Contractile protein isoforms of single and cultured smooth muscle cells from guinea pig ileum

Single smooth muscle cells isolated from guinea pig ileum using collagenase and papain produce contractile response to muscarinic agents, while the cultured cells do not. Using fluo-3/AM and a confocal laser scanning fluorescence microscope, it was observed that carbachol, a muscarinic agent, caused an increase in the intracellular Ca2+ of both single and cultured cells. SDS-PAGE and Western Blot analyses revealed the expression of myosin heavy chain isoforms of SM1 (204 kDa) and SM2 (200 kDa) in single smooth muscle cells, and non muscle isoform (196 kDa) of myosin heavy chain only in the cultured cells. With respect to actin isoforms, alpha-actin was predominant in single cells and beta-actin was major in the cultured cells. Two types of tropomyosin monomer, 39 kDa and 41 kDa, were detected in single cells, while the 41 kDa monomer was lost in cultured cells. These differences in contractile protein profiles between single and cultured cells were collaborated with the observation of cells using immunofluorescence microscope with responsible antibodies to isoforms of myosin heavy chain, actin and tropomyosin. These results suggest that the loss of contractility in cultured smooth muscle cells is profoundly related to changes in contractile protein profiles from smooth muscle type to non muscle type.

Flame figures associated with bullous pemphigoid

We report a case of bullous pemphigoid showing the histological features of flame figures. An 80-year-old man was admitted with multiple, tense, thumb-sized blisters among erythematous plaques on his trunk and limbs. A biopsy showed accumulations of eosinophil granules on the collagen fibers, forming characteristic "flame figures", in addition to the features of bullous pemphigoid. We retrospectively examined biopsy specimens from 34 patients with bullous pemphigoid treated in our department over the last 10 years for the presence of flame figures. They were observed in 3 of these patients (8.8%), all of whom were more than 80 years of age. Our retrospective study indicates that the association of flame figures with bullous pemphigoid is not rare, considering the fact that the present case is only the third report of this association. Our data also suggest that the degree of dermal eosinophilia and the formation of flame figures could be related.

A Dictyostelium discoideum homologue to Tcp-1 is essential for growth and development

Tcp-1 (t-complex polypeptide 1 gene) was first identified in the mouse as relevant for tail-less and embryonic lethal phenotypes. Since then, its homologous sequences have been isolated in several other species, and the yeast Tcp-1 has been shown to encode a molecular chaperon for actin and tubulin. In a random sample of genes expressed in the gamete of Dictyostelium discoideum (Dd), we encountered a sequence containg the TCP1 motifs. The complete ORF of the gene (DdTcp-1) showed more than 60% similarity to TCP-1 of several organisms, including human. DdTcp-1 was found to be expressed in both sexually mature and immature cells at the growth phase. Although the sexual process itself was not affected, antisense interference of this gene resulted in severe retardation of cell growth, leading to the complete cessation of division. In addition, the antisense transformants stopped asexual development at the finger stage. These results suggest an important function of DdTcp-1 in growth and development of this organism.

[A case manifested overlapping neuropathologic features of both progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD)]

A 62-year-old man developed clumsiness, vertical ophthalmoplegia, right-side dominant parkinsonism, pyramidal signs, limb-kinetic apraxia and dementia. His brain MRI and SPECT revealed mild fronto-parietal atrophy and hypoperfusion predominately on the right side. At the age of 65, the patient died of sepsis. The duration of his illness was approximately 3 years. Clinical diagnosis was corticobasal degeneration (CBD). On neuropathological examination, there was no neuronal loss and many neurofibrillary tangles (NFTs) in the cerebral cortices. Basal ganglia and substantia nigra showed moderate to severe neuronal loss. And there were many NFTs and argyrophillic threads (threads) in the subthalamic nucleus and nuclei of the brainstem. These findings were almost compatible to those of PSP. However, the following findings were atypical for PSP, 1) mild atrophy and absence of gliosis in the tegmentum of the brain stem, 2) Mild neuronal loss in the subthalamic nucleus and the dentate nucleus without grumose degeneration. Furthermore, characteristic findings were noted on modified Gallyas-Braak stain. Numerous threads and many astrocytic plaques (AP) were shown in cerebral cortices, which were particular to CBD cases. So this case demonstrated neuropathological findings of both PSP and CBD. Therefore, it was difficult to classify this case as either PSP or CBD, and we diagnosed this case as a neuropathological overlapping case of both PSP and CBD.

Effect of Cr and Cu addition on corrosion behavior of Ni-Ti alloys

The corrosion behavior of three Ni-Ti alloys with compositions as commercial super-elastic orthodontic wires was investigated using polished plate specimens. Corrosion resistance was estimated by potentiodynamic polarization measurement in 0.9% NaCl and 1% lactic acid solutions and analysis of released metals by atomic absorption spectrophotometry. The influence of Cr and Cu addition on the structure of the surface oxide film was examined by X-ray photoelectron spectroscopy (XPS). Addition of 0.19 at% Cr had little effect on the structure of the oxide films and the corrosion resistance of the Ni-Ti alloys. For Ni-Ti-5Cu-0.3Cr alloy, the metallic Cu was enriched at the alloy/oxide film interface, resulting in increased susceptibility to pitting corrosion above +1000 mV. However, the passive current density and the amount of released Ni were not significantly increased by the addition of Cu. The study showed that small amounts of Cr and Cu added to change the super-elastic characteristics do not change the corrosion resistance of the Ni-Ti alloy freely immersed in simulated physiological environments.

A case report of removable partial denture using the dimple-bar telescopic system

The authors have devised a new attachment for a removable partial denture with a dimple-bar clasp, guiding channels, and a shoulder, named the dimple-bar telescopic system. This system has advantages over the clasp-type retention device in that it not only satisfies esthetic requirements, but also improves the handling and adjustability of the attachment denture. Furthermore, it was shown clinically that the dimple-bar telescopic system was free from food impaction when used as an intracoronal attachment, and maintained a feeling of comfort during tongue movement and speech. We present a typical case in which the dimple-bar telescopic system was used.

Prurigo pigmentosa (Nagashima) associated with anorexia nervosa

Prurigo pigmentosa (Nagashima), which is not rare in Japan, is an inflammatory disease of unknown aetiology. The characteristic lesions are pruritic red papules, superseded by reticular hyperpigmentation, characteristically on the back, neck, and chest. We now report a case of prurgio pigmentosa associated with anorexia nervosa. These findings suggest that the ketosis produced by anorexia nervosa may well contribute to the pathogenesis of prurigo pigmentosa.

Lithium deficiency reduces thymus weight and alters differential blood count in rats

Effects of lithium (Li) deficiency and/or immobilization stress on the thymus weight and differential blood count of rats were studied. The thymus weight of the rats fed a low Li diet were lighter than those of rats fed a Li supplemented diet, whether the rats were exposed to stress or not. Of the rats not exposed to stress, those in the low Li diet group showed a significant decrease in the ratios of neutrophils and T helper lymphocytes. However, there was an increase in the total number of lymphocytes in the low Li dietary group. It was shown that Li deficiency altered the responses to stress in rats.

Oriented and lengthwise growth of octacalcium phosphate on collagenous matrix in vitro

A correlation among the oriented growth of octacalcium phosphate (OCP), the arrangement of the collagen fibrils in a collagenous matrix and direction of ionic flow was studied in vitro at pH7.0 and at 37 degrees, using two types of collagen disks made from sliced bovine Achilles tendon. Disk A and disk B were made from slices cut perpendicular and parallel to the collagen fibrils, respectively. The products on the collagen fibrils were a mixture of OCP and apatite in the both disks, but the relative amounts of apatite and OCP could not be determined. Short plate-like or flake-like OCP crystals grew parallel to the collagen fibrils and ionic flow on the Ca-side of the disk A. On the contrary, ribbon-like or rectangular OCP crystals grew along the collagen fibrils lying on the disk B. Apatite also grew with the same orientation as OCP in the both cases. The oriented and length-wise growth of OCP crystals on the disk B was ascribed to the arrangement of the collagen fibrils in the disk.

[Differential diagnosis of post-transfusion graft-versus-host disease (GVHD) by rapid immunopathologic examination of the skin]

The diagnosis of post-transfusion graft-versus-host disease (GVHD) in early period is critical for the prognosis of the patients. Exanthema and fever are the earliest symptom of the post-transfusion GVHD and usually precede the disturbance of the liver and bone marrow. Snap-frozen, cryostat-sectioned specimens from the lesional and perilesional skin were labeled by monoclonal antibodies against HLA-ABC, HLA- DR, ICAM-1, CD1a and CD8. The reaction was visualized by indirect immunofluorescence. Graft-versus-host reaction (GVHR) was immunopathologically characterized by extensive expression of HLA-DR and ICAM-1 in the epidermal keratinocytes, exocytosis of CD8 positive cytotoxic T-cell and the reduction or disappearance of CD1a expression by epidermal dendritic cells. The other GVHRs such as erythema exudativum multiforme (EEM), fixed drug eruption, toxic epidermal necrolysis (TEN) and lichen planus could not be separated. Our protocol of the immunopathologic examination could be done quickly (within 3 hours) and provides more detailed and useful information for the diagnosis of GVHD in early period compared with conventional histopathology.

Progressive supranuclear palsy with palatal myoclonus

We present a case of progressive supranuclear palsy (PSP) with palatal myoclonus occurred in a 64-year-old man. The nucleus olivaris of the medulla oblongata showed high signal intensity on T2-weighted MR images, indicating brainstem tegmental atrophy, which were confirmed as hypertrophy of the nucleus inferior olivaris at autopsy. The characteristic neuropathological findings were marked grumose degeneration of the dentate nucleus, degeneration and gliosis of the superior cerebellar peduncle, and hypertrophy of the bilateral olivary nuclei. As far as we know, although a few cases of PSP with olivary hypertrophy have been described, only one case has presented with palatal myoclonus.

Short-term hemodialysis treatment in dogs and cats with total uretic obstruction

This study evaluated the single-pass system for the short-term dialysis treatment of dogs and cats with experimental renal failure. The hemodialyzer was equipped with a thin and highly permeable Cuprophan membrane. Four animals (two dogs and two cats) with total uretic obstruction were dialyzed twice in a one-week period. The vascular access by venipuncture of external jugular vein delivered more than 5 ml/min/kg/body weight of blood repeatedly, even for the cats. The evaluation of the effects of the blood flow, dialysate flow and ultrafiltration pressure revealed that the blood flow was the most important factor for effective dialysis. A 300 ml/min dialysate flow provided enough clearance of blood urea nitrogen and creatinine. The ultrafiltration pressure played an important role in ensuring that the fluid removal was constant. Laboratory studies revealed a 50.0% (range 42.0 to 59.3%) reduction of blood urea nitrogen, a 48.7% (range 42.5 to 58.7%) reduction of creatinine, and a 49.8% (range 34.3 to 66.2%) reduction of inorganic phosphate during the dialysis treatment. No dialysis disequilibrium syndrome was shown by the clinical signs. We conclude that this short-term dialysis using a single-pass system for small animals was sufficiently applicable to dogs and cats, and that the optimal duration of the dialysis was 2 hours.

[Efficacy of nasal bi-level positive airway pressure ventilation in a patient with olivo-ponto-cerebellar atrophy suffering from sleep apnea syndrome]

Sleep apnea with neuromuscular disorders has been successfully treated with bi-level positive airway pressure ventilation (BiPAP), which, unlike continuous positive airway pressure ventilation (CPAP), creates pressure difference between expiratory and inspiratory phases. Hence if the respiration of patients stops longer than a pre-set duration, BiPAP can automatically force them to breath through a nasal mask. We report a 60-year-old woman with olivo-ponto-cerebellar atrophy (OPCA), whose mixed-type sleep apnea was difficult to treat with conventional CPAP. We therefore tried BiPAP on this patient at night. Nocturnal CO2 retention was nearly resolved, and unexpectedly daytime PaCO2 was also corrected with marked improvement of daytime somnolence. BiPAP is totally non-invasive, and may be one of the most effective treatments in patients with OPCA suffering from sleep apnea.

Human choroid plexus is an uniquely involved area of the brain in amyloidosis: a histochemical, immunohistochemical and ultrastructural study

To better understand the characteristics of amyloid deposition in the choroid plexus, we examined autopsied brain by routine histology, immunohistochemistry, and electron microscopy in three group of patients: primary systemic amyloidosis (n = 7), cerebral amyloid angiopathy (CAA, n = 6), and controls (n = 3). Three of the CAA patients had Alzheimer's disease. Congophilic, birefringent amyloid deposits of the choroid plexus were seen in six of the seven cases of systemic light chain amyloidosis. Immunohistochemistry revealed that the deposited amyloids had reactivity for immunoglobulin light chain and amyloid P component. Accumulation of macrophages labeled with monoclonal antibodies against CD 68 and major histocompatibility complex class II antigens were observed around the massive amyloid deposits. The presence of approximately 10 nm amyloid fibrils along the epithelial basement membrane as well as in the vascular walls was ascertained by electron microscopy. In CAA, Congo red-positive amyloid deposits were consistently present in meningeal blood vessels and were often found in senile plaques of the cerebral parenchyma; congophilic amyloid deposits were absent in the choroid plexus. Choroid plexus epithelial cells exhibited immunostaining for beta amyloid precursor protein (APP) with N-terminal- and C-terminal-specific antibodies; in particular, consistent staining was obtained for the latter antibody. Immunoreactivity for amyloid beta protein (A beta) with monoclonal antibodies (6E10, 4G8) was often found in choroid plexus epithelial cells. These findings suggest that amyloid deposition of the choroid plexus depends on the major component protein in amyloidosis, and that the choroid plexus may produce APP and A beta protein although A beta amyloidosis is not evident in the choroid plexus.

Patch test materials for mercury allergic contact dermatitis

The objective of this study was to define adequate patch test materials to evaluate mercury allergic contact dermatitis. We applied 0.1% and 0.05% mercuric chloride, and 0.5% and 0.2% mercury in petrolatum to systemic eczematous contact-type dermatitis (baboon syndrome), and gold-dermatitis patients. All baboon-syndrome patients reacted not only to mercuric chloride but also to metallic mercury. In gold-dermatitis patients, significantly more patients reacted to mercuric chloride than to metallic mercury (21 of 35, 60%, versus 2 of 19, 10.5%, p < 0.0005). We speculated that sensitization to mercury may be of 2 types: one a reaction to ionized mercury only, the other to both ionized mercury and non-ionized mercury. The possibility that the phenomenon is caused by differences in bioavailability or percutaneous penetration between ionized and non-ionized mercury cannot be ruled out, but could be explored by penetration measurement. For the evaluation of mercury hypersensitivity, it may be more reliable to apply both ionized and non-ionized mercury, rather than only mercuric chloride or ammoniated mercury.

Rôle of ear piercing in metal allergic contact dermatitis

To evaluate the effect of ear piercing on sensitization to gold and other metals, diagnostic patch testing with 18 metals was performed. 377 patients (65 men and 312 women, ranging in age from 15 to 78 years; mean 34.2, S.D +/- 15.1 years) were patch tested; 107 had pierced earlobes. Metals were applied on the back for 2 days, and the results read with the ICDRG scoring system 3 days after application. Reactions of + to +3 were regarded as positive. There were significantly more patients reacting to gold chloride (p < 0.001), mercuric chloride and nickel sulfate (p < 0.05) in patients with pierced ears than in those without. Statistical issues included: (i) a significant number of patients with pierced ears referred because of earring dermatitis; (ii) those with pierced ears represented a different age group from those without; (iii) a significant number of patients without eczema in the non-pierced ear group. However, our data suggests that ear piercing is a risk factor not only for nickel but also for gold sensitization. Gold was the second most frequent metal allergen after nickel in the pierced group.

An unusual variant of ependymoma with extensive tumor cell vacuolization

We report a case of ependymoma with unusual vacuolar features arising in the left occipital lobe of a 2-year-old child. The tumor was composed of cells with single or multiple cytoplasmic vacuoles and clear cells. Some cells showed a signet ring-like configuration. Clear cells were compactly arranged and showed an oligodendro-glioma-like appearance. In addition, there were cellular ependymoma-like areas including perivascular pseudorosettes. On immunohistochemistry, glial fibrillary acidic protein and vimentin were mainly detected in cytoplasmic processes, and epithelial membrane antigen (EMA) staining showed granular and small vesicular reactivity. Ultrastructural investigation demonstrated intercellular microrosettes with or without cilia and long zonula adherens-type junctions that are typical of ependymoma. Furthermore, many intracytoplasmic lumina (ICL) were observed. Some ICL had microvilli and some did not. The latter varied in size, and may have fused with each other to develop giant ICL which could correspond to the signet ring-like configuration. Small ICL without microvilli had an appearance similar to that of distended endoplasmic reticula. Serial semithin and ultrathin sections revealed that EMA-positive structures were consistent with ICL containing microvilli and intercellular microrosettes. To determine the presence of unusual vacuolated ependymoma, electron microscopical examination was required. However, light microscopy was useful for detecting EMA-positive microvesicular and granular structures.

Transformation of normal human fibroblasts into immortalized cells with the mutant p53 gene and X-rays

In vitro cell transformation is a valuable approach for studying the mechanisms of multistep carcinogenesis of human cells. Since immortalization is an essential step for in vitro neoplastic transformation of human cells, this study addresses the question of whether mutant p53 contributes to the immortalization process of human cells. The mutant p53 gene (mp53: codon273Arg-His) was introduced into normal human fibroblasts (OUMS-24 line) and a G418-resistant clone, OUMS-24/P6 line, was obtained. This clone showed an extended life span and chromosome abnormalities, but senesced at the 79th population doubling level (PDL). When these cells were subjected to intermittent X-ray treatment, they became an immortalized cell line (OUMS-24/P6X). Although these immortalized cells showed chromosome abnormalities, they were not tumorigenic. On the other hand, normal OUMS-24 cells into which mp53 had not been introduced were not immortalized by the same X-ray treatment. These results indicate that introduction and expression of mp53 alone were not sufficient for immortalization of human cells, and that mutations of the remaining wild-type p53 or other genes may have been necessary for immortalization. In fact, no expression of the wild-type p53 was detected in the immortalized cells by RT-PCR. Expression of p21, which is located downstream of p53, was remarkably reduced in the immortalized cells, resulting in an increase in cdk2 and cdc2 kinase activity. These findings indicate that the p53-p21 cascade may play some role in the immortalization of human cells. On the other hand, there was no significant difference in expression of proteins such as Rb, p16, cdk4, cdk6, cyclin A and cyclin D1 between the normal and immortalized human fibroblasts.

The influence of trace elements on calcium phosphate formation by matrix vesicles

The effects of two inhibitors, fluoride (F-) and zinc (Zn2+), were studied on the formation of mineral by matrix vesicles (MV) in an in vitro system. Kinetically, mineral formation by MV incubated in a synthetic cartilage lymph (SCL) is characterized by three phases: a lag period, a period of rapid uptake, and finally a period of slow uptake. Zn2+ at > or = 5 microM completely inhibited MV mineralization; at < or = 1 microM, it had little effect on rate of ion uptake, but delayed conversion of an OCP-like intermediate into hydroxyapatite (OHAp). F- at > or = 10 microM reduced the rate of rapid uptake by MV and caused the OCP-like precursor to convert to OHAp. When synthetic OCP was seeded into SCL, mineralization ensued and OHAp became the dominant phase. With Zn2+ present, OCP-like features persisted longer; with F-, the OCP-like features were lost more rapidly. When ACP was seeded into SCL, OHAp formed; Zn2+ at < or = 1 microM caused OCP-like mineral to form. Our findings indicate that Zn2+ stabilizes a noncrystalline precursor in MV regulating the length of the lag period; Zn2+ also favors the formation of an OCP-like intermediate whose growth accounts for the rapid uptake phase. This OCP-like phase appears to nucleate formation of OHAp by MV.

Pale islands in medulloblastoma consist of differentiated cells with low growth potential

Cerebellar medulloblastomas are the most common embryonal neoplasms occurring in the pediatric age group. Thirty-five specimens from 28 cases of medulloblastoma and variant neoplasms were examined to elucidate the histopathologic significance of the reticulin-free pale islands. In 10 specimens, there were light-looking areas corresponding to pale islands: three specimens from desmoplastic and seven from classic medulloblastoma. The difference in cell population, 1.73-fold more cells in dark areas than in light areas (P < 0.001), seemed to be a major factor in the formation of the biphasic architecture. Immunohistochemically, occasional tumor cells in both areas were found to express neuronal phenotypes. In addition, positive immunoreactivity for glial markers was exceptional. There was significant difference in the staining indices (SI) for cell proliferation markers. The light areas consistently showed low SI values (mean MIB-1 SI, 5.75; mean PCNA SI, 11.8) compared with the dark areas (mean MIB-1 SI, 22.7; mean PCNA SI, 44.9). It is suggested that light areas (pale islands) consist of more differentiated cells of neuronal lineage with relatively low proliferation potential. These tumor cells might proliferate in a group, and then expand, thereby compressing the surrounding tissue to form pale islands.

Fluoride analysis of apatite crystals with a central planar OCP inclusion: concerning the role of F- ions on apatite/OCP/apatite structure formation

To study the roles of F- ions in the formation of apatite crystals embedding octacalcium phosphate (OCP) lamella in the center of apatite (Ap), a range of the Ap/OCP/Ap lamellar-mixed crystals were synthesized under various concentrations of fluoride ion (F-) from 0. 1-1.0 ppm at pH 6.5 and 37 degrees C. The products were analyzed for the F- incorporation, F- distribution, and the amount of OCP and Ap by chemical analysis, X-ray diffraction (XRD), electron probe microanalysis (EPMA), and nuclear magnetic resonance (NMR) techniques. The F- content and the amount of apatite in the crystalline product increased with an increase in the F- concentration in solution, whereas the amount of OCP and the yield of total product decreased. EPMA indicated that F- ions are distributed in the crystals almost homogeneously. The combined analysis suggested that a low-substituted fluoridated hydroxyapatite (FHAp) grew on a small amount of F--containing OCP or on a surface-reaction layer of OCP, which has accumulated a small amount of F-. The roles of F- ions were hypothesized as the reduction of the growth rate and/or the critical thickness in the a*-axis direction of OCP, the enhancement of hydrolysis of OCP, and the activation of the growth of FHAp, resulting in thinner OCP lamella and thicker apatite lamella in the a*-axis direction with an increase in F- concentration.

[A case of atypical progressive supranuclear palsy with degeneration of the fronto-pontine tracts, and without grumose degeneration of the dentate nucleus]

An autopsy case of progressive supranuclear palsy (PSP) with degeneration of the fronto-pontine tracts of the midbrain and pons, and without grumose degeneration of the dentate nucleus is reported. A 72-year-old woman was suffering from dysarthria and gait disturbance. Moderate dementia was noted and gradually worsened. Pyramidal and extrapyramidal signs and cerebellar ataxia were not observed. Eye movements were fully preserved. Brain CT showed cerebellar atrophy. Three years later, she was unable to stand or move, and became mutistic. At the age of 75, she died suddenly. The duration of her illness was approximately 4 years. Clinical diagnosis was LCCA (late cortical cerebellar atrophy). Neuropathological examination revealed gliosis of the deep layers of the cerebral cortex around the precentral gyrus, fronto-pontine tracts degeneration (posterior part of the anterior crus, genu and anterior part of the posterior crus of the internal capsule, cerebral peduncles of the midbrain, pontine base and pyramis of the medulla oblongata). Also, atrophy of the pons and marked degeneration of the superior colliculi and substantia nigra were observed. Neurofibrillary tangles (NFTs) and glial fibrillary tangles (GFTs) were found in the subcortical nuclei. These findings were almost consistent with PSP. However, the following differed from those of previously reported typical PSP cases: firstly, mild gliosis in the reticular formation of the midbrain; secondly, few NFTs in the pontine nuclei and superior colliculi and; thirdly, no grumose degeneration in the dentate nucleus. In addition, clinical symptoms of the present case are not consistent with PSP. Therefore, we concluded this case to be an atypical PSP both clinically and neuropathologically.

[A case of neuroborreliosis with unilateral radiculoneuropathy and elevated serum antibodies for Borrelia garinii and Borrelia afzelii]

A 24-year-old male patient was admitted to our hospital because of dysesthesia and weakness of the right leg. Six weeks before admission he traveled to southern China. A week later he noticed multiple papules with itching on his right leg that were suspected to be insect bites. Four days later numbness of the right leg developed. Then he began to limp because of the leg weakness. Two weeks before admission severe pain in the right leg developed. On admission neurological examination revealed hypesthesia, muscle weakness and atrophy, areflexia, radicular pain and Lasègue sign of the right leg, and patchy hypesthesia of the left leg. The cranial nerves were intact, and meningeal signs were negative. Complete blood counts and serum biochemistry were unremarkable except for eosinophilia and mild elevation of IgE. A test for antinuclear antibody was positive. Cerebrospinal fluid was normal. Nerve conduction study and sural nerve biopsy showed multifocal severe axonopathy. Although antibody for Borrelia burgdorferi sensu stricto was negative, antibodies for B. garinii and for B. afzelii were positive in serum immunoblotting. Neurological symptoms improved after administration of intravenous ceftriaxon following oral doxycycline. In Japan, this is the second case of neuroborreliosis not due to B. burgdorferi sensu stricto. To test antibodies for B.garinii and for B. afzelii is recommended in patients with suspected neuroborreliosis.

Plasma endothelin level in the acute stage of Bell palsy

OBJECTIVE

To determine the plasma endothelin level in the acute stage in patients with Bell palsy (based on the hypothesis that endothelin, which is a potent vasoconstrictor, may play a role in the mechanism of the onset of facial nerve paralysis and in view of the fact that the etiology of Bell palsy is still a maze of unknowns).

DESIGN

The study involved 62 patients with the acute stage (tested within 10 days of onset) of Bell palsy (i.e., idiopathic acute peripheral facial paralysis) and an additional 36 healthy persons who served as control subjects. To determine the content of endothelin, 2 ml of plasma samples was collected from each subject. Endothelin-1 was extracted and analyzed by a radioimmunoassay by using anti-endothelin-1 antibody.

SETTING

Nihon University Itabashi Hospital, a referral and institutional center in Tokyo, Japan.

RESULTS

The patients who were suffering from Bell palsy exhibited a statistically significant (P < .01) increase in the endothelin level compared with that in the 36 normal control subjects. An age-matched comparison (ranges, 20-29 years and 30-39 years) of patients with Bell palsy with normal control subjects revealed a significant difference between the normal group and the group with Bell palsy in the plasma endothelin level for both age groups that were tested (P < .01). The mean value of the endothelin level in patients with Bell palsy was maximal on day 5, and the percentage of patients with abnormally elevated endothelin levels was 100% from days 6 to 9.

CONCLUSION

Endothelin, which has potent vasoconstrictive effects, may contribute to the pathogenesis of the microcirculatory impairment that occurs in patients with Bell palsy, mainly by promoting secondary ischemia.