Prevalence and clinical characteristics of REM sleep behavior disorder in Japanese elderly people.

STUDY OBJECTIVES: To evaluate the prevalence and clinical characteristics of isolated REM sleep behavior disorder (iRBD) among a general population of elderly Japanese people. METHODS: This epidemiological study targeted 2714 elderly residents (76.0 ± 8.0 years, 52.9% female) of a rural community. Questionnaires including the REM sleep behavior disorder single question and demographic information were distributed. All respondents with the question positive were interviewed by telephone. Respondents suspected of having iRBD proceeded to face-to-face interviews and underwent video-polysomnography and neurological/neuropsychological examination. These results were compared to those of previously diagnosed clinical iRBD patients in our sleep clinic. RESULTS: Of 1464 respondents to the questionnaire, 18 respondents were diagnosed as iRBD (1.23 [0.66-1.79]%), including eight respondents who satisfied diagnostic criteria with REM sleep without atonia (RWA) above the cut-off value (0.54 [0.17-0.92]%) and 10 respondents who had clear dream enactment behaviors but not RWA above the cut-off (provisionally diagnosed iRBD; p-iRBD) (0.69 [0.26-1.11]%). Severity of RBD and RWA of the population-based iRBD were compatible with those of the clinical iRBD. Half of the population-based iRBD showed orthostatic hypotension and they showed lower olfactory function than population-based p-iRBD and non-RBD. However, their olfactory and cognitive functions were higher than those in the clinical iRBD patients. CONCLUSIONS: Prevalence of iRBD in Japanese elderly people was comparable with the rate reported from other countries. Population-based iRBD/p-iRBD showed lower neurodegenerative loading than clinical iRBD in spite of comparable disease duration of RBD, that may indicate their lower risk of future neurodegeneration.

Successful Treatment of Acute Fulminant Eosinophilic Myocarditis in a Patient with Ulcerative Colitis Using Steroid Therapy and Percutaneous Cardiopulmonary Support.

A 47-year-old man with ulcerative colitis was transferred to our hospital due to progressive dyspnea. Electrocardiography on admission showed ST elevation in leads II, III, aVF, and V5-V6. Coronary angiography revealed no remarkable coronary stenosis, and left ventriculography showed a depressed left ventricular ejection fraction (EF) of 23%. Although the patient received percutaneous cardiopulmonary support, his EF progressively decreased (7-15%), and both ventricular tachycardia (VT) and high-degree atrial-ventricular block occurred. An endomyocardial biopsy showed eosinophilic infiltration in the myocardium. Steroid therapy improved the patient's EF. However, his severe inferior wall hypokinesis and non-sustained VT remained after the abovementioned treatment.

Blood pressure categories and cardiovascular risk factors in Japan: the Jichi Medical School (JMS) Cohort Study.

Few studies have reported on risk factors by blood pressure categories based on antihypertensive treatment in the general population. We examined the associations between blood pressure categories and other risk factors in Japan. Cross-sectional study, multicenter population-based study was designed. A total of 11,302 men and women were eligible. Data were obtained from April 1992 to July 1995 in 12 rural districts in Japan. Subjects were divided into three categories: normotensives (with blood pressure <140/90 mmHg), treated hypertensives (antihypertensive treatment regardless of current blood pressure), and nontreated hypertensives (blood pressure >or=140/90 mmHg without hypertensive treatment). The proportions of normotensives, treated hypertensives, and nontreated hypertensives were 63%, 10%, and 27% among men, and 67%, 13%, and 20% among women, respectively. Total cholesterol, triglyceride, blood glucose, and body mass index were higher in treated or nontreated hypertensives than in normotensives. Fibrinogen, factor VIIc, and physical activity index were higher in treated hypertensives than in normotensives. High-density lipoprotein (HDL) cholesterol was higher in normotensives than in treated or nontreated hypertensives in women; but no tendency was shown in men. The proportions of dyslipidemia, impaired glucose tolerance, and metabolic syndrome were significantly higher in treated and nontreated hypertensives than in normotensive men and women. In conclusion, cardiovascular risk factors were higher in hypertensives with or without treatment than in normotensives in a general population in Japan.

[Incidence and risk indicators of thromboembolism during the acute phase of single chamber ventricular pacing].

BACKGROUND: The incidence of thromboembolism may be higher in single chamber ventricular pacing than in physiological pacing. However, the incidence of thromboembolism during the acute phase of single chamber ventricular pacing (within 14 days) is not known. OBJECTIVES: The incidence and the risk indicators of thromboembolism were investigated during the acute phase of single chamber ventricular pacing. METHODS: Fifty-five consecutive patients (22 males, 33 females, mean age 67 +/- 9 years) who required VVI pacemakers due to brady-tachy sick sinus syndrome (42 patients) or brady atrial fibrillation (13 patients) in the period from April 1975 to December 2000 were retrospectively reviewed. The patients were divided into groups with thromboembolism and without thromboembolism, and the risk indicators for thromboembolism were analyzed. RESULTS: Seven patients (13%) suffered systemic thromboembolism. Three patients had thromboembolic events during temporary ventricular pacing, and four patients had thromboembolic events just after permanent VVI pacemaker implantation. The following risk indicators were identified in the patients with thromboembolism: hyperlipidemia, hypertension, organic heart disease (p < 0.05, respectively), and diabetes mellitus (p < 0.0005). CONCLUSIONS: Patients with brady-tachy sick sinus syndrome and brady atrial fibrillation have a significant risk of thromboembolism during the acute phase of single chamber ventricular pacing. Effective anticoagulation is needed in these patients.

[The prevalence of iron deficiency anemia among 6- to 18-month-old children in Japan].

BACKGROUND: Iron deficiency anemia is one of the treatable causes of developmental delay in infants and is therefore screened in several countries. However, in Japan, a screening program for anemia among infants has not been introduced and data on the prevalence of iron deficiency anemia and results of therapeutic trial with iron supplementation are limited. OBJECTIVE: To examine the prevalence of anemia, diagnosis was made with venipuncture blood and iron deficiency anemia was confirmed in a therapeutic trial of infants in Japanese communities. PARTICIPANTS: Six- to 18-month-old infants participated in the anemia screening program in Shinshiro city and Shitara districts, Aichi, and Fujisawa town, Iwate, Japan. METHODS: Capillary blood samples in microtubes were obtained by skin puncture, and centrifuged to measure the hematocrit. When the value was low, venipuncture blood was examined. A hemoglobin concentration under 11 g/dl was judged as a positive result. Anemic infants were referred to pediatrics for prescription of ferrous sulfate. Iron deficiency anemia was defined as a hemoglobin concentration elevated by 1 g/dl or more with a 4-week regimen of ferrous sulfate (therapeutic trial). RESULTS: Of 283 eligible infants, 161 were screened (participation rate, 57%). Mean (SD) microhematocrit by skin puncture was 35.9(2.2)%. Thirteen infants (8%, 95% Cl: 4 to 13%) were anemic, and 7 infants (4%, 95% Cl: 2 to 9%) demonstrated iron deficiency anemia in the therapeutic trial. There was no significant difference between study sites in mean microhematocrit, and prevalence of anemia or iron deficiency anemia. CONCLUSIONS: The prevalence of anemia and iron deficiency anemia among infants in the study communities is high enough to warrant considering routine screening. Further studies are needed to determine whether a high prevalence of anemia is widespread in Japan.

SEM observations of resected root canal ends following apicoectomy.

The purpose of this study was to examine the apical foramen of root apices extracted during apicotomies. A total of 25 teeth extracted from 25 patients admitted to the Department of Conservative Dentistry at Tokyo Dental College's Chiba Hospital were used for the study. All patients were between 22 to 56 years of age at the time of the study, and each of the 25 cases was determined clinically on radiographs to be chronic apical suppurative periodontitis. Microsurgery was performed on all cases, and the extracted root apices were then observed using SEM. The results demonstrated a wide opening, greater than 350 microns as measured along the major axis, of the apical foramen in 80% of the cases. Various characteristics indicative of resorption were observed around the apical foramen. These features included those believed to have been caused by overinstrumentation during root canal treatment as well as irregularly shaped areas presumed to be apical lesions that had enlarged and eroded. We observed a high frequency of manifestations of cementum resorption surrounding the root apices of teeth with apical lesions. Furthermore, we concluded that in the majority of cases in the present study, due to the fact that the apical foramen exceeded normal opening dimensions as a result of overinstrumentation during root canal treatment or resorption around the root apex, prolongation of the lesions had occurred in response to direct contact of microbial infectious matter and tissues surrounding the root apex over a large area. The above finding suggested that, in cases in which the apical foramen is destroyed through overinstrumentation larger than #35 or in which the apical foramen opens up to dimensions greater than 350 microns due to pathologic resorption, surgical intervention may be indicated. On the other hand, in 64% of the cases, an accessory canal was observed in the root apical lesion. Based on this observation, the presence of an accessory canal in the root apex may contribute to some degree to the prolongation of the lesion.