Inhibition of thyrotropin-induced adenosine 3'5'-monophosphate increase by immunoglobulins from patients with primary myxedema.

Immunoglobulin G (IgG) fractions prepared from the serum of 18 patients with primary myxedema, 9 patients with goitrous Hashimoto's thyroiditis, and 14 normal controls were tested for their ability to alter TSH stimulation of cAMP production in cultured human thyroid cells and the binding of TSH to its receptor. When compared with the cAMP increase induced by 0.1 mU/ml bovine TSH in the presence of normal IgG, cAMP accumulation was significantly inhibited (P less than 0.005) by the addition of IgG from patients with primary myxedema. TSH-induced cAMP accumulation was not affected by IgG from patients with goitrous thyroiditis. IgG from patients with primary myxedema also inhibited the cAMP increase induced by thyroid-stimulating immunoglobulins, but not against the increase induced by prostaglandin E1. None of the IgG tested affected the basal level of cAMP. Two potent inhibitory IgG were strongly positive for TSH-binding inhibitor immunoglobulins. Excluding these, no significant correlation was found between the thyroid stimulation-blocking activity and the TSH-binding inhibitory activity. These data suggest the presence of at least two different types of antibodies in primary myxedema which block adenylate cyclase stimulation by TSH and might be responsible for thyroid dysfunction and atrophy.

Action of chondroitinase ABC on epidurally transplanted nucleus pulposus in the rabbit.

STUDY DESIGN: After autotransplanting the nucleus pulposus into the epidural space of rabbits, chondroitinase ABC was administered, and the effect of chondroitinase ABC was examined. OBJECTIVES: To examine whether chondroitinase ABC accelerates resolution of the nucleus pulposus transplanted into the epidural space. SUMMARY OF BACKGROUND DATA: No previous reports exist on the effect of chondroitinase ABC on the nucleus pulposus in the epidural space. METHODS: In Study 1, autotransplantation of the nucleus pulposus into the epidural space was performed in rabbits. Histologic change was observed. In Study 2, dry weight, deoxyribonucleic acid content, and the amount of glycosaminoglycans of autotransplanted nucleus pulposus were quantified and compared with the respective values in the control group, chondroitinase-ABC-injected group, and phosphate-buffered saline-injected group. In Study 3, granulocytes obtained from the blood of a rabbit treated with chondroitinase ABC or phosphate-buffered saline were added to the nucleus pulposus taken from the same rabbit. RESULTS: In chondroitinase ABC group, inflammatory cells tended to infiltrate earlier than those in the control group (Study 1). The dry weight of recollected nucleus pulposus in the chondroitinase ABC group was significantly less than in the other groups. Deoxyribonucleic acid content in the nucleus pulposus tended to be larger in the chondroitinase ABC group, although no significant difference in content compared with that in the other groups was found. Regarding the residual glycosaminoglycans in the transplanted nucleus pulposus, the amount of chondroitin sulfate markedly decreased in the chondroitinase ABC group (Study 2). The number of granulocytes infiltrating the nucleus pulposus was distinctly large in the chondroitinase ABC group (Study 3). CONCLUSION: Chondroitinase ABC can enhance resolution of the nucleus pulposus in the epidural space.

Distraction rod instrumentation with posterolateral fusion in isthmic spondylolisthesis. 53 cases followed for 18-89 months.

Fifty-three cases of isthmic spondylolisthesis were treated with distraction rod instrumentation and posterolateral fusion with or without nerve root decompression, and they were followed for an average of 39 months. Thirty-one cases without neurologic deficit were treated with instrumentation and fusion only. In 22 cases of predominant sciatic pain with neurologic deficit signs, nerve root decompression and instrumentation with fusion were conducted. The results showed a 90.6% solid union rate with satisfactory clinical improvement. Realignment of the vertebral displacement such as reduction of olisthesis and widening of the olisthetic disc spaces was obtained to some extent. No serious complications were encountered.

Lymphatic drainage of epidural space in rabbits.

Epidural lymphatic drainage was examined using epidural catheterization and an infusion of india ink. The india ink was drained quickly through a connecting lymphatic vessel from the nerve root foramen to the anterior lumbar lymphatic vessels. Many kinds of epidurally administered agents may be drained in this manner.

Emergence of permanent teeth and onset of dental stages in Japanese children.

The purpose of the present cross-sectional study was to provide mean times of emergence of permanent teeth and onset of dental stages in Japanese children. A total of 1819 schoolchildren aged 6-15 yr were recorded. The results demonstrated specific sequences of emergence in the two arches and earlier emergence times in girls than in boys, both findings in keeping with investigations on other ethnic groups. Secular trend in tooth emergence was studied by comparing the results with data on Japanese children in 1934. The comparison revealed earlier mean times of emergence in general in contemporary Japanese.

[Computed tomography in lumbar degenerative disease].

We reported the 18 patients which underwent surgical exploration and reviewed these CT findings. Method. All CT scans were obtained on Somatom II, high resolution CT scanner, with the patient in the supine position. A lateral localizer image (Topogram) was used to select the appropriate intervertebral disk space. The slice thickness was 4 mm. Results. CT findings in lumbar degenerative diseases include bony canal stenosis (central canal stenosis, narrowed lateral recess), soft tissue abnormalities (herniated nucleus pulposus, bulging annulus, hypertrophy and/or ossification of ligamentum flavum, no delineation of nerve root in lateral recess), and spinal instability (spondylolisthesis, vacuum phenomenon). The above three factors contribute to narrowing of spinal canal. No delineation of nerve root or soft tissue replacement of epidural fat in lateral recess suggests that the nerve root may be compressed by some factors. Herniated nucleus pulposus may cause nerve root compression with or without canal stenosis. Conclusion. This study revealed that the CT findings correlated closely with the surgical findings and the site of nerve root compression could be determined.

[Family history and the frequency of human leukocyte antigen (HLA-DR) in centenarians].

There are a few reports that associate several loci of the human leukocyte antigen (HLA) with longevity, such as DR1 which is significantly frequent in the very old, especially in Okinawa centenarians. In contrast DR9 is decreased. This report investigates 87 healthy Okinawan centenarians and 148 healthy Okinawan controls examined since 1987 with HLA phenotyping and family history questionnaires. The mean age in centenarians was 101.6 years, and that of controls was 66.4. We inquired the age and the cause of death of the parents of the subjects. Subjects whose parent's deaths were by suicide, homicide, accident, war or due to war trauma, were excluded and only those resulting from illness or natural causes were included. The relation between age of death of parents and DR types were studied. Compared to controls, DR1 was significantly increased in the centenarians (p = 0.036, RR 4.239), and DR8 was decreased (p = 0.012, RR = 0.412). When the mean age of death of parents for each DR group and that of total was determined, the mean death age of those with DR9 was significantly lower than the mean of the total (p < 0.05). More over, when the frequency rate of the DR types were compared with the parents' death age, that of DR9 decreased as the age of death increased. It is suggested that some loci of HLA-DR relate to longevity and some genetic protection against immunorelated diseases contributes to long-lived lineage.

[Serum albumin level and activities of daily living in centenarians].

The relationship between serum albumin level and activities of daily living was studied in 95 centenarians. There were 73 women (12 rank J: free-living, 18 rank A: unable to go outside without help, 20 rank B: bedridden but able to sit on the bed, 23 rank C: completely bedridden) and 22 men (9 rank J, 7 rank A, 6 rank B or C). The serum albumin level (mean +/- S.D. 4.0 +/- 0.4 g/dl) of the rank J women was at the lower limit of normal for young adults. The albumin levels of rank A, rank B, and rank C were 3.7 +/- 0.4 g/dl, 3.5 +/- 0.3 g/dl, and 3.4 +/- 0.4 g/dl, respectively. The levels of rank B and rank C women were significantly lower than that of rank J women. The albumin level of rank J men (3.9 +/- 0.3 g/dl) was lower than that of young adults. The albumin level of ranks B and C men (3.1 +/- 0.3 g/dl) was significantly lower than that of rank J men. The A/G ratio or albumin fraction (%) measured by serum electrophoresis was similar to that of the serum albumin level of centenarians of both sexes. There were no significant differences in the serum protein level or in the peripheral hemoglobin level between rank J centenarians and those of other ranks, for both sexes. The serum albumin level is a valuable indicator of the ability to perform activities of daily living and may be a useful prognostic index in centenarians.

[Serum globulin levels and activities of daily living in centenarians].

Serum globulin levels in 101 centenarians (77 women, 24 men) were analyzed by zonal electrophoresis and immunoglobulin assays. Six subjects showed an M band in electrophoretograms. Five M bands were immunoglobulin G (IgG) type and one was IgA. One subject was suspected to suffer from IgG-type multiple myeloma, and the others were thought to have essential (benign) monoclonal gammopathy. The relationship between serum globulin levels and activities of daily living (ADL) was studied in remaining 95 subjects. There were 21 rank-J (free-living), 25 rank-A (unable to go outside without help), 23 rank-B (bedridden but able to sit on the bed), and 26 rank-C (completely bedridden) centenarians. The mean serum alpha 1-, alpha 2-, and beta-globulin level in the rank-J centenarians was at the upper limit of the normal adult range. The mean alpha 1-globulin levels in rank-B (3.3 +/- 0.4%) and C (3.4 +/- 0.5%) subjects were significantly higher than those in rank-J (2.9 +/- 0.3%) centenarians. The mean serum gamma-globulin level of rank-J centenarians (16.9 +/- 3.7%) was within the normal range. The mean gamma-globulin levels in rank-B (21.0 +/- 2.7%) and C (22.8 +/- 4.9%) subjects were significantly higher than that in rank-J centenarians. The mean immunoglobulin G concentrations in rank-B (1.620 +/- 304 mg/dl) and C (1.720 +/- 392 mg/dl) subjects were significantly higher than those in rank-J centenarians (1.320 +/- 361 mg/dl) and in normal adults (1.150 +/- 235 mg/dl). IgA concentrations in all centenarians were higher than in normal controls. There was no significant difference in IgA or IgM concentration between rank-J subjects and those in other ranks. Serum globulin levels measured with electrophoresis, and the immunoglobulin concentrations, can be valuable indicators of the ability to perform activities of daily living, and may be useful predictors of subclinical diseases or morbidity in centenarians.