Background factors involved in the epidemiology of functional constipation in the Japanese population: a cross-sectional study

Background

Functional constipation (FC), a functional bowel disorder with symptoms of constipation, has considerable impact on quality of life. As data regarding its prevalence and epidemiology are lacking, this study aimed to evaluate the prevalence, population composition, lifestyle, quality of life, and clinical characteristics of these individuals by comparing people with and without FC. These parameters were also compared among individuals with strong and weak awareness of constipation.

Methods

An internet survey was conducted among 10,000 individuals aged 20–69 years from the general Japanese population; they were registered with an internet survey company. The following data were obtained: age, sex, educational history, occupation, residence, history of other diseases, lifestyle (including smoking/drinking habits using the Japanese Health Practice Index, medication use, symptoms of constipation according to the Rome III criteria, stool types according to the Bristol stool scale, and use of laxatives, including the place of purchase and cost per month or acceptable cost per month. The 8-item Short Form Health Survey Questionnaire was also used; FC was diagnosed based on Rome III criteria. All respondents were classified according to their awareness of constipation (i.e. strong or weak), and their characteristic features were compared.

Results

The data of 3000 respondents were evaluated; 262 (8.7%) had FC, which was common among older adults, women, and homemakers. FC was associated with changes in the frequency of bowel movement, sensation of incomplete or scanty evacuation, and the use of manual maneuvers; these are consequential clinical symptoms of FC. These individuals frequently skipped breakfast, had insufficient sleep, had more severe constipation, and had purchased laxatives in pharmacies or online more often than those without FC. A strong awareness of constipation was significantly more prevalent among women and homemakers. A history of anemia and cardiovascular disease was significantly more frequent in the strong awareness group, whereas a history of hypertension was more frequent in the weak awareness group.

Conclusions

Appropriate and comprehensive management should be provided for FC, based on the understanding of its characteristic features and considering the symptoms and lifestyle.

Oral Litholysis in Patients with Chronic Calcific Pancreatitis Unresponsive to or Ineligible for Extracorporeal Shock Wave Lithotripsy and Endoscopic Therapy

BACKGROUND/AIMS

Our study aimed to evaluate the effect of oral litholysis in patients with chronic calcific pancreatitis (CCP) unresponsive to or ineligible for extracorporeal shock wave lithotripsy (ESWL) and endoscopic therapy.

METHODS

Trimethadione, an antiepileptic agent, was administered orally at a dose of 0.6-0.9 g/day to 15 patients with this condition. Treatment outcome was evaluated by assessment of dissolution of the pancreatic stones on plain X-ray films and computed tomography scans of the upper abdomen. Plasma glucose, hemoglobin A1c, and body mass index (BMI) were also monitored throughout the therapy.

RESULTS

Litholysis was observed in 13 out of 15 patients (86.7%) and was definite in 10 and partial in 3. Six patients had pancreatitis attacks during the therapy; 5 of whom showed definite litholysis and had only 1 mild attack. Of the 11 patients with normal or impaired glucose tolerance at baseline, none developed diabetes mellitus and all showed litholysis. BMI significantly increased in patients whose pancreatic stones dissolved. There was no vital organ impairment by trimethadione.

CONCLUSION

Oral litholysis using trimethadione may represent a noninvasive and effective complementary treatment in patients with CCP unresponsive to or ineligible for ESWL and endoscopic therapy.

[Mycobacterium shinshuense isolated from cutaneous ulcer lesion of right lower extremity in a 37-year-old woman]

PURPOSE

Second clinical infection case of Mycobacterium shinshuense was presented, we tried the identification of M. shinshuense that is isolated from skin.

OBJECT

Mycobacteria species isolated from cutaneous ulcer lesion of right lower extremity in a 37-year-old woman.

METHOD

Identification by DNA-DNA Hybridization, 16S rRNA and rpoB method as genomic level and conventional method.

RESULT

It did not grow on 1% Ogawa's slant medium at both 37 degrees C and 42 degrees C, but grew at 28 degrees C. It formed yellowish colonies in the dark. It was difficult to distinguish M. shinshuense from M. ulcerans and M. marinum by DNA-DNA hybridization (DDH) and DNA sequencing. To identify that it is M. shinshuense, growth rate, temperature range of mycobacterial growth, light coloration reaction, biochemical and biological tests, and drug susceptibility testing were further explored. Finally it was identified as M. shinshuense based on these CONSIDERATION: For Mycobacteria species which grow 2 weeks after inoculation at 28 degrees C, and which is identified as M. marinum by DDH method, it is necessary to identify with sequence and conventional method.

Mixed connective tissue disease associated with antineutrophil cytoplasmic antibodies against proteinase-3 and systemic atherosclerosis: a case report

A 47-year-old woman presented with facial spasm, swollen fingers and Raynaud's phenomenon due to cerebrovascular disorder and mixed connective tissue disease (MCTD). Although she was positive for both antineutrophil cytoplasmic antibodies against proteinase-3 (PR3-ANCA) and anti-U1 RNP antibodies, she did not meet the American College of Rheumatology classification criteria for Wegener's granulomatosis (WG). Physical and histopathological examinations revealed severe systemic atherosclerosis without any of the traditional risk factors. Elevated levels of malondialdehyde-modified LDL and antioxidized LDL autoantibodies, which are considered to be key factors in the pathogenesis of atherosclerosis, were also detected in the serum of this patient. In this case, systemic atherosclerosis might have been linked to these autoimmune reactions.

Secretory carcinoma of the breast with a cystically dilated intraductal component: report of a case

A case of secretory carcinoma of the breast in a 61-year-old woman is described. She came to our hospital complaining of a bloody nipple discharge. The physical examination revealed a 2.8 x 2.1-cm, firm, irregular lump with bloody nipple discharge in her left breast. Mammography demonstrated an irregular mass and ultrasonography showed an irregular hypoechoic mass accompanied with a cyst. Ductgraphy was done. It showed a dilated mammary duct leading to the cyst which was partially occupied with carcinoma. A cytologic smear of the nipple discharge and fine-needle aspiration cytology revealed similar findings, and both findings were malignant. A modified radical mastectomy was performed. A pathological examination revealed secretory carcinoma of the breast which had spread inward and outward from the cyst. In addition, the nipple discharge flowed from the cyst through the dilated mammary duct. The patient is presently alive and well 2 years after the operation. Secretory carcinoma is an extremely rare tumor of the breast and 48 cases have been reported in Japan. The present case is the first known case of secretory carcinoma demonstrating a bloody nipple discharge to come from a cyst which has been invaded by carcinoma.

[Analytical studies of both initial symptoms and clinical symptoms and signs of different etiologies of chronic pancreatitis: an approach by using odds ratios]

We conducted the statistical analysis of both initial symptoms and clinical symptoms and signs of different etiologies of chronic pancreatitis by using odds ratios which was one of the techniques of evidence-based medicine. The official report published by The Research Group of Intractable Pancreatic Diseases sponsored by the Welfare Ministry of Japan in 1986 was available as the data source of the present study. Nine items of initial symptoms and 25 items of 28 clinical symptoms and signs were compared in 4 different etiologies of the disease which were alcoholic, biliary, idiopatic and nonalcoholic (both biliary and idiopatic). In initial symptoms, 1.5 items were significantly more observed in alcoholic pancreatitis than in nonalcoholic, biliary and idioatic pancreatitis, 4 of which (abdominal pain, back pain, poor appetite and loss of body weight) were common items as might be related closely to the alcohol intake, 2. only one item of jaundice was significantly more observed in biliary pancreatitis than in alcoholic and idiopatic pancreatitis, 3.3 items of poor appetite, diarrhea and abdominal mass were more frequently observed in idiopatic pancreatitis than in biliary pancreatitis. In clinical symptoms and signs, 1. almost all items (21 to 24) were significantly more observed in alcoholic pancreatitis than in the other etiologies of the disease, and seemed to be related directly or indirectly to alcohol intake, 2.3 or 4 items which were related closely to gallstone and acute cholecystitis were significantly more observed in biliary pancreatitis than the other two etiologies of the disease, and 3.4 items consisting of diarrhea, loss of body weight, and pancreatic swelling were more frequently observed in idiopathic pancreatitis than in biliary pancreatitis.

Direct communication between the parabiliary and paraumbilical venous network: a case report

A case with a direct communication between the parabiliary vein and the paraumbilical vein observed on CT obtained after portal vein embolization is presented. The object of this paper is to draw attention to this rare venous communication since it can serve as various collateral pathways.

Novel polymeric membranes having chiral recognition sites converted from tripeptide derivatives

Six kinds of tripeptide derivative consisting of L-glutamic acid gamma-benzyl ester [Glu(OBzl)] (E) and L-phenylalanine (Phe) (F), i.e. EEF, EFE, FEE, FEF, FFE and FFF, were converted into chiral recognition sites by adopting Boc-L-Trp as a print molecule. The formed chiral recognition sites discriminated between Ac-L-Trp and the corresponding D-isomer, and the L-isomer was incorporated into the membrane in preference to the D-isomer. The affinity constants between the recognition site formed in each membrane and Ac-L-Trp were determined to be 9.6 x 10(3) to 8.4 x 10(3) mol-1 dm3. The affinity constant depends on both the tripeptide sequence and the amino acid residue content. Tripeptide derivatives containing more glutamic acid derivative residues or glutamic acid derivative as an amino-terminal residue show higher affinity constants.

Immunoblotting detection of gamma-catenin (plakoglobin) antibody in the serum of a patient with paraneoplastic pemphigus

We report a patient with paraneoplastic pemphigus associated with a thymic tumour. Immunoblot study using affinity-purified gamma-catenin protein revealed that his serum recognized gamma-catenin (plakoglobin) in epidermal, thymic tumour and mouse bladder extracts.

Pulmonary CT findings in acute mercury vapour exposure

AIM

We describe the pulmonary computed tomography (CT) findings in acute mercury poisoning.

MATERIALS AND METHODS

Initial (n= 8) and follow-up (n= 6) chest CT examinations in eight patients exposed to mercury vapour while cutting pipes in a sulphuric acid plant were reviewed. Of the eight patients, two were asymptomatic and had normal CT results, two were asymptomatic but had abnormalities on CT, and four had both acute symptoms and positive CT results. The patients were all men whose ages ranged from 37 to 54 years (mean, 49 years).

RESULTS

Poorly defined nodules were present in five of six patients with positive CT findings, present alone in two patients or as part of a mixed pattern in three. They were random in distribution. Alveolar consolidation (n= 3) and areas of ground-glass opacity (n= 4) were observed and were more prominent in the most severely affected patients with the highest blood and urine level of mercury, predominantly in the upper and/or middle zone. These abnormal findings on CT resolved with (n= 1) or without (n= 5) steroid therapy. Pathological findings (n= 1) demonstrated acute interstitial changes predominantly with oedema.

CONCLUSION

We report CT findings in eight patients acutely exposed to mercury vapour. The pulmonary injury was reversible on CT in these cases. Hashimoto, M. (2001). Clinical Radiology56, 17-21.

Internal mammary artery embolization for hemoptysis

PURPOSE

The purpose of this study was to determine the factors influencing development of blood supply from the internal mammary artery and to discuss the value of embolization of the abnormal branches from this vessel using small particles following occlusion of the normal distal branches using microcoils in treating hemoptysis.

MATERIAL AND METHODS

Five patients with hemoptysis underwent internal mammary artery embolization with coaxial microcatheter systems. Bronchoscopy, chest radiographs, and CT were performed to determine the site and extent of the basic disease before embolotherapy in all patients.

RESULTS

In all patients, pulmonary lesions had extended from the lung to the adjacent pleural surface at the anterior lung field. Four patients underwent embolization from the proximal portion of the internal mammary artery following distal coil embolization. One patient who underwent only proximal embolization had recurrent bleeding.

CONCLUSION

The internal mammary artery contributes to the perfusion of lesions responsible for hemoptysis when the basic lesion involves the pulmonary parenchyma adjacent to the anterior pleural surface. Initial distal occlusion of the internal mammary artery may improve the efficacy of embolization of this artery for hemoptysis.

The use and cost of HIV service provision in England in 1996. National Prospective Monitoring System (NPMS) Steering Group and NPMS Working Party on Costs

OBJECTIVE

The aim of the study was to measure the use and estimate the cost of HIV service provision in England.

DESIGN AND SETTING

Standardised activity and case-severity data were collected prospectively in 10 English HIV clinics (5 London and 5 non-London sites) for the periods 1 January 1996 to 30 June 1996 and 1 July 1996 to 31 December 1996 and linked to unit cost data. In total, 5440 patients with HIV infection attended during the first 6 months and 5708 during the second 6 months in 1996.

MAIN OUTCOME MEASURES AND RESULTS

The mean number of inpatient days per patient-year for patients with AIDS was 19.7 [95% confidence interval (CI): 13.7 to 25.7] for January to June and 20.8 (95% CI: 15.3 to 26.4) for July to December 1996. The mean number of outpatient visits for asymptomatic patients with HIV infection was 14.8 (95% CI: 11.9 to 17.6) and 13.3 (95% CI: 10.8 to 15.7) for the respective periods and 16.1 (95% CI: 13.21 to 18.97) and 15.7 (95% CI: 11.2 to 20.2), respectively, for patients with symptomatic non-AIDS (i.e. symptomatic patients with HIV infection but without AIDS-defining conditions). Substantial centre-to-centre variation was observed, suggesting that many clinics can continue the shift from an inpatient- to an outpatient-based service. Cost estimates per patient-year for HIV service provision for 1996 varied from 4695 Pounds (95% CI: 3769 Pounds to 5648 Pounds) for asymptomatic patients, to 7605 Pounds (95% CI: 6273 Pounds to 8909 Pounds) for symptomatic non-AIDS patients to 20,358 Pounds (95% CI: 17,681 Pounds to 23,206 Pounds) for patients with AIDS.

CONCLUSIONS

Different combinations of antiretroviral therapy affect the cost estimates of HIV service provision differently. Anticipated reduction in inpatient-related activity through the increased use of combination antiretroviral therapy will further shift service provision from an inpatient- to outpatient-based service and reduce costs per patient-year. The extent and duration of such effects are currently unknown. The long term effects of combination treatment on the morbidity and mortality patterns of individuals infected with HIV are also currently unknown, as are their implications on the use and cost of HIV service provision. Multicentre databases like the National Prospective Monitoring System (NPMS) will provide healthcare professionals with information to improve existing services and anticipate the impact of new developments.

Chondromyxoid fibroma of the ethmoid sinus

Only a small proportion of cases of this rare neoplasm occur in the skull. We present an unusually extensive tumour in a young man.

[Effect of liver hydrolysate on ethanol- and acetaldehyde-induced deficiencies]

Since it has been reported that amino acids have alleviating effects on ethanol- and acetaldehyde-induced toxicity, we investigated the effect of liver hydrolysate derived from bovine liver on ethanol- or acetaldehyde-induced toxicity and deficiency models of mice and rats in the present study. Liver hydrolysate improved the deficiencies of beam walking and food intake of mice in a dose-dependent fashion when challenged with ethanol at the dose of 5 ml/kg, p.o. According to the analysis using selective inhibitors for alcohol dehydrogenase and acetaldehyde dehydrogenase, it has been suggested that this improvement effect of liver hydrolysate is mainly due to the reduction of acetaldehyde toxicity. No effect of liver hydrolysate was found in coma and death produced by orally treated ethanol at 10 ml/kg. In contrast, liver hydrolysate dose-dependently decreased the coma and death of mice administered acetaldehyde at 1.8 ml/kg, p.o. Furthermore, an increase in serum GPT activity, which was caused by twice oral administration of acetaldehyde at 1.2 ml/kg at interval of 1 hr, was inhibited by liver hydrolysate. These results suggest that liver hydrolysate has a protective effect against ethanol- and acetaldehyde-induced toxicity.

Evidence for a depressive-like state induced by repeated saline injections in Fischer 344 rats

We investigated the behavioral changes induced by mild stress in animals that may be relatively susceptible to a depressive-like state, the Fischer 344 rat strain. The mild stress of repeated handling and intraperitoneal (i.p.) injections with saline (2 ml/kg, twice a day for 14 days) elicited a moderate suppression of body weight gain, a decrease in open field activity, and a prolonged immobility during the tail suspension test in Fischer 344 rats compared with Sprague-Dawley rats. Chronic treatment of Fischer 344 rats with imipramine (10 mg/kg i.p., twice a day for 14 days) effectively suppressed open field activity and prolonged immobility. These results suggest that repeated saline injections may be a mild stressor in these rats. In the Fischer 344 strain, which may be vulnerable to the effects of mild stressors, repeated saline injections might induce a depressive-like state and could presumably represent an experimental model for depression.

Role of hippocampal serotonergic neurons in ischemic neuronal death

To clarify the serotonergic mechanisms involved in the protection against ischemic neuronal damage, ZD-211 (citalopram HBr), a serotonin (5-hydroxytryptamine; 5-HT) re-uptake inhibitor, or buspirone, a 5-HT1A agonist, was locally administered into the hippocampus of gerbils. Additionally, to clarify the role of the 5-HT nervous system in the hippocampus during ischemic neuronal damage, animals were subjected to the local administration of 5,7-dihydroxytryptamine (5,7-DHT), a 5-HT neurotoxin, before ischemia challenge. Gerbils received intrahippocampal administration of ZD-211 (200 nmol/animal) or buspirone (20 nmol/animal) before 5-min ischemia. 5,7-DHT was intrahippocampally administered 7 days before a 2-min non-lethal ischemia challenge. In vehicle-treated animals subjected to 5 min of ischemia, almost all hippocampal CA1 pyramidal neurons were lost. The treatment with ZD-211 or buspirone showed a significant protective effect, and the number of neurons was significantly increased compared to vehicle-treated animals. Pretreatment with NAN-190, a 5-HT1A antagonist, completely abolished the protective effect of ZD-211 or buspirone. In the 5,7-DHT-treated animals, the number of neurons was significantly reduced following 2 min of ischemia compared to vehicle-treated animals in which this period of ischemia is non-lethal. Thus, intrahippocampal treatment with ZD-211 or buspirone can protect neuronal damage following transient ischemia in gerbils. These effects of ZD-211 and buspirone were mediated through the 5-HT1A receptor in the hippocampus. Furthermore, the destruction of the 5-HT nervous system in the hippocampus aggravated ischemic neuronal damage. Therefore, this study showed that the enhanced activity of the 5-HT nervous system in the hippocampus may protect against neuronal damage following cerebral ischemia.

Protective effect of citalopram against the attenuation of the alpha 1-potentiation of cAMP formation in Fischer 344 strain rats

We investigated the effects of citalopram, a selective serotonin reuptake inhibitor (SSRI), using an animal model for a depressive state. In Fischer 344 rats, known as emotional animals, repeated stress by twice-daily intraperitoneal (i.p.) saline injections for 14 days elicited a depressive state characterized by a decreased open-field activity and a prolonged immobility during the tail-suspension test. Concomitantly, suppression of norepinephrine (NE)-induced cAMP formation was found in the cerebral cortical slices of the stress-exposed rats without changes in adrenergic alpha 1- or beta-receptors. The difference in cAMP formation between the intact and the stress groups was totally abolished under the blockade of the alpha 1-receptor system or by the stimulation with isoproterenol or forskolin, whereas the suppressed response in the stress group was also observed in combination with isoproterenol and phenylephrine. From these results, we confirmed that the potentiation of the beta-receptor-stimulated cAMP formation by the alpha 1-receptor is attenuated following repeated stress. Chronic i.p. administration of citalopram dissolved in saline improved both the suppressed open-field activity and the prolonged immobility in the tail-suspension test. The animals treated with citalopram exhibited a comparable alpha 1-potentiation effect as observed in the intact rats. However, another SSRI, paroxetine, was less effective on the attenuation of the alpha 1-potentiation in spite of its behavioral improvement in the depressive state. These findings suggest that citalopram has a protective effect against the repeated stress-induced depressive state by mechanisms besides the serotonin reuptake inhibition.

An attenuated alpha-1 potentiation of beta adrenoceptor-stimulated cyclic AMP formation after repeated saline injections in Fischer 344 strain rats

We investigated the behavioral and neurochemical features of Fischer 344 strain rats in which a depressive state was induced by repeated handling and saline injections as a mild stressor. The repeated intraperitoneal injections of saline (2 ml/kg, twice a day for 14 days) elicited a moderate suppression of body weight gain, a decrease in their open field activity and a prolonged immobility in the tail suspension test. In the stress-exposed rats, the tissue content of norepinephrine (NE) was increased in the cerebral cortex and hypothalamus, whereas that of dopamine or serotonin was not affected. Although the stress exposure did not affect the binding properties of either the alpha-1 or beta adrenoceptors, it suppressed cAMP formation stimulated by NE, but not by isoproterenol or forskolin, in the cerebral cortical slices. In the presence of prazosin or phorbol ester, the difference in NE-stimulated cAMP formation between the control and the stress groups was totally abolished. Phenylephrine enhanced isoproterenol-stimulated cAMP formation in the control but not in the stress group. From these results, it is postulated that the alpha-1 potentiation of beta adrenoceptor- stimulated cAMP formation was attenuated in the stress group. These findings suggest that the manipulation of mild stressor with repeated handling and saline injections to Fischer 344 rats elicits a depressive state characterized by the behavioral changes and the attenuated alpha-1 potentiation in the cerebral cortex, and that this manipulation might be available for the study of the stress-induced depressive state as a generally acceptable mild stress model.

Perpetual atrial arrhythmias causing a prolonged returning cycle as an expression of cardiac resonant oscillation

A theoretical method of calculating ventricular myocardial voltage and time constant from the findings of 40 portions in electrocardiographic (ECG) tracings of 25 cases, in which atrial premature beats with full returning cycle can be observed, is presented. An resonant electric circuit of an alternating current series element containing resistance (R) of 500 ohms, inductance (L), and capacitance (C) was assumed as a model in this study. The steady-state voltage (Vm) was calculated in terms of the real part of the complex expression L(d2q/dt2) + 500(dq/dt) + (1/C)q = Vmej omega t, where L = 250/ zeta omega n, 1/C = omega n2 L, and Vm = A(zero) omega n2 Lx 100. The effective voltage derived ranged from 0.77 to 0.88 (mean, 0.82) V. The mean value approximated the mean voltage stimulation threshould of the human right ventricle. The time constant RC ranged from 73 to 135 ms. This is the first paper to establish that this method is clinically applicable. The dynamical system regulating the heart rhythm was described as a finite-dimensional matrix representation, which possesses diagonal elements, i.e. eigenvalues, of I/4 square root of 2 pi and 1/2.

HNK-1-reactive novel oligosaccharide, sulfate-O-3GlcA beta 1-4Xyl beta 1-(4-methylumbelliferone), synthesized by cultured human skin fibroblasts

4-Methylumbelliferyl-beta-D-xyloside (Xyl-MU) was added to the medium of cultured human skin fibroblasts. After incubation, the culture medium was pooled, and the Xyl-MU-induced oligosaccharides in the medium were purified by gel filtration chromatography. A novel Xyl-MU derivative was obtained, in addition to the previously reported Xyl-MU derivatives such as Gal-Gal-Xyl-MU, Gal-Xyl-MU, Sia-Gal-Xyl-MU, GlcA-Xyl-MU, and Xyl-Xyl-MU. The novel Xyl-MU derivative was purified using gel-filtration chromatography and high performance liquid chromatography and then subjected to carbohydrate composition analysis, enzymic digestion, Smith degradation, and ion spray mass spectrometric analysis. The results indicated that it was sulfate-O-3GlcA beta 1-4Xyl beta 1-MU. The structure of the nonreducing terminal of this Xyl-MU-induced oligosaccharide was the same as that of the oligosaccharide chain of a human peripheral nerve-derived glycolipid, reactive with the mouse monoclonal antibody HNK-1, and this Xyl-MU-induced oligosaccharide also reacted with HNK-1. These results suggest that the oligosaccharide, which is structurally identical to that of human peripheral nerve-derived glycolipid synthesized by nervous tissue and related to cell adhesion, is synthesized also by mesenchymal cells.

[Effect of efonidipine hydrochloride, a calcium channel blocker, on the experimental cerebral ischemia/anoxia]

The anti-ischemic and anti-anoxic effects of efonidipine, a dihydropyridine calcium antagonist, were studied in several models for cerebral ischemia and anoxia in mice and rats, and the effects were compared with those of nicardipine and flunarizine. Both efonidipine and flunarizine showed protective effects in the models of KCN-induced anoxia and complete ischemia induced by decapitation in mice 6 hr after the treatment, while nicardipine did not show such a long-lasting effect. Efonidipine (1 mg/kg, i.p.), but not nicardipine and flunarizine, prolonged the tolerance times in the asphyxic anoxia model. In mice, efonidipine (4 mg/kg, i.p.) significantly reduced the cumulative mortality rate after bilateral carotid artery ligation. The survival rates at 20 hr after bilateral carotid artery ligation were 33% in the group treated with efonidipine, significantly higher than that in the control group, 0%. On the other hand, the treatment with nicardipine or flunarizine did not increase the rates at 20 hr after the ligation. Moreover, efonidipine attenuated the disturbance of cerebral energy metabolism induced by decapitation in rats. These effects of efonidipine observed in this study were on the whole superior to those of the reference drugs, strongly suggesting the improving effect of efonidipine on cerebral ischemia and anoxia.

Effects of citalopram, a synthetic serotonin uptake inhibitor, on indoleamine and catecholamine concentrations in the cerebrospinal fluid of freely moving rats

We studied changes in the concentrations of 5-hydroxytryptamine (5-HT), other indoleamines, and catecholamines in the cerebrospinal fluid (CSF) of freely-moving rats that had been administered citalopram, +/-1-[3- (Dimethylamino)propyl)-1-(4-fluorophenyl)-1, 3-dihydro-5-isobenzo-furancarbonitrile hydrobromide), a selective inhibitor of 5-HT uptake. In a microdialysis experiment, the intracerebral extracellular free 5-HT increased significantly, peaking 60 to 90 min after citalopram (30 mg/kg p.o.) was administered. The 5-HT concentrations in CSF from the cisterna magna increased significantly, reaching a maximum 6 hours after a single dose of citalopram (30 mg/kg p.o.) was given. Six hours after this dose, the CSF 5-HT concentration in the cisterna magna was significantly increased, and the 5-hydroxyindoleacetic acid (5-HIAA) concentration was significantly decreased. There were non-significant changes in the other indoleamines (tryptophan, 5-hydroxytryptophan, and kynurenine) and in the catecholamines (dopamine, homovanillic acid, normetanephrine, and 3-methoxy-4-hydroxyphenethyleneglycol). The 5-HT/tryptophan ratio was correlated significantly with the kynurenine/tryptophan ratio before treatment with citalopram (r = 0.81, p = 0.051), indicative that there is coordination of the serotonin and kynurenine pathways in normal rats. In the animals posttreatment there was no such correlation, suggesting that the changes in 5-HT are independent of the kynurenine system at least within the 6 hours postreatment. These CSF results appear to reflect selective inhibition of 5-HT uptake in brain tissues by citalopram that is not associated with changes in catecholamines.

Probable Alzheimer disease: diagnosis with proton MR spectroscopy

PURPOSE

To distinguish probable Alzheimer disease (AD) from other dementias (ODs) and normality in the elderly.

MATERIALS AND METHODS

A double-blind trial of proton magnetic resonance (MR) spectroscopy was performed, principally in gray matter, in the occipital cortex of 114 patients with dementia (AD [n = 65], OD [n = 39], or frontal lobe dementia [FLD] [n = 10]), 98 patients without dementia, and 32 healthy control subjects.

RESULTS

Reduced levels of N-acetylaspartate (NAA) (P < .0005) and increased levels of myo-inositol (MI) (P < .0005) characterize AD. Patients with OD had significantly reduced levels of NAA (P < .01) but normal levels of MI (P [vs AD] < .0005). When MI/NAA was used, AD was distinguished from normality with 83% sensitivity and 98% specificity. When MI/creatine was used, OD was distinguished from AD and FLD with a negative predictive rate of 80%, sensitivity of 82%, and specificity of 64%.

CONCLUSION

Hydrogen-1 MR spectroscopy enables identification of mild to moderate AD with a specificity and sensitivity that suggest clinical utility.

Citalopram, a serotonin reuptake inhibitor, and brain ischemia in SHR

The effects of citalopram, a serotonin (5-HT) reuptake inhibitor, on cerebral blood flow (CBF) and concentration of 5-HT and its metabolite were investigated in spontaneously hypertensives rats (SHR) subjected to forebrain ischemia. Cerebral ischemia was induced by bilateral carotid artery occlusion. The concentration of the 5-HT metabolite, 5-hydroxyindoleacetic acid (5-HIAA), increased during cerebral ischemia in most brain regions examined, while that of 5-HT increased only in the frontal cortex and the striatum. Citalopram restored the 5-HIAA concentrations to the preischemic normal levels. Citalopram had no effect on the cortical CBF, before and during ischemia. These results suggest that citalopram attenuates ischemia-induced hypermetabolism of 5-HT in the brain. The effects of citalopram are independent of hemodynamic factors including cerebral blood flow, and are likely to be mediated by a direct inhibition of the neuronal 5-HT reuptake system.

A novel oligosaccharide, GlcA beta 1-4Xyl beta 1-(4-methylumbelliferone), synthesized by human cultured skin fibroblasts

Human skin fibroblasts were cultured in the presence of 4-methylumbelliferyl-beta-D-xyloside (Xyl-MU) using a mass-culture system with a microcarrier. The structures of Xyl-MU-induced sugars purified from the dialysable fraction of the incubation medium were investigated. In addition to glycosaminoglycans the elongation of which initiated by Xyl-MU has already been reported, and oligosaccharides similarly initiated by Xyl-MU, such as Gal-Gal-Xyl-MU, Gal-Xyl-MU and SA-Gal-Xyl-MU, a novel Xyl-MU-induced oligosaccharide was detected. This oligosaccharide was identified as GlcA beta 1-4Xyl beta 1-(4-methylumbelliferone) using sugar composition analysis, enzyme digestion, mass spectrometry and Smith degradation. Using this culture system, the amount of the new oligosaccharide produced increased with the incubation time, even after the production of glycosaminoglycan initiated by Xyl-MU and Gal-Xyl-MU had reached a plateau. These results suggest that this oligosaccharide may be involved in terminating the elongation of glycosaminoglycan chains that is initiated by Xyl-MU.

A novel oligosaccharide, xylosyl beta 1-4xylosyl beta 1-(4-methylumbelliferone), synthesized by cultured human skin fibroblasts in the presence of 4-methylumbelliferyl-beta-D-xyloside

4-Methylumbelliferyl-beta-D-xyloside (Xyl-MU) was added to the medium of cultured human skin fibroblasts. After incubation, the culture medium was pooled, concentrated with a lyophilizer, and dialyzed against distilled water. Then the Xyl-MU derivatives in the diffusate were purified by gel-filtration and HPLC. A novel Xyl-MU derivative was obtained, in addition to the previously reported Xyl-MU derivatives, Xyl-MU-induced glycosaminoglycan (GAG-MU), SA-Gal-Xyl-MU, GlcA-Xyl-MU, Gal-Gal-Xyl-MU, and Gal-Xyl-MU. This Xyl-MU derivative was subjected to carbohydrate composition analysis, enzyme digestion, Smith degradation and ion-spray mass spectrometric analysis, and the results indicated that it was Xyl beta 1-4Xyl beta 1-MU. Although the quantity of Xyl beta 1-4Xyl beta 1-MU synthesized by human skin fibroblasts increased with incubation time, its production was independent of that of the GAG-MU. Xyl-Xyl-MU is different from the intermediates in the regular pathway of GAG-MU biosynthesis initiated by added Xyl-MU, posing an interesting question as to its significance in GAG biosynthesis.

Characterization of hydrolysis and transglycosylation by testicular hyaluronidase using ion-spray mass spectrometry

Various oligosaccharides from hyaluronic acid, which were fluorescence-labeled and blocked by pyridylamination at the reducing terminal, were incubated as substrates or acceptors with bovine testicular hyaluronidase. Fluorescence-labeled reaction products in the reaction mixture were monitored selectively and directly by ion-spray mass spectrometry without chemical derivatization. As a result, several features of the relationship between oligosaccharides, substrates, and testicular hyaluronidase were clarified. When hexasaccharides or larger oligosaccharides having D-glucuronic acid at the nonreducing terminal were used as substrates, they were hydrolyzed sequentially to disaccharides from the nonreducing terminal, and these disaccharides were then transferred to other hexasaccharides. On the other hand, when heptasaccharides or larger oligosaccharides having N-acetyl-D-glucosamine at the nonreducing terminal were used as substrates, trisaccharides were released from the nonreducing terminal, and then also transferred to other hexasaccharides, thus forming nonasaccharides. Thus, the relationship between hydrolysis and transglycosylation reactions with testicular hyaluronidase was characterized using ion-spray mass spectrometry.

Hippocampal serotonin 5-HT1A receptor enhances acetylcholine release in conscious rats

We investigated changes in the extracellular levels of acetylcholine (ACh) following local application of serotonergic agents to the dorsal hippocampus of freely moving rats by means of perfusion using a microdialysis technique. Perfusion of serotonin (5-HT; 10 microM, for 30 min at a rate of 3 microliters/min), dissolved in Ringer's solution containing 10 microM eserine, showed no marked effect on the extracellular levels of ACh. 8-Hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT; 20 microM), a 5-HT1A agonist, increased ACh levels, whereas 7-trifluoromethyl-4-(4-methyl-1-piperazinyl)-pyrrolo[1,2-a]quinoxaline (CGS-12066B; 100 microM), a 5-HT1B agonist, decreased it. Clomipramine (2 microM), an uptake inhibitor of 5-HT, had no effect on ACh levels. Following perfusion of 1-(2-methoxyphenyl)-4-[4-(2-phthalimido)butyl]piperazine (NAN-190; 10 microM), which is a selective 5-HT1A antagonist, the effect of 8-OH-DPAT was totally abolished, whereas CGS-12066B decreased extracellular ACh levels. 5-HT, as well as clomipramine, had a decreasing effect on ACh levels after pretreatment with NAN-190. These results indicate that the 5-HT1A receptor, which exists in the dorsal hippocampus, enhances the spontaneous ACh release, and that the mechanism of serotonergic modulation of ACh release partly depends on both the stimulatory control via the 5-HT1A receptor and the suppressive one via the 5-HT1B receptor in the dorsal hippocampus of rats.

Sustained increase in adrenergic activity in gerbil striatum following transient ischemia

We investigated the changes in striatal monoaminergic functions, focusing on the release and metabolism, in a cerebral ischemic model induced by a 5-min bilateral occlusion of the carotid arteries (BOCA) and reperfusion in anesthetized gerbils. In the microdialysis study, the striatal extracellular level of dopamine (DA) markedly increased (144-fold) immediately after BOCA. Although norepinephrine (NE) and 5-hydroxytryptamine (5-HT) could not be detected in the dialysates throughout the baseline period, they increased to detectable levels after BOCA. On the contrary, the tissue contents of NE and 5-HT decreased or tended to decrease up to 4 hr following reperfusion. Striatal DA contents did not show any changes in the early period after ischemia-reperfusion and slightly increased at 4 hr or later. Tissue contents of 3-methoxytyramine (3-MT), a metabolite of DA by catechol-O-methyltransferase (COMT), increased 0 and 5 min after reperfusion. Normethanephrine (NMN), which is a metabolite of NE by COMT, also increased not only 5 min after but also up to 4 hr after ischemia-reperfusion, indicating a sustained increase in NE release. These results suggested that the neuronal activity of NE, which is supposed to exert a protective effect on ischemic damage, was enhanced for a longer period than that of DA after transient ischemia.

Role of calcium ions in dopamine release induced by sodium cyanide perfusion in rat striatum

We have previously reported a transient and remarkable increase in dopamine (DA) release in the rat striatum during application of 2 mM sodium cyanide (NaCN) through a brain microdialysis membrane. In the present study we examined the involvement of extracellular Ca2+ in this response. Rats were divided into 4 groups. In the NaCN group a microdialysis probe inserted into the striatum was perfused with Ringer's solution containing 2 mM NaCN for 60 min. The Ca2+ free + NaCN group was subjected to perfusion with NaCN dissolved in Ca2+ free Ringer's solution, and the CdCl2 + NaCN group with the same plus 0.3 mM CdCl2 (a non-specific Ca2+ channel blocker). In the NaCN and Ca2+ free + NaCN groups DA levels in the dialysates increased to 36- and 44-fold of the control level, respectively, while this was suppressed to only a 16-fold increase in the CdCl2 + NaCN group. In response to a 100 mM KCl perfusion given 3 hr later DA levels were increased (22-fold) in the control group. On the other hand this response was inhibited in the NaCN group (3-fold), but not in the other two groups. An in vitro study with striatal slices showed a gradual increase in intracellular Ca2+ during incubation with 2 mM NaCN. These results suggest that excessive influx of extracellular Ca2+ during NaCN perfusion may contribute partly to the increase in the extracellular DA level in the striatum, and also to the suppression of a DA increase in response to high K+ stimulation observed 3 hr later.

Enzyme properties of monoamine oxidase in the frontal cortex and liver of the gerbil (Meriones unguiculatus)

1. Enzyme properties of monoamine oxidase (MAO) in the frontal cortex and liver of the gerbil were investigated using 5-hydroxytryptamine (5-HT), benzylamine (Bz) and tyramine (Tyr) as substrates. 2. The Km values of MAO towards the three substrates were almost similar to the values in other species. The Vmax value of MAO towards Bz was much lower than the value towards 5-HT. 3. In the inhibition studies with selective MAO-A and MAO-B inhibitors, clorgyline and deprenyl, deamination of 5-HT, Bz and Tyr in both tissues was induced by MAO-A alone, MAO-B alone and both forms of the enzyme, respectively, indicating the same substrate specificity as that in rats. 4. The apparent proportion of MAO-A to MAO-B activities in the gerbil liver was approximately 6:4, whereas MAO-A in the frontal cortex of the gerbil was exclusively predominant, consistent with the previous data in the golden hamster which belongs to the same family as the gerbil.

[Effects of NC-1100, a calcium channel blocker, on experimental cerebral ischemia/anoxia in rodents]

The anti-ischemic and anoxic effects of NC-1100, a piperazine type calcium channel blocker, were investigated in various cerebral ischemia and anoxia models in mice, gerbils and guinea pigs. Minimal effective doses of NC-1100 were 8 mg/kg, i.p. and 30 mg/kg, p.o. for KCN-induced anoxia; 16 mg/kg, i.p. for decapitation-induced gasping; 30 mg/kg, i.p. for cerebral ischemia induced by occlusion of bilateral carotid arteries in gerbils; and 10 microM for the in vitro ischemic model in hippocampal slices. Moreover, NC-1100 attenuated the disturbance of cerebral energy metabolism induced by decapitation in mice. These results suggest that NC-1100 has a cerebral protective effect, and that attributable to its ability to improve the cerebral energy metabolism disturbance.

Effect of local cyanide perfusion on rat striatal extracellular dopamine and its metabolites as studied by in vivo brain microdialysis

To investigate in vivo effects of energy failure on functions of dopaminergic neurons, we administered 0 (control), 0.2, 1 or 2 mM sodium cyanide (NaCN) dissolved in Ringer's solution for 60 min into the rat striatum through a brain microdialysis membrane. During NaCN perfusion, a transient and concentration-dependent increase in dopamine (DA) levels in the dialysate was observed. The maximum DA level during 2 mM NaCN perfusion was found to be 63-fold higher than the control levels. Leves of 3,4-dihydroxyphenylacetic acid and homovanillic acid were continuously lowered during and after NaCN perfusion. These data suggest that suppression of ATP production by NaCN induces an abrupt and remarkable increase in dopamine release from the nerve terminal in the striatum.

Successful surgical obliteration of a huge intradural arteriovenous fistula of the spinal cord in a child

We report the case of an 8-year-old boy with a huge intradural spinal arteriovenous fistula (AVF), which was successfully obliterated by surgery. The symptoms were episodic headaches and progressive motor and sensory deficits. He had suffered a subarachnoid hemorrhage twice before but no ensuing neurological deficits. Neuroradiological examinations revealed an intradural AVF with a huge venous aneurysm ventral to the spinal cord of C7 to T2, which was fed by the left 5th intercostal artery and the right thyrocervical artery. These two feeding arteries were occluded intradurally just at the venous aneurysm emerging point. MR images taken sequentially after surgery demonstrated complete thrombosis and subsequent disappearance of the thrombosed malformation. Neurological symptoms improved gradually. Treatment of such malformations is discussed.

Percutaneous trigeminal rhizotomy and percutaneous cordotomy under general anesthesia

Most percutaneous procedures for the treatment of pain are done under local anesthesia and considerable pain can be involved. If the patient is elderly or confused because of severe pain, it is difficult or impossible to perform these procedures successfully. We treated 3 elderly patients with trigeminal neuralgia and 1 patient with severe bone pain due to metastatic osteosarcoma in the lumbosacral region by percutaneous trigeminal rhizotomy and percutaneous cordotomy under general anesthesia with intratracheal intubation. We conclude that percutaneous trigeminal rhizotomy and percutaneous cordotomy can be safely done under general anesthesia.

Germinability and heat resistance of spores of Clostridium difficile strains

Out of 111 Clostridium difficile strains, 108 produced spores in numbers of more than 10(5)/ml and the remaining three did not produce any spores in brain heart infusion medium. The germination frequency in the medium without lysozyme varied widely from strain to strain, ranging from less than 10(-8) to 10(0), and in 77 of the 108 strains the germination frequency was 10(-5) or less. The spores, when treated with sodium thioglycollate and then inoculated into the medium containing lysozyme, germinated in all of the 108 strains at a frequency of 10(-0.5) or more. The spores of two strains germinated at a frequency of more than 10(-0.5) in all methods. Spores of C. difficile strains were fairly highly heat-resistant; D100C values ranged from 2.5 to 33.5 min.

Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage. Report of two cases

The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.