[Incidence of acute idiopathic optic neuritis and its therapy in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG)]

Data on the incidence of and treatment for acute idiopathic optic neuritis were obtained by questionnaire sent to departments of ophthalmology, university hospitals, and general hospitals throughout Japan. Inquiry was made as to the number of cases which developed idiopathic optic neuritis from April 1992 to March 1993 along with their clinical features. The response rate was 53.6%. There were a total of 550 cases, and the male to female ratio was 1:1.22. Patients 14 to 55 years old were 65.9%; bilateral involvement: 28.2%; recurrence: 18.6%; positive past history of the other eye; 7.5%. Assuming the answering rate to be 100% and two thirds of the patients to be included, annual incidence of this disease (the annual number of patients) was determined to be 1.62 for an adult population of 100,000 (1.03 cases/100,000 people). Tochigi, Tokyo, Kanagawa, Hyogo, Wakayama, Okayama, Yamaguchi, Tottori, Shimane, Ehime, and Fukuoka showed an annual incidence exceeding 2.0/100,000 adults. At more than 95% of all medical institutions questioned, patients with optic neuritis were usually treated with systemic corticosteroids. Oral corticosteroid therapy, which was shown in a recent study in USA to be contraindicated, was still being used at 15% of the institutions.

Immunosuppressive effect of monoclonal antibodies to ICAM-1 and LFA-1 on peripheral nerve allograft in mice

This study evaluated the immunosuppressive effect of monoclonal antibodies against cell surface molecules in a murine peripheral nerve allograft model. After nerve allografting, 18 recipients were treated with both anti-intercellular adhesion molecule-1 (ICAM-1) and anti-lymphocyte function-associated molecule-1 (LFA-1) monoclonal antibodies in low or high dose. Nerve allografts were harvested at 8 weeks for histologic and morphometric evaluation. Recipients were subsequently challenged with skin grafts at 9 weeks and a cytotoxic assay at 12 weeks. The majority of the antibody-treated allografts (13 of 18) showed excellent regeneration comparable to the autografts with preservation of the normal nerve architecture and scant cellular infiltrate. All untreated allografts demonstrated severe structural disorganization with cellular infiltrate consistent with acute rejection. In the high dose group, the mean skin graft survival time from nerve donor mice, but not third-party mice, was significantly prolonged. (17.5 vs. 11.3 days). Similarly, the cytotoxic activity against nerve donor alloantigen was significantly suppressed. These preliminary findings suggest that antibody therapy alone can facilitate nerve regeneration in a murine nerve allograft model.

Acute organophosphate poisoning after disulfoton ingestion

A 75-year-old woman attempted suicide by ingesting a large quantity of granular Di-Syston which is an organophosphate insecticide containing 5% disulfoton (ethylthiometon). On admission, the total plasma phosphorodithioate sulfone concentration (disulfoton and its metabolites, phosphorodithioate sulfoxide and its sulfone) determined by gas chromatography was 1095 ng/mL. After gastric lavage, the concentration gradually decreased to 505 ng/mL. However, it began to increase again 20 h after admission and reached the peak concentration (1322 ng/mL) at 56 h. It was concluded that the secondary elevation of the plasma concentration was due to the prolonged absorption of the organophosphate from the residual granules in the stomach, despite the early gastric lavage. Pralidoxime iodide administration temporarily restored erythrocyte cholinesterase activity to almost normal and inhibited the excessive, delayed reduction of cholinesterase activity. It is recommended that poisoning with the granular form of disulfoton should be treated with repetitive or prolonged gastric and intestinal lavage, charcoal, and a continuous intravenous infusion of pralidoxime iodide in addition to atropine sulfate.

Vascular permeability to sodium fluorescein in the rabbit cranial nerve root: possible correlation with normal cranial nerve enhancement on gadolinium-enhanced magnetic resonance imaging

Vascular permeability in cranial nerve roots was examined after intravenous injection of sodium fluorescein in the adult rabbit. Fluorescence was observed in the distal nerves through the following portions: intracavernous portion of the oculomotor nerve, distal internal auditory canal segment of the facial nerve, and ganglionic portions of the trigeminal, glossopharyngeal and vagus nerves. In the acoustic nerve, the vestibular ganglion showed fluorescence. No fluorescence was observed in the olfactory or optic nerves. During in vivo gadolinium-enhanced magnetic resonance imaging (Gd-MRI) of two separate animals, trigeminal nerve enhancement was observed in the region showing fluorescence. Histologically, intense fluorescence was observed in ganglia and external nerve sheaths of the cranial nerves showing macroscopic fluorescence. A slight fluorescence was also seen in endoneurial connective tissue but not observed within the nerve fibers. The results of this study suggest that the physiological enhancement of human cranial nerves seen on Gd-MRI may correlate with vascular permeability.

Transplantation of allogeneic peripheral blood stem cells after myeloablative treatment of a patient in blastic crisis of chronic myelocytic leukemia

A 48-year-old man in blastic crisis of chronic myelocytic leukemia received a transplant of allogeneic peripheral blood stem cells. The donor was his HLA-identical sister, who refused to donate bone marrow cells, but agreed to donate peripheral blood stem cells. The patient received standard transplant conditioning with cyclophosphamide (120 mg/kg) and busulfan (16 mg/kg). Peripheral blood stem cells were mobilized with granulocyte colony stimulating factor and collected by apheresis. After transplantation, the white blood cell count and the result of microscopic analysis of the bone marrow became normal, and the leukocyte karyotype became 46XX. DNA fingerprinting showed complete chimerism. Graft-versus-host disease was suppressed with cyclosporine and methyl-prednisolone. The patient died of recurrence of leukemia on day 102+.

Regeneration of perineurium after nerve injury and autografting. An experimental study

Regeneration of the perineurium after crush injury to the rat sciatic nerve and after autografting was studied in an experimental model. After injury, fibroblast-like cells formed compartments inside the funiculus which gradually acquired the characteristics of the perineurial cell. After grafting, the pattern of perineural regeneration depended on the degree of Schwann cell damage. In the graft and distal nerve trunk the epineurium degenerated and disappeared and new perineural tissue was formed by endoneurial fibroblasts from the inside of the funiculus. At the suture line, fibroblasts encircled the regenerating axons and the Schwann cells to form new compartments resulting in a large number of minifasciles of regenerating nerve. The function of the perineurium as a diffusion barrier was restored satisfactorily in the crushed nerve, although there was no satisfactory repair at 30 weeks after nerve grafting.

Decreased myotonin-protein kinase in the skeletal and cardiac muscles in myotonic dystrophy

To investigate the role of myotonin-protein kinase (MT-PK) in the pathophysiology of myotonic dystrophy (DM), we developed specific antibodies against synthetic MT-PK peptides. The antibody identified a 53kDa protein in skeletal muscle and recognized decreases in the amount of the protein in both adult and congenital DM patients, compared with amounts in controls and in patients with other muscle diseases. In cardiac muscle, this antibody identified a 62kDa protein, and in brain, both the 53 and 62kDa proteins were detected. These results suggest the presence of tissue-specific isoforms of MT-PK.

Studies on the regulation of insulin-like growth factor binding protein 3 secretion in human osteosarcoma cells in vitro

Previous studies demonstrated that insulin-like growth factors (IGFs) are important autocrine and paracrine mitogens for human bone cells in vitro and that IGF binding proteins (IGFBPs) are important regulators of the biologic actions of IGFs. Thus, the actions of IGFs may be determined not only by their concentrations but also by the type and amount of IGFBPs produced by human bone cells at a local site in bone. In this study, we sought to determine the effects of dexamethasone, 1,25-(OH)2D3, and parathyroid hormone (PTH) on the secretion of IGFBP-3 in human osteosarcoma cell lines. Serum-free cultures of low- and high-alkaline phosphatase (ALP) SaOS-2, MG-63, and TE89 human osteosarcoma cells were treated for 24 or 48 h with the effectors and the conditioned media used for determination of IGFBP-3 using a radioimmunoassay. We report that (1) the basal rate of IGFBP-3 secretion (ng/mg cellular protein) was dependent upon cell type, with TE89 > low-ALP Saos-2 > MG-63 > high-ALP SaOS-2 cells, and did not correlate with either basal cell proliferation or basal cellular ALP activity; (2) dexamethasone (10(-12)-10(-7) M) inhibited IGFBP-3 secretion in a dose-dependent manner in low-ALP SaOS-2, MG-63, and TE89 cells but not in high-ALP SaOS-2 cells; (3) 1,25-(OH)2D3 (10(-11)-10(-8) M) stimulated IGFBP-3 secretion in a dose-dependent manner in MG-63, low-ALP SaOS-2, and high-ALP SaOS-2 cells, and the coaddition of TGF-beta and 1,25-(OH)2D3 increased synergistically IGFBP-3 secretion and cellular ALP activity in MG-63 cells; and (4) human PTH-(1-34) (0.1-100 ng/ml) had no significant effect on IGFBP-3 secretion in MG-63, low-ALP SaOS-2, or high-ALP SaOS-2 cells. We conclude that such agents as dexamethasone, 1,25-(OH)2D3, and PTH differentially regulate IGFBP-3 secretion in human osteosarcoma cells in vitro.

Nerve crush injuries--a model for axonotmesis

Nerve crush is a commonly used experimental model in the rat; however, a standard method of inducing this injury has not been defined. This study examined six crush techniques that are frequently used and characterized the subsequent nerve injury. Five types of nerve crush using a No. 5 jeweler's forceps and a sixth using a 30-s single crush with a serrated hemostat were studied in the posterior tibial nerve of the Lewis rat. Regeneration was evaluated using serial walking track assessments at 1, 2, 4, 6, and 8 weeks postoperatively. Nerve conduction studies and histological examination were performed at 2 days, 2 weeks, and 8 weeks. Blood-nerve barrier breakdown was observed at 2 days and recovered by 2 weeks. By 4 weeks normal walking track patterns were obtained in all groups. A pattern of Wallerian degeneration and axonal regeneration was noted at 2 weeks, with histological recovery in all groups by 8 weeks. Nerve crush, induced by any of the six methods tested, was similar and provides a reliable model of axonotmesis.

Detection of human papillomavirus types 16 and 18 in primary and in metastatic lesions of cervical carcinomas

Human papillomavirus (HPV) types 16 and 18 are most prevalent in cervical carcinomas and are also present in metastatic sites. Thirty-six patients with lymph node metastases were examined for the possible presence of HPV 16 and 18 DNA sequences in the primary tumors as well as in metastatic lymph nodes. Polymerase chain reaction (PCR) analysis revealed the presence of the genome of HPV type 16 (HPV 16) in 17 tumors (47%) and that of HPV type 18 (HPV 18) in 2 tumors (6%), while 17 tumors (47%) were negative for both types. Of the 17 HPV 16-positive patients, 15 metastatic lymph nodes were also positive and 2 were negative. In 2 patients positive for HPV 18, the metastatic sites were negative. All the 17 patients negative for HPV in the primary tumors were also negative for HPV 16 and HPV 18 in the metastatic lymph nodes. These data confirmed the positive correlation of HPV DNA status between primary and metastatic tumors. However, the discrepancy in 11% of cases was attributed to presence of heterogeneous clones in the primary tumor.

[Extramedullary blastic crisis of chronic myelogenous leukemia--a case with various additional chromosomal appearance]

We describe a characteristic case of chromosomal abnormalities in a 47-year-old man with chronic myelogenous leukemia (CML). He had been diagnosed with the chronic phase of CML on May 1990, but he refused treatment. He was readmitted in October 1991 because of peripheral lymphadenopathy. Hematologic studies showed that he remained in the chronic phase of CML. There were no additional chromosomal findings in the bone marrow, but cervical lymph node biopsy revealed complete replacement with blastoid cells. The blasts were positive for CD13 and CD33. DNA analysis for the breakpoint cluster region gene showed rearrangement pattern, but immunoglobulin heavy chain joining region genes and T-cell antigen receptor gene rearrangement were not observed. The karyotype of lymph node cells showed various additional chromosomal abnormalities. Therefore, we concluded that the patient had an extramedullary blastic crisis in his peripheral lymph nodes. Abnormal clones were composed of one main clone and three subclones, with the latter occupying more than 10% of the volume each other. Considering the types of the additional chromosomal abnormalities, all four types of clones were thought to have evolved through independent pathways.

Comparison of two monoclonal antibodies, H6B11 and GS2C4, against human plasma gelsolin

We compared the properties of a new monoclonal antibody developed in our laboratory, H6B11, against human plasma gelsolin with those of GS2C4, which is commercially available. Both antibodies recognize human plasma gelsolin in an enzyme-linked immunosorbent assay (ELISA), and demonstrated similar interference activity for actin gelation, but exhibited differing behaviors toward gel electrophoresis and electroblotting. H6B11 did not bind to gelsolin on an electroblotted membrane after electrophoresis on sodium dodecyl sulfate-polyacrylamide gel, in contrast to GS2C4. However, under certain milder conditions, H6B11 was able to bind to gelsolin. H6B11 was thus judged to be capable of partially recognizing gelsolin conformation, while GS2C4 recognized part of the amino acid-sequence of gelsolin. The faster reaction of H6B11 in the ELISA and the linearity of the results, indicates that the ELISA for plasma gelsolin can be used in routine laboratory testing.

Neuromuscular effects of pipecuronium during sevoflurane anesthesia compared with isoflurane and enflurane anesthesia

We evaluated the neuromuscular effects of pipecuronium during anesthesia with equipotent concentrations of either sevoflurane, isoflurane or enflurane. Twenty-seven patients scheduled for minor elective otolaryngeal or plastic surgery were studied and randomly assigned to 3 groups, one group per anesthetic agent. Anesthesia was induced with thiamylal 5 mg.kg(-1) and the trachea was intubated with succinylcholine 1 mg.kg(-1), then anesthesia was maintained with 60% nitrous oxide in oxygen and sevolfurane, isoflurane or enflurane, depending on the group. Neuromuscular blocking effects were monitored by recording the electromyographic activity of the adductor pollicis muscle from supramaximal stimulation of the ulnar nerve at 10-s intervals. Pipecuronium 40 microg.kg(-1) was administered when electromyographic activity had reached a stable state, 30 min after succinylcholine administration. The maximum effect (% block of control) and clinical duration (time to 25% recovery) of pipecuronium were 99.1 +/- 1.4% and 63.7 +/- 14.7 min (mean +/- S.D.) for sevoflurane, 99.0 +/- 2.0% and 60.9 +/- 20.5 min for isoflurane, and 98.0 +/- 2.5% and 62.8 +/- 28.7 min for enflurane, respectively. There were no significant differences in these values between the anesthetics. Cardiovascular stimulant effects were not observed in any of the groups. We conclude that the effect of pipecuronium under seveflurane anesthesia is similar to that under isoflurane and enflurane anesthesia.

[Adult T cell leukemia/lymphoma effectively treated with chronic oral etoposide]

A 52-year-old man, who complained of tarry stool and systemic lymphadenopathy, was admitted to our hospital on July 2, 1992. Biopsy showed diffuse large cell lymphoma. Leukocytosis with atypical lymphocytes was not shown in the peripheral blood, but there was an elevated serum LDH level. The man was found to have both HTLV-I antibody and the monoclonal integration of proviral DNA in malignant lymph node cells obtained at biopsy. The diagnosis was lymphoma-type adult T-cell leukemia (ATLL). The chemotherapy regimens of MI-FP, CHOP and modified DHAP were used for the treatment, but were not effective. So, he was treated with etoposide 75 mg orally for 25 days (chronic oral etoposide therapy) and achieved partial remission. This chemotherapy induced myelosuppression with neutropenia, but there was no documented infection. Chronic oral etoposide therapy is an effective regimen for patients with relapse or refractory lymphoma.

[Quantitative and qualitative alterations of plasma lipoproteins in obesity]

In order to clarify lipoprotein abnormality in mild to moderate obesity (BMI > or = 25), plasma was separated by table top ultracentrifugation into VLDL (chylomicron), IDL, LDL and HDL. Chol, TG and ApoB were determined in each fraction by enzymatic and sensitive Latex method. The data were analysed according to glucose intolerance and hyperinsulinemia (HI). In obese subjects, irrespective of glucose intolerance, Chol, TG & ApoB levels were high in plasma, and an increase in VLDL (Chol, TG & ApoB), IDL (Chol & ApoB), LDL (Chol & ApoB), and a decrease in HDL-Chol were observed. These levels were also abnormal in nonDM particularly with HI. In DM, HI did not seem to affect hyperlipidemia. Correlation between Chol, TG and ApoB in three ApoB containing lipoprotein subfractions was noted in obesity. The ratio of Chol/ApoB and TG/ApoB in LDL was significantly lower in obesity implying that LDL particles were smaller in size. Half of nonDM patients had HI, and only 29% of DM patients had HI, and both groups had almost the same lipoprotein abnormality. Hyperlipidemia was severe in nonDMHI(+) compared to nonDMHI(-). Therefore, in hyperlipidemia of obesity, hyperinsulinemia plays a role in nonDM and hyperglycemia in DM. Insulin resistance seems to be an important factor in DM. Although the mechanism may be different, the consequence of hyperlipidemia is similar. Increased numbers of ApoB containing lipoproteins and smaller size of LDL are the characteristic features of hyperlipidemia in mild to moderate obesity. Because these quantitative and qualitative changes appear to be linked to an increased risk for premature arteriosclerosis, intensive therapy should be recommended even in mild to moderate obesity.

Haemodynamic and humoral consequences of chronic infusion of vasopressin in conscious rats

1. To determine the long-term haemodynamic and humoral effects of arginine vasopressin (AVP), a chronic intravenous infusion of AVP was performed in conscious Wistar normotensive rats. 2. AVP (1, 10, 50 or 100 ng/h) or saline as a vehicle control was infused continuously into the right jugular vein at a rate of 1 microL/h using an osmotic minipump for 7 days. 3. As a result, significant elevations of systolic blood pressure were observed in association with increases in plasma AVP concentration. Significant decreases in heart rate were observed during infusion of 100 ng/h of AVP. Mean arterial pressures measured directly on the sixth day of infusion were significantly higher in the rats given 50 ng/h (125 +/- 3 mmHg) or 100 ng/h (125 +/- 2 mmHg) compared with control rats (117 +/- 2 mmHg). Intravenous injection of the V1 antagonist, d(CH2)5Tyr(Me)AVP, significantly reduced the elevated mean arterial pressure induced by 50 or 100 ng/h of AVP (-7 +/- 4 and -11 +/- 2 mmHg, respectively). Plasma renin and norepinephrine concentrations were not affected by AVP infusion, while plasma epinephrine concentration was lower in the rats given 100 ng/h of AVP. Intravenous infusion of AVP did not alter bodyweight, serum electrolytes or osmolality. 4. These results suggest that AVP has a long-term pressor effect which is attributable to its vasoconstrictor action in conscious rats.

Effect of cold preservation on lymphocyte migration into peripheral nerve allografts in sheep

Lymphocyte migration into fresh and preserved peripheral nerve allografts was quantitated to assess the effect of cold preservation and freeze-thawing pretreatment on the local immunological response to nerve allografts. Out-bred ewes received multiple 1.5-cm subcutaneous heterotopic peroneal nerve autografts, fresh allografts, and pretreated allografts, implanted within the same recipient. Lymphocyte migration was studied at 7 days by injecting autologous 111indium-labeled lymphocytes intravenously. After 3 hr of recirculation, lymphocyte migration into graft tissue was quantitated by a gamma counter (epm/g, mean +/- SEM). Lymphocyte traffic into fresh nerve allografts (21,623 +/- 3783) increased an average 9.4-fold over the autograft value (2918 +/- 377, P < 0.04). Histologic studies illustrated a marked lymphocytic infiltrate of CD4+ and CD8+ cells and enhanced class I and II MHC expression in fresh allografts, but not in autografts. Short-term cold preservation, for 6 and 12 hr (5 degrees C), enhanced lymphocyte entry into pretreated allograft tissue. Conversely, cold preservation for longer periods (1 and 3 weeks) dramatically reduced lymphocyte migration to values below corresponding autograft levels (783 +/- 100 and 1,252 +/- 120, respectively, P < 0.01). A comparable reduction in lymphocyte migration into nerve allografts was observed after freeze-thawing pretreatment (P < 0.01). Cold preservation of donor allogeneic lymphocytes inhibited their capacity to induce intradermal host lymphocyte migration, implicating passenger lymphocytes as a potential cold-sensitive allogeneic component of the nerve allograft. Assessment of the local response to ovine peripheral nerve allografts, utilizing radiolabeled autologous lymphocytes, demonstrated that cold preservation and freeze-thawing pretreatment significantly reduced lymphocyte migration into nerve allografts. The mechanism(s) of reduced lymphocyte migration may involve inactivation or death of antigen-presenting cells, including passenger lymphocytes.

FK506 and cyclosporin a regulate proliferation and proto-oncogene expression in HTLV-1-associated myelopathy/tropical-spastic-paraparesis-derived T cells

Human T-cell-leukemia-virus-type-1 (HTLV-1) infection is associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). The T-cell-targeting immunosuppressants, FK506 and cyclosporin A (CsA), suppressed proliferation of the HAM/TSP-derived T-cell lines, H89-59, H89-79 and H109. FK506 and CsA also reduced expression of the proto-oncogenes, c-myc and c-fos, but not c-jun and interleukin-2-receptor-alpha (IL-2R alpha) gene in H109 cells. The growth-inhibitory effects of FK506 and CsA were not abrogated by interleukin 2 (IL-2). These results suggest that the inhibitory effects of FK506 and CsA are independent of IL-2, and are associated with the reduction of c-myc and c-fos gene expression.

Diagnostic value of push-type jejunal endoscopy in primary jejunal carcinoma

Push-type jejunal endoscopy using a long forward-viewing duodenofiberscope was performed in two patients with primary jejunal carcinoma. Patient 1, a 48-year-old female, complained of nausea, vomiting, and weight loss, whereas patient 2, a 65-year-old female, presented epigastric pain. The lesion was located in the upper portion of the jejunum, and diagnosis was made by a double-contrast X-ray study of the small intestine in both patients. Endoscopic examinations revealed a reddish, nodular polypoid lesion with an annular constriction and an irregular central ulceration. Endoscopic biopsy confirmed a diagnosis of adenocarcinoma in both patients. Push-type jejunal endoscopy is valuable for an accurate preoperative diagnosis of primary jejunal carcinoma.

[Evaluation of the localizing procedures of primary aldosteronism]

The validity of preoperative localizing procedures was studied in 36 patients with primary aldosteronism due to adrenal adenoma, all of whom were confirmed surgically. Adrenalectomy resulted in normalization of blood pressure and serum potassium. Furthermore, we reviewed the correlation between mass size and some clinical parameters as well as the accuracy of localization procedures. Adopted localization procedures included imaging techniques such as abdominal ultrasonography, computed tomography (CT), adrenal scintiscan, magnetic resonance imaging (MRI) and adrenal venography, and as a functional diagnostic procedure, adrenal venous sampling. Among imaging procedures, CT was the most effective to detect adrenal mass with as high accuracy as 88%, adrenal venography following with 83%. The correct localization was obtained in 60% by adrenal scintiscan and only 39% by ultrasonography. Although MRI was performed only in 2 cases, the smallest adenoma could be detected only by MRI, suggesting that MRI might be useful to detect microadenoma by increased signal intensity. Although adrenal scintiscan had been considered to be useful because of its functional diagnostic characteristics, the correct localization was as low accuracy as 60%, which was not improved by the administration of dexamethasone. To assess the accuracy of lateralization for adrenal venous sampling, we calculated the ratio of aldosterone concentration in adrenal vein to inferior vena cava. When the ratio was more than 10 or less than 1, the correct localization was made.(ABSTRACT TRUNCATED AT 250 WORDS)