High-incidence of C9 deficiency throughout Japan: there are no significant differences in incidence among eight areas of Japan

From 92,686 sera sent from hospitals throughout Japan to the Special Reference Laboratories for CH50 assay, we were able to classify 80 patients as C9-deficient using a sensitive screening test, as well as hemolytic and immunochemical C9 assays. The incidence of C9 deficiency was determined to be 0.086%, and there were no distinct differences among the eight areas of Japan tested. Serum CH50 levels of these C9-deficient patients varied widely (9.4-63.8 U/ml), and exhibited a higher value (average: 34.1 U/ml) than that of healthy C9-deficient individuals, probably due to elevated C3, C4, and C5 levels. These patients suffered from a variety of autoimmune, renal, and infectious diseases, which, however, are thought to be only incidentally associated with C9 deficiency.

IL-2 receptor subunit, p75: direct demonstration of its IL-2 binding ability by using a novel monoclonal antibody

A new monoclonal antibody (mAb), TU11 mAb, was found to be specific for the p75 subunit of human interleukin 2 receptor (IL-2R). TU11 mAb reacted with human and Gibbon ape cell lines positive for IL-2Rp75 but not with cell lines negative for IL-2Rp75 tested. TU11 mAb specifically detected a single cell surface molecule with a molecular weight of 75 kd. The 75 kd molecule was identical to p75 detected by TU27 mAb specific for human IL-2Rp75 in sequential immunoprecipitation. TU11 mAb did not block IL-2 binding to the high-affinity IL-2R at all and precipitated p75 bound with IL-2. Using TU11 mAb, we have demonstrated here that solubilized p75 has an IL-2 binding site.

Impact of stress on alcoholic liver injury; a histopathological study

Certain behaviors can have an influence on the cause and progression of liver disorders. To clarify the relation between histopathological change of the liver and psychosocial stress, behavioral traits, and psychological state, patients with fatty liver (n = 14) were compared with patients with chronic hepatitis (n = 16). Both groups were alcohol-induced without other causes and consumed the same dose of alcohol. By morphometric methods, fat deposit ratio (FDR) and degree of liver damage (DLD) which reflects lobular fibrosis, inflammatory cell infiltration, and necrosis were evaluated. Life Change Unit scores from the Social Readjustment Rating Scale were significantly higher in chronic hepatitis than in fatty liver (p less than 0.001). DLD was significantly correlated with Life Change Unit (r = 0.59, p less than 0.01). It is suggested that psychosocial stress is one of the aggravating factors of fibrosis and inflammatory change of the liver which is previously damaged by alcohol in man just like the rat liver following stress.

How could canal-pluggings result in intensive direction changing type of positional nystagmus?

The objectives of this study in Rhesus monkeys is to observe the sequences which appear in the oculo-spinal-motor system after selected semicircular canals had been plugged. The left anterior and the right posterior canals in a monkey "LARP", the left anterior and posterior canals in "LALP", and the left lateral canal in "LL" were plugged under intubation general anesthesia. Three-dimensional eye recordings were performed, using two scleral coils. Behavior, posture, and vestibulo-ocular reflex were studied. Compensation was established in the light within 2 days. In darkness, no spontaneous nystagmus was recorded in the sitting position. The monkey "LALP" developed marked positional nystagmus. When the head position was changed up to 360 degrees in 15 degrees steps, horizontal, vertical and torsional eye movements showed remarkable changes. Spontaneous direction changing nystagmus in darkness was also recorded in "LALP". To conclude, direction changing positional nystagmus, which was seen for several months after the canal plugging, was difficult to explain by the damage to the adjacent ampullary and/or otolithic endorgans, but may be explained by the limited otolithic compensation in the earth parallel plane for the defective dynamic canal inputs. These observations and conclusions were from experiments using three monkeys only and should still be confirmed in more extended experiments.

Cloning, nucleotide sequence, and expression in Escherichia coli of the gene for poly(3-hydroxybutyrate) depolymerase from Alcaligenes faecalis

The extracellular poly(3-hydroxybutyrate) depolymerase gene from Alcaligenes faecalis T1 was cloned into Escherichia coli DH1 by using the plasmid pUC8. An A. faecalis T1 genomic library was prepared in E. coli from a partial Sau3AI digest and screened with antibody against the depolymerase. Of the 29 antibody-positive clones, 1 (pDP14), containing about 4 kilobase pairs of A. faecalis T1 DNA, caused expression of a high level of depolymerase activity in E. coli. The enzyme purified from E. coli was not significantly different from the depolymerase of A. faecalis in molecular weight, immunological properties, peptide map, specific activity, or substrate specificity. Most of the expressed enzyme was found to be localized in the periplasmic space of E. coli, although about 10% of the total activity was found in the culture medium. Results of a deletion experiment with pDP14 showed that a large SalI fragment of about 2 kilobase pairs was responsible for expression of the enzyme in E. coli. The nucleotide sequence of the large SalI fragment has been determined. Comparison of the deduced amino terminus with that obtained from sequence analysis of the purified protein indicated that poly(3-hydroxybutyrate) depolymerase exists as a 488-amino-acid precursor with a signal peptide of 27 amino acids.

Further clinical experiences with middle-ear implantable hearing aids: indications and sound quality evaluation

Since 1983, when the 5-year project on the middle-ear implantable hearing aids (MEI) was completed, we have been concentrating our studies on the clinical application of the partially implantable MEI (PMEI). The study was on the indication of implantation, improvement of the implantation operation, follow-up of the implanted patients, minor modification of the MEI, preparation of necessary surgical tools, and so on. Clinical study was also necessary for our team to finally confirm the clinical usefulness of this device. The present report is focussed mostly on the problem of indication for the application of PMEI.

Correlation among lipid peroxidation, brain energy metabolism and brain oedema in cerebral ischaemia

In order to study the involvement of lipid peroxidation in the generation of ischaemic cell damage, sequential measurements were made on the chemiluminescence, energy metabolism, water content and the volume of Na+ and K+ in the cerebral cortex using a rat model for severe cerebral ischaemia. It was found that the amount of chemiluminescence increased due to ischaemia and increased further following recirculation. In chemiluminescence spectral analysis, peaks were found at 480, 520-530, 570, 620-640, 680-700 nm. It is thought that these wavelengths reflect the release of energy due to the reduction of active oxygens to more stable states during the breakdown of lipid hydroperoxide. The recovery of ATP in the 5 min ischaemic brain after reflow with ATP stopped at approx. 60% of the pre-ischaemia level, whereas the water content of the cortex showed an increase after 5 min of recirculation, and a gradual recovery thereafter for 30 min. There was a strong correlation between the increase in cortical water content after recirculation and the amount of chemiluminescence. It is concluded that causes of the ischaemic cerebral oedema include not only decreased activation of ATP-dependent Na+, K+-ATPase, but also functional changes in ion channels due to an increase in free radicals following recirculation.

[Computed tomographic evaluation due to ruptured intracranial aneurysms in the posterior fossa]

From April, 1978 through December, 1984, computed tomographic (CT) findings were carefully examined in 34 cases of initial subarachnoid bleeding due to a single ruptured aneurysm in the posterior fossa. All of the patients were hospitalized within 3 days of the onset of symptoms. High-density areas, which indicate the presence of subarachnoid clots, were evaluated in the interhemispheric and Sylvian fissures and the interpeduncular, prepontine, ambient, and quadrigeminal cisterns. The CT data suggest that hematomas in the four cisterns are thicker than those in the supratentorial subarachnoid spaces. Only one patient had an intracerebral hematoma. Hydrocephalus accompanied aneurysms of the posterior fossa more frequently than those of the anterior circulation.

[The effect of phenytoin on free fatty acid liberation and mononucleotide metabolism in transient ischemia]

Ischemia gives rise to severe energy depletion and influx of Ca from the extracellular space, and it is suggested that increased intracellular Ca leads to the activation of phospholipase C and A, and to liberation of free fatty acids (FFA) in particular arachidonic acid. Phenytoin has been reported not only to maintain the intra- and extracellular cation balance but blockade the Ca channel. The purpose of the present study is to investigate the effect of phenytoin on the liberation of FFA, energy metabolism and mononucleotide metabolism in ischemic brain. Male Wistar rats were subjected to global cerebral ischemia induced by the occlusion of basilar and bilateral common carotid arteries. The brains were frozen in situ by the funnel technique after 5 or 30 min of ischemia or after 10, 30, or 60 min of recirculation following 30 min of ischemia. Purine and pyrimidine nucleotides, FFA, and glycolytic intermediates were measured by HPLC, GLC, and fluoro-enzymatic method. In non-treated rats, ATP reached a nadir after 5 and 30 min of ischemia. Phenytoin significantly attenuated ATP depletion after 5 and 30 min of ischemia. And also E.C. is higher in phenytoin treated rats than in non-treated rats in ischemia. After 60 min of recirculation, ATP recovered to 1.93 +/- 0.02 mumol (72.3% of pre-ischemia) in treated rats but 1.60 +/- 0.07 mumol/g (60% of pre-ischemia) in non treated rats. In E.C., there are significant differences between non-treated and treated rats after 10 and 30 min of recirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Protective effect of various agents against ischemic neuronal damage in guinea pig hippocampal neurons studied in vitro]

A study was made of protective effect of several drugs (mannitol, phenytoin, vitamin E and dexamethasone) against the deprivation of both glucose and oxygen from the bathing medium on electrical activities of guinea-pig hippocampal neurons in vitro. Using guinea-pig hippocampal slice, we recorded antidromic field potentials in the granular cell layer of the dentate gyrus with stimulating mossy fibers. "Ischemia" of a slice was achieved by substracting both glucose and oxygen from the perfusing medium. In standard medium, after 10 minutes of ischemia, field potentials had minimum recovery with an amplitude of 5% of control after 60 minutes in the standard medium. Mannitol treatment had no protective effect, but phenytoin, vitamin E and dexamethasone had clear dose-dependent effect. The protective effect was evaluated by recovery of field potential amplitude of the 60 minutes postischemic response and histological examination of the brain slice tissue. The degree of the histological damage was correlated with recovery of field potential. In this experiment we have demonstrated that phenytoin and vitamin E obviously have the protective action against ischemic neuronal damage in the guinea-pig hippocampal slice and the combined application of these drugs were more effective.

Experimental retrograde adriamycin trigeminal sensory ganglionectomy

Direct destruction of the sensory ganglion or its root, by either surgical transection or injection of phenol, has been employed as preferred treatment for a variety of neuralgic pain syndromes. In this report, the suicide axoplasmic transport of adriamycin is described as a novel approach to sensory ganglionectomy. When injected into a branch of the trigeminal nerve in the cat, adriamycin was swiftly transported by way of retrograde axoplasmic flow to the sensory neurons parental to the injected nerve, where adriamycin-specific autofluorescence was observed. Trigeminal sensory evoked potentials became unobtainable 24 to 48 hours after injection of adriamycin in concentrations of 1% to 10%. The sensory neurons underwent subacute degeneration within a week due to the delayed action of adriamycin, and consequently the primary afferents degenerated in a restricted projection field of the brain-stem trigeminal sensory nuclei. These results indicate that retrograde axoplasmic transport of adriamycin is a unique approach to noninvasive sensory ganglionectomy with strict, albeit simple, safe targeting of sensory neurons and little likelihood of regeneration.

Assessment of the thickness of the right ventricular free wall by magnetic resonance imaging in patients with hypertrophic cardiomyopathy

Electrocardiogram gated magnetic resonance imaging was performed in nine healthy volunteers, in four patients with pulmonary hypertension, and in 16 patients with hypertrophic cardiomyopathy. Fifty two short axis images in diastole were examined to assess the usefulness of magnetic resonance imaging for the measurement of the thickness of the free wall of the right ventricle and the degree of hypertrophy of the right ventricular free wall in hypertrophic cardiomyopathy and pulmonary hypertension. Magnetic resonance imaging gave a clear image of 68% of the length of the right ventricular free wall, showing both the endocardial and epicardial margins. The mean (1 SD) thickness of the right ventricular free wall measured at a total of 512 points was 0.44 (0.12) cm in patients with hypertrophic cardiomyopathy, 0.29 (0.08) cm in healthy individuals, and 0.73 (0.27) cm in patients with pulmonary hypertension.

Cerebral protective effect of flunarizine in a canine model of cerebral ischaemia

To test the effect of flunarizine on cerebral ischaemia, 15 dogs were subjected to ischaemia, using the 'canine model of the completely ischaemic brain regulated with a perfusion method' in which the cerebral blood flow (CBF) can be fully regulated. Five animals served as untreated controls, 10 received flunarizine, a calcium antagonist (1 mg/kg in 5 dogs and 3 mg/kg in 5 dogs), before the ischaemic period. After 1 h CBF was restored and recovery of the electrical activity of the brain and the degree of brain swelling were observed for 3 h. At the end of the experiments, the degree of extravasation of Evans blue was examined. Remarkable recovery of EEG was found in the groups given flunarizine when compared with untreated controls. However, no significant difference was found between untreated controls and flunarizine treated groups for the degree of brain swelling and the degree of extravasation of Evans blue. These results suggest that the treatment of flunarizine is of benefit for functional recovery against cerebral ischaemia, but does not suppress ischaemic brain oedema.

Bifrontal interhemispheric approach for carotid-ophthalmic aneurysms

The authors report their experience with the surgical treatment of carotid-ophthalmic aneurysms in 29 cases, and describe their surgical technique. The technique can be summarized as follows. When dissecting the aneurysm, temporary vascular occlusion of the common carotid artery and external carotid artery is done in the neck under the administration of cerebral protective substances. Through a bifrontal craniotomy, wide dissection of the Sylvian fissures and the interhemispheric fissure is performed. When necessary, the anterior clinoid process and the roof of the optic canal are removed. This approach allows for observation of the neck of the aneurysm from various angles, thus facilitating clipping of the neck. There have been no previous reports of direct surgery on carotid-ophthalmic aneurysms using an interhemispheric approach, but this approach provides a much larger operative field and a better exposure of the aneurysm than other surgical approaches.

[Distribution patterns of hypertrophy at the apical level in patients with giant negative T waves: identification by magnetic resonance imaging]

To clarify the distribution patterns of hypertrophy at the apical level in patients with giant negative T waves (GNT), ECG-gated magnetic resonance imaging (MRI) was performed in 10 patients with GNT and in five normal controls. End-diastolic left ventricular short-axis images at the basal and apical levels were obtained in all subjects. Thicknesses of the septal, anterior, lateral and posterior walls at these two levels were measured and distribution of hypertrophied myocardium (more than or equal to 15 mm) at the apical level was examined. The ratio (R) of the maximal thickness at the apical level over that at the basal level was calculated. In normal subjects, the mean apical wall thickness was 8.7 +/- 1.9 mm. In the GNT group, the wall thickness was always greater than the mean value +3 SD of the normal control, and there were no differences among the four segmental walls. The hypertrophic portions at the apex were circumferential in three, septal-anterior-lateral in two, septal-anterior in two, septal in one, anterior in one and lateral in one. In patients with GNT, the average maximal thickness at the apical level was 19.3 +/- 3.2 mm; by location, four cases in the septum, four in the anterior wall and two in the lateral wall, and the average minimum thickness was 11.7 +/- 3.7 mm; all in the posterior wall. The R was more than 1.3 in nine patients with GNT and less than 1.0 in all normal subjects. In conclusion, there was a variety of patterns of apical hypertrophy, and the R greater than or equal to 1.3 was characteristic in patients with GNT.

[A case of cavernous angioma extended from the ventral part of the pons to the midbrain: subtemporal and trans-tentorial approach]

The authors presented a surgically treated case of cavernous angioma extending from the ventral part of the pons to the midbrain. A 20-year old man was admitted to our service with left motor weakness, dysarthria and consciousness disturbance. CT scan revealed a round well-circumscribed high density lesion in the pons and midbrain. This was diagnosed preoperatively as a cryptic vascular malformation with hemorrhage. The right temporal craniotomy with keel form skin incision and subtemporal & trans-tentorial approach was performed in an attempt to remove the hematoma and the angioma. Histological examination of the surgical specimen revealed abnormal vessels as a cavernous angioma. The postoperative course was uneventful.

Heterogeneity of hemolytic efficiency and isoelectric point of streptolysin O

Using thin-layer agarose gel isoelectric focusing overlaid with thin-layer erythrocyte agar plates, we found that crude streptolysin O (SLO) consisted of a variety of hemolytic components with different isoelectric points (pIs) and that the distribution of pIs in crude SLO was different even in samples which were produced from a single strain of Streptococcus pyogenes under similar conditions. All of the hemolytic components in crude SLO were shown to have the properties of SLO with respect to their susceptibility to oxygen and anti-SLO serum and their molecular weight. The SLO components showed a single molecular weight of 64,000, but they exhibited various pIs ranging from pH 5.4 to 8.3, with major components showing a pI of 6 and/or 7.5. Further examination revealed the slope of the hemolytic titration curve to be dissimilar among the samples of crude SLO. Since the slope of the hemolytic titration curve of a component appears to be based on its hemolytic efficiency, the value of the slope was designated its hemolytic efficiency index. When SLO was purified by isoelectric focusing, the pI of the components was correlated with its hemolytic efficiency index; hemolytic components with lower pIs exhibited a lower hemolytic efficiency index. These results indicate that SLO consists of heterogeneous components with different pIs and suggest that the differences in hemolytic efficiency indices of SLO components are due to the different electrical charges of SLO molecules, which are related to their polymerization and affect hemolytic efficiency.

A novel sodium channel inhibitor from Conus geographus: purification, structure, and pharmacological properties

A novel toxin, tentatively named conotoxin GS (CGS), has been isolated from a marine snail, Conus geographus. CGS was found to exist as a single polypeptide chain, consisting of 34 amino acid residues, cross-linked by three disulfide bonds. Its amino acid sequence was shown to be Ala-Cys-Ser-Gly-Arg-Gly-Ser-Arg-Cys-Hyp-Hyp-Gln-Cys-Cys-Met-Gly-Leu-Arg- Cys-Gly - Arg-Gly-Asn-Pro-Gln-Lys-Cys-Ile-Gly-Ala-His-Gla-Asp-Val. In competition experiments, CGS inhibited the bindings of [3H]Lys-tetrodotoxin ([3H]Lys-TTX) and [3H]propionylconotoxin GIIIA to Electrophorus electricus electroplax membranes, with Ki values of 34 nM and 24 nM, respectively. The toxin inhibited the binding of [3H]Lys-TTX (1 nM) to rat skeletal muscle homogenates with an IC50 value of 880 nM but showed very little effect on this binding to the rat brain P2 fraction at 10 microM. These binding studies indicate that CGS belongs to the same group of Na channel inhibitors as TTX, STX (saxitoxin), and mu-conotoxins. Although CGS, like the mu-conotoxins, is a pharmacological probe for distinguishing between neuronal and muscle Na channel subtypes, the homology in the sequences of CGS and mu-conotoxins is very limited.

Influence of liver dysfunction on volume of putaminal hemorrhage

We studied the relations of age, sex, hypertension, alcohol consumption, liver dysfunction, and thrombocyte count to the volume of the hematoma in 141 patients with spontaneous putaminal hemorrhage. Hematomas were significantly larger in men, regular alcohol consumers, those with liver dysfunction, and those with low platelet counts. Our findings reflect the fact that almost all of the alcohol consumers were men, most of them had liver disorders, and the volume of hematoma in such patients was relatively large.

Spontaneous intracerebral hemorrhage and liver dysfunction

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated gamma-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage.