Carbamazepine-induced pneumonitis definitively diagnosed by accidental readministration]

An 82-year-old man had been treated by carbamazepine for convulsions. A month later he felt febrile and malaise. Laboratory data revealed liver dysfunction, hypoxemia, and chest radiograph and computed tomography (CT) of the thorax showed ground glass opacity in both lungs and mediastinal lymphadenopathy. Analysis of bronchoalveolar lavage fluid revealed pulmonary lymphocytosis. Drug-induced lymphocyte stimulation test (DLST) for carbamazepine using peripheral blood lymphocytes was negative. We gave him a possible diagnosis of carbamazepine-induced liver damage and pneumonitis. After stopping carbamazepine, we initiated corticosteroid therapy and he recovered well. One year later he again suffered from convulsions and was treated with carbamazepine in another hospital. A week later he became febrile and suffered appetite loss, and came to our hospital. His chest radiograph and CT again showed ground glass opacity and pleural effusion in both lungs. Along with the laboratory data we established a definitive diagnosis of carbamazepine-induced pneumonitis. We discuss the mechanism of carbamazepine-induced pneumonitis in which the DLST results were negative and the challenge test was positive.     

An immunohistochemical study on neuron specific enolase in testicular germ cell tumors]

Testicular germ cell tumors obtained from 44 patients were immunohistochemically studied using anti-neuron specific enolase (NSE) antibody. The level of NSE in the serum was also measured in 9 patients before and after extirpation of the tumor. As for tumor cells of seminoma, 19 of 20 pure seminomas and all 9 of mixed type were positive for NSE. On the contrary, a spermatocytic seminoma was NSE-negative. As for embryonal carcinomas, some tumor cells were NSE-positive in 13 of 15 of mixed type. In yolk sac tumor, a few tumor cells were also NSE-positive in 8 of 21 of both pure and mixed types. Some NSE-positive cells were found in teratomatous components of 10 of 14 mature and immature teratomas of both pure and mixed types. These were in neural cells, chondrocytes, and glandular epithelial cells. Spermatogonia in 5 normal testes were NSE-positive. NSE level in the serum was elevated before extirpation and decreased after extirpation in 4 of 5 cases of seminoma of pure type and in 1 of 2 of mixed type which included seminomatous elements. All of these cases were either in the advanced stage or had a rather large primary tumors. Immunohistochemical study of testicular germ cell tumors using anti-NSE antibody may facilitate histological diagnosis, and serum NSE level may be useful for monitoring the clinical course as well as for clinical diagnosis of seminoma.     

A case of gastric cancer with liver metastasis had a good reaction to S-1/CDDP chemotherapy after S-1 chemotherapy was ineffective

A woman in her sixties underwent total gastrectomy for gastric cancer. The pathological diagnosis was pT3, pN3, sH0, pCY0, sP0, sM0, fStage IV. Chemotherapy with S-1 was used after surgical treatment. Because a CT scan after three courses chemotherapy showed the paraaortic lymph nodes swelling, combination chemotherapy with S-1 and docetaxel was used as a second-line chemotherapy. When the CT scan after 8 courses of this combination chemotherapy revealed multiple liver metastases, the chemotherapy was changed to CPT-11 monotherapy and paclitaxel monotherapy as the third-and fourth-line chemotherapy, respectively. In spite of those chemotherapies, the metastatic disease progressed, and therefore, combination chemotherapy with S-1 and CDDP was used as the fifth-line chemotherapy. After 6 courses of this treatment, serum CEA and CA19-9 levels dropped into the normal range. Multiple liver metastases were markedly reduced, and were considered as a partial response(PR). The patient is still alive, maintaining the effect of PR for 17 months without any adverse effects except appetite loss and vomiting of grade 2.     

Cognitive patterns and depression: study of a Japanese university student population

According to Beck's cognitive theory, individuals who endure negative self-schemas (dysfunctional attitudes) are more likely to present automatic thoughts consisting of negative schemata of oneself and one's world while experiencing depression. In order to examine the relationships between depression, automatic thought, and dysfunctional attitude, 329 Japanese university students were given a set of questionnaires, including the Center for Epidemiologic Studies Depression Scale (CES-D), Automatic Thought Questionnaire-revised (ATQ-R), and Dysfunctional Attitude Scale (DAS). A structural equation model revealed that depression was predicted predominantly by automatic thought, which was in turn predicted by dysfunctional attitude. The male gender had a tendency to predict dysfunctional attitude. The link between a student's depression and dysfunctional attitude was mediated by automatic thought.     

Occurrence of traumatic injuries in the oromaxillary region of children in a Japanese prefecture

Abstract The authors conducted a survey by sending questionnaires to school-aged boys (7966) and girls (7856) in Kumamoto Prefecture, to study the actual condition of traumatic injuries of teeth and in the maxillary and mandibular regions by comparing the results with those reported by others. An average of 21.8% of the pupils suffered from some kind of trauma in the oral region. It was also found that 37.7% of the traumas resulted from falls and 29.2% from sporting activities. Tooth luxation and fractures accounted for a relatively high percentage of the tooth injuries: 17.3% for the former and 6.9% for the latter, while exarticulation was only 1.6%. Of the total number of traumas, only 12.9% were treated at hospitals or dental clinics. The rest were left untreated.     

Spectral characteristics of electroretinography in congenital red-green color blindness

There are few conclusive electroretinography (ERG) studies comparing the spectral characteristics in deutans and normals in contrast to protans and normals. The difficulties of research on deutans were thought to be due to problems in detecting the very slight differences in the spectral characteristics between deutans and normal subjects. To record monochromatic ERG responses accurately in deutans, our time-locked scanning method was improved as follows: We used 12 interference filters for stimulus lights with narrow half widths (4-6 nm) and wavelengths of peak transmission arranged at intervals of 10 nm between 520 nm and 600 nm. Each stimulus light was strictly adjusted to an equal energy and checked simultaneously with ERG recordings. Contact lens electrodes were reformed for comfortable fitting to subjects' corneas. The time interval between each stimulation was set at 300 msec and one scanning of all stimulations took only 3.9 sec. ERG bp-waves were recorded in congenital color blindness by scanning monochromatic light stimuli, and spectral responses obtained could be evaluated as a spectral pattern. Different spectral patterns of responses from those of normal subjects and shift of the peak in the spectral response curves were obtained for congenital color blind subjects. The maximal responses were recorded at around 540 nm in protans and at 570-580 nm in deutans under white adaptation. Differences in the response curves were not found between dichromats and anomalous trichromats. Moreover, selective chromatic adaptation disclosed the separate responses of green cone and red cone systems. In normal subjects the peak of the spectral response curves was shifted to around 540 nm by red adaptation and to around 580 nm by blue adaptation. The spectral patterns changed so that they looked like the patterns under white adaptation of protans and deutans, respectively. But in protans and deutans the same spectral response patterns and almost the same wavelengths of the peak in the spectral response curves as those obtained under white adaptation were recorded under chromatic adaptation. This method provides the possibility of differentiating between red and green color blind subjects and normal subjects by the ERG. Defects or marked abnormality in the red cone system in protans and the green cone system in deutans can also be detected. Monochromatic ERGs of deutans were recorded under more intense red adaptation.(ABSTRACT TRUNCATED AT 400 WORDS)