Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness.

Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92-180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.

X-ray diffraction study of low-temperature phase transformations in nickel-titanium orthodontic wires.

OBJECTIVES: Employ conventional X-ray diffraction (XRD) to analyze three clinically important nickel-titanium orthodontic wire alloys over a range of temperatures between 25 and -110 degrees C, for comparison with previous results from temperature-modulated differential scanning calorimetry (TMDSC) studies. METHODS: The archwires selected were 35 degrees C Copper Ni-Ti (Ormco), Neo Sentalloy (GAC International), and Nitinol SE (3M Unitek). Neo Sentalloy, which exhibits superelastic behavior, is marketed as having shape memory in the oral environment, and Nitinol SE and 35 degrees C Copper Ni-Ti also exhibit superelastic behavior. All archwires had dimensions of 0.016in.x0.022in. (0.41 mm x 0.56 mm). Straight segments cut with a water-cooled diamond saw were placed side-by-side to yield a 1 cm x 1cm test sample of each wire product for XRD analysis (Rint-Ultima(+), Rigaku) over a 2theta range from 30 degrees to 130 degrees and at successive temperatures of 25, -110, -60, -20, 0 and 25 degrees C. RESULTS: The phases revealed by XRD at the different analysis temperatures were in good agreement with those found in previous TMDSC studies of transformations in these alloys, in particular verifying the presence of R-phase at 25 degrees C. Precise comparisons are not possible because of the approximate nature of the transformation temperatures determined by TMDSC and the preferred crystallographic orientation present in the wires. New XRD peaks appear to result from low-temperature transformation in martensite, which a recent transmission electron microscopy (TEM) study has shown to arise from twinning. SIGNIFICANCE: While XRD is a useful technique to study phases in nickel-titanium orthodontic wires and their transformations as a function of temperature, optimum insight is obtained when XRD analyses are combined with complementary TMDSC and TEM study of the wires.

Generalized convulsions after consuming a large amount of gingko nuts.

We report a 36-year-old woman, without any past or family histories of epilepsy, who presented frequent vomiting and generalized convulsions. About 4 h before the convulsion, she had consumed approximately 70-80 gingko nuts, seeds of Gingko biloba, in an attempt to improve her health. It is important to know that convulsion may be induced if a large amount of gingko nuts is consumed. The neurotoxicity of gingko nuts, particularly their convulsion-inducing effect, should be recognized.

A new method for in vitro calcification using acrylamide gel and bovine serum.

To investigate the mechanism of biological calcification in vitro, a model system consisting of an acrylamide gel block (1 x 3 x 3 mm) and fetal bovine serum was developed. Mineral deposition was induced in gel blocks which were immersed in 300 microliters of fetal bovine serum at 37 degrees C for 7 days in a CO2 incubator. X-ray diffraction indicated that the mineral was hydroxyapatite with low crystallinity. Effects of the concentration of acrylamide gel, the partial pressure of CO2 and matrix proteins within the gel on the mineral formation were investigated. In the gel concentration range of 10-60%, the largest amount of crystal grew in 40% acrylamide gel, where the serum protein did not penetrate. With an increase in the partial pressure of CO2 the Ca content in the gel block increased, reached the highest level at about 3.5% CO2 and then began to decrease. In 40% gel and at 5% CO2, the mineral formation was enhanced by phosvitin, phosphophoryn, demineralized dentin powder and alkaline phosphatase. Mineral deposition occurred around the collagen fibers immobilized in 40% acrylamide gel. These results indicate that 1) a putatively serum-derived inhibitor of calcification with high-molecular weight was prevented from penetrating into the 40% acrylamide gels, 2) immobilized polyanionic proteins and alkaline phosphatase were able to increase mineral deposition and 3) the partial pressure of CO2 greatly influenced the mineral deposition. It was concluded that this gel system is useful to investigate the mechanism of biological calcification in vitro.

[A case of vertical gaze palsy associated with a unilateral infarct in the thalamo-mesencephalic junction on MR imaging].

We report a case of a 54-year-old man with sudden-onset double-vision. On admission, neurological examination showed upward and downward gaze palsy on voluntary and smooth pursuit movements, and vertical oculocephalic maneuver elicited a full upward and downward response. Bell's phenomenon, horizontal eye movements and convergence were not impaired. Based on these findings, supranuclear dissociated vertical gaze palsy was diagnosed. T1-weighted MR images revealed low intensity on the medial side of the right thalamo-mesencephalic junction, which impaired the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). T2-weighted MR images revealed a high-intensity area. The posterior commissure was spared. The clinical signs gradually improved, and the vertical gaze palsy almost disappeared one month after onset. Based on these findings, unilateral infarct in the thalamo-mesencephalic junction in the distribution of the right paramedian thalamic artery was diagnosed. Only two cases of upward and downward gaze palsy in association with unilateral upper midbrain lesion without posterior commissure have been previously reported. Since we did not perform a pathological examination, we cannot deny that there may have been some denervation of fibers at the posterior commissure. Cases of upward and downward gaze palsy in association with unilateral upper midbrain lesion without posterior commissure are rare, and it is very interesting that the lesion in our patients, like that seen in the two pathological reports, was right-sided.

[Radiotherapy for advanced carcinoma of the gallbladder: special reference to IORT and hyperthermo-chemo-radiotherapy].

The results of radiotherapy in 37 patients who were treated for carcinoma of the gallbladder from April 1975 to April 1992 are presented. To analyze the treatment results, patients were divided into four groups depending on treatment modality: intraoperative radiotherapy (IORT) with surgical resection in 9 (resection group), IORT with palliative surgery in 5 (palliative surgery group), hyperthermo-chemo-radiotherapy for inoperable cases in 11 (HCR group), external irradiation for inoperable cases in 12 (ExRT alone group). Most of the patients in the resection group received ExRT. The HCR group showed better local response than the groups treated with palliative surgery and ExRT alone. The mean length of survival in the resection, palliative surgery, HCR and ExRT alone groups was 315 days, 144 days, 246 days and 74 days, respectively. Although no statistically significant difference in survival was observed between the resection and HCR groups, the relapse-free interval of the resection group was significantly longer than that of the other groups. The application of IORT for surgically resectable tumors contributed to improved prognosis and better quality of life. Although IORT for patients with unresectable tumors had little effect on survival, it was considered to play a palliative role in improving the quality of life. The HCR group had a significantly longer survival time and relapse-free interval than the palliative surgery and ExRT alone groups. In conclusion, the application of HCR for inoperable carcinoma of the gallbladder contributed to the improvement of prognosis and quality of life.

An autopsy case of Binswanger's disease without hypertension and associated with cerebral infarction in the terminal stage.

We report here an autopsy case of Binswanger's disease (BD) without hypertension and associated with cerebral infarction in the terminal stage. The female patient, who was 74 years old at the time of death, had initially demonstrated manic-depressive disorder-like mental disorder, followed by dementia and neurological deficits. A brain CT scan showed white matter low attenuation bilaterally and symmetrically. BD was clinically diagnosed despite the lack of hypertension. In the terminal stage, she suffered an infarction in the left anterior cerebral artery region, and died of pneumonia. Neuropathologically, we found the infarction of the left anterior cerebral artery region, demyelination, fibrillary gliosis, lacunae and arteriosclerosis of the small arteries and arterioles in the white matter.

A study of hypertension: participation of central adrenaergic mechanism on the angiotensin II-induced hypertension.

I. Interactions of angiotensin II and norepinephrine in the rat hypothalamus and other brainstem were studied by intraventricular perfusion or/and intravenous administration. (1) Intravenous administration of angiotensin reduced the hypothalamus norepinephrine content. (2) Intraventricularly perfused angiotensin reduced the hypothalamus norepinephrine but did not alter that in other parts of brainstem. Hypothalamus norepinephrine was reduced more by intravenous administration of angiotensin than by intraventricularly perfused angiotensin. II. The involvements of adrenergic mechanism in the central pressor effect of angiotensin II were studied through observation of blood pressure changes following injection of angiotensin II, phentolamine and propranolol into the rabbit lateral ventricle of rabbit brain.(1) Intraventricular administration of phentolamine suppressed the central mediated pressor respons of angiotensin. (2) Simultaneous intraventricular administration of propranolol enhanced the angiotensin pressor effect in anesthetized rabbits.

Effect of angiotensin II on noradrenaline content in the rat hypothalamus.

1. Intravenous administration of angiotensin II reduced the adrenaline content, increased the catechol-O-methyltransferase activity, and decreased the monoamine oxidase activity of rat hypothalamus. 2. Intraventricularly administrated angiotensin II reduced the noradreanline content to a smaller extent. 3. The change produced by intravenous administration of angiotensin might be indirectly caused by a response to angiotensin.