The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 41, Issue 3
Displaying 1-9 of 9 articles from this issue
  • Thomas E Kottke
    1992 Volume 41 Issue 3 Pages 123-127
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The goal of cardiac rehabilitation is to optimize function through attention to the patient's medical needs, risk factors for recurrent events, physical reconditioning, and psycho-social needs. Medical needs include beta-adrenergic blocking agents and aspirin unless contraindicated, angiotensin converting inhibitors for left ventricular dysfunction, and relief of residual ischemia. Smoking, lipid abnormalities, physical inactivity, and hypertension remain important predictors of reinfarction and death and must be controlled. Obesity must be addressed because it exacerbates these problems. Therefore, the principles of behavior change should be applied to help patients control their risk factors and adopt healthy lifestyles. Smoking cessation and appropriate dietary behaviors canbe adopted by the patient while in the hospital. Physical reconditioning can also begin with twice-daily exercises. After discharge from hospital and after an initial submaximal exercise evaluation, the patient will benefit from three sessions per week of outpatient cardiac rehabilitation for six to eight weeks. These sessions should last about an hour and raise the patient's heart rate as much as30 beats per minute. Along with physical reconditioning, the cardiac rehabilitation program provides an opportunity to address risk factor modification, return to work, return to sexual activity, management of depression and anxiety, and the presence of risk factors in the patient's family. The patient should attend reinforcing sessions every three months for the first year and as necessary after that to control risk factors and reinforce the necessity for physical fitness.
    Download PDF (397K)
  • Yu Ying Liu, Soichiro Miura, Hidekazu Suzuki, Iwao Kurose, Dai Fukumur ...
    1992 Volume 41 Issue 3 Pages 128-133
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    In this study, we have demonstrated that repeated electrical stimuli to the artery of the mesenteric pedicle can produce mesenteric microcirculatory disturbance by autonomic nervous irritation in rats. The parameters to demonstrate microcirculatory damage were observed and quantitatively analyzed using the intravital microscopy after electrical stimulation for 40 minutes. The blood flow of arterioles and venules in the mesentery showed ischemia-reperfusion pattern during the repeated electrical stimulations. The diameter of arterioles did not show significant change, while RBC velocity of arterioles was significantly decreased at 30 min after the irritation. The RBC velocity in venules was decreased from the early period to about 20%. But this values were not significantly dropped during the later observation period, suggesting the formation of short circuit flow by passing the collapsed capillary beds. The number of rolling WBC in the venules was notably increased at the time immediately after irritation, and thereafter the number of rolling WBC number was rather reduced. The number of sticking WBC in venules was time-dependently increased and reached its maximum at 30 min. When permeability of venular wall was determined by the injection of pontamine sky blue, significant increase in permeability was already shown immediately after irritation, suggesting that the integrity of microvascular wall was disturbed in this early period. The permeated area expanded thereafter in parallel with the increase in sticking WBC number. From these observations, it is suggested that endothelial cell damage and following leukocyte-endothelium interaction induced by autonomic nerve irritation appear to be an important factor in microcirculatory disturbances.
    Download PDF (2277K)
  • Yoshio Izumi, Fumio Gotoh, Yasuo Fukuuchi, Takashi Hata, Akira Imai, K ...
    1992 Volume 41 Issue 3 Pages 134-140
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    We examined the mechanism of impairment of the cerebrovascular CO2 responsiveness in moderate hypoglycemia. Twelve fasted cats were used. The brain-PO2, brain-PCO2 and brain-pH were measured continuously with electrodes placed on the brain surface. Hypoglycemia was induced with insulin. Intravenous injection of hexamethonium (a sympathetic ganglion blocker, C6; 0.1mg/kg) was performed at the following stages: Control, hypoglycemia and recovery. Before and after the C6 administration, 5%CO2 in air was inhaled for 3 min at the respective stages. The CO2 responsiveness (cerebrovascular dilatory response to increased PaCO2) at the control stage was not altered after the ganglionic blockade. At the hypoglycemic stage, the increase in BrPO2 by CO2 inhalation was significantly less than that at the control stage. This reduction of ΔBrPO2 was significantly improved after the administration of C6. At the recovery stage, the CO2 responsiveness before and after the administration of C6 was not significantly different. An impaired CO2 responsiveness in the hypoglycemic state was im-proved by sympathetic ganglion blockade with C6 which did not alter the reactivity during normoglycemia. It is suggested that the sympathetic activity plays an important role in impairment of the cerebrovascular CO2 responsiveness during moderate hypoglycemia.
    Download PDF (2987K)
  • Junichi Kaburaki, Chang Chur Lee, Masataka Kuwana, Takeshi Tojo, Yasuo ...
    1992 Volume 41 Issue 3 Pages 141-145
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    We conducted a retrospective study of 86 patients with systemic sclerosis (SSc) to clarify the initial predictors of survival at the first visit to the hospital. A life-table analysis of survival was performed concerning 137 items from their histories, physical examinations, and laboratory data. The observed cumulative survival rates were 78.0 percent at 5 years and 68.2 percent at 10 years. Ten items were found to be the initial predictors of survival in patientswith SSc. Of these 10 items, 9 items showed significant differences within 5 years of the first visit to the hospital. Patients with resting electrocardiographic abnor-malities, such as atrial or ventricular arrhythmias, or conduction disturbances, pulmonary fibrosis on the chest x-ray films, or decreased vital capacity had significantly lower survival rates. However, patients with anti-centromereantibody had a significantly better survival rate. In addition, males, aged patients over 65 years old, and patients with proteinuria, leucopenia, or hypergammaglobulinemia had significantly lower survival rates. Only patients with proximalscleroderma at the first visit to the hospital had a significantly lower survival rate after 8 years. These results are useful in predicting individual patientsat risk of short-ened survival and in managing these patients.
    Download PDF (314K)
  • Shintaro Hasegawa
    1992 Volume 41 Issue 3 Pages 146-153
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Tumor-infiltrating lymphocytes (TIL) were tested for cytotoxicity against autologous tumor cells in a study utilizing a chemically induced cancer ofthe bladder (transitional cell carcinoma), BC-47, in inbred ACI/N rats. From tumors grown after subcutaneous implantation of BC-47 in the rats TIL were separated by density gradient centrifugation and incubated in plastic dishes for separation of non-adherent from adherent cells. The non-adherent cells were further fractionated into T and B cells by the panning method using anti-rat F(ab')2 antibody. The cell fractions were each added to BC-47 in culture to be assessed for antitumor effect by the crystal violet dye exclusion method and 3H-thymidine incorporation inhibition assay. Peripheral blood mononuclear cells (PBMC) were also tested as described above. TIL expressed significantly higher cytotoxicity against BC-47 with the mean % cytotoxicity of 56.6±5.6% and 87.5±7.1% at E/T ratios of 10:1 and 20:1, respectively, as compared to PBMC(9.9±5.0% at E/T 10:1) (P<0.001). The adherent cells, B and T cell fractions showed respective % cytotoxicity of 92.4±2.8%, 57.9±10.6% and 9.9±7.8% at an E/T ratio of 10:1. TIL pretreated with IFN or rIL-2 for 24or 48 hours did not exhibit any noticeably enhanced antitumor activity at an E/T ratio of 5:1. Prevention of direct contact of BC-47 cells and TIL by an interposed Millipore membrane (0.45μm) resulted in an unequivocal reduction of antitumor effect. This finding clearly indicates that the direct contact with BC-47cells and TIL is necessary for TIL to manifest their cytotoxicity against the autologous tumor cells, suggesting that TIL exhibit autologous tumor killing activity through cell-mediated cytotoxicity.
    Download PDF (2301K)
  • Takashi Muto, Haruhiko Sakurai, Kazuyuki Omae, Haruo Minaguchi, Masato ...
    1992 Volume 41 Issue 3 Pages 154-160
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The objective of this study was to reveal the health effects of acrylonitrile (AN) in seven Japanese acrylic fiber manufacturing factories. The study subjects were 157 AN-exposed male shift workers who had been exposed to AN for 17 years on the average and 537 control workers whose working conditions were similar to those of the AN-exposed workers. The seven factories were classified into two groups according to their AN exposure levels in 1987, and also into threegroups on the basis of 1976 exposure levels. The most highly exposed group of subjects showed a mean AN concentration of 1.13 ppm by personal sampling. Medical examination failed to detect any health effects attributable to long-term exposure to AN, although the existence of some symptoms of acute irritation could not be completely ruled out. The results of this study may provide a “no observed effects level” for human on-the-job exposure with regard to the health effects examined here.
    Download PDF (390K)
  • Kiyoshi Takamatsu
    1992 Volume 41 Issue 3 Pages 161-167
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    In human cervical epithelium and uterine endometrium, globo-series neutral glycosphingolipids with N-α-hydroxy fatty acyl phytosphingosine (4-D-hydroxysphinganine) as the ceramide and sulfatide (I3SO3-GalCer), which were contained in trace amount at the follicular phase, significantly increased in concentration at the luteal phase, comprising about 20% of the individual neutral glycosphingolipids and about 15% of the total acidic glycosphingolipids, respectively. However, in the mucosa of fallopian tube, neutral glycosphingolipids with the same polarity as those in the cervical epithelium and uterine endometrium at the luteal phase and sulfatide remained at a constant and higher level independently of the menstrual cycle. The structures of neutral glycosphingolipids in the fallopian tube, having the same polarity as that of N-α-hydroxy fatty acyl phytosphingosine-containing molecules appeared in the cervical epithelium and uterine endometrium at the luteal phase, were determined to be N-α-hydroxy palmitoyl 4-sphingenine-containing ones by negative-ion FABMS. Also, laminin, but not collagen type IV, was found to be contained in the concentration correlated well with that of sulfatide in the genital tract, when determined by western blotting with monoclonal anti-laminin and anti-collagen type IV antibodies, indicating a possible function of sulfatide as a receptor for laminin in the human female genital tract.
    Download PDF (2997K)
  • Yasuo Unai
    1992 Volume 41 Issue 3 Pages 168-176
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Factors influencing prognosis and relapse in schizophrenia were investigated systematically. The results agreed with Jacksonism. Data were collectedfrom 166 patients who suffered relapses and were readmitted to Hospital, into seven categories from Nov 15, 1971 to Dec 31, 1974. The psychiatric symptoms were classified from A to G, positive to negative. The initial symptoms were divided into 4 groups. There was interrelation between the somatic and psychiatric symptoms; in the initial symptoms and the prognosis, courses, and psychiatric symptoms. Based on the author's results, the author suggests that an evolutional and hierarchical interpretation, which Jackson emphasized, in the correlation between brain and mind is applicable in the psychopathology of schizophrenia.
    Download PDF (594K)
  • Klaus J Lewin
    1992 Volume 41 Issue 3 Pages 177-183
    Published: 1992
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Squamous cell carcinoma is the most common malignant tumor of the esophagus and it is one of the most common fatal cancers worldwide. There is greatgeographic variation in occurrence of these tumors. Especially high-risk areas have been identified in Northern Iran, Central Asian Republics, Northern China and South Africa. In some of these areas annual mortality rates reach 133/100, 000 and over 20% of the population dies of esophageal cancer. The mortality in the US is considerably lower (3 to 8 per 100, 000). In common with squamous dysplasiaselsewhere eg the cervix, squamous dysplasia of the esophagus also appears to be a precancerous lesion. We have found that squamous dysplasia and early cancer are characterized by a number of distinctive endoscopic changes, namely, mucosal friability, erosions, plaques and nodules. Another finding of interest is the failure on our part to confirm the frequency of esophagitis in high risk areas. Barrett's esophagus is an epithelial metaplasia which replaces esophageal squamous epithelium for variable lengths from the lower esophageal sphincter region cephalad. It is a complication that occurs in approximately 12% of patients with prolonged gastroesophageal reflux. The importance of this disorder is that it is associated with an increased risk of adenocarcinoma of the esophagus. In assessing biopsies from patients with Barrett's esophagus, the main role of the pathologist is to be on the alert for histologic features of dysplasia and adenocarcinoma.Since dysplasia in Barrett's is endoscopically invisible, multiple biopsies are necessary if surveillance is to be successful in detecting dysplastic lesions and early carcinoma. Recently we have found that carcinoma can occur in any part of the Barrett's and that the risk is unrelated to the length of Barrett's.
    Download PDF (658K)
feedback
Top