The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 46, Issue 4
Displaying 1-5 of 5 articles from this issue
  • Takahiko Funabiki, Toshiki Matsubara, Masahiro Ochiai, Yoshihisa Marug ...
    1997 Volume 46 Issue 4 Pages 169-172
    Published: 1997
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    It is well known that the frequency of an associated gallbladder cancer in patients with pancreaticobiliary maljunction (PBM) without congenital choledochal dilation (CCD) is very high, while that of bile duct cancer with CCD is remarkably high, and that of bile duct malignancy without CCD is low. However, recent statistical evaluations have demonstrated that the coincidence rates of gallbladder and bile duct cancer with CCD are 11.5% and 4.6%, respectively, whereas without CCD the rates are 57.1% and 4.1%, respectively. Rates of bile duct cancer with CCD are comparable to those without CCD. We have performed biliary reconstruction after resection of extrahepatic bile ducts along with the gallbladder for PBM patients who had neither CCD nor cancer. Our surgical strategy for these patients without CCD with PBM was assessed from K-ras point mutations and overexpression of p53 protein in the epithelia of the cancerous portions and non-neoplastic portions of the gallbladder and bile duct affected by PBM regardless of choledochal dilatation. The mutation rate in the non-neoplastic gallbladder epithelium without CCD was 80%, that of the bile duct without CCD 57%, not significantly different from the 50% and 40%, respectively, with CCD. The frequency of p53 overexpression in the non-neoplastic bile duct epithelium without CCD was 14%, comparable to the 11% in gallbladder epithelium with CCD. Judging from the statistical data and the molecular biological data, resection of an extrahepatic bile duct with the gallbladder should be the treatment of choice for carcinogenesis prevention.
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  • Yoshikazu Fujimura, Masaya Nakamura, Morio Matsumoto
    1997 Volume 46 Issue 4 Pages 173-176
    Published: 1997
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Anterior decompression and fusion via an extrapleural approach was performed for 33 patients with myelopathy arising from thoracic disc herniation and the clinical usefulness and problems related to this procedure were assessed on the basis of surgical results and complications. The severity of the myelopathy was evaluated by the Japanese Orthopaedic Association score, and the surgical results were based on the recovery rate. The upper-level limit of decompression and fusion via the extrapleural approach was T4-5. The recovery rate for the mean postoperative follow-up period of 41 months was 66.7%. An age of 60 years or more, long duration of illness and severe preoperative myelopathy were indicators of a poor prognosis. Two patients suffered from a postoperative transient pulmonary complication due to hemothorax. X-ray examinations revealed good bone union in all the patients. The present study indicates that anterior decompression and fusion via the extrapleural approach is a useful technique which can be used to achieve a high success rate in the surgical treatment of thoracic disc herniation, if intervention is early.
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  • Hidetsugu Saito, Hirotoshi Ebinuma, Masaya Oda, Hiromasa Ishii
    1997 Volume 46 Issue 4 Pages 177-183
    Published: 1997
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The efficacy of different doses and administration periods of interferon (IFN)-α treatment for patients with chronic hepatitis C was retrosepctively evaluated by using the return of serum alanine aminotransferase (ALT) to normal levels 12 months after therapy as an index. Two hundred forty-one patients with chronic hepatitis C received 6 to 9 mega units of IFN-α once, twice, or three times per week for a different number of weeks. ALT levels generally returned to normal in 77 of the 241 patients (32.0%). The efficacy of IFN-α therapy with a total dose of 350 mega units or more was significantly superior to that with 350 mega units or less (30 to 45%, p<0.05). However, the efficacy was the same if a total dose was more than 350 mega units, and more than 700 mega units did not improve the response rate. Administration periods of more than 6 months and less than 1 year appeared to be the most effective in this study. To achieve a complete response, administration three times a week was better than once a week. The higher the dose administered within a certain period, the higher was the efficacy of the IFN-a treatment. However, the factors affecting response must be further studied, because there are patients who respond to therapy with a total of only about 200 mega units, and patients who do not respond even to 800 mega units given for more than 1 year
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  • Masaru Tanaka, Peter J Dykes, Ronald Marks
    1997 Volume 46 Issue 4 Pages 184-187
    Published: 1997
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Human granulocyte-macrophage colony stimulating factor (GM-CSF) is a 22 kD glycoprotein derived from activated T cells, endothelial cells, fibroblasts and macrophages. It stimulates the proliferation and differentiation of haematopoietic cells and certain nonhaematopoietic cells. This study investigated the effect of GM-CSF on cultured human keratinocytes and determined whether these cells express GM-CSF receptors. Measurement of keratinocyte growth by image analysis showed that GMCSF mildly stimulated the growth of keratinocytes. With 4ng/ml GM-CSF the growth of primary keratinocytes and subcultured keratinocytes was only stimulated up to 25% and 18% of the control cell level, respectively. Human keratinocytes were incubated with GM-CSF at 4 ng/ml for 4 days to induce receptor expression. These cells showed only a weak positive reaction on affinity labelling using digoxigenated GM-CSF. We conclude that keratinocyte growth may be stimulated by GM-CSF but that the presence of GM-CSF receptors on these cells is equivocal.
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  • Hisao Ogata
    1997 Volume 46 Issue 4 Pages 188-195
    Published: 1997
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Q-switched ruby laser (QSRL) and Q-switched Nd-YAG laser (QSNYL) treatment of dermal melanocytosis, especially nevus of Ota, has produced favorable results that are mediated by selective photothermolysis. However, the precise effects of irradiation on melanosomes and cells containing melanosomes remain unclear, and an optimal method of irradiation has not been found. In this study synthetic melanin powder and pigmented dermal tissue obtained from five blue nevus lesions, also classified as dermal melanocytosis, were used as targets to identify the specific effects of these forms of irradiation in vitro. Morphological changes were assessed by microscopy after irradiation with QSRL and QSNYL at a fluence of 5 J/cm2, the fluence ordinarily utilized in clinical applications. Light microscopy revealed that most of the synthetic melanin powder retained in 1% agar was no longer visible after QSRL irradiation. In contrast, melanin powder particles were partly crushed by QSNYL irradiation. Electron microscopic examination of melanosomes in the blue nevus tissue after irradiation showed expansion and various other forms of disruption. Statistical analysis by 2-way analysis of variance (ANOVA) of the length of the major axis of the melanosomes indicated that QSRL irradiation caused significantly greater melanosome expansion than QSNYL irradiation. These findings indicate that QSRL irradiation had a greater photothermal effect on dermal melanosomes than QSNYL irradiation. This suggests that QSRL is more efficacious in the treatment of dermal melanocytosis than QSNYL.
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