Five cases of frontotemporal dementia with behavioral symptoms improved by Yokukansan

Herein, we present five cases with frontotemporal dementia whose behavioral symptoms were improved by Yokukansan, a traditional Japanese medicine (Kampo). All five patients were prescribed Yokukansan (7.5 g/day) to reduce their symptoms. The patients' symptoms were evaluated comprehensively using the Neuropsychiatric Inventory (NPI) and the Stereotypy Rating Inventory (SRI) before and 4 weeks after Yokukansan treatment. The mean (± SD) scores on the NPI and the SRI before treatment were 55.6 ± 5.4 and 22.2 ± 6.5, respectively. After treatment, these scores were 30.0 ± 7.8 and 11.6 ± 7.5, respectively. Yokukansan was effective for the treatment of clinical symptoms in all five patients without adverse effects and significant changes in laboratory data. Although antipsychotic drugs have been used to control behavioral symptoms, their associated adverse effects frequently impact on the activities of daily living and quality of life of treated patients. The present cases suggest significant improvement of behavioral symptoms in frontotemporal dementia with Yokukansan treatment, leading to probable benefit of the use of Yokukansan in individuals with frontotemporal dementia.     

First Alert for Recurrence During Follow-up After Potentially Curative Resection for Colorectal Carcinoma: CA 19-9 Should Be Included in Surveillance Programs

BackgroundThe aim of this study was to evaluate the contribution of each examination included in the postoperative surveillance program, especially that of serum tumor markers.Patients and MethodsPatients who underwent curative surgery for colorectal carcinoma (CRC) from January 2000 to December 2006 were enrolled. The postoperative surveillance program in our department includes tumor marker (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA] 19-9) measurement every 3 months for 5 years, chest radiograph or chest computed tomography (CT) every 3 months for 2 years and then every 6 months until 5 years, and abdominal CT every 3 months for 2 years and then every 6 months until 5 years. The first examination that revealed abnormality in patients who developed recurrence was analyzed.ResultsDuring the study period, 105 recurrences were diagnosed. There were 45 hepatic recurrences, 23 local recurrences, 20 pulmonary recurrences, 16 lymph node recurrences, and 10 peritoneal recurrences. Computed tomography, CEA, and CA 19-9 were the first abnormal examination(s) in 77, 23, and 26 patients, respectively. Tumor markers detected the recurrence earlier than did CT in 27% of patients. CEA and CA 19-9 equally contributed to detection with respect to the number of patients, while the sites of detected recurrences differed.ConclusionFor early detection of occult recurrence of CRC, CT was the most reliable modality. On the other hand, tumor markers were also relevant. Given the recent advances in multimodal approaches for advanced CRC, the combination of CT, CEA, and CA 19-9, which is currently not included in guidelines, should be routinely performed.     

Three Cases with Cavitary Lesions in a Twin Gestation Complicated by a Single Intrauterine Fetal Demise

Three cases with cavitary lesions on the cerebral convexities in twin gestation complicated by a single intrauterine fetal demise were investigated clinicopathologically. They all exhibited profound mental retardation and severe motor disturbance due to rigidospastic tetraplegia. The co-twins were macerated. Neuropathologically, malformed lesions and destructive lesions coexisted in varying degrees according to the time in fetal life, at which insults probably occurred. The cavitary lesions were located bilaterally and symmetrically on the central, parietal and occipital region of the cerebral hemispheres, in some cases, including the frontal region. Case 1 showed an incomplete gyral pattern and porencephaly with polymicrogyria bordering the defect, thus allowing us to date the insult before the 5th fetal month. In case 2, multicystic encephalomalacia was disclosed with cortical dysgenesis exhibiting status marmoratus of the cortex. Case 3 displayed sclerotic cavitary lesions with sclerosis of the insula and a few instances of cortical dysgenesis. Based on the clinical data and pathological findings, the cavitary lesions of case3 may be dated in the third trimester of gestation. Case 2 can be considered to have sustained injuries between the times estimated for cases 1 and 3. As the pathogenesis of the congenital cavitary lesions, several concepts have been proposed: intrauterine DIC (Moore et al. 1969;Romero et al. 1984), vascular disruption (Hoyme et al. 1981;Jung et al. 1984), intrauterine infection such as cytomegalic inclusion disease (Friede et al. 1976), and hypoxia due to CO intoxication of the mother (Bank1 et al. 1967) or other cause. Though the pathological observation of our cases revealed no evidence of intrauterine DIC, renal cortic necrosis, intrauterine infection or occlusion of the intracranial vessels, long-term exposure to the dead twin might have contributed to the lesions of the liveborn co-twin.     

Endosonographic diagnosis of intraductal papillary‐mucinous pancreatic tumors by intraductal ultrasonography

Background: Intraductal papillary‐mucinous pancreatic tumors (IPMT) are intraductal lesions formed by mucin‐producing epithelium, which proliferates in a papillary pattern, and presents a spectrum from hyperplasia to adenocarcinoma. The value of intraductal ultrasonography (IDUS) for excluding malignancy has not been assessed in a case series previously. Methods: Intraductal ultrasonography was performed in 17 patients with IPMT (12 with adenocarcinoma and five with adenoma) between November 1993 and June 2002. Intraductal ultrasonography was used to determine the maximum height and maximum cross‐sectional area of protruding lesions. Results were compared after dividing the tumors into three groups: a benign lesion group, a non‐invasive cancer group, and an invasive cancer group. The resection line was located over 10 mm from the edge of the protruding lesion visualized by intraductal ultrasonography. Results: All adenocarcinomas had a height ≥ 5 mm and all benign lesions had a height ≤ 3 mm, with this difference being significant (P = 0.0034). The height of non‐invasive and invasive cancer was similar. The maximum cross‐sectional area of the protrusion was smaller for benign lesions (≤ 15 mm²) than for non‐invasive cancer (≥ 34 mm², P = 0.0034). The cross‐sectional area of the protrusion was greater in patients with invasive cancer than in those with non‐invasive cancer (P = 0.0367). All surgical margins have remained clear and no patient has suffered from a recurrence during 1 to 8 years of follow‐up computed tomography and ultrasonography. Conclusions: Intraductal ultrasonography can distinguish benign from malignant IPMT based on the height and maximum cross‐sectional area of the protruding tumor.     

Radiological features of primary central nervous system lymphoma

Radiological features of 12 cases of primary malignant lymphoma of the central nervous system with histological confirmation were reviewed. Ten patients had primary intracranial lymphoma, and two spinal. Angiography yielded no specific findings. CT appearances varied widely. Any positive relationships were not found between histologic types of tumors and patterns of contrast enhancement in the present cases as well as in those reported previously. Gd-DTPA was used in two patients. All lymphomas showed low to isointensity signals on T1-WI and high signal intensities on rho-WI and T2-WI. Although MRI gave no additional informations to those on CT with regard to the differential diagnosis, it proved to be a very accurate, non-invasive method of providing better delineation of tumor on multiplanar basis. Use of Gd-DTPA improved quality of T1-WI by markedly enhancing the tumor. It is generally difficult to distinguish primary from secondary spinal lymphoma, but two spinal epidural lymphomas in the present series were considered primary, as we could detect no other lesion elsewhere in the body. We expect that MR imaging would lead to an improvement in the detection of lesion in the paravertebral area.