Ataxic vs painful form of paraneoplastic neuropathy

OBJECTIVE

To characterize the clinicopathologic features of ataxic and painful forms of paraneoplastic neuropathy.

METHODS

Clinical, electrophysiologic, and histopathologic findings were assessed in 17 patients with paraneoplastic neuropathy.

RESULTS

Clinical features can be categorized into two groups: one group (13 patients) with predominantly deep sensory disturbance and a second group (4 patients) with predominantly superficial sensory disturbance. The former group showed severe sensory ataxia and predominantly large myelinated fiber loss in the sural nerve. The latter group showed marked pain, in particular, severe mechanical hyperalgesia, and predominantly small myelinated and unmyelinated fiber loss. Nerve conduction assessment indicated an axonal neuropathy pattern in both groups, while sensory action potentials were more markedly diminished in the sensory ataxic form. Anti-Hu antibodies were detected in half of the patients in both groups. Treatment for cancer was effective to improve or stabilize neuropathic symptoms in some cases from both groups. Immunotherapy was effective only for a short time.

CONCLUSIONS

Paraneoplastic neuropathy can be characterized into two groups by the presence of sensory ataxia or severe spontaneous pain and severe mechanical hyperalgesia. Preferential small myelinated and unmyelinated fiber loss correlated to the cases of severe pain.

Production of large multienzyme complex by aerobic thermophilic fungus Chaetomium sp. nov. MS-017 grown on palm oil mill fibre

AIMS

A novel xylanolytic multienzyme complex of the aerobic thermophilic fungus Chaetomium sp. nov. MS-017 was produced on palm oil mill fibre (POMF) and partially characterized.

METHODS AND RESULTS

The assay of the extracellular enzymes of Chaetomium sp. nov. MS-017 on POMF in solid-state fermentation revealed cellulolytic, pectinolytic and extremely high xylanolytic activities. The protein was purified by Sephadex G-200 column chromatography. The SDS-PAGE demonstrated that the purified protein is a complex with at least five xylanolytic, four cellulolytic and eight pectinolytic components. The characterization of the complex at various temperatures showed that the reactivity and stability of the complex are not lost up to 60 degrees C. In addition, the complex was very stable in a wide range of pH (3-9) and at high concentrations (10 mm) of cations and EDTA. The major products of xylan hydrolysis by the purified complex were determined to be xylobiose and xylotriose by thin-layer chromatography.

CONCLUSION

Chaetomium sp. nov. MS-017 preferentially produces a xylanolytic multienzyme complex on POMF in solid-state fermentation.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report on the xylanolytic multienzyme complex produced by an aerobic thermophilic fungus.

Isolation of a novel thermophilic fungus Chaetomium sp. nov. MS-017 and description of its palm-oil mill fiber-decomposing properties

Palm-oil mill fiber (POMF) is a fibrous, natural hard material discharged in enormous amounts from palm-oil mills in tropical plantations; therefore, research to find microorganisms that decompose POMF was conducted. As the result of screening, a new thermophilic fungus, Chaetomium sp. nov. MS-017, exhibiting rapid growth on POMF was isolated from rotted wood. Based on partial characterization of the decomposition of POMF, it was shown that MS-017 preferentially assimilates polysaccharides, especially hemicelluloses such as xylan. A preliminary composting study indicated that MS-017 produced 855 g of decomposed product from 1,000 g of intact POMF in 12 days under optimized solid-culture conditions. The decomposition rate of POMF was 23% (w/w), and the cell yield calculated from consumed POMF was as high as 36% (w/w). These results indicate that MS-017 has a very high potential to decompose POMF and that it is suitable for economical production of compost to recycle by-product biomass from oil-palm plantations.

Effects of thyroid hormone deficiency on electrocardiogram findings of congenitally hypothyroid neonates

Hypothyroid status is believed to cause various metabolic changes in infants. However, it is interesting that even severely hypothyroid neonates, detected during mass neonatal screening, rarely show bradycardia, hypothermia, or inactivity. To study cardiac functions of screen-detected neonates with congenital hypothyroidism (CH), we recorded the electrocardiograms (ECG) of 53 screen-detected CH neonates before levothyroxine (LT4) replacement therapy, and 15 age-matched normal neonates for controls. The 53 CH neonates were divided into two groups according to initial serum thyroid hormone levels: a mildly hypothyroid group (n = 37), serum thyroid-stimulating hormone (TSH) less than 100 microIU/mL and free thyroxine (FT4) 0.6 ng/dl or more; and a severely hypothyroid group (n = 16), TSH 100 microIU/mL or more and FT4 less than 0.6 ng/dL. TSH, FT4, and other blood chemicals were measured on an autoanalyzer (Hitachi 7170). After blood sampling, the ECG was recorded during induced sleep by oral administration of triclofos sodium syrup. ECG parameters, including HR, PR, QRS, QT time and corrected QT time (QTc) were automatically obtained, using an auto-ECG analyzing system. The following results were obtained. No CH patients showed abnormal ECG findings. There was no significant difference of the mean heart rates (HRs) between the mildly hypothyroid (147.5 +/- 16.3 beats per minute) and the control group (148.3 +/- 12.1 beats per minute). The mean HR in the severely hypothyroid group (134.0 +/- 17.9 beats per minute, p = 0.007) was significantly low compared with the normal control group. However, all values were within normal ranges. QTc in the severely hypothyroid group (0.414 +/- 0.015, p = 0.033) was significantly shorter than in the control group (0.440 +/- 0.052). No statistical differences of PR, QRS, and QT time were noted among the three groups. All ECG parameters were within normal ranges. HR positively correlated with FT4 and log (FT4), and negatively with TSH and log (TSH). From these results we conclude that the deficiency of thyroid hormones does not affect ECG findings of congenitally hypothyroid neonates. This may be consistent with the unexpectedly mild signs and symptoms of screen-detected hypothyroid neonates.

Infant case with a malignant form of Brugada syndrome

We report a 6-month-old Japanese infant with a malignant form of Brugada syndrome, who had frequent episodes of ventricular fibrillation (VF) and nonsustained polymorphic ventricular tachycardia (VT). To the best of our knowledge, this infant is the youngest patient reported to have Brugada syndrome. Continuous infusion of a beta-adrenergic agonist and intravenous injection of a parasympathetic antagonist suppressed the electrical storm of polymorphic VT and VF. Combined oral administration of a beta1-adrenergic agonist, a parasympathetic antagonist, and quinidine has successfully suppressed recurrences of VT or VF for 6 months, and the combination may have the potential to decrease the incidence of VT or VF as an adjunctive therapy with prophylactic placement of an implantable cardioverter defibrillator.

Dialysis-related spinal canal stenosis: a clinicopathological study on amyloid deposition and its AGE modification

Three cases operated for spinal canal stenosis induced by dialysis-related amyloidosis (DRA) were investigated clinicopathologically. Cases were all-male, and had undergone hemodialysis around 20 years. In two cases, cervical plain X-rays showed only minor spondylotic changes. However, magnetic resonance imaging (MRI), myelography, and computed tomography (CT) showed extradural thickness with compression on the cervical spinal cord and cauda equina. In one case cervical X-rays showed typical destructive spondyloarthropathy (DSA), and MRI showed compression myelopathy. Surgical treatment on both cervical and lumbar spine in two cases and on cervical spine only in one case successfully reduced the symptoms. Extradural thickened tissue and ligament flavum obtained during surgery were studied histopathologically and immunostained by using anti-CD68, anti-beta2-microglobulin (beta2m), and anti-advanced glycation end product (AGE) antibody. Congo red stain showed diffuse or nodular amyloid deposition, and immunostaining with anti-beta2m and anti-AGE antibodies also demonstrated the same distribution pattern. Thus, beta2m-positive amyloid tissue in the extradural thickness (extradural amyloid deposition) was immunohistochemically demonstrated to be modified with AGE. Inflammatory reaction with histiocytic and giant cell infiltration was also shown around the amyloid tissues. There were CD68-positive cells, and some cells were positive for AGE and beta2m. These findings suggest that beta2m accumulation and inflammatory reaction finally promote destruction of connective tissues. MRI, CT and/or myelography are necessary for diagnosing spinal canal stenosis accompanied by DRA. In conclusion, we propose a more comprehensive concept of dialysis-related spinal canal stenosis, which includes both DSA and myeloradiculopathy induced by extradural thickness.

Influence of emission from rice straw burning on bronchial asthma in children

BACKGROUND

Emission from rice straw burning (ERSB) is observed everywhere after harvest of rice in Niigata Prefecture every year. Pediatricians and many guardians in this district have had the impression that ERSB may induce asthma attack. Recent studies have suggested that particulate air pollution plays a role in the exacerbation of asthma. The authors investigated relationship of ERSB to asthma attack in children.

METHODS

A questionnaire on rice straw burning (RSB) was circulated to guardians and pediatric institutions. Change in the monthly number of children with asthma attack (CAA) for 5 years from January 1994 to December 1998 was investigated. In addition, change in the number of CAA from the meteorologic conditions and RSB was investigated from the fourth week of August to the third week of September in 1996, 1997 and 1998. Challenge test exposure to ERSB was tried on a volunteer adult with chronic asthma. The situation of air pollution was examined by measuring suspended particulate matter (PM10). The relationship between PM10 and the number of CAA was studied.

RESULTS

A majority of the guardians had the impression that ERSB induces asthma attack. Pediatricians replied similarly to the questionnaire. The number of CAA visiting our emergency room and admitted to our ward increased in the season of RSB. The PM10 had a significant correlation with the number of CAA. It was suggested that the increase in CAA may be not due to the meteorologic conditions, but to the influence of ERSB.

CONCLUSION

The ERSB has made an issue of air pollution. Furthermore, the possibility that ERSB induces or exacerbates asthma attack has become clear in the present study. Therefore, it is recommended that RSB should be abolished for the health of inhabitants, especially children with asthma.

Sympathetic skin response in diabetic children: do diabetic children have diabetic neuropathy?

BACKGROUND

Abnormal sympathetic skin response (SSR) has been reported in adult patients with diabetic neuropathy. In addition, other studies have revealed abnormal SSR in diabetic patients not having autonomic symptoms and autonomic dysfunctions. These findings have been only obtained from adult patients. There have been few reports on the autonomic functions in diabetic children. Accordingly, it is not clear whether the autonomic neuropathy occurs in diabetic children. The aim of the present study is to clear autonomic function in children with insulin-dependent diabetes mellitus by SSR.

METHODS

The SSR was measured in 28 normal healthy children and in eight patients with IDDM not having symptoms of dysautonomia. The SSR was elicited using 10 stimuli on programmed Nihonkoden Neuropack Sigma model machine. Following a single electrical stimulation, four SSR were recorded in both the palms and the soles simultaneously.

RESULTS

The SSR were simultaneously obtained in 100% of the two groups. The amplitudes in the palms and soles were not significantly different between the two groups. The mean and shortest latency in the soles were significantly longer in the IDDM group than in the control group (P < 0.01). None of the measurements of SSR revealed correlation with duration of diabetes and onset of illness.

CONCLUSIONS

Diabetic neuropathy may not have occurred in young patients having shorter duration of illness. Conversely, assuming that prolonged latency is abnormal, it may even have occurred in them. Follow up on these patients with prolonged latencies would be required.

Contingent negative variation in children with anorexia nervosa

BACKGROUND

Central catecholamines, particularly dopaminergic and noradrenergic systems, have affected the appetitive behavior in patients with anorexia nervosa (AN). The purpose of this study is to distinguish the characteristics of contingent negative variation (CNV) and postimperative negative variation (PINV), which may reflect the level of catecholamine in children with AN.

METHODS

Eight children with AN aged 10 to 15 years and 23 age-matched healthy children were recruited. Contingent negative variation was recorded from the frontal midline (Fz), central midline (Cz) and parietal midline (Pz) referenced to linked earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval of 2 s and an intertrial interval of 10 s. The imperative stimulus of each trial required a button press.

RESULTS

Children with AN had a diminished amplitude of the CNV. They had a significantly more attenuated early CNV and late CNV amplitude at Cz than normal children. No significant differences were observed between AN children and normal children in the amplitude of PINV at all three electrode sites. No difference could be found between the two groups in the frequencies of normal and abnormal duration of PINV.

CONCLUSION

These findings suggest that early CNV may be diminished by norepinephrine deficiency and late CNV may be attenuated by dopaminergic deficiency in children with AN. Reduced CNV may represent impaired cognitive processes which reflect impaired appetitive behavior in AN children.

Evidence for direct binding of intracellularly distributed ganglioside GM2 to isolated vimentin intermediate filaments in normal and Tay-Sachs disease human fibroblasts

Although some intracellularly distributed glycosphingolipids are reported to be associated with vimentin intermediate filaments or colchicine sensitive cytoskeleton, no direct evidence for such an association has yet been shown. In this report we demonstrated that the intracellularly distributed ganglioside GM2 directly binds to isolated vimentin intermediate filaments in normal and Tay-Sachs disease human fibroblasts. Indirect immunofluorescence microscopy using a GM2-specific monoclonal antibody demonstrated filamentously distributed GM2 in the cytoplasm. A double staining of Tay-Sachs fibroblasts with anti-GM2 and anti-vimentin monoclonal antibodies strongly suggested that the GM2 positive filaments are vimentin intermediate filaments. We then isolated vimentin, in the presence of a detergent and urea, from the normal human skin fibroblasts and murine mastocytoma cells. In a solid phase enzyme-linked immunosorbent assay, the isolated vimentin dose-dependently reacted with both anti-vimentin and anti-GM2 monoclonal antibodies but not with anti-GM3 or anti-GM1 monoclonal antibody. The molar ratio of GM2 to vimentin was approximately 20:1. The lipid fraction extracted from the purified vimentin preparation was immunostained with anti-GM2 on a thin-layer chromatography plate. Furthermore, only one band was detected at the molecular weight of 57 kDa, after electroblotting and simultaneous immunostaining with anti-GM2 and anti-vimentin monoclonal antibodies. These results clearly indicated that ganglioside GM2 directly binds to vimentin.

[Neurological sequelae caused by surgical procedures during adenoidectomy under anesthesia]

A five-year old boy with good risk was anesthetized with nitrous-oxide and halothane under orotracheal intubation for adenoidectomy and tubing of bilateral middle-ear cavities. Patient was on supine position with extension of neck. A mouth-gag was applied and the pharynx was packed with gauze. After long unskilled surgical procedures, severe neurological complications which were initiated with severe arrhythmias and followed by signs of paralysis of bilateral IX, X, XI, XII cranial nerves at their nuclei in medulla oblongata, were observed during the post-anesthetic period. The patient was saved with neurological sequelae of the cranial nerves and is alive after 6 years from the incident. The causes of this complications were discussed.

[A case of malignant lymphoma of the uterine cervix]

The case of an 85-year-old woman with a malignant lymphoma of the uterine cervix is reported, and the pertinent literature is reviewed. The patient was found to have vaginal bleeding and abnormal cytological smears. According to the Working Formulation, the histological diagnosis was a malignant lymphoma with diffuse, small, cleaved cells. As her condition was determined as being in FIGO's Stage I b, the patient was only given a hysterectomy, and she remains in complete remission 1 year after the initial diagnosis. This is the 21st reported case in Japan of a primary malignant lymphoma in the uterus. Such patients typically present vaginal bleeding and a cervical cytological examination is reliable way to achieve a diagnosis. From the small number of reports that exist, it appears that radiation therapy is proper curative method of procedure as some Stage I b patients who underwent surgery were found to have positive nodes.

[A case of Becker type congenital myotonia with myalgia]

We reported a case of Becker type congenital myotonia with myalgia. A 28 year-old woman admitted to our hospital because of right anterior chest pain and back pain. She was diagnosed as myotonic dystrophy by other university hospital when she was 16 years old. Physical examination revealed only myotonia and could not find muscle atrophy or cataracta which were usually found in myotonic dystrophy. The quadriceps muscle biopsy revealed complete absence of type IIB muscle fiber. We diagnosed her Becker type congenital myotonia by the clinical course and family history and the histopathological findings of quadriceps muscle. Myalgia which she complained seemed to have some connection with this disease. But we could not prove the pathogenesis of this myalgia.

[Venous pressure in the vertebral venous plexus and its role in cauda equina claudication]

The venous pressure in the ascending lumbar vein was measured by catheter and pressure transducer to document venous stasis in degenerative lumbar spinal canal stenosis. Measurement of the pressure in the ascending lumbar vein at rest revealed a progressive rise of the mean pressure from the control group to the lumbar intervertebral disc herniation group, and the lumbar spinal canal stenosis (LSCS) group in ascending order. Pressure curve tracings showed a plateau accompanying increased abdominal pressure during the Valsalva maneuver. Phase 3 was defined as the recovery period of decreasing pressure which began with the release of abdominal compression and terminated with the return to the initial pressure. The duration of phase 3 was prolonged in LSCS (p less than 0.01). It followed that the prolonged phase 3 documented the existence of venous stasis and its extent in LSCS. It is conceivable that increased venous pressure in the lumbar vertebral venous plexus participates in the pathogenesis of cauda equina claudication in LSCS.

A study of the clinical usefulness of dobutamine administered orally

Dobutamine 300 mg was administered orally to both healthy volunteers and to patients with circulatory failure. After the 300 mg dose of dobutamine, subjects were found to have a higher concentration of the drug in their plasma than the effective levels of 37.5 (SD 2.9) ng/ml (n = 5) normally seen during intravenous infusion of the clinically effective (5 micrograms/kg/min) dose. This increased concentration waned within 90 minutes. A clinical effect of dobutamine on the circulation was observed in both the healthy volunteers and the patients. An increase in the cardiac index of the patients continued longer than 90 minutes. An unidentified substance was noticed on chromatography measuring plasma dobutamine concentrations, which may have contributed to the increased cardiac index, although its chemical formula could not be determined. The results suggest that the oral administration of dobutamine may be expected to have a long-lasting and significant therapeutic effect on patients with chronic circulatory failure.

The molecular phylogenic tree of the genus Trichinella constructed from isozyme patterns

Six zymograms were compared for extracts of muscle-stage larvae of the seven Trichinella isolates, using isoelectric focusing in polyacrylamide gels. The isozyme patterns of acid phosphatase among them fell into four types. T. pseudospiralis from a raccoon and the Polar strain from a polar bear formed type 1 and type 2, respectively. The Iwasaki strain from a Japanese black bear and the Yamagata strain from a raccoon dog, both from Japan, were type 3. Type 4 consisted of three remaining strains, viz. the Polish strain from a wild pig, the USA strain from a pig, and the Thai strain from a human case, all of which have similar infectivity to pigs. The isozyme patterns of esterase 1, beta-N-acetylglucosaminidase, and peptidase were similar in types 2 and 3. Those of esterase D were common to types 2-4 but not to type 1. In the zymogram of mannosephosphate isomerase, types 2-4 but not type 1 had one common band, whereas in the other bands type 2 was markedly distinguished from types 3 and 4. In the present study, the molecular phylogenic tree was constructed for the first time on the basis of our present and previous electrophoretic data by the use of cluster analysis, and the evolutionary process was considered as follows: T. pseudospiralis (type 1) and T. spiralis (the common ancestor of types 2-4) were initially separated. Next, the common ancestor of the strains from wild carnivores (types 2 and 3) and type 4 were separated. Finally, the Polar strain (type 2) and the Japanese strain (type 3) were separated.

Early development of four Diphyllobothrium species in the final host

The early development of four Diphyllobothrium species, D. latum, D. dendriticum, D. ditremum, and D. vogeli, are described. D. latum sheds the entire larval body easily and shows a high shedding rate of 82.1% on average. On the other hand, D. dendriticum exhibits a different developmental pattern, with a low shedding rate of 8.7% in the hamster and a high shedding rate of 34.9% in the rat. D. ditremum is difficult to recover from hamsters but shows a high shedding rate of 42.9%. D. vogeli shows a constant recovery rate of 38.3% without shedding. The species specificity of these four diphyllobothriids is discussed briefly in relation to the early developmental pattern and the growth rate.

[Efficacy of paromomycin sulfate in the elimination of Diphyllobothrium species and Taenia saginata in clinical cases]

Recently it has been known that paromomycin sulfate had marked anthelmintic activity against some species of tapeworms. In this investigation, paromomycin sulfate was used for treating 6 cases of diphyllobothriasis and 1 case of Taenia saginata infection. Paromomycin sulfate was administered orally in a single dose or 2 divided doses of 40--60 mg/kg, being followed by a purge about 1.5 hours later. Strobila or fragments of proglottids were expelled from 5 cases, of which only 1 scolex was found in a case of infection with marine species of Diphyllobothrium. In 1 case of diphyllobothriasis no worm or worm-fragment was found in the stool even after the second challenge of treatment. Nevertheless follow-up examination for more than 1 month showed no evidence of remaining infection in all cases. Transient dizziness was observed in only 1 case, disappearing within about 30 minutes. Serum- and urine-examinations detected no abnormal signs in all cases excepting 1 case of diphyllobothriasis with suspected hepatitis. It was concluded that paromomycin sulfate is effective therapeutic agent for the treatment of taeniasis and diphyllobothriasis including marine species.

Neuromuscular effects of i.a. infusion of lignocaine in man

Neuromuscular effects of lignocaine during and after i.a. infusion were studied in healthy adult patients, using evoked electromyography. Supramaximal, paired stimuli were applied to the ulnar nerve with variable intervals between the two stimuli. The amplitude of the hypothenar muscle action potential to the second component of the paired stimulus (test response) was compared with that evoked by the first component (conditioning response). During and after i.a. infusion of lignocaine, there were marked decreases of the test response at intervals from 7 to 100 ms after the conditioning stimulus, although the decreases of the conditioning response were slight or negligible. The finding of decreased test responses coincided with the results obtained with tetanic stimulation such as pronounced fade and only slight post-tetanic potentiation. Differences between these findings and those found with muscle relaxants were compared, and it was concluded that the mechanism responsible for these results might be attributed to an effect of lignocaine on the motor nerve terminal.

An electromyographic study of muscle relaxants in man

Supramaximal paired stimuli were applied to the ulnar nerve, and the amplitude of the muscle action potential evoked in the abductor digiti minimi by the second member of the stimulus pair (test response) was compared with that evoked by the first component (conditioning response). The interval between the two components of the stimulus pair (the pair interval) was increased stepwise from 7 to 100 msec and a curve (recovery curve) was obtained by relating the changes in pair interval to the difference in amplitude of the test and conditioning responses. Alterations of the recovery curve (RC) during partial paralysis by muscle relaxants were investigated in healthy adult patients under the lightest plane of general anaesthesia. The control curve obtained in 32 subjects before the administration of a muscle relaxant drug was characterized by slight depressions at very short intervals of paired stimuli, followed by a slight potentiation at 20-100 msec. With non-depolarizing relaxants, RC altered to the characteristic pattern of potentiation at very short intervals of stimuli, followed by a notable depression at longer intervals. In depolarizing blocks with small doses of suxamethonium, the depression of RC at short intervals in the control was enhanced and the pattern of RC was different from that of non-depolarizing agents. When desensitization blocks were instigated by the i.v. administration of suxamethonium, the RC patterns were similar to those of competitive agents.