Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 47, Issue 3
Displaying 1-18 of 18 articles from this issue
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Contents
  • Efficacy and Effectiveness of Vaccination with Bacillus Calmette-Guerin
    TORU MORI, KAZUHIRO UCHIMURA
    2001 Volume 47 Issue 3 Pages 278-289
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.278
    JOURNAL FREE ACCESS
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    Revision of the programme for vaccination with Bacillus Calmette-Guerin (BCG) is one of the issues being discussed in relation to the total remodeling of the national tuberculosis control programme in Japan. This discussion includes the modification of re-vaccination and the total discontinuation of the vaccination. The paper summarizes the past epidemetric studies related to this problem that mainly uses the model approach, including the authors' previous research, and discusses the potential usefulness and weaknesses of this methodology for decision making in public health policy.
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  • The present situation of disaster medicine in Japan
    NORIYUKI KUWABARA, YUKIYA HAKOZAKI
    2001 Volume 47 Issue 3 Pages 290-301
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.290
    JOURNAL FREE ACCESS
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    In Japan at the present time, it is necessary to establish medical protocols for the management of nuclear, chemical, toxic and biological agents in case of a large-scale disaster or terrorism. There is no method of optimal preparation for these casualties. In particular, biological (bacteria, viruses and toxins) casualties are very important, be-cause of the difficult in identifying the technology and treatment. Also, the domain should include not only biomedical research and training in disease handling in a disaster, but also investigation into the psychology of mental trauma. Therefore, it is necessary to establish closed communication between the medical community and other national agencies (governments, police, fire services and self defense forces etc)
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  • Overview of the Current Status of Acute Medicine in Japan
    AKIO KIDOKORO
    2001 Volume 47 Issue 3 Pages 302-312
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.302
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    The history of emergency care in Japan started in 1931 with the establishment of Japan Red Cross in Osaka. Soon after, the emergency care organization was moved to the police department in the early 1930s. In 1948, laws concerning fire and disaster were enacted and emergency care was organized by the Fire and Disaster Management Agency of the Ministry of Public Management. Facilities for emergency care were divided into primary, secondary and tertiary grade depending on their function by the Ministry of Health and Welfare in 1977. At the time of April 2000, a total of 5098 institutes (4315 hospital and 783 clinic) existed in Japan, and among them, 157 were tertiary grade emergency centers. At present, 99.8% of the population in 98% of the local communities are covered by this network. However, the survival rate of the patients remains low compared to that in U. S. A. To improve this low survival rate, the system of the Japanese Emergency Life-Saving Technician was introduced in 1991 following the paramedic system in the USA. Under this law, intraesophageal intubation, semi-automatic external defibrillator and intravenous fluid resuscitation can be performed by Japanese Emergency Life-Saving Technician. Despite these advances, the improvement in survival remains much less than expected, and the importance of pre-hospital care by bystanders is now advocated. The first Section of emergency care was established in the Department of Trauma Care of Osaka University Hospital in 1967 and the first department was opened in Kawasaki University in 1977. Since then, the number has increased to 22 departments in 45 national universities and 18 departments in 29 private universities. As for the medical societies, the Japanese Association for Acute care Medicine was first established in 1973 followed by the Japanese Society for Emergency Medicine in 1998. In addition to those two, the Association for Trauma Surgery, the Burn Association and other groups are actively working in this area. The problems regarding pediatric and psychological emergency, emergency care for foreign and homeless people remain to be solved.
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  • Hemodialysis (HD) therapy for 21 years in Juntendo University Hospital
    -the effects of antihypertensive therapy before starting HD-
    MICHI KOKOIZUMI, MITSUMINE FUKUI, ICHIYU SHO, CHIEKO HAMADA, ISAO SHIR ...
    2001 Volume 47 Issue 3 Pages 334-341
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.334
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    Objective : We investigated hemodialysis (HD) therapy in Juntendo University Hospital for 21 years (1979-1999) and the efficacy of antihypertensive therapy against the progression of chronic renal disease. Patients and methods : Age of the patients at the start of HD, underlying disease of HD, duration from onset of renal disease to HD, complications during HD therapy and blood pressure (BP) were examined in this study. The efficacy of antihypertensive therapy before HD was also evaluated. We divided the patients into two groups, i. e. diabetic nephropathy patients (DM group) and non-diabetic nephropathy patients (non-DM group), and compared clinical parameters between the groups. Results : DM patients who progressed to HD increased significantly from 1997 in this study. The mean duration from onset of the disease to HD increased significantly from 1997 in this study. The mean duration from onset of the disease to HD in the DM group from 1995 to 1999 was significantly prolonged compared with that from 1979 to 1983 (p<0.01). The mean BP in the non-DM group treated with Ca channel blockers was significantly lower than in those treated with α-adrenoceptor agonist (α-Methyldopa) (p<0.01). However, there were no significant changes in the prolongation from onset to HD between patients treated with Ca channel blockers and those treated with the α-adrenoceptor agonist. Conclusion : It appears that stricter control of BP might inhibit the progression to HD in chronic renal diseases.
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  • Burden of Eye Diseases in Japan
    -Introduction of Eye-Healthy Life Years Lost-
    YOSHIMUNE HIRATSUKA
    2001 Volume 47 Issue 3 Pages 342-348
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.342
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    Purpose : To investigate the burden of eye diseases in Japan. Methods : The impact of an eye disease is measured by the number of eye-healthy years of life which are lost through illness, disability and blindness as a consequence of the disease. Results : The new indicator Eye-HeaLY incorporates blindness and morbidity into a single number. Conclusion : The methodology may be used to help determine priorities for the allocation of resources to alternative eye-health improvement procedures by estimating the number of eye-healthy years lost.
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  • A trial to define poorly achieving students at the final stage of medical education and to detect them during their preliminary classes
    TAKAO OKADA, BRUCE ALLEN, TAKASHI DANBARA
    2001 Volume 47 Issue 3 Pages 349-356
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.349
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    Objectives : A scheme was investigated to identify during the early stages of medical school the students who are likely to show extremely poor academic achievement. Materials and Methods : Scores and standings, based on graduation examinations from 1995 to 2000, were examined and the conditions of extremely poorly achieving students were analyzed retrospectively. Results : Poorly achieving students, who were shown to be qualitatively different from their classmates, were identified by analysis of their graduation examinations. By retrospectively examining the records from their earlier classes, it was found that a lack of knowlege of basic medical sciences, rather than that of clinical medicine, was the main cause of the decline in their scholastic attainments during clinical rounds in the hospital. Conclusions : By putting together the student records in basic and clinical medicine, a new standard was proposed for identifying at an early stage the students who are most likely to present academic problems by graduation.
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  • The healing of corneal epithelial abrasions observed by Tandem Scanning confocal microscopy
    KIMIKO SAITO, AKIRA MURAKAMI, KIYOO NAKAYASU
    2001 Volume 47 Issue 3 Pages 357-368
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.357
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    As methods of removing corneal epithelium, there are mechanical scraping with a spatula blade, tapping with a gelatin-sticky coated slide glass and chemical deepithelialization with iodine gas or n-heptanol. Using these different methods, we removed the epithelium from rabbit corneas. Following epithelial removal, we performed comparative studies on the wound healing process of the epithelium and keratocytes in the living cornea using a tandem scanning confocal microscope, which is a newly developed instrument that allows in vivo and real time images of the cornea. We also observed denuded corneas histopathologically with both light and electron microscopes. Among the corneas treated by the four different methods, the cornea deepithelialized with iodine gas showed the most deepithelialization and the least damage to keratocytes. The tandem scanning confocal microscope used at this experiment still has slight limitation in the resolution, but it is thought to be a useful tool for observing a living cornea clinically.
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  • Methylation of the tumor suppressor gene p16 in gynecological carcinosarcoma
    XUEGONG ZHU
    2001 Volume 47 Issue 3 Pages 369-377
    Published: December 25, 2001
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.369
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    Objective : Carcinosarcoma of the female genital organs is an uncommon but clinically highly aggressive neoplasm with biphasic histology of carcinomatous and sarcomatous components. In previous studies, we have found frequent loss of heterozygosity (LOH) at 9p21 (41.2%) the loci of the tumor suppressor gene p16, in carcinosarcoma cases. Alteration of p16 is known to be one of the most frequent genetic abnormalities in human neoplasias. p16 is frequently inactivated by methylation of its CpG islands, and much less frequently by mutations or homozygous deletions. In the present study, we investigated whether abnormalities of p16 are involved in the evolution of carcinosarcomas. Methods : Eighteen cases of gynecological carcinosarcomas were submitted for genetic studies. DNA was prepared from microdissected paraffin sections. Mutation of p16 was examined by the single-strand conformational polymorphism (SSCP) technique. Methylation status of p16 was examined by methylation specific PCR (MSP) and methylation-sensitive restriction enzyme digest PCR (MSREDP). The methylation levels of p16 in carcinomatous and sarcomatous foci were quantified by the combined bisulfite-restriction analysis (COBRA) technique. Results : There were mutations detected in any carcinosarcoma cases. Four of 17 cases showed methylation in the p16 promoter region, four of 17 showed methylation in exon 1, and 15 of 17 showed methylation in exon2. COBRA analysis of both the carcinomatous and sarcomatous components showed almost equal levels of methylation ranging from 27 to 33%. However, the methylation level of microdissected chondrosarcomatous elements was about 20%, which was approximately 10% lower than that of the other components. Conclusions : Hypermethylation of s p16 exon 2 but not promotor or exon 1 is a frequent abnormality in carcinosarcomas. Exon 2 methylation has been reported in some advanced cancers and in a few different types of cancers. Thus, 9p21 LOH together with methylation of p16 exon 2 may be a unique mechanism for the two-hit inactivation of p16in carcinosarcomas. Additionally, different levels of methylation in the neoplastic foci may affect the histological diversity of carcinosarcoma.
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