Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 52, Issue 3
Displaying 1-25 of 25 articles from this issue
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Contents
  • Social and historical background of astbestosis issues in Japan
    EIJI MARUI
    2006 Volume 52 Issue 3 Pages 312-318
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.312
    JOURNAL FREE ACCESS
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    Although asbestos-related mesothelioma appeared to be reported almost suddenly by the media in June 2005, it had been recognized as a severe medical and environmental issue. The historical trend of the amount of asbestos consumption in Japan during the last fifty years indicates that asbestos was considered a useful material for buildings in the era of economic development after the War. The Japanese administration is often criticized for lagging behind other industrialized countries such as the US, UK or France. Just before the enforcement of the “Asbestosis prevention regulation” on 1 July 2005, the issue was being discussed in the media. Since asbestos was often used for buildings, not only factory workers but also the people around the factory, construction workers and consumers such as residents or school students were affected. This makes medical care more difficult since the natural history of mesothelioma has not yet been clearly identified and the latent period can be as long as 30 years. In Japan, asbestos was imported and used during 1970-80 at its peak. This means that many more cases of mesothelioma will arise 20-30 years later. Asbestos-related mesothelioma is one of the social problems caused by the cost-oriented economic development after the War. The social and historical background needs to be considered as an important aspect in this medical issue.
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  • Epidemiology of Mesothelioma related with Asbestos
    YUTAKA INABA, SHUKO NOJIRI
    2006 Volume 52 Issue 3 Pages 319-333
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.319
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    Asbestos has been used by humans since ancient times, and in the modern age its use has been increasing especially in construction materials, insulations and so on. Asbestos is the generic name for six related polysilicate fibrous minerals, consisting of chrysotile (serpentine family), crocidolite, tremolite, anthophyllite, actinolite and amosite (amphibole family), and three of these minerals (chrysotile, crocidolite and amosite) have been commonly used in Japan. Asbestos exposure causes pulmonary fibrosis (asbestosis), lung cancers, and mesothelioma of the pleura and peritoneum. Since the 1960s, many studies on asbestos miners and asbestos-related manufacturing workers have documented the high risk of mesothelioma. Recently, the high risk was recognized to extend to the families of workers and inhabitants near asbestos factories. The risk ratio is 4.8-11.5 even for environmental exposure. A characterization of mesothelioma is a long latency period (more than 30 years) between exposure and disease development. In Japan, mesothelioma cases were detected in the 1970s and the incidence has continued to rise. However, the research and control measure were just started. The new control system for asbestos initiated in 2006 and more effective epidemiologic studies on mesothelioma are expected.
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  • Histopathological Diagnosis of Pleural Mesothelioma
    HIROSHI IZUMI, KOICHI SUDA
    2006 Volume 52 Issue 3 Pages 334-341
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.334
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    Asbestos fibers are fibrogenic/carcinogenetic agents to the exposed organs ; asbestos cause both non-neoplastic diseases/lesions such as asbestosis, benign asbestos-induced pleural effusion, and pleural plaques/diffuse pleural thickenings, and neoplastic lesions such as lung cancer and mesothelioma. These asbestos-induced diseases show prolonged latency and a history of asbestos use in Japan suggests an increase in these diseases in the near future. Pleural mesothelioma, one of the most notorious diseases among asbestos-associated tumors, appears as multiple small nodules in the parietal pleura during the early phase, then proliferates both laterally and vertically around the lung, compressing the affected lung. In advanced cases, mesothelioma may infiltrate surrounding tissues, and may metastasize via lymphatics/blood vessels. The final diagnosis of mesothelioma is made histopathologically. Mesothelioma may present a variety of histopathological appearances; there are 3 basic histological types, the epithelial type, sarcomatous type, and biphasic type. Additionally, each type can present various histopathological pictures. In practice, several histochemical and immunohistochemical techniques are utilized in addition to routine hematoxylin / eosin staining, to differentiate mesothelioma from adenocarcinoma and other tumors. Histochemical features of mesothelioma include hyaluronic acid on the surface of tumor cells, which is positively stained with alcian-blue/colloidal iron stain. Calretinin, cytokeratin 5/6, WT1, and D2-40 are mesothelial markers, and show fairly good sensitivity/specificity in differentiating this lesion from adenocarcinoma of the lung. Furthermore, the fact that most mesothelioma is positive both for keratin and vimentin is sometimes helpful in differentiating from sarcomas. Pleural mesothelioma is often accompanied by pleural fluid/ascites. Cytologic diagnosis may be possible in the epithelial type of mesothelioma, although difficulties in differentiating adenocarcinoma persist. As for mesothlioma of biphasic/sarcomatous types, atypical cells may not be recognizable.
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  • Asbestos-related mesothelioma is an aggressive tumor and the prognosis is dismal.
    OKIO HINO
    2006 Volume 52 Issue 3 Pages 342-346
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.342
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    We previously identified the Erc (Expression in renal carcinoma) gene in an Eker rat model (Tsc2 gene mutant) and demonstrated that it was a homologue of the human mesothelin gene. Our newly developed ELISA system detects a 31kDa N-terminal fragment (we call this fragment N-ERC/Mesothelin), which is cleaved from a 71kDa precursor protein and physiologically secreted into the blood.
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  • Diagnosis and medical treatment of malignant mesothelioma
    KAZUHISA TAKAHASHI
    2006 Volume 52 Issue 3 Pages 347-355
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.347
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    Malignant mesothelioma is a rare disease involving not only the pleura but also the peritoneum, and pericardium. In 80% of patients with mesothelioma, it is caused by asbestos inhalation. The predicted number of deaths due to mesothelioma is increasing, and expected to reach 55,000 between 2030 and 2035. Diagnosis of mesothelioma is made by pathological findings including immunohistochemical staining. Since early diagnosis of mesothelioma is generally difficult, nearly 80% of patients with mesothelioma undergo systemic chemotherapy. Recent randomized phase III study of cisplatin plus pemetrexed (CDDP/MTA) versus cisplatin alone (CDDP) demonstrated a survival benefit of CDDP/MTA (13M vs. 9M). CDDP/MTA could be come the standard chemotherapeutic regimen for malignant mesothelioma.
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  • Thoracoscopic biopsy and Surgical management of malignant pleural mesothelioma
    KAZU SHIOMI, YUKINORI SAKAO, MOTOKI SAKURABA, TUMIN OH, AKIO YAMASAKI, ...
    2006 Volume 52 Issue 3 Pages 356-367
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.356
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    Pleural mesothelioma initially progresses in a very narrow intrathoracic space, and its presence cannot be identified even by chest CT examination. After progressing in this manner, it is often discovered by pleural effusion or as an abnormal shadow on chest radiographs (pleural thickening). Therefore, it is difficult to detect at an early stage. In addition, it is very difficult to differentiate imaging findings between mesothelioma and the following diseases with accompanying pleural fluid and pleural thickening : tuberculous pleurisy, lung cancer, chest wall tumor, pleural plaque, benign pleurisy, and diffuse pleural thickening. Furthermore, mesothelioma is a tumor that is difficult to differentiate histopathologically from pleural metastasis of adenocarcinoma from other organs, fibrosarcoma, malignant fibrous histiocytosis, synovial sarcoma, and carcinosarcoma. For this reason, performing thoracoscopic biopsy even more proactively, intrathoracic observation, and collecting sufficient tissue should lead to early detection and improvement in the rate of definitive diagnosis. Various treatments for pleural mesothelioma have been attempted, but it is still a disease with poor prognosis. The median survival time is 6-18 months. Single modality therapy such as radiation therapy, chemotherapy, and surgical treatment alone has not provided local control or improvement in survival rates. In recent years, multidisciplinary therapy combining all of these treatment approaches has been actively attempted, In particular, for cases in the early stages, Sugarbaker et al. reported a groundbreaking result of multidisciplinary treatment of chemoradiation therapy performed post-pleuropneumonectomy. The 5-year survival rate exceeded 40%. In addition, the safety of pleuropheumonectomy itself has improved to an acceptable level, and a few prognostic factors have also been identified. In these settings, the expectation of surgical treatment for pleural mesothelioma has been increasing rapidly.
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  • Mechanism and pathogenesis of monocytosis development in mice model of systemic lupus erythematosus
    HIROFUMI AMANO
    2006 Volume 52 Issue 3 Pages 368-375
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.368
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    The accelerated development of systemic lupus erythematosus (SLE) in BXSB male mice is associated with the presence of the Yaa (Y-linked autoimmune acceleration) mutation, which induces age-dependent monocytosis. To study the mechanisms for this cellular abnormality, BrdU (bromodeoxyuridine) was injected intravenously and observed excessive production of monocytes in BXSB Yaa mice. We produced bone marrow chimeras reconstituted with a mixture of Yaa and non-Yaa bone marrow cells. The analysis of the allotype of blood monocytes in chimeric mice demonstrated that monocytes of both Yaa and non-Yaa origin were similarly involved in monocytosis. Significantly, the development of monocytosis paralleled the dominant expansion of a Gr-1-CD62L- monocyte population over a Gr-1+CD62L+ subset, and the former selectively expressed CD11c, a marker of dendritic cells. Our findings suggest that Yaa-associated monocytosis is not due to hyperresponsiveness of monocyte lineage cells bearing the Yaa mutation to monocyte- specific growth factors, but rather a result of excessive production of growth factors during the course of SLE, and that the Yaa mutation could lead to the expansion of dendritic cells, thereby accelerating the development of SLE.
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  • A Medical risk management system checklist for use in hospitals comprising 10 items (A-J) concerning the individual efforts of medical personnel to improve risk management
    AKIRA YANAI, KAZUE NAKAJIMA
    2006 Volume 52 Issue 3 Pages 376-381
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.376
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    Over the past several years, there have been calls to improve medical risk management systems in medical institutions. Pro forma fulfillment of the conditions being required by the Ministry of Health, Labor and Welfare would not be very difficult for individual medical institutions. For individual hospitals, however, construction of a practical system, not merely a matter of form, is a necessary step for ensuring patient safety. If the safety of medical treatment could be maintained with medical risk management measures that have been implemented simply “as a matter of form, ” then it would be a simple matter to obtain a “Medical Risk Management Manual” from a hospital with a properly implemented medical risk management system, then cross out the previous hospital's name on the front and replace it with the new hospital's name. Naturally, functional medical risk management systems could not be created in medical institutions by such a practice. When initiating efforts to improve medical safety or the quality of medical treatment, it is imperative that five elements-people, money, things, time, and information-be kept in mind, regardless of the details. When establishing a medical risk management system the most vital of these five elements to keep in mind is the securing of finances to enable the implementation of medical safety measures-in other words, “money”. In hospital administration, it is imperative that a financial base be secured. The next most important element is “people”; from their individual perspectives, each person involved in medical care must be aware of the safety of patients as their most important issue and exercise this awareness in their duties. If we keep these five elements in mind as we consider medical risk management systems, it is possible to complete a convenient “A-to-J” list of 10 points that are necessary for the creation of an ideal system : A=All Members ; B=Back up ; C=Continuity ; D=Doctors ; E = Education ; F=Feedback ; G=GRM ; H= Hold ; I=IT ; and J=Joint Conference. If a medical institution conducts checks based on these 10 items and finds areas that are wanting, the institution needs to implement reforms that give consideration to the situation of that institution's “people, ” “money, ” “things, ” “time, ” and “information, ” then implement a medical risk management system appropriate for that institution.
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  • Clinical significance of postoperative serum carcinoembryonic antigen levels in patients with colorectal cancer
    HIRONOBU SENGOKU, TOMOO WATANABE, NAOKI NEGAMI, YUKIHIRO YAGINUMA, MAK ...
    2006 Volume 52 Issue 3 Pages 382-389
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.382
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    Objective : In patients with colorectal cancer, serum carcinoembryonic antigen (CEA) determination is a common method for evaluating therapeutic responses and disease progress. We assessed the usefulness of postoperative CEA levels for detecting disease recurrence using preoperative CEA levels and clinical/pathological factors. Patients : We reviewed 399 patients with colorectal cancer, which was resected completely at our department between 1997 and 2001. Methods : Pre-and postoperative serum CEA levels were determined using the sandwich enzyme immunoassay. The postoperative assay was performed about one month after surgery, when the patient's postoperative condition would not affect assay results. Receiver operating characteristic (ROC) analysis was performed using a model for predicting disease recurrence. Results : Of the 399 colorectal cancer patients, 68 (17.0%) developed disease recurrence. Higher pre-and postoperative serum CEA levels were associated with an increased incidence of recurrence compared to normal CEA (p<0.001). The incidence of recurrence was significantly increased in patients with higher preoperative and normal/higher postoperative CEA than those with normal pre-and postoperative CEA. Serum CEA levels were significantly elevated in recurrent patients compared with that in non-recurrent patients (p<0.001). Univariate analysis was performed to assess the relationship of recurrence to CEA levels as well as various pathological factors, and significant differences were noted for pre-and postoperative serum CEA levels, the depth of cancer invasion, lymph node metastasis, lymphatic invasion, venous invasion, maximal tumor diameter, and histological type of tumor. When these variables were also used for multivariate analysis, pre-and postoperative serum CEA levels, depth of cancer invasion, and lymph node metastasis were identified as independent risk factors for recurrence. ROC analysis demonstrated an increased area under the time-concentration curve (AUC) of 0.806 in the discriminant formula, which was higher than that obtained from patients classified according to disease stage (0.766). Conclusion : Postoperative CEA levels are considered a useful marker for detecting recurrence of colorectal cancer. Patients with higher postoperative CEA levels are at increased risk of recurrence, and should be followed carefully. In patients who underwent surgery for colorectal cancer, the accuracy of predicting disease recurrence will be improved if postoperative CEA levels are used when the tumor is classified according to disease stage.
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  • Esophageal hypersensitivity in Japanese patients with gastro-esophageal reflux diseases
    TOSHOKU MINOO, HIROTO MIWA, AKIHITO NAGAHARA, NOBUHIRO SATO
    2006 Volume 52 Issue 3 Pages 390-398
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.390
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    Object : To investigate esophageal hypersensitivity in Japanese GERD patients by esophageal acid perfusion test and determine the relationship of esophageal hypersensitivity to efficacy of treatment. Subject and Method : We performed upper GI endoscopy to confirm the diagnosis of GERD. Modified acid perfusion test was performed in 26 controls, 60 NERD, 53 e-GERD and 10 Barrett patients. The stimulus-response function to acid was quantified by lag time, intensity rating and sensitivity index (SI) which was calculated as the product of lag time and intensity rating. Findings were compared among each groups. Six months later, the intensity of reflux symptoms was surveyed by questionnaire in 16 NERD and 11 e-GERD patients who undertook PPI or H2receptor antagonist. We defined patients with SI>20 as “hypersensitivity group” and SI≤20 as “normal sensitivity group”. Improvement of reflux symptoms was compared between the hypersensitivity group and normal sensitivity group. Result : By acid perfusion test, the mean values of the lag time, intensity rating and SI in NERD patients were higher than those in e-GERD and Barrett patients, and significantly higher than that in the control group. The “Hypersensitivity group” in NERD patients showed improvement of reflux symptoms while the “normal sensitivity group” in NERD showed worsening of symptom. Conclusion : 1) Esophageal sensitivity to acid perfusion was enhanced in NERD and e-GERD in comparison with that in controls. 2) Anti-acid therapy was effective for the hypersensitivity group in NERD but not effective for the normal sensitivity group in NERD, suggesting that factors other than acid might play a role in the pathogenesis of normal sensitivity NERD. 3) Acid perfusion test might be useful to predict the efficacy of treatment and determine the optimal strategy for treatment in NERD.
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  • Evaluation of the physiological and clinical significance of serum hyocholic acid in healthy subjects and hepatocirrhosis patients
    ATSUSHI OKUZAWA, KOUJI SHINMURA, KIYOSHI TERAI, MICHITOSHI GOTO, MITSU ...
    2006 Volume 52 Issue 3 Pages 399-405
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.399
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    Objectives : Hyocholic acid (HCA, which is a bile acid extracted from swine bile, has been reported to exist in humans. In this study, we evaluated the physiological and clinical significance of HCA in healthy subjects and hepatocirrhosis patients. Subjects : The subjects consisted of 380 healthy subjects (healthy group) and 41 hepatocirrhosis patients (disease group). Methods : The HCA level in blood samples collected at fasting in the early morning was determined by ELISA. Glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and total bile acid (TBA) levels were also measured, and statistical analysis was performed. Results : 1) The median HCA level was significantly higher in the healthy 10s and 90 years or older groups than in the other healthy age groups.2) There was no significant difference in the median HCA level between the healthy male and female groups. 3) The median HCA, GOT, GPT, and TBA levels were significantly higher in the disease group than in the healthy group. 4) In the disease group, the median HCA level was positively correlated with the GOT and TBA levels, but not with the GPT level. Conclusions : The HCA level was correlated with the TBA level, suggesting that HCA is related to cholestasis. It was suggested that human serum HCA can be a parameter for the diagnosis and prognostic evaluation of cholestatic diseases, such as hepatocirrhosis.
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  • Clinical significance of the detection of carcinoembryonic antigen (CEA) mRNA in blood samples from patients with colorectal cancer.
    KOJI SHINMURA, MASAHIKO SUGANO, YUKO TSUTSUMI-ISHII, KAZUHIRO SAKAMOTO ...
    2006 Volume 52 Issue 3 Pages 406-414
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.406
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    Objective : We evaluated the clinical significance of the detection of carcinoembryonic antigen (CEA) mRNA in blood samples from patients with colorectal cancer by quantitative real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR). Materials and Methods : Blood samples were obtained preoperatively, intraoperatively and postoperatively (immediately post operatively and on the first day and seventh day post operatively) from 59 colorectal cancer patients. RNA was isolated from the blood, and the expression of CEA mRNA was investigated by quantitative real-time RT-PCR. In addition, CEA levels in sera were evaluated. Results : The expression of CEA mRNA was increased during and immediately after the operation; however, it could not be detected on the seventh day following operation. Furthermore, the increased expression of CEA mRNA was correlated with the clinicopathological stage, intramural infiltration and lymph node metastasis of the cancer. Moreover, serum CEA-positive (preoperative and postoperative) and CEA mRNA-positive (during and after the operation) patients exhibited lowsurvival rates due to metastasis. Conclusions : Evaluation of the expression of CEA mRNA in blood samples obtained during the perioperative period using blood samples by real-time RT-PCR could be of clinical importance to predict risk of metastatic diseases in colorectal cancer patients.
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  • A cross sectional study of participants in health-related events for life style modification and health improvement--with special emphasis on water exercise--
    DAICHI SUZUKI, TSUYOSHI MATSUBA, YUTAKA INABA, YASUO SHIRAISHI
    2006 Volume 52 Issue 3 Pages 415-426
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.415
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    Objectives : In recent years, there have been an increasing number of pool installations in municipal institutions and an increased effort to promote health through water exercise and swimming programs. Our study conducted cross-sectional research on adult men and women to determine the state of participation in water exercise programs and its association with health. Materials and Methods : We surveyed 257 subjects who participated in health checkups and a water exercise program, using a questionnaire. We measured blood pressure and visceral fat, then obtained blood biochemistry data. Results : To analyze differences in the means and distributions among psychological factors, nutrition, exercise and physical factors including biochemistry data, the subjects were divided into three groups, namely, the “water-exercise group”, “exercise other than waterexercise group” and the “not exercising group”. About significantly psychological factors related to health condition, life satisfaction and happiness, more subjects in the groups performing water exercise and exercise other than water exercise indicated “better” compared to those in the non-exercising group (p<0.01). About nutritional habits, significantly more subjects in the groups performing water exercise and exercise other than water exercise to indicate a preference for non salty food compared to those in the non-exercising group (p<0.01). On biochemistry data, HDL cholesterol was significantly higher in the water exercise group than in the other two groups (p<0.01). The mean systolic blood pressure in the water exercise group was significantly lower than that in either the exercise other than water exercise or non exercising group (p<0.01). To evaluate the relationship between a healthy life and health-related factors including psychological factors, nutrition, exercise and physiological factors, covariance structure analysis was adopted to analyze the causation modeling composed by those factors. The results suggested that performing water exercise was strongly related to a healthy life. Conclusion : Water exercise was found to be effective in building a healthy life.
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  • The psychiatric assessment of candidates for liver transplantation in Juntendo University Hospital--annual report--
    NOBUTO SHIBATA, HIROMI SHIMAZAKI, SEIJI KAWASAKI, HEII ARAI
    2006 Volume 52 Issue 3 Pages 455-460
    Published: September 30, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.455
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    Nine cases of living donor liver transplantation (LDLT) were performed in Juntendo University Hospital last year. We reported the results of psychiatric interviews and psychological assessments of LDLT patients and discussed three representative cases. Psychological studies demonstrated anxiety and conflicts in each of the donors. These assessments helped patients to describe their own conflicts and stress. The importance of communications among staff and each family member was suggested by these three cases. Both psychiatric interviews and psychological assessments are significant especially for LDLT donors. We think that this is a crucial part of future assessments.
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