Anisotropy of magnetothermal conductivity in Sr2RuO4

The dependence of in-plane and interplane thermal conductivities of Sr2RuO4 on temperature, as well as magnetic field strength and orientation, is reported. We found no notable anisotropy in the thermal conductivity for the magnetic field rotation parallel to the conducting plane in the whole range of experimental temperatures and fields, except in the vicinity of the upper critical field H(c2), where the anisotropy of the H(c2) itself plays a dominant role. This finding imposes strong constraints on the possible models of superconductivity in Sr2RuO4 and supports the existence of a superconducting gap with a line of nodes running orthogonal to the Fermi surface cylinder.

Directly linked soluble IL-6 receptor-IL-6 fusion protein induces astrocyte differentiation from neuroepithelial cells via activation of STAT3

Signals of interleukin 6 (IL-6) are transduced by binding of IL-6 to its cell surface receptor (IL-6R) and subsequent association of the resultant IL-6/IL-6R complex with gp130, the signal transducing receptor component utilized in common by all the IL-6 family of cytokines. A soluble form of IL-6R (sIL-6R), which lacks transmembrane and cytoplasmic regions, retains the ability to bind IL-6 and signal through gp130. We show here that a fusion protein of sIL-6R and IL-6 without a polypeptide linker, termed FP6, induces differentiation of astrocytes from fetal mouse neuroepithelial cells as potently as a representative IL-6 family cytokine, leukaemia inhibitory factor (LIF). FP6 has a potential to activate a transcription factor, signal transducer and activator of transcription 3 (STAT3), and mitogen-activated protein kinases, ERK1 and ERK2, in these cells as does LIF. FP6 activates a promoter of the gene for an astrocytic marker, glial fibrillary acidic protein (GFAP), in neuroepithelial cells. This activation is virtually abolished by ectopic expression of a dominant-negative form of STAT3, or by introducing a point mutation into the STAT3 response element located in the GFAP promoter. These results suggest that FP6 induces astrocyte differentiation from neuroepithelial cells through STAT3 activation and that FP6 could be of use as a substitute for natural IL-6 family cytokines.

[Home drug therapy for a patient who rejected use of morphine--management of dyspnea and pain by codeine phosphate]

We encountered a terminal lung cancer patient with severe back pain and dyspnea who refused the use of morphine, and succeeded in home palliative care with the use of an original prescription (CA), the main ingredient of which was codeine phosphate.

[Death at home and hospital of home terminal cancer patients]

We think that death at home has increased among patients from our hospital due to following factors: 1) solid cooperation with visiting nurse stations, 2) progress in judgments of care ability, 3) changes in family consciousness, 4) enrichment of other support systems for home care.

Studies of amphetamine or methamphetamine psychosis in Japan: relation of methamphetamine psychosis to schizophrenia

There exist clinical characteristics of methamphetamine (MAP) psychosis in the Japanese population. MAP psychosis involves paranoid-hallucinatory states indistinguishable from paranoid schizophrenia, with residual volitional disturbances (e.g., loss of spontaneity and idleness). Paranoid-hallucinatory states persist after the pharmacological effects of MAP have worn off and readily reappear upon a reinjection of MAP. Individuals with a history of MAP psychosis further undergo spontaneous recurrence of their paranoid-hallucinatory states in response to stress. The development of MAP psychosis might therefore be related to persisting brain damage or changes in brain metabolism induced by repeated MAP use, and thus studies of the clinical course and neurological basis of MAP psychosis could provide insights into the pathophysiology of schizophrenia. Accordingly, psychiatrists have studied the clinical characteristics of MAP psychosis and examined the neurobiological basis of MAP-induced behavioral sensitization, using animals. MAP-induced behavioral sensitization might well be related to dopamine supersensitivity; however, the contribution of presynaptic autoreceptors remains controversial, and other hypotheses should be considered. Recently, the process that triggers spontaneous recurrence of MAP psychosis (flashbacks) and corresponding peripheral neurotransmitter functions has been studied. Stress sensitization associated with noradrenergic hyperactivity, involving increased dopamine release, appears to be crucial in the development of flashbacks. Overall, MAP-induced susceptibility to paranoid-hallucinatory states and to abnormal behavior (e.g., stereotyped behavior) in animals is examined as a model for predicting relapses of paranoid schizophrenia. Further extensive studies on the neurobiological and molecular mechanisms of this susceptibility are required.

Susceptibility to subsequent episodes in spontaneous recurrence of methamphetamine psychosis

The relation is examined between increased sensitivity to stress associated with noradrenergic hyperactivity and dopaminergic changes, and susceptibility to subsequent spontaneous recurrences of methamphetamine (MAP) psychosis (i.e., flashbacks). Plasma monoamine metabolite levels were assayed in 23 flashbackers, 19 nonflashbackers with a history of MAP psychosis, 10 subjects with persistent MAP psychosis, and 21 MAP user and 9 nonuser controls. All 23 flashbackers had undergone frightening stressful experiences during previous MAP use. Mild psychosocial stressors then triggered flashbacks. The 12 flashbackers with further episodes had markedly increased norepinephrine levels and slightly increased plasma levels of 3-methoxytyramine, an index of dopamine release. While the 11 flashbackers with a single episode displayed small increases in norepinephrine and 3-methoxytyramine levels. Thus, robust noradrenergic hyperreactivity, involving increased dopamine release in response to mild stress may predispose to further episodes of flashbacks.

Inhibitory effect of ATF3 antisense oligonucleotide on ectopic growth of HT29 human colon cancer cells

ATF3 is a transcription factor belonging to the Jun / Fos family whose mouse homologue (TI-241) was isolated, using the differential screening method, from B16 mouse melanoma cells as a blood-borne metastasis-associated gene. Here we show the tumorigenicity-inhibiting effect of an antisense oligonucleotide designed to reduce the expression of ATF3 in HT29 colon cancer cells. HT29 cells were reported to metastasize to the skin after intravenous inoculation. The antisense oligonucleotide inhibited cell attachment to the collagen-coated floor of the plates and invasion of HT29 cells in vitro, which are thought to be two important factors in the process of cancer metastasis and ectopic tumor growth. While the antisense oligonucleotide had no effect on cell growth of HT29 cells in vitro, mice that were inoculated subcutaneously with HT29 cells and treated with the antisense oligonucleotide survived longer than the control mice due to the inhibition of tumor growth in vivo. These show that ATF3 plays an important role in the ectopic growth / metastasis of HT29 colon cancer cells.

Homogeneous detection of a target nucleic acid sequence by combination of the intercalation activating fluorescence DNA probe and the isothermal sequence amplification

We demonstrated the homogeneous real-time detection of RNA produced during isothermal TRC amplification by INAF probe.

Increased sensitivity to stress associated with noradrenergic hyperactivity, involving dopaminergic hyperactivity in spontaneous recurrences in methamphetamine psychosis

Abstract The study examined the significance of increased sensitivity to stress associated with noradrenergic hyperactivity and dopaminergic changes in spontaneous recurrences of methamphetamine (MAP) psychosis (flashbacks). Plasma monoamine metabolite levels were assayed in the subjects: 19 flashbackers, 18 non-flashbackers with a history of MAP psychosis and 37 controls. Monoaminergic values underwent a square-root transformation. All flashbackers had been exposed to stressful events plus MAP-induced fear-related psychotic symptoms (n = 11) or fear-related symptoms alone (n = 8). Factors triggering flashbacks met the DSM-III-R criteria for mild psychosocial stressors. During flashbacks norepinephrine levels increased markedly and 3-methoxytyramine, which is indicative of dopaminergic activity, increased to a lesser extent. Among the flashbackers, 11 with a history of stressful events plus fear-related symptoms displayed further a small increase in 3-methoxytyramine levels. Thus, stressful events plus fear-related symptoms, together with MAP use, may induce noradrenergic hyperactivity and some degree of dopaminergic hyperactivity in response to mild stressors. Increased sensitivity to stress associated with a predominance of noradrenergic over dopaminergic hyperactivity may be a precipitating factor in flashbacks.

[A multicenter study of cardiac events and anesthetic management of patients with ischemic heart diseases for noncardiac surgery--a follow-up report]

We have conducted a joint research project to investigate the incidence of ischemic heart disease in patients for noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. From September to November 1997 we had 7288 patients scheduled to undergo noncardiac surgery in the 8 departments of anesthesiology. Of these patients, 228 (3.1%) patients had ischemic heart disease, and 30 of them (13.2%) developed perioperative cardiac events. Critical cardiac events, including perioperative myocardial ischemia and lethal arrhythmia, occurred in 7 of these patients. In our region of Japan, 3-4% of surgical patients tend to develop ischemic heart disease and 3.1% of them demonstrated severe cardiac complications perioperatively. Compared with United States we encounter fewer surgical patients with ischemic heart disease, but the risk of developing perioperative cardiac complications in such patients is almost the same for both countries.

[Multicenter study of cardiac events and anesthetic management of patients with ischemic heart diseases undergoing noncardiac surgery]

We designed a joint research project to investigate the incidence of ischemic heart diseases in patients undergoing noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. Of the 8358 surgical patients in the 8 departments of anesthesiology between March 1997 and June 1997, 328 (3.9%) had ischemic heart diseases. Among the 328 patients, 54 (16.4%) developed perioperative cardiac events, including myocardial infarction (3 patients) and either lethal or potentially dangerous dysrhythmias (51 patients). Preoperative cardiac assessments were performed while the anesthetic techniques including intensive monitoring and perioperative prophylactic therapy were also employed. Patients with ischemic heart diseases received various types of preoperative evaluation to identify the degree of coronary artery disease and to assess the overall cardiac function. The patients were monitored using a multilead electrocardiogram, an arterial line, a central venous catheter, a pulmonary artery catheter, and by transesophageal echocardiography intraoperatively. Therapeutically, isosorbide, nitroglycerin, beta-blockers, calcium channel blockers, and/or nicorandil were administered to prevent perioperative ischemia. So far, no generally accepted management strategies have been established in patients with cardiovascular disorders based on large-scale outcome trials in Japan. Therefore, nationwide large multicenter trials are awaited with interest in order to establish helpful guidelines to improve the perioperative management and to reduce ischemia in cardiac patients undergoing noncardiac surgery.

Risperidone counteracts lethality in an animal model of the serotonin syndrome

RATIONALE

The serotonin (5-HT) syndrome is the most serious side effect of antidepressants, and pharmacologic treatment should be offered in severe cases.

OBJECTIVE

In the present study, the effects of risperidone, ketanserin, and haloperidol on an animal model of the serotonin (5-HT) syndrome were evaluated.

METHODS

Intraperitoneal administration of 100 mg/kg 5-hydroxy-L-tryptophan (5-HTP) (a precursor of 5-HT) and 2 mg/kg clorgyline (a monoamine oxidase type-A inhibiting antidepressant) induced the 5-HT syndrome in rats. The rectal temperature of the rats was measured, and the microdialysis method was used to measure noradrenaline (NA) levels in the anterior hypothalamus.

RESULTS

In the group pre-treated with saline, the NA concentration increased to 13 times the pre-administration level, rectal temperature increased to more than 40 degrees C, and all of the animals died 75 min later. In the group pre-treated with risperidone (0.5 mg/kg), the 5-HT syndrome was completely inhibited, and the NA level increased to 6.5 times the pre-administration level. Ketanserin, a selective 5-HT2A antagonist (5 mg/kg) also inhibited the 5-HT syndrome. In contrast, all of the rats in the group pre-treated with haloperidol (0.5 mg/kg) died earlier than in the saline group.

CONCLUSIONS

These results suggest that strong 5-HT2A antagonists such as risperidone, but not dopamine D2 antagonists, counteract lethality due to 5-HT syndrome, and that not only does enhancement of 5-HT activity occur in the 5-HT syndrome, but NA activity also increases.

Utility of blasts with a clear halo around the nucleolus as a predictive indicator for disease progression in patients with myelodysplastic syndromes and aplastic anemia

This study was designed to evaluate the utility of blasts with a clear halo around their nucleoli (BCHN) as a predictive indicator of disease progression in myelodysplastic syndromes (MDSs) and aplastic anemia (AA). Bone marrow aspirates from 75 patients with MDSs and 18 with AA were fixed in 95% ethanol solution or 10% neutral formalin and stained with the Papanicolaou method. BCHNs were detected in 57 of 75 patients with MDSs and in 10 of 18 AA patients. Disease progression was restrictedly observed in 17 patients with MDSs who had BCHNs at onset and in 1 patient with AA. The proportion of BCHNs increased with disease progression in these 16 of 17 patients with MDSs. The presence of BCHNs at onset and the increase in proportion of BCHNs during the clinical course of MDSs were significant indications for predicting disease progression.

Analysis of novel metastasis-associated gene TI-227

TI-227 is a cancer metastasis-associated gene isolated from the B16-F10 mouse melanoma subline that preferentially metastasizes to the lung following intravenous injection. TI-227 is more highly expressed in the B16-F10 and colon26-nl17 sublines, which preferentially metastasize to the lung following intravenous injection, than in the B16-BL6 and colon26-nl22 sublines, which preferentially metastasize to the lung following subcutaneous injection. Since TI-227 could not be detected in normal tissues, there is a possibility that it is expressed specifically in tumors that preferentially metastasize to the lung following intravenous inoculation. Although the 5' end of TI-227 was analyzed, its total sequence contained no obvious open reading frame. However comparison with the isolated human counterpart, TI-227H gene, revealed a highly homologous region near the 3' end, which was expected to contain a very short open reading frame.

Increased sensitivity to stress in spontaneous recurrence of methamphetamine psychosis: noradrenergic hyperactivity with contribution from dopaminergic hyperactivity

The significance of increased sensitivity to stress associated with noradrenergic hyperactivity involving dopaminergic change in spontaneous recurrences of methamphetamine (MAP) psychosis (flashbacks) was examined. Plasma monoamine metabolite levels were assayed in 18 subjects with flashbacks who had been exposed to stressful events plus MAP-induced frightening psychotic symptoms (N = 11) or frightening psychotic symptoms alone (N = 7) during previous MAP use, in 15 nonflashbackers with a history of MAP psychosis, in 8 subjects with persistent MAP psychosis, and in 27 control subjects. Monoaminergic values were subjected to a square-root transformation, rendering the distribution normal. The numbers of stressful events (mostly threatening events) and frightening psychotic symptoms were significantly higher in the flashbackers than in the nonflashbackers. Factors triggering flashbacks were mild psychosocial stressors (mostly a mild fear of other people). During flashbacks, plasma norepinephrine levels increased, and the flashbackers, 11 of whom had experienced stressful events plus frightening psychotic symptoms, had an additional small increase in plasma levels of 3-methoxytyramine, which is indicative of dopamine release. Thus, threatening stressful events, together with MAP use, may induce noradrenergic hyperreactivity to subsequent mild stressors. Threatening, stressful events plus frightening psychotic symptoms may further induce increased dopamine release in response to mild stressors. Increased sensitivity to stress associated with noradrenergic hyperactivity involving increased dopamine release may have elicited memories of MAP psychosis related to frightening, stressful experiences. The increased sensitivity may be critical for the development of flashbacks.

Stress induced spontaneous recurrence of methamphetamine psychosis: the relation between stressful experiences and sensitivity to stress

We examined increased sensitivity to stress in relation to spontaneous recurrences of methamphetamine (MAP) psychosis (i.e., flashbacks). Plasma monoamine metabolite levels were assayed in: 26 flashbackers, of whom 11 were on neuroleptics before and during the study, and the other 15 received neuroleptics in the course of the study; 18 non-flashbackers with a history of MAP psychosis; eight subjects with persistent MAP psychosis; and 23 MAP user and 11 non-user controls. The 26 flashbackers had experienced stressful events and/or MAP-induced fear-related psychotic symptoms during previous MAP use. Mild psychosocial stressors then triggered flashbacks. During flashbacks plasma norepinephrine levels increased markedly; among the flashbackers, those with a history of stressful events, whether or not they had experienced fear-related symptoms, showed a further increase in 3-methoxytyramine levels. Stressful experiences, together with MAP use, may therefore induce sensitization to stress associated with noradrenergic hyperactivity, involving increased dopamine release, and so triggering flashbacks.

In-plane anisotropy of upper critical field in Sr2RuO4

We investigated the behavior of the spin-triplet superconductor Sr2RuO4 ( T(c) approximately 1.5 K) under the magnetic fields parallel to the quasi-two-dimensional plane. The upper critical field H(c2) exhibits a clear fourfold anisotropy of about 3% at 0.35 K. Furthermore, we detected an additional transition feature below H(c2) in both the ac susceptibility and the specific heat. These second-transition features as well as the pronounced in-plane H(c2) anisotropy disappear above 0.8 K or under intentional field misalignment of less than 1 degrees. Most of these characteristics are consistent with the predicted emergence of the second superconducting phase with a line-node gap.

The Effects of Stride Walking on Cardiovascular and Electromyographic Responses under Different Conditions in Velocity or Grade in Healthy Young Women

This study was conducted to investigate the effects of stride walking on cardiovascular and electromyographical responses on a treadmill in healthy young female (mean age of 23.0 yrs, height of 156.2 cm and weight of 50.6 kg). The subjects performed initial 6 minutes walking based on a heart rate of anaerobic threshold minus 10 beats per minute under two conditions of treadmill walking, on increased velocity with horizontal inclination (A) and on a constant velocity (2.0 mph) with increased grade (B). Consequently, the subjects performed stride walking which was made by 10% reduction of steps under each condition. The results were as follows: 1) Under A condition, the values of leg fatigue by Borg's 20 numeric scale in stride walking was significantly higher than in non-stride walking, while no difference under B condition. 2) Under A condition, the mean values in oxygen uptake and heart rate during stride walking were significantly higher than during non-stride walking, while no difference under B condition. 3) Under A condition, total amount of integrated electromyogram in gastrocnemius, vastus medialis and tibialis anterior were higher during stride walking than during non-stride walking. Under B condition, gastrocnemius and gluteus maximus showed higher values during stride walking than in non-stride walking. These findings suggest that stride walking manipulated on a high velocity tends to alter cardiovascular and electromyographical parameters than on a lower velocity with higher inclination on treadmill walking in healthy young adults.

[Role of pharmacists in the medical team--attempting palliative care]

The Pharmacy Department at our hospital is attempting to develop methods for palliative care, for example of cancer pain or smelly tumors. The participation of pharmacists on the medical team for home care is necessary, because the supply of proper drugs for patients' individual conditions is indispensable in palliative care. Communication between not only patients, but also between their families and us, as well as the maintenance of close contact with the medical team, are important in home care.

Neurobiological basis of relapse prediction in stimulant-induced psychosis and schizophrenia: the role of sensitization

A number of consistent clinical observations provide direction for the hypothesis that pathological sensitization of neuronal systems may be an important factor for relapse or the onset of stimulant-induced psychosis (eg, methamphetamine or amphetamine psychosis, cocaine psychosis and phencyclidine psychosis) and schizophrenia. First, psychotic symptoms can be produced in normal subjects by stimulants. Secondly, a large portion of schizophrenic patients exhibit exacerbation of psychotic symptoms in response to stimulants at doses which would not be psychotogenic in normal subjects. Lastly, the ability of stress to precipitate the onset and relapse of schizophrenia is well documented. In this regard, acute responses to stimulants provide useful information for relapse prediction of schizophrenia and substance abuse. This paper addresses the nature and role of pathological sensitization in relapse of stimulant- and phencyclidine-induced psychosis and schizophrenia, and its relation to pathophysiology of schizophrenia.

[A multicenter early phase II study of high-dose chemotherapy with autologous peripheral blood stem cell transplantation for treatment of intermediate-grade non-Hodgkin's lymphoma. Japan Blood Cell Transplantation Study Group]

We conducted a multicenter early phase II study to evaluate the feasibility and therapeutic efficacy of high-dose chemotherapy supported by autologous peripheral blood stem cell transplantation (auto-PBSCT) for the treatment of intermediate grade non-Hodgkin's lymphoma (IG-NHL). High-dose etoposide or cyclophosphamide followed by G-CSF was used for PBSC mobilization, and a sufficient number of CD34+ cells (> 1 x 10(6)/kg) were collected. Out of 81 enrolled patients, 50 received high-dose chemotherapy with auto-PBSCT; Hematologic recovery after transplantation was rapid. The incidence of grade III/IV toxicity (Bearman) was about 6%; treatment-related mortality was 6% (3/50). The Disease-free survival rate for the patients in complete remission who received high-dose chemotherapy with auto-PBSCT was better than that for the patients who were treated with conventional chemotherapy (57% vs 35%). These preliminary results indicated that high-dose chemotherapy with auto-PBSCT is feasible and effective. A prospective randomized phase III clinical trial will be required to assess the efficacy of high-dose chemotherapy with auto-PBSCT as a post-remission therapy for IG-NHL.

Factors affecting late survival after elective abdominal aortic aneurysm repair

BACKGROUND

The late prognosis after repair of an abdominal aortic aneurysm (AAA) may be affected by atherosclerosis, which involves various organs including the aorta.

METHODS

The influence of organ dysfunction and atherosclerosis on the long-term survival of 338 consecutive patients undergoing successful elective AAA repair between 1980 and 1997 was analysed using Cox hazards model. Survival rate was compared with that of 349 patients undergoing successful revascularization for aortoiliac occlusive disease (AIOD) during the same interval.

RESULTS

Renal dysfunction and a previous history of cerebrovascular events were important variables predicting late death (risk ratio 1.980 and 1.903 respectively), while a history of cardiac disease predicted only cardiac-related death. The survival rate in patients with normal renal function was significantly better than that in those with renal dysfunction (P = 0.0371). Similarly, the survival rate was significantly better in patients without a history of previous cerebrovascular events (P = 0.0414). The survival rate after AAA repair was nearly identical to that of age- and sex-matched patients with grade II or III symptoms who had surgery for AIOD.

CONCLUSION

Advanced atherosclerosis with underlying organ dysfunction is a true determinant of long-term survival following elective repair of AAA.

Increased sensitivity to stress and episode recurrence in spontaneous recurrence of methamphetamine psychosis

Increased sensitivity to stress associated with noradrenergic hyperactivity and dopaminergic changes may precipitate stress-related psychiatric disorders. The present study examines the relation between this increased sensitivity and vulnerability to subsequent spontaneous recurrences of methamphetamine (MAP) psychosis (i.e. flashbacks). Plasma monoamine metabolite levels were assayed in 18 subjects with flashbacks, of whom ten experienced a single flashback and eight experienced further subsequent flashbacks; in 21 subjects with a history of MAP psychosis who did not experience flashbacks; and 33 controls. A square-root transformation was applied to monoaminergic values, rendering the distribution normal. The subjects with flashbacks had undergone frightening stressful experiences during previous MAP use. The dominant factor triggering flashbacks was a mild fear of other people. During flashbacks, plasma noradrenaline levels markedly increased and 3-methoxytyramine levels, an indicator of dopamine release, were elevated. Among the 18 subjects with flashbacks, the ten with subsequent flashbacks had markedly increased noradrenaline levels during flashbacks, whereas the eight with a single flashback displayed small increases in noradrenaline levels as well as 3-methoxytyramine levels. Thus, a mild fear of other people may have elicited memories of MAP psychosis, related to frightening stressful experiences through increased sensitivity to stress associated with noradrenergic hyperactivity, involving increased dopamine release. Robust noradrenergic hyperreactivity to mild stress may predispose subjects to subsequent flashbacks.

Spontaneous recurrence of methampetamine psychosis: increased sensitivity to stress associated with noradrenergic hyperactivity and dopaminergic change

We studied the factors precipitating spontaneous recurrences of methamphetamine (MAP)-induced paranoid-hallucinatory states (referred to as "flashbacks") in 28 flashbackers, along with 18 non-flashbackers with a history of MAP psychosis. Plasma levels of catecholamines and their metabolites were assayed in the 28 flashbackers, the 18 non-flashbackers, 8 subjects with persistent MAP psychosis, and 33 normal controls (22 MAP users and 11 non-users). The flashbackers had been exposed to significantly higher numbers of stressful events, and/or MAP-induced frightening paranoid-hallucinatory states during previous MAP use, than the non-flashbackers. Factors triggering the flashbacks met the DSM-III-R criteria for a mild psychosocial stressor. During flashbacks, plasma norepinephrine levels increased and plasma levels of 3-methoxytyramine, which is an indicator of dopamine release, showed a smaller increase. It follows that stressful experiences together with MAP use may induce sensitization to mild psychosocial stressors. Noradrenergic hyperactivity and some degree of increased dopamine release may be involved in this process. Stress sensitization may elicit memories of MAP psychosis associated with stressful experiences in response to mild psychosocial stressors, leading to the occurrence of flashbacks. Sensitization to stress associated with noradrenergic hyperactivity, involving increased dopamine release may be central to spontaneous recurrences of MAP psychosis.

Electroconvulsive therapy for the treatment of neuroleptic malignant syndrome with psychotic symptoms: a report of five cases

We report five cases of neuroleptic malignant syndrome (NMS) with psychotic symptoms treated with electroconvulsive therapy (ECT). Clinical response was observed after the first or the second session of ECT in every case, and the symptoms of NMS resolved by the third or fourth session. The mean time from the initial ECT to complete resolution was 6.0 days. No side effects from ECT were observed. Although the first treatment for NMS is pharmacotherapy using drugs such as dantrolene and bromocriptine, our results suggest that ECT is a useful therapeutic method for patients with NMS and psychotic symptoms.

Fluorescence property of oxazole yellow-linked oligonucleotide. Triple helix formation and photocleavage of double-stranded DNA in the presence of spermine

Oxazole yellow is an intercalator that shows enhanced fluorescence upon binding to DNA. We prepared an oxazole yellow-linked oligonucleotide that can form triple helix with interleukin 2 receptor alpha chain promoter. The oxazole yellow-linked oligonucleotide showed linear increase of fluorescence by the triple helix formation with double-stranded DNA and also induced photocleavage of the targeted DNA in the presence of spermine upon visible illumination. Cleavage site of one strand was 7 or 8 bases away from the site of intercalation whereas the other strand was cleaved at the intercalated site.

Three generations of hereditary chronic pancreatitis

The patient was a 22 year-old male. Hereditary chronic pancreatitis was suspected as a diagnosis since his mother's uncle had been operated on for chronic pancreatitis 14 years previously at the age of 64 years and his mother had been operated on for chronic pancreatitis with calculi 5 years previously at the age of 40 years. Surgery was needed, since: 1) he had experienced abdominal pain for 8 years; 2) endoscopic retrograde cholangiopancreatography (ERCP) revealed a marked irregular dilatation in the main pancreatic duct and a marked irregular dilatation and protein plugs in the ductule of the tail of the pancreas; and, 3) pancreatic functional diagnostic (PFD) test examination showed a 75% decrease in exocrine function. If a surgical procedure had not been performed, the patient would likely have experienced calculi formation in the pancreas and a further decrease in exocrine function. Since the patient was very young and had many protein plugs in the dilated ductule of the tail of the pancreas, we decided to perform a spleen-preserving Puestow's procedure with removal of the tail of the pancreas. Clinical and pathological findings of hereditary pancreatitis are reviewed.

[Drug consultation for patients who present with symptoms like dementia]

It is a lowering of compliance in taking drugs of patients who present with symptoms like dementia that being impairment in a therapy for disease. We started drug consultation to that one at home care, because of improvement of non-compliance in taking drugs. Improvement of consciousness in taking drugs for patients and consciousness in necessity of taking drugs for their family that be brought about by our drug consultation could be made progress of compliance in taking drugs.

Addition of carbamazepine to long-term treatment with neuroleptics may induce neuroleptic malignant syndrome

BACKGROUND

Carbamazepine is an anticonvulsant, but also has an anti-manic effect, and recently it has been increasingly used in combination with neuroleptics. Nevertheless, there have been very few reports on the involvement of carbamazepine in the occurrence of neuroleptic malignant syndrome (NMS).

METHODS

A case of NMS occurring after addition of carbamazepine to long-term neuroleptic administration is described.

RESULTS

The patient had been treated with neuroleptics for about 30 years, and NMS developed when carbamazepine (400 mg/day) was added.

CONCLUSIONS

This case suggests that clinicians should consider the risk of NMS when carbamazepine is administered to patients undergoing long-term treatment with neuroleptics.

Treatment of tardive dystonia with an antispastic agent

Tardive dystonia is a difficult condition to treat. We describe the case of a patient with tardive dystonia that was unresponsive to various pharmacological and electroconvulsive therapies. The patient showed dramatic improvement after the administration of eperisone, a centrally acting muscle relaxant. Eperisone and tolperisone are beta-aminopropiophenone derivatives which are used clinically as antispastic agents. To date there have been no reports describing the effect of such muscle relaxants on tardive dystonia. The results of our study suggest that these muscle relaxants may be promising therapeutic drugs for the treatment of tardive dystonia.

Transcriptional and translational regulation of phosphodiesterase type IV isozymes in rat brain by electroconvulsive seizure and antidepressant drug treatment

We examined the influence of electroconvulsive seizure (ECS) and imipramine (IMI) treatment on the transcription and translation of cyclic nucleotide phosphodiesterase type IV (PDE IV) isozymes in the rat brain. Our in situ hybridization studies revealed an increase of PDE IV-B mRNA level in various brain regions after acute ECS. However, the increase of PDE IV activity was produced not by acute but by chronic ECS treatment in the frontal cortex. Increased PDE IV-B mRNA expression in frontal but not in hippocampal subfields was induced also after chronic ECS treatment. Although an increase in PDE IV-A mRNA expression of the dentate gyrus in the hippocampus was observed, no change of PDE IV activity was produced in the hippocampus by acute or chronic ECS treatment. These results suggest that the repeated increases of PDE IV-B mRNA expression are attributable to the increase of PDE IV translation. Increased PDE IV-B transcription and PDE IV translation in the frontal cortex were also produced after chronic IMI treatment. This is the first report demonstrating an expressional regulation of Drosophila melanogaster dunce (dnc) gene homologue PDE IV isozymes in the brain. Although no pathophysiological conditions with reduced PDE IV activity in the nervous system are known except for a learning deficit in the mutant fly dnc-, our results suggest possible treatments to cope with reduced PDE IV activity.

Immunological quantitation of DT-diaphorase in carcinoma cell lines and clinical colon cancers: advanced tumors express greater levels of DT-diaphorase

NAD(P)H:quinone oxidoreductase (DT-diaphorase; DTD) plays a major role in activating mitomycin C (MMC) in human colon and gastric carcinoma cell lines. Thus, measurement of DTD in clinical tumor samples could be beneficial in designing adjuvant chemotherapy. We explored immunological quantitation of DTD protein using a monoclonal antibody against DTD, demonstrating a close correlation between protein expression and enzyme activity of DTD in colon and gastric carcinoma cell lines and in colorectal tumor samples. This indicates that such immunoblot analysis is a simple alternative method for quantitating DTD in clinically excised samples. In most colorectal tumor samples, the tumors expressed larger amounts of DTD than did the peripheral normal tissues, suggesting a selective toxicity of MMC toward tumor cells. Also tumors with nodal metastases showed significantly higher DTD levels than did tumors without metastasis. These results raise the possibility that DTD expression is related to tumorigenesis and malignant progression of colorectal tumors. Measurement of DTD by the immunological method described here could be beneficial in designing a rational adjuvant chemotherapy with MMC.

Proportion of blasts with a clear halo around nucleoli at the end of induction therapy of acute myeloid leukemia correlates with achievement of complete remission, remission duration and relapse

Bone marrow aspirates from 60 patients with acute myeloid leukemia (AML) were investigated using 95% ethanol fixation Papanicolaou stained preparations. The blasts were grouped into those with a clear halo around nucleoli (BCHN) and those without a clear halo. The patients were classified into three groups according to the degree of persistent BCHN at the end of induction therapy: group 1, no BCHN; group 2, less than 1% BCHN; and group 3, 1% or more BCHN. All patients in groups 1 (17 cases) and 2 (12 cases), and 12 of 31 cases in group 3 achieved complete remission (CR). Of 17 patients in group 1, two underwent bone marrow transplantation and two died from infection. Of the 37 patients who achieved CR, relapse was observed in two of 13 patients in group 1, and in all patients in groups 2 and 3. As to the patients treated with N4-behenoyl-1-beta-D-arabinofuranosyl-cytosine + daunorubicin + 6-mercaptopurine + prednisolone (BHAC-DMP) protocol, the percentages and number of BCHN at the diagnosis of AML in group 1 were significantly lower than those of groups 2 and 3. The percentage and number of BCHN at the diagnosis of AML were significant factors for the achievement of CR and for the prediction of long-term outcome. The reduction of BCHN to less than 1% at the end of induction therapy is a good indicator for the achievement of CR, and the disappearance of BCHN is a useful target for a long-lasting first CR; conversely, the persistence of BCHN is a major adverse factor for relapse.

Short report: An imported case of cystic echinococcosis in Japan diagnosed by imaging and serology with confirmation of Echinococcus granulosus-specific DNA sequences

We report one case of cystic echinococcosis (CE) in Japan in a native of Nepal. Ultrasonography and computed tomography scan of the liver revealed unique cystic lesions with or without daughter cysts of Echinococcus granulosus. Immunoblot analysis using crude antigens of E. multilocularis and cyst fluid of E. granulosus, without reference to these image analyses, strongly suggested this was a case of CE. We found protoscoleces in surgically removed hepatic lesions and analyzed the mitochondrial cytochrome c oxidase subunit I (COI) gene by the polymerase chain reaction. Based on the similarity in DNA sequences of the COI gene of this Echinococcus spp. with that of previously reported sheep-dog strain (GI), the parasite was considered to be the so-called common sheep strain of E. granulosus.

Factors affecting the development of spontaneous recurrence of methamphetamine psychosis

The process triggering spontaneous recurrences of methamphetamine (MAP) psychosis (i.e. flashbacks) was studied in 41 flashbackers, along with 84 non-flashbackers with a history of MAP psychosis. Plasma monoamine metabolite levels were assayed in 25 of the 41 flashbackers, 16 of the 84 non-flashbackers, 9 subjects with persistent MAP psychosis and 28 control subjects. All flashbackers had experienced threatening events or frightening paranoid-hallucinatory states during previous MAP use. The dominant factor triggering flashbacks was a mild fear of other people. Plasma norepinephrine levels were elevated during flashbacks. The results suggest that a mild fear of other people may have elicited memories of MAP psychosis associated with threatening experiences through increased sensitivity to psychosocial stressors. As a result the flashbacks occurred, including an increase in peripheral noradrenergic activity.

[Assessment of the practicability of coronary risk index as a screening method for ischemic heart disease in preoperative evaluation]

Coronary risk index (CRI) is our newly developed screening method for ischemic heart disease in preoperative evaluation. In this study, we assessed the practicability of CRI examining coronary angiograms (CAG) obtained in 106 patients scheduled for operations. CAG was rated with CAG score, then CRI and CAG score were statistically analyzed. These two parameters showed a significant positive relationship; the higher CRI, the higher CAG score (P < 0.0001). When the patients were divided into five groups by their CRI (0-9, 10-14, 15-19, 20-24, and more than 25), the group with higher CRI contained significantly more patients with severe multivessel coronary lesion (P < 0.0001). Similar results were obtained even in the patient with minimal change in ECG or exercise ECG, or those with minimal chest symptoms (P < 0.001). These results suggests that CRI works effectively as a screening method for ischemic heart disease regardless of abnormalities in ECG or the chest symptoms. More cautious perioperative management should be carried out in patients with higher CRI.

Enhanced metastasis of B16 melanoma cells by unexpected elevated expression of the metastasis-associated TI-241 (LRF-1-, Jun-Fos-related) gene treated with antisense oligonucleotide

B16-F10 is a B16 mouse melanoma subline that preferentially metastasizes to the lung following intravenous injection. Previously we isolated TI-241 (LRF-1 homologue related to Jun-Fos) gene that was expressed higher in the high metastatic clone B16-F10 than the low metastatic clone F1. Transfection of TI-241 into F1 converted it into a high-metastatic cell. We studied the effect of antisense oligonucleotide designed to reduce the expression of TI-241 in B16-F10 cells, and observed an unexpected increase in the TI-241 level. The increase in the expression was maximal at 30 h, then it decreased during further culture with or without TI-241 antisense oligonucleotide. This increased TI-241 expression by antisense oligonucleotide was also observed in B16-F1 cells whereas sense oligonucleotide did not affect the expression. B16-F10 cells cultured with TI-241 antisense oligonucleotide showed enhanced experimental metastatic potential to the mouse lungs compared with untreated B16-F10 and B16-F10 cultured with TI-241 sense oligonucleotide.