Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 48, Issue 17
Displaying 1-18 of 18 articles from this issue
  • Tomonari Okada, Toshiyuki Nakao, Hiroshi Matsumoto, Tamami Yamanaka, Y ...
    2009 Volume 48 Issue 17 Pages 1495-1499
    Published: 2009
    Released on J-STAGE: September 01, 2009
    Objective Several studies have shown glycated albumin (GA) to be a more accurate glycemic marker than HbA1c in diabetic patients with end-stage renal disease (ESRD). However GA values are influenced by several factors associated with albumin turnover independent of glycemia. We tried to clarify the factors other than glycemic control affecting GA values in ESRD patients.
    Patients and Methods We examined the associations between GA values and several clinical variables related to albumin metabolism in 41 non-diabetic patients on maintenance hemodialysis.
    Results Although there were no significant correlations between glucose, albumin, and GA values, there were significant correlations between age, cholinesterase (ChE) values, BMI, and GA values (r=0.515, p=0.0004, r=-0.394, p=0.010, r=-0.327, p=0.036). Stepwise multivariate regression analysis showed that age and ChE values were significant independent variables associated with GA values (β=0.479, -0.343, R2=0.382).
    Conclusion GA values are influenced by age and nutritional status independent of glycemia in non-diabetic ESRD patients. We should be aware of factors other than glycemic control affecting GA values.
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  • Keiko Hisatomi, Noriho Sakamoto, Hiroshi Mukae, Tomayoshi Hayashi, Mis ...
    2009 Volume 48 Issue 17 Pages 1501-1507
    Published: 2009
    Released on J-STAGE: September 01, 2009
    Objective Idiopathic interstitial pneumonias (IIPs) comprises a group of diffuse parenchymal lung diseases of unknown etiology with varying degrees of inflammation and fibrosis including cryptogenic organizing pneumonia (COP), idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP). Tenascin-C is an extracellular matrix molecule that is expressed during wound healing in various tissues. The present study was aimed to investigate the role of tenascin-C in the pathogenesis of IIPs.
    Methods We used enzyme-linked immunosorbent assays to measure levels of tenascin-C in serum and bronchoalveolar lavage fluid (BALF) from 17 patients with IPF, 12 with NSIP, 15 with COP and from 23 healthy individuals.
    Results Serum levels of tenascin-C were significantly elevated in patients with COP compared with those in all other participants, whereas those in patients with IPF and NSIP were not significantly elevated compared with healthy individuals. The levels of tenascin-C in BALF from patients with COP and NSIP were significantly higher than those of healthy individuals. In addition, serum tenascin-C was significantly correlated with levels of serum C-reactive protein, which is a serum acute phase protein.
    Conclusion Systemic inflammation in the lung with IIPs might be associated with tenascin-C. These results suggest that tenascin-C is responsible for the pathogenesis of IIPs especially via inflammation, and that it might serve as a serum marker of COP.
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  • Osamu Imataki, Yotaro Tamai, Koiku Yokoe, Takayoshi Furukawa, Kimihiro ...
    2009 Volume 48 Issue 17 Pages 1509-1513
    Published: 2009
    Released on J-STAGE: September 01, 2009
    Objective 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) has been widely applied to malignant lymphoma both for initial staging and response evaluation. The objective is to compare the efficacy of the less common, but more easily implemented modality, CT, with that of FDG.
    Methods We retrospectively reviewed consecutive patients diagnosed with malignant lymphoma in our hospital between October 2002 and March 2006, and compared the efficacy of FDG-PET and CT. The standard reference was defined by the pathology and clinical course of patients followed for more than 3 months.
    Results Thirty-three cases for staging and 62 cases for response evaluation after treatment were included. We calculated the sensitivity and specificity of each modality. The accuracy of the diagnostic modality was evaluated using receiver operating characteristic (ROC) analysis. The sensitivity and specificity of the initial staging were 87% and 100% on CT evaluation and 87% and 100% on FDG-PET, respectively. Sensitivity and specificity of the re-staging were 81% and 78% on CT evaluation and 82% and 97% on FDG-PET, respectively. The diagnostic accuracy of FDG-PET was comparable with that of CT both in initial staging and response evaluation. The maximum standardized uptake value was not associated with patient survival. In subgroup analysis, a tendency of lower sensitivity in the initial staging was found in FDG-PET for follicular lymphoma and CT for diffuse large B-cell lymphoma.
    Conclusion Although different staging procedures appear better suited to certain subtypes of lymphoma, in general CT imaging might be as useful as FDG-PET in initial staging in selected patients.
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  • Nobuo Nara, Masashi Beppu, Shuji Tohda, Toshiya Suzuki
    2009 Volume 48 Issue 17 Pages 1515-1519
    Published: 2009
    Released on J-STAGE: September 01, 2009
    Objective To contribute to reforming the medical education system in Japan, we visited overseas medical schools and observed the methods utilized in medical education.
    Materials and Methods We visited 28 medical schools and five institutes in the United States, Europe, Australia and Asia in 2008. We met deans and specialists in medical affairs and observed the medical schools' facilities.
    Results Among the several effective educational methods used in overseas medical schools, simulation-based learning was being used in all that we visited. Simulation-based learning is used to promote medical students' mastery of communication skills, medical interviewing, physical examination and basic clinical procedures. Students and tutors both recognize the effectiveness of simulation-based learning in medical education.
    Conclusion In contrast to overseas medical schools, simulation-based learning is not common in Japan. There remain many barriers to introduce simulation-based education in Japan, such as a shortage of medical tutors, staff, mannequins and budget. However, enhancing the motivation of tutors is likely the most important factor to facilitate simulation-based education in Japanese medical schools to become common place.
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