These findings suggest that longer use of methamphetamine may cause more severe psychiatric symptoms and greater reduction of dopamine transporter density in the brain. They also show that the dopamine transporter reduction may be long-lasting, even if methamphetamine use ceases. Further, persistent psychiatric symptoms in methamphetamine users, including psychotic symptoms, may be attributable to the reduction of dopamine transporter density.

A laceration deep enough to reach the bone occurs very rarely in skiing or snowboarding. Two such cases are presented here. In one case, the popliteal fossa of a skier was cut during a collision with a snowboarder. All structures posterior to the knee were severed and the leg became ischaemic. The other case was of a snowboarder who sustained a deep cut to the distal forearm during landing after a jump, resulting in a ''spaghetti wrist''. S nowboarding has become one of the most popular winter sports not only in European countries 1 but also in Japan 2 , especially among young people. Many enjoy snowboarding and skiing on relatively small and crowded public slopes in Japan. As a result, lacerations from the edges of the snowboard can be caused not only to snowboarders themselves during falls but also by snowboarders in collisions. Although several studies on lacerations caused by snowboarding have been published, 3-6 cutting injuries have never received much attention probably because most can successfully be treated by irrigation and simple closure. There have been no reports on deep lacerations caused by snowboard edges.We recently encountered two patients who sustained cuts deep enough to reach the bone from snowboard edges, resulting in life or limb threatening injury. CASE REPORTSCase 1 A 25 year old female skier was hit from behind by a snowboarder while she was standing on a crowded mountain slope. Her left popliteal region was cut by the edge of the snowboard. She was drowsy from haemorrhagic shock when she arrived at the hospital one and a half hours later with a bandage tightly bound around the knee. Systolic/diastolic blood pressure was 73/38 mm Hg, and the pulse was 108 per minute. A tourniquet at the thigh was inflated before the bandage was taken off to avoid massive bleeding from the wound. There was a sharp, transverse, 8 cm long cut in her left popliteal fossa (fig 1), which completely impeded movement of the ankle and toes. The limb distal to the wound was anaesthetic, as well as ischaemic. Plain radiographs revealed air reaching the posterior aspect of the proximal tibia and fibula and a fracture in the neck of the fibula (fig 2). Surgery started about six hours after the injury. The popliteal artery and vein, the tibial and common peroneal nerves, both heads of the gastrocnemius, and the popliteal muscle were found to have been completely severed by the wound, which reached the posterior aspect of the proximal tibia and fibula and had caused a fracture in the neck of the fibula. The popliteal artery and vein were repaired by end to end anastomosis, and the severed muscles were sutured. The two nerves were repaired by epineural suturing under a surgical microscope.Haemoglobin concentration and packed cell volume after the operation were 87 g/l and 25.4% respectively; 1600 ml of blood was transfused during surgery, and an additional 800 ml over the next two days. Magnetic resonance angiography two months later showed patency of the repaired popliteal artery with little stenosis (fig 3). The pat...

Chronic treatment with haloperidol, a D2-receptor antagonist and a neuroleptic, increases the number of D2-receptors in rat striatum. However, there have been inconsistent reports on the D2-receptor mRNA level, one showing the increase in the mRNA level and another detecting no changes. Furthermore, they did not distinguish the two isoforms of D2-receptor, D2A and D2B. In the present work, both D2- and DeA-receptor mRNA levels in rat striatum were estimated after chronic administration of haloperidol. There was, within the sensitivity of the assay, no significant increase in either of them between 3 and 24 h after the last administration. This suggests that chronic haloperidol treatment does not affect the transcriptional regulation of the D2-receptor gene or the alternative splicing process of its transcripts.

Sir: Your recent publication (JCP Visuals, January 1999 1 ) unfairly characterizes some atypical antipsychotics as more likely to produce weight gain than risperidone.Weight gain is a side effect of the atypicals, but our work with olanzapine, clozapine, and risperidone demonstrates that a patient's diet is a better predictor of weight gain than a physician's selection of a particular atypical antipsychotic medication.Contrary to the view expressed in JCP Visuals-that weight gain is unmanageable-our work tells quite the opposite story. With nutritional counseling and dietary changes, patients in our study who gained weight were able to shed that weight and keep it off. 2 This was true for each drug and contradicts JCP Visuals, which infers that once weight is added (my receptors made me eat it!), it never comes off. Having followed the individuals in our study for 2 years, we conclude that while symptoms and medications can complicate the process of weight management, the critical variables are more likely to be healthy eating habits and dietary education.Interestingly, prior to starting atypical medications in our study, patients who were apathetic, with little or no motivation to attend programs or work outside the residence, gained the most weight. We attribute the atypicals' efficacy in treating negative symptoms to successful weight management in these patients.As evidence continues to mount that atypicals can lead to higher productivity 3 and greater self-sufficiency, we regard the JCP Visuals publication on weight gain to be misleading and an impediment to greater prescription of these newer agents.

The suicide rate in Japan was the highest in the world the 10 years after World War II. There were many suicides among young and aged people. Now, Japan has many suicides among middle-aged people, and suicides among elderly people are still remarkable. These findings suggest that middle-aged people in 1980s have a high risk of suicide and that suicide among elderly people will increase in 10-20 years.