Neurological deterioration due to missed thoracic spinal stenosis after decompressive lumbar surgery: A report of six cases of tandem thoracic and lumbar spinal stenosis.

There have been a few reports of patients with a combination of lumbar and thoracic spinal stenosis. We describe six patients who suffered unexpected acute neurological deterioration at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery. Five had progressive weakness and one had recurrent pain in the lower limbs. There was incomplete recovery following subsequent thoracic decompressive surgery. The neurological presentation can be confusing. Patients with compressive myelopathy due to lower thoracic lesions, especially epiconus lesions (T10 to T12/L1 disc level), present with similar symptoms to those with lumbar radiculopathy or cauda equina lesions. Despite the rarity of this condition we advise that patients who undergo lumbar decompressive surgery for stenosis should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression.

Characteristics of receipt rate of financial aid for intractable disease patients in Gifu Prefecture, Japan.

The data on intractable disease patients who applied for official financial aid for medical treatment in Gifu Prefecture, Japan, in fiscal year 1997 were analyzed. In addition, to assess the nonapplied patients, a questionnaire on intractable disease patients with disabilities needing assistance was sent to all medical institutions in the prefecture. The results suggest that the low receipt rate of financial aid in Gifu Prefecture results from both nonapplication by patients and underdiagnosis at medical institutions. Percent completion of medical treatment for intractable disease patients in a single secondary medical service area was low. Although the percentage of patients with disabilities authorized to receive financial aid was 4.6%, the estimated ratio of patients with disabilities needing assistance exceeded this value. Therefore, the dissemination of information on official services for patients and medical care facilities must be strengthened.

Anomalous stereochemistry of pyrazolato-3,5-dicarboxylato-bridged dinuclear chromate(III) complexes containing ethylenediamine-N,N'-dicarboxylates with entrapped unstable conformations: X-ray structure of Na[Cr2(eddp)(mu-pzdc)].6H2O.

Several new pyrazolato-3,5-dicarboxylato (pzdc) bridged dinuclear chromate(III) complexes containing linear tetradentate O-N-N-O type ligands were synthesized and structurally characterized. Among them, the X-ray structure of the eddp complex Na[Cr2(eddp)(mu-pzdc)].6H2O (eddp = ethylenediamine-N,N'-dipropionate) was determined to have a (sym-cis)-(unsym-cis) geometrical configuration with intramolecular three-center hydrogen bonds, entrapping the unfavored sym-cis configuration for the Cr(eddp) moiety as well as the favored unsym-cis one. As a pair of positional disorders, there were also found to be two conformational isomers with respect to the absolute configurations of the coordinated asymmetric nitrogen atom at the G (in-plane) ring for the unsym-cis moiety. Moreover, chiral pzdc-bridged dinuclear complexes with another type of O-N-N-O ligand, 1,2-cyclohexanediamine-N,N'-diacetate (cdda), were successfully synthesized, isolated, and characterized by column chromatographic behavior, elemental analysis, and chiroptical spectra. There were two diastereomers for Na[(R,R-cdda)Cr(mu-pzdc)Cr(S,S-cdda)] and only one isomer for Na[(R,R-cdda)Cr(mu-pzdc)Cr(R,S-cdda)] and Na[(R,R-cdda)Cr(mu-pzdc)Cr(edda)] (R,R- or S,S- and R,S-cdda = R,R-trans- or S,S-trans- and R,S-cis-1,2-cyclohexanediamine-N,N'-diacetate, and edda = ethylenediamine-N,N'-diacetate). From their circular dichroism (CD) spectra, these complexes could exhibit the delta-delta absolute configuration with ((sym-cis-R,R-cdda)-(unsym-cis-edda or S,S- or R,S-cdda)) geometrical configuration, indicating the abnormal eq-eq (N-Ceq) configuration for the R,R-cdda. The comparison among the CD spectra of the ((cdda)-(cdda)) complexes revealed that two diastereomers of the ((R,R-cdda)-(S,S-cdda)) complex correspond to the conformational isomers resulting from the difference in geometrical orientations of the secondary amine protons on two coordinated asymmetric nitrogen atoms with the opposite absolute configuration in the unsym-cis-S,S-cdda moiety. In a series of the pzdc-bridged Cr(III) complexes the anomalous conformations in two different geometrical configurations could be entrapped probably owing to stereognostic coordination through the intramolecular N-H...O hydrogen bond interaction.

Recent trend of the decrease in mean birthweights of infants in the western provinces of Gifu Prefecture, Japan.

The mean birthweight has decreased recently in Japan. The author assessed the etiology of this trend by comparing the birthweight during the years 1983-1984 and 1993-1994 in Central Japan. All birth certificates of 3767 and 3423 infants were available for 1983-1984 and 1993-1994, respectively. The mean birthweight decreased from 3165 g to 3128 g. The proportion of first infants whose mean birthweight decreased more than that of the other infants increased from 41.0% to 47.1%. Comparison and multivariate analysis revealed the main cause of decreased birthweight as a decrease of the mean birthweight of first infants and changes of the proportion of birth order. Influences of the increases in the proportion of multiple births and that of low birthweight infants to the decrease of mean birthweight were small. The mean birthweight of infants who were born in public hospitals was lower than that of infants born in clinics, private hospitals, and others. The proportion of low birthweight infants was also highest among the infants born in public hospitals. These results indicate that pregnant women with high risk factors are more likely to be referred to the care of public hospitals.

Factors affecting the incidence of death at home of residents of Hida district, Japan.

This study compared the percentage of residents who died from disease at home in Hida district, Japan, between the years 1979-1981 and 1989-1991, and found it decreased from 46.9% during the earlier period to 32.6% during the latter. It differed significantly by age and underlying cause of death. Residents aged 85 and over were almost twice as likely to die at home as were all other subjects. Patients who died of malignant neoplasms showed the lowest proportion of death at home. A greater percentage of residents who lived far from hospitals or those who had the causal disease for a prolonged time died at home. The proportion for 1989-1991 was lower than that for 1979-1981 after adjustment for age, gender, cause of death, period of illness, and availability of hospital. It was speculated that the increase of hospital beds affected the proportion of death at home.

[Morphological changes of Plasmodium-infected red blood cells in thin blood smears].

Malaria is absent in Japan, but about sixty imported cases are reported in a year. We think it desirable that all medical care institutions should examine for malaria infection promptly. Diagnosis of malaria, in Japan, depends mostly on the examination of thin blood smears stained by Giemsa. However, we sometimes find atypical changes of infected red blood cells, especially in their size. It was also presumed that infected red cells may differ in their size and other morphology by their geographical origin. The present study was designed to investigate the influences of malaria infection on the morphology of host red cells. Thin blood smear samples from the cases of a single species plasmodial infection with epidemiological circumstances were chosen for this investigation from the specimens which we examined in our laboratory. Cases with a history of chemoprophylactic or chemotherapeutic use within 1 month prior to the blood examination were excluded. Cases were classified according to species of the infected parasites and the geographical origin; Africa, South-East Asia, and Western Pacific. The distribution of red cell diameters and the ratio of maximum diameter to minimum diameter were determined on blood smears using oil immersion lens. Measurement was completed with 20 or 30 infected red cells for each developmental stage of the parasites and 30 non-infected red cells per slide. The presence of Schüffner's dots was observed on blood smears from vivax or ovale malaria patients. We examined also for Maurer's dots and fimbriated margin of red cells on falciparum and ovale malaria specimens respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of life style and health practices between the subjects of occupational health services and those of community health services].

A questionnaire was mailed to a total of 3,889 residents 40, 45, 50, 55, 60, and 65 years of age living in 11 municipalities of Hida district, Gifu Prefecture, Japan, to inquire about their life style and health practices. Of the 3,889 residents, 2,919 (75.1%) responded to the questionnaire. They were divided into two groups for comparison; the subjects of occupational health services and those of community health services. The subjects of occupational health services at ages 40-55 showed lighter daily physical activity level than those of community health services. However, the subjects at ages 60 and 65 showed equally heavy daily physical activity level in two groups, which indicates that the subjects of occupational health services aged 60 and 65 years are engaged in heavier job at worksite and home. The prevalence of self-rated stress tended to be higher in the subjects of occupational health services. The mean health practice scores tended to be higher for the subjects of occupational health services than for those of community health services at ages 40-55. The percentage of people who had examinations for circulatory diseases were higher among the subjects of occupational health services at ages 40-60 compared with those for the subjects of community health services. Many of the subjects of occupational health services receiving an examination for stomach cancer had obtained the examination service at municipalities provided by local governments. The subjects of occupational health services generally showed superior attitudes toward health care, which suggests that health management for the former is more easily approached than the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of seasonal and intermittent work at high altitude on health status].

Health status of 7 men was examined in order to study the effect of duty work cycle of 3-d stay at the altitude of 2,000 m and one-day holiday at 600 m for a period of 6 months from May to October. Their usual works were desk work and road patrol. Total hemoglobin concentration in blood increased significantly after work at high altitude, which was considered to be a compensatory response to the hypoxic state. Subjective symptoms were obtained by a self-administered questionnaire before (April), during (June and October) and after (November) work at high altitude. Fatigue was observed in three out of the seven subjects in June, which subsequently disappeared in October. Dyspnea was observed also in June in three of the subjects, which disappeared in two, persisted in one, and newly appeared in another subject in November. In contrast, a tendency of favorable effects of the work environment on nausea and lumbago was observed. Blood pressure and pulse rate were measured for 24 h. The mean systolic blood pressure during 24 h decreased in two of five subjects in October and November, and the mean values during the working hours decreased in two in October from 145 to 131 mmHg and from 147 to 129 mmHg, respectively. The blood pressure measured at health examination correlated well with the mean blood pressure during 24 h and working hours. The mean pulse rate during 24 h and working hours increased in one in June, October and November. These results indicate that adaptive responses to low barometric pressure environment developed during a work period of 5 months at high altitude.(ABSTRACT TRUNCATED AT 250 WORDS)

[Trends of tissue hypoxia following chemotherapy of acute malaria in mice].

The effects of antimalarial treatment on the blood oxygen-transporting properties and on the tissue hypoxia were investigated in severe murine malaria, using mice infected with Plasmodium berghei (NK65). Five week old male ddY mice were inoculated intraperitoneally with 1 X 10(7) of P. berghei-infected red blood cells and treated with Fansidar (20 mg/kg body weight sulfadoxine and 1 mg/kg body weight pyrimethamine orally) on day 5 after inoculation. Parasitemia in these mice decreased rapidly on day 1 after treatment. Blood hemoglobin concentration, however, decreased on days 1 and 2 of treatment, then began to increase. The actual oxygen equilibrium curve (OEC) in vivo (actual pH; actual Pco2; 36.5 degrees C) was calculated from the measured OEC and the results of blood gas analysis. Looking from arterial and venous Po2 of each group, blood oxygen-transporting properties decreased markedly on day 2 of treatment. This decrease resulted mainly from the decrease of hemoglobin concentration and also partly from the raised hemoglobin affinity for oxygen. Adenosine triphosphate concentration in liver tissues, however, began to increase on day 1 of treatment. Adenylate energy charge of liver tissues also recovered on day 1. Blood glucose concentration began to increase and blood lactate concentration began to decrease simultaneously on day 1 of treatment. Glucose concentration in liver tissues, in contrast, decreased on days 1 and 2 of inoculation. Lactate concentration in liver tissue decreased earlier on day 1. These data indicate that tissue hypoxia was removed on day 1 following antimalarial treatment although blood oxygen-transporting properties decreased on days 1 and 2 after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy in the precise coulometric titration of ammonia and ammonium ion with electrogenerated hypobromite.

A precise and accurate method in which ammonia and ammonium ions are coulometrically titrated with electrogenerated hypobromite was studied. Through the measurement of the current efficiency for generating hypobromite and the dependencies of titration results on electrolysis current and delay time between sampling and starting electrolysis, precision and accuracy of 0.01 and 0.02%, respectively, were obtained. The accuracy of the titration was compared with that of acidimetric coulometric titration of ammonia.

[Studies on tsutsugamushi disease in Gifu prefecture. 4. Survey results in Ena and Takayama City, and the summary of the studies in the prefecture].

Investigations of trombiculid mites and Rickettsia tsutsugamushi in wild rodents were made in Ena (Nov. 1988) and Takayama (May 1989) City. In the former area where no patient has been reported so far, Leptotrombidium pallidum (63.9%) was most predominant and no L. scutellare was found. A Karp-related rickettsia (11.1%) was isolated from wild rodents and 30% of them had antibody to R. tsutsugamushi (anti-Karp was prominent). The latter area where patients were reported in spring as well as in autumn, L. pallidum (22.4%) was one of the dominant species in spring. Karp-related strains were isolated from 37.5% of wild rodents. And the antibody possession rate was 50.0%. These data reconfirmed our hypothesis that the majority of patients in autumn were infected by L. scutellare and a part by L. pallidum. In spring in Takayama area, the vector was L. pallidum which possessed Karp-related strain(s).

Trombiculid mites (Acari: Trombiculidae) and Rickettsia tsutsugamushi isolated from wild rodents in a new endemic area of Japan.

Investigations of trombiculid mites and Rickettsia tsutsugamushi in wild rodents were made in southern Gifu Prefecture where patients infected with tsutsugamushi disease recently have been found. A total of 16,396 trombiculid mites, consisting of 10 species from three genera, was collected from 170 Apodemus speciosus in two locations. Kani-Sakahogi and Kuze. Leptotrombidium scutellare (Nagayo et al.) (44.0%) was most predominant, followed by L. pallidum (Nagayo et al.) (26.9%); L. fuji (Kuwata et al.) (13.6%); and Gahrliepia saduski Womersley (14.2%). These four species constituted the bulk of the chigger mite fauna. L. scutellare was present from October to February with a remarkably high peak in November, whereas pallidum occurred from November to March with the highest peak in December. L. fuji and G. saduski showed their highest peaks in December and moderate peaks in early summer (April and May). Positive identification of Rickettsia tsutsugamushi in wild rodents from Kani-Sakahogi were found to be 50 and 58.3% in November 1985 and 1986, respectively, and 38.5% in November 1986 from Kuze. R. tsutsugamushi was isolated from chigger mites of an L. pallidum-rich group, displaying the highest titer to Karp strain. Serological investigation of rodents to R. tsutsugamushi antibodies were calculated as 41.6 and 50% positive in November 1985 and 1986 in Kani-Sakahogi, respectively, and 50% in November 1986 in Kuze. The Karp strain was dominant in specificity to antibodies. These results indicate that the surveyed areas have a high probability of occurrence of tsutsugamushi disease, and L. scutellare and L. pallidum may serve as the vectors in these areas. Particularly, we suggest that L. scutellare is the most important vector which has caused a recent outbreak of this disease in southern Gifu Prefecture.

Influence of pregnancy on the course of malaria in mice infected with Plasmodium berghei.

The course of malarial infection was compared in pregnant mice inoculated with Plasmodium berghei at different stages of gestation. When 12-14 wk old, pregnant BALB/c mice were inoculated with 1 x 10(6) of P. berghei NK65-infected red cells at gestation day 0, 2, 4, 6, 8, 10, 12, 14 or 16, the mice inoculated on gestation days 6-12 expired 6.5 days after inoculation compared to 9.5 days in non-pregnant mice. Parasitemia in these pregnant mice increased rapidly on day 4 after inoculation and anemia also developed earlier on day 5. However, the degree of parasitemia and anemia in the terminal stage of infection in these pregnant mice was milder than that of non-pregnant controls. Blood urea nitrogen increased at the terminal stage although the degree of increase in mice inoculated on gestation days 6-10 was comparatively small. Pregnant malarial mice died earlier with less physiological changes than non-pregnant controls. It was concluded that pregnancy makes the host susceptible to physiological changes caused by malaria.

A examination of the EDTA titration of manganese(II) taking into consideration formation of 1:1 and 1:2 complexes with Eriochrome Black T indicator.

In the EDTA titration of manganese(II) with Eriochrome Black T as indicator, the effect of formation of 1:1 and 1:2 manganese(II)-indicator complexes must be taken into consideration. The titration error can be reduced to less than 0.1%. For comparison purpose the titration of zinc(II) has also been studied.

Significance of blood urea nitrogen as an index of renal function in mice infected with Plasmodium berghei.

Parameters of renal function were evaluated in severe malarial infection, using mice infected with Plasmodium berghei. When 7-week-old male BALB/c mice were inoculated with 1 x 10(7) P. berghei NK65-infected red blood cells, the rodents died an average of 7.4 days after inoculation. Anemia developed on day 5 after inoculation and progressed markedly on days 6 and 7. Plasma urea nitrogen increased rapidly on day 6 or 7, after which death occurred within 24 h. In contrast, urinary urea nitrogen excretion decreased on the same day. Urinary beta-N-acetyl-D-glucosaminidase (NAG) activity increased from day 3 to day 5, then decreased to normal levels on day 7. Renal ATP concentration and energy charge decreased markedly on day 7. These data indicate that the blood oxygen supply to the tissues began to decrease on day 6 and that renal insufficiency developed in the terminal stage of infection. We concluded that even a moderate increase in the level of plasma urea nitrogen could be a useful index of renal insufficiency in this infection system.

Clinical evaluation of antimalarial regimens in Japan.

The actual situation of the treatment of malaria for the past 10 years in Japan was investigated and analyzed. As a result, it was revealed that there were not a few cases which had been treated improperly probably because of the difficulty of getting antimalarial agents. Moreover, it was made clear that the death rate on falciparum malaria was constantly high, 8.7%, as expected and the relapse rate of vivax malaria was still as high as 18.0%. There was the recrudescence of falciparum malaria at 8.1%, maybe because of the influence of the prevalence of the drug-resistant strains of Plasmodium falciparum. The trouble in getting antimalarial agents has been overcome since 1980. Study Group on Pharmacotherapy of Imported Tropical Diseases was organized by the Ministry of Health and Welfare in 1980, and antimalarial agents have been supplied free of charge through the Study Group for the treatment of the disease. The number of cases of imported malaria has increased in our country. There are a lot of problems to be solved quickly to cope with the situation: people who travel abroad should be enlightened on the danger of the infection of malaria and take prophylactics for the disease and physicians should get familiar with the disease being supplied with information about it.

Pathophysiology of hypoxia in mice infected with Plasmodium berghei.

Pathophysiological significance of hypoxia in malarial infection was investigated in mice infected with Plasmodium berghei NK65. Intraperitoneal inoculation of mice with 1 X 10(7) parasitized red blood cells resulted in death of the hosts 6-7 days later. Anaemia of infected animals developed on day 4 after inoculation and oxygen affinity of whole blood, measured as P50 act pH, increased simultaneously. This change may be a physiological adaptive response to a reduction in oxygen delivery to the tissues to day 5. However, the blood oxygen supply on day 6 appeared to be deteriorating and this is thought to be an important factor contributing to the death of the host. The value of adenylate energy charge in red cells during malarial infection, however, was comparatively well-maintained. Allopurinol stimulated the multiplication of malaria parasites and seems to have induced collapse in host-parasite balance more rapidly. Decrease in blood pH and in blood oxygen transport may be important factors for the pathogenesis of the allopurinol-treated hosts.