Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 48, Issue 4
Displaying 1-16 of 16 articles from this issue
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Contents
  • New strategies on metabolic syndrome
    RYUZO KAWAMORI
    2003 Volume 48 Issue 4 Pages 444-447
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.444
    JOURNAL FREE ACCESS
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    The association of various clusters of metabolic abnormalities with cardiovascular diseases and type 2 diabetes has been recognized by clinicians for many years. The cluster has been referred to by many different names : Syndrome X, Insulin Resistance Syndrome, Deadly Quartet, Cardiovascular-metabolic Syndrome, Dysmetabolic Syndrome. Recently, risk determinants for the diagnosis of the metabolic syndrome were defined as : large waist circumference, high serum triglycerides, low HDL-cholesterol, high blood pressure, and slightly higher fasting plasma glucose concentration. However, the author has been proposing from the viewpoint of the nature of diabetes that subjects with the phenotype of type 2 diabetes, in other words, showing delayed insulin secretion in response to the rapid rise in postprandial glycemia, the metabolic syndrome could be easily established if physical inactivity and overeating co-exist. Thus, before the onset of diabetes, we have to be careful to identify the subjects with metabolic syndrome as early as possible, since recently we have so many therapeutic modalities, which the author names metabolic modulators, which may alter the natural history of diabetes and metabolic syndrome.
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  • Acute coronary syndrome--Diagnosis, and treatment--
    HIROYUKI DAIDA
    2003 Volume 48 Issue 4 Pages 448-457
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.448
    JOURNAL FREE ACCESS
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    Acute coronary syndrome (ACS) is a pathophysiology in which acute thrombotic occlusion occurs at the site of plaque rupture or erosion followed by sudden onset of myocardial ischemia and chest pain. This syndrome includes ST elevation myocardial infarction, non-ST elevation Myocardial Infarction, and unstable angina as well as sudden cardiac death. The pathophysiology varies widely in its severity of symptoms, signs and prognosis. With regard to diagnosis, it is crucial to monitor the type and degree of ischemia, which can change from time to time. Essential diagnostic clues include the patient's symptoms, physical findings and electrocardiogram. In addition, troponin T and other serum markers have recently been introduced for diagnostic tools at the bedside. Treatment should be initiated immediately, including control of chest pain, reduction of myocardial ischemia, coronary revascularization, and prevention of recurrence. This review summarizes the current therapeutic strategy for acute coronary syndrome.
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  • Coronary artery surgery
    --Change from on-pump surgery to off-pump surgery--
    ATSUSHI AMANO
    2003 Volume 48 Issue 4 Pages 458-465
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.458
    JOURNAL FREE ACCESS
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    The development of on-pump, i, e. under extracorporeal circulation, coronary artery bypass grafting (CABG) was established by improvement of the surgical technique, medical equipment and myocardial protection during cardioplegic arrest, and has shown sufficiently satisfactory results. However, complicated preoperative characteristics and coronary lesions require further improvement of surgical techniques. Against such background, various methods have been sought at each institution to improve the off-pump beating heart CABG method performed under severely limited indications since 1995. Based on the improvement in clinical results for severely. 11 patients, extension of the indications for off-pump CABG has been a Hempted and there has been some improvement in graft harvesting techniques and surgical instruments as a result. The presence of extracorporeal circulation is the most important factor generating complications in the perioperative period, the new management for postoperative atrial fibrillation is required for off-pump CABG strategies. Finally it is considered that a change in the surgical procedure from on-pump to off-pump would be able to contribute to medical economy by providing less invasive treatment to the patient without decreasing the quality of the results.
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  • Results and transition of treatment of keratoconus over 41 years in Juntendo university hospital
    AYUMI TAKEI, KEIKO FUJIKI, MOTOZUMI ITOI, AKIRA MURAKAMI, KIYOO NAKAYA ...
    2003 Volume 48 Issue 4 Pages 466-475
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.466
    JOURNAL FREE ACCESS
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    Purpose, object and method : Between January 1961 and December 2001, 4659 keratoconus patients (3199 males and 1460 females) have consulted the ophthalmology department of Juntendo Clinic after obtaining contact lenses from another center. Gender distribution date of birth, date and age at first examination in our clinic, the appearance of bilateral or unilateral keratoconus, (passage afterwards is included) the anamnesis of the rupture of Descemet's membrane, anamnesis of Dr. Sato's type posterior corneal incision and, anamnesis of penetrating keratoplasty were investigated based on the clinical records of diagnosis and treatment. Result : The overall gender ratio was 2.19 : 1. The ratio of female patients increased gradually from 2.44 : 1 (1970-1979 years). 2.24 : 1 (1980-1989 years) and 2.21 : 1 (1990-1999 years) to 1.99 : 1 (2000-2001 years) after 1970 when the age at the first examination was classified by ten intervals. During the follow-up period, rupture of Descemet's membrane was noted in 202 of 242 eyes and posterior corneal incision as deseribed by Dr. Sato was recognized in 28 of 34 eyes. Penetrating keratoplasty was performed in 640 of 739 eyes comprising 13.7% of the cases and 8.2% of the number of eyes. There was a slight gradual decrease in cases treated by penetrating keratoplasty when patients were classfied by age at first examination. Among cases in which the history of allergy was recorded, there were 452 patients reporting allergy and 668 without allergy and some allergy history was admitted by 40.4%. Consideration : When laterality of the affected eye, ratio of rupture in Descemet's membrane, and posterior corneal incision were compared between males and females, a history of penetrating keratoplasty and the ratio of cases with some allergy history were almost equal to those in previous reports. The tendency toward an increase in female patients and toward decreased number of patients requiring penetrating keratoplasty was admitted in recent years when classifying patients by age at first medical examination.
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  • Treatment of lymphangioma in children. A report of 105 cases
    SAORI HIKI, ATSUYUKI YAMATAKA, HIROYUKI KOBAYASHI, YASUHIRO OKADA, TAK ...
    2003 Volume 48 Issue 4 Pages 476-483
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.476
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    Objective : Lymphangioma has an unsatisfactory therapeutic outcome due to its invasive nature. Although the standard treatment is surgical excision, sclerosing therapy with either Bleomycin or OK-432 is now being performed with increasing frequency. Lymphangioma commonly develops in the head and neck, but can arise anywhere, and there is no consensus on treatment according to location or subtype (cystic or cavernous). This study investigated the optimal treatment for lynphangioma by analyzing the effectiveness of treatment modalities versus complications with respect to location and subtypes. Patients : One hundred five patients with lymphangioma treated in our unit between 1979 and 1999 were included. Methods : We created a new classification system for lymphangioma based on radiological appearance and histopathology and examined the effectiveness of treatment and incidence of complications for each type of lymphangioma. Result : (1) The effectiveness of the surgical excision (88.4%) was higher than that of sclerosing therapy (69.4 %), but the risk of complication with surgery was three times greater. (2) Lymphangiomas were located in the head and neck in 54.3 % of patients. The majority of serious complications were also seen in this area. (3) The multiple cystic type of lymphangioma, a classification similar to the cavernous type, was less responsive to treatment compared with other cystic types. Conclusion : We found sclerosing therapy to be not as effective as reported in the literature (80-90 % effectiveness). The treatment for the multiple cystic type of lymphangioma located in the head and neck need to be considered for then.
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  • Assessment of issues during develoment of a scale for subjective QOL in patients with various intractable disease, by standard-associated validity testing
    KATSUHIKO KAWAMINAMI
    2003 Volume 48 Issue 4 Pages 484-494
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.484
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    Objective : We assessed issues during the develoment of a scale for subjective QOL in patients with various intractable diseases (a scale measvring subjective QOL) then assessed the standard-associated validity of the scale for subjective QOL using the Short Form 36 Health Survey (SF-36). Subjects : The study included 2060 patients receiving treatment for newly diagnosed or exsisting diseases targeted by the Ministry of Health and Welfare's Specific Disease Treatment Research Project at 30 public health centers throughout Japan between December 1998 and July 1999 and who were able to cooperate in this survey. Methods : Medical recipient applications, clinical survey, a scale of subjective QOL, and the SF-36 of subjects were examined, and confirmation of internal structure, reliability testing, assessment of score distributions, intercorrelations between scores on each SF-36 subscales, and associations with disease severity were assessed in relation to scores on a scale for subjective QOL. Results : 1) Valid responses were obtained from 1,563 patients (497 of the subjects either declined to participate in the survey altogether or refused to answer specific questions ; the valid response rate was 75.9%). 2) ''Acceptance'' and ''morale'' comprised the 2-factor structure used (initial eigenvalue with 2 factors of 1.0 or more, cumulative contribution rate of 70% or more), and no changes were observed compared with the 2-factor structure during development. 3) Reliability and internal consistency were high (alpha coefficient=0.85) and showed a distribution close to the normal distribution in scores on a scale for subjective QOL, and there were no differences from the results of a survey during its development. 4) There were no significant associations observed with regard to disease severity. 5) Correlations to an itermediate degreeor higher (r≥0.5, p<0.01) were observed for ''mentalhealth'', ''vitality'', and ''general health perception'' among the SF-36 subscales. Conclusion : We considered the issues during development by adding diseases such as intractable skin diseases and idiopathic dilated cardiomyopathy and including patients with severe limited activities of daily living as the target of this survey, then assessed the validity of the scale for subjective QOL by adding the severity of diseases in order to evaluate the function standard of each disease. Results showed that this scale for subjective QOL possesses internal validity and it was confirmed to be unaffected by the severity of individual diseases. Associations with the SF-36 also confirmed that a scale for subjective QOL possessed standard-associated validity.
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  • Study on chinese diagnostic criteria for Sjögren's syndrome
    --Comparison of sensitivity and specificity with otherdiagnostic criteria-
    ZHIQUAN XU, YOSHIAKI TOKANO, RAN MATSUDAIRA, YOSHINORI KANAI, KEN TAKE ...
    2003 Volume 48 Issue 4 Pages 495-504
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.495
    JOURNAL FREE ACCESS
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    Objective : This study will examine the validity, sensitivity and specificity of Chinese diagnostic criteria for Sjogren's syndrome (SS) in comparison with Daniels-Talal's criteria (D-T cri-teria), European criteria, and Japanese criteria proposed by the Ministry of Health and Welfare of Japan. Materials and Methods : Ninety-six cases fulfilling at least two of the above cited criteria comprised the SS patients' group. Nineteen cases that met at most one criterion were used as the controls' group. The validity of Chinese criteria was also examined in relation to findings of anti-SS-A/ B antibodies, in addition to comparative studies of sensitivity and specificity among the above four criteria. Results : From sixty cases of primary SS, we found that the order of sensitivity was 100 % for Japanese criteria, 98.3 % for Chinese criteria, 98.3 % for European criteria, and 78.9 % for D-T criteria, which showed significantly lower sensitivity than the first three. In contrast, the specificity was 100% for Japanese criteria, 100 % for D-T criteria, 94.7 % for Chinese criteria, and 89.5 % for European criteria in the controls' group. When the primary SS patients fulfilled Chinese criteria were compared with controls, we found the former was significantly associated with Schirmer test, rose bengal staining, fluorescein staining, lower lip biopsy, gum test, rheumatoid factor (RF) positivity, hyperglobulinemia, renal failure, leukopenia and anemia. By investigating whether any clinical features of primary SS might correlate with presence of anti-SS-A or SS-B antibodies, we found the patients with anti-SS-A or SS-B antibodies showed significantly increased RF positivity and hyperglobulinemia, significantly decreased urinary abnormalities and renal failure compared with those in the seronegative group. A revision of the Chinese criteria to include the items of anti-SS-A or SS-B antibodies and tests of the lacrymal and salivary glands was proposed, and its sensitivity and specificity were 100 % in our cases. Conclusion : Chinese criteria showed high sensitivity and specificity compared to the Japanese criteria. By studying of the combination of highly specific items, criteria that have not only fewer items but also higher sensitivity and specificity could be developed.
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  • Relationship between reflux esophagitis and pyloric incompetence
    KOH MORICHIKA, TAKAYUKI HASHIMOTO, MASAKO KUSANO, TAKAO KURAMOTO, KEIM ...
    2003 Volume 48 Issue 4 Pages 505-515
    Published: March 28, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.48.505
    JOURNAL FREE ACCESS
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    Objective : Reflux esophagitis (RE) is often seen in patients with pyloric incompetence at endoscopy. This study investigated the prevalence of RE in patients with pyloric incompetence and assessed the relationship between the appearance of the stomach, define on first use and pyloric function. Participants : The 1,060 subjects were investigated. (413 women and 647 men) Methods : RE was evaluated by Los Angeles classification on endoscopy. The pyloric incompetence was judged at endoscopy by better to indicate number endoscopists. The appearance of the stomach was indicated by the His angle crossing the stomach axis to the esophagus, and was below 29°in group I, from 30°to 59°in group II and above 60°in group III. BMI was calculated as kg/m2, that was below 18.5 in emaciated, from 18.5 to 25 in normal and above 25 in obese patients. Results : The prevalence of RE in pyloric incompetence was more than two-fold that in normal subjects, particularly 87.75% in group III and 86.67% in obese patients. Conclusions : There was a high frequency of RE in the steer horn type and in obese patients with pyloric incompetence. Duodenogastric reflux should be kept in mind at endoscopy.
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