A case of Meniere's disease with vertical nystagmus after administration of glycerol

A 62-year-old woman who complained of repetitive vertigo with a left fluctuating hearing loss was admitted to our hospital three times. A glycerol test was done on the third admission. Two hours after the administration of glycerol, the patient complained of rotatory vertigo with a downbeat vertical nystagmus. This nystagmus then changed its direction upward. Her left hearing loss was improved during the glycerol test. On the day after the glycerol test, a caloric test was done. The caloric response of the right ear was remarkably improved. Although she had not felt a hearing loss in the right ear, an overwritten audiogram showed a fluctuation of hearing in the right ear. The bilateral caloric responses fluctuated. From these findings, it appears that the function of the inner ear on both sides fluctuating. We speculate that the administration of glycerol elicited an asymmetry in the function of the inner ear on both sides and ocuured vertigo with vertical nystagmus because of the irritation of both ears.

Highly efficient kinetic resolution of beta-halohydrins catalyzed by a chiral 1,2-diamine

Kinetic resolution of racemic beta-halohydrins has been achieved by reaction with benzoyl chloride in the presence of a catalytic amount (0.3 mol%) of a chiral diamine combined with diisopropylethylamine to afford the corresponding benzoates and unreacted beta-halohydrins in good to excellent enantioselectivities. The benzoate can be converted to the corresponding allylic benzoate without loss of optical purity by treatment with (1,5-diazabicyclo[4.3.0]non-5-ene).

[Lens epithelial cell damage and apoptosis in atopic cataract--histopathological and immunohistochemical studies]

PURPOSE

To elucidate the relationship between damage of lens epithelial cells and apoptotic cell death in patients with atopic cataract.

METHODS

Histopathological and immunohistochemical studies were carried out using anterior lens capsules obtained at surgery from 13 patients with atopic cataract and from 25 patients with senile cataract.

RESULTS

No specific histopathological findings were found in the lens epithelial cells in atopic cases. However, the frequency and severity of histopathological findings such as flattening, nuclear pyknosis, and loss of cells were more frequent and more severe in atopic cases than in senile cases. The terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labelling (TUNEL) method revealed that the mean ratio of cells containing fragmented DNA to whole epithelial cells was almost the same in both atopic and senile cases. However, the mean ratio of Bax-positive cells was significantly higher in atopic cases (mean +/- standard deviation, 29.1 +/- 35.0%) than in senile cases (2.7 +/- 7.0%) (p < 0.05). The mean ratio of Bcl-2-positive cells was significantly lower in atopic cases (1.4 +/- 3.4%) than in senile cases (44.3 +/- 35.7%) (p < 0.05).

CONCLUSION

These results suggest that apoptotic cell death may play an important role in the development of lens epithelial cell damage in atopic cataract.

Overexpression of bcl-2 in transient abnormal myelopoiesis associated with Down syndrome

Transient abnormal myelopoiesis (TAM) is a haematological complication found in Down syndrome. To determine the mechanisms of sustained proliferation of TAM cells, we studied the expression of apoptosis-related proteins, such as bcl-2, Fas (APO-1/CD95) and p-53, in peripheral blood cells from a new-born infant with Down syndrome and TAM. Using flow cytometry, peripheral blood mononuclear cells (PBMCs), consisting mostly of blast cells, showed marked expression of bcl-2 protein but not of Fas or p-53 products. DNA gel electrophoresis of PBMCs, cultured in the absence of serum factors, revealed no marked fragmentation. Our findings suggest that bcl-2 overexpression may be associated with prolonged cell survival of TAM cells.

High frequency of postnatal transmission of TT virus in infancy

DNA of TT virus (TTV), a novel human circovirus, was tested for in 116 mother-infant pairs who had participated in the adult T-cell leukemia prevention program (APP) in Nagasaki, Japan, and refrained from breast-feeding. By polymerase chain reaction with Okamoto's seminested primers, 36 of the 115 (31%) mothers were positive. At the age of 6-8 months, 7 of 29 (24%) and 6 of 72 (8%) infants born to infected and uninfected mothers were positive, respectively (P = 0.047; RR, 2.90). Maternal TTV DNA load did not correlate with infantile infections. Since 99 of 100 (99%) cord blood samples were negative and all the mothers refrained from breast-feeding, the infantile TTV transmission would not be intrauterine or milk-borne. Between 6-8 and 12-21 months of age, 4 of 12 (33%) and 5 of 22 (23%) children born to infected and uninfected mothers turned positive, respectively (NS). At 12-21 months of age, 8 of 21 (38%) and 12 of 32 (38%) children born to infected and uninfected mothers were positive, respectively (NS). These results indicate that the TTV infection prevails in children at a frequency comparative to that in their mothers within the first 2 years of life, regardless of the maternal TTV status.

Inhibitory effects of tranilast on the proliferation and functions of human pterygium-derived fibroblasts

PURPOSE

We studied the possibility that tranilast, an antiallergic and antiproliferative drug, may be beneficial for the treatment of pterygium.

METHODS

Pterygium-derived cells were identified by immunohistochemical methods. Growth rate of pterygium-derived cells was determined by using a hemocytometer. Chemotaxis was determined in a microchemotaxis chamber. Pterygium-derived cells were cultured on floating collagen gel, and the contracted diameter was measured. Collagen synthesis by pterygium-derived cells was determined by the collagenase digestive method. Tranilast was added to the culture medium at final concentrations of 0, 12.5, 25, 50, and 100 microg/ml.

RESULTS

Pterygium-derived cells were stained with anti-prolylhydroxylase and anti-alpha-smooth muscle actin, and identified as fibroblasts. Tranilast inhibited the proliferation and chemotaxis of pterygium-derived fibroblasts, and the collagen-gel contraction induced by these cells, but it exerted no inhibitory action on collagen synthesis by pterygium-derived fibroblasts.

CONCLUSION

Tranilast may be useful for suppressing the recurrence and, possibly, the development of pterygium.

Does edema formation occur in the rabbit brain exposed to head-down tilt?

Earlier studies showed that exposure to microgravity caused cephalad fluid shift, increased capillary pressure in the head, and produced facial edema and nasal congestion. In the present study, edema formation in the brain was investigated in rabbits exposed to simulated microgravity, head-down tilt (HDT), by measuring water content and histological examinations. Water content in the brain tissues of rabbits exposed to 2 and 8 days of HDT did not increase significantly compared with that of control animals. Neither vital staining using Evans blue nor immunohistochemical examination demonstrated extravasation of plasma constituents in the brain tissues of the HDT rabbits. Although marked congestion was noted in the brain, hematoxylin and eosin staining did not show edematous changes, such as distension of the perivascular and pericellular spaces and vacuolar appearance, in the tissues obtained from HDT rabbits. Transmission electron microscopy revealed that tight junctions of the capillary endothelium were intact in the HDT rabbits. These results suggest that either HDT up to 8 days does not cause brain edema in rabbits or it induces only a slight brain edema which is hard to be demonstrated by measurement of water content or histological examinations.

Treatment of malignant melanoma of the lower eyelid using anterolateral thigh flap

Malignant melanoma is a poor prognostic disease with the potential for high mortality despite early diagnosis and currently available treatment. Surgical judgment pertaining to the extent of primary resection and regional node dissections must be tempered by cosmetic considerations and by the anatomically diffuse pathways for lymphatic spread in certain lesions. We reported a case of malignant melanoma of the left lower eyelid, and presented the surgical excision and reconstruction using anterolateral thigh flap for skin defect. It is evident that comprehensive treatment using radical surgery and adjuvant chemotherapy is necessary for cutaneous malignant melanoma of head and neck areas.

Distribution of Helicobacter pylori in a Mongolian gerbil gastric ulcer model

BACKGROUND AND PURPOSE

To the authors' knowledge, histopathologic changes associated with early H. pylori infection and ulceration have not been established. We examined presence of H. pylori infection in an acetic acid-induced gastric ulcer (AAU) model in Mongolian gerbils.

METHODS

Sixty Mongolian gerbils were used as an AAU model, and another 60 gerbils were studied as a control (non-AAU) group. All animals were orally administered H. pylori, then were evaluated by use of histologic and bacteriologic examinations.

RESULTS

Helicobacter pylori were scattered on the surface mucous gel layer and in the pyloric gland gastric were pits; inflammation seen at the early stages later extended to the mucosa of the fundic gland area. The organisms were predominantly observed in the AAU model, but findings were comparable to those in controls at 1, 3, 7, 14, 28, or 56 days. Evaluation with regard to viable bacterial numbers reflected the histologic aspects, that the pyloric gland area had more viable counts than did the fundic gland area. Carbohydrate composition of mucin differed between pyloric and fundic gland areas. These findings shed light on L-fucose related to the H. pylori adhesive factor abundant in mucin of the pyloric gland area.

CONCLUSIONS

Findings for this ulcer model of Helicobacter pylori infection make it useful for the study of onset of infection and screening of anti-ulcer agents.

Muscle adaptation of Thoroughbred racehorses trained on a flat or sloped track

OBJECTIVE

To determine histochemical and biochemical properties of muscle during adaptation to training on a flat or sloped track.

ANIMALS

22 Thoroughbreds.

PROCEDURE

Samples were obtained from the middle gluteus muscle before and after training programs were conducted, using a needle-biopsy technique. Training programs consisted of horses running 1,600 m on a flat or sloped track for 16 weeks. Amplitude of middle gluteus muscle activity per burst was calculated. Muscle fiber composition and area were examined on serial cross sections processed by standard histochemical staining procedures (ATPase stain after prior incubation with an acid or base, followed by succinate dehydrogenase [SDH] stain). Furthermore, SDH and phosphofructokinase activities were determined biochemically, and composition of myosin heavy chain (MHC) isoforms was analyzed electrophoretically.

RESULTS

Training resulted in substantial adaptations. Relative contribution of muscle fiber with high SDH activity (type-I and -IIa fibers) to total cross-sectional area, SDH activity, and composition of MHC-IIa isoforms were increased. Gel electrophoresis revealed a large amount of MHC-IIx isoform and a small amount of MHC-IIb isoform in the muscle. Although root mean square of muscle activity for training on a sloped track was 7.6% higher than the value obtained while training on a flat track, muscle histochemical and biochemical properties did not differ significantly between groups training on flat and sloped tracks.

CONCLUSIONS

Training adaptations for contractile and metabolic properties of the middle gluteus muscle were evident for the 2 types of training. However, training adaptations did not differ significantly between groups trained on flat or sloped tracks.

Segment-specific branching patterns of single vestibulospinal tract axons arising from the lateral vestibular nucleus in the cat: A PHA-L tracing study

The purpose of the present study was to detail the spinal cord (SC) trajectories and arborization patterns of vestibulospinal axons descending from the lateral vestibular nucleus (LVN). An anterograde neural tracer, Phaseolus vulgaris-leucoagglutinin (PHA-L), was focally injected into the right-side LVN in 8 cats. Their subsequent survival times varied from 4 days to 12 weeks. The labeled axons were found mainly in the brainstem after 4-5 days and in successively more caudal spinal segments after longer survival times: i.e., in C1-T2 after 2-3 weeks, in C3-T11 after 6-7 weeks, and in T7-S1 after 10-12 weeks. The trajectories of 28 single, thick (diameter >/=2.4 microm) lateral vestibulospinal tract (LVST) axons were traced from serial transverse sections of the SC from C1-8 (n = 10), T1-9 (n = 11), and T11-L7 (n = 7). In the cervical segments, the LVST axons gave off collateral fibers, which terminated mainly in Rexed's laminae VII-VIII. The terminal-field patterns of these collaterals differed from one stem axon to another. In the thoracic segments, the terminal-field patterns from a given LVST axon were similar at each segmental level, i.e., a few main branches with or without short side branches. At the L3-5 midlumbar level, the collaterals usually arborized more extensively, such that their terminal fields occupied a much greater region of laminae VII-VIII. In contrast, at the L6-7 lower lumbar level, collaterals arising from thin axons (diameter <1.0 microm) tended to innervate, with even more extensive arborization, the medial part of the lamina VIII. These results revealed common and segment-specific collateral distribution patterns of LVST axons along the full extent of the spinal neuraxis.

[Apneic anesthesia for microsurgery of the larynx under propofol anesthesia]

Apneic anesthesia with intermittent ventilation (AAIV) under inhalational anesthesia has been reported to improve visualization of the larynx with lack of vocal cord motion in laryngeal microsurgery. In this study, we evaluated AAIV using total intravenous anesthesia with propofol and fentanyl instead of inhalational anesthesia in 11 patients undergoing microsurgery of the larynx, and examined the effects of AAIV on respiration and circulation. Anesthesia was maintained with infusion of propofol 4-10 mg.kg-1.h-1 and intermittent administration of fentanyl and vecuronium intravenously. The lungs were ventilated with 100% oxygen, and the endotracheal tube was removed during the apneic period. AAIV provided the otorhinolaryngologist sufficient room in which to operate and an immobile field without complications in any of the patients. The number of periods of apnea (mean +/- SD) was 3.3 +/- 1.3, and the duration of apnea was 292 +/- 23 seconds. Neither blood pressure nor heart rate changed during the apneic periods. Arterial oxygen saturation measured using pulse oxymetry (Spo2) changed in none of the patients except an obese patient whose Spo2 declined to 90%. End-tidal carbon dioxide level increased for 14.9 mmHg immediately after apneic periods. Propofol vielded stable and adequate levels of anesthesia during apneic periods. We conclude that AAIV using constant monitoring of Spo2 is a useful and safe technique, and that propofol is a suitable anesthetic agent for AAIV.

Analysis of human error in nursing care

Analysis of reports about incidental and accidental events in nursing care were made using a reliability engineering method. Unnatural working hours, such as evening duty, night duty falling next to a holiday, two consecutive night-duty shifts, and two consecutive evening-duty shifts were major factors in the occurrence of errors. In a mixed-division ward (a ward containing patients belonging to different divisions), rule-based errors happened more frequently than in a single-division ward. Also, less experienced nursing staffs made errors more frequently than experienced nursing staffs.

Long-term survivors of advanced neuroblastoma with MYCN amplification: A report of 19 patients surviving disease-free for more than 66 months

PURPOSE

According to initial reports, stage 4 neuroblastoma patients with amplification of the MYCN proto-oncogene developed progressive disease within 8 months. The prognosis for such patients, however, should now be reevaluated in light of recent results achieved with up-to-date combination chemotherapy.

PATIENTS AND METHODS

Patients with stage 3, 4, and 4S neuroblastoma and more than 10 copies of MYCN received induction chemotherapy, which from January 1985 to February 1991 consisted of regimen A(1 )(cyclophosphamide 1,200 mg/m(2) on day 1, vincristine 1.5 mg/m(2) on day 1, pirarubicin 40 mg/m(2) on day 3, and cisplatin 90 mg/m(2) on day 5) and from March 1991 to September 1993 consisted of regimen A(3 )(cyclophosphamide 1,200 mg/m(2) on days 1 and 2, pirarubicin 40 mg/m(2) on day 3, etoposide 100 mg/m(2) on days 1 through 5, and continuous infusion cisplatin 25 mg/m(2) on days 1 through 5). Most of these patients underwent radical surgery to remove the original tumor and local metastases, irradiation, and supralethal preconditioning regimens, followed by blood stem-cell transplantation (SCT). Data on the patients were collected in December 1998, and the factors contributing to disease-free survival were analyzed.

RESULTS

During the study period, 66 patients with more than 10 copies of MYCN were treated. Five of nine patients with stage 3 disease, 13 of 55 with stage 4, and one of two with stage 4S survived for at least 66 months. It is interesting that all but one patient who survived for more than 66 months underwent SCT, in contrast with only five of 45 patients who died.

CONCLUSION

Not all patients with advanced neuroblastoma who have more than 10 copies of MYCN will die. The requisites for survival in such patients seem to be intensive induction chemotherapy, effective surgery, irradiation, and the use of SCT.

Autonomic nervous function in patients with Meniere's disease evaluated by power spectral analysis of heart rate variability

OBJECTIVE

A hypothesis has been advanced that the autonomic nervous dysfunction (AND) relates to the development of vertigo in Meniere's disease (MD). We also studied the causal relationship between AND and vertigo in MD.

METHODS

We evaluated autonomic nervous function in 17 patients with MD (five men and 12 women ranging in age from 16 to 70 years) by classifying them by their stages of attack and interval of vertigo and with power spectral analysis (PSA) of heart rate variability. Fourteen healthy volunteers were also tested as controls.

RESULTS

At the interval stage, parasympathetic nervous hypofunction and significant depression of sympathetic response due to postural changes from the supine to the standing position were observed in many of those patients. At the attack stage, sympathetic nervous hypofunction was observed in some of the patients.

CONCLUSION

These findings lead us to the conclusion that AND relates to vertigo in MD as a predisposing factor. However, the question of whether AND relates as a trigger or as a consequence of vertigo in MD has not been adequately solved in this study. We will make further studies on circadian variation of autonomic nervous function.

Development of Purkinje cells in humans: an immunohistochemical study using a monoclonal antibody against the inositol 1,4,5-triphosphate type 1 receptor (IP3R1)

Immunohistochemical analyses were carried out on the Purkinje cells from 21 autopsied fetal and early postnatal normal cerebella using a monoclonal antibody against the inositol 1, 4, 5-triphosphate type 1 receptor (IP3R1) as a cytochemical marker of Purkinje cells. In normal adult cerebella used as positive controls, the cell bodies, axons, and dendrites, including spiny branchlets of the Purkinje cells, were specifically stained by the antibody. In the fetal cerebella examined, the IP3R1 immunoreactivity was first detected in the soma of multilayered cells just beneath the molecular layer at 16 weeks of gestation. The IP3R1 immunoreactivity gradually increased in area of positive staining from soma to dendrites and spiny branchlets, and the dendritic outgrowth rapidly progressed during 6 months after birth. The Purkinje cell maturation was more advanced in the vermis than in the hemisphere, more in the posterior lobe than in the anterior lobe, and more at the bottom of the folia than at the top. Partial absence of the Purkinje cells in the cerebellar cortex was observed in three cases. Heterotopias including Purkinje cells were often noted in the cerebellar white matter in five cases.

Chronic rheumatoid arthritis complicated by myeloperoxidase antineutrophil cytoplasmic antibody-associated nephritis

We report a myeloperoxidase antineutrophil cytoplasmic antibody-positive rheumatoid arthritis patient who developed necrotizing crescentic glomerulonephritis. Steroid therapy was given combined with an immunosuppressant agent, and double-filtration plasmapheresis was started with the aim of removing antibodies from the blood. This therapeutic regimen was found to be useful.

CD4+ and/or gammadelta+ T cells in the liver spontaneously produce IL-4 in vitro during the early phase of Leishmania major infection in susceptible BALB/c mice

Numerous studies on the cytokine production profile in Leishmania major infected susceptible and resistant mice have been carried out to elucidate the mechanisms of healing or non-healing of this infection. However, many methods may have failed to detect the actual cytokine production in the inflammatory foci. To overcome this problems, the ELISPOT assay was used to examine the spontaneous production of IL-4 and IFN-gamma in vitro by mononuclear cells from the spleen, lymph nodes and liver in L. major-infected susceptible BALB/c and resistant C57BL/6 mice. None of these mononuclear cells spontaneously produced IFN-gamma in either mouse strains in vitro in the absence of the corresponding antigen(s). However, liver mononuclear cells from infected BALB/c mice spontaneously produced IL-4 in vitro in as early as 2 weeks after the infection, but this was not observed in C57BL/6 mice. The IL-4 producing liver lymphocytes consisted of CD4+ and/or gammadelta+ T cells and uncharacterized cells. These results suggest that liver lymphocytes play some role in the establishment of Th2 prevalence in susceptible BALB/c mice, based on the importance of IL.4 production in the early phase of L. major infection in establishing Th2 dominance in this parasite susceptible mouse.

Medial prefrontal cortex is involved in the discriminative stimulus effects of nicotine in rats

RATIONALE

Central nicotinic receptors have been reported to be involved in the discriminative stimulus (DS) effects of nicotine.

OBJECTIVES

The purpose of the present study was to investigate the role of the medial prefrontal cortex (mPFC) and the medial habenular nucleus (mHb) in the DS effects of nicotine.

METHODS

Substitution tests with nicotine administered into mPFC and mHb were conducted in rats trained to discriminate nicotine (0.5 mg/kg, SC) from saline in a two-lever, food reinforced, operant task.

RESULTS

Nicotine (40 microg) administered into mPFC substituted for nicotine (0.5 mg/kg, SC), whereas nicotine administered into mHb did not.

CONCLUSIONS

Together with our previous study indicating that the nucleus accumbens and the ventral tegmental area are partially involved in the DS effects of nicotine, the present study suggests that mPFC is primarily involved in the DS effects of nicotine.

Tying a molecular knot with optical tweezers

Filamentous structures are abundant in cells. Relatively rigid filaments, such as microtubules and actin, serve as intracellular scaffolds that support movement and force, and their mechanical properties are crucial to their function in the cell. Some aspects of the behaviour of DNA, meanwhile, depend critically on its flexibility-for example, DNA-binding proteins can induce sharp bends in the helix. The mechanical characterization of such filaments has generally been conducted without controlling the filament shape, by the observation of thermal motions or of the response to external forces or flows. Controlled buckling of a microtubule has been reported, but the analysis of the buckled shape was complicated. Here we report the continuous control of the radius of curvature of a molecular strand by tying a knot in it, using optical tweezers to manipulate the strand's ends. We find that actin filaments break at the knot when the knot diameter falls below 0.4 microm. The pulling force at breakage is around 1 pN, two orders of magnitude smaller than the tensile stress of a straight filament. The flexural rigidity of the filament remained unchanged down to this diameter. We have also knotted a single DNA molecule, opening up the possibility of studying curvature-dependent interactions with associated proteins. We find that the knotted DNA is stronger than actin.

Identification of a novel GC-rich 113-nucleotide region to complete the circular, single-stranded DNA genome of TT virus, the first human circovirus

The sequence data (H. Okamoto et al., Hepatol. Res. 10:1-16, 1998) of a newly discovered single-stranded DNA virus, TT virus (TTV), showed that it did not have the terminal structure typical of a parvovirus. Elucidation of the complete genome structure was necessary to understand the nature of TTV. We obtained a 1.0-kb amplified product from serum samples of four TTV carriers by an inverted, nested long PCR targeted for nucleotides (nt) 3025 to 3739 and 1 to 216 of TTV. The sequence of a clone obtained from serum sample TA278 was compared with those registered in GenBank. The complete circular TTV genome contained a novel sequence of 113 nt (nt 3740 to 3852 [=0]) in between the known 3'- and 5'-end arms, forming a 117-nt GC-rich stretch (GC content, 90.6% at nt 3736 to 3852). We found a 36-nt stretch (nt 3816 to 3851) with an 80.6% similarity to chicken anemia virus (CAV) (nt 2237 to 2272 of M55918), a vertebrate circovirus. A putative SP-1 site was located at nt 3834 to 3839, followed by a TATA box at nt 85 to 90, the first initiation codon of a putative VP2 at nt 107 to 109, the termination codon of a putative VP1 at nt 2899 to 2901, and a poly(A) signal at nt 3073 to 3078. The arrangement was similar to that of CAV. Furthermore, several AP-2 and ATF/CREB binding sites and an NF-kappaB site were arranged around the GC-rich region in both TTV and CAV. The data suggested that TTV is circular and similar to CAV in its genomic organization, implying that TTV is the first human circovirus.

Increased expression of phospholipase D1 mRNA during cAMP- or NGF-induced differentiation in PC12 cells

The rat pheochromocytoma PC12 cells have been employed as a useful model to study neuronal differentiation. To gain insight into the molecular events involved in extension of neurites, the differential expression of phospholipase D (PLD) isozymes were examined in cyclic AMP- or nerve growth factor (NGF)-treated PC12 cells. When the cells were incubated with dibutyryl cyclic AMP (dbcAMP), almost all the cells displayed prominent neurite outgrowth at 24 h. The neurites developed in NGF-treated cells at 24 h were shorter than those in the cells treated with dbcAMP. However, most of the NGF-treated cells extended long neurites at day 5. The rPLD1b mRNA increased within 6 h following dbcAMP treatment and maintained a high level up to 24 h. In contrast, the levels of rPLD1a and rPLD2 mRNAs were rather consistent throughout the time course examined. However, when the cells were treated with NGF, rPLD1a and rPLD1b mRNAs, but not rPLD2 mRNA, increased within 2 days and remained elevated up to 5 days. These results suggest the possible implication of PLD1 in PC12 cell differentiation.