Tardive dystonia improved with discontinuation of trazodone in an elderly schizophrenia patient: a case report.

BACKGROUND: Tardive dystonia associated with antidepressant use is rare and often under-recognized. We had an experience with trazodone, which is used for delirium and insomnia prescribed in general hospital, inducing tardive dystonia. CASE PRESENTATION: A 61-year-old Japanese woman had been treated for schizophrenia. She was moved to general hospital because of consciousness disturbance. She was prescribed trazodone (25 mg/day) for delirium and insomnia. After she was discharged, she returned to the psychiatric hospital with tardive dystonia. Her dystonia symptoms improved with 3 days of discontinuing trazodone. CONCLUSION: In the present case, long-term use of trazodone induced tardive dystonia. Discontinuing trazodone rapidly improved tardive dystonia.

New method of differentiating wild-type varicella-zoster virus (VZV) strains from Oka varicella vaccine strain by VZV ORF 6-based PCR and restriction fragment length polymorphism analysis.

A new method was developed to distinguish accurately wild-type varicella-zoster virus (VZV) strains from the Oka vaccine strain. Several DNA fragments covering open reading frame (ORF) 1-37 were amplified from wild-type VZV strains including the Oka parent strain and from the Oka vaccine strain. Restriction fragment length polymorphisms of these regions were compared, and nucleotide differences between the vaccine virus and other wild-type VZV strains were noted in ORFs 6, 10, and 35. In addition, variations of the R2 and R4 reiterated structures of the vaccine and its parent strains were examined. The Oka vaccine strain used in Japan was shown to be a mixture of viruses with different nucleotide sequences that had variations in at least three nucleotide positions in ORF 1-37 and had variable polymorphisms at R2 and R4 repeat regions (two and three patterns, respectively). The Oka parent strain on the other hand showed a single sequence and had only one reiterated structure at these regions. When VZV ORF 6 was amplified and its product was digested with AluI, the Oka vaccine strain could be precisely differentiated from its parent and from 56 other Japanese clinical isolates.

[Long PCR amplification of varicella-zoster virus DNA in clinical specimens from the patients with varicella and herpes zoster].

Long PCR amplification of the 7.7 to 33.5 Kbp regions of varicella-zoster virus (VZV) genomic DNA was performed using template DNAs extracted from clinical specimens such as vesicle fluid and crusts which had been obtained from varicella or herpes zoster patients. PCR products of 7.7-14.4 Kbp in length were efficiently amplified from all of the 14 template DNAs of crust specimens. Targets of 18.6-20.0 Kbp DNA could be also amplified from 14 crust samples except one. From all of the 7 samples derived from infected cells, the DNA targets up to 27.2 Kbp in length could be amplified. Whereas, the efficiency of amplification of 27.2 Kbp DNAs from crust samples was somewhat lower (9/14,64%) than that of DNAs from infected cells. In 83% (5/6) of target DNAs from infected cells, amplification of DNA as long as 33.5 Kbp was possible, while only in 40% (2/5) of these from crust specimens. From crust samples, the efficiency of amplification of DNA longer than 20 Kbp tended to decline. We also confirmed that long target DNA was amplifiable directly from vesicle fluid specimens as effective as from crust specimens. Restriction fragment length polymorphism (RFLP) analyses combined with R2-nested PCR of the long PCR products allowed classification of the 14 clinical specimens into 9 groups. Long PCR derived from clinical specimens was demonstrated to be applicable to RFLP analyses and sequencing without laborious test of virus isolation. Furthermore, the long PCR method described here will be useful for studies of the molecular epidemiology of VZV and for investigating variations among VZV isolates.

[Four cases of pediatric Ramsay Hunt syndrome].

Four cases of the Ramsay Hunt syndrome were admitted to our hospital during the two years from February 1997 to January 1999. Though one of the 4 patients had been immunized with varicella vaccine, the causative virus was not a vaccine strain but a wild-type strain. These patients were not suffering from underlying diseases. Because the number of pediatric zoster patient without underlying diseases who visited our clinic between 1981 and 1999 was 35 cases, the Ramsay Hunt syndrome turned out not to be extremely rare even among children having no underlying diseases. The prognosis of the Ramsay Hunt syndrome is assumed to be good if the treatment begins at the early stage. To begin the treatment at the early stage, it is necessary to confirm the diagnosis with virological examinations.