-Delta in HBV carriers was 42%. The prevalence of HBV carriers and HBV marker positive cases was high in family members of HBV carriers. The yearly attack ratio of HBV was low in primary school children, non-carrier family members and even carrier family members. Mother to baby vertical transmission was very high when mothers were HBeAg positive HBV carriers. Such vertical transmission may now be of major importance.

[A case report of the compression syndrome due to hypertrophic neuropathy]

We reported a case of hypertrophic neuropathy of adult onset. The pathological change in the sural nerve was decreased axonal population with onion-bulb formation. On examination, there were enlarged nerve on palpation and she was found to have distal muscle atrophy, weakness and sensory loss. The deep tendon reflexes of extremities were weak. The first clinical feature of this patient was mainly polyneuropathy. The lower limbs were slightly spastic and plantar responses were extensor bilaterally. There was also sensory level at C6 level. After 1.5 years from first examination, she had shown myelopathy. Magnetic resonance imaging (MRI) of the spine showed marked thickening of the nerve roots and it revealed the compression of the spinal cord by enlarged nerve roots from C2 to C6 level. The compression syndrome of the patients with hypertrophic neuropathy was unclear at the onset in this case. MRI study of the spinal cord would be very beneficial to disclose subclinical myelopathy associated with hypertrophic neuropathy, as indicated in this report.

Dissociation of IgG antibody-mediated clumps of Trypanosoma brucei gambiense by complement

Aggregated trypanosome masses that had formed in the region of equivalence in the absence of complement were readily dissociated by complement. Complement-mediated dissociation of the clumped trypanosomes in the area of equivalence released approximately 50% of the previously bound surface antigens. These antigens were capable of rebinding to new IgG antibody. Experiments indicated that complement deposition altered the bivalent IgG antibody in the immune complex into a univalent form. The occurrence of such an event in the presence of complement provides a great advantage to the infected host in the killing of pathogens in vivo, as it enables a greater number of antibodies to attach to surface antigens and subsequently initiate complement activity.

An effective axenic culture system for Trypanosoma brucei rhodesiense blood stream forms in vitro

An effective axenic culture system for Trypanosoma brucei rhodesiense (ILRAD 1501) bloodstream forms is demonstrated. Bloodstream forms were continuously grown in 25 mM HEPES-buffered D-MEM supplemented with 10 microM bathocuproine sulfonate (BCS), 100 microM cysteine, and 20% heat-inactivated fetal bovine serum at 37 degrees C in vitro. At the initiation of the culture, T. b. rhodesiense bloodstream forms required the presence of 0.2 IU/ml insulin and 1 mM pyruvate, while bloodstream forms were grown in the culture medium without these supplements 4 days after initiation of the culture. Under this culture condition, T. b. rhodesiense bloodstream forms increased in number to 7 to 8 x 10(6) trypanosomes/ml, by day 4 after initiation of the culture. The trypanosomes cultured in this axenic system for 150 days were typically long and slender and retained their virulence for mice. This axenic culture system is extremely useful for in vitro cloning of T. b. rhodesiense bloodstream forms in vitro.

[Amyotrophic lateral sclerosis and mercury--preliminary report]

The mercury and selenium content in the hair of 13 ALS cases was studied by neutron activation analysis. The total mercury content of the hair was 3.70 +/- 2.73 ppm (mean +/- standard deviation) in the ALS patients as a whole, 4.46 +/- 3.16 ppm in the ALS patients from the middle of Kii Peninsula, and 2.49 +/- 1.38 ppm in the ALS patients from other region. As the comparison, mercury content was 2.43 +/- 0.79 ppm in the patients with Parkinsonism, and 2.10 +/- 1.13 ppm in the patients with multiple sclerosis (MS). The selenium content of the hair was 0.36 +/- 0.35 ppm for all ALS patients as a whole, 0.45 +/- 0.25 ppm in the ALS patients from the middle of the Kii Peninsula, and 0.21 +/- 0.47 ppm in the ALS from other region. There were no cases with higher values than mean values of control group, except one case from other regions. It is well known that the selenium decreases the toxicity of mercury in the human body. From these data mercury with low content of selenium might be one of the environmental factors which are thought to be involved in producing of ALS.

[MRI study of three siblings of suspicious Sjögren-Larsson syndrome]

We report the characteristics of high field magnetic resonance imaging (MRI) of three siblings with hereditary spastic paraplegia (HSP), probably of autosomal recessive inheritance. The proband was a 25-year-old woman who manifested slowly progressive spastic paraplegia, mental deficit, decayed teeth since her childhood. The siblings of the proband, 29-year-old woman and 27-year-old man, also showed the same clinical course as hers, and the symptoms are more severe in elder siblings. The proband solely had ichthyosis on her neck and lower thighs, which suggested Sjögren-Larsson syndrome. Sagittal and transverse slices of high field MRI (1.5T), T2-weighted (SE 2800/90) and T1-weighted (500/15) images were obtained. The cerebral atrophies were observed in the frontal and the parietal lobes, especially at the precentral and superior frontal gyri, whereas the occipital lobes were relatively spared. The atrophies of motor cortex seemed to be responsible for the disorder of voluntary movement. T2WI demonstrated a diffuse hyperintensity in the cerebral white matter, which suggested demyelination. T2WI also showed remarkable hypointensities in the globus pallidus, putamen, and thalamus. The degenerative involvement in these regions was also suspected. These abnormal intensities, both hyper- and hypo-intensities, were stronger in elder siblings, which indicated the intensity changes to be of progressive nature. Severe atrophy or hypoplasia of corpus callosum was also observed, however the cingulate gyri could be confirmed. We were not able to detect the callosal disconnection syndrome, because of their severe mental impairment. Spinal cord was slender and its degenerative changes were suggested. The high field MRI of a HSP family showed the extensive abnormal findings of the central nervous system in this HSP family, such as cerebral motor area, extrapyramidal system, corpus callosum, and spinal cord.

Pernicious anemia in a patient with hypogammaglobulinemia

A 19-year-old male with pernicious anemia and hypogammaglobulinemia (common variable immunodeficiency: CVID) is reported in comparison with classical pernicious anemia. This case was characterized by an earlier onset of anemia, the absence of autoantibodies to intrinsic factor or gastric parietal cells and involvement of the pyloric antrum as well as the gastric corpus. It is suggested that dysregulation of cellular immunity produces the autoimmune lesion in the gastric mucosa, including the pyloric antrum, in a patient with CVID, and that some of such cases develop pernicious anemia.

[Central motor conduction time (CMCT) in hereditary motor sensory neuropathy type I (HMSN type I)]

The motor system of 13 cases with hereditary motor sensory neuropathy (HMSN) type I were analysed by clinical neurophysiological method. The motor conduction velocity (MCV) and F wave latency in lower motor neurone were markedly delayed. The latency of the muscle evoked potential (MEP) by cortical magnetic stimulation were also markedly delayed. The central motor conduction times (CMCT) were calculated by two methods. CMCT-mag was calculated by subtraction of the MEP by cervical magnetic stimulation from the MEP by cortical magnetic stimulation. CMCT-f was calculated by subtraction of the [(F wave latency -1 + distal latency)/2] from the MEP by cortical magnetic stimulation. There were positive correlation between CMCT-f and CMCT-mag. CMCT of HMSN type I were divided to two groups. CMCT of the first group was markedly delayed. CMCT of the second group was mildly delayed or normal. The former group showed marked weakness in distal muscles clinically. The latter group showed mild or moderate weakness in distal muscles clinically. All these patients did not show any pyramidal tract signs, which could be covered by severe lower motor neurone involvements. The classification of HMSN type I by gene was well known, genetical analysis might be important to these groups in HMSN type I.

[Study of the blink reflex in spinocerebellar degeneration]

Blink reflex (BR) was composed of R1 and R2. R1 is considered to indicate the brainstem function. The purpose of this study was to evaluate the brainstem function of spinocerebellar degeneration (SCD) by the R1 latency (R1). BR was evoked by the percutaneous stimulation of supraorbital nerve. And R1 was measured by the action potential of orbucularis oculi muscle. Direct response was recorded by the percutaneous stimulation of facial nerve to determine the terminal latency of facial nerve (D). By these methods R1, D, R1/D and difference between at right and left side of these data (delta R1, delta D, delta R1/D) were measured in 21 normal subjects (57.7 +/- 10.1 ys.) and 28 cases of SCD (56.6 +/- 8.2 ys.), including 12 cases of sporadic type olivopontocerebellar atrophy (SOPCA), 4 of Menzel type olivopontocerebellar atrophy (MOPCA), 6 of late cortical cerebellar atrophy (LCCA) and 6 of Holmes type cortical cerebellar atrophy (HCCA). There was no difference between all types of SCD and normal subject at D, but significant difference of R1 and R1/d was observed between at MOPCA and normal subject. Concerning the difference between right and left side delta R1 and delta R1/D showed the significant difference with MOCA and SOPCA, but delta D showed no difference. Elongation of R1 and R1/D without the delay of facial nerve and the significant difference of R1 and R1/d between at right and left side suggested the synaptic transmission disorder form trigeminal nerve to facial nerve at brainstem of MOCA.

[MRI study of hemiballism]

MRI findings of four hemiballism cases are described, and pathophysiology, pathogenesis and treatment of hemiballism are discussed. All cases had no family history. The lesions revealed by MRI and the pathogenesis were different each other. Case 1, a 17 years aged girl with a history of hyperthyroidism and repeated tonsillitis, showed right sided hemiballism which was recovered by prednisolone and haloperidol. Although her involuntary movement was ameliorated by administration of sodium valproate and phenytoin, phenytoin caused allergic agranulocytosis which required prednisolone treatment. T2 weighted MRI at the 31st disease day demonstrated hyperintensities in the left caudate nucleus, putamen, lateral pallidum, perirubral area and substantia nigra. Hyperintensity in the prerubral area suggested involvement of the subthalamic nucleus or its connecting pathway. Fourteen months later, she suffered from convulsion and mental confusion. There were theta wave bursts and delta waves in EEG. No abnormal findings in MRI and positive antinuclear antibody (ANA: X320, speckled type) were observed. Case 2, a 78 year aged woman, suffered from right sided hemiballism. MRI findings at the 58th disease day were the left putaminal infarction and lacunar state in the bilateral caudate nuclei and the deep white matter of the centrum semiovale. There were no abnormal findings in the subthalamic nucleus. Case 3, a 51 year aged man with diabetes mellitus, had right sided hemiballism. X-ray CT at the 8th disease day showed hyperdensity in the left subthalamic nucleus region which could not be observed at the 12th day. Hypointensity in the left subthalamic nucleus region was observed in both T2 weighted and proton density MRI at the 52nd day. Case 4, an 82 year aged woman, had right sided hemiballism which remarkably diminished at the third disease day and disappeared by the fifth day. Any pathogenic lesion concerning to hemiballism was detected by X-ray CT or MRI.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation of clinical course with MRI findings in olivo-pontocerebellar atrophy and late-cortical cerebellar atrophy]

We quantitatively analyzed 1.5 T MRI in 36 cases of sporadic spinocerebellar degeneration (SCD) and 30 control cases without intracranial lesions, using graphic analyzer. SCD consisted of 21 olivo-ponto-cerebellar atrophy (OPCA) and 15 late cortical cerebellar atrophy (LCCA). There was negative correlation between vermian size and the duration of illness both in OPCA (r = 0.8960, p less than 0.001) and LCCA (r = 0.7756, p less than 0.01), but the progression rate in OPCA was three times greater than that in LCCA. LCCA was suggested the preclinical vermian atrophy by the statistical regression study. In OPCA, the duration of illness also revealed significant correlations with atrophy of ventral pons (r = 0.8308, p less than 0.001) and also cerebellar hemisphere (medial hemisphere; r = 0.7278, p less than 0.001. lateral hemisphere; r = 0.6039, p less than 0.01). OPCA showed diffuse atrophy of cerebellar hemisphere, whereas LCCA showed medial dominant atrophy. OPCA demonstrated significant correlation between the fourth ventricle dilatation and the duration of illness (r = 0.6005, p less than 0.01). A discriminant study significantly separated OPCA, LCCA and control each other by sizes of ventral pons and cerebellar vermis (p less than 0.001). In T2 weighted MRI, 10 cases out of 14 LCCA did not show hypointensity in dentate nucleus in spite of normal appearance in the other portions usually decreased intensity. The dentate nucleus of OPCA showed a significant atrophy. The incidence of putaminal hypointensity in OPCA was significantly greater than that of control group (chi-square = 6.476, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)