Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 46, Issue 3
Displaying 1-13 of 13 articles from this issue
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Contents
  • Epidemiology of Helicobacter pylori and stomach cancer in Japan
    SHOGO KIKUCHI
    2001 Volume 46 Issue 3 Pages 286-292
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.286
    JOURNAL FREE ACCESS
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    In Japan the seroprevalence of Helicobacter pylori increases with age and most infections of H. pylori are expected to occur during childhood. Large sibship size and a family history of gastric diseases are positively, and smoking and drinking habits are negatively related with seroprevalence. Infection elevates serum pepsinogen I and II, and reduces pepsinogen I to II ratio (PG I/II). Over a 7-year span, patients infected with H. pylori showed a higher frequency of PG I/II decline than those not infected. Both epidemiological evidence and experimental studies using Mongolian gerbil have provided supportive evidence on the causal relationship between H. pylori and stomach cancer, and the eradication of H. pylori is considered to prevent stomach cancer. The eradication may provoke both the decline of the occurrence of stomach cancer and an increase of cardia cancer or adenocarcinoma of the esophagus, and the frequency of the increase may not be as large as that of the decline.
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  • Diagnosis and Treatment for Helicobacter pylori infection
    HIROTO MIWA, NOBUHIRO SATO
    2001 Volume 46 Issue 3 Pages 293-303
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.293
    JOURNAL FREE ACCESS
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    Various kinds of gastric diseases have been reported to relate with H. pylori infection and the clinical management for this infection is to correctly diagnose the infection and effectively administer eradication treatment, although the indications for eradication treatment are still partially controversial. Diagnostic methods are both invasive and non-invasive method and among the non-invasive methods, 13C urea breath test is considered to one of the best in that it provides high performance, and can be used to evaluate cure after treatment. In regard to antibody detection for this bacteria, most serological kits are imported from Western countries and the performance of these imported kits has been revealed to be considerably poor in the Japanese population; thus, domestically developed kits are necessary. Recently, an IgG antibody detection kit using urine has been developed and has been shown to be comparable or better than imported serological detection kits. In addition, a recently developed antigen detection kits using stools (HpSA) has also been reported to be useful in the Japanese population. Recent trends for eradication regimens are proton-pump-inhibitor (PPI) based triple therapies. Although there have been many reports describing the usefulness of these regimens, their efficacy remains to be validated in Japanese patients. From our studies for the optimization of these regimens, 7 days regimens consisting of PPI, 1,500 mg of amoxicillin and 400 mg of clarithromycin was the most useful regimen in our patient population. These regimens are basically safe, although mild adverse effects such as diarrhea or taste disturbance are often reported. The diagnosis and treatment of H. pylori infection is still progressing. A scientific approach to H. pylori infected patients in which new knowledge on its diagnosis and treatment is applied should further improve the quality of management for these patients.
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  • Helicobacter pylori-associated upper gastrointestinal diseases
    SHU HIRAI
    2001 Volume 46 Issue 3 Pages 304-310
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.304
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    The essential features of Helicobacter pylori (H.p) and its related diseases in the upper alimentary tracts are briefly summarized. Pathology plays a major role in the study of H. p, such as microscopic screening for H. p and evaluation of the various reactions seen in infected organs. Concerning the microscopic screening of H.p, there could be a problem in the fixation method, special staining, and judgement of coccoid-formed organisms. However, the inflammation caused by H.p infection is pathologically categorized as non-specific, and some interesting features are recognized histologically. For example, “chronic active gastritis” and “follicular gastritis” are well known as H.p-related gastric diseases. The relationship between H. p infection and gastric cancer or MALT lymphoma is also considered, but there remain unresolved questions about these diseases. With the recent clarification of the gene map of H. p, these issues will be clarified in the near future.
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  • The future of the research on the prion disease in the 21st century
    TAKESHI SATO
    2001 Volume 46 Issue 3 Pages 311-321
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.311
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    Prion diseases encompass inherited, sporadic and iatrogenic mammalian neurological disorders, and is characterized by the conversion of the cellular prion in an insoluble and protease-resistant isoform. A nationwide survey and recent information documented 70 patients with Creutzfeldt-Jakob disease (CJD) who had received cadaveric dura mater grafts during the period between January 1979 and September 1999 in Japan. At least 64 of these 70 patients received the same brand of dura mater grafts from the same processor. Mean age at disease onset in the 70 patients with dural grafts was younger (53years) than that in patients with sporadic disorders (63years) (p<0.0001). Initial predominant symptoms were cerebellar ataxia and disoirientation.
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  • Clinical status of catheter-related infections in CAPD patients in Juntendo University Hospital
    ARAKI TANAKA, CHIEKO HAMADA, MINORU KUBOTA
    2001 Volume 46 Issue 3 Pages 322-330
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.322
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    Objective : Clinical findings of catheter-related infections, i, e. exit site infection, tunnel infection and peritonitis, were investigated since such infections might influence the continuation of long-term peritoneal dialysis (PD) therapy. Materials and Methods : The subjects were 172 patients with end stage renal disease (ESRD) who underwent PD therapy for more than six months in Juntendo University Hospital. They included 115 men and 57 women. The clinical status of catheter infections was determined in these patients. Results : Exit site infection, tunnel infection and peritonitis occurred 53 times (1/130.1 patients·month), 50 times (1/137.9 patients·month) and 103 times (1/67.10 patients·month), respectively. The most frequent causative agent of catheter-related infections was Stapylococcusaureus, followed by Staphylococcus epidermidis, hemolytic streptococcl and Gram-negative bacflli. The incidence of catheter-related infections in patients older than 65 years was significantly lower than that in patients younger than 64 years (p<0.05). There was no significant change in the incidence of catheter-related infections between patients with chronic glomerulonephritis and those with diabetic nephropathy as the diseases underlying ESRD. Conclusions : The incidence of catheter-related infections observed in the present study was significantly lower than that observed in previous reports. It appears that improvements in catheter insertion and catheter care for PD as well as intensive education for ESRD patients might be related to the good results in this study.
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  • Mediastinal lymph node dissection for non-small cell lung cancer
    KAZUKI NAKAHARA, SADAHIKO MASUDA
    2001 Volume 46 Issue 3 Pages 331-343
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.331
    JOURNAL FREE ACCESS
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    Objective : This study evaluated the feasibility of limited mediastinal lymphadenectomy for patients without mediastinal lymph node metastases, and the usefulness of extended systemic mediastinal lymphadenectomy for patients with left lung cancer who had mediastinal lymph nodes metastases. Patients and methods : We retrospectively analyzed the clinical records of patients who were surgically treated for non-small cell lung cancer. The patients were classified according to the presence of p-N0, N1, N2 disease and their records were examined for prognosis, recurrent site and the relation of metastatic mediastinal lymph nodes to the primary tumor site. Results : There were 307 patients with p-N0 disease. The 5-year survival rate was 78.1% for patients who had undergone ND0 or ND1 (n=27), 73.4% for ND2 (n=280), 78.1% for those with left lung cancer who had undergone complete mediastinal lymphadenectomy (n=24) and 72.5% for those who had undergone incomplete mediastinal lymphadenectomy (n=71). There were 93 patients with p-N1 disease. The 5-year survival rate was 28.6% for those who had undergone ND1 (n=7), 45.4% for ND2 (n=86), 39.0% for patients with left lung cancer who had undergone complete mediastinal lymphadenectomy (n=21) and 62.7% for patients who had undergone incomplete mediastinal lymphadenectomy. There were no significant differences between ND0, ND1 and ND2 nor between complete resection and incomplete resection. There were 110 patients with p-N2 disease, 72 had adenocarcinoma, 27 squamous cell carcinoma, and 8 had large cell carcinoma. There were no patients with squamous cell carcinoma or Noguchi's type A or B adenocarcinoma measuring 2cm or less in maximal diameter. The 5-year survival rate was 17.0% for patients with p-N2 disease, 43.9 % for those with p-N1 disease and 73.8% for those with p-NO disease. There were significant differences among these three groups (N2 vs N1 : p<0.001, N2 vs NO : p<0.001, N1 vs NO : p<0.001). As for the relation of the primary site with metastatic mediastinal lymph nodes, all right upper lobe lesions with p-N2 disease metastasized to #3 and/or #4 and/or #7, right middle and lower lobe to #3 and/or #4 and/or #7, left upper lobe to #4 and/or #5 and/or #6, left lower lobe to #4 and/or #7. There were 3 cases of p-N2 disease with recurrence in the contralateral mediastinal nodes in the left lower lobe, but no cases of recurrence in the contralateral mediastinal nodes in other lobes. Conclusion : Limited mediastinal lymphadenectomy was feasible in patients with p-N0, p-N1 disease. Systematic extended mediastinal lymph node dissection was useful for some cases of p-N2 disease in the left lower lobe.
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  • The practice of stepwise truth-telling in patients with incurable cancer of digestive organs
    --Aretrospectivesurveyofpatientsandfamilycaregiver--
    MOTOMICHI URABE, HEII ARAI, MASATAKA HIROSAWA, TOSHIKI KAMANO, MASAHIK ...
    2001 Volume 46 Issue 3 Pages 344-352
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.344
    JOURNAL FREE ACCESS
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    Objective : The purpose of the survey was to investigate the mental state and emotional reactions of incurable cancer patients and their families after they received stepwise information about their true diagnosis and to verify whether such a practice is clinically useful for doctors to perform. Participants : Nine randomly selected patients with incurable cancer of digestive organs, who had been treated by one of the authors and gave informed consent, were included in this study. Methods : A questionnaire survey to the patients and their families as well as retrospective reviews of medical records were performed. Results : (1) The patients expressed a clear desire to know their diagnosis and the current state of their disease, and such attitudes tended to be respected by their families. (2) The practice of stepwise truth-telling as well as confirmation of the selection of treatment at each stage was effective in maintaining a stable mental state in the patients and in maintaining a good relationship between the patient and medical staff. (3) Most of the families accepted and positively supported the practice of stepwise truth-telling. Conclusion : Stepwise truth-telling is a method that should be used for patients with incurable cancer in view of not only the patient's but also their family's mental state.
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  • Two cases of lupus-like symptoms associated with human parvovirus-B19 infection
    KAORU OBINATA
    2001 Volume 46 Issue 3 Pages 353-356
    Published: January 20, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.46.353
    JOURNAL FREE ACCESS
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    We report two cases of human parvovirus-B19 infection mimicking systemic lupus erythematosus. Both patients presented with rash, fever, arthritis, cytopenia, hypocomplementemia and positive antinuclear antibodies. These initial manifestrations strongly suggested a diagnosis of systemic lupus erythematosus. However, serologic studies indicated recent human parvovirus-B19 infection. Regression occurred clinically and serologically within one year. It is considered that human parvovirus-B19 infection manifests lupus-like presentation and accompanies a transient autoimmune state.
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