The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 38, Issue 2
Displaying 1-7 of 7 articles from this issue
  • Wolf-Dieter Heiss, Karl Herholz, Günter Pawlik, Ina Hebold, Peter ...
    1989 Volume 38 Issue 2 Pages 111-135
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    At present, positron emission tomography (PET) is the only technology affording the quantitative three-dimensional imaging of various aspects of brain function. Since glucose is the dominant substrate of the brain's energy metabolism, studies of glucose metabolism by PET of 2 (18F)-fluoro-2-deoxy-D-glucose (FDG) are widely applied for investigating the participation of various brain systems in simple or complex stimulations and tasks. In focal or diffuse disorders of the brain, functional impairment of affected or inactivated brain regions is a reproducible finding. While glucose metabolism is decreased slightly with age in a regionally different degree, in most types of dementia severe changes of glucose metabolism are observed. Degenerative dementia of the Alzheimer type is characterized by a metabolic disturbance most prominent in the parieto-occipito-temporal association cortex and later in the frontal lobe, while primary cortical areas, basal ganglia, thalamus, and cerebellum are not affected. By this typical pattern Alzheimer disease can be differentiated from other dementia syndromes, as e. g. Pick's disease (with the metabolic depression most prominent in the frontal and temporal lobe), multi infarct dementia (with multiple focal metabolic defects), and Huntington's chorea (with metabolic disturbance in the neostriatum). In demented patients PET studies can also be applied to the quantification of treatment effects on disturbed metabolism. Such studies demon-strated an equalization of metabolic heterogeneities in patients responding to muscarinergic cholinagonists and diffuse increase of metabolism during treatment with piracetam. The therapeutic relevance of such metabolic effects, however, must be proved in controlled clinical trials.
    Download PDF (5247K)
  • Tetsuo Kato
    1989 Volume 38 Issue 2 Pages 136-151
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The etiology of choledochal cyst has been investigated by clinicians and pathologists primarily of Germany, Austria, United States, United Kingdom, and Japan from the end of the last century, but Japanese investigators contributed greatly to the study of the relationship between choledochal cyst and anomalous junction of the pancreaticobiliary ductal system. Heid (1893) is considered to be the first to document choledochal cyst associated with anomalous pancreaticobiliary junction, but it was probably Kozumi et al. (1916) that first evaluated anomalous junction in relation to the etiology of choledochal cyst. Yotsuyanagi (1936), who is noted for his work on the etiological studies of choledochal cyst, attached particular importance to anomalous junction and attempted to establish a relationship between dysplasia of the primordial common bile duct and its anomalous junction with the pancreatic duct. It is no exaggeration to say that this area was led by Japanese investigators even after the introduction of Babbitt's anomalous junction theory (1968). In this review, etiological theories of choledochal cyst and their changes with time were discussed separately for those before and after the advent of Babbitt's anomalous junction theory (1968) with particular reference to the causative relationship between anomalous junction and choledochal cyst. Although there is as yet no definite answer to this problem, the theories advanced to date are considered to be summarized as the following three major lines of thought: 1) bile duct dilatation and anomalous junction are both congenital dysplasia occurring simultaneously during the embryonic development, 2) bile duct dilatation is a secondary change induced by influx of pancreatic juice into the biliary tract due to anomalous pancreaticobiliary junction, and 3) bile duct dilatation is induced secondarily by stenosis of the distal bile duct, which is a part of complex anomaly of the pancreaticobility system. Which of these etiological mechanisms is more important than others must still be clarified, but these three factors are considered to be interrelated with one another in the etiology of choledochal cyst.
    Download PDF (800K)
  • Nancy L. Harris
    1989 Volume 38 Issue 2 Pages 152-166
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Immunologic analysis has greatly improved diagnostic accuracy in several clinically important areas, however, the ultimate goal of a lymphoma classification based on immunophenotype has not been reached and may not be forthcoming. In the evaluation of a patient suspected of having lymphoma, lymphocyte marker studies may be essential for a correct diagnosis, helpful but not essential, or entirely noncontributory, depending on the specific clinical setting and histological differential diagnosis. This review will cover the basic principles and technical aspects of marker studies, and will explore several problems in differential diagnosis to clarify the role of marker studies in determining patient management.
    Download PDF (681K)
  • Tetsuo Kato, Kiyoshi Matsuda, Hiroyuki Kayaba, Shinya Enomoto, Tatsuzo ...
    1989 Volume 38 Issue 2 Pages 167-176
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Congenital biliary dilatation is frequently complicated by biliary tract cancer, and anomalous junction of the pancreaticobiliary ductal system, a major factor constituting the pathology of this disease, is considered to be important as a background for carcinogenesis in the biliary tract. To clarify the mechanism of carcinogenesis in the biliary tract under the circumstance of anomalous junction, we evaluated the mutagenicity of the contents of the biliary tract in patients with congenital biliary dilatation and analyzed the nuclear atypia of the biliary epithelium by fluorocytometry. A mutagenicity test using Bacillus subtilis showed positive results in 6 of 12 patients. Since mutagenicity correlates well with carcinogenicity, these results suggest the necessity of separation surgery between the bile and pancreatic ducts in patients with anomalous junction regardless of the presence or absence of biliary dilatation. On the other hand, DNA histograms of the nuclei of gallbladder epithelial cells produced by fluorocytometry in 4 patients revealed a high incidence of polyploid DNA in 2 patients with marked hypertrophic changes. These patients were also positive for mutagenicity of the contents of the biliary tract, suggesting that mutagens are involved in the atypia at the cellular and nuclear levels.
    Download PDF (328K)
  • Yoshiyuki Haga, Yasuhiro Soma, Kozo Kawada, Takahiko Misumi, Tadashi I ...
    1989 Volume 38 Issue 2 Pages 177-183
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Postoperative erythroderma is a rare disease of which the clinical course is almost always fatal. It is characterized by fever, skin rash, hepatic dysfunction and leukopenia, and many of the cases occur after cardiovascular surgery. We have experienced two cases of this disease which are suspected to be related to a large amount of blood transfusion. In the second case, we observed genetical mismatch of the HLA typing between the patient and his family members. This observation strongly suggests the possibility that postoperative erythroderma is a form of graft-versus-host (GVH) reaction induced by transfused lymphocytes. The reason why the patient's immunity is so suppressed as to cause GVH reaction is still unknown. Cardiopulmonary bypass and a large amount of fresh blood transfusion are suspected for immune suppression. The fact that postoperative erythroderma occurs almost exclusively in the Japanese cannot be fairly explained, either. Racial homogeneity in Japan might cause immune tolerance in blood transfusion.
    Download PDF (249K)
  • Kazuhiko Hayashi, Toshihiko Kondo, Keisuke Nosaka, Shoji Yamanaka, Hir ...
    1989 Volume 38 Issue 2 Pages 184-191
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    When Rh incompatible pregnancies occur, intrauterine fetal transfusion (IUT) and plasma exchange (PE) have made it possible to prolong the prenatal duration and to dramatically decrease the neonatal mortality. We administered a total of 10 PEs (from 20 weeks to 27 weeks of gestation) and one IUT (at 27 weeks and 1 day) for an Rh-isoimmunized gravida who already had a high maternal serum Rh antibody titer at the 14th gestational week, and delivered by Caesarian section (CS) an extremely immature infant of only 873 grams at 27 weeks and 4 days of gestation. The infant was hydropic with hyperbilirubinemia, there-fore exchange transfusions were administered immediately after birth. The infant's weight reached the lowest point of 669 grams on the 13th day after birth, but began to increase thereafter. The baby weighed 3, 052 grams on the 144th day and left the hospital without any complications.
    Download PDF (709K)
  • Dalmas A. R. Dominicus, Takashi Akamatsu
    1989 Volume 38 Issue 2 Pages 192-200
    Published: 1989
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    This paper describes the current health policy in Tanzania and its implementations. The present health policy in Tanzania originated from Arusha declaration of 1967, the country's most popular national policy after independence. Arusha declaration proclaims socialism and self-reliance, which has had important impact on the form and content of the present country's health policy in mainland Tanzania. Much of the wide-spread health care services infrastructure that is evident now in rural areas of Tanzania mainland is a result of the re-emphasis of the Arusha declaration in 1971. In Tanzania, the Ministry of Health has the responsibility for elaborating the health policy, ensuring that strategies and appropriate program are developed to give effect to the policy. In the present health policy discussed, the goal is seen to have shifted from having one dispensary in each village to one primary health unit in each village. One dispensary is intended to serve several villages together. In Tanzania, according to the present health policy, the village primary health care are mainly preventive oriented and only being managed by short term trained health staff. The candidate for training in each village is selected, among the village residents, by the villagers themselves. The primary health care system adopted by Tanzania is viewed as the only way through which it can achieve the social goal of health for everyone by the year 2000, provided the present political will which is evident continue, and enough availability of, human, financial and material resources. In additional to international effort required in Tanzania's economy, local initiative is important in the achievement of national policy objectives of which national health policy objectives form the part. The areas of success in implementation of the health system in Tanzania are discussed, pointing out areas in which implementations are unsatisfactory.
    Download PDF (328K)
feedback
Top