Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 49, Issue 1
Displaying 1-20 of 20 articles from this issue
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Contents
  • [title in Japanese]
    EIKI KOMINAMI
    2003 Volume 49 Issue 1 Pages 1
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.1
    JOURNAL FREE ACCESS
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  • Inhibitory effect of insulin-like growth factor-I in lung cancer
    YUZO KODAMA
    2003 Volume 49 Issue 1 Pages 2-11
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.2
    JOURNAL FREE ACCESS
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    Insulin-like growth factors are potent mitogenic agents for many cell types. However, IGF-I inhibits DNA synthesis and cell proliferation in lung adenocarcinoma cell line A549. IGF-I-induced inhibition was reversed by an IGF-I receptor antibody, αIR-3, indicating IGF-I receptor activation is involved in its inhibition. PD98059 (p44/42 MAPKK inhibitor) and LY294002 (PI3′-kinase inhibitor) partially reversed IGF-I-induced inhibition. Acute (2-60 min) and chronic (24h) exposure of A549 cells to IGF-I resulted in sustained phosphorylation of Akt, whereas p44/42 MAPK phosphorylation was decreased in response to chronic exposure to IGF-I. An IGF-I dose-dependent increase in the cyclin dependent kinase inhibitor p21Cip1/WAF1was also observed over 24 h treatment. These data suggest that IGF-I is growth inhibitory to A549 cells, possibly via sustained activation of the PI3′-kinase pathway, and induction of p21Cip1/WAF1
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  • Effects of n-3 polyunsaturated fatty acids on the pathophysiology of various diseases
    TOSHIAKI SHIMIZU
    2003 Volume 49 Issue 1 Pages 12-23
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.12
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    N-3 polyunsaturated fatty acids (n-3 PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are abundant in fish oil, have received increasing attention in various clinical fields. The actions of n-3 PUFAs are performed as components of cell membranes or through the production of eicosanoids, including prostaglandins (PGs) and leukotriens (LTs). In pediatric practice, n-3 PUFAs participate in the development of visual and brain functions in infants and in the anti-inflammatory and anti-allergic functions. This paper reports the results of our clinical and animal studies concerning the effects of n-3 PUFAs on inflammatory bowel diseases and allergic diseases.
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  • An attempt to analyze the pathogenesis of congenital keratinization disorders, and the future prospects of gene therapy for the patients in our out-patient department
    YASUSHI SUGA
    2003 Volume 49 Issue 1 Pages 24-32
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.24
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    Congenital keratinization disorders are classified according to clinical, histopathological and genetic findings. Keratin is a form of cytoskeleton consisting of intermediate filaments in epidermal cells. Mutations in genes encoding several types of keratin have been implicated in the pathogenesis of “keratin diseases”. Previous studies have shown that these genodermatoses are due to mutations in the KRT1, 10 and KRT2E genes. We have reported on the molecular analyses of several patients with rare autosomal dominant disorders, namely, bullous congenital ichthyosiform erythroderma (BCIE) and ichthyosis bullosa Siemens. Future studies will also evaluate the relationship between genotype and phenotype in these disorders. The cornified cell envelope (CCE), a form of membrane-skeleton in terminally differentiating keratinocytes, consists of precursor proteins such as involucrin and loricrin, catalyzed by transglutaminase. As in keratin disorders, recent studies have identified the genetic mutations responsible for “CCE diseases”. Lamellar ichthyosis and Vohwinkel disease, caused by mutations in the TGM1 and LOR genes, respectively, are two examples of such genodermatoses. Discoveries such as those given above have improved diagnostic capabilities and genetic counseling, allowing researchers to focus on the molecular mechanisms involved in the pathogenesis of these diseases. Moreover, identification of the pathogenic genes has led to the generation of mouse models for some of the disorders, further facilitating research into the pathological mechanisms. A study of the keratin 10 deficient mouse, a model for BCIE, and the preparation of a mouse model for Vohwinkel disease, both recently performed by Pr. D Roop's Lab. are reviewed in this article. Given these developments, gene therapy has become an increasingly attractive mode of treating congenital keratinization disorders. This review focuses on ex vivo approaches for gene therapy. In addition, we discuss the advantages of employing transgenic mouse model systems to test the efficacy of a given gene therapy prior to the clinical trials.
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  • Role of secreted glycoprotein osteopontin in the pathogenesis of pulmonary diseases
    KAZUHISA TAKAHASHI
    2003 Volume 49 Issue 1 Pages 33-43
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.33
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    Osteopontin (OPN) is a phosphorylated glycoprotein with a molecular weight of 60kDa secreted by activated macrophages and lymphocytes. It consists of a cell adhesive sequence, arginine-glycine-aspartic acid (RGD), at the center of its structure and a specific sequence, argnine-serine (RS), which can be cleaved with thrombin at several amino acids toward amino-terminal from the RGD sequence. OPN is a multifunctional glycoprotein, with roles in not only cell adhesion but also cell migration, cancer metastasis, angiogenesis, inhibition of inducible nitric oxide synthase, resistance to infection and suppression of antibody production from B-cells. These functions are regulated by posttranslational modification, including thrombin cleavage, glycosylation and phosphorylation. It has been shown that OPN plays an important role in granuloma formation, mycobacterium infection and cancer metastasis by several studies using the OPN knockout mouse. We have shown that OPN is involved in the pathogenesis of pulmonary fibrosis, pulmonary involvement in sarcoidosis and cancer angiogenesis. Much attention has recently been paid to the role of OPN in the pathogenesis of pulmonary diseases.
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  • The world of anatomy-from cytoskeleton to evolution
    TATSUO SAKAI
    2003 Volume 49 Issue 1 Pages 44-50
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.44
    JOURNAL FREE ACCESS
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    Excellent electron micrographs are those visualizing the functional status of the tissue. In the case of blood vessels, the vascular wall should be extended by blood pressure, and the constituent cells and extracellular matrices should be stained clearly. For this purpose we employed perfusion fixation with constant pressure and cold-dehydration technique. The main task of the 1st department of anatomy is human anatomy, including administration of the dissection course and associated activities. The cadavers to be dissected are supplied by donation, which is a voluntary act based on human love. In the dissection hall of Juntendo University, you will find a symbolic phrase “Truth in death, delight from life”.
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  • Recent progress in percutaneous coronary intervention
    HIROYUKI DAIDA
    2003 Volume 49 Issue 1 Pages 51-57
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.51
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    Revascularization therapy with percutaneous coronary intervention (PCI) and coronary artery bypass surgery are the two major treatments of choice for coronary artery disease. PCI is characterized by its less invasive nature, however, its application and efficacy had been somewhat limited by the acute complications and unsuitable lesion characteristics in certain patient groups. This was partially overcome by the recent introduction of new device technology, however, restenosis after PCI is still a major clinical problem. We have been investigating the preventive effect of an antioxidant, probucol, on restenosis after balloon angioplasty. Our multi-center study, called the Probucol Angioplasty Restenosis Trial, has demonstrated the significant preventive effect of probucol on restenosis after balloon angioplasty. More recent research interests include the efficacy of radiation therapy and drug-eluting stents on in-stent restenosis. Current available data of these new interventional technology is promising, but further follow-up investigation is essential.
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  • Clinicopathologic study of liver biopsy tissues after living-related partial liver transplantation
    YOSHIHIRO MIYAGAWA
    2003 Volume 49 Issue 1 Pages 58-67
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.58
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    Objective : The purpose of this study was to evaluate the clinicopathology of liver biopsy tissues after living-related partial liver transplantation (LRPLT) for children with intractable liver diseases. Materials : Seven patients with intractable liver diseases who underwent LRPLT were enrolled in this study : three patients had Wilson's disease, two patients had ornithin transcarbamylase deficiency, one patient had primary sclerosing cholangitis and one patient had congenital hepatic fibrosis. Tissue specimens were obtained from the liver tissues of each patient by needle biopsy. Methods : Histological analysis for such complications as humoral, acute, and chronic rejection were evaluated with liver tissue specimens, which were stained with HE, Azan-Mallory, PAS, and silver. Results : 1) No humoral or chronic rejection was found in any patient. 2) No clinical or histopathological acute rejection was found in any patient at the acute stage after LRPLT. However, severe grade findings of acute liver allograft rejection were observed in one of two patients who showed clinical acute rejection at the chronic stage after LRPLT. 3) Nonspecific inflammatory reactions were observed in all patients. Conclusions : This study revealed a difference between clinical findings of chronic stage and histopathological findings corresponding to acute rejection. Furthermore, it may indicate a problem in pathological evaluation of rejection that nonspecific inflammatory reactions were observed in all patients.
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  • Association study of genetic polymorphisms in endometriosis
    TAKANORI NAKAMURA
    2003 Volume 49 Issue 1 Pages 68-76
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.68
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    Objective : Endometriosis is the heterotopic growth of endometrial tissue in pelvic sites outside the uterine cavity. It is widely considered that endometriosis is caused by an interaction between multiple genes and environmental factors. In the present study, patients with endometriosis followed in the Department of Obstetrics and Gynecology at Juntendo University were categorized into three groups, and the association between endometriosis and genetic polymorphisms 0f estrogen receptor α (ESRα), ESRβ and glutathione S-transferase (GSTM1 and GSTT1) were investigated. Patients & Methods : Patients with endometriosis were categorized into the recurrent group (RE=40 cases), non-recurrent group (NR=42 cases), and patients with deep lesions in the Douglas pouch (DP=58 cases), and their DNA samples were used for the genetic study. Healthy individuals were used as controls (CL=90 cases). Polymorphisms of ER-TA repeat (ESRα) and D14S1026 (ESRβ) were allelotyped with Genetic Analyzer. ESRα Pvu II polymorphism was typed by PCR-restriction enzyme digestion. Null genotype of GSTM1 and GSTT1 was detected by PCR. Results : In the ER-TA repeats, only the DP group showed higher frequency of the allele, with 22 repeats. When ER-TA alleles were divided into shorter repeats and longer repeats, only the NR group showed significantly more smaller allelic genotypes than the control group. In the DP group only, ESR-Pvu II genotype was frequent, which was contrary to previous reports. There was no association between ESRβ polymorphism and endometriosis. The frequency of null genotype of GSTM1 was higher in NR, and GSTT1 null genotype was higher in NR and DP as compared to the controls. Conclusion : Associations between genetic polymorphisms and endometriosis were investigated.Statistically significant differences in the allelic distribution of ESRα and GSTM1/TI null genotypes were detected in some of the patient groups, however, allelic frequencies of the genes were different between recurrent, non-recurrent, and deep lesion groups. Thus, genetic polymorphisms are more complex than previously thought, and these allelic variations possibly influence the severity and manifestation of disease in conjunction with racial, ethnic, geographic and environmental factors.
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  • The role of hospice and palliative care facilities in the home hospice care system
    -Survey of Japanese hospice and palliative care facilities-
    MASAKO SUGIMOTO, JUNKO TAKAISHI, NAOKO ARAGA, YOSHIKO S. LEIBOWITZ, KA ...
    2003 Volume 49 Issue 1 Pages 77-88
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.77
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    Objective : In this study we attempted to analyze the role of hospice and palliative care in community services in order to improve home hospice care in the community. Sample : We utilized the book of Japanese hospice and palliative information committee membership lists. 218 people from 109 facilities comprised the sample population, which consisted of one head of facility (doctor) and one nurse from each facility. Methods : Questionnaires were mailed without requesting names during the period of November to December, 1999. Results : 104 (47.7%) answered out of 218. 77 (74%) answered appropriately. The types of facilities were : 61.0% provide palliative care only, 19.5% provide hospice and palliative care, and 13.0 % provide independent hospice care. Although half of the facilities provide home hospice care, < the home hospice patients who died at home was below 5 patients (77.1% of the answering facilities that provide home hospice care).> The vast majority of hospice patients still die in the facilities and not at home. The highest home care hospice functions preformed by the facilities were providing short stays for cancer patients, and education for volunteers. Day care, medical equipment rental, and public health education were not preformed by all the facilities. The facility staff expressed a desire to participate in volunteer education, nursing education for nurses who work in private physicians' offices, home health agencies and public health education. Physicians showed a strong interest in education for home health agencies. Conclusion : Although half of the hospice and palliative care facilities provide homecare hospice services, only a small number of patients die at home. Doctors and nurses at hospice and palliative facility showed a strong interest in contributing to community services related to home hospice care.
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  • Variations in reciprocal distances between the ethmoidal sinus, sphenoidal sinus and posterior orbit : measurement on CTscans
    KIMIKO HAYAKAWA, HIROSHI YOSHIKAWA, MIYAKO SUZUKI, HIDENORI YOKOI, AKI ...
    2003 Volume 49 Issue 1 Pages 89-96
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.89
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    Objective : In concluding surgery of the paranasal sinuses (anterior and posterior) and the sphenoidal sinus, caution is demanded because intraorbital complications may develop in the skull. It is well-known that there is substantial variation in the form of the internal wall of the orbit, and the anterior and posterior walls of the sphenoidal sinus. In the present study, we measured the size of the structure around the paranasal sinus on patient CTscans to be used in surgery on the paranasal sinuses. Participants : A total of 387 people (184 males and 203 females) with no destructive bone lesions who visited the Juntendo University Hospital between 1999 and June 2002 were investigated. Methods : A plane was selected 14mm above a line drawn between the medial angle and the external acoustic orifice on CTscans performed using axial projection. This framework was used to conduct the measurements. We employed this method because we consider it ideal for rendering the ethmoidal sinuses, the internal wall of the orbit, medial rectus muscle, optic nerve, and the anterior and posterior walls of the sphenoidal sinus most clearly visible. We measured the length between these anatomically important regions. We measured 1) the length of a line drawn between the opening of the nose and the line drawn between the right and left optic canals, 2) the length between the nasal opening and the posterior wall of the sphenoidal sinus, on the same horizontal line drawn between the posterior end of the eyeball and the nasal septum, 3) the length of a line from the site where the optic nerve adheres to the nasal septum, 4) the length between the lateral wall of the ethmoidal sinus, 5) the length between the nasal septum and the medial side of the medial rectus muscle, 6) the length between the medial side of the medial rectus muscle and the medial side of the optic nerve. The measurements were performed on both sides. We analyzed the above results statistically according to gender and age. Measurement and Results : The results of the analysis showed1) 51.3mm±5.Omm2) 76.6mm±7.9mm 3) 23.7mm±2.2mm 4) 2.1mm±0.9mm 5) 15.7mm±2.0mm 6) 8.0mm±1.2mminmales, and 1) 48.3mm±4.7mm 2) 70.3mm±7.2mm 3) 22.1mm±1.9mm 4) 1.6mm±0.7mm 5) 14.2mm±1.8mm 6) 7.9mm±1.3mm in females. Conclusions : Age and sex-related differences were seen in each area measured, and distances were shortest in the subjects' teens and twenties. The data collected was found to be useful in parasinus operations to prevent complications.
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  • Clinical study of behavioral and psychological symptoms of dementia (BPSD) in a geriatric medical center
    YOSUKE ICHIMIYA, KOU ETO, MICHIHIRO KIMURA, HEII ARAI
    2003 Volume 49 Issue 1 Pages 97-101
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.97
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    Objective : To study the roles and functions of medical center for the elderly, we assessed the clinical data, especially behavioral and psychological symptoms of dementia (BPSD), of psycho-geriatric inpatients in Tokyo Metropolitan Koto Geriatric Medical Center. Materials : The subjects were psycho-geriatric inpatients in a ward for dementia patients at this medical center. Methods : Clinical data were collected for the period between June 2002 and August 2002. This period was the first 3 months after the opening of this medical center. Measurement and Results : During this period, the total number of psycho-geriatric outpatient in the Mental Clinic was 101 (41 males and 60 females, mean age 78 years old). Out of those patients, 26 were admitted to the ward for dementia. The reasons for admission were treatment of BPSD (17 cases), short-stay care (3 cases), diagnostic work-up (2 cases) and others. The clinical features of BPSD consisted of wandering (4 cases), aggression (4 cases), sleep disorder (4 cases), affective disorder (3 cases) and delusion (2 cases). Treatment for BPSD was administered with a combination of medication, individual care and rehabilitation. Clinical diagnoses included Alzheimer's disease (13 cases), vascular dementia (7 cases), subdural hematoma (3 cases), fronto-temporal dementia (2 cases) and alcoholism (1 case). Two representative cases are described to facilitate practical issues in the management on the ward. Conclusions : These findings suggest that the treatment of BPSD should be one of the most important roles and functions of the medical center for the elderly. In order to provide safe and shortterm medical care, some standardized procedures for BPSD treatment need to be established.
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  • Survey of outpatient waiting time Patient service improvement committee
    --Working group on outpatient waiting time--
    [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    2003 Volume 49 Issue 1 Pages 102-107
    Published: May 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.102
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    On September 9 and 10, 2002, we conducted a survey on the waiting time at the outpatient clinics of all the clinical departments in our hospital. The longest waiting time period was “from reception to medical consultation”, averaging 97.5 minutes and constituting approximately 70% of the total waiting time. At worst, it was as long as 445 minutes. The appointment time was overrun by an average of 49.0 minutes, and 30% of the patients waited more than 60 minutes beyond the appointment time. In the future, substantial shortening of waiting time and effective utilization of waiting time are issues requiring consideration.
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