Follow-up study on F-wave in patients with lumbosacral radiculopathy. Comparison between before and after surgery

The aim of this study is to explore the clinical value of follow-up examinations of F-wave in patients with lumbosacral radiculopathy. Postoperative changes in the initial abnormalities and their relationship with improvement in clinical findings were examined. Results from conventional motor nerve conduction study at knee-ankle segment are also discussed. The subjects were 30 patients with unilateral lumbosacral radiculopathy caused by herniated disc. F-waves were obtained from abductor hallucis and extensor digitorum brevis by supramaximal stimulation to tibial and peroneal nerves, respectively, at the ankle. Minimal latency (Fmin), maximal latency (Fmax), chronodispersion (Fdif) and duration (Fdur) were used as the parameters. No subject had abnormal motor nerve conduction velocity (MCV) throughout the course of this study, and there was no significant difference between preoperative and postoperative levels. Peroneal Fmin, Fmax, Fdif and tibial Fdur all showed significant (p < 0.05 in Wicoxon signed-rank test) improvement after surgery. Moreover, these overall improvements significantly (p < 0.05 in chi 2 test) correlated with recovery in muscle weakness. However, normalization of F-wave was not always associated with full recovery in muscle weakness at that time. These findings suggested that follow-up examination of F-wave was of value for objective assessment after operation.

Evidence that autophosphorylation at Thr-286/Thr-287 is required for full activation of calmodulin-dependent protein kinase II

Calmodulin-dependent protein kinase II (CaM-kinase II) undergoes a very rapid autophosphorylation at Thr-286/Thr-287 in the presence of Ca2+/calmodulin and ATP/Mg2+, and this has greatly hampered studies on the role of the autophosphorylation in the regulation of the enzyme activity, because it has been difficult to measure the activity of the non-autophosphorylated enzyme in the presence of Ca2+/calmodulin. In the present study, this difficulty was overcome by using adenosine 5'-O-(3-thiotriphosphate) (ATP gamma S) in place of ATP. When the enzyme was assayed with 2 microM ATP gamma S and 200 microM syntide-2 at 5 degrees C in the presence of Ca2+/calmodulin, the linear reaction rate of thiophosphorylation of syntide-2 was much slower than that of the enzyme which had previously undergone autothiophosphorylation. Under the limiting assay conditions, thiophosphorylation of the enzyme did not occur significantly during assay. Using this assay condition, activation by autothiophosphorylation was examined. When CaM-kinase II was autothiophosphorylated at 5 degrees C, the concomitant stimulation of both activities in the presence and absence of Ca2+/calmodulin was observed. The activity of the recombinant wild-type enzyme in the presence of Ca2+/calmodulin as well as in its absence was also markedly activated upon autothiophosphorylation, whereas those of the recombinant mutated enzyme, whose Thr-287 was replaced by Ala, was not activated at all. These results provide strong support for the contention that CaM-kinase II initially possesses a basal low level of the total activity and that the initial rapid autophosphorylation on Thr-286/Thr-287 results in full activation of the enzyme.

A novel homozygous mutation of the myelin Po gene producing Dejerine-Sottas disease (hereditary motor and sensory neuropathy type III)

We have previously reported that heterozygosity for myelin Po gene mutations were associated with Charcot-Marie-Tooth disease type 1B (CMT1B) or Dejerine-Sottas disease. We investigated the Po gene in a family with clinical Dejerine-Sottas disease and found two children were homozygous for a deletion of Phe 64. The parents were heterozygous first cousins with subclinical CMT1B and slow nerve conduction velocities. These results suggest that the effect of homozygous Phe 64 deletion on impairment of myelination is dosage-dependent. Clinical phenotype and/or myelin impairment may be determined both by the type of mutation and by the dosage of mutated gene.

[A case of swallowed fish bone-induced esophageal perforation and mediastinitis treated with pedicled omental graft]

We experienced a case of 47-year-old man who suffered swallowed fish bone-induced esophageal perforation with purulent mediastinitis and underwent direct suture closure of the perforation and reinforcement with a pedicled parietal pleura four days after the onset. Postoperative esophageal suture insufficiency was occured and reoperation was performed two months after the first operation. The esophageal fistula was plugged with a pedicled omental graft successfully. The postoperative course of the patient was uneventful and he discharged 45 days after the second operation. A reinforcement by pedicled omental graft for esophageal rupture accompanied with mediastinitis was considered to be a useful procedure.

Oesophageal carcinoma with humoral hypercalcaemia of malignancy and leucocytosis

We report a case of oesophageal carcinoma with humoral hypercalcaemia of malignancy and leucocytosis in a 66-year-old man. We also demonstrate parathyroid hormone-related protein, by immunohistology. After admission, calcitonin was administered for the hypercalcaemia but the patient died of pneumonia on the 17th day of hospitalization. As oesophageal carcinoma with humoral hypercalcaemia of malignancy and leucocytosis is characterized by rapid progression and metastasis, earlier diagnosis and treatment is mandatory.

Phorbol ester inhibits the phosphorylation of the retinoblastoma protein without suppressing cyclin D-associated kinase in vascular smooth muscle cells

To elucidate the role of protein kinase C in vascular smooth muscle cell proliferation, we examined the effects of phorbol 12-myristate 13-acetate (PMA) on G1 events in human arterial cells. About 15 h after G0 cells were stimulated with fetal bovine serum and basic fibroblast growth factor, [3H]thymidine incorporation started. PMA (10 nM) inhibited the incorporation over 90% when added earlier than 3 h after stimulation, but had no effect when added 12 h or later. PMA inhibited the phosphorylation of the retinoblastoma protein (pRb), which normally began at about 9 h. PMA did not inhibit the gene expression of Cdk2, Cdk3, Cdk4, Cdk5, and cyclins G, C, and D, all of which began at 0-3 h. However, PMA reduced the expression of cyclins E and A, which usually began at 3-9 h and about 15 h, respectively. PMA inhibited the histone H1 kinase activity of Cdk2, which increased from about 9 h, whereas PMA did not inhibit the pRb kinase activities of cyclin D-associated kinase(s) and Cdk4, detectable from 0-3 h. These results suggested that the PMA-induced inhibition of pRb phosphorylation is not mediated by suppressing cyclin D-associated kinase(s) including Cdk4, but involves the suppression of Cdk2 activity that results from the reduced expression of cyclins E and A.

Immunohistochemical study of rat renal interstitial fibrosis induced by repeated injection of cisplatin, with special reference to the kinetics of macrophages and myofibroblasts

Progressive renal interstitial fibrosis occurs following tissue injury, resulting in chronic renal failure. In the fibrogenesis, macrophages are speculated to induce myofibroblasts producing matrix protein. The kinetics of these cells in renal fibrosis induced in rats by repeated injection of cisplatin (CDDP) (2 mg/kg body weight, once weekly) was investigated immunohistochemically. During the 10-wk injection period, epithelial damage of the proximal renal tubules in the corticomedullary junction was seen, followed by cystic dilation of the affected tubules. During the 8-wk recovery period following the seventh injection, the size of the dilated lumina was diminished and atrophic tubules lined by regenerating epithelial cells appeared. Morphometrical analysis revealed that fibrosis began to develop around the dilated renal tubules in the injection period and was more advanced in the following recovery period. Coinciding with development of fibrotic tissues, the number of alpha-smooth muscle actin-positive myofibroblasts was significantly increased in the areas compared to that of controls. In the injection period, despite a significant increase in myofibroblast number, an elevation of ED-1 (primary antibody)-positive macrophage number was not observed. In the recovery period, however, a significant elevation of macrophage number was noticed in markedly advanced interstitial fibrosis. This suggests that rapid expansion of the macrophage population, probably resulting from release from myelosuppression due to CDDP, might contribute in part to development of myofibroblasts, leading to the augmented fibrosis in the recovery period.

Cerebellar vermis defect: a new neurological mutation in the rat

A new neurological rat mutation showing hind-leg paralysis, cerebellar vermis defect, and cerebellar cortical dysplasia was named "cerebellar vermis defect" (CVD). Pathologically, affected animals already had a small-sized cerebellum in newborns and started to show hind-leg paralysis at approximately 14 days of age. The CVD rat was fertile in both sexes. Genetic analysis indicated that the CVD character is controlled by an autosomal recessive gene with 100% penetrance. The proposed gene symbol is Cvd.

Headache as a manifestation of myocardial infarction

We report a 64-year-old man who complained of headache without chest pain at the onset of acute myocardial infarction (AMI). He had no history of chest pain or headache. Severe headache in this case was the first symptom of AMI. The headache was reproduced during stress test. During the angioplasty procedure, he also complained of headache without vasospastic change in the coronary artery. These findings suggest that the headache which accompanied AMI or myocardial ischemia in this case was due to referred pain rather than a generalized vasospastic disorder.

[Surgical correction of total anomalous pulmonary venous drainage: an adult case of successful repair]

Total anomalous pulmonary venous drainage (TAPVD) is a rare congenital cardiac anomaly. It occurs in only 1.5% of children born with congenital heart defects. But, it is one of the most common lesions necessitating intracardiac operation in the neonatal period. We have experienced a 33-year-old man with supracardiac type TAPVD who was operated upon successfully. Cardiac catheterization showed 0.35 in Pp/Ps, 3.33 in Qp/Qs and 0.11 in Rp/Rs. The left to right shunt ratio was 77%, while the right to left shunt ratio was 23%. The operation was composed of anastomosis between the left atrium and the common pulmonary vein, patch closure of the atrial septal defect, ligation of the vertical vein and tricuspid annuloplasty. The posterior approach was adopted in anastomosis between the left atrium and the common pulmonary vein. The association of a normal pulmonary vascular resistance, a large interatrial communication and absence of a pulmonary venous obstruction was considered as factors of a favorable result.

The effects of physical activity on rehabilitation for acute hepatitis

We studied 19 patients with acute hepatitis who were instructed to follow a 5-stage exercise regimen. The mean period of hospitalization was 31.9 days, slightly shorter than the mean duration for acute hepatitis patients. The exercise program had no adverse effects on the patients. They returned to works an average of 9.5 days after discharge, demonstrating a marked reduction in the rehabilitation period. Hepatitis should be primarily treated under the internist's management. However, physical exercise should be recognized as an equally important treatment modality.

Changes in left ventricular volume and systolic function before and after the closure of ductus arteriosus in full-term infants

Using echocardiographic techniques, the change in left ventricular (LV) volume and its effect on systolic function were studied before and after the closure of ductus arteriosus in 18 full-term infants. Examinations were performed twice in each infant, within 6 h after birth and on day 5, and the patency of the ductus with left-to-right shunt was confirmed at the first examination by Doppler echocardiography. A biplane Simpson's rule method was used for volume measurements. The LV end-diastolic volume, stroke volume, and cardiac output were more than 1.3-fold before the ductal closure, and the ejection fraction showed the similar change. However, the mean normalized systolic ejection rate, an index of contractility, and heart rate showed no significant difference. The Frank-Starling curve was obtained from the relationship between the LV end-diastolic and stroke volumes, and the LV performance was operated at a higher level on that curve when the ductus was open. Our data indicated that LV cardiac output was significantly higher during the patency of the ductus arteriosus and that this high cardiac performance might depend more on the Frank-Starling response to the volume load through the ductus arteriosus than on the increase of LV contractility and heart rate.

Doppler echocardiographic findings of indomethacin-induced occlusion of the fetal ductus arteriosus

We present an unusual case of indomethacin-induced occlusion of the fetal ductus arteriosus, which occurred in one of twins. In fetal echocardiography, the characteristic findings, a to and fro regurgitation pattern at pulmonary valve and postvalvular dilation of the main pulmonary artery, were obtained in addition to right ventricular dilation and hypertrophy, tricuspid regurgitation, right atrium dilation, and pericardial effusion. This fetus developed fetal distress and was delivered by an emergency cesarean section at 35 weeks' gestation. We suggest that these fetal echocardiographic findings may be the end-stage signs of the fetal ductal occlusion as well as the signs for emergent delivery.

Cell cycle arrest in the G2 phase induced by phorbol ester and diacylglycerol in vascular endothelial cells

The role of protein kinase C (PKC) in vascular endothelial cell proliferation was investigated using human umbilical vein endothelial cells released from the G1/S border. Phorbol 12-myristate 13-acetate (PMA) caused G2 arrest because 1) when added to G2 cells, PMA inhibited subsequent cell division; 2) these growth-arrested cells did not show morphological features of mitotic cells; and 3) PMA did not interrupt mitosis in cells released from nocodazole-induced M phase arrest. 1-Oleoyl-2-acetyl-sn-glycerol (OAG) added repeatedly from G2 also inhibited mitosis. The activation of cdc2 kinase around the G2/M transition was suppressed by PMA and OAG. Although cdc2 was expressed in the presence of PMA, dephosphorylation of its tyrosine residue was inhibited by PMA. In parallel, the expression of cdc25B was suppressed by PMA. The total and the cdc2-associated amount of cyclin B were both reduced by PMA. These data suggested that the PKC pathway negatively regulates the G2/M transition and that the inhibition of cdc2 kinase by the reduction in the levels of cdc25B and cyclin B may contribute to this effect.

Requirement of calmodulin-dependent protein kinase II in cyclic ADP-ribose-mediated intracellular Ca2+ mobilization

Cyclic ADP-ribose (cADPR) is generated in pancreatic islets by glucose stimulation, serving as a second messenger for Ca2+ mobilization from the endoplasmic reticulum for insulin secretion (Takasawa, S., Nata, K., Yonekura, H., and Okamoto, H. (1993) Science 259, 370-373). In the present study, we observed that the addition of calmodulin (CaM) to rat islet microsomes sensitized and activated the cADPR-mediated Ca2+ release. Inhibitors for CaM-dependent protein kinase II (CaM kinase II) completely abolished the glucose-induced insulin secretion as well as the cADPR-mediated and CaM-activated Ca2+ mobilization. Western blot analysis revealed that the microsomes contain the alpha isoform of CaM kinase II but do not contain CaM. When the active 30-kDa chymotryptic fragment of CaM kinase II was added to the microsomes, fully activated cADPR-mediated Ca2+ release was observed in the absence of CaM. These results along with available evidence strongly suggest that CaM kinase II is required to phosphorylate and activate the ryanodine-like receptor, a Ca2+ channel for cADPR as an endogenous activator, for the cADPR-mediated Ca2+ release.

mel-18, a Polycomb group-related mammalian gene, encodes a transcriptional negative regulator with tumor suppressive activity

The mammalian mel-18/bmi-1 gene products share an amino acid sequence and a secondary structure, including a RING-finger motif, with the Drosophila Polycomb group (PcG) gene products Psc and Su(z)2, implying that they represent a gene family with related functions. As Drosophila PcG gene products are thought to function as transcriptional repressors by modifying chromatin structure, Mel-18/Bmi-1 might be expected to have similar activities. Here we have analyzed the function of mel-18 and found that Mel-18 acts as a transcriptional repressor via its target DNA sequence, 5'-GACTNGACT-3'. Interestingly, this binding sequence is found within regulatory or non-coding regions of various genes, including the c-myc, bcl-2 and Hox genes, suggesting diverse functions of mel-18 as the mammalian homolog of the PcG gene. We also demonstrate that mel-18 has tumor suppressor activity, in contrast to bmi-1, which has been defined as a proto-oncogene.

[Erythroblastic transformation of chronic myelogenous leukemia associated with an additional chromosome abnormality translocation (6;9]

A 57-year-old female was diagnosed being in the blastic phase of chronic myelogenous leukemia (CML) on her second admission in May 1993. The patient was previously treated with vincristine and prednisolone in the accelerated phase of CML in December 1991 without improvement. Other chemotherapeutic agents such as BHAC-DMP (enocitabine, daunorubicin, mercaptopurine, prednisolone), interferon, mercaptopurine and ranimustine were also administered. After the second chronic phase was achieved, she was treated with busulfan as an outpatient. On her second admission, the diagnosis of erythroblastic transformation was made, and cytogenetic study revealed t(9;22) (q34;q11) with the additional chromosomal abnormalities, t(6;9) (p23;q34). This karyotype rearrangement has been reported neither in Ph-positive CML nor in blastic crisis.

The effects of endothelin-1 on isolated bovine ciliary muscles

The effects of endothelin-1 on bovine ciliary muscle were investigated in vitro using muscle strips prepared in two different directions (longitudinal and circular). Fifty-two bovine ciliary muscle strips (4 x 6 mm) were prepared. Chemicals were added to both types of strips suspended in an organ chamber, and their changes in isometric tension were recorded. The concentration-response relationship of endothelin-1 (n = 20), the magnitudes of contractions caused by endothelin-1 and carbachol (n = 12), and the effects of an endothelin receptor subtype A antagonist BQ123 (n = 4) and an endothelin receptor subtype B agonist IRL1620 (n = 4) were studied. The cumulative addition of endothelin-1 caused relaxation at low concentrations (10(-11) and 10(-10) M), while it caused contraction of the ciliary muscles at high concentrations (10(-9), 10(-8) and 3 x 10(-8) M). The magnitude of the contraction caused by 10(-8) M endothelin-1 was about 30% in the longitudinal muscle strips and 29% in the circular muscle strips, relative to the contraction caused by 10(-5) M carbachol, a muscarinic agonist. The contractile response caused by 10(-8) M endothelin-1 was abolished and converted to relaxation by pretreatment with BQ123, a selective endothelin receptor subtype A antagonist. Single addition of IRL1620, a selective endothelin receptor subtype B agonist, caused only relaxation. These results suggest that, endothelin-1 causes not only contraction at high concentrations, but also relaxation at low concentrations in bovine ciliary muscle. Also, it suggested that the relaxation is mediated by endothelin receptor subtype B, whereas the contraction is mediated by endothelin receptor subtype A.

Psychiatric evaluation of physical rehabilitation patients

We conducted a study to demonstrate the frequency and types of psychiatric/psychological symptoms. A Structured Interview according to the DSM-III-R was conducted which demonstrated that 46 (41.4%) of 111 rehabilitation inpatients met the criteria for some forms of psychiatric disorders: 34 patients for major depression, 10 for adjustment disorder with anxious mood, and 2 for posttraumatic stress disorder. The remaining 65 patients (58.6%) showed normal reactions to their diseases. Average length of hospital stay for patients with major depression was significantly longer than those with no or the other types of psychiatric disease. They were also tested with Zung's Self-Rating Anxiety Scale (SAS), Zung's Self-Rating Depression Scale (SDS), and Profile of Mood States (POMS). Three psychological tests were useful in detecting depression or adjustment disorder among rehabilitation patients; however, these tests are not always specific to the type of psychiatric disorders. Patients with higher scores in those three tests should be referred to a psychiatric consultant for detailed examinations and proper treatments, if necessary.

[A case of thymic squamous cell carcinoma successfully treated with curative resection]

A case of rare thymic squamous cell carcinoma was reported. A 46-year-old female was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest CT showed anterior mediastinal tumor and histological diagnosis of squamous cell carcinoma was made by needle biopsy under CT guide. Esophagus and lung were no abnormal findings, we thought the primary region was thymus. On mid-sternotomy, anterior mediastinal tumor was resected with thymus, right phrenic nerve and pericardium, however it was not direct invasion to heart, great vessels, lung and chest wall. Resection of peripheral fatty tissue and dissection of mediastinal lymph nodes as much as possible, it was not capsular invasion and mediastinal lymph nodes metastasis and complete curative resection was able to perform. Additional radiation therapy was done, post-operative course was uneventful.

A case report of mixed P- and C-ANCA positive patients with pauci-immune crescentic glomerulonephritis

We describe 2 patients with pauci-immune crescentic glomerulonephritis and elevated titers of perinuclear and cytoplasmic anti-neutrophil cytoplasmic antibody (P-ANCA and C-ANCA) which were associated with both 29 and 59 kD bands on Western blots. The presence of C-ANCA corresponds with a clinical and/or histological diagnosis of Wegener's granulomatosis, but although both patients suffered from pulmonary complications there was no clinical nor histological evidence of granulomatosis. Transbronchial lung biopsy showed only interstitial pneumonia and old hemorrhage. Therefore, the patients' conditions were interpreted as microscopic polyarteritis nodosa or hitherto undefined vasculitis associated with ANCA.

[Identification and analysis of immune cells infiltrating into the glomerulus and interstitium in lupus nephritis]

This study was performed to investigate the role of cell-mediated immunity in lupus nephritis (LN). Frozen sections from 38 patients with LN were examined by indirect immunoalkaline-phosphatase labeling using monoclonal antibodies to identify the immune cells infiltrating into the interstitium and glomerulus. 14 patients showed minor glomerular abnormality (MGA), 9 had mesangial LN (MesLN), 12 had diffuse proliferative LN (DPLN) and 3 had membranous LN (MLN). Monocyte/macrophage and helper/inducer T cells infiltrated in the interstitium predominantly, but intraglomerular infiltration of these cells was rare. Monocyte/macrophage and suppressor/cytotoxic T cell levels were significantly higher (p < 0.05) in the interstitium in DPLN patients and monocyte/macrophage level was significantly higher (p < 0.05) in MesLN patients than in MGA patients. In the interstitium, serum creatinine level was highly correlated with infiltrations of suppressor/cytotoxic T cell, monocyte/macrophage (p < 0.01), pan T cell and total leucocyte (p < 0.05). Clinical activity score was correlated with suppressor/cytotoxic T cell (p < 0.001), monocyte/macrophage and pan T cell (p < 0.01). These results suggest that suppressor/cytotoxic T cell and and monocyte/macrophage may play an important role in the progression of lupus nephritis.

[L-DOPA-producing primary fibroblasts genetically modified with a retrovirus vector system]

Although intracerebral grafting has become a new strategy for the treatment of Parkinson's disease, many problems related to the grafts remain. We focused on primary skin fibroblasts as grafts. Rat primary skin fibroblasts were transfected with a retrovirus vector containing the cDNA of human tyrosine hydroxylase (TH) (pLTHSNL) or cytomegalovirus promoter (pCTHSNL) as a foreign promoter, and catecholamine production and release by these genetically modified fibroblasts, were analyzed in vitro immunocytochemically and by high-performance liquid chromatography with electrochemical detection (HPLC-ECD). The cells were supplemented with biopterin (BH4; (6R)-L-erythro-tetrahydrobiopterin), a cofactor required for TH activity, and they produced and released L-DOPA into the culture medium. When exposed to the combination of a foreign promoter and BH4, L-DOPA production increased in a time-dependent manner, and was unaffected by the number of cell-passages or the duration of liquid-nitrogen freezing. This suggests that the foreign gene (THcDNA)-containing retrovirus vector had integrated into the chromosomal DNA of the target cells (fibroblasts). Primary fibroblasts can be easily obtained and cultured. Thus, genetically modified primary skin fibroblasts transfected with THcDNA using this retrovirus vector system appear to be a promising graft for transplantation and gene therapy of Parkinson's disease in the future.

A novel highly specific and potent inhibitor of calmodulin-dependent protein kinase II

A novel synthetic peptide AIP (autocamtide-2-related inhibitory peptide), a nonphosphorylatable analog of autocamtide-2, was found to be a highly specific and potent inhibitor of calmodulin-dependent protein kinase II (CaM-kinase II). It was 50 and 500 times more potent than CaMK-(281-302Ala286) and KN-93, respectively, under the assay conditions used. The inhibition was unaffected by the presence or absence of Ca2+/calmodulin, and it was competitive with autocamtide-2 and noncompetitive with syntide-2. AIP (1 microM) completely inhibited CaM-kinase II activity, but did not affect cyclic AMP-dependent protein kinase, protein kinase C, calmodulin-dependent protein kinase IV, and unidentified protein kinases occurring in a rat brain extract. These results indicate that AIP is a useful tool for studying the physiological roles of CaM-kinase II.