Brain and nerve = Shinkei kenkyū no shinpo
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Intravascular malignant lymphomatosis (IML) is a relatively rare type of malignant lymphoma that is mostly caused by B-cell type neoplastic lymphocytes and rarely by T-cell and NL-cell type cells. B-cell type IML is currently considered to consist of 2 types: a conventional European type and an Asian variant that was originally reported from Japan. In IML, the tumor cells primarily grow within the blood vessel lumina but may cause minimal extravascular infiltration around the involved vessels in some patients. ⋯ Although the antemortem diagnosis of IML has been difficult, the results of recent studies involving random skin biopsy are promising for such a diagnosis. Since the recent addition of rituximab to CHOP therapy has proven to markedly improve the prognosis of IML. We should therefore try to avoid overlooking this treatable disease.
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To investigate the various clinical courses of patients with amyotrophic lateral sclerosis (ALS), we developed a telephone survey system for determining the activities of daily living (ADL) status of patients with ALS. In this system, every 3 months, clinical research coordinators (CRCs) conducted a telephone survey using the flow charts of the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R; Japanese version). To confirm the reliability of the results of the telephone survey, we compared the scores of 37 ALS patients obtained in the telephone surveys (telephone scores) to the scores obtained during clinical examinations by neurologists (neurologists' scores). ⋯ In the JaCALS, prospective clinical information was obtained using this telephone survey system. Of the 284 ALS patients who were registered at JaCALS over a year ago, 93% were followed up and provided ALSFRS-R scores and information relevant to prognosis. We have established an efficient and reliable telephone survey system for studying the longitudinal clinical courses of patients with ALS.
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Surgery is a better treatment option than prolonged medical therapy for patients with temporal lobe epilepsy. Randomized trials on surgery for epilepsy are feasible and appear to yield precise estimates of the effects of surgical treatment. This study includes 56 patients who underwent anterior temporal lobectomy with a mean follow-up of 11.3 years. ⋯ No significant relationships were found between objective indices of change and subjective ratings for postoperative memory function. A new surgical method based on multiple subpial transections for the hippocampus was developed in 2006. It remains unclear whether mesial resection involving a larger area leads to better seizure outcomes.
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Warfarin is underused because it has many disadvantages for clinical use despite it has been used more than a half century as an only oral anticoagulant. Dabigatran is a direct thrombin inhibitor, which is not metabolized by cytochrome P450, and thus does not require blood coagulation monitoring or vitamin K intake limitation, or produce drug interaction. ⋯ Dabigatran is expected to be approved as a more effective and safer oral anticoagulant than warfarin for stroke prevention in patients with atrial fibrillation. Randomized controlled trials of many factor Xa inhibitors in comparison with warfarin are also ongoing in patients with atrial fibrillation.
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Despite the advances in pharmacologic treatments for epilepsy, approximately one-third of patients with epilepsy continue to have seizures, and alternative treatment approaches are necessary in such cases. For many patients, resective surgery can be an alternative for achieving seizure freedom; however, its success depend on identifying seizure foci before surgery. Many patients with medically intractable epilepsy are not suitable candidates for surgery. ⋯ The responsive neurostimulator, which can be called a brain pacemaker, is another stimulation device for the treatment of epilepsy. A clinical trial involving the Neuropace system is in progress in the USA. Preliminary results indicating the efficacy of the Neuropace study were presented at the annual American Epilepsy Society meeting in 2010; the final results of this study are awaited.