Effective electroconvulsive therapy for stupor in the high risk patient: A report of two cases

Abstract We report two cases of stupor in which the patients were safely treated by electroconvulsive therapy (ECT) despite high risk conditions. Case 1 was a 72 year old schizophrenic woman who had developed catatonic stupor and had joint contractures as a complication of rheumatoid arthritis. Case 2 was a 52 year old woman who developed a stuporous state which was complicated by severe dehydration with hypernatremia. In both cases, psychotic symptoms were improved by ECT without event. Careful application of ECT seemed to be effective and safe even for stupor in high risk patients.     

Ultrastructural studies of hepatocyte cytoskeleton in experimental cholestasis by quick-freezing and deep-etching method

The ultrastructural association between the cytoskeleton and other organelles was studied by the quick-freezing and deep-etching method in rats treated with alpha-naphthylisothiocyanate (ANIT), or phalloidin, and in rats with obstructive jaundice. Cytoplasmic filaments were classified by measuring their diameters, and actin filaments were identified by specific decoration with myosin subfragment 1 (S1). S1-positive actin filaments and S1-negative intermediate filaments (12-14 nm in diameter) were observed to form a three-dimensional network around bile canaliculi, and were more numerous than in controls, not only in phalloidin-treated rats and rats with obstructive jaundice, but also in ANIT-administered rats. In all cholestatic rats, vesicular structures were also more numerous than in controls in the pericanalicular regions, and were closely associated with the microfilaments and the intermediate filaments. Filaments of a new type were localized between the lamellae of rough-surfaced endoplasmic reticulum and mitochondria, and between the lamellae of Golgi sacs and vesicles. Other thin filaments were also observed within the network of actin filaments. These filaments were 4-6 nm in diameter on replica membranes and were never decorated with S1. They were also directly connected with the canalicular membranes. Cytoskeletal components associated with membrane-bound organelles, including these new filaments, were suggested to be involved in the localization and migration of organelles.     

A Case of Terminal Ileum Lipoma Treated by Endoscopic Polypectomy

Abstract: This study reports on the case of a 71-year-old man who complained of repeated episodes of right lower abdominal pain. A barium enema and colonoscopy revealed a 20 times 20 times 15 mm smooth-surfaced polypoid tumor (Yamada type III) located in the terminal ileum. An endoscopy showed that the lesion had a slightly yellowish surface and the cushion sign was observed, so the tumor was considered to be an intestinal lipoma. During colonoscopy, prolapse of the tumor occurred through the orifice of Bauhin's valve and the patient simultaneously complained of right lower abdominal pain. The tumor was removed endoscopically. After a colonoscopic polypectomy, the patient's right lower abdominal pain disappeared. A pathological examination of the specimen revealed a lipoma of the terminal ileum. In general, the correct preoperative diagnosis of intestinal lipoma is difficult. Furthermore, 80% of lipomas situated at the terminal ileum are complicated by acute intussusception. We suggest that a colonoscopic polypectomy is a useful procedure for confirming the diagnosis of intestinal lipoma and for the prophylaxis of intussusception when the tumor is located in the terminal ileum.     

The detection of clonal proliferation in granular lymphocyte-proliferative disorders of natural killer cell lineage

Summary. The clonal proliferation of large granular lymphocytes can be detected in patients with T-cell-lineage granular lymphocyte-proliferative disorders (T-GLPD) by Southern blotting T-cell receptor genes. However, this cannot be applied to patients with natural killer-cell-lineage GLPD (NK-GLPD) as it lacks a clonal marker. We therefore investigated the use of two other diagnostic techniques in evaluating clonal proliferation in Japanese patients with NK-GLPD (n = 4) and T-GLPD (n=3) by chromosomal analysis of peripheral blood mononuclear cells (PBMC) stimulated with either interleukin-2 or phytohaemaggluti-nin, and Epstein-Barr viral (EBV) genomic DNA analysis. Chromosomal analysis revealed abnormal karyotypes in the PBMC of three of four patients with NK-GLPD, whereas EBV analysis showed a monoclonal terminal configuration in the PBMC in the fourth patient. Southern blots revealed rearrangements of the TCR genes in all three patients with T-GLPD but in none of those with NK-GLPD. It is suggested that these methods may be useful in detecting the abnormal proliferation of large granular lymphocytes in NK-GLPD.     

Evaluation of Splenectomy in Chronic Myelogenous Leukemia

Fifteen patients with CML who have undergone splenectomy havebeen presented. Our results would suggest that when splenectomyis performed during remission significant benefits in survivaland the quality of the survival can be offered to the patient,with minimal operative risk. On the other hand when splenectomyis performed during non-remission period a more operative riskand poor prognosis must be weighed.     

Healing of Ulcers in Early Gastric Cancers: Supplementary Report

It has already been confirmed by several investigators thatulcers in early gastric cancers show significant healing withantacids and anticholinergics. This paper presents 10 casesin which ulcers in malignant lesions healed to form scars, demonstratinggastroscopic and histological findings. The purpose of the presentpaper is to emphasize that a trial medical therapy for gastriculcers is not always reliable for differentiation of the benignfrom the malignant lesions.     

Multiple organ failure associated with extensive metastatic calcification in a patient with an intermediate state of human T lymphotropic virus type I (HTLV-I) infection: Report of an autopsy case

A patient with an intermediate state of human T lymphotropic virus type I (WLV-I) infection and in whom autopsy showed multiple organ failure (MOP associated with extensive metastatic calcification in systemic organs is described. A 56-year-old man presented with signs and symptoms of advanced cardiac insufficiency, respiratory disturbance and renal failure. Serologically, the anti-human T lymphotropic virus type I (HTLV-I) antibody tier and the levels of both calcium and parathyroid hormonerelated peptide (PTHrP) were dlstinctly elevated. These data suggested a diagnosis of adult T cell lymphoma/leukemia (ATLL). However, examination of a peripheral blood sample revealed only a few atypical lymphoid cells (3%) associated with mild leukocytosis (white blood cell count, 13.7 × 10³/mm³). Lymph node swelling was systemic but mild, with some nodes up to 10 mm In diameter. The patient died of MOF. Adult T cell leukemla/lymphoma was unable to be diagnosed definitively because of the short duration of laboratory abnormalities and because of the discrepancy between the laboratory data and the magnitude of lymphoprollferation in both the lymph nodes and peripheral blood. At autopsy, the most conspicuous finding was extensive metastatic calcification in the multiple organs, including the heart, lungs, kidneys, tongue, liver, pancreas, spleen and systemic arterial walls. Very small numbers of medium-sized atypical lymphoid cells admixed with small reactive lymphocytes were Identified in multiple organs, with no evidence of massive Infiltration. Molecular analyses could not detect monoclonal Integratlon of HTLV-I provirus DNA or monoclonality of T cell lineage cells. Parathyroid hormone-related peptide was demonstrated In the cytoplasm of the atypical lymphoid cells on lmmunohls-tochemical examination. The bone trabeculae generally showed distinct evidence of resorption associated with marked proliferation of osteoclasts. These findings suggested that the hypercalcemia in the present case was categorized as humoral hypercalcemia of malignancy rather than local osteolytic hypercalcemia.