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症例は77歳，女性．2005年8月5日，左腎細胞癌で腎摘出術を施行された．腎摘出術前の腹部CTで肝左葉外側区域に10mm大の肝嚢胞性病変を指摘されていた．腎摘出術後，その嚢胞性病変が次第に増大し，嚢胞壁に壁在結節，隔壁の形成を認めたために，腎細胞癌の嚢胞性肝転移を強く疑い，2006年6月12日に肝外側区域部分切除術を施行した．組織病理診断では腎細胞癌の肝転移であった．手術後8カ月後のCTでは肝に新たな嚢胞性転移が多数認められた．悪性腫瘍の嚢胞性肝転移は比較的稀であり，機序は不明である．そのなかでも，嚢胞性肝転移に対して手術を行った報告は稀である．また，診断時と再発時のCT検査で一見すると単純肝嚢胞に類似した興味深い画像所見を呈していたので，文献的考察を加え報告する．

症例は62歳，男性．既往歴として1年前に胸部食道癌で開胸開腹の手術歴がある．某年11月8日腹痛を主訴として当院を受診した．腹部CTでは大腸の拡張像を認め，腸閉塞の診断で入院となった．イレウス管を挿入し保存的加療を行ったが，入院後6日目より腹満の増悪，発熱，呼吸困難を認め，胸腹部CTを行ったところ，左気胸，横行結腸の左胸腔内への脱出を認め，胸腔内での大腸穿孔と診断し，緊急手術を行った．食道裂孔より胸腔内に横行結腸が約40cm脱出し，虚血性壊死により2カ所で穿孔していた．脱出した横行結腸を切除し，人工肛門造設，開胸開腹ドレナージ術を行った．術後はエンドトキシン吸着，人工呼吸器管理を行った．術後膿胸の加療を必要としたが，術後98病日に退院することができた．食道切除後に胸腔内で大腸穿孔をきたした症例は稀である．胸腔内での大腸穿孔例について若干の文献的考察を加えて報告する．

The objective of this study was to elucidate the relationship between the effects of donepezil hydrochloride (donepezil) and cerebral blood flow, and to evaluate the usefulness of cerebral blood flow imaging in assessing and predicting treatment effectiveness.The subjects were 29 outpatients (12 men and 17 women; age 50-82 years; mean age 69.2 years), who had received a diagnosis of Alzheimer's disease (AD). Efficacy was evaluated before donepezil administration; after 1 month, 3 months, and 6 months of drug administration; and at 1 year after completion of administration using the Japanese version of the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog), as a measure of cognitive function. The ADAS-cog has been frequently used to evaluate cognitive function in AD patients. Patients whose ADAS-cog scores improved by 3 or more points during the observation period were classified as responders, and those with no improvement were classified as nonresponders. (123)I-IMP was used for single photon emission computed tomography cerebral blood flow scintigraphy.On the basis of ADAS-cog score improvement, 22 of the 29 patients were responders (7 men and 15 women; age 50-82 years; mean age 69.0 years) and seven were nonresponders (5 men and 2 women; age 61-80 years; mean age 70.0 years). The results indicate that a difference in cerebral blood flow responsiveness after 1 month of treatment distinguishes responders from nonresponders. After 1 month, blood flow was significantly decreased in all regions of nonresponders, whereas significant increases in blood flow were seen in the anterior frontal lobe and parietal lobe of responders. At that time point, blood flow in the basal ganglion differed significantly between the two groups, indicating that this difference in responsiveness after 1 month of treatment may distinguish responders from nonresponders.In cognitive function testing, the group that exhibited a complete response showed improvement primarily in parameters reflecting frontal lobe function. Complete responders also showed significantly greater blood flow increases in the basal ganglion and thalamus early during the treatment period. This indicates that the drug responsiveness of the basal ganglion and thalamus affects frontal lobe function and distinguishes complete responders from patients who do not exhibit such a response.

There are inconsistent reports regarding the caudate nucleus volume in patients with schizophrenia compared with healthy subjects. The reason for this is that neuroleptic medication may affect the volume of the caudate nucleus in schizophrenic patients. To clarify which antipsychotic medication changes the volume of the caudate nucleus in patients with schizophrenia, we measured the volumes of grey and white matter in the caudate nucleus of schizophrenic patients. Ten patients with schizophrenia were examined twice by magnetic resonance imaging (MRI) to measure the grey and white matter volumes in the caudate nucleus. After the first MRI examination, all the patients were treated with olanzapine. The clinical responses were evaluated by the positive and negative rating scale. When the symptoms improved, the patients were examined by a second MRI scan. Ten healthy control subjects also underwent MRI. The schizophrenic patients had reduced volumes of grey and white matter in the caudate nucleus compared to the healthy control subjects. The volumes of grey and white matter in the caudate nucleus of the schizophrenic patients increased after treatment with olanzapine. These findings suggest that treatment with olanzapine may increase the grey and white matter volumes in the caudate nucleus in patients with schizophrenia.

Disconnection in the frontal-thalamic-cerebellar circuit is thought to be associated with cognitive abnormality in patients with schizophrenia. The superior cerebellar peduncle is involved in neural connectivity in the circuit. Because diffusion tensor imaging (DTI) can detect neural disconnection, we investigated whether there was neural disruption in the superior cerebellar peduncle in patients with schizophrenia. DTI was performed in 21 schizophrenic subjects and 21 age- and sex-matched healthy subjects. Cognitive cluster scores were attained by using the Positive and Negative Syndrome Scale (PANSS). Schizophrenic subjects had significantly lower fractional anisotropy (FA) in the right and left superior cerebellar peduncles than healthy subjects. Higher FA in the left superior cerebellar peduncle was associated with worse cognitive function in patients with schizophrenia. These findings suggest that there is neural disruption in the superior cerebellar peduncle in patients with schizophrenia, which may be involved in the cognitive abnormalities found in schizophrenia.

Recent evidence from neuroimaging studies suggests that neural dysfunction is involved in the pathophysiology of schizophrenia. Diffusion tensor imaging (DTI) is a technique that has the potential to detect subtle disruptions of neural connectivity. Fractional anisotropy (FA), which is measured by DTI, is a measure of the directionality of diffusion anisotropy. Decrease in FA indicates abnormalities of white matter due to increased water diffusion accompanied by an increase in extracellular space. In the literature, previous studies reported that patients with schizophrenia showed widespread lower FA in the white matter. These findings suggest that patients with schizophrenia have microstructural lesions in the cerebral white matter. We used DTI to determine whether neural connectivity was disturbed in the middle cerebellar peduncles in schizophrenic subjects. We found a significant FA reduction in the middle cerebellar peduncle in patients with schizophrenia. Therefore, neural disconnectivity between the cerebellum and cerebrum was considered present in patients with schizophrenia and may be involved in the pathology of schizophrenia. This review provides current findings regarding DTI study on the cerebellar peduncle in patients with schizophrenia.

To examine volumetric abnormality, the caudate nucleus was measured in patients with schizophrenia and healthy subjects using magnetic resonance imaging. The absolute and relative volumes of white matter in the caudate nucleus were found to be significantly smaller in patients with schizophrenia compared to those in healthy subjects. There were significant correlations between dosages of neuroleptics during the previous year and absolute gray matter volumes of the caudate nucleus as well as relative white matter volumes in patients with schizophrenia. These findings suggest that reduced white matter volume of the caudate nucleus may be a factor affecting the abnormal connectivity of the corticostriatal loop, and that neuroleptic medication would be related to white matter alteration in patients with schizophrenia. Our result replicates a previous study reporting that there is a lack of negative correlation between age and caudate nucleus volume. We also suggest that the disease process of schizophrenia might interfere with normal aging.

Diffusion tensor imaging (DTI) was used to investigate subtle disruption in the middle cerebellar peduncles in patients with schizophrenia. Fractional anisotropy (FA) was measured in 25 patients with schizophrenia and 21 healthy subjects using DTI. The FA of the right and left middle cerebellar peduncles was significantly lower in the schizophrenic patients compared to healthy subjects. FA in the left middle cerebellar peduncles was significantly correlated with the dosage of neuroleptics in patients with schizophrenia. There were no significant differences of mean diffusivity in the right and left middle cerebellar peduncles between patients with schizophrenia and healthy subjects. The findings of the study suggest that antipsychotics may improve the subtle disruption in the middle cerebellar peduncles in patients with schizophrenia.

To establish an early diagnosis of Alzheimer’s disease (AD), we evaluated brain spatial dynamics and cognitive function in mild AD. Seventeen patients with the diagnosis of mild AD and 17 age-matched controls were examined for Ω (global complexity), Σ (total power) and Φ (generalized frequency) by 19-channel electroencephalography (EEG). As a result, the mild AD group showed significantly higher Ω values than the control group. The Φ values were highly correlated with the Mini-Mental State Examination scores and the full IQ and performance IQ scores of the Japanese Wechsler Adult Intelligence Scale Revised. These results indicate an increase in spatial complexity of the brain electric field in mild AD, as well as a close relationship between slowing of the global frequency of field changes and the cognitive decline in mild AD.

Grey matter, white matter and cerebrospinal volume in the human brain were measured using magnetic resonance image analysis software BRAINS. Ten volunteers were scanned in the MR sequence (3D-SPGR; 1.5-mm slice thickness and T2 images; 3mm slice thickness). Two operators obtained ten volume measures of grey matter,white matter and cerebrospinal fluid (CSF) in the intracranial box, frontal box, temporal box, parietal box and occipital box. The same data set of ten scans was segmented and the volumes measured on a second occasion by one operator using the same procedure. The interoperator and intraoperator reliabilities for measures of the three brain tissues were very good, with reliability coefficients (intraclass correlation coefficients) ranging between 0.971 and 0.999. The segmentation and measurement are useful for volumetric studies in the human brain using BRAINS.

Single-photon emission tomography (SPET) and positron emission tomography (PET), when coupled to suitable radioligands, are uniquely powerful for investigating the status of neurotransmitter receptors in vivo. The serotonin subtype-4 (5-HT(4)) receptor has discrete and very similar distributions in rodent and primate brain. This receptor population may play a role in normal cognition and memory and is perhaps perturbed in some neuropsychiatric disorders. SB 207710 [(1-butyl-4-piperidinylmethyl)-8-amino-7-iodo-1,4-benzodioxan-5-carboxylate] is a selective high-affinity antagonist at 5-HT(4) receptors. We explored radioiodinated SB 207710 as a possible radioligand for imaging 5-HT(4) receptors in vivo. Rats were injected intravenously with iodine-125 labelled SB 207710, euthanised at known times and dissected to establish radioactivity content in brain tissues. Radioactivity entered brain but cleared rapidly and to a high extent from blood and plasma. Between 45 and 75 min after injection, the ratios of radioactivity concentration in each of 12 selected brain tissues to that in receptor-poor cerebellum correlated with previous measures of 5-HT(4) receptor density distribution in vitro. The highest ratio was about 3.4 in striatum. SB 207710 was labelled with iodine-123 by an iododestannylation procedure. A cynomolgus monkey was injected intravenously with [(123)I]SB 207710 and examined by SPET. Maximal whole brain uptake of radioactivity was 2.3% of the injected dose at 18 min after radioligand injection. Brain images acquired between 9 and 90 min showed high radioactivity uptake in 5-HT(4) receptor-rich regions, such as striatum, and low uptake in receptor-poor cerebellum. At 169 min the ratio of radioactivity concentration in striatum to that in cerebellum was 4.0. In a second SPET experiment, the cynomolgus monkey was pretreated with a selective 5-HT(4) receptor antagonist, SB 204070, at 20 min before [(123)I]SB 207710 injection. Radioactivity in all brain regions was reduced almost to the level in cerebellum by 176 min after radioligand injection. These findings show that [(123)I]SB 207710 is an effective radioligand for imaging brain 5-HT(4) receptors in vivo.

われわれは，外傷性胸部大動脈損傷の1例を経験したので報告する．症例は22歳，男性．作業中に1.5mの高さから転落し，当院救命救急センター搬入．レントゲン検査．CT検査にて，胸部大動脈損傷，肝損傷，下顎骨骨折，腰椎骨折，左大腿骨骨折，左脛骨骨折，左腓骨骨折の診断．肝損傷については保存的加療，多発骨折については，後日，観血的手術の方針とし，胸部大動脈損傷に対して緊急手術施行．大動脈は遠位弓部で損傷しており，周囲の血腫と胸腔内出血を認めた．胸部大動脈人工血管置換術を施行．術後経過は良好で，下顎骨骨折，腰椎骨折，左大腿骨骨折に対する手術を経たのち，119日目に軽快退院となった．

1-Azabicyclo[2.2.2]oct-3-yl alpha-hydroxy-alpha-(1-iodo-1-propen-3-yl)-alpha-phenylacetate (IQNP) is a muscarinic acetylcholine receptor (mAChR) antagonist and the racemic ligand contains eight stereoisomers. In a single-photon emission tomography (SPET) study in monkeys we recently confirmed that [123I]E-(R,R)-IQNP ([123I]E-IQNP) is a radioligand with modest selectivity for the M1 and M4 subtypes, whereas [123I]Z-(R,R)-IQNP ([123I]Z-IQNP) is non-subtype selective. In the present SPET study, E- and Z-IQNP were examined in human subjects. SPET examination was performed on three male subjects after i.v. injection of [123I]E-IQNP and in another three after i.v. injection of [123I]Z-IQNP. The binding potential (BP) for [123I]E-IQNP was calculated using several quantitative approaches with the cerebellum as a reference region. High-performance liquid chromatography was used to measure radioligand metabolism in plasma. Following [123I]E-IQNP, the radioactivity was high in the neocortex and striatum, intermediate in the thalamus and low in the pons and cerebellum, which is consistent with the rank order for the regional density of M1 and M4 subtypes in vitro. For all regions, peak equilibrium was identified within the 48-h data acquisition. The simplified reference tissue approach using SPET data from 0 to 48 h was the most reliable in this limited series of subjects. Following injection of [123I]Z-IQNP, radioactivity was high in the neocortex and striatum, intermediate in the thalamus and pons and low in the cerebellum, which is in agreement with the density of M1, M2 and M4 subtypes as measured in vitro. Quantitative analyses provided indirect support for specific M2 binding of Z-IQNP in the cerebellum. The high selectivity of [123I]E-IQNP for M1 and M4 receptors allowed the use of cerebellum as a reference region devoid of specific binding, and may be advantageous for applied clinical studies of M1 and M4 receptors binding in man. [123I]Z-IQNP has potential for exploration of M2 receptor binding in the cerebellum.

Rationale: The density of the M2 subtype of muscarinic acetylcholine receptors (mAChR) has been shown to be reduced in the brain of patients with Alzheimer’s disease (AD). It is therefore of interest to develop a brain imaging method for diagnostic purposes. Z-(R,R)-1-azabicyclo[2.2.2]oct-3-yl α-hydroxy-α-(1-iodo-1-propen-3-yl)-α-phenylacetate (Z-IQNP) is a muscarinic antagonist with high affinity for the M2 subtype. Objective: The pharmacological characteristics and topographic distribution of radiolabelled Z-IQNP as a radioligand for the M2 mAChR subtype were examined in vitro and in vivo. Methods: Z-IQNP was labelled with 125I and 123I. Autoradiography was performed on whole-hemisphere cryosections from human post mortem brains. SPECT was performed in a cynomolgus monkey. Results: Autoradiography showed binding of [125I]Z-IQNP in all brain regions, which was inhibited by the non-selective muscarinic antagonist scopolamine. The addition of BIBN 99, a compound with high affinity for the M2 subtype, inhibited [125I]Z-IQNP binding particularly in the cerebellum, which has a high density of the M2 subtype. SPECT demonstrated high uptake of [123I]Z-IQNP in all brain regions. The binding was markedly reduced in all brain regions after pretreatment with the non-selective muscarinic antagonist dexetimide and also the M1 antagonist biperiden. Dexetimide markedly inhibited [123I]Z-IQNP binding in the cerebellum, which is consistent with a high density of M2-receptors in this region. The sigma receptor binding compound DuP 734 had no effect on Z-IQNP binding either in vitro or in vivo. Conclusions: This study indicates that radiolabelled Z-IQNP has high specificity for mAChR with higher affinity for the M2 than the M1 subtype and negligible affinity for sigma recognition sites both in vitro and in vivo. [123I]Z-IQNP should be useful for future SPECT studies in AD for examination of the density of M2 receptors particularly in the cerebellum.

There is growing consensus that dementia caused by white matter alterations is called ‘white matter dementia’. Because the symptoms of adrenoleukodystrophy (ALD) are associated with diffuse white matter dysfunction, ALD is categorized as white matter dementia. Herein, we describe the case of a 47-year-old man affected by ALD whose symptoms first appeared a few years earlier in the form of deteriorating personality and memory disturbances, heralded by neurological symptoms. On neuroimaging, a discrepancy was found between magnetic resonance imaging and single photon emission computed tomography in the early stage of the disease process. We suggest that this discrepancy may be an important finding in the diagnosis of early stage white matter dementia.

Aortoesophageal fistula is a rare but fatal disease. Many such fistulas are caused by an aortic aneurysm, a previous operation, or esophageal disease. We report a case of aortoesophageal fistula due to an esophageal ulcer. A 66-year-old man suffered massive hematemesis; he was diagnosed as having an aortoesophageal fistula due to an esophageal ulcer after examination by upper endoscopy, computed tomography, and angiography. He had no aortic aneurysm, nor was there a history of a previous operation. An emergency operation was performed, but we could only accomplish closure because clamping of the aorta was impossible, and the source of the bleeding could not be established. He died 4 days later after sudden hemorrhage. Surgical outcome depends on early surgical intervention before massive hemorrhage occurs.

To prospectively examine microstructural white matter abnormalities in the corpus callosum (CC) of patients with obsessive-compulsive disorder (OCD), as compared with control subjects, and to investigate the relationship between diffusion-tensor (DT) imaging measures of the CC region and clinical symptoms of OCD.Institutional review board approval was obtained, and each participant--or the participant's parent(s)--provided written informed consent. Sixteen patients with OCD (seven male, nine female; mean age, 28.7 years +/- 9.8 [standard deviation]) and 16 matched healthy volunteers (control subjects) (seven male, nine female; mean age, 29.9 years +/- 9.0) were examined. Mean diffusivity and fractional anisotropy (FA) were measured in five subdivisions of the CC. The paired t test was performed to compare the mean diffusivity or the FA in CC regions between the patients with OCD and the control subjects.There were no significant differences (rostrum, P = .15; genu, P = .88; rostral body, P = .12; isthmus, P = .77; splenium, P = .88) in mean diffusivity between the patients with OCD and the healthy volunteers. A significant reduction in FA was observed in the rostrum of the CC in patients with OCD compared with the rostral FA in the control subjects (P.001). Higher FA in only the rostrum correlated significantly with lower Yale-Brown obsessive-compulsive scale score (r = -0.72, P = .002).Study results support the widely held view that the orbital prefrontal region is involved in the pathophysiology of OCD and indicate that the orbitofrontal circuit influences symptom severity in patients with OCD.

To explore brain functions in schizophrenic patients, the global analytic strategy of multichannel EEG was performed that combines measures of global complexity (Omega), total power (Sigma) and generalized frequency (Phi), and EEG microstate analysis was applied to multichannel EEG data for 24 nonmedicated patients and 24 healthy subjects. The patients had higher Omega and Sigma values, and lower Phi values compared with healthy subjects. Three topographical classes were obtained from all EEG data by EEG microstate analysis. The mean duration of one topographical class in the patients was shortened compared to healthy subjects. These results indicated looser cooperativity, or decreased connectivity of the active brain process and deviant brain information processing in schizophrenic patients.

In this study, we tested the influence of the serotonin type 2A, 3A and 3B receptor genes (HTR2A, HTR3A, HTR3B) in addition to a polymorphism in the promoter region of the serotonin transporter (SERTPR), and investigated the different characteristics of clinical responses to paroxetine and fluvoxamine. A total of 100 Japanese patients affected by major recurrent depression were enrolled in a randomized 6-week study. The clinical response was evaluated using the Hamilton Rating Scale for Depression (HAM-D), and adverse drug reactions were assessed at each visit. Patients with the l allele of SERTPR showed a better response to SSRIs than s/s genotype carriers (p = 0.015–0.042), more significantly to fluvoxamine. The –1438G/G genotype of HTR2A was associated with a good response to SSRIs (p = 0.010–0.039), especially to fluvoxamine, and significantly with severe nausea in paroxetine-treated patients (p = 0.013). The 178C/C genotype of the HTR3A was associated with an antidepressant response (p = 0.022–0.042), and more significantly in paroxetine-treated patients (p = 0.002–0.042). These effects were independent of one another. We replicated the finding that the SERPTR polymorphism was associated with a response to SSRIs. We additionally found that HTR2A and HTR3A polymorphisms are associated with the efficacy, and the HTR2A polymorphism is also associated with adverse drug reactions. Furthermore, the effects of these polymorphisms varied from one SSRI to another and thus may depend on the characteristics of each SSRI.

Objectives: To investigate the disruption of neural circuits in the frontal lobes and limbic structures in late-life depressed patients compared with healthy controls, and to examine the correlation between the degree of microstructural abnormalities of white matter and clinical symptom severity in late-life depression. Methods: Thirteen patients with late-life depression and matched control subjects underwent diffusion tensor imaging. Fractional anisotropy (FA), an index of the integrity of white matter tracts, was determined in the white matter of frontal, temporal, and occipital brain regions and the corpus callosum. Results: A significant reduction was found in white matter FA values of widespread regions of the frontal and temporal lobes of depressed patients. Also, there was some evidence suggesting that white matter FA values of the inferior frontal brain region are inversely related to severity of depression. Conclusions: These results suggest the possible loss of integrity within frontal and temporal white matter fibre tracts and implicate the orbitofrontal circuit in symptom severity in late-life depression.

The present study aimed to compare the effects of two currently used selective serotonin reuptake inhibitors (SSRIs) in Japan taking the individual background in 5-HTT gene-linked polymorphic region (5HTTLPR) genotype into account. Clinical responses to paroxetine and fluvoxamine were evaluated by total and cluster depressive symptoms for 81 Japanese patients who were diagnosed with major depression. Patients with the l allele had a greater percentage reduction on the total score (P=0.059) and somatic anxiety items (P=0.026) of the 21-item Hamilton Depression Rating Scale (HAM-D) score compared to s/s genotype carriers. Paroxetine was significantly more effective than fluvoxamine in the s/s carriers, as evaluated on the percentage reduction in total score (P=0.012) and core (P=0.049) HAM-D after 4 weeks of medication, but not in the l/s carriers. These findings suggest that the genetic test may be useful in investigating the efficacy of the two SSRIs, and that normalization by the 5HTTLPR genotypes may lead to improvement of the precision of comparative analysis.

This study was conducted to elucidate the effects of electroconvulsive therapy (ECT) on frontal white matter in late-life depressed patients. Diffusion tensor imaging was performed on 8 late-life depressed patients and 12 healthy age-matched controls. The patients were scanned before and after a course of ECT. Fractional anisotropy (FA) was determined in the frontal and temporal regions and the corpus callosum. A significant white matter FA reduction was found in widespread frontal and temporal brain regions in patients with depression before ECT treatment compared with controls. A significant increase in frontal white matter FA was seen following ECT treatment. A course of bilateral ECT ameliorated white matter integrity in frontal brain regions. This suggests a strong relationship with the antidepressant action of ECT.

Diffusion tensor imaging provides a new approach for quantifying anisotropic diffusion of white matter in vivo. We used this technique to investigate subtle disruption of regional white matter in schizophrenia. Twelve patients with schizophrenia were compared with 11 healthy controls. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. A significant fractional anisotropy (FA) reduction was found in all white matter regions bilaterally in schizophrenic patients. Higher FA of left frontal white matter correlated significantly with higher dosage of antipsychotic medication. These findings support the view that the pathological process is a distortion of the central nervous system myelination affecting the whole white matter. Our findings also show the effects of antipsychotics on the white matter in the left frontal region in schizophrenia.

Z-(R)-1-Azabicyclo[2.2.2]oct-3-yl (R)-alpha-hydroxy-alpha-(1-iodo-1-propen-3-yl)-alpha-phenylacetate (Z-IQNP) has high affinity to the M(1 )and M(2) muscarinic acetylcholine receptor (mAChR) subtypes according to previous in vitro and in vivo studies in rats. In the present study iodine-123 labelled Z-IQNP was prepared for in vivo single-photon emission tomography (SPET) studies in cynomolgus monkeys. SPET studies with Z-[(123)I]IQNP demonstrated high accumulation in monkey brain (5% of injected dose at 70 min p.i.) and marked accumulation in brain regions such as the thalamus, the neocortex, the striatum and the cerebellum. Pretreatment with the non-selective mAChR antagonist scopolamine (0.2 mg/kg) inhibited Z-[(123)I]IQNP binding in all these regions. The percentage of unchanged Z-[(123)I]IQNP measured in plasma was less than 10% at 10 min after injection, which may be due to rapid hydrolysis, as has been demonstrated previously with the E-isomer of IQNP. Z-[(123)I]IQNP showed higher uptake in M(2)-rich regions, compared with previously obtained results with E-[(123)I]IQNP. In conclusion, the radioactivity distribution from Z-[(123)I]IQNP in monkey brain indicates that Z-[(123)I]IQNP binds to the M(1)- and M(2)-rich areas and provides a high signal for specific binding, and is thus a potential ligand for mAChR imaging with SPET.

This report describes improvement of tardive dyskinesia (TD) in a patient who received electroconvulsive therapy (ECT) for depression. The patient, an elderly Asian male, was treated for major depression with ECT and showed a rapid improvement of TD that may have been caused by any number of drugs or combination of drugs. We discuss the possibility of improving TD by treating the depression with ECT.