bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathology of familial amyloidotic polyneuropathy with TTR Met 30 in Kumamoto, Japan
Authors: Araki Shukuro , Yi Shigehiro
Published: March 2003

Seventeen autopsy and 12 sural nerve biopsy cases of familial amyloidotic polyneuropathy (FAP) with transthyretin (TTR) Met 30 were examined clinicopathologically. In the autopsy cases, amyloid deposits were prominent in the peripheral nerve tissues, autonomic nervous system, choroid plexus, cardiovascular system and kidneys. Amyloid involvement in the posterior and anterior roots of the spinal cord, spinal ganglia, thyroid and gastrointestinal tract were also frequent. In the sural nerve biopsy, degenerative changes corresponding in degree to the duration of the clinical course were observed in the endoneurium, and amyloid deposition occurred around the blood vessels. Electron microscopy revealed degenerative changes in the axon, myelin sheath and Schwann cells. The morphometric study showed decreased numbers of small‐caliber myelinated fibers during the early stage. TTR was confirmed immunohistochemically as a major component of amyloid deposits. In transgenic mice carrying the human mutant TTR gene, amyloid deposition was observed in various organs except in the peripheral nerves and choroid plexus. Liver transplantation therapy to FAP patients has been carried out and future follow‐up studies should investigate the effects of therapy.
Sources of neuronal material for implantation
Authors: Singh Gurminder
Published: March 2003

The adult brain is an organ that does not have the natural ability to replace cells that have been lost through damage. Possible human interventions to rectify this situation include transplanting either developing neural tissue into the damaged host brain or transplantation of neural stem cells (cells that have the capacity to proliferate into neural cells and self‐replicate) into the damaged area. Fetal or embryonic stem cells can be extracted and differentiated in vitro into the specific desired progeny (e.g. neurons). The neuronal stem cells themselves can be extracted from fetuses and multiplied in culture and then transplanted into the damaged brain. There is the possibility of de‐differentiation, in which cells of one type can be converted into a different cell type; for example, a differentiated blood cell could be de‐differentiated back to its own hemopoietic stem cell and that stem cell could be converted into a neuronal stem cell which could then be differentiated into a neuron. It is probable that methods of generating large numbers of committed stem cells to treat conditions such as Alzheimer's disease will soon be increasingly common.
Neurotoxicity of MPTP
Authors: Fukuda Takahiro
Published: March 2003

After the discovery of 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP), we acquired a good animal model of Parkinson's disease. The extraordinary recent growth in knowledge using MPTP parkinsonism has fostered increased understanding of Parkinson's disease. In the present paper, the discovery of MPTP and the biochemical, pathological, and clinical findings of MPTP parkinsonism are first reviewed briefly. Next, using MPTP parkinsonism, unresolved issuses such as the apoptosis of MPTP, levodopa toxicity, and neuroprotective effects of monoamine oxidase inhibitors or dopamine agonists are discussed. Finally, environmental factors such as the etiology of Parkinson's disease are examined. Some genetic factors that lead to familial Parkinson's disease have recently been reported, but most cases of Parkinson's disease are sporadic. Recent epidemiological evidence emphasizes an etiological relation of 18th and 19th century industrialization to Parkinson's disease. Man‐made toxins, such as industrial chemicals and herbicides/pesticides, have been suggested to increase the risk of developing Parkinson's disease. I would like to highlight the significance of re‐examination of environmental factors in the etiology of Parkinson's disease.
A case of non‐functioning pituitary adenoma with Cushing's syndrome upon recurrence
Authors: Yokoyama Shunichi , Kawahara Yoshihiro , Sano Toshiaki , Nakayama Masaki , Kitajima Shin‐ichi , Kuratsu Jun‐ichi
Published: March 2003

A 49‐year‐old woman presented with left visual disturbance. No signs of Cushing's disease were evident. Basal levels of serum cortisol and plasma adrenocorticotropic hormone (ACTH) were 16.8 μg/dL and 66.0 pg/mL, respectively. MRI demonstrated an irregularly shaped large pituitary tumor, and the patient then underwent transsphenoidal surgery. By light microscopy the tumor represented a chromophobic adenoma with a few of the adenoma cells showing immunoreactivity for ACTH. On the basis of clinical and light microscopic examinations, the diagnosis of silent corticotroph adenoma was made. Electron microscopy, however, demonstrated the honeycomb Golgi complex that has been reported as a typical finding of gonadotroph adenomas. MRI taken 7 months after the first operation revealed adenoma regrowth. Transcranial surgery was performed, and histology demonstrated a chromophobic pituitary adenoma with most cells immunopositive for ACTH. She was treated with gamma knife postoperatively. Three months later, MRI revealed remarkable shrinkage of the adenoma, but she developed typical signs and symptoms of Cushing's disease. Thus, the hormone immunostaining and biological activity of pituitary adenomas may change with time.
Masses of phosphorylated neurofilaments are associated with abnormal Golgi apparatus of anterior horn neurons of β, β′‐iminodipropionitrile‐intoxicated rats
Authors: Uesugi Makoto , Okamoto Koichi , Tanaka Makoto , Gonatas Nicholas K
Published: March 2003

The Golgi apparatus (GA) of anterior horn neurons of rats chronically intoxicated with β,β′‐iminodipropionitrile (IDPN) in drinking water was examined with an organelle‐specific antibody. The neuropile of the anterior horns contained the typical axonal spheroids associated with IDPN toxicity while the perikarya of approximately one‐third of the neurons contained phosphorylated neurofilaments, which are not found in the perikarya of control rat neurons. By serial or double immunostaining with the SMI‐31 and anti‐MG 160 antibodies, there were no morphological changes of the GA in the majority of neurons including neurons with a mild to moderate degree of neurofilamentous accumulation. However, a few neurons with a massive accumulation of phosphorylated neurofilaments contained abnormal profiles of the GA which consisted of focal clustering, reduction in size and fragmentation. The results suggest that masses of phosphorylated neurofilaments are associated with struc‐tural abnormalities of the GA.
Clinicopathological studies of peripheral neuropathy in Churg–Strauss syndrome
Authors: Nagashima Toshiko , Cao Bingzhen , Takeuchi Naoto , Chuma Takayo , Mano Yukio , Fujimoto Matoko , Nunomura Mitsuru , Oshikiri Taro , Miyazaki Kyohsuke , Dohke Mituru , Kashimura Nobukazu , Shinohara Toshiya , Orba Yasuko , Ishizawa Shin , Nagashima Kazuo
Published: March 2003

Clinicopathological studies were performed on the visceral organs and the sural nerve of a male patient with Churg–Strauss syndrome (CSS) in order to understand the mechanisms of peripheral nervous system damage. A 67‐year‐old man, with a 2‐year history of bronchial asthma, developed acutely painful paraplegia and dyspnea. Laboratory data showed a leukocytosis, an elevated serum creatinine kinase (CK) and marked eosionophilia. Autoantibodies including p‐ and c‐ANCA were negative. Electrophysiological studies revealed a severe sensory‐motor neuropathy of multiple mononeuritis type. Steroid pulse therapy performed a day after biopsy of skin, muscle and sural nerve was effective in resolving his respiratory and neurological dysfunction but a perforation of an intestinal ulcer occurred which required surgical intervention. In the biopsied sural nerve and the surgically resected intestine and mesentery there was vasculitis with fibrinoid necrosis accompanied by numerous eosinophils and macrophages containing eosinophil cationic protein (ECP). These findings suggest that in addition to ischemic changes due to vasculitis some neurotoxic substances generated by the eosinophils may be involved in the development of neuropathy in CSS.
Exit‐site and catheter‐related infections in peritoneal dialysis: Problems and progress
Authors: Dasgupta Mrinal K
Published: March 2003

SUMMARY:

Silastic peritoneal catheters are used routinely for peritoneal access in peritoneal dialysis (PD) because they are biocompatible. Catheter insertions are usually succeeded by bacterial adhesion and subsequent colonization of the catheter exit site. Despite the reduction in the proportion of peritonitis due to touch contamination, exit‐site and catheter‐related infections, particularly those caused by Staphylococcus aureus, remain the major cause of catheter loss and technique failure in PD. The peritonitis rate in the global PD population is steadily declining, but as the number of patients on PD increases by about 10% per year the stakes in infection control become greater, and one is forced to consider new options that will reduce the PD patient drop‐out rate. Three areas of promising advances in the prevention of exit‐site and catheter‐related infections are reviewed in this paper: (i) the use of prophylactic antibiotics to eliminate the nasal carriage of Staph. aureus and to reduce exit‐site infections; (ii) the Moncrief–Popovich catheter and implantation technique which reduces bacterial colonization of the catheter exit tunnel; (iii) new catheter implants composed in part of rigid biomaterials with antibacterial properties. This last category includes the silver‐coated silastic PD catheter, significant not only because it has great potential as a replacement for the silastic catheter, but also because it is a reminder that caution must be exercised before fully embracing new treatment options.
Renal interstitial tenascin immunostaining and immune cell infiltration in IgA nephropathy
Authors: Wa¸growska‐Danilewicz Maĺgorzata , Danilewicz Marian
Published: March 2003

SUMMARY: Interstitial expression of tenascin and interstitial leucocyte infiltration were examined by an indirect immunoperoxidase method using monoclonal antibodies against tenascin, CD45 (all leucocytes), CD45RO (T cells) and CD68 (monocytes/macrophages) on renal biopsy specimens from 25 patients with mesangial proliferative IgA‐positive glomerulonephritis (IgAN). Ten biopsy kidney specimens, which were removed because of renal trauma, were used as the control group. In patients with IgAN, the mean interstitial expression of tenascin was significantly higher than in the control group. Strong tenascin staining was detected in areas with interstitial damage. In patients with IgAN there were positive correlations between the interstitial expression of tenascin and the relative interstitial cortical volume, as well as serum creatinine. In the IgAN patents, a significant increase in the total number of interstitial CD45‐immunopositive cells, CD45RO‐positive and CD68‐positive cells was seen compared with the control group. In patients with IgAN, immunostaining of tenascin did not correlate with the number of T‐cells, monocytes/macrophages or all leucocytes in the renal interstitium. These results suggest that in patients with IgAN the interstitial accumulation of tenascin did not depend on the type or the density of interstitial inflammatory infiltrates.
Left ventricular diastolic function in patients on maintenance haemodialysis
Authors: Qian Ying , Wang Guan‐yu , Dong De‐chang , Zhu Ping , Wang Su‐er
Published: March 2003

SUMMARY: The aim of this study was to elucidate the differences in left ventricular (LV) diastolic function between patients on maintenance haemodialysis (HD) with LV hypertrophy (LVH) and those with LVH from other causes. Twenty HD patients (HD group), 11 patients with hypertensive heart disease (HHD group), 11 with hypertrophic cardiomyopathy (HCM group) and 11 age‐matched healthy individuals (N group) were examined using echocardiography. Compared with the HCM group, the HD and HHD groups had smaller total LV wall thickness and left atrial dimension, a higher ratio of LV end‐diastolic dimension to LV posterior wall thickness, a shorter isovolumic relaxation time and a higher ratio of peak flow velocity of early to late LV fillings (E/A). There was a correlation between LV mass index or E/A and systolic blood pressure. These results indicate that HD patients have an LV diastolic dysfunction similar to that observed in HHD patients but which is less severe than that found in HCM patients. It seems reasonable to control hypertension in HD patients in order to favourably influence LV diastolic function.
Familial fibronectin glomerulopathy: analysis of chromosome 1q32 and uteroglobin gene loci in a large New Zealand family
Authors: Walker Robert , Dixon Stephen , Ruger Beate , Davis Paul , Hildebrant Friedhelm , Kremer Mathias , Eccles Michael , Mcnoe Leslie , Watson Michael , Reid James
Published: March 2003

SUMMARY: Recently, a newly recognized familial glomerulopathy with predominant fibronectin deposits has been reported. This is the first report of a family with this condition in Australasia and spans two generations over a 30‐year period, with the histologically confirmed glomerulopathy present in the father and five out of eight siblings. The clinical presentations have ranged from asymptomatic proteinuria, pregnancy‐associated proteinuria and the nephrotic syndrome to hypertension and proteinuria with progressive renal failure. The time‐course from presentation to renal failure was over a 20 years. Histology demonstrated global and diffuse thickening of capillary loops, but no cellular proliferation. Immunofluorescence demonstrated granular positivity for IgM in the capillary loops only. Electron microscopy demonstrated massive electron‐dense subendothelial granular deposits with occasional small fibrils and unremarkable epithelial cell foot processes. Immunohistochemical staining was strongly positive for fibronectin and negative for type I or type IV collagen and transforming growth factor β in all biopsies. Genetic studies of familial fibronectin glomerulopathy have recently highlighted two genetic loci. Firstly, a large five‐generation pedigree has been described with linkage of fibronectin glomerulopathy to chromosome 1q32. Secondly, fibronectin glomerulopathy has been reported in uteroglobin gene knockout mice. In our studies, DNA sequence analysis of the uteroglobin gene showed that it was normal in all family members, and a DNA polymorphism in the uteroglobin gene did not co‐segregate with the disease. In addition, DNA microsatellite markers at the 1q32 locus did not co‐segregate with the disease in our family. We presume that the underlying abnormality involves as yet undefined glomerular extracellular matrix regulation and is inherited as an autosomal dominant condition. These data favour genetic heterogeneity for the aetiology of fibronectin glomerulopathy.
Transforming growth factor‐β superfamily members: roles in branching morphogenesis in the kidney
Authors: Martinez Gemma , Cullen‐McEwen Luise A , Bertram John F
Published: March 2003

The process of nephrogenesis and the number of nephrons formed during kidney development are both highly dependent upon ureteric branching morphogenesis. Abnormalities in branching and growth of the ureter have been implicated in a range of urogenital/renal pathologies including cystic renal disease and some forms of renal agenesis. The issue of how the branching of the ureter is regulated is therefore an important one. There is a growing list of candidate molecules (growth factors, oncogenes, transcription factors and extracellular matrix components) which have been directly or indirectly implicated in the regulation of ureteric branching. Among these, members of the transforming growth factor‐β (TGF‐β) superfamily are well represented. This review summarizes our knowledge of the roles of TGF‐β superfamily members in ureteric branching morphogenesis.
Acute vascular access catheters for haemodialysis: Complications limiting technique survival
Authors: JEFFERYS ANDREW , CHOW JOSEPHINE SF , SURANYI Michael G
Published: March 2003

SUMMARY: The use of acute vascular access catheters (AVACs) has facilitated the delivery of haemodialysis to patients lacking functioning access. A review of the experience of a tertiary Australian renal treatment centre, consisting of 205 sequential AVACs in 93 patients, was undertaken over 1 year, to identify issues limiting technique survival. Acute vascular access catheters were inserted as acute dialysis access for patients with chronic renal failure (CRF; 21%), failed grafts or fistulae (18%), acute renal failure (12%), failed chronic ambulatory peritoneal dialysis (CAPD; 8%) or failed prior AVACs (37%). The majority of AVACs were on the right (74%), and the placement site was simple jugular (69%), tunnelled jugular (15%), femoral (12%), or subclavian (4%). During follow up, 198 of 205 AVACs were removed. The mean AVAC survival was superior (P < 0.0001, Fisher's protected least significant difference (PLSD) for tunnelled jugular AVACS (62 ± 46 (SD) days) compared with simple jugular (20 ± 19), subclavian (18 ± 13) and femoral (7 ± 6). Causes for AVAC removal were: elective (47%), blockage (31%), infection (20%) or cracked catheter (1%). Routine postremoval tip cultures grew coagulase negative Staphylococcus (CNS, 46%), negative culture (33%), methicillin‐resistant Staphylococcus aureus (MRSA; 9%), Staphylococcus aureus (9%), Gram‐negative rods (1%), Pseudomonas (0.5%) or other uncommon organisms (2%). Blood cultures were drawn through the AVAC in the setting of suspected bacteraemia in 42 of 198 AVACs. Blood cultures were negative in 40%. Positive cultures included Staphylococcus species in 55%: including MRSA (19%), Staphylococcus aureus (29%) and CNS (34%). Rare cultures identified Escherichia coli (2%) or Serratia (2%). Infection and blockage significantly reduced AVAC survival, affecting more than 50% of cases. Approaches to minimize these complications are likely to lead to improved clinical outcomes with AVAC use.
Skin as cover: the discursive effects of 'covering' metaphors on wound care practices
Authors: Rudge Trudy
Published: March 2003

Skin as cover: the discursive effects of 'covering' metaphors on wound care practices

This paper outlines a Foucauldian analysis of interactions between nurses and patients during wound care procedures in a burns unit. It explores the use of Kristeva's psychoanalytic concepts of abjection and the abject body to illuminate the emotional affects of wounds on nurse and patient. In this process, I identify how cultural metaphoric understandings about skin influence and organise the care of burns patients. Such analysis suggests the import of the complete skin, the medical scientific control over the definition of this work, and the emotional forces that resist such control.
Foucault and nursing: a history of the present
Authors: Gastaldo Denise , Holmes Dave
Published: March 2003

While a commitment to the development of nursing theory has been a significant force in nursing scholarship, particularly in the US, the authors have noted a recent trend among nurses in different countries to develop Foucauldian interpretations of nursing. The objective of this paper is to identify those publications by nurses that employ a Foucauldian perspective and to provide a useful summative review of these works to date, which illustrate the potential contribution of a Foucauldian reading of nursing. The authors have reviewed 27 publications written by nurses which present a Foucauldian analysis. These publications were issued between 1987 and 1998 in English, Portuguese and German. The most frequent concepts treated in the literature reviewed are power/knowledge, surveillance, discourse, discipline, resistance, docile bodies, clinical gaze, and panopticon. The literature reviewed illustrates that Foucault’s concepts can have a profound impact on the way we conceive of nursing as a discipline and as a profession. Nursing care becomes a political event, nursing knowledge contributes to the dissemination of regimes of truth, and nurses, rather than being powerless, are perceived as professionals who exercise power over life in society. A Foucauldian reading of nursing enables nurses to move into a broader interdisciplinary and critical scholarship.
Feeling old: being in a phase of transition in later life
Authors: Nilsson Margareta , Sarvimäki Anneli , Ekman Sirkka‐Liisa
Published: March 2003

Feeling old: being in a phase of transition in later life

The aim of the study was to illuminate very old persons’ experiences of feeling old in order to get a nuanced understanding of the ageing process in later life. Fifteen persons 85–96 years of age, living in their own homes, were interviewed in‐depth. Data were analysed utilising a phenomenological‐hermeneutic approach. Eight persons reported that they felt old. The experience of feeling old entailed four characteristics: being able to date the beginning of feeling old, fear of helplessness and of being unable to manage one’s life situation, not recognising one’s former self, and feeling different from others. These characteristics corresponded to the main properties of a transition process. The comprehensive understanding was that the very old persons who also felt old were in a phase of transition. The distinguishing qualities of those that felt old were also found to be in line with the dystonic dominance in the ninth stage designated by Joan Erikson of the previously described life cycle. Knowledge about transition processes and sensitivity to very old people’s experiences of feeling old are of great importance to nursing in order to provide adequate health care services and prevent unhealthy transitions.
The impact of managed care on nurses’ workplace learning and teaching*
Authors: White Jerry P. , Armstrong Hugh , Armstrong Pat , Bourgeault Ivy , Choiniere Jacqueline , Mykhalovskiy Eric
Published: March 2003

The impact of managed care on nurses’ workplace learning and teaching

This paper examines the impact of managed care on the informal learning process for nurses in a major US‐based health organisation. Through the analysis of focus group data we report the nurses’ view of the effect recent changes have had on the nurse/patient/care relationship. Managed care, our research indicates, has transformed the learning milieus for nurses with two effects. First, nurses have seen their need for informal learning increase while the time and context for that learning has diminished. Second, the process of teaching patients and families has also been adversely affected even as managed care creates the need for more patient education. We report the analysis of the data collected at group interviews involving nurses working in both hospital and community settings of a leading US‐based HMO. All interviews took place during September of 1997 at various sites in California. This study is part of a larger Social Science Research Council of Canada funded investigation into managed care in the US and Canada.
Silence in court: the devaluation of the stories of nurses in the narratives of health law
Authors: Chiarella Mary
Published: March 2003

Silence in court: the devaluation of the stories of nurses in the narratives of health law

This paper sets out to address one of the major findings from an extensive analysis of case law involving nurses from 1904 to 1999. The 180 cases were collected from the civil, coronial, professional and industrial jurisdictions of Australia, Canada and the UK. It specifically examines the way in which nurses’ voices and experiences are excluded from legislation and case law, and the resultant effect which this has on the status of the nurse in clinical and healthcare decision‐making. It addresses two of the many issues which emerged from the research, but which are particularly problematic for nurses. The first is that doctors are not necessarily required to heed the clinical concerns of nurses, and the second is that nurses are not necessarily expected to intervene to prevent imminent harm to the patient. This paper also suggests some possible solutions to these issues.
Personality differences in the Munich Personality Test between patients with major depression and panic disorder
Authors: SATO TETSUYA , SAKADO KAORU , UEHARA TORU , SATO SATOSHI , NISHIOKA KAZUO , KASAHARA YOMISHI
Published: March 2003

This study attempted to determine whether patients with major depression and panic disorder could be differentiated by personality features, measured by the Munich Personality Test (MPT). One of the six MPT personality dimensions, `rigidity', was developed in relation to the `melancholic type of personality', which may be a specific personality feature of depressive subjects. We therefore hypothesized that the MPT might be sensitive to possible personality differences between patients with major depression and panic disorder. Sixty‐six patients with major depression and 27 patients with panic disorder, taken from consecutive intakes at an outpatient unit, were compared in terms of six personality dimensions of the MPT. The results demonstrated that rigidity could significantly differentiate the two patient groups, even after the possible confounding effects on the personality assessments were statistically partialled out. The MPT was suggested to be powerful for describing distinctive personality features of depressive subjects from anxiety subjects.
One‐year prognosis of depressive illness in the elderly population in Japan
Authors: OIJI ARATA , MURAOKA YOSHIAKI , NADAOKA TOSHIHIDE , KASHIWAKURA MASAKI , TOTSUKA SHIRO , IHARA KAZUSHIGE , MORIOKA YUKIKO
Published: March 2003

A 1‐year prospective study of 43 elderly depressed residents (13 men and 30 women) in Nagai City in Japan is described. An initial survey was carried out in 1993 to find depressed residents. The subjects of the survey were 2056 residents of 65 years of age and older. The Japanese version of the Geriatric Depression Scale (GDS) was employed as a screening tool in the first phase of the survey. In the second phase, screened subjects and control subjects were interviewed by psychiatrists using the Structured Interview for DSM‐III‐R (SCID). The diagnosis of depression was made by the psychiatrists on the basis of the results of the SCID. Forty‐three persons were judged to be depressed. At follow‐up, 10 were still depressed and 15 were well. Four were demented. Fourteen dropped out due to death, hospitalization, absence from home or refusal. The results showed that approximately half of the elderly depressed persons seemed to recover by the time of the 1‐year follow‐up. One‐year prognosis of dysthymia was the worst. Some types of depression seemed to be a precursor for dementia. The concern is with how the findings may be used as an aid in understanding and planning community mental health services strategies. The results indicate that it is very important to pay close attention to patients with depressive illness who do not meet the criteria for major depression.
Trauma and memory
Authors: VAN DER KOLK BESSEL A.
Published: March 2003

The study of traumatic memories challenges several basic notions about the nature of memory: (i) that memory always is a constructive process; (ii) that memory is primarily declarative (i.e. that people can articulate what they know in words and symbol) (iii) that memory is present in consciousness in a continuous and uninterrupted fashion; and (iv) that memory always disintegrates in accuracy over time. A century of study of traumatic memories shows that (i) semantic representations may coexist with sensory imprints; (ii) unlike trauma narratives, these sensory experiences often remain stable over time, unaltered by other life experiences; (iii) they may return, triggered by reminders, with a vividness as if the experience were happening all over again; and (iv) these flashbacks may occur in a mental state in which victims are unable to precisely articulate what they are feeling and thinking. The present paper reviews the literature on traumatic memories and discusses the recent neuroimaging studies which seem to clarify the neurobiological underpinnings of the differences between ordinary and traumatic memories.
Non‐linear analysis of the sleep EEG
Authors: Kobayashi Toshio , Misaki Kiwamu , Nakagawa Hiroki , Madokoro Shigeki , Ihara Hisataka , Tsuda Kyoko , Umezawa Yumiko , Murayama Jyunichi , Isaki Kiminori
Published: March 2003

A sleep electroencephalogram was analyzed by non‐linear analysis. The polysomnography of a healthy male subject was analyzed and the correlation dimensions calculated. The correlation dimensions decreased from the ‘awake’ stage to sleep stages 1–3 and increased during rapid eye movement (REM) sleep. These results were seen during each sleep cycle. In each sleep cycle, the correlation dimensions decrease for slow wave sleep, and increase for REM sleep.
Functional changes of the brainstem triggering vertex sharp wave with spindle
Authors: Sakai Taeko , Kohsaka Shinobu , Kohsaka Masako
Published: March 2003

A vertex sharp wave followed by spindle (VS‐spindle) is one of the hallmarks of human stage 2 sleep. We recorded sleep electroencephalograms (EEG) simultaneously with brainstem auditory evoked potentials (BAEP) from nine healthy male subjects. To investigate the generating mechanism of the VS‐spindle, sequentially changing BAEP were analyzed around the VS‐spindle. The results revealed the preceding changes of wave‐V amplitude to the onset of the VS‐spindle. When the generator site of wave‐V in the brainstem was considered, the results suggest that the functional changes in the dorsal area of the midbrain–pontine junction participate in the organization of the VS‐spindle.
Clinical efficacy and indication of acetazolamide treatment on sleep apnea syndrome
Authors: Inoue Yuichi , Takata Kokichi , Sakamoto Izumi , Hazama Hidebumi , Kawahara Ryuzo
Published: March 2003

The efficacy and indication of acetazolamide treatment on patients with sleep apnea syndrome (SAS) were discussed from assessing the changes of polysomnographic findings with the treatment in 75 SAS patients. For the patients as a whole, respiratory disorder variables improved significantly during the treatment. However, the number of acetazolamide treatment responders who showed a decrease of apnea hypopnea index (AHI) to 50% or less of the pretreatment value numbered only 34 (45.3%). The lower values of body mass index and AHI in the responder group indicated that monotherapy with acetazolamide is the treatment choice only for mild SAS cases without obesity. However, combined treatment with acetazolamide and uvulopalatopharyngoplasty was thought to be beneficial for severe cases.
Clinical efficacy of prosthetic mandibular advancement on obstructive sleep apnea syndrome
Authors: Ishida Masae , Inoue Yuichi , Okamoto Kazumi , Suto Yuji , Higami Shigeru , Kawahara Ryuzo , Ryoke Kazuo
Published: March 2003

In order to clarify the efficacy and indication of prosthetic mandibular advancement (PMA) on obstructive sleep apnea syndrome (OSAS), we made a comparison of both the polysomnographic findings and the upper airway configuration between before and during PMA on 19 OSAS patients. During PMA, there was a significant decreased apnea hypopnea index compared to before treatment. The changes in magnetic resonance imaging of the upper airway during sleep with PMA indicated that the treatment is regarded to be the first choice for OSAS patients with glossopharyngeal obstruction. In addition to that, the treatment might be considered for use in velopharyngeal obstruction.
A case of psychotic disorder associated with a right temporal lesion: A special reference to magnetic resonance imaging and single photon emission computed tomography findings
Authors: Mizukami Katsuyoshi , Yamakawa Yuriko , Yokoyama Haruyuki , Shiraishi Hiroyasu , Kobayashi Shiro
Published: March 2003

A case of psychotic disorder with a right temporal lesion was reported. The patient, a 19 year old male, who underwent a brain surgery to remove the trigeminal Schwannoma, occupying from the right cerebellopontine angle to the right middle cranial fossa. One year postoperatively, he presented with a psychotic disorder, including auditory hallucinations, delusions of persecution and reference, thought hearing, thought insertion and passive experiences. T1‐weighted images on magnetic resonance imaging (MRI) demonstrated a low intensity signal area in the right temporal cortex and white matter. T2‐weighted images demonstrated a high intensity signal within the same region. Single photon emission computed tomograghy (SPECT) demonstrated a severe low perfusion corresponding to the region in which the MRI demonstrated the abnormalities. The clinical and neuroimaging studies of this case suggest that psychotic disorder may occur in association with a right temporal lesion and MRI and SPECT are useful to evaluate an organic basis for the psychotic disorder.
Bipolar II disorder is common among depressed outpatients
Authors: Benazzi Franco
Published: March 2003

The aim of this study was to find the prevalence of bipolar II disorder among major depressive episode private practice outpatients. Consecutive 578 unipolar and bipolar outpatients were interviewed with Comprehensive Assessment of Symptoms and History structured interview, Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. The prevalence of bipolar II disorder was 43.4%. Bipolar II disorder is common among depressed outpatients.
Precedents of perceived social support: Personality and early life experiences
Authors: Kitamura Toshinori , Kijima Nobuhiko , Watanabe Kyoko , Takezaki Yoshie
Published: March 2003

In order to examine the effects of personality and early life experiences on perceived social support, a total of 97 young Japanese women were investigated. Current interpersonal relationships were measured by an interview modified from Henderson et al.’s Interview Schedule for Social Interaction (ISSI). Personality was measured by Cloninger et al.’s Temperament and Character Inventory. Early life experiences at home and outside of home were also identified in the interview. The number of sources of perceived support was correlated with self‐directness, while satisfaction with perceived support was correlated with novelty seeking and with low harm avoidance. No early life experiences — early loss of a parent, perceived parenting, childhood abuse experiences, experiences of being bullied and/or other life events — showed significant correlations with the number or satisfaction of supportive people. The quantity and quality of perception of social support differ in their link to personality, and perceived social support may, to some extent, be explainable in terms of personality.
Autonomic function in the early stage of panic disorder: Power spectral analysis of heart rate variability
Authors: Ito Takashi , Inoue Yuichi , Sugihara Tokurou , Yamada Harumi , Katayama Seiji , Kawahara Ryuzo
Published: March 2003

Previous studies of autonomic nervous system (ANS) function in panic disorder (PD) patients have yielded conflicting results. We speculate that these differences might result from the variety of clinical stages of PD. In order to investigate this, we compared ANS activity in untreated patients in the early stage of PD with control subjects using power spectral analysis of electrocardiogram R‐R intervals (PSR‐R) in supine rest and during head‐up tilt, which was performed according to the maximum entropy method (MEM). It recognizes two main components: high‐frequency power (HF), which mainly reflects cardiac parasympathetic activity, and low‐frequency power (LF), which reflects both cardiac sympathetic and parasympathetic activity. The patients with PD had significantly higher values for all components of PSR‐R only in tilt position total power (TP), LF, and HF than did the control subjects (P < 0.01, < 0.01, < 0.02, respectively). However, the LF/HF ratio which indicated sympathovagal balance did not differ significantly between the two groups in tilt position. Our findings suggest that patients with PD in the early stage of illness have co‐activation of sympathetic and parasympathetic nervous systems, which might act to maintain a balance between the two autonomic systems.
Myotonic dystrophy associated with 47 XYY syndrome
Authors: Asano Atsutoshi , Motomura Naoyasu , Yokota Shingo , Yoneda Hiroshi , Sakai Toshiaki , Tsutsumi Shigetoshi
Published: March 2003

A case of myotonic dystrophy with 47 XYY presented with tall stature and mental retardation. The patient was a 37‐year‐old male. In addition to grip myotonia and percussion myotonia, severe weakness and atrophy were noted in the face and the neck muscles and in the distal muscles of the four limbs. He also had diabetes mellitus, cataracts and sexual behavior abnormalities. He was found to be 47 XYY from chromosomal examinations. The combination of 47 XYY syndrome and myotonic dystrophy has not been reported previously.
A clinical study on suicide among schizophrenics
Authors: Funahashi Tatsuhide , Ibuki Yasuo , Domon Yuji , Nishimura Tsutomu , Akehashi Daiji , Sugiura Hideo
Published: March 2003

We conducted a clinical investigation of 80 suicides who met the DSM‐III‐R criteria for schizophrenia. The results using this approach showed no significant difference with those of preceding studies, and general features regarding the phenomenology of suicide among schizophrenics worldwide were recognized. The present study, however, served to underscore the following points: (i) suicide of schizophrenics must be considered a concern at all stages of the disease; (ii) the subjective strength of the will to die may be more important for the committing suicides than the lethality of the methods employed; and (iii) a change in the environment, for example, a hospital admission or discharge, may trigger suicide. A control group of 80 living schizophrenics with no past attempted suicide was then matched to the suicide group with respect to sex and illness duration, in order to identify the predictors of suicide. In a logistic regression analysis, the presence of suicidal ideation, degree of anxiety estimated by positive and negative syndrome scale, and birth order were revealed as predictors of suicide. As to the birth order, the risk is higher in middle children.
Functional significance of stimulatory GTP‐binding protein in hippocampus is associated with kindling‐elicited epileptogenesis
Authors: Iwasa Hiroto , Kikuchi Shuichi , Mine Seiichiro , Sugita Katsuo , Miyagishima Hiro , Hasegawa Shuji
Published: March 2003

In order to evaluate the involvement of the stimulatory G‐protein (Gs)‐related transduction system in the basic mechanisms of epilepsy, we examine the expression levels of Gsα mRNA and specific GTP‐binding ability in the hippocampus of amygdaloid‐kindled rats at various seizure stages. Northern blot analysis showed a significant increase in the Gsα mRNA expression level in the bilateral hippocampus at 24 h after the last generalized seizure. The [3H]‐GTP‐binding assay with isoproterenol (IPN), a β‐receptor agonist, revealed a remarkable increase of Bmax values in the sham‐operated control and partially kindled groups. However, the IPN‐induced increase of Bmax values was abolished on both sides of the hippocampus at 24 h after and at 4 weeks after the last generalized seizure in fully kindled rats. These data suggest that alteration in the Gs function and β‐adrenergic receptor‐Gs coupling might be implicated in the neurobiological basis of the induction mechanisms of the generalization of seizures and the mechanisms of the maintenance of enduring epileptogenesis. Conversely, the Gs‐related transduction system might have a lesser impact on the acquisition process of epileptogenesis.
An unusual case of rhythmic movement disorder
Authors: Kaneda Reizo , Furuta Hisakazu , Kazuto Kosaka , Arayama Kotaro , Sano Joh , Koshino Yoshifumi
Published: March 2003

Rhythmic movement disorder is one of the sleep–wake transition disorders listed in the International Classification of Sleep Disorders. According to this classification, the condition commonly occurs in infants and toddlers, and persistence beyond 4 years of age is unusual. Recently, we encountered a case in which rhythmic movement disorder persisted up until the age of 12 years with spikes registering on the sleep electroencephalogram. Epileptic seizure was ruled out because of the characteristic rolling movement, absence of any other epileptic symptoms (e.g. vocalization and tonic‐clonic seizure) and cessation as a result of removal of the blanket.
Abnormal illness behavior and psychiatric disorders: A study in an outpatient clinic in Japan
Authors: Guo Yingqiu , Kuroki Toshihide , Yamashiro Seiji , Sato Takeshi , Takeichi Masashi , Koizumi Shunzo
Published: March 2003

Abstract Abnormal illness behavior, such as hypochondriacal attitude and inappropriate treatment‐seeking, has been associated with various psychiatric disorders in which patients tend to abuse medical services and seek inappropriate treatment in general practice clinics rather than psychiatric clinics. However, the relationship between illness behavior and psychiatric disorders in Japan is yet to be elucidated. We examined the abnormal illness behavior of 243 patients who visited the outpatient department of psychiatry at Saga Medical School Hospital, Saga, Japan, using a Japanese version of the Illness Behavior Questionnaire (IBQ). Multivariate analysis indicated significant association between some of the IBQ scale scores and age, sex and employment status. Patients with anxiety disorder scored higher on five of the seven IBQ scales compared with patients with another major disorder (mood disorder, schizophrenia or somatoform disorder). When compared with the IBQ scale scores reported in Australian patients in a psychiatric hospital, most of the IBQ scale scores differed significantly in our patients; a higher score among Japanese patients on the general hypochondriasis scale was most prominent. A similar trend in IBQ scale scores was also noted among Japanese patients visiting the hospital's general medicine clinic in comparison with Australian patients visiting a general practice clinic. Japanese patients with anxiety disorder may display the most salient abnormal illness behaviors among patients with psychiatric disorders. Sociocultural background may contribute to the characteristic abnormal illness behaviors of Japanese patients.
Olanzapine optimal dose: Results of an open‐label multicenter study in schizophrenic patients
Authors: Ishigooka Jun , Murasaki Mitsukuni , Miura Sadanori , Group The Olanzapine Late‐Phase Ii Study
Published: March 2003

Abstract This open‐label clinical study was conducted for patients with schizophrenia in order to investigate the efficacy, safety and optimal dose of olanzapine. One hundred and fifty‐six of the 159 enrolled patients were included in the analysis set. For the primary efficacy measure, the Final Global Improvement Rating (FGIR) score, 15.4% of patients had remarkable improvement, 58.3% of patients had moderate improvement or more, 79.5% of patients had slight improvement or more, and 10.3% of patients had increase in disease symptomatology (worsening). Results from the Brief Psychiatric Rating Scale (BPRS) in all individual items were improved from baseline. Olanzapine was effective not only against positive psychotic symptoms but also against negative symptoms. This was consistent with results from the Positive and Negative Syndrome Scale (PANSS). For the majority of patients, a dose range of 7.5–10.0 mg/day, as a lower bound on the minimally effective dose, was suggested by the results of the dose to first response based on improvement in Global Improvement Rating (GIR) analyses. The ratio of olanzapine dose to equivalent haloperidol dose was estimated at 1.2 : 1. The most commonly reported treatment‐emergent signs and symptoms (TESS) occurring at a frequency of 10% or more were insomnia, weight increase, excitement, sleepiness, anxiety, malaise and dull headaches. There was a low incidence of extrapyramidal treatment‐emergent signs and symptoms; the most commonly reported were akathisia (6.4%), tremor (5.8%) and muscle rigidity (2.6%).
One‐year prevalence and incidence of depression among first‐year university students in Japan: A preliminary study
Authors: Tomoda Atsuko , Mori Katsuaki , Kimura Mitsuru , Takahashi Takuya , Kitamura Toshinori
Published: March 2003

Abstract A structured interview was used to examine the 1‐year incidence and prevalence of depression among 116 first‐year university students. While 24 of the subjects (20.7%) met the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM‐IV) criteria for Major Depressive Episode (MDE), 62 (53.4%) met the Diagnostic and Statistical Manual of Mental Disorders 3rd ed. Revised (DSM‐III‐R) criteria for MDE, and 27 (23.3%) also met the Research Diagnostic Criteria (RDC) for Major Depressive Disorder (MDD) for the 12 months prior to the interview. Moreover, 23 of the subjects (19.8%) had onset of the DSM‐IV criteria for MDE, 54 (46.6%) had onset of the DSM‐III‐R criteria for MDE, 24 (20.7%) had onset of the RDC for MDD, during the same time period. These high rates of depression may be explained by the students’ difficulties in and by their readjustment after entering university.
Neuroleptic therapy influences basal ganglia activation: A functional magnetic resonance imaging study comparing controls to haloperidol‐ and olanzapine‐treated inpatients
Authors: Müller Jürgen L. , Klein Helmfried E.
Published: March 2003

Abstract Functional magnetic resonance imaging (fMRI) is a non‐invasive technique for mapping the working brain. Using a fingertapping task, imaging of subcortical regions has proven to be difficult. We studied an inpatient under treatment with olanzapine and haloperidol, focusing on subcortical brain activation. We compared this patient with normal controls and with patients using haloperidol or olanzapine. Brain activation was induced by a unilateral self‐paced fingertapping task. Brainvoyager software package (version 3.7) was used for data analyzing. Significant increases in blood oxygen level‐dependent response were found in the contralateral motor area and the ipsilateral cerebellum in all patients. Differences with regard to the subcortical regions could be revealed in both the examinations of the same patient and the different treatment groups. Functional magnetic resonance imaging is an important method to study the interaction between basal ganglia, thalamus and the motor cortex. It is especially helpful to investigate intra‐individual differences under different treatment conditions.
Ethanol effect on sleep electroencephalogram by the correlation dimension
Authors: Kobayashi Toshio , Madokoro Shigeki , Wada Yuji , Misaki Kiwamu , Nakagawa Hiroki
Published: March 2003

The influence on sleep of alcohol (ethanol) was investigated in nine males using the correlation dimension (CD). Polysomnography (PSG) was recorded on a baseline night (BL‐N) and on an ethanol (0.8 g/kg) night (Et‐N). The mean correlation dimensions on Et‐N, as well as on BL‐N, significantly decreased from sleep stage ‘awake’ to sleep Stages 1, 2 and 3 and increased during rapid eye movement (REM) sleep. The mean correlation dimensions of the sleep EEG during sleep Stage 2 and those for the second sleep cycle on the Et‐N were significantly higher than those on the BL‐N. The changes in the correlation dimensions between sleep cycles were reduced on Et‐N as compared to BL‐N.