Sero-survey of polio antibodies and quality of acute flaccid paralysis surveillance in Chongqing, China: A cross-sectional study

Serums were collected from people to assess whether polio immunity level was high enough to satisfy the polio vaccine immunization switch in Chongqing.People in 7 age groups (<1 year, 1-2 years, 3-4 years, 5-6 years, 7-14 years, 15-19 years, ≧20 years) were randomly selected in 3 areas by different geographical features in 2015. Peripheral venous blood samples were obtained and assays to detect poliovirus (PV) -neutralizing antibodies were performed. Acute flaccid paralysis (AFP) data was collected from 2012 to 2016 in Chongqing to evaluate the performance of AFP surveillance system by indicator analysis.A total of 636 people were tested for PV neutralization antibodies (NA). Overall NA seroprevalence for PV1, PV2 and PV3 were 93.40%, 96.38% and 91.82%, and geometric mean titers (GMTs) were 61.14, 66.78 and 21.47, respectively. GMTs and NA seroprevalence for PV1, PV2 and PV3 in older people were lower than young people. There were significant differences in seroprevalences of PV1 and PV3 among geographic areas (P < .05) in Chongqing.High seroprevalence for PV1, PV2, and PV3 and qualified capability for monitoring AFP cases showed that the polio eradication program has made positive achievements in Chongqing and established a stable base for a polio vaccine immunization switch. Nevertheless, GMTs were negatively associated with age in the geographic districts with poor economical features, which will increase the risk of emergence of vaccine-derived PV after polio vaccine switch. More than 1 dose of inactivated polio vaccine should be introduced into the polio vaccine schedule, and the supplementary immunization of polio should still be annually carried out after polio vaccine switch, especially among elder children and the adults.

Coronary artery bypass grafting is associated with immunoparalysis of monocytes and dendritic cells

Coronary artery bypass grafting (CABG) triggers a systemic inflammatory response that may contribute to adverse outcomes. Dendritic cells (DC) and monocytes are immunoregulatory cells potentially affected by CABG, contributing to an altered immune state. This study investigated changes in DC and monocyte responses in CABG patients at 5 time-points: admission, peri-operative, ICU, day 3 and day 5. Whole blood from 49 CABG patients was used in an ex vivo whole blood culture model to prospectively assess DC and monocyte responses. Lipopolysaccharide (LPS) was added in parallel to model responses to an infectious complication. Co-stimulatory and adhesion molecule expression and intracellular mediator production was measured by flow cytometry. CABG modulated monocyte and DC responses. In addition, DC and monocytes were immunoparalysed, evidenced by failure of co-stimulatory and adhesion molecules (eg HLA-DR), and intracellular mediators (eg IL-6) to respond to LPS stimulation. DC and monocyte modulation was associated with prolonged ICU length of stay and post-operative atrial fibrillation. DC and monocyte cytokine production did not recover by day 5 post-surgery. This study provides evidence that CABG modulates DC and monocyte responses. Using an ex vivo model to assess immune competency of CABG patients may help identify biomarkers to predict adverse outcomes.

Bioactive extracellular compounds produced by the dinoflagellate Alexandrium minutum are highly detrimental for oysters

Blooms of the dinoflagellate Alexandrium spp., known as producers of paralytic shellfish toxins (PSTs), are regularly detected on the French coastline. PSTs accumulate into harvested shellfish species, such as the Pacific oyster Crassostrea gigas, and can cause strong disorders to consumers at high doses. The impacts of Alexandrium minutum on C. gigas have often been attributed to its production of PSTs without testing separately the effects of the bioactive extracellular compounds (BECs) with allelopathic, hemolytic, cytotoxic or ichthyotoxic properties, which can also be produced by these algae. The BECs, still uncharacterized, are excreted within the environment thereby impacting not only phytoplankton, zooplankton but also marine invertebrates and fishes, without implicating any PST. The aim of this work was to compare the effects of three strains of A. minutum producing either only PSTs, only BECs, or both PSTs and BECs, on the oyster C. gigas. Behavioral and physiological responses of oysters exposed during 4 days were monitored and showed contrasted behavioral and physiological responses in oysters supposedly depending on produced bioactive substances. The non-PST extracellular-compound-producing strain primarily strongly modified valve-activity behavior of C. gigas and induced hemocyte mobilization within the gills, whereas the PST-producing strain caused inflammatory responses within the digestive gland and disrupted the daily biological rhythm of valve activity behavior. BECs may therefore have a significant harmful effect on the gills, which is one of the first organ in contact with the extracellular substances released in the water by A. minutum. Conversely, the PSTs impact the digestive gland, where they are released and mainly accumulated, after degradation of algal cells during digestion process of bivalves. This study provides a better understanding of the toxicity of A. minutum on oyster and highlights the significant role of BECs in this toxicity calling for further chemical characterization of these substances.

Lower Extremity Paralysis

Severe hypokalemia in the absence of other electrolyte abnormalities, the result of diarrhea, caused striking electrocardiographic changes, generalized weakness, flaccid paralysis of the lower extremities, and biochemical evidence of mild skeletal and cardiac rhabdomyolysis in a 33-year-old man. Repletion of potassium reversed all abnormalities in 24 hours.

[Diagnostic value of determination of the blood concentrations of serotonin and high-sensitivity C-reactive protein in patients with tick-borne encephalitis]

The paper shows the informative value of changes in the serum levels of serotonin and high-sensitivity C-reactive protein in 44 patients in the acute period of tickborne encephalitis. Group 1 included 35 patients with non-paralytic neuroinfection; Group 2 comprised 9 patients with paralytic neuroinfection. The serum level of high-sensitivity C-reactive protein increased and that of serotonin decreased in relation to the form and severity of the disease at its height. The elevated level of the former and the low concentration of the latter may serve as an early predictor of the development of a severe paralytic form. Investigating their serum concentrations should be included into an examination plan for patients with acute tick-borne encephalitis.

[Comparative study on effects between electroacupuncture and acupuncture for spastic paralysis after stroke]

OBJECTIVE

To observe the differences of therapeutic effect of spastic paralysis after stroke between electroacupuncture and acupuncture and explore the mechanism.

METHODS

Sixty-four cases were randomly divided into an electroacupuncture group (n = 33) and an acupuncture group (n = 31). Both groups were treated with Bobath facilitation techniques and medicine treatments. Quchi (LI 11), Hegu (LI 4), Yanglingquan (GB 34), Sanyinjiao (SP 6), et al. on the affected side were selected in each group. The needle was retained for 30 min, and the manipulation was applied for 1 min in the acupuncture group, and electroacupuncture was added in the electroacupuncture group. Stroke Impairment Assessment Set (SIAS) was adopted to assess the whole function status after sroke, and the contents of glutamate (Glu) and gamma-aminobutyric acid (GABA) in serum and clinical efficacy were observed in the two groups.

RESULTS

The SIAS score increased after treatment as compared with that before treatment in either group (both P < 0.01), and the electroacupuncture group was superior to the acupuncture group (P < 0.01); the content of Glu in blood serum and ratio of Glu/GABA reduced, while the content of GABA in serum increased after treatment as compared with those before treatment in either group (all P < 0.01), but the improvement of above indices were much more apparently in the electroacupuncture group as compared with those in the acupuncture group (P < 0.01, P < 0.05); the total effective rate of 90.9% (30/33) in the electroacupuncture group was superior to that of 83.9% (26/31) in the acupuncture group (P < 0.05).

CONCLUSION

Electroacupuncture can improve therapeutic effect of spastic paralysis after stroke, it's mechanism may be ralated to ajusting the contents of Glu and GABA in serum.

Levels of arsenic, cadmium, lead, manganese and zinc in biological samples of paralysed steel mill workers with related to controls

The determination of essential trace and toxic elements in the biological samples of human beings is an important clinical screening procedure. This study aimed to assess the possible effects of environmental exposure on paralysed male workers (n = 75) belonging to the production and quality control departments of a steel mill. In this investigation, the concentrations of arsenic, cadmium, lead, manganese and zinc were determined in biological samples (blood, urine and scalp hair samples) of exposed paralysis and non-paralysed steel mill workers. For comparative purposes, unexposed healthy subjects of same age group were selected as referents. The elements in the biological samples were measured by atomic absorption spectrophotometry prior to microwave-assisted acid digestion. The validity of the methodology was checked by the biological certified reference materials. The results indicate that the level understudy elements in all three biological samples were significantly higher in paralysed workers of both groups (quality control and production) as compared to referents (p < 0.01). The possible connection of these elements with the aetiology of disease is discussed. The results also show the need for immediate improvements of workplace ventilation and industrial hygiene practices.

[Cold pathology and experimental therapy of deep hypothermia]

A complete cold paralysis of respiration and thermoregulation occurs in rats at the temperature in the brain 16.6 +/- 0.3 and in the rectum 15.2 +/- 0.3 degrees C. Under the conditions of room temperature 18-19 degrees C, the respiration never restores, and the animals die. This is believed [6] to be the result of calcium ion Ca2+ accumulation in the cells of respiration and thermoregulation centers. After the arrest of respiration the animals were injected with the solution of disodium salt of ethylenediaminetetraacetic acid (Na2EDTA), which binds calcium ions in the blood and facilitates their removal from the cell (explanations in the text). In 7-9 min after the injection the calcium content in the blood decreased and the respiration began to restore at the temperature of the cold paralysis. Thermoregulation was also restored. All the test animals survived. All the control animals, which were not injected with Na2EDTA, died.

Effects of sex steroid hormones, thyroid hormone levels, and insulin regulation on thyrotoxic periodic paralysis in Chinese men

Our study is to determine the expression of thyroid hormone, sex hormone, insulin, and C-peptide in Chinese male patients with thyrotoxic periodic paralysis (TPP). This study covered 102 patients with hyperthyroidism from Xijing Hospital. According to whether occurrence of TPP or not, patients were divided into two groups (those that were hyperthyroid with and without TPP) that were, matched with age, blood pressure, urea, and creatinine. We found the body mass index (BMI) in patients with TPP was higher than that in pure hyperthyroidism patients. The levels of the total thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4) were significantly lower in patients with TPP compared with pure hyperthyroidism patients, while serum testosterone levels were higher compared with pure hyperthyroidism patients. Moreover, after glucose administration, the concentration of insulin at 60, 120, and 180 min were significantly higher in patients with TPP than those in pure hyperthyroidism patients. The insulin area under the curve (AUC) was significantly increased in patients with TPP compared with pure hyperthyroidism patients. The levels of thyroid hormone, sex hormone, and insulin were different in Chinese male patients with TPP compared to those with only hyperthyroidism.

Paralysis and pernicious anemia in a young woman

Vitamin B12 is important for normal nervous system functioning, and deficiencies are associated with various neurological abnormalities. We present a case of an 18-year-old woman who presented with significant neurological sequelae, but only mild hematologic abnormalities and normal vitamin B12 levels. She was found to have a moderately increased mean corpuscular volume, a markedly elevated homocysteine level, and a greatly increased methylmalonic acid level. In symptomatic patients it is important for physicians to maintain a high index of suspicion for B12 deficiency despite normal serum levels. The measurement of MMA and homocysteine levels provides much more sensitive tests, but even these tests do not completely rule out a deficiency. Although, the traditional treatment for vitamin B12 deficiency has been intramuscular cobalamin injections, recent studies have shown that oral cobalamin may be as efficacious.

Hypokalemic paralysis due to primary hyperaldosteronism simulating Gitelman's syndrome

Some diseases, such as Gitelman's syndrome, Bartter's syndrome, and primary hyperaldosteronism (Conn's syndrome), may bear some similar clinical and laboratory findings. Their treatment modalities being different from one another, the need for a scrupulous diagnostic evaluation arises as far as clinical practice is concerned. In this report, we present a patient with Conn's syndrome who was initially considered to have Gitelman's syndrome due to displaying a few overlapping features of both diseases. We also give an account of the hardships encountered during the diagnostic evaluation.

The effects of surgical levels of sevoflurane and propofol anaesthesia on heart rate variability

BACKGROUND AND OBJECTIVE

The laryngeal mask has become a widely accepted alternative to endotracheal intubation and mask ventilation. The laryngeal tube is a relatively new supraglottic airway device for airway management. We compared the new version of the laryngeal tube with the laryngeal mask.

METHODS

In a randomized design, either a laryngeal tube (n = 66) or a laryngeal mask (n = 66) were inserted. Ease of insertion, oxygenation and ventilation, spirometry data and postoperative airway morbidity were determined.

RESULTS

After successful insertion, it was possible to maintain oxygenation and ventilation in all the patients. Insertion success rates after the first, second and third attempts were 84.8% (n = 56), 12.1% (n = 8) and 3% (n = 2) for the laryngeal tube compared with 56.1% (n = 37), 25.8% (n = 17) and 18.2% (n = 12) for the laryngeal mask (P = 0.001). There was no significant difference in peak airway pressure, and dynamic compliance between the groups (P > 0.05). Blood on the cuff after removal of the device was noted in one patient with the laryngeal tube and in 10 patients with the laryngeal mask. Six patients in the laryngeal mask group complained of hoarseness (P = 0.012).

CONCLUSION

With respect to clinical function, the new version of the laryngeal tube and the laryngeal mask are similar and either device can be used to establish a safe and effective airway in paralysed patients.

Celiac crisis with hypokalemic paralysis in a young lady

Celiac crisis presents as severe acute diarrhea with life-threatening metabolic derangement in a patient with celiac disease. We report a 30-year-old lady who was admitted with one-month history of worsening small bowel-type diarrhea. She developed acute quadriparesis due to refractory hypokalemia. Celiac disease was diagnosed on the basis of positive serology and histological features. She improved with aggressive correction of hypokalemia and gluten-free diet. Celiac crisis is a rare presentation of this heterogeneous disease in adulthood.

Primary Sjögren's syndrome associated with Gitelman's syndrome presenting with muscular paralysis

A 38-year-old woman presented with muscle cramping of 4 extremities and paralysis for months. Laboratory results showed an elevated antinuclear antibody titer; antibodies to the ribonucleoprotein antigen Ro; hypokalemia; hypomagnesemia with hyperreninemia, but abnormally high urine potassium and magnesium levels and low urine calcium levels; and a blunted diuretic effect to thiazide, but not furosemide, which met the criteria for Gitelman's syndrome (GS) and led to the diagnosis of primary Sjögren's syndrome (pSS). She received medical treatment, including a potassium supplement and aldosterone antagonist. GS as a presentation of pSS has never been reported in the literature. The features of renal diseases related to SS are reviewed. SS is the underlying cause of GS, which may precede the onset of the well-known sicca complex.

Thyrotoxic periodic paralysis in Mexican mestizo patients: a clinical, biochemical and HLA-serological study

BACKGROUND

Thyrotoxic periodic paralysis (TPP) is characterized by episodes of neuromuscular weakness occurring in the context of hypokalemia and hyperthyroidism and has been predominantly described in Oriental populations. Whereas it is uncommon in Caucasians and Blacks, TPP does occur in individuals of Native American descent. The objective was to analyze the clinical, biochemical, and HLA characteristics of a group of Mexican mestizo patients with TPP.

METHODS

The sample was comprised of 14 men with TPP diagnosed since January 1990, based on one or more episodes of flaccid paralysis, accompanied by hypokalemia and occurring in the context of clinical and biochemical hyperthyroidism. Eight were available for HLA testing.

RESULTS

Hyperthyroidism was diagnosed before the development of periodic paralysis in five of the patients, whereas in six it occurred afterward. The severity of paralysis did not correlate with the degree of either hypokalemia or hyperthyroidism. An increased frequency of HLA-DR3 was found in Graves' patients without paralysis but not in those with paralysis, as compared to the general population.

CONCLUSIONS

TPP is more common than previously thought in Mexicans, in whom it behaves as in other Native American groups. The lack of HLA-DR3 association in Graves' patients with TPP is interesting, but at the moment has no pathophysiological implications.

Clinical diagnosis in Karwinskia humboldtiana polyneuropathy

Intoxication by Karwinskia humboldtiana presents a neurological picture similar to that for Guillain-Barré syndrome or other polyradiculoneuropathies. Clinical diagnosis in poisoned humans may be difficult if no evidence of previous fruit ingestion is available. We present our experience in the clinical diagnosis of Karwinskia humboldtiana polyneuropathy, as confirmed by toxin detection in blood. We designed an open trial at the Pediatric Neurology service and included all cases with acute ascending paralysis that were admitted to our hospital in the last two years. In all cases, we performed hematological, immunological and biochemical profiles, CSF analysis including immunological studies, oligoclonal bands and myelin basic protein determinations. Electrodiagnostic studies were performed, including motor conduction velocities, distal latencies, F-wave latency and compound muscle action potential (CAMP) amplitude. The presence of Karwinskia humboldtiana toxins in blood were determined by thin layer chromatography. In six cases, T-514 Karwinskia humboldtiana toxin was detected. These cases had a symmetric motor polyneuropathy with the absence of tendon reflexes and no sensory signs or cranial nerve involvement. Only one patient required assisted ventilation due to bulbar paralysis. In two of these cases, a sural nerve biopsy revealed a segmental demyelination with swelling and phagocytic chambers in Schwann cells and without lymphocytic infiltration. All six cases survived, with complete recovery in five. We conclude that this intoxication is common in Mexico. The availability of toxin detection in blood samples allows the clinician to establish an accurate diagnosis and should be included in the study of children with polyradiculoneuropathy, especially in countries where this poisonous plant grows.

Effect of prone and supine positions on functional residual capacity, oxygenation, and respiratory mechanics in ventilated infants and children

Although numerous reports have described the improvement in PAO2 in patients in the prone position, the underlying mechanism has yet to be determined. Some authors have suggested this phenomenon may be related to an increase in functional residual capacity (FRC); however, no previous studies have described positional changes in FRC in children with severe lung disease or in those under neuromuscular blockade. We measured arterial blood gases, FRC, Rrs, and Crs in supine and prone positions in 30 patients under neuromuscular blockade with lung disorders including moderately severe restrictive (n = 10) and obstructive (n = 10) disease and control subjects without significant lung disease (n = 10). Prone positioning was not associated with a significant increase in FRC in the cohort of 30 patients, nor in any of the subgroups. Although individual patients demonstrated large improvements in oxygenation, a statistically significant (but clinically insignificant) increase in AaPO2 ratio was observed only in the subgroup of patients with obstructive disease (0.35+/-0.03 to 0.38+/-0.04, p = 0.027). There was no correlation between changes in FRC and changes in AaPO2 (r = 0.225, p = 0.23). A significant improvement in Rrs occurred in the prone position compared to supine in patients with obstructive lung disease, decreasing from 0.264+/-0.024 to 0.216+/-0.021 cm H2O/ml/s, p = 0.009. No significant changes in Crs were seen in the prone position. We conclude that prone positioning has no effect on FRC and in this series of 30 patients significantly improved oxygenation only in patients with obstructive airway disease. A significant decrease in Rrs in patients with obstructive lung disease was also observed.

Paralytic myopathy--a leading clinical presentation for primary aldosteronism in Taiwan

Between 1982 and 1995, 43 cases of primary aldosteronism, 36 cases of adenoma, and 7 cases of hyperplasia were treated in Chang Gung Medical Center. Twenty-one of these (49%) presented with muscular paralysis as an initial symptom (categorized as the paralytic group). Seven patients in the paralytic group (33%) had extralimb muscle involvement. Six of them presented with bulbar palsy and one patient had a peripheral-type facial palsy. The serum potassium levels in the paralytic group were significantly lower than those of the nonparalytic group (1.8 +/- 0.3 vs. 2.3 +/- 0.4 mmol/L, P = 0.0001). There were no significant differences in blood pressure or the serum aldosterone level between the two groups. Provocative factors such as a high carbohydrate diet, vigorous exercise, or seasonal variation did not appear to play a significant role in inducing the symptoms. Paralytic myopathy appears to be more common in Oriental people. The symptom is rarely reported among western populations. Primary aldosteronism should be considered in patients presenting with neuromuscular weakness associated with hypokalemia, regardless of the degree of hypertension.

Normal insulin release during sustained hyperglycaemia in hypokalaemic periodic paralysis: role of the potassium channel opener pinacidil in impaired muscle strength

1. Hypokalaemic periodic paralysis is characterized by attacks of muscle weakness. Glucose, insulin and an abnormal regulation of ATP-sensitive potassium channels may be involved in these attacks. We studied the effect of hyperglycaemia and of the potassium channel opener pinacidil on insulin release and muscle strength in patients with hypokalaemic periodic paralysis. 2. Insulin release was assessed on two occasions in four patients with hypokalaemic periodic paralysis and in eight matched control subjects, with and without treatment with 25 mg pinacidil orally, during a hyperglycaemic glucose clamp at a blood glucose level of 10 mmol/l, in a placebo-controlled, double-blind study. Muscle strength was measured in the hypokalaemic periodic paralysis patients before and during hyperglycaemia using a handheld dynamometer. 3. During the clamp, the mean glucose concentration (10-180 min) in control subjects was 9.9 +/- 0.07 and 10.0 +/- 0.03 mmol/l with and without pinacidil respectively, and in patients with hypokalaemic periodic paralysis was 10.0 +/- 0.04 and 10.1 +/- 0.06 mmol/l respectively (not significantly different). In both groups, the areas under the insulin curve from 0 to 10 min (first-phase insulin release) and from 30 to 180 min (second phase) were not different on the pinacidil study day compared with on the placebo day. The areas under the insulin curve of the first and second phases also did not differ between control subjects and patients with hypokalaemic periodic paralysis (with or without pinacidil). The M/I ratio, a measure of insulin sensitivity, was not different in the two groups. On the placebo day, baseline muscle strength in patients with hypokalaemic periodic paralysis was 165 +/- 16 N for the hip abductors and 168 +/- 19 N for the knee flexors. During the period of hyperglycaemia on the placebo day, muscle strength did not decrease in either muscle group. On the pinacidil study day, an increase in muscle strength was found only in the two hypokalaemic periodic paralysis patients with the lowest mean muscle strength (< 150 N) on the placebo day. The two hypokalaemic periodic paralysis patients with a mean muscle strength on the placebo day > 150 N showed no increase in muscle strength with pinacidil. 4. Insulin secretion and sensitivity were normal in patients with hypokalaemic periodic paralysis. Hyperglycaemia during hyperglycaemic clamping did not provoke paralytic attacks and did not result in a decrease in muscle strength. The potassium channel opener pinacidil had no effect on insulin secretion in hypokalaemic periodic paralysis patients or in normal subjects. Pinacidil may enhance muscle strength in those hypokalaemic periodic paralysis patients who suffer partial paralytic attacks.

[Familial poisoning with Karwinskia humboldtiana]

The ingestion of ripe fruit of the Karwinskia humboldtiana, a shrub commonly known as tullidora or coyotillo, produces an intoxication described in the literature as a symmetric flaccid paralysis of the hind limbs, progressive and ascendent, that in severe cases may cause bulbar paralysis and death. The cause of an acute accidental intoxication of an entire family is presented here, wherein ten out of thirteen members ingested the ripe fruit of the tullidora. Three died, the father and two daughters. For the first time the toxins determination in blood by thin layer chromatography method is described. This method supports the diagnosis with other polyradiculoneuritis such as poliomyelitis and the Guillain Barre's syndrome.

Hyperinsulinaemia and Na+, K(+)-ATPase activity in thyrotoxic periodic paralysis

OBJECTIVE

Thyrotoxic periodic paralysis (TPP) usually follows a heavy carbohydrate meal and this may be explained by hyperinsulinaemia stimulating Na+, K(+)-ATPase activity. To clarify this the effect of glucose load on serum insulin concentration and platelet Na+, K(+)-ATPase activity in thyrotoxic periodic paralysis (TPP) was examined.

DESIGN

In all subjects a standard 75-g glucose tolerance test was done and blood samples were taken at 0, 1 and 2 hours.

SUBJECTS

Twenty-five healthy controls (8 M and 17 F), 17 uncomplicated thyrotoxic patients (7 M and 10 F), 15 TPP patients who presented with paralysis and 4 TPP patients after treatment with antithyroid drugs.

MEASUREMENTS

Plasma glucose was measured by the glucose oxidase method, serum insulin by radioimmunoassay and platelet Na+, K(+)-ATPase by the release of phosphate from ATP.

RESULTS

TPP patients showed glucose intolerance (area under the curve (AUC) 16.5 +/- 4.4 (mean +/- SD) in TPP compared to 12.9 +/- 4.5 in controls (P < 0.01)) and hyperinsulinaemia (AUC 189.6 +/- 100.6 vs 98.5 +/- 53.4, P < 0.001). In uncomplicated thyrotoxicosis the results were similar to that in healthy controls. Platelet Na+, K(+)-ATPase were significantly higher in thyrotoxic patients compared to controls and in TPP patients were even higher. Ingestion of glucose increased platelet Na+, K(+)-ATPase in all groups. AUC for platelet Na+, K(+)-ATPase in TPP patients were significantly higher than in uncomplicated thyrotoxicosis (601 +/- 99.3 vs 482 +/- 109.4, P < 0.01) or healthy controls (320 +/- 107.3). In the 4 TPP patients studied after antithyroid treatment the results were similar to healthy controls.

CONCLUSION

Patients with thyrotoxic periodic paralysis have hyperinsulinaemia and this is accompanied by higher Na+, K(+)-ATPase activity.

A 23Na-NMR study on cation transport systems in a patient with hypokalemic periodic paralysis

Erythrocytes from a patient with hypokalemic periodic paralysis (HPP) have been studied, in order to investigate the presence of alterations of membrane cation active transport systems. An original 23Na-NMR method has been used, capable of evaluating quantitatively the Na+ efflux due to the Na+/K+/Cl- cotransport. This method uses a loading system to increase internal cellular Na+ concentration: in the patient with HPP both the internal Na+ concentration after loading and the Na+/K+/Cl- cotransport activity were decreased in comparison to the controls. Our data seem to confirm that the fall of K+ serum levels during attacks in HPP must be ascribed to a shift of K+ from extra- to intracellular compartment (with consequent changes in the fibrocellular membrane polarity), due to an alteration of membrane cation transport system: which does not only consist in a hyperactivity of Na+/K+ ATPase (already described by other AA.), but also in a "secondary" decreased K+ efflux driven by the cotransport. The decrease of cotransport activity may be considered as "compensatory" (in fact, the intracellular Na+ content is normal), since this transport system can work as a kind of "emergency" system that can "help" the ATPase-dependent pump in extruding any excess of cell Na+ content, or can be depressed by any decrease of this value, caused by an hyperactivity of the Na+/K+ ATPase. The decreased cotransport activity results in a powerful contribution to the increase of intracellular potassium due to the hyperactivity of the Na+/K+ pump. This method could supply a useful diagnostic marker in all uncertain cases.

Effect of adrenalectomy on the latency of radiation myelopathy in rats

The effect of adrenalectomy on the development of radiation myelopathy was studied. A 1-cm section of cervical cord of adrenalectomized and intact animals was exposed to graded doses (18 to 30 Gy) of gamma rays. The radiation tolerance, the latent period from exposure to paralysis, plasma corticosterone levels at the time of paralysis, and histopathology of the cord were evaluated. Adrenalectomy essentially eliminated endogenous production of corticosterone and significantly shortened the mean latent period between irradiation (24 to 30 Gy) and paralysis by more than 10 weeks. This reduced latent period was not reversed by the administration of the exogenous glucocorticoid, dexamethasone, and corticosterone, although prolonged administration of dexamethasone resulted in the development of Cushingoid features, indicating hypercorticoidism. Histopathological examinations indicated that adrenalectomized paretic animals had multiple hemorrhages in both the gray and the white matter, but less white matter necrosis than normally observed in intact paretic animals irradiated similarly. Possible mechanisms for the shortened latent period in adrenalectomized animals are discussed.

Use of corticotropin-induced potassium changes in the diagnosis of both hypo- and hyperkalemic periodic paralysis

Both hypo- and hyperkalemic periodic paralysis may be difficult to diagnose conclusively when patients are not seen during attacks. Since paralysis of both types can be induced with ACTH, we have determined the frequency of this response in small groups of patients. Weakness or paralysis with appropriate changes in serum K concentration resulted from ACTH gel administration, in 4 of 5 patients with known hypokalemic periodic paralysis and in 3 of 3 patients with hyperkalemic paralysis. No adverse effects of the test were observed, but hospitalization and careful monitoring were necessary. The response to ACTH appears to be a sensitive, useful aid to the diagnosis of both hypo- and hyperkalemic periodic paralysis.

Diagnosis of familial hypokalemic periodic paralysis: role of the potassium exercise test

Familial hypokalemic periodic paralysis (FHOPP) is a rare, dominantly inherited disease, the diagnosis of which may require the induction of paralysis. We studied whether the increase in plasma potassium concentration during exercise can be used in the diagnosis of FHOPP. Potassium concentration increased 0.3 +/- 0.1 mEq/l in patients with FHOPP and 0.6 +/- 0.1 mEq/l in healthy controls (p < 0.001) during a 10-minute bicycle exercise test, and 0.3 +/- 0.1 mEq/l in patients with FHOPP and 0.8 +/- 0.2 mEq/l in healthy controls (p < 0.001) during a 30-minute bicycle exercise test. We conclude that the potassium exercise test may be useful in the diagnosis of FHOPP.

Effect of erythromycin on gastric motility in controls and in diabetic gastroparesis

The effect of three doses of erythromycin on interdigestive gastrointestinal motility and on plasma motilin levels was studied in healthy volunteers and patients with diabetic gastroparesis. Abnormalities of interdigestive motility were observed in 40% of the patients. In healthy volunteers, 40 mg erythromycin elicited a premature phase 3 that started in the stomach. In contrast to the spontaneous gastric phase 3, this erythromycin-induced phase 3 was not accompanied by a motilin peak. In patients with diabetic gastroparesis, 40 mg erythromycin induced a premature phase 3 in three patients, no response in one patient, and a burst of antral contractions in another patient. Doses of 200 and 350 mg erythromycin elicited a burst of antral phase-3-like contractions in both volunteers and patients, which was not accompanied by a motilin peak. This phase-3-like activity did not migrate to the small intestine and was not followed by a phase 1, but by a prolonged period of antral contractile activity. The number and amplitude of antral contractions after 200 or 350 mg erythromycin were significantly higher than after 40 mg. The motor patterns induced by different doses of erythromycin offer potential therapeutic applications.

In vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis

OBJECTIVE

To examine whether sodium pump activity plays a part in the pathogenesis of thyrotoxic periodic paralysis.

DESIGN

Measurement of platelet sodium-potassium ATPase and in vivo sodium pump activities in healthy subjects and thyrotoxic subjects with and without paralysis.

SETTING

University hospital in Hong Kong.

SUBJECTS

21 healthy subjects, 23 untreated thyrotoxic subjects, 13 untreated men with periodic paralysis, seven treated thyrotoxic subjects, and six treated men with periodic paralysis.

MAIN OUTCOME MEASURES

Platelet Na+, K(+)-ATPase activity and plasma rubidium concentration after oral loading.

RESULTS

Median (range) platelet Na+, K(+)-ATPase activity in thyrotoxic subjects was 253 (169-821) mumol inorganic phosphate/h/g protein--significantly higher than that in healthy subjects (134 (81-180) mumol/h/g protein; p less than 0.001). Na+, K(+)-ATPase activity in those with periodic paralysis was 374 (195-1196) mumol/h/g protein, again significantly higher than that in healthy subjects (p less than 0.001) and that in other thyrotoxic subjects (p less than 0.01) despite similar degrees of hyperthyroidism. Activities in treated thyrotoxic subjects with and without periodic paralysis were 148 (110-234) and 131 (86-173) mumol/h/g protein respectively. Mean (95% confidence interval) plasma rubidium concentration five hours after oral administration in thyrotoxic subjects (7.0 (6.6 to 7.5) mumol/l) was significantly lower than in healthy subjects (10.2 (9.5 to 10.9) mumol/l; p less than 0.001) and higher than in those with periodic paralysis (6.0 (5.7 to 6.3) mumol/l; p less than 0.01).

CONCLUSIONS

Sodium pump activity in untreated subjects with periodic paralysis is higher than in other thyrotoxic subjects, and this may be responsible for the hypokalaemia.

Alteration from T- to B-cell tropism reduces thymic atrophy and cytocidal effects in thymocytes but not neurovirulence induced by ts1, a mutant of Moloney murine leukemia virus TB

The ts1 mutant of Moloney murine leukemia virus TB causes degenerative neurologic and immunologic disease in mice, characterized by development of spongiform encephalomyelopathy resulting in hindlimb paralysis, marked thymic atrophy associated with immunodeficiency, and generalized body wasting. To investigate the pathogenesis of the thymic atrophy caused by ts1, we constructed a chimeric virus, ts1-Cas(NS), in which a major portion of the U3 region of the long terminal repeat of ts1, a T-lymphotropic and neurovirulent murine leukemia virus, was replaced by the corresponding U3 region of Cas-Br-E, a B-lymphotropic and neurovirulent murine leukemia virus. In FVB/N mice, ts1-Cas(NS) induced paralytic and wasting disease with incidence, severity, and latency similar to that induced by ts1, but it failed to cause thymic atrophy as severe as that observed in ts1-infected mice. Furthermore, thymocytes cultured from ts1-Cas(NS)-infected mice died at a much slower rate than those of ts1-infected mice. The U3 substitution in ts1-Cas(NS) specifically diminished the ability of the virus to replicate in the thymus, whereas viral replication in the spinal cord was not significantly affected; thus, neurovirulence was not changed. The correlation of reduced thymic atrophy with decreased thymic viral titers and the decreased ability of ts1-Cas(NS) to cause thymocyte death in mice suggest strongly that the marked thymic atrophy in ts1-infected mice is not an indirect effect occurring secondary to neurodegenerative and wasting disease but is a direct cytopathic effect of high-level viral replication in the thymus.

Hyperinsulinaemia in thyrotoxic hypokalaemic periodic paralysis

To test the hypothesis that there is an abnormal serum insulin response to a carbohydrate load in thyrotoxic hypokalaemic periodic paralysis (THPP), 18 men with THPP and 15 with uncomplicated thyrotoxicosis were studied during an oral glucose tolerance test. The THPP group had significantly higher fasting insulin concentrations (27.6 [3.6] vs 13.4 [1.8] mU/l; p less than 0.005) and a higher overall insulin response to oral glucose (p less than 0.001 by ANOVA) than the thyrotoxicosis group. There were no significant differences in fasting or stimulated glucose. Hyperinsulinaemia may be an important factor in the precipitation of acute paralysis in THPP.

Increase in serum myoglobin, creatine kinase, and free fatty acids, during recovery from a paralytic attack in hypokalemic periodic paralysis

In a patient with hypokalemic periodic paralysis (HPP), recovery from a paralytic attack, coinciding with the restoration of plasma potassium, was associated with a rise in serum myoglobin (Mb) and creatine kinase (CK). The increase of muscle proteins in serum was preceded by an increase in serum free fatty acids (FFA). An increased permeability of the sarcolemma, caused by an accumulation of FFA within the muscle cell, might underly the reflux of potassium into the circulation. This might represent a mechanism by which the paralytic attacks in HPP terminate.

[Evaluation of cardiac function during KCl-induced paralytic attack in the patients with normokalemic periodic paralysis]

Some reports have been written about hypokalemic periodic paralysis dealing with cardiac dysfunction and arrhythmia during the paralytic attack. However, no reports have been written about the cardiac function during the attack in cases of normokalemic periodic paralysis. So, we investigated cardiac function in two patients with normokalemic periodic paralysis. A 3.0 g dose of KCl was administered orally to the patients (1 male, 1 female) and 10 healthy volunteers (5 males, 5 females). Cardiac function by using ejection time (ET)/pre-ejection period (PEP), grasping power, and the level of plasma catecholamine were measured during the paralytic attack. Changes in the patients were compared with those in the volunteers. Next, a 3.0 g dose of KCl was administered to the patient, followed by intravenous dosing of 10% NaCl (50 ml) after which ET/PEP and grasping power measured. Lastly, a 60 mg dose of diltiazem, a 10 mg dose of nifedipine or a 80 mg dose of verapamil were administered, followed by a 3.0 g dose of KCl after which ET/PEP and grasping power were measured again. Thirty minutes after the administration of KCl, the grasping power decreased remarkably, from 32.0 kg to 17.0 kg in the male patient and from 30.0 kg to 20.0 kg in the female patient. By contrast, the ET/PEP showed a clear increase, from 3.47 to 6.17 in the male patient and from 2.84 to 5.45 in the female patient. Grasping power of the volunteers, however, did not change remarkably (avg. 40.3 kg before vs. 40.9 kg after in the males and avg. 26.9 kg before vs. 26.0 kg after in the females) and ET/PEP of the volunteers did not change remarkably (avg. 3.37 before vs. 3.17 after in the males and avg. 3.30 before vs. 3.43 after in the females). No significant changes were found in the levels of plasma catecholamine during the paralytic attack.(ABSTRACT TRUNCATED AT 250 WORDS)

Normokalaemic periodic paralysis as the presenting manifestation of hyperthyroidism

We report a 50 year old male admitted with complaints of episodic weakness. During the attack of paralysis there was no hypokalaemia. There were no clinical signs of thyrotoxicosis, but since thyroid function tests revealed hyperthyroidism, he was treated as a case of thyrotoxic periodic paralysis, with no recurrence of symptoms over 6 months.

Hyperkalemic periodic paralysis in Gordon's syndrome: a possible defect in atrial natriuretic peptide function

We present the case of a 14-year-old boy who had secondary hyperkalemic periodic paralysis caused by Gordon's syndrome. This syndrome consists of hypertension, tubular acidosis, and hyperkalemia with normal glomerular filtration rate. The pathophysiological mechanism is still unknown. Pathophysiological studies suggest that in this disorder the kidney lacks sensitivity to atrial natriuretic peptide. After treatment with hydrochlorothiazide, serum potassium and plasma aldosterone values, plasma renin activity, and blood pressure became normal and the attacks of periodic paralysis disappeared.

Potassium uptake in muscle during paramyotonic weakness

Previous studies have suggested that an abnormal release of potassium from muscle may accompany attacks of paramyotonic weakness. We investigated 3 patients with paramyotonia congenita before and after the induction of forearm muscle weakness by exercise in cold water. Two of these patients had paralysis periodica paramyotonica and the 3rd had paramyotonia congenita. At the time of paramyotonic weakness there was a marked increase in the arterialized-venous concentration difference of potassium across forearm muscle. This indicated a significant uptake of potassium by forearm muscle in all 3 patients. Normal controls showed a slight release of potassium both at rest and after exercise in cold water. These results suggest that (1) the sodium-potassium pump of the muscle fiber is operating efficiently during paramyotonic weakness; and (2) there is a different mechanism responsible for the generalized weakness that occurs in hyperkalemic periodic paralysis.

Simulating the time-course of clinical paralysis

This computer program depicts the concentration-time curves for the nondepolarizing neuromuscular blocking agents. It simulates their administration by single and multiple iv injections, and with continuous infusion, alone and in combination. It provides the plasma concentrations related to 75% and 25% depression of the twitch response, using these to calculate clinically useful pharmacodynamic values, such as the duration of surgical relaxation, and the recovery index. These simulations allow the user to contrast the time-course of relaxation to be expected with various dosage regimens.

Significance of low concentrations of creatinine in serum from hospital patients

We present an analysis of the clinical significance of creatinine concentrations less than or equal to 4 mg/L (35 mumol/L) in serum as measured by a specific enzymatic method. In an unselected hospital patient population, 4% of whom had serum creatinine concentrations this low, a value of 5 mg/L (44 mumol/L) or higher was obtained on repeat analysis for a third of these patients, but the remaining two-thirds had persistently low values. Associated clinical conditions included low body mass, pregnancy, insulin-dependent diabetes mellitus, and total immobilization, but 12% of the patients, all female, had no obvious cause for the persistently low creatinine concentration. We conclude that low concentrations of creatinine in serum have no profound clinical significance.

Isolation of an HTLV-1-like retrovirus from patients with tropical spastic paraparesis

Tropical spastic paraparesis (TSP) is a slowly progressive myelopathy associated with increased serum and cerebrospinal fluid antibodies to the human T-lymphotropic retrovirus type I (HTLV-I) (ref. 1), and has been observed in many regions of the world. A similar condition known as HTLV-I-associated myelopathy occurs in the Kagoshima prefecture of Japan. Recent but controversial reports suggest involvement of virus related to HTLV-I in multiple sclerosis. Magnetic resonance imaging and electrophysiological studies indicate that TSP lesions are like multiple sclerosis in that they are disseminated throughout the nervous system. Complete virus from patients with TSP has proved difficult to isolate using techniques successful in adult T-cell leukaemia cases associated with HTLV-I. Here we report the isolation of an HTLV-I-like virus from T-cell lines derived from the peripheral blood and cerebrospinal fluid of TSP patients. The monoclonal antibody OKT3 was used to generate non-transformed T-cell lines that express HTLV-I antigens. Infectious virus was demonstrated by co-cultivation and complete, replicating virions were visualized ultrastructurally.

A new syndrome: angiotensin-converting enzyme dysfunction syndrome: differential diagnosis and pathogenesis--case reports

The authors previously reported a new syndrome, angiotensin-converting enzyme dysfunction syndrome (ACEDS), which is clinically characterized by mild systemic hypertension, a hypokalemic alkalosis, and hyperreninism with a high concentration of angiotensin-I (ANG-I), a normal angiotensin-II (ANG-II) value, and a normal aldosterone level. In the present study, they investigated the diagnosis and differentiation of diseases concomitant with hyperreninism, such as ACEDS, Bartter's syndrome, familial periodic paralysis, and renovascular hypertension treated with captopril for two months, and discussed the pathogenesis of ACEDS.

Hormonal changes during a spontaneous attack of hypokalemic periodic paralysis

We studied the hormonal changes during a spontaneous attack of hypokalemic periodic paralysis in a 20-year-old man, before and after treatment with potassium chloride. During paralysis, we observed high circulating levels of insulin, epinephrine, norepinephrine, growth hormone, ACTH and cortisol, most likely reflecting a condition of stress. Normalization of all these hormones occurred with recovery. Plasma aldosterone concentrations were normal. The increased plasma levels of insulin, but also of catecholamines and growth hormone, created a condition promoting potassium uptake in muscle cells. We suggest that stress may play a role in the pathophysiology of the paralytic attacks in this disorder.

Adynamia episodica and paralysis periodica paramyotonica

We studied hyperkalemic attacks in one family with adynamia episodica (AE) and one family with paralysis periodica paramyotonica (PPP). Under exercise, serum potassium increased as in healthy subjects. Thiazide did not affect this increase. Thirty minutes after exercise, a second potassium increase occurred, but could be prevented by thiazide and not by mexiletine. After cooling, muscle relaxation time was normal in AE but increased up to 100 times in PPP; this cooling effect was prevented by mexiletine. Although hyperkalemic attacks are similar in AE and in PPP, the membrane defect in PPP seems more complex.