[Pulmonary Carcinosarcoma Presenting Hemothorax Caused by Pleural Invasion;Report of a Case]

A 71-year-old man presented with hemothorax with cough, sputa and worsening dyspnea. On chest X-ray and computed tomography(CT), a huge tumor in the right upper lobe with hematoma and small amount of gas suggesting hemopneumothorax was revealed. No apparent lymphadenopathy nor intrapulmonary metastases were observed. The tumor showed a little enhancement on the contrastenhanced CT. Then the resction of the tumor was performed, and the pathological evaluation revealed a carcionosarcoma (adenocarcinoma+osteosarcoma) pT3N0 (stage II B) G4 pl2. Sarcomatoid carcinoma such as carcinosarcoma should be considered as a possible cause of hemothorax in making a diagnosis of hemorrhagic hypovascular huge lung tumor.

Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia

Although quantitative analyses of clock drawings (CD) have achieved widespread clinical use as a cognitive screening, little is known about the qualitative profiles of CD in Alzheimer's disease (AD) and vascular dementia (VD). To address this issue, the present study examined the significance of qualitative analyses of CD in AD and VD. Sixty-seven AD patients, 44 VD patients and eight controls underwent a clock drawing test and took the Mini-Mental State Examinations (MMSE). In the dementia groups, quantitative scores significantly decreased compared with controls and were significantly correlated with MMSE scores. Qualitative analysis demonstrated that in AD patients qualitative error patterns were stable and independent of severity. In contrast, in VD patients the frequency of graphic difficulties and conceptual deficit increased, while the frequency of spatial and/or planning deficit decreased, as severity worsened. In mild dementia groups the frequency of spatial and/or planning deficit was significantly higher in VD. In moderate dementia groups, the frequency of graphic difficulties was significantly higher in VD and the difference in the frequency of spatial and/or planning deficit seen in mild dementia disappeared. The present study suggests that qualitative analyses of clock drawings could demonstrate the neuropsychological profiles of AD and VD and their differences between these dementias.

Relationship between regional cerebral blood flow and verbal fluency in Alzheimer's disease

Category and letter verbal fluency tests are widely used for dementia detection and severity measure. Performances of these tasks have been regarded to be mainly associated with the left frontal lobe function. However, some recent studies suggest that there are different neuropsychological bases between these two tasks, and the brain region which contributes to these performances still remains unclear in Alzheimer's disease (AD). To clarify the neural basis of verbal fluency in AD, we examined the relationship between performances of these tasks and regional cerebral blood flow (rCBF). Twenty-five AD patients were administered verbal fluency tasks and single photon emission computed tomography (SPECT) scans. Thirteen cortical regions of interest were symmetrically defined in each hemisphere. Letter fluency scores were correlated significantly only with the left prefrontal (Brodmann's area (BA) 10-46) regional cerebral blood flow (rCBF). In contrast, category fluency scores were correlated most strongly with the left temporal rCBF and also with the left prefrontal (BA 10-46) rCBF. In conclusion, the present study suggests that left prefrontal (BA 10-46) dysfunction contributes to decline in both letter and category fluency scores in AD, while typical posterior dysfunction of AD has a closer relationship with decline in category fluency scores.

[A case study of BRON (cough suppressant) tablet dependence--its social psychiatric and biological aspects]

A case of BRON tablet dependence is demonstrated. BRON is an over-the-counter (OTC) cough suppressant, which contains methylephedrine, dihydrocodeine, chlorpheniramine and caffeine. He took BRON tablet for the first time at the age of 16. In progress, he developed psychomotor excitement twice and finally manifested amotivational syndrome 3 years later from his first use. Longitudinal 123I-IMP SPECT (autoradiography method) findings demonstrated diffuse cerebral blood flow (CBF) decrease and relative hyperactivity in the lower frontal lobe. Diffuse decreased regional CBF, which was unchanged through its course for about 4 months, may show irreversible brain damage due to chronic BRON abuse. The findings of relative hyperactivity in the lower frontal lobe (orbitofrontal lobe) may reflect "craving for BRON" based on abnormal dopaminergic neural system activity. Based on the evidence that orbitofrontal hyperactivity is also seen in cases of cocaine abuse, methylephedrine, which is a cocaine-like central nervous system stimulant, may play the main role in BRON dependence formation. In Japan, BRON syrup abuse and dependence were in fashion for youth in 1980s. After the legal regulation of the market in 1988, it has gone out of fashion. While it is still easy to acquire OTC cough suppressant, reports of BRON tablet abuse and dependence are quite rare through 1980s and 1990s. This case suggests that BRON tablet abuse also could lead to dependence and come into new vogue for youth in the future. We should pay attention to the trend of OTC cough suppressant abuse and may need to regulate the market by law more severely.

[A case report of male alcoholics treated the left replacement prosthesis on account of the idiopathic avascular necrosis of the left femoral head]

Idiopathic necrosis of the femoral head is already described associated with alcoholism. However, it is unusual to meet alcoholic patient with idiopathic necrosis of the femoral head in psychiatric hospital. In this report, we describe about the psychiatric treatment of an alcoholic male patient who complicated idiopathic necrosis of the femoral head. He begun drinking a large amount of alcohol at the age of 20. After 32 years old, he repeated admission to psychiatric hospitals for the treatment against alcohol dependence. At the age of 35, he felt left hip pain. At 36 years old, the illness was diagnosed as idiopathic necrosis of the femoral head and osteotomy was performed. After the operation, he did not keep the direction to keep a rest and not to drink. At last, total replacement arthroplasty was undergone. All through the treatment, we supported the patient to participate in group therapy and Alcoholics Anonymous, and approached directively and supportively to gain an insight about problems of drinking. As a result, after the last operation he hoped psychiatric treatment of his own will and began to gain insight gradually about his own alcoholic problems. This case emphasizes the necessity of psychotherapeutic approach and treatment programs for alcohol dependence and its physical complications.

[A case report of organic solvent abuse with amotivational syndrome]

We investigated an organic solvent abuser who developed amotivational syndrome employing neuropsychological examination (Rorschach test, Bender Gestalt test and Benton visual retention test), electroencephalography, magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). The patient manifested a disability to maintain a goal-orient mental activity, immature reality testing and poor set shifting, which suggest frontal lobe dysfunction, as we have reported before in neuropsychological examination. In this case, single photon emission computed tomography (SPECT) also revealed a decrease of regional cerebral blood flow (rCBF) in the medial frontal lobe. These results may suggest a contribution of frontal lobe (especially medial frontal lobe) dysfunction to the pathogenesis of amotivational syndrome due to organic solvent abuse.