The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 53, Issue 1
March
Displaying 1-5 of 5 articles from this issue
REVIEWS
  • Yutaka Ono
    Article type: Others
    Subject area: Others
    2004 Volume 53 Issue 1 Pages 1-6
    Published: 2004
    Released on J-STAGE: June 17, 2005
    JOURNAL FREE ACCESS
    In this article, the author describes a suicide prevention program for the elderly in Japan carried out in a small town, Nagawamachi, Aomori. Because of the recent sharp increase in this town in the rate of suicides, we started to develop a suicide prevention program with the goal of trying to detect depression in its early stages. At first we adopted various questionnaires and used structured interviews, and then developed a screener for depression. Screening is an important part of our suicide prevention program, because elderly who are suicidal often do not recognize their distress is a treatable medical condition, partly due to a negative image of mental illness, and most of them do not seek medical help. The author underscores the importance of educational programs to address how to recognize the symptoms of depression and to develop a community network for the elderly to communicate with locals and support each other. It is also important to focus on a social schema to produce a society that respects “being” and not just “doing”.
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  • Kazuo Isozumi
    Article type: Others
    Subject area: Others
    2004 Volume 53 Issue 1 Pages 7-11
    Published: 2004
    Released on J-STAGE: June 17, 2005
    JOURNAL FREE ACCESS
    Obesity is widely recognized as a risk factor for coronary artery disease, but opinion is divided regarding whether it is an independent risk factor for cerebrovascular disease; even now there is no common view. In this study, the review sought to focus on a prospective study, but since obesity and non-obesity basically cannot be randomly assigned, randomized controlled trials (RCT) are non-existent. Accordingly, a cohort study (a method of clinical study in which the obesity group is actively followed up for comparison with the non-obesity group in regard to cerebrovascular disease) was mainly conducted. For reference, retrospective case-control studies are also shown. As a result, most epidemiological surveys on the relation between simple obesity and cerebrovascular disease denied any relation. That is, obesity alone, determined only on the basis of height and weight as shown by BMI (body mass index), etc., cannot be an independent risk factor for cerebrovascular disease; obesity can become a risk factor only when accompanied by hypertension, hyperlipidemia, impaired glucose tolerance, etc. Recently, however, most papers conclude that abdominal obesity is a risk factor for cerebral infarction, provided that there are no data confirming that obesity is a risk factor for hemorrhagic cerebrovascular disease (cerebral hemorrhage and subarachnoid hemorrhage).
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ORIGINAL ARTICLE
  • Jun Iwamoto, Tsuyoshi Takeda, Shoichi Ichimura
    Article type: Others
    Subject area: Others
    2004 Volume 53 Issue 1 Pages 12-17
    Published: 2004
    Released on J-STAGE: June 17, 2005
    JOURNAL FREE ACCESS
    The aim of the present study was to analyze the effects of short-term treatment with the antiresorptive agent, etidronate, on orchidectomized adult rats, via comparison of three cancellous bone sites, the lumbar vertebral body (LVB), proximal tibial metaphysis (PTM), and distal tibial metaphysis (DTM). Thirty-five male Wistar rats, aged 10 months, were randomly divided into four groups: baseline control (BLC, n = 10), age-matched sham-operated control (AMC, n = 9), orchidectomy (ORX, n = 9), and ORX + etidronate treatment (n = 7). Etidronate treatment (10 mg/kg, daily subcutaneous injection) was initiated 2 weeks after surgery and was continued for 2 weeks. Four weeks after surgery, the 5th LVB, PTM, and DTM were processed for histomorphometric analysis of cancellous bone (secondary spongiosa). ORX resulted in a decrease in body weight. No significant difference in cancellous bone volume (BV/TV) was found between the BLC and AMC groups at any skeletal site. The cancellous BV/TV loss was attributable to increased eroded surface (ES/BS) with no significant alteration in the mineral apposition rate (MAR), at all skeletal sites and etidronate treatment in ORX rats significantly decreased ES/BS to a level not significantly different from that in the AMC group, resulting in complete prevention of ORX-induced cancellous BV/TV loss. The MAR was markedly decreased in the PTM and LVB, but maintained in the DTM by etidronate treatment. The present study showed that etidronate treatment could completely prevent ORX-induced cancellous bone loss regardless skeletal sites by suppressing bone resorption. In particular, suppression of bone formation in terms of osteoblastic activity by etidronate treatment was not evident only in the DTM.
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LECTURES
  • Ron Shapiro
    Article type: Others
    Subject area: Others
    2004 Volume 53 Issue 1 Pages 18-22
    Published: 2004
    Released on J-STAGE: June 17, 2005
    JOURNAL FREE ACCESS
    With the development of increasingly potent new immunosuppressive agents, the outcomes after renal transplantation have continued to improve. However, patients continue to require long term chronic immunosuppression. The toxicities associated with cyclosporine, azathioprine, prednisone, and anti-lymphocyte antibodies are well known; those associated with the newer agents, tacrolimus, mycophenolate mofetil, and sirolimus, have also been described. In an attempt to minimize these side effects, a number of low toxicity protocols have been developed. They can be categorized into those that withdraw, minimize, or avoid calcineurin inhibitors, those that withdraw or avoid steroids, and those that withdraw adjunctive (third) agents. This presentation will review the various low toxicity protocols that have been utilized in clinical renal transplantation. While there are a number of combinations that have been tried, it is not yet clear which regimen(s) will prove to be the most efficacious and least toxic. In addition, the presentation will also describe preliminary outcomes with a new tolerogenic protocol developed at the University of Pittsburgh. This regimen combines steroid avoidance with low doses and gradual tapering of calcineurin inhibitors, and has shown considerable promise in kidney, pancreas, liver, and intestine recipients.
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  • Lukas Radbruch, Frank Elsner
    Article type: Others
    Subject area: Others
    2004 Volume 53 Issue 1 Pages 23-29
    Published: 2004
    Released on J-STAGE: June 17, 2005
    JOURNAL FREE ACCESS
    The transdermal therapeutic system with fentanyl was released in Germany in 1995. Before and after the release several clinical trials were performed in our pain management unit and in other German pain centers, showing good efficacy after initial dose titration with intravenous patient-controlled analgesia or switching from pretreatment with oral morphine or other opioids. A sequential trial showed less use of laxatives with transdermal fentanyl compared to pretreatment with oral morphine. Safety and efficacy of the transdermal system in clinical practice were confirmed in a nationwide survey with 1005 patients, nearly all of them with cancer pain. Most patients had been treated with opioids, though 22% had received no opioids or only as required before initiation of transdermal fentanyl. The mean duration of transdermal treatment was 71 ± 83 days. Pain relief with transdermal therapy was swift and efficient. Adverse events with the possibility of a causal relationship to transdermal therapy were documented for 26% of the patients, most frequently nausea, vomiting, constipation and drowsiness. Severe neurotoxic or respiratory complications were reported only rarely. Problems with transdermal application were reported by 12% of the patients, with patch detachment and dermatologic symptoms on the site of application being most frequent. Most patients showered regularly with the patches and only three patients reported that patches became loose under the shower or in the bathtub. In a recent prospective trial driving ability was tested in patients with continuous non-cancer pain, who had received stable doses of transdermal fentanyl. Data were available from 90 healthy volunteers matched to 30 patients, of whom 9 were excluded from the analysis because they took additional drugs in violation of the protocol. None of the performance measures for the 21 remaining fentanyl patients was significantly inferior to the controls. In conclusion, experience with the transdermal therapeutic system with fentanyl has been gathered in clinical trials, a large nationwide survey and clinical practice since the release in 1995. The conversion table based on a conversion ratio of 100:1 was safe and efficient in trials and clinical practice. Transdermal fentanyl has become a wellknown and frequently used opioid in the treatment of chronic cancer and non-cancer pain in Germany.
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