[Investigation on daily life concerning patients with spinocerebellar degeneration].

Patients with spinocerebellar degeneration show gradual progression of symptoms and decreasing ADL (activities of daily living), resulting in their having many problems concerning daily care. However, there are relatively few patients with such diseases who have participated in those education and consultation services provided by the public health center. To better meet the needs of these patients, we investigated their attitudes and the various parameters affecting their actual daily life. A survey of patients in Sakai-city was conducted via a questionnaire mailed to 100 patients who applied for financial aid for spinocerebellar degeneration in 1996. A total of 74% of the patients responded to the questionnaire. Patients over 50 years old accounted for 77% of the total, Among all responding patients, 14% had their own occupation. The average period of morbidity was 4.8 years. Most (62%) patients were being treated as outpatients. Main symptoms of the patients were associated with speech and trunk movement. About one-fourth of the patients required constant assistance for bathing and transportation. The main person providing care for the patients was the spouse. Main demands for health and welfare services were, "consulting on care and daily life", and "the opportunity for patients to talk with each other." The need for health services is high because such patients have several symptoms. Information acquired through this investigation from patients and their families will be useful for providing better care for patients, with spinocerebellar degeneration.

Placental Na+, K+ activated ATP-ase activity in SHRSP in connection with pregnancy induced hypertension and intra-uterine growth retardation.

1. Placental Na+, K+ -ATPase activities were measured in connection with the active transport of amino acid, intra-uterine growth retardation (IUGR) or small for date infants (SFD) in salt-loaded pregnant SHRSP. 2. All parameters such as fetal weight, placental weight and Na+, K+ -ATPase activity in the placental tissue were significantly depressed in SHRSP, especially in the salt-loaded SHRSP compared with WKY. 3. Besides a decrease of blood flow, a decline of Na+, K+ -ATPase activity associated with an active transport of amino acid in the placenta would cause IUGR and SFD in the salt-loaded pregnant SHRSP. 4. Pregnant SHRSP given water containing salt would be a good model for pregnancy induced hypertension in humans.

Studies on pregnancy hypertension and IUGR-SFD: effects of drugs on the blood vessels in the placenta of pregnant SHRSP.

1. Based upon our previous work, we came to the conclusion that a decrease in placental blood volume was a possible factor behind intrauterine growth retardation (IUGR) in pregnancy-induced hypertension. 2. In a second study, we used an image analysis system to measure cross-sectional areas and wall thicknesses of central blood vessels of the spiral artery, the so-called 'central artery'. 3. It was thought that one of the more basic factors behind IUGR in pregnancy-induced hypertension might possibly be narrowings and spasms of the maternal placental blood vessels. 4. In this study, we found that the three drugs we used (MgSO4 center dot 7H2O, Solcoseryl and KCl) all resulted in an enlargement of the cross-sectional areas of the maternal blood vessels, and that MgSO4 center dot 7H2O, in particular, also relaxed maternal blood vessel spasms in SHRSP placenta.

Twin umbilical cord blood gas values.

In vaginally delivered births (including a few cases where the mothers were under epidural anesthesia), differences between first and second born twins were compared according to presentation at delivery. Of twins with vertex/vertex presentation in 15 primipara cases and in 14 multipara cases, pO2 levels for the second born were significantly lower (both being p < 0.05) than for the first born. Of twins vertex/non-vertex presentation, the second born in 9 primipara cases showed significantly lower pH, pO2 and HCO3 levels (p < 0.05). Also for multipara twins, the second born had significantly lower pH (p < 0.05) and significantly higher pCO2 (p < 0.05) values. Umbilical cord blood gas value findings indicate unfavourable conditions for second born twins.

Perinatal management of twin pregnancy.

Of 104 cases, 38 (ie, 36.53%) experienced premature delivery (controls: 4.32%). In instances of threatened premature delivery, 28 cases (26.92%) underwent ligation of the cervix. EPH gestosis occurred in 62 cases--a high incidence rate of 59.61% (controls: 12.9%). Forty-nine cases (47.11%) were complicated by anemia (controls: 8.36%). There were 57 cases of SFD infants, again a high 27.40% incidence rate (controls: 5.94%). Apgar scores of 7 or less at 1 minute after birth indicated that of the 208 neonates, the second-born twin only in 20 cases (9.61%); both infants in 14 cases (6.73%); and, the first-born only in 3 cases (1.44%), developed asphyxia neonatorum. Given the high incidence of premature and immature infants in cases of twins, caution should be employed against threatened premature delivery from around the 28th week of gestation onwards. Ligation of the cervix with ritodrine administration should be performed following admission to hospital, and EPH gestosis, anemia and IUGR should be carefully monitored.

Serum bilirubin fractions in healthy subjects and patients with unconjugated hyperbilirubinemia.

Serum bilirubin fractions were determined by a newly developed, high performance liquid chromatography method in 23 healthy subjects, and in 15 patients with Gilbert's syndrome, five with type 2 Crigler-Najjar syndrome, seven with hemolytic disorders, and 26 with neonatal jaundice. In the healthy subjects, 92.6% of the bilirubin was unconjugated (UCB), 6.2% was bilirubin monoglucoronide (BMG), and 0.5% was bilirubin diglucuronide (BDG). Delta bilirubin (B delta) was not detected. In the patients, the percentage of UCB was significantly higher and that of BMG was significantly lower than in the healthy subjects. The proportion of BDG tended to decrease in Gilbert's and type 2 Crigler-Najjar syndromes; the proportion of B delta tended to increase in hyperbilirubinemia, except in Gilbert's syndrome. In particular, B delta was frequently detected in serum which also contained BDG (mainly in hemolytic disorders) or which presented with high concentrations (above 100 mumol/L) of UCB (mainly in type 2 Crigler-Najjar syndrome and neonatal jaundice). Trace amounts of (Z,E)- and/or (E,Z)-UCB were detected in approximately one fourth of the serum samples analyzed.