The neurotic versus delusional subtype of taijin-kyofu-sho: their DSM diagnoses

The main purpose of the present study was to investigate the diagnostic concepts of taijin-kyofu-sho (TKS) and social phobia, by comparing the clinical diagnosis of TKS and the operational diagnosis of Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised; DSM-III-R). Three evaluators conducted semistructured interview for DSM-III-R (SCID axis I and II, the Japanese version) to 88 outpatients who visited Jikei University Daisan Hospital, Japan, over a period of 1 year, requesting Morita therapy. The patients were also independently diagnosed by three psychiatrists to identify TKS. A total of 65.8% of 38 cases of TKS were diagnosed as social phobia. Among the neurotic TKS cases, the percentage was high at 81.5%, while among the delusional TKS cases it was 27.3%. A total of 42.1% of the TKS cases were diagnosed as mood disorder; 60.5% of the TKS cases presented some axis II disorders, among which avoidant personality disorder was the most prevalent (31.6%). There was no significant difference between the neurotic and delusional subtypes of TKS, regarding comorbidity with axis I diagnoses. As for axis II diagnoses, delusional TKS patients had a higher rate of comorbidity with paranoid personality disorder, although they demonstrated very similar trends in comorbidity with all other personality disorders. In the diagnostic system of DSM-III-R, it is highly likely that the neurotic and delusional subtypes of TKS will be seen to correspond to different diagnostic categories.     

Diagnostic consideration of Morita shinkeishitsu and DSM-III-R

The purpose of the present study was to empirically and objectively clarify the diagnostic standing of Morita shinkeishitsu, the subject of Morita therapy, by comparing and contrasting it with the operational diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised; DSM-III-R). Morita therapists' clinical diagnoses of 88 outpatients who requested Morita therapy were compared with the results of the independently conducted operational diagnoses (structured clinical interview for DSM (SCID) for DSM-III-R, the Japanese version). In view of the result of axis I diagnoses, Morita shinkeishitsu corresponds to anxiety disorders, although it is a complex that also embodies mood disorders, which were found in one-quarter of the cases, as well as personality disorders, which were found in half of the cases, especially cluster C (avoidant, obsessive-compulsive, and dependent personality disorders). Morita shinkeishitsu is almost equivalent to anxiety disorders (DSM-III-R, axis I), and is a complex, a part of which includes mood disorders and cluster C personality disorders.     

Multi-center study for the evaluation of clinical usefulness of attenuation and scatter correction on 201Tl myocardial SPECT

The aim of this study was to evaluate the clinical usefulness of attenuation and scatter correction (AC, SC) on a 201Tl myocardial single-photon emission computed tomography (201Tl SPECT) as a multi-center trial. With a dual-detecter and a triple-detector SPECT systems with a 99mTc transmission source, simultaneous transmission/emission tomography (TCT/ECT) was performed on 38 patients with angiographically coronary heart disease (CHD) and 26 patients without evidence of CHD. Stress and delayed attenuation and scatter corrected images (SAC) and uncorrected images (NC) were reconstructed. On NC images of normal cases, influence of attenuation was greater in male than female. In comparison of 201Tl distribution between male and female, significant decrease in 201Tl activity was observed in the inferoposterior wall in male and that was observed in the anterobasal wall of the left myocardium in female. Such a difference in 201Tl distribution between male and female disappeared on SAC images. On the diagnostic performance for the identification of CHD, SAC images demonstrated improved specificity and accuracy values in the right coronary arterial territory (RCA) with visual analysis statistically. Sensitivity value in the RCA was also improved, but it was not statistically significant. Sensitivity value in the left circumflex arterial territory (LCX) increased without decrease in specificity value on SAC images. In the left anterior descending arterial territory (LAD), sensitivity value increased on SAC images. Although specificity value decreased on SAC images in LAD territory, it was not statistically significant. The difference in 201Tl distribution between male and female is improved in normal cases by attenuation and scatter correction on 201Tl myocardial SPECT. Diagnostic performance of CHD is also improved by attenuation and scatter correction, especially in territories of which specificity in assessing the absence of disease have been suboptimal. In conclusion, attenuation and scatter correction on 201Tl myocardial SPECT is considered to be clinically useful.     

Death and survival of neuronal cells exposed to Alzheimer's insults

Neuronal cell death is the central abnormality occurring in brains suffering from Alzheimer's disease (AD). The notion that AD is a disease caused by loss of neurons points toward suppression of neuronal death as the most important therapeutic target. Nevertheless, the mechanisms for neuronal death in AD are still relatively unclear. Three known mutant genes cause familial AD (FAD): amyloid precursor protein, presenilin 1, and presenilin 2. Detailed analysis of cytotoxic mechanisms of the FAD-linked mutant genes reveals that they cause neuronal cell death at physiologically low expression levels. Unexpectedly, cytotoxic mechanisms vary depending on the type of mutations and genes, suggesting that various mechanisms for neuronal cell death are involved in AD patients. In support of this, activity-dependent neurotrophic factor, basic fibroblast growth factor, and insulin-like growth factor-I can completely protect neurons from beta-amyloid (A beta) cytotoxicity but exhibit incomplete or little effect on cytotoxicity by FAD mutant genes. By contrast, Humanin, a newly identified 24-residue peptide, suppresses neuronal cell death by various FAD mutants and A beta, whereas this factor has no effect on cytotoxicity from AD-irrelevant insults. Studies investigating death and survival of neuronal cells exposed to AD insults will open a new horizon in developing therapy aimed at neuroprotection.     

Death in epilepsy with special attention to suicide cases

To examine clinical features of cases of death among epilepsy patients as a case-control study, with special attention to suicide, we analyzed the records of 43 deceased patients with well-classified epilepsy. The subjects were compared with 1,722 control patients who showed definite subtypes of epilepsy. As a result, among the major causes of death, 13 of the subjects suffered accidents (mostly drowning), ten experienced sudden unexpected death, seven had status epilepticus, and six committed suicide. There were no significant differences with regard to clinical variables except for psychotic episodes, which were more frequently encountered in subjects than in controls (chi(2)=6.771, P=0.009, Yates' modification). Statistically significant differences were found by epilepsy type as well (chi(2)=14.72, P=0.002), with temporal lobe epilepsy (TLE) proving to be most closely associated with death among the epilepsy patients. Further, suicide was only encountered in patients with TLE and the association was statistically significant (chi(2)=5.119, P=0.024). Half of those who committed suicide (n=3), did so by jumping in front of an oncoming train while in the midst of an episode of postictal psychosis. In conclusion, most cases of suicide in patients with epilepsy were found to be the result of an immediate causal relationship with ictal or interictal epileptic manifestations, rather than a result of augmentation of psychosocial stressors generated by a long-standing handicap derived from the severe illness.     

Prognostic value of serum immunosuppressive acidic protein in renal cell carcinoma

BACKGROUND: To determine whether the immunosuppressive acidic protein (IAP) could be a useful marker for renal cell carcinoma (RCC), serum IAP levels were compared with clinicopathological features in RCC patients. Furthermore, IAP cutoff level to predict the recurrence was determined using receiver operating characteristics (ROC) curve analysis. PATIENTS AND METHODS: Between January 1994 and December 1998, pretreatment serum IAP was measured in 123 consecutive patients with PCC at Kitasato University Hospital. Ninety-eight patients were received radical surgery and 86 patients were performed as clinically curable renal cell carcinoma (pT1-pT3N0M0). ROC curve analysis was utilized to set the cutoff value of IAP for prediction of cancer recurrence. Significance of prognostic factors in RCC recurrence was analyzed by Cox proportional hazard model. RESULTS: The mean age of the 123 patients was 58.6 years (range 33 to 90, median 59). The mean follow-up period was 24.8 months (range 1 to 78, median 26). The median IAP levels were 447 ug/ml in stage I, 629 ug/ml in stage II, 588 ug/ml in stage III and 1,150 ug/ml in stage IV (p < 0.05). Tumor size and venous involvement were significantly associated with IAP concentrations (p < 0.05). However, tumor grade did not correlate with IAP level. Of 86 patients with clinically curable tumor, 79 patients were disease-free after median follow-up of 27 months. Using ROC curve analysis, IAP cutoff level for prediction of cancer recurrence was set at 620 ug/ml. Disease-free survival rate in patients with preoperative IAP levels of 620 ug/ml or lower was 98.5% (67/68) at 27 months postoperatively, whereas that in patients with IAP greater than 620 ug/ml was 75.0% (12/18). This difference was statistically significant (p < 0.05). Results of multivariate analysis revealed that preoperative IAP and pT stage were statistically significant factors for tumor recurrence after radical surgery (p < 0.05). CONCLUSIONS: The present study indicates that preoperative IAP level is a useful prognostic marker in patients with RCC. In particular, patients with clinically curable tumors (pT1-3N0M0), whose preoperative IAP levels greater then 620 ug/ml may have high risk for recurrence after radical nephrectomy.     

The role of plasma endothelin in the Fontan circulation

BACKGROUND: Various vasoactive substances are released during cardiopulmonary bypass. They may deteriorate pulmonary circulation after the Fontan operation. Effects of plasma endothelin-1 (ET-1), a vasoconstricting peptide, on the Fontan circulation have not been investigated. METHODS: Eleven patients (aged 11.1+/-7.5 years) who underwent the modified Fontan operation (group F) and seven patients (aged 9.9+/-6.0 years) who underwent the biventricular repair (group C) were studied. Plasma samples were obtained for measuring ET-1 on the first postoperative day (Early I), on returning to floor care from the intensive care unit (Early II), and during postoperative cardiac catheterization (Late). RESULTS: Plasma concentrations of ET-1 increased in group F (Early I, 4.37+/-1.78 pg/ml; Early II, 4.07+/-1.90 pg/ml) as compared with the basal value of 1.0+/-0.5 pg/ml. The central venous pressure, which reflects the pulmonary circulatory state, soon after the Fontan operation correlated significantly with the increased ET-1 concentration (y=1.809 x+6.484; r=0.809; p=0.0026). Although the Late ET-1 concentrations in group F were significantly decreased, the central venous pressure and the ET-1 concentrations demonstrated a significant correlation (y=3.074 x +5.427; r=0.740; p=0.0227). CONCLUSIONS: The increased humoral vasoactive substances such as ET-1, which induces pulmonary vasoconstriction following the Fontan operation, may have important implications for the Fontan circulation.     

Cerebral hemodynamics and metabolism in patients with cerebral arteriovenous malformations: an evaluation using positron emission tomography scanning

OBJECT: The purpose of this study was to evaluate cerebral hemodynamic and metabolic features in patients with arteriovenous malformations (AVMs) by using positron emission tomography (PET) scanning. METHODS: Twenty-four patients with supratentorial cerebral AVMs participated in PET studies in which 15O inhalation steady-state methods were used. The authors recorded the values of regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), the regional oxygen extraction fraction (rOEF), and the regional cerebral metabolic rate of O2 (rCMRO2) at three designated regions of interest (ROIs) in each patient. These ROIs included perilesional (ROI-p), ipsilateral remote (ROI-i), and contralateral symmetrical (ROI-c) brain regions. To identify the factors that exert a direct effect on the hemodynamics of brains affected by AVM, we also separated the lesions according to their size and flow type shown on angiograms, and grouped the patients according to the presence or absence of progressive neurological deficits. We then compared the PET parameters at different ROIs in individual patients and evaluated the mean values obtained for all 24 patients according to AVM flow type and size, and the presence or absence of progressive neurological deficits. CONCLUSIONS: Overall, mean rCBV and rOEF values were significantly higher in ROI-p than in ROI-c (p = 0.00046 and p = 0.015, respectively). No significant differences were seen between the ROI-i and ROI-c with respect to rCBF, rCBV, and rOEF. Mean rCMRO2 values were similar in the three ROIs; however, the mean rCBF was significantly lower in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.019), large AVMs (p = 0.017), and progressive neurological deficits (p = 0.021). Furthermore, the mean rOEF values were significantly higher in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.005), large AVMs (p = 0.019), and progressive neurological deficits (p = 0.017). The PET studies revealed hemodynamic impairment characterized by decreased rCBF and increased rOEF and rCBV values in the ROI-p of patients with large, high-flow AVMs regardless of whether they exhibited progressive neurological deficits.     

Analysis of homozygous deletion of the p16 gene and correlation with survival in patients with glioblastoma multiforme

OBJECT: One of the most frequent genetic abnormalities found in patients with glioblastoma multiforme (GBM) is homozygous deletion of the p16 tumor suppressor gene. The authors investigated whether this deletion is associated with prognosis in patients with GBM. METHODS: In 46 adult patients with supratentorial GBM, homozygous deletion of the p16 gene in tumor DNA was examined using the multiplex polymerase chain reaction assay. The deletion was confirmed in 14 (30.4%) of 46 patients, eight (30.8%) of 26 men and six (30.0%) of 20 women. Cox proportional hazard regression analysis, adjusted for age at surgery, the Karnofsky Performance Scale score, extent of resection, and the MIB-1 labeling index. revealed that homozygous deletion of the p16 gene was significantly associated with overall survival and progression-free survival in men, but not in women. CONCLUSIONS: The results of this study suggest that p16 homozygous deletion is a significant unfavorable prognostic factor in male patients with GBM.     

PVN c-fos expression,HPA axis response and immune cell distribution during restraint stress

It is well known that stress affects the central nervous system (CNS), neuroendocrinoimmune system and other peripheral organs such as the gastrointestinal tract. However, the process of adaptation or recovery after acute stress reactions in these systems or organs during prolonged stress has not yet been adequately investigated. To clarify the process of adaptation or recovery in these systems and organs after acute stress reactions, the time course of these responses during a single long-duration restraint stress (RTS) was studied. The expression of c-fos in the hypothalamic paraventricular nucleus (PVN) region of the brain was induced and reached a peak at 0.5 hours for c-fos mRNA and 4 hours for c-fos protein (Fos), but disappeared at 2 hours for mRNA and 16 hours for Fos during continuous RTS. The activation of the hypothalamic-pituitary-adrenal (HPA) axis during stress resulted in rapid increases in the plasma levels of adrenocorticotropic hormone (ACTH) and corticosterone (CORT). Whereas the increase in ACTH was transient, the rise in CORT was maintained throughout the duration of the stress. A rapid significant decrease after stress exposure and following a slow and complete or partial recovery were observed in a number of total white blood cells (WBC), lymphocytes (LYM), helper T cells (Th) and cytotoxic/suppressor T cells (CTL/Ts). A gastric ulcer was found in 1/6 and 6/6 rats at 8 hours and 16 hours RTS, respectively. These results suggest that adaptive changes may occur in c-fos expression in the PVN, ACTH release and immune response, but not for CORT release, following acute stress reaction during long-duration RTS. In addition, any associated organic damage, such as gastric ulceration, was also suggested to possibly be progressive according to the duration of RTS.