Response of Japanese patients to the change of department name for the psychiatric outpatient clinic in a university hospital

There has long been controversy over the stigma associated with mental illness and psychiatric facilities. In Japan, the department name "Department of Psychiatry" (in Japanese, Seishin-ka) itself evokes the lay public's and psychiatric patients' feelings of stigma. This phenomenon may hamper psychiatric treatment of adequate duration and quality. On July 1st, 1999, the Juntendo University Hospital changed the department name from "Department of Psychiatry and Neurology" (in Japanese, Seishin-Shinkei-ka) to Mental Clinic, accompanied by an increased number of new outpatients, as reported previously. In the present study, we turn our attention to the opinions of those patients who have received treatment in the department under both names. Questionnaires asking for their opinions about the department names revealed that the majority have feelings of stigma associated with the name "Department of Psychiatry and Neurology." This result did not correlate with demographic factors or the length of psychiatric treatment. However, those who experienced psychiatric admission were significantly less uncomfortable with the name than those who did not. It was also revealed that the change in the name lessened their feelings of stigma and negative self-image as patients of a general hospital. These results suggest the importance of the name of the psychiatric department in general hospitals, in Japan, from therapeutic, psychosocial and ethical viewpoints.     

Long-term results of neoadjuvant hormonal therapy prior to radical prostatectomy in patients with clinically localized prostate cancer: biochemical and pathological effects

The objective of this study was to evaluate the long-term biochemical and pathological effects induced by neoadjuvant hormonal therapy (NHT) in patients with clinically localized disease. Between March 1993 and May 1997, 24 patients with clinically localized prostate cancer received NHT for 3 to 11 months (median: 5 months) using luteinizing hormone-releasing hormone analogue prior to radical prostatectomy and pelvic lymphadenectomy. The clinical stage was T1 in 1 patient, T2 in 17 and T3 in 6, the pretreatment serum prostate-specific antigen (PSA) value was < or = 10 ng/ml in 5 patients, 10 to 20 ng/ml in 4 and > 20 ng/ml in 15 (mean: 34.7 micrograms/l), and the Gleason score was < or = 4 in 9 patients, 5 to 7 in 11 and > 8 in 3. The mean prostate specific antigen (PSA) value 3 months after NHT had reduced below 2 ng/ml in 18 of the 24 patients (67%), and finally decreased by an average of 95% (i.e., 1.9 ng/ml) prior to surgery. The pathological stage was pT0 in 2 patients, pT2 in 10 and pT3 in 12. The incidence of organ-confined disease (OCD) was significantly higher in patients with clinical stage T1 or T2a than with T2b or T3, with pretreatment PSA values < or = 10 ng/ml than with PSA values > 10 ng/ml, and with PSA values < or = 2 than with PSA values > 2 at 3 months after NHT; in contrast, the Gleason score had no significant impact on the rate of OCD. After a median follow-up of 49 months (range 34 to 85 months), 6 patients (25%) had a recurrence evidenced by rising PSA, and the 3-year recurrence-free survival rate was 79%. These results suggest that NHT appears not to be of significant additional benefit to patients who have a higher clinical T stage, higher pretreatment PSA values and/or in patients whose PSA values do not normalize early in the treatment process.     

A case of intracystic carcinoma of the breast: the importance of measuring carcinoembryonic antigen in aspirated cystic fluid

Summary We report a case of intracystic carcinoma of the breast in which a correct preoperative diagnosis was achieved on the basis of an increased level of carcinoembryonic antigen (CEA) in the aspirated cystic fluid.A 62-year-old woman was admitted with a 10 × 10 cm painful mass occupying the right breast. Ultrasonography revealed a cystic lesion with papillary projections arising from the cyst wall. Cytological examinations showed no malignant cells in the hemorrhagic aspirated fluid. However, the CEA level in the fluid was 5.5 times higher than the serum CEA level using a murine anti-CEA monoclonal antibody. The high level of CEA led to the preoperative diagnosis of intracystic carcinoma. Histological examinations confirmed the diagnosis of intracystic carcinoma after a modified radical mastectomy. Immunohistochemical staining by an anti-CEA monoclonal antibody elicited a strong positivity with diffuse intracytoplasmic distribution in the carcinoma cells, although heterogeneity of staining was observed.It is suggested that the measurement of the CEA value by anti-CEA monoclonal antibody in the aspirated fluid is easy, safe, and helpful for the definitive diagnosis of intracystic carcinoma of the breast.     

Recurrent Annular Erythema in a Case of Seronegative Sjögren's Syndrome

We describe a case of Sjögren's syndrome who repeatedly developed annular erythema on her extremities. Her anti-nuclear antibody, anti-SSA/Ro antibody, and anti-SSB/La antibody were all negative. Characteristics of the annular erythema included a tendency to appear on the extremities especially in summer, spontaneous regression after 1–2 weeks, and residual slight pigmentation. The histological findings revealed dermal perivascular lymphocytic infiltration admixed with some neutrophils. Slight exsudative changes were found in the upper dermis. There were no epidermal changes. This case suggests the existence of annular erythema which may not be related to the anti-SSA/Ro or anti-SSB/La antibody. Unknown factors other than those antibodies may be involved in the pathogenesis of the annular erythema.     

Apolipoprotein E polymorphism and hyperlipoproteinemia in obesity

The purpose of this study is to elucidate the relationship between apolipoprotein (apo) E polymorphism and plasma lipid profiles and the frequency of hyperlipoproteinemia (HLP) in obesity. Eighty-seven obese subjects with 131 percent of ideal body weight (mean) were studied. One hundred and thirty-two nonobese subjects with 105 percent of ideal body weight were also selected as the controls. There was no significant difference in apo E allele and phenotype frequencies between the obese and nonobese subjects. The frequency of HLP was 100 percent in obese subjects with apo E2 and/or apo E4, whereas it was 47.3 percent in obese subjects with the common apo E3/3 phenotype. In obesity apo E2 was associated with increased plasma triglyceride (TG) and apo E, and decreased plasma high density lipoprotein (HDL) cholesterol (type III and IV HLP), whereas apo E4 was associated with increased plasma TG, total cholesterol, and apo E (type IIa, IIb, IV and V HLP). These results indicate that obese subjects with apo E2 and/or E4 were more susceptible to HLP than obese subjects with the common apo E3/3 phenotype. It is concluded that apo E2 and/or E4 are closely related to HLP in obesity and thus may be one factor linking obesity with cardiovascular disease.