Clinical experience of quetiapine in 24 elderly patients with delirium

Background: A recent study reported that patients with delirium responded well to the administration of atypical antipsychotic agents. In the present study we administered quetiapine to patients with delirium and obtained good results. Methods: This study included 24 patients (10 men, 14 women), referred to the psychiatry department during admission to other hospital departments, who were diagnosed as having delirium according to the diagnostic and statistical manual of mental disorders (4th edition) (DSM‐IV) between April 2001 and September 2002. The mean age of the patients was 76.5 years (men 71.0 years; women 80.5 years). An initial dose of quetiapine was established at 25–50 mg/day. Depending on the symptoms, the dose and frequency were increased as required. According to Trzepacz's delirium rating scale (DRS), the treatment response was evaluated prior to the administration of quetiapine and 1, 3, 5 and 7 days after administration began. Results: Prior to the administration of quetiapine, the mean DRS score was 18.1. The mean scores were 12.2, 10.8, 9.7 and 8.9 after 1, 3, 5 and 7 days of quetiapine administration, respectively. These values were significantly lower than the value before administration (P < 0.001). Seven days after the administration of quetiapine commenced, the total DRS score was lower than the cutoff point (12) in 20 patients (83.3%). In 18 patients (75.0%), delirium was clinically relieved. Doses ranged from 25 mg/day to 125 mg/day, with a mean dose of 54.7 mg/day. With respect to the administration method, the majority of patients (i.e. 13 patients) received quetiapine once per day (after dinner). Somnolence was observed in three patients as a side‐effect of quetiapine administration. However, this side‐effect improved after 1–2 days, without decreasing the dose. Conclusions: Quetiapine may be useful for controlling delirium and concerning side‐effects and extrapyramidal symptoms were not recorded in the present study. Thus, it is appropriate to trial quetiapine in the treatment of delirium.     

Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling

Vasospasm, initial neurological damage, rebleeding, and periprocedural complications are associated prognostic factors for clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH). In this study, factors related to delayed ischemic neurological deficit (DIND) are evaluated using data from our institute for the last 18 years. Data from 2001 to 2018 of patients with aneurysmal SAH who underwent surgical clipping (SC) or endovascular coiling (EC) within 7 days of onset were retrospectively analyzed. Cases of mortality within 5 days after treatment were excluded. Multivariate analysis was used to identify the risk factors for DIND. In total, 840 cases of SAH were assessed; among these cases, 384 (45.7%) and 456 (54.3%) were treated with SC and EC, respectively. The frequency of DIND in the EC group was significantly less than that in the SC group (11.8% vs. 17.7%; p = 0.016). In the results of multivariate analysis, internal carotid artery (ICA) aneurysm and hemorrhagic complications were the risk factors for DIND. Cilostazol administration and EC were significant factors for vasospasm prevention after aneurysmal SAH (odds ratio of ICA aneurysm: 1.59, hemorrhagic complications: 1.76, SC: 1.51, and cilostazol administration: 0.51, respectively). Cilostazol administration was also a significant factor in patients who were treated with EC. ICA aneurysm, treatment strategy, hemorrhagic complications, and cilostazol administration were associated with DIND. Oral administration of cilostazol and avoiding hemorrhagic complications were effective in DIND prevention. If both treatments are available for ruptured aneurysms, clinicians should choose EC on the basis of its ability to prevent DIND.     

Testicular Toxicity of Gallium Arsenide, Indium Arsenide, and Arsenic Oxide in Rats by Repetitive Intratracheal Instillation

The testicular toxicities of two compound semiconductor materials,gallium arsenide (GaAs) and indium arsenide (InAs), and arsenicoxide (As₂O₃) were examined in rats by repetitive intratrachealinstillation of these substances in suspension twice a week,a total of 16 times. A single instillation dose was 7.7 mg/kgin the GaAs and the InAs groups and 1.3 mg/kg in the As₂O₃ group.A significant decrease in sperm count and significant increasein the proportion of morphologically abnormal sperm were foundin the epididymis in the GaAs group. Especially, abnormal spermwith a straight head increased markedly in this group. In theGaAs–treated rats, there was 40-fold increase in the degeneratinglate elongated spermatids at the postspermiation stages, stagesIX, XI, and XI. From these results, it is indicated that GaAsdisturbed the spermatid head transformation at the late spermiogenicphases and caused spermiation failure. InAs caused a sperm countdecrease in the epididymis, though its testicular toxicity wasrelatively weak compared with that of GaAs. As₂O₃, a probabledissolution arsenic product of GaAs and InAs in vivo, did notshow any testicular toxicities in this study. It seems likelythat, along with arsenics, gallium and indium play a role inthe testicular toxicities of GaAs and InAs.     

Use of the Ultrasonic Microprobe to Evaluate Gastric Varices –Comparison with Endoscopic Color Doppler Ultrasonography–

Abstract: This study was designed to evaluate the usefulness of the ultrasonic microprobe (UMP), as compared with endoscopic color Doppler ultrasonography (ECDUS), in detecting gastric varices in 18 patients. The gastric varices detected were categorized as follows: 14 F₂ type varices, four F₃ type. Among the 18 cases, four had cardiac varices, nine cardiofornical varices, and five fundic varices. UMP was easily performed visually by using an endoscope with a UM-3R (20MHz) probe, inserted via the biopsy channel, and a display unit (Olympus EU-M20). ECDUS was performed using a PENTAX FG-32UA and a FG-36UX, 7.5MHz, convex type. The display monitor was a HITACHI EUB 565. We were able to clearly delineate the vessel images of gastric varices in all 18 patients using UMP. Although the overall features of the peri-gastric collateral veins could not be discerned with UMP, the color flow images of gastric varices and peri-gastric collateral veins were clearly visualized in all 18 patients using ECDUS. It was thus possible to determine blood flow direction using ECDUS. We found the use of UMP to be advantageous in terms of the ease of operation and the excellent view provided of gastric varices. The fact that, due to limited penetration, UMP inadequately delineates the peri-gastric collateral veins was determined to be a major drawback. Therefore, we recommend ECDUS for evaluating overall hemodynamics. It was, however, technically difficult to scan the fundal region because of the characteristics of the ECDUS instrument. Thus, we conclude that detailed evaluation of gastric varix hemodynamics is most successfully accomplished by using UMP in conjunction with ECDUS.     

SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE-CONTROL EPIDEMIOLOGIC STUDY IN JAPAN

Background. Systemic lupus erythematosus (SLE) is designated by the Japanese government as one of the intractable diseases and all patients, who suffer from these diseases, are registered to get financial aid for treatment. Using newly registered SLE patients, a case-control study was conducted to evaluate potential risk factors. Methods. Two-hundred and eighty-two women SLE patients, newly registered to receive financial aid for treatment, and 292 randomly selected health examination participants at public health centers (controls) were surveyed from April 1988 through March 1990. By means of a self-administered questionnaire, data concerning demographic variables, smoking and drinking habits, past medical and reproductive history, and family history were collected. Results. Based on unconditional logistic regression analysis, the risk of SLE was significantly increased for current smokers (age-adjusted odds ratio (OR) = 2.31, 95% confidence interval (CI) (1.34–3.97). Alcohol and milk intake were inversely associated with risk. Family histories of asthma and collagen diseases, including SLE, were associated with significantly elevated risk of SLE (OR = 2.07, 95% ci 1.14–3.77; OR = 5.20, 95% CI 1.08–24.95, respectively). Regarding reproductive function, women with menarche at age 15 or later had significantly higher risk than those, who started menstruating before age 12 (OR = 3.82, 95% CI 1.66–8.81 for menarche at > 15 years and OR = 2.90, 95% a 1.14–7.39 for menarche at 16y). Conclusions. Our study suggests several risk factors, including smoking, family history, and reproductive history that may increase the risk of SLE.     

A case control study of female systemic lupus erythematosus in Japan

In a multi-institutional case-control study, we investigatedrisk factors for systemic lupus erythematosus (SLE) in 151 Japanesewomen treated for SLE during the period September 1988 to August1990. We used two control groups: sisters of SLE patients andsisters of female patients with another disease. Informationwas obtained by a self-administered questionnaire. Our findingssuggest that having a history of operations and blood transfusionsand working in a cold environment may be risk factors for SLE.Viral infections, psychological stress, and pet ownership werenot risk factors for SLE in our study. In addition, smokingwas not protective for SLE. Skin sensitivity to sunlight andcold feet, which may be symptoms of SLE that occurred beforethe diagnosis, were also positively associated with SLE.     

Macrophage-colony stimulating factor (M-CSF) enhances proteinuria and recruitment of macrophages into the glomerulus in experimental murine nephritis

In this study, we examined the effects of macrophage-colony stimulating factor (M-CSF) on glomerular macrophages in lipopolysaccharide (LPS)-induced murine nephritis. Mice injected intraperitoneally with either M-CSF plus LPS, LPS alone, M-CSF alone or saline every day for 8 days were examined for the degree of urine albumin excretion and lymphocyte-function associated antigen-1-positive (LFA-1⁺) cells in peripheral blood as well as renal pathology. From our results, LPS or M-CSF combined with LPS emphasized the degree of proteinuria, glomerular deposition of immunoglobulins and mesangial proliferation, associated with accumulation of macrophages in the glomeruli. However, in immunohistological examination of kidneys from these nephritic mice, neither intercellular adhesion molecule-1 (ICAM-1), which may play an important role in the recruitment of macrophages into glomeruli, M-CSF receptor nor the number of LFA-1⁺ cells in peripheral blood was enhanced by M-CSF. On the other hand, M-CSF alone induced neither proteinuria nor any pathological changes and did not increase the number of glomerular Mac-1⁺ cells above that in saline-treated controls. These results indicate that M-CSF does not directly cause glomerulonephritis but might participate in accelerating the glomerular inflammatory process by stimulating a potent chemoattractant to recruit monocytes-macrophages into the glomeruli.