We report a case of Nothnagel syndrome with inattention. A 69-year-old laborer was admitted to our hospital for rehabilitation therapy complaining of gait disturbance a month after the onset of brainstem infarction. He had right oculomotor palsy, ataxia on the left side and upward movement limitation of the left eye. Magnetic resonance imaging demonstrated high signal intensity in the right tegmentum of the midbrain and the medial aspect of the right thalamus on T2-weighted and diffusion weighted images. This lesion involving nuclei in the medial aspect of the right thalamus, which is considered to be closely related with the reticular activating system, might explain his inattention. And it is suggested that the low blood flow in the right basal ganglia and parietal lobe revealed by his SPECT scan, could be related with that as well. We administered rehabilitation programs for his ataxia and inattention. Because diplopia is thought to be difficult to improve, we did not attempt to treat the patient's eye movement limitation. Three months after our intervention, he was able to walk without support. However, his inattention remained. Patients with brainstem infarction are apt to have plural impairments concurrently. In such cases, it is necessary to assess the treatment priority for each impairment adequately. Evidence based guidelines for the assessment of treatment priority would aid in this endeavor and the development of such guidelines is therefore expected.

Healthy male subjects were asked to hold their breath in air at the tidal inspiratory level, and time-dependent changes in mean values of several parameters of cardiovascular function were studied. The heart rate increased abruptly after the beginning of breath-holding and then decreased slightly with time. The stroke volume (SV) remained significantly low until the end of breath-holding, so that the cardiac output was decreased in parallel. With regard to the systolic time interval, the totai eiectromechanical systole and the left-ventricular systolic time (LVET) were not significantly changed, whereas the pre-ejection period (PEP) was markedly prolonged. Therefore, ratios of PEP/LVET and SV/LVET were increased and decreased with time, respectively. As the systolic, and in particular the diastolic blood pressures were elevated, the pulse pressure was reduced. Ratios of the diastolic and systolic times in relation to the heart rate at rest, during breath-holding and during recovery after breath-holding were all proved to be described by a single regression curve. However, the ratios obtained for cycling exercise at various heart rates showed a marked shift above the curve. These results clearly indicate that cardiac performance is lowered during breath-holding in air.

A 70-year-old man had annular erythema on the area extending from the right scapular region to the right axillary region, where he got tick bites on June 20, 1991. The erythema occurred soon after the bites and spread gradually to become as large as 20 square cm within 25 days. He also felt fatigue. An electrocardiogram revealed an atrioventiricular nodal block. We treated the patient with amoxycillin (750 mg daily) for 35 days. He has been now free from any symptoms over one year. Although repeated serological tests could not detect an antibody to Borrelia burgdorferi, typical erythema chronicum migrans and cardiac manifestation strongly suggested that the case could be diagnosed as Lyme disease.

We examined the rates of sudden death to ordinary deaths of the patients in two hospitals in Obihiro. A total of 130 sudden death cases (89 men and 41 women) out of 1, 088 ordinary deaths were listed (11.9%) during the period of two years from 1992 through 1993.
We also looked into the cause of sudden death in 86 autopsied cases over a 15-year period from 1985 through 1999 from a pathological stand point. Cardiac diseases underlay 49 cases of sudden death. Myocardial infarction (42 cases), cardiomyopathy (2), sarcoidosis (1), amyloidosis (2) and valvular disease (2) were regarded as the causes of death in the 49 cases. Myocardial infarction occurred more frequently in men than in women (27: 15). Next to cardiac diseases came aortic diseases such as ruptured aortic aneurysm (7 cases) and dissecting aneurysm (6). Cardiac diseases (49 cases) and aortic diseases (13) combined to account for 62 of 86 (72.1%) autopsied cases. Among noncardiovascular diseases, respiratory diseases (18 cases) topped the list, followed by alimentary diseases (3) and cerebral bleeding (2). The major cause of respiratory diseases was pulmonary embolism (16). Pulmonary embolism more often occurred in women than in men (14: 2). There was one case of unidentifiable sudden death, namely Pokkuri disease. A decreased incidence of sudden death on Sunday should be noted. A circadian rhythm was evident. The incidence of sudden death started rising from 6: 00 and peaked at 15: 00. Sudden death occurred during rest (42 cases), during routine daily activity (14), during sleep (11), during bathing (1), during defecation (8), during surgery (2), during physical exercise (6) and during agricultural work (2).

Purpose : The purpose of this study was to investigate the risk factors for falls among wheelchair users who were institutionalized in a long-term care health facility. Subjects : The participants were 62 new residents (mean age, 85.4±7.9) of a long-term care health facility. Methods : A longitudinal study of 6 months follow-up for falls was carried out. Baseline data were obtained regarding age, history of falls, functional status, psychological variables, physiological function, medical treatments and economic status. Risk factors for falls were analyzed by logistic regression. Results : During the follow-up, falls by 29 patients (46.8% of participants) were reported. Our analysis showed that four risk factors were significantly associated with falls : the patient had a bent back, a high FIM score, polypharmacy and benzodiazepine use. Logistic regression analysis revealed that a bent back was the best predictor of falls (OR 4.11 ; CI 95% 1.25-13.5).

Introduction: CPT-11 induced diarrhea reduces patient compliance, lowers quality of life, and can be potentially life threatening. Loperamide is effective in the majority of cases of CPT-11-induced diarrhea. However, the case of advanced gastrointestinal cancer where oral administration is difficult. We adapted octreotide for use in a case of CPT-11-induced diarrhea where oral administration was difficult due to digestive tract stenosis. Case Report: A 61-year old man was diagnosed with advanced gastric cancer. He was treated with CPT-11 100mg/m² weekly for three weeks followed by a 1-week rest. CPT-11-induced diarrhea developed after 10 days of treatment. At the same time, his digestive tract stenosis worsened, making Loperamide unusable. We administered octreotide 200μg continuous intravenous drip infusion. One day after octreotide administration, the number of diarrhea has decreased from 20 times to four times. Conclusions: Octreotide is one of the effective treatments for CPT-11-induced diarrhea. Palliat Care Res 2010; 5(2): 338-341