Functional and structural properties of lipid-associated apolipoprotein J (clusterin)

Apolipoprotein J (apoJ, clusterin) is a multifunctional protein normally associated with lipids in plasma and cerebrospinal fluid, and secreted as lipoparticles by hepatocytes and astrocytes. To investigate whether the structural and functional properties of apoJ are modulated upon binding to lipids, we prepared apoJ high-density lipoprotein (HDL)-like particles employing either synthetic or plasma HDL-derived lipids. The majority of the resulting lipoparticles contained one molecule of apoJ per particle and exhibited the same alpha2 electrophoretic mobility characteristic of apoJ-containing plasma HDL. Particle size seemed to be dependent on the presence of cholesterol in the lipid mixture and ranged from diameters of 10 nm in the presence of cholesterol to 20 nm in the absence of cholesterol. CD analysis and Fourier-transform infrared spectroscopy revealed similar changes in the apoJ secondary structure induced by its incorporation into lipoparticles, namely a decrease in alpha-helix content and an increase in beta-turn structures. Two functional assays, the binding interaction with Alzheimer's amyloid beta peptides and the inhibitory activity of the complement membrane-attack complex, did not detect any changes in apoJ activity following its lipidation (P>0.05). On the contrary, the binding affinity to the cellular receptor megalin was enhanced significantly (P<0.01) after the association with lipids; the K(d) value decreased from 78.8+/-10.7 nM for the delipidated form to 37. 0+/-7.3 nM for apoJ-HDL. Although it is not known whether the structural changes observed are directly responsible for the higher receptor-binding affinity, the data suggest that the complement inhibition and amyloid beta-binding motifs are located in areas of the molecule different from those involved in the apoJ-megalin interaction.

Licorice-induced hypokalemic myopathy and hypokalemic renal tubular damage in anorexia nervosa

A patient with a history of anorexia nervosa developed licorice-induced hypokalemic myopathy. With potassium replacement, high CPK blood level and myopathic signs returned to normal. However, the patient manifested persistent hypokalemia and impaired renal function to concentrate and acidify the urine. Renal biopsy demonstrated intense degeneration and vacuolation of tubules with a normal glomerus which was consistent with hypokalemic nephropathy. Prolonged hypokalemia in anorexia nervosa is sometimes attributed to surreptitious purging or taking diuretics, but it is necessary to check the urine pH, the urine-specific gravity, and the urine potassium level in order to find underlying renal damage even after hypokalemic myopathy is treated successfully.

Presenilin-1 exists in the axoplasm fraction in the brains of aged Down's syndrome subjects and non-demented individuals

Missense mutations in the presenilin-1 (PS-1) gene are known to be responsible for early-onset familial Alzheimer's disease (AD). The normal physiological functions of PS-1 are still incompletely understood, although data on the intracellular localization of PS-1 are accumulating, indicating that it exists mainly in endoplasmic reticulum and Golgi compartments. To investigate the localization and functions of PS-1 in the human brain, we separated axoplasm fractions from the cerebral white matter of Down's syndrome (DS) subjects with AD pathology and non-demented individuals using the axonal flotation method, and analyzed them immunocytochemically. All axoplasm fractions contained the 28-34 kDa amino-terminal fragment and the 18 kDa carboxy-terminal fragment of PS-1, although there was no specific abnormality of this protein in the DS brains with AD pathology. This finding indicates that there is intracellular trafficking of PS-1 through the axons in the human brain, and thus provides new information about the physiology of PS-1.

Radical surgery after neoadjuvant intra-arterial chemotherapy in stage IIIb squamous cell carcinoma of the cervix

We examined the efficacy and safety of neoadjuvant intra-arterial chemotherapy (NAC) followed by radical hysterectomy and/or radiotherapy in patients with stage IIIb cervical cancer. Treatment consisted of bilateral internal iliac artery infusion of cisplatin or carboplatin and peplomycin every 21 days for two courses. Patients who responded to NAC underwent radical surgery. Patients who did not respond to NAC were treated with pelvic radiotherapy. Complete response was achieved in 2 (7.1%) of 28 patients, while a partial response was observed in 17 (60.7%) and stable disease in 9 (32.1%) patients. Sixteen patients (57.2%) were able to undergo surgery. The median blood loss (674 ml) and operating time (232 min) for radical surgery in patients with stage IIIb disease was similar to that in patients with stages Ib to IIb disease. No intra-operative or immediate postoperative complications were observed. The 5-year disease-free survival (DFS) for patients who underwent surgery (81.3%) was higher than for patients who underwent radiotherapy after NAC (31.3%). Radical surgery after NAC for stage IIIb disease was safe, and a survival benefit followed by surgery with or without radiotherapy.

Enzymatic properties of endo-beta-N-acetylglucosaminidases from developing tomato fruits and soybean seeds: substrate specificity of plant origin endoglycosidase

Substrate specificity and some other enzymatic properties of partial purified endo-beta-N-acetylglucosaminidases (endo-beta-GlcNAc-ase) from developing soybean seeds (Glycine max, Endo-GM) and developing tomato fruits (Lycopersicum esculentum, Endo-LE) were studied. The substrate specificity of these two endoglycosidases was explored and compared with regard to various pyridylaminated N-glycans derived from some naturally occurring glycoproteins. For Endo-GM and Endo-LE, several high mannose-type sugar chains bearing alpha 1-2 mannosyl residue(s), Man9-6GlcNAc2-PA (PA is pyridylamino) (80-100% relative hydrolysis), were most favored substrates followed by Man5GlcNAc2-PA (32% for Endo-LE, 43% for Endo-GM), a typical hybrid-type structure (GlcNAc1Man5GlcNAc2-PA; 34% for Endo-LE, 37% for Endo-GM), and then the common core pentasaccharide of N-glycan (Man3GlcNAc2-PA; 9% for Endo-GM and 16% for Endo-LE). On the contrary, both Endo-GM and Endo-LE could barely hydrolyze the xylose-containing N-glycans (Man3Xyl1GlcNAc2-PA, Man3Fuc1Xyl1GlcNAc2-PA) found ubiquitously in plant cells. The molecular mass of these two endoglycosidases was approximately 62 kDa by gel filtration and both Endo-GM and Endo-LE showed maximal activities for Man6GlcNAc2-PA in a weak acidic region (pH 6.0-6.5).

A selective transthyretin-adsorption column for the treatment of patients with familial amyloid polyneuropathy

A transthyretin (TTR)-adsorption column has been developed for the removal of variant TTR from the plasma of patients with familial amyloid polyneuropathy (FAP). The adsorbent is an ion-exchange resin made of porous beads of polyvinyl alcohol gel covalently bound with dimethylaminoethanol. This column was used for three patients with type I FAP. It reduced the concentrations of both normal and variant TTR in the plasma to about half of their pre-adsorption levels. Except for thyroxine, retinol-binding protein and IgM, other proteins in serum were not significantly decreased and there were no adverse effects in long term clinical usage of this TTR-adsorption column. In this trial, we did not obtain concrete evidence that TTR-adsorption therapy can stop or delay the progression of the disease in a FAP patient. However, if we are able to apply this technique more frequently and effectively, TTR-adsorption therapy using our column might be useful for the treatment of FAP patients.

[A case of severe status epilepticus of frontal lobe origin successfully treated with corticosteroids]

A 17-year-old girl was admitted to our hospital due to low-grade fever, confusion, numbness in her right hand and automatism. On admission, she was slightly disoriented but there were no meningeal signs. Weakness and sensory disturbance were observed in her right hand. Automatism and clonic seizures frequently appeared. Electroencephalography revealed frequent delta bursts in her left frontal lobe. 123I-IMP-SPECT study showed abnormally increased isotope uptake in the left cerebral hemisphere. She was diagnosed as status epilepticus of left frontal lobe origin and treated with anti-convulsants including carbamazepine, phenytoin, diazepam, phenobarbital, and thiopental, which were not effective. Then we started corticosteroid therapy. Three cycles of intravenous injections of methylprednisolone, followed by oral prednisolone led to marked improvement in her symptoms. It is known that corticosteroid decreases the threshold of seizure, so we do not use it for idiopathic epilepsy. On the other hand, in some secondary epilepsy due to vasculitis in the brain, corticosteroid is very effective for seizures. It is still unclear whether our patient actually had vasculitis or not. However, it is important to recognize that steroid therapy might be effective in a certain portion of epilepsies resistant to anti-convulsants, especially in young patients with non-infectious fever.

[A case of chronic inflammatory demyelinating polyradiculoneuropathy complicated by phrenic nerve palsy]

We report on a patient with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) complicated by phrenic nerve palsy. A 50-year-old man was admitted to our hospital due to dyspnea and numbness in his limbs. On admission, severe muscle atrophy, weakness, and sensory disturbance were seen in the distal part of his extremities. Deep tendon reflexes were absent in all the limbs. Routine blood examinations showed no abnormal findings except for mild hyperglycemia (fasting blood sugar 145 mg/dl). Right phrenic nerve palsy was observed on a chest roentgenogram and % vital capacity (%VC) was 56%. Cerebrospinal fluid showed elevated levels of total protein (116 mg/dl) and IgG (16.9 mg/dl). Sural nerve biopsy revealed severe loss of myelinated fibers with demyelination and onion-bulb formation. After immunoadsorption plasmapheresis, the phrenic nerve palsy improved rapidly and %VC recovered to 76%. Although phrenic nerve palsy is rare in patients with CIDP, it is important to take notice of this condition, because phrenic nerve palsy is critical when it occurs bilaterally or when it develops in patients who have suffered from respiratory diseases. Immunoadsorption plasmapheresis is one of the effective treatments for CIDP, especially in patients with serious complications such as phrenic nerve palsy.

Impaired modulation of tonic muscle activities and H-reflexes in the soleus muscle during standing in patients with Parkinson's disease

The presence of postural disturbance in patients with Parkinson's disease (PD) was assessed by the displacement of the centre of foot pressure (CFP) and by changes in the amplitude of the soleus H-reflex when patients maintained an upright standing posture, followed by a forward-leaning posture. Thirteen patients and 13 age-matched normal controls (N) were studied. PD patients showed the following differences when compared to normal subjects: (1) the range of displacement of the CFP associated with forward leaning was significantly smaller (P<0.01); (2) the ratio of the increase in the soleus EMG activity to the CFP displacement (deltaEMG/deltaCFP) was larger (P<0.01), and the value of the deltaEMG/deltaCFP increased significantly in relation to the scale of clinical severity (P<0.01); and (3) the ratio of the increase in the amplitude of the soleus H-reflex to the soleus muscle EMG activity (deltaH-reflex/deltaEMG) was significantly lower in PD patients (P<0.05). The value of the deltaH-reflex/deltaEMG decreased significantly with the scale of clinical severity among the patients (P<0.05). These results suggest that the modulation of both the tonic stretch reflex and the phasic stretch reflex in the soleus muscle during standing are impaired in PD patients, and these impairments may partly cause their disability in the maintenance of a standing posture. Abnormalities in Ib inhibition and presynaptic inhibition are considered to be possible mechanisms in the disturbed modulation of the tonic stretch reflex and the phasic stretch reflex in PD patients during standing.

Three-Hertz postural oscillation in patients with brain stem or cerebellar lesions

Postural instability was quantitatively studied in patients with lesions in the 1) pontine tegmentum, 2) deep cerebellar nuclei, or 3) cerebellar hemisphere. As compared to controls, patients with each lesion demonstrated a characteristic 3 Hertz (Hz) body oscillation. Cross-correlation functions revealed a strong correlation between the body sway and activities in the lower leg muscles. Based on these findings, we conclude that the 3 Hz body oscillation may be the result of any disturbance in the loop of long-latency reflexes mediated by the cerebellum.

[A case of corticobasal degeneration presenting with primary progressive aphasia]

We report a 64-year-old right-handed woman whose initial symptom was slowly progressive aphasia without generalized dementia and who was subsequently diagnosed as having corticobasal degeneration (CBD). Neurological examination revealed disturbed vertical gaze, dysarthria, rigidity of the right upper extremity, and bilateral instinctive grasp reaction. Neuropsychological assessment disclosed Broca's aphasia, buccofacial apraxia, and memory disturbance. MRI of the brain showed atrophy of the frontotemporal lobes, which was more severe on the left than on the right, especially the left inferior frontal gyrus. In most reported cases of CBD, the initial symptom is motor dysfunction of the unilateral upper or lower extremity. However, we should be cautious that among cases with CBD, there have been rare cases that begin with progressive aphasia alone. In our case, the atrophied region of the cerebral cortex was most severe around the left inferior frontal gyrus. In a few reported cases with the initial symptom of aphasia, the atrophied region corresponded considerably to the type of the aphasia. On the other hand, in those whose initial symptom was mainly motor dysfunction of the unilateral extremity, the atrophied region was remarkable in the posterior part of the frontal lobe and parietal lobe. Therefore, we suggest that in CBD the distribution of the cerebral cortical lesions differs in accordance with whether the initial symptom is motor disturbance or aphasia, and that the type of aphasia corresponds to the location of the cortical lesion.

Plasma levels of amyloid beta proteins Abeta1-40 and Abeta1-42(43) are elevated in Down's syndrome

To investigate the effect of the overexpression of beta-amyloid precursor protein (APP) on the production of two major amyloid beta protein (Abeta) species, Abeta40 and Abeta42(43), we measured amounts of Abeta1-40 and Abeta1-42(43) in the plasma from 44 patients with Down's syndrome (DS) (age, 19-61 years) and 66 age-matched normal controls using enzyme-linked immunosorbent assays. Plasma concentrations of both Abeta1-40 and Abeta1-42(43) were increased about 3-fold and 2-fold, respectively, in DS patients compared with normal controls. Especially, the increases in plasma Abeta1-40 in DS patients were statistically higher than the 1.5-fold increase one might predict based on the gene dose of APP in DS. These findings showed that both Abeta1-40 and Abeta1-42(43) are increased in plasma in DS patients, the former more than the latter, suggesting that overexpression of APP and/or other genes may have different effects on the production of these two Abeta species in DS.

Serial magnetic resonance imaging (MRI) study of a patient with Balo's concentric sclerosis treated with immunoadsorption plasmapheresis

A 28-year-old Japanese woman with Balo's concentric sclerosis developed a rapidly progressive form of encephalopathy. Magnetic resonance imaging (MRI) showed multiple concentric lesions in the central white matter and the cerebellum. The administration of corticosteroid regimen resulted in little benefit. Immunoadsorption plasmapheresis led to a remission within 1 month of onset. Serial MRI study was described here for the first time, which allowed us to observe the development of concentric structures. The observation indicated that, initially, a central core, a round demyelinated area, and surrounding edema appeared around a vessel. Subsequently, concentric demyelinated bands formed simultaneously, not centrifugally, with diminution of the edema. Analysis of cerebrospinal fluid showed elevated levels of interleukin-6 and tumor necrosis factor-alpha. The success of immunoadsorption plasmapheresis therapy in this patient suggests that both humoral demyelinating factors and cell-mediated immunity may be involved in the pathogenesis of this disorder.

Amyloid beta protein and its 3-kDa fragment are present in the axoplasm fraction of the white matter in human brain

Production of the soluble amyloid beta-protein (A beta) precedes abnormal accumulation of A beta amyloid in the brains of subjects with Alzheimer's disease. To determine the cellular source and generating mechanisms of soluble A beta in the human brain, we separated an axoplasm fraction from the cerebral white matter and analyzed it. The axoplasm fraction contained secretory isoforms of beta-amyloid precursor protein (APP) and 11.5 kDa A beta-bearing carboxyl-terminal fragments (CTFs) of APP. Furthermore, soluble 4 kDa A beta and 3 kDa fragments of A beta (p3) were obtained from the axoplasm fraction. These results suggest that amyloidogenic 4 kDa A beta is intracellularly produced in cerebral neurons and carried through the axons in human brain.

No association between apolipoprotein E epsilon4 allele and the age of onset in type I familial amyloid polyneuropathy

It has been shown that the Apolipoprotein E (ApoE) epsilon4 allele increases the risk of developing Alzheimer's disease (AD) and lowers the age of its onset. ApoE has also been suggested to be a common facilitating factor in the different types of amyloidoses. However, the association of ApoE epsilon4 with the onset of disease in various types of amyloidoses has not been extensively investigated. Type I familial amyloid polyneuropathy (FAP) is one form of systemic amyloidosis in which ApoE co-localizes with amyloid deposits. We examined 54 patients with type I FAP and found that there was no significant effect of either ApoE epsilon2 or epsilon4 allele on the age at onset. Our results suggest that ApoE4 is not a facilitating factor in the development of FAP, transthyretin amyloidosis.

The immunoreactive profile at the N-terminal region of A beta 1-39/40 but not A beta 1-42 changes with transition from monomer/dimer to further peptide aggregates

Using site-specific antibodies, we assessed the effect of aggregation of various length forms of A beta on the immunoreactive profile of the peptides. All of the antibodies tested reacted with monomeric/dimeric forms of A beta 1-42 and its further aggregates. However, antibodies directed against the 1-24 region of A beta reacted weakly or not at all with A beta 1-39/40 monomers or dimers, but immunoreactivity was enhanced substantially following peptide incubation and aggregation. These results suggest that the conformation of the N-terminal region of monomeric and dimeric A beta 1-39/40 is different from that of aggregated forms, whereas the longer A beta 1-42 does not significantly change its N-terminal conformation during beta-sheet fibril formation. These immunochemical results are consistent with previous structural data, and help to explain the differential effects of A beta 1-39/40 and 1-42 on fibril formation in brain.

Thorn-shaped astrocytes: possibly secondarily induced tau-positive glial fibrillary tangles

Argyrophilic and tau-positive abnormal structures occurring in glial cells are called glial fibrillary tangles. In the astrocyte, a conspicuous tau-positive structure is known to appear in progressive supranuclear palsy (PSP). In this report, another type of argyrophilic and tau-positive astrocytes is reported. The morphology of this new type is quite different from that of the previously reported tau-positive astrocyte in PSP and they are designated here as thorn-shaped astrocytes (TSA). TSA have an apparently argyrophilic cytoplasm with a few short processes and often have a small eccentric nucleus, whose appearance resembles that of a reactive astrocyte. Immunohistochemically, TSA are positive to anti-tau antibodies but are negative for ubiquitin. Simultaneous immunostaining revealed the coexistence of tau and glial fibrillary acidic protein epitopes in the same cytoplasm. Electron microscopically, bundles of 15-nm straight tubules were included in the cytoplasm together with abundant glial filaments. In the vicinity of a cluster of TSA, related structures of perivascular or subpial tau-positive linings, which correspond to astrocytic end-feet, are sometimes observed. In almost all cases, a few TSA are generally located in a confined area of subpial and subependymal regions. Although TSA appear to be intimately associated with some diseases, they are also found in a wide range of cytoskeletal disorders including the aged brain with neurofibrillary tangles. TSA are presumed to be a secondary induced product in relation to astrocytic reaction.

[An autopsy case of fungal (Mucor) cerebral aneurysm]

An autopsy of rupture of Mucor cerebral aneurysm, not diagnosed during the patient's life, was experienced. A 63-year-old female was admitted to our hospital with the chief complaint of disturbance of consciousness and high fever. Her past histories were diabetes mellitus, liver cirrhosis and nasal sinusitis. The remarkable findings on admission were moderate inflammatory data, high blood sugar level in serum and ascites. Brain CT film revealed a non-enhanced low-density area in the frontal region. The cerebrospinal fluid showed bloody color and white blood cell counts were 3300/microliter (mostly neutrophils). Under our suspected of bacterial encephalomeningitis, intravenous cefotaxime and ampicillin therapy was started immediately. Cultures of cerebrospinal fluid for bacteria were negative. The disturbance of her consciousness gradually improved under general treatment. However, her conscious level suddenly became a coma on the 6th hospital day and she died on the 9th hospital day. An autopsy revealed Mucor at the site of the rupture of the cerebral aneurysm.

Secretory cleavage of beta-amyloid precursor protein in the cerebral white matter produces amyloidogenic carboxyl-terminal fragments

To elucidate the metabolic process generating amyloid-beta protein (A beta) from beta-amyloid precursor protein (APP) in human brain, we partially purified secretory forms and carboxyl-terminal fragments (CTFs) of APP from the white matter of a Down's syndrome brain. We obtained secretory forms of APP which lack the entire A beta sequence and CTFs which contain the full-length A beta from the cerebral white matter. Some A beta-lacking secretory APP isoforms in the white matter were derived from APP695. These results suggest that amyloidogenic CTFs can be produced by secretory cleavage of APP which is anterogradely transported through the axon in human brain.

[Noninvasive recording of His-Purkinje activity in man]

To clarify the etiology of the prepotentials (PPs) between the end of P wave and the onset of QRS complex (P'-R segment) in signal averaged electrocardiogram (SAECG), SAECG was recorded in 26 healthy volunteers and 15 patients with idiopathic left ventricular tachycardia (VT) and electrophysiologic study (EPS) was done in those 15 VT patients. The PPs which had three components (PP1, PP2, PP3) were recorded in 14 of the 26 volunteers (53.8%) and 10 of the 15 VT patients (66.7%). The intervals from the PPs to the onset of QRS complex were 45.4 +/- 6.6, 30.6 +/- 5.6, 16.0 +/- 4.7 ms, respectively. These intervals in SAECG were very similar to the intervals from the electrograms of His bundle, right bundle, Purkinje network to the onset of QRS complex in EPS. The PPs in SAECG were thought to represent the electrical activity of His bundle, right bundle and Purkinje network.

Variability of beta-amyloid protein deposited lesions in Down's syndrome brains

An immunohistochemical study was carried out on the brains of 7 adult Down's syndrome cases (ages 31 to 62) using antibodies to beta-protein, beta-amyloid protein precursor and tau-protein. Variable forms of beta-protein deposited lesions (including senile plaques and cerebrovascular amyloidosis) were observed in extensive areas of the neocortex of all cases and coexistence of both beta-protein amyloid fibrils and beta-amyloid protein precursors was also seen in some of these lesions. Moreover, 3 cases at an advanced stage showed a few plaque-like lesions with beta-protein immunoreactivity in the white matter. The following temporal morphological change is suggested for the pathogenesis of Alzheimer's disease: senile plaque undergo sequential structural changes and beta-protein amyloid deposits in the form of "early plaque" precede the development of tau-immunoreactive neurofibrillary degeneration.

Secretory cleavage site of Alzheimer amyloid precursor protein is heterogeneous in Down's syndrome brain

A beta (beta/A4) is the major constituent of brain amyloid in Alzheimer's disease (AD), Down's syndrome (DS) and normal aged persons. This protein is presumably derived by normal proteolysis from a precursor protein (APP). In this study, C-terminal fragments of APP in a Tris/Triton soluble fraction were partially purified from DS brain by heparin-affinity and reverse phase chromatography, and analyzed by N-terminal amino acid sequencing after SDS polyacrylamide gel electrophoresis and Western blotting. We found at least six different C-terminal fragments including those with the entire A beta region. These results suggest that secretory processing of APP is heterogeneous and generates amyloidogenic C-terminal fragments.

Secretory form of beta-amyloid precursor protein is much abundantly contained in the cerebral white matter in human brain

To elucidate the metabolic process of beta-amyloid precursor proteins (APP) in cerebral gray and white matter of the human brain, we compared the content and characteristics of secretory APP between these two parts. The white matter contained much more secretory APP than the gray matter in both a control and a Down's syndrome brain, but no difference in the characteristics of the APP isoforms was detected. Our results suggest that, in the human brain, a considerable amount of APP is carried by axonal transport, during which some of the APP isoforms are processed to their secretory forms.

Epinephrine-induced ventricular premature complexes due to early afterdepolarizations and effects of verapamil and propranolol in a patient with congenital long QT syndrome

We report a patient with congenital long QT syndrome in whom early afterdepolarizations (EADs) were demonstrated on monophasic action potential (MAP) recordings in the left ventricular mid-base inferior wall. Epinephrine infusion at 5 micrograms/min increased the amplitude of the EADs and the late component of the T(U) wave. Epinephrine also induced ventricular premature complexes (VPCs) with right bundle branch block morphology and left-axis deviation that occurred from the peak of the EADs. Verapamil injection (5 mg) during continuous epinephrine infusion abolished all VPCs with a slight reduction in the amplitude of the EADs. Propranolol injection (5 mg) in addition to verapamil further reduced the amplitude of the EADs and the late component of the T(U) wave. These findings suggest that the epinephrine-induced VPCs were closely related to triggered rhythm arising from the EADs, and that both verapamil and propranolol were effective for the suppression of VPCs and EADs.

[A case of transverse myelopathy caused by pyogenic vertebral osteomyelitis having extended from a pedal ulcer]

A 64-year-old man who had suffered from diabetes mellitus and a recurrent intractable ulcer of the foot developed subacute transverse myelopathy with severe inflammatory reactions. Magnetic resonance imaging (MRI) revealed destructive lesions in both upper thoracic and lumbar spines. In plain X-ray film, although intervertebral spaces of the lumbar spines were apparently normal on the supine position, they became narrow spaces on the sitting position. The aspiration biopsy from the intervertebral spaces of the lumbar spines showed non-specific necrotic tissues. These findings suggested that the destruction of the intervertebral disks also occurred simultaneously. According to the clinical course and radiological studies, we diagnosed this patient as pyogenic osteomyelitis, and performed the antibiotics therapy. Although he showed no change in his signs and symptoms due to transverse myelopathy, radiological studies exhibited an improvement of both the lumbar and thoracic lesions. In addition, MRI studies in the lumbar lesions revealed low intensity signals on both T1 and T2 weighted images before the antibiotics therapy. It was suggested that lumbar lesions were older than the thoracic lesions. Serial studies including bone X-ray film and MRI were not only useful for the diagnosis of pyogenic osteomyelitis but also for an evaluation of the lesions.

Analyses of metal ions in spider venoms in relation to insecticidal activity of clavamine

To elucidate insecticidal activity of spider toxins, metal ions in venoms and in the bodies were determined by thin layer chromatography, spark source mass spectrometry, ion chromatography, inductively coupled plasma emission spectrometry and atomic absorption spectrometry. Two kinds of spiders were used, Nephila clavata and Nephila maculata. Metals from their venom glands were extracted with hydrochloric acid and the metal concentrations were almost the same in the two species. Many kinds of metals, Fe, Zn, Pb, Cu, Ca, Mg, Na, P and S were found at higher levels in the venoms at concentrations higher than in the bodies. The contents of metal ions were low in the dragonfly and the cicada which are considered to be preys. Clavamine, the main insecticidal component in N. clavata, was effective on larvae of a mosquito with Ca2+, Fe3+ or Pb2+, but ineffective with Mg2+, Zn2+, Fe2+ or Cu2+. It is suggested that the metal chelates play an important role in the intoxication and detoxication of the spider toxins.

[Apraxia of gait and disorders in posture and locomotion]

Apraxia of gait is a unique disorder of locomotion characterized by inability in lifting the feet from the floor despite alternating stepping action (frozen gait), and disequilibrium. Responsible site of lesions are in the frontal lobe and/or the basal ganglia. It is observed in an advanced stage of Parkinson's (PD) or vascular parkinsonism with multiple cerebral infarction (MCI). Studies on equilibrium and natural gait have disclosed unique features in this condition. Records of floor reaction forces in forward locomotion showed that vertical-foreaft vector angles at kick-off phase is small in both PD and MCI with frozen gait. EMG of antagonists in leg muscles were either reciprocal or coincided in frozen gait, and rhythm of stepping was crucial for development of freezing. Center of foot pressure (CFP) in forward-bent natural posture in PD still locates behind that of normals. For voluntary forward bending, maximal shift of CFP was smaller, and increase in EMG was larger in PD subjects. Pushing chest backward results in step-out or fall in parkinsonians. In this response, EMG in the pretibial muscles were the same amount in both PD and normals. However, velocity in hip extension and amount of knee and ankle displacement were smaller in PD.

[A case of bronchogenic squamous cell carcinoma associated with Swyer-James syndrome]

Swyer-James syndrome is considered to be a relatively uncommon disease entity presenting with unilateral hyperlucent lung due to hypoplasia of a pulmonary artery and bronchiectasis of the affected lung. Association of bronchogenic carcinoma with Swyer-James syndrome has not apparently been reported in any previous literature, except for one Japanese case. In the present paper, we describe a 48-year-old male individual, who developed poorly differentiated squamous cell carcinoma of the right upper lobe bronchus after he had been diagnosed to have Swyer-James syndrome with unilateral hyperradiancy of the left lung. It is suggested that the bronchial epithelium of the unaffected lung in Swyer-James syndrome is likely to be more exposed to extrinsic carcinogens than that of the affected, underventilated lung, hence resulting in a higher risk of developing bronchogenic carcinoma.

Tumour angiogenesis in prostatic carcinoma with and without bone marrow metastasis: a morphometric study

One hundred and one cases of clinical prostatic carcinoma (PCa), primary site, were analysed to define the interrelationship between tumour angiogenesis, histological grade, and bone marrow metastasis. Tumour angiogenesis was determined by the blood capillary density ratio (BCDR; a/b), defined as the ratio between the area of the blood capillaries (a) and the area of the tumour (b). The BCDR was evaluated by a colour image analysis system employing a computerized morphometrical method. A total of 43 cases of PCa with bone marrow metastasis (stage D2) and 58 cases of PCa without metastasis (stage B, C) were utilized. The prostatic carcinomas were classified into three groups (low, intermediate, and high) using Gleason's grading system. The BCDR of the primary PCa with bone marrow metastasis was similar in each of the three histologically graded scores. On the other hand, in the cases of PCa without metastasis, the BCDR of high score PCa was higher than those of the low and intermediate score PCa (U-test; P < 0.001). The BCDR of the high score PCa without metastasis was similar to that of the PCa with bone marrow metastasis. The BCDR may provide help in predicting tumour progression with regard to bone marrow metastasis of PCa with low and intermediate Gleason's scores.

[A case of Tolosa-Hunt syndrome accompanied by facial and vestibular nerve damage]

A 37-year old man, who had repeatedly suffered from transient ophthalmoplegia in his left eye at the age of 29 and 36, developed left painful ophthalmoplegia accompanied by ipsilateral facial nerve palsy in August, 1991. Neurological examination revealed involvement of the left oculomotor, trochlear, ophthalmic division of the trigeminal, abducens, facial and vestibular nerves. Gadolinium-enhanced MRI which was taken at the acute phase of the illness demonstrated markedly enhanced left cavernous sinus and adjacent thickened dura mater in the middle cranial fossa. At the remission phase after starting corticosteroid therapy, these enhanced lesions were no longer observed even in enhanced MRI studies. We diagnosed him as suffering from Tolosa-Hunt syndrome presently accompanied by facial and vestibular nerve damage because of his history of illness, confined lesion in the left cavernous sinus and steroid-induced remission. We concluded that Tolosa-Hunt syndrome may be accompanied by damage of other cranial nerves in its course and that repeated gadolinium-enhanced MRIs are necessary for diagnosis and observation of the patients.

Spinal cord vascular and leptomeningeal amyloid beta-protein deposition in a case with cerebral amyloid angiopathy

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid fibrils on leptomeningeal and cortical blood vessels, and the incidence of this disorder increases with age. However, this form of vascular amyloid deposition rarely involves tissues outside of the brain. A 71-year-old woman first developed some deterioration in memory, and soon afterwards suffered from recurrent episodes of subcortical hemorrhage. Histopathological examination of this case revealed typical pathology of Alzheimer's disease with an extensive appearance of beta-protein type CAA, and additionally, the spinal leptomeningeal vessels and the pia-arachnoid membranes were also affected by amyloid beta-protein deposits. The spinal cord involvement associated with CAA and Alzheimer's disease is unusual, and the present case provides additional important information on the pathogenesis of disorders with beta-protein deposition including Alzheimer's disease.

Interstitial nephritis associated with glomerulonephritis in a patient with Hashimoto's disease and idiopathic portal hypertension

A middle-aged women with hypothyroidism, idiopathic portal hypertension and nephrotic syndrome is presented. This unusual clinical appearance could not be explained as SLE by serological examinations. Pathohistological examinations showed "Banti's liver", Hashimoto's thyroiditis and diffuse proliferative glomerulonephritis with severe tubulo-interstitial nephritis. Immunohistochemical studies revealed IgA deposits in glomeruli. Electron microscopic study disclosed peculiar lucent areas of rarefaction with osmiophilic particles in tubular basement membranes. This tubulointerstitial nephritis was considered to be related to the immunological mechanism involving thyroid gland, liver and kidney disorders. This case thus had a clinically rare combination of these three.

Comparison of amplitude of human soleus H-reflex during sitting and standing

The modulation of the H-reflex in the human soleus muscle under conditions of different length or of background EMG activity was compared in 7 healthy subjects under three conditions: sitting, standing with support, and standing without support. The amplitude of the H-reflex increased when the muscle was shortened in both the sitting and standing conditions. The degree of increase in H-reflex was smaller during standing than sitting for the same change in muscle length. The H-reflex was augmented according to the increase of the background EMG. The "reflex gain", the ratio of the increase in amplitude of the H-reflex to soleus muscle EMG activity, decreased on sitting, standing with support and standing without support, ranked in that order. From these observations, it is concluded that the H-reflex is modulated by both muscle length and the degree of postural stability. The modulation of the reflex could be interpreted in terms of gain compensation and would serve to stabilize posture. A decrease in reflex gain may be appropriate in stabilizing the spinal reflex feedback loop during standing, especially without support.

Structures of N-linked oligosaccharides of microsomal glycoproteins from developing castor bean endosperms

The structures of sugar chains of the glycoproteins from the microsomal fraction of developing castor bean endosperms have been analyzed. The structural analyses were done by a fluorescence method combined with component analysis, exoglycosidase digestions, partial acetolysis, Smith degradation, and 1H-NMR spectroscopy. The estimated structures fell into three categories; the first was oligomannose-type, the second xylomannose-type, the third complex-type. Among these oligosaccharides, Man3Fuc1Xyl1GlcNAc2 (M3FX) and Man6GlcNAc2 (M6B) were the major structures. The structures of Man4GlcNAc2 (M4C) and Man4Xyl1GlcNAc2 (M4X) have also been found in the microsomal glycoproteins of the developing bean endosperms. These results could indicate that the structures of M4C, M4X, and M3FX are formed in the stage of sugar chain processing in the microsomal fraction, in which oligomannose-type sugar chains are modified into complex-type ones by several kinds of processing enzymes.

Disturbed modulation of the stretch reflex gain during standing in cerebellar ataxia

The postural control disturbance in patients with spino-cerebellar degeneration (SCD) was evaluated by the displacement of the center of foot pressure (CFP) and the amplitude of the triceps surae muscle H reflex in various standing postures. Twelve patients and 8 age-matched normal subjects (NL) were studied. The CFP, surface electromyograms (EMG) in the lower leg and the soleus H reflex were recorded in all subjects. The CFP displacement area was recorded in 10 patients. The following results were obtained: (1) the range of displacement of CFP from forward to backward leaning as a fraction of foot length was significantly smaller in the patients than in the controls (mean +/- S.D.; SCD = 52.8 +/- 12.7%; NL = 62.3 +/- 9.9%; P less than 0.05%, Student's t test); (2) the ratio of the increase in amplitude of the H reflex to soleus muscle EMG activity when the subjects leaned forward from an upright posture was significantly higher in the patients than in the controls (SCD = 0.41 +/- 0.40; NL = 0.17 +/- 0.15, P less than 0.05); (3) this ratio correlated with the area of CFP displacement during upright standing in the patients (r = 0.75, n = 10, P less than 0.05). These results indicate that the suppression of the stretch reflex observed in normal controls during standing is impaired in patients with SCD. We conclude that a decreased suppression of the stretch reflex is one of the mechanisms responsible for the instability on standing in patients with SCD.

[A case of anti-phospholipid antibody syndrome associated with subdural hematoma]

We report a case of a 47-year-old man with anti-phospholipid antibody syndrome associated with subdural hematoma. The patient had several episodes of arthritis during his thirties. He developed venous thrombosis in his right lower leg at the age of 35, when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT) and a biological false-positive result occurred on a syphilis test. When bulbar palsy and Horner's syndrome in the right eye suddenly appeared at the age of 42, he was diagnosed as having brain stem infarction. At the age of 47, he developed constructional apraxia, dyscalculia, skilled movement disturbances and generalized convulsions. Subdural hematoma and multiple lacunes in the cerebral white matter were demonstrated with brain MRI. Furthermore, the patient was positive for Rumpel-Leede phenomenon. Laboratory studies revealed mild thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely anti-phospholipid antibodies. Based on these findings, we consider that the tendency of this patient to bleed may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Anti-phospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with anti-phospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction.

Re-examination of ex-boxers' brains using immunohistochemistry with antibodies to amyloid beta-protein and tau protein

A histopathological study was carried out on the brains of eight ex-boxers (ages 56 to 83) using conventional histological staining methods and immunocytochemistry with antibodies to amyloid beta-protein and the PHF-related tau protein. All cases showed a large number of tau-immunoreactive neurofibrillary tangles and also beta-protein immunoreactive senile plaques in the cortex. In the areas with many neurofibrillary tangles, neuropil threads with tau-immunoreactivity were also observed, and some of the senile plaque lesions were surrounded by abnormal neurites with tau-immunoreactivity. Moreover, three cases revealed beta-protein-type cerebrovascular amyloid deposits on both leptomeningeal and cortical blood vessels. The present observations indicate that the cerebral pathology of dementia pugilistica is very similar to that of Alzheimer's disease and suggest that these two disorders share some common etiological and pathogenic mechanisms.

Primary structures of N-linked oligosaccharides of momordin-a, a ribosome-inactivating protein from Momordica charantia seeds

The structures of the N-linked oligosaccharides of momordin-a, which is a ribosome-inactivating protein from the seeds of Momordica charantia, were analyzed. First, the N-linked oligosaccharides of this glycoprotein were liberated by hydrazinolysis. After N-acetylation, the reducing ends of the oligosaccharides were coupled with 2-aminopyridine and the pyridylamino (PA-) derivatives were purified by gel filtration and high performance liquid chromatography (HPLC) on an ODS-silica column. Three kinds of oligosaccharide fractions were separated by HPLC. The structure of each oligosaccharide isolated was analyzed by a combination of sugar component analysis, exoglycosidase digestion, another kind of HPLC using an amide-silica column, and 500-MHz 1H NMR spectroscopy. The structures of two main oligosaccharides were established to be: [Formula; see text] and [Formula; see text]. These two oligosaccharides were the first examples having xylose (or fucose) but no alpha-mannosyl linkage among the N-linked oligosaccharides of glycoproteins from both animal and plant origins.

[A case progressive dementia developed after repeated head trauma]

A 46-year-old man who developed progressive dementia after repeated head trauma was reported. At the age of 30 and 36, he encountered traffic accidents and suffered from blows to his head. At 37 years old, he noticed impairment of memory and comprehension. At 41 years old, he was observed to become easily angered. These symptoms were slowly progressive, and at age 46 he was examined by us. He had no particular family history of dementia. Neurological examination revealed a disturbance of cognitive ability. The brain CT and MRI showed marked atrophy of the cerebral cortex, especially in the frontal and temporal lobes without any demonstrable lesions in the white matter. A single photon emission computed tomography (SPECT) using inhalation of 133Xenon disclosed hypoperfusion of the cerebral blood flow localized in the bilateral frontal and parietal lobes. He was supposed to suffer from juvenile Alzheimer's disease which might have developed after repeated head trauma. One similar case had been reported as a posttraumatic premature Alzheimer's disease. Finally, we discussed other causes of dementia including metabolic, infectious and vascular diseases. The present case also suggests that head trauma might be one of the provoking or promoting factors of Alzheimer's disease.

[The application of repelling magnets to distal movement of maxillary molars. Report of three cases]

Report on three cases of maxillary first molar distalization with the aid of intra-arch repelling magnets were presented in this paper. Two cases were Class II malocclusion and one was a Class I discrepancy case whereby all resulted in rapid distalization of the upper first molars into Class I molar relationship in a relatively short time. Despite the unwanted rotation and tipping of the molars and the anteriors occurred slightly, numerous advantages of the repelling magnetic system were noted applicable to early mixed dentition cases to obtain the sufficient space of the molars rapidly. Moreover, since this is a fixed appliance, no patient cooperation was necessary. In conclusion, this magnetic system was found to be an effective device for molar distalization.

[An autopsied case of insulin dependent diabetes mellitus complicated by chronic thyroiditis and chronic hepatitis]

A deceased 59-year-old woman with insulin dependent diabetes mellitus complicated by chronic thyroiditis and chronic hepatitis was autopsied. She had had diabetes mellitus since she was 30 years old, and insulin therapy was started at 34 years. Laboratory findings were as follows: s-GOT 85, s-GPT 31, gamma-globulin 2.45 g/dl. Immunological tests were positive for anti-smooth muscle antibody and anti-ENA antibody with high titers of antithyroglobulin and anti-microsome antibodies. HLA analysis revealed the presence of DR-4. The thyroid biopsy specimen showed microscopic features characteristic of chronic thyroiditis at 52 years of age. She had been repeatedly admitted for the control of diabetes mellitus. She was admitted for the 9th time in June, 1987 following complaints of abdominal pain. After admission, her general condition became gradually worse, and she died of peritonitis in September, 1987. Pathological examination of the liver revealed an expansion of fibrous tissue on Glisson's capsule accompanied by lymphocytic infiltration and was diagnosed to be chronic inactive hepatitis. As for the thyroid gland, fibrous tissue replaced an extensive area of the thyroid gland, and normal thyroid tissue was not observed. Lymphocytic infiltration was less in comparison with that in the previous biopsy. As for the pancreas, atrophy of exocrine pancreatic tissue and fibrous change in interstitial tissue was observed. Lymphocytic infiltration was also seen in the interstitial exocrine tissue but not in the islet. Immunohistochemical examination of the islets using anti-insulin, glucagon and somatostatin antibodies by ABC peroxidase method showed the selective disappearance of B cells in the islets. The pathological changes in the thyroid gland, liver and pancreas suggest that autoimmune mechanism may be involved in the pathogenesis of chronic thyroiditis, chronic hepatitis and IDDM with exocrine pancreatic impairment in this case.

Crystalloids in latent prostatic carcinoma

Intraglandular crystalloids have been studied in 108 cases of latent prostatic carcinoma collected at autopsy. The morphological features of these crystalloids are essentially the same as reported by previous authors. The crystalloids were identified in 62.0% of cases over age 50 years. They were present in 76.9% of cases in the seventh decade, the highest prevalence among the decades. The number of crystalloids relative to the number of malignant glands tended to be inversely proportional to the size of the carcinoma. We conclude that crystalloids are related to the early development of prostatic carcinoma.

Decreased serum cholesteryl-ester transfer activity in a patient with familial hyperalphalipoproteinemia

Lipoprotein patterns and cholesteryl-ester transfer activity (CETA) were examined in a patient with familial hyperalphalipoproteinemia (FHALP). The proband was a 41-year-old Japanese male. He was found to have hypercholesterolemia, with a serum total cholesterol level of 382 mg/dl and a HDL-cholesterol level of 177 mg/dl. HDL showed a high cholesterol/Apo AI ratio. His father, all of his siblings and one of his children showed high HDL-cholesterol levels (91, 100, 70, 108, 75 and 98 mg/dl, respectively). These data suggest that all members of his family were heterozygotes. He had neither cutaneous or tendinous xanthomas nor any clinical signs of atherosclerosis. The proband appears to have only one-tenth of the normal level of CETA. However, the level of lipid-transfer protein I (LTP-I) activity was near normal. Thus, this patient is most likely to have an exaggerated level of LTP-I inhibitor(s). Effects of probucol on serum lipoprotein and apolipoprotein levels were studied in our patient. Treatment with 250 mg of probucol twice daily reduced total serum cholesterol, low density lipoprotein (LDL) and HDL-cholesterol levels by 33.32 and 33%, respectively. Apo AI, B and E levels decreased by 22, 16 and 35% respectively. HDL-cholesterol/Apo AI ratio decreased from 0.9 to 0.76. CETA showed no significant changes. However, cholesterol ester mass transfer increased from 10.8 to 14.9% after treatment with probucol. These results suggest that probucol appears to be a useful drug for FHALP.