The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 51, Issue 3
Displaying 1-6 of 6 articles from this issue
  • Hideyuki Okano
    2002 Volume 51 Issue 3 Pages 115-128
    Published: 2002
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    It has long been thought that functional regeneration of the injured central nervous system (CNS) is impossible, as Santiago Ramóny Cajal described in the early 20th century, “once the devel-opment was ended, the fonts of growth and regeneration ... dried up irrevocably”. In mammalian neural development, most neuronal production (neurogenesis) occurs in the embryonic stage. How-ever, recent findings indicate that neurogenesis continues in the olfactory bulb, hippocampus, and dentate gyrus of adult mammalian animals, from the neural stem cells (NSCs). Recently developed techniques have made it possible to isolate, culture, and grow pluripotent self-renewing NSCs from both embryonic and adult brains. This basic research is attracting a lot of attention because of the hope that it will lead to regeneration and reconstruction therapy for the damaged CNS. In this review, recent findings on the stem cell biology of the CNS and strategies for its potential therapeutic application will be discussed.
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  • Takamori Nakayama, Seiji Kobayashi, Kou Shiraishi, Takao Nishiumi, Syu ...
    2002 Volume 51 Issue 3 Pages 129-132
    Published: 2002
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n = 7) or an inguinal approach (n = 5). The hernial orifice was closed using the uterine fundus (n = 6), a patch (n = 5), and direct suture (n = 1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery.
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  • Masayuki Amagai
    2002 Volume 51 Issue 3 Pages 133-139
    Published: 2002
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Pemphigus is a group of autoimmune blistering diseases of the skin and mucous membranes that are characterized histologically by intraepidermal blisters due to the loss of cell-cell adhesion of keratinocytes and immunopathologically by the finding of pathogenic IgG autoantibodies directed against the cell surface of keratinocytes. Identification of the target antigens has redefined pemphigus as an autoimmune disease against desmosomal cadherin or desmoglein. The IgG autoantibody-mediated functional inhibition of desmoglein which plays an important role in the cell-cell adhesion of keratinocytes results in blister formation. Patients with pemphigus vulgaris and pemphigus foliaceus have IgG autoantibodies against desmoglein3 and desmogleinl, respectively. Even complex clinical variations of pemphigus vulgaris and foliaceus are now logically explained by the desmoglein com-pensation theory. As an extension of this theory, the exfoliative toxin produced by Staphylococcus aureus, which causes staphylococcal scalded skin syndrome and bullous impetigo, was found to specif-ically cleave desmogleinl and induce the identical histology to pemphigus foliaceus. Another recent innovation has been the development of an active disease mouse-model for pemphigus using auto-antigen knockout mice, in which self-tolerance of the defective gene product is not acquired. When splenocytes from desmoglein3 knockout mice are adoptively transferred into mice expressing desmo-glein3, anti-desmoglein3 IgG is stably produced in the recipient mice that develop the phenotype of pemphigus vulgaris. This model will be valuable not only for dissecting the cellular and molecular mechanisms in pathogenic antibody production but also for developing novel therapeutic strategies.
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  • Ronald L. Linscheid, James H. Dobyns
    2002 Volume 51 Issue 3 Pages 140-147
    Published: 2002
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The term carpal instability is commonly used, but what carpal stability actually is has not been defined. Much of the mechanically complex wrist's versatility is due to the intercalated three bone proximal carpal row. Landsmeer described the collapse tendency associated with intercalated segments. The factors which provide static stability are the oblique alignment of the scaphoid, the obliquely aligned dorsal and palmar ligamentous complexs, the intrinsic perilunate ligaments, the transiting transcarpal tendons and the negative intraarticular pressure. The proximal carpal row adjusts its posture on the counterbalancing flexion/pronation torque exerted by the scaphoid and the exten-sion/supination torque exerted by the triquetrum. The dynamic factors are the compressive force exerted across the joint acting on the joint surfaces and the effect of the bowstringing force provided by the flexor carpi radialis acting at the scaphoid tuberosity. The proximal carpal row has a tendency to translate ulnarly along the ulnarly sloped radial articular surface while the distal row has a tendency to slide radially on the radially sloped lunatatotriqueteral distal articular surface. This activity produces differential tension in the ligaments attaching to the triquetrum which effects an extension/supination stance of the triquetrum. The force couple acting on the scaphoid effects the flexion tendency of the scaphoid. The bowstringing of the flexor carpi radialis also counteracts scaphoid flexion. Alterations in any of these factors may upset the delicate mechanical balance of the joint.
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  • Henry F. Bradford
    2002 Volume 51 Issue 3 Pages 148-153
    Published: 2002
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The use of dopaminergic mesencephalic (VM) human foetal brain tissue as implants to neurosurgically treat Parkinson's disease has been in progress since the 1980's. A major limitation in the use of VM tissue is the amount of tissue available from each human embryo. Usually tissue from about 7 embryos is required to treat each patient unilaterally. To overcome this we have developed various strategies. One is to convert embryonic cerebral cortex in human embryos into dopaminergic tissue which is stable, and which will secrete dopamine in vivo once implanted. The cerebral cortex is about 500 times larger than the VM and can therefore provide a lot more tissue for transplantation. This can be achieved by genetic manipulation of the embryonic cerebral cortex tissue, involving the lipo-transfection of multiple copies of the human tyrosine hydroxylase gene into both neurones and glial cells. In another approach we have biochemically manipulated the development of the cerebral cortex to direct the neurotransmitter phenotype towards the dopaminergic type, and away from other phenotypes. This tissue, too, is stable and will synthesise and secrete dopamine when transplanted. Our third approach has been to manipulate pluripotential neural cells which are yet to develop into neu-rones and gfial cells. These cells can be expanded in number many-fold before treatment to direct their development into stable dopaminergic neurones in large numbers (70%), which synthesise and release dopamine. When used as transplants in animal models of Parkinson's disease, these various types of artificially induced dopaminergic tissue are very effective at reducing the Parkinsonian syndrome.
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  • Noga Vardi, Anuradha Dhingra, Lingli Zhang, Arkady Lyubarsky, Tian Li ...
    2002 Volume 51 Issue 3 Pages 154-164
    Published: 2002
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The retina employs two main synaptic relays in which information converges to higher order cells, and at the same time is modified by lateral inhibitory interneurons. At the first synaptic layer, rod and cone terminals contact second order neurons (horizontal and bipolar cells), and in turn, horizontal cells contact cones and bipolar cells. In this talk/review we describe the structures and the neurochemicals involved in transmitting the visual signal at this synaptic complex.
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