[A case of mitochondrial encephalomyopathy with decreased cytochrome c oxidase].
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Biomedical subjects
Publications and source records attributed to A Igata.
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Following our proposal of a new clinical entity, HTLV-I-associated myelopathy (HAM), at least 270 cases have now been diagnosed in Japan. The geographical distribution resembles that of adult T-cell leukemia-lymphoma. Our laboratory has now identified 85 cases (27 males and 58 females aged 18-75 [mean 52] yrs. with age at onset 6-75 [mean 37] yrs.). The illness duration ranged from 4 mos. to 55 yrs. (mean 15.6 yrs.). Of the 85 cases, 81 lived in Kagoshima, where about 16% of the population have HTLV-I antibodies. Previously, we recognized a subgroup of cases who had frequent histories of blood transfusion, and from our recent data, 18 (21%) had the same history. The group with no history of transfusion was younger at onset of HAM (33 [SD 18] yrs. vs 49 [12] yrs.; p less than 0.05). From the latter, we have also recognized another subgroup consisting of 6 young cases (under 15 yrs.) whose mothers were positive for HTLV-I antibody titer. This group has been labeled mother-to-child or vertical transmission. Notably, the progression of symptoms was slower in the vertically transmitted group when compared to the group with a history of transfusion. We also reported the effectiveness of corticosteroids in 4 HAM cases and from the present data, 65 cases have been followed up for treatment response. Based on a 14-grade disability scoring, excellent response was noted in 20%, good in 37%, fair in 34% and no response in 9% of the total 65 cases. Compared with the vertically transmitted group, the group a history of blood transfusion appeared to have a better response to corticosteroids.
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From our past clinical observations, we have identified a cluster of cases with distinct neurological manifestations and, together with our viral studies, it has been proven that in fact these cases belong to a new clinical entity. The association of this slowly progressive spastic paraparesis with human T-cell lymphotropic virus type I (HTLV-I) enabled us to designate this clinical entity as HTLV-I-associated myelopathy or HAM. Later studies showed that 1) the geographical distribution of HAM follows that of adult T-cell leukemia (ATL) and 2) viruses detected in both disorders were identical by DNA blotting assay, but HAM and ATL are definitely expressed clinically as distinct from the other. In this regard, human leukocyte antigen (HLA) studies and the pattern of immune responsiveness seem to show a clear segregation of one from the other. As many initially studied cases have responded favorably to corticosteroids and had frequent perivascular cuffing in the spinal cord of a necropsied case, it is likely that, in part, immune events play a role in the pathogenesis. Our efforts are now directed to determining whether a) HAM is purely an autoimmune process, or b) a slow virus infection with a long incubation period may be the culprit.
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The present report analyzed a clinical and myopathological findings of 60 patients defined for the diagnosis of polymyositis. Patients were classified in four groups according to the system Walton and Adams. Forty five per cent were classified as Group I, 28.3 per cent as Group II, 15.0 per cent as Group III and 11.7 per cent as Group IV. Seven patients were associated with a malignant neoplasm and all of them were over fifty. The primary growth was carcinoma of the lung in 2, of the prostate, ovarium, stomach in one case each, and in one case a chronic myelogenous leukemia and in one case a malignant lymphoma. The female to male ratio was 2:1. Though cases were seen in all age groups, the largest number was in the sixth decade. The presenting symptoms and signs were essentially similar to those reported before. Proximal lower and upper limb weakness was the most frequent symptoms (91.7 and 83.3 per cent respectively). Other characteristic symptoms were skin changes, muscle pain, arthralgia and Raynaud's phenomenon. The CK was measured at the time of presentation in 58 of the 60 cases. Normal values were found in 18.3 per cent of cases. In general, muscle biopsy was performed in the first stage of the disease. A diagnostically abnormal biopsy was 55 cases (92 per cent), but 8 per cent of cases had normal biopsy. The characteristic changes in the biopsies from 60 cases were muscle fiber necrosis, inflammatory infiltration, fibrosis, basophilia and increase of internal nuclei. We could not get a significant difference between the two groups. However all of the cases of Group IV had muscle fiber necrosis, inflammatory infiltration and fibrosis.
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Tardive dyskinesia seems to occur as a result of diminished cholinergic and enhanced dopaminergic activity in the striatum. Meclofenoxate has been shown to increase cerebral cholinergic activity. To ameliorate the tardive dyskinesia, meclofenoxate was given orally, 600-1200 mg/day, for 6-12 weeks. The effects of the drug were evaluated by scoring the degree of involuntary movement. Among 11 subjects with tardive dyskinesia or dystonia, 4 improved markedly, 1 moderately, 2 slightly, and there was no improvement in 4. One patient with subacute oral dyskinesia, induced by administration of neuroleptics for 1 month, improved markedly. The possibility that meclofenoxate may be effective in dealing with dyskinesias that are induced by neuroleptics warrants further attention.
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