Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 49, Issue 3
Displaying 1-18 of 18 articles from this issue
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Contents
  • Pathology of pulmonary emphysema
    SHIGEKI SAIKI, TOSHIO KUMASAKA
    2003 Volume 49 Issue 3 Pages 278-287
    Published: September 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.278
    JOURNAL FREE ACCESS
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    Diffuse lung disease includes many disorders, such as pulmonary emphysematosis, diffuse panbronchiolitis (DPB), acute or chronic interstitial pneumonia, acute or chronic hypersensitivity pneumonitis, pulmonary eosinophilic granulomatosis (PEG), pulmonary lymphangiomyomatosis (LAM) and pulmonary sarcoidosis. In this article, we describe the history of pulmonary emphysematosis and the morophological approach to the diagnosis. In addition, is described handling of lung materials for pathological diagnosis. In the early 19th Century, Laennec described pulmonary emphaysematosis for the first time. Pulmonary emphysema is now defined as the destruction of alveolar walls and the permanent enlargement of the airspaces distal to the terminal bronchioles. Recently, high resolution computed tomography has been used for the diagnosis of emphysema. We consider that the necessity for pathological study is increasing because pathological morphology is useful for the recognition of roentgenological images. Morphologically, pulmonary emphysema is classified into three types : centrilobular emphysema, panlobular emphysema and focal emphysema based on the distribution in the pulmonary lobules. These types are developed or combined by different causes, such as smoking, air pollution, genetic disorders, tuberculosis. However, the mechanism of development of pulmonary emphysema is not completely known. It is considered that pulmonary emphysema may be caused by the imbalance of protease and protease inhibitor.
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  • Unruptured intracranial aneurysms : a short review of the natural history, risk factors and operative indications
    MINORU MAEDA
    2003 Volume 49 Issue 3 Pages 288-299
    Published: September 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.288
    JOURNAL FREE ACCESS
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    The etiology and pathogenesis of the typical saccular aneurysm probably involve multiple factors, but the critical event is most likely to be acquired degeneration of the internal elastic lamina secondary to abnormal hemodynamic stresses at the circle of Willis. Flow-induced arterial dilation is accompanied by adaptive remodeling of the intima. The prevalence of aneurysms in the adult population is approximately 2% to 3%. The incidence of aneurysm rupture is between 15 and 20 / 100,000 population /year in Japan. However, the widespread use of magnetic resonance angiography and 3DCT angiography has led to a significant increase in the number of incidentally discovered aneurysms. Prospective data from the ISUTA study show that the cumulative rate of rupture for patients in Group 1 with aneurysms of 7 to 9mm diameter was 0.7% per year. The rupture rate of aneurysms 10mm or larger (10-24mm) was 7% in the first year. The rupture rate of intracranial aneurysms in Japan is estimated to be higher than that reported in the ISUTA study. My own experience may be summarized as follows. Larger aneurysms are more likely to rupture. The majority of ruptured aneurysms are smaller than 10mm. Small midline aneurysms are likely to rupture in patients at a younger age than laterally located lesions. Smoking, familial history of ruptured aneurysms, and autosomal-dominant history of polycystic kidney disease are all indicators of aneurysm rupture at a younger age. I believe that there is no specific size associated with a dramatic increase in the risk of rupture. The time interval between diagnostic follow-up studies in patients with unruptured aneurysms can not be based on available scientific data. The data obtained at Juntendo University Izunagaoka Hospital shows that the mortality of surgery for unruptured intracranial aneurysms is less than 1% (actually 0%) and the risk of all complications, including morbidity, is less than 5%. Surgery should be considered for lesions larger than 3 to 4mm and for patients estimated as having more than 10 remaining years of life. The key problem is how to balance the risks versus benefits of surgical treatment, and the risk of rupture during the projected remaining years of life, as well as the general state of health and personal wishes of the patient.
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  • Surgery for aortic aneurysms
    SHIN YAMAMOTO
    2003 Volume 49 Issue 3 Pages 300-306
    Published: September 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.300
    JOURNAL FREE ACCESS
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    Patients undergoing aortic aneurysm repair are often marginal operative candidates because of their advanced age and coexistent comorbidities, including pulmonary and renal disease. Although aortic aneurysm repair has consistently been associated with high levels of mortality and complication, the actuarial survival rates in patients treated surgically remains superior to those managed medically. The purpose of this paper is to explain guldelines for aortic surgery and the necessity for surgical procedure.
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  • Characteristics of MRSA strains isolated in Japan in 1999
    DAISUKE IMAI, XIAO XUEMA, HIROYUKI YANAGAWA, TERUYO ITO, KEIICHI HIRAM ...
    2003 Volume 49 Issue 3 Pages 343-354
    Published: September 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.343
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    Objective: To investigate the characteristics of MRSA strains isolated in Japan in 1999 by determination of MIC, types of SCCmec, and prevalence of conjugative plasmid. Materials and methods: One hundred thirty-eight MRSA strains were generously donated by 14 university hospitals. MICs of 15 antibiotics were determined by the agar dilution method recommended by NCCLS. PCR reactions were carried out to identify traK gene, ccr genes, and the genes in mec gene complex. Filter-mating method was used to test the transferability of the conjugative plasmids. Results and conclusions: MRSA strains showed MIC values indicating resistance to β-lactams (oxacillin, ceftizoxim, imipenem, and ampicillin), tetracyclines, erythromycin, levofloxacin, tobramycin and gentamicin. However, these strains had susceptible MIC values to arbekacin, linezolid, vancomycin and teicoplanin. One hundred twenty-six of 138 MRSA strains (91.3%) carried type- II SCCmec (other strains: 1, type- I ; 6, type- IV ; 5, untypable). There were MRSA strains carrying type- III SCCmec. Thirteen of the MRSA strains (9.4%) carried conjugative plasmids. We found that MRSA strains with type- II SCCmec that carry multiple antibiotic resistance genes were widely disseminated in Japanese hospitals.
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  • Onset of diabetes mellitus with anti-GAD antibody after interferon therapy for chronic hepatitis C
    SATORU MIYAKATA, HIROYUKI KURODA, TOSHIAKI KAWANISHI, MASATO KAWABE, K ...
    2003 Volume 49 Issue 3 Pages 355-359
    Published: September 30, 2003
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.49.355
    JOURNAL FREE ACCESS
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    A 65-year-old man with chronic hepatitis C received interferon (IFN) therapy and a good outcome was achieved after IFN. Thirst and weight loss was presented and his postprandial plasma glucose and glycosylated hemoglobin (HbA1C) levels increased. Dietary therapy and oral hypoglycemic agents improved glucose and hemoglobin to moderate levels. He was positive for anti-glutamic acid decarboxylase (anti-GAD) antibody 29 months after IFN therapy and required insulin therapy because of the positive anti-GAD antibody and development of severe hyperglycemia. Insulin gradually improved his glycemic level. We report a case of insulin-dependent diabetes mellitus with anti-GAD antibody which developed after IFN therapy for chronic hepatitis C.
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