A case of medial temporal lobe epilepsy associated with occult focal cortical dysplasia in the lateral temporal neocortex]

A 29-year-old male with medial temporal lobe epilepsy(MTLE) was revealed to have "occult" focal cortical dysplasia(FCD) in the lateral temporal neocortex. He had no history of febrile convulsion and developed complex partial seizure at the age of 14 year, which became intractable. Although MRI failed to reveal structural abnormality in the temporal lobe, even retrospectively, the findings of non-invasive preoperative examination, such as video-EEG monitoring and interictal ECD-SPECT and FDG-PET, were consistent with those of the left MTLE. Intraoperative electrocorticography(ECoG) demonstrated almost continuous paroxysmal activities on the anterior part of the inferior temporal gyrus(ITG). Anterior temporal lobectomy(ATL) with hippocampectomy was performed. Histological examination revealed FCD in the small area with 0.8 mm in diameter of the resected ITG. In the ATL without preoperative invasive examination such as chronic subdural electrode recording, intraoperative ECoG recording is mandatory.     

Socioeconomic factors and cancer incidence, mortality, and survival in a metropolitan area of Japan: a cross-sectional ecological study

Cancer mortality is generally high in people of low socioeconomic status compared with people of high socioeconomic status (SES). Although these differences in mortality may be caused by differences in cancer incidence and survival, analysis of these factors has rarely been conducted. The objective of our cross-sectional ecological study was to analyze socioeconomic differences in cancer incidence, mortality and survival in a metropolitan area of Japan. The age-adjusted cancer incidence rates, age-adjusted mortality rates, relative 5-year survival, and proportions of early stage cancer were calculated for 67 municipalities in Osaka, Japan. For area-based socioeconomic variables, we used the percentages of male unemployment, college or graduate school graduates, home ownership, households receiving government assistance, and households below the subsistence habitation level in each municipality. We performed linear regression taking each municipality's population as weight to examine the relationships between measurements relating cancer and socioeconomic variables. Factor analysis of socioeconomic variables was carried out to determine whether a particular socioeconomic variable tended to be associated with another. Cancer incidence, cancer mortality, 5-year cancer survival, and proportion of early stage cancer were highly correlated with each socioeconomic variable at the municipality level. Five area-based socioeconomic variables could be explained by three factors: economic status, housing characteristics and educational attainment. Despite the major limitation of a lack of individual information about socioeconomic characteristics and outcomes related to cancer, we hypothesize that a municipal area's socioeconomic status might be a predictor of individual incidence, mortality, and survival of cancer.     

Duration of cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage for prevention of symptomatic vasospasm and late hydrocephalus

The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p = 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p = 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.     

Health characteristics of elderly Japanese requiring care at home

The number of elderly subjects requiring care is rapidly increasing, however, their health status has not been well studied. The purposes of this study were to describe the health characteristics of the elderly at home who were using long-term care insurance, and to clarify factors that influence dependence for activities of daily living (ADL). The subjects were 194 elderly people living at home, who were approved for care. The items surveyed were the demographic characteristics, care level (or level of dependence for ADL), Barthel index, grip strength, thigh muscle volume, cognitive impairment using the mini-mental state examination (MMSE), depressed mood using the geriatric depression scale (GDS-15), and serum albumin and hemoglobin levels. The grip strength (p=0.0001), thigh muscle volume (p=0.0030), MMSE score (p=< 0.0001) and serum albumin level (p= < 0.0001) decreased, while the GDS-15 score (p=0.0142) increased with deteriorating care levels. The proportion of subjects not requiring assistance for the items "bathing" and "stair-climbing" in the Barthel index was markedly low in the subjects belonging to the relatively low (mild) care levels. The logistic regression analysis showed that factors associated with dependence for "bathing" and "stair-climbing" were the use of day-services, male sex, decline of grip strength, and a high GDS-15 score. In conclusion, it is important to strengthen the muscles of the upper half of the body, and to correct depressed moods for maintaining levels of ADL in the elderly requiring care at home.     

AN AUTOPSY CASE OF NIEMANN-PICK DISEASE

An autopsy case of Niemann-Pick disease whichμ was characterized by hepatosplenomegaly and lymphadenopathy is reported. On microscopic examination, numerous foamy cells were observed in the liver, spleen, kidneys, bone marrow, lungs, thymus, intestine and general lymph nodes. These cells were generally negative for periodic acid-Schiff (PAS) stain and positive for staining of phospholipid. Based upon the morphologic characteristics of Niemann-Pick disease, its relation to other lipidosis is discussed.     

Brief Atonia Associated with Electroencephalographic Paroxysm in an Infant with Infantile Spasms

The loss of muscular tone or muscular inhibition associated with sharp waves observed during abnormal tonic posture in a patient with infantile spasms of early onset is described. The latency between the beginning of a sharp wave and the muscular inhibition varied from 30 to 700 msec, and the duration of the inhibition ranged from 100 to 400 msec. These brief muscular inhibitions may sometimes precede tonic seizures, and these phenomena might be noticeable only in the state of steady tonic muscular contraction.     

The largest outbreak of legionellosis in Japan associated with spa baths: epidemic curve and environmental investigation

In July 2002, a large outbreak of legionellosis occurred in a bathhouse with spa facilities in Miyazaki Prefecture. Two hundred-ninety-five patients (including suspected cases) that had pneumonia and/or symptoms of fever, cough and so forth were reported; 37% of them were hospitalized and seven people died. In environmental investigations, Legionella pneumophila serogroups (SGs) land 8, L. dumoffii, L. londiniensis, some other Legionella species and many kinds of amoeba were isolated from 55 samples of bathtub water, tank water, filters and so forth in the spa facilities. The dominant isolates from the bathtab waters belonged to L. londiniensis, L. dumoffii and L. pneumophila SG1, and their maximum concentrations were 1.5 x 10(6), 5.2 x 10(5) and 1.6 x 10(5) cfu/100 mL, respectively. L. pneumophila SG1 strains isolated from bathtub water, tank water, filters and sputa of patients showed a indistinguishable DNA fingerprint pattern by pulsed-field gel electrophoresis (PFGE), confirming that the source of infection was the spa water. Our study indicate that spas may be a significant health hazard if hygienic management fails.     

HMOCC-1, a human monoclonal antibody that inhibits adhesion of ovarian cancer cells to human mesothelial cells

OBJECTIVES: Ovarian carcinoma is one of the most common gynecologic cancers and shows the worst prognosis since current therapies are not sufficiently effective at achieving and maintaining remission. To develop new treatment, a monoclonal antibody recognizing human ovarian cancer cells was raised in KM mice. METHODS: A human monoclonal antibody targeting RMG-I (an ovarian carcinoma cell line) was established with hybridomas of myeloma cells and spleen cells from KM mice. The immunohistochemical reactivity of various types of ovarian carcinoma and other tumors was investigated. RMG-I cells were treated with N-glycosidase F, NaOH, H(2)SO(4), and Gal NAC-alpha-benzyl to investigate the target antigens by Western blotting. The effect of HMOCC-1 on adhesion of RMG-I cells to cultured human mesothelial cells was also investigated. RESULTS: The new human monoclonal antibody, HMOCC-1, was an immunoglobulin M that recognized ovarian epithelial carcinoma. Immunohistochemical staining revealed HMOCC-1 positivity in 83.2% of ovarian carcinomas. The antigen recognized by HMOCC-1 was apparently a glycoprotein since Western blotting yielded a broad band (34.8-49.1 kDa). HMOCC-1 inhibited the attachment of RMG-I cells to monolayers of cultured peritoneal mesothelial cells in a concentration-dependent manner. CONCLUSIONS: This new human monoclonal antibody reacted with most ovarian cancers tested. The antigen recognized by HMOCC-1 is a glycoprotein located on the cell membrane. Inhibition of the attachment of RMG-1 cells to mesothelial cells by HMOCC-1 suggests a potential role for this antibody in the treatment of ovarian cancer.