An acute form of tyrosinemia type I with multiple intrahepatic mass lesions

The acute form of tyrosinemia type I usually causes severe hepatocellular dysfunction. We report a 4-month-old infant with hepatosplenomegaly, ascites, and multiple intrahepatic mass lesions mimicking hepatoma. A marked increase of serum alpha-fetoprotein (97.6 micrograms/ml) and multiple small low-density lesions in the liver demonstrated by computed tomography suggested the presence of hepatoma. The liver specimens obtained at laparatomy showed mixed nodular cirrhosis with fatty metamorphosis. Serum levels of tyrosine (6.6 mg/100 ml) and methionine (5.9 mg/100 ml) were increased. Urinary organic acid analyses disclosed increased excretions of succinylacetone (1,330 mg/g creatinine) and delta-amino-levulinic acid (113.6 mg/g creatinine). Histological abnormalities and biochemical evidences led to the correct diagnosis. This case emphasizes the need for complete investigations of puzzling cases and warns against undue reliance on noninvasive imaging techniques.

Reduced regional cerebral metabolic rate for glucose at the terminal stage in a case of late infantile neuronal ceroid lipofuscinosis

Regional cerebral metabolic rate for glucose was determined for six different areas of the gray matter in an 8-year-old girl with late infantile neuronal ceroid lipofuscinosis. In all regions, the rates were almost half of the control values. The regional cerebral metabolic rate for glucose was relatively preserved in the striatal region and severely reduced in the frontal cortex.

Fine assignment of beta-hexosaminidase A alpha-subunit on 15q23-q24 by high resolution in situ hybridization

Tay-Sachs disease results from mutation in the gene encoding beta-hexosaminidase A alpha-subunit. Although some reports have suggested the locus on 15q, we tried to determine the finer gene locus using high resolution in situ hybridization. cDNA probe, p beta H alpha-5, containing the full-length sequence for the enzyme subunit, was 3H-labeled within 1-4 x 10(7) cpm/micrograms of cDNA by nick-translation. After molecular hybridization and autoradiography, prometaphases were G-banded by Hoechst 33258, UV-exposure and Giemsa. A total of 227 silver grains on chromosomes within 115 prometaphase spreads were analyzed. The region 15q23-q24 had 27 grains, corresponding to 11.9% of the total grains and to 77.1% of the grains on chromosome 15. 20.9% of prometaphases were observed with a grain at 15q23-q24. According to several previous reports, the shortest region of overlap (SRO) of the locus has been 15q22-q25.1. Here we have assigned the gene locus to the narrower region 15q23-q24 by high-resolution in situ hybridization, which is one of the most powerful strategy for the completion of human gene map.

Acute autonomic and sensory neuropathy: a case report

A female patient with acute autonomic and sensory neuropathy is described. Urinary disturbance developed rapidly and was followed by orthostatic syncope, absence of lacrimation, salivation and sweating, and sensory impairment. Muscle strength had been consistently normal despite diffuse muscular atrophy. Marked decrease in the number of small myelinated and unmyelinated fibres was revealed in biopsied sural nerve. Eighteen months after the onset, her autonomic symptoms have partially improved.

Secondary amyloidosis in glycogen storage disease type Ib

We observed the development of generalized amyloidosis in a girl with glycogen storage disease type Ib (GSD-Ib) who showed neutropenia, neutrophil dysfunction and recurrent infections. Renal and thyroid biopsies showed secondary amyloidosis, characterized by the presence of potassium permanganate sensitive Dylon positive deposits in glomeruli, renal vessels and thyroid interstitium. Immunohistochemistry showed that the deposits were composed of amyloid A (AA) protein. Possibly neutrophil abnormalities are involved in the pathogenesis of amyloidosis.

Aged-onset Kienböck's disease

Kienböck's disease with onset after 50 years of age was studied. Of 127 patients with Kineböck's disease seen over the past 30 years, the cases of 15 (12 female, 3 male) were analyzed. The average age of onset was 58.3 years. Five specimens were obtained operatively in which necrosis of the lunate bone mixed with empty lacunae was identified, as was bony remodelling. Ulnar variance in the aged diseased group (group A) was smaller than that of the aged control group (group C). Moreover, it was noteworthy that the variance among aged controls (group C) was higher than among the young controls (group D). The metacarpal index of the patients with aged-onset Kienböck's disease was markedly lower than that of the young. Considering the increase of ulnar variance with age, the persistence of minus variance and the presence of osteoporosis might make the lunate bone susceptible to injury.

Restoration of axial and appendicular bone volumes by h-PTH(1-34) in parathyroidectomized and osteopenic rats

Effects of h-PTH(1-34) were histomorphometrically evaluated in both cancellous and cortical bone tissues of axial and appendicular skeletons of parathyroidectomized and osteopenic rats. Osteopenia was induced by hemicordotomy immobilization and by estrogen depletion as a result of ovariectomy. The rats received intramuscular injections of 50 units (15 micrograms) of h-PTH(1-34) six times weekly during weeks 11 through 18 of the experiment. Significant restoration of cancellous and cortical bone volumes was observed in axial and appendicular skeletons of animals treated with h-PTH(1-34). The stimulatory effects of h-PTH(1-34) on osteoid surface, independent of eroded surface, in cancellous and cortical bone tissues, were clearly observed histomorphometrically. Mineralizing surface, mineral apposition rate and bone formation rate in cancellous bone tissues were markedly increased by h-PTH(1-34). It should be noted that h-PTH(1-34) increased trabecular thickness, but did not increase trabecular number. In conclusion, h-PTH(1-34) stimulated bone formation independent of bone resorption, and restored cancellous and cortical bone volumes in parathyroidectomized and osteopenic rats.

Age-dependent change in activities of lysosomal enzymes in rat brain

The age-dependent change in activities of seven lysosomal enzymes (cathepsin D, beta-glucuronidase, acid phosphatase, acid/alkaline DNases and acid/alkaline RNases) was studied in four brain regions (cerebrum, hippocampus, pons and cerebellum) of Wistar rats. The activity of cathepsin D was significantly increased with aging in the four regions. The age-dependent change in activities of acid and alkaline DNases showed the characteristic regional difference, and the ratio of acid to alkaline DNases was increased with aging in all regions. Acid RNase showed the lowest activity in 18-month-old rats, and alkaline RNase activity was decreased with aging. The activity of beta-glucuronidase was higher in 2-month-old rats in all of the regions studied. Acid phosphatase showed no significant age-dependent change except in pons. The study demonstrated that all of the lysosomal enzyme activities do not change in parallel with aging, and that the age-dependent change showed the characteristic regional difference.

Enzyme-linked immunosorbent assay for human autoantibody to glial fibrillary acidic protein: higher titer of the antibody is detected in serum of patients with Alzheimer's disease

We have developed an enzyme-linked immunosorbent assay (ELISA) to detect anti-glial fibrillary acidic protein (GFAP) autoantibody in human sera. The ELISA was prepared by coating microtest plates with purified GFAP from bovine spinal cord. The autoantibody activities were assayed in the serum from 219 control subjects, 39 Alzheimer's disease patients and 39 cerebrovascular dementia patients. Higher titer of the antibody was observed in the serum of Alzheimer's disease patients. Since the titer showed no significant change with aging or with sex in the control serum, we could determine a certain normal value of the antibody titer. The percentage of abnormal subjects whose antibody levels were over the normal value was 53.8% in Alzheimer's disease (presenile onset) patients, 30.8% in Alzheimer's disease (senile onset) patients, 10.3% in cerebrovascular dementia patients and 5.5% in control subjects. We discuss the relationship between the anti-GFAP autoantibody and the pathogenesis of Alzheimer's disease and suggest that the evaluation of anti-GFAP autoantibody level may be useful in diagnosing Alzheimer's disease.

Posterior extensive simultaneous multisegment decompression with posterolateral fusion for cervical myelopathy with cervical instability and kyphotic and/or S-shaped deformities

From June 1978 to May 1988, posterior decompression with posterolateral fusion was performed at Tenri Hospital on 63 cases of cervical myelopathy with instability and/or malalignment including kyphotic and/or S-shaped deformities. Among 46 cases followed up for more than 1 year, 41 cases (89.1%) improved; 21 cases (45.7%) were rated excellent, six (13%), good; 14 (30.4%), fair; one (2.2%), unchanged; and four (8.7%), poor. On x-ray examination, bone consolidation at the bone implanted area was satisfactory in 30 cases (65.2%). Cervical instability disappeared at 55 cervical interspaces of 40 cases (78.6%). Displacement at unstable interspace disappeared or improved at 49 of 61 cervical interspaces (80.3%). Although cervical kyphosis or S-shaped deformity could not be improved, accelerated progression of these deformities appeared to be prevented.

Enzyme-linked immunosorbent assay for IgG and IgM antibodies against human parvovirus B19: use of monoclonal antibodies and viral antigen propagated in vitro

Enzyme-linked immunosorbent assay (ELISA) systems for serum IgG and IgM antibodies to human parvovirus B19 were established by utilizing anti-B19 monoclonal antibodies (mAbs) and human plasma B19 antigen. The specificities of IgG and IgM ELISA were confirmed by indirect immunofluorescence staining and Western blot immunoassay with panel sera. The series of serum specimens obtained from two B19-infected patients were examined with ELISA. The IgM antibody titers increased quickly after the onset of the symptoms and returned to a negative range after five months. The IgG antibody titers also increased just after the increasing of IgM titers and the elevated levels continued for more than a year. We also established the same ELISA systems by utilizing in vitro propagated B19 antigen and similar results were obtained.

Somatosensory evoked potentials in rats with acute uremia

The effects of acute renal failure (ARF) on somatosensory evoked potentials (SEPs) were studied in rats. With the increase in blood urea nitrogen caused by the ligation of bilateral ureters, both a significant augmentation of amplitudes of the SEP and an increase in the SEP latencies were observed. The nerve conduction velocities of peripheral nerves were unchanged. Thus a kind of cortical irritability and a lesser degree of damage in the peripheral nervous system are characteristics in ARF.

Assay of methylmalonyl CoA mutase with high-performance liquid chromatography

An assay for methylmalonyl CoA mutase activity is described. Succinyl CoA produced in this method is separated from the substrate, methylmalonyl CoA, by reverse-phase high-performance liquid chromatography and is quantified. This method is useful to differentiate mutase apoenzyme deficiency (mut0, mut-) and the defect in deoxyadenosylcobalamin synthesis using fibroblasts cultured in high concentration of supplementary hydroxocobalamin. In methylmalonic acidemia, measurement of lymphocytes mutase activity offers therapeutical and prognostic informations.

Effect of YM-09151-2, a putative D2 dopamine receptor antagonist, on dopamine metabolism in the striatum of rats

YM-09151-2, a novel benzamide derivative, significantly increased the concentrations of dopamine (DA) metabolites, both 3,4-dihydroxyphenylacetic acid and 3-methoxy-4-hydroxyphenylacetic acid (homovanillic acid). The maximum increase in such metabolites was about 4-fold the concentration in control animals, and was observed at 2 hr after oral administration. 3-Methoxy-4-hydroxyphenylethylene glycol, a metabolite of noradrenaline, was slightly increased in its concentration exhibiting a transient effect, but 5-hydroxyindoleacetic acid was not. YM-09151-2 antagonized the decreasing effects of apomorphine, a nonselective DA agonist, and LY-171555, a selective D2 DA receptor agonist, on the concentrations of DA metabolites in the brain. In contrast, SCH-23390, a selective D1 DA receptor antagonist, did not antagonize the effects of DA agonist. These results strongly suggest that YM-09151-2 is a selective antagonist of D2 DA receptor and a candidate as a new antipsychotic agent for clinical use.

[Correlation of serum gamma-seminoprotein and serum prostate-specific antigen in patients with prostate cancer]

Enzyme immunoassays (EIAs) using rabbit anti-gamma-seminoprotein (gamma-Sm) antibody and rabbit anti-prostate-specific antigen antibody (PA) for measurements of gamma-Sm and PA were developed in order to determine the correlation between serum gamma-Sm levels and serum PA levels in patients with prostate cancer. Each EIA for measurement of gamma-Sm or PA was revealed to be sensitive and reproducible by fundamental analysis of the quality of EIAs. A significant correlation was established between serum gamma-Sm levels and serum PA levels which were measured by these assays and expressed as protein concentration of seminal plasma (r = 0.99). This result coincided with our previous observation that gamma-Sm and PA are immunologically identical materials. We conclude, therefore, that gamma-Sm and PA should be regarded as tumor markers identical to each other for serodiagnosis of prostate cancer.

[A case of nonpenetrating ureteral avulsion]

A 7-year-old boy who had been in a traffic accident was hospitalized in Hamamatsu Red Cross Hospital with diagnosis of head abrasion, contusion of abdomen and multiple fractures. On the 17th day of hospitalization, he complained of left flank pain and high fever. Examinations by IVP and enhanced computed tomographic scan revealed a left ureter avulsed at the level of uretero-pelvic junction. Operative reconstruction by end-to-end anastomosis of the ureter was performed immediately. The function of left ureter was recovered 4 months after operation. This rare case of ureteral avulsion is briefly discussed along with a review of the recent literature.

Calcitonin gene-related peptide enhances spontaneous acetylcholine release from the rat motor nerve terminal

The effect of synthetic rat calcitonin gene-related peptide (rCGRP) on neuromuscular transmission was examined in a superfused rat phrenic nerve-diaphragm preparation using an intracellular microelectrode technique. The superfusion with rCGRP (10(-8) to 2 x 10(-7) M) caused significant increases in the frequency of miniature endplate potentials (MEPPs). It, however, had no effect on the resting membrane potential, amplitude of MEPPs, or acetylcholine quantum size and content. Enhancement of spontaneous acetylcholine release from the motor nerve terminal by rCGRP was demonstrated.

Characterization of monoclonal antibodies against human parvovirus B19

Eleven hybridoma cell lines producing mouse monoclonal antibodies (mAbs) against human parvovirus B19 were established. Their specificity was as follows. Approximately 5% of fetal erythroid cells inoculated with B19 reacted with all the mAbs and with anti-B19 positive human serum, but not with negative serum by indirect double immunofluorescence staining. All the mAbs recognized both VP-1 (84 kDa) and VP-2 (58 kDa) capsid proteins of B19 virions propagated in vitro and in vivo by Western blotting, and immunoprecipitated B19 virions.

Somatosensory evoked potentials in Huntington's disease--studies with paired stimulation

The somatosensory evoked potentials (SEPs) and recovery functions of the SEP with paired stimulation were studied in patients with Huntington's disease (HD). A significant decrease in amplitude of the SEP was observed in 4 of the 5 patients. In addition, with paired stimulation, the second SEP amplitudes were normalized at intervals of about 10 ms. These findings possibly suggest that functional block rather than organic change in the thalamus may play an important role in the reduction in SEP amplitude in HD.

[Two siblings of Leber's congenital amaurosis with an increase in very long chain fatty acid in blood: relationship between peroxisomal disorders and Leber's congenital amaurosis]

We reported two siblings of Leber's congenital amaurosis associated with increased level of very long chain fatty acid (VLCFA) in blood. Case 1, a 3 1/2-year-old boy had congenital blindness, severe psychomotor retardation, hepatomegaly, profound hypotonia, loss of deep tendon reflexes, muscular atrophy and weakness, and non-convulsive status epilepticus characterized by a sudden respiratory failure, and also showed a flat electroretinogram, non-pigmentary retinal degeneration, severe atrophy of the brain stem and cerebellum, hepatic fibrosis, decreased motor and sensory conduction velocities and atlanto-axial instability. Sural nerve biopsy revealed severely decreased number of total myelinated fibers without remarkable demyelination or remyelination. Case 2, an elder sister of case 1, with pigmentary retinal degeneration, hepatomegaly and pericarditis had died at 3 months. Autopsy revealed hypomyelination and heterotopy of the cerebral white matter, hepatic fibrosis, renal microcysts and normal adrenal cytoarchitecture. In case 1, the level of VLCFA was increased twofold and sevenfold of controls in serum and in red cell membrane, respectively. Phytanic or trihydroxycholestanoic acid was not detected in the serum and bile. Normal shaped peroxisomes were definitely recognized in biopsied liver by means of electronmicroscopic histochemistry. From the above findings, these patients was thought to be a new variant of peroxisomal disorders relating to degradation of VLCFA, other than Zellweger syndrome, infantile Refsum disease and infantile adrenoleukodystrophy. It was concluded that peroxisomal functions should be studied in cases of Leber's congenital amaurosis.