Male-Dominant Effects of Chd8 Haploinsufficiency on Synaptic Phenotypes during Development in Mouse Prefrontal Cortex

CHD8 is a high penetrance, high confidence risk gene for autism spectrum disorder (ASD), a neurodevelopmental disorder that is substantially more prevalent among males than among females. Recent studies have demonstrated variable sex differences in the behaviors and synaptic phenotypes of mice carrying different heterozygous ASD-associated mutations in Chd8. We examined functional and structural cellular phenotypes linked to synaptic transmission in deep layer pyramidal neurons of the prefrontal cortex in male and female mice carrying a heterozygous, loss-of-function Chd8 mutation in the C57BL/6J strain across development from postnatal day 2 to adulthood. Notably, excitatory neurotransmission was decreased only in Chd8+/- males with no differences in Chd8+/- females, and the majority of alterations in inhibitory transmission were found in males. Similarly, analysis of cellular morphology showed male-specific effects of reduced Chd8 expression. Both functional and structural phenotypes were most prominent at postnatal days 14-20, a stage approximately corresponding to childhood. Our findings suggest that the effects of Chd8 mutation are predominantly seen in males and are maximal during childhood.

Phylogeny and morphology of new species of Globisporangium

An isolate originally obtained from pond water in Osaka in 1992 and identified as Pythium marsipium, was subsequently classified as Globisporangium marsipium. According to molecular phylogenetic analyses based on the internal transcribed spacer regions of the nuclear ribosomal RNA and mitochondrial cytochrome c oxidase subunit 1 genes, this isolate was shown to represent a new species, described here as G. lacustre sp. nov. In addition, two further new combinations are introduced in Globisporangium as G. camurandrum and G. takayamanum based on their DNA phylogeny.

P2514Pupillary area predicts all-cause mortality in patients with cardiovascular disease

Background

Autonomic dysfunction is among the most important pathophysiological factors involved in the high mortality rate associated with cardiovascular disease (CVD). Autonomic function is generally evaluated by heart rate variability, which is obtained by Holter electrocardiography. However, the measurement of heart rate variability requires continuous electrocardiographic monitoring for 24 h, which is time consuming and not always feasible. The pupillary area is controlled by the autonomic nervous system; however, limited data are available regarding the utility of the pupillary area for predicting prognosis in patients with CVD.

Purpose

We aimed to investigate whether pupillary area can be used as a novel prognostic marker in patients with CVD.

Methods

We retrospectively reviewed 1342 consecutive Japanese patients hospitalized for CVD. The study was performed in accordance with the tenets of the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of our University Hospital. The pupillary area measurement was performed on both eyes at least 7 days after hospitalization for CVD using a portable videopupillography system (Iriscorder Dual C10641; Hamamatsu Photonics, Hamamatsu, Japan) consisting of a goggle-shaped measurement portion with a charge-coupled device camera and a control portion with a video monitor and microcomputer with software for data analysis. After securing the goggles on the patient's face and fully covering the patient's eyes, a 5-minute period was allowed for dark adaptation. All patients were tested once between 09:00 and 12:00 h. The primary outcome of this study was all-cause mortality, and the endpoint time was calculated as the number of days from the date of pupillary area measurement up to three years. We performed the Kaplan–Meier and log-rank tests and multivariable Cox regression analysis to evaluate the prognostic predictive capability of the pupillary area.

Results

The study population had a mean age of 65±13 years, and 69.4% of the patients were male. The median of the pupillary area was 18.5 mm2 (interquartile range: 13.3–23.4 mm2). Over a median follow-up period of 1.9 years (interquartile range: 1.0–3.0 years), a total of 114 deaths occurred in the patient population. The Kaplan–Meier and log-rank tests revealed that all-cause mortality was significantly higher in the small pupillary area group than in the large pupillary area group (P<0.0001, Figure). Furthermore, Cox regression analysis indicated that the pupillary area was an independent predictor of mortality (Hazard ratio: 0.96; 95% confidence interval: 0.93–0.98; P=0.006) even after adjusting for several preexisting prognostic factors.

Kaplan-Meire Curve

Conclusion

The pupillary area can be an independent predictor of prognosis in patients with CVD, and our observations suggest that the assessment of the pupillary area can be useful as a new noninvasive prognostic predictor in patients with CVD.

Modifications of PARP Medium Using Fluazinam, Miconazole, and Nystatin for Detection of Pythium spp. in Soil

The standard Pythium selective medium PARP (pimaricin + ampicillin + rifampicin + pentachloronitrobenzene [PCNB] agar), was modified by replacing PCNB and pimaricin with other antifungal agents. Several antifungal agents such as fluazinam, miconazole, 2,4,5,6-tetrachloroisophthalonitrile (TPN), iminoctadine triacetate, tolclofos-methyl, captan, and nystatin, initially were screened for effects on Pythium growth. Based on these results, the following three media were developed: PARF (pimaricin + ampicillin + rifampicin + fluazinam agar), NARF (nystatin + ampicillin + rifampicin + fluazinam agar), and NARM (nystatin + ampicillin + rifampicin + miconazole agar). New media were comparable with PARP on yield of naturally occurring Pythium spp. from two different types of soil using the soil-dilution plating technique. PARF and NARF were significantly better than PARP on inhibition of non-pythiaceous microbes on the soil-dilution plates, but were significantly lower than PARP on the rate of mycelial growth of six of eight isolates belonging to seven species of Pythium. NARM was equivalent to PARP on inhibition of non-pythiaceous microbes except for Fusarium oxysporum, and was significantly better than PARP on rate of mycelial growth of five of eight isolates of Pythium.

Congenital neuromuscular disease with uniform type 1 fiber and RYR1 mutation

BACKGROUND

Congenital neuromuscular disease with uniform type 1 fiber (CNMDU1) is a rare form of congenital myopathy, which is pathologically diagnosed by the presence of more than 99% of type 1 fiber, with no specific structural changes. Its pathogenic mechanism is still unknown. We recently reported that almost all patients with central core disease (CCD) with ryanodine receptor 1 gene (RYR1) mutations in the C-terminal domain had type 1 fibers, nearly exclusively, in addition to typical central cores.

OBJECTIVE

To investigate whether CNMDU1 is associated with RYR1 mutation.

METHODS

We studied 10 unrelated Japanese patients who were diagnosed to have CNMDU1 based on clinical features and muscle pathology showing more than 99% type 1 muscle fibers. We extracted genomic DNA from frozen muscles and directly sequenced all 106 exons and their flanking intron-exon boundaries of RYR1.

RESULTS

Four of 10 patients had a heterozygous mutation, three missense and one deletion, all in the C-terminal domain of RYR1. Two missense mutations were previously reported in CCD patients. Clinically, patients with mutations in RYR1 showed milder phenotype compared with those without mutations.

CONCLUSION

Congenital neuromuscular disease with uniform type 1 fiber (CNMDU1) in 40% of patients is associated with mutations in the C-terminal domain of RYR1, suggesting that CNMDU1 is allelic to central core disease at least in some patients.

First Report of Pythium aphanidermatum on Basella rubra in Japan

Basella rubra L. (Indian spinach, Japanese name Tsurumurasaki) is cultivated worldwide as an ornamental and its aerial parts are consumed as a vegetable and health food. A severe rot of leaves, stems, and roots was found on B. rubra cv. Midori grown in a commercial field at Naruto-City (34°11'N, 134°36(E) in Tokushima Prefecture, Japan from May to September 2004. More than 50% of approximately 2,100 plants in the field were destroyed by the disease. Soft, black lesions appeared initially at the base of the stems in 2- to 5-month-old plants and enlarged gradually upward and downward within 2 days after plant injury caused by heavy rainfall. A fluffy, white mass of mycelium appeared on the surface of lesions under moist conditions. A Pythium species was routinely isolated from rotted stems and roots and identified as Pythium aphanidermatum (Edson) Fitzpatrick on the basis of its morphology on a grass leaf water culture (2). Characteristics of isolate OPU743 (NBRC No. 101556, MAFF No. 239847) included hyphae as much as 10 μm wide, terminal oogonia 17.8 to 28.8 μm in diameter, and monoclinous or diclinous antheridia 8.8 to 10.9 μm wide, either terminal or intercalary, with one or rarely two per oogonium. Oospores were aplerotic, 13.5 to 22.6 μm in diameter. Sporangia were terminal or occasionally intercalary, and either inflated filamentous hyphae or complexes of swollen hyphal branches were present in cultures. Cardinal temperatures for growth on potato carrot agar were 10°C minimum, 37°C optimum, and 40°C maximum with a daily radial growth rate of 32.9 mm at 25°C. Pathogenicity tests were conducted on potted 3-month-old B. rubra (cv. Midori). A wound (1 mm deep and 5 mm long made by a razor) on the surface of the stem of the plant was inoculated with an 8-mm-diameter agar disk of isolate OPU743 (grown at 25°C for 48 h on potato dextrose agar) attached to a stem of the plant using a paraffin film. The inoculated plants were placed in transparent plastic bags and kept in a growth chamber at 24 to 26°C with continuous light (82 to 126 μmol·m^-2·s^-1). The experiment was done four times with three plants in each experiment. The same number of plants was used for the noninoculated control. Dark brown rot of stems and leaves developed on 66.7% of inoculated plants within 2 days after inoculation. P. aphanidermatum reisolated from diseased tissues was morphologically identical to the original isolate OPU743. Noninoculated control plants showed no symptoms. P. aphanidermatum has been described on B. rubra in Brazil (1), but has not been reported from other regions of the world. To our knowledge, this is the first report of P. aphanidermatum on B. rubra in Japan. References: (1) C. F. Robbs. A Lavoura 74:43, 1972. (2) A. J. Van Der Plaats-Niterink. Stud. Mycol. 21:1, 1981.

First Report of Root Rot of Cocoyam Caused by Pythium myriotylum in Sri Lanka

Root rot of cocoyam (Xanthosoma sagittifolium L. Schott) caused by Pythium myriotylum Drechsler is a major disease of this crop in Africa (1,2) but is unreported from other regions of the world. During September 1999, commercially grown cocoyam (cv. Ratu-kiri-ala) in Gampaha (7°05'N, 80°00'E), Sri Lanka suffered from severe root rot. Initial symptoms were water-soaked lesions at the root tips that gradually enlarged to rot the entire root system and tuber. Wilting and yellowing of leaves were observed in advanced stages of disease. A Pythium sp. was regularly isolated from the affected roots and an isolate, SC5, was identified as P. myriotylum on the basis of morphology and the internal transcribed spacer (ITS) rDNA sequence. Characteristics of isolate SC5, grown on a grass-leaf water culture (3) were main hyphae up to 8.5 μm wide, oogonia terminal or intercalary (22.5 to 33.8 μm in diameter), antheridia diclinous occasionally monoclinous, one to eight per oogonium, stalks branched, often more or less loosely enveloping the oogonium, antheridium clavate or crook-necked, making apical contact with the oogonium, breadth of antheridium 2.5 to 7.0 μm, oospores aplerotic (17.0 to 22.5 μm in diameter), oospore wall 0.8 to 2.0 μm in thickness, sporangia terminal or intercalary, filamentous, inflated lobulate, and digitate, of variable length, breadth of sporangia 7.0 to 17.5 μm, formed in water; zoospores formed at 25°C, and diameter of encysted zoospores 10.0 to 12.5 μm. Cardinal temperatures on potato carrot agar 8°C minimum, 34°C optimum, and 37°C maximum with daily radial growth rate for 34°C at 32.8 mm. The ITS rDNA sequence of the isolate matched the sequences of P. myriotylum in GenBank (Accession Nos. AB095051 and AF452156) and isolate CBS254.70 used for the species description by van der Plaats-Niterink (3). The sequence of SC5 has been deposited in GenBank, Accession No. DQ102701. Pathogenicity tests used potted cocoyam plants (20 cm high), planted in an autoclaved potting mix. Four agar disks (8 mm in diameter) of isolate SC5 grown at 25°C for 48 h on potato dextrose agar was mashed and injected at a depth of 2 to 3 cm in the soil around the roots. Inoculated plants were placed in transparent plastic bags and kept for 7 days in a growth chamber maintained at 24 to 26°C with continuous light (52 to 98 μmol m^-2·s^-1). The experiment was carried out twice with three replications for each test. Dark brown rotting on roots and wilting of leaves were observed in 7 days after the inoculation. P. myriotylum was reisolated from diseased tissues and found to be morphologically identical to the original isolate SC5. Noninoculated control plants remained healthy. On the basis of the symptoms, morphological and molecular characteristics and confirmation of pathogenicity, P. myriotylum is the causal agent of root rot of cocoyam. To our knowledge, this is the first report of P. myriotylum causing root rot of cocoyam in Sri Lanka. References: (1) S. Nzietchueng. L'agronomie Tropicale 38:321, 1983. (2) R. P. Pacumbaba et al. J. Phytopathol. 135:265, 1992. (3) A. J. Van Der Plaats-Niterink. Stud. Mycol. 21:1, 1981.

Distribution of Pythium porphyrae, the Causal Agent of Red Rot Disease of Porphyrae spp., in the Ariake Sea, Japan

Distribution of Pythium porphyrae, the causal agent of red rot disease of Porphyra spp., in seafloor sediment was investigated in the Ariake Sea, Japan. A total of 170 samples of each 200 ml of sediment was collected from the seafloor at a total of 13 sites across the sea from 1998 to 2002. Each sample was filtered through two layers of nylon mesh with pore sizes of 100 and 15 μm. The residue on 15 μm mesh was assayed by a soil plating technique using a semiselective medium for P. porphyrae and by polymerase chain reaction (PCR) using species-specific primers. P. porphyrae were detected in 6 out of 13 sites and 2 out of 10 sites surveyed by soil plating and PCR, respectively. The representative isolate of P. porphyrae from the sediment was identical to the Porphyra thallus isolate from the same sea based on pathogenicity to the thallus, morphology, and rDNA internal transcribed spacer sequences. Recovery of P. porphyrae propagules in the sediment was up to 60 CFU per 100 ml of the fresh sample and was consistently higher in May than in the other months. The results suggest that P. porphyrae is distributed in the seafloor sediment in a wide area of the Ariake Sea.

First Report of Stem Rot of Guiana Chestnut (Pachira aquatica) Caused by Pythium splendens

Guiana chestnut is a perennial tropical plant that has recently become popular as a potted ornamental in Japan. In October 2001, severe stem rot occurred on Guiana chestnut plants grown in a greenhouse in Mie Prefecture, Japan. Water-soaked lesions appeared initially at the base of the stems and enlarged gradually toward the tops of plants. The affected tissues were softened and turned dark brown. Rotting was observed in the vascular bundles with advanced disease development. Globose hyphal swellings were numerous on diseased stems. Sections from diseased stems were cleaned by washing with running tap-water, placed on water agar, and incubated at 25°C. A species of Pythium was identified on the basis of morphological and cultural characteristics (1) and isolated consistently from the rotted stems of diseased plants. All isolates produced abundant hyphal swellings that were globose, smooth, 12 to 39 μm in diameter, mostly terminal, dark colored, and with dense granulated contents. Zoospores were absent. All isolates were of the compatibility '+ type' with production of sexual organs when paired with cultures of the '- type' tester isolate of Pythium splendens Braun (CBS462.48). Oogonia produced by crossings between Guiana chestnut isolates and isolate CBS462.48 were terminal or intercalary, globose, smooth-walled, and 32 to 38 μm in diameter. Antheridia were terminal, one to three per oogonium, sac-like, and diclinous. Oospores were single, aplerotic, globose, and 28 to 32 μm in diameter. The thickness of the oospore wall ranged from 1 to 2 μm. The internal transcribed spacer rDNA sequences of representative isolate OPU591 from Guiana chestnut matched those of CBS462.48 (similarity 99.2%) and have been deposited in GenBank under the Accession No. AY375242. Pathogenicity tests were conducted on potted Guiana chestnut plants (30 cm high and 7 to 10 cm in diameter at base of the stem) using isolate OPU591. A mycelial suspension from one culture, grown at 25°C for 7 days on water agar, was inoculated onto a single plant. Prior to inoculation, a wound (10 mm deep and 30 mm long) was made on the surface at the stem base on five plants. The mycelial suspension was poured onto the base of the stems of five wounded and five nonwounded plants. In addition, five wounded and five nonwounded, noninoculated plants were used as controls. Plants were maintained in a greenhouse for 8 weeks after inoculation. The temperature and relative humidity in the greenhouse ranged from 25 to 30°C and 65 to 75%, respectively. Dark-brown rotting developed on the stems of all wounded, inoculated plants by 20 days after inoculation. P. splendens was isolated from diseased tissues and found to be morphologically identical to the original isolate. This confirmed P. splendens as the causal agent of the disease. Disease did not develop on nonwounded inoculated plants or noninoculated plants. To our knowledge, this is the first report of P. splendens on Guiana chestnut. Potted plants of Guiana chestnut are often injured by frequent transplanting and transferring. Such injuries may have predisposed the plant to infection by P. splendens. Reference: (1) A. J. van der Plaats-Niterink. Page 1 in: Monograph of the Genus Pythium. Studies in Mycology Vol. 21, Centraalbureau Voor Schimmelcultures, Baarn, the Netherlands, 1981.

Expression of the GLI2 oncogene and its isoforms in human basal cell carcinoma

BACKGROUND

Mutations of the patched (Ptc) gene, a developmental regulator implicated in the signalling pathway via sonic hedgehog (Shh) and smoothened (Smo), play an essential pathogenic role in the development of basal cell carcinomas (BCCs). We previously reported the upregulation of Shh signal transducers, including Ptc, Smo and hedgehog-interacting protein, in BCCs. In vertebrates, specific downstream effectors in the Shh signalling pathway include three zinc-finger transcription factors, Gli1, Gli2 and Gli3. Gli1 possesses only an activation domain, while Gli2 and Gli3 contain both activation and repression domains. It remains unclear which of these transcription factors are responsible for the development of BCCs.

OBJECTIVES

To examine the expression pattern of Gli2 mRNA by human BCCs in comparison with those by normal human skin and various skin tumours.

METHODS

We performed quantitative reverse transcriptase-polymerase chain reaction analyses with a series of samples from BCCs, other skin tumours and normal skin.

RESULTS

We found that Gli2 mRNA expression was enhanced in the BCCs we examined, whereas there was no significant increase in other skin tumours or normal skin. Of four spliced Gli2 isoforms designated Gli2alpha, beta, gamma and delta, the expression of Gli2beta mRNA was increased the most in BCCs.

CONCLUSIONS

As Gli2beta is an isoform spliced at the first splicing site containing a repression domain and consists of an intact activation domain, its overexpression may lead to the upregulation of the Shh signalling pathway, thereby inducing BCCs.

Chilling resistances of isolates of Pythium ultimum var. ultimum from the Arctic and Temperate Zones

Chilling resistances in moss pathogenic fungi, Pythium ultimum var. ultimum, from Longyearbyen, Svalbard (78 degree N, 15 degree E), located in the Arctic Zone and in the same isolates from Temperate Zone, were determined. Both strains had similar optimum growth temperatures. However, the strains from Svalbard could grow and survive at 0 - 5 degrees C. In addition, chilling treatment induced irregular mycelial morphology in the Arctic isolates. On the other hand, the isolates from Japan did not grow at temperatures below 5C and were destroyed after chilling stress (0 degree C for 3 days or at 4 degrees C for 1 week). The results suggested that isolates from Svalbard highly adapted to the severe spring condition in Polar environments.

Expression of a sonic hedgehog signal transducer, hedgehog-interacting protein, by human basal cell carcinoma

BACKGROUND

Aberrant activation of the hedgehog pathway has been identified in various human tumours, including familial and sporadic basal cell carcinomas (BCCs). It has been postulated that binding of sonic hedgehog protein (SHH) to its receptor, patched protein (PTC), releases the inhibitory effect of PTC against smoothened protein (SMO), another protein of the SHH signalling pathway. The positive SMO signalling is not downregulated in BCCs because of the mutational inactivation of PTC. Recently, hedgehog-interacting protein (HIP) was found to bind to SHH directly and attenuate SHH signalling like PTC, while its expression was induced by SHH signals.

OBJECTIVES

To examine the expression patterns of HIP, SHH and PTC gene mRNA by human BCCs, in comparison with those by normal human skin and various skin tumours.

METHODS

We performed quantitative reverse transcriptase-polymerase chain reaction analyses with a series of samples from BCCs, other skin tumours and normal skin.

RESULTS

We found that the mRNA expression of both HIP and PTC genes was enhanced in all samples of BCCs, whereas none of the other skin tumours tested exhibited an increased level of such mRNAs as compared with normal skin. The transcription of the SHH gene, however, was at a baseline level in most BCCs.

CONCLUSIONS

These results indicate that both HIP and PTC gene expression are specifically involved in the development of BCCs, and that the production of HIP is linked with the expression of the PTC gene but not the SHH gene.

No evidence of deregulated patched-hedgehog signaling pathway in trichoblastomas and other tumors arising within nevus sebaceous

Nevus sebaceous is a congenital malformation of the skin within which a number of neoplasms showing adnexal differentiation may arise. Recently, deletions in the patched gene region were reported in nevus sebaceous and constitutive activation of the patched-hedgehog signaling pathway was implicated in the development of tumors arising within nevus sebaceous. To substantiate further a role of the patched-hedgehog signaling pathway in secondary tumors arising within nevus sebaceous, we examined 11 nevus sebaceous associated with secondary tumors for loss of heterozygosity of the patched gene region by microsatellite polymerase chain reaction and patched mRNA expression by in situ hybridization. Unexpectedly, however, none of the tumors (including eight trichoblastomas) and nevus sebaceous lesions showed loss of heterozygosity at any polymorphic loci close to the patched gene. Further more, none of the nevus sebaceous lesions and secondary tumors gave detectable signals for patched mRNA. In contrast, four of 11 sporadic basal cell carcinomas, that were examined for comparison, showed loss of heterozygosity at the patched gene locus (p <0.05), and moderate to strong signals for patched mRNA was observed in all seven basal cell carcinoma tumors examined (p <0.0001). Additional investigation by reverse transcription-polymerase chain reaction in four basal cell carcinomas and two nevus sebaceous tumors also showed the expression of Gli-1, another target gene in the patched-hedgehog signaling pathway, in all the basal cell carcinomas samples but not in any of the nevus sebaceous tumors examined. The findings in this study do not support the view that the deregulation of the patched-hedgehog signaling pathway is involved in the pathogenesis of nevus sebaceous and associated tumors, and show that, although morphologically similar, trichoblastomas and basal cell carcinomas have a different molecular pathogenesis.

Micturitional disturbance in Wernicke's encephalopathy

A 24-year-old pregnant woman started to have hyperemesis gravidarum 6 weeks before admission. Four weeks later she had vertigo, diplopia, staggering gait, mild dyspnea, dysphagia, and incontinence of urine. On admission she presented with ophthalmoplegia, ptosis, ataxia, decreased tendon reflex, and memory disturbance. Brain magnetic resonance imaging revealed abnormal intensities in medial thalamic-hypothalamic regions and the periaqueductal area, and she was diagnosed with Wernicke's encephalopathy. Urodynamic studies revealed decreased bladder volume and detrusor hyperreflexia. Six weeks after the administration of 100 mg/day of thiamine, urge incontinence gradually recovered, together with neurological signs. Lesions of the medial thalamic-hypothalamic area and the periaqueductal gray matter seemed to be mainly responsible for micturitional disturbance in our patient with Wernicke's encephalopathy.

Central core disease and congenital neuromuscular disease with uniform type 1 fibers in one family

We report a family in which the father had central core disease and his son had congenital neuromuscular disease with uniform type 1 fibers. This is the first report of such a combination. Although they had no recognized mutation in the ryanodine receptor gene, it is highly likely that the son also had central core disease but without core structures. The absence of cores may be due to the muscle sample or the young age of the patient since core structures have been reported to increase with age. Although the prevalence of core structures in individual muscles is unknown, there is a possibility of sampling error. In some patients, congenital neuromuscular disease with uniform type 1 fibers is closely related to or identical with central core disease.

[A case of riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency (glutaric aciduria type II)]

We reported a male infant with multiple acyl CoA dehydrogenase deficiency, probably due to electron transfer flavoprotein dehydrogenase deficiency. He was noted to have severe muscle weakness, a high serum creatine kinase (CK) level up to 6920 IU/L, lipid storage myopathy and fatty liver at 6 months of age. A GC/MS analysis of urinary organic acids showed excess excretion of dicarboxylic acids, including glutaric, 2-hydroxyglutaric, adipic, suberic, sebacic, malonic, ethylmalonic and methylsuccinic acids. On a urinary acylglycine analysis, hexanoylglycine and suberylglycine were increased, but not isovalerylglycine, in amount. No ketosis was noted. The muscle pathology showed increased oil-red O positive lipid droplets of various sizes indicative of lipid storage myopathy. There was diffuse decrease in the activity of cytochrome c oxidase. No ragged-red fibers were noted. His clinical symptoms improved remarkably after the administration of riboflavin (100 mg/day) and L-carnitine (1000 mg/day). He was then diagnosed as having probable riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency. The glutaryl CoA dehydrogenase activity in lymphocytes was normal, as were the alpha- and beta-subunits of electron transfer flavoprotein. These findings led us to suspect electron transfer flavoprotein dehydrogenation deficiency. Although he had several episodes of short-term deterioration in clinical and laboratory findings, he developed normally with normal intelligent till 10 years of age.

The effectiveness of terazosin, an alpha1-blocker, on bladder neck obstruction as assessed by urodynamic hydraulic energy

OBJECTIVE

To investigate the effectiveness of terazosin, an alpha1-adrenoceptor blocking agent, on bladder neck obstruction (BNO), by assessing the urodynamic hydraulic energy profile. Patients, subjects and methods The study included 17 men (mean age 60.1 years, range 24-84), comprising 11 patients with BNO (mean age 66.5 years) and six normal volunteers (mean age 48.1 years). A five-transducer microtip catheter was used to measure the pressure in the bladder and at the bladder neck, and in the membranous and bulbous urethra during voiding. All the subjects then received terazosin, 1 mg/day orally for 2 weeks, and were re-assessed.

RESULTS

The bladder neck diameter at maximum flow significantly (P < 0.02) increased in the 11 patients with BNO after treatment with terazosin. The relative hydraulic energy profiles before terazosin treatment showed the greatest hydraulic energy loss between the membranous and the bulbous urethra in the normal subjects, and between the bladder neck and the membranous urethra in the men with BNO. After terazosin treatment, the greatest energy loss was between the membranous and the bulbous urethra in men with BNO, similar to that in the normal controls, i.e. the whole profile of relative hydraulic energy became normal.

CONCLUSION

Terazosin was effective in opening the bladder neck and improving the hydraulic energy profile in men with BNO.

[Serial cerebral computed tomography and magnetic resonance imaging in a case of hemolytic uremic syndrome with the complication of the central nervous system due to Escherichia coli O157:H7]

We report serial cerebral computed tomography (CT) and magnetic resonance imaging (MRI) in a case of hemolytic uremic syndrome (HUS) with the complication of the central nervous system due to Escherichia coli O157:H7. Although initial brain CT was normal, follow-up CT and MRI revealed lesions in the white matter and bilateral basal ganglia, representing brain edema and infarcts, respectively. Especially, lesions in the bilateral basal ganglia were very unique. Serial CT and MRI findings are useful to understand the mechanism of the complications of the central nervous system associated with HUS.

Localization of huntingtin-interacting protein-2 (Hip-2) mRNA in the developing mouse brain

Huntingtin-interacting protein-2 (Hip-2) was identified as a human protein specifically associated with huntingtin in vitro, a gene product affected in patients with Huntington disease (HD). It is a ubiquitin-conjugating enzyme identical to the previously characterized bovine E2-25k. We identified the mouse Hip-2 homologue (mHip-2) and examined its distribution patterns in the developing mouse brain in order to gain an insight into the functional significance of the Hip-2 protein in the normal brain as well as in the pathogenesis of HD. As reported with huntingtin, the mHip-2 mRNA expression developed in parallel with neuronal maturation and became distributed widely in the postnatal mouse brain. This spatiotemporal pattern of mHip-2 mRNA expression resembled that of huntingtin. We further demonstrated that mHip-2 mRNA was colocalized with huntingtin-like immunoreactivity in a single neuron. These findings suggested that the Hip-2 interacted with huntingtin in vivo and played an important role in HD pathogenesis.

Expression of sonic hedgehog signal transducers, patched and smoothened, in human basal cell carcinoma

In basal cell nevus syndrome (BCNS) patients, mutations of a gene, patched (ptc), which encodes a putative signal transducer of sonic hedgehog protein (SHH), were found and are thought to be one of the major causes of BCNS. The SHH signaling pathway is an important developmental pathway, and ptc protein (PTC) is a suppressive component serving as a receptor for the secreted SHH. Another transmembrane protein, smoothened (SMO), forms a complex with PTC and regulates this signaling pathway. Recent transgenic studies have strengthened the importance of the SHH signaling system in the etiology of basal cell carcinoma (BCC). In this study, we examined the expression patterns of mRNA for ptc and smo in two different BCC subtypes and normal skin. We found that the expressions of ptc and smo mRNA were enhanced in the tumor nests of the nodular BCC, especially at the advancing portions, but were under the detectable level in the superficial BCC cases examined, indicating that ptc and smo mRNA expressions might be associated with BCC tumor progression and divide the BCC histologic types into two subtypes, superficial and nodular types. In addition, no obvious signals for ptc and smo mRNA were detected in the normal human epidermis, appendages, or seborrheic keratosis, indicating that the abnormal proliferation of follicular epithelial cells caused by ptc, smo and/or other genetic changes, which also cause ptc and smo overexpressions, might result in BCC tumor formation.

Identification of a novel gene, OASIS, which encodes for a putative CREB/ATF family transcription factor in the long-term cultured astrocytes and gliotic tissue

Gliosis is a characteristic response of astrocytes to inflammation and trauma of the central nervous system (CNS). To study the mechanisms underlying gliosis, we performed differential display screening for genes specifically induced in long-term cultured astrocytes used as an in vitro gliosis model. We identified and characterized a gene (named OASIS, for old astrocyte specifically-induced substance) expressed in long-term cultured mouse astrocytes, or 'old astrocytes (OA)'. The OASIS gene encoded a putative transcription factor belonging to the cyclic AMP responsive element binding protein/activating transcription factor (CREB/ATF) gene family, with homology to box B-binding factor-2 (BBF-2), a Drosophila transcription factor. Its expression was developmentally regulated; OASIS mRNA was primarily expressed in the salivary gland and cartilage in the mouse embryo and it was transiently upregulated in the brain during postnatal two weeks. The expression became weaker in the adult brain. We also demonstrated that an expression of the OASIS mRNA was induced in response to the cryo-injury of the mouse cerebral cortex. The distribution pattern of the OASIS-positive cells in the injured cortex was very similar to that of the glial fibrillary acidic protein (GFAP)-positive cells. These results suggest that OASIS protein may play a role in gliotic events.

Eos: a novel member of the Ikaros gene family expressed predominantly in the developing nervous system

We identified a novel member of the Ikaros gene family, which has critical roles in the development of lymphoid lineages. This gene, which we named Eos, was expressed predominantly in the developing central and peripheral nervous system. Eos protein could interact with itself and Ikaros protein through its C-terminal portion in the yeast two hybrid assay. These findings suggested that Eos may have important roles in neural development similarly to the Ikaros family in the development of hemolymphoid tissue.

Expression pattern of a novel death-promoting gene, DP5, in the developing murine nervous system

We examined the expression patterns of the DP5 gene, which encodes a protein with apoptosis-inducing activity, in the developing nervous system of mice. This gene was primarily expressed in the spinal motor neurons and peripheral sensory ganglia of mouse embryos and transiently in the postnatal brain, particularly in the entorhinal cortex and hippocampus. These expression patterns suggest that the DP5 gene may be involved in the apoptosis, if not all, of the developing nervous system.

[What change was caused under short-time treatment by the Ueda method for severely disabled infants with cerebral palsy? Report of two cases]

A new physical therapy, Ueda method (UM), were performed on two patients with severe motor and intellectual disabilities syndrome and spastic cerebral palsy (CP). The period of the UM therapy was 5 days in one case with spastic CP and 10 days in another case with rigo-spastic CP. They showed the remarkable reduction of abnormal muscle tone and interesting phenomena such as postural changes of extremities and changes of some primitive reflexes. First, peculiar postures of treated extremities appeared on the first day of the UM therapy, associated with the reducing muscle tone of extremities only in the treated side. One case showed immediate change of the posture of treated upper extremity from internal to external rotation of the shoulder joint. Another case disclosed immediate appearance of internal rotation of the hip joint of the treated lower extremity and scissoring posture of legs. These phenomena were transient and disappeared under the UM treatment. Secondly, interesting phenomena in some primitive reflexes were observed after the beginning of the UM therapy. Moro reflex was elicited only in the treated upper extremity, which could not be obtained by stimuli before the UM therapy. After the UM therapy on bilateral arms. Moro reflex appeared bilaterally in two cases. On the other hand, the degree of asymmetrical tonic neck reflex (ATNR) in one case with spastic CP reduced on 5th days under the UM therapy. In another case with rigo-spastic CP automatic walking disappeared on 3rd days after the UM therapy and ATNR appeared. The first phenomena could be due to imbalances of the reduced muscle tones by the UM therapy. Second phenomena could result from the interaction between the nervous systems of Moro reflex, ATNR and automatic walking and the nervous system owing to the abnormal muscle hypertone. Moro reflex might be suppressed by abnormal muscle hypertone. The disappearance of some primitive reflexes might not depend on the maturation of the central nervous system.

The nature of detrusor bladder neck dyssynergia in non-neurogenic bladder dysfunction

There have been two major opinions on the pathology or nature of the bladder neck contracture. One is an organic fibrosis, and the other is an accentuated sympathetic nervous function, or detrusor bladder neck dyssynergia. The existence of active detrusor bladder neck dyssynergia in neurogenic bladder was reported in a urodynamical manner using microtip transducer catheters. However, it has not been confirmed whether or not detrusor bladder neck dyssynergia is responsible for bladder neck contracture in patient without neurogenic bladder. The present study was designed to determine by means of video urodynamic study whether or not bladder neck contracture would be of the same nature as detrusor bladder neck dyssynergia in non-neurogenic bladder subjects. The study included 32 male subjects of 16-84 years old (average 52.3): 17 bladder neck contracture subjects including 7 subjects associated with minimum complications (4 with trapped benign prostatic hyperplasia and 3 with incomplete neurological lesion) and 15 non-bladder neck contracture subjects (10 healthy volunteers, 2 chronic prostatitis, 3 prostatodynia). A 5-microtip transducer catheter was used to measure the pressure in the bladder and at the bladder neck, the external urethral sphincter and the bulbous urethra during voiding. Proper localization of the transducers was done with an image intensifier. Bladder outlet obstruction localized at the bladder neck (diameters smaller than 0.75 cm) on voiding cystourethrogram was defined as bladder neck contracture. Detrusor bladder neck dyssynergia was defined where pressures were higher at the level of bladder neck than in the bladder during detrusor contraction. An alpha-blocker, terazosin hydrochloride (0.5 mg, b.i.d., two weeks), was orally administered to subjects judged to have detrusor bladder neck dyssynergia by the above methods for the purpose of confirming whether detrusor bladder neck dyssynergia was really due to accentuated sympathetic nervous function. Detrusor bladder neck dyssynergia was found in seven cases with bladder neck contracture: 6 cases with bladder neck contracture with minimum complications and only 1 case with bladder neck contracture without complications (p < 0.01). Detrusor bladder neck dyssynergia was found at the beginning and ending of micturition, but not at maximum flow. In six cases with detrusor bladder neck dyssynergia, the condition disappeared after terazosin. In conclusion, detrusor bladder neck dyssynergia was not thought to be a major factor of voiding dysfunction in bladder neck contracture in non-neurogenic bladder. In the presence of sympathetic hyperactivity or in cases with increased number of alphareceptors, detrusor bladder neck dyssynergia occurs, being predominantly noted in trapped benign prostatic hyperplasia and neurological disorder patients.

[The effect of "Ueda" method for the treatment of a severe motor and intellectual disabilities syndrome]

A case of severe motor and intellectual disabilities syndrome after being nearly drowned was reported. He could walk at the age of one year. But his condition became to a bedridden state by the hypoxic brain damage due to near drowning at one year and 5 months old. At one year and 8 months, he was treated by the "Ueda" method for physical therapy to cerebral palsy (CP). Before the treatment he showed decorticate posture and opisthotonic posture. Six weeks after the treatment, the severity of spasticity was remarkably decreased. He could take hip flexion posture and relaxed posture easily. His status remarkably improved. The effectiveness of the "Ueda" method to different spasticity from CP was also confirmed.

[Therapeutic effect of "Ueda" method for a case of spastic paraplegia as a sequela of transverse myelitis]

This paper showed the therapeutic effect of the "Ueda" method (UM) for one case with spastic paraplegia as a sequela of transverse myelitis. The effects of UM was dramatic. Two weeks after the beginning of UM, spastic gait improved moderately and inner rotation of lower extremities on supine posture changed to external rotation. Transitionally the fast stretch ROM by the procedure of straight leg raising improved to the level of the normal range four months after the beginning of UM. Although UM was originally designed for cerebral palsy, it was effective for spasticity due to transverse myelitis. Spasticity showed reversible changes depending on UM. Therapists will be able to reduce and control spasticity by means of UM. This result suggests that spasticity treated by UM does not depend on the maturity of central nervous system (CNS) or recovery of the CNS lesion, but is caused by the lesions of the spinal loop.

The location of the paths subserving micturition: studies in patients with cervical myelopathy

Urodynamic studies and neurological examinations were performed on 128 patients with cervical myelopathies including 82 with spondylitic myelopathy and 46 with ossification of the posterior longitudinal ligament (OPLL), investigating the location of the paths subserving micturition in the spinal cord. Accurate history taking revealed micturitional symptoms in 95 patients, including irritative symptoms in 61 and obstructive symptoms in 71. Urinary incontinence was noted in 25 and residual urine of over 100 ml or retention was found in 22. Neurological examination revealed disturbed deep sensation in 55, disturbed superficial sensation in 63 and pyramidal signs (weakness, hyperreflexia of legs and Babinski sign) in 96 patients. Urodynamic studies revealed uninhibited contraction in 61 and detrusor-sphincter dyssynergia in 22 patients. Bladder capacity was smaller in patients with Babinski sign (P < 0.05) and in patients with uninhibited contraction (P < 0.001). Uninhibited contraction was more frequent in patients with all three of the above-mentioned pyramidal signs (P < 0.05). Detrusor-sphincter dyssynergia was more frequent in patients with disturbed deep sensation (P < 0.05) and pyramidal signs (P < 0.05, P < 0.0005). From above results and our previous findings in patients with anterior spinal artery syndrome and with tabes dorsalis, it is concluded that the pathway subserving detrusor function seems to be located mainly in the lateral column of the spinal cord. The descending pathway subserving coordination of bladder and urethral sphincter seems to be located mainly in the lateral column, and its ascending pathway seems to be located in the dorsal column. The path subserving urinary sensation seems to be located mainly in the dorsal column of the spinal cord.

[Administration of a single oral high-dose of diazepam at bedtime as therapy for intractable seizures]

Recently the usage of diazepam as an anticonvulsant has been reduced. But, in this report, the effect of diazepam in the treatment of infantile spasms and intractable epilepsies were reported. Single high-dose oral administration of diazepam at bedtime was tried to the patients with intractable seizures. There were good responses to the therapy of partial seizures and infantile spasms basically escaping from hypsarhythmia. The therapeutic range of blood concentration was not decided, but probably the following values are necessary; over 200 nl/ml for partial seizures and over 300 ng/ml for infantile spasms 2 hours after the administration. Plasma level of diazepam during the daytime was very low, but the seizures were controlled sufficiently.

Effects of NG-nitro-L-arginine on alpha-agonists-induced contraction of aortae from Wistar Kyoto rats and stroke-prone spontaneously hypertensive rats

Differences in the influences of endothelium-derived nitric oxside (NO) on alpha-agonists-induced contraction in the aortae of spontaneously hypertensive and normotensive rats were studied by blocking NO synthesis with NG-nitro-L-arginine (L-NNA). L-NNA potentiated the contraction induced by noradrenaline. The potentiation was smaller in the preparation from stroke-prone spontaneously hypertensive rats (SHRSP) than in the preparation from Wistar Kyoto rats (WKY). Similar potentiation was observed in the contraction induced by phenylephrine; the potentiation was also smaller in the preparation from SHRSP. alpha 2-agonists, clonidine and UK-14304 induced dose-dependent contraction only in the presence of L-NNA. The dose-response curves for alpha 2-agonists in SHRSP aorta were different from those in WKY aorta; the maximum tension was observed at the concentration of 10(-6) M in the preparation from WKY, while the contraction further increased up to 10(-4) M in the preparation from WKY. Noradrenaline, clonidine and UK-14304 but not phenylephrine induced relaxation which was blocked by L-NNA. The relaxation was impaired in the preparation from SHRSP in greater extent than that by acetylcholine. It is suggested that basic or noradrenaline-stimulated NO release from endothelium decreased in the preparation from SHRSP and that alpha 2-adrenoceptor of both the endothelium and smooth muscle may be altered in the preparation from SHRSP.

Micturitional disturbance in myotonic dystrophy

Micturitional disturbance has attracted little attention in myotonic dystrophy, but detailed micturitional histories revealed that two out of six patients (33%) had micturitional symptoms. One had difficulty urinating and the other had urinary frequency, urgency and stress incontinence. Urodynamic studies were performed in all patients and the results were as follows: Two had low maximum urethral closure pressure, two had large and three had small bladder capacities, one had detrusor hyperreflexia and one had atonic cystometrogram. Urethral sphincter electromyography revealed a decreased bulbocavernosus reflex in one, and an absent anal reflex in two. Motor unit analysis of external sphincter was performed with one patient and showed polyphasic potentials. Dystrophic changes of the lower urinary tract muscles, as well as supranuclear type of pelvic nerve dysfunction, could cause micturitional disturbance in patients with myotonic dystrophy.

Correlation between serum pepsinogen concentration and gastric acidity measured by 24 h pH monitoring

The relationship between the intragastric pH measured by 24 h pH monitoring system and the serum pepsinogen I/II ratio was studied in 68 cases. When pepsinogen I/II ratio was compared with pH 3.0 holding time (the percentage time during which the gastric pH is above 3.0), there was a negative correlation between these two parameters (correlation coefficient r = -0.62, P < 0.001). Furthermore, there was also a strong negative correlation between the early morning (from 03.00 to 06.00 h) gastric pH and pepsinogen I/II ratio (r = -0.76, P < 0.001). Accordingly, by simply measuring serum pepsinogen I and II, it may be possible to infer gastric acidity and to obtain the information concerning the early morning intragastric pH.

Relationship between bladder neck diameter and hydraulic energy at maximum flow

A pressure-flow study was performed with a 5-micro-tip transducer catheter in 6 normal male volunteers (bladder neck diameters 0.80 cm. or larger) and 13 male subjects suspected of having bladder neck contracture. Intraurethral pressure was measured at various sites in the urethra at maximum flow to calculate hydraulic energy at these sites using the Bernoulli equation. When the subjects were divided into 2 groups (1 group with a bladder neck diameter of 0.73 cm. or larger and 1 with a bladder neck diameter of 0.60 cm. or smaller), the relative value of energy (ratios to the initial energy generated in the bladder) at the external urethral sphincter was significantly (p < 0.01) greater in the former than in the latter group. Therefore, the "flow rate controlling zone" lies at the external urethral sphincter in the former group and at the bladder neck in the latter group.

Effect of naftopidil on urethral obstruction in benign prostatic hyperplasia: assessment by urodynamic studies

Thirty-two patients with voiding dysfunction attributable to symptomatic benign prostatic hyperplasia were treated with naftopidil, an alpha 1-blocker, at doses of 25-75 mg/day for 4-6 weeks. The efficacy of the drug was assessed from the changes in urinary symptoms and urodynamic data. Total symptom scores were significantly reduced after treatment (P < 0.001). Average flow rate and maximum flow rate were significantly increased (P < 0.001 and P < 0.001, respectively), and residual urine volume, residual urine rate (ratio of residual urine volume/sum of voided volume and residual urine volume), and maximum urethral closure pressure were significantly (P < 0.05, P < 0.01, and P < 0.05, respectively) reduced, and at bladder capacity, the first desire to void was significantly (P < 0.05) increased. The pressure/flow study demonstrated no changes in intravesical pressure at maximum flow, but a significant (P < 0.05) reduction in minimum urethral resistance. A mild side effect (dizziness) was noted in one patient (3.3%), which soon disappeared after the dose was decreased. The efficacy was good or excellent in 21 of 30 patients (70.0%). The drug was evaluated to be promising in the treatment of bladder outlet obstruction due to benign prostatic hyperplasia.

Effects of beta 2-stimulants on contractility and fatigue of canine urethral sphincter

The effects of beta 2-stimulants [clenbuterol (CB) and terbutaline (TB)] on the contractility of the urethral sphincter of female dogs were studied by measuring intraurethral pressure (IUP) during stimulation of bilateral pudendal nerves. In nine dogs 1, 10 and 100 micrograms/kg. of CB were administered, but no changes in IUP were observed. In the other 33 dogs, sphincteric fatigue was experimentally prepared by electrically stimulating the pudendal nerves at 15 V, 20 Hz for 30 to 40 minutes. In fatigued sphincters, CB (n = 17) and TB (n = 7) increased the contracting pressure (pressure difference between stimulation-generated peak level and baseline level of IUP). The inotropic effect of beta 2-stimulant (TB) on the fatigued urethral sphincter was abolished by a beta-blocker, propranolol. From the present study it was concluded that beta 2-stimulants have little effect on the total contractility of the nonfatigued urethral sphincter because it is composed of smooth and striated muscles (fast- and slow-contracting muscles). However, beta 2-stimulants enhanced the contractility of fatigued urethral sphincter. These results suggest that beta 2-stimulants act on fast-contracting fibers in the urethral sphincter because the inotropic effect of sympathomimetic amine is much greater on fatigued, fast-contracting fibers than on nonfatigued ones and its depressive effect on slow-contracting fibers is not potentiated after fatigue.

Improvement of urethral resistance after the administration of an alpha-adrenoceptor blocking agent, urapidil, for neuropathic voiding dysfunction

We assessed the effect of a new alpha-blocking agent, urapidil, on neuropathic voiding dysfunction, by urodynamic studies. The residual urine volume and rate significantly decreased, whereas the average and the maximum flow rate did not increase significantly. The pressure at maximum flow and minimum urethral resistance decreased significantly. These results suggest that improvement of the voiding dysfunction in some cases could be due to the decreased micturition pressure without increasing the flow rate. The urethral resistance calculated from the pressure/flow data seemed to be a valuable index in evaluating the effects of the drug on neuropathic voiding dysfunction.

Micturitional disturbance in progressive supranuclear palsy

Detailed micturitional histories were taken from nine patients with progressive supranuclear palsy (PSP), and eight of them (89%) had micturitional symptoms including urinary incontinence in seven. Urodynamic studies were performed in six patients and the results were as follows. Three had residual urine of 100 ml on average. Four had detrusor hyperreflexia and one had a low compliance cystometrogram. One had detrusor-sphincter dyssynergia. Motor unit analysis of external sphincter was performed in four patients and two had neurogenic changes. The results were compared with our previous findings in Parkinson's disease and in striato-nigral degeneration (SND), and we found that a severe degree of micturitional disturbance in PSP seems to be as common as in SND, especially in the urinary storage phase, and more frequent than in Parkinson's disease. Supranuclear types of pelvic and pudendal nerve dysfunctions seemed to be mainly responsible for micturitional disturbance in PSP.

[Mitomycin C associated hemolytic uremic syndrome--a case report and review of the Japanese cases]

A 36-year-old man who developed hemolytic uremic syndrome (HUS) associated with mitomycin C (MMC) after the radical operation for early gastric cancer was reported. He was successfully treated with hemodialysis and transfusion of fresh frozen plasma. However, the pathogenesis and the effective treatment of this syndrome are still undetermined. The literature on MMC-induced HUS in Japan was reviewed, and the relationship between the prognosis and the patients conditions, such as sex, age, site of primary cancer, total dose of MMC, latent period from MMC administration, laboratory findings at the time of diagnosis and treatment with steroids or plasma exchange, were analysed. Patients less than 60 years old or treated with plasma exchange were found to be associated significantly with a favorable outcome. The most frequent cause of death was pulmonary edema or respiratory failure. In conclusion, early treatment with plasma exchange appeared to result in a better prognosis.

Micturitional disturbance in radiation myelopathy

Detailed micturitional histories and urodynamic studies were performed in five patients with radiation myelopathy. All patients had micturitional symptoms that were irritative in five and obstructive in four, and four had urinary incontinence. Urodynamic studies showed that three patients had residual urine of 158 ml on average. Cystometry showed that four patients had detrusor hyperreflexia and one had low compliance cystometrogram. External sphincter electromyography showed that four patients had detrusor-sphincter dyssynergia. These results indicated that micturitional disturbance seemed to be common and severe in storage as well as evacuation function. The main responsible sites of lesions seemed to be supranuclear parasympathetic and somatic nervous systems regulating the lower urinary tract. Two of three patients who underwent combination of steroid pulse therapy and hyperbaric oxygen therapy experienced improvement of micturitional disturbance and other neurological deficits.

Micturitional disturbance in multiple system atrophy

Detailed micturitional histories and urodynamic studies were conducted to investigate the micturitional disturbance in multiple system atrophy (MSA). Eighty-six patients with MSA comprised of 14 with striatonigral degeneration (SND), 42 with olivopontocerebellar atrophy (OPCA) and 30 with Shy-Drager syndrome (SDS). The results were as follows. Micturitional symptoms were noted in over 90% of patients with each type of MSA. Dominant symptoms were irritative ones in SND and OPCA, and a combination of irritative and obstructive ones in SDS. Micturitional symptoms in SDS appeared earlier than those in SND or OPCA. The degree of micturitional disturbance was severer in SDS than in SND or OPCA. Micturitional disturbance tended to become worse as the disease progressed. The responsible sites of lesions of micturitional disturbance seemed to be supra- as well as infranuclear lesions of the pelvic and pudendal nerves in MSA. Infranuclear lesions were more prominent in SDS than in SND or OPCA. Follow-up studies of some of the patients with SDS and OPCA suggested that the responsible sites of pelvic nerve lesions changed from supra- to infranuclear lesions during the course of disease.

[A case with severe neurological involvement due to vitamin B1 deficiency associated with megaduodenum]

We reported a case of 4-year-old boy with multiple vitamin deficiencies, especially vitamin B1 deficiency. He had megaduodenum associated with membranous stenosis on upper jejunum. He showed recurrent vomiting at his infantile period, and recently intermittent neurological symptoms. When he was admitted to our hospital, he could not walk and showed masked face, absent deep tendon reflexes, horizontal and vertical nystagmus, proximally dominant muscle weakness and multiple vitamin deficiencies. Oral administration of small doses of vitamin B1 (20 mg/day) could make remarkable clinical improvements. At three weeks after the treatment he could walk and run. Before the admission he had febrile convulsions and showed transiently striatal low density on CT image. We concluded that his neurological symptoms were due to vitamin B1 deficiency associated with megaduodenum. When a patient with intestinal anomaly shows neurological symptoms, we should think of vitamin deficiency.

Incidence of fundic gland polyps in patients without familial adenomatous polyposis

The incidence of fundic gland polyps was evaluated using a high-resolution videoendoscope. In 1388 upper gastrointestinal endoscopic studies, 26 cases of fundic gland polyps (1.9% of the studied cases) were found. None of these patients had evidence of familial adenomatous polyposis. Fifteen of these patients (58%) had a solitary polyp in the gastric body, most of which were small sessile polyps of less than 2 mm in diameter. The results of this study indicated that a small solitary fundic gland polyp is not a rare gastric lesion and that little relationship exists between these solitary fundic gland polyps and familial adenomatous polyposis.

Cytomegalovirus mononucleosis--associated gastric ulcers in normal host

A case of cytomegalovirus (CMV) mononucleosis associated with gastric ulcers is reported in a normal non-immunocompromised host. The demonstration of intranuclear inclusion bodies in a few gastric glandular epithelial cells contributed to the diagnosis of CMV gastritis. Extraction of DNA from the gastric biopsy specimens and the amplification of CMV-DNA by the polymerase chain reaction (PCR) showed the presence of CMV-DNA in the gastric mucosa. In situ hybridization with a probe derived from CMV genomic regions demonstrated the numerous glandular cells with CMV-DNA at the nuclear region. Treatment with a proton pump inhibitor to suppress gastric acid secretion was useful to mitigate the epigastralgia and to hasten the ulcer healing. The value of highly sensitive PCR and the in situ hybridization method to detect the CMV-DNA were emphasized for rapid and sensitive diagnosis of CMV gastritis.

Acinar cell carcinoma of the pancreas with elevated serum alpha-fetoprotein levels: a case report and a review of 28 cases reported in Japan

A 60-year-old male with elevated serum AFP levels is reported. Other tumor markers apart from AFP were normal. Serum AFP did not bind to Con A or Lentil-lectin by affinity chromatography. Abdominal ultrasonography, computed tomography and endoscopic retrograded cholangiopancreatography demonstrated a tumor extending from the body to the tail of the pancreas. The tumor was strongly suggested to be an acinar cell carcinoma of the pancreas, based on the histological findings of the resected specimen. The peroxidase-antiperoxidase method showed cancer cells to be positive for AFP. In Japan, only 27 cases of pancreatic cancer with elevated serum AFP level have been reported. This is the first Japanese case of pancreatic cancer in which the binding of serum AFP to lectins was investigated.