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The patient was an 85-year-old man with a one-year history of difficulty reading kana. Neuropsychological evaluation revealed kana (phonogram)-selective reading impairment and kanji (ideogram)-dominant writing impairment. MRI revealed significant cerebral atrophy in the left occipital cortex, leading to the clinical diagnosis of posterior cortical atrophy (PCA). Cerebrospinal fluid amyloid β 1-42 levels were reduced, and amyloid PET showed accumulation in the posterior cingulate cortex, precuneus, and frontal lobe. In contrast, tau PET showed no accumulation in the atrophied brain areas. Episodes of REM sleep behavior disorder and decreased uptake on meta-iodobenzylguanidine (MIBG) myocardial scintigraphy suggested the involvement of Lewy body pathology. PCA with distinct laterality has been rarely reported, and ‍this is the first case to present Kana-selective reading impairment and Kanji-dominant writing impairment with neurodegenerative background.

For the establishment of an effective comprehensive anti-suicide policy, a multifaceted strategy including primary, secondary, and tertiary prevention measures is needed. In urban cities, however, there are many obstacles to projects such as comprehensive programs for suicide prevention. In Sendai city, which has a population of approximately 1,000,000, a comprehensive anti-suicide project was launched as a public enterprise as a pioneer among ordinance-designated cities in Japan. This project was supported by several important factors. 1) A series of epidemiological observation and intervention studies on depression among the elderly had previously been conducted in a large residential district. As a result, a comprehensive community program for depression among the elderly was implemented as a public enterprise and a subsequent decreasing trend in the later-life suicide rate was found. 2) The municipal authorities recognized the importance of the anti-suicide program and made an effort to reorganize the existing health-related programs in terms of suicide prevention. 3) the action of the municipality was facilitated by the passing of an anti-suicide law by the National Diet in 2006 and the establishment of fundamental principles for a comprehensive anti-suicide policy by the National Diet in 2007. 4) The activities of nongovernmental groups also influenced the municipality. In order to establish a comprehensive anti-suicide program in urban cities with a large population, an interaction model in which various governmental and nongovernmental networks influence and activate each other should be considered.

A 56-year-old woman with cholecystolithiasis was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with fentanyl and propofol IV, and the trachea was intubated using vecuronium IV. Anesthesia was maintained with 60% nitrous oxide and propofol intravenously, and vecuronium was used for muscle relaxation. Following induction of carbon dioxide pneumoperitoneum, PETCO2 slightly increased. During pneumoperitoneum PETCO2 as easily controlled by increasing minute volume of ventilation. Fifty minutes after the start of pneumoperitoneum, suddenly the peak airway pressure increased and PETCO2 reached 70 mmHg continuously. At this time, severe massive subcutaneous emphysema from the anterior thorax to the head and neck was noted, and the manual lung ventilation was very difficult. After discontinuation of pneumoperitoneum, PETCO2 gradually decreased with improvement of the neck subcutaneous emphysema. At the same time the lung ventilation improved. We speculate that major causes of difficulty in ventilation were the decreased compliance and the tracheal tube comppression, which were due to massive subcutaneous emphysema. Our findings show that we have to stop pneumoperitoneum immediately, when we find a sudden increase of the peak airway pressure or PETCO2 with subcutaneous emphysema during laparoscopic cholecystectomy.

The pathophysiology of psychiatric diseases including depression is characterized by the involvement of many genes contributing a small effect. This genetic complexity means larger amounts of information can be gathered by studying the disease process as a single entity, in an animal model. A number of genetically modified animals showing both depressive and anti-depressive phenotypes have been generated. Approximately ten of these models are in current use for screening novel antidepressants. The development of new therapies is intimately linked to the elucidation of mechanisms via which the drugs work and therefore the mechanisms of disease. It is now possible to combine the information from animal models with sophisticated technology including DNA microarray analysis. In this setting, the animal models can provide information about genes altered in both the depressive state and after anti-depressive treatment, whilst DNA microarrays can identify these genes, as well as the direction of change. This information will eventually lead to the discovery of new mechanisms involved in disease pathology. Here we summarize approaches for identifying genes related to depression.

Although acetaminophen (APAP) method is widely used to evaluate the gastric emptying rates of liquids in Japan, patients need to take a large dose of APAP. A scintigraphic technique requires the gamma camera. In this present state we try to search for an alternative method, which is easy to perform and noninvasive for the patient. 13C-acetate breath test and APAP method were performed at the same time in 59 patients after overnight fasting. The liquid test meal OKUNOS-A (200 ml, 200 kcal), contained APAP (20 mg/kg) and 13C-acetate 100 mg was orally administered to the patient. Breath sampling for 13CO2 measurements was obtained every 5 min up to 20 min and every 10 min up to 90 min. Blood sampling for plasma APAP concentration was collected 15, 30, 45, and 60 min after oral administration of the test meal. The time of 13CO2 peak excretion in 13C-acetate breath test was ranged from 50 to 70 min in 37 out of 59 patients. Plasma APAP concentration at 45 min in over 80 min group was significantly lower than in 50-70 min group. In contrast, that in under 40 min group was significantly higher. 13CO2 breath excretion at 30-40 min correlated with plasma APAP concentration at 45 min significantly. These results suggest that optimal sampling time of breath test is 20-40 min. In conclusion, 13C-acetate breath test is reliable as a qualitative analysis, easy to perform, and a noninvasive method without taking blood and radiation exposure for a measurement of gastric emptying rates.

Quantitative study of serum protein loss into the alimentary tract from the tumor of gastric cancer using 111Indium-transferrin (111In-Tf) was performed. Gamma counting of 111In-Tf excreted in feces and 111In-Tf scintigram were performed in 24 patients with gastric cancer and 10 controls. Transferrin was labelled by incubating 111MBq (3mCi) of 111In chloride with approximately 13ml of patient plasma in vitro. After intravenous injection of 111In-Tf, an aliquot was weighed and its radioactivity was measured in a gamma-counter. Feces were collected every 24hrs up to 72hrs. Then 111In in the feces was calculated as a percentage of the injection dose. 111In excreted in the feces within 72hrs in patients with gastric cancer was 3.71 +/- 3.87% (mean +/- SD), which was significantly higher than the 0.48 +/- 0.26% in 10 controls. 111In in feces correlated the area of the tumor in the stomach (p < 0.001). In 18 patients positive scan was recognized and was localized the protein loss in the cavity of the stomach within 10 minutes. Positive scan was found to move along the intestine successively. 111In-Tf can be useful in assessing of hypoproteinemia of gastric cancer.

As assessment was made regarding the clinical value of 111In transferrin in scintigraphy on 28 lesions in 26 cases of colorectal cancer. The positive rate of colorectal cancer was high: 21 lesions out of the 28 (75%) were found to be positive. As for the location of cancer, there was a tendency for the positive rate to be high in the ascending and transverse colon. There was no obvious trend regarding Borrmann's classification, histological type, or macroscopic depth of invasion. There was a trend for cases in which the maximum diameter of the tumor was large and depth of invasion was in progress to be positive. Ten cases in which a specimen was resected were all shown to be positive by scintigraphy. Radioactivity in the tumorous regions was 4.41 +/- 2.96 times that of the non-tumorous regions. Moreover, tumorous tissue was strongly stained by the immuno-histological staining with anti-Tf.receptor antibody. From the above findings, it was considered that 111In transferrin is clinically useful in scintigraphy, since it is evident that it accumulates in the tissue of colorectal cancer.

The therapeutic effects on pneumatic dilatation were evaluated quantitatively by radionuclide transit study using 99mTc-Sn colloid in an achalasia patient. After dilatation, transit time (T3/4) with distilled water has improved from 13.5 seconds to 5.5 seconds. Radionuclide transit study using 99mTc-Sn colloid was a preferable method to evaluate the efficacy of the treatment quantitatively in an achalasia.