Kanji-predominant alexia with agraphia in opticospinal multiple sclerosis]

Alexia with agraphia is very rare symptom in multiple sclerosis. We present a patient of opticospinal multiple sclerosis with kanji-predominant alexia with agraphia. A 55-year-old, right-handed man was admitted to our hospital because of difficulty in reading and writing in August 2001. The patient had been diagnosed as having relapsing-remitting opticospinal multiple sclerosis eight years prior to admission. Language examination showed alexia with agraphia predominantly affecting kanji and also mild naming difficulties, but a good comprehension and a normal repetition. T2-weighted MRI demonstrated hyperintensity area in the left temporo-parietal lobe, involving the white matter beneath the postero-inferior temporal lobe and inferior parietal lobule. On brain SPECT, low blood perfusion was observed in the left temporo-parietal regions. Although agraphia for kana and alexia for both kana and kanji improved after steroid therapy, agraphia for kanji did not improve. After the treatment, high intensity area of inferior parietal lobule was disappeared on MRI, and the hypoperfusion of inferior parietal lobule on brain SPECT was also improved, but the lesion of left postero-inferior temporal lobe did not show any remarkable changes. We considered that the kanji-predominant alexia with agraphia was due to the lesions of left inferior parietal lobule and postero-inferior temporal lobe, and agraphia for kanji was due to the lesion of left postero-inferior temporal lobe.     

What should general hospital psychiatry do in a community?]

Some experiences in Nagano Red Cross hospital and Nagano Prefecture are presented, and the role of general hospital psychiatry (GHP) in a community is discussed. Psychiatric services in Nagano prefecture with population 2.21 million consist of four blocks. Our unit is in north block, providing treatment for acute phase and, in 2000, 1504 cases were new outpatients, daily outpatients were 198 cases and new inpatients were 604 cases including 146 emergency inpatients. In fiscal 2001, 25.6% of notifications of involuntary hospitalization from all psychiatric hospitals were submitted from GHP occupying 12.9% psychiatric beds, and 129 notifications from our unit were largest in Nagano prefecture. Total 7 GHPs with beds are presented by some data, suggesting two types as GHP. One type has relatively many new inpatients by small beds with short-term hospitalization like our GHP, and another type has relatively small new inpatients by large beds with long-term hospitalization like conventional mental hospital. It is necessary for GHP to pursue the former type, and to functionally differentiate from psychiatric hospital. Results of psychiatric emergency system in Nagano prefecture are presented. Designated hospitals are our GHP with 60 beds in north block, Prefectural Hospital with 310 beds in south block, National Sanatorium with 280 beds in east block and rotating 5 psychiatric hospitals with total 968 beds in west block. GHP with 60 beds hospitalized more emergency new cases than other psychiatric hospitals with large beds and discharged 84% of emergency inpatients to their home. Recently, short-term hospitalization of general hospital beds has rapidly progressed, and shared goal settings are needed, and treatment plans with teamwork by various types of experts have started from community-based home care. This teamwork will be expected throughout community psychiatric services. Although until today GHP's ward unit is financially disadvantageous, patients anticipate medical care of GHP on same level as a part of general hospital of course. For community psychiatric care and short-term hospitalization it is necessary for GHP to cooperate with various types of social resources. As for users of rehabilitation facilities in Nagano prefecture, GHP outpatients occupy 27.2%, and as for day care users, these occupy 19.6%, thus GHPs are able to cooperate with facilities. Above-mentioned facts indicate there is high necessity as a GHP, not a psychiatric hospital or a clinic. Cooperation between GHP and other social resources including welfare services will enrich community psychiatric services. GHP is a wide entrance for psychiatric care from a viewpoints of whole psychiatric care. When GHP accepted all patients on demands from acute cases to chronic, manpower will be diffused, and safety of medical care will be undermined. Therefore, psychiatric triage mainly functioning to treat early stage in severe cases with combined medical and psychiatric illness above all is necessary for GHP in order to offer proper treatment to a community. Accessibility in early stage of disease, priority of seriously ill patients and rehabilitation programs at a community as daily life space are essential for community mental health. We believe the first role of GHP in a community is to seek for psychiatric treatment on same level as general medicine. The second role is the psychiatric triage in order to function as GHP in a community. The third role is to cooperate with other social resources in a community. In order to promote the above it is necessary to self-evaluate GHP concerning the difference with specialized psychiatric hospitals or clinics. From these viewpoints GHP will become a core of community psychiatry. Currently, however, preparation concerned with GHP is poor compared with other advanced countries, so an aggressive improvement in medical policy is expected.     

Possible Role of Streptococcus Pyogenes in Mucocutaneous Lymph Node Syndrome. XII. Variable Responses of Platelets in MCLS Seem to Be Explainable by Streptococcal Pyrogenic Exotoxin

As a model system for mucocutaneous lymph node syndrome (MCLS), we have advocated and used mice which had been rendered tolerant to Streptococcus pyogenes-associated antigens by neonatal infection with group A fteta-hemolytic streptococci, because these mice have shown a variety of peculiar bioimmunological characteristics bearing a striking resemblance to those of MCLS patients. The results of our current investigations reaffirmed the reliability of the animal model by indicating that mice subjected to neonatal infection with 5. pyogenes , or inoculation with streptococcal pyrogenic exotoxin (SPE) in Freund's adjuvant, were perfect counterparts of patients with MCLS on account of their platelet activation and hyperaggregability in response to provocative treatment, which are familiar findings in this disease.     

Successful surgical repair of delayed chronic type a dissection after previous coronary artery bypass grafting.

This reports a case of a 68-year-old woman who had undergone coronary artery bypass 5 years previously. Magnetic resonance angiography (MRA) revealed that the ascending aorta was dilated to about 8 cm in diameter, with type A dissection, and with a patent left internal thoracic artery (LITA) graft to the left anterior descending artery (LAD). Angiography at the ascending aorta did not reveal a coronary artery, nor did it show the sequential saphenous vein graft (SVG) to the obtuse marginal and posterolateral branches. Although the risk of surgical treatment via repeat median sternotomy was very high, we successfully performed the reoperation using profound hypothermic circulatory arrest. The dissection in the mediastinum was facilitated by a sternum retractor for ITA-graft dissection, intraoperative surface echocardiography, and ultrasonic scalpel, with a widely opened bilateral pleural cavity. Furthermore, assuming that most of the myocardium was maintained by perfusion from the in-situ, patent, ITA graft, it was thought that cardioplegia was not necessary during profound hypothermic circulation.     

Mechano-active scaffold design of small-diameter artificial graft made of electrospun segmented polyurethane fabrics

To fabricate a "mechano-active" tubular scaffold of nonwoven mesh-type small-diameter artificial graft made of the synthetic durable elastomer, segmented polyurethane, the fabrication technique of electrospinning on a mandrel under a high rotation speed and transverse movement was used. Emphasis was placed on how the rotation speed of the mandrel and the fusion or welding states of fibers at contact points affect the compliance (ease of intraluminal pressure-dependent circumferential inflation) and Young's modulus determined by uniaxial stretching in the longitudinal and circumferential directions. The results showed that a high rotation speed is attributed to exhibit isotropic mechanical properties in the entire range of applied strain but reduces the compliance, and a high fusion state, which is produced using a mixed solvent with a high content of high-boiling-point solvent, reduces the compliance but is expected to exhibit high durability in a continuously loaded pulsatile stress field in an arterial circulatory system.     

Quasi-living surface graft polymerization with phosphorylcholine group(s) at the terminal end

A surface graft polymer with one or two phosphorylcholine (PC) polarheads at the terminus of the growing chain end was prepared by sequential reactions on a glass substrate. The dithiocarbamate group covalently bound to glass surfaces was derivatized with one or two PC groups and then irradiated with ultraviolet light in the presence of N,N-dimethylacrylamide (DMAAm). X-ray photoelectron spectroscopy, wettability measurements and dye staining experiment for the PC group showed that the resultant graft copolymers were produced via iniferter-based quasi-living radical polymerization, in which the polyDMAAm graft chain contains one or two PC groups at the terminal end of the graft chain. These polymer surface grafts may help provide biocompatibility.     

Confocal imaging of biofilm formation process using fluoroprobed Escherichia coli and fluoro-stained exopolysaccharide

We developed a novel method of evaluating biofilm architecture on a synthetic material using green fluorescent protein-expressing Escherichia coli and red fluorescence staining of exopolysaccharides. Confocal laser scanning microscopy observation revealed the time course of the change in the in situ three-dimensional structural features of biofilm on a polyurethane film without structural destruction: initially adhered cells are grown to form cellular aggregates and secrete exopolysaccharides. These cells were spottily distributed on the surface at an early incubation time but fused to form a vertically grown biofilm with incubation time. Fluorescence intensity, which is a measure of the number of cells, determined using a fluorometer and biofilm thickness determined from confocal laser scanning microscopy vertical images were found to be effective for quantification of time-dependent growth of biofilms. The curli (surface-located fibers specifically binding to fibronectin and laminin)-producing Escherichia coli strain, YMel, significantly proliferated on fibronectin-coated polyurethane, whereas the curli-deficient isogenic mutant, YMel-1, did not. The understanding of biofilm architecture in molecular and morphological events and new fluorescence microscopic techniques may help in the logical surface design of biomaterials with a high antibacterial potential.     

Liquid photocurable biodegradable copolymers: in vivo degradation of photocured poly(epsilon-caprolactone-co-trimethylene carbonate)

The present investigation was designed to test cellular toxicity of modern dentin adhesives. With the use of the products Ariston Liner, Etch & Prime 3.0, Optibond Solo, Prime & Bond NT, Scotchbond 1, and Syntac Sprint, test specimens were prepared according to the manufacturers' instructions and transferred into a culture medium. Eluates were obtained and pipetted onto fibroblast cultures, incubated, and subsequently stained. The respective cell densities and the numbers of normal, altered, and dead cells were determined and compared with control cell cultures. Statistical analysis of the data showed that all materials caused cytotoxic effects. Scotchbond 1 displayed the highest number of dead cells. The difference was statistically significant compared to Etch" 3.0, Optibond Solo, Prime&Bond NT, and the control. The lowest cell density was found for Scotchbond 1 and Ariston Liner. The difference was also statistically significant in comparison with Etch" 3.0, Optibond Solo, Prime&Bond NT, and the control. To conclude, all tested dentin adhesives caused cytotoxic reactions. Taking the limitations of an in vitro experiment into consideration, Prime&Bond NT, Optibond Solo, and Etch" 3.0 appear to be the most recommendable products, and Scotchbond 1 and Ariston Liner the least.