Comparison of gastrointestinal symptoms and psychological factors of functional dyspepsia to peptic ulcer or panic disorder patients.

UNLABELLED: Symptoms of functional dyspepsia (FD) may look like those of peptic ulcers or panic disorders. But, there is no comparative data between the symptoms of peptic ulcers or panic disorders. METHODS: To evaluate general symptoms, we used the previously validated questionnaires: 1. the Gastrointestinal Symptom Rating Scale (GSRS), 2. the Self-Rating Depression Scale (SDS), 3. the State-Trait Anxiety Inventory (STAI), and 4. the Coping Inventory for Stressful Situations (CISS). Ninety-six patients with FD (ulcer-like, dysmotility-like, and nonspecific: 28.1 %, 41.7 %, and 30.2 %) diagnosed according to the Rome II criteria, 24 peptic ulcer patients, 21 panic disorders, and 50 healthy controls were enrolled in this study. RESULTS: Total GSRS score of FD was higher than controls (12.8 +/- 1.2 vs. 5.9 +/- 0.7), and similar to peptic ulcers. Ratio over than a cut-off SDS score of FD was higher than controls (28 % vs. 11 %), although it was lower than panic disorders (65 %). Ratios over than cut-off scores of state- and trait-anxiety of FD were higher than controls (74 % and 62 % vs. 50 % and 36 %) and tended to be higher than peptic ulcers. Positive ratio of state-anxiety scores of FD was similar to panic disorders. As these scores increased, morbidity rate of FD (FD/FD+control) increased (P for trend <0.01). Among CISS scores, task-oriented coping scores of FD tended to be low compared to controls, but emotion-oriented coping scores of FD and controls were significantly lower than panic disorders. CONCLUSION: Severity of gastrointestinal symptoms but not anxiety of FD was similar to peptic ulcers. Psychological scales of FD were also similar to panic disorders except for the emotion-oriented coping. These findings suggested that the complicated pathogenesis of FD was similar to but not completely consistent with peptic ulcers or panic disorders.

Relationship between perfectionism, personality disorders and agoraphobia in patients with panic disorder.

OBJECTIVE: In earlier reports, we found that perfectionism might be involved in the development and/or maintenance of agoraphobia in panic disorder. The present report extends this work by examining the relationship between perfectionism and comorbidity with personality disorders in panic disorder patients with agoraphobia (PDA) and those without agoraphobia (PD). METHOD: We examined comorbidity of personality disorders by Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and assessed perfectionism using multidimensional perfectionism scale in 56 PDA and 42 PD patients. RESULTS: The PDA group met criteria for at least one personality disorder significantly more often than the PD group. With stepwise regression analyses, avoidant and obsessive-compulsive personality disorders emerged as significant indicators of perfectionism in patients with panic disorder. CONCLUSION: These findings suggest that perfectionism in panic disorder patients may be more common in those with comorbid personality disorders, and may be an important target for preventive and therapeutic efforts.

The influence of the peripheral reflection wave on left ventricular hypertrophy in patients with essential hypertension.

The objective of this study was to clarify the relationship between afterload, which consists mainly of the vascular reflection wave, and left ventricular hypertrophy in patients with untreated essential hypertension using the fingertip photoplethysmogram (PTG) and second derivative wave (SDPTG) methods, the simplest and most convenient tools for pulse wave analysis. The augmentation index (AI) is defined as the ratio of the height of the late systolic peak, augmented by the peripheral reflection wave, to that of the early systolic peak caused mainly by left ventricular ejection in the pulse. Increased AI of the PTG and negative d/a, obtained by multiplying the ratio of the late re-decreasing wave (d wave) to the initial positive wave (a wave) of the SDPTG by -1, have the same meaning as increased ascending aortic AI. The left brachial artery blood pressure was measured in 60 patients. The PTG and SDPTG of the right second finger were recorded by a digital photoplethysmograph. The left ventricular mass index (LVMI) was investigated by ultrasonography. Subjects were assigned to one of two groups: a low AI (AI of PTG<1.6; group 1) or a high AI (AI of PTG> or =1.6; group 2) group. LVMI was significantly higher in group 2 than in group 1. In the study group as a whole, the LVMI was positively correlated with both the AI of PTG (r=0.60, p<0.0001) and negative d/a (r=0.63, p<0.0001). An increase in the LVMI was seen in subjects with an augmented late systolic component in the waveform. It was concluded that an increase in the peripheral reflection wave on the left ventricle is one of the important factors causing cardiac hypertrophy in patients with hypertension.

Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity.

Several studies have noted that multi-impulsive bulimia nervosa tends to be refractory to treatment. However, it is not known whether these impulsivities are an expression of more fundamental psychopathology or simply the consequence of chaotic eating behaviors. Studies of the temporal relationship between the onset of eating disorder and the occurrence of impulsive behaviors will facilitate a better understanding of these issues. Subjects consisted of 60 patients with anorexia nervosa restricting type (AN-R), 62 patients with anorexia nervosa binge-eating/purging type (AN-BP), 114 patients with bulimia nervosa purging type (BN) and 66 control subjects. Impulsive behaviors and childhood traumatic experiences were assessed by self-report questionnaire. Multi-impulsivity (defined by at least three of the following: heavy regular alcohol drinking; suicide attempt; self-mutilation; repeated shoplifting of items other than food; sexual relationships with persons not well known to the subject) was found in 2% of AN-R, 11% of AN-BP, 18% of BN and 2% of control subjects. Eighty percent of BN patients with multi-impulsivity had a history of suicide attempts or self-mutilation history prior to the onset of bulimia nervosa. In BN patients, there tended to be a relationship between childhood parental loss or borderline personality disorder and multi-impulsivity. In conclusion, primary impulsivity (chronological prior occurrence of impulsive behaviors) does exist even in a very different culture, although the number of patients of this type is very limited.

Stress coping strategy in Japanese patients with eating disorders: relationship with bulimic and impulsive behaviors.

Although maladaptive coping strategies in eating disorder patients have been reported, the relationship between impulsivity and coping strategy has not previously been studied. Subjects consisted of 43 patients with anorexia nervosa restricting type (AN-R), 42 patients with anorexia nervosa binge eating/purging type (AN-BP), 71 patients with bulimia nervosa purging type (BN), and 97 controls. The Coping Inventory for Stressful Situations was used to evaluate coping strategies. Only AN-BP patients had a significantly lower task oriented-coping score than controls, and AN-R and BN patient groups used significantly less social diversion-avoidance coping strategies than controls. Emotion-oriented coping scores of AN-BP and BN patients were significantly higher than those of controls. In addition, impulsive BN patients had significantly higher emotional coping scores than less impulsive BN patients. These results suggest that maladaptive coping strategies may be a perpetuating factor even for impulsive patients and emphasizing a change in maladaptive coping strategies may be a useful treatment strategy even for highly impulsive patients.

Second derivative of photoplethysmogram in children and young people.

The characteristics of the second derivative of the photoplethysmogram (SDPTG) were clarified in children and young people, and the factors affecting the SDPTG wave pattern were examined. The study group comprised 775 healthy subjects aged 3-20 years (mean, 10+/-5). The blood pressure of the left brachial artery was determined in the resting sitting position and then the fingertip PTG and the SDPTG were automatically measured using a digital photoplethysmograph, with the sensor located at the cuticle of the second digit of the right hand. The values used were the b/a, c/a, d/a, and e/a ratios, and the SDPTG aging index (SDPTG-AI). With increasing age, the systolic blood pressure and height increased (r = 0.52, 0.92). Aging decreased the b/a ratio and SDPTG-AI (r = -0.58, -0.67) and increased the c/a and e/a ratios (r = 0.42 and 0.42). There was no significant correlation between blood pressure and indices of SDPTG. As height increased, the b/a ratio and SDPTG-AI decreased (r = -0.57, -0.71), whereas the c/a and e/a ratios increased (r = 0.42 and 0.46). In males the SDPTG-AI decreased with age from 3 to 18 years and then increased, and in females it decreased with age from 3 to 15 years and then increased. Overall, the SDPTG-AI decreased with age between 3 and 18 years and then increased, forming a J curve. In the children's and young people's SDPTG, the b/a and SDPTG-AI decreased and the c/a and e/a ratios increased with age. The length of the vascular system and the inner diameter and wall thickness of vessels may modify the SDPTG wave pattern in the growth period. Thereafter, as the effects of these factors decrease, the increase in intravascular pressure and decreasing wall elasticity due to aging may affect the wave pattern.

History of childhood sexual or physical abuse in Japanese patients with eating disorders: relationship with dissociation and impulsive behaviours.

BACKGROUND: Empirical data regarding prevalence of sexual and physical abuse histories in Japanese patients with eating disorders is lacking, in contrast to Western countries. This study investigated the prevalence of traumatic events in Japanese patients with eating disorders, and examined the relationship between such traumatic events and clinical features. METHODS: Subjects consisted of 33 patients with anorexia nervosa restricting type (RAN), 40 patients with anorexia nervosa binge eating/purging type (AN-BP), 63 patients with bulimia nervosa purging type (BN) and 99 healthy controls. All were female and diagnoses were based on DSM-IV. The Physical and Sexual Abuse Questionnaire (PSA), Eating Disorder Inventory (EDI) and Dissociation Experience Scale (DES) were administered to all of the subjects. RESULTS: Paradoxically, victims of minor sexual abuse committed by Chikan (a Japanese word indicating a person who commits minor sexual crimes) were more prevalent among controls than among patients with RAN, AN-BP or BN. However, physical punishment histories tended to be more prevalent among patients with AN-BP or BN than among RAN or controls. Only AN-BP and BN patients with physical punishment histories had twofold higher scores for DES and significantly more frequent histories of self-mutilation (67% v. 33%) compared with patients without such histories. CONCLUSION: An abuse history is not essential or a prerequisite to developing an eating disorder in Japan.

Altered body fat distribution after recovery of weight in patients with anorexia nervosa.

OBJECTIVE: This study investigated the changes in regional body composition such as bone mineral content, lean body mass, and fat mass in patients with anorexia nervosa before and after weight gain. METHODS: Body composition was measured before and after weight gain by dual photon absorptiometry in 21 female patients who met the DSM-III-R criteria. RESULTS: Soft mass of the pelvis, trunk, and upper and lower extremities in patients with anorexia nervosa was remarkably reduced to less than 70% of standard body weight. After restoring normal weight, soft mass of the pelvis and trunk increased remarkably and reached the levels of controls, but the soft mass in the upper and lower extremities remained below the control level. As a result, patients with anorexia nervosa demonstrated central obesity after weight recovery. DISCUSSION: We briefly discussed the cause of the altered fat distribution, such as central obesity, in patients with anorexia nervosa after weight recovery.

Capacity to produce cytokines during weight restoration in patients with anorexia nervosa.

OBJECTIVE: Anorexic patients are surprisingly free of infectious complications despite their seriously undernourished state. To study this phenomenon, we longitudinally measured the capacity to produce cytokines in restricting-type anorexic patients. METHODS: Lymphoproliferative responses with phytohemagglutinin (PHA) and the capacity of whole blood to produce cytokines, such as interleukin-1 (IL-1), IL-6, tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and granulocyte-colony stimulating factor (G-CSF), were longitudinally measured before and after weight gain, that is, at admission and at less than 60, 65, and 75% of standard body weight (SBW), in 17 patients with restricting-type anorexia nervosa and in 17 control subjects. RESULTS: Cytokine production of IL-1, IL-6, and TNF-alpha per monocyte in the anorexic patients recovered only with the start of refeeding, whereas IFN-gamma production per lymphocyte was similar to that in control subjects and did not change during weight restoration. Only G-CSF production, even at 75% SBW, did not improve during weight restoration. Between the weight at admission and 65% SBW, the increase in the percentage of SBW and improvement of the total protein level were significantly correlated with improvement of the lymphocyte proliferative response with PHA. CONCLUSIONS: The capacity to produce most cytokines recovered with the start of weight gain; however, recovery was not correlated with weight gain. The results suggest that the capacity to produce cytokines in these anorexic patients was dependent on something other than the absolute value of body weight, such as the start of refeeding, the neuroendocrine system, or the autonomic nervous system.

The influence of changes in loading patterns on left ventricular relaxation in humans.

This clinical investigation was designed to determine the effect of changes in loading patterns on left ventricular (LV) relaxation when heart rate was maintained constant. Not only were changes noted in total load or time in which load is changed, but also the contour of the ascending aortic systolic pressure wave. Twenty patients were studied. LV and ascending aortic pressure were measured by a multisensor catheter under baseline conditions (C) and after an intravenous injection of 2.5 microg angiotensin (A) and sublingual administration of 0.3 mg nitroglycerin (N). A bipolar pacing catheter was placed in the right atrium to maintain a constant heart rate throughout the protocol. The augmentation index (AI), which characterizes the contour of the ascending aortic systolic pressure wave, was defined as the ratio of the height of the late systolic shoulder/peak to that of the early systolic shoulder/peak in the pulse. The rate of isovolumic LV pressure decline was calculated as a time constant (Tau). Ascending aortic systolic pressures (mmHg) were 127+/-29 (C), 158+/-20 (A) and 109+/-15 (N). AI were 1.61+/-1.14 (C), 2.08+/-1.11 (A) and 1.27+/-1.14 (N). Tau values (msec) were 49+/-4 (C), 54+/-4 (A) and 45+/-5 (N). Tau was prolonged proportionally with increasing AI (p<0.001, r=0.64). It was concluded that late systolic pressure augmentation in the ascending aorta is one important factor that influences the rate of isovolumic left ventricular pressure decline in humans.

[Minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass: a case report].

A new coronary artery bypass grafting of the left anterior descending coronary arteries (LAD) with in situ internal thoracic artery (ITA) bypass grafts through a limited anterior thoracotomy was performed in a 70-year-old [correction of 60] patient. The left ITA-LAD anastomosis was completed without cardiopulmonary bypass and postoperative angiography showed a patent anastomosis. With this minimally invasive approach, the procedure should provide the benefits of ITA grafting with rapid recovery short hospital stay without complication associated with cardiopulmonary bypass in selected cases.

Effects of weight gain and resumption of menses on reduced bone density in patients with anorexia nervosa.

The bone mineral density (BMD) of the lumbar vertebrae (L2-L4) and of the whole body were measured in cross-sectional and longitudinal studies in female patients with eating disorders, using dual photon absorptiometry before and after weight gain with or without resumption of menses. In the cross-sectional study, the low-body-weight anorectic patients, with or without bulimia nervosa, were found to have lower BMD of the lumbar vertebrae associated with severe weight loss, low physical activity, and earlier onset and longer duration of amenorrhea. In the longitudinal study, 11 patients attained subnormal body weight (70%SBW < or = approximately < 85% SBW), 10 patients attained normal body weight (> or = 85%SBW, 6 patients of them resumed regular menses) after treatment. The BMD of the lumbar vertebrae was found to increase with weight gain, but not to the control level. The BMD was further increased with the resumption of menses in patients with anorexia nervosa. These results suggest that resumption of menses, in addition to weight gain, is essential to normalize reduced bone mineral density.

[Intravascular ultrasound assessment at the site of balloon angioplasty: comparison with quantitative coronary angiography].

The effect of coronary angioplasty is usually evaluated on the basis of coronary angiography. However, angiographic images taken after angioplasty vary and the angiographic assessment of the therapeutic success of angioplasty is limited by local disruptions and dissections at the site of the dilatation, which are often difficult to detect by angiography. Intravascular ultrasound imaging is a new method for evaluation of coronary dimensions and wall morphology. Quantitative coronary angiographic analysis was compared with intravascular ultrasound assessment after balloon angioplasty in 42 patients. A diagnostic ultrasound imaging catheter was used during percutaneous transluminal coronary angioplasty (PTCA) to image both the lesion and the vessel segment just proximal (reference segment). Correlation between angiographic and ultrasound findings of vessel diameters and areas at reference segments was closer (r = 0.78, 0.66) than at the sites of PTCA (r = 0.54, 0.36). Dilated sites were analyzed in two subgroups segregated by degree of lumen eccentricity. An eccentric vessel lumen, defined as a circular shape factor of less than 0.92, was present at 25 of 42 sites. The correlation between angiographic and ultrasonic cross sectional area was not as close for these eccentric segments (r = 0.37). The difference in luminal areas between eccentric lumens estimated by edge detection and densitometry methods was 0.93 +/- 0.3 mm2, significantly greater than 0.54 +/- 0.31 mm2 in the circular group (p < 0.01). Luminal area after balloon angioplasty is clinically important to confirm by intravascular ultrasound especially in patients with large differences in measured values by quantitative coronary angiography.

[Pulse wave velocity, thermography in the diagnosis of arteriosclerosis].

1. Pulse wave velocity (PWV) increased with increasing organic stiffness of the arterial wall mainly caused by arterio-sclerosis and also increasing functional stiffness of the arterial wall mainly caused by elevation of blood pressure. Age related changes in PWV have been recognized in variable countries. The PWV in the ascending aorta calculated by the characteristic impedance (378 +/- 141 cm/sec) was lower than that of conventional measurement in the descending aorta (697 +/- 144 cm/sec). 2. Thermography provide us indirect information of arteriosclerosis through reduction of skin temperature caused by disturbance of blood flow.

Reduced bone density and major hormones regulating calcium metabolism in anorexia nervosa.

Bone density of lumbar vertebrae (L2 to L4) and the whole body in 29 patients with anorexia nervosa were measured by dual photon absorptiometry, and the results were compared with those of 10 age-matched normal controls. The patients had significantly lower bone mineral density (BMD) in L3 and L2-4 than controls. However, there was no difference in whole-body BMD. L3 and L2-4 BMD was positively correlated with body weight and was negatively correlated with duration of illness and amenorrhea. Patients who had been more active 6 months before the time of the study had significantly higher L3 BMD than the less active patients. Most patients had an abnormally low serum estrogen level, whereas the mean serum levels of thyroid hormone (T3, T4), cortisol, calcitonin, parathyroid hormone and vitamin D were within the normal range. No correlation was found between L3 or L2-4 BMD and the levels of these hormones. These results suggest that severe weight loss, low physical activity, longer duration of amenorrhea and deficiency of estrogen contribute to bone loss in patients with anorexia nervosa, whereas calcium-regulating hormones such as parathyroid hormone, calcitonin and vitamin D are unlikely to be a primary contributor to bone loss.

Immunization of the elderly and patients with collagen vascular diseases with live varicella vaccine and use of varicella skin antigen.

Elderly subjects and patients with collagen vascular diseases were immunized with a live varicella vaccine to assess the vaccine's potential for preventing herpes zoster. An improved varicella-zoster virus (VZV) skin test antigen was then used to assess cell-mediated immunity to VZV. The antigen was prepared from culture fluid of VZV-infected cells and had far less protein content than crude antigen prepared by sonication of infected cells. In 11 of 12 patients with ophthalmic zoster and 17 of 21 with dermal zoster, the skin reaction was negative at the beginning of the disease but became positive later. After two doses of VZV vaccine, 8 of 12 elderly subjects (greater than 60 years old) and 4 of 6 patients with collagen vascular diseases, who were VZV-skin test negative but purified protein derivative tuberculin test-positive, became VZV skin test-positive.