Absence of sleep spindles in human medial and basal temporal lobes.

All-night recordings from subdural electrocorticographic (ECoG) electrodes on the human medial and basal temporal lobes were analysed to examine spindling activities during sleep. Subjects were three males and three females who were candidates for neurosurgical treatments of partial epilepsy. Subdural electrodes were attached to the medial and basal temporal lobe cortices, allowing ECoG and electroencephalogram from the scalp vertex (Cz EEG) to be recorded simultaneously during all night sleep. In one case, subdural electrodes were attached also on the parietal lobe. Fast Fourier transformation (FFT) analyses were performed on the ECoG and Cz EEG signals. No organized sleep spindles or sigma band (12-16 Hz) peaks in FFT power spectra were observed from the medial or basal temporal lobes of the non-epileptogenic hemispheres during non-rapid eye movement (NREM) sleep. In a case with parietal electrodes, organized spindle bursts were observed in parietal signals synchronized with Cz spindles. Although delta band (0.3-3 Hz) power from both the medial and basal temporal lobes fluctuated across each night as expected, sigma activity changed little. However, 14 Hz oscillatory bursts were observed in the medial basal temporal lobe of epileptogenic hemisphere in two cases and bilaterally in one case during not only NREM sleep but rapid eye movement (REM) sleep and wakefulness. From the present study we conclude that sleep spindle activities are absent in the medial and basal temporal lobes. Fourteen Hz oscillatory bursts observed from the medial or basal temporal lobe in some cases were not considered to be sleep spindles since they also appeared during REM sleep and wakefulness. These waveforms could have originated due to epileptic pathology, since they frequently appeared in epileptic regions.

Clinical utility and validation of the Japanese version of Memorial Delirium Assessment Scale in a psychogeriatric inpatient setting.

Delirium is a common mental disorder in the elderly. The Memorial Delirium Assessment Scale (MDAS) was developed in 1997 to assess delirium severity over time. The purpose of the current prospective study is to assess the clinical utility, diagnostic potential, reliability and validity of the Japanese version of MDAS in a psychogeriatric unit setting. Reliability was examined by testing 37 elderly patients; validity was examined concurrently by 16 patients with delirium. Two psychiatrists evaluated each patient simultaneously. Mean MDAS ratings differed among groups of patients with delirium, dementia, or no cognitive impairment. High levels of consistency within raters (Cronbach's alpha=0.92) and reliability between raters (0.98) were indicated. The correlation between MDAS scores and rating on the Delirium Rating Scale (r=.74, P=.0011), the Clinician's Global Rating of delirium severity (r=.67, P=.0047), and the Mini Mental State Examination (r=-.54, P=.029) was fair. The MDAS seems to be a reliable measuring instrument for assessing delirium in elderly patients.

Inhibitory effects of Alpinia speciosa K. SCHUM on the porphyrin photooxidative reaction.

It is thought that the beta-carotene defense mechanism against photosensitivity involves the inhibition of singlet oxygen formation, a kind of active oxygen. When we screened chemical substances obtained from plants indigenous to Okinawa, known to have residents with the longest life span in Japan, we found that Alpinia speciosa K. SCHUM (Japanese name: gettou), which is used as a food preservative, has an activity similar to that of beta-carotene. We measured the amount of lipid peroxide (LPO) formed from a hematoporphyrin-containing rat liver microsomal suspension irradiated with visible light. The inhibitory effect of Alpinia speciosa on LPO formation was confirmed when the addition of increasing concentrations of Alpinia speciosa extract led to a decrease in the amount of LPO formed. Moreover, the reaction mechanism that affects the amount of singlet oxygen formed was measured, and the effect of the extract was determined by the ESR trapping technique. It was found that the extract effectively inhibited the formation of singlet oxygen. The extract of Alpinia speciosa contains dihydro-5,6-dehydrokawain. It was confirmed that dihydro-5,6-dehydrokawain, which is a water-soluble compound, has singlet oxygen quenching activity. We synthesized five derivatives of kawain and found that dimethyl [6-(2-phenylethyl)-2-oxo-2H-pyran-4-yl] phosphorothionate has the strongest singlet oxygen quenching activity. The use of the compound from Alpinia speciosa that exhibits singlet oxygen quenching activity as an inhibitory agent of the phototoxic reaction in porphyria is expected.

Suppression of gamma activity in the human medial temporal lobe by sevoflurane anesthesia.

We have reported the presence of continuous gamma (30-150 Hz) activity in the human medial temporal lobe (MTL). Since the MTL is involved in learning and memory, we speculated that MTL gamma activity is related to such higher brain functions. It is thus of interest to learn how this activity changes during different states of consciousness. In this study, we recorded electrocorticographic (ECoG) activity directly from the surface of the MTL after various doses of sevoflurane anesthesia. Five epileptic patients underwent electrode placement operations in which electrodes were attached to the surfaces of the MTL and the basal temporal lobe (BTL). Immediately following the operation ECoG was recorded from each patient under four concentrations of sevoflurane anesthesia (1.5, 2.0, 2.5 and 3.0%). Fast Fourier Transform (FFT) analysis was performed on the MTL ECoGs. Under the lowest sevoflurane concentration, MTL gamma activity was observed in all patients. However, gamma activity was progressively suppressed by increased concentrations of sevoflurane, in a dose-dependent manner. Sevoflurane has been known to reduce neuronal excitability in the rat hippocampus in vitro, probably by changing GABAergic inhibition. The reduction of MTL gamma in the present study may be the result of such a mechanism. Although memory function was not tested in this study, the amount of MTL gamma activity may be related to residual memory function during anesthesia.

N2 and P3b components of the event-related potential in students at risk for psychosis.

The N2 and P3b components of event-related potentials (ERPs) were studied in students who were identified as being at high risk for psychosis on the basis of their scores on the Chapman Psychosis Proneness Scales (PPS). The Magical Ideation subscale (MIS), the Perceptual Aberration subscale (PABS), and the Social Anhedonia subscale (SAS) were administered to 2,022 undergraduate university students. To determine if there were any relationships between these psychometric instruments and electrophysiological measures, 40 high-risk students were compared with 40 age- and gender-matched control students using auditory ERPs obtained from three midline electrodes (Fz, Cz, Pz) in a standard oddball paradigm. N2 (rare stimuli) and N2b latencies were significantly longer in the high-risk than in the control subjects, and the high-risk group also evidenced significantly smaller amplitude of the P3b component. No significant correlations between scores on the PPS or its three subscales and the amplitudes or latencies of the P3b or N200 component were found. These findings suggest that the N2 and P3b ERP components might serve as trait markers for psychosis and that individuals psychometrically identified as being at high risk for psychosis have deficits in the maintenance of attention and in decision-making.

Lower left temporal lobe MRI volumes in patients with first-episode schizophrenia compared with psychotic patients with first-episode affective disorder and normal subjects.

OBJECTIVE: Magnetic resonance imaging (MRI) studies of schizophrenic patients have revealed structural brain abnormalities, with low volumes of gray matter in the left posterior superior temporal gyrus and in medial temporal lobe structures. However, the specificity to schizophrenia and the roles of chronic morbidity and neuroleptic treatment in these abnormalities remain unclear. METHOD: Magnetic resonance (1.5-T) scans were obtained from 33 patients with first-episode psychosis and 18 age-matched normal comparison subjects, all right-handed. Sixteen of the patients were diagnosed with affective disorder and 17 with schizophrenia. RESULTS: Quantitative volumetric analysis showed that the patients with first-episode schizophrenia had significantly smaller gray matter volume in the left posterior superior temporal gyrus than did the patients with first-episode affective psychosis or the comparison subjects, with a significant left-less-than-right asymmetry. The schizophrenic patients also showed a smaller gray matter volume of the left posterior amygdala-hippocampal complex than the comparison subjects. Both the patients with schizophrenia and those with affective psychosis had significant left-less-than-right asymmetry of the posterior amygdala-hippocampal complex. CONCLUSIONS: These findings suggest that temporal lobe abnormalities are present at the first hospitalization for schizophrenia and that low volume of the left posterior superior temporal gyrus gray matter is specific to schizophrenia compared with affective disorder.

Auditory mismatch negativity in schizophrenia: topographic evaluation with a high-density recording montage.

OBJECTIVE: The mismatch negativity, a negative component in the auditory event-related potential, is thought to index automatic processes involved in sensory or echoic memory. The authors' goal in this study was to examine the topography of auditory mismatch negativity in schizophrenia with a high-density, 64-channel recording montage. METHOD: Mismatch negativity topography was evaluated in 23 right-handed male patients with schizophrenia who were receiving medication and in 23 nonschizophrenic comparison subjects who were matched in age, handedness, and parental socioeconomic status. The Positive and Negative Syndrome Scale was used to measure psychiatric symptoms. RESULTS: Mismatch negativity amplitude was reduced in the patients with schizophrenia. They showed a greater left-less-than-right asymmetry than comparison subjects at homotopic electrode pairs near the parietotemporal junction. There were correlations between mismatch negativity amplitude and hallucinations at left frontal electrodes and between mismatch negativity amplitude and passive-apathetic social withdrawal at left and right frontal electrodes. CONCLUSIONS: Mismatch negativity was reduced in schizophrenia, especially in the left hemisphere. This finding is consistent with abnormalities of primary or adjacent auditory cortex involved in auditory sensory or echoic memory.

Assessment of psychosocial stressors and maladjustment among foreign students of the University of the Ryukyus.

An extensive survey of problems encountered by foreign students of the University of the Ryukyus and the resulting levels of stress was carried out in order to determine the main stressors hindering academic progress and personal adjustment. Subjectively perceived stress levels after arrival in Japan were obtained from 134 subjects through a comprehensive questionnaire for reporting specific stressors. The 30-item General Health Questionnaire (GHQ) was included to assess mental health state. Differences in scores by area of origin were also determined for the total GHQ scores and its sub-scales. The GHQ results showed that regardless of length of time in Japan, more than 60% of the subjects scored within a range usually indicative of a mental health risk. Mean scores by area of origin showed a 50% reduction over time for non-Chinese Asians and North American/Europeans, but only a reduction of 1.1% or less for Chinese, Latin American, Middle/Near Eastern and African subjects. Limitations in achievement of academic goals were reported by the greatest number of students as causing moderate to excessive stress (57.5%); most frequently reported causes were language inadequacy (55.2%), reference materials unavailable (34.3%), unfamiliarity with Japanese study methods (32.1%), and inadequate guidance from teachers/advisors (26.9%). Various social, personal and daily life problems in the non-academic setting were also reported as causing high stress levels. Most of the stressors identified are not considered inevitable and point toward directions to pursue in preventive strategies in mitigating psychological distress and maladjustment of students.

Abnormalities of auditory event-related potentials in schizophrenia prior to treatment.

BACKGROUND: P300 amplitude reduction is a consistent finding in schizophrenic patients, but it is unclear if this abnormality predates neuroleptic treatment or is present at onset of illness. METHODS: Auditory event-related potentials (ERPs), during a standard oddball paradigm, were recorded from 45 neuroleptic-naive schizophrenics, 56 drug-free, previously treated schizophrenics, and 73 healthy normal controls. Forty-seven of the schizophrenic subjects had their first episode within the past year. RESULTS: N200 amplitude did not differ among groups. P300 amplitude was significantly smaller in both neuroleptic-naive and previously treated schizophrenic groups compared to the control groups. There were no significant differences between the two schizophrenic groups in P300 amplitude. N200 and P300 latency were prolonged in previously treated schizophrenics compared to neuroleptic-naive schizophrenics and normal controls. CONCLUSIONS: The present study suggests that ERP abnormalities, especially P300 amplitude reduction, are already present prior to the administration of neuroleptic medication in the earliest stage of schizophrenia.

Effect of anticoagulants on the incidence of late pericardial tamponade following open heart surgery. The Hawaii experience.

We report on 17 cases of late pericardial tamponade (LPT, > 60 hours postoperatively) occurring post aortic and/or mitral valve replacement or coronary artery bypass graft surgery between 1979 and 1994. This includes one patient in whom LPT occurred twice. These cases were found from a search of 374 patients including those who were diagnosed with hemorrhagic complications secondary to open heart surgery, pericardial effusion and tamponade, those who underwent pericardiocentesis and a randomly picked group of patients. The mean age of the group was 57.8 years and included 11 males and 6 females. Due to the relatively small size of our sample (reflecting the infrequency of this complication) we force matched this tamponade group to look for any relationships that may exist between the incidence of LPT and anticoagulant therapy. No significant difference was found between the two groups with documented preoperative anticoagulant therapy (number of days; p > 0.2) or in relation to coagulation tests (prothrombin time, partial thromboplastin time and platelet counts; p > 0.2). In our case series, anticoagulant therapy did not appear to significantly affect the incidence of LPT.

[Developing the portable type sleep apnea detector, and verifying the usefulness of the device].

Polysomnographic recording is indispensable in the diagnosis of sleep apnea syndrome (SAS). However, this method has a number of drawbacks, for example, subjects cannot sleep naturally like at their homes, and the methodology involved is complicated. We have now developed Portable Type Sleep Apnea Detector (PSD) that needs to equipment to provide subject's body. This study was done to verify the usefulness of this device. Subjects were 50 patients (42 male and 8 female, average and S.D. of age: 47.0 +/- 14.5), who were suspected to have SAS. Polysomnography and sleep recording using PSD were performed simultaneously. PSD consisted of three sensors for respiratory movements, a sensor for breathing sounds and a data recorder. The recorder was an 8K32 type 4-channel Handycorder (Nippon Denki Sanei, 370 mm x 115 mm x 200 mm, 7.5 kg) and the sensor for respiratory movements was a thin plate (180 mm x 100 mm). The three sensors for respiratory movements were placed between the mattress and bedsheet, hence the subjects did not feel them during sleep. A sound sensor detected breathing sounds such as snoring. We defined whether a subject is in sleep or awake by the number of body movements recorded by this device. Apnea was defined as depressed or stopped respiratory movement with no snoring for a period longer than 10 seconds. Standard polysomnography which consisted of electroencephalogram (2 channels), electrooculogram (2 channels), electromyogram (2 channels), electrocardiogram (1 channel), oral (1 channel) and nasal airflow (1 channel) and chest movements (1 channel) were performed. Sleep stages were evaluated according to the standard methods. The apnea hypopnea index (AHI) was defined as the number of apneas and hypopneas per sleep-hour. Significant correlation between each type of sleep apneas, AI and AHI as measured by two methods, was found (obstructive type: r = 0.929; p < 0.001, central type: r = 0.880; p < 0.001, mixed type: r = 0.952; p < 0.001, AI and AHI: r = 0.956; p < 0.001). It was concluded that this device is useful for screening SAS.

Surgical management of ventricular septal rupture following myocardial infarction: the Hawaii experience.

OBJECTIVE: To assess the diagnostic and treatment methods of ventricular septal rupture following myocardial infarction in a small patient population. EXPERIMENTAL DESIGN: Retrospective medical record review. SETTING: Four Honolulu area teaching hospitals. PATIENTS OR PARTICIPANTS: Eighteen patients with ventricular septal rupture (VSR) following myocardial infarction (MI) between 1979 and 1993. RESULTS: Ventricular septal rupture occurred more frequently in the elderly, in females and in those presenting for the first time with an MI. Thirteen patients (72%) underwent surgical repair including the two survivors. Three patients (17%) also underwent coronary artery bypass grafting, one of who survived. Very few of the patients had a history of stable angina pectoris before MI. Sudden deterioration in the patient's condition as manifested by tachycardia, hypotension and signs of right heart failure in those with an acute MI, especially if accompanied by a systolic murmur should encourage a search for a mechanical cause, especially a VSR. CONCLUSIONS: Two dimensional echocardiography or Swan-Ganz catheterization is 100% diagnostic and can be rapidly done at the bed side. Early surgical repair is important to the overall prognosis.

Programas supervisionados em reabilitaçào cardiovascular - abordagem de prescriçäo de exercício / Supervised programs in cardiovascular rehabilitation - approach to exercise prescription

Nas últimas décadas, a prática de exercícios físicos tem sido estimulada entre sadios e pacientes cardíacos. Os programas de reabilitaçäo cardíaca têm objetivos profiláticos e terapêuticos. Classicamente, esses programas säo divididos em 3 fases. A Fase I é dirigida para pacientes hospitalizados, convalescendo de infarto agudo do miocárdio ou pós-cirurgia cardiovascular visando evitar os efeitos negativos do repouso prolongado no leito, o retorno mais breve às atividades cotidianas, diminuir o impao psicológico e evitar complicaçöes pulmonares; os tipos de exercício para essa fase säo leves, graduais e individualizados. na Fase II é feita a estratificaçäo de risco (alto, médio e baixo): os de alto risco seräo orientados como os de Fase I e os demais fazem exercícios acima de 5 METs, 3 a 4 vezes por semana, em sessöes de 30 a 60 minutos. Os programas podem ser supervisionados ou näo. As contra-indicaçöes devem ser observadas. Na Fase III procede-se à avaliaçäo do consumo de oxigênio pelo teste caripulmonar para estabelecer o limiar anaeróbico e programa a instensidade de exercício, que deve ficar a 70 por cento da capacidade aeróbia máxima. como há linearidade entre o consumo de oxigênio e a frequência cardíaca, a contagem do pulso serve para determinar o limite de exercício. Cada sessäo deve durar de 30 a 60 minutos, 3 a 4 vezes por semana, observando-se o aquecimento, o estímulo e o desaquecimento. As reavaliaçöes devem ser feitas a cada 6 meses, quando poderäo ser reprogramados os exercícios.

Atividade física e qualidade de vida após transplante cardíaco / Physical activity and quality of life after heart transplantation

O crescente número de transplantes cardíacos em nosso país e as limitaçöes funcionais, psicológicas e sociais após a cirurgia justificam a inclusäo desse grupo especial de pacientes em programa de reabilitaçäo cardiovascular, com abrangência multidisciplinar. Idealmente, o programa deve iniciar no período pré-transplante, pois estudos recentes demonstram que o tratamento farmacológico da insuficiência cardíaca avançada, isoladamente, näo reduz os sintomas como fadiga e dispnéia ao exercício. Váriosutores têm reportado melhora das respostas hemodinâmicas e respiratórias ao esforço com programas supervisionados de exercícios regulares e de moderada intensidade. Particularidades como a denervaçäo do coraçäo do doador, que resulta em taquicardia de repouso e insuficiência cronotrópica, assim como a disfunçäo diastólica säo fatores presentes e que limitam as adaptaçöes periféricas ao treinamento físico. Os benefícios descritos ocorrem a partir de oito semanas, destacando-se os aumentos entre 30 por cet e 40 por cento do consumo máximo de oxigênio e entre 30 por cento e 35 por cento na capacidade de exercício. Melhora da qualidade de vida e estabilidade psicológica também säo relatadas após período de 3 a 6 meses e o apoio e o envolvimento familiar säo imprescindíveis. A terapia imunossupressora, particularemente os corticosteróides, os episódios de rejeiçäo aguda e infecçöes säo fatores que interferem negativamente nos resultados funcionais e psicológicos, daí a necessidade de seguimento clínico coníno e frequente durante todo o processo de reabilitaçäo.

Effects of nifedipine ryanodine and cyclopiazonic acid on tension development of ileal longitudinal muscle by manganese ions in Ca(2+)-free high-K+ medium.

1. Mn2+ (5 mM) could evoke the contraction in a Ca(2+)-free, high-K+ (60 mM) medium in ileal longitudinal muscle. Nifedipine, L-type Ca2+ channel blocker, inhibited dose-dependently both the contraction and manganese uptake in the presence of 5 mM Mn2+, in the Ca(2+)-free, high-K+ medium. 2. However, both ryanodine, Ca2+ release blocker from SR and cyclopiazonic acid, specific SR Ca(2+)-ATPase blocker, had no effects on the contractions evoked by Mn2+ and the manganese uptake in the Ca(2+)-free, high-K+ medium. 3. These results suggest that Mn2+ did not liberate Ca2+ at the storage sites during the Mn(2+)-induced contraction in Ca(2+)-free, high-K+ medium. Mn2+ is entering via voltage-dependent Ca2+ channels in the ileal cell membranes and it directly activates the contractile elements.

Atrial myxomas: experiences with 35 patients in Hawaii.

BACKGROUND: Thirty-five patients with an intracardiac myxoma underwent excision of the tumor in Hawaii between 1974 and 1993. PATIENTS AND METHODS: There were 28 female and 7 male patients in the group. Their ages ranged from 11 to 79 years (mean 48) with the majority (71%) between 30 and 60 years old. The patients' medical records were reviewed and special attention was paid to clinical presentation, methods of diagnosis, operative findings, and postoperative course. RESULTS: No ethnic predisposition was found. Forty-six percent of the presenting symptoms were cardiac (congestive heart failure 26%, palpitations 14%, and syncope 6%) while arterial embolization accounted for 11%. Diagnosis was made by angiography, echocardiography, or gated cardiac blood pool imaging. All were reliable, but two-dimensional (2-D) echocardiography was used most often, with no false-positive or false-negative results. There were 32 left atrial, 2 right atrial, and 1 biatrial myxomas. Limited septectomy was performed in most cases, but 9 patients (26%) required Dacron patch repair of the atrial septum. There was 1 death from a cerebrovascular accident the day after the removal of a left-sided atrial myxoma. Other patients had few minor postoperative complications. One patient presented with a recurrence 8 years after resection at another institution; no further recurrences were found. CONCLUSIONS: We conclude that due to the non-specific presentation of atrial myxoma, a high index of suspicion is needed. The diagnostic method of choice is 2-D echocardiography. Limited septectomy is a safe procedure, but close follow-up for at least 10 years may be needed to rule out recurrence.

[Sequential change of cerebral angiography in a case of cerebral angiitis following herpes zoster ophthalmicus].

Delayed neurological symptoms and signs following herpes zoster ophthalmicus (HZO) such as "Delayed contralateral hemiplegia with HZO" are supposed to be due to ipsilateral intracranial angiitis and ischemic disorder. We experienced a rare case with ipsilateral cerebral hemorrhage following HZO. Under the diagnosis of cerebral angiitis associated with HZO, we treated her conservatively and observed sequential change of angiography for four months. A 54-year-old female, who had been treated for systemic lupus erythematosus (SLE), developed HZO on left ophthalmic nerve area. Seven weeks after the onset of HZO, she complained of headache, mild right hemiparesis, and disturbance of consciousness. Computed tomography revealed subcortical hemorrhage at the left temporo-occipital lobe. Cerebral angiography showed vascular irregularities such as segmental narrowing and sausage-like dilation on proximal portion of the ipsilateral anterior, middle and posterior cerebral arteries. Same findings were seen on peripheral portions of the posterior cerebral artery on the same side. Moreover sequential angiograms showed appearance of an aneurysm in the left middle cerebral artery (M2 potion). Under the diagnosis of cerebral angiitis associated with HZO, she was treated with antiviral agents, antiplatelet drugs, steroid and stellate ganglion block. Those irregularities were found to diminish on the sequential angiograms, and the aneurysm disappeared four month later.

Detection of hydroxyl free radicals in the reperfused primate heart.

Early reperfusion of an ischemic region can result in significant salvage of the area at risk. We show the presence of hydroxyl free radicals at the time of post ischemia reperfusion using electron paramagnetic resonance (EPR) spectroscopy in a macaque model. These free radicals may be formed as a result of reperfusion or may be an un-involved bystander. It is possible that they may be involved in reperfusion injury.

Deviate P200 and P300 in non-patient college students with high scores on the schizophrenia scale of the Minnesota Multiphasic Personality Inventory (MMPI).

Event-related potentials (ERPs) were examined in 16 college students who had high scores on the Schizophrenia Scale of the MMPI (HSS) but were without a hereditary disposition for major psychiatric disorders. 32 sex- and age-matched college students were used as controls. Subjects whose T scores were higher than 70 were designated the HSS subjects. ERPs were recorded during an auditory oddball task. Although neither the P300 latencies nor the P200 latencies differed between the two subject groups, the amplitudes of P300 to rare stimuli and P200 to frequent stimuli were lower in the HSS subjects than in the controls. These results suggest that deficits, both in the P300-related cognitive function to rare relevant stimuli, as well as matching and/or the comparison process for irrelevant frequent stimuli, may be present in HSS subjects. The HSS subjects, especially those with a combination of P300 and P200 deficits, even though without a hereditary diathesis for schizophrenia, may constitute one type of high-risk group.

Immune responses and serum levels of cytokines in adult T-cell leukemia patients and human T-cell leukemia virus type-I carriers.

To find predictive parameters for development and progression of adult T-cell leukemia (ATL) in human T-cell leukemia virus type-I (HTLV-I) carriers, we investigated cellular immune responses such as mitogenic responses and natural killer activity of the peripheral blood mononuclear cells (PBMC). And serum or plasma levels of cytokines, including tumor-necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and immunosuppressive acidic protein (IAP), were also measured in patients with ATL, healthy HTLV-I carriers and healthy HTLV-I non-carriers as controls. Results are as follows: (1) increased spontaneous proliferation and decreased mitogenic responses of PBMC already existed in HTLV-I carriers; (2) IAP was significantly higher in patients with acute/lymphoma type ATL than in those with chronic/smoldering type, HTLV-I carriers and HTLV-I non-carriers. These results suggest that spontaneous proliferation or mitogenic responses and IAP may be useful parameters for the development and progression of ATL from the carriers. Since HTLV-I carriers already have various grades of immunosuppression, we should seriously try to prevent further HTLV-I transmission.