Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 51, Issue 3
Displaying 1-21 of 21 articles from this issue
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Contents
  • My study of bradycardia
    YASURO NAKATA
    2005 Volume 51 Issue 3 Pages 296-303
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.296
    JOURNAL FREE ACCESS
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    Albstract : In the late 90s, His bundle electrography became available in clinical practice, and our understanding of the mechanism of tachyarrhyhmia was significantly improved. In bradyarrhythmia, we now can diagnose the conduction block site in more detail. The author continues to study mainly bradycardia, and part of the studies are presented here. The clinical course of AV block varies depending upon the site of block. In general, we observed that the block located in a more distal site suggested a more severe clinical status, Moreover, intrahisian block was more common in elderly women. The concept of an anatomical conduction system could be explained by electrophysiological study and the findings from such a study were well supported by autopsy. Regarding pacemaker therapy, the long-term effectiveness of atrial pacing for sick sinus syndrome was confirmed. However, depressed cardiac function associated with prolonged QRS duration on pacing has been a clinical issue in AV block patients and the recently developed Cardiac Resynchronization Therapy has been shown to confer some resolution of this issue.
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  • Sleep apnea syndrome and otorhinolaryngological treatment
    FUYUKI ENOMOTO
    2005 Volume 51 Issue 3 Pages 304-310
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.304
    JOURNAL FREE ACCESS
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    Sleep apnea syndrome(SAS) was defined by Guilleminault et al. as“episodes of apnea each lasting for 10 sec. or longer repeated 30 times or more during 7 hours of sleeping” or “episodes of apnea repeated 5 times or more during one hour of non-REM sleeping” in 1976. SAS is classified into obstructive, central, and mixed type categories. Central SAS is said to account for 4% of all SAS, and obstructive and mixed-type SAS the residual major proportion. In the department of otorhinolaryngology, obstructive and mixed-type SAS are treated by surgical intervention. Obstructive apnea is divided into rhinogenous, rhinopharyngeal, middle pharyngeal, and inferior pharyngeal, laryngeal, and tracheal apnea according to the site of obstruction. In practice, since rhinogenous and middle pharyngeal obstruction are common, surgical correction of septal deviation, inferior nasal concha resection, tonsillectomy, uvulo-palato-pharyngoplasty (UPPP), and midline glossectomy have been used. Tracheotomy is performed in the most severe cases of central SAS. Seventy-six percent of patients with SAS have associated allergic rhinitis. Treatment of allergic rhinitis is useful for the management of SAS.
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  • Diagnosis and management of sleep apnea syndrome.
    NAOAKI TAMURA, KAZUHISA TAKAHASHI
    2005 Volume 51 Issue 3 Pages 311-321
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.311
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    Sleep apnea syndrome (SAS), especially obstructive sleep apnea/hypopnea syndrome (OSAHS) can be defined as the coexistence of excessive daytime sleepiness with irregular breathing at night, impairment of cognitive function, mood and personality changes. All patients suspected of SAS should complete an Epworth questionnaire to assess the degree of sleepiness. Polysomnography (PSG) with EEG-based sleep staging is not necessary to diagnose sleep apnea in most patients. Oximetry study may play a role in the initial assessment of OSAHS with limitations. Weight loss should be encouraged in all OSAHS patients. nCPAP (nasal continuous positive airway pressure) is the first choice of therapy for patients with moderate or severe OSAHS. Persistent low CPAP use should lead to a review of treatment. Pharmacological therapy should not be used as first line therapy.
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  • Management of sleep apnea syndrome as an important strategy for cardiovascular diseases
    YOSHITAKA IWAMA, HIROYUKI DAIDA
    2005 Volume 51 Issue 3 Pages 322-333
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.322
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    Sleep apnea constitutes a major public health problem because of its high prevalence and its emerging association with cardiovascular morbidity. Recently it has been recognized that sleep apnea and cardiovascular diseases are not only coexistent diseases but also strongly related diseases, and direct mechanisms affecting cardiovascular diseases in patients with sleep apnea have been clarified. The treatment of sleep apnea therefore becomes one choice for the treatment of cardiovascular diseases. Sleep apnea can be obstructive or central. Obstructive sleep apnea (OSA) has been associated with several cardiovascular diseases, most notably hypertension, coronary artery disease, and cardiac arrhythmias. It is known that hypertension is resistant to anti-hypertensive medications in patients with OSA. OSA should be considered in patients with refractory hypertension, particularly in obese subjects without the expected nocturnal decline in blood pressure. Epidemiological evidence supports the concept of OSA being etiologically linked to the development of atherosclerosis. There is a high prevalence of OSA in patients with coronary artery disease, and several case-control or prospective studies suggest OSA as an independent predictor of coronary artery disease. Both sleep apnea and coronary artery disease are related to metabolic syndrome (increased visceral fat, dyslipidemia, hypertension, and glucose intolerance). Although the exact mechanisms of any atherogenic effects of OSA have not been established, one possibility is the involvement of inflammatory processes and endothelial dysfunction. Central sleep apnea (CSA) is especially relevant to congestive heart failure (CHF). Prevention of CSA by continuous positive airway pressure (CPAP) and nocturnal oxygen supplementation may contribute to improved outcome in CHF. Both OSA and CSA should be considered in CHF patients who are poorly responsive to conventional treatment. Several reports also suggest that OSA may be associated with bradyarrhythmia and atrial fibrillation, moreover CPAP therapy is effective in patients with cardiac arrhythmias. SAS may play a role in the pathogenesis and progression of cardiovascular diseases. Basic research will be required to determine precise mechanisms affecting cardiovascular diseases. Moreover, clinical investigation, especially large scale randomized trials of various interventions for SAS in patients with cardiovascular diseases, will be required to determine the long-term effectiveness of these therapies on cardiovascular outcomes.
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  • Decrease of erythrocyte complement receptor type 1 (E-CR1) in patients undergoing hemodialysis with diabetic nephropathy
    MICHIRO WAKABAYASHI, HIROYUKI OHI, MARIKO TAMANO, KISARA ONDA, KUNIMI ...
    2005 Volume 51 Issue 3 Pages 334-343
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.334
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    Background: It is well known that patients undergoing hemodialysis (HD) with diabetic nephropathy (DMN) are very susceptible to infections. Decreased complement receptor type 1 on erythrocytes (E-CR1) has previously been found in HD patients. We observed that prevalence of DMN among patients with low E-CR1 expression was significantly higher than that in patients with high E-CR1 expression. We thought that the low E-CR1 expression in HD patients with DMN may be a risk factor for infection. Therefore, we measured the levels of E-CR1, DAF and CD59 in HD patients with DMN and without DMN. Each level was compared with clinical data. Methods: Levels of E-CR1, DAF and CD59 were analyzed for a group of 176 HD patients with DMN and compared with those of 101 HD patients without DMN. Polymorphism of CR1 was analyzed in all patients. Values of E-CR1 expression and distribution of genotypes (HH, HL and LL) were evaluated along with the clinical data. Results: Values for E-CR1 (p<0.0001), DAF (p<0.01) and CD59 (p<0.0001) in HD patients with DMN were significantly lower than those in patients without DMN. Genotype frequencies did not differ between HD patients with DMN and those without DMN. However, each level of E - CR1 expression grouped by genotype significantly differed between the DMN group and non-DMN group. The mean HD period in DMN patients was significantly longer in the low E-CR1 expression group than in the high E-CR1 expression group (3.2±2.5 versus 1.8±1.5 years; p<0.013). Conclusion: The level of E-CR1 in HD patients with DMN was significantly lower than that in those without DMN. There is a possibility that loss of E-CR1 was promoted by long-term hemodialysis in HD patients with DMN. It appeared that an acquired loss of E-CR1 is a risk factor affecting host defense in HD patients with DMN.
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  • Evaluation of surgical stress in laparoscopic-assisted colectomy for advanced colorectal cancer
    SEIICHIRO YOSHIKAWA, AKIO KIDOKORO, MASAKI FUKUNAGA, TOSHIAKI IBA, KAZ ...
    2005 Volume 51 Issue 3 Pages 344-351
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.344
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    Objective : Laparoscopic-assisted colectomy (LAC) is feasible for early colorectal cancer. However, surgical stress for advanced colorectal cancer is higher than early cancer, and it is not clear that LAC is actually less invasive than open colectomy (OC) for advanced cancer. This study assessed the surgical stress of LAC and OC for advanced colorectal cancer. Patients : We compared two groups of patients undergoing either 95 cases of LAC or 41 cases of OC for advanced colorectal cancer. And we measured changes in the levels of humoral mediator in patients undergoing LAC (n=9) and OC (n=8). Method : We compared surgical procedures and perioperative results for two groups of patients undergoing either LAC or OC for advanced colorectal cancer. And we measured changes in the levels of humoral mediator to evaluate surgical stress in LAC for advanced colon cancer. The measured mediators were Granulocyte Colony-Stimulating-Factor (G-CSF), White Blood Cell (WBC), and polymorphonuclear elastase (PMN-E). Perioperative courses of these groups were compared. Resuls : LAC involved a small amount of blood loss, shorter surgical duration, faster recovery of gastrointestinal function, and shorter hospital stay. Postoperative G-CSF, WBC and PMN-E values were lower in the LAC group than in the OC group. Conclusion : LAC is technically feasible, offers many short-term advantages, and adequate lymphnode resection can be achieved. Furthermore, the observation of lower mediator levels after LAC suggests that LAC causes less surgical stress than OC for treatment of advanced colorectal cancer. This finding may indicate that surgical stress due to LAC is less than that of OC. Therefore, this procedure is not only less invasive, but also egually curative.
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  • Spontaneous mutation accompanying decreased growth rate and cell wall thickening confers vancomycin resistance in the subpopulation of heterogeneously vancomycim-resistaut strain Mu3.
    MARIA KPI, FUMIHIKO TAKEUCHI, KEIKO OKUMA, MAKOTO KURODA, LONGZHU CUI, ...
    2005 Volume 51 Issue 3 Pages 352-360
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.352
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    Objective : Heterogeneous vancomycin-resistant Staphylococcus aureus (hetero-VRSA) may cause vancomycin refractory infection due to its frequent generation of vancomycin-resistant cell subpopulations. We study whether a mutant having the same phenotypic properties as the clinical VRSA strains is generated within the resistant cell subpopulation of hetero-VRSA strain. Materials : Hetero-VRSA strain Mu3 was used. Methods : By using the fluctuation test of Luria and Delbrük we tested whether vancomycin-resistant mutants were generated spontaneously. Results : Vancomycin-resistant mutants occurred spontaneously at high frequencies of 2.5-4.9 × 10-6 per cell division, and the mutants exhibited the characteristic phenotype of the vancomycin-resistant S.aureus clinical strains, i.e. thickened cell wall and reduced growth rate. Conclusions : This study implies that low-level vancomycin resistance may emerge at high frequency in the bodies of patients infected with hetero-VRSA strain.
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  • Identification of a high-risk group for colorectal cancer based on fecal bile acid composition ratios: Usefulness of gas chromatography-mass spectrometry and rates of reduction to secondary bile acids.
    MASAKAZU OUCHI, YASUNORI ISHIDO, MAKOTO TAKAHASHI, YUKIHIRO YAGINUMA, ...
    2005 Volume 51 Issue 3 Pages 361-367
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.361
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    Purpose: Gas chromatography-mass spectrometry (GC-MS) is a complex analytical method incorporating abilities of both qualitative analysis and separation. Using GC-MS, the ratios of individual bile acids to total bile acids were obtained to reevaluate the clinical usefulness of fecal DCA/ CA ratios. Subjects: The subjects consisted of 39 colorectal cancer patients undergoing radical tumorectomy and 15 patients with benign diseases, in whom fecal bile acid levels were determined by GC-MS. Methods: Fecal levels of primary bile acids (CA and CDCA) and secondary bile acids (DCA and LCA) were determined by GC-MS preoperatively in colorectal cancer patients, and compared to those in patients with benign diseases. Results: 1)Fecal DCA/CA ratios were significantly higher in colorectal cancer patients than in those with benign diseases. 2)Ratios of CA and CDCA to total bile acids were significantly higher in patients with benign diseases than in colorectal cancer patients. However, the ratios of DCA to total bile acids were significantly higher in colorectal cancer patients than in patients with benign diseases. The ratio of LCA to total bile acids did not significantly differ between the 2 groups. Conclusions: Using GC-MS, it was reconfirmed that fecal DCA/CA ratios were higher in colorectal cancer patients, demonstrating the close association of fecal DCA/CA ratios with the rate of reduction of CA to DCA induced by intestinal bacterial flora. In addition, it was confirmed that the evaluation of fecal bile acid levels by GC-MS is useful for comprehensive screening of colorectal cancer.
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  • Clinical study of oral health status and occlusal force in athletes
    MITSUYO SHINOHARA, SHUNSUKE NAMAKI, MITSUHIKO MATSUMOTO, ICHIRO NAKAJ ...
    2005 Volume 51 Issue 3 Pages 368-373
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.368
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    Objective : Recently, the relationship between the stomatognathic system and motor ability of the entire body has been studied from various viewpoints. Some reports suggested that the motions athletes make during training or a game, such as the clenching of teeth, have training effects on their masseter muscles. To determine the relationship between the oral health status of athletes with considerable sports experience and their muscle strength in the stomatognathic system, we examined the oral health status and measured the occlusal force of athletes enrolled in the School of Health and Sports Science of our university. We compared the results with those of students who were enrolled in the School of Medicine and who did not belong to any sports clubs as the control group. The oral conditions of 20 athletes and 8 control subjects were examined, the decayed, missing and filled (DMF) index of teeth was calculated, and the maximum occlusal force when subject were not exercising was measured. We analyzed whether there are significant differences in oral health status (DMF index) and occlusal force between the athletes and the control group, and whether there is a correlation between oral health status (DMF index) and occlusal force in each group. The results were as follows : 1. The average DMF indices in the control group and the group of athletes were 7.3 and 8.2, respectively. The average occlusal forces of the control group and the athlete group were 728.8 N and 789.9 N, respectively. 2. There was no significant difference in the DMF index or occlusal force between the athlete group and the control group. 3. In the control group, a significant negative correlation was observed between the DMF index and occlusal force. Specifically, muscle strength in the stomatognathic system tended to decrease as the DMF index increased. On the other hand, in the athlete group, no significant correlation was observed between the DMF index and occlusal force. These results suggest that the exercising of the entire body of athletes prevented the decrease in muscle strength in the stomatognathic system.
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  • A case of decompensated cirrhosis improved to compensated cirrhosis due to lamivudine treatment
    MASATO KAWABE, HIROYUKI KURODA, KAZUKI OHTA, AKIMITSU OHKAWA, JUNKO KA ...
    2005 Volume 51 Issue 3 Pages 401-405
    Published: September 30, 2005
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.51.401
    JOURNAL FREE ACCESS
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    A 39 y.o. man was admitted to the hospital because of impaired liver related to chronic hepatitis B virus infection. He had been HbsAg and HbeAg positive and experienced repeated acute exacerbation many times for 2 years. He had been treated by SNMC, IFN, hemoexchange and so on, but he had gradually progressed to decompensated liver cirrhosis. He then started to accept lamivudine treatment. Subsequently ALT, ascites, jaundice and Child-Pugh score has gradually improved and his liver function test has indicated compensated liver cirrhosis. However, the lamivudine treatment has caused hyperglycemia. The patient has been treated for diabetes mellitus by insulin. Lamivudine has improved liver cirrhosis from decompensation to the compensation. Key words decompensated cirrhosis, lamivudine, diabetes mellitus
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