bluuebunny/crossref_metadata_2025 huggingface dataset:
An ethic of the fitting: a conceptual framework for nursing practice
Authors: Tuckett Anthony G.
Published: March 2003

An ethic of the fitting: a conceptual framework for nursing practice

Nurses are expected to act within an ethos of care cognisant of duty, the right, and the good. Concepts of virtue theory, utilitarianism and deontology are used to outline a conceptual ethical framework for nurses in practice. This ‘Moebius’ framework aims to locate the virtues in a symbiotic relationship with the principles of utilitarianism and deontology. Under this framework, fitting ethical responses are sought. Within an ethic of the fitting, rules and principles do not guarantee the most ethically justifiable outcomes. Within the Moebius approach, the nurse ought to respond with a sense of compassion that befits the moment rather than adhere to a rule at all costs.
Phenomenologies as research methodologies for nursing: From philosophy to researching practice
Authors: Lawler Jocalyn
Published: March 2003

This paper is concerned with the popularity of phenomenologies and the tensions that arise from their use as research methodologies in nursing. Among these tensions are: the troublesome issues of adapting a fundamentally philosophical means of understanding human being(s) for use as a more pragmatic and robust research approach in a practice discipline; the various types of phenomenology and the confusions that surround these and other interpretive methodologies, particularly within different intellectual and cultural traditions; and the need for nursing to find a space in which it can give voice to aspects of its practice that are silenced in less existentially oriented methodologies. Although phenomenologies are currently popular and possibly fashionable in nursing, there are important issues in relation to their use in a methodological sense that remain to be addressed.
Medical science, nursing, and the future
Authors: Wiltshire John
Published: March 2003

Drawing on the work of Evelyn Fox Keller, this paper examines the notion of ‘objectivism’ and suggests that medicine as a science is premised upon the denial of common mortality. Alternative models for medicine are then examined, including the ‘romantic science’ of Oliver Sacks, and the paper concludes with a brief discussion of nursing as a key concept in the articulation of a more comprehensive medicine of the future.
Theory and language: locating agency between free will and discursive marionettes
Authors: Hardin Pamela K.
Published: March 2003

Theory and language: locating agency between free will and discursive marionettes

This article outlines a research methodology that embraces individual narratives, yet recognizes that individual narratives are nested within a backdrop of broader social and cultural understandings of who we are and how we come to understand our world. This dialectical move requires an epistemological shift, focusing on the utility of reconceptualizing the ‘environment’, not only as the social, political, or economic conditions in society, but also as language. Reconceptualizing the environment as language makes it epistemologically possible to construct a bridge between varying levels of analysis, namely, between individual accounts and life stories and the cultural, social, and historical worlds from which those accounts emerge.
The conversational and discursive construction of community psychiatric nursing for chronically confused people and their families
Authors: Adams Trevor
Published: March 2003

The conversational and discursive construction of community psychiatric nursing for chronically confused people and their families

The paper examines the conversational and discursive processes that occur within domiciliary visits between community psychiatric nurses (CPNs) and relatives of chronically confused people. Three conversation formats are identified, through which talk between CPNs and carers is organised. In addition, various discursive practices are also identified within domiciliary meetings. The contribution of these conversational and discursive features to the work of CPNs is fully discussed in relation to what they accomplish within the visit. The data comprised 48 paired tape recordings. Of these recordings, 24 were unstructured interviews between CPNs and informal carers to people who had been diagnosed as having dementia by a medical practitioner. In addition, 24 domiciliary meetings between primary informal carers and their CPNs were tape recorded and fully transcribed. The transcripts were analysed using techniques drawn from conversation analysis and discourse analysis. The implications of the findings upon CPN practice are examined.
The oil crisis, risk and evidence‐based practice
Authors: Traynor Michael
Published: March 2003

The oil crisis, risk and evidence‐based practice

Evidence‐based practice has risen to prominence over the last 20 years. Different professions have taken it up in different ways and for different purposes. It has been seen as holding both threats and advantages to professionalising endeavours and professional identity. It has engendered controversy but some criticisms of it have been unconvincing. It is possible to account for its rise as a response to tightening financial constraints on state spending in the west, as a sign of a culture increasingly concerned with risk, distrust of professionals and experts, as well as a way for professionals themselves to maintain control over their activity in the face of growing managerialism. This paper reviews the literature of some of the movement's proponents as well as criticism from various professional groups. It concludes that more useful than either arguing for or against it, is to understand the policy background and sociological reasons for its emergence and spread.
Multiple personality disorder in Japan
Authors: Fujii Yoichiro , Suzuki Kunifumi , Sato Tetsuya , Murakami Yasuhiko , Takahashi Toshihiko
Published: March 2003

The aim of this study was to determine whether the features of multiple personality disorder (MPD) in Japan are similar to those in North America, although a wide disparity exists in the prevalence of MPD between the two areas. In order to describe the features of MPD in Japan, we obtained clinical data from MPD case reports, including two of our own cases, published in Japanese academic journals and compared it with the data from other countries. The cases in Japan differed significantly from those in North America in the mean number of personalities and prevalence of sexual and/or physical abuse.
Tourette syndrome in Japan: A nationwide questionnaire survey of psychiatrists and pediatricians
Authors: KANO YUKIKO , OHTA MASATAKA , NAGAI YOKO
Published: March 2003

In order to shed light on the clinical picture of patients with Tourette syndrome (TS) treated at medical institutions in Japan, a nationwide survey covering both pediatric patients and psychiatric patients was conducted. We mailed 316 questionnaires on experience in treating TS cases and the patients' present conditions etc. to specialists such as psychiatrists and pediatricians. A total of 164 responded. The survey found 154 TS patients being treated at the time of survey, 45 (29.2%) had obsessive–compulsive symptoms (OCS), and 10 (6.5%) had family histories of TS. It was suggested that TS is often associated with OCS and that familial cases of TS are slightly less common in Japan than they are in the USA. Of the 116 respondents who described their experiences, 85 (73.2%) said that they had treated one or more patients displaying the symptoms of frequent coprolalia, and 42 (36.2%) said that they had treated one or more patients suffering from developmental disorders. Based on these findings, we speculated that the rate of coprolalia in Japan is a little higher than the previously reported 4% and that TS is often associated with developmental disorders.
Dipole analysis of epileptic source generator with manual zero potential shifting method
Authors: TANAKA KEI‐ICHI , WADA YUJI , NANBU YUKO , KOSHINO YOSHIFUMI , KUROUME TAKAYOSHI , HASHIMOTO TAKUMA
Published: March 2003

The dipole tracing method is a technique whereby an electric source generator is estimated as an equivalent current dipole (ECD) based on potential distribution on the scalp. To estimate the electric source generator of low amplitude spikes, a manual zero potential shifting (MZPS) method was introduced in which a zero potential is set manually in dipole analysis. The subjects were three patients with localization‐related epilepsy with temporal spikes. When low‐amplitude spikes (<50 μV) were analyzed by the conventional mean zero potential method, the dipolarity, an indicator of ECD reliability, had a low value and its locations were scattered. In contrast, when these low‐amplitude spikes were analyzed by the MZPS method, ECD showed a high dipolarity value comparable to that obtained when high‐amplitude spikes (≥ 50 μV) were analyzed by the mean zero potential method. Furthermore, the locations of the former ECD tended to converge and were almost identical to those of the latter ECD. These findings suggest the usefulness of the MZPS method in dipole analysis in terms of the dipolarity and ECD locations of low‐amplitude spikes.
A case of West syndrome well controlled by very short and low‐dose ACTH therapy
Authors: Kimura Masahiko , Miyamoto Satomi , Sejima Hitoshi , Yamaguchi Seiji
Published: March 2003

The case of a 5‐month‐old boy with tuberous sclerosis and West syndrome is reported. Tonic spasms were noted from the age of 4 months. High‐dose pyridoxal phosphate could not control the seizures completely. Very short and low‐dose adrenocorticotropic hormone (ACTH) therapy (i.e. 0.011 mg/kg per dose, 12 times in 20 days) controlled the seizures, while pyridoxal phosphate was on. Early tapering of ACTH was successfully done while abnormal electroencephalogram (EEG) findings remained. Although side effects such as hypertension and brain shrinkage were transiently observed, both the cognitive and seizure prognoses were excellent at the age of 3 years and 2 months. The good response to a small dosage of ACTH might be due to some responsiveness of the high‐dose pyridoxal phosphate and the underlying cause of tuberous sclerosis with normal development before onset. The present case illustrates that the duration and dosage of ACTH therapy in West syndrome should be modified according to the individual’s requirements.
Efficacy of media in motivating patients with panic disorder to visit specialists
Authors: Kato Tadafumi , Yamanaka Gaku , Kaiya Hisanobu
Published: March 2003

In 97 patients who visited Akasaka Clinic, their chief complaints, the form of media which motivated patients to visit the clinic, and their DSM‐IV diagnoses were examined. The media which most frequently motivated the patients were books (35%), TV programs (23%), and the Internet (16%). While many of patients complained of panic attacks, 74.2% were diagnosed as having anxiety disorder, 12% had somatoform disorder and 8% did not have any mental illness. The rate of panic disorder tended to be higher in patients motivated by TV programs (70%) and significantly lower in those motivated by the reading of books (48%). These results suggest that enlightenment of panic disorder using the media, especially that by TV programs, effectively motivates patients with panic disorder.
Multicenter study on the effects of day care therapy on schizophrenia: A comparison of day care patients with outpatients
Authors: Oka Kozaburo , Maeda Masaharu , Hirano Takayuki , Funahashi Tatsuhide , Yamada Sumio
Published: March 2003

The effects of day care therapy for a period of 6 months upon patients with schizophrenia were studied through comparison with schizophrenia outpatients at four facilities in Japan. The clinical features of the 31 day care patients and 30 outpatients were evaluated by the hospital staff using the Positive and Negative Syndrome Scale (PANSS) and Global Assessment Scale (GAS), and by the patients’ close relatives using the Katz Adjustment Scale (KAS) before and after 6 months of treatment. Day care patients showed a significant decrease in the general pathological score of PANSS and GAS, but outpatients did not show any comparable improvement. As for KAS scores, similar improvement was observed for both the day care patients and outpatients. After 6 months, 43% of the day care patients improved on the post‐/pre‐ PANSS total scores ratio, as against only 13% of the outpatients. In addition, 13% of the outpatients were readmitted due to an exacerbation of their symptoms, whereas all day care patients were able to remain at home for 6 months. This study clearly demonstrated that day care therapy for patients with schizophrenia was more effective than the usual outpatients treatment setting. Further therapeutic efforts (e.g. psycho‐education) in day care therapy are needed in order to improve family member’s evaluation of the patient.
Add‐on polytherapy with antidepressants and its significance in inpatients with major depression
Authors: Wada Ken , Yamada Norihito , Hamamura Takashi , Suzuki Hiroshi , Nakano Yoshiyuki , Kuroda Shigetoshi
Published: March 2003

Add‐on polytherapy with antidepressant agents was reviewed in 42 inpatients with major depression diagnosed according to the ICD‐10 criteria. Twenty‐eight (67.7%) patients were treated with two or more antidepressants. The most frequent combination consisted of a tricyclic antidepressant and a non‐tricyclic antidepressant. Nineteen (67.8%) patients of the polytherapy group were treated with a dosage equivalent to 150 mg/day of tricyclic antidepressant. Clinically, not every patient with major depression can tolerate the adverse side effects induced by an effective dose of a single tricyclic antidepressant. From this viewpoint, add‐on polytherapy with antidepressants could be one of the treatment options, especially for such intolerant patients.
Cultural difference in recognition of facial emotional expression: Contrast between Japanese and American raters
Authors: Shioiri Toshiki , Someya Toshiyuki , Helmeste Daiga , Wa Tang Siu
Published: March 2003

Using the Japanese and Caucasian Facial Expressions of Emotion (JACFEE) photo set, the relationship between recognition and intensity ratings of universal facial expressions of emotions in 123 Japanese undergraduate students was examined and compared with data reported by American raters. In Japanese raters, although the intensity was rated as high for some of the poses, their correctness scores were poor, suggesting a serious misjudgment of the intended emotions as defined in the JACFEE photo set. Only in Japanese raters were significant relationships between the intensity scores and the percentage correctness scores for sadness detected (r = 0.97, P < 0.0001), but no significant relationship was observed for other emotions. The robust correlation suggests the possibility that Japanese raters might be more responsive to certain emotional expressions when they are fully or intensely expressed. It is proposed that the facial emotional expression paradigm cannot be applied to the psychiatric setting without first refining for cultural differences.
Hyperperfusion in the lateral temporal cortex, the striatum and the thalamus during complex visual hallucinations: Single photon emission computed tomography findings in patients with Charles Bonnet Syndrome
Authors: Adachi Naoto , Watanabe Tsuyoshi , Matsuda Hiroshi , Onuma Teiichi
Published: March 2003

We report the findings of single photon emission computed tomography using 123I‐IMP and magnetic resonance image studies of five patients with Charles Bonnet syndrome (CBS) while they were having visual hallucinations. All patients developed complex visual hallucinations after suffering from eye disease. The mean age at onset of CBS was 71.6 years. Single photon emission computed tomography studies in all patients disclosed hyperperfusion areas with some asymmetrical appearances in the lateral temporal cortex, striatum and thalamus. These results suggest that when elderly people suffer from eye disease, subsequent excessive cortical compensation in the lateral temporal cortex, striatum and thalamus may precipitate the development of visual hallucinations.
Differences in electroencephalogram power densities between genuine narcolepsy and secondary narcolepsy
Authors: Honma Hiroshi , Kohsaka Masako , Fukuda Noriko , Kobayashi Riko , Sakakibara Satoshi , Koyama Tsukasa
Published: March 2003

Diagnosing narcolepsy is not always simple. Some patients secondarily show narcoleptic tetrad through irregular sleep patterns or psychotic diseases. The power densities of daytime electroencephalograms in genuine narcolepsy and secondary narcolepsy were analysed and compared. Electroencephalogram power densities for a 6.5‐h period after waking in genuine narcoleptic patients were lower than those of secondary narcoleptic patients in the 11.0–12.5 Hz bands. Arousal levels may be lower in genuine narcoleptic patients than in secondary narcoleptic patients. Spectral analysis may be useful in clarifying differences between the two groups.
Case of a non‐24 h sleep–wake syndrome patient improved by phototherapy
Authors: Watanabe Tsuyoshi , Kajimura Naofumi , Kato Masaaki , Sekimoto Masanori , Hori Toru , Takahashi Kiyohisa
Published: March 2003

Polysomnography (PSG) and body temperature were examined in a patient with non‐24 h sleep–wake syndrome who responded to phototherapy. The patient was a 17‐year‐old male who had been suffering from a free‐running sleep–wake rhythm for 2 months. Phototherapy was administered to the patient while he was admitted to our hospital. This treatment immediately changed the free‐running sleep–wake and body temperature rhythm of the patient to the environmental 24‐h rhythm. On a polysomnography, total sleep time and stages 1 and 2 and REM sleep were decreased, and percentage stage 3 + 4 was increased by phototherapy. The time of minimum body temperature (mBT) was located at the latter half of the sleep phase through the clinical course of the patient.
Effects of phototherapy on the phase relationship between sleep and body temperature rhythm in a delayed sleep phase syndrome case
Authors: Hori Toru , Watanabe Tsuyoshi , Kajimura Naofumi , Kato Masaaki , Sekimoto Masanori , Takahashi Kiyohisa
Published: March 2003

We examined polysomnography (PSG) and body temperature of a patient with delayed sleep phase syndrome (DSPS) who was successfully treated with only phototherapy. This case showed a possible improvement of the phase relationship between sleep and body temperature rhythm given that the time of minimum body temperature (mBT) shifted to the latter portion of the sleep phase after constant phototherapy.
Neuronal loss and neurofibrillary degeneration in the hippocampal cortex in late‐onset sporadic Alzheimer's disease
Authors: Fukutani Yuken , Cairns Nigel J , Shiozawa Masaki , Sasaki Kazuo , Sudo Satoru , Isaki Kiminori , Lantos Peter L
Published: March 2003

Abstract To explore more fully the relationship between neuronal death and neurofibrillary degeneration, unaffected neurons, intracellular neurofibrillary tangles (i‐NFT) and extracellular NFT (e‐NFT) in 22 patients with late‐onset sporadic Alzheimer's disease (AD) were morphometrically evaluated in eight subdivisions of the hippocampal cortex, using the Gallyas hematoxylin‐eosin stain. The subdivisions examined included CA4, CA3, CA2, CA1 (CA: cornu ammonis), prosubiculum (PRO), subiculum and presubiculum (PRE), parasubiculum (PARA) and the entorhinal cortex (ENT). The unaffected neuron density was significantly lower and both i‐NFT and e‐NFT densities were significantly higher in subdivisions other than CA4 and CA3 in AD patients compared with those in the aged controls. Unaffected neuron density was significantly, inversely correlated with e‐NFT density and with total NFT density in all subdivisions except for PRE in AD patients. Especially in CA2, CA1, PRO and ENT, there were strong correlations between the neuron density and these NFT densities. Both unaffected neuron and e‐NFT densities in CA1 and ENT were significantly correlated with the disease duration. The i/e‐NFT ratio, an index of the degree and/or rate of progress of neuronal death via neurofibrillary degeneration, showed the lowest value in ENT in AD patients. The findings suggest that neuronal death via neurofibrillary degeneration starts earliest and/or most rapidly progresses in ENT. Furthermore, the i/e‐NFT ratios in both ENT and CA1 were significantly correlated with the disease duration, suggesting that the neuronal death pattern in the two subdivisions parallels disease progression.
Relationship between EEG dimensional complexity and neuropsychological findings in Alzheimer's disease
Authors: Ikawa Makoto , Nakanishi Masao , Furukawa Toshiaki , Nakaaki Shutaro , Hori Shiro , Yoshida Shinichi
Published: March 2003

Abstract The aim of the present study was to examine the region‐specific correlations between electroencephalography (EEG) dimensional complexity (DC), a measure of non‐linear dynamics, and neuropsychological performance in 25 right‐handed patients with Alzheimer's disease (AD). Electroencephalography recording sites were according to the international 10–20 system. Neuropsychological tests included Wechelor Adult Intelligence Scale‐Revised (WAIS‐R) (Full‐scale Intelligence Quotient (FIQ), Verbal Intelligence Quotient (VIQ), Performance Intelligent Quotient (PIQ)); Mini‐Mental State Examination; Raven's Coloured Progressive Matrices (RCPM); Rey Auditory–Verbal Learning Test (RAVLT); seven word pairs‐revised Miyake Paired‐Associate Word Learning Test; Benton Visual Retention Test; and Rey Complex Figure Test. A partial correlational analysis was carried out, controlling for age and sex (P < 0.005). The FIQ, VIQ and RCPM scores were found to be significantly correlated with DC at the F3, C3 and T3 electrodes. Significant correlations were also found between RAVLT scores and DC at the C3, P3 and T5 electrodes. The study on AD indicated region‐specific correlations between DC and neuropsychological performance: one between the DC value in the left frontal, central and mid‐temporal areas and intellectual function; and another between the DC value in the left central, parietal and post‐temporal areas and verbal memory. Dimensional complexity would therefore seem to be a useful indicator for the assessment of neuropsychological deficits in AD.
The Japanese version of the Barratt Impulsiveness Scale, 11th version (BIS‐11): Its reliability and validity
Authors: Someya Toshiyuki , Sakado Kaoru , Seki Tetsuya , Kojima Maki , Reist Chris , Tang Siu Wa , Takahashi Saburo
Published: March 2003

Abstract No instrument for assessing impulsiveness has been developed in Japan. After translating the Barratt Impulsiveness Scale 11th version (BIS‐11) into Japanese, we investigated reliability and validity in student (n = 34) and worker (n = 416) samples. To assess test–retest reliability, the intraclass coefficient between test and retest was calculated in the student sample. Internal consistency was examined by calculating Cronbach's alpha in the worker sample. To see factor validity, we examined by confirmatory factor analysis whether the three‐factor model, proposed by a previous report, fit the data. The results showed that the Japanese version of the BIS‐11 had excellent test–retest reliability and acceptable internal consistency reliability. In addition, the Japanese version was judged to have similar factor structure to the original one. The Japanese version of the BIS‐11 is a reliable and valid measure and has possible utility for assessing impulsiveness.
Postexercise facilitation appears durable in normal subjects
Authors: Pridmore Saxby , Bruno Raimondo , Turnier‐Shea Yvonne , Rybak Marzena , Reid Phil
Published: March 2003

Abstract Transcranial magnetic stimulation (TMS) was used to study the postexercise facilitation of 11 normal subjects on eight occasions. Between individuals, there was almost a sixfold difference in facilitation. The greatest positive percentage change for any individual was 61%, and the greatest negative percentage change was 51%. The results suggest that facilitation is a durable individual characteristic of normal subjects. Serial studies may therefore be indicated in monitoring individuals suffering relapsing conditions.
Outcome of severe anorexia nervosa patients receiving inpatient treatment in Japan: An 8‐year follow‐up study
Authors: Tanaka Hideki , Kiriike Nobuo , Nagata Toshihiko , Riku Keisen
Published: March 2003

Abstract Sixty‐one subjects with anorexia nervosa (AN) were followed for a minimum of 4 years after discharge (mean 8.3 years). They were evaluated using the Morgan‐Russell Outcome Assessment Scale. Thirty‐one (51%) were categorized as having good outcome, eight (13%) as intermediate, 15 (25%) as poor, and seven (11%) had died. As predictors of outcome, later onset (after 20 years of age) and low minimum body mass index were associated with poor prognosis. The outcome of AN in Japan is relatively similar to those in Western countries, irrespective of different sociocultural backgrounds and health systems.
Acute pancreatic damage associated with convulsive status epilepticus: A report of three cases
Authors: Ogawa Katsuhiko , Kanemoto Kosuke , Shirasaka Yukiyoshi , Kawasaki Jun , Yamasaki Shousaku
Published: March 2003

Abstract Three cases involving a previously unreported association of acute pancreatic damage following convulsive status epilepticus (SE) are presented. A review of literature failed to reveal a similar association between SE and acute pancreatic damage. As possible pathophysiological mechanisms of this so far unknown sequel of SE, increased intraduodenal pressure during SE leading to the reflux of the duodenal contents into the pancreatic duct, along with altered metabolism of oxygen‐derived free radicals during a prolonged seizure with hypoxia and ischemia resulting in acinar cell injury are suggested. We believe that SE should be considered as an additional risk factor of acute pancreatitis and that pancreatic enzymes should be monitored in patients who have prolonged seizures.
Characteristics of postictal psychosis in a psychiatric center
Authors: Liu Hsing‐Cheng , Chen Chin‐Hung , Yeh I‐Jin , Sung And Sing‐Ming
Published: March 2003

Abstract The clinical characteristics of 12 cases of postictal psychosis treated at Taipei City Psychiatric Center, Taipei, Taiwan, were retrospectively reviewed. Increased seizure frequency, especially with generalized tonic–clonic seizures, was the major risk factor predisposing to postictal psychosis. The psychotic symptoms were variable with delusions and/or hallucinations. These patients showed a much longer history of epilepsy (21.9 ± 10.7 years) prior to the development of postictal psychosis than has been previously reported. The possible mechanisms in the pathophysiology of psychosis in epileptics were discussed.
Frustration and fulfillment of needs in dissociative and conversion disorders
Authors: ISHIKURA REIJI , TASHIRO NOBUTADA
Published: March 2003

AbstractWe reviewed all patients with dissociative disorders (nine patients with dissociative amnesia or dissociative fugue) and conversion disorders (10 patients) who were admitted and treated during the past 15 years. Needs frustrated at the appearance of the symptoms and those fulfilled at discharge were studied in both groups using Maslow's hierarchy of needs. The patients of both groups who encountered troubles in their life events were found to have frustrated needs. These symptoms tended to be accompanied more often by frustrations regarding a ‘need for love’ in the dissociative disorders group and by frustration in the need for ‘self‐esteem and self‐actualization’ in the conversion disorders group. In addition, needs of lower orders were already threatened at onset in many patients. The symptoms disappeared in patients in whom the situation completely improved (needs were fulfilled), but the symptoms were alleviated or unchanged in those in whom the problems remained unresolved.
Efficacy of day care treatment against readmission in patients with schizophrenia: A comparison between out‐patients with and without day care treatment
Authors: YOSHIMASU KOUICHI , KIYOHARA CHIKAKO , OHKUMA KAZUTAKA
Published: March 2003

Abstract The present study examined the efficacy of day care (DC) treatment against readmission to a mental hospital. Subjects were 65 out‐patients with chronic schizophrenia after discharge. Day care treatment was defined as positive if patients were under DC treatment constantly for 4 months or more with a frequency of at least one visit per week. Information regarding demographic and disease‐related factors was obtained from medical records at the time of discharge. Logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) with adjustment for confounding variables. The modestly preventive efficacy of DC treatment against readmission was observed within 2 years after discharge (adjusted OR 0.52; 95% CI 0.12–2.35). The present findings suggest that DC treatment may be preventive against readmission for schizophrenic out‐patients.
Reliability and validity of the Turkish version of the adolescent dissociative experiences scale
Authors: ZOROGLU SULEYMAN SALIH , SAR VEDAT , TUZUN UMRAN , TUTKUN HAMDI , SAVAS HALUK ASUMAN
Published: March 2003

The Adolescent Dissociative Experiences Scale (A‐DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A‐DES. The Turkish version of the A‐DES was administered to 20 patients with a dissociative disorder, 24 patients with post‐traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit–hyperactivity disorder (ADHD), and 201 non‐clinical participants. The internal consistency and the test–retest correlation of the A‐DES were excellent. The mean total score of A‐DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non‐clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A‐DES total score. The good psychometric characteristics of the A‐DES among Turkish participants support its cross‐cultural validity.
Alcohol dehydrogenase‐2 and aldehyde dehydrogenase‐2 genotypes and male alcohol use disorders in Khon Kaen, north‐east Thailand
Authors: Osaka Ryoko , Nanakorn Somsong , Sakata Ritsu , Nishiyori Atsushi , Shibata Akira , Nakamura Jun , Fukuda Katsuhiro
Published: March 2003

Abstract A case–control study on the relationship between alcohol dehydrogenase‐2 (ADH2), aldehyde dehydrogenase‐2 (ALDH2) and male probable alcohol use disorders (AUD) was performed in Khon Kaen, north‐east Thailand. One hundred and fifty‐three paired cases (probable AUD) and controls (non‐probable AUD) were sampled from villagers aged 18–65 years using the modified Michigan Alcoholism Screening Test − Thai version, controls being matched for gender, age (± 4 years) and village. All of the cases and 86.9% of the controls were current drinkers. The percentage of ADH2*1/1 among cases was 47.1%, being significantly larger than the 29.4% among controls, and yielding a univariate odds ratio (OR) of 2.421* (95% confidence interval (CI) = 1.419–4.132) for developing probable AUD. The ALDH2*1/1 proportion among cases, 92.8%, was comparable to the 92.2% among controls, yielding a univariate OR of 1.100 (95%CI = 0.757–1.599). Multivariate analysis based on a conditional logistic regression model and a hierarchically well‐formulated model strategy revealed that: (i) the OR of developing probable AUD due to 1 g increment of daily ethanol drinking was 1.110* among farmers (95%CI = 1.054–1.170); (ii) OR due to 1 g increment of daily ethanol drinking was 1.329* among non‐farmers (95%CI = 1.109–1.593); (iii) OR due to either ADH2*1/1 or ALDH2*1/1 was insignificant; and (iv) the daily amount of smoking is independently associated with probable AUD. The present findings suggest that one of the genetic factors that may be related to probable AUD among Thai males living in the north‐east is the ADH2 gene.
K‐ras codon 12 and p53 mutations in biopsy specimens and bile from biliary tract cancers
Authors: Itoi Takao , Takei Kazuo , Shinohara Yasushi , Takeda Kazuya , Nakamura Kazuto , Horibe Toshiya , Sanada Atsushi , Ohno Hiroyuki , Matsubayashi Hiroyuki , Saito Toshihiko , Watanabe Hidenobu
Published: March 2003

To evaluate whether it is useful for diagnosis to detect K‐ras and p53 mutations in biopsy specimens and bile of biliary tract lesions, 12 cholangiocarcinomas (CC), eight cases of cholangitis, seven gallbladder carcinomas (GBC), seven gallbladder cholesterol polyps, four cases of adenomyomatosis of the gallbladder and five cases of cholecystitis were examined. K‐ras and p53 mutations in bile were detected by a two‐step polymerase chain reaction (PCR) and nested PCR–single‐strand conformation polymorphism (SSCP) analysis. In addition, p53 protein expression in biopsy specimens from CC were examined by immunostaining. K‐ras mutations at codon 12 were detected in 50% of CC and 57.1% of GBC in both biopsy specimens and bile. The incidence of p53 mutations was 33.3% in CC and 42.9% in GBC. p53 protein overexpression was observed in 60% CC biopsy specimens. In contrast, K‐ras and p53 abnormalities were not detected in any non‐neoplastic biliary tract lesion. K‐ras and p53 mutations in biliary tract cancers showed the same mutation patterns in spite of differences in the collection methods used between bile and biopsy specimens or surgically resected tissue. Genetic analysis of K‐ras and p53 mutations in biopsy specimens and bile may be useful for the diagnosis of biliary tract cancers, although it may be effectively limited to patients with advanced disease.
Pseudovascular squamous cell carcinoma of the uterine cervix: A lesion that may simulate an angiosarcoma
Authors: Horie Yasushi , Kato Masako
Published: March 2003

A case of pseudovascular squamous cell carcinoma in the uterine cervix of a 64‐year‐old woman was examined. Histologically, the lesion consisted of atypical, large, non‐keratinizing squamous cells that exhibited not only acantholytic changes but also pseudovascular changes. Immunohistochemically, these tumor cells were positive for cytokeratin, epithelial membrane antigen and carcinoembryonic antigen, but none of them were positive for Factor VIII‐related antigen or CD34. To our knowledge, pseudovascular carcinoma of the uterine cervix has not been described in the literature. Pathologists should be aware of this unusual form of cervical squamous cell carcinoma, particularly in the differential diagnosis of angiosarcoma.
Small cell type malignant melanoma which developed in a 16‐year‐old female with a congenital dermal nevus and metastasized 12 years after excision
Authors: Miura Katsutoshi , Harada Hidekazu , Tsutsui Yoshihiro
Published: March 2003

A case of malignant melanoma arising from a congenital dermal nevus on the right forehead of a 16‐year‐old female is presented. In the mole, small pigmented nevoid cells gathered around the skin appendages and between the collagen fibers. From the age of 17, a verrucous nevoid melanoma consisting of lymphoblast‐like large nevoid cells, which were positive for HMB‐45 and had a high Ki‐67 index up to 18.7%, gradually increased in size. The melanoma cells vertically invaded the dermis to a depth of 3 mm and radially spread in the papillary dermis. Twelve years after undergoing a wide local resection and additional chemotherapy, metastatic lesions were found in the lung and the anterior mediastinum, which gradually increased in size and caused death a few months later. Metastatic melanoma cells were positive for HMB‐45 and had a high Ki‐67 index up to 33.7%. Most metastatic melanoma cells were positive for p53 while the primary ones were negative. Deteriorating mutations probably accumulated during the latent period.
A rare case of extramedullary spinal cord germinoma
Authors: Kiyuna Masaya , Toda Takayoshi , Sadi Al Muktafi , Toyoda Zensei , Nakashima Yasuaki
Published: March 2003

A rare case of spinal cord germinoma in a 20‐year‐old Japanese female is presented. The tumor was detected at the level of T11 and L3 by myelography. Histological findings of the resected tumor were identical to germinoma, which is characterized by polygonal tumor cells, lymphocytic infiltrate, and granuloma. Tumor cells and lymphocytes reacted with antibodies for placental alkaline phosphatase and CD45, respectively. A few multinucleated giant cells, negative immunohistochemically for human chorionic gonadotropin were also seen. The present case is the 10th case of spinal cord germinoma and is thought to be the first case of such a tumor located extramedullary. Diagnosis of such a rare tumor in an unusual location needs proper histological, ultrastructural and immunohistochemical evaluation.
Lobular involvement: Prognostic indicator for invasive ductal carcinoma of the breast
Authors: Ishige Hideo , Kondo Yoichiro , Yagata Hiroshi , Onoki Jun , Suzuki Masato , Oshida Masaki , Nagashima Takeshi , Hashimoto Hideyuki , Nakajima Nobuyuki
Published: March 2003

One of the striking microscopic appearances of breast carcinoma is malignant transformation of the epithelium of an entire lobule, although the lobular architecture is still preserved. We termed this pathological feature ‘lobular involvement’. An investigation was carried out to determine whether lobular involvement would be a useful prognostic indicator for invasive ductal carcinoma. One hundred and fifty cases of invasive ductal carcinoma were included in this study. The lobular involvement, as well as the conventional prognostic factors, was evaluated to find out the correlation with the overall and relapse‐free survivals by univariate and multivariate analyses. The lobular involvement was identified in 31 of 150 patients (20.6%). Of the patients with lobular involvement, two had experienced recurrence (6.5%) and one had died (3.2%). The lobular involvement and lymph node metastases were significantly and independently correlated with the overall and relapse‐free survivals. The presence of lobular involvement was statistically correlated with the favorable outcome. Lobular involvement can be assumed as a new prognostic indicator for invasive ductal carcinoma.
Yolk sac tumor of the stomach with an adenocarcinomatous component: A case report with immunohistochemical analysis
Authors: Suzuki Takashi , Kimura Noriko , Shizawa Soichiro , Yabuki Noritaka , Yamaki Toshihiko , Sasano Hironobu , Nagura Hiroshi
Published: March 2003

A 56‐year‐old male treated for a gastric yolk sac tumor with an adenocarcinomatous component is described. A mixed area of reticular and glandular neoplastic components was morphologically identified in this tumor. Immunohistochemically, the yolk sac tumor expressed alpha‐fetoprotein (AFP), placental alkaline phosphatase (PLAP), and cytokeratin, but was negative for carcinoembryonic antigen (CEA). The adenocarcinoma was positive for CEA and cytokeratin, partially positive for PLAP, and negative for AFP. In the mixed area, the tumor cells were positive for cytokeratin, weakly expressed AFP and PLAP, and sporadically stained for CEA both in the reticular and glandular components. This area was identified as a transitional area of the yolk sac tumor and adenocarcinoma. These findings demonstrate that the yolk sac and adenocarcinomatous components are closely related. It also suggests that the tumor arose from multipotential neoplastic mucosal epithelial cells with both yolk sac and gastric mucosal phenotypes.
Aeromonas sobria infection with severe soft tissue damage and segmental necrotizing gastroenteritis in a patient with alcoholic liver cirrhosis
Authors: Itoh Hiroshi , Kuwata Go , Tateyama Sunao , Yamashita Kiyoshi , Inoue Takuya , Kataoka Hiroaki , Ido Akio , Ogata Katsumi , Takasaki Mayumi , Inoue Shohei , Tsubouchi Hirohito , Koono Masashi
Published: March 2003

A 49‐year‐old man, who had a 3‐year history of liver dysfunction but had not been treated, was admitted to the hospital with a sudden onset of fever and generalized muscle pain. He subsequently developed generalized purpura with scattered hemorrhagic bullae of the skin and massive bloody stools. Aeromonas sobria was proven by culture of both blood and bullous fluid. In spite of the extensive treatment with antibiotics and other medications in the intensive care unit (ICU), the patient went into septic shock and died 2 days after admission. Pathological examination on autopsy revealed segmental necrotizing gastroenteritis with bacterial colonies and alcoholic liver cirrhosis, in addition to extensive severe soft tissue damage involving cellulitis and rhabdomyolysis and epidermolysis. Although the prognosis for Vibrio vulnificus infection with severe soft tissue damage in patients with liver cirrhosis, malignancy, diabetes mellitus or other pre‐existing diseases is poor, the unfavorable progression of Aeromonas species, especially A. sobria infection is rare. This is thought to be the first report of an autopsied case.
Inflammatory pseudotumor of the liver in a patient with chronic hepatitis C: Difficulty in differentiating it from hepatocellular carcinoma
Authors: Kim Soo Ryang , Hayashi Yoshitake , Kudo Masatoshi , Matsuoka Toshiyuki , Imoto Susumu , Sasaki Kazunori , Shintani Shigeyuki , Song Kyung Boo , Park Sok Yong , Kim Jung Hyo , Ando Kenji , Koterazawa Toshihiro , Kim Ke Ih , Ninomiya Toshiaki
Published: March 2003

A case of an inflammatory pseudotumor of the liver in a 75‐year‐old female with chronic hepatitis C whose radiologic features simulated that of hepatocellular carcinoma (HCC) is presented. On imaging studies, hypervascularity by CO2 ultrasound (US) angiography, enhancement at an early phase and isodensity at a late phase by incremental dynamic computed tomography (CT), perfusion defect by CT during arteriography (CTAP), and clinical background of hepatitis C virus (HCV) infection strongly suggested HCC. A US‐guided needle biopsy revealed a mainly diffuse and polyclonal proliferation of lymphocytes positive for leukocyte common antigen (pan‐lymphocyte cells), L‐26 (B cell lymphocytes), and UCHL‐1 (T cell lymphocytes), negative for both κ and λ light chains and sparsely distributed neutrophils and histiocytes. No lymphoid follicles were observed. The liver tissue around this tumor showed chronic hepatitis with mild activity and mild fibrosis. These histopathologic findings suggested that the diagnosis of inflammatory pseudotumor of the liver was tenable. As it is difficult to differentiate between inflammatory pseudotumor of the liver and HCC by imaging studies alone, supplemental biopsy, where possible, should be obtained when diagnostic imaging of tumors suggesting HCC is carried out. We emphasize that histopathology is a true gold standard in the diagnosis of this disease.
Identification of thorotrast by gamma‐spectrometry and simplified autoradiography in pathological specimens
Authors: Yasumizu Ryoji , Amoh Yasuo , Ikehara Susumu
Published: March 2003

Simplified and reliable methods for identifying thorotrast are demonstrated. On gamma‐ray spectrometry, as little as 0.1 g of liver tissue gives gamma‐ray spectrum characteristics to the thorium decay series, despite a low net count. When conventional film for photography is kept in contact with a paraffin section of the liver for 4 months, it develops silver grains exactly corresponding to the area of granular deposition. By combining this method with clinical and pathological findings, a diagnosis of thorotrastosis can be established without the need for special instruments or materials.
Incidence of P53 and K‐ras alterations in ovarian mucinous and serous tumors
Authors: Morita Katsuo , Ono Yuko , Fukui Hirokazu , Tomita Shigeki , Ueda Yoshihiko , Terano Akira , Fujimori Takahiro
Published: March 2003

Clarification of the pathogenic relationships existing among ovarian cystadenomas, tumors of low malignant potential (LMP) and various adenocarcinoma types, a series of 29 mucinous and 19 serous ovarian tumors including adenomas, LMP tumors and adenocarcinomas were examined. P53 protein was detected by the streptavidin–biotin method and point mutation of K‐ras codon 12 was detected by polymerase chain reaction‐restriction fragment length polymorphism analysis. P53 overexpression was observed more frequently in serous adenocarcinomas (5/8, 63%) than in mucinous adenocarcinomas (2/9, 22%) and was correlated with the malignant potential of serous tumors. Furthermore, the proportion of P53‐positive cells was significantly higher in serous adenocarcinomas than in mucinous adenocarcinomas. P53 overexpression may therefore be closely related to the early events of carcinogenesis in serous tumors. Although mutation of the K‐ras oncogene appears to be an important event in the early tumorigenesis of mucinous tumors, mutation of the K‐ras oncogene in serous tumors may be dependent on morphology. Different complex pathways of oncogene and/or tumor suppressor gene abnormalities may be involved in the development of mucinous and serous adenocarcinomas.
Anaplastic osteosarcoma with abundant eosinophilic cytoplasm and minimal osteoid production
Authors: Yamamoto Tetsuji , Marui Takashi , Mizuno Kosaku , Kizaki Tomohiko , Minami Rieko , Hanioka Keisuke , Hayashi Yoshitake
Published: March 2003

A case of osteosarcoma with unusual microscopic features, occurring in the right proximal tibial metaphysis of a 12‐year‐old boy is reported. Radiographically, the tumor was ill‐defined and purely osteolytic. On gross examination, the tumor was soft, fragile, spongy and red to brown in color. Microscopically, the tumor consisted of pleomorphic cells possessing abundant eosinophilic cytoplasm, including cells larger than 100 μm in diameter. The cells were arranged in a sheet, with few extracellular collagen fibers. Multiple sectioning of the specimens revealed a small amount of osteoid production. Immunohistochemical study revealed a positive reaction for vimentin and osteocalcin. Electron microscopic study suggested the fibroblastic or osteoblastic origin of the cells.
Correlation of tumor markers p53, bcl‐2 and cathepsin‐D with clinicopathologic features and disease‐free survival in laryngeal squamous cell carcinoma
Authors: Lazaris Andreas Ch. , Lendari Irene , Kavantzas Nikolaos , Kandiloros Dimitrios , Adamopoulos Georgios , Davaris Panagiotis
Published: March 2003

Various recognized prognostic factors in squamous cell carcinoma (SCC) of the larynx influence the therapeutic options offered to an individual patient in order to extend the survival expectancy. Additional prognostic indicators are required in specific patient subgroups. The present study used a standard immunohistochemical technique in order to retrospectively evaluate the accumulation of p53 gene product and the immunoreactivity of bcl‐2 protein and cathepsin‐D as possible prognostic markers of laryngeal SCC. Formalin‐fixed, paraffin‐embedded tumor materials were obtained from a series of 64 patients with cancer of the larynx. Immunostaining was evaluated by computerized image analysis. The accumulation of p53 protein was found in 57.8% (37/64) of the patients and was associated with large tumor size. The percentage of p53‐positive neoplastic cells increased in high‐grade carcinomas, particularly when they simultaneously demonstrated cathepsin‐D immunoreaction in stromal cells (P = 0.049); bcl‐2 immunoexpression was found to be generally limited. Cathepsin‐D immunostaining was observed in tumor parenchymal and stromal cells (31.25% and 37.5% of all cases, respectively); it was found to be useful in defining patient subgroups with differences in relapse‐free survival. Among patients with posi‐tive lymph nodes, those with cathepsin‐D immunopositive tumor cells were at higher risk for relapsing (P = 0.0395). Although the classical prognostic factors of laryngeal carcinoma retain their predominance, cathepsin‐D immunoreactivity may serve as an additional prognosticator in specific patient subgroups.