The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 58, Issue 1
Displaying 1-8 of 8 articles from this issue
REVIEWS
  • Mototsugu Oya
    2009 Volume 58 Issue 1 Pages 1-11
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Cancer cells are characterized by indefinite proliferation, invasiveness and metastases. These characteristics are usually related to one another. Namely, cancer cells that proliferate rapidly tend to invade and metastasize. Renal cell carcinoma (RCC) typically does not proliferate rapidly nor does it invade the surrounding tissues, but it does metastasize. RCC has several peculiar characteristics that are not observed in other cancers: a relatively late recurrence, a high frequency of paraneoplastic syndrome, hypervascularity and the spontaneous regression of metastatic lesions after the excision of the primary tumor. These clinical observations suggest that cytokines or growth factors are important contributors to microenvironments favoring the growth of cancer cells. Thus, the blockade of cell-to-cell communication might have some therapeutic potential. Accordingly, a popular strategy for molecular-targeted therapy for RCC targets the vasculization of RCC induced by vascular endothelial growth factor (VEGF). This review highlights the biological features of RCC that are relevant to molecular-targeted therapy.
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  • John M. Inadomi
    2009 Volume 58 Issue 1 Pages 12-18
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Background: It is recommended that patients in whom Barrett's esophagus is diagnosed undergo surveillance endoscopy. However, multiple issues regarding the efficacy and feasibility of surveillance remain.
    Methods: Quantitative techniques were used to examine surveillance in patients with Barrett's esophagus. A retrospective case-control study was performed to determine whether surveillance endoscopy prolonged survival in a cohort of U.S. veterans diagnosed with esophageal adenocarcinoma. Cost-effectiveness analysis was employed to compare competing strategies of management for patients with Barrett's esophagus to determine whether surveillance strategies using alternative biomarkers could out-perform dysplasia based surveillance, and whether new techniques for eradicating Barrett's metaplasia would constitute cost-effective strategies.
    Results: Surveillance did not improve long-term survival among veterans diagnosed with esophageal adenocarcinoma. Lead-time bias has confounded previous reports claiming the efficacy of endoscopic surveillance. Cost-effectiveness analysis revealed that while screening 50-year old Caucasian males with heartburn may be cost-effective, surveillance even at 5 year intervals among patients with Barrett's esophagus without dysplasia exceeded the threshold of cost-effective care. If a biomarker were developed whose sensitivity and specificity to predict cancer development exceeded 80%, this could represent a more viable strategy than dysplasia-based surveillance and overcome the inherent inter- and intra-observer variations in dysplasia diagnosis that currently limit the effectiveness of surveillance programs. Finally, techniques that reduce cancer incidence such as endoscopic mucosal resection or ablation will likely be more cost-effective than current surveillance strategies that rely on early detection of cancer.
    Conclusions: Current recommendations for the management of patients with Barrett's esophagus are flawed. Future guidelines should include alternative markers of cancer risk and focus on strategies that reduce cancer incidence instead of cancer detection.
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  • Matthew R. Lewin
    2009 Volume 58 Issue 1 Pages 19-23
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    The Emergency Department (ED) may be an ideal place to screen and refer patients for blood pressure monitoring in the outpatient setting. Yet, little is known about the public health significance of asymptomatically elevated blood pressure measurements in the ED and what to tell patients when these abnormal vital signs are recorded. Since the prevalence of hypertension and inadequately treated hypertension is so high, the incidental finding of elevated blood pressure in a previously undiagnosed patient may be a pivotal moment in that patient's life. For those patients carrying the diagnosis of hypertension, it is the author's opinion that the observation of elevated blood pressures should trigger advice to see their physicians to consider medication adjustments or changes. Emergency Physicians and their staff are in a unique position to screen and refer large populations of patients to their community physicians and help abort the long-term sequelae of unidentified or inadequately managed hypertension. How best to advise physicians and their patients requires research and innovative methods for transmitting important information to patients that may be unrelated to their primary complaint in the ED.
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  • Federico Brugnami, Alfonso Caiazzo, Cataldo Leone
    2009 Volume 58 Issue 1 Pages 24-28
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Dental implants are established alternatives for replacing missing teeth. In case of alveolar bone resorption, implant placement may be prevented unless the volume of hard tissues is increased before or during implantation. Autologous bone graft is still regarded as the "gold standard" in alveolar reconstruction., but many factors may influence the final outcome. The success of intraoral bone grafts, in fact, depends, among other factors, on the choice of donor graft material as well as on how the material is handled. The evidence supporting the use of autogenous intramembranous bone with or without the use of barrier membranes is briefly reviewed. The rational of donor site choice is also presented. Advantages and disadvantages of different harvesting site are discussed.
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  • Steeve Kwan Tat, Jean-Pierre Pelletier, Carmen Ruiz Velasco, Marc Padr ...
    2009 Volume 58 Issue 1 Pages 29-40
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Bone remodelling is tightly regulated by a molecular triad composed of OPG/RANK/RANKL. The receptor activator of NF-κB ligand (RANKL) (localized on osteoblasts) enhances osteoclastogenesis via interaction with its receptor RANK (localized on osteoclasts), whereas osteoprotegerin (OPG) (produced by osteoblasts) inhibits this osteoclastogenesis by binding to RANKL. The equilibrium between OPG and RANKL plays a crucial role in the pathophysiology of bone. Although some studies have shown the efficacy of OPG as a therapeutic agent against bone resorption, its bioavailability and mechanism of action after binding to RANKL have only recently been studied. A mechanistic investigation based on what becomes of OPG after binding to cells expressing membranous RANKL demonstrated an internalization process of OPG through the clathrin pathway prior to proteasomal and/or lysosomal degradation. Interestingly, the OPG internalization process reduced the half-life of RANKL. Recent evidence has shown that subchondral bone alterations in osteoarthritis (OA) are intimately involved in cartilage degradation, and that OPG/RANKL may be implicated. Data show that human OA subchondral bone osteoblasts have abnormal OPG and RANKL levels and consequently an altered OPG and RANKL ratio. Further data also reveal the involvement of some osteotropic factors in these altered levels and that some of these factors generally target RANKL with a differential modulation of the RANKL isoforms. Altogether, data suggest that this system could be targeted as a new strategy for the treatment of OA.
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  • Osamu Kawaguchi, Yoshiyuki Nyui, Etsuo Kunieda, Satoshi Onozuka, Nobuh ...
    2009 Volume 58 Issue 1 Pages 41-49
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Background: One of the most important factors in stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM) is to determine accurate target delineation of the nidus. However, since intracranial AVMs are complicated in structure, it is often difficult to clearly determine the target delineation.
    Purpose: To investigate the usefulness of principal component analysis (PCA) on intra-arterial contrast enhanced dynamic CT (IADCT) images as a tool for delineating accurate target volumes for stereotactic radiosurgery of AVMs.
    Materials and Methods: IADCT and intravenous contrast-enhanced CT (IVCT) were used to examine 4 randomly selected cases of AVM. PCA images were generated from the IADCT data. The first component images were considered feeding artery predominant, the second component images were considered draining vein predominant, and the third component images were considered background. Target delineations were first carried out from IVCT, and then again while referring to the first and second components of the PCA images. Dose calculation simulations for radiosurgical treatment plans with IVCT and PCA images were performed. Dose volume histograms of the vein areas as well as the target volumes were compared.
    Results: In all cases, the calculated target volumes based on IVCT images were larger than those based on PCA images, and the irradiation doses for the vein areas were reduced.
    Conclusion: In this study, we simulated radiosurgical treatment planning for intracranial AVM based on PCA images. By using PCA images, the irradiation doses for the vein areas were substantially reduced.
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CASE REPORTS
  • Jun Iwamoto, Tsuyoshi Takeda, Yoshihiro Sato, Hideo Matsumoto
    2009 Volume 58 Issue 1 Pages 50-53
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    We examined radiographs of the inferior pole of the patella in seven juvenile athletes diagnosed as having Sinding-Larsen-Johansson disease (SLJD) and discussed the etiology of the syndrome. Eight knees had tenderness at the inferior pole of the patella accompanied by radiographic abnormalities. A regular or irregular calcification was found at the inferior pole of the patella in three knees; coalescence of the calcification was found in two knees; incorporation of the calcification into the patella to yield a normal radiographic configuration of the area was found in two knees; and a small calcification separated from the patella was found in one knee. All of these findings varied and did not always correspond to the radiographic stages of the disease process identified by Medlar. One case was not clearly distinguished from either osteochondritis or stress fracture, and one case had a similar symptom to tendinitis. Thus, the etiology of the syndrome seems not to be unified, and the differential diagnosis between SLJD and osteochondritis, stress fracture, or tendinitis was difficult to arrive at. We were only able to conclude that the radiographic abnormalities and consequently the etiology of the syndrome vary, and therefore there is a limitation to call the syndrome accompanied by abnormal findings of the inferior pole of the patella under the umbrella term of SLJD.
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  • Masayuki Ohira, Daisuke Ito, Toshihiko Shimizu, Mamoru Shibata, Hisao ...
    2009 Volume 58 Issue 1 Pages 54-56
    Published: March 25, 2009
    Released on J-STAGE: April 28, 2009
    JOURNAL FREE ACCESS
    Interferon (IFN), which is an established maintaining therapy for multiple sclerosis (MS), has been reported various adverse effects. This paper describes a case of IFN-associated retinopathy, representing an overlooked adverse effect in MS. A 46-year-old woman with diabetes mellitus was diagnosed with MS and treated with IFNβ-1b for three years. She displayed sudden defect of the visual field and ocular fundi showed retinal cotton wool spots indicating IFN-retinopathy, which resolved rapidly after IFN was discontinued. To evaluate the prevalence of retinopathy in MS, we performed fundoscopic examination on twenty MS patients treated with IFNβ-1b in our hospital. However, none of the patients displayed retinopathy. Only four other cases of IFN- retinopathy in MS have been reported in the literature. Therefore, IFN-retinopathy may be uncommon in MS, but neurologist should be mindful of this adverse effect and regularly check the fundus, particularly in patients with possible risk factor, diabetes mellitus.
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