Radiofrequency ablation (RFA) plays an important role in the treatment of liver tumors. Juntendo University is now the highest-volume center for RFA in Japan, which obliges us to teach technical aspects of RFA skills to doctors in other institutions and standardize the RFA procedure. In order to provide an opportunity to understand the basic concept and learn essential technical tips for successful ablation, we held a training program at Juntendo University on October 31st and November 1st, 2014. The quota for the program was filled instantly. Eighteen doctors from various regions of Japan participated in it. The program had comprehensive lectures, live demonstration and case study. We performed RFA on three patients. Through the two-day intensive course, the participants learned the current status of RFA. A questionnaire survey after the program revealed overwhelmingly positive feedback from the participants. We plan to hold this program several times a year. We would also like to hold a longer-term training program, such as for 2 weeks. Additionally, we would like to have an international training program in which we would accept foreign doctors in the near future.
Intra-arterial chemoembolization has been performed for more than 30 years as a standard anti-cancer therapy for unresectable cases of hepatocellular carcinoma. Recent developments in diagnostic machines and the advent of micro-catheters, micro-guidewires, and new embolic agents (such as microspheres) have enabled this technique to be used for the treatment of other tumors, such as lung cancer, breast cancer, liver metastasis, lung metastasis, lymph node metastasis, and bone metastasis. This review article describes these developments in intra-arterial chemotherapy, with a focus on liver tumors and pulmonary tumors.
Subarachnoid hemorrhage due to the rupture of intracranial aneurysms is one of the causes of life-threatening strokes. The incidence is about 20 per 100,000 among the Japanese population. An intracranial aneurysm is a bulging, weakened area in the wall of an artery in the brain, resulting in abnormal widening or ballooning. Because the aneurysm has a weakened spot, there is a risk of rupture. Although surgical clipping has been the standard treatment for intracranial aneurysms, the procedure is extremely invasive. Coiling is another recent endovascular therapy that has become an important alternative to clipping because it is considerably less invasive. The procedure uses a catheter percutaneously inserted into an artery under fluoroscopic imaging. When the microcatheter has been inserted into the aneurysm, platinum coils are inserted to occupy the aneurysm cavity, which prevents blood flow into the aneurysm. The simple technique, requiring only one microcatheter, without other assisting devices, is standard. When this simple technique cannot achieve satisfactory occlusion, adjunctive techniques using a balloon or stent are used. Coiling is more advantageous than surgical clipping because it does not involve opening the skull, and hospitalization and recovery times are often shorter than with surgical clipping. In the near future, the introduction of flow diverters may dramatically change the treatment outcome of large, fusiform or complex aneurysms.
In Japan, out of the total number of deaths classified by cause in 2013, 120,000 deaths were due to strokes, making up 9.3% of the total and putting stroke in 4th position. On the other hand, strokes are the number one cause that requires long-term nursing care and comprise 20% of the total. Strokes are broadly classified into cerebral infarctions, intracerebral hemorrhages, and subarachnoid hemorrhages. A cerebral infarction is caused by the occlusion of a blood vessel in the brain. The most important form of treatment for cerebral infarction is prevention. The purpose of performing recanalization therapy for acute ischemic stroke, in which the occluded vessel has reopened, is minimizing the extent of possible cerebral infarction. Intravenous administration of thrombolytic drugs to treat acute ischemic stroke within three hours of onset started being performed in Japan in 2005. In 2010, a spiral-shaped device, Merci Retrieval System, became available for use in Japan for thrombi retrieval and heralded the era of mechanical thrombectomy. In 2011, a thrombus aspiration device that used a catheter, Penumbra System, was introduced. In 2014, stent thrombectomy devices, Solitaire Flow Restoration device and Trevo ProVue Retriever, were successively introduced, which allowed for a full range of treatment selections for full-scale endovascular treatment for acute ischemic stroke.
Acute gastrointestinal (GI) bleeding is a common medical emergency that varies from minor to potentially life-threatening bleeding. Endoscopy is a first-line diagnostic procedure for both upper and lower GI bleeding. Therapeutic options for the treatment of acute GI bleeding include conservative management, therapeutic endoscopy, transcatheter embolization, and surgery. Transcatheter embolization and surgery are both options for recurrent GI bleeding when therapeutic endoscopy fails; however, both options are associated with several complications and the risk of rebleeding. The choice of management depends upon the status of the patient. Emergency surgery is typically associated with high rates of morbidity and death. Recently, superselective transcatheter embolization has become a safer procedure and is now widely used for the management of acute GI bleeding. This review article describes the role of interventional radiology in the management of acute GI bleeding.
The authors and all of the faculty at the Department of Bacteriology (Dept. of Microbiology from April 2015) have studied methicillin-resistant Staphylococcus aureus (MRSA), a representative multi-drug-resistant pathogen prevalent globally. During this study, we have identified the extreme flexibility of this organism to survive antibiotic pressure. S. aureus is part of the normal flora of human beings, yet it possesses high pathogenic potential, being aptly called ‘the department of toxins’. We are probably destined to continue our lives in association with this dangerous neighbor. For this reason, in 2008, KH launched a new project searching for novel antibiotics that are effective against MRSA. A newly found antibiotic called nybomycin has a curious property: it is effective against quinolone-resistant S. aureus strains (including most MRSA), but not against quinolone-susceptible ones. Moreover, the mutant strains derived from the parent S. aureus strain after treatment with nybomycin were cured of their quinolone resistance. Subsequently, we found an antibiotic with the same property in flavones, too. We designated these antibiotics with such unique properties reverse antibiotics (RA). By using RA and extant antibiotics in a well-controlled way, we should be able to establish sophisticated anti-microbial chemotherapy in the future.
In Japan, major causes of end-stage kidney disease (ESKD) are type 2 diabetic nephropathy, IgA nephropathy, and nephrosclerosis. Renal replacement therapies are hemodialysis (HD) and peritoneal dialysis (PD). Since PD patients have shown some complications, such as peritonitis, infections of the exit sites of catheters, and encapsulated peritoneal sclerosis (EPS), it is necessary to determine infections at an early stage of PD. Although a definite diagnosis in patients with chronic kidney disease (CKD) is made through the biopsy of renal tissue and peritoneum, we cannot always perform such diagnostic procedures. Thus, it is necessary to develop non-invasive diagnostic biomarkers prior to biopsies in CKD patients. The objective of this review is to explain the efficacy of new biomarkers in such patients.
In my final lecture, I have looked back the history of rehabilitation service in Juntendo Hospital. Rehabilitation service was started as early as 1947, and was subordinated under the Department of Orthopedic Surgery. In 1972, the then Professor of Neurology started another physiotherapy room mainly for neurological diseases. The Department of Rehabilitation Medicine was inaugurated in 2003 and I became head of the department. At that time, Juntendo Hospital had already enjoyed therapist-centered service for 56 years. One of my objectives was to build a sound cooperation between their service and the new physician-centered service. The other objective was to establish the attitude among all therapists to generate evidence in rehabilitation service. After my eleven years’ work in Juntendo, I have noticed that the demand for rehabilitation service is increasing steadily for patients with many diseases other than neurological disorders. In 2015, we are engaging in many multi-disciplinary activities in our hospital, such as participation in the skeletal related events (SRE) team, rehabilitation for pediatric patients, and rehabilitation for cardiac patients. Along with the advance in medicine, rehabilitation physicians and therapists need to continue to make efforts to develop and establish novel therapeutic skills in cooperation with each specialist in medicine. When I review the history and the trend of rehabilitation service in Juntendo, it is obvious that our task is to provide rehabilitation service to meet the growing demands from different medical specialties.
From April 1974 through March 2015, I spent most of the time at the Department of Biochemistry to give lectures of biochemistry to under graduate students of the Faculty of Medicine as well as to conduct basic research. Here, I look back on my research life mainly in relation to peers of the department, intramural friends, and extramural collaborators. The recollection covers three periods sequentially: the infancy of muscle research (1974～1985), the transition stage to study non-muscle cell motility (1985～1995), and the developmental period engaged in autophagy (1995～2014).
Most people know that mosquitoes bite us, and cause mild or sometimes severe itching, but it is not necessarily common knowledge that only female mosquitoes suck blood to produce eggs for the next generation to succeed. Unfortunately this insect does not produce just one batch of eggs, but bites again and again, and as is well known they may transmit dangerous microorganisms from the previous host to the next host during the biting and oogenesis cycle. Understanding the role of animal blood in mosquito oogenesis may help establish effective methods to control this vector insect. Although the digestive products of the ingested blood are obviously translated into nutritional materials in the developing oocyte, such as yolk proteins or lipids, we hypothesized that animal blood may contain some special substances to activate mosquito ovarian development, since blood-feeding is quite a unique behavior among insects. During 40 years of experiments from such a nutritional point of view, however, it turned out to be rather simple; amino acids resulting from blood protein digestion have the potential to activate and promote the whole process of mosquito ovarian development when the nutrients are gradually and continuously supplied into the hemolymph of females. In this review, we will describe the studies used to reach this conclusion.
Objectives: The World Health Organization (WHO) classification (2008) is widely used to diagnose polycythemia vera (PV). However, some patients clinically suspected of PV may not be definitely diagnosed because they do not have a high hemoglobin (Hb) level, one of the main and essential diagnostic criteria, or because of the lack of or unfilled minor criteria such as bone marrow biopsy, endogenous erythroid colonies, and serum erythropoietin. The British Committee for Standards in Haematology (BCSH) employed hematocrit (Ht), but not Hb, as an indicator in the PV diagnostic guidelines. Furthermore, if the presence of the JAK2 gene mutation is demonstrated, PV can be diagnosed with Ht only by BCSH. Therefore, we evaluated the usefulness of BCSH criteria for diagnosing PV in Japanese patients. Methods: We determined hematological and clinical differences in 99 patients who met the BCSH criteria (Group A) and 69 PV patients who met the WHO criteria (Group B). Results: All patients in Group B also met the BCSH criteria. Thirty patients in Group A (43%) did not fulfill the WHO criteria. No significant differences were observed in white blood cell and platelet counts, serum erythropoietin levels, the JAK2V617F allele burden, or the risk of thrombosis and transformation into myelofibrosis between Groups A and B. Conclusions: PV cases diagnosed by the BCSH criteria showed the same clinical picture as those diagnosed by the WHO criteria. In view of actual clinical settings, the diagnostic criteria of BCSH criteria may be useful for the diagnosis of PV in Japanese patients.
Objective: We studied how the course and branching of peripheral arteries are influenced by the diversity of the proximal arteries, taking examples in the leg and foot region. Materials and methods: The arteries in the leg and foot was studied in 18 lower extremities of Japanese cadavers and their diversity was correlated with the relative thickness of fibular and posterior tibial artery. Results: The posterior tibial artery was dominant in 8 cases (PTAD) and the fibular artery was dominant in 10 cases (FAD). The communicating branch between the two arteries was single in 7 cases and multiple in 11 cases. The perforating branch of the fibular artery was large in 4 cases, medium in 6 cases, and small in 8 cases. The large perforating branch was found in FAD group, and the small perforating branch was mainly found in PTAD group. The dorsalis pedis artery was formed mainly by the anterior tibial artery, but by the perforating branch in the cases of thick perforating branches. The anterior lateral malleolar artery was single in 10 cases and multiple in 8 cases. The number of dorsal roots of dorsal metatarsal arteries was 3.3 in the cases of thick perforating branch, 2.2 in medium perforating branch, and 0.6 in small perforating branch. Conclusions: The formation of the dorsalis pedis artery and the number of dorsal roots of the dorsal metatarsal arteries were influenced by the thickness of the perforating branch and thus by the relative thickness of the fibular artery.
Background: Azuki bean is sometimes a nutritional alternative for those with soybean allergy. Although soybean and peanut are relatively common food allergens, azuki bean allergy has not previously been reported. Case Report: A 3-year-old male was referred for investigation of suspected azuki bean allergy. He developed urticarial lesions within 30 min after eating an azuki bean product (manju, a sort of Japanese sweet), with a similar episode reported 1 year prior. The total serum immunoglobulin E (IgE) level was 677 IU/ml, with elevated specific IgE antibodies (ImmunoCAP) to soybean, peanut, kidney bean, and pea. Azuki bean specific IgE antibodies are not available, currently. The wheals produced by skin prick test (SPT) were boiled azuki bean without sugar 5 mm, yohkan (a typical Japanese sweet) 8 mm, sweetened azuki bean paste 7 mm, and soybean 4 mm. Double-blind placebo-controlled food challenge (DBPCFC) with azuki bean without sugar induced urticaria after 60 min, which resolved after oral antihistamine administration. He did not develop symptoms after ingestion of control. Conclusions: This is the first reported case of immediate-type azuki bean allergy, diagnosed by SPT and DBPCFC. Further study such as immunoblotting is needed to elucidate the specific allergenic antigen.
It is widely held that the hippocampus plays a crucial role in the retrieval of recent memory, and that memory representation is later formed in the temporal neocortex through consolidation processes. However, accumulating evidence from functional magnetic resonance imaging studies has revealed that memory representation is formed in multiple areas in the lateral temporal cortex (LTC) in humans. Connectivity analyses further suggest possible memory retrieval circuits in the human temporal lobe: 1) memory is initially encoded into the hippocampus, 2) the encoded memory is consolidated in the posterior part of the LTC, and 3) the memory stored in the posterior LTC is retrieved via the anterior part of the LTC.