Influenza virus purification with the zonal ultracentrifuge.

Sufficient amounts of influenza virus (density, 1.185; size, 722S) can be highly purified (22,000 chicken cell agglutinating units per milligram of protein) with a zonal ultracentrifuge, used first in a rate process followed by isopycnic banding, to permit its detailed biological and physical-chemical evaluation.

Effects of continuous infusion of endothelin-1 in pregnant sheep.

Plasma concentration of endothelin-1, a potent vasoconstrictor produced by the vascular endothelium, has been observed to be significantly increased in a number of pathophysiological states, including preeclampsia. In the present study we have evaluated the effects of elevated plasma endothelin-1 in pregnant sheep by continuous exogenous endothelin-1 administration. Nine pregnant ewes (110+/-5 days' gestation) were instrumented for measurements of maternal mean arterial pressure, renal blood flow, and uterine blood flow. After recovery, endothelin-1 was infused intravenously for 4 hours at a dose that was adjusted to raise mean arterial pressure by approximately 20 mm Hg by the end of the first hour (range 5 to 20 ng/kg per minute). Mean arterial pressure, renal blood flow, uterine blood flow, urinary protein excretion, hematocrit, and plasma endothelin-1 concentration were measured hourly, and renal and uterine vascular resistances were calculated. Endothelin-1 produced significant increases (% change from baseline at t=4 hours) in mean arterial pressure (45+/-8%), renal vascular resistance (353+/-66 %), and uterine vascular resistance (59+/-21%). Endothelin-1 also increased microvascular permeability both systemically and within the kidney, as suggested by marked increases in hematocrit (0.27+/-0.01 to 0.32+/-0.01) and urinary protein concentration (0.95+/-0.1 to 7.9+/-3.2 mg/mL per mg creatinine). There was a highly significant correlation (P<.0001) between plasma endothelin-1 and mean arterial pressure, renal vascular resistance, uterine vascular resistance, hematocrit, and urinary protein content in all sheep studied. In addition, plasma endothelin-1 corresponded well with the time course of the changes in cardiovascular parameters and urinary protein excretion observed. These results provide evidence to suggest that elevation of circulating endothelin-1 in pregnant sheep can produce cardiovascular and hemodynamic changes that in many ways resemble the human disease preeclampsia. This supports the hypothesis that endothelial cell damage and/or dysfunction that is associated with increased production of endothelin-1 could directly contribute to the progression of preeclampsia.

Early menopausal changes in bone mass and sex steroids.

Eighty-four healthy perimenopausal and early postmenopausal women were divided into four groups: group A, those with slightly irregular menstrual periods and plasma FSH below 40 mIU/ml; group B, those with irregular periods and FSH above 40 mIU/ml; group C, those whose last menstrual period was within 1 yr of study; and, group D, those whose last menstrual period was between 12 and 55 months before the study. Plasma concentrations of estrone and estradiol progressively decreased in groups B, C and D compared to those in A in parallel with a decrease in the production rates, and FSH and LH were significantly increased. There was little change in the concentration of androstenedione or testosterone. Vertebral bone mass was significantly decreased in groups B, C, and D compared to that in A, and radial bone mass was decreased in group D. There was a significantly positive correlation between plasma estrone and estradiol and bone mass at both the radius and vertebra. Increased bone remodeling was suggested by increases in serum calcium and bone gla protein. These data suggest that bone loss, at least from the spine, may begin before menses cease and is correlated with decreases in estrogen production and increases in bone remodeling.

Sudden visual loss in pseudotumor cerebri due to central retinal artery occlusion.

A patient with a 16-month history of papilledema from pseudotumor cerebri had sudden loss of vision in one eye because of a central retinal artery occlusion (CRAO). The CRAO was transient and visual acuity improved from light perception to 6/7.5 OS in long-term follow-up. A visual field abnormality and color-vision deficit have persisted. Both eyes demonstrated peripapillary neovascular membranes. The eye with CRAO had extensive chorioretinal folds extending from the disc through the macula. Thorough investigations failed to demonstrate a coagulation abnormality, hyperviscosity, or source of emboli. Although the mechanism remains unclear, we postulate that CRAO may have been caused by a local pathologic condition in the optic nerve.

Neurologic complications of the epidermal nevus syndrome.

The epidermal nevus syndrome is a neurocutaneous disorder characterized by distinctive skin lesions and often serious somatic and central nervous system (CNS) abnormalities. We observed four cases of this disorder with epidermal nevi and neurologic manifestations, including mental retardation, seizures, ophthalmologic abnormalities, intracranial aneurysm, and porencephalic cyst. A review of 60 reported cases of the epidermal syndrome and our experience suggest that CNS complications are more likely to be associated with epidermal nevi on the head and that the CNS abnormalities are most often ipsilateral to the skin lesion.

Muscles of a different 'color': the unusual properties of the extraocular muscles may predispose or protect them in neurogenic and myogenic disease.

The rules that govern many aspects of skeletal muscle structure and function are very different for the extraocular muscle allotype. The myoblast lineages present in the extraocular muscle primordia are permissive for generation of an unusually wide range of fiber types. The balance that is struck between genetic specification and activity dependent factors in shaping fiber phenotype to suit the demands of complex visuomotor systems is not yet well defined. Because skeletal muscle has high energy demands, diversity in fiber types is needed to maximize efficiency; greater diversity in fiber composition then indicates a more diverse functional repertoire. Together, the characteristics of small motor unit size, precise dependence of muscle force upon motor neuron discharge rate, high contractile speed but low tension development, and contractile protein heterogeneity contribute toward the high precision and diversity that is required for eye movements. Finally, the structural and functional characteristics and plasticity of the individual extraocular muscle fiber types play an important role in determining their response to disease or manipulation. The lack of uniform responses across the muscle allotypes in disease, or in response to pharmaceutical or surgical interventions, requires that we obtain a better understanding of the fundamental differences that exist between muscle groups.

Carotid-retinal embolism with coexistent mitral valve prolapse.

A 63-year-old hypertensive woman with a prolapsing mitral valve developed sudden blindness of the left eye secondary to a central retinal artery embolus. The decision to perform carotid arteriography led to discovery of an ulcerated plaque in the left internal carotid artery, which was found at the time of endarterectomy to bear a large friable platelet thrombus. The frequent occurrence of mitral valve prolapse in normal populations suggests that this anomaly may be incidental rather than etiologic in patients with cerebral embolic phenomena. The finding of mitral valve prolapse should not routinely exclude evaluation for other sources of embolic stroke.

Maladaptive neural compensatory mechanisms in Bell's palsy-induced blepharospasm.

We described four patients with Bell's palsy and blepharospasm and evaluated potential mechanisms that may be responsible for an apparent association between the two disorders. Eyelid movements in spontaneous blinks were studied by the search coil technique in patients with this novel disorder. Kinematic analyses documented bilateral eyelid spasm subsequent to unilateral Bell's palsy. The temporal interval between the onset of palsy and onset of blepharospasm was highly variable (weeks to > 20 years). Changes in the relationship between spontaneous blink peak velocity and amplitude, the main sequence, shared features previously found in uncomplicated Bell's palsy and blepharospasm patients. Furthermore, as in patients with typical Bell's palsy and idiopathic blepharospasm, both normal blinks and spasms were conjugate in spite of interocular differences in blink amplitude/peak velocity. We suggest that there is a correlation between the eyelid palsy and subsequent blepharospasm, and have designated this potentially new disease entity as Bell's palsy-induced blepharospasm. We propose a two-stage model for Bell's palsy-induced blepharospasm in which blink adaptive systems may produce the maladaptive consequence of eyelid spasms.

Optic nerve edema as a consequence of respiratory disease.

The authors describe a patient with bilateral papilledema, visual field abnormalities, poorly reactive pupils, meningeal enhancement on cranial MRI, and diffuse brain parenchymal hypervascularity. The opening pressure at the time of lumbar puncture was normal, and results of other CSF studies were normal. All abnormalities resolved with home oxygen therapy.

Aberrant reinnervation of facial musculature in a subhuman primate: a correlative analysis of eyelid kinematics, muscle synkinesis, and motoneuron localization.

A macaque monkey with a preexisting facial nerve injury showed a synkinesis of perioral muscles with blinking and thus provided a serendipitous model for a multiphasic analysis of this common neurologic syndrome. The amplitude of the paretic eyelid in spontaneous and air-puff-induced blinks was about one-third that of the normal eyelid. Despite the blink hypometria, induced blink durations remained matched for the two lids. EMG confirmed co-contraction of the zygomaticus and orbicularis oculi muscles on the affected side during blinking, with silence of the zygomaticus on the normal side. Neuroanatomic investigation showed that, on the affected side, some zygomaticus motoneurons were in the somatotopically correct nuclear subdivisions but that the majority were in the dorsal subdivision, which normally innervates the orbicularis oculi. This study supports the contention that some orbicularis oculi motoneurons are incorrectly rerouted to supply the perioral musculature following recovery from a peripheral seventh-nerve injury. This same pattern of relative weakness in eyelid muscles and the stereotyped co-contraction of lid and perioral muscles with blinking occurs in humans, suggesting that aberrant reinnervation may be the mechanism for this clinical phenomenon.

Kinematic analysis of eyelid movements in patients recovering from unilateral facial nerve palsy.

We assessed eyelid function by subjective clinical examination and quantitative means in patients recovering from facial nerve palsy. Electromagnetic search coil techniques were used to record the concurrent movements of the two eyelids to study alterations in blink main sequence (peak velocity versus amplitude) relationships and interocular differences in eyelid kinematics. After onset of unilateral palsy, the paresis of eyelid closure showed varying degrees of recovery. Adaptive increases in blink main sequence slope contributed to maximizing closure of the paretic eyelid. However, blink adaptation mechanisms must operate bilaterally, as there also was evidence of altered main sequence slope in the nonparetic eyelid. In general, main sequence slope was inversely related to the level of eyelid paresis. The highest indices of blink adaptation were in those patients with moderate paresis, and main sequence slope was decreased in those patients with increasing degrees of recovery. The assessment of eyelid function with search coil techniques provides a sensitive means of monitoring disease and treatment course. Data also aid understanding of adaptive gain control in the neural control of blink in health and disease.

Prenatal morphogenesis of primate extraocular muscle: neuromuscular junction formation and fiber type differentiation.

Extraocular muscle represents a distinctive class among mammalian skeletal musculature in exhibiting the full range of muscle fiber type variability found in vertebrate species. To better understand the basis for the unique structural/functional diversity of extraocular muscle, the ontogeny of lateral rectus muscles was studied in Macaca nemestrina fetuses of 62-156 days gestation using light and electron microscopy. At E62, myotubes and myofibers are evident, but fiber-type differentiation has not yet occurred and neuromuscular junctions are primitive. By E92, presumptive singly and multiply innervated fiber types could be distinguished on the basis of myofibril delineation. Like other skeletal muscles, extraocular myogenesis proceeds through at least two generations of myofibers. All primary and secondary myofibers were generated and were maturing by E121. The phylogenetically "old" global multiply innervated fiber type was the first to attain adult form. This was followed by maturation of global layer singly innervated fiber types, which are developed by E156, except for attainment of definitive size and mitochondrial content. Orbital layer fiber types, particularly the orbital singly innervated fiber, are the last to mature. Neuromuscular junction maturation paralleled the changes observed during fiber-type differentiation. In summary, the sequential development of their constituent muscle fiber types may reflect the functional pressures the extraocular muscles are exposed to by maturing visual and visuomotor systems. In particular, ontogenic and phylogenic changes observed in the orbital singly innervated fiber type may have direct implications for the types, range, and precision of eye movements used by different species and at different gestational ages.

New muscle growth in denervated extraocular muscle.

Current therapies for paralytic ocular motility disorders often provide less than satisfactory results. Promising new techniques of nerve grafting and muscle transplantation used to treat muscle paralysis elsewhere in the body may have application to the ocular motor system. In studying a procedure designed to reinnervate paretic extraocular muscle (e.o.m.), we produced not only the expected nerve growth but also abundant new muscle growth. A considerable amount of this muscle growth occurred within the axon depleted nerve fascicles of the paretic muscle, suggesting that this structure was a particularly good matrix for muscle fiber growth. These observations suggest that new, entire neuromuscular units may be induced to grow in the plane of a paretic muscle if appropriate surface characteristics can be established.

Extraocular muscle regeneration in freeze-treated extraocular muscle autografts.

New growth of extraocular muscle has been demonstrated in degenerating peripheral nerve autografts implanted between two extraocular muscles. This suggests that extraocular muscle may be lengthened for therapeutic purposes if a suitable matrix can be found to support this new growth. Investigators of peripheral nerve regeneration have found that the basal lamina of freeze-killed skeletal muscle remains intact and supports axonal regeneration. This study was designed to investigate the feasibility of inducing regenerative growth of extraocular muscle in freeze-treated extraocular muscle autografts. In six beagles the inferior oblique muscle was removed from both orbits, frozen in liquid nitrogen, and allowed to thaw at room temperature. The freeze-thaw cycle was repeated. The freeze-treated grafts were then sewn in an end-to-end fashion between the cut end of the lateral rectus and the globe. At both 4 and 8 weeks postoperatively, three dogs were killed, and the grafts were removed from both orbits. These were prepared for light and electron microscopic examination. This revealed robust growth of mature-appearing, innervated muscle fibers in the proximal graft that could be differentiated by adenosine triphosphatase histochemistry. Rare, immature fibers were seen in the distal graft. These results demonstrate that freeze-treated extraocular muscle autografts support regenerative growth of extraocular muscle.

A quantitative assessment of extraocular muscle growth in peripheral nerve autografts.

In previous studies, we have documented new growth of extraocular muscle fibers within axon-depleted motor neurons of denervated muscle. This study was designed to quantitate the regenerative growth of extraocular muscle within autologous peripheral sensory nerve transplants and to determine whether acutely denervated extraocular muscle affects this growth. Fifteen anesthetized beagles were subjected to an intracranial lesion of the left third cranial nerve. Segments of the infraorbital sensory nerve were removed from the nose and implanted between the lateral rectus and inferior oblique muscles in both orbits. At 2, 4 and 8 weeks postoperatively, five dogs were killed and the nerve grafts were removed. Muscle fibers were counted at four levels along each nerve segment. Fiber number increased significantly at each successive postoperative interval in implanted nerve segments on both the denervated and nondenervated side. At 8 weeks, fiber number was significantly greater on the denervated side. These results indicate that autologous peripheral sensory nerve is capable of supporting regenerative growth of extraocular muscle and that denervation has a significant positive influence on muscle fiber growth.

Structure-function correlations in the human medial rectus extraocular muscle pulleys.

PURPOSE: Fibroelastic pulleys function like the trochlea to fix the position and pulling direction of the recti extraocular muscles within the orbit. This study characterized the fine structure of the human medial rectus muscle pulley. METHODS: Human medial rectus muscle pulley tissue was dissected at autopsy, immersed in aldehyde fixative solution, and processed for and examined with light and electron microscopy. RESULTS: Pulley structure were located within posterior Tenon's fascia, closely surrounding the medial rectus muscle. Pulleys were comprised of a dense collagen matrix with alternating bands of collagen fibers precisely arranged at right angles to one another. This three-dimensional organization most likely confers high tensile strength to the pulley. Elastin fibrils were interspersed in the collagen matrix. Fibroblasts and mast cells were scattered throughout the relatively acellular and avascular collagen latticework. Connective tissue and smooth muscle bundles suspended the pulley from the periorbita. Smooth muscle was distributed in small, discrete bundles attached deeply into the dense pulley tissue. CONCLUSIONS: Fine structural observations confirm the existence and substantial structure of a pulley system in association with the medial rectus extraocular muscle. The presence of pulleys must be considered in models of the oculomotor plant. The cytoarchitecture and placement of pulleys suggest that they are internally rigid structures and are consistent with the idea that they determine functional origins for the extraocular muscles. However, the nature of the connective tissue-smooth muscle struts suspending the pulley system to the orbit supports the notion that the pulley position, and thus the vector force of the eye muscles, may be adjustable.

Palisade endings in human extraocular muscles.

The presence of nerve terminals in the tendinous insertions of human eye muscles was investigated histologically in adult human eye muscles obtained from donor eyes and in muscle pieces resected from juvenile patients undergoing surgical correction for strabismus. Lateral and medial recti, superior and inferior oblique muscles from adults, were stained "en bloc" using a silver impregnation method. Numbers of nerve terminals were isolated that resembled "palisade endings" previously described in other species. A single palisade ending usually appeared as an interwoven network of fine neural filaments that cupped the inserting tip of a single extrafusal fiber. A collection of palisade endings on several neighboring muscle fibers were supplied by a single myelinated axon that branched from a nerve bundle in the muscle mass. The presence of nerve terminals at the distal musculotendinous interface of juvenile muscle also was observed when some resected specimens of lateral and medial recti were sectioned and stained using Holmes' silver method with a picrofuschin counterstain. No conventional Golgi tendon organs were seen.

Conjugacy of spontaneous blinks in man: eyelid kinematics exhibit bilateral symmetry.

PURPOSE: To provide a quantitative description of the conjugacy of human eyelid movements during spontaneous blinks. METHODS: Eyelid movements occurring during spontaneous blinks were recorded bilaterally using a modification of the electromagnetic search coil technique. In off-line analyses, covariation of amplitude, peak velocity, and duration of blink down phases were determined for the two eyelids. Interocular differences in the timing of blink onset and offset, and time to peak velocity, also were evaluated. RESULTS: Human blink motor control systems act to link tightly the spatial and temporal characteristics of movements of the two eyelids. Data show that human spontaneous blinks are conjugate. Analysis of interocular covariation of blink amplitude, peak velocity, and duration yielded linear functions with high correlation coefficients. Interocular comparison of eyelid movement durations during blinks showed a particularly high correlation. There were negligible interocular differences in blink down-phase onset time, termination time, and time to peak velocity. A small percentage of blinks exhibited interocular differences in amplitude and peak velocity of > 20%; however, even in these cases, blink duration remained tightly linked. CONCLUSION: Spatial and temporal properties of eyelid movements occurring during spontaneous blinks are conjugate. These data support the hypothesis that a bilateral gating mechanism regulates blink duration. Elements downstream from the gate may differentially and unilaterally alter blink amplitude and peak velocity, but the duration of blinks remains time-locked for the two eyelids.

Age-related changes in human blinks. Passive and active changes in eyelid kinematics.

PURPOSE: The authors analyzed eyelid kinematics in normal aging subjects to test the hypothesis that eyelid movements exhibit age-related changes and that blink disorders prevalent among the elderly, in turn, represent an outcome of normal aging processes. METHODS: The electromagnetic search coil technique was used to study blinks in normal human subjects for each decade from 40 to 89 years. Blink metrics (amplitude, peak velocity, and duration), main sequence relationships, and conjugacy were assessed. RESULTS: Mean amplitude and peak velocity of blinks decreased with age for spontaneous blinks and, to a lesser extent, for voluntary blinks. Some but not all, of this decline could be attributed to a peripheral phenomenon, narrowed palpebral fissure width. The spontaneous blink down phase main sequence slope also declined with age. By contrast, blink rate and the coordination of movements of the two eyelids--blink conjugacy--exhibited no change. CONCLUSIONS: These data demonstrate that disorders of blink systems typically seen in persons 50 years of age or older occur on a background of normal age-dependent changes in eyelid kinematics. Alterations in main sequence slope imply the operation of central adaptive systems during aging. Reduction in main sequence slope is interpreted as a reduction in aggregate orbicularis oculi motoneuron activity. Such a central neurologic adjustment in the motor output of blink systems may serve to compensate for an age-related increase in blink reflex excitability. Compensatory reduction in the main sequence relationship may offset a potentially hyperexcitable blink reflex, thereby reducing the likelihood of disorders such as blepharospasm. The authors conclude that although there are changes in the kinematics of blinking with age, such changes do not necessarily predispose an aging population to eyelid motility disorders.

Sensitivity of HRA/Skh hairless mice to initiation/promotion of skin tumors by chemical treatment.

HRA/Skh hairless mice were investigated for their sensitivity to initiation and promotion by chemicals because of (a) the known sensitivity of these mice to photocarcinogenesis, (b) their low background papilloma incidence (2/3000 mice under 1 year of age) and (c) ease of treatment and identification of tumors, in the absence of hair. Employing a variety of treatments with 7,12-dimethylbenz[a]anthracene (DMBA) as initiator and 12-O-tetradecanoylphorbol-13-acetate (TPA) as promoter, it was found that the strain was susceptible to both initiation and promotion. Papilloma incidence was at least equivalent to that observed with other sensitive mouse strains. Following initiation with 2.56 micrograms DMBA, papilloma development was promoter-concentration-dependent, resulting in 22.5 papillomas/mouse at 20 weeks in animals administered 5 micrograms TPA. In the absence of DMBA initiation, TPA treatment was weakly carcinogenic in HRA/Skh mice. This treatment induced a dose-dependent increase in papillomas, one of which progressed to a keratoacanthoma-like tumor after 65 weeks. These results show that HRA/Skh mice are highly sensitive, not only to UV carcinogenesis, but also to chemical initiation and promotion of skin papillomas.