Journal of The Showa Medical Association
Online ISSN : 2185-0976
Print ISSN : 0037-4342
ISSN-L : 0037-4342
Volume 72, Issue 2
Displaying 1-19 of 19 articles from this issue
Feature Articles: Reverification of human beings and anthropoid apes: Is it really that Homo sapiens excels anthropoid apes in all?
Final Lecture
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  • EXAMINATION OF A NEW CLASSIFICATION
    Mio ABE
    2012 Volume 72 Issue 2 Pages 216-221
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    In facial bone fractures, the treatment for mandible fracture is determined by the location of the fracture and the number of fracture lines. To date, we have used a classification system of fractures based on their location (“old method” in this article) or known as “the classification of location of fracture as based on the number of fracture lines”. In this study, we compared the old method to a new classification method based on the number of fracture lines based on each patient (“new method”). Fractures were classified as follows: one fracture line on mandibula was called type I, two lines type II, three lines type III, and four or more lines type IV. From April 1997 to July 2011, we treated 1735 cases of facial fractures including 153 cases of mandible fractures. We studied the mandible fractures. Of the patients, 110 were males and 43 were females. Patient ages ranged from 3 to 92 years, and averaged 36.2 years old. The most frequent fracture involved nasal bones (57%), followed by the zygoma (18%), mandible (9%) and maxilla 4%. In our classification of mandible fractures, the most frequent type of mandible fracture was type I (50%), followed by the type II (42%), type III (7%) and type IV (1%). The most frequent cause was falls (49%) followed by traffic accidents (24%), assault (12%), sports (8%) and suicide (4%). In the treatment methods, only type I received conservative treatment (62%) more often than operative treatment (38%). The other types received more conservative treatment (over 70%) than operative treatment. We found that the new classification system offered an improved prediction of the method of treatment and length of hospitalization.
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  • Ryohei TOKUNAKA, Koichi KADOMATSU, Shinya YOSHIMOTO, Hideyuki MURAMATS ...
    2012 Volume 72 Issue 2 Pages 222-228
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    We evaluated the effectiveness of using bioresorbable devices compared with metal devices to treat cranio-maxillo-facial bone fractures and osteotomy. Multicenter clinical evaluation was performed including 10 hospitals. We used bioresorbable devices made of forged composites of hydoxyapatite (HA) particles and poly-l-lactide (PLLA) and then carefully observed each patient for signs of swelling, infection, plate exposure, migration and foreign body reaction. In the comparison of bioresorbable devices and metal devices, there was no significant difference in the number of complications. The number of re-operations was clearly reduced. Bioresorbable devices are useful and equally safe compared to metal devices; these devices can be considered a good alternative for metal devices.
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  • Tomoko SHIOZAWA, Tomoko NOROSE, Toshiko YAMOCHI-ONIZUKA, Masafumi TAKI ...
    2012 Volume 72 Issue 2 Pages 229-237
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    Human intestinal spirochetosis is a common condition in Western countries, but it is not well recognized in Japan. To determine the incidence and clinicopathologic findings of human intestinal spirochetosis in Japan, we performed a prospective study of a series of endoscopically resected biopsy specimens of the large intestine over a 4-month period at a single hospital located in Tokyo, Japan. Among 1025 samples, 42 cases of human intestinal spirochetosis were detected (4.1%). Genomic DNA from formalin-fixed paraffin-embedded biopsy specimen tissue samples was subjected to polymerase chain reaction analysis for the detection of two strains of spirochetes (Brachyspira aalborgi and Brachyspira pilosicoli) by amplifying species-specific portions of the NADH oxidase gene and 16S ribosomal RNA. B. aalborgi and B. pilosicoli were detected in 37 and 8 cases, respectively, with 5 cases having dual infection of both species. These results from a precise prospective study suggest that intestinal spirochetosis infection in Japan is not rare, and that the incidence is similar to that in Western countries. This finding differs from those of several retrospective studies that have claimed that the prevalence of intestinal spirochetosis is extremely low in Japan. In the current study, most cases of intestinal spirochetosis were asymptomatic, and the cases with digestive symptoms among the 1025 samples did not show any correlation with the status of intestinal spirochetosis infection. These results suggest that human intestinal spirochetosis infection is not pathogenic, but it is an incidental and/or indigenous infection that does not require treatment.
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  • Toshio TANAKA, Akiko SASAKI, Daisuke TANIOKA, Masayuki NODA, Hirotake ...
    2012 Volume 72 Issue 2 Pages 238-245
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    Glioblastoma is a malignant brain tumor which is difficult to completely cure by surgical treatment and consequently in attempt for cure it is treated with a combination of radiotherapy and chemotherapy following surgery. Unfortunately however, these procedures are not curative for this type of tumor due to the development of resistance to anticancer drugs and radiation during treatment. P53 is a radiation-resistant factor. It plays an important role in apoptosis regulation. When cells are irradiated DNA is injured; P53 is then activated and it regulates the transcription of the target genes related to apoptosis. However, the p53 gene is defective or mutated in 50% of glioblastoma cases, thereby impairing the transcription activation capability, and thus the P53 apoptosis induction pathway does not function and apoptosis is not induced. Accordingly, the cells are less radiosensitive and show marked resistance to radiation. Apoptosis induction is an important cancer-suppressive function and it determines the sensitivity to treatments, such as chemotherapy and radiotherapy. miRNA which regulates this gene transcription has recently been reported. miRNAs are small RNAs comprised of 21-23 base-pairs. They bind to several proteins to form complexes, and bind to the N-terminal of the target mRNA for the post-transcriptional inhibition of gene expression. In this study, we analyzed the protein expression of P53, Bcl-2, Bax, and Caspase9 and miRNA expression-regulating genes involved in the P53 apoptosis pathway using a P53 mutant, T98G glioblastoma cells, and P53 wild-type A172 glioblastoma cells. Regarding miRNA, the involvement of P53-regulating mi-125b, mi-34a, mi-504, mi-380-5P, mi-885-5P, mi-145, Bax-regulating mi-21, mi-222, and mi-34a, and mi-21-regulating Bcl-2 and Caspase9 was suggested. In particular, P53 and mi-34a expressions in P53 wild-type A172 cells and Bcl-2 and mi-21 expressions in the P53 mutant type were closely involved in the P53 apoptosis induction pathway, suggesting their strong influence on the effect of radiotherapy.
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  • Yusuke SARUTA, Toshiko YAMOCHI, Tomoko NOROSE, Miki KUSHIMA, Masafumi ...
    2012 Volume 72 Issue 2 Pages 246-258
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    T/NK cells are involved in approximately 85% of primary cutaneous lymphomas, and more than half of the cases are mycosis fungoides (MF) and Sezary syndrome. Primary cutaneous lymphoma is classified functionally based on clinical behavior, histology and surface characteristics; the diagnostic rate has improved due to implementation of clonality analysis. We examined the progression to lymphoma in 14 cases that were clinicopathologically diagnosed as lichen planus (LP); 18 as parapsoriasis en plaques (PP), an inflammatory disorder; and 8 (28 samples) as MF in Showa University Hospital from 1993 to 2011. Immunohistochemical staining was performed on all samples, and PP and MF samples were further examined by clonality analysis. Dissociation of CD4/CD8 was not found in any LP samples, but was revealed in 33% of PP and 88% of MF samples. There was a strong tendency for a decrease of CD7 in PP and MF samples. CCR3 was negative in all LP, PP, and MF samples. CCR4 and CXCR3 were positive in many more PP and MF samples, compared with LP samples. All of the PP samples were negative in the T-cell clonality analysis, but 50% of MF samples were positive. These results suggest that the surface properties of PP are closer to those of MF, rather than LP. Therefore, PP may also have the potential for tumorous change, in addition to being an inflammatory skin disease. Moreover, the validity of the clonality analysis in auxiliary diagnosis of MF should be checked further.
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Clinical Report
  • Naoto SUZUKI, Satoshi SUZUKI, Koji TOMINAGA, Mitsunori HOSHINO, Hiroak ...
    2012 Volume 72 Issue 2 Pages 259-263
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    To date there is no consensus on the necessity of intraoperative irrigation in laparoscopic appendectomy. At our hospital, laparoscopic appendectomy is indicated in all cases of acute appendicitis for which appendectomy is performed. Using a high-speed irrigation device that allows intraoperative massive irrigation, we perform intraoperative irrigation in all cases of appendectomy. In cases in which intraoperative inflammatory ascites is evident, intraoperative irrigation is performed with 10 L of warm saline; in other cases, 5 L is used. We insert the trocar on the right side in the cases with 10 L and on the left side in cases with 5 L of warm saline. We insert a drain into the cul-de-sac in all cases and remove the drain the following day. A total of 92 cases were studied. Histologically, 7 cases were catarrhal, 41 cases were phlegmonous, and 44 cases were gangrenous. No postoperative complications occurred in any of the cases. Here, we describe our technique of intraoperative massive irrigation.
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Case Report
  • Kazuma SAKURABA, Gaku KIGAWA, Atsushi SHIRAHATA, Kazuhiro KIJIMA, Yosh ...
    2012 Volume 72 Issue 2 Pages 264-268
    Published: 2012
    Released on J-STAGE: December 14, 2012
    JOURNAL FREE ACCESS
    A 66-year-old woman visited our hospital because of melena. Despite gastrofiberscopic and colonoscopic exams, the bleeding source was unclear. We suspected a small intestinal lesion, and performed double-balloon enteroscopy. A submucosal tumor in the small intestine was found and this tumor was considered to be the bleeding source. An abdominal computed tomography scan showed an enhanced diffuse thickening of the small intestinal wall and lymph node metastasis. However, it was difficult of make a preoperative diagnosis, because endoscopic biopsy was impossible. Therefore, single incision laparoscopic surgery (TANKO) was performed in order to make the diagnosis and for treatment of the small intestinal tumor. Ileocecal resection and anastomosis were performed under umbilical minimal incision with TANKO. We were able to perform a less invasive surgery and effective diagnosis and resection with TANKO. For this case of small intestinal malignant lymphoma, TANKO was very useful.
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