The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 45, Issue 1
Displaying 1-9 of 9 articles from this issue
  • Hideo Mitamura
    1996 Volume 45 Issue 1 Pages 1-8
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    In the management of patients with chronic heart failure, our attention is shifting from just improving left ventricular function and abolishing ventricular arrhythmias to improving personal longevity. Importantly, sudden cardiac death is a pattern of death in as many as a half of patients with chronic heart failure. Arrhythmias are common in this disorder, but may possibly be a marker of diseased heart rather than a predictor of sudden cardiac death. The mechanisms and triggers of rapid ventricular tachycardia or fibrillation responsible for sudden cardiac death have not been well established. At present, it is important to be reminded that pharmacologic augmentation of cardiac contractility or suppression of asymptomatic ventricular arrhythmias is not an effective approach to preventing sudden cardiac death, but may even be deleterious. Three groups of drugs that have shown efficacy in preventing sudden cardiac death in patients with chronic heart failure are amiodarone, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Although how these drugs improve prognosis of heart failure are not clear at present, myocardial protection by these agents appears to be most important.
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  • Samuel J Shubrooks Jr
    1996 Volume 45 Issue 1 Pages 9-13
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Cardiology training in the United States has been evolving into well organized programs aiming at providing comprehensive education in all areas of cardiology - invasive, non-invasive, clinical, and research. Changes in the overall healthcare system are being reflected in more intensive training of fewer cardiologists who will function as consultants and directors of cardiology care. In this paper, trends in cardiology training programs in the United States, and in our own institution in particular, are described and discussed.
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  • Kortaro Tanaka
    1996 Volume 45 Issue 1 Pages 14-27
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Since endothelium-dependent relaxation of cerebral vessels was first identified in 1980, the pivotal role of the endothelium has become evident not only in dilator responses but also in constrictor responses to various kinds of stimulation. Involvement of endothelium-derived relaxing factors (EDRFs) as well as endothelium-derived contracting factors (EDCFs) has been postulated in such vascular responses. In 1987, one of the EDRFs was determined to be nitric oxide (NO), a simple and very labile molecule, whereas endothelin composed of 21 amino acid residues was identified as one of the EDCFs in 1988. Since 1990, numerous studies which exclusively employed L-arginine analogues as specific NO synthase (NOS) inhibitors, have been undertaken to examine the role of NO in the regulation of the cerebral circulation. However, some conflicting data have emerged. The few points of consensus among the researchers may be summarized as follows: (1) NO, probably produced in the endothelium, plays an important role in the maintenance of the basal cerebral blood flow, (2) NO is not directly involved in hypoxic vasodilation, and (3) NO mediates a functional coupling of metabolism and cerebral blood flow in certain types of neural activation. Hypercapnic vasodilation and autoregulatory responses are still the main topics providing conflicting data with substantial areas of controversy. Besides ensuring appropriate experimental protocols, future studies require the precise monitoring of the degree and cellular specificity (endothelium, perivascular nerve fibers, neurons, etc.) of NOS inhibition in order to obtain concrete and reliable experimental data.
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  • Hiroshi Shimizu
    1996 Volume 45 Issue 1 Pages 28-36
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Significant advances in the prenatal diagnosis of hereditary skin disorders, including severe forms of epidermolysis bullosa (EB) and tyrosinase-negative oculocutaneous albinism (OCA1A), have been reviewed. Fetal skin biopsy during the second trimester of pregnancy has been utilized successfully for the prenatal diagnosis of EB and OCA1A. Recently, elucidation of the specific gene mutation in affected individuals allowed us to perform DNA-based prenatal diagnosis during the first trimester of pregnancy. Over the last 5 years, we have established several new strategies for prenatal diagnosis for EB and OCA1A at the Special Clinic for Inherited Skin Disorders at Keio University Hospital.
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  • Michiko N Fukuda
    1996 Volume 45 Issue 1 Pages 37-43
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Implantation following placentation is a unique system for mammals to reproduce. The initial attachment of the embryo to the uterus occurs via the apical cell membranes of two epithelial cells, trophoblast of the blastocyst and surface epithelial cells of the endometrium. Analysis of the implantation at the molecular level has been a difficult problem in reproductive biology. Recently, a major break through was made in this area: A discovery of a novel cell adhesion molecule complex mediating the initial attachment of trophoblast to the endometrial epithelium.1 This review provides a brief overview of cell adhesion molecules involved in implantation and introduces identification and characterization of trophinin and tastin.
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  • Atsutoshi Tsuji, Michiko Sasaki, Takefumi Kanemitsu, Norio Uehara, Hir ...
    1996 Volume 45 Issue 1 Pages 44-47
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Ten cases of hemolytic uremic syndrome (HUS) following hemorrhagic colitis caused by verotoxin T2-producing Escherichia coli 0157: H7 (VTEC) occurred in a Kindergarten. Slight changes in results of peripheral blood and blood chemistry studies an average of 4 days after onset suggested HUS, and within the following 12 hours platelet counts and levels of haptoglobin and lactic dehydrogenase decreased. Treatment was mainly directed toward the management of renal failure and included supportive therapy and anticoagulant and antiplatelet treatment. Although neurological complications occurred in some cases, all patients eventually recovered completely.
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  • Hidetsugu Saito, Hirotoshi Ebinuma, Shinichiro Tada, Satoshi Tsunemats ...
    1996 Volume 45 Issue 1 Pages 48-53
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    A combined preparation of liver extract and flavin adenin dinucleotide (FAD) (Adelavin®) has been widely used in patients with chronic liver diseases in Japan. One milliliter of this agent contains 15 μl of phenol-soluble phase of liver nucleic acid fraction and 10 mg of FAD. To examine the advantages of using this preparation in the elimination of hepatitis C virus (HCV) from patients with chronic hepatitis (CH)-C receiving interferon (IFN), 2 ml of this preparation was intravenously (n=9) or intramuscularly (n=8) administered daily for 5 days before 6 million units of IFN-α was intramuscularly injected once. Before and 48 hours after the injection of IFN, serum ALT, 2'5'-oligoadenylate synthetase (2'5-AS) activity, and HCV RNA levels were measured. The daily administration of this preparation alone for 5 days did not significantly change serum ALT, 2'S-AS activities, and HCV RNA levels. The 2'5-AS activities were significantly increased by IFN after the intravenous injection of this preparation (p<0.01), while an injection of IFN alone of this dose did not change its activities (n=10). HCV RNA levels were significantly decreased by IFN only after the administration of the preparation (intramuscular, p<0.01; intravenous, p<0.01). The effect of intravenous injection of this preparation was also elicited in patients with HCV genotype H and with HCV more than 105 copies/ml. These results suggest that this preparation may enhance the 2'5-AS production by IFN as a result of the increase in mitochondrial adenosin triphosphate production and may be a potent agent to enhance the anti-viral efficacy of IFN in patients with CH-C.
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  • Hideo Baba, Takashi Fukutomi, Sadako Akashi, Takeshi Nanasawa, Hiroshi ...
    1996 Volume 45 Issue 1 Pages 54-57
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    A prospective randomized study was conducted to compare the adjuvant efficacy of 12 cycles of low-dose CMF (cyclophosphamide: CPA, methotrexate; MTX, 5-fluorouracil; 5-FU) with that of orally administered CPA plus FT (futraful) in premenopausal patients with stage I-II and one- to three-node-positive breast cancer. The 12-cycle CMF group (91 patients) received, 100 mg CPA orally on days 1 to 14 plus 20 mg MTX and 500 mg 5-FU intravenously (iv) on days 1 and 8 of each cycle. The CPA plus FT group (85 patients) received 100 mg CPA and 600 mg FT orally each day for one year. The background characteristics of the two groups were comparable. At 5 and 10 years, there were non-significant trends towards better disease-free and overall survival rates in the CMF group. Both treatments were well tolerated, but more patients in the CPA plus FT group refused to continue chemotherapy because of continuous gastrointestinal disturbances. No clear benefit of adding low-dose MTX to CPA and fluoro-pyrimidines was observed in this subgroup of Japanese patients. Further studies will be required to clarify the superiority of conventional-dose of CMF treatment to orally administered CPA plust FT treatment.
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  • Shingo Tajima
    1996 Volume 45 Issue 1 Pages 58-62
    Published: 1996
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Elastin expression in cultured vascular smooth muscle cell (VSMC) was found to be enhanced by potent inhibitors of VSMC proliferation including minoxidil, heparin and retinoic acid. By contrast, elastin expression was declined by potent stimulators of VSMC proliferation like epidermal growth factor, high K+, angiotension II and phorbol ester. To elucidate the relationship between elastin expression and cell proliferation, the elastin expression in the different cell growth states brought by cell-synchronizing culture or suspension culture, a culture system independent of potent modulators of VSMC proliferation. Elastin was found to be expressed maximally at G0 and minimally at G2/M phases, suggesting that cell growth state regulates elastin expression in VSMC culture. Synthetic elastin peptide VPGVG or its polymeric form (VPGVG)n enhanced VSMC proliferation, which resulted in the reduction of elastin expression. The results suggests that elastin fragment regulates VSMC proliferation. These correlation between elastin expression and cell growth state may play an essential role in elastin metabolism under the normal and diseased conditions.
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