Radial-sequence magnetic resonance imaging in evaluation of acetabular labrum

We investigated the usefulness of a radial-sequence magnetic resonance imaging (MRI) technique in the visualization of the acetabular labrum, which surrounds the acetabulum. In 22 hip joints of 12 volunteers, T2-weighted images were obtained on 24 radial planes of the acetabular rim, set at 15 degrees -intervals, using the small tip angle gradient echo method. We examined 7 planes in the weight-bearing portion. The acetabular labrum in the weight-bearing portion was depicted in good contrast to the surrounding tissues. The shape of the labrum differed among individuals and also in the anterior and posterior portions of the labrum. The signal intensity of the labrum was low or partially moderate. There was a high signal intensity band on the base of the acetabular labrum in several portions, which should be carefully interpreted to avoid confusion with abnormality. We concluded that radial-sequence MRI could be a useful technique for evaluation of the condition of the acetabular labrum in the weight-bearing portion.

Perphenazine-induced hiccups

Hiccup is a spasmodic, involuntary contraction of the inspiratory muscles, associated with delayed and abrupt glottic closure causing a peculiar sound (Launois et al., 1993). A number of medical conditions are known to cause persistent and intractable hiccups. Among the drugs reported to induce hiccups, Thompson et al. stated that corticosteroids and benzodiazepines are the drug classes most frequently associated with the development of hiccups (Thompson and Landry, 1997). Antidopaminergic agents such as chlorpromazine and haloperidol are the preferred drugs used for the treatment of chronic hiccups (Launois et al., 1993). We report a case of severe hiccups occurring in association with the administration of perphenazine, which is a dopamine antagonist. To the best of our knowledge, this is the first report of hiccups occurring as a side effect of antidopaminergic drugs.

[A survey of drug utilization in psychiatric hospitals in Japan: the basic analysis of the current status of prescription patterns]

Although concern about the prescription pattern of psychotropics is growing, there have been very few surveys in Japan. In this survey conducted in 1993, prescription data, patient characteristics, etc. were collected for 2,395 inpatients from 18 psychiatric hospitals. Their mean age was 48.4 (S.D. = 13.6). Of these patients, 1,818 (75.9%) were diagnosed with schizophrenia, 115 (4.8%) with mood disorder, and 102 (4.3%) with mental retardation. The results were as follows. 1) They were prescribed an average of 10.1 different drugs: of these, 5.6 were various psychotropics (2.6 neuroleptics, 1.2 antiparkinsonian drugs, 1.0 hypnotics). 2) The mean daily dose of antipsychotics was 1,082 mg of chlorpromazine equivalent. 3) The most commonly prescribed neuroleptic was haloperidol (53.2% of the total patients) followed by levomepromazine (48.7%), chlorpromazine (24.8%), bromperidol (18.7%), and zotepine (18.3%).

Impact of sociodemographic and diabetes-related characteristics on depressive state among non-insulin-dependent diabetic patients

One hundred and fifty-one non-insulin-dependent diabetic patients were assessed to detect sociodemographic, psychological and disease-related characteristics that were related to depressive state among diabetic patients. Depressive state in the patients was correlated with poor social support and low economic status, premorbid neurotic personality and the presence of complications, retinopathy in particular. However, depressive state did not correlate with age, gender, education, serum level of HbA1C or duration of diabetes. The severity of the depressive state in diabetic patients may vary with the cultural background of the patient and/or the country in which he or she is living. In treating diabetic patients, doctors need to pay special attention to these factors.

Insight and clinical correlates in schizophrenia

It is not clear to what extent poor insight is inherent in schizophrenic psychopathology or is related to clinical factors. It is clinically important to elucidate this point to know how some insight remains intact in schizophrenia. Sixty-three ICD-10 schizophrenics were recruited. Insight was measured by David's three-dimensional scale, which deals with the awareness of the need for treatment, of the illness, and of psychotic experiences. Clinical factors that may influence insight were grouped into objective psychopathology, subjective experience, and treatment settings, according to the normal development of insight starting from objective illness, through subjective perception of it, to seeking treatment. Psychopathology was measured by the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and the subjective experience was measured by a checklist of our own. Positive symptoms, especially disordered thought, hallucinations, and delusions, had a modest inverse correlation with awareness of illness and of psychotic experiences, but these were not correlated with alogia or other negative symptoms. Later age at the first onset was significantly correlated with poor awareness of psychotic experience, but no correlation of subjective experience with insight emerged. Awareness of the need for treatment was significantly higher in outpatient than in inpatient groups, and was not correlated with any other variables. Poor awareness of illness and of psychotic experience seems to be a trait of the acute rather than the chronic psychopathology of schizophrenia. Poor awareness of psychotic experience was related to later onset. Awareness of the need for treatment seems to improve, even in the absence of awareness of illness or of psychotic experience, in outpatient settings--the effects of social interaction may be relevant to this.

[Depression during interferon therapy in chronic hepatitis C patients--a prospective study]

The number of patients treated with interferon (IFN) has increased markedly in Japan since 1992, when the Health and Welfare Ministry approved the use of IFN for treating chronic active hepatitis C. It is important to identify and treat depression, which is one of the psychiatric complications of IFN therapy and often leads to discontinuation of the therapy, in patients with chronic hepatitis C. In this study we prospectively investigated the incidence of depression during IFN therapy in patients with chronic active hepatitis C. The psychiatric status of 85 patients (53 men, 32 women; mean age 49.1 years) with chronic active hepatitis C who began receiving IFN at Showa University Hospital was assessed before and 2, 4, 12 and 24 weeks after the start of IFN therapy, using the major depressive episode diagnostic criteria listed in the DSM-III-R and the Hamilton Depression Scale HDS). All of the patients provided informed consent prior to participation in this study. IFN therapy was discontinued in 5 cases (5.9%) because of physical side effects and in 4 cases (4.7%) because of depression. Two, 11, 14, 25 and 16 patients were diagnosed as having major depressive episodes before and 2, 4, 12 and 24 weeks after the start of IFN therapy, respectively. The number of patients who were asymptomatic before the start of IFN therapy but were diagnosed as having a major depressive episode at least once during IFN therapy was 31 (31/83 = 37.3%). The mean HDS scores at 2, 4, 12 and 24 weeks (5.4, 6.0, 8.8 and 6.6) were significantly higher than that before the start of IFN therapy (3.0). The patients whose first diagnosed major depressive episodes occurred more than 4 weeks after the start of IFN therapy tended to be more severely depressed than those in whom it occurred less than 4 weeks after the start of IFN therapy. Compared to the 47 patients who completed 24 weeks of IFN therapy without experiencing depression, the 31 patients who were diagnosed as experiencing major depressive episodes during IFN therapy had significantly higher neuroticism scores determined using the Eysenck Personality Questionnaire, showed a more severely depressed mood and experienced more severe sleep disturbances before the start of IFN therapy. The latter group of patients also tended to have comorbid chronic physical disorders such as hypertension or diabetes mellitus and the histories of mental disorders before the IFN therapy; however these differences were not statistically significant. There were no differences between the two groups in patient age or sex, the severity of hepatitis before the IFN therapy, the type of IFN used in the therapy or the efficacy of IFN in the treatment of the hepatitis C. Our results indicate that the decision as to whether to treat chronic active hepatitis C with IFN should be made carefully and that early intervention and careful monitoring of depression are required during IFN therapy in the treatment of chronic active hepatitis C.

Diabetes with the 3243 mitochondrial tRNALeu(UUR) mutation. Characteristic neuroimaging findings

OBJECTIVE

To investigate the basis of central nervous system dysfunction in diabetes associated with the 3243 mitochondrial tRNA mutation, we studied neuroimaging findings in patients with this disease.

RESEARCH DESIGN AND METHODS

We screened 205 diabetic patients. Those patients who had the 3243 mutation in leukocytes or muscle were enrolled. All the subjects underwent computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) single-photon emission computed tomography (SPECT) of the brain.

RESULTS

None of the nine subjects with the 3243 mutation had the typical clinical picture of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes, and none had neurological focal signs. CT or MRI revealed diffuse brain atrophy in three patients (33%) and cerebellar atrophy in one (11%). Abnormal high intensity areas were observed on MRI in five patients (56%). The overall prevalence of brain abnormalities was 56% (5 of 9) on CT and 78% (7 of 9) on MRI scans. MRA revealed no stenotic lesions. SPECT showed reduced accumulation of [123I]IMP in the right or left parieto-occipital region in eight patients (89%).

CONCLUSIONS

Reduced accumulation of [123I]IMP in the parieto-occipital cortex was found in a high proportion of our subjects on SPECT. This imaging finding might be characteristic of diabetes associated with the 3243 mitochondrial tRNA mutation and may be a sign of latent central nervous system dysfunction.

A psychiatric appraisal of "glossodynia"

"Glossodynia" is a diagnostic rubric that includes patients enduring pain or a burning sensation in the tongue without any oral pathology or systemic disease. Psychiatric profiles of 50 women patients with "glossodynia" were compared with those of control subjects. The patients scored significantly lower on the Extraversion Scale of the Eysenck Personality Questionnaire and higher on the Toronto Alexithymia Scale than the control subjects, whereas there was no significant difference in the mean General Health Questionnaire score. The psychopathology of "glossodynia" may be more markedly associated with personality trait characteristics than with neurotic or depressive symptoms.

Criterion-related validity of diagnostic criteria for alexithymia in a general hospital psychiatric setting

BACKGROUND

The diagnostic criteria for alexithymia (DCA) was proposed by Fava et al. in 1995. The purpose of this study was to examine the criterion-related validity of the DCA in a general hospital psychiatric setting.

METHODS

The subjects included 126 outpatients with psychiatric disturbance. The severity of alexithymic characteristics was assessed using the DCA and Beth Israel Hospital Psychosomatic Questionnaire (BIQ). Two Japanese versions of the 26-item Toronto Alexithymia Scale (TAS-26) and Minnesota Multiphasic. Personality Inventory-2 (MMPI-2) were administered.

RESULTS

The DCA had relatively high sensitivity and specificity, indicating adequate discriminant validity. The discriminant validity of the DCA was also supported by significant associations of the DCA with the TAS-26 and MMPI-2. These results indicate that when used for screening, the DCA has adequate criterion-related validity.

CONCLUSIONS

The DCA may be clinically useful in a general hospital psychiatric setting.

Encephalopathy during amitriptyline therapy: are neuroleptic malignant syndrome and serotonin syndrome spectrum disorders?

This report describes a case of encephalopathy developed in the course of amitriptyline therapy, during a remission of unipolar depression. This patient could have been diagnosed as having either neuroleptic malignant syndrome (NMS) or serotonin syndrome (SS). The major determinant of the symptoms may have been dopamine/serotonin imbalance in the central nervous system. The NMS-like encephalopathy that develops in association with the use of antidepressants indicates that NMS and SS are spectrum disorders induced by drugs with both antidopaminergic and serotonergic effects.

Serum levels of soluble CD4 and CD8 in patients with chronic viral hepatitis

The blood levels of soluble CD8 (sCD8) and soluble CD4 (sCD4) were measured in patients with various liver diseases, and their significance was studied. The levels of sCD8 were significantly higher in patients with chronic active hepatitis (CAH), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), acute hepatitis (AH), fulminant hepatitis (FH) and liver cirrhosis (LC) as compared with the normal controls (NC), and correlated positively with those of GPT (r = 0.67, p < 0.001). In addition, a comparison of the exacerbation of CAH with remission showed that the sCD8 levels were significantly higher in the former. On the other hand, there was no significant rise in the level of sCD4 in patients with any liver disease, except FH, no definite relationship between sCD4 and sGPT, and no consistant tendency in sCD4 levels between exacerbation and remission. The reason for an insignificant elevation of the sCD4 level is the fact that in hepatitis the CD8-positive cells, which are cytotoxic T cells, are directly involved in hepatocyte damage; therefore the CD8-positive cells are predominantly activated, while the activity of the CD4-positive cells is considered to be lower. Instead of determining the number of CD4-positive cells and CD8-positive cells in the mononuclear cells of peripheral blood, serum sCD4 and sCD8 levels can be measured simply and inexpensively. Thus, these levels may be useful immune markers.

Origin of carbon atoms of biotin. 13C-NMR studies on biotin biosynthesis in Escherichia coli

The origin of the carbon atoms of pimeloyl-CoA, the earliest known precursor in the pathway of de novo biotin biosynthesis in Escherichia coli, was investigated by 13C-NMR spectroscopy. In fermentation of the biotin-overproducing DRK332/pXBA312 strain of Escherichia coli (a repressor mutant carrying a biotin operon fragment in the plasmid), a high dose of L-alanine (8 g/l) stimulated dethiobiotin and biotin accumulation. Although L-alanine is a known precursor of 7-keto-8-aminopelargonic acid in biotin biosynthesis, the 13C-NMR spectrum of dethiobiotin showed that the C-3 of L-[3-13C]alanine was incorporated into not only the methyl carbon (C-9) but also alternate carbons (C-2, C-4, C-6) of the side chain, and these latter positions are the same as those labeled with D-[1-13C]glucose. These data indicate that L-alanine can act as an alternative carbon source, suggesting that acetyl-CoA is a possible precursor for pimeloyl-CoA synthesis. In accordance with this hypothesis, the C-1 of sodium (1-13C)acetate and the C-2 of sodium (2-13C)acetate were incorporated into alternate carbons in the side chain of dethiobiotin, i.e., (C-1, C-3, C-5, C-7) and (C-1, C-2, C-4, C-6), respectively. These results suggested firstly that in E. coli pimeloyl-CoA is biosynthesized from L-alanine and/or acetate via acetyl-CoA, but not via pimelic acid, which has been suggested as a biotin precursor in other species, and secondly that the carboxyl group of biotin originates from carbon dioxide produced through the tricarboxylic acid cycle.

[Long-term artificial ventilation by nasal intermittent positive pressure ventilation; 6 cases of domiciliary assisted ventilation]

Six patients with chronic respiratory failure associated with hypercapnia were treated with nasal intermittent positive pressure ventilation (NIPPV) at home. NIPPV was delivered via a custom molded nasal interface described by McDermott. The patients consisted of one patient with kyphoscoliosis, three with Tb-sequela, one with COPD, and one with neuromuscular disease. Each patient had been treated with oxygen therapy until assisted ventilation was initiated because of CO2 retention. NIPPV was administered using a volume cycled flow generator set to deliver a minute volume such that PaCO2 was maintained between 35 and 45 Torr on NIPPV trial performed during wakefulness under the condition of no leakage from the mask. Supplementary oxygen was added so that oxygen saturation was maintained above 90 percent during more than 95% of nighttime NIPPV. Arterial blood gas tensions during daytime spontaneous breathing showed an improvement (PaCO2 68.3 +/- 7.2 Torr, PaO2 70.4 +/- 15.5 Torr, SaO2 91.6 +/- 4.3% before treatment; PaCO2 55.8 +/- 4.7 Torr, PaO2 87.5 +/- 16.5 Torr, SaO2 95.5 +/- 1.7% on treatment, mean +/- SD). The duration of NIPPV at home ranged from 2 to 24 months (11.7 +/- 6.8), and there was no hospitalization due to exacerbation during this period. In conclusion, NIPPV via a custom molded mask is simple, noninvasive, and suitable for the provision of long-term and domiciliary assisted ventilation.

Novel microbial metabolites of the phoslactomycins family induce production of colony-stimulating factors by bone marrow stromal cells. I. Taxonomy, fermentation and biological properties

Three metabolites were isolated from the culture broth of an actinomycete strain identified as Streptomyces platensis SANK 60191, that induce the production of colony-stimulating factors (CSFs) by stromal cell line KM-102 at ED50 concentrations from 40 to 200 ng/ml. The compounds induced quantities of granulocyte CSF (G-CSF) and granulocyte-macrophage CSF (GM-CSF) comparable to those induced by interleukin-1, a strong CSF inducer. These metabolites were called leustroducsins (A, B and C) and were later found to be structurally related to phoslactomycins. This is the first report of CSF inducing activity by members of the phoslactomycin class.

Screening method for colony-stimulating factor inducers using a human bone marrow stromal cell line, KM-102

A new screening method for inducers of colony-stimulating factors (CSFs) was established using KM-102, a human bone marrow stromal cell line as the producer. In this method, the assay system which uses CSF dependent cell lines is combined with the CSF production system. Interleukin-1 (IL-1), which is known to upregulate CSF production in many cell populations, was used as a positive control for production of granulocyte CSF (G-CSF) and granulocyte-macrophage CSF (GM-CSF). Induction in the positive controls was clearly detected within 24 hours. Activators of protein kinase C (PKC), protein phosphatase inhibitors and lipopolysaccharide (LPS) were positive in this assay system, but muramyl dipeptide (MDP) and Bestatin which are known macrophage activators, were negative. Inducers of CSFs were successfully detected using this assay method. Among 1,600 microbial strains tested, 2 actinomycete strains were found to produce active substances. One strain produces teleocidin-A, a strong activator of PKC, and the other strain produces a mixture of active compounds including three novel compounds. These three compounds do not induce terminal differentiation of HL-60 cells, suggesting that they are not teleocidin-like substances and form a new class of CSF inducers.

[Clock drawing task as screening for cognitive impairment in the elderly population]

This study compared the "Clock-Drawing Task" to the Mini-Mental State Test (MMST) in 834 elderly persons. A cut-off score of 20 or less on the MMST was used to determine cognitive impairment. The "Clock drawing Task" was score of 20 or less on the MMST was used to determine cognitive impairment. The "Clock drawing Task" was scored by three components; frame, numbers, and two hands. Using a criterion of completion on two or more of the three components, the sensitivity, specificity, and correct identification of the diagnosis of cognitive impairment of "Clock Drawing Task" were 89%, 65% and 83% respectively. "Clock Drawing" appears to be a practical test which can be useful for clinicians as a screening for cognitive impairment in old age.

Milbemycins alpha 11, alpha 12, alpha 13, alpha 14 and alpha 15: a new family of milbemycins from Streptomyces hygroscopicus subsp. aureolacrimosus. Taxonomy, fermentation, isolation, structure elucidation and biological properties

Streptomyces hygroscopicus subsp. aureolacrimosus SANK 60286 produces a new family of milbemycins, named milbemycins alpha 11, alpha 12 [corrected], alpha 13, alpha 14 and alpha 15, together with other milbemycins. Their structures are 3-methyl-2-butenoyloxy and 3-methylbutyroyloxy derivatives at C-4a of milbemycins A3 and A4, or 3-methyl-2-pentenoyloxy derivative at C-4a of milbemycin A3, respectively. Milbemycin alpha 14, 3-methyl-2-butenoyloxy derivative, especially possesses a potent acaricidal activity.