The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 39, Issue 3
Displaying 1-6 of 6 articles from this issue
  • William I. Rosenblum
    1990 Volume 39 Issue 3 Pages 137-141
    Published: 1990
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Pial arterioles of mice are studied by in vivo TV microscopy. Focal endothelial injury is produced by a laser/Evans blue technique. Moderate damage results in local platelet aggregation. Very slight damage, without electron microscopic evidence of injury, results in loss of many endothelium derived vasoactive factors. These include “EDRFs” for acetylcholine, bradykinin and calcium ionophore, and “EDCFs” for histamine and serotonin. In the cases of acetylcholine, histamine and serotonin, each agonist possesses an additional opposing action which is independent of endothelium. The latter action is unmasked by the endothelial injury. The balance between simultaneously acting endothelium dependent and endothelium independent actions is a determinant of the response to an agonist with two opposing actions. This balance is partly dependent upon initial tone. Thus the effect of the agonist depends on initial tone. One of the determinants of initial tone may be basal release of one or more EDRFs or EDCFs. Evidence in pial arterioles for the basal release of EDRF for acetylcholine, comes from our data showing that L-NMMA constricts these arterioles. L-NMMA is a known inhibitor of synthesis of “classical” EDRF from L-arginine. The response to L-ARG is relaxation. Both the response to L-NMMA and the response to L-ARG are abolished by laser/dye injury of the endothelium. Thus these agents are really acting via an endothelial mechanism in brain arterioles, just as has been reported for their actions in conductance vessels. Finally mild injury associated with loss of “EDRFs” is also accompanied by a reduced ability of pial arteriolar endothelium to repell activated platelets.
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  • Masaaki Murakami
    1990 Volume 39 Issue 3 Pages 142-158
    Published: 1990
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    This paper describes a multi-dimensional study of non-organic hallucinatory states in the oversixties. The subjects totalled 43 with no signs of obvious dementia or sustained confusion. Eleven biological, socio-psychological factors and 15 aspects of the clinical picture were assessed at the initial interview. Clinical symptoms were followed under medical treatment. Thirty eight subjects were followed for a further one year. One month later these subjects were classified into three groups. Group I, Complete Recovery Group (18 subjects). The characteristics of this group were: same sex ratio, good previous adaptation, high educational level, normal marital state, high rate of precipitating events, good response to treatment, acute onset, vividness and concreteness of the hallucination, fragmentariness of the delusion high rate of anxiety and psychomotor excitement and good rapport. The course resembled “psychogenic reaction” and at the same time it resembled “organic brain syndrome” in symptoms. A possible interpretation is that under the influence of precipitating factors, “subclinical” cerebral hypofunction due to senility lapsed transiently into “apparent” cerebral hypofunction, leading to acute hallucinatory-delusional state. Group II, Partial Recovery Group (22 subjects). The characteristics of this group were: predominance of females, presence of precipitating events, fair response to treatment and subacute onset. This group was similar to Roth's “late paraphrenia” and Janzarik's Altersschizophrenie. Group III, Refractory Group (3 subjects). The characteristics of this group were: poor response to treatment and chronic onset. Two fell into dementia within one year. The symptoms of two subjects in the refractory group could be interpreted as prodromal symptoms of dementia. Aging reduces the redundancy of cerebral function to cope with the environmental changes. Among the elderly, events in daily life may often become precipitating factors of hallucinatory-delusional states. For the prophylaxis of hallucinatory-delusional states in elderly, serious attention should be paid to the psychological and somatic conditions which precede to these precipitating factors.
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  • Yoshihide Otani
    1990 Volume 39 Issue 3 Pages 159-167
    Published: 1990
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    In order to investigate the role of collagenase in cancer invasion and metastasis, two collagenase activities of interstitial collagenase and type IV collagen degrading enzyme (type IV collagenase) were determined in 40 cases of human stomach cancer tissue. Elevated cancers which are known to have a propensity to cause blood-borne metastases showed higher activities of both interstitial collagenase and type IV collagenase than flat or ulcerous type of cancer. Using the parameters of lymph node metastasis vs tumor size or vs depth of cancerous invasion into the stomach wall, classification of the cases was attempted according to the degree of malignancy. In the cases with marked lymph node metastases in spite of small tumor size and/or shallow cancerous invasion into the stomach wall, type IV collagenase activity was higher than that in the cases with lower malignancy (p<0.025, p<0.05, respectively). These results suggest that collagenase in stomach cancer tissue play an important role in the invasion and metastasis of cancer cells. Type IV collagenase activity in stomach cancer tissue could be one of the useful biological markers for the degree of malignancy.
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  • Tai Akera, Kyosuke Temma, Hiroshi Kondo, Kazuhiko Hagane
    1990 Volume 39 Issue 3 Pages 168-172
    Published: 1990
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    To examine the origin and spreading of the Ca2+ transient following electrical stimulation of isolated myocyte, a system capable of recording intracellular Ca2+ distribution with sufficient temporal and spatial resolution was constructed. The system consists of a fluorescence microscope with computer-controlled pulse illumination and a digital image analyzer. The results with this new equipment show that the Ca2+ transient originates from one or a few points within a myocyte, and spreads throughout the cell. During the initial 60-msec period, the distribution of Ca2+ within a myocyte was not uniform. The system may be used for better understanding of the excitation-contraction coupling mechanism occurring within a cardiac myocyte or of changes in intracellular Ca2+ concentrations in other cells in which Ca2+ plays a crucial role in signal transduction.
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  • Milo Zachmann
    1990 Volume 39 Issue 3 Pages 173-186
    Published: 1990
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Growth hormone (GH).is secreted in a pulsatile way during the whole life under the reciprocal influence of somatostatin and GH-releasing hormone (GHRH). It mediates many effects by stimulating production of insuline like growth factor I (IGF I).in liver and other tissues, but IGF I is also regulated by the nutritional state. Women secrete more GH than men, and older men and women less than young women. This suggests importance of estradiol in regulating secretion. Sex hormone effects are also demonstrated by the increment of GH and IGF I at puberty, which is an amplitude-modulated phenomenon. Classic metabolic studies have shown that patients with GH-deficiency retain more nitrogen in response to a given dose of exogenous hGH than normal subjects. The use of the stable isotope 15N has simplified such studies. In GH-deficient patients, there was with this technique a marked positive hGH-induced balance change. In girls with Turner syndrome (as example of subjects with normal GH-secretion), balance change was less marked with the same dose. Girls with Turner syndrome, who were given a double hGH-dose showed a response in the same range as that in the GH-deficient patients with the lower dose. A conclusion from this is that patients with normal GH-secretion need higher doses to obtain a similar response, than patients with GH-deficiency. The dosage in such patients will have to be selected individually, and needs to be about twice or three times as high as in GH-deficient patients.
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  • Jules Constant
    1990 Volume 39 Issue 3 Pages 187-192
    Published: 1990
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The term “atypical chest pain” is a waste-basket term that leads physicians to send any patient with chest pain to coronary angiography. In order to avoid this term, we must learn to distinguish atypical angina from nonanginal chest pain before angiography is considered in order to avoid unnecessary invasive procedures. A chest pain is very likely nonanginal if its duration is over 30 minutes or less than 5 seconds, it increases with inspiration, can be brought on with one movement of the trunk or arm, can be brought on by local fingers pressure, or bending forward, or it can be relieved immediately on lying down. There are also many presumptive signs of nonanginal chest pain such as localization with one finger, radiation to the nuchal area, an inframammary primary site, a pain that reaches maximum at the onset, or relief within a few seconds of swallowing food. Cervical root compression pain and esophageal spasm are the greatest mimics of angina since they can both be relieved by nitroglycerin but they have several features which help to rule out angina.
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