Civilization, culture and neurotic depression: In view of the Freudian theory

Abstract Our discussion is based on the psychoanalytic theory of Freud. We, however, discuss a case of neurotic depression which is not considered a subtype in Freud's concept of neurosis. We discuss the difference between culture and civilization, referring to what Freud discussed in Totem and Taboo and Moses and Monotheism. We then discuss two matters specific to Japanese culture; the assimilation of foreign cultures, and the sexual differences found in Japanese culture. On the basis of these discussions, we attempt to link these with the problem of structure of the neurotic depression. We conclude with Confucianism which we can consider as relative to the East-Asian world.     

Nonfluoroscopic Guidance for Catheter Placement into the Coronary Sinus under Direct Vision Using a Balloon-Tipped Cardioscope

The right atrial posterior septum, including the coronary sinus (CS) ostium, is an important landmark in radio frequency catheter ablation therapy for supraventricular tachycardia or atrial flutter. The anatomical findings around the CS ostium would be useful to determine a target site or line during catheter ablation. The aim of the study was to test the ability of the imaging catheter to identify structures in the posterior septal area of the right atrium and to evaluate the feasibility of guidance for catheter placement in the CS using a cardiosccpe that we recently developed. In 12 anesthetized dogs, the Cardioscope, consisting of a deflectable 7 Fr fiberoptic endoscope with an inflatable and transparent balloon, was introduced into the right atrium via the femoral vein. The cardioscope was manipulated to observe the right atrial posterior septum. A deflectable electrode catheter was inserted via the jugular vein and positioned in the CS under cardioscopic guidance. In 10 of 12 dogs, the right atrial posterior septum, including the CS ostium, and the tendon of Todaro could be anatomically identified by cardioscopy. It was possible to position an electrode catheter in the CS in all 10 dogs under direct vision without fluoroscopy. But the CS ostium could not be detected in the remaining two dogs, although the cardioscope was placed at as many sites as possible. No complication occurred. The balloon-tipped cardioscope appears to be useful in observing the right atrial posterior septum and in guiding an electrode catheter into the CS.     

IDENTIFICATION OF THE NORMAL MICROGLIAL POPULATION IN HUMAN AND RODENT NERVOUS TISSUE USING LECTIN–HISTOCHEMISTRY

Mistletoe lectin-1 (ML-1) and Ricinus communis agglutinin-120 (RCA-1) both possess D-galactose-specific surface-binding sites. They were used to selectively identify microglial populations in aldehyde-fixed normal brain tissue by lectin immunohistochemistry on paraffin and frozen sections. Mistletoe lectin-1 was superior to RCA-1 in labelling microglia in the rat brain, whereas RCA-1 labelled human microglia better than ML-1. Thus, RCA-1 and ML-1 supplement each other for identifying microglial in human and rodent central nervous system tissues. The high reproducibility of the results and the applicability of the technique to routine histology, using formalin-fixed tissue, should facilitate study of the histogenesis and role of microglia in the CNS.     

CASE REPORT: Haemorrhagic colitis associated with royal jelly intake

The case report of a 53-year-old woman with abdominal pain and bloody diarrhoea is described. Prior to the onset of symptoms the patient had taken royal jelly for 25 days. Colonoscopy revealed that the mucosa was haemorrhagic and oedematous throughout the 20 cm long sigmoid colon. Histopathologically, mucosal haemorrhage, oedema, and infiltration of inflammatory cells were observed. Transmission electron microscopic examination revealed platelet aggregation in 30% of capillaries in the mucosal lesions. The drug-induced lymphocyte stimulation test was slightly positive for royal jelly (847 c.p.m., SI= 147%) compared with the control (576 c.p.m.). The patient's signs and symptoms disappeared within a few days after the initiation of conservative therapy, and the colonic lesions disappeared after 2 weeks of this therapy. This is the first reported case of haemorrhagic colitis associated with royal jelly intake.     

Evidence of Bone Resorption-Stimulating Factor in Adult T-Cell Leukemia

Adult T-cell leukemia (ATL) is known to be frequently accompaniedby hypercalcemia, but the mechanisms responsible for hypercalcemiain this disorder are not fully understood. We have recentlyexperienced two male patients (25 and 36 yr old) with ATL diagnosedfrom typical leukemic cells with grooved and folded nucleus,surface marker, anti-ATLA antibody etc. Serum calcium levelsof these patients were 16.4 and 21.4 mg/dl, respectively, withno radiological evidence of bone destruction. Peripheral bloodleukemic lymphocytes from these patients were purified by theFicoll-Hypaque method and cultured at a concentration of 1.5x 10⁶ cells/ml for 3 days on F-10 medium supplemented with 10%fetal calf serum. The supernatant fluids from the cell cultureswere bioassayed for bone resorption-stimulating activity (BRSA)by an assay based on the release of ⁴⁵Ca from prelabeled fetalmouse forearm bones in organ culture according to Raisz's method.The supernatant fluid of cultures from both patients which showedmarked BRSA was nondialyzable through a dialysis membrane witha molecular weight cutoff of 3500. Parathyroid hormone and prostaglandinswere not detectable in the supernatant fluids of the leukemiccell cultures. In one patient, BRSA was measured twice and foundto be decreased to a normal level when the patient was in hematologicalremission with a normal calcium level (8.3 mg/dl). These resultssuggest that the hypercalcemia observed in patients with ATLis due, in part, to a bone resorptionstimulating factor whichis produced by leukemic T-cell lymphocytes.     

Analysis of salivary proteins by thin layer sodium dodecylsulphate polyacrylamide gel electrophoresis

Samples of the whole, parotid, submandibular and palatine salivas and serum, all collected from the same human subject, were developed by simultaneous electrophoresis on a single SDS thin layer gel plate, and simple proteins, glycoproteins and sialoglycoproteins in the samples were isolated and analysed. Simultaneous electrophoresis of the salivas and serum showed the presence of thirty-four protein bands in serum, twenty-two bands in whole saliva, sixteen bands in parotid saliva, nineteen bands in submandibular saliva and ten bands in palatine saliva. Glycoprotein bands in the isolating gel zone presented five bands in whole saliva, four bands in submandibular saliva, three bands in parotid saliva and no band in palatine saliva. Palatine saliva, however, showed a single clear band in the concentrating gel zone. Palatine saliva showed only one sialoglycoprotein band in the concentrating gel zone.     

The Diagnosis of the Anomalous Connection of Pancreaticobiliary Ducts Without Biliary Dilatation—The Usefulness of US/EUS Serial Examination—

The anomalous connection of the pancreaticobiliary duct (ACPBD) without accompanying dilatation of the bile duct (non-dilated type of ACPBD) has recently been found to be associated with gallbladder cancer at a rather high rate. We analyzed the diagnostic process of 5 patients with non-dilated type of ACPBD including 3 asymptomatic cases and reviewed the literature. Symptoms and laboratory data were not useful in detecting this type of lesion. All our patients were checked by ultrasonography for gallbladder lesions which are suggested by: wall thickening, multiple polyps, intramural gall stones, cholecystolithiaisis, and debris. ACT revealed only wall thickening of the gallbladder. An EUS revealed a high rate of ACPBD in addition to the ultrasonographic findings of gallbladder lesions obtained by US. An ERCP was effective in clearly demonstrating ACPBD, but was not so useful for the diagnosis of concomitant gallbladder lesions. Therefore, an US is considered to be a useful means for screening this disease, and EUS is useful as a procedure to follow in order to select patients with or without ACPBD, because EUS can be conducted on an outpatient basis and is highly sensitive in detecting ductal anomalies in ACPBD. Therefore, the US/EUS serial examination is thought to be an effective means for diagnosing this disease.     

Expression of urokinase-type plasminogen activator receptor and plasminogen activator inhibitor-1 in gastric cancer

In gastric cancer, the urokinase-type plasminogen activator (uPA) system plays important roles in invasion and metastasis, processes which entail proteolysis and adhesion. Both the urokinasetype plasminogen activator receptor (uPAR) and the plasminogen activator inhibitor-1 (PAI-1) are thought to be important factors in this system. To clarify the relationship between these two factors and gastric cancer invasiveness, we evaluated the expression of uPAR and PAI-1 in 91 cases of gastric cancer by immunohistochemistry and in situ hybridization. Urokinase-type plasminogen activator receptor-mRNA, PAI-1-mRNA, uPAR and PAI-1 protein were diffusely distributed in the cytoplasm of the cancer cells and concentrated at invasive foci. Urokinase-type plasminogen activator receptor protein expression correlated with lymphatic, venous invasion (P<.01) and lymph node metastasis (P<0.05); uPAR-mRNA expression correlated with lymphatic, venous invasion and lymph node metastasis (P<0.05). Plasminogen activator inhibitor-1 protein expression correlated with lymphatic, venous invasion, lymph node metastasis and depth of invasion (P<0.01); PAI-1-mRNA expression was linked to lymphatic, venous invasion (P<0.01), lymph node metastasis and depth of invasion (P<0.05). This suggests that the proteolytic activity of uPAR and the cellular motility of PAI-1 in gastric cancer cells may determine penetration of lymphatic and blood vessels, whereby lymph node metastasis may be promoted and that the promotion of cellular motility by PAI-1 may influence the depth of cancer invasion.     

Effect of TKS159, a novel 5-hydroxytryptamine4 agonist, on gastric contractile activity in conscious dogs

A novel 5-hydroxytryptamine (5-HT)₄ receptor agonist, TKS159, {4-amino-5-chloro-2-methoxy-N-[(2S,4S)-1-ethyl-2-hydroxymethyl-4-pyrrolidinyl] benzamide}, has recently been developed as a gastroprokinetic drug. Cisapride is already used clinically to increase gastric contractions. The stimulatory effects of TKS159 and cisapride on gastric contractions were examined using force transducers chronically implanted on the vagally denervated pouch (Heidenhain pouch) and the vagally innervated main stomach in conscious dogs. Contractile activity was analysed by computer and expressed as a motor index. Intravenous administration of TKS159 or cisapride significantly increased the motor index in both the main stomach and the Heidenhain pouch during the fed and fasted states. Pharmacological characterization in the fasted state revealed that the contraction-stimulating activity of TKS159 and cisapride on the stomach was significantly inhibited by atropine, hexamethonium and a 5-HT₄ receptor antagonist, SDZ 205–557. Granisetron (a 5-HT₃ receptor antagonist) significantly inhibited cisapride-induced, but not TKS159-induced gastric contractions. The plasma motilin concentration was significantly increased after cisapride, but not after TKS159 injection. In conclusion, TKS159 has a contractile-stimulating effect on both the innervated and the denervated stomach. It is likely that a cholinergic pathway and 5-HT₄ receptors are involved in producing the contractions, although other mechanisms cannot be excluded. Cisapride has almost the same characteristics, but the present findings suggest the involvement of motilin and 5-HT₃ receptors in the effects of cisapride.