Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 32, Issue 1
Displaying 1-15 of 15 articles from this issue
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Contents
  • A Clinical Study on ''Sudden Cardiac Death''
    NEN-CHUNG CHANG
    1986 Volume 32 Issue 1 Pages 41-54
    Published: March 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.41
    JOURNAL FREE ACCESS
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    Sixteen prehospital sudden death patients, 3,509 admitted patients and 2,449 longterm follow-up patients after angiographic studies were reviewed. Sudden death was defined as death occurring within 24 hours of being ambulatory, stable and well. The long-term follow-up of survivors of prehospital sudden death was extremely poor. Half of these patients had underlying coronary artery disease. The survivors were younger and showed more ventricular fibrillation on electrocardiographic recording when arriving at the emergency ward than the dead. Twenty-four patients died a sudden death during admission, 15 of them from acute myocardial infarction. The three leading causes of sudden cardiac death were ventricular fibrillation, cardiogenic shock and cardiac repture, in that order. Sixty-six patients died a sudden cardiac death during long-term follow-up for periods of up to nine years after angiographic studies. Coronary artery disease was the main cause (55%). The majority of these patients had history of old myocardial infarction (78%), especially anterior wall involvement (75%) and multiple coronary risk factors (83%). The common coronary arteriographic findings in most of them had been the presence of proximal left anterior descending artery disease (81%); multivessel including left main trunk disease (70%); proximal sites disease (77%); advanced atherosclerosis with poor collateral circulation (83%) and far more severe abnormalities of left ventricular contraction (70%). Sudden cardiac death could also be predicted by the severity and anatomic sites of coronary artery disease. Thirteen patients (20%) died a sudden cardiac death due to valvular heart disease, mainly aortic valvular disease. Five patients with dilated cardiomyopathy and one with hypertrophic cardiomyopathy died suddenly. All of them had advanced grades of ventricular arrhythmias. Sudden cardiac death in congenital heart disease, such as tetralogy of Fallot seemed to be caused by the fact that the patients missed the chance for surgical repair Most of the sudden deaths in disease of the great vessels were due to ruptured aneurysm, and all but one was associated with hypertension.
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  • Clinical and Radiogical Studies of Carcinoma in the Gastric Stump
    TSUTOMU HAMADA
    1986 Volume 32 Issue 1 Pages 55-67
    Published: March 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.55
    JOURNAL FREE ACCESS
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    The authors treated 30 patients requiring gastrectomy for carcinoma of the postoperative stomach between December 1968 and December 1983. The patients were divided into two groups : 13 were operated on for Primary carcinoma lesions (Group A) and 17 for benign lesions (Group B). Respective areas of carcinoma development and the length of time from the initial operation to the discovery of carcinoma of the postoperative stomach were investigated. A period of less than 10 years had elapsed in 11 of the patients (84.6%) in Group A and advanced carcinoma had developed in the area of the suture in many of them. In contrast, a period of more than 10 years had elapsed in 16 of the patients (94.1%) in Group B. Early carcinoma was found in four out of six patients after 10-20 years, whereas advanced carcinoma was found in six our of the remaining 10 after more than 20 years. Carcinoma developed in the gastric remnant of the area of anastomosis in many patients. This suggests that carcinoma that is discovered within 10 years postoperatively might have been missed at the initial operation or might have recurred. Therefore, we defined carcinoma discovered more than 10 years after surgery as primary stump carcinoma. To determine areas of carcinoma development and macroscopic findings, 91 patients with primary stump carcinoma (consisting of 18 of our patients and 73 from the Japanese literature) were compared with those with cancer in the upper third of the stomach (unoperated) (181 of our patients). Primary stump carcinoma was often found in the area anastomosed with the Billroth II operation, and primary cancer in the gastric stump tended to be protuberant rather than excavative. Twenty-three out of 33 lesions in 28 patients with primary early cancer in the gastric stump (69.7%) (consisting of 11 lesions in eight of our patients and 22 lesions in 20 patienss reported in the Japanese literature) could be detected by roentgen examination. The limits of detection were 1 cm for the protuberant type and 4 cm for the excavative type. We emphasize that not only the double-contrast method but also the compression technique should be undertaken in order to detect early carcinoma.
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  • Clinicopathological Study of Chance Proteinuria and/or Hematuria (CPH)
    MIYOKO YOSHIDA
    1986 Volume 32 Issue 1 Pages 68-76
    Published: March 10, 1986
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.32.68
    JOURNAL FREE ACCESS
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    A clinicopathological study on 284 cases of chance proteinuria and/or hematuria (CPH) was carried out. The subjects comprised 194 males and 90 females. Their ages ranged from 11 to 49 years, averaging 26.2. At the time of renal biopsy, proteinuria was mild, not exceeding 100 mg/dl in 58%. Patterns of hematuria varied widely without showing any specific tendency. About 10% of the patients revealed decreased renal function. Hypertension was detected in 21%. The most frequent glomerular lesions were minimal change and mild focal proliferative glomerulonephritis. The cases with proteinuria and hematuria or with isolated proteinuria had various glomerular lesions, but cases with isolated hematuria had mild lesions. One hundred thirty-nine patients were followed for a mean period of six years after renal biopsy. Forty-six (33%) of them were improved, and 31 (22%) had deteriorated. The 3-, 5- and 10-year survival rates of CPH were 93%, 91% and 72%, respectively. There was a good correlation between the prognosis and the severity of glomerularlesions. Severe glomerular lesions, massive proteinuria which was resistant to treatment, impaired renal function, and hypertension, were more frequently seen in patients with an unfavoirable course. IgA nephropathy was found in 109 (60%) out of 181 cases in whom immunofluorescent staining had been performed. Histological study showed minimal change in 17 cases and mild focal proliferative glomerulonephritis in 42. Follow-up observations were possible in 51 patients of them, 19 (37%) were improved, 25 (49%) unchanged and seven (14%) deteriorated. The survival rate of IgA nephropathy was similar to that of CPH cases. These results indicate that patients with CPH should be followed carefully even if they are found to be completely asymptomatic.
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