Comparison between famciclovir and valacyclovir for acute pain in adult Japanese immunocompetent patients with herpes zoster

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster‐associated pain including post‐herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2–3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3–4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.     

Association of Sjögren's syndrome and rosacea: a diagnostic challenge

Both Sjögren's syndrome and rosacea present clinical manifestations that include ocular involvement. We report a case of a 45‐year‐old woman with a history of persistent erythematous malar rash, associated with conjunctival hyperemia, xerophthalmia and blefaritis. The patient filled the current classification criteria proposed for Sjögren's syndrome and those for rosacea. The coexistence of these diseases has not been previously described in the literature. Both diseases have similar symptoms and different treatment approaches. We believe that it is important for clinicians to identify this association in order to provide better care for the patient.     

阿尔茨海默病和额颞叶痴呆徘徊行为的比较

目的 比较阿尔茨海默病和额颞叶痴呆徘徊者步行活动水平及活动节律的差异.方法 利用电子示踪监测系统对阿尔茨海默病(Alzheimer disease,AD)徘徊者27例及额颞叶痴呆(frontotemporal dementia,FTD)徘徊者7例进行连续30 d的24 h活动监测,比较两组日、夜活动水平(步行距离),以及活动节律的日间稳定性和日内变异性.结果 AD组和FTD组的年龄分别为 (73.89 ± 9.12)岁和(63.43 ± 14.93)岁,而发病年龄分别为 (70.16 ± 9.26)岁、(58.17 ± 15.16)岁.AD组的年龄较大而发病年龄较晚(P ＜ 0.05).AD组和FTD组在6:00 ～ 23:59的步行距离分别为(2119.39 ± 2535.59)m、(4842.44 ± 2617.94)m,后者较长(P ＜ 0.05),但两组在0:00 ～ 5:59的活动水平差异无统计学意义(P ＞ 0.05).FTD组活动节律更加稳定[(0.50 ± 0.11) vs (0.29 ± 0.15),P ＜ 0.01],日内活动变异片段数更少[(2.80 ± 0.74) vs (4.07 ± 0.95),P ＜ 0.01].结论 AD 和FTD 两类痴呆的徘徊行为特点不同,提示有必要建立痴呆亚型特异性徘徊行为的非药物干预策略.     

Morphological comparison and functional reconstitution of rat hepatic parenchymal cells on various matrices

Four types of materials, type I collagen coat (Coat), acid-soluble type I collagen gel (Hardgel), pepsin-treated acid-soluble type I collagen gel (Softgel), and an extract of extracellular matrix of the murine Engelbreth-Holm-Swarm sarcoma (Matrigel), were used as matrices to culture rat hepatic parenchymal cells, and their morphological changes and adhesion were compared to the matrices by electron microscopic observations. Hepatic parenchymal cells cultured on Coat and Hardgel were extended and flattened, whereas cells cultured on Softgel and Matrigel assembled and formed aggregates. Such aggregates consisted of several hepatic parenchymal cells, with a recognizable bile duct-like alveolus on the inside. Morphologically, the aggregates were more spherical on Matrigel and oval shaped on Softgel. Microvilli of the cell surface were parallel to the matrix on Matrigel, but invaded into the gel on Softgel. Subsequently, investigation into how these morphological features affected the liver-specific functions, including secretion of albumin and induction of P450 by 3-methylcholanthrene, demonstrated that a high level of liver function was maintained in a long-term culture in hepatic parenchymal cells on Softgel. These results suggest that hepatic parenchymal cell interactions were stronger with Softgel than with Matrigel, and that Softgel appears to closely mimic the in vivo environment.     

Laparoscopic treatment of colonic stenosis due to perforation in crohn’s disease

A 23‐year‐old woman was admitted to the Teikyo University Hospital with symptoms of watery diarrhea and left lower abdominal pain. A painful mass was palpated in the left lower abdomen. Abdominal computed tomography demonstrated an inflammatory mass associated with gas accumulation. Abscess formation and perforation of the intestine was strongly suspected. Considering her general condition, antibiotic therapy was adopted first. The size of the mass decreased markedly with antibiotic administration. Upper gastrointestinal series showed no abnormalities in the small intestine. Barium enema showed complete obstruction of the descending colon. Colonoscopy revealed the granular change of the mucosa and stenosis at the descending colon. Non‐caseous granuloma was histopathologically noted. The condition of the patient was diagnosed as colonic stenosis due to the perforation at the descending colon as a complication of Crohn’s disease and laparoscopic resection of the colon was performed. Although marked adhesion was noted around the lesion, surgery was successfully completed. Crohn’s disease is a chronic, potentially panintestinal, incurable affliction. Colonic perforation in Crohn’s disease is a relatively rare complication. Surgical management should be as minimal as possible. Laparoscopic surgery for this particular patient was considered to be an adequate choice of treatment.     

‘Lung age’ predicts post‐operative complications and survival in lung cancer patients

Background and objective: The Japanese Respiratory Society recently proposed ‘lung age’ as an easily understood concept of respiratory function. In this study, we evaluated whether ‘lung age’ could be a useful predictor of post‐operative respiratory complications and survival patients with lung cancer treated surgically. Methods: The study recruited 308 patients who underwent surgery for primary non‐small‐cell lung cancer. All patients had preoperative pulmonary function testing. ‘Lung age’ was determined using the methods advocated by the Japanese Respiratory Society. Based on the difference between ‘real age’ (R) and ‘lung age’ (L), patients were classified into five groups: group A: R?L > 15 (n = 37), B: 5 < R?L ≤ 15 (n = 50), C: ?5 ≤ R?L ≤ 5 (n = 73), D: ?15 ≤ R?L < ?5 (n = 54), E: ?15 > R?L (n = 94). Clinicopathological factors, post‐operative respiratory complications and survival were compared between the groups. Results: Gender, smoking status and index, histology, operative approach and FEV₁ were significantly associated with the group classification. The incidence of complications was significantly higher in group E compared with other groups (P = 0.003). Multivariate analysis showed that the group classification by ‘lung age’ was an independent predictor of post‐operative respiratory complications (P = 0.02). Overall survival differed significantly between the groups (P = 0.03). Conclusions: ‘Lung age’ could be useful for the prediction of post‐operative respiratory complications and survival in patients with lung cancer treated surgically.     

Potentiation of carbon tetrachloride-induced liver damage by dibutylyl-3',5'-cyclic AMP in unstarved rats

It has been reported that carbon tetrachloride-induced liver damage is potentiated by starvation partly due to fat accumulation in the liver and a decrease in hepatic reduced glutathione concentration and that dibutylyl-3′,5′-cyclic AMP (DBcAMP) affects fuel metabolism and decreases hepatic reduced glutathione. We investigated the effects of DBcAMP on carbon tetrachloride-induced liver damage both in unstarved and starved rats. In unstarved rats, intraperitoneal administration of DBcAMP potentiated an increase in serum alanine aminotransferase activity and fatty vacuolization in the liver, both of which were induced by carbon tetrachloride. Hepatic reduced glutathione concentration was also reduced by DBcAMP, although the change was not significant. In contrast, the administration of DBcAMP in starved rats did not affect carbon tetrachloride-induced changes in serum alanine aminotransferase activity, histological alterations and hepatic reduced glutathione concentration. Administration of DBcAMP to control rats induced different responses in unstarved control rats compared with starved control rats: in unstarved rats, blood glucose concentration decreased but serum free fatty acid concentration increased, whereas in starved rats, blood glucose concentration increased and serum free fatty acid concentration decreased. It was suggested that DBcAMP potentiated carbon tetrachloride-induced liver damage in unstarved rats, probably due to hepatic fat accumulation and a decreased hepatic reduced glutathione concentration. The former could increase the affinity of the liver for carbon tetrachloride and the latter could accelerate carbon tetrachloride-induced lipid peroxidation. It was also suggested that DBcAMP failed to affect carbon tetrachloride-induced liver damage in starved rats, probably because starvation had already decreased hepatic glutathione concentration and DBcAMP had different effects on fuel metabolism compared with effects observed in unstarved rats.