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An 80-year-old woman had an aortic valve replacement 1 month before admission and took warfarin for transient atrial fibrillation. She developed a disturbance of consciousness and left hemiplegia. On admission, the right radial artery was slightly palpable. Head MRI images showed a hyper-intense area in the right middle cerebral artery territory. MRA images showed an occlusion of the right M1 distal site and decreased signal at the right internal carotid artery. Contrast CT images of the ascending aorta showed an embolus in the innominate artery. She was diagnosed with an innominate artery saddle embolus and occlusion of the right cerebral artery due to cardiac embolism. She was treated with a heparin infusion and warfarin. She recovered consciousness and from hemiplegia gradually. Recanalization of the innominate artery and right cerebral artery was confirmed. In cases where the radial artery is slightly palpable, it is necessary to consider an innominate artery saddle embolus in addition to aortic dissection.

In 2002 we estimated the measles cumulative vaccination coverage (CVC) in Japan by randomly selecting a total of 5,000 3-year-old children from the total Japanese population and examining the age in months when they were vaccinated against measles. This survey revealed that in Japan measles CVC at ages 18, 24, and 36 months were 61.7 +/- 1.6%, 79.6 +/- 1.3%, and 86.9 +/- 1.1%, respectively. The results obtained in 2003 revealed that the measles CVC among 3-year-old children in 2003 was higher than that obtained in 2002, with especially noticeable improvement in their period of 12 to 23 months of age. It is estimated that this improvement was attributed to the effort made by many persons concerning vaccination to raise the vaccination rate. In 2003 oral polio vaccine (OPV) CVC was investigated for the first time, in addition to measles CVC. OPV CVC of the first dose at 6, 12, and 36 months of age were 44.2 +/- 1.5%, 85.5 +/- 1.1%, and 94.7 +/- 0.8%, respectively. The results of the second dose at 12, 18, and 36 months of age were 42.3 +/- 1.5%, 73.5 +/- 1.3%, and 90.7 +/- 0.9%, respectively. Even at 36 months of age the CVC level of the second dose of OPV was found to be slightly lower than that of the first dose.

While the mortality rate of cerebral hemorrhage of Okinawa Prefecture is the lowest in Japan, the presence of a high incidence rate for cerebral hemorrhage has been pointed out in Hirara-city, Okinawa Prefecture. In order to develop an effective counter-measure, a case-control study of risk factors for cerebral hemorrhage was performed. Cases were 62 residents in Hirara city aged 40-69 years who had experienced cerebral hemorrhage between April 1987 through March 1992. From the 62 cases interviewed, responses were obtained from 49 cases. Controls were 147 residents without a history of stroke who were matched to cases individually by sex and age (control/case ratio = 3). From the 49 cases, 28 cases who had participated in residential mass health examinations before experiencing the cerebral hemorrhage, were matched individually sex and age with different randomly selected controls (control/case ratio = 10). From conditional logistic regression analysis of the interview survey data, history of hypertension, interruption of hypertension therapy, family history of stroke, long working hours, overwork and difficulty of taking a day-off each week were strongly related to increased risk of cerebral hemorrhage. Smoking, preference for salty taste and habitual drinking, also, elevated risk slightly. From analysis of the residential mass health examination data, high blood pressure was found to be strongly associated with cerebral hemorrhage, while serum cholesterol was inversely related.

Patients with human T-cell lymphotropic virus type 1 associated myelopathy (HAM) have complaints of urinary disturbance frequently. Symptoms and urodynamic examinations were evaluated in untreated twenty-one patients with HAM. Although two cases (11%) had no urinary symptom, nineteen cases (89%) suffered from dysuria, pollakisuria, incontinence or urgency. The combination of irritative and obstructive urinary disturbance was a characteristic symptom in the HAM patients. In three cases the urinary symptoms preceded the gait disturbance which is a main symptom of HAM. In urodynamic study overactive bladder was found in fourteen cases (66%), although three cases (15%) showed underactive or acontractile bladder with disturbance of urinary sensation. There was no abnormal finding by urethral pressure profile (UPP), but detrusor sphincter dyssynergia (DSD) was revealed frequently by EMG. This typical dysfunction of the HAM patients was thought to be caused by destruction of the lateral column of the spinal cord.