The Kurume Medical Journal
Online ISSN : 1881-2090
Print ISSN : 0023-5679
ISSN-L : 0023-5679
Volume 46, Issue 1
Displaying 1-13 of 13 articles from this issue
  • HIDETOMO NAKAMURA
    1999 Volume 46 Issue 1 Pages 1-7
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    I report the results from gait analysis for coxarthrotic patients using a ground reaction force plate and a three-dimensional motion analysis system. Twenty-seven coxarthrosic patients, and 9 healthy females as controls, participated in this study. The waveform of the ground reaction force and the joint moment during the stance phase were evaluated. The waveform of the hip joint moment changed and flattened in both pre-coxarthrosis and early-coxarthrotic patients, compared to those in controls, indicating that coxarthrotic patients adopted a particular gait pattern to reduce the load on the affected hip joint. Beyond X-ray observations and physical examinations, joint moment analysis could achieve a more objective evaluation of the clinical stage of coxarthrosis.
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  • MANABU KUBO
    1999 Volume 46 Issue 1 Pages 9-15
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    Although plain X-ray analysis is able to reveal anatomical changes in the frontal plane of the pelvis after Chiari pelvic osteotomy involving medial displacement (medialization) in the distal fragment and lateral displacement (lateralization) in the proximal fragment, changes in the horizontal or sagittal plane can not be discerned. Here, I have investigated three dimensional changes in the pelvis using CT in 22 patients before and after Chiari pelvic osteotomy. The various changes were investigated. Medialization in the distal fragment (average 0.4 cm) occurred in the 14 cases and to a slight extent in the other 8 cases. Also anterior or posterior displacement, and anterior rotation occurred in the distal fragment. Lateralization in the proximal fragment (average 0.8 cm) occurred in 19 cases and to a slight extent in the other 3 cases. Furthermore, the acetabular coverage over the femoral head, assessed by superimposing the acetabular region over the femoral head, improved by about 30% of the anterior half of femoral head and by about 20% of the posterior half of femoral head. It is suggested that the acetabular coverage over the femoral head is most affected by lateralization in the proximal fragment.
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  • MIKA SATOI
    1999 Volume 46 Issue 1 Pages 17-23
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    To clarify the role of β-phenylethylamine (PEA) in pediatric neurological disorders, we have measured the cerebrospinal fluid (CSF) levels of PEA in 12 children with aseptic meningitis-6 were in the acute phase and the other 6 were in the recovery phase- and 5 children with Rett Syndrome (RS). The findings were compared with those obtained from 13 age-matched children with leukemia as child controls and from 10 adults patients without any neurological symptoms and signs as control. In the control group, the CSF PEA level was negatively correlated with age until 200 months (17 years) old. The mean PEA levels in meningitis and RS were significantly lower than that of child controls (p<0.03). The alteration in the CSF levels of PEA may be related to transient changes in the dopaminergic tone in aseptic meningitis and neurological impairment, especially in the dopaminergic neurons in RS.
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  • AKIHIRO HAYASHI, SHINZO TAKAMORI, TOSHIHIRO MATSUO, KOHSUKE TAYAMA, MA ...
    1999 Volume 46 Issue 1 Pages 25-29
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    The Harmonic Scalpel is an ultrasonic instrument for cutting and coagulating tissue. We are reporting our evaluation of the Harmonic Scalpel safety and efficacy in both experimental and clinical thoracic surgery. First, we confirmed the safety in thoracic surgery by following two preliminary studies using the Harmonic Scalpel. 1: Pulmonary parenchyma was incised using “Coagulating Shears” to evaluate hemostasis and air leakage. 2: Pulmonary hilar vessels were contacted directly with “Dissecting Hook” blade at optimum cutting power mode to evaluate potential vascular wall injury by the Harmonic Scalpel. Subsequently, the Harmonic Scalpel was used for a partial lung resection due to metastatic lung cancer. Particular application was for a chest wall incision, interlobar separation of the lung, and dissection of a pulmonary artery, in lung cancer operations. We concluded that cutting and hemostasis of pulmonary parenchyma could be achieved with minimal tissue damage using the Harmonic Scalpel. Compared to electric coagulation, the Harmonic Scalpel minimizes tissue charring and dissection, and eliminates thermal injury in thoracic surgery.
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  • HIROSHI TOMOEDA
    1999 Volume 46 Issue 1 Pages 31-38
    Published: April 01, 1999
    Released on J-STAGE: February 08, 2010
    JOURNAL FREE ACCESS
    It has been reported that neutrophils and platelets have deleterious effects on myocardium and endothelium during and after ischemia. In this study we evaluated the effects of a leukocyte-depleting filter (Sepacell PLX, Asahi medical, Tokyo) during warm blood cardioplegia and early reperfusion on cardiac and endothelial function in the blood-perfused rat heart. Hearts (n=7 per group) from donor rats were excised and perfused with blood at 37°C from a support rat. After 10 min of stabilization, the hearts were arrested for 60 min with warm blood cardioplegia given at 20 min intervals. This was followed by 60 min of reperfusion. Aleukocyte-depleting filter was used during the cardioplegia and the initial 10 min of reperfusion in the experimental group (Group F) and it was not used in the control group (Group N). Left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), maximum rate of left ventricular pressure rise (+dp/dt) and maximum rate of left ventricular pressure fall (-dp/dt) were measured as indices of left ventricular function before and after cardioplegic arrest. Coronary sinus effluent was obtained and the levels of MB isozyme of creatine kinase (CKMB), malondialdehide (MDA), elastase and thromboxane B2 (TXB2) were measured as indices of myocardial and endothelial injury. After 60 min of reperfusion, acetylcholine (Ach.) was administered to the coronary perfusate and the difference of nitric oxide (NO) concentration between inflow and outflow, and coronary blood flow were measured as an indication of endothelial function. Group F showed significantly lower LVEDP than Group N at 10 min of reperfusion. The elastase levels were significantly (p<0.05) lower and the CKMB levels tended (p<0.1) to be lower in Group F at 60 min of reperfusion. The admin-istration of Ach. to the coronary perfusate showed significantly (p<0.05) greater coronary blood flow and NO production in Group F. The results suggested that the use of aleukocyte-depleting filter during warm blood cardioplegia and early reperfusion preserves endothelial function and left ventricular diastolic compliance. The technique may provide beneficial effects by reducing reper-fusion injury in patients undergoing cardiac surgery.
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  • TOSHIHARU NISHIDA
    1999 Volume 46 Issue 1 Pages 39-50
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    We have evaluated the correlation between disc herniation or degeneration and the levels of matrix metalloproteinase-3 (MMP-3) or tissue inhibitor of metalloproteinases-1 (TIMP-1). The lumbar discs obtained from 22 autopsied cadavers and 21 patients with lumbar disc herniation were examined. Immunohistochemical study : The number of MMP-3-producing and TIMP-1-producing cells increased as disc herniation or degeneration progressed. Zymography : Activated type MMP-3 was observed in the normal and herniated intervertebral disc excluding the intervertebral disc with protrusion-type herniation. RT-PCR : The MMP-3 gene was expressed in all groups. However, the expression of the TIMP-1 gene was weak in the normal group as well as in the protrusion type disc herniation. Determination of tissue and serum levels of MMP-3 and TIMP-1 was increased as disc degeneration or herniation progressed. There were positive correlations between the number of MMP-3-producing or TIMP-1-producing cells in the intervertebral disc and the tissue or serum levels of MMP-3 and TIMP-1. These results suggested that MMP-3 and TIMP-1 were closely related to the progression of disc degeneration or herniation. The results also suggested that MMP-3 and TIMP-1 exhibited similar kinetics. Moreover, the serum levels of MMP-3 and TIMP-1 reflected the progression of disc degeneration and herniation.
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  • TAKAHIKO SANNOMIYA
    1999 Volume 46 Issue 1 Pages 51-60
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    The effect of resetting the hip joint limbus on acetabular development was studied. Ten infant Japanese monkeys were used as experimental subjects. The limbus was resected on one side and the developmental effects were observed. The period of observation ranged from 12 to 31 months with a mean of 17 months. After histological examination of the resected limbus, the monkeys were divided into two groups, group A (5 cases) in which the hyaline cartilage had not been resected, and group B (5 cases) in which the hyaline cartilage had been resected. Every 2 months after the operation, each monkey was x-rayed and the acetabular angle, acetabular index, acetabular edge angle and Wiberg's Center-Edge angle were measured and the differences between the resected and unoperated sides were subjected to regression analysis. Neither Group A nor Group B developed acetabular dysplasia.
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  • Should the Mitral Complex Be Preserved?
    TAKESHI ODA
    1999 Volume 46 Issue 1 Pages 61-70
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    To evaluate the importance of preserving the mitral complex, clinical outcomes and postoperative left ventricular (LV) functions of 175 patients with pure mitral regurgitation (MR) were analyzed. They were divided into three groups; patients who had conventional mitral valve replacement (cMVR; n=47), posterior mitral leaflet preserved MVR (pMVR; n=66) or mitral valvuloplasty (MVP; n=62). There was no operative death or hospital death in this study. The actuarial survival rate was 85.2% in cMVR, 78.5% in pMVR, and 84.7% in MVP at 10 years after operation. The actuarial freedom from reoperation 10 years postoperatively was 100% in cMVR, 97.9% in pMVR, 85.8% in MVP. The actuarial freedom from thromboembolism (TE) at 10 years was 92.2% in cMVR, 87.1% in pMVR, 93.5% in MVP. Freedom from all types of events including non-cardiac death was 78.3% in cMVR, 64.8% in pMVR, 65.3% in MVP at 10 years, respectively. Pre-and postoperative LV function was evaluated using echocardiography. Patients with MVP had better LV performance than those with MVR. However, there was no significant difference between the cMVR and pMVR groups. For further estimation of postoperative LV function, dobutaminestress echocardiography (DSE) was performed. The results of DSE revealed that the LV contractility in MVP was obviously better than those in MVR groups especially in systole. The change in ejection fraction (EF) from baseline to peak dobutamine stress in the pMVR group was significantly greater than in cMVR. This study supports the concept that the preservation of continuity between the mitral annulus and papillary muscle plays an important role in clinical outcome and postoperative LV function. In conclusion, MVP should be a first choice as an operative method for pure MR when technically feasible. When it is impossible to perform MVP, pMVR, not cMVR, should be the next choice. This study suggests that preservation of papillary muscle-mitral annular continuity during mitral valve surgery for pure MR is beneficial to LV systolic function.
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  • CHIE KIYOKAWA
    1999 Volume 46 Issue 1 Pages 71-78
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    Paraneoplastic pemphigus (PNP) sera have been reported to immunoprecipitate multiple proteins, including the 250 kDa and 210 kDa proteins believed to correspond to desmoplakins I/II, BP230, and two unidentified proteins of 190 kDa and 170 kDa. We have recently provided evidence that the presence of the 210 kDa and 190 kDa proteins is the most prominent feature of PNP, and have suggested that the major 210 kDa antigen may not correspond to desmoplakin II. Using immunoprecipitation and immunoblotting, we found that some PNP sera identified a doublet protein migrating at 210 kDa, with the larger protein corresponding to desmoplakin II, and the smaller protein corresponding to envoplakin, a recently described precursor of the keratinocyte cornified envelope. In contrast to desmoplakin II, envoplakin was detected by all PNP sera analyzed. Using immunoblotting and immunoprecipitation, we further showed that the 190 kDa PNP antigen is identical to periplakin, another recently identified envelope precursor that can form complexes with envoplakin. Like desmoplakin and BP230, envoplakin and periplakin belong to the plakin family of proteins.
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  • HIROKI INUTSUKA
    1999 Volume 46 Issue 1 Pages 79-82
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    To examine whether gene conversion occurs between two homologous loci of HLA-A and HLA-B, DNA sequences were compared and the differences or the numbers of substitutions per site at synonymous and nonsynonymous sites were calculated in the coding region and in the non-coding region. (1) Totally differences at synonymous sites in introns and coding regions are small as compared with the differences in the 5' flanking region. This indicates that gene conversion should occur between HLA-A and HLA-B loci. (2) In exon2 and exon3, the differences at synonymous sites are smaller than at nonsynonymous sites. This suggests that these exons are subject to positive natural selection, which is consistent with the reports of Hughes and Nei [1, 2], because exon2 and exon3 encode α1 and α2 domains of the HLA molecule respectively which include mainly the antigen recognition sites (ARS). (3) In exon4, the difference at the synonymous site is the same as that in the 5' flanking region, which suggests that gene conversion does not frequently occur. The difference in this exon is extremely small at the nonsynonymous sites. This exon encodes the α3 domain which does not have the antigen recognition sites but have an important function in maintaining the structure of the HLA molecule. From the above results, it can be concluded that gene conversion between HLA-A and HLA-B occurs more frequently in the two exons, exon2 and exon3 which have ARS regions. Furthermore, to examine a possibility that the variability of GC content along sequence influences the difference, the GC content was calculated along the sequence.
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  • NAOFUMI ERIGUCHI, SHIGEAKI AOYAGI, SHUICHI FUKUDA, MASAO HARA, ICHIRO ...
    1999 Volume 46 Issue 1 Pages 83-86
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    A case of gallbladder carcinoma was reported. A 42-year-old woman was admitted with epigastralgia. Abdominal ultrasonography, computed tomography, and other diagnostic modalities suggested gallbladder carcinoma with multiple liver metastases. These findings indicated no surgical procedure because of the advanced nature of her disease. After the hepatic arterial chemoinfusion therapy, her multiple liver metastatic lesions showed a decrease in size and number. Therefore, extended left lobectomy of the liver with gallbladder and bile duct resection were performed. Five years after initial operation, a solitary liver metastatic lesion (S5) was diagnosed by ultrasonography. Partial resection of the liver was performed for the liver metastasis, and her postoperative recovery was uneventful and had a good follow-up course. One year after the second operation bone metastases occurred, therefore, peroral administration of UFT (Tegafur+Uracil) and radiation therapy for the metastatic lesions of sternum and lumbar vertebra (L1) were performed.
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  • NAOKI TSUMURA, YUKO AKASU, HIROMASA YAMANE, SHIGERU IKEZAWA, TOMOSHIGE ...
    1999 Volume 46 Issue 1 Pages 87-90
    Published: April 01, 1999
    Released on J-STAGE: August 11, 2009
    JOURNAL FREE ACCESS
    Here we describe Aspergillus osteomyelitis of the tibia in a 9-year-old boy who has an autosomal recessive form of chronic granulomatous disease (CGD). The patient showed a p67-phagocyte oxidase (phox) deficiency, which is rare type of CGD in Japan. The initial treatment which consisted of surgical debridement and antibiotic therapy with amphotericin B (AMPH), did not control the infection. Aspergillus fumigatus (A. fumigatus) pure isolated from drainage fluid and necrotic bone tissue demonstrated less susceptible to antifungal agents, including AMPH, fluconazole and flucytosine. Recombinant interferon gamma was then administrated, and it was effective in controlling the course of severe invasive aspergillosis. This report indicates the use of interferon gamma might be helpful in control for Aspergillus osteomyelitis of the tibia in a child with CGD demonstrated p67-phox deficiency refractory to conventional therapy with AMPH.
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  • 1999 Volume 46 Issue 1 Pages e1
    Published: 1999
    Released on J-STAGE: February 08, 2010
    JOURNAL FREE ACCESS
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