Zonisamide has beneficial effects on Parkinson's disease patients.

Zonisamide (ZNS) is a generally well tolerated anticonvulsant that has beneficial effects on Parkinson's disease (PD). ZNS (300 mg/day) given to a patient with PD who incidentally had convulsive attacks, ameliorated the attacks and, surprisingly, his parkinsonian symptoms. We, therefore, carried out an open trial of ZNS on nine patients with PD. Patients were given 50-200 mg/day ZNS in addition to their anti-PD drugs. Seven clearly showed lessening of symptoms, especially wearing-off. We speculate that long lasting activation of dopamine synthesis by ZNS ameliorates parkinsonian symptoms, in particular wearing-off.

Alexia caused by a fusiform or posterior inferior temporal lesion.

We evaluated the alexia and agraphia of three patients with different lesions using Japanese kanji (morphograms) and kana (phonograms) and made a lesion-to-symptom analysis. Patient 1 (pure alexia for both kanji and kana and minor agraphia for kanji after a fusiform lesion) made more paragraphic errors for kanji, whereas patient 2 (alexia with agraphia for kanji after a posterior inferior temporal lesion) showed severe reading and writing disturbances and more agraphic errors for kanji. Brodmann Area 37 was affected in both patients, but in patient 2 the lesion was located lateral to that in patient 1. Patient 3 showed agraphia without alexia after restricted lesion to the angular gyrus. We believe that pure alexia (patient 1) results from a disconnection between the medial fusiform gyrus and posterior inferior temporal area (the lateral fusiform and inferior temporal gyri), whereas alexia with agraphia for kanji (patient 2), corresponding to lexical agraphia in Western countries, results from damage to the posterior inferior temporal area, in which whole-word images of words are thought to be stored. Furthermore, restricted lesion in the angular gyrus (patient 3) does not produce alexia; the alexic symptom of "angular" alexia with agraphia may be the result of damage to the adjacent lateral occipital gyri.

A case of inclusion body myositis with benign monoclonal gammopathy successfully responding to repeated immunoabsorption.

A 69 year old woman with inclusion body myositis is described. She presented with benign monoclonal gammopathy. She was resistant to steroid therapy, but responded to repeated immunoabsorption. Up to now, there has been no established therapy for inclusion body myositis, including IVIg. It is suggested that immunoabsorption could be an alternative therapy for inclusion body myositis, when it was accompanied by immunological abnormality.

[Acute compression neuropathy of the proximal sciatic nerve in a patient with facioscapulohumeral muscular dystrophy].

We reported a 58-year-old man with facioscapulohumeral muscular dystrophy who had acute compression neuropathy of the sciatic nerve after prolonged sitting position. MRI and percutaneous electric stimulation studies were usefull for the diagnosis. Gd-DTPA T1-weighted MRI images showed the enhanced right sciatic nerve at the level of gluteus maximus muscle. An evoked potential study by a percutaneous electric stimulation revealed evidence of a conduction block at the same level. After methylprednisolone pulse therapy, muscle weakness and sensory disturbance improved. Acute compression neuropathy of the sciatic nerve may be seen as a complication in the advanced stage of (FSH) muscular dystrophy.

[Role of pharmacist in cancer pain management].

It is essential for patients to have understanding of the significance of morphine administration and to cope well with its side effects, as it leads to enhancement of the analgesic effects of morphine in the treatment of cancer pain. Since August 1993 we have used the booklet "Relieving Pain Effectively--Manual for Patients" and have consulted up to date approximately 670 patients about taking narcotics. The initial information eliminates the anxiety before taking morphine--we set up the time that each patient should take medicine to fit their life-style and explain about the the medicine and its side-effects. For this reason, the above information takes approximately 30 to 60 minutes per patient. We guide the patient over to over till the pain and side-effects have disappeared and file a "Morphine Education Record" with the details. We also prepare a "Pain and Side-Effect Control Sheet" that consists of 6 items and a pain scale where 0 equals no pain and no side-effect and 5 equals most pain and side-effects. Patients select the scale themselves every day. Pharmacists provide the information to a doctor and advise him on steps against side-effects, selection of dose, interval and rescue-dose. This is a report on the role of the pharmacist in patient narcotics guideline for cancer pain management.

[Renal angiomyolipoma: diagnosis and treatment].

In 10 years the diagnosis of renal angiomyolipoma (RAML) was made in 14 patients (male-to female ratio 1:3.7) at our institution; 1 case was associated with tuberous sclerosis (TS) and 1 case had regional lymph node involvement. A statistical study was done on data taken from 739 cases of RAML in the Japanese literature, including our cases. The male to female ratio was 1 to 3. Twenty eight percent of the cases were associated with TS. The ratio of bilateral cases to the unilateral one was 1 to 3. The main clinical signs were flank pain, abdominal mass, hematuria and fever elevation. Recently the ratio of nephrectomy has decreased to 30%. The percentage of detecting the fat component by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging were 88.1%, 86.5% and 80.8% respectively. The percentages of visualizing hypervascularity, aneurysms, absence of arterio-venous shunt and onion peel appearance by selective renal angiography were 77.3%, 71.4%, 48.1% and 4.9% respectively. Small (less than 3 cm), asymptomatic, simple lesions with adipose component may be observed annually by CT and US until more experiences is gained with surveillance of these patients. Embolization was useful for emergency cases or pre-treatment of nephron sparing surgery, but insufficient by itself. As there still remain problems in the diagnosis of RAML, especially in the case of very small tumors, in the case with almost no adipose component and in the case associated with renal cell carcinoma, the diagnosis of RAML should be made synthetically including angiography.

Negative chronotropic effects of thyroxine on the isolated bullfrog heart.

An acute application of L-thyroxine (T4) to everted sinus-atrium preparations of bullfrog showed negative chronotropic effects consisting of two processes: an initial peak at 2-5 min and a delayed plateau at 40-60 min. The initial effect was blocked by Cd2+ and tetraethyl-ammonium (TEA). The delayed effect was suppressed by Cd2+ and NaCN.

[Retention cyst of the prostate gland: report of a case].

A 55-year-old man was admitted to our hospital because of pollakisuria and dysuria. Rectal examination revealed a normal prostate and did not show fluctuation or tenderness. Cystography and cystoscopic examination revealed a lesion projecting into the bladder cavity. An echogram showed an irregular internal echo at the left lobe of the prostate, but prostatic biopsy revealed benign prostatic hypertrophy. Transvesical removal of the prostatic cyst was performed. The cyst was about 3 cm in diameter and filled with yellow fluid (5.8 ml). The fluid contained no sperm and its acid phosphatase and zinc levels were high. The cystic wall was lined by cubo-collumnar cells and partly by flattened epithelium.

Effects of cadmium on the contractility of a frog cardiac muscle in relation to pH of external solution.

In order to examine the pH dependency of Cd effects on cardiac muscle, the electrical and mechanical activities in the bullfrog heart were investigated in relation to various external pHs and concentrations of Cd. The amplitude and duration of the action potential or the spontaneously beating frequency in the atrium were not significantly affected during the 3-min administration of various concentrations of Cd in a range from pH 6 to 10, but the isotonic contraction at the end of the same period was greatly altered: the lower the external pH the more Cd decreased the contractility of the atrium. This pH dependency of Cd effects was also observed in SO4-Ringer's solution whose anions, SO4, were more impermeable than Cl. Decrease in contractility in Cd-Ringer's solution was counteracted by excess Ca. The lower the pH of the Cd-Ringer's solution, the more Ca was necessary to counteract an equal amount of Cd. The amount of Cd-uptake into the atrium was analyzed after soaking the atrium in various concentrations of Cd-Ringer's solution. The higher the concentration of external Cd, the larger the Cd-uptake into the atrium. No pH dependency, however, was observed in this relationship. This suggests that probably only a small fraction of total Cd-uptake interacts with Ca-binding sites which is specific to contraction, and causes the Cd-induced decrease in contractility. This process is considered to be pH-dependent. However, most Cd-uptake into cardiac muscle is pH-independent and may be nonspecific to contraction.

[Clinical experience with S-6436 in patients with urinary tract infections (author's transl)].

Forty eight patients with urinary tract infections including a case of acute prostatitis were treated with S-6436 and the following results were obtained: 1. Thirty eight patients with acute cystitis resulted in 19 excellent, 15 good and 4 poor with effectiveness rate of 89.5%. 2. Ten patients with complicated urinary tract infections resulted in 1 excellent, 5 good and 4 poor with effectiveness rate of 60%. 3. Infecting organisms from 38 patients with acute cystitis were occupied by 28 strains of E. coli. The sensitivity rate of the infecting organisms to cephalexin was 96.4%. 4. In a few cases (6.25%) side effects of S-6436 were observed. 5. S-6436 will be one of the good first choice antibiotics for acute cystitis.