Prevalence of GORD (gastro-oesophageal reflux disease) in Type 2 diabetes and a comparison of clinical profiles between diabetic patients with and without GORD.

AIMS: To examine the incidence of gastro-oesophageal reflux disease (GORD) and its associated factors in patients with Type 2 diabetes mellitus (Type 2 DM). METHODS: In 859 Type 2 DM outpatients, we conducted a QUEST inquiry and considered those showing a QUEST score of 4 or higher as having GORD. We surveyed clinical variables (physical findings, gender, age, duration of disease, glycated haemoglobin (HbA(1c)), type of oral glucose-lowering agent, presence or absence of insulin therapy, complications, and presence or absence of agents that may be associated with GORD [Ca channel blocker (CCB) anti-platelet agents]) to investigate their association with the onset of GORD. RESULTS: We analysed 813 subjects, of whom 56.6% were male. The mean age was 63.7 +/- 11.3 years and HbA(1c) 7.2 +/- 1.2%. The incidence of GORD was 29.0% (n = 221). GORD was positively correlated with body weight, body mass index (BMI) and HbA(1c). It was negatively correlated with age, serum creatinine and proportion of patients treated with pioglitazone or CCB. In addition, GORD was more common in females. The incidence of GORD was significantly higher in younger patients. CONCLUSIONS: Previous studies have suggested a relationship of GORD with pioglitazone/CCB. However, the results of this study do not support this; these agents may not induce GORD.

Interaction of triazolam with desipramine. Effects of single and repeated treatment on certain pharmacologic responses and brain catecholamine levels.

The present study was undertaken to evaluate the effects of single and repeated doses of triazolam (1 mg/kg IP) and desipramine (DMI) (10 mg/kg IP) alone and in combination on certain pharmacologic responses and brain catecholamine levels in rats. The significant findings were: (1) triazolam and DMI given alone and in combination were synergistic with pentobarbital (PB) hypnosis; (2) repeated treatment with DMI alone repressed body weight gain; triazolam potentiated this anorectic effect; (3) triazolam induced muscle relaxation acutely, but was not affected by concomitant DMI treatment; and (4) triazolam and DMI given in combination produced hypothermia although the drugs given separately did not. Development of tolerance to hypothermia and to anorectic effects produced by triazolam and DMI significantly decreased norepinephrine (NE) levels in the hypothalamus as compared to the repeated treatment with triazolam, and significantly increased NE and dopamine (DA) levels in the striatum and DA levels in the cortex, as compared to the single treatments.

Impaired verbal description ability assessed by the Picture Description Task in Alzheimer's disease.

The language of patients with Alzheimer's disease (AD) is globally non-informative and characterized by selective impairment of lexical-semantic processing as compared with a relative sparing of syntactic and phonological aspects. Verbal picture description is one of the most sensitive tests for detecting language disorders in AD. We assessed verbal description ability in AD and investigated its relation to regional cerebral blood flow (CBF). In part I of the study, 23 AD patients and 17 age-matched normal subjects performed the Picture Description Task, which yields six variables: (1) the amount of information, (2) the number of constituent parts of the picture, (3) the number of relevant and irrelevant descriptions, (4) efficiency of description, (5) appropriateness, and (6) sentence structure. In the study, variables 1, 3 and 4 were analyzed. In part II of the study, regional CBF of 14 of the above AD patients was measured using N-isopropyl-p-[(123)I]iodoamphetamine and single photon emission CT. In part I, there were significant difference between the groups for variables 1 and 4. In part II, there were significant correlations between variable 1 and rCBF in the bilateral occipital lobes and left thalamus. Variables 1 and 4 were useful in discriminating between AD patients and controls. Variable 1 was suggested to be related to the function of the left thalamus and the bilateral visual cortex.

A patient with improvement in short-term memory disturbance brought about by radiation therapy for germinoma involving Papez circuit.

A 27-year-old male presented with memory loss. With magnetic resonance imaging (MRI), enhanced masses on the right side of hypothalamus, right side of anterior basal ganglia, and left side of hypothalamus were found. Histological analysis of the tumor by stereotactic biopsy proved it to be a germinoma. When related to the map of the thalamic nuclei, the tumor involved anterior column of the fornix and anterior nuclei of the thalamus. Neuropsychological tests prior to radiation therapy disclosed only short-term memory disturbance. The patient received radiation therapy to a total dose of 55 Gy to the primary lesion. After the completion of radiation therapy, the enhanced effect disappeared on gadolinium enhanced T1-weighted MRI. Single photon emission computed tomography indicated improvement in blood flow in the anterior portion of the bilateral thalami. Neuropsychological tests after radiation therapy showed improvement in short-term memory compared with baseline. Test results have remained stable for two and half years. This case indicates the possibility of improvement in memory function by treatment for tumor when it involves part of Papez circuit. Nevertheless, a decrease in intellectual ability by irradiation remains the major problem. Better approaches not only for cure but also to reduce the late effects should be undertaken when radiation therapy is the treatment of choice.

[Clinical evaluation of cefmenoxime in internal medicine, with special reference to infections associated with hematological disorders].

Clinical evaluation of cefmenoxime (CMX, Bestcall) was examined in the infection associated with hematological disorders, respiratory tract and other disorders. Clinical effectiveness for severe infection of hematological disorders was 47.4% in good and 84.2% in fair response, however, in the respiratory tract infections, 89.7% in good response was obtained. Opportunistic infection due to Gram-negative bacilli are often experienced in patients with hematological disorders. It was discussed that CMX would be a good therapeutic agent against infectious diseases associated with hematological disorders because it's antibacterial spectrum would be parallel to pathogens of such disorders.

Morphological changes in osteoblastic cells (MC3T3-E1) due to fluid shear stress: cellular damage by prolonged application of fluid shear stress.

We investigated the effect of fluid shear stress on both changes in morphology and in resting level of cytosolic concentrations of Ca2+ ([Ca2+]i) in MC3T3-E1 cells, osteoblast-like cells derived from the neonatal mouse calvaria. The cells were subjected to fluid shear stress at about 1.0 Pa. Morphological characteristics were compared between stressed and control cells by scanning electron microscopic examination, actin filament evaluation using phalloidin fluorescence and [Ca2+]i measurement using fura-2/AM. The stressed cells changed from a polygonal to a spindle shape after 1-hour exposure to fluid shear stress, whereas control cells remained polygonal, and the stressed cells exhibited an increase in the number of microvilli. The diameter in the long axis of the stressed cells was significantly larger than that of controls, and about half of the stressed cells were oriented nearly along the direction of the fluid shear stress. The arrangement of the actin filaments of the stressed cells changed to parallel, and was positioned along the long axis of the cell process. The resting level of [Ca2+]i in the stressed cells showed a peak at 1 hour after the application of the stress. A more prolonged stress period over 1 hour caused cell shrinkage, an irregularity on the cell surface, and a gradual decrease in the resting level of [Ca2+]i, suggesting that prolonged stress time may cause cellular damage.

A new microwave device for rapid thermal fixation of the murine brain.

A microwave applicator was developed to provide rapid thermal fixation of enzymes in the murine brain. Although the power output of the device is only 1.3 kW, whole-brain levels of acetyicholine after microwave fixation are comparable to those observed at a power output of 5 kW, and are markedly higher than those obtained by a conventional method (freezing) of fixation.

Simple method for the determination of choline and acetylcholine by prolysis gas chromatography.

An improved purification procedure is described for the simultaneous assay of endogenous choline and acetylcholine by pyrolysis gas chromatography, particularly for providing a simple and effective method for propionylation of choline in the presence of acetylcholine. The reaction was carried out in acetonitrile solution prepared by dissolving the evaporated residue of the supernatant of brain homogenate. Thus samples for propionylation were prepared without the use of ion-exchange chromatography.

Hemispatial visual-searching impairment correlated with decreased contralateral parietal blood flow in Alzheimer disease.

BACKGROUND: Impairment of visuospatial attention in Alzheimer disease (AD) has not been fully investigated. Mendez et al reported that patients with AD showed hemispatial biases on visual search tasks. Parietal lobe involvement might be related to such impairment. The Picture Description Task is one of the most sensitive tests for detecting language disorders and might be also useful in assessing visual search. OBJECTIVE: The applicability of the Picture Description Task for evaluating hemispatial visual search impairment of AD was investigated, as well as whether the hemispheric difference in parietal blood flow is related to such impairment. METHODS: Thirty-four patients with AD and age-matched 16 normal subjects performed the Picture Description Task. The elements of the picture were divided into three portions: the right portions (five elements), the central portions (two elements), and the left portions (five elements), so as to assess the patients' hemispatial visual searching ability. Using single photon emission CT, the absolute regional cerebral blood flow (CBF) values at resting condition were calculated by the method of Kuhl et al. RESULTS: Fourteen patients with AD showed a decreased number of elements pointed out in the left portion of the picture, whereas 12 patients had decreased attention in the right portion. The remaining eight pointed only to the central portion. None of them showed hemispatial neglect on the figure copying tasks. The patients with decreased left spatial attention had lower CBF in the right parietal lobe, and vice versa. A significant negative (biologically meaningful) Spearman correlation was found between the right-left indices of the elements pointed out in the picture and the CBF values. CONCLUSIONS: The results suggest that the Picture Description Task is useful for assessing visual search, and impaired hemispatial visual search in AD is related to decreased contralateral parietal blood flow. The right-left asymmetry of the parietal CBF might be associated with hemispatial visual attention impairments in AD.

Postural and gait disturbance correlated with decreased frontal cerebral blood flow in Alzheimer disease.

In a group of 45 patients with Alzheimer disease (AD) and 15 control subjects, we studied the relationship between parameters showing postural and gait disturbance and regional cerebral blood flow (rCBF) measured with N-isopropyl-p-[123I]iodoam-phetamine single photon emission computed tomography at different clinical stages. Patients with AD with mild dementia exhibited only increased postural sway associated with a reduced mean value of rCBF in the cortex. At a moderate stage, the reduced mean values of rCBF in the cortex and in the frontal lobe were associated with increased postural sway and stride length variability and with decreased stride length. At a severe stage, reduced rCBF in the basal ganglia and in the frontal lobe additionally were associated with increased postural sway, double support time, and stride length variability, and with decreased walking speed and stride length. In multiple regression analysis, there was a high contribution by rCBF in the frontal lobe to account for postural and gait disturbance in AD. We propose that impaired frontal lobe circulation is an important factor causing postural and gait disturbance as AD progresses.

HLA and Japanese MS.

Determination of HLA-A, -B and -C types in 43 Japanese patients with multiple sclerosis (MS) and of DR type in 25 MS patients was carried out using antisera from the 7th International Histocompatibility Workshop. The results were compared with 46 controls typed simultaneously. Twenty-three patients were also tested for HLA-Dw2. The conclusions were: 1) There were no significantly higher occurrences of HLA-A3, B7, Dw2 or DRw2 in Japanese MS. 2) Japanese MS might nevertheless be associated with the human major histocompatibility complex, because HLA-B40 was significantly less frequent in MS and two anti HLA-DRw sera, 7w008 and 034, reacted positively more often against lymphocytes from MS patients.

[MR imaging of cerebral palsy].

We evaluated 35 patients with cerebral palsy on the basis of MR imaging findings in the brain. The types of palsy were spastic quadriplegia (n = 11), spastic diplegia (n = 9), spastic hemiplegia (n = 2), double hemiplegia (n = 1), athetosis (n = 10) and mixed (n = 2). Of all patients, 28 (80%) generated abnormal findings. In spastic quadriplegia, although eight cases revealed severe brain damage, two cases showed no abnormal findings in the brain. One of the three had cervical cord compression caused by atlanto-axial subluxation. In spastic diplegia, the findings were divided according to whether the patient was born at term or preterm. If the patient had been born prematurely, the findings showed periventricular leukomalacia and abnormally high intensity in the posterior limbs of the internal capsule on T2-weighted images. MR imaging in spastic hemiplegia revealed cerebral infarction. In the athetoid type, half of all cases showed either no abnormal findings or slight widening of the lateral ventricle. Three cases showed abnormal signals of the basal ganglia. The reason why athetoid-type palsy did not show severe abnormality is unknown. We believe that MR imaging is a useful diagnostic modality to detect damage in the brain in cerebral palsy and plays an important role in the differentiation of cerebral palsy from the spastic palsy disease.