Longitudinal study of the mental health of caregivers caring for elderly patients with dementia: Effect of institutional placement on mental health

Abstract  One hundred and three family caregivers of relatives with dementia were longitudinally surveyed to examine the course of caregivers' mental health after the relatives had been placed in full-time care facilities. Mental health was assessed twice, with a 6-month interval, using the Japanese version of the 60-item General Health Questionnaire. The degree of social dysfunction was significantly reduced within 6 months after placement, while the other indicators of mental health (e.g. anxiety-insomnia, depression, somatic symptom and psychiatric morbidity) were not reduced within this term. However, anxiety-insomnia and psychiatric morbidity were significantly reduced more than 6 months after placement. Analyses by caregivers' lineal relations to the relatives indicated that only daughters-in-law showed a significant decrease in anxiety-insomnia and a marginal reduction in psychiatric morbidity. This study suggests that caregivers' social dysfunction was more greatly reduced than anxiety-insomnia and psychiatric morbidity within a relatively short term after placement, and that its effects on mental health might vary with the lineal relations.     

Extrauterine low-grade endometrial stromal sarcoma: Report of three cases

Three cases of rare low-grade endometrial stromal sarcoma of the extrauterine tissue are presented. Each one occurred In the ovary, pelvic and abdominal cavities. Two were associated with endometriosls. Histologically, the tumors were characterized by an infiltrative and diffuse proliferation of uniform round or oval cells, abundant small vessels, low mitotic activity, the presence of foam cells and vascular Invasion. lmmunohistochemically, all tumors expressed vimentin, muscle markers (desmin, muscle-specific actin and α-smooth muscle actin) and progesterone receptors. Two tumors were diploid and one was aneuploid by flow cytometry. All patients were well with no evidence of disease 16–39 months after surgery. It Is suggested that this neoplasm may arise with or without endometriosis under hormonal Influence. This rare variant of Müllerian tumors should not be confused with adenosarcoma and soft tissue tumors, such as smooth muscle tumors and solitary fibrous tumor.     

A Case of Thrombosed Giant Aneurysm of the Azygos Anterior Cerebral Artery: Clipping under Monitoring of Motor Evoked Potentials of the Lower Extremities

Giant aneurysms of the distal anterior cerebral artery (ACA), especially the azygos ACA, are rare. We treated a patient with giant aneurysm of the azygos ACA who underwent aspiration of thrombus and clipping under monitoring of motor evoked potentials of the lower extremities (L-MEPs), resulting in remarkable recovery of motor and intellectual function. A 72-year-old male was admitted with left motor weakness persisting for 2 weeks. Neurologically, disorientation and intellectual impairment were also noted. Imaging disclosed a 60-mm diameter aneurysm with heterochronous thrombi arising from the distal bifurcation of the azygos ACA. One month after the onset, radical surgery was scheduled. The azygos ACA was secured and the aneurysm was dissected, and the distal parts of the azygos ACA were confirmed. After removal of the thrombus, the neck was reconstructed with eight clips. L-MEPs disappeared due to occlusion of the azygos ACA for 20 minutes but reappeared after 22 minutes and normalized 78 minutes after reperfusion. Motor weakness improved entirely with mini-mental state examination score of 29 points at 1 month after surgery. One year later, Wechsler Adult Intelligence Scale-Third Edition and Wechsler Memory Scale-Revised scores reached normal levels. Review of reported cases found this aneurysm tends to occur in males in their 50s to 70s presenting with mass sign. Decompression of the aneurysm in the frontal lobe and monitoring of L-MEPs during temporary occlusion of the ACA are important.