Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 45, Issue 3
Displaying 1-26 of 26 articles from this issue
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Contents
  • Relationship between supply of use of home welfare services for the aged and socioeconomic factors among municipalities in Japan
    HIDEKI SATOH
    1999 Volume 45 Issue 3 Pages 372-383
    Published: December 20, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.372
    JOURNAL FREE ACCESS
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    Objective : The relationships between socioeconomic factors and supplies of home help service, day service, and short stay service among 3,255 municipalities in Japan (cities, towns, and villages) were investigated. Materials and methods : Multiple regression analysis using the stepwise forward method was conducted to clarify the relationships between the utility levels of these three welfare services and 16 socioeconomic indices showing the movement of population, state of the economy, and state of medical services. Results : The following results were obtained from the analysis. The utility level of home help service was associated with the following four indices : percentage of the population between 15 and 29 years old, percentage of the population aged 65 and over, increasing rate in the population of registered citizens, and index of financial power. The utility level of day service was associated with the following four indices : percentage of the population aged 65 and over, index of financial power, income differentials, and percentage of people working in primary industry. The utility level of short stay service was associated with the following two indices : percentage of the population between 15 and 29 years old and medical cost per capita among the aged eligible for old age medical benefits. Conclusion : These results suggested that the differences in the utility level of these welfare services between municipalities in Japan are due not only to the differences in the extent of aging of the population and the extent of depopulation, but also to the differences in factors such as the state of finances, economic benefit in terms of location, and industrial structure of each municipality.
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  • Long-term survival after abdominal aortic aneurys msurgery
    SHIN YAMAMOTO
    1999 Volume 45 Issue 3 Pages 384-395
    Published: December 20, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.384
    JOURNAL FREE ACCESS
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    Objective : To find out whether patients undergoing repair of ruptured abdominal aortic aneurysms (AAA) could have better long-term survival rates than those listed for elective resection. Design : Retrospective study Setting : Teaching hospital, Juntendo Izunagaoka Materials and methods : The medical records of 100 patients who underwent repair of AAA between May 1990 to January 1999 were reviewed. The data were examined for the following factors : age, sex, symptoms, size of the AAA at the first outpatient clinic, size of the AAA at surgery, interval between first outpatient clinic and surgery, blood pressure, cardiac function (ejection fraction), coronary risk factor, coronary artery disease, preoperative and postoperative laboratory data, hemodynamics at operation, duration of operation, duration of aortic cross clamping, and size of the implanted graft. Univariate analysis was performed with Student's t test and X2 test. Survival curves were constructed using Kaplan-Meier analysis for the patients from the ruptured AAA and elective AAA groups who survived more than 30 days after surgery. Results : No statistical differences were found between the two groups in regard to the following factors : age, the initial diameter of AAA, interval to operation, preoperative blood pressure, the duration of operation, the duration of aortic cross clamping, the diameter of the graft, postoperative hospitalization. In a comparison of group I and group II, statistically significant differences were found in the following variables : the diameter of the AAAs at operation (p=0.004), symptoms (p=0.0001), preoperative hemodynamic deterioration (an SBP of 80mmHg or less of more than 30 minutes' duration (p=0.0018), chronic renal insufficiency (Cr>1.5mg/dl) (p=0.0001). The overall mortality rate was 24% (24/100). Ten of the deaths were operative deaths and 4 were intraoperative deaths, and were excluded from survival analysis. Cumulative survival rates of the patients of the ruptured group were 81.3%, 71.1% and 71.1% at 1, 3, and 5 years after AAA surgery, respectively, and those of the non-ruptured group patients were 86.2%, 81.9%, 76.0%, and 76.0% at 1, 3, 5, and 7 years after AAA surgery, respectively. In a comparison of the patients who underwent emergency repair for ruptured AAA with those who underwent elective surgery for non-ruptured AAA, no statistically significant differences were found in the cumulative survival. Conclusion : In patients surviving surgery for ruptured aortic aneurysms, their life expectancy will parallel that achieved by patients undergoing elective surgery.
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  • Relationship between disease progression and podocyte injury in patients with IgA nephropathy
    YALI ZHENG, ISAO SHIRATO, TOSHIMASA HISHIKI, KAZUHIKO FUNABIKI, SATOSH ...
    1999 Volume 45 Issue 3 Pages 396-402
    Published: December 20, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.396
    JOURNAL FREE ACCESS
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    The podocyte is regarded as a highly differentiated cell with a very limited capacity for mitosis or repair after cell damage or excessive tuft enlargement. When podocytes are injured, they are not able to repair themselves by replication as glomerular mesangial cells or endothelial cells do. In this study, we carried out a morphometric analysis of glomeruli on PAS-stained renal sections from 27 patients with IgA nephropathy, and discussed the relationship between the morphometric parameters and the clinical data, i.e., urinary protein excretion, serum creatinine, and creatinine clearance at the time of renal biopsy. It was evident that the areas of glomerular capillary walls covered by one podocyte were significantly increased and were inversely correlated with creatinine clearance. Podocyte damage might be correlated with the progression of glomerulosclerosis in patients with IgA nephropathy. It is assumed that the maladaptive changes of podocytes will result in the onset and development of glomerulosclerosis.
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  • Reasons for prevention of telling the diagnosis of cancer and clinical problems after the disclosure
    -The 2nd report of a questionnaire survey at Juntendo University Hospital-
    HEII ARAI, TETSU KAWAMURA, KOU ETO, MASATAKA HIROSAWA, MICHIHIRO KIMUR ...
    1999 Volume 45 Issue 3 Pages 403-409
    Published: December 20, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.403
    JOURNAL FREE ACCESS
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    Objective : The purpose of this survey was to clarify medical staff members' attitudes toward informing cancer patients of their true diagnosis in Juntendo University Hospital. The present paper, as the 2nd report related to the survey, reports on the reasons for the prevention of telling the truth, and clinical problems after disclosure. Participants : Two hundred physicians and 100 nurses at the hospital were selected at random. Methods : A questionnaire survey was performed in the autumn of 1998, as mentioned in the 1st report of the survey. Results : The total number of answered questionnaires obtained was 243. Most of the staff members (61.9%) answered that the main reason for not disclosing the true diagnosis was the families' refusal to accept the option of disclosure. Concerning clinical problems after disclosure, most of the staff members (70.0%) pointed out psychiatric problems. Moreover, the staff members with relatively long clinical careers evaluated the level of terminal care in our hospital as relatively low, and pointed out the necessity to establish a system related to psychiatric support and palliative care for cancer patients. Conclusion : Our survey revealed the present situation of cancer medicine in Juntendo University Hospital, and suggested the necessity for further improvements in the medical services for cancer patients in terms of support for their quality of life.
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  • Relation of serum lipoprotein (a) concentration to lesion stenosis of infarction related coronary artery in survivors of myocardial infarction
    SHIGERU MATSUDA
    1999 Volume 45 Issue 3 Pages 410-419
    Published: December 20, 1999
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.45.410
    JOURNAL FREE ACCESS
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    Objective : Lipoprotein (a) [Lp (a)] is an atherogenic lipoprotein that is an important risk factor for coronary artery disease. In addition to its role as a lipoprotein, several studies have suggested that it may contribute to atherogenesis by inhibition of intrinsic fibrinolysis because of its structural homology with plasminogen. The aim of this study was to investigate whether the serum concentration of Lp (a) influences lesion stenosis and patency in infarction-related coronary arteries after acute myocardial infarction. Patients and methods : The study subjects consisted of 129 patients with acute myocardial infarction who did not undergo thrombolytic therapy, coronary angioplasty, or coronary bypass surgery. They underwent cardiac catheterization and coronary angiography between 8 days and 180 days after myocardial infarction. The relationship between the severity of the culprit lesion and Lp (a) was investigated. Results : The severity of stenosis at the culprit lesion in male patients with high Lp (a) levels (≥30mg/dl) was greater than that in patients with low Lp (a) levels (<30mg/dl) (lesion stenosis : 96.8±5.5% vs.85.5±23.7%, P=0.0033; TIMI flow grade : 1.7±1.3 vs.2.2±1.2, P=0.0309). The difference of severity in lesion stenosis between high and low Lp (a) levels was more obvious in male patients with normal total cholesterol levels (<220mg/dl) and without diabetes mellitus. Significant association between Lp (a) levels and severity of lesion stenosis was seen in this group (lesion stenosis : 98.4±3.2% vs.78.9±31.2%, P=0.0012; TIMI flow grade : 1.3±1.3 vs.2.3±1.1, P=0.0040; extent of coronary artery disease : 1.8±0.9VD vs.1.2±0.8VD, P=0.0444). Other factors including age, diabetes mellitus, hypertension, total cholesterol level, and triglyceride level were not associated with the severity of culprit lesions. Conclusions : High Lp (a) level may influence the severity of lesion stenosis after acute myocardial infarction. This phenomenon could be explained in part by the antifibrinolytic property of Lp (a).
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