Histamine release and morphological changes in basophilic granulocytes of atopic asthmatics induced by antigen, anti-IgE and Ca ionophore A 23187.

Morphological changes of basophils from atopic asthmatics were compared among antigen, anti-IgE and Ca ionophore A23187 stimulation. 1. Antigen induced rapid and marked increase of histamine release from basophils compared with Ca ionophore A23187. 2. The decrease in number of basophils following stimulation with the agents was significantly higher in antigen stimulation than in Ca ionophore A23187 stimulation. 3. The increased ratio of short to long axis diameter (L/Sb ratio) of the cells, which shows an increased motility of basophils, was significantly higher in antigen stimulation. The ratio did not change by stimulation with Ca ionophore A23187. 4. Stimulation of basophils by Ca ionophore A23187 induced marked increase in mean diameter (MD) of the cells. Activation of basophils by anti-IgE was similar to that by antigen, but slower in start and shorter in duration compared with antigen. The results show that an increase in motility is essential for release mechanism of chemical mediators from basophils in antigen and anti-IgE stimulation, but not in Ca ionophore A23187 stimulation.     

Bone mineral density in steroid-dependent asthma assessed by peripheral quantitative computed tomography.

Chronic use of systemic glucocorticoids results in progressive bone loss and pathologic fractures. This study identified the predictive variables for bone loss and used peripheral quantitative computed tomography (pQCT) to measure changes in cortical and trabecular bone in patients receiving systemic glucocorticoid therapy of prednisone 15.4 g. Eighty-four asthmatic patients were included in the study. Vertebral fractures were diagnosed via plain spinal radiograms. pQCT was used to measure cortical and trabecular bone mineral density. Multiple regression analysis identified variables with predictive value. The cumulative dose of glucocorticoid correlated with the bone mineral density (p<0.05) and the trabecular bone density (p<0.01). Among patients > or = 65 yrs of age, the cumulative dose of glucocorticoid correlated with the occurrence of vertebral fractures (p<0.05), total bone mineral density (p<0.01) and cortical bone mineral density (p<0.01). Bone mineral density in the distal radius measured by pQCT and the vertebral bodies by axis QCT were correlated, regardless of whether systemic glucocorticoids were administered. Glucocorticoid administration not only decreases trabecular but also cortical bone mineral density. Since cortical bone provides strength and stiffness, it appears that the loss of cortical bone is responsible for the increased incidence of fracture seen in patients receiving systemic glucocorticoid therapy.     

Quantitative analysis of neurofibrillary pathology in a general population to reappraise neuropathological criteria for senile dementia of the neurofibrillary tangle type (tangle‐only dementia): The Hisayama study

Senile dementia of the neurofibrillary tangle type (SD‐NFT) is characterized by numerous neurofibrillary tangles (NFT) in the hippocampal region and the absence or minimal presence of senile plaques throughout the brain. We analyzed 207 demented subjects and 68 non‐demented subjects autopsied in the Hisayama study to investigate the clinicopathological aspects of SD‐NFT in the general Japanese population. The prevalence of SD‐NFT in the consecutive autopsy cases was 8/207 (3.9%), comprising three men and five women. The average age at onset and death was 83.8 ± 6.8 (mean ± SD; standard deviation) and 88.1 ± 7.6 years, respectively. A mild memory disturbance preceded a decrease in the ability to undertake the activities of daily living and the diagnosis of dementia. Focal cerebral symptoms, such as aphasia and paralysis, did not appear during the disease course of any subject. Gross examination of the brains showed moderate to severe diffuse cerebral atrophy with brain weight loss (mean ± SD; standard deviation: 1118.1 ± 124.0 g). Histologically, there were abundant NFT and neuropil threads predominantly in or limited to the limbic cortex. The density of NFT in the CA1/subiculum in SD‐NFT was much higher than the densities in the other hippocampal regions. The average density of NFT in CA1 in SD‐NFT subjects was 115.4 per 100× field (range 23–247), that in Alzheimer disease (AD) subjects was 80.1 (range 1–227), and that in non‐demented elderly subjects was 37.2 (range 0–203). Although many previous papers have reported that the densities of NFT in the limbic system in SD‐NFT were significantly higher than those in AD, there was considerable overlap of NFT densities in CA1 among the non‐demented elderly, AD subjects and SD‐NFT subjects.     

Improvement of ventilatory function by spa therapy in patients with intractable asthma

Twenty-five patients with intractable asthma had swimming training in a hot spring pool for 3 months. The subjects were divided into three groups according to their clinical symptoms and ages. Changes of ventilatory function during swimming training were observed in in each group. The ventilatory function test revealed that free swimming training in a hot spring pool for 30 min did not induce bronchoconstriction in any of the groups. The values of ventilatory parameters such as FEV 1.0%, %PEFR, %V50 and %V25 were improved after the 3-month swimming training. The improvement of ventilatory parameters, especially %MMF, %V50 and %V25, by the training was most remarkable in the type II asthma group. The percent increase in %MMF, %V50 and %V25 was highest in patients more than 61 years of age, and higher in patients aged 40 to 60 years than in younger patients.     

Clinical characteristics of bronchial asthma in the elderly in relation to cell component in the airways

Cellular responses in the airways of bronchial asthma, which might be affected with aging, were compared between 28 elderly (60 years old or more) and 28 younger (40 years old or less) patients with bronchial asthma. The cellular responses were observed to differentiate 500 cells in bronchoalveolar lavage fluid (BALF), excluding epithelial cells. The average frequency of each type of cell in the BALF of the elderly asthmatics was 65.7% for macrophages, 15.5% for lymphocytes, 8.9% for neutrophils and 9.5% for eosinophils. In the younger asthmatics the average frequency was 61.8% for macrophages, 17.1% for lymphocytes, 4.1% for neutrophils and 16.1% for eosinophils. A significant increase in the frequency of neutrophils in BALF of the elderly cases was observed in steroid-dependent intractable asthmatics compared to the younger cases (p less than 0.05). An increase in frequency of eosinophils in the younger cases was also observed, although the difference in the frequency was not significant between the elderly and the younger intractable cases. A significant difference in the frequency of each type of cell in the clinical type of bronchial asthma was not present between the elderly and the younger cases. However, the frequency of neutrophils in elderly cases was significantly increased in Ib. bronchospasm + hypersecretion type compared to Ia. bronchospasm type (p less than 0.05), and was more elevated in II. bronchiolar obstruction type (p less than 0.01). The frequency of neutrophils was markedly more increased in the elderly cases with poor prognosis than in the younger cases (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Radiological features of germinoma arising from atypical locations

Three cases of intracranial germinoma arising from atypical locations occurred in 13-, 22-, and 28-year-old males. The location of the tumor was the corpus callosum (2 cases) and the temporal lobe. Computed tomography and magnetic resonance imaging showed all three tumors had a largest dimension, including the internal cyst, of over 6 cm, and the cysts were larger than 2.5 cm. Radiotherapy and chemotherapy caused all tumors to disappear. Large tumor and large cyst are features of germinoma arising from atypical locations.     

Primary germinoma arising from the midbrain

Summary A 29-year-old man presented with diplopia, dysarthria, anisocoria, oculomotor nerve paralysis, abducens nerve paralysis, right facial palsy, and spastic hemiparetic gait. Magnetic resonance imaging (MRI) showed a homogenously enhanced mass in the midbrain. MRI-guided stereotactic biopsy was performed, and the histologic diagnosis was pure germinoma. The tumor disappeared after chemotherapy and radiotherapy. Germinoma should be included in the differential diagnosis of midbrain lesions in young adults. MRI-guided stereotactic biopsy provided a helpful diagnostic clue in a patient with a midbrain lesion.     

Mortality study of patients with subarachnoid haemorrhage at University hospitals and their affiliated hospitals in Japan

Summary This study was undertaken to examine the differences in aneurysm statistics between University hospitals where subacute or chronic patients are primarily treated and University-affiliated hospitals where both acute and chronic cases are also admitted. In each hospital group, the transition of the statistics in the last decade was studied. The purpose of this study was also to see if any conclusion could be drawn regarding the surgical treatment of acute cases.The death rate for all aneurysm cases admitted is 8% at University hospitals, whilst that at affiliated hospitals is roughly 30% during the 1970s. The operative death rate at the University hospitals is 3%, whilst that at affiliated hospitals is 16% which improved at one affiliated hospital to 8% in the 1980–1981 period. Morbidity also improved in the latest series in the affiliated hospital. These improvements are considered to be due to the change of operative and postoperative policies for acute cases to : limited surgical indications for grade IV patients, extensive cisternal clot removal at the time of surgery, and oral administration of Ticlopidine, a new antiplatelet agent.