Nō to shinkei = Brain and nerve
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Dementia patients need assistance or supervision in their daily activities. This often places a major burden on their caregivers. The caregiver burden is reportedly a critical determinant for negative caregiving outcomes. However, in Japan, no study evaluating the burden experienced by caregivers for patients with established dementia diagnosis with a standardized instrument has been carried out. The Zarit Caregiver Burden Interview (ZBI) is a standardized, validated, reliable tool for assessment of the burden of caregivers for dementia patients, and has been used in many studies in North America. In this study, we arranged a Japanese version of the ZBI and applied it to caregivers who were caring dementia patients. After examining the reliability and validity of this version, we then studied a relationship between patients' impairments and caregivers' burden. ⋯ This Japanese version of the ZBI has a sufficient reliability and validity comparable to those reported for the original version. Our results suggested that the patients' functional and neuropsychiatric impairments were main patient's factors to increase the caregiver's burden.
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Case Reports
[An 81-year-old woman with progressive motor disturbance, extrapyramidal features, dementia, and oculomotor palsy].
We report an 81-year-old woman who presented with motor disturbance in her right hand which was followed by parkinsonism, dementia, and supranuclear gaze palsy. She was well until her age of 73 (1989) when she had an onset of difficulty in using her right hand; she did not have weakness. She also developed small step gait. ⋯ It was interesting to note that anti-tau immunostaining and Gallyas staining revealed neuropil threads and astrocytic plaques in the cortical areas, and intracytoplasmic inclusion bodies in the cortical neurons; these inclusions were not stained by Bodian stain. Tuft-shaped astrocytes which may be seen in progressive supranuclear palsy were not observed in this patient. Although corticobasal degeneration and progressive supranuclear palsy share some neurological features in common, this patient showed typical pathologic changes of corticobasal degeneration.
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We report a 62-year-old man who developed coma and died in a fulminant course. The patient was well until May 1, 1996 when he noted chillness, tenderness in his shoulders, and he went to bed without having his lunch and dinner. In the early morning of May 2, his families found him unresponsive and snoring; he was brought into the ER of our hospital. ⋯ Cardiac rupture appeared to be the cause of terminal sudden hypotension and cardiopulmonary arrest. It appears likely that a vegetation which had been attached to the aortic valve induced thromboembolic occlusion of the left internal carotid artery which had already been markedly sclerotic by atherosclerosis. It is also possible that the vegetations in the aortic valve came from mural thrombi at the site of acute myocardial infarction, as no bacteria were found in those vegetations.
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Clinical Trial
[Clinical evaluation on etiology and surgical outcome in syringomyelia associated with Chiari type I malformation].
Etiology of syringomyelia associated with Chiari type I malformation has been unknown. Moreover, the surgical procedure of foramen magnum decompression for this type of syringomyelia has not been standardized yet. No one procedure has been always successful, leading to many alternative procedures. ⋯ There was no significant difference among 4 groups on the degree of reduction of syrinx in the sagittal plane as evaluated on MRI, whereas with regards to improvement of the clinical symptoms, dural group was significantly worse than the other three groups. The surgical procedure of dural plasty was clearly less invasive than those of tonsillectomy and lysis of subarachnoidal trabecula. These results suggest that we should select dural plasty as a primary surgical procedure for syringomyelia associated with Chiari type I malformation.
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We report a 65-year-old man with progressive loss of vision and consciousness disturbance. The patient was well until his age of 63 when he was found to have a gastric cancer. He was treated by the tumor resection and chemotherapy; he was apparently well, but hepatic metastases were found in the next year (1996). ⋯ These findings most likely mass formation from macroglobulinemia which underwent necrotic change after radiation. Mass formation in the brain is rare for Waldenström's macroglobulinemia, although it has been reported. The relation between gastric cancer and macroglobulinemia in this patient is unclear.