Short-and Long-term Efficacy of Electroconvulsive Therapy for Late-life Depression: A Pilot Study

Background : Electroconvulsive therapy (ECT) is often administered among the elderly, who are particularly likely to have concurrent medical conditions and medication intolerance. Objective : To examine the short‐and long‐term efficacy of ECT for late‐life depression, we performed a two‐phase, prospective, naturalistic follow‐up study that compared treatment outcome in old‐aged with that in middle‐aged subjects. Methods : Phase I study: Twenty‐one subjects who were consecutively referred for ECT, aged at least 50 years, and met the DSM‐IV criteria for a major depressive episode were enrolled. Before ECT, severity of concurrent medical conditions was assessed with the cumulative illness rating scale (CIRS). Before and after a course of ECT, the severity of depressive symptoms was evaluated with the 17‐item Hamilton rating scale for depression (HAM‐D). Phase II study: Seventeen subjects who responded to an acute ECT course in the phase I study were enrolled. Various continuation medications were administered, and symptoms were monitored and evaluated with the HAM‐D for 24 weeks or until relapse. Results : Overall the subjects had an 81 % short‐term response rate and a 47% relapse rate within 24 weeks after ECT. Response and relapse rates were not significantly different between the middle‐and old‐aged groups (response rates: 91% vs. 70%; relapse rates: 40% vs. 57%). However, the old‐aged patients had higher post‐ECT HAM‐D scores than the middle‐aged patients did (P<0.05), and CIRS scores positively correlated with post‐ECT HAM‐D scores (P<0.05). Relapsers tended to have higher CIRS scores than non‐relapsers did (P=0.06). Conclusion : In late‐life depression, the short‐term response rate to ECT is considerably good, but the relapse rate was relatively high. Clinicians need to take into consideration the age of patient and any concurrent medical conditions, when planning long‐term management of residual depressive symptoms and prevention of relapse after an initial good response to ECT.     

Real-time quantitative polymerase chain reaction for MDR1, MRP1, MRP2, and CYP3A-mRNA levels in Caco-2 cell lines, human duodenal enterocytes, normal colorectal tissues, and colorectal adenocarcinomas.

The expression levels of mRNAs for MDR1 (P-glycoprotein), multidrug resistance-associated proteins (MRP1, MRP2), and cytochrome P450 3A (CYP3A) in Caco-2 cells were quantitatively compared with those in human duodenal enterocytes, normal colorectal tissues, and colorectal adenocarcinomas. Caco-2 cells (passages 36-88) were kindly supplied by several laboratories in Japan. Human duodenal enterocytes were obtained from five healthy male volunteers. Normal colorectal tissues and colorectal adenocarcinomas were simultaneously obtained from seven patients with primary colorectal adenocarcinoma. MDR1, MRP1, MRP2, and CYP3A mRNA levels were determined by real-time quantitative polymerase chain reactions (PCR). Relative concentrations of mRNAs for target proteins (MDR1, MRP1, MRP2, and CYP3A) and glyceraldehyde-3-phosphate dehydrogenase in Caco-2 cells were 1.00 +/- 0.15, 1.02 +/- 0.06, 0.94 +/- 0.10, and 0.68 +/-0.60, respectively, and those in human enterocytes were about 12-, 3-, 7-, and 8000-fold higher than in the Caco-2 cells, respectively. In contrast, MDR1, MRP1, and CYP3A mRNA levels in Caco-2 cells were comparable to those in normal colorectal tissue and colorectal adenocarcinoma.     

Malignant Cell Detection in Burkitt's Lymphoma Using Third-complementarity-determining Region (CDRIII), Clone-specific Probe Developed by Sequencing DNA from Stored Slides

The DNA sequence of the third-complementarity-determining region (CDRIII) of the immunoglobulin heavy chain (IgH) gene in a case of Burkitt's lymphoma was determined hy polymerase chain reaction (PCR) using template DNA extracted from a smear stored at room temperature for more than one year. The DNA sequence obtained from the stored slide was compared with that of DNA from a frozen lymph node biopsied at the initial presentation. The sequences were shown to he identical, implying that DNA from a smear on a stored slide can he used as a source of DNA for PCR amplification, sequencing, and development of a clone-specific probe. Using oligonucleotides generated from one of the CDRIII sequences of the IgH gene as molecular probes, a retrospective study for the malignant clone on the smears was carried out. Malignant ceils were detectable in the peripheral blood at an early stage of hone marrow relapse but not in the peripheral blood or bone marrow at the initial presentation. No malignant clone was detected in the bone marrow when testicular infiltration was diagnosed by examination of a pathological specimen. Thus, the technique permits molecular analysis of hematologic malignancies of B-cell lineage in cases where fresh or frozen specimens are not available.     

Stenting of a stenosed major aortopulmonary collateral artery in a baby with pulmonary atresia and a ventricular septal defect: Rescue from critical hypoxia in the immediate postoperative stage of unifocalization supported by extracorporeal membrane oxygenation

A 4‐month baby with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries (MAPCAs) and an extremely hypoplastic central pulmonary artery developed critical hypoxia following right unifocalization combined with a right Blalock‐Taussig shunt. To increase pulmonary blood flow we stented the left lower MAPCA during extracorporeal membrane oxygenation (ECMO) support. He was successfully weaned from ECMO 2 days after stenting. Percutaneous intervention for a stenosed MAPCA is an effective means of increasing pulmonary blood flow in critically hypoxic patients following unilateral unifocalization, even in the immediate postoperative stage. © 2008 Wiley‐Liss, Inc.     

Foreign accent syndrome in a case of dissociative (conversion) disorder]

Psychiatric symptoms are often manifested in verbal expression. Generally, the contents of such expression are pathological. The formal abnormalities of speech are also observed in various mental disorders, as far as quantitative abnormalities are concerned. However, disturbance of intonation, namely disprosody, is more commonly observed in organic disorders of the brain. When the accent of words and the intonation of sentences changes from that of a native speaker, the speech sounds like the broken language of untrained foreigners. Such foreign accent syndrome is usually an issue of neuropsychology. In this paper, the authors report a case of foreign accent syndrome without organic brain syndrome. The patient was a 44-year-old woman, who developed panic disorder about year after her father's death. Then she developed aphonia. After aphonia was resolved, she began to speak haltingly as if a Chinese woman was trying to speak Japanese. Organic brain diseases were subsequently excluded. She had complicated familial conflicts, including a divorce from a violent and faithless husband, interpersonal difficulties with her husband's parents, and her pubertal daughter. We diagnosed her with dissociative (conversion) disorder of ICD-10. Our patient is clinically interesting, because case reports of dysprosody are unusual and often involve organic brain diseases. We suppose that foreign accent syndrome in our patient is a variant of aphonia, and the patient unconsciously assigned the symptom two ambivalent rolls: to snow that she cannot speak well, and to express her meaning. In addition, she had a Chinese-speaking aunt-in-law who was her ideal role model. We surmise that her symptom signifies identification with her aunt-in-law.     

Glucose-supported oxidative metabolism and evoked potentials are sensitive to fluoroacetate, an inhibitor of glial tricar☐ylic acid cycle in the olfactory cortex slice

Optical absorbance change was measured by reflectance spectrophotometry in the olfactory cortex slice prepared from the rat brain. Optical absorbance of the piriform area of the slice was increased by perifusion with an anoxic (N₂-gassed) solution. Components of the absorbance spectrum recorded from the slice in anoxia corresponded to that of cytochromes (cyt)aa₃ and c + c₁, but did not to that of cyt c. Reduction of cytochromes in anoxia coincided with decrease in the amplitude of the presynaptic potential and a slower negative wave (N-wave). The reduced state of cytochromes switched to an oxidized state when a well-oxygenated solution was reintroduced. An almost complete recovery of redox state coincided with full recovery of the evoked potential. A metabolic inhibitor, 2-deoxy-d-glucose (2DG) (10 mM) or iodoacetic acid (IAA) (3 mM) caused little or slight oxidation of cytochromes, but significantly decreased the amplitude of evoked potentials. Marked oxidation of cytochromes was observed only by perifusion with a solution containing 2 DG (10 mM) and IAA (3 mM). The rate of oxygen uptake was significantly lowered by these metabolic inhibitors. When the slice was perifused with a solution containing fluoroacetate (1 or 10 mM), a selective inhibitor of glial metabolism, cytochromes shifted to oxidized levels. The amplitude of evoked potentials tended to decline by a low dose (1 mM), and significantly decreased by a high dose (10 mM) of fluoroacetate. Oxygen consumption of the slice was dose-relatedly lowered by fluoroacetate.These results indicate (1) that the mitochondrial redox state becomes reduced in anoxia and the evoked potential is concomitantly suppressed, (2) that metabolic and neuronal activities are primarily supported by glucose supply, and (3) that reducing equivalents into the respiratory chain are derived from metabolic activities, which are linked to glucose metabolism, in glia as well as in neurons of the olfactory cortex slice.