We investigated the effectiveness of bright light therapy on cognitive disturbances and its effect on circadian (sleep-wake) rhythm in Alzheimer-type dementia (ATD). Twenty-seven patients with ATD were treated with bright light therapy in the morning for 4 consecutive weeks. We evaluated the cognitive functions and circadian rhythms of the patients as a whale, and as menbers of two groups (one: questionable and mild dementia; the other: moderate and severe dementia; both groups classified by the severity criteria of Clinical Dementia Rating). We assessed circadian rhythms by actigraphy and cognitive states by Mini-Mental-State Examination (MMSE) and Alzheimer's Disease Assessment Scale (ADAS) before and after light therapy. Bright light therapy improved circadian rhythm. Although bright light therapy had no Significant effect on the Severity of dementia, it improved the MMSE scores, cognitive functions of ADAS scores (memory>language) and non-cognitive function of ADAS scores (behavior≒mood), especially in the questionable and mild dementia group. These results suggest that bright light therapy improves cognitive functions with the modification of circadian rhythm, especially in the early stages of ATD. (J Nippon Med Sch 1999; 66: 229-238)

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We have encounted two patients with fibromyalgia (FM) initially diagnosed as having autoimmune fatigue syndrome (AIFS). To investigate the relationship between AIFS and FM, the distribution of the tender points in patients with AIFS was assessed according to the ACR criteria for FM. It was revealed that AIFS patients had 5.6 tender points on averages. Patients with headaches, digestive problems, or difficulty going to school had more tender points than patients without. Patients with ANA titers<1: 160 had more tender points than patients with ANA≥1: 160. Anti-Sa negative patients had more tender points than positive patients. These results suggest a relationship between AIFS and FM in terms of the pathophysiologic mechanisms of the numerous tender points. In other words, ANA-positive FM patients could be one form of AIFS, as well as ANA-positive chronic fatigue syndrome patients. Thus, autoimmunity could explain the controversial disease entities of FM and/or CFS. (J Nippon Med Sch 1999; 66: 239-244)

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The purpose of this study is to evaluate the usefulness of magnetization transfer contrast (MTC) as a technique to reflect histopathological changes in the white matter adjacent to the frontal horns of the lateral ventricles. Radiological-pathological correlation was performed in six patients who underwent Magnetic Resonance (MR) examination prior to death and in whom postmortem examinations of the brain were obtained. The extent and the severity of degeneration in the white matter adjacent to the frontal horns were evaluated histopathologically, and compared with those observed on the conventional proton density (PD) weighted MR images (Group 1). Changes in the white matter of another 35 patients were classified into three types according to the pattern of high signals adjacent to the frontal horns on conventional PD weighted MR images, and magnetization transfer ratio (MTR) in the white matter adjacent to the frontal horns was calculated from multi-slice and single-slice FSE images (Group 2.) The relationship between signal intensities and MTR in the white matter adjacent to the frontal horns was evaluated. The extent of degeneration in the white matter adjacent to the frontal horns was classified into mild, moderate and severe types on the basis of stainin for myelins, axons and astrocytes. In Group 1, histopathological findings indicated a difference in severity of degeneration in the white matter adjacent to the frontal horns among the three types, while no significant differences were noted in the signals on PD weighted MR images. In Group 2, MTR showed significant differences in the signal intensities in the white matter adjacent to the frontal horns (p<0.01) between the three types, while conventional PD weighted MR images failed to differentiate between them. In conclusion, MT imaging is a sensitive technique to evaluate the histopathological changes in the white matter adjacent to the frontal horns that cannot be detected by conventional MR imaging. (J Nippon Med Sch 1999; 66: 245-252)

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Peritoneal dissemination has an unfavorable impact on the prognosis of pancreatic cancer, and a peritoneal dissemination model was created in hamsters by using an experimental pancreatic cancer to clarify its pathological characteristics. PGHAM-1, a cancer cell line we established from BOP induced pancreatic cancer in Syrian golden hamsters, was inoculated into the abdominal cavity of Syrian golden hamsters. After inoculation, sequential changes in the diaphragm, omentum, and parietal peritoneum, and the metastatic patterns of the PGHAM-1 cells were morphologically investigated by macroscopical, microscopical, and ultrastructural observation. The cancer cells were easily absorbed at the stomata in the diaphragm and milky spots in the omentum, which were absorptive lymphatic structures, and lymphatic metastasis occurred 4 days after inoculation. In the parietal peritoneum, however, the cancer cells attached to and proliferated on the parietal peritoneum where mesothelial cells had exfoliated and the basement membrane was exposed. This process was comparatively time-consuming, and metastasis occurred in the parietal peritoneum at 7 days after inoculation. This study suggested that there might be two patterns of peritoneal dissemination of hamster pancreatic cancer. One route is lymphatic metastasis via stomata in the diaphragm and milky spots in the omentum, and the other is direct metastasis on the parietal peritoneum; each metastasis forms independently. (J Nippon Med Sch 1999; 66: 253-261)

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Neuroleptic malignant syndrome (NMS) is the most serious side effect produced by the administration of antipsychotic drugs. NMS shares many clinical similarities with malignant hyperthemia (MH), but the etiology of NMS and the relation between NMS and MH remain unknown. Anesthetic regiments for patients with NMS are not well established. We gave repeated anesthesia to a patient with a history of NMS undergoing electroconvulsive therapy for the treatment of depression. Propofol and vecuronium were used in twelve consecutive ECT sessions without complications. In this case report, we describe the safe and satisfactory repeated use of propofol in a patient with a history of NMS, and outline NMS and its questionable relation to MH. (J Nippon Med Sch 1999; 66: 262-265)

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We present here 2 cases of acute and 2 cases of chronic massive fetomaternal hemorrhage. A sinusoidal fetal heart rate pattern may indicate chronic fetomaternal hemorrhage, but, when increased variability is observed in fetal monitoring, maternal hemoglobin F should be measured to exclude acute fetomaternal hemorrhage. (J Nippon Med Sch 1999; 66: 266-269)

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The object of this study was to improve the completion of discharge summaries. The purpose of this article is: 1. to describe the perceptions of outpatient department physicians as to whether incomplete discharge summaries affect outpatient medical care or not, and 2. to elucidate the factors contributing to their perceptions. The physicians were randomly selected from among “the National Certified Training Hospitals” and “Japan Society for Quality in Health Care”, and the size of the hospitals, the medical record management system and the format of the discharge summary were chosen for analysis of the factors that affect physicians' perceptions. Of the 2, 304 questionnaires sent, 935 (40.6%) were returned. The results showed that 832 (89.0%) of the physicians thought that outpatient medical care would be affected if discharge summaries were not completed. Based on the analysis of the factors affecting the perceptions of the physicians, there was a trend showing that the influence was lower in small hospitals (p<0.05), that the centralized management system for medical records had a higher influence (p<0.05), and that the format of the discharge summary also affects physician's perceptions (p<0.05). (J Nippon Med Sch 1999; 66: 270-278)

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