We describe two patients and a previously reported patient who acquired unique pendular vergence oscillations of the eyes and concurrent contractions of the masticatory muscles, i.e., oculomasticatory myorhythmia (OMM). The smooth disjunctive eye movements cycled with a frequency of 0.8 to 1.2 Hz. An analysis of peak velocities (15 to 200 degrees/sec) with respect to peak amplitudes (5 to 25 degrees) revealed dynamics characteristic of normal vergence movements. The pathological alterations resulting in pendular vergence oscillations implicate a separately functioning, physiologically normal vergence system within the brainstem. In addition to paralysis of vertical gaze, each patient also experienced progressive somnolence and intellectual deterioration. An intestinal biopsy in 1 patient established a diagnosis of Whipple's disease, which led to appropriate treatment and amelioration of the OMM. A pathological diagnosis of Whipple's disease of the central nervous system was made in the other 2 patients; results of an intestinal biopsy in one of these patients were normal. No patient had palatal myoclonus, and olivary pseudohypertrophy was not found in two autopsy examinations. Thus, OMM is a distinct movement disorder and has been recognized only in Whipple's disease. We conclude that patients with OMM should be treated presumptively for Whipple's disease of the central nervous system, even if a jejunal biopsy is normal.

No abstract

Caffeine (1,3,7-trimethylxanthine) is a popular mild central nervous system stimulant found in the leaves, seeds and fruits of various plants and in foodstuffs such as coffee, tea, and chocolate, among others. Caffeine is widely used and is not associated with severe side effects when consumed at relatively low doses. Although rarely observed, overdoses can occur. However, only a few fatal caffeine intoxication cases have been reported in the literature. Herein, we report the pathological examination results and information on caffeine concentrations in the blood, urine and main organs in a fatal caffeine intoxication case. Even though high caffeine concentrations were found in the systemic organs, no caffeine-related pathological changes were detected.

Forensic laboratories are often faced with cases in which methamphetamine hydrochloride-mixed blood is unable to be identified as human blood by immunochromatography against human hemoglobin A0. The application of mRNA expression analysis to samples that showed a false-negative with immunochromatography was investigated as an alternative approach that did not depend on the antigen-antibody reaction. Real-time PCR was used to examine the expression levels of blood markers such as glycophorin A, spectrin beta, and hemoglobin beta. Hemoglobin beta was the only marker that was specifically detected in blood, while glycophorin A was useful for determining human specificity. Hemoglobin beta showed good detection sensitivity and was detectable in 37-year-old blood stains. Hemoglobin beta was exclusively detectable in methamphetamine hydrochloride-mixed blood stains. Detergents and disinfectants did not significantly influence mRNA markers. The proposed mRNA expression analysis was suitable for human blood identification as an alternative method to immunochromatography.

A summary of HD and non -HD cases is shown in Table 1. Kidney weights were markedly lower in HD cases than in non-HD cases. MaterialsStandards of o -, m-, and p-cresol were purchased from Wako Pure Chemical Industries (Tokyo, Japan). The deuterated internal standard (IS), p -cresol-d8, was obtained from C/D/N Isotopes Inc. (Quebec, Canada). NaCl, MgSO4, ethyl acetate, acetic anhydride, and acetyl chloride were also obtained from Wako. BSTFA + TMCS (99 : 1, v/v, 100 µL) were purchased from Supelco (Bellefonte, USA). n-Propyl acetate, methanol, pyridine, and heptane were purchased from Kanto Chemical Co., Inc. (Tokyo, Japan). Concentrated sulfuric acid was purchased from Nacalai Tesque, Inc. (Kyoto, Japan). The standard of creatinine was purchased from Katayama Chemical, Inc. (Osaka, Japan). The deuterated internal standard (IS), creatinine -d3, was obtained from Funakoshi Co., Ltd. (Tokyo, Japan). Amicon ! ! Ultra -4 centrifugal filter units were purchased from Merck KGaA (Darmstadt, Germany). Analysis of p-cresol Preparation of case samplesBlood, urine, and organ samples were prepared according to the following methods. A 0.1 -mL aliquot of sample blood and 0.9 mL of distilled water were mixed. A 0.01 -mL aliquot of sample urine and 0.99 mL of distilled water were mixed. A 0.1-g sample of organ tissue was homogenized in a bead crusher with 1 mL of distilled water. Pretreatment before extractionAn outline of the procedure used is showed in Figure 1. "Free p-cresol" is non-protein-bound and unconjugated p-cresol (F p-cresol). "Conjugated p -cresol" is non-protein-binding conjugated p-cresol (C p-cresol). "Total p -cresol" includes free p -cresol, protein-bound conjugated p-cresol, and conjugated p-cresol.