Trichotillomania is a disorder of recurrent hair pulling, resulting in the dermatological expression of partial or total hair loss. Trichotillomania has been thought rare for many years, but recently it has been speculated that it is far more common than previously believed. The number of patients is increasing daily. In 1987, a new definition was proposed in the United States, and trichotillomania is now considered to be distinct from mere hair pulling behavior. Worldwide, a debate about the conditions and cures for trichotillomania continues, specifically debates based on the definition adopted in the United States. The author reviews the latest Japanese reports on trichotillomania, comparing key literature from abroad.

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  Abnormal lipid metabolism associated with various renal diseases has been known for a long time. Hypercholesterolemia is one of the characteristic features of nephotic syndrome, and hypertriglyceridemia is often observed in chronic renal failure (CRF). The role of lipid abnormalities in the pathogenesis of renal diseases has been variously discussed. However, direct evidence only recently became possible when more sophisticated analyses of renal histopathology as well as an application of molecular biology were introduced in the field of clinical nephrology. The recent identification of lipoprotein nephropathy (LPG), reported most often by Japanese authors since 1989, is particularly noteworthy. The detailed analysis of lipid profiles and renal histology has been instrumental in clarifying the relationship between lipids and the kidney not only in LPG but also in other disease entities such as familial-type dyslipidemias, CRF, focal glomerulosclerosis, and diabetic nephropathy. Dyslipidemias common to these diseases, together with the presence of hypertension, cause systemic atherosclerotic lesions (including lesions in the kidney) and terminal renal failure.

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Objective: The purpose of this study was to evaluate the efficacy of risedronate for the improvement of the quality of life (QOL) in patients with primary osteoporosis.
Methods: Twenty-seven Japanese patients who had receutly been diagnosed with primary osteoporosis (mean age: 73.8 ± 9.1yr, 18 men and 9 women) were the subjects of this study. Using the Japan Osteoporosis Society Quality of Life Questionnaire (JOQOL), each patient's QOL was evaluated before treatment with oral risedronate 2.5mg once daily, and 3, 6, and 12 months during treatment. We also measured the bone mineral density (BMD), serum bone-specific alkaline phosphatase (BAP), and serum N-terminal telopeptide of type I collagen (NTx) before treatment and at 6 and 12 months.
Results: The JOQOL total score gradually increased and significantly improved after 12 months of treatment in both male (p=0.026) and female patient groups (p=0.021). The pain scores in the female group first improved significantly at 3 months (p=0.018) and continued to improve over the remaining 9 months of the study, while improvement in the male group reached a significant level at 12 months (p=0.048). Along with the improved pain scores, the other five scores (assessment of activities of daily living, entertainment and social activity, overall health, posture, and falls and anxiety) also tended to improve. Although risedronate did not significantly improve the BMD over the 12 months of this study, the serum BAP levels decreased over the 12 months period and significantly decreased in male (p=0.004) and female groups (p<0.001) at 6 months. The serum NTx level also decreased significantly in male (p=0.003) and female groups (p=0.046) at 12 months.
Conclusion: The administration of risedronate for 12 months significantly improved the QOL in patients with primary osteoporosis and resulted in improved bone metabolism. The JOQOL may be an efficacious index for judging the outcome of osteoporosis treatment.

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Objective: The diagnostic criteria for the metabolic syndrome (MetS) were published in Japan in April 2005. However, there have been no large-scale studies in rural areas to confirm these criteria. We examined the prevalence of MetS in subjects who had undergone a routine medical health checkup at our hospital, located in a rural area. This data was used to investigate the appropriateness of the diagnostic criteria for MetS.
Subjects and Methods: The MetS status was examined retrospectively in 2340 subjects (1408 men, 932 women ; mean age 49.6 ± 9.7 years) who underwent a routine medical health checkup at our hospital between April 2004 and March 2005.
Results: Of the 1408 men and 932 women, 209 men (14.8%) and 23 women (2.5%) were diagnosed with MetS. Forty-four men (3.1%) and 4 women (0.4%) met all three diagnostic criteria for metabolic disorders. In the female group, only 8.7% of the 932 women met the waist circumference criterion of ≥90 cm. Because this waist circumference criterion was used during the first screening but was not met by most of the women, they were eliminated from our study. Using receiver operating characteristic (ROC) analysis, the cutoff values for waist circumference were 85.0 cm (sensitivity 0.750, specificity 0.564) in men and 79.5 cm (sensitivity 0.787, specificity 0.709) in women. If the women's waist circumference criterion had been set at the value of ≥79.5 cm, this would have resulted in 48 (5.2%) women meeting the criterion.
Conclusion: From the viewpoint of preventive medicine, the Japanese male MetS diagnostic criteria are fairly appropriate. However, for the women, the waist circumference criterion of ≥90 cm has been set too high and was not met by most of the female subjects. Therefore, the Japanese MetS criteria for women, particularly the cutoff value for waist circumference, requires further verification.

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  A 65-year-old man was referred to our hospital in April 2003 with a pancreas tumor detected by a thorough medical checkup. Computed tomography (CT) showed swelling of the pancreatic body and tail, and magnetic resonance cholangiopancreatography (MRCP) showed only the main pancreatic duct in the head of the pancreas. Diagnosing autoimmune pancreatitis, we observed the patient without medication. However, one year later CT showed stenosis of the splenic artery and portal vein accompanied by development of collateral circulation around the pancreas. He had no symptoms, and CT showed no changes in the pancreatic swelling.
  He was admitted to our hospital on January 6, 2005, presenting with a history of jaundice which first appeared on January 1, 2005, and increased collateral circulation around the pancreas with pancreatic swelling were seen on CT. We started prednisolone therapy at 40 mg/day for exacerbation of autoimmune pancreatitis. Serum bilirubin levels improved from 11.9 mg/dl to 2.5 mg/dl, and pancreatic swelling also improved four weeks after starting therapy.
  We present a rare case of autoimmune pancreatitis that developed marked collateral circulations.

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  Apical ballooning cardiomyopathy (Takotsubo or ampulla cardiomyopathy) is a well-known transient and localized left ventricular (LV) dysfunction characterized by apical severe hypokinesis, typical electrocardiogram (ECG) changes of negative T, and a lack of organic lesions of the coronary arteries which could cause myocardial ischemia leading to segmental asynergy. Here we report on two cases of transient cardiomyopathy showing atypically localized asynergy, which is different from Takotsubo cardiomyopathy. Case 1 was diagnosed as atypical Takotsubo cardiomyopathy, and the current findings suggest case 2 was viral myocarditis. These cases suggest that there exist variant patterns of transient cardiomyopathy, and non-invasive and serial clinical evaluations are important for differential diagnosis in acute and atypical cardiomyopathy.

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