The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 54, Issue 2
Displaying 1-8 of 8 articles from this issue
REVIEWS
  • Michael J. Coughlin, J. Speight Grimes
    2005 Volume 54 Issue 2 Pages 60-65
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    The correction of a hallux valgus deformity with a proximal 1st metatarsal osteotomy and distal soft tissue repair is achieved with a three-incision technique. A lateral soft tissue release and reconstruction at the first metatarsophalangeal joint releases contracted structures including the lateral capsule, the transverse inter-metatarsal ligament and the conjoint adductor tendon. Rarely is the lateral sesamoid excised. Through a medial incision, the medial eminence or exostosis is resected. The sesamoids are realigned and the medial capsule is reefed. With a third incision, a proximal first meta-tarsal osteotomy is performed that corrects a widened 1-2 intermetatarsal angle. With correction of the hallux valgus and the 1-2 intermetatarsal angle, pronation of the hallux is corrected. This correction is routinely used for hallux valgus deformities characterized by subluxation of the metatarsophalangeal joint. In the presence of a mild hallux valgus deformity an osteotomy may not be necessary. With degenerative arthritis or a congruent metatarsophalangeal joint, alternative surgical procedures are indicated.
    Download PDF (168K)
  • Jun Iwamoto, Tsuyoshi Takeda, Yoshihiro Sato
    2005 Volume 54 Issue 2 Pages 55-59
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    This paper reviews the interventions to stabilize calcium balance and bone metabolism and prevent bone loss in astronauts during space flight. Weightlessness during space flight results in calcium, vitamin D, and vitamin K deficiency, increases urinary calcium excretion, decreases intestinal calcium absorption, and increases serum calcium level, with decreased levels of serum parathyroid hormone and calcitriol. Bone resorption is increased, whereas bone formation is decreased. The loss of bone mineral density (BMD) in the spine, femoral neck and trochanter, and pelvis is 1.0-1.6% per month. High calcium intake and vitamin D supplementation during space flight does not affect bone metabolism, but prevents an elevation of serum calcium level through increased calcitriol level, while vitamin K counteracts the reduction in bone formation. However, there are no data to show the efficacy of pharmaceutical agents for prevention of development of osteoporosis in astronauts during flight, although the preventative effect of bisphosphonates, testosterone, and vitamin K2 on cancellous bone loss in the tibia or BMD loss in the hindlimb was reported in tail-suspended mature rats. It still remains uncertain whether these agents can prevent cortical bone loss caused by weightlessness in tail-suspended rats. Therefore, in addition to calcium, vitamin D, and vitamin K supplementation, agents that have both potent anti-resorptive and anabolic effects on cancellous and cortical bone may be needed to stabilize calcium balance and bone metabolism and prevent bone loss in astronauts duringspace flight.
    Download PDF (69K)
  • Nirmala Jagadish, Ritu Rana, Deepshikha Mishra, Manoj Kumar, Anil Suri
    2005 Volume 54 Issue 2 Pages 66-71
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    Previously, we cloned and sequenced a novel human sperm associated antigen 9 (SPAG9). Northern blot analysis and RNA in situ hybridization experiments revealed testis- and stage-specific expression of SPAG9 mRNA, mainly confined to round spermatid suggesting haploid germ cell expression. Studies on the human and non-human primates (macaque and baboon) have shown a homology of 84.9% and 90.6% at amino acid level and 94% and 96.8% at DNA level, respectively. The presence of high level of homology at amino acid and DNA level indicates that SPAG9 is conserved in human, baboon and macaque sharing common function and common origin in the biological past. In addition, SPAG9 protein revealed structural homology with c-Jun NH2-terminal kinase (JNK) interacting protein (JIP). The amino acid sequence analysis of SPAG9 predicted coiled coil, leucine zipper and transmembrane domain, speculating the involvement of SPAG9 mediated signal transduction pathways in reproductive processes.
    Download PDF (100K)
  • John A McGrath, Vesarat Wessagowit
    2005 Volume 54 Issue 2 Pages 72-79
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    Over the last eight years, several naturally occurring human gene mutations in structural components of desmosomes, cell-cell adhesion junctions found in skin, heart and meninges, have been reported. These comprise dominant or recessive mutations in plakophilin 1, plakophilin 2, desmoplakin, desmoglein 1, desmoglein 4, plakoglobin and corneodesmosin. Of note, as well as compromising tissue integrity, many of the resulting phenotypes have been associated with visible changes in hair. This article describes the particular hair abnormalities resulting from these desmosome gene mutations. Collectively, the data demonstrate the surprising effects inherited desmosome gene/protein pathology may have on hair growth and development. Further analysis of these and other desmosome genes is likely to resolve more hair disease mysteries and provides several further intriguing new discoveries in years to come.
    Download PDF (380K)
  • Valerie T. Cotter
    2005 Volume 54 Issue 2 Pages 80-84
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    During the past two decades, significant research and several government and health care quality groups have advised against the use of physical restraints in hospitals and nursing homes, yet older adults are continuing to die, become injured or experience the iatrogenic complications associated with this practice. Deaths are usually caused by asphyxiation, but also occur from strangulation, or cardiac arrest. Older adults with dementia are at high risk for restraint use because of impaired memory, language, judgment and visual perception. In moderate to severe dementia, the risk of falls is greater because of gait apraxia and unsteadiness. Agitation, disorientation, and pacing behaviors from delirium or dementia can precipitate staff to use restraints to prevent harm to the older adult or to others. Physical restraints should be eliminated as an intervention in older adults with dementia because they are also very likely to cause acute functional decline, incontinence, pressure ulcers and regressive behaviors in a short period of time. The purpose of this paper is to disseminate the dangers of this clinical practice and to summarize the latest research in restraint free care and restraint alternatives in the United States.
    Download PDF (77K)
  • Terry Grossman
    2005 Volume 54 Issue 2 Pages 85-94
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    Rapid progress is being made in our ability to modify the aging process. Rather than serving as a period of debility and decreasing health, for many people, the later years of life are becoming a period of continued productivity, independence and good health. Progress is also being made in increasing average lifespan. The leading causes of death (cardiovascular disease, cancer, lung disease, diabetes) are the end result of decades-long processes. With current knowledge, it is possible to delay the onset of these diseases. This can be assisted by lifestyle choices incorporating healthful diet, exercise, stress management, and nutritional supplementation. Emerging genomics technology will allow individuals to establish personalized programs, while early detection of heart disease and cancer will contribute to longevity. Biotechnological therapies involving stem cells, recombinant DNA, proteomics, therapeutic cloning and gene-based therapies are expected to play major roles in promoting successful aging. We are at the threshold of artificial intelligence (AI) and nanotechnology (NT). AI will allow for a merging of our biological thinking with advanced forms of non-biological intelligence to vastly expand our ability to think, create and experience. NT will ultimately allow us to build devices able to build molecules much like our current cellular machinery does, one atom at a time. It is the goal of today’s antiaging medicine to forestall disease and aging long enough for people to utilize the powerful biotechnology and nanotechnology therapies that will be developed over the decades ahead. These future therapies have the potential to greatly extend longevity.
    Download PDF (122K)
ORIGINAL ARTICLES
  • Masafumi Mizuno, Kei Sakuma, Yonosuke Ryu, Shunichi Munakata, Toru Tak ...
    2005 Volume 54 Issue 2 Pages 95-101
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    Japanese psychiatric services are still typically hospital-based. The Sasagawa Project is the first systematized deinstitutionalization project in Japan that aims to make the transition from hospital to residential living while ensuring both the quality and continuity of care for the patients. Seventy-eight (51 males) patients (mean age 54.6) with chronic schizophrenia, who were considered appropriate for discharge received continuous cognitive behavioural therapies based on the Optimal Treatment Project manualised protocol, both before and after the hospital closure. During the first 12 months after the deinstitutionalisation was initiated on April 1st, 2002, ten people had incidents that interrupted their stay in the residential Sasagawa Village. A common criticism of many treatment outcome trials is that evaluation is focused on changes in clinical severity. In the Sasagawa project the transition appeared to have been smooth and relatively few incidents occurred could be related to the transition to a less intensive residential care. This project might be a useful model for effecting and monitoring transition from hospital to community care in Japan and other countries where such changes have beenproposed.
    Download PDF (80K)
  • Studies in the isolated perfused hydronephrotic kidney
    Koichi Hayashi, Shu Wakino, Yuri Ozawa, Koichiro Homma, Takeshi Kanda, ...
    2005 Volume 54 Issue 2 Pages 102-108
    Published: 2005
    Released on J-STAGE: June 20, 2006
    JOURNAL FREE ACCESS
    The present study examined the role of L-/T-type Ca channels and the interaction between these channels and protein kinase C (PKC) in hypertension. The isolated perfused hydronephrotic rat kidney model was used to visualize directly the renal microvascular effects of L-/T-type Ca channel blockers (nifedipine and mibefradil, respectively). Nifedipine reversed the angiotensin II-induced constriction of afferent, but not efferent, arterioles in kidneys from Wistar-Kyoto rats (WKY), and similar magnitude in dilation was observed in spontaneously hypertensive rats (SHR). Although mibefradil elicited dilation of both arterioles, the afferent arteriolar dilation was less in SHR than in WKY (57 ± 5% vs. 80 ± 4% reversal at 1 μmol/L). The pretreatment with staurosporine did not alter the angiotensin II-induced afferent arteriolar constriction in WKY, but attenuated this response in SHR. Furthermore, staurosporine enhanced the nifedipine-induced afferent arteriolar dilation (62 ± 3% vs. 50 ± 3% reversal at 10 μmol/L), and restored the attenuated afferent arteriolar response to mibefradil in SHR. The pretreatment with thapsigargin (a blocker of IP3-mediated intracellular calcium release) prevented the angiotensin II-induced afferent arteriolar constriction in WKY, but caused a significant constriction of afferent arterioles in SHR and efferent arterioles in WKY and SHR; in this setting, mibefradil did not alter efferent arteriolar tone. In conclusion, although both L-type (nifedipine) and T-type Ca channel blockers (mibefradil) exerted potent vasodilation of rat renal microvessels, these actions were modified by PKC, which determined the afferent arteriolar sensitivity to these blockers in SHR. Furthermore, the enhancement in nifedipine-induced afferent arteriolar dilation by staurosporine in SHR suggests that L-type Ca channel activity is augmented in hypertensive animals.
    Download PDF (125K)
feedback
Top