Relationship between the administration of nicardipine hydrochloride and the development of delirium in patients on mechanical ventilation.

A history of hypertension is a known risk factor for delirium in patients in intensive care units, but the effect of antihypertensive agents on delirium development is unclear. Nicardipine, a calcium channel blocker, is widely used in ICU as a treatment agent for hypertensive emergency. This study investigated the relationship between the administration of nicardipine hydrochloride and delirium development in patients under mechanical ventilation. We conducted a medical chart review of 103 patients, who were divided into two groups according to the use of nicardipine hydrochloride. The prevalence of delirium was compared with respect to factors such as age, sex, laboratory data, and medical history, by multivariate analysis. 21 patients (20.4 %) were treated with nicardipine hydrochloride in 103 patients. The treatment and non-treatment groups differed significantly in age (72 vs. 65 years) and history of high blood pressure (57% vs. 11%). Multivariate analysis revealed that patients in the treatment group developed delirium significantly less often than those in the non-treatment group (19% vs. 48%). These results suggested that treatment of high blood pressure with nicardipine hydrochloride is a possible method for preventing the development of delirium.

Anxiety induced by repetitive transcranial magnetic stimulation is suppressed by chronic treatment of paroxetine in rats.

Repetitive transcranial magnetic stimulation (rTMS) has been shown to have a therapeutic effect on affective disorder and anxiety disorders. However, some reports have linked rTMS to a significant increase in anxiety in normal volunteers. This study investigates the effect of rTMS on anxiety and the use of acute and chronic paroxetine treatment on this animal model of anxiety. In normal rats, rTMS for 10 days induced anxiety, as shown by elevated plus maze, black and white box, and conditioned fear tests. This anxiety was suppressed by chronic, but not acute, paroxetine. These results suggest that rats receiving chronic rTMS treatment can be used as a model of anxiety and that the anxiety induced by rTMS might involve the serotonergic system.

[Role of life events on onset of major depression].

Many kinds of stressful life events have been regarded as important factors in the causation and management of depression, based on empirical and descriptive studies. The instrument for assessment of life events has been established. There is consistent evidence for dose-response relationship between stressful events and depression. The effect of life events close to onset is more important, but sometimes the expected response appears after a delay. The effect of life events varies by early adverse experience, cognition and genetics. The association between life events exposure and risk of major depression progressively declines, it is consistent with the kindling hypothesis.

Numb chin syndrome as an initial symptom of acute lymphocytic leukemia: report of three cases.

This article describes three cases of acute lymphocytic leukemia that presented with mental neuropathy, or so-called "numb chin syndrome," as the initial symptom of the disease. This symptom heralded the initial progression of the disease in the first and second cases and the recurrence of the disease in the third case. In these cases tenderness in the mental foramen, percussion pain of the teeth, loosening and extrusion of the teeth, and radiographic abnormalities were also, if not always, observed in association with mental neuropathy. The radiographic abnormalities included a disappearance of the mandibular canals, an enlarged periodontal ligament space, a loss or thinning of the lamina dura, and a destruction of the alveolar crestal bone. This report indicates that oral manifestations can therefore occasionally play an extremely important role in the early recognition of acute lymphocytic leukemia. The unexplained oral abnormalities such as numbness of the chin and lower lip must thus be considered, potentially ominous indication of acute lymphocytic leukemia.

Preoperative diagnosis of a small, depressed rectal cancer complicating ulcerative colitis. Report of a case.

PURPOSE: This study was designed to clarify the importance of detecting small, depressed colorectal cancer complicating ulcerative colitis. METHODS: A 39-year-old Japanese male, who had an 18-year history of left-sided ulcerative colitis, was admitted to Fukuoka University Hospital for further evaluation of his colitis. Colonoscopy with a dye spraying method clearly revealed a small, depressed lesion and flat plaque-like lesions in the rectum. Biopsies taken from a depressed lesion and plaque-like lesions revealed a signet-ring cell carcinoma and dysplasia, respectively. Total colectomy was performed. RESULTS: Sections from the depressed rectal lesion, measuring 7 x 8 mm in size, revealed a signet-ring cell carcinoma that diffusely invaded the muscularis propria. Lymph node metastasis was evident. Flat plaques and mucosa around the depressed lesion were positive for dysplasia. CONCLUSION: This is the first report of a case of small, depressed rectal cancer complicating ulcerative colitis diagnosed by preoperative colonoscopy. To improve outcome of colonoscopic surveillance in ulcerative colitis, detecting such small, depressed lesions are important, and colonoscopy with a dye spraying method would be useful in detecting them.

Ultrasonographic evaluation of inflammatory changes in the masseter muscle.

The ultrasonographic images of 32 patients with inflammatory change in the masseteric region were investigated to clarify the characteristic findings and to evaluate the utility of ultrasonography. Inflamed masseter muscles frequently demonstrated reduction of echo intensity and complete or partial absence of hyperechoic bands. The mean thickness of the masseter muscle on the unaffected side was 8.6 mm, whereas that on the affected side was 12.9 mm. Nine of 10 patients with heterogeneous hypoechoic area, but only 1 of 10 patients with homogeneous hypoechoic area, had received surgical treatment before ultrasonographic examination.

Mechanisms of vancomycin-induced histamine release from rat peritoneal mast cells.

The mechanisms of vancomycin (VCM)-induced histamine release were studied with rat peritoneal mast cells. VCM (> 1 x 10(-3) M) released histamine from the isolated mast cells in a dose-dependent and noncytotoxic manner. In the absence of extracellular Ca2+, the histamine release was reduced markedly. When the intracellular Ca2+ was depleted, it was further decreased. The Fura-2-loaded single mast cells showed a biphasic increase in the intracellular Ca2+ concentration ([Ca2+]i) by VCM: the first transient and the second sustained components. In the absence of extracellular Ca2+, the transient component was unchanged, while the sustained component was eliminated completely. The IP3 content in the mast cells increased within 10 s after the application of VCM. These results suggest that VCM release histamine from rat peritoneal mast cells via an IP3 production and increase in [Ca2+]i.

Benign mesenchymoma of the tongue. Report of a case, with review of the literature.

A benign mesenchymoma of the dorsal midtongue in an 88-year-old woman is presented. The tumour was excised under local anaesthesia, and microscopic examination revealed cartilage, bone, striated muscle, peripheral nerve, adipose and myxoid tissue, and blood vessels in addition to fibrous tissue. Eight cases including ours were found in the literature.

(Butylthio)carbonyl group: a new protecting group for the guanine and uracil residues in oligoribonucleotide synthesis.

The protection of the O6-amide and N2-amino groups of guanosine and the N3-imide group of uridine with the (butylthio)carbonyl group is described. This group could be rapidly introduced in good yields and removed very easily under the conventional deprotective conditions of the exo-amino acyl groups of other nucleoside bases.