Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 47, Issue 4
Displaying 1-21 of 21 articles from this issue
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Contents
  • Risk Management
    SAIJIN KATO
    2002 Volume 47 Issue 4 Pages 472-478
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.472
    JOURNAL FREE ACCESS
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    Recently, accidents in the health care system have become an issue of strong public concern, forcing health care facilities and hospital groups at all levels-even the government-to actively face the issue of risk management. Risk management involves in part, the achievement of a standard of health care by focusing on the “prevention of accidents that should not happen”. Nevertheless, accidents are inevitable, and risk management should also cover how to manage accidents that have occurred. This paper discusses problems associated with policies for preventing accidents in the health care system, and how to manage accidents that have occurred from the perspective of someone involved in the settlement of disputes arising from accidents in the health care system.
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  • The risk management and medical accidents
    MICHIO INUI
    2002 Volume 47 Issue 4 Pages 479-485
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.479
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    Recently, increasing numbers of lawsuits over medical accidents have become a big problem. Examination of those cases to develop risk management strategies to prevent further accidents is required. This report describes the current status of risk management, both generally and medically. Concrete situations in criminal and civil medical accidents along with fault, and problems of medical lawsuits are also discussed.
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  • Selective modulation of the secretion of cathepsin L and its inhibitor by b-FGF in differentiated cultured podocytes.
    KATSUHIKO ASANUMA
    2002 Volume 47 Issue 4 Pages 486-492
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.486
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    Object : In various disease processes, secretion of proteinases and their modulators including growth factors may play a key role in remodeling of the extracellular matrix. The present study examined the effects of basic fibroblast growth factor (b-FGF) on the secretion of proteinases and their inhibitors from differentiated podocytes in culture. Materials : Proteinases (cathepsin L) and their inhibitors (cystatin C) secreted from differentiated podocytes in culture. Methods : We cultured differentiated podocytes and analyzed the secretion of proteinases in the culture medium after stimulation with b-FGF using immunoblotting. Results and conclusions : The presence of b-FGF increased the secretion of cathepsin L, but did not alter the secretion of its extracellular inhibitor, cystatin C. These results indicate that in differentiated podocytes, both proteinases regulated by growth factor. It appears that increases in proteolytic activities may induce degradation of the glomerular basement membrane (GBM), which plays an important role in the progression of glomerulosclerosis
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  • Effect of Aurintricarboxylic acid on myocardial ischemia-reperfusion injury in mice
    NORIHIDE TAKAYA
    2002 Volume 47 Issue 4 Pages 493-500
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.493
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    Background : Interaction of von Willebrand factor (vWF) and platelet glycoprotein Ib induces tyrosine phosphorylation of Syk, leading to initial activation of platelets at inflammatory sites. We examined the effect of aurintricarboxylic acid (ATA), an inhibitor of vWF-glycoprotein Ib interaction, on myocardial ischemia and reperfusion injury in mice. Methods and Results : Coronary occlusion and reperfusion experiments were done in C57BL6 mice with or without ATA. Infarct size after 30 min of ischemia followed by 120 min of reperfusion was decreased by ATA. Phosphorylation of platelet Syk, which is coupled with GPIb, was measured after 30 min of ischemia followed by 15 min of reperfusion. Syk activity was decreased in ATA-treated mice compared with sham-operated mice. Moreover, regardless of the presence or absence of ATA, plasma vWF levels were increased after reperfusion. Conclusions : These results indicate that the activation of platelets through vWF-GPIb intereaction plays an important role in myocardial ischemia-reperfusion injury, and that ATA is a potential agent to prevent this injury. This observation provides a rationale for focusing on antiplatelet therapy as a treatment for ischemic heart disease.
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  • Platelets activated by shear stress through an immunoreceptor tyrosine-based activation motif play a pivotal role in the initiation and generation of atherosclerotic lesions
    HAKUOH KONISHI
    2002 Volume 47 Issue 4 Pages 501-507
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.501
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    Background : Upon damage to the vascular system, platelets adhere to subendothelial collagen, leading to platelet degranulation, aggregation, and the development of a homeostatic plug. Recent studies have shown that the activation of platelets by shear stress is mediated through the same pathway as that used by immune receptors, with an immunoreceptor tyrosine-based activation motif (ITAM) on the Fc receptorγ-chain (FcRγ) playing a pivotal role. Methods and Results : We examined the role of collagen-stimulated platelets in the development of injury-induced neointimal formation using mice deficient in FcRγ. The right carotid arteries of 8-to12-week-old FcRγ-deficient (K/O) mice (n=16) and C57BL/6 (wild) mice (n=16) were ligated. Segments of the ligated carotid arteries were excised 7 days and 28 days after ligation. Arterial segments were studied using immunohistochemistry and electron microscopy. Three days after ligation, electron microscopy showed marked decreases in platelet adhesion and neutrophil attachment to the endothelial cell surface in FcRγ-K/O mice compared with those in wild mice. Seven days after ligation, the cell count in the intima was also smaller in FcRγK/0 mice than in wild mice. Staining against anti-neutrophil antibody showed fewer inflammatory cells in FcRγ-K/O mice than in wild mice. Computer-aided morphometry performed to measure the neointimal area, intima / media ratio, and stenotic area 28 days after ligation showed a significantly smaller ratio and area in FcRγ-K/O mice than in wild mice (2215±475μm2, 0.085±0.01, 5.4±0.4% vs 34362±3013μm2, 0.87±0.054, 38.4±2.6%, respectively). Conclusion : These results demonstrate that Ib and GPVI may play important roles in the initiation of atherosclerosis through platelets activation.
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  • Supporting the Mental Health of Mothers of Children with Atopic Dermatitis
    NAOKO ARAGA, YASUO SHIRAISHI, TAKURO MOTONAGA
    2002 Volume 47 Issue 4 Pages 508-518
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.508
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    Objective : To define the requirements for mental support of mothers of children with Atopic Dermatitis (AD). Materials : Subjects were 44 mothers with 3, 4, and 5-year-old children diagnosed with AD, and 108 mothers of3, 4, and 5-year-old children without AD. Method : We compared and analyzed differences between the two groups the results of questionnaires on child-rearing anxiety STAI (Japanese version), and other tests. Results : The results showed that specific factors contributing to child-rearing anxiety in both groups of mothers in the present study could be categorized into 5 categories under characteristic anxiety : “age of child”, “job-related stress”, “joy related to child-rearing”, “depression related to child-rearing”, and “anxiety about miscellaneous matters”; and 2 categories under situation anxiety; “feeling that the father is participating in child-rearing”, and “number of family members living together”. In mothers with children with AD older children with AD and the mother holding a job seemed to increase anxiety while an increase in the number of family members living together decreased anxiety. The Psychological condition of those mothers was stable at low anxiety levels, and they were able to enjoy child rearing and cooperation with the father, although these mothers do have some concerns. In comparison mothers in the control group cooperate and enjoy child rearing with the fathers, but have many concerns and display high levels of anxiety. Conclusions : Based on these observations, it was indicated that a good relationship between all parties involved (e. g., husband, doctors) is important in supporting the mental health of mothers with children with AD.
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  • Pathogenesis of chorio-retinopathy in systemic lupus erythematosus using (NZB×NZW) F1 mice
    REIFUl NAKAYAMA, TOSHIYUKI YOKOYAMA, YOSHIMUNE HIRATSUKA, ATSUO NAKAMU ...
    2002 Volume 47 Issue 4 Pages 519-527
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.519
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    We investigated the ocular fundus of (NZB×NZW) F1 (B/WF1) mice and (NZW×BXSB) F1 mice, both of which are considered to be good models of systemic lupus erythematosus (SLE). The abnormal fundus findings were documented by fundus photography, and the chorioretinal lesions were studied histopathologically. The ophthalmoscopic examination revealed marked dilatation of the retinal veins and narrowing of the arteries, and white spots were seen subretinally in the posterior pole. The spots increased in number, size and distribution with the passage of time. These lesions developed into exudative retinal detachment in some of the animals. The incidence of ocular fundus abnormalities were significantly higher in B /W Fl mice than in (NZW×BXSB) F1 mice. Histopathological findings included : 1) degeneration, thinning and loss of the retinal pigment epithelium, 2) narrowing and occlusion of the choriocapillaris, 3) thickening of the wall of the choroidal arterioles. Immunohistological findings suggested SLE chorio-retinopathy is due to damage of the retinal pigment epithelium secondary to the disturbance of the choroidal arterial circulation. The study of the SLE mouse model will contribute to the understanding of the various mechanisms of SLE.
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  • A rare case of Potter's syndrome associated with megabladder (or megacystis) extending along the coccyx/ sacrum to the gluteal region is reported.
    SHOEI SATAKE, TOSHIHIRO YANAI, ATSUYUKI YAMATAKA, TAKESHI MIYANO, ATSU ...
    2002 Volume 47 Issue 4 Pages 528-531
    Published: March 22, 2002
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.47.528
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    The patient was male, the second born of twins, and had megabladder, bilateral multicystic dysplastic kidneys, and bilateral pulmonary hypoplasia detected prenatally. At delivery, a massive cystic mass, 7cm in diameter extending from the coccyx/ sacrum to the gluteal region was found, and despite of cardiorespiratory resuscitation, the patient developed respiratory and renal failure, and died on day two of life. At autopsy, a megabladder, bilateral multicystic dysplastic kidneys, bilateral fibrous fusion (or union) of the kidneys, right hydroureter, left ureteric aplasia, bladder diverticulum, steno-sis of the bladder neck, anterior urethral stenosis, and bilateral pulmonary hypoplasia were identified. Although the literature contains few case reports describing megabladder pro-gressed to this extent, it should be considered in the differential diagnosis when prenatal screening is performed.
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