Alcohol utilization and dependence with special reference to protein level in a liquid diet for rats

Experiments were carried out with a nutritionally balanced diet to test the response of rats to levels of ethanol between 0% and 6%, and to different levels and sources of protein and amino acid supplements in relation to alcohol utilization and withdrawal seizures. The high-calorie/high-carbohydrate liquid diet was well tolerated when the alcohol level was less than 30% of total calories, or 4.5% of diet. When alcohol was provided at 6% of diet, or 33% of total calories, growth and withdrawal seizure rates were negatively affected in comparison with the lower ethanol levels, even though ethanol consumption (in g/kg/day) was not different. The 6% alcohol diet was then altered through the addition of more protein calories, from 13% to 20%. This supplementation improved growth rate of the animals and reduced the rate of withdrawal seizures. The improvement from the additional protein was observed with both casein and soy protein, and was not attributable to any one or even several amino acids that might serve as transmitter precursors. A mixture of all essential amino acids representing the difference in amino acids between 13% and 20% casein protein calories was an effective as the equivalent amount of intact protein. The nonessential amino acids equivalent to 7% casein protein calories, when added to the 13% protein calories diet, increased the rate of withdrawal seizures, presumably by exacerbating the protein deficiency in the 13% protein diet. It was concluded that a 1000-1200 kcal/kg diet with 20% kcal from protein and 50% kcal from carbohydrate provides an optimal nutrient balance for efficient utilization of a 6% ethanol liquid diet for rats.

Amphetamine and fenfluramine suppress ethanol intake in ethanol-dependent rats

Alcohol intake or preference for alcohol has been attributed to concomitant dopamine and serotonin dysfunction in rats. Amphetamine and fenfluramine, administered alone, have been shown to reduce food and fluid intake as well as alcohol consumption while acute coadministration of these agents has been shown to suppress audiogenic seizure in rats withdrawn from alcohol. The present study was designed to assess the effectiveness of chronic amphetamine and fenfluramine coadministration on reducing alcohol intake. Chronic coadministration of amphetamine (2 mg/kg) and fenfluramine (8 mg/kg) reduced alcohol consumption during choice trials in both alcohol-dependent and alcohol-nondependent rats while not affecting water intake. The findings indicate that coadministration of amphetamine and fenfluramine, a treatment effective in reducing alcohol withdrawal seizures, also selectively attenuates alcohol consumption.

A natural kinase-deficient variant of fibroblast growth factor receptor 1

A fibroblast growth factor receptor 1 variant missing 37 amino acids from the carboxy-terminal tyrosine kinase catalytic domain was discovered in human lung fibroblasts and several other human cell lines. The receptor variant binds specifically to acidic fibroblast growth factor but has no tyrosine kinase activity. It was found that cellular transfectants expressing the fibroblast growth factor receptor 1 variant are mitogenically inactive and ligand binding to the receptor causes neither receptor autophosphorylation nor phospholipase C-gamma transphosphorylation. The fibroblast growth factor receptor 1 variant therefore represents an inactive receptor for acidic fibroblast growth factor. Since both kinase and kinase-deficient receptor forms are expressed in cells, it is conceivable that the kinase-deficient receptor plays an important role in regulating cellular responses elicited by acidic fibroblast growth factor stimulation.

[Serotype distribution and antimicrobial susceptibility of group A streptococci (Streptococcus pyogenes) isolated in Taiwan]

T-protein serotypes and antimicrobial susceptibility of a total of 139 group A streptococci (GAS) strains isolated in Taiwan area in 1993 and during the outbreak of scarlet fever in 1994 were analyzed. All strains were T-typable, and T12 (42.46%) and T4 (38.85%) were the dominant T types. According to the results of analysis of antimicrobial susceptibility, all GAS strains were divided into 9 resistotypes, A (all susceptible), B (resistant to tetracycline), C (resistant to erythromycin and tetracycline), D (resistant to chloramphenicol and tetracycline), E (resistant to chloramphenicol and clindamycin), F (resistant to chloramphenicol, clindamycin and tetracycline), G (resistant to clindamycin, erythromycin and tetracycline), H (resistant to chloramphenicol, clindamycin, erythromycin and tetracycline), and I (resistant to chloramphenicol, clindamycin, erythromycin, tetracycline and vancomycin). Type B (37.42%) was the dominant type. Type A (25.91%), and type H (26.63%) also appered with high incidence. Most of strains isolated from Mid-Taiwan were type H. Only one strain, that was isolated in I-lan, was resistant to vancomycin, in addition to resistant to chloramphenicol, clindamycin, erythromycin, and tetracycline. All strains were susceptible to penicillin G, ampicillin, and ceftriaxone. Some strains were resistant to chloramphenicol (32.38%), clindamycin (30.22%), erythromycin (31.66%), tetracycline (73.39%), and vancomycin (0.70%). During the outbreak of scarlet fever in 1994, the dominant T types of strains isolated in North-Taiwan and Mid-Taiwan were T4 and T12, respectively, and the major resistotypes of those strains were B and H types, respectively. These clues suggested that the outbreaks occurring in North-Taiwan and Mid-Taiwan may have no epidemiological linkage between each other.

[Comparison of immunoassay kits for detection of staphylococcal enterotoxins produced by Staphylococcus aureus]

Four commercial kits, SET-RPLA, RIDASCREEN, SET-EIA, and TECRA, were compared for the efficiency of detecting staphylococcal enterotoxins (SE). There was no non-specific reaction for detection of SE produced by 21 Staphylococcus aureus strains from 5 outbreaks of food poisoning using SET-RPLA, SET-EIA and TECRA kits. The background of the results of RIDASCREEN kit was high and non-specific reactions were present in some strains.

IN CONCLUSION

(i) TECRA kit is suggested to be used for screening SE producing strains; (ii) SET-RPLA and RIDASCREEN kits are suitable for epidemiological investigation of SE types, but the lack of ability for detecting SEE, long time required for testing with SET-RPLA kit and high background when using RIDASCREEN kit must be overcome; and (iii) because of the complicated test procedures and the lack of ability for detecting SEE, the practicality of SET-EIA kit in screening and epidemiological research purposes is low.

Diet composition, alcohol utilization, and dependence

Experiments were carried out in which a nutritionally balanced liquid diet previously used in this laboratory was modified as to total calorie content and high or low carbohydrate and fat concentration. Ethanol was added at 4.5% and 6.2% of diet weight and provided either 27% or 34-37% of total calories depending upon the changes in nutrient content. Measurements included 8-day food/calorie and ethanol consumption, plasma ethanol level, liver alcohol dehydrogenase (ADH) activity, and rate of audiogenic-induced withdrawal seizures. The original liquid diet with 4.5% ethanol was consumed in significantly lesser amounts than the alcohol-free diet, and essentially no body weight gain occurred, regardless if the major nonalcohol, nonprotein calorie source was fat or carbohydrate. When the calorie content of the diet was boosted through the addition of extra carbohydrate or fat (at the expense of water), appreciable weight gain was noted; in the case of the higher calorie diet boosted with more carbohydrate (maltodextrin) calories, growth was similar to that observed on the alcohol-free control diet. On this latter diet ethanol calories appeared to be utilized close to their theoretical value of 7 kcal/g. Blood alcohol levels were significantly higher on the lower calorie diets and were lowest on the high-calorie, high-carbohydrate, 4.5% ethanol diet. This diet also allowed for the lowest rate of withdrawal seizures despite an ethanol intake that was as high as on the lower calorie diets. Essentially, no differences were noted among ADH activities for the dietary treatments studied and thus, did not explain the differences observed among blood ethanol levels. When the alcohol concentration in the high-carbohydrate, high-calorie diet was raised to 6.2% from 4.5% to provide 34% of total calories, the rats responded by decreasing their food (and alcohol) intake to the same level as did the animals receiving a much lower calorie diet, but with 37% of caloric alcohol content. This suggests that at a diet alcohol concentration of 34-37%, one or more nutrient metabolites become limiting in the utilization of ethanol, resulting in food intake adjustments that maintain similar amounts of alcohol consumption.

Motor neuron disease in Hong Kong Chinese: epidemiology and clinical picture

This study documents the clinical features, incidence and prevalence of motor neuron disease (MND) in Hong Kong Chinese. Patients with MND who were alive between 1989 and 1992 were recruited by retrieval of medical records from the four major hospitals in Hong Kong, and by referral of neurologists, neurosurgeons and medical consultants. Mortality statistics was provided by the Census and Statistics Department. A total of 84 cases were identified with a male preponderance of 1.98:1. The average annual period incidence was 0.31/100,000 and the point prevalence on December 31, 1992, was 0.95/100,000. The mean age at onset was 55.5 years (range 19-81) with a peak observed from 55 to 65 years. The clinical features are similar to other reported series of MND. The incidence and mortality of MND in Hong Kong are therefore lower than the worldwide figures of 2.0/100,000 and 1.5/ 100,000, respectively.

Low-molecular-weight heparin for the treatment of acute ischemic stroke

BACKGROUND

Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute ischemic stroke. Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke. Patients were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti-factor Xa IU twice daily), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was death or dependency regarding activities of daily living six months after randomization. Secondary outcomes were death, hemorrhagic transformation of the infarction, and other complications at 10 days, and death or dependency at 3 months.

RESULTS

A total of 2750 patients were screened for the study. Among 312 patients randomized, 306 had outcomes that were analyzed at six months. Forty-five patients (45 percent) in the high-dose group, 53 patients (52 percent) in the low-dose group, and 68 patients (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P = 0.005 by the chi-square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days.

CONCLUSIONS

For patients with ischemic stroke treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomes at six months.

Novel synergistic treatment of ethanol withdrawal seizures in rats with dopamine and serotonin agonists

A recent observation in this laboratory of a simultaneous increase in striatal dopamine and a decrease in serotonin in ethanol-dependent rats during ethanol withdrawal prompted studies with combined dopaminergic + serotoninergic agonists to stop withdrawal seizures. Amphetamine (2 mg/kg) + fenfluramine (8 mg/kg) given jointly, but not separately, prevented ethanol withdrawal seizures as effectively as benzodiazepines (chlordiazepoxide), the current drugs of choice. The combination of amphetamine and fenfluramine, unlike chlordiazepoxide, significantly reduced intake of ethanol during and immediately following ethanol withdrawal.

DNA analysis of Huntington's disease in southern Chinese

Allelic frequencies of RFLPs at loci closely linked to the HD gene, D4S95, D4S91, D4S141, and D4S90, were determined in 13 Huntington's disease (HD) patients from nine Chinese families and 129 normal subjects. These were similar for non-HD and HD chromosomes and the HD gene in Chinese is associated with multiple haplotypes. Hence the HD gene probably arose independently in the background haplotypes of the Chinese population. The heterozygosity rates for the two most useful RFLP sites are 0.659 for D4S95-AccI VNTR and 0.494 for D4S141-HindIII. (CAG)n repeat numbers ranged from 12 to 27 in 174 normal chromosomes. In 52 meiotic recombinations, the (CAG)n repeats were stably inherited in normal families. In HD families, 12 of 13 HD patients had expanded (CAG)n repeats of 40 to 58. Additionally, 10 asymptomatic family members had expanded (CAG)n repeats and the inheritance of the expanded repeat was unstable in these families.

Influence of gonadal hormones on sexual differences in sensitivity to methamphetamine-induced neurotoxicity

The administration of high doses of methamphetamine to mice causes long-lasting depletions of striatal dopamine to a greater extent in males than in females. Likewise, the incidence of Parkinson's disease is higher in males than in females. The present study investigated the roles of estrogen and testosterone in mediating the dopamine depletion induced by methamphetamine. Male and female mice received four cumulative SC doses of methamphetamine (10 mg/kg) at two hour intervals and were sacrificed two weeks later for HPLC analysis of striatal monoamines. Intact male mice were found to have a 76% dopamine depletion, which was significantly greater than the 37% depletion exhibited by the intact female mice. Neither removal of the ovaries nor removal of the testes one month prior to the methamphetamine treatment significantly changed the magnitude of the methamphetamine-induced dopamine depletion. Thus, the reduced sensitivity of female mice to methamphetamine may be independent of physiological gonadal hormones.

The morphologic changes of endometrial spiral arterioles in IUD-induced menorrhagia

To investigate the relationship between IUD-induced menorrhagia and spiral arteriolar function, we examined the endometrium under light and electron microscope on samples obtained within 24 hours after the onset of premenstrual spotting. These samples included an IUD bleeding group (20 cases), an IUD non-bleeding group (20 cases) and an IUD non-user group (10 cases) as controls. Compared with the IUD non-user group the degenerative changes of spiral arteriolar wall were more severe and dilation of the spiral arteriolar lumen was more obvious, especially in the spongeous layer. In the IUD non-user group these changes were mild, suggesting that IUD-induced menorrhagia might be correlated with poor contractility of spiral arterioles in the spongeous layer.

Psychosocial impact of Huntington's disease on Hong Kong Chinese families

Twenty-eight asymptomatic relatives from 7 Chinese families with Huntington's disease (HD) received psychosocial assessment. One third of these subjects (n = 9) had symptoms of anxiety and depression that warranted a Present State Examination (PSE) diagnosis. One quarter of these subjects (n = 8) would contemplate suicide if their predictive testing indicated a high risk of having the disease. This suicidal risk was associated with a PSE diagnosis of depression and a stress-coping repertoire with a high proportion of coping strategies of the avoidance type at the time of interview. Early and close liaison with these subjects for the detection of mental symptoms and provision of counselling on a balanced and positive coping style is essential.

Management of Tetanus: A Review of 18 Cases

Eighteen patients with generalized tetanus seen during an 8-year period in three regional hospitals in Hong Kong are reviewed. Eighty-nine per cent of the patients were intravenous heroin addicts who developed a severe type of generalized tetanus with autonomic dysfunction. Pain or stiffness of the neck or back was the commonest presenting symptom, followed by trismus and dysphagia. Most of the patients developed muscle spasms within 24 h of the onset of presenting symptoms. Early ventilatory support and tracheostomy, together with intensive nursing care, were the mainstay of the treatment. Pulmonary and gastrointestinal complications were common during the course of illness and treatment of autonomic dysfunction was often unsatisfactory. The case fatality rate was 25% among the heroin addicts, but full recovery was the usual outcome for those who survived. The simultaneous administration of intrathecal tetanus immunoglobulin tends to reduce mortality.

Huntington's disease in Hong Kong Chinese: epidemiology and clinical picture

In a territory-wide survey of Huntington's disease (HD) in the Chinese population of Hong Kong, 20 patients from 11 families were identified from 1984 to 1991, giving a low period prevalence of 3.7 per 10(6) population. Six patients had died by 1991, hence the point prevalence was even lower, being 2.5 per 10(6) population. The male to female ratio was 3:1. No paternal transmission effect on the age of onset was observed. Apart from these differences, the clinical and pathological features were similar to those seen in the West.

Restrictive fragment length polymorphisms of markers 3'HVR and 24-1 and their applications in gene diagnosis of adult polycystic disease in Chinese

Adult polycystic kidney disease was diagnosed with pedigree analysis using polymorphic DNA markers linked to the disease gene in 5 families. The markers were thoroughly characterized in the population. We noted two important markers, 3'HVR and 24-1, which flank the disease gene PKD1 in normal Chinese. Southern hybridization was used, and numerous 3'HVR/PvuII polymorphic allelic bands varied from 1.4 kb to 8.0 kb with a positive skew distribution. They were divided into 11 groups with an interval of 0.6 kb and a heterozygosity rate of 0.86. Allele frequencies were observed. When the probe 24-1 was hybridized with genomic DNA digested by TaqI, two alleles, B1 and B2, were detected with frequencies of 0.76 and 0.24, respectively. B1 was 3.8 kb in size and B2 was composed of 2 bands, 1.5 kb and 1.3 kb. The polymorphism information content was found to be 0.297. Using these two markers for linkage analyses of 5 affected families, we confirmed the linkage between 3'HVR and the disease gene PKD1 and made presymptomatic diagnosis of the members at risk.

Investigation of nimodipine pharmacokinetics in Chinese patients with acute subarachnoid haemorrhage

Nimodipine pharmacokinetics was investigated in 12 Chinese patients with acute subarachnoid haemorrhage receiving an IV infusion of 1.6 or 2 mg/h (based on estimated body weight) for 10 days. Peripheral venous blood samples were collected for up to 4 days and plasma nimodipine was assayed by GC/ECD. The mean value was taken as the steady state concentration (Css) and Clearance (CL) (hourly dose/Css) was calculated. Eight survivors were given oral nimodipine (60 or 90 mg) every 6h (based on body weight), blood was sampled over 6 h and the plasma nimodipine level determined. The values for Css, CL and CL.kg-1 were 33.5 micrograms.l-1, 58 l.h-1 and 1.0 l.h-1 x kg-1 respectively; in survivors receiving the drug orally, bioavailability of the 30 mg tablet was 9%. In one very sick patient given crushed tablets by naso-gastric tube, the AUC was very low; in vitro studies indicated that adsorption of nimodipine by the tubing was unlikely to have been the cause. The pharmacokinetic findings in Chinese patients are comparable to previously reported values in Caucasians.

Growth factor gene expression in lung fibroblasts

A lung fibroblast cell line was isolated from lung biopsy of a patient with lung fibrosis. Gene expression of ten growth factors in the fibroblasts were investigated by a reverse transcription-DNA polymerase chain reaction. The results indicated that the fibroblasts expressed acidic fibroblast growth factor (aFGF) mRNA transcript. Further experiments revealed that recombinant aFGF could be internalized by the fibroblasts and stimulated the proliferation of the cells. These data suggest that aFGF may activate lung fibroblasts in a way of autocrine and, therefore, may be involved in the development of lung fibrosis.

Treatment of acute cortical infarct with intravenous glycerol. A double-blind, placebo-controlled randomized trial

BACKGROUND AND PURPOSE

This clinical trial investigates the effectiveness of intravenous glycerol therapy in patients with acute cortical infarction in whom intracerebral hemorrhage was rigorously excluded.

METHODS

Within 48 hours of symptoms from their first ischemic stroke, 113 hospital inpatients were randomized into the trial, provided that hemorrhage was excluded by computed tomography and informed consent was obtained. Patients were stratified into alert, semicoma, and coma groups using the Glasgow Coma Scale. Treatment was allocated according to a double-blind, randomized protocol; 56 patients received 500 mL of 10% glycerol in saline over 4 hours on 6 consecutive days, and 57 patients received corresponding placebo treatment with saline. Using a variety of objective scoring systems, patient follow-up was up to 6 months.

RESULTS

Corresponding measures of outcome in the glycerol and placebo groups were similar. At 6 months, respective mortality rates were 17 of 56 and 16 of 57, and mean +/- SD improvements in scores were 9.98 +/- 14.40 vs 10.51 +/- 12.68 (long-term), 1.12 +/- 7.20 vs 1.57 +/- 6.30 (prognostic), -1.94 +/- 5.53 vs -2.06 +/- 5.34 (Glasgow Coma Scale), and 21.72 +/- 23.40 vs 11.94 +/- 18.10 (Barthel Index rating in survivors). Hemolysis (generally subclinical) was the only adverse effect.

CONCLUSIONS

There was no clinically or statistically significant difference in outcome between the groups; a trend toward greater functional recovery among survivors was evident after treatment with glycerol.

N-hexane neuropathy in offset printers

In an offset printing factory with 56 workers, 20 (36%) developed symptomatic peripheral neuropathy due to exposure to n-hexane. Another 26 workers (46%) were found to have subclinical neuropathy. The initial change in the nerve conduction study was reduced amplitude of the sensory action potentials, followed by reduced amplitude of the motor action potentials, reduction in motor conduction velocities and increase in distal latencies. These changes indicate primary axonal degeneration with secondary demyelination. Sural nerve biopsy in a severe case showed giant axonal swellings due to accumulation of 10nm neurofilaments, myelin sheath attenuation and widening of nodal gaps. The development of neuropathy bore no direct relationship to the duration of exposure, hence factors such as individual susceptibility may be important. Optic neuropathy and CNS involvement were uncommon and autonomic neuropathy was not encountered.

Myocardial infarction complicating postsplenectomy thrombocytosis, with early left ventricular mural thrombus formation and cerebral embolism--a case report

Thrombocytosis is a rare cause of ischemic cardiovascular and cerebrovascular events in patients with intrinsically normal coronary and cerebral vasculature. This report details the occurrence of inferior wall myocardial infarction (MI) consequent upon postsplenectomy thrombocytosis in a thirty-four-year-old man with angiographically normal coronary arteries. The MI was complicated by early left ventricular mural thrombus formation and embolic cerebral infarction. Combined anticoagulant and antiplatelet therapy was required to prevent the recurrence of ischemic events.

TNF alpha mRNA expression in bronchoalveolar lavage cells from patients with lung fibrosis and TNF alpha activity in the lavage supernatants

Tumor necrosis factor alpha (TNF alpha) mRNA expression in bronchoalveolar lavage (BAL) cells from patients with lung fibrosis was studied by a reverse transcription-DNA polymerase chain reaction (RT-PCR). The results indicated that two thirds of the tested samples were TNF alpha mRNA positive. On the other hand, TNF alpha activity was detected in a big part of the BAL supernatants from the patients. Furthermore, recombinant TNF alpha was found to be mitogenic to lung fibroblasts. These data suggest that TNF alpha expression in BAL cells may play a role in the development of lung fibrosis in human.

HLA-DPB1 alleles correlate with risk for multiple sclerosis in Caucasoid and Cantonese patients lacking the high-risk DQB1*0602 allele

Multiple sclerosis (MS) is a demyelinating disease associated with the HLA-DR2-related haplotype DRB1*1501, DQB1*0602 in Caucasoids and with DQB1*0602 in DR2-positive Cantonese. However, many MS patients do not have the high-risk HLA-D determinants and alternative genes may contribute to the pathogenesis of MS. One candidate gene is HLA-DPB1. Our reanalysis of five earlier reports of HLA-DPB1 antigen distributions in Caucasoid MS patients shows a consistent and highly significant increase (p = 1.5 x 10(-5)) in frequency of HLA-DPw3 in the combined data set. This study tests whether HLA-DPw3 (DPB1*0301) is also increased in frequency in Australian and Cantonese MS patients and whether any distortion in DPB1 allelic distributions can be attributed to linkage disequilibrium with DQB1*0602. PCR-RFLPs were used to determine distributions of 20 HLA-DPB1 alleles in 41 Australian MS patients and 67 controls of known DQB1*0602 status and in 11 Cantonese MS patients and 33 controls positive for HLA-DR2. HLA-DP distributions in Australian MS patients and controls positive for DQB1*0602 did not differ, but in those MS patients lacking DQB1*0602, the DPB1*0301 antigen (phenotype) frequency was significantly (p = 0.006) increased (50.0%) when compared with DQB1*0602-negative controls (9.1%). DPB1*0301 was associated (p = 0.003) with DQB1*0402 (DR8) in Caucasoid MS patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular pseudoparkinsonism

Vascular pseudoparkinsonism may be confused with idiopathic Parkinson's disease. Patients may be unnecessarily treated with anti-parkinsonian drugs while their underlying vascular disease is ignored. We investigated 250 parkinsonian patients seen in our Movement Disorders Clinic for a possible vascular etiology. After excluding those with a known secondary cause such as drug-induced parkinsonism, progressive supranuclear palsy, multiple system atrophy and hyperparathyroidism, brain computed tomography and/or magnetic resonance imaging were performed on those who showed poor or no response to levodopa. In those with an ischemic lesion demonstrated on neuroimaging, anti-parkinsonian drugs were stopped and the patients were reassessed. Eleven patients (4.4%) had ischemic brain lesions accounting for their parkinsonism. All were initially diagnosed as Parkinson's disease because of the prominence of bradykinesia and rigidity. Gait disturbance was also common, but resting tremor was distinctly absent. Three anatomical patterns with different prognosis were identified. Three patients with basal ganglia lacunar infarct recovered spontaneously, three with frontal lobe infarcts remained static and five with periventricular and deep subcortical white matter lesions had progressive deterioration. Autopsy in one patient confirmed bilateral frontal lobe watershed infarcts and the absence of brain stem Lewy bodies. Parkinsonian patients with poor or no response to levodopa therapy should be investigated for a vascular etiology.

Myasthenia gravis in Hong Kong Chinese. 1. Epidemiology and adult disease

A territory-wide study of myasthenia gravis (MG) was conducted in Hong Kong. Two hundred and sixty-two Chinese patients (159 adult and 103 paediatric onset) were identified, corresponding to a point prevalence and period prevalence of 53.5 and 62.2 per million respectively, and an average annual incidence of 4.0 per million population. Nine patients died, 7 from MG, giving a case fatality rate of 0.027. Female predominance was present in the whole group of patients (female to male ratio 1.6:1) and in those with adult disease (ratio 2.1:1), but not in those with onset in childhood (ration 1.1:1). Onset of disease was most common in the first 3 decades of life, and became less common in subsequent decades. Juvenile onset MG occurred in 39.3% of patients and restricted ocular MG in 47.9%. Familial occurrence was found in 5 patients. In the 159 adult onset patients, ocular disease was most common (32.7%), followed by mild generalised (29.6%), moderately severe generalised (24.5%), fulminating (11.9%) and late severe disease (1.3%). The mean age of onset of symptoms was 36.7 years. The symptomatology was similar to that of Caucasoid populations. Autoimmune thyroid disease was the commonest associated disease, and the incidence of thymoma among thymic abnormalities was high at 38%.

Huntington's disease in Chinese: a hypothesis of its origin

The period prevalence (1984-91) of Huntington's disease (HD) in Hong Kong Chinese was 3.7 per million population. HD patients in Mainland China and Hong Kong showed similar hereditary pattern, clinical and pathological features as in the West. Chinese HD patients were male predominant with a younger age of onset and death. Their ancestral origin could be traced mostly to the coastal provinces of China. It is proposed that Chinese HD patients may have a European origin and share the same gene pool as their white counterparts.

Myasthenia gravis in Hong Kong Chinese. 2. Paediatric disease

In a study covering 85% of the population of Hong Kong, 39% of all myasthenia gravis (MG) patients, i.e. 103 individuals (54 girls and 49 boys) were found to have had MG with onset before puberty. Two patients had transient neonatal MG, 20 had early onset juvenile MG and 81 had late onset juvenile MG. Restricted ocular MG occurred in 71% of patients and the remainder had generalised MG. The median age at onset was 4 years. Complete remission occurred in 34 patients (34%), a good response in 14 (14%), and fair response in 32 (32%). The clinical course remained static in 16 patients (16%) and 3 patients deteriorated. Two patients died, 1 with myasthenic crisis and the other with cholinergic crisis. All patients, except 2 with neonatal MG, were initially treated with anticholinesterase, but 24% also required steroid therapy. Thymectomy was performed for 12 patients, of whom 5 (42%) showed marked improvement. Thymic histology was normal in 3, showed hyperplasia in 6, non-invasive thymoma in 1 and involution in 2. The most commonly associated disease was Graves' disease which occurred in 7 patients (7%).

Treatment of acute cerebral hemorrhage with intravenous glycerol. A double-blind, placebo-controlled, randomized trial

BACKGROUND AND PURPOSE

Hitherto, treatment of acute cerebral hemorrhage with intravenous glycerol has not been evaluated in rigorous clinical studies with sufficient patient numbers.

METHODS

We undertook a double-blind, stratified and randomized, placebo-controlled clinical trial. Only patients with a first stroke admitted to the hospital within 24 hours after onset of symptoms were recruited, provided computed tomography confirmed hemorrhage and informed consent was obtained. After stratification into alert, semicoma, and coma subgroups using the Glasgow Coma Scale, 107 patients received active treatment (500 ml of 10% glycerol in saline by intravenous infusion over 4 hours on 6 consecutive days) and 109 were given corresponding saline treatment. Using a variety of objective scoring systems, patients were followed up for up to 6 months.

RESULTS

At follow-up, all measures of outcome in the treated and control groups were very similar. At 6 months, respective mortality rates were 37 of 107 and 33 of 109. Corresponding mean +/- SD improvements in Scandinavian Stroke Study Group scores were 8.35 +/- 16.9 versus 11.55 +/- 15.6 (long-term) and 0.64 +/- 7.3 versus 2.40 +/- 6.9 (prognostic), and improvements in the Barthel Index ratings were 10.72 +/- 24.7 versus 13.95 +/- 23.3, respectively. Glasgow Coma Scale score improvements in the survivors were 0.81 +/- 1.5 and 1.16 +/- 1.7 in the treated and control groups, respectively. Hemolysis (generally subclinical) was the only adverse effect of glycerol noted.

CONCLUSIONS

In the absence of any clinically or statistically significant difference in outcome between the treated and control groups, this trial provides no justification for glycerol therapy following acute cerebral hemorrhage.

An acidic fibroblast growth factor protein generated by alternate splicing acts like an antagonist

Polymerase chain reaction amplification of cDNA for acidic fibroblast growth factor in several lines of cultured human cells revealed two forms of mRNA. The novel smaller mRNA lacks the entire second coding exon of the acidic fibroblast growth factor gene, whereas the previously identified mRNA consists of three coding exons. The truncated variant of acidic fibroblast growth factor (aFGF') is only 60 amino acids long with an apparent molecular mass of 6.7 kD on sodium dodecyl sulfate gels in contrast to 18 kD for the full-length acidic fibroblast growth factor. aFGF' elicits only minimal fibroblast proliferation and antagonizes the effects of acidic fibroblast growth factor when added exogenously to or when coexpressed with aFGF in BALB/c/3T3 fibroblasts. Thus, the truncated variant of acidic fibroblast growth factor may provide fibroblasts with a unique mechanism for endogenous regulation of their responses to acidic fibroblast growth factor.

Novel HLA-DR2-related haplotypes in Hong Kong Chinese implicate the DQB1*0602 allele in susceptibility to multiple sclerosis

Multiple sclerosis (MS) is strongly associated with the HLA-Dw2 haplotype DRw15.DQw6 in Caucasoids, although the relative contributions of DR and DQ loci to disease susceptibility are unknown. The situation is further complicated by the apparent lack of an association between DR2 and MS in Orientals. This study examined 42 DR2-positive chromosomes in healthy Chinese and 12 DR2-positive chromosomes in MS patients from Hong Kong, using oligonucleotide hybridizations of DQA1, DQB1, DRB1, and DRB5 polymerase chain reaction (PCR) products. There was marked heterogeneity in DR2-related haplotypes in controls (ten types), where the most frequent haplotype, confirmed in one family, involved the novel arrangement DRB1*1501, DQB1*0601. Another common haplotype had the unusual combination of DRB1*1602, DRB5*0101 as confirmed by DNA sequencing of the DRB5 allele. In contrast, the most common DR2-related haplotype in MS patients was the 'classical' Dw2 haplotype DRB1*1501, DQB1*0602, with a frequency of 50% compared with 12% in controls (P = 0.01). Novel DR,DQ linkage disequilibrium relationship in Hong Kong Chinese have permitted recognition of DQB1*0602 as a susceptibility allele in DR2-positive MS patients, although a role for the DRB1*1501 allele in MS pathogenesis has not been excluded by this study.

Treatment of idiopathic hemifacial spasm with botulinum toxin

Twelve patients with idiopathic hemifacial spasm received treatment with botulinum toxin A over a period of 18 months. Of 76 treatments given, most (94.7%) led to successful relief of eyelid spasms and all treatments were successful for perioral and lower facial muscle spasms. An average dose of 9.3 units of toxin per session was given to produce a mean interval of relief of 10.8 weeks. Blepharoptosis was the only ocular side effect; it was mild, reversible and occurred in 2 patients. However, lower facial palsy was frequent (9 patients); it was mild to moderate in severity but only partially reversible in 8 patients. Dosage for lower facial muscles should therefore be reduced.

Postinfectious myelitis, encephalitis and encephalomyelitis

Six cases of post-infectious encephalomyelitis are described. A preceding non-specific viral-like illness occurred 4 to 20 days before the onset of the neurological deficits. The clinical syndromes included transverse myelitis, focal encephalitis and encephalomyelitis (each in one case) and diffuse encephalitis in 3. Magnetic resonance imaging appeared to be the investigation of choice. High dose corticosteroids were given to 4 patients who recovered partially or fully. The patient with focal encephalitis had a spontaneous and complete recovery. The remaining patient with diffuse encephalitis died 3 days after the onset; autopsy showed prominent lymphocytic perivascular cuffing in the white matter and lymphocytic infiltration of the meninges.

High prevalence of undiagnosed diabetes among Chinese patients with ischaemic stroke

We reviewed the prevalence of diabetes mellitus, hypertension and cigarette smoking in 176 Chinese patients with acute stroke, classified, on computed tomographic findings, as intracerebral haemorrhage or cerebral infarction. In all patients with no known history of diabetes, a 75 g OGTT was done 3-6 months after ictus and interpreted using WHO criteria. The overall prevalence of diabetes and impaired glucose tolerance (IGT) was 33.5% and 21.0%, respectively, with a higher prevalence being found in patients with cerebral infarction (P less than 0.05). Forty percent of those with diabetes were previously undiagnosed - all but 2 had ischaemic stroke. Compared to reported findings in the general population, an increased prevalence of hypertension, and possibly also cigarette smoking was found in patients with both stroke categories. On the other hand, significant hypercholesterolaemia was not found in patients of either category. In view of the high prevalence of undiagnosed diabetes among these stroke patients and the increased morbidity and mortality associated with diabetes mellitus, screening for diabetes is recommended especially in those with ischaemic stroke. If a fasting plasma glucose of greater than or equal to 6 mmol/l was used for the initial screening of undiagnosed diabetes in this group of patients, the sensitivity and specificity values would have been 78% and 94%, respectively. Whether this cut-off value can be cost-effectively employed for mass screening remains to be confirmed by studies involving larger numbers of stroke patients.

Neurological manifestations of systemic lupus erythematosus: a prospective study

A prospective study of the neurological manifestations in all patients with systemic lupus erythematous (SLE) was conducted between February 1985 to January 1989. Excluding herpes zoster infection of peripheral or cranial nerves, post-herpetic neuralgia and migraine, 36 neurological episodes occurred in 33 patients. The presenting symptoms were mental confusion (10), psychosis (five), seizures (six), focal neurological deficit (three), coma (two), headache (five), blurring of vision (three), neuropathy (one) and myelopathy (one). Of these manifestations, only eight episodes were due to primary involvement by SLE: psychosis (two), seizure (two), multiple cerebral infarcts (one), papillitis (one), neuropathy (one) and myelopathy (one). Infection was the most common secondary cause of neurological episodes: all 10 episodes of mental confusion (fungal seven, pyogenic two, tuberculous one, nocardial one); two of six seizures (tuberculous one, pyogenic one); all five headaches (tuberculous meningitis three, cryptococcal meningitis two). The other secondary causes included steroid psychosis (two), hypertensive encephalopathy with seizure (one) and hypertensive retinopathy (one). Three of five cases of focal neurological deficit were due to macrovascular disease rather than to vasculitic infarction. We concluded that cerebral psychosis was a relatively rare presentation in our patients with SLE. In patients who presented with a neurological problem, especially mental confusion, efforts should be made to ascertain the underlying cause, especially if this may be an infection.

Cerebral haemorrhage in anticoagulated patients with non-septic mechanical valvular prosthesis

Cerebral haemorrhage in anticoagulated patients with mechanical valvular prosthesis poses an uncommon but difficult management problem. Four such patients are presented: one patient had delayed haemorrhagic transformation of a preexisting cerebral infarct, one probably had de novo haemorrhage complicating hypertension and in two patients cerebral haemorrhage was associated with excessive anticoagulation. Conservative management including the use of fresh frozen plasma, delayed heparinisation and warfarinisation was used. Both patients with anticoagulant overdose died as a result of extensive haemorrhage despite the drainage of cerebellar haematoma in one patient. The remaining two patients survived with minimal neurological deficits. Diagnosis of the underlying cause of cerebral haemorrhage, and the timing of heparinisation and anticoagulation are discussed.

A multimodal neurophysiological assessment in terminal renal failure

A prospective multimodal neurophysiological study was conducted on 36 patients with end-stage renal failure, 16 of whom subsequently underwent renal transplantation (TR). Nerve conduction study and somatosensory evoked potentials revealed that peripheral conduction deficit, often subclinical, was the commonest abnormality, and TR resulted in substantial improvement. Visual evoked potentials demonstrated subclinical impairment, which did not improve after TR. The brainstem auditory evoked potentials were essentially normal and unaffected by TR.

Relative quantification of collagen mRNA in fibroblasts by a radioactive polymerase chain reaction technique

A radioactive polymerase chain reaction (PCR) method has been developed for the relative quantification of the human alpha-2 chain of type I collagen [hu alpha-2(I)] in cells. cDNAs generated by reverse transcription from the total pool of cytoplasmic RNA serve as a template for polymerase chain reaction amplification of a hu alpha-2(I) cDNA primed by two sequence-specific synthetic oligonucleotides. The distinctive 390 bp hu alpha-2(I) cDNA and two Aval fragments of 220 and 170 bp are identified by agarose gel electrophoresis. alpha-32P-dCTP of defined specific activity is included in the PCR reaction and the 390 bp cDNA is excised from the electrophoresis gel to permit direct radioactive quantification of hu alpha-2(I) mRNA. The amount of hu alpha-2(I) mRNA expressed in as few as 111 fibroblasts was determined reliably. In contrast, the hu alpha-2(I) mRNA from at least 5 x 10(5) fibroblasts was required for detection by Northern blot analysis developed with the same cDNA probe radiolabelled with alpha-32P-dCTP by random priming. Human bronchoalveolar lavage (BAL) fluids of six patients with fibrosing lung diseases stimulated the level of expression of hu alpha-2(I) mRNA in cultured human fibroblasts as determined by this technique. The radioactive PCR method thus quantifies hu alpha-2(I) mRNA in fibroblasts with sufficient sensitivity to study fibroblast activation in vitro and detect fibroblast stimuli in human clinical samples.

Encephalopathy and neuropathy following ingestion of a Chinese herbal broth containing podophyllin

Two patients developed podophyllin intoxication following ingestion of a broth of the Chinese herb guijiu. The neurological manifestations are described and the pathology of the peripheral neuropathy is fully documented with ultrastructural and quantitative studies.

Fatal bilateral vertebral artery dissection in a patient with cystic medial necrosis

A 38-year-old man experienced severe neck pain while playing badminton. This was followed by symptoms of vertebrobasilar ischaemia, seizure and coma. Autopsy showed bilateral vertebral artery dissection and cystic medial necrosis.

Cervical spondylotic radiculopathy precipitated by decompression sickness

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Cerebral thrombosis in beta-thalassemia/hemoglobin E disease

We describe two Chinese patients with beta-thalassemia/hemoglobin E disease who developed cerebral infarction due to occlusion or stenosis of their extracranial carotid arteries. The roles of platelet abnormalities and other factors in this condition are discussed.

Investigation of intravascular haemolysis during treatment of acute stroke with intravenous glycerol

1. In patients with acute strokes entering a large ongoing randomised double-blind controlled trial of intravenous glycerol therapy, the extent and pathogenesis of any ensuing haemolysis were evaluated using standard clinical investigations and in vitro techniques. 2. Twenty patients received 10% glycerol in saline (500 ml over 4 h on 6 consecutive days) and 15 received corresponding control treatment with saline. 3. Intravascular haemolysis was evident after the first infusion; compared with the controls the glycerol group had i) a greater mean reduction in serum haptoglobin concentration (P less than .05), and ii) a greater proportion exhibiting haemoglobinaemia (P = 0.03). 4. After 6 days of glycerol treatment, the mean reduction in haemoglobin concentration was only 0.8 g more than in controls; this difference being neither clinically nor statistically significant. 5. Glycerol therapy was not associated with haemoglobinuria, renal insufficiency or disseminated intravascular coagulation. 6. Exposure of red blood cells to 1-10% glycerol in vitro did not induce haemolysis per se; on re-exposure to lower concentrations lysis ensued provided a minimum osmotic gradient was present. 7. Whilst taking standard dosage regimes of glycerol, the stroke patients we studied manifested a degree of intravascular haemolysis but its consequences were not clinically significant; lysis probably ensued after venous blood acquiring high glycerol concentrations mixed with blood containing little or no glycerol.

Chronic effects of phenytoin on brain-stem auditory evoked potentials in man

The effects of phenytoin (PHT) on brain-stem auditory evoked potentials (BAEPs) were studied in 65 epileptic patients who received long-term PHT monotherapy at therapeutic and supra-therapeutic levels with no clinical evidence of brain-stem toxicity. Abnormal BAEPs were found in 7.5% and 33.3% of patients with therapeutic and supra-therapeutic PHT levels respectively. Serum PHT levels had a trend towards a positive relationship with the I-V interpeak latency (IPL), and a significant negative relationship with the amplitudes of waves I and V. At supra-therapeutic levels, both I-V and I-III IPLs were significantly prolonged while at therapeutic levels only I-III IPLs were prolonged. The absolute latency of wave I was prolonged in both the therapeutic and the supra-therapeutic groups. These results suggest that PHT acts both peripherally on either the auditory nerve or the cochlea, and centrally on brain-stem conduction.

Cerebrovascular disease in Hong Kong Chinese

Our prospective study of cerebrovascular disease in Hong Kong confirms a previous clinical impression that stroke in the Chinese has a pattern different from that in Caucasians. We studied 540 patients (aged 20-70 years) with stroke. Computed tomography or autopsy was obtained in 86.1% and showed an increase in the proportion with lacunar infarction, striatocapsular infarction, and parenchymal hemorrhage relative to the frequencies in Caucasians. This increase in the incidence of cerebral hemorrhage occurs not only in semicomatose and comatose patients but also in alert patients (16.9%) and those with a lacunar syndrome (12.5%). Our findings suggest that cerebrovascular disease in the Chinese selectively affects small vessels, causing lacunes and hemorrhages. In future community studies on stroke prevalence, researchers should be cautious about interpreting similar prevalence rates as reflecting similar risk factors or pathologies.

Multiple sclerosis amongst Chinese in Hong Kong

A territory-wide investigation of southern Chinese patients with multiple sclerosis (MS) was conducted in Hong Kong. There were 47 patients, 35 of whom were clinically definite (CDMS), 6 laboratory-supported definite (LSDMS) and 6 clinically probable (CPMS). The prevalence rate was 0.88 per 10(5) population, which is of the same order as in other Oriental populations but much lower than in Caucasoid populations. Comparisons with major Oriental and Caucasian series showed essentially the same clinical picture with only minor variations. In one autopsy case, the lesions were found mainly in the optic nerves and spinal cord, with marked softening in addition to the classical demyelination features. In contrast to findings in Caucasians, the detection rate of oligoclonal bands in the cerebrospinal fluid was low (33% in CDMS patients) and there was no association with human leucocyte antigens. The possible implications of these findings on the pathogenesis of MS are discussed.

Type I familial amyloid polyneuropathy in a Chinese family

A Chinese family with at least 3 members having the typical clinical picture of type I familial amyloid polyneuropathy is presented. The pathological features, including the immunohistochemical typing of the amyloid deposits, are described and the literature is briefly reviewed.

Central nervous system involvement in non-Hodgkin's lymphoma

Fifty-eight Hong Kong Chinese patients with CNS lymphoma were reviewed (primary seven, secondary 51). The incidence of secondary CNS lymphoma in patients with non-Hodgkin's lymphoma was estimated to be 9.4%. The Working Formulation separated subtypes which had a special propensity to involve the CNS. Significant proportions of our patients with secondary CNS lymphoma had other features which were known to be associated with a high risk of CNS disease including stage IV (48/51, 91.4%), bone marrow (26/51, 50.9%), peripheral blood (7.51, 13.7%), nasal (7/51, 13.7%), orbital (3/51, 5.9%), testicular (2/51, 3.9%) and bulky retroperitoneal (6/51, 11.8%) disease. 82% of patients with secondary CNS lymphoma had concurrent systemic disease and a further 12% had systemic relapse shortly afterward. CNS lymphoma is associated with poor prognosis and only 29% and 14% of the patients with primary and secondary CNS lymphoma respectively survived beyond 1 year. Patients responding to therapy had significantly better survival. 69.9% of the deaths were related to progressive systemic disease.