Histological changes in the rat common carotid artery induced by aneurysmal wrapping and coating materials

Histological changes in and around the arterial walls of rats were investigated following topical application of aneurysmal wrapping and coating materials, including a fibrin glue, a cyanoacrylate glue (Biobond), and cotton fibers (Bemsheet). Bilateral common carotid arteries were exposed using sterile techniques, and one of the test materials was applied to the right artery. The left artery was used as the control. Changes in arterial histology were evaluated at 2 weeks, 1 month, 2 months, and 3 months after surgery. The fibrin glue was surrounded by intense inflammation at 2 weeks after surgery. Both the fibrin glue and inflammation had disappeared at 2 months, but the glue had induced mild inflammation in the adventitia. Biobond caused chronic inflammation, necrosis of the media, and thickening of the arterial wall due to fibrosis in both the media and adventitia. Bemsheet produced chronic inflammation, progressive fibrosis, and granuloma. Connective tissue increased in the adventitia, but no major changes were observed in the media. The Bemsheet fibers remained unchanged, and adhered to the arterial wall. Although arterial stenoses were not observed in the present study, the results suggest that cyanoacrylate glue can cause the arterial occlusive lesions observed following aneurysm surgery.

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

BACKGROUND

Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer.

METHODS

Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space.

RESULTS

Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux.

CONCLUSIONS

Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.

Enzyme-linked immunosorbent assay detection of prostate-specific antigen messenger ribonucleic acid in prostate cancer

OBJECTIVES

To develop a rapid, sensitive, reverse transcriptase-polymerase chain reaction (RT-PCR) prostate-specific antigen (PSA) messenger ribonucleic acid (mRNA) detection method by applying colorimetric enzyme-linked immunosorbent assay (ELISA).

METHODS

Total RNA was extracted from 16 urogenital cancer cells (including PSA-producing LNCaP cells) from pelvic and inguinal lymph node aspiration biopsy samples from patients with prostate, bladder, and penile cancer, as well as from blood samples of 500 patients with urogenital cancer. We used rTth polymerase for RT and PCR. The RNA target was amplified by RT-PCR with dinitrophenyl-labeled primer. The PCR product was denatured and hybridized on a PSA-specific probe-coated microwell plate.

RESULTS

In 1 6 cancer cell lines, only LNCaP cells expressed especially high PSA mRNA values, with an optical density (OD) greater than 3. In other cell lines, two testicular cells had relatively high ODs, 1.909 and 0.987, respectively. A high PSA mRNA value was obtained by fine needle aspiration from pelvic lymph node specimens of cytologically positive lymph nodes from patients with prostate cancer but not from patients with cytologically proved bladder or penile cancer. Sensitivity and specificity of fine needle aspiration samples were 70% and 100%, respectively. Blood tests obtained from patients with prostate cancer demonstrated high PSA mRNA values.

CONCLUSIONS

The PSA mRNA RT-PCR ELISA method provides a sensitive photometric enzyme immunoassay for the detection of PSA mRNA, using nonradioactive techniques.

[Itraconazole-induced hypokalemia in a patient with pulmonary aspergilloma]

An 80-year-old man was admitted to the hospital with a diagnosis of pulmonary aspergilloma. A new azole antifungal agent, D 0870, was administered to the patient for 7 days orally, and itraconazole (400 mg/day) was started on March 5, 1997. After 1 month of chemotherapy, facial and pretibial edema were observed and the patient's serum potassium concentration decreased to 2.5 mEq/l. A chest radiograph disclosed cardiomegaly with cardiac effusion and right pleural effusion on admission. The serum potassium concentration rose after the cessation of itraconazole therapy. The serum ITCZ concentration remained high for 2 weeks after admission. Although reports of hypopotassemia induced by ITCZ are rare, we concluded that blood concentrations should be monitored more carefully when treating pulmonary aspergilloma patients with high-dose regimens of ITCZ.

[Public health nurses' disaster responses for intractable neurological patients at home]

OBJECTIVE

This paper describes the 1995 Hanshin-Awaji Earthquake experience of the local public health nurses. The purpose of the study was to identify problems regarding assistance of intractable neurological patients at home during and after the earthquake and to discuss ways to improve future local disaster responses by public health nurses for those patients.

METHODS

Approximately 2 hours of a group interview of public health nurses from 2 public health centers in Kobe City was conducted in August, 1996. Interview data was collected via audio-tape and transcribed. The data was organized according to phases of the earthquake. The acute phase of the earthquake disaster ended within 72 hours. The data was then analyzed to identify problems in assisting intractable neurological home patients in order to discuss disaster responses by public health nurses.

RESULTS

There was a delay in confirming the safety of and providing needed assistance for intractable neurological patients at home by public health nurses. During the first 3 days after the earthquake, the majority of public health nurses were unable to commute to work due to the shutdown of transportation systems. In addition, nurses, who were able to come to work, were preoccupied with treating earthquake casualties and distributing medical supplies. Other factors associated with the delay included the following: lack of a registration list for intractable neurological patients at home; lack of close contacts between public health nurses and patients, and between public health nurses and patient support groups; and sparing nurses for guiding volunteers and for coordinating between shelters and hospitals.

CONCLUSION

Measures to improve future disaster responses are as follows: a) teaching patients and their families how to safeguard against disaster; b) preparing registration lists; c) establishing support networks and cooperating with network members; and d) upon disaster, assigning some nurses to assess the needs of patients.

Comparison between PCR and detection of antigen in sera for diagnosis of pulmonary aspergillosis

We evaluated the usefulness of PCR and antigen detection for the diagnosis of pulmonary aspergillosis. Forty-four serum samples from patients with pulmonary aspergillosis (33 with pulmonary aspergilloma, 4 with allergic bronchopulmonary aspergillosis, 4 with invasive pulmonary aspergillosis, and 3 with aspergillus pyothorax) were used in this study. PCR detection of Aspergillus DNA in serum samples was successful in 39 patients. Galactomannan antigen was detected by sandwich enzyme-linked immunosorbent assay in 25 patients and by latex agglutination test in 13 patients. Detection of Aspergillus DNA in serum samples by nested PCR had the highest sensitivity of the three methods tested for the diagnosis of pulmonary aspergillosis.

Severe rhabdomyolysis as a complication of high-dose chemotherapy in a patient with advanced testicular cancer

BACKGROUND

A 38-year-old man was diagnosed with choriocarcinoma in the left testis, a 9 cm retroperitoneal tumor, left hydronephrosis, multiple lung metastasis and gynecomastia. His serum hCG level decreased but was still above the normal range after four courses of standard chemotherapy.

METHODS

High-dose chemotherapy was then given with ICE (ifosfamide, carboplatin, etoposide) from days -7 to-3.

RESULTS/DISCUSSION

On day -2 the patient became confused and hallucinated, so the sedatives haloperidol and flunitrazepam were administrated. His creatinine phosphokinase levels increased to 6150 IU/L (reference range <197 IU/L) on day 0. Myoglobinuria and myoglobinemia were noted and the renal dysfunction progressed. A peripheral blood stem cell transplantation was performed after hemodialysis on day 0. Although his bone marrow recovered, the patient died of respiratory failure on day 18. An autopsy revealed massive pulmonary bleeding. Pretreatment renal dysfunction, renal damage by high-dose chemotherapy, ifosfamide-induced hallucinations and the administration of sedatives, such as haloperidol and flunitrazepam, may have been causative factors for the rhabdomyolysis observed in this patient.

Ischemic preconditioning translocates PKC-delta and -epsilon, which mediate functional protection in isolated rat heart

Protein kinase C (PKC) plays an important role in mediating ischemic preconditioning (PC). However, the relationship between PKC isoforms and PC is still uncertain. We analyzed subcellular localization of PKC isoforms by Western blot analysis in isolated rat heart and demonstrate that PKC-alpha, -delta, and -epsilon were translocated to the membrane fraction associated with the improvement of cardiac function. Translocation of PKC-delta and -epsilon persisted after a 30-min period following PC, but the translocation of PKC-alpha was transient. Under low Ca2+ perfusion (0.2 mmol/l), PC improved the cardiac function associated with the translocation of PKC-delta. Chelerythrine (1.0 micromol/l) suppressed the translocation of all PKC isoforms associated with the loss of improvement of the cardiac function. On the other hand, bisindolylmaleimide (0.1 micromol/l) did not inhibit the improvement of cardiac function induced by PC, which was associated with the translocation of PKC-epsilon. These results indicate that the effect of PC on cardiac function is mediated by the translocation of either PKC-delta or -epsilon independently in rat hearts.

Induction of Fas-mediated apoptosis in a human renal epithelial cell line by interferon-gamma: involvement of Fas-mediated apoptosis in acute renal rejection

To examine the role of the Fas ligand/Fas (FasL/Fas) system and apoptosis in renal allograft rejection, we analyzed FasL/Fas expression and apoptosis in 63 renal allograft biopsy specimens obtained from 56 renal transplant recipients in Tokyo, Japan. Sixteen biopsy specimens were diagnosed (Banff criteria) as acute rejection (AR), 17 as AR plus chronic rejection, 10 as borderline stages, and 20 as no rejection (NR). Immunohistochemically, Fas antigen was highly expressed in the renal tubular epithelium in tissues from patients with rejection. The mean number of Fas-positive tubular epithelium was significantly higher in biopsy specimens with AR than in those with NR, but FasL expression was highly expressed in infiltrating lymphocytes in the interstitium of allografts with cellular rejection. The mean number of FasL-positive infiltrating lymphocytes was significantly higher in specimens with AR than in those with NR or borderline stages. For detection of apoptotic cells, the specimens were subjected to terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling, which showed that the mean number of tubular epithelial cells positive for this labeling was highest for the specimens with AR, the number being significantly higher than in those with AR plus chronic rejection or with NR. Thus, Fas expression on epithelial cells might actively trigger their apoptosis by the interaction between Fas and FasL. Studies of human normal renal-derived cell lines (RPTEC 2601 [epithelial] and NHMC 5155 [mesangial]) showed that both constitutively expressed Fas (but not FasL) mRNA. After pretreatment with interferon-gamma, Fas-induced apoptosis was observed in the RPTEC 2601 line, but without interferon-gamma pretreatment, anti-Fas-mediated apoptosis was not seen. Under identical conditions, the NHMC 5155 line was resistant to anti-Fas-mediated apoptosis regardless of interferon-gamma pretreatment. This suggested that AR might be associated with increased apoptosis in the renal tubular epithelial cells mediated by the Fas/FasL system.

Differential expression of genes involved in the biosynthesis and perception of ethylene during ripening of passion fruit (Passiflora edulis Sims)

An increase in the enzyme activity of 1-aminocyclopropane-1-carboxylic acid (ACC) synthase and ACC oxidase induces the evolution of ethylene during the ripening of passion fruit. A much higher level of ethylene is produced in arils than in seeds or peels during ripening. The pattern of expression of two ACC synthase genes (PE-ACS1 and PE-ACS2), one ACC oxidase gene (PE-ACO1), and two ethylene receptor genes (PE-ETR1 and PE-ERS1) revealed that the expression of these genes is differentially regulated. Expression of PE-ACS1 and PE-ACO1 was enhanced during ripening and after ethylene treatment. However, prominent expression of PE-ACS1 was delayed compared to that of PE-ACO1. Much larger quantities of PE-ACS1 mRNA and PE-ACO1 mRNA were seen in arils than in seeds; this corresponds well with an increase in the amount of ethylene produced by the plant tissue itself. The level of PE-ACS2 mRNA was detectable in arils of the preclimacteric fruit, although it decreased during ripening. These results suggest that expression of PE-ACS1 and PE-ACO1 is required to increase the activity of ethylene biosynthetic enzymes during ripening. The level of expression of PE-ETR1 and PE-ERS1 did not significantly change over the course of ripening; however, the mRNA levels of PE-ETR1 and PE-ERS1 were much higher in arils than in seeds.

[A case of malignant rheumatoid arthritis complicated by secondary amyloidosis and membranous nephropathy]

A 30-year-old man had been treated for malignant rheumatoid arthritis from 1989 with a non-steroidal anti-inflammatory drug, then bucillamine for six months and prednisolone. Mild proteinuria appeared in May 1994, 4 years after bucillamine therapy was conducted. The patient was admitted to our hospital for a renal biopsy in July 1994. The specimen revealed secondary amyloidosis and membranous nephropathy (MGN). These findings suggest that MGN unrelated to bucillamine therapy might have occurred with secondary amyloidosis in rheumatoid arthritis.

[Severe mycosis-factors with fungus and host]

The deep-seated mycosis occurred in immunocompromized patients. Normally, the deep-seated mycosis became sever infection because of the defects of host defense or the adverse effects of antifungal agents. The major factors of the reason on the severity of the deep-seated mycosis depends on the pathogenesity and the drug resistance for antifungal agents in infected fungi. The clinical factors related with hosts defenses are important to the other reason on the severity. We investigated that the multiple drug resistant (MDR) mechanism may be one of the major roles plays in the azole resistant Candida albicans strains isolated form the patients with oropharyngeal candidiasis infected HIV. We analyzed which clinical factors are related with the prognosis of the patients with pulmonary cryptococcosis and aspergilloma. The titer of cryptococcal capsular antigen was earlier improve in the patient without underline disease than in the patients with underline diseases diagnosed pulmonary cryptococcosis. CRP was higher in the death cases in the patients with pulmonary aspergilloma, compared with alive cases.

Purification and molecular cloning of a novel calcium-binding protein, p26olf, in the frog olfactory epithelium

Olfactory adaptation requires the change of intracellular calcium concentration during stimuli. To contribute in the study of the molecular mechanism of calcium-dependent regulations in olfactory receptor cells, we isolated a novel 26-kDa Ca2+-binding protein named p26olf from the frog olfactory epithelium after four chromatographical steps. Based on the partial amino acid sequences of the proteolysed fragments of p26olf, we obtained a cDNA clone that encodes p26olf. The analysis of its amino acid sequence revealed that p26olf consists of two S-100-like regions aligned sequentially with a calculated molecular mass of 24,493. Northern blot analysis showed that p26olf is expressed in the frog olfactory epithelium and also in other tissues. Immunoreactivity against p26olf was detected in the cilia layer of the olfactory epithelium. These results suggest that p26olf is a dimeric form of S-100 proteins and is involved in the olfactory transduction or adaptation.

Intrameatal tumours presenting as a hearing disturbance: case reports of meningioma and lymphoma

This paper presents two patients with chronic progressive hearing disturbance. Each patients had an intrameatal tumour, part of which extended to the cerebellopontine (CP) angle. In both cases, the patients were initially diagnosed with an acoustic neurinoma. A 63-year-old male experienced a hearing disturbance in the left ear for 1.5 years prior to visiting our hospital. Magnetic resonance (MR) imaging revealed a mass which was surgically resected. The tumour originated from the intrameatal dura mater. Histologically, the tumour was a meningioma. Similarly, a 53-year-old male presented with systemic lymphoma diagnosed 10 months earlier, and a hearing disturbance in the right ear that began 3 months prior to visiting our hospital. MR imaging prior to chemotherapy revealed a mass which extended to the CP angle. Part of the tumour in the CP angle disappeared after chemotherapy, suggesting a secondary lymphoma. Another tumour appeared later in Meckel's cave on the left side; however, it decreased in size following repeated chemotherapy. The present results indicate that differential diagnosis of intrameatal tumours and acoustic neurinomas may be difficult due to the small tumour size. Recent progress in neuroradiology may allow distinction of intrameatal tumours as a separate tumour classification. Our second patient is the sixth reported case of a CP angle lymphoma in the literature.

Microorganism inactivation using high-pressure generation in sealed vessels under sub-zero temperature

In order to test the possibility of utilizing high pressure in bioscience and biotechnology, a simple method for high-pressure generation and its use for microbial inactivation have been studied. When a pressure vessel was filled with water, sealed tightly and cooled to sub-zero temperatures, high pressure was generated in the vessel. The pressure generation was 60 MPa at -5 degrees C, 103 MPa at -10 degrees C, and 140 MPa at -15 degrees C, -20 degrees C, and -22 degrees C. The high pressure generated inactivated microorganisms effectively: yeasts (Saccharomyces cerevisiae and Zygosaccharomyces rouxii), bacteria (Lactobacillus brevis and Eschericia coli), and fungi (Aspergillus niger and Aspergillus oryzae) were completely inactivated when stored in sealed vessels -20 degrees C for 24 h. However, Staphylococcus aureus was only partly inactivated under the same conditions. This method opens up a new application of high pressure for storing, transporting, and sterilizing of foods and biological materials.

Combination chemotherapy in a patient with severe multiple systemic autoimmune disease

We describe the occurrence of autoimmune haemolytic anaemia (AIHA) in a patient who had had both idiopathic thrombocytopenic purpura (ITP) and bullous pemphigoid (BP) for about 10 years. All of these diseases worsened rapidly, and the patient's clinical condition became critical after an episode of acute pneumonia. His AIHA, ITP and BP were responsive to combination chemotherapy consisting of cyclophosphamide, vincristine and prednisolone (CVP therapy).

Determining the breast-feeding interruption schedule after administration of 123I-iodide

Radioactivity after administration of 123I-sodium iodide was measured in breast milk samples obtained from a patient with postpartum thyroiditis. The breast milk was collected over 93 h during the infant's regular feeding times. The radioactivity in the breast milk was calculated with a 123I capsule of the same lot number as the standard source. 123I was excreted exponentially with an effective half-life of 5.5 h; 2.5% of the total radioactivity administered was excreted in the breast milk over the 93 h, 95% of which was excreted within the first 24 h, and 98.2% within 36 h. The first milk sample collected at 7 h after administration of the radiopharmaceutical contained 48.5% of the total radioactivity excreted. We estimated the potential absorption of radioactivity to an infant's thyroid in uninterrupted breast-feeding to be 30.3 mGy. With a 24-hour interruption, the absorbed radioactivity would be 1.25 mGy; with a 36-hour interruption, it would be 0.24 mGy. According to our calculations, breast feeding should be curtailed for 36 h to reduce the infant's exposure to 123I radioactivity. By using a correction factor based on maximum radioactivity from another 123I capsule of the same lot, we were able to ascertain the appropriate protocol for our patient and establish a measurement method that can be applied in similar clinical situations.

[Pulmonary actinomycosis with "balls-in-a hole" appearance diagnosed by examination of bronchial lavage fluid]

A 49-year-old man was referred to our hospital because of abnormal chest X-ray findings. Chest X-ray films showed infiltrative opacities in the right lung, and histological findings of a transbronchial biopsy specimen showed non-specific inflammation. The patient was treated with Ofloxacin for one month. After the treatment, chest X-ray films showed that the infiltrative opacities in the right upper lobe had decreased, but that opacities in the right lower lobe had increased, with an air meniscus sign. A chest computed tomography scan at the same time revealed that the remaining opacities contained multiple mass-like lesions within a cavity in the right S6, appearing as "balls in a hole". One year after the first visit, the patient visited the hospital again because of cough and sputum. A chest X-ray film showed that the size of the cavity in the right lower lobe had increased. The histological findings from a fresh transbronchial biopsy specimen revealed a non-specific inflammation again; however, black clots obtained from bronchial lavage fluid after biopsy were histologically identified as sulfur granules, a classic pathological indication of actinomycosis. This confirmed the diagnosis of pulmonary actinomycosis. The patient was treated with penicillin, and the opacities in the right lower lobe subsided.

Investigation of the structural basis for thermostability of DNA-binding protein HU from Bacillus stearothermophilus

Site-directed mutagenesis was used to identify amino acid residues essential for the thermostability of the DNA-binding protein HU from the thermophile Bacillus stearothermophilus (BstHU). Two mutants, BstHU-A27S and BstHU-V42I, in which Ala27 and Val42 in BstHU were replaced by the corresponding amino acids Ser27 and Ile42, respectively, in the homologue from a mesophile B. subtilis (BsuHU), were less stable than the wild-type BstHU (63.9 degreesC), showing Tm values of 58.4 degreesC and 60.1 degreesC, respectively, as estimated by circular dichroism (CD) analysis at pH 7.0. The denaturation of two mutants was further characterized using differential scanning calorimetry; the Tm values obtained by calorimetric analysis were in good agreement with those estimated by CD analysis. The results suggest that Ala27 and Val42 are partly responsible for enhancing the thermostability of BstHU. When considered together with previous results, it is revealed that Gly15, Ala27, Glu34, Lys38, and Val42 are essential for the thermostability of thermophilic protein BstHU. Moreover, five thermostabilizing mutations were simultaneously introduced into BsuHU, which resulted in a quintuple mutant with a Tm value of 71.3 degreesC, which is higher than that of BstHU, and also resulted in insusceptibility to proteinase digestion.

[Pneumonia caused by granulomatous Pneumocystis carinii in a patient with the acquired immunodeficiency syndrome]

A 54-year-old man was admitted to the hospital because of fever and general fatigue. A chest roentgenogram on admission showed lobular opacities and ill-defined opacities in both lower lobes. The pneumonia was successfully treated with antibiotics. The acquired immunodeficiency syndrome was diagnosed because ELISA and PCR tests for antibodies to the human immunodeficiency virus were positive and the CD 4+ lymphocyte count was 39 per cubic millimeter. Examination of bronchoalveolar lavage fluid revealed no Pneumocystis carinii. Trimethoprim and sulfamethoxazole were given prophylactically, but were withdrawn because of a rash. The patient began to receive aerosolized pentamindine and was discharged. On the next day, he was readmitted to the hospital because of a high fever. A chest roentgenogram showed diffuse miliary opacities. Chest CT scan also showed diffuse small nodular opacities in both lungs. Examination of a transbronchial biopsy specimen revealed well-defined, noncaseating granulomas with pneumocystis organisms in their centers. Cultures for tuberculosis and fungi were all negative. We diagnosed granulomatous pneumonia caused by Pneumocystis carinii, which is an atypical manifestation of Pneumocystis carinii pneumonia. The patient died of sepsis and cardiac tamponade. Microscopically, the lung tissue was found to have foamy intra-alveolar exdates, which is a typical histological feature of Pneumocystis carinii pneumonia.

Effects of treatment with nilvadipine on cerebral ischemia in rats

The protective effects of a Ca2+ antagonist, nilvadipine, on focal cerebral ischemia were studied in male spontaneously hypertensive rats. The animals received either nilvadipine (3mg x kg(-1) x day(-1)) or a vehicle subcutaneously. Group 1 (n=11) was treated for 7 days, and Group 2 (n=11) for 14 days. The middle cerebral artery was occluded on the 6th (Group 1) or 13th (Group 2) day of the treatment, and neuropathological outcomes were quantified 24 hours later. The mean arterial blood pressure was significantly reduced with nilvadipine to normal levels. The % infarct volumes of Groups 1 (37+/-2) and 2 (34+/-3) were significantly less than those of their controls (39+/-3 [n=11] and 40+/-4 [n=12], respectively), although the difference between Groups 1 and 2 was not significant. When infarct areas were compared in each of 8 coronal sections, the infarct size had decreased in the 5 posterior sections in Group 2, but only in 2 sections of Group 1. A significant decrease in the edema volumes was observed in Group 2, but not in Group 1. Thus, nilvadipine provided protective effects against cerebral ischemia in rats having chronic hypertension, and the effects were dependent on the duration of treatment.

[Characteristics of home care patients with intractable neurological diseases (Nanbyo) in Tokyo]

The purpose of this study was to identify the characteristics of home care of patients with intractable neurological diseases. A survey was conducted of members of Tokyo Medical Association who were home visit doctors. They responded to questions about their patients who have suffered from either Parkinson's disease (PD), spinocerebellar degeneration (SCD), or amyotrophic lateral sclerosis (ALS), and whose home care have been supported by the care system for at least three months. Of 205 survey questionnaires collected, 198 were effective to be analyzed. The sample consisted of 105 patients with PD (53.0%), 63 patients with SCD (31.8%), and 30 patients with ALS (15.2%). The mean age of the PD was 75.5 years with a range of 53 to 90, SCD was 66.5 years with a range of 39 to 88, and ALS was 58.7 years with a range of 42 to 86. The major findings in this study were as follows: 1) The patients who had one or more medical equipment installed at the beginning of home care were 30% of ALS, 9% of PD and 18% of SCD. As time elapsed, patients who needed to have some medical equipment installed increased in ALS greater than in PD and SCD. 2) The home doctors predicted that the condition of 37% of ALS patients, 9% of PD, and 8% of SCD would probably be deteriorating within one month. 3) Of the 30 patients with ALS, 47% experienced hospitalization three times or more compared to 27% of PD and 21% of SCD. The most prevalent reason for hospitalization for ALS was respite of caregivers, PD and SCD, however, were hospitalized for control of prescription, a change for the worse, or treatment of other diseases. 4) Ninety percent of ALS caregivers felt extremely tired or slightly tired. Their home doctors responded that 83% of ALS caregivers did their best in caregiving. 5) ALS patients utilized social resources such as volunteers, care workers, services of supply and maintenance of medical equipment, and emergency care for 24 hours more than SCD and PD. In the conclusion, ALS patients experienced the highest hospitalization of the three diseases and respite of family caregivers was necessary. They showed a higher utilization of various social resources than other diseases. It is important to consider these characteristics of home care patients by diseases in order to prepare and develop the necessary support system of home care for the intractable neurological patients.