A supratentorial primitive neuroectodermal tumor exhibiting pathological characteristics of medulloepithelioma: a case report

A 50-year-old female presented with headache symptoms and left hemifacial paresis. Brain computed tomography and magnetic resonance images demonstrated a right frontal lobe tumor with hemorrhage and calcification. A gross total resection was carried out. Pathologically, the tumor exhibited three kinds of structures. The first was an astrocytic area which occupied the large part of this tumor. Small, round cells, which were positive for glial fibrillary acidic protein, were randomly distributed. The second was an epithelioid area with the highest MIB-1 labeling index of the three structures. Undifferentiated tumor cells demonstrated a dense proliferation, and short spindle-shaped cells exhibited an epithelial and a partly luminal alignment that resembled the embryonal neural tube. The third was a sarcomatoid area. Long spindle-shaped cells, which were positive for vimentin, were in a bundle-like form. We diagnosed this tumor as a primitive neuroectodermal tumor (PNET) with epithelial differentiation. PNETs are rare brain tumors with a predominance in children. Histologically, undifferentiated tumor cells demonstrate dense proliferations. The tumor arises from germinal matrix cells that differentiate into neuronal, glial, and ependymal cells. Medulloepithelioma, which is classified in the PNET category, is a very rare brain tumor that usually develops in childhood. Pathological studies have demonstrated that papillary, tubular, or trabecular arrangements of neoplastic neuroepithelium mimic the embryonic neural tube predominantly. In our case, the tumor partly demonstrated epithelial differentiation, which is a feature of medulloepithelioma, not only glial and mesenchymal differentiation. This is a rare case of PNET with uncommon histological features.     

Difference in age of onset of psychosis between epilepsy and schizophrenia

To clarify the nature of psychosis development in epilepsy patients, we studied differences in age of onset of psychosis between epilepsy patients with psychosis (epilepsy-psychosis) and schizophrenia patients. Subjects were 282 patients with epilepsy-psychosis (36 postictal, 224 interictal, and 22 bimodal psychoses) and 612 schizophrenia patients. Age of onset was compared between the schizophrenia group and the whole epilepsy-psychosis group as well as its subgroups. Effects of sex and family history of psychosis on age of onset were also evaluated. Epilepsy patients developed psychosis later (mean age 30.1) than schizophrenia patients (mean age 26.6). Among epilepsy-psychosis subgroups, postictal psychosis and interictal psychosis showed a later onset than schizophrenia. In interictal psychosis, while chronic schizophrenia-like psychosis occurred at similar age compared to schizophrenia, brief episodic psychosis occurred at later age. Epilepsy-psychosis patients showed no sex difference in age of onset, whereas female schizophrenia patients showed a later onset than male schizophrenia patients. Both the epilepsy and schizophrenia patients with family history of psychosis tended to develop psychosis at an earlier age, although this did not reach statistically significant level. The findings of the study suggest that the nature of epilepsy-psychosis is not fully equivalent to that of schizophrenia.     

Cognitive and affective functions associated with insomnia: a population-based study

Objectives: The number of patients with insomnia is rapidly increasing as society ages. The influence of insomnia on cognitive, affective, and activities of daily living (ADL) functions has not been fully studied.

Methods: Participants were 142 residents of a local super-aged community who underwent health check-ups provided by the local government. Participants completed cognitive, affective and ADL function tests including the MMSE. We divided participants into two subgroups based on Athens Insomnia Scale (AIS) scores (AIS ≤3 and AIS ≥4) and compared cognitive, affective, and ADL functions by sex and age.

Results: Subjective insomnia (AIS ≥4) was found in 36.2% of participants and was more frequent in females than males. No differences were found in cognitive function between the AIS subgroups. For both sexes, Geriatric Depression Scale scores were significantly higher in the AIS ≥4 subgroup than the AIS ≤3 subgroup. Apathy Scale scores were significantly higher in males in the AIS ≥4 subgroup. Of the AIS subscales, ‘sleepiness during the day’ was significantly higher in females than males (**p < 0.01), especially in those aged ≥75 years (**p < 0.01). This group of older females also showed a significantly lower Trail Making Test scores (*p < 0.05).

Discussion: Insomnia was present in 36.2% of the population in a Japanese super-aged community. Those with insomnia showed more depressive symptoms (both sexes) and males showed more apathy. The most distinct characteristic of females aged ≥75 years was a high frequency of daytime sleepiness, possibly related to a decline in attention and executive function.     

Impaired coronary flow reserve in obstructive sleep apnea and its improvement after continuous positive airway pressure therapy: a transthoracic Doppler echocardiographic study

Background  

It is reported that patients with obstructive sleep apnea syndrome (OSAS) show endothelial dysfunction and that treatment of OSAS by continuous positive airway pressure (CPAP) therapy improves it.     

Randomized comparative study of omeprazole and famotidine in reflux esophagitis

BACKGROUND: Although proton pump inhibitors (PPI) and H2-receptor antagonists (H2-RA) are routinely used in the treatment of reflux esophagitis (RE), no consensus has been reached yet as to whether the first-choice drug should be PPI or H2-RA. In this study, the effects of omeprazole (OMP) and famotidine (FAM) on RE have been examined in a randomized comparative study. METHODS: Protocols of OMP 20 mg once daily or FAM 20 mg twice daily for 8 weeks were allocated to 56 cases with RE at random, using an envelope randomization method. Their efficacy in achieving healing was examined endoscopically and a relief from subjective symptoms was compared. RESULTS: Patient's background such as sex, age, recurrence, hiatal hernia, smoking and drinking habits, and complications, and the severity of esophagitis at the time of enrolment were not significantly different between the two groups. Healing in the OMP group and the FAM group was observed in 72 and 32% (P = 0.025) of patients at week 4 and 95 and 53% (P = 0.003) of patients at week 8, respectively. Subjective symptoms were relieved more frequently in the OMP group (at week 2, 67% compared with 29%, P = 0.005; at week 4, 95% compared with 55%, P = 0.009), but this superiority was not significant at week 8 (94% compared with 65%, P = 0.085). No serious adverse events occurred. CONCLUSIONS: Omeprazole provided quicker healing and a greater relief from subjective symptoms than did FAM in the treatment of RE, and was considered more suitable as a first-choice drug.     

Simultaneous determination of riboflavin phosphate and other ingredients in a multivitamin pharmaceutical preparation by on-line automated LC coupled with pre-column immobilized enzyme reactor

An automated chromatographic detection system for the simultaneous determination of riboflavin phosphate, caffeine, nicotinamide and pyridoxine hydrochloride in a multivitamin pharmaceutical preparation was constructed. Hydrolytic pretreatment of riboflavin phosphate to riboflavin was carried out using a pre-column enzyme reactor, in which immobilized sweet potato acid phosphatase was packed, and then enzymatically hydrolyzed riboflavin and other ingredients in the pharmaceutical preparation were concentrated in an ODS trap column. The concentrated riboflavin and other ingredients were back-eluted from the trap column using a mobile phase containing 1-decanesulfonate as an ion-pair reagent, and then subsequently chromatographed on an ODS analytical column. It was necessary to wash the ODS trap column with aqueous acetonitrile to remove 1-decanesulfonate in the trap column, which is advantageous to concentrate the riboflavin and other ingredients for the subsequent analysis. The calibration curves for riboflavin phosphate and other ingredients were linear over the concentration ranges tested, and correlation coefficients for standard curves were 0.9999 for all four ingredients. Analytical recoveries of the four ingredients at different levels of concentration added to the ordinary pharmaceutical preparation were also in the range of 99.1-101.2%. The present method was superior to the ordinary manual and batch-wise enzymatic methods in being harmless to the environment, rapid and accurate under continuous autoanalysis.     

Lateralising value of neuropsychological protocols for presurgical assessment of temporal lobe epilepsy

PURPOSE: To estimate the value of neuropsychological measurements in determining the side of seizure onset for presurgical assessment in patients with temporal lobe epilepsy. The lateralising value of neuropsychological protocols was evaluated for all patients and in subpopulations depending on surgical outcome with regard to seizure control, speech dominance, neuropathology, and need for intracranial EEG recordings. METHODS: A battery of neuropsychological procedures was carried out preoperatively in 125 patients who underwent left (n = 66) or right (n = 59) temporal lobectomies. Binary logistic regression analysis was performed to find sets of variables that allowed the best prediction of the side of seizure onset (assumed to be the operated-on side). RESULTS: Combinations of noninvasive neuropsychological tests and Wada subscores showed the highest lateralising values: 80.8% for all patients, 79.4% in seizure-free patients, 86.0% in patients not rendered seizure free, 85.7% in left speech patients, 77.8% in non-left speech patients, 89.3% in patients with mesial temporal sclerosis (MTS), 78.1% in non-MTS patients, 80.3% in patients who underwent intracranial EEG recordings, and 77.3% in those who did not. CONCLUSIONS: The lateralising value (80-90%) of neuropsychological protocols appears similar to that of other tests widely accepted for lateralisation (ictal and interictal scalp EEG and neuroimaging). Attention should be paid to neuropsychological results, particularly from the Wada test, during presurgical assessment of temporal lobe epilepsy, as they can provide strong support for findings from other lateralising tests, particularly in patients with presumed MTS or in left-speech patients.     

Demographic and psychological features of déjà vu experiences in a nonclinical Japanese population

The authors investigated the frequency and correlates of déjà vu experiences in 386 healthy adult volunteers recruited from several areas in Japan. Déjà vu experiences and related experiences were evaluated using the Inventory of Déjà vu Experiences Assessment. Déjà vu experiences were observed by 294 (76.2%) of the 386 participants. Persons who experienced déjà vu were younger and more educated than persons who had not experienced it. There were no differences in the frequency of déjà vu experiences based on sex, hand preference, or area of residence. Subsequent factor analysis associated déjà vu with precognitive dreams and remembering dreams as dream- and memory-related factors rather than with the dissociation-related factors of depersonalization, derealization, jamais vu, and daydreams or with mental activity-related factors such as paranormal quality and travel frequency. Results suggest that déjà vu experiences are associated with good memory function.