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The patient, a 58-year-old man, experienced weakness of the proximal muscles in both lower extremities, and Lambert-Eaton myasthenic syndrome and small cell carcinoma of unknown primary origin were diagnosed. He received symptomatic treatment for myasthenia and radiochemotherapy for small cell carcinoma; once this regimen, the myasthenic symptoms improved. However, acute myocardial infarction occurred, after which type II respiratory failure developed, and the patient required ventilator management with tracheal intubation. Acute-phase treatment, such as plasma exchange, intravenous immune globulin therapy, and methylprednisolone pulse therapy, and intensification of symptomatic treatment allowed for extubation, and eventually the patient was able to walk independently. According to electrophysiological examination, compound muscle action potentials were larger at discharge than at the time of exacerbation.

We describe herein a case with left-side ptosis induced by pure midbrain infarction in a 49-year-old woman. She also presented with diplopia and right-side cerebellar ataxia. MRI demonstrated new ischemic stroke of the left ventral paramedian midbrain. In this case, ischemia of the left oculomotor fascicles caused the left-side ptosis and diplopia, and ischemia of the left decussation of the superior cerebellar peduncle caused the right-side cerebellar ataxia. These symptoms resulted from inner superior medial mesencephalic branch infraction. This case offers an educational example that can be explained by models proposed in the past and requires knowledge of neuroanatomy and cerebrovasculature.

A 28 year-old man who had been diagnosed as having Dravet syndrome (DS) since his childhood by a pediatric hospital was referred to our department from the local pediatric clinic. Until then, his seizures were medically intractable, and generalized tonic-clonic convulsions had occurred monthly even when administered enough valproate, zonisamide and clorazepate. After adding levetiracetam (LEV) to his drug regimen at the age of 29, the seizures disappeared for more than one year. LEV was found to be effective in this adult patient as well as in a series of children affected with DS.

To clarify the utility of permanent pacemakers in a society composed largely of elderly people, clinical characteristics, pacemaker characteristics, outcome, and quality of life in a total of 116 patients in a community with many (19.6%) elderly people were evaluated after permanent pacemaker implantation. Patients above age 65 accounted for 88.8%, while those above 80 years accounted for 24.1%. Syncope was the most common observation before pacemaker implantation and emergency care was needed in 35% of patients. Sick sinus syndrome and complete AV block were seen in a majority, while atrial fibrillation with bradycardia was seen in a minority of patients. Although the physiological pacing and ventricular pacing mode (VVI) were used in about 50% each, recently the physiological pacing mode has markedly increased. During the mean follow-up of 26.1 +/- 16.2 months, only four patients died. NYHA 3 symptom improved to NYHA 1 after pacemaker implantation and 72.5% patients of all cases returned to their jobs. We conclude that the permanent pacemaker is effective in improving symptoms and reducing the death rate in elderly patients.

The pre-therapy serum levels of immunosuppressive acidic protein (IAP) were assayed in patients with cancer of the uterine cervix and ovarium using the single radial immunodiffusion method. These levels were normal in patients with early cancer of uterine cervix (O and Ia stage); in advanced cancer patients they were increased with cancer stage. The serum IAP levels in ovarian cancer were higher than in patients with advanced uterine cervical cancer.

The mass screening for cervical cancer in the population of Miyagi Prefecture has covered the total 1,078,999 women by March 1981. Invasive cancer of the uterine cervix was discovered in 1032 women, carcinoma in situ in 829. 2) By methods of the examination, the institutional examination was on 72.5% of the examined in 1980. 3) With regards to the rates of examinees by age and the detection rate of the cancer of uterine cervix in 1980, the low detection rate in the age range of 30-50 years whose examination rate was over 20% compares against the high detection rate in the high age range, whose examination rate was low. 4) CAI in years 1965, 1970, 1975 and 1980 were 60.0, 116.7, 193.2 and 229.8 respectively. 5) The 302 cases of invasive cancer detected and treated before the end of 1974 were classified in clinical stages and investigated the results of treatment. The detection in Stage I was in 84.1%, this high percentage being a main factor to make the total treatment results of uterine cervical cancer pushed up to the high figure.