Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 45, Issue 2
Displaying 1-24 of 24 articles from this issue
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Contents
  • Analysis of factors that reflect the quality of life of patients with parkinson's disease at a special functioning hospital
    YOSHIO YAMAJI, HIROYUKI WAKAMATSU, HIDEKI TAKUBO
    1999 Volume 45 Issue 2 Pages 227-239
    Published: September 13, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.227
    JOURNAL FREE ACCESS
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    Objective: Parkinson's disease patients cannot always obtain helpful support that match their needs. This problem occurs because assessment of the Quality of Life (QOL) for such patients, especially those with severe conditions, is difficult and inconvenient. This study was performed to determine the factors that reflect the QOL in patients with Parkinson's disease. Materials and Methods: We studied 106 Parkinson's disease patients who visited or were admitted to a special functioning hospital. We evaluated their QOL using two QOL scales, Life Satisfaction Index K (LSIK) and QOL scale for patients with chronic neurological disease (QSCND). Using the QOL score as the dependent variable, we examined the correlation between QOL and related factors including usage of community, medical, and welfare services by multiple regression analysis. Results: The following results were obtained: 1) The factors that affected the QSCND score were duration of illness and usage of community, medical, and welfare services. 2) No variable significantly affected the LSIK score. 3) A cooperative system that combines special functioning hospitals, community services, health centers and practitioners must be established. Conclusions: These results indicate that the severity of illness and duration of illness are useful factors to determine which services can significantly contribute to the improvement of the QOL in patients with Parkinson's disease in Hoehn & Yahr stage II.
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  • Breast carcinoma with microcalcifications
    -Relationship between extent of radiographic microcalcifications and pathological carcinoma size-
    MASARU SUZUKI, FUMINAO SUZUKI, AKIHIKO SHIRAISHI, HITOSHI KATAYAMA
    1999 Volume 45 Issue 2 Pages 240-252
    Published: September 13, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.240
    JOURNAL FREE ACCESS
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    Objective : To improve the mammographic diagnosis of breast carcinoma withmicrocalcifications, the extent of microcalcifications (S) and that of pathologicalcarcinoma (P) were compared using radiographic findings of specimens. Materials : The materials included 15 cases of breast carcinomas with microcalcifications only, and 14 cases of masses and microcalcifications appearing outside the tumor density on preoperative mammography. Methods : The relationship between S and P was defined as follows ; (1) S<P : pathological carcinoma was present in the area within 20mm from the periphery of microcalcifications on the specimen radiogram. (2) S<<P : pathological carcinoma was present in the area more than 20mm from the periphery of microcalcifications on the specimen radiogram. (3) S=P. (4) S>P : the extent of microcalcifications was larger than the pathological extent of the carcinoma. The distribution of calcifications was classified into three groups; “scattered”, “middle” and “clustered”. The shape of calcifications was classified into two groups; “granular” and “rod/irregular”. Results : Our results were as follows; 1) in 14 (48%) of the 29 cases, pathological carcinoma was present beyond the extent of microcalcifications (S<P or S<<P). The S=P type accounted for 11 of 29 cases (38%), and the S>P type accounted for 4 of 29 (14%) cases. (i) Among the 15 cases of microcalcifications only, no S>P cases were found. (ii) Among the 14 cases of mass and microcalcifications outside the tumor density, 4 cases (29%) were the S>P type. 2) The distribution of calcifications was “scattered” in 13 (45%), “middle” in 11 (38%), and “clustered” in 5 (17%) cases. (i) Among the 15 cases of microcalcifications only, there were 6 cases of “scattered” (3 of S<P, 2 of S<<P, 1 of S=P, none of S>P), 5 cases of “middle” (1 of S<P, 1 of S<<P, 3 of S=P, none of S>P), and 4 cases of “lustered” (1 of S<<P, 3 of S=P). (ii) Among the 14 cases of mass and microcalcifications outside the tumor density, there were 7 cases of “scattered” (2 of S<P, none of S<<P, 1 of S=P, 4 of S>P), 6 cases of “middle” (3 of S<P, 1 of S<<P, 2 of S=P, none of S>P), and 1 case of “clustered” (1 of S=P). 3) Concerning the shape of calcifications; there were 24 cases (83%) of “granular” and “rod/irregular” calcifications. (i) Among the 15 cases of microcalcifications only, there were 2 cases of “granular” (1 of S<P, 1 of S<<P). (ii) Among the 14 cases of mass and microcalcifications outside the tumor density, there were 3 cases of “granular” (1 of S<P, 2 of S>P). Conclusion : It is difficult to diagnose the exact extent of breast carcinoma with microcalcifications using mammography, because pathological carcinoma extends beyond the area of microcalcifications. Our specimen radiographic study confirmed the findings in 48 % of total cases. Regarding the relationship between the distribution of microcalcifications and S : P, there was a discrepancy between the carcinomas with microcalcifications only and those with mass and microcalcifications appearing outside the tumor densities.
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  • Accidental complications and its countermeasures in colonoscopy
    YUICHI TOMIKI, TOSHIKI KAMANO, YASUO HAYASHIDA, SHUICHI SAKAMOTO, SATO ...
    1999 Volume 45 Issue 2 Pages 253-259
    Published: September 13, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.253
    JOURNAL FREE ACCESS
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    Objective: To examine the status of accidental complications associated with colonoscopy in our department, we investigated the causes of accidents, their treatments and preventive measures. Subjects: We studied 5415 patients who underwent colonoscopy between 1989 and 1998, and 1710 patients within this group, who also underwent endoscopic treatments. Methods : Accidental complication was defined as the occurrence of complication between preparation and 1 month after the examination. Cases that were observed for suspected accidental complications were also treated as accidents. Result : Accidental complications of colonoscopy occurred in 19 of 5415 cases (0.351%) in our department during the past 10 years. Accidental complications associated with preparation of the patient or premedication occurred in 6 cases (0.12%), including 3 cases of apnea, 2 cases of ileus, 1 case of miosis. The incidence of accidents associated with endoscopic treatment was 0.76% (13 of 1710 cases), with 12 cases of hemorrhage. There were no perforation cases or cases requiring blood transfusion or laparotomy. Conclusions: Accidental complications cannot be completely avoided. Therefore, obtaining informed consent and performing examinations with awareness of potential accidental complications are necessary. An appropriate method of patient preparation should be chosen according to the individual patient, and premedication should be given with conscious sedation in mind. Accurate assessment of indications for endoscopic treatment is important. Mucosal resection technique or the use of detachable snare is useful for resection. Prophylactic clipping after resection may be an effective measure. In the unfortunate event that accident complication occurs, expeditious and appropriate intervention is the key to avoiding further medical problems.
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  • Clinical results of penetrating keratoplasty for 15years in Juntendo Hospital
    YUKO UESUGI, NOBUKO HASEGAWA, SAKI HORIKAWA, KIYOO NAKAYASU
    1999 Volume 45 Issue 2 Pages 260-268
    Published: September 13, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.260
    JOURNAL FREE ACCESS
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    We performed penetrating keratoplasty in 724 eyes. The series included keratoconus in 347 eyes, interstitial keratitis and corneal scars in 111 eyes, bullous keratopathy in 82 eyes, regraft in 147 eyes and others. In 514 of 724 eyes clear grafts were obtained. Transparency rate was 93.1% in keratoconus, 73.0% in corneal scars and interstitial keratitis, 45.1% in bullous keratopathy, and 36.7% in regraft. The major causes of cloudy grafts were rejection and postoperative infection within 6 months after PKP in keratoconus. In interstitial keratitis and corneal scars, the cause of cloudy grafts were endothelial dysfunction and rejection within 6 months. In bullous keratopathy, endothelial dysfunction was the major cause of cloudy grafts. Glaucoma was significantly involved in many graft failures, except those involving rejection and endothelial dysfunction in regraft.
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  • Medical staffs' attitudes toward telling the diagnosis of cancer
    -The 1st report of a questionnaire survey at Juntendo University Hospital-
    HEII ARAI, TETSU KAWAMURA, KOU ETO, MICHIHIRO KIMURA
    1999 Volume 45 Issue 2 Pages 269-274
    Published: September 13, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.269
    JOURNAL FREE ACCESS
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    Objective : The present survey investigated the attitudes of medical staff at Juntendo University Hospital toward telling cancer patients the true diagnosis. Participants : 200 physicians and 100 nurses at the Hospital and 78 medical students were selected at random. Methods : A questionnaire survey to investigate attitudes toward disclosing cancer diagnoses was conducted in the autumn of 1998. Results : The total number of completed questionnaires was 321. The results disclosed that almost all of the responding staff including physicians support telling the truth, while a preference for not telling a cancer patient the diagnosis was indicated by most of corresponding physicians at the same time. Moreover, although staff members appreciated an attitude of telling the diagnosis, telling the prognosis or the presence of metastasis seemed difficult to accept. There were differences between physicians and nurses concerning several questions, and the medical students were more likely to express relatively strong positive opinions in support of telling the truth. Conclusions : The importance of discussions among medical staff as a team as well as the necessity of arrangements to support patients and their families was suggested.
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