Spinal antinociceptive effects of adenosine compounds in mice

The effects of injecting ATP, ADP, AMP, adenosine and adenine intrathecally on the pain response induced by the injection of substance P (10 ng/mouse) intrathecally were studied. All the compounds except adenine inhibited the pain response in a dose-related manner. The ED50 values of ATP, ADP, AMP and adenosine were 2.10, 0.93, 0.88 and 0.48 micrograms/mouse, respectively. Pretreatment with theophylline at a dose of 100 mg/kg p.o. markedly diminished all the antinociceptive effects. The effect of adenosine was not affected by s.c. injection of naloxone. These results suggest the existence of adenosine receptors which modulate spinal nociceptive sensory processing, independently of the endogenous opiate system.     

School-refusal and social-withdrawal in the clinical setting at a psychiatric medical institution]

Fifty two outpatients, who showed signs of school-refusal-withdrawal at the Shiga Prefectural Psychiatric Institution have been analyzed according to their age, gender, ICD-10 diagnosis, medical evolution, and total number of consultations. A total of 61.5% of the population were male, and they showed a higher average and a wider range of age than female patients. According to the ICD-10 diagnosis, 67.3% were in the group of F40-48 neurotic, stress-related and somatoform disorders, and 11.5% were in the group of F30-39 mood [affective] disorders. Twenty five % of the patients were assumed to have show medical improvement, and 42.3% of the patients continued to have further consultations. This article discusses the possible role of psychiatric medical institutions in supporting cases of school-refusal and social-withdrawal.     

Scintigraphic detection of recurrence of medullary thyroid cancer

A case of recurrent medullary thyroid cancer (MTC) was evaluated with¹²³I-MIBG,^99mTc(V)-dimercaptosuccinic acid (DMSA), and²⁰¹Tl scintigraphy. This patient had been operated on for MTC in the right thyroid. Recently a left neck mass was noticed, and was suspected of being a. recurrence of MTC based on increased plasma calcitonin (CT) and carcinoembryonic antigen (CEA). He was operated on for the neck mass which revealed MTC, and papillary thyroid cancer was incidentally found in the left thyroid, but the CT and CEA levels remained high, and remaining MTC tumor was suspected. But the location of the tumor was unknown. Although^99mTc(V)-DMSA scintigraphy is generally believed to be superior in sensitivity to¹²³I-MIBG scintigraphy, it did not demonstrate the tumor site but²⁰¹Tl and¹²³I-MIBG did. Furthermore,¹²³I-MEBG scintigraphy has greater specificity for tumors which arise in the neural crest. Judging from the results of this case and cases reported in the literatures, both¹²³I-MIBG and^99mTc(V)-DMSA should be performed in the detection of recurrent MTC.     

Relation between toxicity and carcinogenesis in the kidney: an heuristic hypothesis

Cellular toxicity and cellular carcinogenesis are closely linked. In the kidney, this relationship has been emphasized by the recent discovery of a number of putatively non-mutagenic chemicals that result in acute and chronic toxicity and ultimately in carcinogenesis, especially in the male rat. Many, but not all such compounds, result in renal PTE phagolysosomal overload. At the same time, known metabolites of other carcinogens, e.g., HCBD and FBPA, result in acute renal injury and/or necrosis, followed by chronic tubular disease, interstitial nephritis, and ultimately carcinogenesis. A series of cell mechanisms have been suggested that lead from acute cell injury to altered control of cell division. These mechanisms appear to involve ion deregulation, (especially [Ca2+]i) resulting from a variety of continued injuries, (e.g., oxidative stress from inflammatory cells) and ultimately leading to altered gene expression.     

Performance standards for toric soft contact lenses.

PURPOSE: To simplify the clinical assessment of toric soft contact lens (TSCL) on-eye behavior by establishing a set of standard clinical evaluation techniques. The likely performance range expected among the TSCL wearing population was determined for a series of lens designs and acceptable performance standards indicated for each variable. METHODS: Four prism-ballast, two peri-ballast and one dynamic stabilization TSCL designs were each worn by groups of 20 subjects in a nondispensing study. After 20 min of lens wear, lenses were assessed, in right eyes only, for subjective comfort (100-point scale), lens mislocation (degrees deviation from vertical) and rotational recovery after deliberate 30 degrees mislocation (degrees/10 blinks). The percentage of lenses orienting within +/-10 degrees of target orientation (zero rotation) and the variability of orientation (standard deviation of mislocation) were also calculated for each lens group. RESULTS: Based on partitioning of the data distributions for each variable, performance was designated as excellent, acceptable or poor. Corresponding performance cut-offs were determined at > or =90, 89 to 80, and <80 for subjective comfort, < or =+/-6 degrees , +/-7 degrees to 10 degrees , and >+/-10 degrees for mislocation, >10 degrees /10 blinks, 10 degrees to 6 degrees /10 blinks, and <6 degrees /10 blinks for rotational recovery. For groups of wearers the appropriate cut-offs were > or =90%, 89 to 70%, and <70% of lenses orienting within +/-10 degrees of target orientation and <+/-6 degrees , +/-6 degrees to 10 degrees , and >+/-10 degrees for variability of orientation. CONCLUSION: Techniques suitable for the evaluation of TSCL clinical performance have been described and guidelines for the assessment of such lenses established. In the process, we have identified potential performance differences that may relate to variations in TSCL design.     

Kanji-predominant alexia with agraphia in opticospinal multiple sclerosis]

Alexia with agraphia is very rare symptom in multiple sclerosis. We present a patient of opticospinal multiple sclerosis with kanji-predominant alexia with agraphia. A 55-year-old, right-handed man was admitted to our hospital because of difficulty in reading and writing in August 2001. The patient had been diagnosed as having relapsing-remitting opticospinal multiple sclerosis eight years prior to admission. Language examination showed alexia with agraphia predominantly affecting kanji and also mild naming difficulties, but a good comprehension and a normal repetition. T2-weighted MRI demonstrated hyperintensity area in the left temporo-parietal lobe, involving the white matter beneath the postero-inferior temporal lobe and inferior parietal lobule. On brain SPECT, low blood perfusion was observed in the left temporo-parietal regions. Although agraphia for kana and alexia for both kana and kanji improved after steroid therapy, agraphia for kanji did not improve. After the treatment, high intensity area of inferior parietal lobule was disappeared on MRI, and the hypoperfusion of inferior parietal lobule on brain SPECT was also improved, but the lesion of left postero-inferior temporal lobe did not show any remarkable changes. We considered that the kanji-predominant alexia with agraphia was due to the lesions of left inferior parietal lobule and postero-inferior temporal lobe, and agraphia for kanji was due to the lesion of left postero-inferior temporal lobe.     

What should general hospital psychiatry do in a community?]

Some experiences in Nagano Red Cross hospital and Nagano Prefecture are presented, and the role of general hospital psychiatry (GHP) in a community is discussed. Psychiatric services in Nagano prefecture with population 2.21 million consist of four blocks. Our unit is in north block, providing treatment for acute phase and, in 2000, 1504 cases were new outpatients, daily outpatients were 198 cases and new inpatients were 604 cases including 146 emergency inpatients. In fiscal 2001, 25.6% of notifications of involuntary hospitalization from all psychiatric hospitals were submitted from GHP occupying 12.9% psychiatric beds, and 129 notifications from our unit were largest in Nagano prefecture. Total 7 GHPs with beds are presented by some data, suggesting two types as GHP. One type has relatively many new inpatients by small beds with short-term hospitalization like our GHP, and another type has relatively small new inpatients by large beds with long-term hospitalization like conventional mental hospital. It is necessary for GHP to pursue the former type, and to functionally differentiate from psychiatric hospital. Results of psychiatric emergency system in Nagano prefecture are presented. Designated hospitals are our GHP with 60 beds in north block, Prefectural Hospital with 310 beds in south block, National Sanatorium with 280 beds in east block and rotating 5 psychiatric hospitals with total 968 beds in west block. GHP with 60 beds hospitalized more emergency new cases than other psychiatric hospitals with large beds and discharged 84% of emergency inpatients to their home. Recently, short-term hospitalization of general hospital beds has rapidly progressed, and shared goal settings are needed, and treatment plans with teamwork by various types of experts have started from community-based home care. This teamwork will be expected throughout community psychiatric services. Although until today GHP's ward unit is financially disadvantageous, patients anticipate medical care of GHP on same level as a part of general hospital of course. For community psychiatric care and short-term hospitalization it is necessary for GHP to cooperate with various types of social resources. As for users of rehabilitation facilities in Nagano prefecture, GHP outpatients occupy 27.2%, and as for day care users, these occupy 19.6%, thus GHPs are able to cooperate with facilities. Above-mentioned facts indicate there is high necessity as a GHP, not a psychiatric hospital or a clinic. Cooperation between GHP and other social resources including welfare services will enrich community psychiatric services. GHP is a wide entrance for psychiatric care from a viewpoints of whole psychiatric care. When GHP accepted all patients on demands from acute cases to chronic, manpower will be diffused, and safety of medical care will be undermined. Therefore, psychiatric triage mainly functioning to treat early stage in severe cases with combined medical and psychiatric illness above all is necessary for GHP in order to offer proper treatment to a community. Accessibility in early stage of disease, priority of seriously ill patients and rehabilitation programs at a community as daily life space are essential for community mental health. We believe the first role of GHP in a community is to seek for psychiatric treatment on same level as general medicine. The second role is the psychiatric triage in order to function as GHP in a community. The third role is to cooperate with other social resources in a community. In order to promote the above it is necessary to self-evaluate GHP concerning the difference with specialized psychiatric hospitals or clinics. From these viewpoints GHP will become a core of community psychiatry. Currently, however, preparation concerned with GHP is poor compared with other advanced countries, so an aggressive improvement in medical policy is expected.