Intravascular Large B-Cell Lymphoma in Acute Hypoxic Respiratory Failure.

Intravascular large B-cell lymphoma, an extranodal large B-cell lymphoma, is a rare hematological malignancy with only a few reports of lung involvement. We report a case of intravascular large B-cell lymphoma with acute hypoxic respiratory failure and interstitial lung disease diagnosed via random skin biopsies. A 54-year-old woman presented with fever, cough, and dyspnea. Computed tomography imaging revealed findings concerning interstitial lung disease. The patient's respiratory status worsened despite the treatment with antibiotics and steroids. Generalized edema and thrombocytopenia also developed. Intravascular large B-cell lymphoma was clinically suspected and ultimately diagnosed by skin biopsy, although she had no apparent skin lesions. The patient's condition considerably improved after chemotherapy. Intravascular large B-cell lymphoma should be considered in patients with acute respiratory failure and interstitial lung lesions.

Infected aortic pseudoaneurysm caused by an inferior vena cava filter.

Background: Inferior vena cava filters are widely used to prevent pulmonary embolism, but they can cause serious complications. Case Presentation: A 45-year-old man with multiple abscesses was transferred to the emergency department from another hospital. Computed tomography revealed bilateral subscapular abscesses, septic pulmonary embolism, and an abdominal aortic pseudoaneurysm with an abscess at the site of the inferior vena cava filter limb inserted 12 years before. After admission to our hospital, surgical drainage of the bilateral subscapular and right wrist joint abscesses was performed; subsequent treatment with ampicillin improved the patient's condition. Inflammation resolved on the 19th hospitalization day, and abdominal aortic replacement surgery was performed. The patient's postoperative course was uneventful. He returned to the previous hospital for rehabilitation after 40 days of hospitalization. Conclusion: Inferior vena cava filters could cause serious complications.

Diagnostic Pitfalls in Papillary Muscle Rupture-Associated Acute Mitral Regurgitation after Acute Myocardial Infarction.

Papillary muscle rupture (PMR) is a rare and fatal complication of acute myocardial infarction (AMI). We report a case of acute mitral regurgitation (MR) due to PMR with pulmonary edema and cardiogenic shock following AMI with small myocardial necrosis. An 88-year-old woman was brought to our emergency department in acute respiratory distress, shock, and coma. She had no systolic murmur, and transthoracic echocardiography was inconclusive. Coronary angiography showed obstruction of the posterior descending branch of the right coronary artery. Although the infarction was small, the hemodynamics did not improve. Transesophageal echocardiography established papillary muscle rupture with severe mitral regurgitation 5 days after admission. Thereafter, the patient and her family did not consent to heart surgery, and she eventually died of progressive heart failure. Physicians should be aware of papillary muscle rupture with acute mitral regurgitation following AMI in patients with unstable hemodynamics, no systolic murmur, and no abnormalities revealed on transthoracic echocardiography.

Perceptions of traditional and modern types of depression: A cross-cultural vignette survey comparing Japanese and American undergraduate students.

AIM: Depression is a heterogeneous disorder that has various subtypes. In Japan, however, a prevailing misunderstanding is that the term utsu-byo (clinical depression) indicates only the melancholic type. Consequently, a subtype called 'modern-type depression' (MTD), which has contrasting features to those of melancholic or traditional-type depression (TTD), is severely stigmatized in Japan these days. The present study conducted a cross-cultural comparison of perceptions of TTD and MTD between Japan and the USA to examine how the Japanese collectivistic culture contributes to negative biases toward MTD. METHODS: Undergraduate students in Japan (N = 303) and the Midwestern USA (N = 272) completed the survey. They read two vignettes that described the conditions of fictional individuals with either TTD or MTD, and then reported their perceptions of each vignette. RESULTS: Mixed analyses of variance revealed significant interactions between nation (Japan or the USA) and vignette (TTD or MTD) on most perception items. These interactions and subsequent analyses with Bonferroni corrections mainly indicate the following: (i) Japanese are more likely to suppose that conditions of MTD are milder compared with TTD; and (ii) Japanese are more likely to hold stronger aversive attitudes and weaker willingness to provide support toward people with MTD than toward those with TTD. CONCLUSION: These results indicate that people with MTD are more likely to be accepted in the US independent culture than in the Japanese collectivistic culture. Discussion highlights that cultural diversity education potentially reduces stigma of MTD in Japan.

[An examination of a revised psycho-educational program for preventing depression among female undergraduates].

The present study revised a psycho-educational program designed to prevent depression (Oikawa & Sakamoto, 2007) and to enhance interpersonal coping resources for depression. The effects of the revised program on female undergraduates were examined. One hundred and seventy two udergraduates were assigned either to an experimental group or a control group. The experimental group participated in the revised program for ten weeks as part of a psychological class, while the control group did not. All participants were asked to complete a self-report questionnaire about self-efficacy for cognitive, behavioral, and interpersonal coping for depression, the state of their mental health, and perceived social support from their family and friends before and after the program. The experimental group's ratings and responses indicated that the program were interesting and meaningful. Moreover, self-efficacy for coping with depression and perceived support from friends at the post intervention were significantly increased in the experimental group compared with the control group. These results suggest the effectiveness of the revised program for increasing interpersonal coping resources.

The effects of suicide prevention measures reported through a psychoeducational video: a practice in Japan.

BACKGROUND: As the suicide rate in Japan has remained high since 1998, various suicide prevention measures have been implemented in Japanese local communities. AIMS: To report our findings on the effect of a psychoeducational video as a suicide prevention measure in a Japanese rural town. METHODS: Questionnaires were randomly mailed to 2,000 residents aged between 30 and 79 years. Within 4 weeks, volunteers in the town visited the residents individually and collected the questionnaires. The variables reported in this study are demographics, awareness of suicide prevention measures available in the town, whether the residents watched the video, help-seeking from advisers regarding suicidal ideation and financial problems and attitudes towards suicide. RESULTS: We analysed data collected from 1,118 people who reported their demographics (i.e. sex, age, and job) and whether they had watched the video. By conducting a series of logistic regression and multiple regression analyses and controlling for demographic variables, we found that watching the video had substantial psychoeducational effects. CONCLUSION: Despite conducting a cross-sectional study, our new suicide prevention measures were considered effective for psychoeducation. However, further studies using a longitudinal design are needed.

Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases.

AIM: The present study was conducted to examine differences in psychosocial and psychiatric characteristics between suicide completers with and without a history of psychiatric treatment within the year before death, using a psychological autopsy method. METHODS: A semi-structured interview was administered by a psychiatrist and other mental health professionals for the closest bereaved of 76 suicide completers. RESULTS: Suicide completers with a history of psychiatric treatment (n = 38) were significantly younger than those without (n = 38) (P < 0.01), and a significantly higher proportion of cases in the treatment group were estimated to be suffering from schizophrenia. Further, in 57.9% of the treatment group, the fatal suicidal behavior involved overdose with prescribed psychotropic drugs. In addition, female suicide completers in the treatment group were more likely to have a history of self-harm or non-fatal suicidal behavior. CONCLUSION: Many suicide completers who received psychiatric treatment were young adults. It was common for suicide completers to overdose on prescribed drugs as a supplementary means of suicide, and many experienced self-harming behavior before death. In addition, a higher proportion of the treatment cases suffered from schizophrenia.

Mental disorders and suicide in Japan: a nation-wide psychological autopsy case-control study.

BACKGROUND: The purpose of the present nationwide psychological autopsy case-control study is to identify the association between mental disorders and suicide in Japan, adjusting for physical conditions. METHODS: A semi-structured interview was conducted of the closest family members of 49 suicide completers and 145 gender-, age-, and municipality-matched living controls. The interview included sections of socio-demographic characteristics, physical conditions, and a psychiatric interview producing DSM-IV diagnoses of mental disorders prior to suicide (or at survey). We compared prevalences of mental disorders between the two groups, using conditional logistic regression. RESULTS: A significantly higher proportion with any mental disorder was found in the suicide group (65.3%) compared to the control group (4.8%) (p=0.003, odds ratio [OR]=7.5). The population attributable risk proportion associated with mental disorder was 0.24. Mood disorder, particularly major depressive disorder, was the most strongly associated with suicide (p<0.001). Anxiety disorder, alcohol-related disorder, and brief psychotic disorder were also significantly associated with suicide (p<0.05). These patterns were unchanged after adjusting for serious chronic physical conditions. LIMITATIONS: The present study had some limitations, such as small sample size, sampling bias and information bias. CONCLUSIONS: Most mental disorders, particularly mood disorder, were significantly associated with a greater risk of suicide in Japan, independent of physical conditions. Mental disorders are a major target of suicide prevention programs in Japan.

Psychosocial and psychiatric aspects of suicide completers with unmanageable debt: a psychological autopsy study.

This study examined the psychosocial and psychiatric features of 16 Japanese suicide completers with unmanageable debt compared with 23 suicide completers without such debt at time of death, using a psychological autopsy method. The individuals with unmanageable debt were more likely to have been self-employed and to have experienced divorce. They were less likely to have engaged in help-seeking behavior, despite having mental health problems. Our findings suggest that providing comprehensive support and promoting help-seeking behavior may be important for suicide prevention in middle-aged men.

[Psychosocial classification of suicide completers by employment situation: a psychological autopsy study].

OBJECTIVE: This study sought to clarify psychosocial and psychiatric differences of suicide-completers dependent on their employment situation. METHODS: Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, life history f, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of July 2009, we had collected psychosocial and psychiatric information for 46 Japanese suicide cases. RESULTS: More than half of 31 suicide-completers with a job at the time of their death were married men aged 40-59 (mean age 48.1 +/- 12.6). Many had social difficulties such as alcohol-related problems or debt (38.7% and 41.9%, respectively). More than sixty percent of the 15 unemployed suicide-completers were unmarried and aged 20-39 (mean age 43.4 +/- 19.9). The percentage of women in the unemployed suicide-completers was significantly higher than that for women with a job. Although social problems were not confirmed in the unemployed, the prevalence of alcohol use disorders was significantly higher in suicide-completers with ajob than in those who were unemployed. However, the prevalence of schizophrenia was significantly higher in the unemployed. CONCLUSIONS: Our findings suggest that to prevent suicide of those with ajob, enhanced mental health support in the workplace and a better understanding of the association between alcohol use disorders and suicide are required. To prevent suicide of those who are unemployed, mental health support for the younger generation, particularly in cases with schizophrenia, is recommended.

[Psychosocial features of suicide cases with alcohol problem: a psychological autopsy study].

AIMS: Alcohol use disorder is a well-known risk factor for suicide, as alcohol problems can deteriorate the medical and psychosocial conditions of individuals. Furthermore, the pharmacological effect of alcohol can cause impulsive behavior in individuals. However, few studies have investigated the association of alcohol problems with suicide in Japan. The purpose of the present study was to investigate psychosocial and psychiatric features of suicide-completers with alcohol problems in last one year before their death. METHODS: Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, history of life, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of December 2009, we had collected psychosocial and psychiatric information about 76 Japanese suicide cases. RESULTS: 16 suicide-completers with alcohol problems ("Alcohol problem" group 21.1%) were all males and almost middle-aged workers. The percentages of debt and accident proneness in "Alcohol problem" group were significantly higher than "Non-alcohol problem" group. In "Alcohol problem group", none of them have had treatment of alcohol dependence. The prevalence of alcohol use disorders in "Alcohol problem group" was significantly higher than in "Nonalcohol problem" group (81.2% vs. 0%). CONCLUSION: The findings of the present study suggest that it is important to improvement of psychiatric care in alcohol dependence for prevention future suicides among alcoholics. Furthermore, enlightenment the association between alcohol problems and suicide to the public and medical doctors is required.

Characterization of two isoforms of mouse 3(17)alpha-hydroxysteroid dehydrogenases of the aldo-keto reductase family.

Mouse kidney contains two 3(17)alpha-hydroxysteroid dehydrogenases (HSDs) that show essentially the same properties except for their isoelectric points. However, the structural differences and physiological roles of the two enzymes remain unknown. In this study, we have isolated cDNAs for the two 3(17)alpha-HSDs from a total RNA sample of mouse kidney by reverse transcription-PCR. The identity of the cDNAs was confirmed by characterization of the recombinant enzymes that showed the same molecular weights, pI values, pH optima, substrate specificity and inhibitor sensitivity as those of the enzymes from mouse kidney. We also found that the recombinant enzymes reduce precursors of neuroactive progesterone derivatives, 5alpha-dihydrotestoserone, deoxycorticosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate and estrone at low Km values of 0.3-2 microM. The two enzymes belonged to the aldo-keto reductase (AKR) family, and their 323-amino acid sequences differed only by five amino acids. The sequences of the two isoforms are identical to those of proteins that are predicted to be encoded in a gene for AKR1C21 in the database of the mouse genome. However, the mRNAs for the two isoforms were expressed in mouse kidney and other tissues, in which their expression levels were different. The results indicate an important role of 3(17)alpha-HSD in controlling the concentrations of various steroid hormones in the mouse tissues, and suggest the existence of two genes for the two isoforms of the enzyme.