Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities, Especially Diagnosis and Prevention of Recurrence for Chronic Thrombosis-Serial Changes of Sonography and D-Dimer.

Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities. Such patients are associated with a high risk of complications like deep vein thrombosis (DVT). Here, we report twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at prothrombin time-international normalized ratio (PT-INR) values around two to prevent recurrence of chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases above 5 µg/ml for the D-dimer and there were significant differences between the DVT and non-DVT groups in the D-dimer levels. The plasma levels of D-dimer in patients with DVT diminished to less than 1.0 µg/ml after warfarin treatment. Concerning sudden death (4.2%) in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of the underdeveloped vascular system from underlying diseases for the evaluation of DVT. A detailed study of DVT as a vascular complication is very important for the smooth medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremities, as a noninvasive examination and measurement of D-dimer, is very helpful. (This article is a translation of Jpn J Phlebol 2014; 25: 34-42.).

[Control of bone remodeling by nervous system. Bone metabolic changes in neurological diseases].

We introduced the relationship between bone change and neurological disturbance in the patients with cerebrovascular disease (CVD) , Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) . High incidence of osteoporosis and right/left difference in osteopenia are found in the diseases. CVD and PD patients with asymmetrical osteopenia show an association between clinical symptoms, peripheral circulatory symptoms, and predominant osteopenia. Although the muscle strength of PD patients was normal, the more severely affected side for PD symptoms and autonomic symptoms coincided with predominant osteopenia in the body. Increased bone resorption was detected in ALS patients. We speculated that neurological disturbances affect the remodeling of local sites of the bone. We have to start treatment from an early stage of the neurological disease to prevent a fracture.

Uptake behavior of embryonic chick liver cells.

The capacity of selective uptake by liver cells, focusing particularly on the parenchymal and perisinusoidal stellate cells during chick liver development (8-18 days of incubation), was ultrastructurally examined after injection of 240-nm-diameter lecithin (phosphatidylcholine) -coated or noncoated beads into the extraembryonic circulation. Cytoplasmic projections of both cells as well as extrasinusoidal macrophages reached into the sinusoid-like vascular spaces. The primitive perisinusoidal stellate cells were identified by immunocytochemistry as being rich in desmin-positive cytoplasmic intermediate filaments. The cells demonstrated selective uptake of noncoated beads by means of their cytoplasmic projections. These findings were significant in the early period of incubation, indicating that the phagocytic activity is a characteristic and transient phenomenon of developmental differentiation. Large numbers of coated and a few noncoated beads penetrated into the perivascular spaces. The parenchymal cells incorporated only the coated beads that passed through the endothelial lining, suggesting that these cells express selective but limited phagocytic capacity against large "foreign" substances even long before their maturation. The cell projections were not engaged in uptake function. Extrasinusoidal macrophages, Kupffer cells, and intraluminal primitive macrophages all took up both beads; however, lecithin coating of the beads clearly suppressed their uptake function. These data suggest that the uptake function of large "foreign" substances appears to be intrinsic to liver cells and lecithin coating would be useful for delivering large substances to parenchymal cells.

Clinical features of malignant syndrome in Parkinson's disease and related neurological disorders.

INTRODUCTION: We elucidated the cause and clinical characteristics of malignant syndrome (MS) in patients with Parkinson's disease (PD), early-onset parkinsonism (EOP), and other neurological disorders. MATERIALS AND METHODS: Subjects were 260 patients with PD or EOP, and three patients with other neurological disorders associated with MS. We studied clinical symptoms before and after the onset of MS, and evaluated autonomic function particularly before the onset of MS. RESULTS: The overall incidence of MS accompanying PD and EOP in our department was eight of 260 patients (3.1%). The incidence of MS in EOP was significantly higher than that in PD. All patients with MS showed comparatively longer duration of illness and advanced stage of PD and EOP. Factors triggering MS included reduced dosage or discontinuation of anti-parkinsonian drugs, reduction of oral intake, dehydration, infectious disease, postoperative state, and treatment with major tranquilizers. Although patients demonstrated marked autonomic symptoms at the onset of MS, in many cases autonomic dysfunction developed before the onset of MS. Even EOP patients, who usually demonstrated milder autonomic dysfunction, showed abnormalities in the correlation between circadian rhythm of blood pressure and pulse rate, and/or abnormal gastric emptying test, suggesting that autonomic dysfunction plays an important role in the cause of MS. Cooling the body, fluid replacement, resumption or increasing the dosage of anti-parkinsonian drugs and administration of dantrolene sodium overcame MS in all cases. CONCLUSION: Autonomic dysfunction is related to the cause and clinical features of MS in PD, EOP and some other neurological disorders.

Evidence that exogenous substances can be phagocytized by alveolar epithelial cells and transported into blood capillaries.

Since the ability of alveolar epithelial cells to ingest inhaled fine particles has not been characterized in detail, the present study seeks to evaluate this physiological activity. We used a 0.2% suspension of intact or lecithin-coated polystyrene latex beads (240 nm in diameter). A 5-ml suspension of intact or lecithin-coated latex beads was intratracheally administered to rats using a compressor nebulizer. Thereafter, the lungs were perfused intratracheally with glutaraldehyde solution and cut into small pieces. The samples were postfixed with osmium tetroxide, embedded in epoxy resin and examined under an electron microscope. Both lecithin-coated and uncoated beads were incorporated into alveolar macrophages. Some of the ingested beads in the alveolar macrophages were sequestered within lysosomes. Types I and II alveolar epithelial cells selectively incorporated only lecithin-coated beads, which were also observed within the cytoplasm of monocytes in the capillary lumen. These findings suggest that alveolar epithelial cells can incorporate exogenous particles, which are then transferred from the alveoli to intravascular spaces by transcytosis.