Correlation between messenger RNA expression of cytochrome P450 aromatase and its enzyme activity during oocyte development in the red seabream (Pagrus major).

In teleosts, estradiol-17beta (E2) is an important hormone responsible for oocyte development. To elucidate the molecular mechanisms underlying E2 biosynthesis, we characterized the structure of red seabream (Pagrus major) cytochrome P450 aromatase (P450(arom)) that is directly involved in E2 biosynthesis and found changes in mRNA levels of P450(arom) during oocyte development induced by implantation of gonadotropin-releasing hormone analogue. A cDNA clone encoding P450(arom) is 1779 base pairs in length and encodes a protein of 519 amino acids in length, with a calculated molecular weight of 58.9 kDa. Northern blot analysis showed that P450(arom) mRNA levels increased gradually from Day 8, when oocytes reached the secondary yolk globule stage, and were maintained at high levels at the day of spawning (Day 15). The P450(arom) mRNA levels increased in association with an increase of the gonadosomatic index (gonad weight/body weight x 100%), serum E2, and P450(arom) enzyme activity (in vitro conversion of testosterone to E2 in the ovarian fragments). Furthermore, an increase in mRNA levels of the LHbeta, but not FSHbeta, correlated with increased P450(arom) mRNA levels during the course of ovarian development. In addition, the levels of P450(arom) mRNA increased in isolated ovarian follicles during the course of vitellogenic oocyte growth and became undetectable in follicles at the migratory nucleus and the mature stages. These findings, together with those of the previous studies, suggest that LH, not FSH, may regulate E2 biosynthesis via increased levels of P450(arom) mRNA during oocyte development of red seabream.

["Wish to die" and "right to die" in a case of schizophrenia].

Protection of life had long been the ultimate goal of medicine. Recently, patient's subjective judgement and self-determination also became another alternative principle. The situation is the same in psychiatry. Now, most patients with "wish to die" live in community, unless they show strong and urgent suicidal attempt. Meanwhile, "right to die" based on patient's self-determination has been established in the terminal state of cancer. Based on the same logical formulation, the "right to kill oneself" for patients with "intolerable psychological pain", is also asserted. Suicide as a right is now an impending agenda in psychiatry. A case of schizophrenia, who had killed her mother and who had "wish to die", was presented and discussed here. Conclusions were as follows: 1) "Wish to die" was psychologically interpreted as "denial of wish to live". At least, this meant that "wish to die" was unable to be a clear and convincing evidence that "real will" to die actually existed. 2) Nevertheless, the therapist who was overwhelmed by the patient's "wish to die", felt that it was a patient's real will to die. 3) "Wish to die" was not a self-determination to die, but rather a patient's inquiry into the quality of therapy, if the therapist was able to tolerate the wish. 4) If everyone is supposed to have privacy that none can ever intrude, this right should be the one only for limiting excessive intervention of medicine, but not for helping suicide. 5) How to verbalize patient's "wish to live" hidden deeply at the very core of "wish to die" and how to support the patient's "wish to live", had a crucial importance in clinical practice of suicidal patients for therapists to confront "wish to die" together with the patient. 6) In general, it was discussed that the concept of "right to die" in suicide and in terminal states, had to be constructed in some different way.

Heterosexual activity as a risk factor for the transmission of hepatitis C virus.

Hepatitis C virus (HCV), the major causative agent of non-A, non-B hepatitis, is transmitted by parenteral exposure. Transmission by sexual activity, however, is controversial. Possible behavioral risk factors for HCV infection were studied retrospectively among imprisoned men (n = 201, mean age: 45 years [S.D. 13]) who visited a health service center at a Japanese correctional facility for medical examination. Seropositivity of anti-HCV antibody was disproportionately high (49.8%) in comparison with volunteer blood donors. Among possible risk factors significant on univariate analysis, intravenous drug abuse and Tama-Ire, a Japanese custom of sexual behavior that suggests frequent, aggressive or promiscuous heterosexual activity, proved to be independent risk factors for HCV infection (odds ratio = 7.39, 95% CI = 3.41 - 16.05, P < 0.0001; odds ratio = 3.16, 95% CI = 1.16 - 8.64, P = 0.026, respectively) as shown by logistic regression analysis. The data suggest that HCV may be transmitted by sexual activity.

The patient as "subject" and capacity to give informed consent.

In line with Western countries, the idea of "capacity assessment" to determine a person's course of treatment is being introduced to Japanese psychiatry. Herein, some problems associated with the informed consent of mental patients are discussed, and a typical case is presented. The author points out that, when involuntary treatment is necessary, the clinician must consider, 1) the self as a "subject" of the incapable, 2) the dissociation between a subject and a choice, 3) the nature of choice in life, 4) contextual assessment of mental intervention in the patient's life situation. Neglecting these issues will lead to inhumane medical practice in psychiatry.

Medulloblastoma associated with malignant rhabdoid tumor of the kidney: case report.

The authors report a case of 6-month-old boy with cerebellar medulloblastoma associated with malignant rhabdoid tumor of the kidney, presenting with an abdominal mass, large head and projectile vomiting. Following removal of the renal tumor, the mass arising from the superior vermis about 6 cm in diameter was removed by a combined right occipital transtentorial and suboccipital approach. The patient had been well for 3 months after surgery followed by chemotherapy but died eventually of tumor recurrence in the abdomen. Reported cases of malignant rhabdoid tumor of the kidney associated with brain tumor are reviewed and its characteristics are discussed.

Lobar intracerebral hemorrhage. A clinical, radiographic, and pathological study of 29 consecutive operated cases with negative angiography.

The authors operated consecutively on 50 patients with lobar intracerebral hemorrhage during a prospectively designed study period from January, 1986, to March, 1990. They investigated the correlations between the underlying causes and the clinicoradiographic features in 29 patients who showed no angiographic vascular abnormalities, in order to elucidate the operative indication for such cases. Patients with ruptured saccular aneurysm or trauma were not included in this study. There were 15 males and 14 females, ranging in age from 7 to 76 years (mean 52.4 years). Histological diagnoses of the surgical specimens were as follows: vascular malformation in nine cases (arteriovenous malformation (AVM) in six and cavernous malformation in three), microaneurysm in 11, cerebral amyloid angiopathy in six, and brain tumor in two; in the remaining case the cause was not verified histologically. The underlying cause was determined in 96.5% of cases. The mean patient age was lowest in the cavernous malformation group (27.0 years), followed by the AVM (45.8 years), microaneurysm (59.8 years), and cerebral amyloid angiopathy (70.0 years) groups. Four patients with vascular malformation (three AVM's and one cavernous malformation) had previous episodes of bleeding at the same site, whereas none of those with microaneurysms or cerebral amyloid angiopathy had such episodes. On computerized tomography (CT) scans, the round to oval hematoma was related to the presence of an AVM or cavernous malformation in contrast to microaneurysms and cerebral amyloid angiopathy. Upon infusion of contrast material, variable enhancement was seen in five (two AVM's and three cavernous malformations) of the nine vascular malformations while no enhancement was noted in any patient with microaneurysm or cerebral amyloid angiopathy at the acute stage. Subarachnoid extension of the hematoma was associated with cerebral amyloid angiopathy significantly more frequently than with AVM's (p less than 0.05) and microaneurysms (p less than 0.01). The results suggest that clinicoradiographic pictures in cases with negative angiography are quite different among the three major pathological categories; namely, vascular malformation (AVM and cavernous malformation), microaneurysm, and cerebral amyloid angiopathy. It is suggested that the underlying etiology of a given lobar intracerebral hemorrhage with negative angiography may be predicted by a combination of patient age, history of previous bleeding at the same site, hematoma shape, and subarachnoid extension of the hematoma on CT scans. Based upon these findings, the authors discuss operative indications for such cases.

Attitude change towards mental illness during nursing education--a cross-cultural study of student nurses in Korea, Republic of China and Japan.

This is an initial report of a cooperative project by colleagues in Korea, the Republic of China (Taiwan) and Japan, involving the measuring of attitudes toward mental illness. The discussion mainly revolves around the influence of mental health education in nursing on attitudes towards mental illness. The subjects' attitudes were assessed by Wig's profiles. The attitudes of freshmen who had just entered nursing schools and seniors who had already finished clinical training in psychiatry were compared to measure the attitude change during the course of nursing education, if any. Non-medical students served as a control group. As a result, a seemingly "negative and pessimistic" attitude was demonstrated in the senior student nurses. The findings are examined and discussed.

How depressing life is--life-long morbidity risk for depressive disorder in the general population.

We present estimates of lifetime risk and of cumulative risk up to each age for depressive disorder for the population of an inner city area (Camberwell, SE London). Estimates are based on an incidence study for the year 1976 which drew from the records of a case register. The estimates of lifetime risk obtained, 12% for men and 20% for women, are similar to those previously published in the literature. Inception risk by age and risks for in-patient treatment are also presented for men and women. The method of calculation is discussed and we show how to obtain an upper limit for the effect of the increased mortality associated with the disorder. We noted an apparent decline over the 'seventies' in inception rates for depression, and we consider the comparability of our statistics with risks calculated using complete psychiatric history data.

The study of depressive disorders using the PSE-ID-CATEGO system.

The PSE-CATEGO-ID system and its approach to the sub-classification of depression is described. The principle of sub-classification partly corresponds to the empirical relationships between symptoms on affective disorder. Comparison of CATEGO and DSM III demonstrates that major differences of classification can arise because of differences of the classificatory algorithm even though similar lists of symptoms are used. Empirical studies of the PSE-CATEGORO-ID system are described and their importance in providing evidence for a rational choice between classificatory system is emphasised.

The Study of Depressive Disorders Using the PSE-ID-CATEGO System.

The PSE-CATEGO-ID system and its approach to the sub-classification of depression is described. The principle of sub-classification partly corresponds to the empirical relationships between symptoms on affective disorder. Comparison of CATEGO and DSM III demonstrates that major differences of classification can arise because of differences of the classificatory algorithm even though similar lists of symptoms are used. Empirical studies of the PSE-CATEGORO-ID system are described and their importance in providing evidence for a rational choice between classificatory system is emphasised.