The clinical features of Tourette's disorder with obsessive-compulsive symptoms.

Twenty-three patients with Tourette's disorder (13 with obsessive-compulsive symptoms [OCS] and 10 without) were comparatively investigated. In contrast to OCS-free Tourette's disorder patients, those with OCS were found to be characterized by (i) a higher incidence of volatile temper, (ii) a higher incidence of compulsive tics, (iii) a higher incidence of perinatal disorders and brain wave abnormalities, (iv) a higher severity as rated using the Severity Scale, and (v) a higher prevalence of complications, especially of developmental disorders. Of the subjects with OCS-accompanied Tourette's disorder, approximately half had developed OCS by the onset of tics. These findings suggest the likelihood that OCS-accompanied Tourette's disorder is more strongly associated with organic cerebral disorders, independently of sites of tic disorders, than is OCS-free Tourette's disorder.

Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase.

Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.

[A case of exogenous lipoid pneumonia probably due to domestic insecticide].

A 61-year-old female was admitted to our hospital because of cough, hemosputum and right chest pain. The P-A and L-R chest films revealed focal consolidation in the right upper filed and mass-like shadow in the right S3. Transbronchial lung biopsy specimens showed collections of lipid-laden macrophages. The lipid material of macrophages in broncholaveolar lavage fluid was stained yellow-orange with Sudan IV. The patient had no difficulty in swallowing and had no history of regular use of oily drugs. Fiberoptic bronchoscopy and chest CT showed no obstruction of bronchi. She had used much domestic insecticide with the doors closed before going to bed every summer and autumn for 10 years. We concluded that the domestic insecticide containing mineral oil had resulted in exogenous lipoid pneumonia. Her symptoms and abnormal shadows in chest X-ray film disappeared soon after antimicrobial chemotherapy was started. She is now healthy without recurrence.

Bulimia nervosa in a pair of male monozygotic twins.

This is a report of a pair of male monozygotic twins meeting the DSM-III-R criteria for bulimia nervosa. At the age of 15, both brothers began to diet and suffered from bulimia. They were admitted to psychiatric hospitals and separated. After admission, their clinical course dramatically changed. The differences in their clinical courses and endocrinological data are suggestive as to the roles of environmental and hereditary factors in the etiology of bulimia nervosa.

An epidemiological study on hyponatremia in psychiatric patients in mental hospitals in Nara Prefecture.

Hyponatremia occurs often in mental illness. The frequency was not noticed because of the uncharacteristic symptoms of mild hyponatremia. Of the 1,114 psychiatric inpatients retrospectively surveyed, 10.5% had hyponatremia. Not only patients with schizophrenia, but also patients with other mental illness, especially with epilepsy, having hyponatremia were confirmed. An early onset, a long duration of psychiatric disorder and a prolonged admission were statistically significant factors. Nicotine abuse was not a significant factor. It was suggested that the pathogenesis of hyponatremia in psychiatric patients might be involved in a chronic course of psychiatric disorders and poor response to psychopharmacotherapy.

[A case of mediastinal malignant lymphoma with cardiac tamponade treated effectively with chemotherapy].

A 78-year-old man was admitted to the Nishinomiya Municipal Central Hospital with main symptoms of chest pain and dyspnea. Chest CT revealed a large mediastinal mass shadow, and echocardiography revealed pericardial effusion. Serum LDH was elevated. Therefore, malignant lymphoma was suspected to be the cause of cardiac tamponade. VEPA chemotherapy was commenced. Half way through the course of chemotherapy, serum LDH was decreased, the pericardial effusion had disappeared, and the mediastinal mass was reduced in size. A biopsy specimen of the mediastinal tumor revealed malignant lymphoma of diffuse large cell type, and immunoperoxidase staining of frozen sections demonstrated B cell origin. The pericardial effusion had not increased in size after four months, when the patient developed pneumonia and died. Autopsy revealed pericardial and atrial involvement by tumor. In conclusion, this case is very unusual in that (1) pericardial involvement was suspected on admission; (2) the pericardial effusion disappeared with systemic chemotherapy; and (3) cardiac metastasis was demonstrated at autopsy.

[A case of CA19-9 producing adenocarcinoma of the lung associated with idiopathic interstitial pneumonia].

A 63-year-old female, who had been suffering from idiopathic interstitial pneumonia (IIP) since two years and four months previously, was admitted with general fatigue, body weight loss, bloody sputum and progression of dyspnea. Chest roentgenogram on admission showed diffuse coarse ring shadows in the right middle and lower lung fields and in the left middle lung filed. Chest CT clearly showed honeycombing in bilateral dorso-basal segments of the lung. Serum CA19-9 level was elevated, and continued to increase during her clinical course. Sputum cytology was positive. Autopsy showed papillary adenocarcinoma of the lung (alveolar cell type). Immunohistochemical study of lung tissue showed positive CA19-9 staining on the surface of adenocarcinoma cells.

[Wegener's granulomatosis in a woman with asymptomatic primary biliary cirrhosis].

A 60-year-old woman was admitted to our hospital in June 1985, complaining of fever, cough and right lower chest pain, with a five-year history of asymptomatic primary biliary cirrhosis. Chest X-ray on admission showed an infiltrative shadow in the right lower lung field. She was first treated with various antibiotics unsuccessfully. Hemoptysis continued. Dyspnea and anemia appeared. Chest X-ray 17 days after admission showed multiple infiltrative shadows in the both lung fields. She was treated with steroid pulse therapy successfully. During prednisolone treatment decreasing nodular shadows with cavities appeared on chest X-ray. An open lung biopsy was performed in March 1986. The histologic findings showed a necrotizing vasculitis with granuloma and perivascular fibrosis. She was treated with prednisolone and prednisolone-azathioprine therapy unsuccessfully, but successfully with prednisolone-cyclophosphamide therapy. This case was a rare case of Wegener's granulomatosis with transition from fulminant type to granulomatous type. No similar case of Wegener's granulomatosis with asymptomatic primary biliary cirrhosis has been reported in the literature.

[A case of multiple cavities on chest film with high titer of serum cryptococcal antigen].

A 26-year-old man admitted to Nishinomiya Municipal Hospital for further evaluation for abnormal shadows on the chest film in a mass examination. He had no subjective complaints; for example, cough, sputum or dyspnea. His past history and physical examinations yielded no significant findings. The chest film revealed the multiple cavities accompanied with a little infiltration throughout several lobes bilaterally. The inflammatory reactions; such as, CRP and ESR, were all intact, but the titer of the serum cryptococcal antigen was high. He was not immunocompromised. Although bronchoscopy and transbronchial lung biopsy were performed twice during admission, they revealed no pathogenic findings both bacteriologically and histologically. The elevation of the serum cryptococcal antigen titer suggested that this disease is the primary pulmonary cryptococcosis. The titer decreased with spontaneous disappearance of the abnormal shadows on the chest film. This test has a sensitivity of 90% for cryptococcal infection, but in rheumatoid arthritis, a small percentage of false positive results have been reported. Therefore, if the rheumatoid factor is eliminated, the test is more specific for cryptococcal infection. On the other hand, some authors have reported the false positive results in Trichosporon beigelii infection by this method. But this disease is negligible for its frequency in clinical features in our country. We emphasized that this non-invasive test is more useful for the diagnosis of the primary pulmonary cryptococcosis.

Randomized controlled study of adjuvant immunotherapy with Nocardia rubra cell wall skeleton for inoperable lung cancer.

In order to evaluate the clinical benefit of Nocardia rubra cell wall skeleton (N-CWS), a randomized controlled study was performed with inoperable lung cancer patients entered in 5 institutions from October 1978 to June 1981. Patients without pleural effusions were treated initially with conventional therapies such as chemotherapy and/or radiotherapy, according to common protocol, and then patients in performance statuses 0 to 3 were randomized into control and N-CWS groups with stratification into 16 categories according to 4 histological types and 4 clinical stages In the N-CWS group, 400 micrograms N-CWS were initially injected once or twice into the bronchial tumor using a fiberoptic bronchoscope, and subsequently 200 micrograms of N-CWS were injected at monthly intervals into the skin from the shoulders to upper arms. Of 309 patients, 118 patients in the N-CWS group and 108 patients in the control group were eligible for statistical analysis. There was statistically no significant difference in survival rate between the control and the N-CWS groups. According to histological type, significant prolongation of the survival period was observed in patients with small-cell carcinoma. The 97 patients with pleural effusions were initially randomized into control and N-CWS groups. In the control group, local chemotherapy with Adriamycin was performed and, in the N-CWS group, local administrations and monthly intracutaneous injections of N-CWS were given. Tube thoracostomy was performed in both groups. The local response rate was statistically greater in the N-CWS group than in the control group, and survival period was also prolonged significantly in the N-CWS group. The main adverse reactions to N-CWS were skin lesions in the injected sites and fever, but these were temporary and not serious.

[Fundamental and clinical studies on ceftizoxime (author's transl)].

Ceftizoxime was tried in children with various infections and the following results were obtained. 1) Serum levels and urinary recovery of ceftizoxime were studied in 6 patients aged from 6 to 10 years. After intravenous bolus injection of 20 mg/kg, the mean serum concentrations were 113.9 micrograms/ml, 47.6 micrograms/ml, 31.8 micrograms/ml, 18.5 micrograms/ml, 6.3 micrograms/ml and 2.1 micrograms/ml at 5 minutes, 30 minutes, 1 hour, 2 hours, 4 hours and 6 hours, respectively. The average urinary recovery rates of ceftizoxime were 55.1%, 90.9% and 98.3% at 2 hours, 4 hours and 6 hours after the administration, respectively. 2) The therapeutic efficacy was excellent in 11, good in 9 and poor in 2 patients, the efficacy rate being 91%. 3) As for the side effects, elevation of S-GOT and S-GPT, and drug fever were observed in 1 case, but disappeared soon after discontinuation of the therapy.

[Clinical trials with cefroxadine dry syrup in the treatment of infectious disease of children (author's transl)].

Cefroxadine dry syrup was studied clinically and the following results were obtained. The drug was administered to 19 cases of bacterial infections: acute tonsillitis (6), acute bronchitis (6), scarlet fever (2), acute pyelonephritis (4) and acute cystitis (1). The daily dose was about 30 approximately 50 mg/kg except for 1 patient. The drug was given orally, 3 times a day and the duration of administration was from 4 to 11 days. The overall efficacy rate was 100%, i.e., excellent in 17 cases, good in 2 cases. One patient experienced a mild S-GOT elevation and another patient in mild vomiting. From the results obtained in this study, cefroxadine dry syrup seems to be useful in the treatment of infectious diseases of children.

Phase I study with cell wall skeleton of Nocardia rubra.

Toxicity of the cell wall skeleton of Nocardia rubra (N-CWS) was evaluated in 60 patients with lung cancer, leukemia, and malignant melanoma who were given the agent intratumorally, intrapleurally, and intradermally in doses of 100-2000 micrograms. Fever was the most common toxic effect and was more frequent after intratumoral and intrapleural doses than after intradermal doses. The other predominant reaction was skin lesions such as erythema, induration, and abscess at the injection sites.

Primary lung cancer producing alpha-fetoprotein: a case report.

A case of primary lung cancer that produced both alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) is presented. Alphafetoprotein in the supernatant of tissue extract from the primary lesion amounted to more than 40 microgram/ml, and its exact origin from tumor tissues was confirmed by the immunofluorescent study. We suppose that since the lung is one of the foregut derivatives it is not unlikely for lung cancer cells to produce AFP as well as CEA.