Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report

[Purpose] We report our experience with a patient with a central spinal cord injury who showed improved finger and upper limb functions after long-term treatment with a combination of rehabilitation and botulinum toxin type A. [Participants and Methods] The patient had spasms and pain that gradually became more profound and was given botulinum toxin type A at 1 year 3 months after sustaining a spinal cord injury. We administered 14 botulinum toxin type A injections periodically for 7 years 4 months after the injury. We administered the injections at an average interval of 5.6 months. Splints that allowed extension and improved finger muscle tone and contracture were made for the patient. [Results] The patient experienced gradual alleviation of the spasms in the proximal upper limb muscles and improved range of motion after receiving five doses of botulinum toxin type A. The spasms and range of motion in the fingers gradually improved around 4 years after the injury through splint therapy and a combination of botulinum toxin type A administration and rehabilitation. [Conclusion] The combination of botulinum toxin type A, splint, and rehabilitation therapies can lead to positive improvements in finger spasticity and range of motion and is recommended for hypertonia cases with severe contractures.Key words: Carry-over effect, Concomitant use of splint, Restoration of hand function     

A case of extra-anatomic bypass for ruptured thoracoabdominal aortic aneurysm with tuberculosis]

Now aneurysmectomy and graft replacement is the most popular surgical method of aortic aneurysm, but there are many opinions about surgical methods and assist circulation for emergency operation of ruptured aortic aneurysm. We experienced the case of ruptured thoracoabdominal aortic aneurysm with tuberculosis, and rescued the patient by extra-anatomic bypass (EAB). A 60-year-old woman, who had been treated with tuberculosis for about 40 years, was operated on for cold abscess of her left psoas muscle by other orthopedic surgeons. At that time, massive bleeding happened, and she was transferred to us under diagnosis of ruptured thoracoabdominal aortic aneurysm. EAB, as emergency operation, was done because we considered it was dirty and dangerous to replace the prosthesis beside the abscess. The postoperative course was almost uneventful except the evidence of Gaffky's first stage. We considered EAB was an useful method for emergency cases and some infectious aortic aneurysms.     

A randomized study of cisplatin versus cisplatin plus vindesine for non-small cell lung carcinoma.

Between August 1983 and March 1985, a randomized study was conducted that compared cisplatin (CDDP) (80 mg/m2 on day 1) alone with CDDP plus vindesine (VDS) (3 mg/m2 on days 1, 8, and 15) in 160 consecutive patients with inoperable non-small cell lung cancer (NSCLC). There were no complete responses. The response rate for CDDP plus VDS (22 of 77 patients, 29%) was significantly higher than that for CDDP alone (9 of 78 patients, 12%) (P less than 0.05). However, no difference existed in the median duration of response (20 weeks for CDDP plus VDS versus 20 weeks for CDDP alone) or the median survival time (45 weeks for CDDP plus VDS versus 39 weeks for CDDP alone). No significant differences in toxicity were detected between the two arms; myelosuppression, alopecia, and peripheral neuropathy occurred more frequently with CDDP plus VDS and there was one lethal episode of hepatorenal syndrome in the CDDP plus VDS arm. Among the variables Eastern Cooperative Oncology Group (ECOG) performance status (PS), age, sex, stage, weight loss, serum lactate dehydrogenase (LDH) level, albumin level, histologic cell type, and chemotherapy arm, only chemotherapy arm was a significant factor leading to a major response (P = 0.019, multiple logistic regression analysis). The significant predictors of survival were PS (P = 0.000), sex (P = 0.000), and stage (P = 0.002) (Cox's proportional hazards model), with a PS of 0 or 1, female sex, and lower stage yielding the best survival. Although a significantly higher response rate was obtained in the combination arm than in the single agent arm, the survival benefit to patients receiving such combination chemotherapy was not determined and more effective chemotherapy regimens are required.     

Clinical characteristics of cerebral infarction in China and Japan]

In order to elucidate the clinical characteristics of cerebral infarction in a northeastern district of China, 1,353 patients with first-ever cerebral infarction in Shenyang, China, were compared with 2,929 patients registered in Japan. Using the identical database (Japan Standard Stroke Registry Study), we prospectively collected clinical data on acute ischemic stroke patients who were admitted to two main hospitals in Shenyang, China, and 50 hospitals in Japan. The mean age was 67.3 years in China and 71.3 years in Japan. Of the patients in China, 78% were classified as atherothrombotic infarction, 18% as lacunae, and 1% as cardioembolism. By contrast, 30% of the patients in Japan were classified as atherothrombotic infarction, 32% as lacunae, and 31% as cardioembolism. Regarding the risk factors, the incidence of hypertension was 76% in China and 62% in Japan. Diabetes mellitus was 10% in China and 26% in Japan. Hyperlipidemia was 10% in China and 22% in Japan. Atrial fibrillation was 3% in China and 21% in Japan. As the diagnostic criteria for hyperlipidemia differed, we could not compare this risk factor between the two countries statistically; however, cardioembolism, lacunae, and atrial fibrillation were significantly less common in China than in Japan. Our data suggest that hypertension is an important risk factor for ischemic stroke, and the incidence of cardioembolism and atrial fibrillation is very low in Shenyang, China.     

A monoclonal antibody (1G10) recognizes a novel human mesangial antigen.

We have identified a unique mesangial matrix protein of the human glomerulus by using a monoclonal antibody, 1G10, generated against culture human glomerular cells. By immunofluorescence, the antigen recognized by 1G10 (1G10 antigen) is present in mesangium and smooth muscle tissue and cannot be detected in any other tissue examined. Immunoelectron microscopy of glomeruli indicated that 1G10 antigen is present exclusively in the mesangial matrix at the endothelial-mesangial interface. The 1G10 antigen is also expressed by cultured mesangial cells, but not by cultured glomerular epithelial cells, umbilical endothelial cells or fibroblasts. 1G10 did not react with the mesangial matrix proteins [fibronectin (FN), laminin (LAM), collagen types I, III, IV, V, and VI (Col I, III, IV, V, VI), heparin sulfate proteoglycan (HSPG), or thrombospondin (TS)] present under normal and diseased states or smooth muscle antigens (myosin, actin), but did react with a 4 M urea extract of renal cortex and a 0.3% deoxycholate extract of isolated glomeruli. Two dimensional immunoblot analysis using the urea extract demonstrated the binding of 1G10 to an approximately 200 KDa polypeptide with pI 6.0. On one dimensional immunoblot this band did not show cross react with polyclonal antisera to FN, LAM, Col IV, V, VI, HSPG or TS. This mesangial matrix component is trypsin and periodate sensitive, suggesting that it has the character of glycoprotein. In renal biopsy specimens from patients with mesangial proliferative glomerulonephritis (GN) and membranoproliferative GN, the expression of the 1G10 antigen increased along with mesangial hypercellularity or increased accumulation of mesangial matrix, but decreased in completely sclerosed glomeruli. No significant changes in 1G10 antigen expression was observed in membranous GN or minimal change nephrosis compared to normal glomeruli. This study suggests that the 1G10 antigen may not only be a useful marker for the clinical assessment of GN, but may also serve as a potential tool for the study of the pathogenesis of glomerular diseases characterized by cellular proliferation and mesangial matrix expansion.     

Transmission electron microscopic studies of fine structure by fast freeze method on Actinomyces israelii ATCC 12102

Recently, one of the major objectives was to observe cellular structures in biological-materials including microorganisms as raw as possible. For this purpose, Actinomyces israelii ATCC 12102, an experimented strain, was fixed by a fast freeze method using liquid nitrogen as a cryogen, followed by transmission electron microscopic observations on fine structures. Then, the following results were obtained. 1) Cell wall was an electron dense and thick monolayer. In certain cells, numerous granules were found on cell walls, showing lamellar structures. The cell wall surface to be a wave like structure of which limit was unclear. 2) Cytoplasmic membrane consisted of two electron less dense layers holding an electron dense layer in then. However, fine layers with different electron density crossed over one another, representing a formation of stripe structure in other cells. 3) In cytoplasm, we observed that fine fibers with high electron density crossed over fine fibers with low electron density. 4) We also observed that the specialized ring structure in cytoplasm.     

Translocation t(12;16)(q13;p11) in myxoid liposarcoma of a child and implication of the human int-1 gene in tumorigenesis

Cytogenetic and gene analyses were performed in a child with myxoid liposarcoma (MLS). A reciprocal chromosome translocation t(12;16)(q13;p11) was found in the tumor cells. This result, combined with the previous reports of a similar translocation in adult MLS strongly suggests that this translocation may be a characteristic cytogenetic marker in MLS. The human int-1 gene has been reported to be located close to the 12q13 breakpoint associated with MLS. Therefore, we examined the rearrangement of the human int-1 gene by Southern blotting analysis. When genomic DNAs from the tumor cells were digested with KpnI, EcoRI and BamHI, no difference was seen compared to peripheral blood leukocytes (PBL) DNAs from a normal individual. However, with HindIII digestion there appeared a 3.1 kb fragment in tumor cell DNA as compared to a 2.8 kb fragment in DNAs prepared from normal PBL and the patient's PBL. These findings suggest that the int-1 gene may be implicated in tumorigenesis of MLS with t(12;16)(q13;p11).     

Antigenic phenotypes ofEscherichia coli in urine from patients with urinary tract infections

Various antigenic phenotypes ofEscherichia coli in urine were analysed using monoclonal antibody against pyelonephritis-associated P-pili (PAP-pili), and polyvalent O- and K1-antisera, and the results were compared with the clinical diagnosis. PAP-pili, O1- and K1-positiveE. coli were isolated more frequently in urine from patients with acute pyelonephritis.E. coli found in urine from patients with recurrent pyelonephritis were frequently PAP positive. Based on the antigenic phenotypes of strains in urine, it is suggested that pyelonephritopathogenic strains may originate from a small number of clones.