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We attempted to clarify positive benefits in cognitive abilities and motivation during our cognitive intervention [structured floral arrangement (SFA) program] for patients with neurocognitive disorder due to stroke, traumatic brain injury (TBI), and other related disorders. In this SFA program, participants are required to arrange cut flowers and leaves on absorbent foam according to an instruction sheet. In a previous study of patients with schizophrenia, our SFA program encouraged participants and contributed to stimulating their visuospatial process and memory. Here, 27 patients with neurocognitive disorders participated in this study. Sixteen patients were assigned to an SFA-treated group and participated in six sessions during two phases plus to daily activities. Eleven non-treated patients engaged only daily activities during the same period. We compared Apathy Scale scores and neuropsychological scores between the SFA-treated and non-treated patients. Their mean attendance rate was more than 90% during the two phases. SFA-treated patients copied a Rey-Osterrieth complex figure more accurately than non-treated patients ( p < 0.05) during the later intervention phase, whereas during the earlier phase, accuracy was comparable between treated and non-treated groups. In the SFA-treated group, recall scores also improved ( p < 0.01), and the positive outcomes were maintained for about 3 months ( p < 0.05). The Apathy Scale scores did not show significant change in either the SFA-treated or non-treated groups. Our present results suggest that the SFA program encouraged continuous participation to cognitive intervention and was useful for ameliorating dysfunctions in visuospatial memory and recognition in patients with neurocognitive disorder.

Background: Squamous cell carcinoma (SCC) of the oral region often metastasizes to the cervical lymph nodes. To investigate whether the risk of cervical lymph node metastasis are predictable through lymphatic vessel density (LVD) and vascular endothelial growth factor (VEGF) expression, we assessed the relationship between LVD and clinicopathological parameters, and VEGF expression in SCC of the oral region., Methods: The subjects were 109 patients with SCC of the oral region including the lip. Clinicopathological parameters examined for the association with LVD in a peritumoral hot spot were lymph node metastasis, histological grade and disease stage. The association with VEGF expression was similarly studied. LVD was detected by immunohistochemistry using D2-40., Results: LVD was significantly higher in lip cancer than in other oral tumors (P < 0.0001), while there were no significant differences of LVD among other cancers of the oral cavity. LVD tended to decrease with disease progression, increase of tumor size and increase of metastatic lymph node size. Eighty-four of 109 tumors were positive for VEGF-C or D. VEGF-C-positive tumor lesions were also positive for VEGF-D. Significantly higher levels of VEGF-C and D expressions were associated with large size of lymph node metastases (P = 0.02)., Conclusion: SCC of the oral region including the lip that produces VEGF-C and D is significantly more likely to cause cervical lymph node metastasis. LVD in a peritumoral hot spot does not directly indicate the risk of cervical lymph node metastasis, but instead may reflect lymphangiogenesis due to VEGF together with loss of lymphatic vessels through tumor growth and progression.

Primary Objective: To investigate differences between individuals with traumatic brain injury (TBI) and a control group regarding quantitative characteristics of narrative discourse including correct information units (CIUs). The secondary objective was to explore cognitive correlations with narrative discourse measurements., Research Design: Case-control study., Methods: Twenty-six individuals with TBI and 24 age-, gender- and education-matched subjects without brain injury were examined. Four-frame comic strips were used for elicitation of narrative discourse. Six variables of discourse measurements (total time, total number of units and CIUs, units per time, CIUs per time and CIUs per unit) were calculated. The relationships between the 6 discourse measurements and results of standard cognitive tests were also examined, including logical memory, working memory and executive functions., Main Outcomes and Results: The time efficiency for narrative discourse (i.e. total time, units per time and CIUs per time) was significantly decreased in the TBI group. Moreover, time efficiency was significantly related to measurements of working memory and executive function. The TBI group did not differ from the control group with regard to total number of units and CIUs and CIUs per unit., Conclusion: Decreased time efficiency is the most critical characteristic of narrative discourse in individuals with TBI.

The neurobehavioral disability recognized in traumatic brain injury (TBI) is a severe sequela, but there is no appropriate classification due to its various manifestations. In the present study a questionnaire for a simple investigation of this disability was prepared, and its reliability and validity verified. The survey was conducted on 72 patients with TBI by the caregiver of each patient. As a result, good reliability was indicated by the split-half method (coefficient of reliability: 0.95, obtained using Spearman-Brown correction formula). The total score of the questionnaire had a significant correlation with the total score of the simultaneously conducted Japanese version of Neuropsychiatry Inventory at the 0.01 level (Spearman's rank correlation, 0.47). It also had a significant correlation with the total score of the simultaneously conducted Japanese version of the Dysexecutive Questionnaire at the 0.05 level (Spearman's rank correlation, 0.36). Six factors constituting this neurobehavioral disability were extracted from a factor analysis of the questionnaire survey. These factors are angry outburst, avolition, deficits of sympathy, depressed mood, discourse deficits, and degradation of appearance. Each factor indicated good internal consistency (Cronbach alpha, 0.86-0.94). The present results indicate that this questionnaire has good reliability and validity, therefore it can be a significant indicator in TBI neurobehavioral disability study.

A 72-year-old asymptomatic man was admitted to our hospital with abnormal chest radiographic findings: bilateral diffuse linear, reticular, and consolidated shadows. Malignant lymphoma (diffuse small-cell B-cell lymphoma) was diagnosed histologically after an open lung biopsy and was confirmed by a genetic examination. The lymphoma cells had infiltrated widely in various regions of the lung, including the alveolar spaces and walls, the bronchial and vascular spaces, and the pleura. This diffusion of the lymphoma cells might have accounted for the chest X-ray findings. Malignant pulmonary lymphoma should be included in the differential diagnosis patients with diffuse linear, reticular, and consolidated shadows on chest X-ray films.

Squamous cell carcinoma of the lung was diagnosed in a 64-year-old man. Chest roentgenographic and tomographic examinations did not show areas of high-density in the tumor, but chest CT scan showed diffuse, scattered, high-density nodules in the tumor. Histologic examination did not show calcification, and calcium staining (Kossa method) was negative. Examination of the thin-slice CT, the soft X-ray film, and the resected slice of the lung indicated that the high-density nodules seen in the tumor on the chest CT scan corresponded to markedly fibrotic lesions with severe anthracosis. This case shows that high-density areas on a CT scan may reflect non-calcified lesions.

A 60-year-old woman was admitted to our hospital because of progressive cough and chest pain for 2 months. She also complained of exertional dyspnea. Bilateral diffuse infiltlative shadows were found on the chest roentogenogram. Ground-glass opacity in the middle lobe and lingula, and subpleural patchy consolidation were seen on the computed tomogram of the chest. Arterial oxygenation and diffusing capacity were low. The level of angiotensin-converting enzyme in serum was normal, but that of lysozyme was high. In the BAL (broncho-alveolar lavage) fluid, total cell count and the number of lymphocytes were high, and the CD 4/8 ratio of the lymphocytes was high. Open lung biopsy revealed numerous confluent sarcoid granulomas with necrosis, which strongly correlated with severe vasculitis. After necrotizing sarcoid granulomatosis was diagnosed, prednisolone was administered, which resulted in improvement of symptoms and disappearance of chest-radiograph shadows. Necrotizing sarcoid granulomatosis may be seen as a variant type of sarcoidosis. However, clinical findings including the chest-radiograph shadows and clinical course of this case differ from those of ordinary sarcoidosis. These clinical findings can be attributed to severe vasculitis, as revealed by histological examination.