Tongue-palatal contact changes in patients with skeletal mandibular prognathism after sagittal split ramus osteotomy: an electropalatography study

The purpose of this study was to investigate the changes in tongue-palatal contact patterns using electropalatography (EPG) before and after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Nine clients who underwent SSRO for mandibular setback and seven control subjects were participated in this study. Tongue-palatal contact patterns for /t/, /s/ and /k/ production were investigated using EPG before surgery and 3 months after surgery. The mean value of whole total of palate contact (WT) in the maximum contact frame was examined before and after SSRO. The correlation quantity between the change of center of gravity (COG) value and the amount of mandibular setback was also evaluated. The mean value of WT for /t/ and /s/ significantly increased after SSRO, and the EPG pattern became normal. However, a remarkable change in WT for /k/ was not observed, and the mean value was significantly larger in the SSRO group before and after surgery than in the control group. A negative correlation between COG variation and the amount of mandibular setback for /t/ and positive correlation for /s/ was observed. This study demonstrated that tongue-palatal contact patterns for /t/ and /s/ articulation improved clearly after SSRO. There was a significant correlation between COG variation and the amount of mandibular setback. However, no significant change was detected through perceptual assessment before and after SSRO. Further investigation is needed to determine whether these results will change over time.

A randomized phase II study of gemcitabine (GEM) plus S-1 combination chemotherapy versus GEM monotherapy in patients (pts) with advanced biliary tract cancer (BTC)

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Background: Our previous phase II study demonstrated that GEM/S-1 combination chemotherapy was tolerable and showed good efficacy in pts with advanced BTC (Sasaki et al, Cancer Chemother Pharmacol 2010). This randomized phase II study compared the response rate of GEM/S-1 combination chemotherapy and GEM monotherapy in pts with advanced BTC.

Methods: Pts with advanced BTC who had at least one measurable lesion were randomized into two groups. GEM/S-1: GEM 1,000 mg/m2 (day 1, 15) and S-1 80 mg/m2 (day 1-14) repeated every 4 weeks. GEM: GEM 1,000 mg/m2 (day 1, 8, 15) repeated every 4 weeks. Treatment was continued until disease progression. The primary endpoint was objective response according to RECIST version 1.0.

Results: From November 2008 to March 2010, 62 pts were enrolled from 13 institutions. Patient characteristics were: median age 72 (range 47-86); Male/Female 36/26; Performance status 0/1/2 (37/22/3). The primary tumor site was; 30 pts in gallbladders, 16 pts in intrahepatic bile ducts, and 16 pts in extrahepatic bile ducts. Seven pts had previous surgical resection. Response rates of GEM/S-1 and GEM were 16.7% and 9.4%, respectively. The median time-to-progressions of GEM/S-1 and GEM were 5.6 months and 4.1 months, respectively.

Conclusions: GEM/S-1 combination chemotherapy is more active than GEM monotherapy in pts with advanced BTC. Updated time-to-progression and overall survival data will be presented at the meeting.

No significant financial relationships to disclose.

Five mouse homologues of the human dendritic cell C-type lectin, DC-SIGN

DC-SIGN, a human C-type lectin, is expressed on the surface of dendritic cells (DC), while a closely related human gene, DC-SIGNR or L-SIGN, is found on sinusoidal endothelial cells of liver and lymph node. Both DC-SIGN and DC-SIGNR/L-SIGN can bind ICAM-3 and HIV gp120, and transmit HIV to susceptible cells in trans. Here, we report the cloning of five mouse genes homologous to human DC-SIGN and DC-SIGNR/L-SIGN. Only one gene, named mouse DC-SIGN, is highly expressed in DC, and is not found in a panel of mouse macrophage and lymphocyte cell lines. The other four genes, named mouse SIGNR1 (SIGN-Related gene 1), SIGNR2, SIGNR3 and SIGNR4, are expressed at lower levels in various cells according to RT-PCR and Northern blot analyses on RNA. All the genes of mouse DC-SIGN and SIGNRs map to adjacent regions of chromosome 8 A1.2-1.3. However, like human DC-SIGN, only the mouse DC-SIGN gene is closely juxtaposed to the CD23 gene, while the other four SIGNR genes are located close to each other in a neighboring region. mRNAs of mouse DC-SIGN and three SIGNR genes encode type II transmembrane proteins (DC-SIGN, 238 amino acids; SIGNR1, 325 amino acids; SIGNR3, 237 amino acids; SIGNR4, 208 amino acids), but the SIGNR2 gene only encodes a carbohydrate recognition domain (CRD) without a cytosolic domain and a transmembrane domain (SIGNR2, 178 amino acids). Amino acid sequence similarities between the CRD of human DC-SIGN and the mouse homologues are 67% for DC-SIGN, 69% for SIGNR1, 65% for SIGNR2, 68% for SIGNR3 and 70% for SIGNR4 respectively. However, the membrane proximal neck domains in the mouse genes are much shorter than their counterparts in human DC-SIGN and DC-SIGNR/L-SIGN. This family of mouse C-type lectins is therefore complex, but only one of the new genes, DC-SIGN, is juxtaposed to CD23 and is expressed at high levels in DC.

Analysis of sialo-N-glycans in glycoproteins as 1-phenyl-3-methyl-5-pyrazolone derivatives by capillary electrophoresis

A method for the analysis of the sialo-N-glycans in glycoproteins was established by the electrokinetic chromatography mode of capillary electrophoresis (CE) in sodium dodecyl sulfate (SDS) micelles as 1-phenyl-3-methyl-5-pyrazolone (PMP) derivatives, using sialo-N-glycans in fetuin as a model. Six major and some minor peaks were observed for the N-glycans in fetuin, which were well separated from each other using 50 mM phosphate buffer, pH 6.0, containing SDS to a concentration of 30 mM in an uncoated fused-silica capillary, and these peaks were assigned to sialo-N-glycans having either of the biantennary or beta1-3/beta1-4 linked galactose-containing complex type triantennary N-glycans as the basic structures, by an indirect method based on the assignment of the peaks in high-performance liquid chromatography separated in parallel with CE and peak collation between these two separation methods. The attaching position of the sialic acid residue was determined using the linkage preference of neuraminidase isozymes. The established system is considered to be useful for routine analysis of microheterogeneity of the carbohydrate moiety of this model glycoprotein from the following reasons: (1) the derivatization with PMP proceeds quantitatively under mild conditions without causing release of the sialic acid residue, (2) the derivatives can be sensitively detected by UV absorption, (3) the procedure is simple, rapid and reproducible. Preliminary results of N-glycan analysis for several other glycoproteins under these conditions are also presented.

[Pharmacological profiles of mycophenolate mofetil (CellCept), a new immunosuppressive agent]

Mycophenolate mofetil (MMF, CellCept), a semisynthetic derivative of mycophenolic acid (MPA) produced by a fungus, is an inhibitor of the inosine monophosphate dehydrogenase (IMPDH) enzyme (IC50 = 25 nM) that catalyzes the synthesis of guanosine monophosphate (GMP) from inosine. GMP is an essential nucleoside for purine synthesis during cell division. As T and B-lymphocytes almost exclusively use the de novo pathway of purine synthesis, these cells are particularly sensitive to the inhibitory action of MMF. It has a mechanism of action distinct from cyclosporine and tacrolimus. Although MMF does not affect cytokine production, by inhibiting the rate-limiting enzyme IMPDH in the de novo synthesis of purines, it inhibits the proliferation of T and B-lymphocytes, the production of antibodies, and the generation of cytotoxic T lymphocytes. Reversal of acute allograft rejection and increased survival of kidney, heart and bone marrow cell allograft has been shown in several animal studies. Moreover, it was suggested that MMF combined with CsA prevented the acute rejection, and approximately half of the animals became long-term survivors. The Ministry of Health and Welfare approved MMF in 1999 for use for rejection treatment in renal transplantation based on several prospective, randomized and blind efficacy trials.

Echographia as a symptom of interictal state in an epileptic patient: a case report

Echographia is a phenomenon in which a patient continuously translates verbal stimuli into writing. We encountered a patient with epilepsy who developed visual echographia during interictal periods. In this case, echographia was observed during two different periods, namely the period of disturbed consciousness after the epileptic seizure and the period of clear consciousness after suppression of the seizures. Disinhibition due to disturbance of the consciousness is considered to have been the cause of echographia in the former period. In the latter period, it is considered that echographia was caused by the release of lower function from suppression of upper function by brain dysfunction, as the after effect of status epilepticus. As echographia can be observed in epileptic patients, attention and careful observation by epileptologists is needed.

Case report: cheilitis granulomatosa with periodontitis

We report a case of cheilitis granulomatosa with periodontitis in a 39-year-old Japanese man. Biopsy specimens from both areas showed noncaseating epithelioid cell granuloma. Dental examination revealed that the lower left first molar had periodontitis. The lower left first molar was removed, and antibiotics and anti-inflammatory drugs were administered. After 2 months of periodontitis therapy, the lips returned to normal size without recurrence and the swelling of the buccal mucosa regressed.

Differing cell surface distribution of human leukocyte antigen-DR molecules on epidermal Langerhans cells and eccrine duct cells

Scanning electron microscopy (SEM) with immunogold labeling was employed to observe the undersurface of the human epidermis after it was split from dermal connective tissue, in an attempt to localize the molecules actually expressed on cell/tissue surfaces. We found that human leukocyte antigen-DR (HLA-DR) molecules were expressed on the surfaces of eccrine duct cells as well as those of epidermal Langerhans cells (LC) in normal skin. HLA-DR molecules, visualized by the deposition of gold particles, were distributed evenly on the LC surface but were present only along the interdigitating borders of the individual duct cells, thus producing a meshwork pattern on the duct surface. Transmission electron microscopy confirmed that the gold particles labeling cell surface HLA-DR molecules were seen only on the portions of duct cell membranes the interdigitated with neighboring duct cells. These findings suggest that the function of HLA-DR molecules may vary with their location and distribution. On the LC surface, the evenly distributed molecules seem to be well suited for promoting "accessory cell" functions. On duct cell surfaces, the HLA-DR molecules present along the intercellular spaces may be involved in trapping various peptide antigens that pass into the sweat gland filtrate and then are reabsorbed by the excretory duct, since these molecules have a highly permissive capacity for binding various peptides.

Melanocyte chemotactic factor produced by skin metastases of a breast carcinoma

A 65-year-old woman underwent right modified radical mastectomy for a malignant lesion which had developed just below the right nipple. Two years after the operation, skin lesions composed of dark brown to black, pigmented, papular lesions developed in the precordia. A biopsy revealed this to be a cutaneous metastasis of the previous breast carcinoma. However numerous pigment blockade melanocytes were also found in the tumor nests, located in and/or beneath the epidermis. Although a black-colored breast carcinoma has been reported, the presence of pigment blockade melanocytes was not determined. Culture of the tumor nest recovered a population of melanocytes as well as the carcinoma cells. Boyden chamber analysis revealed the presence of a chemotactic factor for melanocytes in the culture medium. This seems to be the first documentation of melanocyte incorporation in breast carcinoma tissue.

Serial changes of SPECT in periodic synchronous discharges in a case with Creutzfeldt-Jakob disease

We conducted serial EEG and SPECT studies on one female with Creutzfeldt-Jakob disease (CJD). In an analysis of EEG, a periodic synchronous discharge (PSD) was observed in the middle of the third stage (terminal stage) of Bernoulli's classification. The frequency of PSD was the highest at the beginning of the third stage, followed by a gradual decrease and disappeared at the end of the third stage. In the middle of the third stage, SPECT disclosed blood flow differences between the cerebrum and other regions (the cerebellum and the brainstem), while no such difference was observed by SPECT at the end of the third stage. It was suggested that the appearance of PSD requires the presence of a pathological change in the cerebrum precedent to other regions.

Lateral asymmetry of eye movements in temporal lobe epileptic patients with unilateral foci

Eye movements in response to visual stimuli (Benton Visual Retention Test) were examined in 22 temporal lobe epileptics (TLEs), 10 primary generalized epileptics (PGEs), and 20 normal controls. In the normal controls, the percent fixation time on the left peripheral figure was higher than that on the right peripheral figure, a tendency also found in the PGEs. In TLEs with right-sided foci, the percent fixation time on the left peripheral figure was higher than that on the right peripheral figure, the direction of asymmetry found in the normal controls and PGEs. However, when calculated as laterality indices (the degree of asymmetry) TLEs with right-sided foci were significantly more negative than those of both the normal controls and PGEs. In TLEs with left sided foci, the percent fixation time on the right peripheral figure tended to be higher than that on the left peripheral figure, an asymmetry which differed significantly from the normal controls, PGEs and the TLEs with right-sided foci. The results here showed that TLEs with unilateral foci had distinct eye movements which varied with the laterality of the lesion in the direction of functional overactivation of the epileptogenic hemisphere.

Three cases of anomic aphasia after lesions in and/or around the basal ganglia

The present paper reports 3 cases of aphasia with small lesions in the region of the basal ganglia to discuss whether neostrial dysfunction can cause aphasic symptoms. The Standard Language Tests of Aphasia (SLTA) was used to assess the type and degree of aphasia. Two patients with infarction either in the left putamen or in the head of the left caudate nucleus showed severe disturbance only in recalling words, especially nouns. The other patient showed the same symptom, in addition to writing disturbance that developed shortly after surgical extirpation of an arteriovenous malformation (AVM) in the left caudate nuclei. The symptoms common to the 3 patients corresponded well to the "anomic aphasia" proposed by Benson. The aphasic symptoms disappeared completely or largely within several months. This easy reversibility suggests that the aphasic disorder in the three patients was caused by damage not to the basal ganglia themselves, but to the affecting axons passing through or by the nuclei.

Neutrophil as a mediator of ischemic edema formation in the brain

We investigated the contribution of neutrophils to brain edema formation using a transient focal ischemia model in rats. Rats were given anti-neutrophil monoclonal antibody (RP3) intraperitoneally to deplete circulating neutrophils. In RP3-treated rats, ischemic brain edema formation 1 day after reperfusion was significantly decreased compared to that of saline-treated control rats. We speculate that chemical mediators released by infiltrating neutrophils alter vascular permeability and play an important role in post-ischemic brain edema formation.

Laser-induced photoacoustic injury of skin: effect of inertial confinement

Argon-fluoride (ArF) excimer laser-induced acoustic injury was confirmed by ablating the stratum corneum (s.c.) inertially confined by water in vivo. Hairless rats were irradiated through a quartz chamber with flowing distilled water or air and a 2.5 mm aperture. The laser was adjusted to deliver 150 mJ/cm2 at the skin surface for both conditions. Partial and complete ablation of the s.c. was achieved with 12 and 24 pulses, respectively. Immediate damage was assessed by the transmission electron microscopy. Partial ablation of the s.c. through air produced no damage, whereas partial ablation through water damaged skin to a mean depth of 114.5 +/- 8.8 microns (+/- SD). Full thickness ablation of the s.c. through air and water produced damage zones measuring 192.2 +/- 16.2 and 293.0 +/- 71.6 microns, respectively (P less than 0.05). The increased depth of damage in the presence of inertial confinement provided by the layer of water strongly supports a photoacoustic mechanism of damage. The damage induced by partial ablation of the s.c. provides evidence that photochemical injury is not a significant factor in the damage at a depth because the retained s.c. acts as a partial barrier to diffusion of photochemical products. Combined with our previous studies, these experiments demonstrate that pressure transients are responsible for the deep damage seen with 193 nm ablation and that photoacoustic effects must be considered when using short-pulse, high-peak power lasers.

Cell selectivity to laser-induced photoacoustic injury of skin

Cell selectivity to photoacoustic injury induced by argon-fluoride excimer laser (193 nm) was studied. Rats were irradiated through air or water and a 2.5 mm aperture. The laser was adjusted to deliver 150 mJ/cm2 at the skin surface with 12 and 24 pulses. Immediate damage was assessed by transmission electron microscopy. Cell selectivity was observed in dermis and epidermis. Fibroblasts showed alteration of nuclear chromatin and cytoplasmic organelles, while some of the migratory cells adjacent to fibroblasts did not. Similar difference of damage was observed between keratinocytes and Langerhans cells in epidermis. Considering the relationship between cells and their microenvironment in tissue, this selectivity may be due to the difference of acoustical coupling of propagation of acoustic waves rather than to differential sensitivity of the cells to damage.

A new concept of basal cell epitheliomas based on the three-dimensional growth pattern of the superficial multicentric type

Little is known about the growth characteristics of basal cell epitheliomas (BCEs), largely because of the difficulty in studying these tumors, both in situ and in vitro. In this study, the authors report that a scanning electron microscopic examination of 2 cases of superficial BCEs reveals that the tumor proliferates centrifugally as a monolayer beneath the epidermis as well as over the surfaces of hair follicles, while eroding and replacing the original basal architecture. Behind the leading edge of this monolayer, the cells split away from the epidermis to form a round border resembling a carpet being rolled up. This border then develops into a mass lesion, which represents the tumor cell foci seen in routine paraffin sections. These findings have led the authors to propose a fundamentally different explanation for the pathogenesis of these tumors: BCEs are conditioned neoplasms that require contact with the epidermal or hair follicular epithelium in order to grow. This hypothesis could explain the behavior of BCEs as well as the clinical and pathologic varieties observed in clinical practice.

Higher density of 125I-neuropeptide Y receptors in the area postrema of SHR

125I-Neuropeptide Y (125I-NPY) binding capacities were quantitated in the areas postrema of young (5 weeks) and adult (20 week SHR and compared with age-matched WKY rats using autoradiography. The maximum binding capacity (Bmax) was significantly higher in the area postrema of adult SHR, while no difference was seen at the age of 5 weeks. Our result supports the idea of a functional role for NPY receptors in the central control of blood pressure. NPY receptors in the area postrema may be involved in the perception of circulating NPY resulting in the alteration of the neuronal activity of the nucleus tractus solitarii.

Clinical features of autistic children with setback course in their infancy

This study examines the incidence rate of setback in 80 autistic children, the correlation between the type of onset and clinical features, developmental level and prognosis based on an originally developed questionnaire. Moreover, this study seeks to investigate the possibility that infantile autism might be classified into subgroups by the type of onset. 1) The acquired (including questionably acquired) group consisted of 39 cases (49%), while the natal group was made up of 41 cases (51%). 2) The age when the setback occurred was 21-22 months in the acquired group. 3) Precipitating psychological events were observed in 22 cases (56%) of the acquired group. 4) The mental developmental level including speech and socialbility function at 5 years of age was significantly lower in the acquired group than in the natal group. 5) The acquired group showed severe behavioral disorders such as "stereotypic behavior," "extremely hyperkinetic behavior" and "self-abusive behavior" compared with the natal group. 6) The adaptive levels at schools or institutions were lower in the acquired group than in the natal group. 7) There was a higher incidence of epileptic seizures or febrile convulsions in the acquired group than in the natal group. Moreover, there was a higher incidence of severe perinatal abnormalities in the acquired group. 8) The above-mentioned results suggest that infantile autism might be classified into two subgroups, acquired and natal groups, based on the type of onset, and also suggest that some types of brain dysfunctions are more severe in the acquired group than in the natal group.

The application of DSM-III diagnostic criteria to school refusal

The DSM-III diagnostic criteria were applied to school refusal cases, and the possibility of a subclassification of school refusal through the DSM-III was studied. The subjects were 50 cases diagnosed as school refusal following the criteria defined by Sumi and Tatara. As for the Axis I diagnoses, the subjects fell under the separation anxiety disorder (7 cases), avoidance disorder (13 cases), overanxious disorder (8 cases), identity disorder (5 cases), adjustment disorder (11 cases) and others. On Axis II, no case was diagnosed as having the personality disorder, but 14 cases showed pathological personality traits. On Axis III, nine cases showed some physical disorders or conditions. Among the five major diagnostic groups, there were some definite differences concerning the onset age, clinical course, psychosocial stress, response to therapy and prognosis of disorders. These results suggest the availability of a subclassification of school refusal by means of the DSM-III criteria.

[The groping phenomena in a case of Alzheimer type dementia]

We reported a case of senile dementia, Alzheimer type, with groping in response to a visual stimulus ("visual groping"). T.S. was a right-handed woman, 69 years old. In the beginning she displayed "visual groping" of the right hand, besides aphasia, lowered registration and Casteigne's "Motor neglect" of the right upper extremity. As the disease progressed, "visual groping" of the left hand developed, followed by "forced grasping" of the left hand. When the patient was 62 years old, she first showed decreased volition and lowered registration. Later poor finger movement and lessened speech were marked. At the age of 69, she was admitted to our hospital with aphasia and reduced registration. The patient showed preservation in naming and drawing tests. She also displayed a "visual groping" phenomenon of the right hand. This phenomenon was revealed when an examiner displayed something about 50 cm in front of the patient, and then she extended the upper extremity gropingly. We considered this phenomenon as "groping in response to a visual stimulus" of Denny-Brown. At the same time, the motor or praxic disorder of this patient consisted of paucity of movement. When she was told to imitate, her right upper extremity was hardly utilized, although later movements could be realized by her practice. When she was told to pour water from one glass into another, she used her left hand, although she used her right hand for spontaneous actions. So we considered this dyspraxia as a motor neglect of Casteigne.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative autoradiographic localization of neuropeptide Y receptors in the rat lower brainstem

Using quantitative autoradiography, we have characterized the binding of 125I-Bolton-Hunter coupled neuropeptide Y ([125I]NPY) and observed the localization of 125I-NPY receptors in the rat lower brainstem. [125I]NPY bound to the receptors in a specific, saturable and reversible manner with high affinity. The binding was blocked only by unlabeled NPY but not by NPY-related peptides i.e. peptide YY, pancreatic polypeptide (avian and human), nor by neurotensin. [125I]NPY receptors were revealed to be coupled to the guanosine triphosphate (GTP)-binding protein. Regional distribution study showed that [125I]NPY has a distinctive pattern of distribution in the rat lower brainstem, being particularly concentrated in the area postrema and the medial subnucleus of the nucleus tractus solitarii. These results suggest that such NPY receptors have an important role in cardiovascular regulation.

An investigation on sleep disturbance of autistic children

For the purpose of clarifying the pathophysiological meaning of sleep disturbance in autistic children, the sleep pattern of 75 such children was examined by a questionnaire method. Forty-nine of them showed sleep disturbance in their early life with an incidence of 65%. The poorly-developed group showed a high rate of sleep disturbance as compared with the relatively well-developed group. There was a negative correlation between the developmental level and duration period of sleep disturbance. The investigation of circumstances in which autistic children often exhibited sleep disturbance proved that abrupt changes in life environment or various problems in the way of bringing up children brought about their sleep disturbance. These findings suggest that sleep disturbance might be one of the main symptoms and related to the pathophysiology of infantile autism.

Computed tomography of the brain in children with early infantile autism

In order to examine the cranial CT of autistic children and investigate the etiological significance of CT scan findings, the CT of the brain was surveyed in 24 children with early infantile autism (3 to 17 years with a mean age of 7.6), and 179 children with the normal CT despite their medical histories such as headaches or febrile convulsions. According to their ages, the autistic and normal children were divided into the following three groups: Group I (age ranging from 3 to 5), Group II (age: 6 to 9) and Group III (age: 10 to 17). There was no significant difference between the bifrontal CVI of the autistic children and that of the normal children. However, in Group III, the bifrontal CVI of the autistic children was significantly higher than that of the normal children. There was no significant difference between the bicaudate CVI of the autistic children and that of the normal children. However, in Groups I and II, the bicaudate CVI of the autistic children was significantly lower than that of the normal children. The maximum widths of the third ventricle showed no significant difference between the autistic and normal children. However, in Groups II and III, those of the autistic children were wider than those of the normal children. In the autistic children, as the age increases, the difference becomes significantly wider. A positive correlation was observed between the width of the third ventricle and ages of the autistic children. An examination of the right-left ratio of maximum transverse diameter of the brain showed that there was no significant difference between the autistic and normal children. The above-mentioned results (1)-4)) might suggest a progressive disorder of the brain structure surrounding the third ventricle or lateral ventricles in the autistic children.

Early symptoms of autistic children and its diagnostic significance

In order to make a checklist for the early diagnosis of autism, the abnormalities of mental development before the age of two were examined retrospectively in autistic children. Additionally, the correlation between these early symptoms and the prognosis of autistic children were investigated. The subjects were 85 autistic children, 64 mentally retarded children and 150 normal children. The parents of these children were interviewed by child psychiatrists based on original questionnaires. The 27 early symptoms indicating disorders in personal relations, perception and sleeping as well as the setback course were found in autistic children. The onset ages of imitating others, pointing at objects and saying Yes were retarded in the poorly developed group as compared with the highly developed group.

The epidemiological study of autism in Fukushima-ken

A survey of children aged under 18 years in Fukushima-ken (prefecture) in Japan showed that 2.33 per 10,000 children suffered from early infantile autism. The average of prevalence rates of autistic children born between 1968 and 1974 was 4.96 per 10,000 children. Based on a comparison between cities and rural districts, the prevalence rates of the former were significantly higher than those of the latter. Autistic boys outnumbered autistic girls with a sex ratio of 9 : 1. Psychiatric illnesses were very rare among the relatives of autistic children. The rate of prenatal and perinatal complications was higher than the national norm among autistic children. Parents of autistic children had a significantly higher education than the national norm. There were more nuclear families in the autistic group than in the national norm.

Plasma cyclic AMP level in psychiatric diseases of childhood

Determinations were made of the plasma cyclic AM level to examine its relationship with hyperkinesis (Werry-Weiss-Peters Activity Scale, WWPAS) and other features of mental disorders in 80 children, of whom 21 had early infantile autism, 15 hyperkinetic mental retardation, 12 minimal brain dysfunction and 32 Down's syndrome. In autistic and hyperkinetic mentally retarded children, the plasma cyclic AMP levels were higher than in normal children and were positively correlated with the WWPAS score. In children with minimal brain dysfunction, the plasma cyclic AMP level was significantly lower than in normal children and was not correlated with the WWPAS score. In children with Down's syndrome, the plasma cyclic AMP level was somewhat higher than in normal children.

[Manometric studies on antireflux effect of fundic patch operation]

Antireflux effect of various operations for achalasia of the esophagus was investigated with the use of the manometric study. Operative procedures subjected to the present comparative study were proximal gastrectomy with end-to-end esophagosgastrostomy, Wendel procedure, Heller procedure and Fundic patch operation, each prepared in four mongrel dogs. Incidence of postoperative reflux with possible esophagitis was greatest in proximal gastrectomy followed by Wendel and Heller procedure. Fundic patch operation well prevented the reflux with greater values of pressure as well as dimension of the lower esophageal sphincter than those of the control series. In other series of experiments in dogs, an attempt was made to reveal the rationale of the effective valvular mechanism of the Fundic patch operation preparing various sizes of the valve. When compared by the manometric study, Fundic patch procedure with an incision of 6 cm in length, formation of the artificial mucosal valve and two thirds enclosure of the distal esophagus with the fundus like fundoplication sufficiently prevented the reflux. Preparation of the valve smaller in size accelerated the incidence of postoperative reflux.