Performance of the Japanese version of the Patient Health Questionnaire-9 (J-PHQ-9) for depression in primary care.

OBJECTIVE: To assess the performance of the Japanese version of the Patient Health Questionnaire-9 (J-PHQ-9) for depression in primary care. METHODS: Participants in both phases completed the J-PHQ-9, while patients in the second phase also completed the SF-8 (the short form for the health-related QOL scale SF-36). Subjects (n = 284; male = 107, female = 177) had to return the questionnaires to their health care professional within 48 hours and undergo a diagnostic evaluation interview based on the Japanese version of M.I.N.I-Plus. RESULTS: 93 patients were diagnosed as having major depressive disorder (MDD). In the J-PHQ-9, the optimal cutpoint ≥ 10 had sensitivity of 90.5% and specificity of 76.6%. As for the categorical algorithms, the sensitivity was 80.6%; specificity was 89.5%, and a positive likelihood ratio of 7.7. The Stratum-specific likelihood ratios (SSLRs) of the J-PHQ-9 scores of 0-9, 10-14, 15-19, and 20-27 for major depression were 0.10 (95% CI: 0.05-0.20), 1.67 (95% CI: 1.02-2.76), 5.41 (95% CI: 2.87-10.22), and 11.98 (95% CI: 5.39-26.63), respectively. The relationship between the severity of J-PHQ-9 and the MCS of SF-8 was significant (χ 2 ＝ 85.72, df = 4, P ≤ 0.0001). CONCLUSIONS: This study has validated the J-PHQ-9 as a useful tool for the assessment of MDD in primary care in Japan.

A Cluster Analysis of Bronchial Asthma Patients with Depressive Symptoms.

Objective Whether or not depression affects the control or severity of asthma is unclear. We performed a cluster analysis of asthma patients with depressive symptoms to clarify their characteristics. Methods Multiple medical institutions in Niigata Prefecture, Japan, were surveyed in 2014. We recorded the age, disease duration, body mass index (BMI), medications, and surveyed asthma control status and severity, as well as depressive symptoms and adherence to treatment using questionnaires. A hierarchical cluster analysis was performed on the group of patients assessed as having depression. Results Of 2,273 patients, 128 were assessed as being positive for depressive symptoms [DS(+)]. Thirty-three were excluded because of missing data, and the remaining 95 DS[+] patients were classified into 3 clusters (A, B, and C). The patients in cluster A (n=19) were elderly, had severe, poorly controlled asthma, and demonstrated possible adherence barriers; those in cluster B (n=26) were elderly with a low BMI and had no significant adherence barriers but had severe, poorly controlled asthma; and those in cluster C (n=50) were younger, with a high BMI, no significant adherence barriers, well-controlled asthma, and few were severely affected. The scores for depressive symptoms were not significantly different between clusters. Conclusion About half of the patients in the DS[+] group had severe, poorly controlled asthma, and these clusters were able to be distinguished by their Adherence Starts with Knowledge (ASK)-12 score, which reflects adherence barriers. The control status and severity of asthma may also be related to the age, disease duration, and BMI in the DS[+] group.

[A case of IgG4-related disease with marked thickening of the bronchial wall].

A 52-year-old man noticed hardening and swelling of his salivary glands in the summer of 2009. We suspected Mikulicz disease and performed several work-ups. His serum IgG4 level was elevated, and a chest computed tomography scan demonstrated marked thickening of the bronchial wall. A histopathologic examination of a bronchial mucosa biopsy specimen revealed diffuse infiltration of IgG4-positive cells in the submucosal layers, and on this basis we diagnosed IgG4-related disease. After the administration of corticosteroids, the patient's symptoms, his serum IgG4 level and bronchial wall thickening all improved. When encountering a patient with thickening of the bronchial wall, IgG4-related disease should be considered.

[A case of primary effusion lymphoma effectively treated by oral corticosteroid therapy].

Primary effusion lymphoma is a rare type of lymphoma which is confined to those body cavities associated with human herpes virus 8 infection in its development. We describe a 93-year-old man with primary effusion lymphoma in the pleura, but who was negative for herpes virus 8 infection. Chest computed tomography revealed bilateral pleural effusion, but did not show any evidence of a tumor mass or lymph node enlargement. Cytological analysis of his pleural effusion revealed atypical lymphoid cells with immunophenotypes which were positive for CD10, CD19 and CD20. Clonal rearrangement of the immunoglobulin-heavy chain gene was detected by Southern blot analysis, and a diagnosis of primary effusion lymphoma was made. Although dyspnea and severe hypoxia developed, accompanied with increased pleural effusion, chemotherapy was not indicated because of his age. We thus tried oral corticosteroid therapy for palliation which resulted in a dramatic, long-term decrease of his pleural effusion. We present a rare case of primary effusion lymphoma effectively controlled by corticosteroid therapy.

[A case of mesalazine-induced lung injury improved by only discontinuation of mesalazine].

We reported a case of drug-induced lung injury associated with mesalazine. A 50-year-old woman was diagnosed as having ulcerative colitis and treated with mesalazine. After administration for 1 month, the patient developed dry cough, fever and bilateral pulmonary infiltrates. A bronchoalveolar lavage showed 6.5 x 10(5) cells/ml, with 58% lymphocytes and 20% eosinophils. Improvement in clinical symptoms and radiological abnormalities occurred spontaneously after discontinuation of mesalazine. Even though the signs and symptoms of mesalazine-induced lung injury are similar to those of the pulmonary involvement of inflammatory bowel disease, it is important to distinguish them differences.

[Case of acute eosinophilic pneumonia probably induced by minocycline].

We reported a case of acute eosinophilic pneumonia (AEP) induced by minocycline. A 55-year-old man presented with a low grade fever and cough and was treated with antibiotics, including minocycline (MINO). During treatment, the patient developed symptoms of acute respiratory failure, and computed tomography (CT) scan showed bilateral ground grass opacities. Bronchoalveolar lavage (BAL) was performed. The percentage of eosinophils in the BAL fluid was elevated (66%). The patient was treated with methylprednisolone under a diagnosis of AEP. Immediately after initiation of therapy, the CT film findings and clinical symptoms improved. Although a drug-induced lymphocyte stimulation test for MINO was negative, we speculated that AEP was caused by MINO in this case.

[A case of refractory Wegener's granulomatosis successfully treated with high-dose methotrexate].

We report a case of generalized Wegener's granulomatosis (WG) successfully treated with high-dose methotrexate (MTX) and predonisolone (PSL). A 35 year-old men had complaints of auditory disturbance and nasal hemorrhage. Diagnosis of WG was made based on positive proteinase-3 anti-neutrophil cytoplasmic antibody (PR3-ANCA), lung nodules, and focal necrotizing glomerulonephritis revealed by renal biopsy. Treatment with cyclophosphamide (CY) and PSL for 3 months was ineffective for the lung nodules. Then, CY was changed to high dose MTX (18mg/week), and his lung lesions improved. In Japan, it is unusual to treat WG with high-dose MTX, but this treatment may be useful in CY-resistant WG.

[A case of primary Sjögren' s syndrome with pathological findings resembling multicentric Castleman' s disease showed multiple nodular opacities on chest CT scans].

A 49-year-old woman with primary Sjögren's syndrome a few years previously was admitted to our hospital complaining of tongue and skin eruptions, swelling of the face and neck and for examination of liver injury and hypereosinophilia. A blood test revealed leukocytosis with eosinophilia, mild liver injury, polyclonal hypergammaglobulinemia, and positive results for anti-nuclear antibody, anti-SS-A antibody and anti-SS-B antibody. Chest CT scan showed multiple nodular opacities with cavities in peripheral regions of both lungs. Biopsy specimens from the right lower lobe obtained by video-assisted thoracoscopy revealed marked infiltration of plasma cells and lymphocytes in alveolar lumina, lymph follicles with germinal centers in other areas of the pulmonary parenchyma, and lymphocytes infiltrate in alveolar wall adjacent bronchi and bronchioles. The histological diagnosis was pulmonary involvement of multicentric Castleman's disease. This was a rare case of Sjögren's syndrome accompanied by pathological findings of multicentric Castleman' s disease showed multiple nodular opacities in chest CT scans.

Ischemic symptoms induced by occlusion of the unilateral vertebral artery with head rotation together with contralateral vertebral artery dissection--case report.

We report a 45-year-old woman whose unilateral vertebral artery (VA) was potentially occluded with head rotation at the C1-C2 level and her ischemic symptoms suddenly appeared because of contralateral VA dissection. She noticed first pain around the posterior part of her neck on the right side, and then dizziness when turning the head to the right side. The dizziness disappeared immediately after her head returned to the natural position. Digital subtraction angiography (DSA) showed a string sign of the right VA. DSA and computed tomography angiography (CTA) showed high grade extrinsic compression of the left VA at the C1-C2 level with head rotation more than 90 degrees to the right. Three-dimensional (3D) CTA also showed clearly kinking of the left VA at the C2 neuroforamina. Her symptoms disappeared completely with conservative therapy, and recanalization of the right VA was also confirmed by 3D-CTA. 3D-CTA was thought to be valuable to diagnose and manage the rotational compression of the artery. VA dissection must be remembered to differentially diagnose the etiology of transient attacks of posterior circulation ischemia due to rotational contralateral VA occlusion.

A clinical and genetic study in a large cohort of patients with spinocerebellar ataxia type 6.

In order to clarify the clinical and genetic features of SCA6, we retrospectively analyzed 140 patients. We observed an inverse correlation between the age of onset and the length of the expanded allele, and also between the age of onset and the sum of CAG repeats in the normal and the expanded alleles. The ages of onset of four homozygous patients correlated better with the sum of CAG repeats in both alleles rather than with the expanded allele calculated from heterozygous SCA6 subjects. Clinically, unsteadiness of gait was the main initial symptom, followed by vertigo and oscillopsia, and cerebellar signs were detected in nearly 100% of the patients. In contrast, extracerebellar signs were relatively mild and infrequent. The results of neuro-otological examination performed in 22 patients suggested the purely cerebellar abnormalities of ocular movements in nature. There was a close relationship between downbeat positioning nystagmus (DPN) and positioning vertigo, which became more common in the later stage. We conclude that total number of CAG repeat-units in both alleles is a good parameter for assessment of age of onset in SCA6 including homozygous patients. In addition, clinical and neuro-otological examinations suggested that SCA6 is a disease with predominantly cerebellar dysfunction.

[Cortical control of saccadic eye movements: a clinical electrophysiological study of antisaccades].

An antisaccadic paradigm in which saccades are directed towards the mirror location opposite to that of target appearance has been thought to reflect frontal lobe function and a saccade-inhibitory mechanism. In order to clarify now the cortical mechanism differs between antisaccades (AS) and reflexive visually guided saccades (VS), we measured scalp EEG potentials preceding AS and VS in 9 young normal subjects, as well as the magnetic brain activities during AS and VS in 1 of them. Prior to the right and left saccades in both paradigms, our measurements revealed the appearance of a slowly developing negative potential, the presaccadic negativity (PSN), and then a steeper negative potential, the presaccadic steep negativity (PSSN). The onset of PSSN was significantly earlier and the maximum amplitude of PSSN was significantly greater in AS than in VS. The peak amplitude of PSSN at each middle electrode (Fz, Cz, Pz) was generally greater in AS than in VS in both directions of saccades. In one normal subject, the difference between AS and VS in the magnetic field distribution just prior to saccades in both directions was demonstrated as current dipoles on the bilateral frontal areas. Our results suggest that the activation of the bilateral frontal lobes is greater prior to AS than it is prior to VS.

Dentatorubropallidoluysian atrophy with chronic renal failure in a Japanese family.

We describe a Japanese family with molecularly confirmed DRPLA associated with chronic renal failure of unclear etiology on hemodialysis. The clinical symptoms and laboratory data show that the renal failure in our DRPLA patients is not associated with known familial renal diseases. Thus, we suggest a possible unifying hypothesis that the coexistence of DRPLA and chronic renal failure may be caused by the same etiology.