The 24-hour Rhythms in Plasma Growth Hormone, Prolactin and Thyroid Stimulating Hormone: Effect of Sleep Deprivation

Twenty-four hour secretory rhythms of growth hormone (GH), prolactin (PRL) and thyroid stimulating hormone (TSH) were investigated in 9 normal adult men by means of serial blood sampling at 30 min intervals. The profiles of pituitary hormones were compared in 6 subjects between in normal nocturnal sleep condition and in delayed sleep condition. Plasma GH was measured with use of highly sensitive enzyme immunoassay (EIA) recently developed. Plasma TSH was also evaluated by highly sensitive time-resolved fluorometric immunoassay (TR-FIA). Time series analysis of plasma GH and PRL was performed by auto- and cross- correlation and spectral analysis. The detection limit of EIA for GH was 0.3 pg/ml and all plasma GH levels were within the detectable range of this EIA. Cross-correlation and spectral analysis suggested the presence of approximately 2–3 h rhythmicity of plasma GH. Plasma PRL appeared to have some 24-hour rhythmicity besides its sleep-dependent component. Sleep deprivation caused marked elevation of plasma TSH during night time. It is suggested that there appears two mechanisms regulating GH secretion: one has a sleep-independent and ultradian rhythm and another has a sleep-dependent rhythm.     

Fractures of the acromion and the lateral scapular spine

We studied 37 fractures lateral to the spinoglenoidal notch to evaluate the validity of collectively handling these fractures as an acromion fracture and to ascertain the mechanism of injury. We divided them into three groups according to the location of the fracture line. Fracture of the anatomic acromion or the extremely lateral scapular spine (groups I and II, 28 fractures) was frequently associated with fracture of the coracoid base, acromioclavicular joint injury, or both. The mechanism of injury in most cases was presumed to be indirect force brought to bear on the shoulder from the lateral direction. Fracture descending to the spinoglenoidal notch (group III, nine fractures) was seldom associated with other shoulder injuries, and surgery was rarely needed. The mechanism was assumed to be direct force brought to bear on the shoulder from the posterior direction. Therefore fractures of the anatomic acromion and the extremely lateral scapular spine may be managed collectively. However, fracture descending to the spinoglenoidal notch should be managed separately. We advocate that these fractures should be classified into two types in terms of clinical consideration: type I fractures, comprising those of the anatomic acromion and the extremely lateral scapular spine, and type II fractures, located in the more medial spine and descending to the spinoglenoidal notch.     

Recent topics on ethical issues in psychiatry, mental care and welfare]

This lecture focuses on several ethical issues on psychiatry research and psychiatric practice. The most important issue in ethics is informed consent in both the national guidelines on ethics in genomic study and epidemiological studies determined by the Ministry of Health, Welfare and Labor, Ministry of Education, Culture, Sports, Science and Technology and Ministry of Economy, Trade and Industry. They recommend researchers to obtain consent from subjects making free voluntary decisions after they are fully provided with the necessary information and explanation. The guidelines on ethics in genomic study strongly recommend organizing an ethical committee committed by several extramural members from the fields of law, social or human sciences. On the other hand, the guidelines on ethics in epidemiological study provide how to obtain informed consent in detail according to how projects are carried out. Strict requirements of informed consent tend to inhibit medical research conduct, in particular a research on post-mortem brain, which is one of the important research areas for elucidation of pathogenesis and pathophysiology of mental disorders. Recently a new trend to organize a brain bank by donation of the patient who has given consent before death. This is a proper way to collect post-mortem brain overcoming the ethical problems and it is our hope that this trend will develop in our country. Disclosure of medical records to patients is one of the most recent and debated issues in psychiatric practices. In 1999, the Ministry of Health and Welfare started investigations on whether medical records should be disclosed to patients. The report of the committee strongly recommends accelerating the disclosure of medical records. Responding to this report, several medical organizations issued a guideline. Recently, we carried out a questionnaire survey on the disclosure rate of medical records in the psychiatric departments of both medical school hospitals and national mental hospitals, where special committees have been organized to determine the disclosure of the medical records when a patient demands it officially. Contrary to our expectation the rate of disclosure demands was very low in both medical schools and national mental hospitals. The average number was only less than one case in medical schools, and less than 0.5 cases in national mental hospitals. It was speculated that patient requests demanding the disclosure of the records are mostly managed by the doctor in charge without consulting the special committee. Looking back the process of debate on the disclosure of medical records, several important issues, such as notice of diagnosis, informed consent, management of records, standardization of medical records, financial support to establish management system of medical records and so on, remain to be further examined thoroughly.     

Prediction of intraoperative bleeding during endoscopic treatment in patients with early gastric cancers: utility of contrast-enhanced MDCT gastrography and the wall-carving image technique

Purpose

To assess the ability of the “wall-carving image (WC) technique,” which uses vascular images from computed tomography (CT) gastrography, to predict bleeding during endoscopic treatment in patients with early gastric cancers (EGC).

Materials and methods

We analyzed the CT enhancement on WC images of 30 patients with EGC who were treated with endoscopic submucosal dissection (ESD). Patients were divided into two groups—a no-bleeding group and a bleeding group—according to the degree of intraoperative bleeding during the ESD. Patient-related variables (age and sex), lesion-related variables (size, location, and morphological type), a procedure-related variable (procedure time), and the CT enhancement on WC images were compared between two groups. To assess the diagnostic performance of the CT findings in the prediction of intraoperative bleeding, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results

Lesion location, procedure time, and CT enhancement were all significantly associated with intraoperative bleeding, with p values of 0.046, 0.0007, and 0.0011, respectively. With a cut-off value of 4 or greater indicating positivity for contrast enhancement, the sensitivity, specificity, PPV, and NPV for predicting intraoperative bleeding were 64.3, 93.8, 90.0, and 75.0 %, respectively.

Conclusions

Contrast enhancement of WC was significantly associated with intraoperative bleeding during ESD.