Clinical experience of the pharmacological treatment algorithm for major depression in advanced cancer patients: preliminary study

INTRODUCTION : Treatment of major depression in advanced cancer patients is often difficult because of their special characteristics. METHOD : The authors developed a treatment algorithm for major depression in advanced cancer patients and report on their clinical experience using it. The applicability, tolerability, and clinical efficacy of the algorithm were evaluated in 95 advanced cancer patients with major depression. RESULTS : The algorithm was not suitable for seven patients and was not used correctly in 14 cases. It was correctly applied to 74 patients (77%), 23 of whom dropped out for cancer-related reasons (deterioration of physical condition, transfer to other hospitals, cancer death). As for tolerability, 22 patients (43%) of the 51 dropped out of the antidepressant treatment regimen because of delirium due to deterioration of their physical condition, adverse effects of the antidepressant, etc. In the 29 cases that could be followed up, clinical efficacy was evaluated for 4 weeks, and improvement was observed in 22 cases (76%). CONCLUSION : These preliminary findings suggest that use of the algorithm may be feasible, but that it requires some alterations to manage major depression in advanced cancer patients. (Int J Psych Clin Pract 2002; 6: 83-89)     

Estimation of the Biphasic Property in a Female’s Menstrual Cycle from Cutaneous Temperature Measured During Sleep

This paper proposes a method to estimate a woman’s menstrual cycle based on the hidden Markov model (HMM). A tiny device was developed that attaches around the abdominal region to measure cutaneous temperature at 10-min intervals during sleep. The measured temperature data were encoded as a two-dimensional image (QR code, i.e., quick response code) and displayed in the LCD window of the device. A mobile phone captured the QR code image, decoded the information and transmitted the data to a database server. The collected data were analyzed by three steps to estimate the biphasic temperature property in a menstrual cycle. The key step was an HMM-based step between preprocessing and postprocessing. A discrete Markov model, with two hidden phases, was assumed to represent higher- and lower-temperature phases during a menstrual cycle. The proposed method was verified by the data collected from 30 female participants, aged from 14 to 46, over six consecutive months. By comparing the estimated results with individual records from the participants, 71.6% of 190 menstrual cycles were correctly estimated. The sensitivity and positive predictability were 91.8 and 96.6%, respectively. This objective evaluation provides a promising approach for managing premenstrual syndrome and birth control.     

Palmar-divergent dislocation of the scaphoid and the lunate

We describe a patient with palmar-divergent dislocation of the scaphoid and lunate. After successful closed reduction, the scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, and the anterior capsule was sutured through the palmar approach. The scapholunate and lunotriquetral joints were fixed with Kirschner wires for 7 weeks. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate, and radiographs showed no evidence of the dorsal and volar intercalated segment instability patterns associated with carpal instability. However, flexion of the scaphoid and a break in Gilula’s line remained. To our knowledge, this is the first report showing treatment of palmar-divergent dislocation of the scaphoid and lunate by suturing the carpal interosseous ligaments.     

Quantification of BCR-ABL mRNA in Plasma/Serum of Patients with Chronic Myelogenous Leukemia

Quantification of tumor-associated mRNA extracted from blood cells/tissues containing tumor cells is used for evaluation of treatment efficacy or residual tumor cell burden in tumors including leukemia. However, this method using tumor cell-containing blood/tissue is difficult to evaluate the whole tumor cell burden in the body. In order to establish an efficient method to evaluate the whole tumor cell burden in the body, we tried to quantify tumor-associated mRNA existing in plasma/serum instead of leukemia cell-containing blood cells in patients with chronic myelogenous leukemia (CML) and compared the levels of BCR-ABL mRNA between plasma/serum and peripheral blood cells. mRNA of BCR-ABL, WT1 or GAPDH (control molecule) was detected by real-time RT-PCR using RNA extracted from plasma/serum of almost all the patients with CML. Copy numbers of BCR-ABL mRNA were significantly correlated between plasma/serum and peripheral blood cells. However, levels of BCR-ABL mRNA extracted from serum were low compared with those extracted with peripheral blood cells. The present findings suggest that although real-time RT-PCR of mRNA existing in plasma/serum could be used for evaluating the whole tumor cell burden in the body, it''s required to establish an efficient method to quantify plasma/serum mRNA by nature without degrading during the procedure.     

Bisphosphonate-related osteonecrosis of the jaw around dental implants in the maxilla: report of a case

Objective: We describe a patient who developed bisphosphonate (BP)-related osteonecrosis of the jaw (ONJ) around implants in the upper molar area.
Patients and methods: The patient was a 54-year-old woman with ulceration of the gum, bone exposure, and severe spontaneous pain around implants in the upper left molar area. She had received BPs intravenously for 2 years to treat bone metastases of breast cancer. She was diagnosed with BP-related ONJ. Sequestrum including implants was resected, and hyperbaric oxygen therapy was performed. Undecalcified ground sections were prepared from the resected bone around the implants and stained with toluidine blue. For the bone around the lesion, decalcified sections were prepared, and examined by histological and immunohistological analysis.
Results: The surgical wound became completely covered with mucosal epithelia, and postoperative pain disappeared. No recurrence of ONJ was noted during a 6-month postoperative follow-up period. However, the patient died from metastatic disease. Although histopathological examination of the resected jaw bone revealed sequestrum, osseointegration of the implant was maintained. In the area around the lesion, there was no progression of bone necrosis, and reactive bone formation, fibrosis, and invasion of lymphoid cells into the marrow cavity were observed.
Conclusion: There is no effective treatment for ONJ caused by BPs, and conservative therapy based on clinicians' experience is recommended. However, if chemotherapy is planned, or if bone necrosis around implants is thought to harbor infection, the option of jaw resection should be considered.     

Neurovisual abnormalities preceding the retinopathy in patients with long-term type 1 diabetes mellitus

BACKGROUND: Changes in the retina caused by diabetes may lead to visual impairment in dim light, even with good visual acuity and visual fields. To evaluate the visual abnormalities preceding the retinopathy in patients with type 1 diabetes mellitus (DM), we applied electrophysiological methods. METHODS: The visual evoked responses were recorded with sinusoidally modulated vertical gratings at 10 spatial frequencies presented sequentially on a high-resolution monitor in patients with type 1 DM and in normal volunteers. Similarly, the contrast visual evoked responses of 10 contrast levels were recorded at five spatial frequencies. Both amplitudes at the second harmonic were calculated by discrete Fourier transform. The visual acuity and contrast thresholds were determined objectively. RESULTS: There was dissociation between the Snellen and the estimated visual evoked response acuity measurements in patients with diabetes (r2=0.077, P=0.44). The saturation phenomena were observed at lower levels of contrast stimuli than in normal individuals at. 1.0, 2.0, 4.0 and 8.0 cycles per degree (P=0.0001). The contrast sensitivity function was deeply abnormal in all tested patients despite the metabolic control. The values of the area under the curve of the visual evoked response amplitude-contrast level function at five spatial frequencies were smaller in patients with DM than in the control group (P<0.05) at all spatial frequencies tested. CONCLUSIONS: Patients with type 1 DM without retinopathy showed significant lower amplitude of the visual evoked responses at all spatial frequencies tested, with the saturation phenomena observed at lower level of contrast stimuli. In addition, there was a dissociation between the sweep visual evoked responses and the Snellen acuity measurements. A significant and nonselective neuronal visual loss involving the visual pathway precedes the ophthalmoscopically detectable retinopathy in patients with type 1 DM.     

Gastric carcinosarcoma presenting as a huge epigastric mass

Gastric carcinosarcoma often presents with an elevated lesion or increased thickness of the stomach wall. Histological diagnosis is achieved using conventional hematoxylin and eosin staining to confirm the coexistence of both epithelial and mesenchymal elements. We report a case of gastric carcinosarcoma presenting as a large mass in the epigastric region. Specimens obtained by endoscopic biopsy and surgical excision showed diffuse proliferation of atypical cells in sheet formation. No mucus production or glandular structures were apparent, but immunoreactivity for both epithelial and mesenchymal markers was noted. These findings led to a definitive diagnosis of gastric carcinosarcoma. Immunohistochemical analysis is useful for the early diagnosis and treatment of gastric carcinosarcoma.