Electroencephalographic changes before the onset of symptomatic West syndrome

To clarify the characteristics of the mode of appearance and morphology of epileptiform discharges before the onset of West syndrome (WS). The subjects were 25 infants whose electroencephalograms (EEGs) were recorded before the onset of WS and whose first EEG was recorded before 6 months of corrected age (CA). We extensively analyzed the chronological and topographical changes of the epileptiform discharges before the onset of WS. The location of the initial epileptiform discharges was in the posterior areas in 14 (Group O), the multiple areas in 7 (Group M), and areas other than occipital in 4 (Group non-O). Twelve of the 14 patients in Group O were premature infants, and all but one had PVL. Most patients in Group M were full-term infants or near full-term infants who had hypoxic damage. The ages at the appearance of the initial epileptiform discharges in Group O were significantly later than those in Group M: 3.0–5.9 months of CA in Group O vs. −0.1 to 2.0 months of CA in Group M. These facts suggest that the difference of brain damage is related to both the topographical characteristics and the age at the appearance of initial epileptiform discharges, and around 3 months of CA is a critical period for the appearance of occipital hyperexcitability. Hypsarrhythmia and tonic spasms appeared almost simultaneously from 4 to 6 months of CA in most patients. To predict the occurrence of WS in high-risk infants, EEG follow-ups from early infancy are very useful.     

Habitual coffee but not green tea consumption is inversely associated with metabolic syndrome: an epidemiological study in a general Japanese population

In Japan, metabolic syndrome used to be rare, and the level of coffee consumption was low. However, the Japanese life style has been changing rapidly, and these changes have been associated with a steady increase in the frequency of metabolic syndrome and with greater consumption of coffee. We examined the relationship between metabolic syndrome and the consumption of coffee or green tea. A total of 1902 Japanese aged over 40 years (785 men and 1117 women) received population-based health check-up in 1999. We measured components of metabolic syndrome (blood pressure, waist circumference, fasting plasma glucose, and lipid profiles). Eating and drinking patterns were evaluated by a food frequency questionnaire. Multivariate analyses were performed to clarify the association between coffee or green tea consumption and the components of metabolic syndrome. All components of metabolic syndrome except for HDL-cholesterol were significantly (p<0.01) and inversely related to coffee but not green tea consumption by multivariate analysis after adjusting for confounding factors. The larger was the number of components of metabolic syndrome, the lower was the level of coffee consumption (p<0.0001). In addition, there was a high frequency of metabolic syndrome in small coffee drinkers. Thus, coffee but not green tea consumption was inversely associated with metabolic syndrome.     

An epidemiological study of children with status epilepticus in Okayama, Japan

BACKGROUND: The incidence of status epilepticus (SE) in Asian children, including Japanese, has not been reported. METHODS: In 2003, we performed an epidemiological study of SE on Japanese children (31 days or older to <15 years of age) in Okayama City by ascertaining all lifetime first episodes of SE. RESULTS: Thirty-seven patients (22 males and 15 females) were identified. The annual incidence of SE was 38.8 per 100,000 population (95% CI: 24.5-49.5). Febrile SE in the absence of CNS infection accounted for 17. Acute symptomatic etiologies other than febrile SE were observed in eight patients, including three cases of influenza encephalitis/encephalopathy. Five were classified as remote symptomatic and the remaining seven as cryptogenic. The highest incidence (155.1/100,000) was seen in the age range of 31 days or older to <1 year, followed by 101.5/100,000 in the age range of one year, and the incidence decreased after eight years. In 26 of the 37 patients, SE was their first seizure. As for seizure types, 32 had convulsive SE, including tonic status in one. Five others showed nonconvulsive SE, including complex partial SE in four and absence status in one. No one died of SE. Two patients who brought on SE because of influenza encephalitis/encephalopathy suffered from motor disturbance with or without mental disturbance after SE. CONCLUSIONS: The incidence of SE tended to be higher in Japanese children than reported in Caucasians. The Japanese had an age-specific incidence pattern similar to that of Caucasians.     

Metabolic syndrome, diabetes and subclinical atherosclerosis as assessed by carotid intima-media thickness

AIM: Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease and is associated with cardiac events. We investigated cross-sectionally the association between carotid intima-media thickness (IMT), confounding risk factors, and metabolic syndrome (MetS) using the modified Japanese criteria. METHODS: Carotid IMT was evaluated on B-mode ultrasonography in 918 patients (394 men aged 66 +/- 15 years and 524 women aged 72 +/- 13 years). RESULTS: Among our 918 patients, 74 (8.1%) had no metabolic abnormalities, 478 (52.1%) had a metabolic abnormality with neither type 2 diabetes or MetS, and 127 had MetS without diabetes. Of the patients with type 2 diabetes, 132 (14.4%) did not have MetS and 107 (11.7%) had both type 2 diabetes and MetS. The carotid IMT values in the four groups with any metabolic abnormalities were significantly greater than the IMT of the group with neither condition (p=0.001), respectively. In syndrome model, type 2 diabetes was significantly associated with carotid atherosclerosis (p= 0.006), but MetS was borderline significant. In the component model of MetS, there was a significant association with hypertension (p<0.001) and dyslipidemia (p=0.006). Multiple logistic regression analysis for carotid atherosclerosis compared to neither condition demonstrated that subjects with both MetS and diabetes (OR, 5.58; 95% CI, 2.64-11.8), those with type 2 diabetes without MetS (OR, 3.00; 95% CI, 1.45-6.22), and those with MetS without type 2 diabetes (OR, 2.58; 75% CI, 1.24-5.39) showed a higher odds ratio after adjustment for covariates. CONCLUSION: Even after taking into account each individual component of MetS, the clustering of visceral obesity with at least 2 of the 3 components, and diabetes are independently associated with increased carotid IMT. This suggests that the components of MetS and type 2 diabetes interact to affect vascular thickness synergistically.     

Percutaneous transhepatic portal embolization for persistent bile leakage after hepatic resection: Report of a case

Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.     

Flat and depressed types of early colorectal cancers: from East to West

Recent advances in colonoscopy have enabled us to diagnose early-stage colorectal tumors. Magnifying colonoscopy is useful for diagnosing histologic types by assessing the microstructure of the mucosal surface in detail, which also helps to predict the depth. This article describes clinicopathologic features and endoscopic treatment of flat and depressed types of early colorectal carcinoma.     

Observer performance in diagnosing osteoporosis by dental panoramic radiographs: results from the osteoporosis screening project in dentistry (OSPD)

Mandibular cortical erosion detected on dental panoramic radiographs (DPRs) may be useful for identifying women with osteoporosis, but little is known about the variation in diagnostic efficacy of observers worldwide. The purpose of this study was to measure the accuracy in identifying women at risk for osteoporosis in a worldwide group of observers using DPRs. We constructed a website that included background information about osteoporosis screening and instructions regarding the interpretation of mandibular cortical erosion. DPRs of 100 Japanese postmenopausal women aged 50 years or older who had completed skeletal bone mineral measurements by dual energy X-ray absorptiometry were digitized at 300 dpi. These were displayed on the website and used for the evaluation of diagnostic efficacy. Sixty observers aged 25 to 66 years recruited from 16 countries participated in this study. These observers classified cortical erosion into one of three groups (none, mild to moderate, and severe) on the website via the Internet, twice with an approximately 2-week interval. The diagnostic efficacy of the Osteoporosis Self-Assessment Tool (OST), a simple clinical decision rule based on age and weight, was also calculated and compared with that of cortical erosion. The overall mean sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 60 observers in identifying women with osteoporosis by cortical erosion on DPRs were 82.5, 46.2, 46.7, and 84.0%, respectively. Those same values by the OST index were 82.9, 43.1, 43.9, and 82.4%, respectively. The intra-observer agreement in classifying cortical erosion on DPRs was sufficient (weighted kappa values>0.6) in 36 (60%) observers. This was significantly increased in observers who specialized in oral radiology (P<0.05). In the 36 observers with sufficient intra-observer agreement, the overall mean sensitivity, specificity, PPV, and NPV in identifying women with osteoporosis by any cortical erosion were 83.5, 48.7, 48.3, and 85.7%, respectively. The mean PPV and NPV were significantly higher in the 36 observers with sufficient intra-observer agreement than in the 24 observers with insufficient intra-observer agreement. Our results reconfirm the efficacy of cortical erosion findings in identifying postmenopausal women at risk for osteoporosis, among observers with sufficient intra-observer agreement. Information gathered from radiographic examination is at least as useful as that gathered from the OST index.     

Abnormal fast activity in infancy with paroxysmal downwards gaze

We report here on 8 infants who showed paroxysmal downwards gaze (PDG). The time of initial appearance of PDG ranged from one month to five months (mean: 2.7 months) of corrected age. Seven out of eight patients showed interictal spikes in EEG, so they were started on prophylactic therapy with antiepileptic drugs. In five of the eight patients, PDG ceased, either spontaneously or with antiepileptic drug treatment, by four to eight months of corrected age. Six out of eight patients showed localized spikes and peculiar abnormal fast activity (AFA) in the occipital area and five of these patients later developed West syndrome. These AFA were observed on EEGs recorded at the time of initial PDG appearance, before hypsarrhythmia was observed and before tonic spasms appeared. We were able to exclude the possibility that PDG was a subtle epileptic seizure by confirming the temporal discordance between individual episodes of PDG and AFA with video-EEG monitoring. Yet topographic data showed that AFA in these patients was characteristically located in the occipital area, with a distribution similar to that of the fast activity which accompanied the tonic spasms that later developed in these patients. As a risk factor for developing WS, we propose the clinical symptom of PDG with characteristic occipital AFA visible in the EEG, both of which represent damage to the occipital region including the optic radiation.