Mycoplasma genitalium in the cervices of Japanese women

BACKGROUND

Mycoplasma genitalium is considered a cause of nongonococcal urethritis in men. This organism also is a cause of genital infections in women, and has been detected in women attending sexually transmitted disease clinics in the United Kingdom and Denmark, although its prevalence is unknown in Japanese women.

GOALS

To determine the prevalence of M. genitalium in the cervices of women with cervicitis or adnexitis as well as in asymptomatic pregnant women in Japan.

STUDY DESIGN

Two hundred women who attended obstetric and gynecologic clinics were recruited. Sixty-four women had cervicitis, 53 had adnexitis, and 3 had both. Eighty pregnant women were asymptomatic for infection. Cervical swab specimens were examined for M. genitalium using a polymerase chain reaction-based assay.

RESULTS

Five (7.8%) of 64 women with cervicitis and 3 (5.7%) of 53 women with adnexitis were positive for M. genitalium. After exclusion of Chlamydia-positive women, 5 (8.8%) of 57 women with cervicitis, and 2 (4.1%) of 49 women with adnexitis were positive for M. genitalium. In none of 80 asymptomatic pregnant women, including a Chlamydia-positive woman, was M. genitalium detected. Overall, 7 (6.6%) of 106 women with Chlamydia-negative genital infections were positive for the M. genitalium. This prevalence was significantly greater than that in asymptomatic pregnant women (P < 0.05).

CONCLUSIONS

A significantly greater prevalence of M. genitalium was demonstrated in Japanese women with Chlamydia-negative cervicitis or adnexitis, compared with that in asymptomatic pregnant women. This study suggests that M. genitalium may play a pathogenic role in a portion of cases with Chlamydia-negative genital infections.

[Management and long-term follow-up results in patients with carotid artery dissection]

The recognized incidence of extra- and intracranial carotid artery dissection has increased concomitantly with the progress and development of diagnostic methods. However, management for this condition is still controversial. We report in the present study the management and long-term follow-up results of 15 patients with carotid artery dissection. Mean age of the patients at onset was 47.8 years old, and male/female ratio was 12:3. Two patients were considered to be traumatic dissections and the other 13 patients were spontaneous dissections. Dissection occurred in 10 patients at the extracranial carotid artery, in 4 at the intracranial carotid artery and in 1 at the middle cerebral artery. Nine of 15 patients demonstrated hemiparesis and 5 complained of headache or facial pain. However, it was not possible to identify a characteristic symptom of dissection. Final diagnosis of dissection was made by cerebral angiography in all patients. Serial angiography was carried out in 10 of those, and 5 of the 10 patients showed some improvements of dissection in the cerebral angiogram. Treatment for those patients was selected according to the neurological and angiographical changes. Five patients were managed conservatively and 10 patients underwent surgical revascularization. During the follow-up period (mean 77.6 months), none of them showed any symptoms of reattack, and all but one, who died of heart failure 193 months after revascularization surgery, have lived independently. Although diagnosis of dissection was difficult because of the lack of characteristic symptom, serial angiography was a useful method for diagnosis and adequate management has led to a good clinical outcome.

Prevalence of Mycoplasma genitalium in asymptomatic men in Japan

We aim to clarify the prevalence of Mycoplasma genitalium in asymptomatic men in Japan. First-catch urine specimens were obtained from 187 asymptomatic Japanese men and examined for the presence of M. genitalium using a polymerase chain reaction (PCR)-based assay. Two (1.1%) of 187 first-catch urine specimens were positive for M. genitalium. The prevalence of M. genitalium in urine specimens of asymptomatic men in Japan is lower than that in asymptomatic men in the UK (6%) and Denmark (9%).

[Epstein-Barr virus penetration mechanism to T lymphoblastoid cell lines]

It had been believed until several years ago that Epstein-Barr virus (EBV) can infect to only B lymphocytes and epithelial cells. However, EBV DNA, RNA derived from EBV and/or EBV latent proteins were detected in the T cells of the patient with Kawasaki-like disease, nasal T cell lymphoma cells, and postpyothrax T cell lymphoma cells. Therefore, it is obvious that EBV can infect to T lymphocytes. It is relatively well studied how EBV infects to B lymphocytes. But the mechanism of EBV infection to T lymphocytes is still obscure due to the difficulty of the purification of T lymphocytes with EBV receptor. Recent topics about EBV infection mechanism to T lymphocytes and T lymphoblastoid cell lines are summarized in this review.

[Regional cerebral blood flow measurements using 99mTc-ECD SPECT in patients with Alzheimer's disease (ad) in the early stage]

Regional cerebral blood flow (rCBF) measurements using a Patlak plot method and SPECT with 99mTc-ECD were performed in 10 patients with possible Alzheimer's disease (AD), 14 patients with probable AD, and 11 age-matched normal control subjects. The whole brain CBF for the probable group showed significant reduction to 37.2 ml/100 g/min as compared with the normal value of 42.1 ml/100 g/min, whereas the possible group did not show significant reduction of the whole brain CBF. In the possible and probable groups, rCBF values in the bilateral hippocampi, supramarginal gyri, angular gyri were lower than normal values. Moreover, in the probable group, rCBF values showed significant decrease in the superior, middle and inferior temporal gyri. The whole brain CBF and rCBF, especially in the bilateral hippocampal regions, showed significant positive correlation with the scale of MMSE and HDS-R. These results suggest that noninvasive rCBF measurements using 99mTc-ECD are quite useful for the early diagnosis of AD.

Prevalence of Mycoplasma genitalium in men with gonococcal urethritis

A significant association of Mycoplasma genitalium with non-gonococcal urethritis has been reported, but the prevalence of this mycoplasma in men with gonococcal urethritis has not been so well studied. In this study, we examined urethral swab specimens from 45 Japanese male patients with gonococcal urethritis for the presence of M. genitalium by using a polymerase chain reaction-based assay. We also sought Chlamydia trachomatis by an enzyme immunoassay (Chlamydiazyme). Of the 45 specimens, 2 (4.4%) were positive for the mycoplasma and 12 (26.7%) were positive for C. trachomatis. The findings suggest that M. genitalium may be a cause not only of non-gonococcal urethritis but also of postgonococcal urethritis.

[An elderly patient with Ph1-positive chronic myelomonocytic leukemia]

An 80-year-old man with leukocytosis was admitted to our hospital on February 20, 1995. There were no blasts in the peripheral blood, but leukocytosis, associated with marked monocytosis, anemia, and thrombocytopenia was observed. The bone marrow was hyperplastic and there was a slight decrease in megakaryocytes. The myelogram showed 5.6% blasts + promyelocytes, and there was no basophilia. Mild dysplasia of third-line cells was observed. Chromosome analysis yielded 47, XY, +8, t (9;22) (q34;q11), and the Philadelphia (Ph1) chromosome and trisomy 8 were detected. Fluorescence in-situ hybridization revealed a large ber. Because the French-American-British (FAB) cooperative group diagnostic criteria for chronic myelomonocytic leukemia (CMMoL) were fulfilled and the Ph1 chromosome was detected, a diagnosis of Ph1-positive CMMoL was made. Hydroxyurea was given for cytoreduction and the patient has been followed with no evidence of acute transformation for about one year. CMMoL is classified as a myelodysplastic syndrome. However, it is rare to find the Ph1 chromosome in patients with these syndromes, and there have been very few reports of its detection in CMMoL. CMMoL may not be a single disease entity, and it may be useful to investigate more cases like the present one, to reassess this disease.

Effectiveness of revascularization surgery evaluated by proton magnetic resonance spectroscopy and single photon emission computed tomography

Proton magnetic resonance spectroscopy (MRS) and single photon emission computed tomography (SPECT) were used to evaluate chronic ischemic regions in 26 stroke patients before and 1, 3, and 6 months after revascularization surgery. The volume of interest for proton MRS was placed in an area including part of the frontal and temporal opercula, insular cortex, and basal ganglia. Twenty healthy volunteers served as controls for proton MRS. Patients were divided into three groups according to the preoperative proton MRS. Group A (n = 12) had significantly lower N-acetylaspartate/choline (NAA/Cho) and N-acetylaspartate/creatine (NAA/Cr) ratios on the operative side compared to those on the contralateral side, and also lower than those in normal subjects. In seven patients in Group A, postoperative serial proton MRS demonstrated no recovery of these ratios on the operative side. However, proton MRS of the other five patients indicated gradual improvement in these ratios on the operative side at 3 to 6 months after surgery, and SPECT indicated an increase in cerebral blood flow on the operative side in four of these five patients. In Group B (n = 9), proton MRS and SPECT showed no laterality before revascularization and no remarkable change during the postoperative course. In Group C (n = 5), NAA/Cho or NAA/Cr decreased on the contralateral side preoperatively. Two patients showed fluctuating values of NAA/Cho or NAA/Cr during the postoperative period. Serial proton MRS and SPECT studies may be useful for the evaluation of revascularization surgery on ischemic regions. The efficacy of revascularization surgery on the metabolism may appear gradually within 3-6 months.

Comparison among performances of a ligase chain reaction-based assay and two enzyme immunoassays in detecting Chlamydia trachomatis in urine specimens from men with nongonococcal urethritis

We evaluated the performances of a ligase chain reaction (LCR)-based assay and two enzyme immunoassays (Chlamydiazyme and IDEIA) in the detection of Chlamydia trachomatis in urine specimens. We compared the results of testing urine specimens by these assays with those of urethral swab culture by examining samples from 131 men with nongonococcal urethritis. Discrepant results were analyzed by testing urethral swab specimens for C. trachomatis by a PCR-based assay. After the resolution of discrepant results, the sensitivity of urethral swab culture was 85.3%, whereas those of the LCR assay, Chlamydiazyme, and IDEIA with urine specimens were 94.1, 82.4, and 94.1%, respectively. The LCR assay and IDEIA were more sensitive than was urethral swab culture. In addition, the LCR assay, with a sensitivity equal to that of IDEIA, was more specific. Overall, the LCR assay proved to be superior to the enzyme immunoassays in detecting C. trachomatis in urine specimens. Testing urine specimens by LCR assay should be a helpful alternative method for diagnosing C. trachomatis urethral infection in men with nongonococcal urethritis.

Critical involvement of interferon gamma in the pathogenesis of T-cell activation-associated hepatitis and regulatory mechanisms of interleukin-6 for the manifestations of hepatitis

A single intravenous injection of concanavalin A (Con A) induces T-cell activation and an acute hepatitis in mice. This study investigated the role of interferon gamma (IFN-gamma) in the pathogenesis of this hepatitis model. Striking increases in the plasma levels of various cytokines, including tumor necrosis factor (TNF), interleukin-2 (IL-2), and IFN-gamma, were detected before the increase in plasma aminotransferase levels induced by Con A injection. TNF levels peaked within 2 hours, whereas IFN-gamma levels peaked at 6 hours after Con A injection. In contrast to a sharp peak of TNF levels, high IFN-gamma levels were detected for a more prolonged period. Passive immunization with anti-IFN-gamma monoclonal antibody (MAb) conferred a dose-dependent protection against liver injury in this model. This protection was observed when anti-IFN-gamma MAb was administered at least 30 minutes before Con A injection but not when given 1 hour after Con A injection. The protection from Con A-induced hepatitis was also induced by administration of rIL-6 before Con A injection. rIL-6 treatment induced significant albeit incomplete inhibition of IFN-gamma and TNF production, whereas this regimen did not affect IL-2 production. Despite striking protective effects of rIL-6 or anti-IFN-gamma MAb, comparable levels of cellular (both T cell and polymorphonuclear cell) infiltration were detected in liver sections from animals untreated, or treated with either rIL-6 or anti-IFN-gamma MAb. Moreover, electron microscopic examination showed that infiltrating T cells exhibited a blastoid appearance in all groups. These results indicate that IFN-gamma plays a critical role in the development of Con A-induced acute hepatitis and suggest that IL-6 administration can regulate the manifestation of hepatitis through mechanisms including the reduced production of inflammatory cytokines such as IFN-gamma.

Conserved motifs in prokaryotic and eukaryotic polypeptide release factors: tRNA-protein mimicry hypothesis

Translation termination requires two codon-specific polypeptide release factors in prokaryotes and one omnipotent factor in eukaryotes. Sequences of 17 different polypeptide release factors from prokaryotes and eukaryotes were compared. The prokaryotic release factors share residues split into seven motifs. Conservation of many discrete, perhaps critical, amino acids is observed in eukaryotic release factors, as well as in the C-terminal portion of elongation factor (EF) G. Given that the C-terminal domains of EF-G interacts with ribosomes by mimicry of a tRNA structure, the pattern of conservation of residues in release factors may reflect requirements for a tRNA-mimicry for binding to the A site of the ribosome. This mimicry would explain why release factors recognize stop codons and suggests that all prokaryotic and eukaryotic release factors evolved from the progenitor of EF-G.

Autoimmune hemolytic anemia in allergic granulomatous angitis (Churg-Strauss syndrome)

We describe a patient with allergic granulomatous angitis who developed autoimmune hemolytic anemia (AIHA). A 44-year-old male had been suffering from bronchial asthma. On admission, laboratory tests revealed the presence of severe eosinophilia (21,500/microliters), elevation of total immunoglobulin E (IgE), high lactic dehydrogenase (LDH) and low haptoglobin levels, in addition to moderate reticulocytosis. During admission, the patient showed almost simultaneous occurrence of vasculitis in the extremities, severe hemolysis and exacerbation of asthma in relation to the progression of eosinophilia. Both IgM and IgG autoantibodies were considered to be responsible for hemolysis. Interestingly, serum levels of interleukin-4 (IL-4) and IL-5 were increased in association with eosinophilia and increased IgE production. These findings suggest that the AIHA in this patient is mediated or enhanced at least partly by high IL-4 and IL-5 production. Although AIHA in this syndrome is very rare, it should be considered as a clinical manifestation.

[Monoballism associated with internal carotid artery occlusion : a case report]

A 62-year-old man was admitted to our hospital with abrupt onset of monoballism in the left arm. Brain MRI showed a hemorrhagic lesion in the right subthalamic nucleus. MRA demonstrated occlusion of the right internal carotid artery occlusion. Cerebral angiogram indicated a leptomeningeal anastomosis to the right middle cerebral artery from the right posterior cerebral artery. SPECT with 99mTc-HMPAO demonstrated the reduction of cerebral blood flow in the right frontotemporal region. Right superficial temporal artery-middle cerebral artery anastomosis was performed 7 months after onset. Monoballism disappeared after surgery and the patient had a good clinical course during the postoperative period. Monoballism associated with internal carotid artery occlusion is rare, and we were able to show the subthalamic nucleus lesion with MRI soon after onset. We considered that the reason for this hemorrhage in the subthalamic nucleus was the hemodynamic stress to the posterior cerebral artery area caused by the ipsilateral occlusion of the internal carotid artery.

[Histochemical studies on glycosaminoglycans in Bruch's membrane of experimental microphthalmic mice]

The Cts mouse is a mutant mouse of the Jcl:ICR strain which has congenital cataracts and small eyes in homozygotes. Therefore, this mouse could be a model for autosomal dominant cataract with microphthalmia in humans. In the present study, attempts were made to demonstrate light-microscopically the molecular species of glycosaminoglycans (GAG) in Bruch's membrane of Cts mice on day 14, 16, and 18 of gestation and at 0, 4, and 7 days after birth by means of combined sensitized high iron diamine staining and testicular hyarulonidase digestion procedures. In Bruch's membrane of the unaffected mice at all stages examined, no substantial amount of chondroitin sulfate A/C could be detected. In homozygous mice, however, a large amount of chondroitin sulfate A/C was contained in Bruch's membrane. These results indicate that the abnormal change in GAG molecular species induced the functional disorder of Bruch's membrane and could play a certain role in the etiology of microphthalmia in homozygotes.

Functional specificity of amino acid at position 246 in the tRNA mimicry domain of bacterial release factor 2

The termination of protein synthesis in bacteria requires codon-specific polypeptide release factors RF-1 (UAG/UAA specific) and RF-2 (UGA/UAA specific). We have proposed that release factors mimic tRNA and recognize the stop codon for polypeptide release (Nakamura et al (1996) Cell 87, 147-150). In contrast to the textbook view, genetic experiments have indicated that Escherichia coli RF-2 terminates translation very weakly at UAA while Salmonella RF-2 decodes this signal efficiently. Moreover, an excess of E coli RF-2 was toxic to cells while an excess of Salmonella RF-2 was not. These two RF-2 proteins are identical except for 16 out of 365 amino acids. Fragment swap experiments and site-directed mutagenesis revealed that a residue at position 246 is solely responsible for these two phenotypes. Upon substituting Ala (equivalent to Salmonella RF-2) for Thr-246 of E coli RF-2, the protein acquired increased release activity for UAA as well as for UGA. These results led us to conclude that E coli RF-2 activity is potentially weak and that the amino acid at position 246 plays a crucial role, not for codon discrimination, but for stop codon recognition or polypeptide release, presumably constituting an essential moiety of tRNA mimicry or interacting with peptidyltransferase centers of the ribosome.

Successful management of infantile hepatic hilar hemangioendothelioma with obstructive jaundice and consumption coagulopathy

A 4-month-old boy with benign hemangioma of the porta hepatis is described. Obstructive jaundice and consumption coagulopathy developed, which were treated by percutaneous transhepatic drainage (PTHD), without resection of the tumor or bypass surgery. Because of tumor regression, the patient has remained free of symptoms even after the PTHD tube was removed. Because juvenile hemangioma is a benign tumor and occasional spontaneous regression is known to occur (as in our case and other reports), it is suggested that complete resection or bypass surgery is not necessary for juvenile hemangioendothelioma, even with obstructive jaundice, if bile drainage is adequately maintained.

[Evaluation by proton magnetic resonance spectroscopy of carotid-cavernous fistula with cortical venous drainage]

Cases with carotid-cavernous fistula (CCF) associated with cortical venous drainage through the sylvian veins are rather rare. However, such cases involve risk for subarachnoid hemorrhage, subcortical hemorrhage and venous infarction due to venous hypertension in the brain. Even without these symptoms, CCF under these conditions provokes disturbance in cerebral metabolism. We report two cases of CCF associated with cortical venous drainage evaluated by proton magnetic resonance spectroscopy (1H-MRS). Case 1: A 56 year-old female suffered from a right CCF associated with cortical venous drainage through the sylvian veins after trauma. Before embolization with a detachable balloon catheter, the ratios of N-acetyl-aspartate (NAA)/Choline (Cho) and NAA/Creatine (Cr) in 1H-MRS on the right temporo-basal ganglia were lower than those in normal volunteers. After curative balloon embolization of the CCF, serial 1H-MRS still demonstrated laterality (NAA/Cho and NAA/Cr ratios on the right side were lower than those on the left). Six months after embolization, these ratios on the right became closer to those on the left. Case 2: A 48 year-old female suffered from spontaneous CCF associated with cortical venous drainage. Before embolization of the CCF, ratios of NAA/Cho and NAA/Cr on the temporo-basal ganglia of the drainage side (left side) were lower than those on the contralateral side. After partial embolization of the CCF, which caused the angiographical disappearance of the cortical venous drainage, NAA/Cho and NAA/Cr ratios on the affected side increased to almost the same levels as those on the contralateral side. We consider that 1H-MRS is noninvasive and is a useful method to generate data evaluation of affected brain metabolism by venous reflux in cases of CCF associated with cortical venous drainage.

Neutral red staining for the assessment of acute outcome in rat focal cerebral ischemia models

Neutral red staining was evaluated as an acute outcome assessment method in rat models of cerebral ischemia by comparison with histological infarction volume. Fischer 344 rats (n = 48) were used in three different models of middle cerebral artery (MCA) occlusion: proximal MCA occlusion (n = 16), distal MCA occlusion followed by ipsilateral common carotid artery (CCA) occlusion (distal MCA/CCA occlusion, n = 15), and MCA occlusion with an intravascularly introduced 4-0 nylon suture (intravascular MCA occlusion, n = 17). At 1 hour, 2 hours, and 4 hours after MCA occlusion, animals were injected with 2.5 ml of 4% neutral red solution via the femoral vein, and then sacrificed. Proximal MCA occlusion caused a neutral red defect volume in the cortex which correlated well with histological infarction volume at 4 hours (r = 0.88, p < 0.05), and in the caudate which correlated well with infarction volume at 4 hours (r = 0.94, p < 0.01). Distal MCA/CCA occlusion caused a neutral red defect volume in the cortex lager than the histological infarction volume (4 hrs: 88.6 +/- 11.8 vs. 74.3 +/- 17.4 mm3, p < 0.05) but closely correlated with the infarction volume at 4 hours (r = 0.81, p < 0.05). Intravascular MCA occlusion caused a neutral red defect volume in only two of 17 animals after 1-4 hours, which correlated well with the absence of histological evidence of infarction. Neutral red staining is a simple method for assessing the acute outcome of focal cerebral ischemia as early as 4 hours after the onset, in an appropriate model of cerebral ischemia.

[Usefulness of coronary angiography in patients undergoing carotid endarterectomy]

We evaluated 37 cases of coronary angiography in patients undergoing carotid endarterectomy (CEA). The severity of coronary stenosis was estimated by Gesini's scoring system. There was no correlation between the severity of carotid stenosis and that of coronary stenosis, but those patients who had a history of coronary artery disease, carotid bruit or intracranial artery stenoses presented significant severe coronary stenosis in most cases. Even in the patients who had no history of coronary artery disease (n = 26), 13 patients (50%) had stenotic lesions shown by coronary angiography. Eight patients required treatment for their coronary stenotic lesions: 5 were treated with percutaneous transluminal coronary angioplasty (PTCA) and 3 with coronary artery bypass grafting. Intraoperative occlusion tests monitored by EEG and SEP showed abnormal findings in 6 CEA operations. One of these patients received PTCA before CEA, and had a good clinical course during and after the CEA procedure. In conclusion, in patients undergoing CEA there is frequently concomitant coronary artery stenosis. We should thus assess the coronary artery lesion more precisely by coronary angiography, and should carry out prophylactic treatment for these lesions.

[A case of Binswanger's disease in which an acute infarcted lesion was detected by diffusion-weighted magnetic resonance imaging]

Diffusion-weighted magnetic resonance imaging (DWI) was carried out on a patient with Binswanger's disease suffering from acute cerebral infarction. Though an acute infarcted lesion was demonstrated as a high signal area on the T2-weighted image, it was impossible to determine whether it was acute or chronic because of extensive deep white matter lesions (periventricular hyperintensity and white matter hyperintensity lesions). However, only the acute infarcted lesion was detected on DWI which showed it as a high signal area, suggesting reduced molecular diffusion of water. The apparent diffusion coefficient (ADC), a physiological parameter that characterizes the self-diffusion on water in tissue, was lower in the acute lesion and higher in the chronic lesion. DWI can differentiate acute from chronic infarcts, which is not possible by conventional CT and MRI.

Relationship of parental bonding to child abuse and dissociation in eating disorders in Japan

Parental bonding patterns were studied in 52 female Japanese eating disorder outpatients with and without histories of sexual or physical abuse and with dissociation. Instruments included the Parental Bonding Instrument (PBI), the Dissociative Experiences Scale (DES) and the Dissociative Disorders Interview Schedule (DDIS). Those with physical abuse history, but not sexual abuse history, had significantly different parental bonding scores and higher DES scores compared with subjects without physical abuse. DES scores and PBI scores were not correlated. Although the PBI was useful in discriminating between those with and those without abuse histories, it did not detect differences in degree of dissociation. Lack of association of sexual abuse to PBI and DES scores may have been due to mild abuse.

[Clinical investigation of severe pulmonary tuberculosis and miliary tuberculosis]

Although the incidence of pulmonary tuberculosis had been rapidly decreased in Japan, it is pointed out that the rate of decrease in annual incidence became smaller in recent years. This slowing down of the rate of decrease is considered to be resulted from an increase in number of individuals who are more susceptible to tuberculous infection; such as the elderly, young people who are not exposed to TB bacilli previously and therefore not immunized, patients with malignant disease or with organ transplantation and HIV-infected persons. Pulmonary tuberculosis still remained as a pulmonary infectious disease of highly ranked importance. Especially, miliary tuberculosis is life-threatening and occasionally fatal unless early intensive antituberculosis chemotherapy was started on the basis of a rapid and definite diagnosis. We made a retrospective survey to clarify the characteristic clinical features of miliary tuberculosis. For this purpose, we compared the characteristics and clinical features of 10 patients with miliary tuberculosis and those of 18 patients with severe pulmonary tuberculosis, not due to hematogenous dissemination. The mean ages of miliary tuberculosis group and that of severe pulmonary tuberculosis group were 62.6 and 63.8 years old, respectively, with no significant difference. Nine out of ten patients with miliary tuberculosis had fever as one of initial symptoms, whereas, all the patients with severe pulmonary tuberculosis had cough and sputa but they seldom developed fever (high fever) at the initial stage of their diseases. Duration from onset of symptom to the admission was 1.2 months on average in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Suicide and aging in Japan: an examination of treated elderly suicide attempters

Although individuals aged 65 and over accounted for 12% of the total population of Japan in 1990, suicides in this age group consisted of 29% of all suicides. The elderly population of Japan is expected to grow rapidly to 24% of the total population by the year 2020, and suicide prevention for the elderly is an urgent mental health problem. Among a total of 1,216 elderly patients who were admitted to the Department of Psychiatry at Tokyo Metropolitan Geriatric Hospital between April 1980 and March 1990, 50 were hospitalized immediately after suicide attempts in order to study their psychosociomedical problems. Because early diagnosis of depression and initiation of proper treatment are indispensable--even if patients do not show obvious depressive symptoms--those who develop persistent somatization and/or delirium should be considered highly suicidal and given special attention. With the cooperation of mental health professionals, it is necessary to educate general practitioners, the public, and the elderly themselves about characteristics of psychiatric disorders and various problems associated with aging. Further research on other elderly Japanese populations, as well as research that examines suicide completion, is needed to confirm the findings of the present study.

[Brain MRI findings in patients with initial cerebral thrombosis and the relationship between incidental findings, aging and dementia]

To estimate the relationship between aging, dementia and changes observed on magnetic resonance imaging (MRI) seen in elderly patients with cerebral thrombosis, MRI findings in 103 patients with an initial stroke event (thrombosis group) were compared with those of 37 patients with hypertension/diabetes (high risk group) and 78 patients without those disorders (low risk group). In addition to the causative lesions in the thrombosis group, periventricular hyperintensities (PVH), spotty lesions (SL), silent infarctions (SI), ventricular dilatation (VD), and cortical atrophy (CA) were analyzed in these groups. Infarctions located in the internal capsule/corona radiata were the most frequent causative lesion. Compared to the low risk group, a high incidence of patchy/diffuse PVH, SI, and severe CA was seen in both the thrombosis group and the high risk group. Widespread PVH and multiple SL increased with age in the thrombosis group, while severe CA was seen in each group. SI and VD tended to increase after age 60, though they were not significant. Dementia, diagnosed in 40 out of 78 patients, increased with age. Multivariate analysis revealed the degree of the effects of MRI findings on dementia to be marked in PVH, brain atrophy, causative lesions, and SL, in that order. These results indicated that diffuse PVH and brain atrophy, developing with age, promoted dementia in the elderly with vascular lesions. Moreover, they suggested that a variety of silent brain lesions recognized on MRI other than infarction can affect symptoms in the elderly.