The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 44, Issue 4
Displaying 1-6 of 6 articles from this issue
  • David A McCarron
    1995 Volume 44 Issue 4 Pages 105-114
    Published: 1995
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Pathological alterations in calcium metabolism are a factor in abnormal blood pressure regulation in some humans. A consistent nutrient/blood pressure association has been demonstrated in epidemiological studies, the strength of which has been acknowledged by leading authorities in the field of nutritional epidemiology. Thus, in patients with mild to moderate hypertension, dietary calcium intake should be assessed, and where appropriate, they should be encouraged to maintain intake levels of 800 to 1000mg/day. More importantly, for normal subjects at risk of developing high blood pressure, inadequate intake of dietary calcium should be avoided. It is clear that the maintenance of the recommended daily calcium intake is essential for optimal blood pressure control as well as bone and cardiovascular health. As the accumulated evidence suggests, it is the prevention of calcium deficiency that should be strived for in patients with essential hypertension or individuals at risk of developing this all-too-common medical disorder. Adequate intake should be promoted of not only calcium, but also potassium, magnesium, phosphorus and essential fatty acids. The published scientific data summarized here support this conclusion as well as the implementation of strategies to effect such an outcome in order to improve cardiovascular health in humans.
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  • Takashi Hashimoto
    1995 Volume 44 Issue 4 Pages 115-123
    Published: 1995
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Autoimmune blistering skin diseases develop separation either between epidermal keratinocytes or dermo-epidermal junction. Recent studies have revealed that the autoantigens for these diseases are components of either the desmosome, the cell adhesion junction between keratinocytes, or the hemidesmosome complex, cell adhesion machinery at the dermo-epidermal junction. Thus, the major pemphigus antigens are desmogleins, one of desmosomal cadherins. Both the 230 kD and 180 kD bullous pemphigoid antigens are present in the hemidesmosome, and epidermal basement membrane zone-specific extracellular matrices, epiligrin and type VII collagen, are detected by sera of cicatricial pemphigoid and epidermolysis bullosa acquisita, respectively. Furthermore, animal model studies using newborn mice have revealed that these autoantibodies are really pathogenic and can induce blister formation by passive transfer into mice. Therefore, these skin diseases seem to be a typical model for various autoimmune diseases, for most of which the role of autoantibodies has not yet been revealed.
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  • Eli Y Adashi
    1995 Volume 44 Issue 4 Pages 124-132
    Published: 1995
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The introduction of steroid “add-back” regimen draws on the recognition that several clinical entities targeted for treatment with GnRHa are not “six-month diseases”. Included under this heading are individuals suffering from symptomatic endometriosis (not desirous of pregnancy), uterine fibroids (ineligible or disinterested in definitive surgical therapy), ovarian hyperandrogenism, premenstrual syndrome, menopausal transition, or dysfunctional uterine bleeding. A six month course of therapy with a GnRHa does not adversely affect lipoprotein economy and therefore presumably the corresponding cardiovascular risk. A six month course of GnRHa therapy appears to be associated with a substantial decrease (of up to 8.2%) in lumbar bone density, a phenomenon which may not be entirely reversible six months after discontinuation of therapy. In principle, steroid “add-back” therapy should diminish some or all of the side effects associated with GnRHa therapy, may provide a medical treatment option for patients representing a high surgical risk, and may delay surgical intervention if desired. On the other hand, a steroid “add-back” therapy may delay tissue diagnosis, be associated with a substantial cost as well as with the need in parenteral route of administration. Norethindrone-only (but not medroxyprogesterone acetateonly) “add-back” regimens have proved promising in the context of endometriosis. Non-concurrent estrogen/progestin “add-back” regimens proved promising in the context of uterine fibroids. Substantial additional studies would have to be carried out to validate the utility of steroid “add-back” regimens. Special emphasis will have to be placed on the evaluation of long-term utility with an eye towards assessing clinical efficacy, impact on lipoprotein economy, impact on bone density, impact on urogenital tissues, and impact on the hot flash. The concurrent or non-concurrent use of non-steroid “add-back” regimen will also most likely constitute a major component of future studies.
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  • Takeshi Kawase
    1995 Volume 44 Issue 4 Pages 133-139
    Published: 1995
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The ventral surface of the brain stem is anatomically surrounded by the clivus anteriorly, brain stem posteriorly and by the petrous pyramid and cranial nerves from IIIrd to XIIth laterally in the deep posterior cranial fossa. Neurosurgical extra-axial pathologies arising from the area are aneurysms on the vertebro-basilar artery, benign tumors such as clival meningiomas, chordomas, chondromas, trigeminal neurinomas and prepontine epidermoid tumors. Surgical access to the area had been difficult for long years since the neurosurgery was established, because located deeply in such a surgical blindness, so-called “no-man's land”. However, recent technical development of “skull base surgery” is opening new doors to light up the surgical darkness of the “no-man's land”. This paper reviews the history, development, technique and future prospect of the skull base surgery to open the “no-man's land”.
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  • Shingo Tajima, Hiroshi Wachi, Akinobu Hayashi
    1995 Volume 44 Issue 4 Pages 140-145
    Published: 1995
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Treatment of cultured smooth muscle cells with ascorbic acid resulted in an accumulation of tropoelastin in the culture medium in dose-dependent and exposure time-dependent manner under the condition in which collagen synthesis was stimulated 2-fold. The steady-state level of elastin mRNA was essentially unchanged, whereas collagen mRNA content increased 2-fold by ascorbic acid treatment. Newly synthesized tropoelastin was hydroxylated in the presence of ascorbic acid but was underhydroxylated in a scorbutic condition. Short pulse experiments showed that the secretion rate of tropoelastin was unaltered by ascorbic acid treatment. Pulse-chase experiment demonstrated that the level of fully hydroxylated tropoelastin in the medium of ascorbate-treated cells was greater than that of underhydroxylated tropoelastin. These results indicate that accumulation of tropoelastin in the medium by ascorbic acid is related to an increased stability of hydroxylated tropoelastin and/or its impaired incorporation into insoluble elastin.
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  • Thomas Ebert, Markus Graefen, Stephan Miller, Dietmar Saddeler, Bernd ...
    1995 Volume 44 Issue 4 Pages 146-149
    Published: 1995
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Transurethral resection of the prostate (TURF) and open adenectomy are regarded the golden standard in the management of patients with symptomatic benign prostatic hyperplasia (BPH). Various alternative treatment forms (microwaves, laser, radiofrequency, focused ultrasound) have been introduced recently. They all aim at reduction of morbidity related to TURP keeping a comparable efficacy at the same time. Since December 1992, 50 patients with BPH have been treated by high intensity focused ultrasound (HIFU-P) at our department. Six weeks following HIFU-P mean Qmax improved from 5.7ml/s to 11.6ml/s. Post voiding residual volume (RV) dropped from 215ml to 100 ml, the International Prostate Symptom Score (IPSS) from 19.8 to 9.9. Both, INS and RV further improved during the following weeks. Follow-up data one year after treatment demonstrate that results remained stable in the majority of patients. Urinary tract infections were observed in 3 patients, macrohematospermia in all and macrohematuria (caused by the suprapubic catheter) requiring blood transfusion in 1 patient.
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