Relationship between psychiatric symptoms and regional cerebral blood flow in patients with mild Alzheimer's disease

Background: Behavioral and psychological symptoms of dementia (BPSD) are frequently observed in patients with dementia and often cause serious problems. However, the cause of BPSD has not yet been elucidated. Moreover, the precise evaluation of BPSD in mild dementia has not been studied in any great detail. In the present study, we investigated the relationship between psychiatric symptoms and regional cerebral blood flow (rCBF) in patients with mild Alzheimer's disease (AD). Methods: The present study included 47 patients (20 men and 27 women) who were diagnosed with mild AD. Mean patient age was 72.8 ± 8.2 years. Single photon emission computed tomography (SPECT) with ^99mTc‐ethyl cysteinate dimer (^99mTc‐ECD) was performed in all patients. The SPECT data were analyzed using a three‐dimensional stereotactic region of interest template, which evaluated CBF in 24 segments. Psychiatric symptoms were evaluated in patients using the Brief Psychiatric Rating Scale. Each psychiatric symptom was designated as ‘symptom present’ in cases in which the BPRS item score was more than 3. We compared 10 segments of rCBF in symptom‐present patients with those in symptom‐absent patients. Results: Motor retardation was the most common psychiatric symptom (36.2%), followed by depression (19.1%), anxiety (17.0%), emotional withdrawal (17.0%), and somatic concern (14.9%). Alzheimer's disease patients with motor retardation exhibited a tendency towards lower rCBF in seven segments (left callosomarginal, bilateral parietal, bilateral angular, and bilateral temporal). However, no specific tendency was observed in depression, anxiety, and somatic concern. Conclusions: In the present study, we observed a tendency for decreased brain perfusion in patients with motor retardation. Further studies are necessary to confirm that this trend contributes to the appearance of psychiatric symptoms in patients with mild AD.     

Neural substrates of emotionally valenced episodic memory: A PET study using film stimuli

Abstract  To reveal the pathogenetic mechanism of post-traumatic stress disorder (PTSD), we modeled the 're-experience' symptom of PTSD in healthy subjects, and investigated its neural substrates using PET activation experiments on an emotionally (fear) valenced episodic memory task and several contrast tasks. Ten right-handed healthy male volunteers underwent H₂¹⁵O-PET. Each subject was required to watch a horror film the previous day. During the PET scan, the subject was shown part of the film for 60 s immediately before the terrifying climax scene and told to recall the following scene. The subject did not watch the scene directly, but re-experienced fear induced by the trigger. The rCBF in this task compared with that in control tasks was analyzed with SPM99. The subjective emotional state of the subject in each task was evaluated using an analog scale. The main cerebral areas where rCBF significantly correlated with the task of emotionally valenced episodic memory, compared with the novel emotional task, were the left retrosplenial cortex (Brodmann's area: BA 31), the left visual association cortex (BA 19) and the right prefrontal cortex (BA 10). Although the retrosplenial cortex or the posterior cingulate gyrus has been regarded as engaged in processing either only emotion or only episodic memory, this area is considered to be involved in processing 'emotionally valenced episodic memory'.     

Complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution (1999–2003)

BACKGROUND: Pseudomonas aeruginosa has been an important uropathogen that causes complicated urinary tract infection. We investigated the clinical characteristics of complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution. METHODS: We studied those patients who had basal disease in their urinary tract that was diagnosed as urinary tract infection caused by more than 10(4) colony forming units (CFU)/mL of Pseudomonas aeruginosa isolated from their urine. In those patients, we analysed infectious risk factors, treatment methods including the use of antimicrobial agents, the presence of a urinary tract catheter, and the relationship between febrile infection and urinary tract catheter. In addition, we examined the various antimicrobial susceptibilities against Pseudomonas aeruginosa. RESULTS: We studied 76 patients (59 men and 17 women). Of their basal diseases of the urinary tract, bladder tumor was the most prevalent (42.1%). Of the 39 patients who had an indwelling urinary tract catheter, 26 (66.7%) experienced a high-grade fever, a higher rate than that of the 37 patients who were not catheterized (40.5%). Seven patients were treated with anticancer chemotherapy drugs and 31 cases of urinary tract infection caused by Pseudomonas aeruginosa were diagnosed in the perioperative period. Piperacillin showed lower susceptibility against Pseudomonas aeruginosa in these 2 years (P<0.05). CONCLUSIONS: Our results indicated that those patients with urinary tract catheterization had a higher incidence of fever than patients without catheterization. Therefore, we must improve not only the antimicrobial treatment of Pseudomonas aeruginosa but also our management of catheters.     

LONG TERM SURVIVAL CASE OF SMALL (OAT) CELL CARCINOMA OF THE RECTUM

A long term survival case of small (oat) cell carinoma of the rectum in a 39-year-old female is presented. She complained of anal pain and occasional anal bleeding. The tumor was located at the anterior wall in the lower rectum. Biopsy specimens revealed a carcinoid tumor. She underwent trans-anal local resection for the first time in December, 1980. Macroscopic findings of the resected specimen showed a small nodule, 0.4 by 0.4 by 0.5 cm, with yellowish cut-surface. Microscopically, the tumor deeply invaded the submucosal layer. The appearances were indistinguishable from pulmonary small (oat) cell carcinoma. Since lymphatic permeations were moderately recognized in the tumor, she underwent radical operation (Miles' operation) with lymphadenectomy. Microscopic findings of the resected rectum revealed an intramural metastatic lesion with marked lymphatic permeations in the submucosal layer 2 cm distant from the primary lesion. Up to date, there is no evidence of local recurrence or liver metastasis. Small (oat) cell carcinoma of the rectum easily metastasizes lymphogenously through the lymph system from an early stage of the development. Wide surgical resection will be needed to give a long term survival even if the tumor is extremely small.     

Malignant mixed müllerian tumor of primary mesenteric origin

Malignant mixed müllerian tumor (MMMT) is a rare tumor. A literature search revealed very few reports on MMMT, especially those arising in the peritoneum. We recently encountered an MMMT of primary mesenteric origin associated with left fallopian tube cancer. There have been no previous reports about its occurrence in the mesentery. When cases of peritoneal MMMT were reviewed, the disease was found to be associated with synchronous or metachronous gynecologic tumors of müllerian duct origin (ie, ovarian tumors, primary serous carcinoma of the peritoneum, fallopian tube cancer, endometrial cancer, and adenocarcinoma of the cervix) in 12 out of 32 patients (37.5%). Peritoneal MMMT are frequently associated with gynecologic tumors.