bluuebunny/crossref_metadata_2025 huggingface dataset:
Considerations on the vicissitudes of unconscious guilt feelings from pre‐adolescence to early adolescence
Authors: Tsutsumi Satoshi
Published: March 2003

The author describes re‐edition of the rapprochement subphase (the early period of the second individuation process) occurring from pre‐adolescence to early adolescence by means of case presentation. Factors that motivate youngsters to become aware of unconscious guilt in their inner world are discussed in the course of this study. In the pre‐adolescent period youngsters begin to develop a conscious guilt more like that of an adult. Under the service of ego, a child modulates from a primitive externalized unconscious guilt conditioned by emotional exchanges with their parents to a more evolved state of self‐awareness. Furthermore, it is possible that changes from externalization of unconscious guilt to guilt with which the ego is directly concerned, (that is, internalized guilt), will resolve the infantile relationship that young adolescents have had with their parents and play an important role in developing social independence.
Direct and buffering effects of social support on depressive symptoms of the elderly with home help
Authors: Hashimoto Kimiko , Kurita Hiroshi , Haratani Takashi , Fujii Ken , Ishibashi Tomoaki
Published: March 2003

The purpose of the present study was to examine the prevalence of depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES‐D) and the effect of life stressors or social support on depressive symptoms in 303 elderly people receiving social services at home. We conducted a questionnaire survey six times with a 1‐month interval. In the initial wave of questionnaires, 92 (31%) scored 16 points or above on the CES‐D, indicative of a risk for depression. Before life stressors, subjects with low‐level support showed significantly more severe depressive symptoms than those with high‐level support. Subjects with low‐level support were significantly more depressive after life stressors than they had been before, whereas those with middle‐ and high‐level support showed no such difference. The former and latter results seem to suggest the direct and buffering effects of social support on depressive symptoms, respectively.
Effects of volitional lifestyle on rest–activity cycle in the aged
Authors: Shirota Ai , Tamaki Munehisa , Tanaka Hideki , Hayashi Mitsuo , Shirakawa Syuichiro , Hori Tadao
Published: March 2003

The present study investigated the relationship among volitional lifestyle, activity and sleep in the aged. We selected 28 subjects over 65 years of age to survey volition to lifestyle. High‐volitional group (14 Ss, mean age: 74.1 years, seven males and seven females) and low‐volitional group (14 Ss, mean age: 73.0 years, seven males and seven females) were identified by the scale of self‐confidence and the Philadelphia Geriatric Center morale scale. Wrist activities were monitored by Actigraph for 10 or 14 consecutive days. The subjects recorded sleep logs by themselves for those days. It was found that high volitional aged individuals had a relatively well structured sleep in comparison with low volitional aged individuals, and that most of them took a clock dependent habitual nap around 14.00 h. On the other hand, low volitional aged individuals had a relatively poor structured sleep, and took a nap time‐dependently after 8 h from the morning rising time. These results suggest that high volitional aged individuals build a short nap into their well organized sleep‐life habits.
Night–day–night sleep–wakefulness monitoring by ambulatory integrated circuit memories
Authors: Yamamoto Mitsuaki , Nakao Mitsuyuki , Katayama Norihiro , Waku Mituru , Suzuki Ken , Irokawa Kazutaka , Abe Masato , Ueno Takashi
Published: March 2003

A medium‐sized portable digital recorder with fully integrated circuit (IC) memories for sleep monitoring has been developed. It has five amplifiers for EEG, EMG, EOG, ECG, and a signal of body acceleration or respiration sound, four event markers, an 8 ch A/D converter, a digital signal processor (DSP), 192 Mbytes IC flash memories, and batteries. The whole system weighs 1200 g including batteries and is put into a small bag worn on the subject’s waist or carried in their hand. The sampling rate for each input channel is programmable through the DSP. This apparatus is valuable for continuously monitoring the states of sleep–wakefulness over 24 h, making a night–day–night recording possible in a hospital, home, or car.
Nurses’ workload associated with 16‐h night shifts. II: Effects of a nap taken during the shifts
Authors: Takahashi Masaya , Arito Heihachiro , Fukuda Hideki
Published: March 2003

This study aimed at examining the effects on the subjective symptoms in nurses of both timing and length of a 2‐h nap during a 16‐h night shift. Compared to pre‐nap levels, sleepiness, fatigue, and dullness increased immediately after napping. Afterwards, sleepiness decreased significantly, and the other symptoms returned to the pre‐nap values. The nurses’ subjective symptoms after napping were not associated with the timing of the nap and post‐nap fatigue lasted longer as the nap time increased (> 1.5 h). These results suggest that for effective napping during long night shifts, the nap length should be determined carefully to avoid persistent sleep inertia.
Multiple sclerosis with extensive lesions, left hemiplegia, mental dysfunction and retrobulbar neuritis
Authors: Ogawa Kana , Kishi Masahiko , Kurihara Teruyuki , Ikeda Ken , Kinoshita Masao
Published: March 2003

Multiple sclerosis (MS) is usually diagnosed on the basis of the typical clinical course, with remission and exacerbation in multiple parts of the central nervous system (CNS). Recently, magnetic resonance imaging (MRI) has made a large contribution to the diagnosis of patients with MS. But it is difficult to make a definite diagnosis due to clinical variability of the disease and variable MRI findings. We report the case of a 26‐year‐old woman who developed pro‐ gressive left hemiplegia, mental dysfunction, and had extensive bilateral cerebral white matter lesions diagnosed by brain MRI. Complete recovery from the left hemiplegia followed the use of corticosteroid, and her brain MRI findings also improved after medication. Early in the clinical course it was difficult to differentiate between multiple sclerosis and granulomatous angiitis of the CNS. After recovery from the first episode of left hemiplegia and mental dysfunction, she developed acute visual disturbance five months after her first admission. Readmission followed and her retrobulbar neuritis was successfully treated by methylpredonisolone pulse therapy. In summary, she experienced two episodes of neurological deficit, had left hemiplegia and mental dysfunction associated with multiple lesions in bilateral cerebral white matter in brain MRI, and the left retrobulbar neuritis with delay of P100 by visual evoked potential study. Due to these two episodes we concluded that she had multiple sclerosis. Though the initial diagnosis was difficult, prompt treatment and close follow‐up was important, since multiple sclerosis and granulomatous angiitis of the CNS can both recur.
Aberrant judgmental pattern of schizophrenic patients in weight discrimination
Authors: Tanno Yoshihiko , Shiihara Yasufumi , Machiyama Yukiteru
Published: March 2003

Sixteen chronic schizophrenics and 16 normal controls were tested on a weight discrimination task in various categories and hand conditions. Schizophrenics made significantly more errors than normals when the ‘equal’ category was included, whereas schizophrenics’ performance could approximate the normals’ discriminations when the ‘equal’ category was excluded. In the former condition, the more inaccurate performance of schizophrenics was ascribed to the selective increase in the errors by the ‘equal’ judgments, which was not due to an increase in ‘doubtful’ judgments. These findings were assumed to reflect schizophrenics’ preference to equal judgments, which seemed to be their fundamental cognitive attitude, because the same tendency was found on the various discrimination tasks of other sensory modalities. Furthermore, the present results supported neither left hemisphere dysfunction nor interhemispheric transfer deficit in schizophrenia, because schizophrenics failed to show consistently more errors in the right hand and the bimanual conditions.
Suicidal thoughts in cancer patients: Clinical experience in psycho‐oncology
Authors: Akechi Tatsuo , Kugaya Akira , Okamura Hitoshi , Nakano Tomohito , Okuyama Toru , Mikami Ichiro , Shima Yasuo , Yamawaki Shigeto , Uchitomi Yosuke
Published: March 2003

Because cancer is a life‐threatening illness, its impact on the patient’s emotional well‐being, such as suicidal thoughts, has become a significant problem in public health as well as in clinical oncology. Factors such as the pain and hopelessness are suggested as making cancer patients more vulnerable to suicide. On the other hand, euthanasia and physician‐assisted suicide are now important medical and social issues all over the world. However, little is known about the relationship between the characteristics of cancer patients and suicidal thoughts. The present study investigated the characteristics of patients who were referred to the Psychiatry Division, National Cancer Center Hospital East, due to risk of suicide or suicide attempts. Fourteen patients were referred, representing 3.9% of all consultations. Most of these patients suffered from advanced cancer and poor physical functioning. The most frequent psychiatric diagnosis was mood disorder (57%), and the next was delirium (29%). In patients with mood disorders (8 cases), suicidal thoughts disappeared after psychiatric treatment in 5 cases, but not in 3 cases. Those three patients survived a significantly shorter time than the others after psychiatric consultation. These empirical data might indicate that most suicidal thoughts experienced by cancer patients are not rational, and a careful evaluation, including psychiatric assessment, should be conducted in such patients.
Prevalence and symptomatology of comorbid obsessive–compulsive disorder among bulimic patients
Authors: Matsunaga Hisato , Kiriike Nobuo , Miyata Akira , Iwasaki Yoko , Matsui Tokuzo , Fujimoto Kayo , Kasai Shinji , Kaye Walter H. , Kaye Walter H.
Published: March 2003

This study sought to assess the prevalence and symptomatology of comorbid obsessive– compulsive disorder (OCD) among Japanese subjects who met the DSM‐III‐R criteria for bulimia nervosa (BN). The Structured Clinical Interview for DSM‐III‐R Patient Version was used to distinguish 26 BN patients with concurrent OCD from 52 BN patients without OCD. Obsessive–compulsive symptoms in BN subjects with concurrent OCD were evaluated using the Japanese version of the Yale‐Brown Obsessive–Compulsive Scale. There were no differences in the prevalence of concurrent OCD between BN subjects with and without a lifetime history of anorexia nervosa. Among BN subjects with concurrent OCD, symptoms related to symmetry and order were most frequently identified, followed by contamination and aggressive obsessions, and checking and cleaning/washing compulsions. Bulimia nervosa subjects with concurrent OCD were more likely than subjects without OCD to have more severe mood and core eating disorder psychopathology. Comorbid OCD is a common phenomenon in Japanese bulimics (33%) similar to that suggested in BN subjects in the Western countries. Obsessive– compulsive symptoms related to symmetry and order were most frequently observed in BN subjects with concurrent OCD, which was a similar finding to that reported among restricting anorexic subjects.
Correlation dimension of the human sleep electroencephalogram
Authors: Kobayashi Toshio , Misaki Kiwamu , Nakagawa Hiroki , Madokoro Shigeki , Ota Tadaaki , Ihara Hisataka , Tsuda Kyoko , Umezawa Yumiko , Murayama Jyunichi , Isaki Kiminori
Published: March 2003

Sleep electroencephalogram (EEG) was analyzed by nonlinear analysis. Polysomnography of a healthy male subject was analyzed and the correlation dimension was calculated. The mean correlation dimensions decreased from stage ‘awake’ to stages 1, 2 and 3, and increased during rapid eye movement (REM) sleep. These results were also seen at every sleep cycle. During each sleep cycle the correlation dimensions decreased for slow wave sleep, then increased for REM sleep. The mean correlation dimension of the sleep EEG in the second half of the night was significantly higher than those in the first half of the night. A significant change was seen both during REM sleep as well as in sleep stage 2. Nonlinear analysis may be a useful method in the analysis of the entire sleep electroencephalogram.
The central mechanism of hypothalamic–pituitary– adrenocortical system hyperfunction in depressed patients
Authors: Jiang Hann‐Kuang , Wang Jia‐Yi , Lin Jiann‐Chyun
Published: March 2003

While hypercortisolemia is commonly observed in depression, exactly where in the hypothalamic–pituitary–adrenocortical (H–P–A) axis this dysfunction arises remains undefined. In attempting to distinguish between central or peripheral locus of dysfunction, we studied in 12 patients (10 females, two males) with primary major depression and eight age‐matched controls (six females, two males) in their adrenal cortisol response to infused adrenocorticotropic hormone (ACTH) (cosyntropin 0.05 μg/kg bodyweight) while endogenous ACTH was suppressed with 1 mg of dexamethasone. Compared with the control group, pre‐dexamethasone plasma baseline cortisol level was significantly higher in depressed patients while ACTH level remained normal. Post‐dexamethasone responses of both hormones were greatly non‐suppressed in the depressed group. Exogenous cosyntropin‐elicited rise in plasma cortisol was significantly lower in depressed patients while the ACTH response was not significantly different. These findings suggest that an adrenal cortisol response to ACTH was significantly decreased during depression as compared with normals in Chinese depressed patients. Therefore, the central mechanism of hyperfunctioning H–P–A axis causing hypercortisolemia should be emphasized.
Reliability of clinical judgment of patients’ competency to give informed consent: A case vignette study
Authors: Kitamura Toshinori , Kitamura Fusako
Published: March 2003

The competency of psychiatric patients to give informed consent is important in respecting patients’ decisions as well as protecting patients from undue exploitation. A total of 176 members of the Japanese Society of Psychiatry and Neurology gave a clinical judgment in a questionnaire of competency in five case transcriptions. Their interrater reliability of competency judgment was slight (generalized kappa 0.31). Clinicians’ global judgment of patients’ competency was not reliable, but it may be improved by the use of a structured interview.
Prevalences of periodic limb movement‐like and restless legs‐like symptoms among Japanese adults
Authors: Kageyama Takayuki , Kabuto Michinori , Nitta Hiroshi , Kurokawa Yoshika , Taira Kazuhiko , Suzuki Shosuke , Takemoto Tai‐Ichiro
Published: March 2003

Prevalences of periodic limb movement‐like and restless legs‐like symptoms among Japanese adults were investigated. The latter symptom was significantly associated with insomnia.
Sleep stage transition and changes in autonomic function in newborn infants
Authors: Goto Kazuya , Sato Keisuke , Izumi Tatsuro
Published: March 2003

The relationships between sleep stage, startle response, electroencephalogram (EEG) pattern, and autonomic function in sleeping full‐term infants was examined. Using autoregressive analysis of heart rate variability (HRV), 12 infants at a mean post‐conception age of 41.1 weeks were studied. Based on HRV characteristics, the present study shows sympathetic nervous system activation during active sleep (AS) and distinct changes in autonomic function based on the startle response and EEG features during quiet sleep (QS). The findings might reflect structural and functional maturation of the central nervous system of newborn infants.
Effects of bright light on cognitive and sleep–wake (circadian) rhythm disturbances in Alzheimer‐type dementia
Authors: Yamadera Hiroshi , Ito Takao , Suzuki Hideaki , Asayama Kentaro , Ito Ritsuko , Endo Shunkichi
Published: March 2003

Twenty‐seven patients with Alzheimer‐type dementia (ATD) were treated with bright light therapy in the morning for four consecutive weeks. The cognitive state of each patient was evaluated with the Mini‐Mental‐State Examination (MMSE) and circadian rhythm with actigram before and after therapy for all of the patients and those of two groups divided by the severity criteria of the Clinical Dementia Rating. The therapy improved the circadian rhythm disturbances. Although the therapy caused no remarkable effects on dementia severity, it improved the MMSE scores, especially in the early stages of ATD. These results suggest that bright light therapy improved the circadian rhythm disturbances and then bettered the cognitive state in early‐stage ATD.
Predisposing factors in delayed sleep phase syndrome
Authors: Takahashi Yasuro , Hohjoh Hirohiko , Matsuura Keiko
Published: March 2003

We classified 64 patients with chronic delayed sleep phase syndrome (DSPS) into the primary (n = 53) and secondary (n = 11) group according to presence or absence of such signs as difficulty in waking up which appeared much earlier than the onset of DSPS. The age at the onset of the early signs concentrated in adolescence. The familial occurrence of DSPS was noted in 11 patients of the primary group. In human leukocyte antigen (HLA) typing, the incidence of DR1 positivity alone was significantly higher in DSPS patients than in healthy subjects. Minnesota Multiphasic Personality Inventory revealed high scores on depression, psychoasthenia and hypochondriasis. We suggest that a predisposition to DSPS includes biological, genetic, social and psychological factors, various combinations of which may lead to DSPS.
Melatonin treatment for circadian rhythm sleep disorders
Authors: Kamei Yuichi , Hayakawa Tatsuro , Urata Jujiro , Uchiyama Makoto , Shibui Kayo , Kim Keiko , Kudo Yoshihisa , Okawa Masako
Published: March 2003

Abstract This study investigated the effects of melatonin administration on circadian rhythm sleep disorders, and aimed to clarify clinical characteristics of melatonin responders. The subjects were 46 patients with circadian rhythm sleep disorders: 30 Delayed Sleep Phase Syndrome (DSPS) and 16 non‐24 h sleep–wake syndrome (non‐24). Patients took 0.3–1.0 mg of melatonin 5, 3 and 1 h before habitual bedtime. Seventeen patients responded to melatonin (12 DSPS, five non‐24). Comparison of clinical background between responders and non‐responders revealed that the responders were characterized by short total sleep time and later onset age of clinical symptoms.
Is the delayed sleep phase syndrome a physical or psychological disease? A case report of disappearance following a change of latitude
Authors: Gottesmann Claude
Published: March 2003

Abstract The delayed sleep phase syndrome is characterized by an abnormally late sleeping and arousal time. Among several available treatments, chronotherapy, light therapy and melatonin administration strongly suggest a frequently recurring disturbance of the brain's circadian clock. However, several studies show psychological disturbances, which are either potentially a consequence or a cause or only fortuitously associated. The first case of disappearance of the disturbance after a move to a tropical latitude does not determine the main responsible factor.
P300 abnormalities in patients with severe sleep apnea syndrome
Authors: Inoue Yuichi , Nanba Kazuyoshi , Kojima Kazushige , Mitani Hideaki , Arai And Heii
Published: March 2003

We investigated the mechanism of abnormal P300 findings in the patients with severe sleep apnea syndrome (SAS). Compared with controls, SAS patients showed significantly longer latency of P300. Not the mean sleep latency in multiple sleep latency test but the percentage of total periods in which percentage desaturation time fell below 90% to total sleep time correlated with P300 latency in the patients. During nasal CPAP treatment, P300 latency was significantly shortened in the patients under 45 years, while the elderly patients did not show statistical change. We speculated that P300 latencies might be prolonged due to nocturnal hypoxia with SAS and the abnormality might be irreversible, especially in elderly patients.
Visual event‐related potential in mild dementia of the Alzheimer's type
Authors: Saito Hidemitsu , Yamazaki Hideki , Matsuoka Hiroo , Matsumoto Kazunori , Numachi Yohtaro , Yoshida Sumiko , Ueno Takashi , Sato Mitsumoto
Published: March 2003

Abstract Visual event‐related potentials (ERP) and behavioral measures were recorded during a geometrical‐figure discrimination task to examine sensory processing in 10 patients with mild dementia of the Alzheimer's type (DAT) and 10 age‐matched controls. No difference existed between the groups in P1, N1, and P2 potentials, which reflects the early stage of sensory processing, as well as in NA potential, which reflects pattern recognition. The patients showed reduced amplitude of P3 potential, retarded reaction time, and increased behavioral errors compared to controls. These findings suggest that the patients with mild DAT were intact in early sensory processing including pattern recognition but were selectively compromised in higher‐level processing, including integration of information and memory matching, which may influence behavioral deviation.
Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia
Authors: Kitabayashi Yurinosuke , Ueda Hideki , Narumoto Jin , Nakamura Kaeko , Kita Hitoshi , Fukui Kenji
Published: March 2003

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.
Reliability and validity of the General Health Questionnaire (GHQ‐12) among urological patients: A Malaysian study
Authors: Quek Kia Fatt , Low Wah Yun , Razack Azad Hassan , Loh Chit Sin
Published: March 2003

Abstract This present study was undertaken to validate the English version of the General Health Questionnaire (GHQ‐12) in urological patients. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test–retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre‐intervention versus post‐intervention score in additional patients with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items with Cronbach's alpha value of 0.37–0.79, while total scores was 0.79 in the population study. Test–retest correlation coefficient for the 12 items score were highly significant. Intraclass correlation coefficient was high (0.35–0.79). It showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post‐treatment scores were observed across all 12 items in the treatment cohort but not in the control group. The GHQ‐12 is suitable, reliable, valid and sensitive to clinical change in urological disorders.
School refusal and depression with school inattendance in children and adolescents: Comparative assessment between the Children’s Depression Inventory and somatic complaints
Authors: Honjo Shuji , Nishide Takanori , Niwa Sachiko , Sasaki Yasuko , Kaneko Hitoshi , Inoko Kayo , Nishide Yumie
Published: March 2003

Abstract School refusal has become a relatively common problem of increasing magnitude in Japan. Although clarification of the relationship between ‘school refusal’ and ‘depression with school inattendance’ is crucial in light of the difference in treatment modalities involved, it is not clear whether the two are to be regarded along the same tangent or as disparate entities. For clarification, a comparison was made between clinical diagnosis, Children’s Depression Inventory (CDI) scores, and scores for the three subordinate scales of the CDI in 34 cases of school refusal, 10 cases of depression with school inattendance, and normal students. Significant difference in CDI score was noted between the three groups: highest among depression cases, followed by school refusers, and lowest in normal students. A larger proportion of school refusers expressed somatic complaints together with low CDI scores. The typical case of school refusal appears to exhibit somatic complaints in the foreground rather than depression, both clinical characteristics and CDI scores indicate school refusal and depression to be separate entities. Although many approaches are being taken in the treatment of school refusal, the results appear to justify primacy of the psychotherapeutic approach with the possible adjuvant use of pharmacological agents, for the phenomenon as it presents in Japan.
Subcortical overactivation in untreated schizophrenic patients: A functional magnetic resonance image finger‐tapping study
Authors: Müller Jürgen L , Röder Christian , Schuierer Gerhardt , Klein Helmfried E
Published: March 2003

Abstract Functional magnetic resonance imaging (fMRI) is a well established, non‐invasive
technique for mapping the working brain. Yet imaging of subcortical regions has proven
to be difficult. We studied 40 subjects performing an unilateral self‐paced finger‐tapping
task. Patients with schizophrenia according to DSM‐IV treated with olanzapine (n
= 10) or haloperidol (n = 10) were compared to healthy controls (n
= 10) and untreated patients (n = 10). Brainvoyager software was used for
data‐analyzing. All subjects showed highly significant activation in the contralateral
sensorimotor area, the supplementary motor area and the ipsilateral cerebellum. In
every investigated subject contralateral subcortical regions were also significantly
activated (P < 0.001). Activation in ipsilateral pallidum was significantly higher in untreated patients compared with the other groups indicating an increase in subcortical coactivation. In addition, significant correlations were revealed within groups. This study emphasizes the possibility of investigating subcortical brain activation in patients with schizophrenia. The results of the present study outline the importance of further fMRI studies to investigate interindividual activation differences under different conditions especially focusing on basal ganglia.
Pulmonary hypertension in patients with severe obstructive sleep apnea
Authors: YAMAKAWA HIROKI , SHIOMI TOSHIAKI , SASANABE RYUUJIROU , HASEGAWA RIKA , OOTAKE KAZUO , BANNO KATSUHISA , WAKAYAMA HIDEO , KATADA MASAKO , KOBAYASHI TADASHI
Published: March 2003

Abstract Thirty‐seven patients (35 men and two women) with obstructive sleep apnea–hypopnea syndrome (OSAHS) without any known cardiovascular and lung diseases were examined by Doppler echocardiography. Eight of the 37 (21.6%) patients experienced daytime pulmonary hypertension (PH), and all of them had severe OSAHS with an apnea–hypopnea index of > 30. The study suggested that one‐third of patients with severe OSAHS had daytime PH.
Routine evening naps and night‐time sleep patterns in junior high and high school students
Authors: FUKUDA KAZUHIKO , ISHIHARA KANEYOSHI
Published: March 2003

Abstract This study investigated the relationship between napping and night‐time sleep patterns in junior high and high school students. A questionnaire concerning sleep‐related lifestyle was given to about 10 000 junior high and high school students. Approximately 50% of the junior high and high school students take at least one nap per week. More than 30% of students take naps later than 17.00 hours. The late naps delayed students’ bedtime; that is, onset of night‐time sleep. The bedtime of students of university‐bound high schools was later than that of students of vocation‐bound high schools. The more frequently students took naps, the later they went to bed. Frequent late naps delayed bedtime and, hence, shortened the length of night‐time sleep.
Evaluation of new monoclonal anti‐MyoD1 and anti‐myogenin antibodies for the diagnosis of rhabdomyosarcoma
Authors: Cui Shunjin , Hano Hiroshi , Harada Tohru , Takai Shigeharu , Masui Fumiaki , Ushigome Shinichiro
Published: March 2003

New monoclonal anti‐MyoD1 and anti‐myogenin antibodies were evaluated immunohistochemically to determine whether they are useful in discriminating rhabdomyosarcoma (RMS) from other soft tissue tumors in routinely processed sections. Neither MyoD1 nor myogenin was expressed in normal, mature striated muscle. In RMS, nuclear expression of MyoD1 and myogenin was found in 82 and 80% of non‐overlapping cases, respectively. MyoD1 was generally expressed in small, primitive tumor cells, and larger cells exhibiting morphological evidence of skeletal muscle differentiation failed to express positive nuclear immunostaining. Positive nuclear staining for myogenin was stronger than that for MyoD1 in cases with abundant differentiated tumor cells, but was less prominent in cases in which small, primitive tumor cells predominated. No leiomyosarcomas, Ewing’s sarcomas/peripheral primitive neuroectodermal tumors or other soft tissue tumors exhibited nuclear expression of MyoD1 or myogenin. In conclusion, both anti‐MyoD1 and anti‐myogenin antibodies are useful for diagnosing RMS and for discriminating RMS from other soft tissue tumors.
Expression pattern of a newly recognized protein, LECT2, in hepatocellular carcinoma and its premalignant lesion
Authors: Uchida Toshikazu , Nagai Hisakazu , Gotoh Kenichiro , Kanagawa Hiroshi , Kouyama Harukazu , Kawanishi Teruaki , Mima Satoaki , Yamagoe Satoshii , Suzuki Kazuo
Published: March 2003

Leukocyte cell‐derived chemotoxin 2 (LECT2) is a recently isolated protein and has been shown to be synthesized by human hepatocytes. All hepatocytes show diffuse immunostaining for LECT2 within the cytoplasm. In the present study, an attempt was made to clarify the expression pattern of LECT2 in nine cases of low‐grade malignant hepatocellular carcinoma (LGM‐HCC) and five cases of advanced HCC and 19 cases of premalignant lesion, termed atypical hyperplasia (AH), using the indirect immunoperoxidase technique. Variable spotty to coarsely diffuse staining in the majority of cells, a mixture of positively staining and negatively staining areas, and essentially negative staining was observed within the cellular cytoplasm of AH, LGM‐HCC and advanced HCC, respectively. The expression of LECT2 became weaker with the progression of multistep hepatocarcinogenesis. The data clearly demonstrate that LECT2 becomes essentially negative in full‐blown HCC cells and that the histological distinction between AH and LGM‐HCC is valid. It also seems likely that LECT2 is related to hepatocyte growth.
Determination of estrogen receptor in primary breast cancer using two different monoclonal antibodies, and correlation with its mRNA expression
Authors: Hori Masao , Iwasaki Mariko , Yoshimi Fuyo , Asato Yuji , Itabashi Masayuki
Published: March 2003

Estrogen receptor (ER) protein status was investigated in the MCF‐7 cell line and 70 invasive ductal carcinomas of the breast. This was achieved by immunohistochemical assay (IHA) using two different monoclonal antibodies (ER‐1D5 and AER311), which are able to recognize either the amino or carboxyl terminal. The staining results were assessed in terms of index score, and compared with the ERα mRNA expression, which was determined by reverse transcription–polymerase chain reaction for the positions of exons 5 and 7. MCF‐7 showed similar immunoreactions with both antibodies, and expressed the wild‐type (WT) ER mRNA coexpressing deletions of exons 5 and 7. Although there was a significant difference between the ER‐1D5 and AER311 indices in the tissue samples (20.5 ± 27.2 and 5.7 ± 16.4; P < 0.001), in the majority of cases ER mRNA expression patterns were similar to that of MCF‐7, and WT ER mRNA was expressed in all cases that yielded PCR products. It was concluded that a number of palpable breast cancers lack the carboxyl terminal of the ER protein, regardless of WT ER mRNA expression. These results suggest that the incidence of WT ER mRNA in such cancers is lower than that in the MCF‐7 cell line, or that WT ER is less stable.
Epithelioid hemangioendothelioma with marked liver deformity and secondary Budd–Chiari syndrome: Pathological and radiological correlation
Authors: Hayashi Yoshitake , Inagaki Kenjiro , Hirota Shozo , Yoshikawa Takeshi , Ikawa Hirotsugu
Published: March 2003

A case of malignant epithelioid hemangioendothelioma of the liver in a 48‐year‐old woman with severe portal hypertension and marked deformity of the liver is presented. This woman had a history of mild liver dysfunction since the age of 30 years, and abdominal distention, esophageal varices, splenomegaly and ascites since October 1996. Imaging examinations revealed liver deformity with severe atrophy of the left lobe and the anterior segment of the right lobe. Celiac arteriography showed narrowing and upward deviation of the proper hepatic artery, and occlusion of the left and right anterior hepatic arteries. Since March 1997, hepatic venography showed stenosis in the right hepatic vein truncus. Budd–Chiari syndrome was clinically diagnosed. She died in June 1997. The autopsy disclosed massive tumor embolism in the left and right anterior portal branches, few in the hepatic artery, and occlusion of the left and right anterior hepatic arteries. The extensive tumor embolism resulted in portal hypertension, and atrophy of the left lobe. The anterior segment of the right lobe was probably caused by the occlusion of both the hepatic arteries and the portal veins. The posterior segment of the right lobe, without massive tumor embolism in its portal branch, appeared hypertrophic.
Myoepithelioma of soft tissue
Authors: Sasaguri Takakazu , Tanimoto Akihide , Arima Nobuyuki , Hamada Tetsuo , Hashimoto Hiroshi , Sasaguri Yasuyuki
Published: March 2003

A myoepithelioma occurred in the subcutaneous tissue of the right shoulder of a 28‐year‐old man. The well‐demarcated nodular tumor (3.0 × 2.8 cm) was located in the subcutaneous tissue with no adhesion to the deltoid muscle. The tumor was composed of a fascicular proliferation of spindle cells with variable amounts of stroma and showed areas of sheets of epithelioid cells. In most areas, the tumor cells had uniform nuclei, but pleomorphic epithelioid cells were focally present. Mitotic activity was three per 10 high‐power fields. No ductular structure was found throughout the tumor. Immunohistochemical and ultrastructural studies confirmed the myoepithelial origin of the tumor cells. The occurrence of myoepithelioma in the subcutaneous tissue has been rarely reported. Even though the tumor showed no aggressive behavior on the 2‐year follow‐up, it is still too early to comment definitely on the behav‐ ior of myoepithelioma of the subcutaneous tissue. This case provides further information about soft tissue myoepithelioma.
Juvenile hemangioma (infantile hemangioendothelioma) of the parotid gland associated with cytomegalovirus infection
Authors: Horie Yasushi , Kato Masako
Published: March 2003

A case of parotid juvenile hemangioma associated with cytomegalovirus infection is reported. A growing lobulated mass, measuring 30 × 20 mm, was extirpated from the left parotid gland in a 4‐month‐old male. Histologically, the tumor consisted of cellular plump endothelial cells, stromal cells and residual ductal and acinar elements of the parotid gland. Numerous intranuclear and cytoplasmic inclusions were observed in the ductal cells of the whole parenchymal part of the parotid gland and the residual part of the tumor. Immunohistochemically, some nuclei of the ductal cells possessing these inclusions were positive for the anti‐cytomegalovirus antibody but there were no positive findings in the endothelial or stromal cells. Although the present lesion may suggest that the human cytomegalovirus plays some role in the etiology of juvenile hemangioma, it is unknown whether or not this association is incidental.
Epithelioid hemangioma of the temporal artery clinically mimicking temporal arteritis
Authors: Kitamura Hajime , Kitamura Hitoshi , Ito Susumu , Kuwana Nobumasa , Yutani Chikao
Published: March 2003

A rare case of epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) arising in the right temporal artery of a 68‐year‐old Japanese woman was investigated. The patient had been treated with corticosteroids (Predonine 5 mg/day p.o.) for 4 years for idiopathic thrombocytopenic purpura. Headaches in the right temporal region with repeated high fevers first appeared 1 year prior to the biopsy of a nodule at the artery. The clinical diagnosis was temporal arteritis (giant cell arteritis). The specimen consisted of a short segment of the superior arterial branch having a sheet‐like proliferation of the epithelioid endothelial cells in the lumen, which was almost occluded, focal rupture of the media, and marked proliferation of the capillaries (neovascularization) radiating out from the media to the adventitia. There were scattered foci of inflammatory cell infiltration composed mainly of small lymphocytes in the adventitia, but there were no histological changes suggestive of giant cell arteritis. The lesion was thus characterized by the proliferation of epithelioid endothelial cells in the lumen of the artery, and neovascularization between the media and adventitia. The histological features were very close to epithelioid hemangioma except for the absence of an eosinophilic reaction. The long‐term administration of corticosteroids may have suppressed it. The authors believe this is the first case of epithelioid hemangioma arising from the temporal artery without a history of trauma. It showed some unique features both clinically and histopathologically, which contributed to the study of the yet not clearly classified vascular proliferative lesion, epithelioid hemangioma.
Brunner’s gland metaplasia of residual jejunum developed long after wide resection of the small intestine
Authors: Nakamura Toshitsugu , Shimada Makoto , Nakayama Jun , Katsuyama Tsutomu
Published: March 2003

We report a rare case in which mucous glands, similar to pyloric or Brunner’s glands, developed in the residual jejunum (46 cm in length) long after wide resection of the small intestine. The mucous glands were observed in the mucosal and submucosal layers near the duodenum, and the mucin showed a positive reaction by paradoxical concanavalin A staining and immunoreactivity for HIK‐1083, which were histochemically the same as those in the pyloric/Brunner’s glands. This type of metaplasia in the small intestine without ulceration has not been described in the literature so far. It was speculated that these glands developed as a defense response or adaptation against relatively excessive acid due to the short small intestine.
Overexpression and genetic abnormality of p53 in parathyroid adenomas
Authors: Kishikawa Seigo , Shan Liang , Ogihara Kikumi , Utsunomiya Hirotoshi , Nakamura Misa , Nakamura Yasushi , Naito Akihiro , Kakudo Kennichi
Published: March 2003

To study the significance of p53 abnormality in parathyroid tumors, 32 parathyroid adenomas and 22 hyperplastic glands from 14 cases of secondary hyperparathyroidism were analysed using immunohistochemistry, polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP), single‐strand conformation polymorphism (SSCP) and DNA sequencing. Immunohistochemical study revealed p53 overexpression in four parathyroid adenomas, of which two showed diffuse and one showed focal nuclear pleomorphism. Genetic analysis disclosed allelic loss in one, and a point mutation (R290H) and a polymorphism (L257 L) in another of the two other adenomas with diffuse nuclear pleomorphism. No abnormalities were discovered in the other two adenomas, although one had a R72P polymorphism in exon 4. There was no evidence of malignancy of the four tumors in either clinical or pathological terms. None of the 22 hyperplastic glands showed p53 overexpression. These results demonstrate that p53 abnormality can occur in benign parathyroid adenomas and is more prevalent in those with nuclear pleomorphism than in those without.
Mammary Paget’s disease: Evidence of diverse origin of the disease with a subgroup of Paget’s disease developing from the superficial portion of lactiferous duct and a discontinuous pattern of tumor spread
Authors: Mai Kien T. , Yazdi Hossein M. , Perkins D. Garth
Published: March 2003

The pattern of spread of intraductal carcinoma associated with mammary Paget’s disease has not been well studied. The purpose of this study was to examine the site of origin and the pattern of tumor spread with a three‐dimensional view by serial sectioning of the tissue blocks from 19 cases of Paget’s disease. Intraductal carcinoma in the superficial portion of the lactiferous ducts was seen in continuity with the overlying epidermis with Paget’s disease in all 19 cases. In seven cases that had adequate tissue sampling, five showed a continuous pattern of the intraductal carcinoma within the superficial as well as the deep breast tissue. In the remaining two cases, a portion of benign duct was identified between the intraductal carcinoma in the superficial lactiferous duct and the deep breast tissue. This discontinuous pattern of spread of the intraductal carcinoma was also identified in the foci of carcinoma in deep tissue. In the five cases in which the tumor involved the skin and only the superficial portions of the lactiferous duct, the leading edge of the intraductal carcinoma was seen orientated in the direction of the nipple towards the deep breast tissue. Our study of Paget’s disease demonstrated that in addition to tumor spread along the lactiferous ducts from intraductal carcinoma in the deep tissue towards the nipple, there was a group of Paget’s disease arising from the nipple. These lesions included: (i) lesions limited to the areolar tissue; and (ii) lesions with intraductal carcinoma involving the duct system in both superficial and deep breast tissue with and, possibly, without skip areas pattern of spread. Although certain cases of Paget’s disease may appear superficial, an independent associated carcinoma in deep breast tissue has to be ruled out.
Choline acetyltransferase: The structure, distribution and pathologic changes in the central nervous system
Authors: Oda Yoshio
Published: March 2003

Choline acetyltransferase (ChAT), the enzyme responsible for the biosynthesis of acetylcholine, is presently the most specific indicator for monitoring the functional state of cholinergic neurones in the central and peripheral nervous systems. ChAT is a single‐strand globular protein. The enzyme is synthesized in the perikaryon of cholinergic neurones and transported to the nerve terminals probably by both slow and rapid axoplasmic flows. ChAT exists in at least two forms in cholinergic nerve terminals: (i) soluble; and (ii) non‐ionically membrane‐bound forms. Multiple mRNA species of ChAT (R‐, N‐and M‐types) are transcribed from different promoter regions and produced by different splicing in the mouse, rat, and human. All transcripts encode the same ChAT protein in rodents, while in human M‐type mRNA has the capability to generate both large and small forms of ChAT proteins and R‐and N‐types ChAT mRNA generate a small form, which corresponds to the rodent ChAT. The genomic structure of ChAT is unique compared with other enzymes for neurotransmitters. The first intron of the ChAT gene encompasses the open reading frame encoding another protein, vesicular acetylcholine transporter (VAChT), which is responsible for the transportation of acetylcholine from the cytoplasm into the synaptic vesicles. The expressions of ChAT and VAChT appear to be coordinately regulated by multiple regulatory elements in cholinergic neurones. Immunohistochemical and in situ hybridization studies have revealed the localization of cholinergic neurones in the central nervous system: the medial septal nucleus, the nucleus of the diagonal band of Broca, the basal nucleus of Meynert, the caudate nucleus, the putamen, the nucleus accumbens, the pedunculopontine tegmental nucleus, the laterodorsal tegmental nucleus, the medial habenular nucleus, the parabigeminal nucleus, some cranial nerve nuclei, and the anterior horn of the spinal cord. Focally distributed cholinergic neurones project fibers to many areas in the central nervous system and construct a complicated cholinergic network, playing an important role in neuropsychic activities, such as learning, memory, arousal, sleep and movement. Central cholinergic neurones are involved in several neurodegenerative diseases such as Alzheimer’s disease and amyotrophic lateral sclerosis, in which disturbance of the central cholinergic system does not appear to be closely related to the etiology, but rather to the development of clinical symptoms. In addition, abnormalities of ChAT in the brain have been recently demonstrated in schizophrenia and sudden infant death syndrome.
Idiopathic granulomatous meningoencephalitis presenting as an intracranial tumor
Authors: Amatya Vishwa Jeet , Takeshima Yukio , Sugiyama Kazuhiko , Yokozaki Hiroshi , Inai Kouki
Published: March 2003

A 2‐year‐old girl presented with a single episode of generalized seizure. Magnetic resonance imaging examination showed an intracranial mass with a diameter of 2.5 cm in the right parieto‐occipital region of the cerebrum. These clinicoradiological findings were suggestive of intracranial tumor. Histologically, fibroblastic proliferation of storiform pattern was noted, associated with epithelioid granulomas. The etiological pathogens for the granulomas could not be detected even though investigation of special histochemical staining, immunohistochemical study and DNA analysis of Mycobacterium tuberculosis by polymerase chain reaction technique was performed. On electron microscopic examination, the area appearing as a storiform pattern consisted of fibroblasts showing much dilated rough endoplasmic reticulum and slender tappering cytoplasmic processes without cellular junctional complex. No organisms were identified in the granulomatous area of the lesion. From those findings the diagnosis as idiopathic granulomatous meningoencephalitis was made.