Motor activity rhythm in dementia with delirium

Using an actigraph, the activity patterns in 13 demented patients with delirium were examined. We analyzed the data of the eight patients, wearing the actigraphs for more than 10 days. They were classified into four types: type A, nocturnal delirium type; type B, wandering type; type C, hypobulia type; and type D, lying down type. The day to day activity variation was most prominent in type A and seemingly the least in type B. The dominant period of activity rhythm was nearly 24 h in all cases. Additional 12-h period was observed in type C. Actigraphs might become useful in making therapeutic decisions regarding demented patients with delirium.

Effects of short duration morning bright light in healthy elderly. II: sleep and motor activity

Subjective sleep feelings and motor activity were measured in seven healthy elderly subjects for 6 days. The subjects were exposed to bright light (6000 lux) for 30 min in the morning or instructed to sit in front of a desktop lighting device without light. The average level of motor activity during the night was significantly decreased in the bright light condition, compared with the controlled condition. However, daytime motor activity did not show significant differences between the two conditions. From these findings, even a short duration of morning bright light is effective in maintaining sleep without changing daytime activity.

Demonstration of double-chambered right ventricle on myocardial perfusion SPECT

A 19-year-old man with a double-chambered right ventricle (DCRV) and an associated ventricular septal defect was admitted to the hospital for surgical correction. Preoperative study of myocardial perfusion with Tc-99m tetrofosmin SPECT depicted the two chambers of the right ventricle. There was a substantial differential in the radioactive uptake between these two chambers. The inflow and outflow chambers with different peak-pressures (94 and 18 mm Hg) showed different uptakes reflecting the pressure difference, which was intense in the inflow chamber and weak in the outflow.

[Sleep-wake transition disorders]

The term sleep-wake transition disorders refers to a group of parasomnias that occur during the transition from wakefulness to sleep or from one sleep stage to another. Rhythmic movement disorder, sleep starts, sleep talking, and nocturnal leg cramps--these four disorders belong to sleep-wake transition disorders in the International Classification of Sleep Disorders. Although these are common disorders, little attention is given to them and their mechanisms are remain unclear. The majority of patients are not so severe as to require any treatment. Their prognosis are usually well. This article describes sleep-wake transition disorders concerning the clinical features, differential diagnosis, treatment, etc.

Intra-mesenteric artery steroid administration relieved severe refractory gastro-intestinal graft-vs.-host disease in an allogeneic bone marrow transplantation patient

We report a case of severe gastro-intestinal (G-I) graft-vs.-host disease (GVHD) successfully treated with intra-mesenteric artery steroid administration. A 29-year-old man with severe aplastic anemia (SAA) was submitted to HLA-identical unrelated allogeneic bone marrow transplantation (BMT) and was found to be suffering from grade IV G-I GVHD. Although cyclosporine, steroid pulse therapy, and FK506 proved ineffective, 30 mg of water-soluble prednisolone as administered into each the superior and inferior mesenteric artery with remarkable effects. This treatment was repeated two times, and the symptoms of G-I GVHD disappeared completely.

Mitral insufficiency as a complication of acute myocardial infarction and left ventricular remodeling

The presence of mitral insufficiency after acute myocardial infarction (AMI) often leads to hemodynamic impairment and heart failure. This study was designed to examine the relationship between mitral regurgitation (MR), an indicator of mitral insufficiency, and the course of recovery from AMI. We evaluated the course of MR after AMI in 223 patients by color Doppler echocardiography. MR was detected in 21% (47/223) of patients at the onset of AMI, and developed in 18% (40/223) of patients during follow-up. Patients were grouped according to the course of MR as well as the success of acute recanalization therapy. No correlation was observed between the presence or course of MR and the site of infarction. The incidence of successful recanalization was higher in patients with MR that improved during follow-up than in patients with MR that was unchanged or that worsened during follow-up. Although no significant differences in hemodynamic variables were noted among the groups at admission, the group with unsuccessful recanalization and unimproved MR (BS-) showed a significantly greater left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter, and left ventricular end-diastolic volume (LVEDV) as well as a lower left ventricular ejection fraction than patients with successful recanalization and no MR (CS+) during the convalescent period. The extent of change in LVDd and LVEDV between admission and convalescence was significantly greater in the BS(-) group than in the CS(+) group. The results suggest that successful recanalization after AMI reduces the incidence of MR. Acute recanalization therapy after AMI may prevent left ventricular remodeling, resulting in a secondary improvement of MR.

Midday exposure to bright light changes the circadian organization of plasma melatonin rhythm in humans

Effects of bright light exposure at midday were examined on plasma melatonin rhythm in humans under controlled living conditions. Bright light of 5000 1x was provided from the ceiling at midday (1100-1700 h) for 3 consecutive days and the circadian rhythm in plasma melatonin was determined from the fourth to fifth day. The control study was performed in the same subjects who spend four days under dim light conditions (less than 200 1x). The subjects were allowed to sleep from 2400 to 0800 h. The onset phase, but not the end phase, of plasma melatonin rhythm was significantly phase-advanced by bright light exposure. Furthermore, the area under the curve of nocturnal melatonin rise was significantly larger under bright light exposure than under dim light. These findings indicate that midday exposure to bright light for 3 consecutive days changes the circadian organization of plasma melatonin rhythm in humans.

Two cases of malignant pheochromocytoma treated with cyclophosphamide, vincristine and dacarbazine in a combined chemotherapy

Two patients with malignant pheochromocytoma were treated with a combination chemotherapy regimen consisting of cyclophosphamide vincristine, and dacarbazine (CVD). With the first few cycles of the treatment, one patient, a 29-year-old man had a marked improvement of clinical symptoms and decreases in tumor size and catecholamine levels in plasma and urine. He had been in a clinically stable condition for 18 months but died 34 months after starting of this treatment because the CVD regimen became ineffective and rapid growth of the metastatic tumors occurred. The other patient, a 35-year-old man showed no significant change in tumor size but decreases in hormonal levels in response to CVD regimen. The patient has been in clinically stable condition in a follow-up of 24 months. The combined chemotherapy with CVD appears to be effective for advanced malignant pheochromocytoma.

Renal dopamine spillover rate using 3H-dopamine radiotracer technique as an index of renal dopaminergic nerve activity

Renal and total dopamine (DA) spillover rates at rest were measured in 25 conscious rabbits with chronically implanted renal vein catheters. Renal DA spillover rate was calculated from veno-arterial difference in plasma free DA concentrations across the kidney corrected by the fractional extraction of infused 3H-DA. Plasma free DA concentrations were 11.0 +/- 2.7 pg/ml in the artery and 14.3 +/- 3.6 in the renal vein. Renal and total DA spillover rates were 0.51 +/- 0.08, 2.61 +/- 0.30 ng/min, respectively, both of which were significantly (p < 0.001) lower than the respective norepinephrine (NE) spillover rates (renal: 16.3 +/- 1.4, total: 39.6 +/- 1.7). The fractional extraction of 3H-DA across the kidney (55 +/- 3%) and the total DA clearance (285 +/- 31 ml/min) were both significantly (p < 0.05) higher than that of 3H-NE (45 +/- 3) and the total NE clearance (198 +/- 9), respectively. The ratio of renal to the total spillover rate of DA (0.23 +/- 0.05) was significantly (p < 0.05) lower than that of NE (0.41 +/- 0.04). These results demonstrate that DA is released into plasma within the kidney and suggest that the measurement of renal DA spillover rate using 3H-DA radiotracer technique is useful to detect resting renal dopaminergic nerve activity.

Regional myocardial sympathetic dysinnervation in patients with coronary vasospasm

The purpose of this study was to assess the presence and location of impaired myocardial sympathetic innervation by using 123I metaiodobenzylguanidine (123I MIBG) in 15 patients with coronary vasospasm induced by intracoronary acetylcholine. The results were compared with those using thallium-201 (Tl-201). We also examined 14 patients with severe coronary stenosis (> 90%) and 8 control subjects without significant coronary stenosis (< 50%) and provokable coronary vasospasm. Regional myocardial sympathetic dysinnervation was detected by 123I MIBG single-photon emission computed tomography (SPECT) in all patients with coronary vasospasm, despite normal uptake during Tl-201 SPECT. This regional uptake-mismatch between 123I MIBG and Tl-201 Spect occurred specifically in the vasospasm group (p < 0.001 vs stenosis and control groups). Moreover, regional myocardial sympathetic dysinnervation was located in the distribution of perfusion in 25 of the 27 vasospasm-induced vessels. Normal uptake of 123I MIBG was observed in the perfused areas in 16 of the 18 non-vasospasm-induced vessels. The sensitivity ans specificity of 123I MIBG for detection of coronary vasospasm were 92% and 88% respectively. In patients with coronary vasospasm, we found regional myocardial sympathetic dysinnervation to be present. Furthermore, we were able to distinguish these patients from patients with critical coronary stenosis by 123I MIBG and Tl-201 SPECT.

Re-evaluation of capillaroscopy of finger nailfold in vibration-exposed workers

Two hundred and ninety-four vibration-exposed workers were examined for vibration disease (VD) for the worker's accident compensation. Most subjects were male. Their ages ranged from 24 to 68 years. Duration of vibration exposure ranged from 3 to 30 years. After acclimatization at 25 degrees C to 27 degrees C for at least an hour, the nailfold capillaries of the ring (or middle) finger were studied with a light microscope. A cold water immersion test (5 degrees C, 10 min) was then performed. The morphological findings of the nailfold capillaries were classified based on the criteria by Fagrell & Lundberg. A hundred and eighty subjects were diagnosed as VD and 75 as non VD, even without taking the capillaroscopic findings into consideration. The classification of the capillarograms retrospectively investigated were as follows, i.e. in 98 VD subjects 40 cases were stage A, 42 stage B, and 16 cases stage C. In 26 nonVD subjects 13 cases were stage A, 10 stage B, and 3 cases stage C, respectively. When the borderline of VD and nonVD existed between stage A and stages B and C, the sensitivity was 59.2%, specificity was 50.0%, and false positive and negative were 50.0% and 40.8%. Relationship between the capillary stage and recovery (%) of the skin temperature during the cold water immersion test was also studied. The recovery in stage C was not always lower than that in stage A. Among them, arteriography was performed in 57 cases. Despite the use of vasodilator, markedly delayed perfusion of the finger tips was observed in 28 cases. Their capillary stages were A in 12 cases, B in 11 and C in 3. The peripheral microcirculatory state in VD should be carefully evaluated in combination with appropriately selected examinations, including finger nailfold capillaroscopy.

[Intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer]

Intracavitary instillation of Tokyo 172 strain Bacillas Calmette-Guerin was performed on 39 patients with superficial bladder cancer after contact Nd:YAG laser irradiation for tumors. The BCG group received intravesical instillation of 80 mg BCG at two week intervals for 6 months. Recurrence occurred in 7 of the 39 patients. In the 7 recurrent cases instillation of BCG had been discontinued after 2-7 instillations due to bladder irritation, with recurrence seen 6-27 months later. The non-recurrence rate in the group (27 cases) instilled BCG more than seven times was 94.0%. The non-recurrence rate in this group was significantly higher than that in the group (12 cases) with less than six BCG instillations. The non-recurrence rate in the group (26 cases) without BCG therapy was not significantly different from that in the group (12 cases) with less than six BCG instillations. Our findings suggested that frequent (more than seven times) instillation of BCG increased the non-recurrence rate, and that less than six BCG instillations is not significantly effective for preventing the recurrence of superficial bladder cancer.

Comparison of blood pressure, heart rate and activity between normotensive and spontaneously-hypertensive rats

Blood pressure, heart rate and physical activity in spontaneously hypertensive rats (SHR) were measured and compared with those of Wistar Kyoto rats (WKY) to see how these parameters vary with age and whether we can find a marker of essential hypertension among these variables. An automatic telemetric system was employed to measure these variables. In SHR, blood pressure and physical activity increased with age, but heart rate decreased. In WKY, neither blood pressure nor physical activity showed significant changes, but heart rate decreased with age. The 24h mean values of blood pressure, heart rate and physical activity were significantly higher in SHR than in WKY. The mean values of blood pressure, heart rate and physical activity were higher during nighttime than during daytime in both SHR and WKY. Circadian MESOR and amplitude of blood pressure increased simultaneously in SHR. These results are compatible with the concept that an increased amplitude of blood pressure may predict subsequent development of essential hypertension.

Skin holes of titanium casting

The present study describes refractories which contribute to formation of skin holes of Ti casting. Plates consisting of quartz (Qu) and cristobalite (Cr) powders and Qu- and Cr-MgO mixtures were fired at high temperatures and used as phosphate-free molds. The cross-section of the castings was investigated using an optical microscope and an electron probe microanalyzer. Whereas the castings into the Qu molds were almost complete, those into the Cr molds were incomplete. The surface reaction zone of the Qu molds formed a typical layered structure with fewer skin holes. That of the latter extended deeply into the interior with a net-shaped Ti-Si phase, cracks, and holes. Addition of MgO to Cr effectively improved the castability and changed the reaction zone to the typical layered structure. However, slender holes occurred along the mold wall. The overall area around the holes was contaminated by Si and Mg. Probably, this resulted from a reaction of forsterite with Ti. The reactivity difference between Qu and Cr was not related to the fired strength of mold.

Hypothenar hammer syndrome in workers occupationally exposed to vibrating tools

Among 330 vibration-exposed workers, 24 cases of hypothenar hammer syndrome in 29 hands were diagnosed by arteriography. The right hand was involved in 13, the left hand in six, and both hands in five cases. The mean age was 55 years, mean duration of vibration exposure 19.4 years, and mean duration of episodic Raynaud's phenomenon 6.4 years. The vascular lesions of the ulnar arteries were classified into three major types with subtypes. Type 1: stenosis of the superficial palmar arch around the hook of the hamate. Type 2a: occlusion of the superficial palmar arch around the hook of the hamate. Type 2b: occlusion of both superficial and deep palmar arches around the hook of the hamate. Type 3a: occlusion of the ulnar artery at the proximal part of the wrist. Type 3b: occlusion of the ulnar artery near the wrist with the occlusion of the dorsal carpal branch of the ulnar artery.

[A clinical study of lomefloxacin on the patients with urinary tract infections--focused on lomefloxacin-induced photosensitivity reaction]

Between April and October 1990, photosensitivity reactions were observed in 19 out of 338 patients who were administered lomefloxacin (LFLX) for the treatment of urinary tract infections (UTI) in our hospital. To certify the effectiveness and safety of LFLX to UTI, we carried out a controlled study with fixed dosages and durations. Patients with acute uncomplicated UTI and chronic complicated UTI were enrolled and LFLX dosages of 200 mg b.i.d. for 7 days and 14 days, respectively, were administered. The overall efficacy rates were 100% and 84% respectively. Concerning the bacteriological effect, Escherichia coli and Klebsiella pneumoniae were eliminated in every case, while 3 strains of Enterococcus faecalis 2 strains of Pseudomonas aeruginosa and one strain of Enterobacter cloacae persisted. No photosensitivity reaction or noteworthy severe adverse reactions were observed among 200 cases enrolled in this study of restricted dosages and durations. We, urologists, need to be well-informed about photosensitivity reactions induced by quinolone antimicrobial agents. LFLX was proven to be effective in UTI without showing any photosensitivity reactions when administered by our fixed dosages and durations.

[Torsion of the undescended testis: report of two cases]

We report the torsion of the inguinal undescended testis seen in two boys 9 and 11 years old. Orchiopexy was performed in each case. We discussed the preoperative diagnosis and treatment of this disease. Orchiectomies are still frequently performed, because the preoperative diagnosis is often delayed.