[Epidemiological studies on tobacco smoking and dependence in Hokkaido prefecture--relation to alcoholism]

Self-report symptom profiles for nicotine psychic dependence and nicotine physical dependence were examined in data obtained from 363 male and 82 female smokers. The subjects consisted of 363 healthy volunteer and 82 alcoholics. The questionnaire used in this study, consisted of items of the ICD-10 and DSM-IV. The ratio of nicotine dependence diagnosed according to the ICD-10 criteria was lower in alcoholics (22.0%) than in non-alcoholics (54.4%). A total of 19.4% of alcoholics experienced "progressive neglect of alternative pleasures or interest in favour of smoking"; however, only 2.2% of non-alcoholics had the same experience. Although the ratio of nicotine physical dependence diagnosed using the DSM-IV criteria (nicotine withdrawal), was 4.9% in alcoholics, only 0.3 % of non-alcoholics exhibited nicotine physical dependence. These results indicate that the potential for nicotine dependence is not higher than that for other drug dependence and suggested that nicotine physical dependence potential is not much stronger than that reported among social smokers.

An autopsy case of unusual massive gastrointestinal hemorrhaging

An autopsy case is presented involving massive gastrointestinal hemorrhaging. A 58-year-old woman was found dead with bloody patches on her body. An autopsy revealed a lacerated wound to the mucosa of the stomach and a sharp fish bone was found among bloody contents within the stomach. The duodenum and small intestines contained abundant tarry contents, but the mucosa of the intestinal tract was intact. The cause of death was certified as hemorrhagic shock due to massive bleeding from a wound to the gastric mucosa inflicted by a sharp fish bone. Therefore the possibility that some foreign body has been swallowed must be considered when forensic pathologists investigate cases with bleeding of unknown origin from the alimentary tract.

Sudden infant death from aspiration of milk due to superior cornual defect of thyroid cartilage

An autopsy case of a 4-month-old boy who died immediately after being fed by a member of the staff of a day-care centre is described in this report. An autopsy certified that the cause of death was the aspiration of milk. There was no other apparent reason for the aspiration of milk into the trachea except for the left superior cornual defect of the thyroid cartilage. We therefore conclude that it was this defect which led to the aspiration of milk into the trachea.

[A clinical study of pulmonary cryptococcosis. The Study Group of Respiratory Mycosis in Kyoto]

During the 7 years from 1990, thirty-two patients (20 in male and 12 in female, mean age; 53 years old) were diagnosed as having pulmonary cryptococcosis. To clarify the essential points for early diagnosis of pulmonary cryptococcosis, we reviewed the clinical records and chest images. Three patients had a past history of pulmonary tuberculosis and eleven patients had underlying disorders such as malignancy, chronic pulmonary diseases and so on, but no HIV infection, which would affect this disease. Eighteen patients did not have any past history nor complications. The symptoms such as cough, sputum, chest pain and fever were generally of low-grade, 14 patients had no symptom at diagnosis. Except of some patients with severe infections and severe underlying disorders, laboratory findings such as inflamatory and nutritious markers were almost within near the normal range. On plain chest X-ray films the distribution of lesions was almost in proprtion to the volume of the lobes. The multifocal nudular and/or infitrative shadows wer observed in about 2/3 cases and single lesion in about 1/3. The width of lesions were minimal except of one case with interstitial pneumonia and two cases with multifocal segmental pneumonia. The cavity lesions were observed in 7 cases and hilar lymphadenopathy in 3 cases. On CT images, the lesions were almost located in the outer zone, the lesions which were adjacent to the pleura were observed in 15 cases. Cavitary lesions were almost smooth in edge and ubiquitous, the walls were also thick. The peripheral air-bronchogram in the nodular/infitrative shadows were observed in three cases. Pulmonary cryptococcosis is air-borne and almost a chronic infection except in AIDS patients, so careful planning for examination is essential with considerations of the characteristics of clinical and imaging features of this infection.

Study of the accelerating effect of shikonin and alkannin on the proliferation of granulation tissue in rats

The present study was carried out to compare the accelerating effect of shikonin and alkannin and to elucidate the expression of CD antigen and histological changes on the proliferation of granulation tissue in rats. Shikonin and alkannin produced a dose-dependent acceleration of the cotton pellet-induced granuloma formation and this accelerating potency of both compounds on the proliferation of granulation tissue was about the same 5 and 10 d after implantation of the cotton pellet. Also, both compounds increased the ratio of CD11b+ cells in the granulation tissue 5 and 10 d after implantation of the cotton pellet. Both compounds increased the expression of CD11b+ cells with granulocytes such as macrophages and histiocytes, and then accelerated the proliferation of fibroblasts and collagen fiber. On the other hand, neither compound increased the ratio of CD3+ cells in the granulation tissue after 5 and 10 d. These results suggest that shikonin and alkannin accelerate the proliferation of granulation tissue induced by the cotton pellet and this accelerating effect may be attributed to an increase in the expression of CD11b+ cells, and the acceleration of the proliferation of fibroblasts and collagen fiber in the granulation tissue.

[A case of pulmonary tuberculosis complicated with intracranial tuberculous abscess]

A 75-year-old male was admitted to our hospital with complaints of fever and cough. Chest X-ray showed infiltrative shadows with cavity, and sputum smears were positive for acid-fast bacilli. About 2 months after the initiation of anti-tuberculous chemotherapy, suddenly generalized convulsion occurred. CT of the brain showed the solitary mass with the ring enhancement in the left subcortical area. About 4 weeks later, brain aspiration drainage was performed and pus was aspirated. He was diagnosed as intracranial tuberculous abscess. After the drainage, neurological symptoms disappeared completely and there were no recurrence of abscess. Attention should be called to the complication of intracranial tuberculosis, especially in cases worsened during anti-tuberculous chemotherapy.

Malignancy associated changes in bronchial epithelial cells and clinical application as a biomarker

A total of 74 bronchial brushing specimens, 24 from patients with advanced stage cancer, eight from patients with CIS, 31 from patients with atypical metaplasia and 11 from normal subjects were examined for the existence of malignancy associated changes (MAC). Conventional fiberoptic bronchoscopy and fluorescence endoscopy was carried out on every case. Each case was classified according to the highest grade of abnormality diagnosed by bronchial biopsy of the suspect areas. During the endoscopy examination, a bronchial brushing specimen was obtained from a visually normal area very remote from the abnormal area as possible such as the opposite lung or another lobe. The bronchial brushing specimens were fixed, mounted and stained by a DNA specific method and approximately 1500 images of individual nuclei per case were captured by an automated high resolution image cytometry. For each of these images, more than 100 nuclear features such as size, shape and chromatin spatial organization were calculated. Discriminant function analysis revealed nuclear features which differentiated between normal bronchial cell nuclei from the normal subjects and ostensively normal nuclei (MAC cell nuclei) from the lung cancer patients. The best discrimination was achieved when the frequency of individual cells expressing MAC was 50% or greater. With this threshold, 75% of the patients with invasive cancer and CIS were correctly classified. Fifty percent of those with severe or moderate atypia and 35% with mild atypia were also MAC positive. The frequency of cells expressing MAC also increased as the degree of abnormality of the groups increased. MAC may be a useful criterium to determine biological behavior of the intra-epithelial (pre-invasive) neoplasia.

WinArrhythmia: a Windows based application for studying cardiac arrhythmias

We have developed Windows-based software for ECG training as a tool in teaching physiology. A standard user interface allows the user to choose which arrhythmia to review. The arrhythmia is drawn in real time with sound beeps synchronized to R waves. The system also presents a brief summary or multiple choice question corresponding to the arrhythmia. A ladder diagram shows how simulate the conduction system, which consisted of 4 modules characterized by 4 parameters: automaticity, refractory period, antegrade- and retrograde-conduction time. This system has proved both useful and effective for training medical students in ECG interpretation of arrhythmias.

Identification of beverages and beverage stains by GC/MS using aroma components as indicators

A method to identify brown coloured beverages or beverage stains for criminological purposes was devised using aroma components as indicators. The examined beverages comprised three brands each of beer, coffee, cola and black tea, two brands of oolong tea, and four brands of green tea. Aroma components in each sample were efficiently concentrated with a porous polymer beads column (Porapak Q) and were analyzed by gas chromatography/mass spectrometry (GC/MS) using n-octyl alcohol as the internal standard. Specific aroma components were found in each beverage and beverage stain, for example cis-terpin hydrate in cola, and thus identification of beverages or beverage stains became feasible through the detection of these specific components. The present method was applied efficiently to two practical criminological cases.

Severe metallosis caused by shaving down of the stem neck due to outer cup impingement of a bipolar endoprosthesis. A case report. off

The authors report on a patient with severe metallosis caused by shaving down of the stem neck due to outer cup impingement. A primary arthroplasty was performed using an Omnifit bipolar endoprosthesis (Stryker) with an acetabular bone graft fixed by ceramic screws. At the time of revision surgery the synovium was stained black. Two ceramic screws were broken, but no scratch was observed on the metal surfaces of the outer cup and the inner head. The ultra-high molecular weight polyethylene (UHMWPE) of the inner-bearing collar was worn and flat. During the operation, a groove was observed at the stem neck where the outer cup impinges. An analysis of the black pseudocapsule by scanning electron microscopy with electron prove microanalysis (SEMEPMA) revealed that the pseudocapsule contained titanium metal particles. To our knowledge, metallosis caused by the same mechanism has only been reported in four joints, which were replaced by a Zimmer BHP bipolar endoprosthesis and Howmedica bicentric cup.

Plasma concentrations of antipsychotic drugs in psychiatric inpatients

In current psychiatric therapy, two or more kinds of antipsychotic drugs are usually prescribed in Japan. However, there are few data on the therapeutic plasma concentrations of antipsychotic drugs or on the correlation between the daily dose and the plasma concentration, in cases where several antipsychotic drugs had been prescribed for each patient. We measured the therapeutic plasma concentrations of 9 antipsychotic drugs in 24 psychiatric inpatients during a 6-month period. They were treated with fixed dosages of antipsychotic drugs. Plasma samples were collected early in the morning once a month, and the concentrations of antipsychotic drugs were determined by gas chromatography with nitrogen phosphorus detection, high-performance liquid chromatography (HPLC) with fluorescence detection and HPLC with UV detection. The plasma levels of chlorpromazine, levomepromazine, thioridazine, haloperidol, bromperidol, zotepine, oxypertine, sulpiride and sultopride were 21.8-92.4, 31.7-156, 101-203, 16.4-56.2, 2.72-11.7, 13.6-84.0, 29.9-80.4, 70.1-1,120 and 35.7-2,990 ng/ml, respectively. A linear correlation between the daily dose and the plasma concentration was noted for sultopride, levomepromazine, sulpiride, haloperidol, chlorpromazine and zotepine.

Arrhythmia curve interpretation using a dynamic system model of the myocardial pacemaker

A problem of identifying the phase response curve of the myocardial pacemaker was investigated using a simple dynamic system model of cardiac arrhythmia. A hybrid optimization method of a genetic algorithm and a local optimization technique was employed to obtain a solution of the model fitting. The method was applied to two categories of arrhythmias, ventricular parasystole and high-degree AV block. The present study offered a new insight into the mechanism of cardiac arrhythmias.

Distribution of drugs in various tissues in a brain dead man

We examined the distribution of drugs in a 49-year-old brain-dead man. Our objective was to determine the possibility of diagnosing how and at what point the patient became brain dead. The presence of mepivacaine, pentazocine, lidocaine and thiamylal in various tissues, including seven regions of the brain were confirmed, using gas chromatography/mass spectrometry. Tissue-to-blood concentration ratios of mepivacaine, pentazocine and lidocaine in the brain were higher than these ratios in other tissues, while ratios of thiamylal were lower. Therefore, cerebral blood flow was likely to have ceased between the administration of the former drugs and that of the latter drug, in agreement with clinical records. Among seven regions of the brain, the ratios of the former three drugs were high in occipital and parietal lobes, and were low in the cerebellum and medulla oblongata. On the other hand, the ratios of the latter drug were high in the cerebellum and the medulla oblongata. Therefore, cerebral blood flow presumably ceased first in occipital and parietal lobes, and last in the cerebellum and the medulla oblongata. Based on these results, assessment of concentrations of drugs in human tissues, including various regions of brain is useful to determine the time and progression of brain death.

Nonideal Mixing in Adsorbed Film and Micelle of Ionic-Nonionic Surfactant Mixtures

The surface tension of aqueous solutions of dodecylammonium chloride-octyl methyl sulfoxide (OMS) and dodecyltrimethylammonium bromide-OMS mixtures was measured as a function of the total molality of surfactants and the composition of OMS. The results were analyzed according to our thermodynamic procedure; the phase diagrams of adsorption and micelle formation and the diagram illustrating the composition relation between the micelle and the adsorbed film at the critical micelle concentration were drawn. The activity coefficient and excess Gibbs energy in the adsorbed film and the micelle were defined and then evaluated from the phase diagrams. They were found to give useful information on the deviation from ideal mixing and intermolecular interaction in the adsorbed film and micelle. Copyright 1997 Academic Press. Copyright 1997Academic Press

A national epidemiological survey of oral mucosal lesions in Malaysia

The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11,707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication, was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+/-14.0. The sample comprised 40.2% males and 59.8% females; 55.8% were Malays, 29.4% Chinese, 10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%) subjects, 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia, erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).

Simple and rapid determination of enflurane in human tissues using gas chromatography and gas chromatography-mass spectrometry

A simple, rapid and reliable method was devised to determine the levels of enflurane in human tissues, using gas chromatography and gas chromatography-mass spectrometry. 1,4-Dioxane was used as an internal standard (I.S.). Enflurane and the I.S. were extracted from 0.25 g of body tissues using an automatic headspace sampler and 1 ml of headspace gas was injected into the gas chromatograph. Enflurane was analyzed qualitatively by gas chromatography-mass spectrometry and quantitatively by gas chromatography with a flame-ionization detector. The calibration curves in all tissues examined were linear in the concentration range 1-100 microg/0.25 g. The lower limit of detection was 200-300 ng/0.25 g. The accuracy and precision of this method were evaluated at two different concentrations, 1 and 20 microg/0.25 g. The coefficient of variation ranged from 3.4-13.4%. We used this method to determine the presence of enflurane in tissues from an autopsied individual who died suddenly during extirpation of a malignant tumor.

Detection of triazolam in skeletal remains buried for 4 years

Analyses of the hypnotic triazolam from the remains of two human skeletons buried underground for 4 years were made for purposes of confirmation. The bone marrow and mummified muscle were digested with 2 M sodium hydroxide, efficiently extracted using a 3-step solvent extraction procedure, and selectively analyzed by gas chromatography/mass spectrometry with the negative ion chemical ionization mode. Estazolam was the internal standard used. Triazolam was detected in all the samples; the concentrations were 0.36 ng/g in the bone marrow of one victim, and 0.37 and 5.5 ng/g in the bone marrow and mummified muscle of the other victim. This method should prove useful for determination of triazolam in extensively decomposed bodies.

Purification, characterization and cloning of a novel variant of the superantigen Yersinia pseudotuberculosis-derived mitogen

The novel superantigen designated as Yersinia pseudotuberculosis-derived mitogen typeB (YPMb) was purified from the cell lysate of Y. pseudotuberculosis O:6 strain (R-104). Proliferative response of human peripheral blood mononuclear cells to the purified YPMb was detectable at a concentration of as low as 1 pg/ml, that is comparable to the previously documented YPM (YPMa). The Vbeta repertoire specificity (3, 9, 13.1 and 13.2) of YPMb was also the same as that of YPMa. A gene (ypmB) encoding YPMb was cloned and its nucleotide sequence was determined. The open reading frame (ORF 453 bp) of the ypmB encodes a protein with 150 amino acid residues, though the precursor protein of YPMa consists of 151 amino acid residues. There is a nucleotide sequence homology of 88.9% between ypmB and ypmA. The low homology in the downstream of the structural gene between ypmB and ypmA and the difference in the GC content in the ORF of ypmB and ypmA from that of the base usage of Y. pseudotuberculosis suggest that the ypm gene originates from another organism. The alignment of the amino acid sequences of mature proteins of YPMb and YPMa revealed that there is 83% homology (108 amino acid residues are identical). Between YPMa and YPMb, the central region is less homologous than the N- and C-terminal regions. Based on the functional similarity of two superantigen molecules, the less homology suggested that the central region is less important for the function of both YPM molecules.