Frequency and risk factors for sepsis resulting from neuroendovascular treatment.

OBJECTIVE: Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors. METHODS: From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses. RESULTS: The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful. CONCLUSIONS: The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.

[Evaluation of the operation of supporting programs for social activity of the elderly by city, town, village governments in Japan].

OBJECTIVES: The aim of this study is to clarify the operative situation of the supporting programs for social activity of the elderly by city, town, village governments in 1997. METHODS: We conducted a study of 3,255 of cities, towns and villages in Japan using a mailed questionnaire, which had been developed to assess the activities of supporting programs for social activity of the elderly. The questionnaire asks government officers whether they had each of the 33 programs in 1997. Each one of these programs belongs to one of the four different aspects of social activities: 1. employment, 2. social participation/volunteering, 3. education/training, 4. individual activities. For each program, the frequency of regions having the program were counted in total, as well as for each of four levels on governments scale: 1. ordinance-designated city, 2. city, 3. town, 4. village. The number of programs operated by the municipality were also evaluated. The main results were as follows One thousand six hundred (49.2%) of cities, towns and villages responded to our questionnaire. 1. Four programs, the promotion of clubs for elderly people, class/lecture meetings for the elderly, sporting events/athletic meetings for the elderly, and a respect-for-age congratulatory gift/money, were put into operation by over 80% of cities, towns and village governments. 2. The number of programs in total or for each of the three aspects of social activities except for social participation/volunteering tended to be high for the large scale governments. There were wide gaps in the number of programs among the regions even of the same level of the government scale. 3. The regions having supporting programs for employment consisted mainly of cities. Seventy-five percent of villages had no supporting program for employment. CONCLUSION: The operational situation of the supporting programs for social activity of the elderly by city, town, village governments was clarified. Furthermore, results obtained by this study can be used for self-assessment of operational situations by municipalities and can contribute to the activation of their supporting programs.

[Evaluation of social activities of the elderly in 27 regions with use of the 'check list for vivid social activities'].

PURPOSE: The aim of this study was to determine the utility of a 'Check list for vivid social activities (Check list)' developed for self-evaluates of social activities by the elderly. In this study, two surveys were made. First, the usefulness of the 'Check list' was evaluated by the person in charge of health and welfare for elderly in each region. Then a survey of the elderly using the 'Check list' was made in some regions to further assess its. METHODS: 1. We conducted a study of 3,255 cities, towns and villages in Japan using a mailed questionnaire. 2. About 4,100 elderly 65 years of age or older from 27 regions filled in the 'Check list'. The participants belonged to various groups such as those receiving physical care and senior citizen organizations. RESULTS: 1. One thousand four hundred and seventy (45.2%) cities, towns and villages responded to our questionnaire. About 50% of those were in favor regarding 'the utility of the Check list' and 'ease of filling in the Check list'. About 25% of them were in favor in terms of 'the efficiency of the Check list for making elderly initiate some social activities'. Forty-four percent of them answered that they intended to take advantage of the 'Check list'. 2. By comparing results from each of the 27 regions, it was possible to evaluate the levels of social activities by the locality. By comparing activities of groups composed of regions with same characteristic, it was possible to characterize social activities at the group. CONCLUSION: These finding suggest utility for the 'Check list'.

[Assessment method for supporting programs for social activities of the elderly by city, town and village governments in Japan].

OBJECTIVES: The authors developed a questionnaire to assess the activities of supporting programs for social activities for the elderly conducted by city, town and village governments, based on the number of such programs. This study aims to examine the validity of the questionnaire. METHODS: We conducted a study of 145 cities, towns and villages from two prefectures in Japan using the questionnaire. The questionnaire asks government officers whether they had each of 32 programs, and the number of programs in total, as well as each of four domains of social activities (i.e., employment, social participation/volunteering, education/training, individual activities) were calculated. They were also asked to classify each of the programs into one of four domains of social activity to which the programs were most related; they were asked to rate how active the programs were for each domain in their community. To examine the validity of the questionnaire, the following indicators were assessed: (1) proportion of reported programs which were not covered by the questionnaire; (2) concordance of classification of programs into four domains of social activity with those judged by government officers; (3) correlations between number of programs and self-rated activity levels by government officers; and (4) correlations of number programs with characteristics of cities, towns or villages. RESULTS: The results indicated that the list of programs covered most of the programs. Proposed classification of programs into four domains of social activities which they are most related to agreed with judgments by officials. The number of programs positively correlated with self-rated activity levels by officers for employment and education/training domains in both prefectures; and for social participation/volunteering and individual activities in one of the prefecture. The numbers of programs for employment of the elderly positively correlated with the total population of the community, number of staffs, proportion of people employed in the tertiary industries and total budget for social welfare of the elderly; it negatively correlated with proportion of people employed in the primary industries. CONCLUSION: It is suggested that the list of programs in the questionnaire is applicable and assessment based on the number of programs by four social activity domains is valid to some extent in either prefecture. The questionnaire can be improved further, e.g., by adding other programs to the list.

[Characteristics of medical institutions visited by patients with intractable diseases--analyses of patients receiving financial aid for treatment].

The Research Committee of Epidemiology of Intractable Diseases (Ministry of Health and Welfare, Japan) conducted a nationwide survey of 34 intractable diseases. Each of 47 prefectural governments reported information on all patients with the diseases who received financial aid for the disease from April 1992 to March 1993. Information collected on each patient included the identification number, sex, age, the code of the municipality where the patient lived, and the medical institution and department where the patient was being treated. Out of 247, 726 patients whose information was reported by prefectural governments, we analysed data of 208,945 patients whose medical institutions were reported. The results can be summarized as follows: 1) Aged patients and children who were less than ten years old tended to visit medical institutions located in their neighborhoods and be treated in small hospitals or clinics. 2) The proportion of patients who visited hospitals with 200 beds or more was 77 percent. 3) Patients with the diseases resulting in physical disabilities such as SMON and malignant rheumatoid arthritis tended to visit clinics. Patients with skin diseases as pemphigus, epidermolysis bullosa and pustular psoriasis tended to be treated in university hospitals. 4) Many patients living in prefectures near large cities such as Tokyo and Ishikawa visited medical institutions in the large cities. 5) The proportion of patients who visited university hospitals decreased during the eight years from 1984 to 1992. However, a quarter of these patients visited university hospitals.

Interindividual variation in cytogenetic response to X-ray and colchicine measured with the cytokinesis-block micronucleus assay.

Interindividual variation in cytogenetic response to two different types of micronucleus (MN) inducer, X-rays (a clastogen) and colchicine (a spindle poison), was investigated in the peripheral blood lymphocytes of normal healthy donors by the cytokinesis-block MN method. The data for 124 donors between the ages of 19 and 80 years showed that the histogram of individual frequency of X-ray (2 Gy)-induced micronucleated cells followed the normal distribution (Shapiro Wilks W-test) with a significant interindividual variance (ANOVA, p < 0.001). This was, however, not the case for colchicine (0.03 microgram/ml)-induced micronucleated cells. Instead, a skewed distribution illustrating interindividual variation was evident (ANOVA, p < 0.001). Statistical analysis of the effect of age and sex on MN incidence by using the Kruskal-Wallis test indicated that age affected the baseline and colchicine-induced MN incidences strongly but not the X-ray-induced MN incidence. There was no effect of sex on the incidence of micronuclei induced by either agent. In order to avoid any possible effect of age on the MN index, data for young subjects aged less than 30 years old were analyzed separately. The results of this analysis again showed significant interindividual variations in baseline, X-ray-induced, and colchicine-induced micronucleated cell rates. Results of the correlation-coefficient analysis showed that neither X-ray-induced MN incidence nor colchicine-induced MN incidence was related to baseline MN incidence. No correlation between X-ray-induced and colchicine-induced MN incidences was also found by this analysis. These results suggest that interindividual variance in chromosomal response to mutagens in normal populations may be a real phenomenon, as is interindividual variance in baseline MN frequency, and that individual susceptibilities to the two different types of micronucleus inducers (X-ray and colchicine) are unrelated, and the baseline MN level is not of predictive value for the susceptibilities.

[Survey of patients with intractable diseases. Analyses of patients receiving financial aid for treatment].

The Research Committee of Epidemiology of Intractable Disease (Ministry of Health and Welfare, Japan) conducted a Nationwide survey of 34 intractable diseases with each of the 47 prefectural governments reporting information on all patients having any of 34 intractable diseases, and who received financial aid for the disease from April 1992 to March 1993. Information collected about each patient was the identification number, which included the disease code, sex, age, the code of the municipality where the patient lived, the medical institution which treated the patient, and the department where the patient was treated. The results can be summarized as follows: 1) The total number of patients who received financial aid for disease was 247,726 (Male 93,251 Female 154,274) for a sex ratio of 0.60, and 61.7% of patients were between 40 and 69 years of age. Of 109,387 patients whose status could be confirmed regarding either outpatient or inpatient, 13.5 percent were inpatients. Of the patients, 47,222 (53.0%) were treated in departments of internal medicine. 2) Of all 34 intractable diseases, the greatest number receiving aid were patients with systemic lupus erythematosus with 35,690 receiving aid between April 1992 and March 1993. Of new patients commencing financial aid between April 1992 and March 1993, the largest group was patients with ulcerative colitis with 5,361. 3) The numbers of patients and those who started receiving the aid in the observed one year was larger than those in 1984 and 1988. The increase in numbers between 25 and 34 years of age was remarkable. By age group, the largest number of patients became older within the 8 years from 1984 to 1992.

[Development of index of social activities for the elderly].

In order to develop indices of social activities for the elderly, two surveys with 2 year intervals were conducted on the same 5,201 elderly subjects in four areas in Japan using a self-administered questionnaire. Social activities were defined as "activities which required contact with society" and were measured by 4 major facets of social activities, which were based on 21 questions relating to job activity, socially-plated activities, learning activities, and personal activities. The results were as follows; 1. The Wilcoxon scores in indices for 4 facets were given in sex and age groups. 2. Means of scores of indices increased with the degree of social activities from a subjective judgment. 3. Rank correlation coefficients between indices in two surveys were 0.60-0.71 for the persons whose answers were "no" to the question "did degrees of your activities change over the two years?" 4. Differences between indices in two surveys were higher in the persons with answers of "increase" to the above question than those with answers of "no", and were lower in those with answers of "decrease". These findings suggest that indices are available for assessing social activities as indicated by the reproducibility, validity and responsiveness found in this study.

[Flow cytometric quantification of numerical chromosome aberrations in non-small cell lung carcinomas using formalin-fixed paraffin-embedded tissue].

Fluorescence in situ hybridization with biotinylated repetitive DNA probe specific for the centromeric region of chromosome 17 (p17H8: Oncor) was applied to suspended nuclei which were isolated by Shutte's method from formalin-fixed paraffin-embedded tissue. The tissues were obtained from surgically resected specimens from nine patients with non-small cell lung carcinoma. The isolated nuclei were prepared with 0.05% pepsin/0.1NHCl for 15 minutes at 37 degrees C. Subsequently, these were immersed in 70% acetic acid for 10 seconds at room temperature. After heat denature with hybridization mixture which contained 3 mu 1 DNA probe for 10 minutesat 70 degrees C, 1 x 10(6) nuclei were incubated overnight at 37 degrees C. After washing with 60% formamide/2 x SSC, the hybridized probes were labeled by FITC conjugated avidin. A number of centromeric signals of chromosome 17 wasevaluated by fluorescence microscopy (BH-2, Olympus). Furthermore, a probe-related FITC intensity was quantified using flow cytometry (FACScan, Becton Dickinson). As the results, there was good correlation between a relative fluorescence intensity determined by flow cytometry and a relative fluorescence signal by fluorescence microscopy (p < 0.05).

A higher proinsulin response to glucose loading predicts deteriorating fasting plasma glucose and worsening to diabetes in subjects with impaired glucose tolerance.

To evaluate the clinical significance of proinsulin determination, we measured glucose, insulin, C-peptide and proinsulin during 75-g oral glucose loading in 59 patients. In a 2.5-year follow-up study of 37 subjects with impaired glucose tolerance (IGT) at the initial test, 11 patients changed from IGT to a normal state and 5 patients showed worsening to overt Type 2 diabetes with elevation of fasting plasma glucose; 21 patients remained unchanged. Although our data showed that both fasting (IGT: p = 0.4523) and 120-min plasma glucose (IGT: p = 0.8168) values at the initial test were not significantly correlated with increased fasting plasma glucose levels in a 2.5-year follow-up study, subjects with a higher 120-min proinsulin response to glucose during the initial OGTT showed a significant correlation (IGT: p < 0.0001) with increased fasting plasma glucose levels after follow-up period and developed Type 2 diabetes. The present findings suggest that the proinsulin response to glucose loading might be a useful indicator for predicting worsening to diabetes in subjects with impaired glucose tolerance.

Antistreptococcal esterase distribution in healthy individuals.

The distribution of serum antistreptococcal esterase titers in healthy school children, aged 10 to 12, and in healthy adults was determined by the method used by Hayano and Tanaka. The upper limit of its normal titer value was 600 ASE units in the children and 500 ASE units in the adults, and its diagnostic levels were over 600 ASE units in children and over 500 ASE units in adults. There was no close correlation between ASE and ASO or ADN-B.

Antideoxyribonuclease B distribution in healthy individuals.

The distribution of ADN-B titers in healthy school children and in healthy adults were determined by the method of the Streptonase B. The upper limit of its normal titer value was 480 in children aged 9 and 10 and 240 in adults, and its diagnostic levels were 480 in children and 320 in adults. There were no close correlations between ADN-B and ASO or ASK.

[Case of multiple calcifications of the cerebellar hemisphere].

A 38-year-old woman with three intracerebellar calcifications visible in roentgenogram was reported. She had not suffered from any disease that should induce intracranial calcification. Plain x-ray films of the skull showed three small calcifications in the posterior fossa. The laboratory study and neurological examination revealed no abnormality. Computerized tomography showed no abnormal findings either. Histological examination was carried out. The tissue surrounding the calcification seemed to be gliosis.

[Primary cerebral neuroblastoma--case report (author's transl)].

Primary cerebral neuroblastoma is rare. The case reported here was a 2-year-old girl who was comatose on admission to the Mito National Hospital. She had experienced headache and vomiting during the last two months. Neurological examination showed bilateral papilledema, left oculomotor palsy and bilateral Babinski's sign. A-P view of the left carotid angiogram showed square shift of the anterior cerebral artery to the right, and the lateral view showed upward and anterior displacement of the middle cerebral artery. CT revealed large mass lesion in the left parieto-temporal lobe, which was slightly enhanced on the contrast study. Subtotal removal of the tumor was performed on the day of admission. On the 15th postoperative day, she was started on radiation therapy to the brain and received 1900 rads. Vincristin and ACNU were administrated with radiation therapy. She improved progressively five weeks after the operation and CT demonstrated marked shrinkage of the tumor. However, signs of increased intracranial pressure were reappeared and she died six months after the operation. Autopsy showed well defined soft and grayish white tumor in the occipito-temporal lobe, which extended to the left thalamus and basal ganglia. No other tumor was present extracranially. Microscopic examination demonstrated Homer-Wright rosette and zonal filament. Pathological diagnosis was neuroblastoma.

[Chronic subdural hematoma associated with intracranial aneurysm (author's transl)].

Four cases of chronic subdural hematoma associated with intracranial aneurysm were reported. In two cases aneurysms were found at the peripheral portion of middle cerebral artery under the hematoma, and in other two cases aneurysms were found incidentally. The causality was discussed about subdural hematoma and intracranial aneurysm especially false aneurysm found in the peripheral artery under the hematoma. Radical operation of intracerebral aneurysm associated with chronic subdural hematoma should be performed after angiography and CT scan regardless the rupture of the aneurysm.

[The association of polycystic kidneys with intracranial aneurysms (author's transl)].

A 48 year-old man is presented who died of rupture of intracranial aneurysm. Autopsy findings revealed a ruptured anterior communicating artery aneurysm associated with polycystic kidneys and polycystic liver. Epidermiological review is performed using "Annual of the Pathological Autopsy Case in Japan" (Vol. 17-20). In 92854 autopsy cases, there are 243 cases of polycystic kidney, 1542 cases of intracranial aneurysm and 10 cases of association with both of them. Several points come clear from comparing our data with foreign ones, as follows; 1) The frequency of polycystic kidney (0.25%) is almost the same between Japan and foreign country. 2) The frequency of intracranial aneurysm (1.6%) is higher in Japan. 3) The frequency of association with both (0.01%) is lower in Japan. 4) The frequency of intracranial aneurysm appears to be higher in cases suffered from polycystic kidney than in others. We suspected that cerebral aneurysm formation is caused by hypertension due to polycystic kidney, although in many reports, the association of polycystic kidney and cerebral aneurysm is explained to be maldevelopment. The operation of cerebral aneurysm with polycystic kidney is the same as that without polycystic kidney. But the control of hypertension and renal function is necessary during and after operation.