Changing pattern of mental health utilization in Hachijojima

Abstract We have reviewed retrospectively 229 patients interviewed by the mental health team in the Hachijojima since the establishment of our services in 1987. The 6 year observation period was classified into three chronological stages for the purposes of identifying any change in the utilization pattern of the mental health services of the island. The rate of schizophrenia was observed to have decreased from 48% in the first 2 years of the study period to 28% in the last 2 years; while that of other mental disorders increased yearly. Interestingly, an increasing number of patients were referred to our services by professionals in areas other than mental health (from 42 to 77%), and patients without any history of psychiatric treatment were more frequently seen (from 36 to 75%) in the later part of the study period. These changes suggest the importance of access to mental health services.     

Radionuclide assessment of left ventricular performance on exercise after external conduit operation

Only limited information is available concerning left ventricular (LV) response to exercise after an external conduit operation for cyanotic congenital heart disease. Sixteen patients who had undergone external conduit repair (EC group) were studied with multi-gated cardiac pool imaging using a supine bicycle ergometer on 20 occasions. Six patients with a history of Kawasaki disease without coronary artery stenosis served as controls (control group). Myocardial imaging and cardiac catheterization were also performed in the EC group. There was no significant difference in left ventricular ejection fraction (LVEF) at rest between the groups. However, on exercise, LVEF of the EC group was significantly lower than that of the control group. Nine patients in the EC group showed a perfusion defect (PD) on 12 occasions. LVEF on exercise of the patients with PD was significantly lower than that of the patients without PD. Furthermore, only the patients with PD showed a LVEF decrease of 5% or more in response to exercise. In the EC group, a significant inverse relationship was demonstrated between right ventricular systolic pressure (RVP) and LVEF response to exercise. However, two out of four patients who underwent external conduit replacement improved their LVEF response to exercise with successful reduction of RVP. These findings indicate that an impaired left ventricular response to exercise was common in patients after external conduit operations. Myocardial damage and right ventricular outflow tract obstruction could be the causes of this left ventricular dysfunction.     

Primary Adenocarcinoma of the Esophagus Report of Six Cases

Six primary adenocarcinomas were found among 1,346 cases ofesophageal carcinoma, an incidence of 0.45%. Three of the adenocarcinomaswere the "type ordinaire" of Lortat-Jacob, two were adenoidcystic carcinoma, and one was mucoepidermoid carcinoma. Theinitial symptom was dysphagia in all six cases. All six lesionswere located in the middle and/or lower third of the esophagus.Esophagograms showed tumorous-type lesions in four cases andspiral-type in two cases. Although endoscopical examinationwas performed in five cases, the biopsied specimen showed adenocarcinomasin only two. Four patients were operated and on two receivedradiation therapy. Four patients died within one year, and twoare still alive more than 21 months after surgery.     

COMPARATIVE STUDY OF ABNORMALITY IN GLYCOGEN STORING CAPACITY AND OTHER HISTOCHEMICAL PHENOTYPIC CHANGES IN CARCINOGEN-INDUCED HEPATOCELLULAR PRENEOPLASTIC LESIONS IN RATS

A sequential comparison was made between abnormal glycogen storage and other histochemical phenotypic changes in hepatocellular precancerous lesions (altered foci and neoplastic nodules) during various stages in the process of development of cancer in rat liver. N-2-fluorenylacetamide was fed to male rats for 8 weeks and groups of rats were killed at the end of carcinogen feeding and at 12 and 24 weeks on control diet. Foci rich in glycogen storage accounted for a majority of all foci over the course of experiment, while foci devoid of glycogen storage, which were absent at the end of carcinogen feeding, gradually increased in number during maintenance. Glycogen-deficient lesions that might appear to arise from glycogen-rich lesions displayed hyper-basophilia demonstrated by toluidine blue reaction, but often lacked gamma-glutamyl transpeptidase activity. Resistance to iron accumulation was consistently shown in all precursor lesions for hepatocellular carcinoma in the siderotic liver regardless of abundance or absence of cellular glycogen. It was suggested that properties such as loss of glycogen storing capacity, hyperbaso-philia, and some cellular atypicality resembling those of carcinoma cells might be essential elements for malignant progression.     

Further investigation of the epitope recognized by the new monoclonal antibody 2C9

OBJECTIVE: We established a new monoclonal antibody (2C9) that reacted with prostate tissue. The immunohistochemical reactivity of this antibody is similar to anti-prostate-specific membrane antigen (PSMA). Herein, we report the antigenic determinant of 2C9 antibody. METHODS: The reactivity of the antibody was characterized by immunohistochemical staining and the antigen target was characterized by amino acid sequencing after immuno-affinity purification from an LNCaP cell lysate and cloning of a cDNA using a mammalian expression cDNA cloning system. RESULTS: The amino acid and nucleotide sequences for the antigen molecule recognized with 2C9 monoclonal antibody demonstrated identity with PSMA. CONCLUSION: The target molecule of the 2C9 monoclonal antibody is PSMA, pointing to future diagnostic and therapeutic applications.     

Health related quality of life in Japanese men after radical prostatectomy or radiation therapy for localized prostate cancer

BACKGROUND: We performed a retrospective survey of general and disease specific health-related quality of life (HRQOL) after radical prostatectomy (RP) and external beam radiotherapy (XRT) in Japanese men. METHODS: A total of 186 patients underwent RP and 78 underwent XRT for clinically localized prostate cancer between 2000 and 2002. We measured the general and disease specific HRQOL with the MOS 36-Item Health Survey and the University of California, Los Angeles Prostate Cancer Index, respectively. Each treatment group was further divided into four subgroups according to the time scale. RESULTS: Patients from the RP group were significantly younger than those from the XRT group. The tumor characteristics differed significantly in their distributions among the treatment groups. Patients undergoing XRT had low scores in most of the general measures of HRQOL just after treatment, but after 6 months there were no differences between the treatment groups, except for the physical domains. The RP group was associated with worse urinary function, whereas the XRT group had worse bowel function and bother during the first 6 months after treatment. Thereafter, however, urinary and bowel domain did not differ between the groups. Both groups reported poor sexual function, although the RP group scored lower sexual bother. CONCLUSION: The patients who underwent RP had significantly worse urinary and better bowel function than those treated with XRT. Both treatment groups had decrements in sexual function throughout the post-treatment period; careful attention should be paid to this side-effect in preoperative counselling, especially in younger patients, regardless of the primary treatments.     

Impact of hormonal therapy prior to radical prostatectomy on the recovery of quality of life

BACKGROUND: We investigated the changes in health-related quality of life (HRQOL) in patients who underwent prostatectomy (RP) with or without neoadjuvant hormonal therapy (NHT). METHODS: A total of 72 patients undergoing direct RP (DRP group) and 26 patients receiving neoadjuvant hormonal therapy (NHT group) were enrolled in the present study. The baseline interview was conducted before RP (not initiation of therapy). Follow-up interviews were conducted in person at scheduled study visits of 3, 6, and 12 months after surgery. We measured general and disease specific HRQOL with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles Prostate Cancer Index, respectively. RESULTS: At baseline, the NHT group scored statistically lower for not only sexual function (P < 0.001), but also the general HRQOL, such as role limitations due to physical problems (P = 0.007), social function (P = 0.045) and mental health (P = 0.034), than the DRP group. The NHT group reported lower scores in social function and mental health at 3 months (P = 0.040 and 0.006, respectively). Patients who received NHT for more than 3 months continued to show significantly lower scores for some HRQOL domains 12 months later. CONCLUSION: Neoadjuvant hormonal therapy may decrease not only sexual function, but also general HRQOL before surgery. The recovery of HRQOL appeared to be further prolonged in patients who received long-term NHT.     

Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.     

Intramolecular sulfhydryl-catalyzed structural alteration of bovine plasma albumin–N-A isomerization*

The N-A isomerization of bovine plasma albumin (BPA) (the intramolecular sulfhydryl-disulfide exchange reaction) is not a two-state but a multi-state reaction as shown in the following equation N ± A₁ + mH⁺ ± A₂ + nH⁺ ± where N and A₁ are the N- and A(aged)-forms, respectively. The N-A isomerization was strongly suppressed by increasing the ionic strength, especially by divalent cations, such as Ca²⁺. The N-A isomerization was completely suppressed in the presence of 20 mM sodium caprylate and 40 mM N-acetyltryptophan. This suppression of the intramolecular sulfhydryl-disulfide exchange reaction might be due to the reduction of the structural fluctuation of BPA.