Transcortical mixed aphasia due to cerebral infarction in left inferior frontal lobe and temporo-parietal lobe.

We present a case of transcortical mixed aphasia caused by a cerebral embolism. A 77-year-old right-handed man was admitted to our hospital with speech disturbance and a right hemianopia. His spontaneous speech was remarkably reduced, and object naming, word fluency, comprehension, reading and writing were all severely disturbed. However, repetition of phonemes and sentences and reading aloud were fully preserved. Although magnetic resonance imaging (MRI) showed cerebral infarcts in the left frontal and parieto-occipital lobe which included the inferior frontal gyrus and angular gyrus, single photon emission CT revealed a wider area of low perfusion over the entire left hemisphere except for part of the left perisylvian language areas. The amytal (Wada) test, which was performed via the left internal carotid artery, revealed that the left hemisphere was dominant for language. Hence, it appears that transcortical mixed aphasia may be caused by the isolation of perisylvian speech areas, even if there is a lesion in the inferior frontal gyrus, due to disconnection from surrounding areas.

Silent cerebral infarction and cognitive function in middle-aged neurologically healthy subjects.

We sought to clarify whether apparently silent cerebral infarcts and periventricular hyperintensities are associated with depressed cognitive function in middle-aged subjects. Subjects were 84 middle-aged neurologically normal adults who wished to undergo a screening examination of the brain. We performed magnetic resonance imaging (MRI) of the brain and neuropsychologic tests in all subjects. Silent cerebral infarcts and periventricular hyperintensities, respectively, were detected in 21 and 14 of 84 subjects. Mini-mental state (MMS) and Raven's colored progressive matrices (RCPM) scores were significantly lower in subjects with than without silent cerebral infarcts. By two-factor analysis of variance, MMS score was affected by silent cerebral infarcts or periventricular hyperintensities, with interactions between the two lesion types (P < 0.05). Silent cerebral infarcts may be an independent factor in the pathogenesis of intellectual dysfunction, but truly independent analysis is difficult because many subjects with silent cerebral infarcts also have periventricular hyperintensities.

Unilateral spatial neglect associated with chronic subdural haematoma: a case report.

A 69-year-old right-handed man who exhibited unilateral spatial neglect in association with a chronic subdural haematoma, presented with mild left arm and leg weakness first noted 4 weeks prior to admission. Neurologic examination on admission revealed a mild left hemiparesis, including the face. Neuropsychologic examination revealed left unilateral spatial neglect, but no language disturbance. Minimal support was necessary to maintain activities of daily living. Computed tomography revealed a large right temporoparietal, extraaxial hypodense fluid collection containing scattered hypodense foci. The haematoma was evacuated via a right parietal burr hole. Following surgery, the patient dramatically improved neurologically and neuropsychologically, as well as in independent performance of daily activities. It is suggested that the improvement in ADL provides a behavioural correlate of improvement in the latter, represented a behavioural correlate of improved cerebral function, and that either direct compression by the chronic subdural haematoma or an interhemispheric pressure difference had caused unilateral spatial neglect. Such neglect is an unusual consequence of chronic subdural haematoma.

Clinical appraisal of vinpocetine for the removal of intractable tumoral calcinosis in haemodialysis patients with renal failure.

Previous studies have shown that vinpocetine [14-ethoxycarbonyl-(3 alpha, 16 alpha-ethyl)-14,15-eburnamenine] scavenges minerals and/or metals in the soft tissues of rabbits with artificially induced arteriosclerosis. The present study was carried out to determine whether or not vinpocetine would bring about the removal of intractable tumoral calcinosis in haemodialysis patients with renal failure. After administration of 15 mg/day vinpocetine for 3-12 months in haemodialysis patients with X-ray evidence of tumoral calcinosis, calcinosis was completely eliminated in all eight cases. Serum alkaline phosphatase and bone osteocalcin concentrations tended to decrease after treatment with vinpocetine compared with before treatment. Vinpocetine thus appears to be an effective scavenger of tumoral calcinosis in haemodialysis patients with renal failure without any side-effects during treatment.

[Speech development test for one-year-old infants: I. Test content].

A new speech development test was prepared for one-year-old infants. The test consists of three parts: test I, II, and III. The overall test originally comprised a total of 98 test items (47 for Test I, 32 for Test II and 19 for Test III). Test I (for pre-speech language) Section 1 Situation of language i) Differentiation of information to be communicated ii) Comprehension of speech-related situation (Initiation of "signe", and comprehension of objects and events by means of speech) Section 2 Development of symbolizing function (Development and transformation of ability to handle and manipulate objects) section 3 Representing the function of language (First utterance, and acquisition of meaningful words after first utterance) Test II (for speech comprehension) Ability to name concrete objects, and to relate objects to their uses and functions; comprehension of words representing spatial concept such as quantity, number and dimensions, as well as words representing color or position. Test III (for speech expression) Ability to verbalize or name concrete objects, and to verbalize the conduct and state of a person. For infants, language is an objective to be achieved, while for adults it is the mean of thinking and communicating. Despite this difference the scope of this test comprises two major aspects common to the language-related experience of infants and of adults: pragmatics and vocabulary.

[Speech development test for one-year-old infants: II. Test statistics].

The test result of language ability for infants of second year of life was examined statistically. In descriptive statistics, average score, standard deviation, and proportion of right answers for all test items for each age group subjects were included. Then factor analysis was carried out to determine the structural characteristics of the test. The analysis revealed that test pertains of the following five stages. First two stage of five were overlapped with the previously reported result for pre-speech language test for infant within one year of life. Then, the stage was determined as follows; (4) Initial language acquirement and differentiation of language functions (5) Speech increasing stage (increase of spontaneously uttered words and understood words related to persons and objects) (6) Differentiation of expressed words (expression of words differentiated to suit objects) (7) Understanding of words representing actions or conditions (8) Understanding of words representing uses or functions, and verbalization of words representing actions or movements In spite of the fact that six and seven stage represent the same development level in term of chronological age, they were distinctive into those which achieve speech understanding earlier (stage 7), and others whose development centers on speech expression (stage 6). Then reliability and validity was performed. Reliability: (1) As to homogeneity, the reliability coefficients were calculated on the 60 test items by Spearman-Brown's odd-even method. (2) As to inter-rater reliability, Pearson's product movement correlation coefficient was calculated based on the results produced by two separate experienced testers. (3) As to test stability, reliability was determined through repetitive testing.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of immunosuppressive acid protein (IAP) in patients with rheumatoid arthritis].

Immunosuppressive acidic protein (IAP) is evaluated to be a useful parameter for the observation of the clinical course of patients with cancer, who are frequently associated with an increment of serum IAP levels. And also, immune complex diseases such as rheumatoid arthritis (RA), SLE and so on, have been described to produce immune-complex and, consequently, to generate IAP in vivo. Our study focuses on correlations of the IAP values with acute phase reactants, chronic phase reactants and grading of bone stages in patients with RA. Serum IAP showed the positive relationships with grading of bone stages, erythrocyte sedimentation rate (ESR), CRP, RF, RAHA, beta 2-microglobulin (BMG) and IgA in RA. Serum IAP was influenced by deterioration of bone pathological change. The more progressed pathological change of bone, the more increased serum IAP levels. It seems likely that there exist the similar mechanisms with production of IAP and parts of acute and chronic phase reactants and also, serum IAP level may be a useful parameter to predict bone pathological change in patients with RA.

[Sex hormones and calcium regulating hormones in rheumatoid arthritis].

Rheumatoid arthritis (RA) occurred frequently in women. Exogenous estrogen has been reported to alleviate the symptoms of patients with RA. But the implications of sex hormones and immunological abnormalities in RA remain to be elucidated. Therefore, we measured sex hormones (LH, FSH, estradiol, testosterone and prolactin), bone metabolic markers (midregion and carboxy terminal mainly recognized PTH1-84, intact PTH1-84, bone GLA protein and alkaline phosphatase), bone mineral, in lumbal bone with quantitative tomography (QCT) and with of cortex with microdensitometry in 52 females with RA and 46 females with osteoarthritis (OA) as a control group. Sex hormones and bone metabolic markers were analyzed as independent variables of serum LH, FSH and estradiol levels, using one way analysis, in patients with RA and OA. The more increased serum FSH and LH levels were, the more decreased serum estradiol levels were in both RA and OA groups, when they were considered as independent variables. These results indicate that the secretory function of pituitary and ovary axis hormones are normally enacted in RA. On the other hand, when the sex hormones of the patients under 53 years of age were studied in both groups, serum FSH adn LH showed significantly higher levels, while serum estradiol levels revealed decreased tendency in RA, compared with these in RA. Thus the pituitary ovary secretory function in patients with RA was suggested to be disturbed in early stage of age, indicating that the sex hormones would be partly implicated in calcium and bone metabolism in patients with RA.

[Test method for pre-speech language: I. Outline of test].

The purpose of this study is to determine infants' preliminary linguistic ability. For this a pre-speech language test method has been developed. The test method is as follows. First, a definition of language is given. Then the development process in infancy is explained according to the definition. Subsequently, the test items are decided according to the above process. (1) Definition of language: It is difficult to define language because of its many aspects. Here, for the language definition, the aspects are restricted to the following based on the properties of natural language. Section-1 Situation of language i) Formation of communication ii) Understanding and grasping of situation circumstance Section-2 Development of symbolizing function Section-3 Representing the function of language (generally, articulation of babbling and functional change) (2) Development of language: the above three aspects develop and change from preterm infancy to late infancy. The development process is as follows. Section-1 i) The formation of communication is confirmed by action situations between baby and mother. The actions include a steady gaze in the early stage and talking baby talk later. Requests for instruction assistance and emotional communication appear with gradual differentiation of communication. Section-1 ii) Understanding and grasping of the situation circumstance is confirmed with response to action from mother to baby in the early stage. These are then confirmed with the ability to understand the action and situation of surroundings as time and space extensity, and to give appropriate appeal to the surroundings. Subsequently, understanding with language only is acquired by daily experience, including language and understanding of the surrounding.(ABSTRACT TRUNCATED AT 250 WORDS)

[Test method for pre-speech language: II. Outline of test result].

UNLABELLED: The tests as reported in the previous paper were conducted on 281 healthy babies. The test included 47 items. An accomplished item was accorded one point, and the total points were counted. RESULTS: descriptive statistics: i) Table 4 shows the proportion of right answers of each item by age (day). The day when the item was accomplished was definite and showed the properties of development. ii) Fig. 1 and table 1 showed the relationship between the total points and the age (day). The total points increased linearly with age (day). Discussion of test properties: i) Reliability: special attention was devoted to maintain consistent conditions on item formation to increase reliability. Consequently, the confidence coefficient was 0.989 in all cases. ii) VALIDITY: predictive validity was tested. The changes in language ability were investigated in 90 cases for observation over the passage of time (including cases other than those for standardization). The cases were divided into three groups by age (0-200, 201-400, 401-day) (Table 7). For an estimated value, the PPV was 0.60-0.67 and the NPV was 0.94-1.00 (Table 8). The NPV was higher than the PPV. iii) Test construction and figure of test construction: it was found that the test construction was composed of five factors and had stages of development as follows. (1) Initial call, communication (2) Positive appeal to the surrounding (3) Stage just before speech (4) Initial language acquirement and differentiation of language function (5) Speech-increasing stage The items included in each factor (each stage) are shown in the Fig. 1. profile in the previous paper.(ABSTRACT TRUNCATED AT 250 WORDS)

[Calcium regulating hormone in the pathological changes of bone in rheumatoid arthritis].

To further elucidate the pathogenesis of calcium regulating hormones and bone Gla-protein (BGP) on the deteriorated bone changes in rheumatoid arthritis (RA), the degree of the appendicular bone atrophy, using microdensitometry method in patients with RA, and the concentrations of midchain mainly recognized parathyroid hormone (p-PTH1-84, intact parathyroid hormone (in-PTH1-84) and BGP in sera of patients with RA were measured. With concomitant progression in X-ray stage in RA, the levels of p-PTH1-84, in-PTH1-84, BGP, 25 (OH) D, and 24, 25 (OH)2D were significantly increased in sera of RA patients. The levels of 1,25 (OH)2D were not shown significant differences among RA patients classified by bone stage. These results might be concluded that the pathogenesis of the deteriorated bone change in RA seemed to be implicated in hyper-turnover bone presumably caused by the actions of parathyroid hormone and abnormal vitamin D metabolism.

[The correlation of serum parathyroid hormones among patients with dementia of vascular type, hemodialysis, and bone-joint disorders].

PTH levels were analysed in sera of patients receiving maintenance hemodialysis, with the vascular type of dementia and orthopedic patients with bone-joint disorders, using PTH assay kits. There were significant interrelationship among all kinds of PTH levels in the hemodialysis patients, but not in patients with the vascular type of dementia and the bone-joint disorders. Renal functions might be responsible for fragmentation of PTH in blood stream. These results suggested that the measurement of PTH levels is needed to examine various kinds of amino-sequence of PTH levels in keeping normal function of kidney.

[Accumulation velocity of 99mTc-HMDP in hip joint diseases].

The accumulation rate and velocity of 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) in hip joints were determined within four minutes after a bolus of injection of 99mTc-HMDP in the patients with hip joint disorders. There exist a significant relationship between accumulation velocity of 99mTc-HMDP in the affected joint and serum osteocalcin in the patients with eight cases of degenerative osteoarthropathy and six cases of femoral necrosis. This result indicates that the accumulation velocity of 99mTc-HMDP in the affected joint is likely to become a marker of bone turnover in hip joint disorder.

[Magnesium, parathyroid hormone and osteocalcin in the sera of hospitalized patients with chronic alcoholism].

Levels of parathyroid hormone (PTH) and osteocalcin in hypomagnesemic sera of chronic alcoholism patients were carried out to evaluate the roles of chronic alcohol poisoning on bone metabolism. Serum gamma-GTP activity showed inverse relationships among serum Mg and osteocalcin in these patients and PTH levels were also more decreased in these patients than in healthy subjects. These results indicated that the direct actions of alcohol might be brought about by the deterioration of bone metabolism, due to the decrease of serum PTH and osteocalcin levels by chronic alcohol poisoning.

[Clinical evaluation of osteocalcin in sera of the patients with neoplasms of bone].

The clinical significance of osteocalcin in sera of bone tumors were measured in sera of various kinds of bone tumors. The levels of osteocalcin were higher in bone tumors than those in normal subjects. Serum osteocalcin levels in hypercalcemic groups of bone metastasis and myeloma showed a remarkable increase in a parallelism with serum ALP and LDH levels. These results suggested to be directly or indirectly activated on osteoblast by bone tumors and to be synthesized osteocalcin in osteoblast.

[Influences of serum magnesium on measurements of serum parathyroid hormone].

The amino sequence recognizable parathyroid hormones (PTH) in lower and non-lower magnesemic groups in randomized samples were measured by using various kinds of the well established PTH kits. The levels of carboxy terminal, mid-region and intact PTH in lower magnesemic group were more decreased than these in non-lower magnesemic group. It is likely that the shortage of magnesium in serum makes a suppression of PTH secretion.

[Relationship between parathyroid hormone and magnesium in sera of the dementia patients].

The dementia patients with central nervous or neuro-cerebro vascular disorders seemed to be decreased serum Mg due to abnormal Mg uptake in diet. An increment of PTH level was paralleled with a rise of serum Mg and hypomagnesemic group was shown to have a lower PTH level in these patients. Our results suggested that secondary hypoparathyroidism was likely to be induced by normo-calcemic hypomagnesemia.

[The measurements of parathyroid hormones in sera of elderly osteoporotic patients with serum high alkaline phosphatase activity].

This study was carried out to investigate effects of drugs treated in the elderly osteoporotic patients on measurements of carboxy terminal, mid-region and intact PTH, by using the various kinds of PTH kits. The drugs such as 1 alpha(OH)D3, calcitonin and so on, in the treatment of osteoporotic patients, was brought about no significant inter-relationships among carboxy terminal, mid-region and intact PTH in sera of the elderly osteoporotic patients with serum high alkaline phosphatase activity.