Closed head injuries are usually classified into 2 categories: focal brain injury and diffuse brain injury. Among the latter, there are a number of cases showing protracted consciousness disturbance without macroscopic intracranial lesion. Adams et al, proposed the notion of “diffuse axonal injury (DAI)” in order to explain the pathophysiological mechanism of such cases. They insisted that axonal retraction balls, proof of axonal disruption, were the hallmark of DAI underlying the syndrome. However, according to literature review and personal experience, their hypothesis could not be admitted because histological investigation of cerebral white matter have revealed diffuse myelin pallor, suggesting the existence of diffuse brain swelling at acute stage. Moreover retraction balls have been noticed in various kinds of lesions other than trauma. In the case of histopathological examination of head injury, it is important to pay closer attention to cerebral white matter lesion.
With regard to the well-known “dementia pugilistica” or “punch-drunk syndrome”, the authors found neurofibrillary tangles (NFTs) in the cerebral cortex of a 31-year-old professional boxer who was not in the least demented at the time of death. NFTs were, however, not noted in the hippocampus and the amygdala commonly involved in Alzheimer's disease. In the injured brain, clinicopathologically or experimentally, expression of presenilin-1 gene and deposition of β-amyloid protein have been recently reported. Relationship between head injury and dementia still remains to be elucidated.

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Angiotensin II receptor antagonist losartan potassium is demonstrated to have uricosuric effect. We investigated the usefulness of the uricosuric action in the combination therapy using losartan potassium, and furosemide increase serum uric acid concentration.
Forty-nine patients with normal renal function and not having any drugs influenced on serum uric acid concentration, were randomly devised into 4 groups; F group who take furosemide monotherapy, FL group who take furosemide and losartan simultaneously, L group who take losartan monotherapy, F→L group who taking furosemide followed by losartan. As for 4 groups the serum uric acid concentration and change rate were compared of around the losartan and furosemide intake. As a result change rate of F group and FL group was increased 33.3%, 21.3%, respectively. Change rate of F group was increased than FL group; however, there was no significant difference between the two groups. Change rate of L group and F→L group was decreased 2.2%, 15.0%, respectively. Change rate of F→L group decreased significantly than the other groups (non pared t-test).
These results suggested that uricosuric effects of losartan might a meliorated the uric acid retention effect of furosemide therapy.

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We studied the drug resistance in 14 Japanese cases of leprosy. All of them were relapsed cases after once cured with various anti-leprosy drugs. Genomic DNA was prepared with Mycobacterium leprae isolates harvested from skin biopsy samples. Mutations of genes involved in resistance to DDS (diaphenylsulfone), RFP (rifampicin), and OFLX (ofloxacin) were examined.
The mutations related to DDS-resistance were found in 10 out of 11 cases having long history of DDS-taking. The same to RFP-resistance were found in 9 out of 11 cases having history of RFP-taking, and the same to OFLX-resistance were found in 2 out of 3 cases having history of OFLX-taking. Seven cases had mutations related to multiple drugs, 5 cases to DDS and RFP, 1 case to DDS and OFLX, and 1 case to all these 3 drugs, In most cases, the drugs were given with small dosage for long periods in the manner similar to monotherapy. No mutation was found in the cases that had no history of administration of particular drug (s).
We found that this simple molecular test is effective and reliable in the assessment of the drug-related mutations in Mycobacterium leprae. Application of this test is useful for the planning of effective regimen in the relapsed cases and may offer another strategy to the leprosy control in the endemic areas where no apparent decrease in the leprosy incidence has been shown.

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It is not an easy task to make an informed consent in case of amyotrophic lateral sclerosis (ALS) to the patients and their family. We must keep in mind that the influence of the announcement will linger on for the rest of their life. This is a report of questionnaire directed to the persons living with ALS. Questions involve how it was done, what they felt about it, what they think it should be.
The reality of the announcement revealed by this study gives us valuable materials for establishing a common base of the announcement of ALS. Informed consent should not be one way, but also should include patients' opinions.

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Beginning in the new century, the role of national hospitals has been reconsidered increasingly from various viewpoints. Since last year, the clinical study group project has started, involving 35 national hospitals (37 this year). It is quite significant and epoch-making that this project has provided an opportunity for discussion within the policy-based medical service network.
The number of hospitalized neurological patients in these hospitals per day turned to be ALS 300, Parkinson disease 400, SCD 300, multiple sclerosis 100 and cerebrovascular disorder 400 respectively, highly exceeding the expectation prior to the survey. This fact not only confirms the importance of the role of national hospitals, but also suggests the necessity to review the conventional standpoint of medical staff.
For the qualitative improvement of the medical care for neurological diseases, not only the technical innovations on diagnosis and treatment, but also the rapport with suffering patients and their family are indispensable. To that end, medical staff needs to share the same standpoint with them. Needless to say, important topics such as disclosure of information, announcing the diagnosis of incurable diseaes and pain-relieving care are to be also studied deeply for the improvement.
To the symposium are invited those who work for serious neurological diseases from various fields. Its purpose is exchanging constructive opinions in order to establish the appropriate medical care that is not given one-sidedly but enables us to advance together with patients.

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In four patients with stable congestive heart failure (CHF) with echocardiographic left ventricular ejection fraction (LVEF) below 30%, we performed polysomnography, revealing all the patients had Cheyne-Stokes respiration (CSR) with central sleep apnea. To treat this type of sleep disordered breathing, we appliedcontinuous positive airway pressure (CPAP) of 4-6cmH₂O for three months. The repeated polysomnography showed a decrease in number of apnea/hypopnea, and an increase in slow wave sleep. The LVEF was increased above 30% in all the patients. We suggest that CPAP is effective not only in alleviating CSR but also improving cardiac function, providing a new non-pharmacol-ogical approach to CHF.

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The prevention against the nosocomial MRSA infection was studied by using electrolyzed oxidizing water since December 1999. Examination of MRSA infection of all admitted patients in our hospital revealed that 24 (32%) of 75 patients in April 2000 were colonized or infected with MRSA. So we made the manual of environmental controls and confirmed that the improved manual was effective on bacteriological survey. Also electrolyzed oxidizing water was introduced for concurrent disinfection method of catheter after airway aspiration and the catheter was kept in the water for recurrent use. Molecular epidemiology of MRSA isolates in our hospital in December 2000 strongly suggested nosocomial infection. As a result of continuous hospital infection controls, MRSA disappeared from our hospital environment. The MRSA outbreak by a single strain were being stamped out in September 2001. (Only 2 of 9 isolates in September 2001 showed the same PFGE pattern (A1).) We consider that handwashing by medical personnel before and after all patient contacts is very important as hospital infection controls.

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