A comparison of family care infrastructure for demented elderly in inner cities and regional areas in Japan

Background: Family members' observations of daily life are important for the diagnosis and treatment of dementia. However, elderly people are increasingly living alone, and family structures tend to differ between inner‐city areas and regional areas. We aimed to compare the family caregiving infrastructure of demented elderly visiting a memory clinic. Methods: Subjects were consecutive outpatients with dementia at the memory clinic at a university hospital in two different areas. We compared subjects' demographic data, residency status, housemates and companion status at the time of their initial visit. Results: Patients in the inner‐city area (n= 99) had more education and higher Mini‐Mental State Examination scores than those in the regional area (n= 172). In both areas, the highest proportion of patients lived with their spouse. In the inner city, patients' housemates were either their spouse (34%) or their child (13%); 22% lived alone. In regional areas, patients lived with their spouse only (39%) or in their child's household (23%); 14% lived alone. At their initial consultation, inner‐city patients were accompanied by a family member other than their spouse (49%), a spouse (27%), or they were alone (7%). In the regional area, patients' companions were their spouse (35%) or their spouse and other family members (18%); patients rarely arrived alone. Regression analysis showed that education, diagnosis, housemate state (child only), and companion state (alone) significantly influenced the living area. Conclusion: Our results suggest family caregiving infrastructure of demented elderly differ between the two areas. This may reflect changes in social structure and increased awareness regarding dementia in inner‐city areas.     

Managing abnormal eating behaviours in frontotemporal lobar degeneration patients with topiramate

Abnormal eating behaviours are specific to frontotemporal lobar degeneration and increase caregiver burden. Topiramate, an anticonvulsant, suppresses cravings for alcohol and other substances and is a potential treatment for binge eating. However, there are few reports on topiramate efficacy for abnormal eating behaviours in frontotemporal lobar degeneration patients. We present three Japanese frontotemporal lobar degeneration patients with abnormal eating behaviours. Topiramate was effective, especially for compulsive eating, in cases with distinct lobar atrophy, but not for all abnormal eating behaviours.     

Two cases of panic disorder treated with autogenic training and in vivo exposure without medication

Abstract The aim of this study was to use autogenic training in combination with in vivo exposure in the behavioral treatment of panic disorder without medication. Two cases of panic disorder with agoraphobic avoidance were presented. Case 1 was a 33 year old married female who exhibited mild panic symptoms, and case 2 was a 23 year old single male who had severe panic symptoms. Both subjects were successfully treated with the combination of these two techniques. Treatment effects were maintained for 9 years as a follow up in case 1, and for 4 years in case 2.     

Squamous Cell Papilloma of the Esophagus -A Report of Two Cases and a Review of the Literature-

We present two cases of squamous cell papilloma of the esophagus (SPE) diagnosed by panendoscopy and confirmed by histology. In one case the SPE was removed by endoscopy, and in the other, the SPE detached during severe vomiting. Our patients both had a previous history of heartburn and repeated vomiting. An immunological study for human papilloma virus (HPV) was conducted in both cases, with negative results.     

Depressed tubular adenoma of the stomach: pathological and immunohistochemical features

We examined 12 depressed tubular adenomas of the stomach pathologically and immunohistochemically in order to clarify the difference between the depressed type and the elevated type. Depressed tubular adenomas showed shallow mucosal depression and, of the 12, nine were endoscopically diagnosed as early gastric cancer. Histologically, the adenoma cells showed dysplasia in varying degree and focal adenocarcinoma occurred in two adenomas measuring over 2 cm. The mean height of the adenoma glands was 0.63 +/- 0.31 mm in the 12 depressed adenomas and 1.32 +/- 0.43 mm in 44 elevated adenomas, while the mean heights of the subjacent mucosa were 0.18 +/- 0.19 mm and 1.07 +/- 0.71 mm, respectively. Thus, depressed adenomas resulted from paucity of the mucosa subjacent to the adenoma glands and the height of the adenomatous glands was half that found in the elevated type. Goblet cells, a variety of endocrine cells and lysozyme-containing cells were found in nine, nine and eight depressed adenomas, respectively, in variable numbers. Hyperplasia of these cells was also detected in depressed adenomas showing mild or moderate dysplasia. Immunohistochemical examination revealed no difference in the phenotypic expression of adenoma cells as between the depressed and the elevated type.     

Blockade of ATP-sensitive K+ channel abolishes the anti-ischemic effects of isoflurane in dog hearts

Background: Although isoflurane is reported to have a protective effect against ischemic damage on the myocardium, the mechanisms of this effect are not clear. Activation of adenosine triphosphate sensitive potassium (KATP) channels is indicated to protect myocardium during ischemia. Thus, it was hypothesized that if isoflurane could activate KATP channels, blockade of KATP channels would decrease its cardioprotective effect.
Methods: Mongrel dogs, anesthetized with morphine, urethane, and chloralose, were subjected to 15 min of left anterior descending coronary artery occlusion followed by 60 min reperfusion. The dogs were divided into three groups: the control group (n=8), IS0 group (n=8) and ISOGC group (n=8). In the IS0 and ISOGC groups, 1 MAC of isoflurane was administrated during ischemia and reperfusion. In the ISOGC group, 0.3 mg/ kg of glibenclamide, the KATP channel blocker, was given 45 min before ischemia. Full-thickness samples of myocardium were obtained and the concentrations of adenosine monophosphate, adenosine diphosphate, adenosine triphosphate (ATP), creatine phosphate and lactate in the endocardial portion of the myocardium were measured.
Results: The ischemia-reperfusion caused a 25.4% and 27.6% reduction of myocardial ATP in the control and ISOGC groups, respectively. In contrast, the IS0 group showed only 11.0% reduction of AT, which was significantly lower compared to the other groups ( P < 0.01).
Conclusions: Our results shows that blockade of the KATP channel abolishes cardioprotective effects of isoflurane in myocardial ischemia-reperfusion. The KATP channel may play a role in the ATP-sparing effect of isoflurane.     

Extramedullary plasmacytoma: cytological and genotypic studies

A 62-year-old woman had multiple plasmacytomas in the skin and lymph nodes, without Bence-Jones protein or a monoclonal peak of serum immunoglobulins. Infiltrating plasmacytoid cells expressed cytoplasmic IgG (λ) and surface CD38, without any B-cell markers. There was no visceral or bone marrow involvement suggestive of multiple myeloma. Southern blot analysis of extracted DNA from the cutaneous lesions showed two rearranged bands with an immunoglobulin, but not a T-cell receptor, gene probe. The patient showed a poor response to chemotherapy, and died of bronchopneumonia. The clinical course and cytological features differentiate multiple cutaneous extramedullary plasmacytomas from solitary cutaneous extramedullary plasmacytoma and cutaneous lesions associated with tnultiple myeloma.     

Effects of Thyrotrophin-releasing Hormone Tartrate and its Sustained Release Formulation on Cerebral Glucose Metabolism in Aged Rats

The effects of a sustained release formulation of thyrotrophin-releasing hormone (TRH) over two weeks (TRH-SR, 10 or 50 mg kg^? equivalent to 0.56 or 2.80 mg kg^? free TRH, respectively) and repeated treatment with TRH tartrate (TRH-T, 0.3, 1.0 or 3.0 mg kg^?, equivalent to 0.2, 0.7 or 2.0 mg kg^? free TRH, respectively) on the rate of local cerebral glucose utilization (LCGU) were investigated using the quantitative autoradiographic 2-deoxy-[¹⁴C]d -glucose method in various brain regions of aged rats. In aged rats (28 months old), the LCGU was significantly reduced as compared with young adult rats (3 months old), while treatment with TRH-SR ameliorated the reduction of the LCGU in a dose-dependent manner. The brain regions ameliorated by TRH-SR were the auditory cortex, septal nucleus, substantia nigra, cerebellar cortex and cerebellar nucleus. In contrast, once-daily repeated treatment over one week with TRH-T at a dose of 0.3 mg kg^? (equivalent to 50 mg kg^? of TRH-SR) had no effect on the reduced LCGU in various brain regions in aged rats (27 months old), whereas treatment with a higher dose of TRH-T (0.7 or 2.0 mg kg^? free TRH) significantly ameliorated the reduction. The comparison of the ameliorating potencies between TRH-T and TRH-SR indicated that TRH-SR had a potency about 7 times greater than TRH-T.     

Congenital Pyloric Atresia

Congenital pyloric atresia, a rare malformation producing gastric outlet obstruction during the neonatal period, was found in three patients. Sixty percent of these malformations are membranous in type. Excision of the membrane and Heineke-Mikulicz pyloroplasty, which has been advocated as the procedure of choice, inevitably results in postoperative duodenogastric bile reflux. We suggest that to minimize reflux and hence possible increased risk of future development of gastric ulcer, maximal preservation of pyloric function in the operative management of the malformations is important.