Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 52, Issue 4
Displaying 1-18 of 18 articles from this issue
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Contents
  • Most recent progress in chemotherapy for inoperatable and / or recurrent advanced gastric cancer
    KATSUYORI IIJIMA, SUMIO WATANABE
    2006 Volume 52 Issue 4 Pages 518-527
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.518
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    Although the incidence of gastric cancer in Japan has recently been decreasing, its mortality still ranks second after that of lung cancer. Yet there is no standard therapeutic modality for this disease and treatment is chosen in each clinical setting to suit the individual patient. During the last several years, new anti-neoplastic agents-e. g., TS-1, CPT-11 and taxanes一have been approved in succession by the government. Although the survival time of patients has gradually been prolonged by designing various combinations of these agents, the outcome is not yet satisfactory. At our department, the properties of paclitaxel (TXL) was recognized ; and a phase I clinical trial is being conducted to establish a standard frontline therapy for gastric cancer by adopting a regimen in which TXL is added to the conventional FP therapy. The concept is that the establishments of the frontline therapy in combination with subsequent chemotherapies as well as multimodal therapy to suit each patient is essential in prolonging the patient's survival time and improving guality of life at home. In view of the recent increase in the number of the elderly cancer patients, greater consideration has been given toward therapy that will improve their quality of life rather than merely prolonging life. We plan to investigate the effects of chemotherapy for gastric cancer on QOL using the EORTC QLQ-C30 questionnaires; and then incorporate the results of this survey in designing future therapeutic strategies.
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  • Current chemotherapy regimens against hematologic malignancies
    KOICHI SUGIMOTO
    2006 Volume 52 Issue 4 Pages 528-535
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.528
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    Acute myelogenous leukemia (AML) and diffuse large B-cell lymphoma (DLBCL) are representative hematologic malignancies against which chemotherapy is very effective. Induction and consolidation therapies with anthracyclines plus ara-C induce remission in about one third of AML patients. CHOP therapy achieves remission in about 40% of DLBCL. These chemotherapies consist of anthracyclines, DNA antimetabolites, alkylating agents and Vinca alkaloids. These agents are more active against cycling tumor cells than quiescent ones. Recently, several highly targeted compounds have been introduced into the therapeutics of hematologic malignancies. These agents are based on an understanding of the molecular pathogenesis of leukemia and lymphoma. In this review, we assess the mechanism of action and efficacy of imatinib, all-trans retinoic acid and rituximab in CML (chronic myeloid leukemia), APL (acute promyelocytic leukemia) and follicular lymphoma, respectively.
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  • Update Chemotherapy for Lung Cancer
    KAZUHISA TAKAHASHI, MICHIHIRO HIRAMA, TOSHIJI ISHIWATA, KAYO MIURA, YU ...
    2006 Volume 52 Issue 4 Pages 536-545
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.536
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    Lung cancer is the leading cause of cancer deaths in Japan. Non-small cell lung cancer (NSCLC) accounts for 80% of lung cancer, while small cell lung cancer accounts for 20%. Over 60% patients with NSCLC are inoperable at the time of diagnosis and receive chemotherapy and/ or radiotherapy. Survival benefit from chemotherapy for inoperable NSCLC has been reported, since new agents and molecular targeting agents have developed in the 1990's. The standard chemotherapeutic regimen is a combination of platinum (cisplatin or carboplatin) and new agents including paclitaxel, gemcitabine, irinotecan, vinorelbine and docetaxel. For elderly patients with NSCLC, vinorelbine or docetaxel monotherapy is recommended as a first line chemotherapy. Docetaxel monotherapy is effective as a second line chemotherapeutic regimen. Giftinib (Iressa) is the molecular targeting agent that inhibits tyrosine phosphorylation of epidermal growth factor receptor (EGFR). Many factors predicting response to gefitinib have been suggested, such as East Asian ethnic, female gender, adenocarcinoma, non-smoker, and the presence of gene mutations and/or amplifications of EGFR. Acute lung injury is reported as a serious adverse effect in about 5% of patients given gefitinib. Such a complication is often seen in the patients who smoke, those with interstitial pneumonia or a poor performance status and so on. The majority of patients with small cell lung cancer receive chemotherapy and/or radiation therapy. For limited disease (LD) SCLC patients, chemotherapy using cisplatin plus etoposide with concurrently hyperfractionated radiotherapy is recommended as a first line therapy. However, patients with extensive disease (ED) receive chemotherapy alone using cisplatin and irinotecan. Quality of life (QOL) should be considered when prescribing chemotherapy for patients with advanced lung cancer.
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  • Chemotherapy for Breast Cancer
    MITSUE SAITO
    2006 Volume 52 Issue 4 Pages 546-558
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.546
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    Although the mortality rate of the breast cancer is decreasing in western countries, the incidence is increasing all over the world. The development of safe and effective treatment and early detection of the cancer are required first, even if the carcinogenesis of breast cancer should be discovered theoretically, since methods of disrupting the developmental process have yet to be resolved. Currently, the standard therapy for breast cancer is minimally required local therapy and maximal systemic therapy. The prognosis is influenced by the extent of disease at diagnosis, I. e. whether it is already a systemic disease or not and the response of each cancer to chemotherapy. The purpose, regimen and evidence for various kinds of chemotherapy : primary systemic chemotherapy (PSC), adjuvant chemotherapy and chemotherapy for metastasis are described in this paper.
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  • Metallic stents provide better QOL than plastic stents in patients with stricture of unresectable advanced esophageal cancer.
    KAZUKI OHTA, AKIHITO NAGAHARA, KATSUYORI IIJIMA, JUNKO KATO, NOBUKO SE ...
    2006 Volume 52 Issue 4 Pages 560-565
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.560
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    Aims : To elucidate the utility and safety of treatment with esophageal stents (plastic and metallic stents) for unresectable advanced esophageal cancer. Subjects and Methods : Between 1992 and 2002, 14 cases of unresectable advanced esophageal cancer were treated with esophageal stents (the plastic stent group, 7 cases; and the metallic stent group, 7 cases). Of these, 10 cases had a history of chemotherapy and/or radiotherapy. An improvement in oral intake and performance status (PS), survival time, periods at home, and adverse events were compared between the two groups. Results : After stenting, oral intake and PS were significantly improved in the metallic stent group. Follow-up at home was possible in 71.4%. There was no significant difference in survival or duration of time at home between the two groups. All adverse events were controllable and there was no difference between the two groups. Conclusions : Stenting not only improved oral intake and PS but also allowed a stay at home, resulting in a marked improvement in patients' QOL. Stenting was performed safely even in cases with a history of radiotherapy. There was no difference in survival, ratios of staying at home, and safety between the two groups, but QOL was significantly improved in the metallic stent group. These outcomes indicate that placement of metallic stents should be actively considered to treat stricture due to advanced esophageal cancer.
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  • Mechanism of the contractions in normal and inflamed canine ileum.
    SHUICHI SAKAMOTO, KAZUHIRO SAKAMOTO, TOSHIKI KAMANO
    2006 Volume 52 Issue 4 Pages 566-572
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.566
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    Objective : Our aim was to investigate the contractions activated by Sodium Fluoride (NaF), a GTP-binding protein activator, in normal and inflamed ileum. Materials and methods : The experiments were performed on conscious dogs by close-intraarterial infusions of test substances of inhibitors of neuron, NO and signal transduction pathway. Inflammation was induced by mucosal exposure to ethanol and acetic acid. Results : NaF stimulated phasic contractions dose-dependently in normal and inflamed ileum. The contraction in inflamed ileum was significantly suppressed (p <0.05). Phasic contractions by NaF were inhibited by nicotinic receptor blockade, blockade of neuronal conduction and muscarinic receptors in the normal and inflamed ileum. By contrast, the response to NaF was enhanced after blockade of NO. The smooth muscle signal transduction pathways utilized by NaF were investigated after cholinergic and nitronergic blockade. The smooth muscle response to NaF was inhibited dose-dependently by Calcium antagonist and inhibitor of phospholipase C. The response in the inflamed ileum was smaller than those in the normal ileum. Conclusions : NaF activates the cholinergic and nitronergic neurons and may also act directly on ileal circular smooth muscle cells to stimulate phasic contractions. Contractions in inflamed ileum may be regulated by neurons more than by the signal transduction pathway in smooth muscle.
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  • Roles of obstetrician-gynecologists in remote-island healthcare
    YUSUKE ANDO, HIROYUKI TAKEUCHI, KATSUYUKI KINOSHITA
    2006 Volume 52 Issue 4 Pages 573-579
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.573
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    Objective : To clarify physicians responsible for obstetrics and gynecology in remote-island healthcare, and the roles of obstetrician-gynecologists in remote-island healthcare as well as their future directions. Materials : A questionnaire survey was conducted for physicians engaged full-time in obstetrical-gynecological care on 10 islands in the Kanto region. Methods : An 81-item questionnaire was prepared to clarify the characteristics of both medical practice and life on remote islands. The questionnaire was sent to 11 physicians, who responded in writing. Results : Among the 10 remote islands (total population : app. 27,500), there are two islands (combined population : app. 18,500) that each had a full-time obstetrician-gynecologist. On the other eight islands (combined population : app. 9,000), Jichi Medical School dispatched physicians from various specialties. Although the school provide obstetrical-gynecological care including maternity examinations, these physicians were not involved in delivery. The two obstetriciangynecologists also provided care for patients with other medical or surgical disorders. Among the physicians surveyed, 72.7% indicated a willingness to be involved in remote-island healthcare despite professional and personal inconveniences specific to remote islands. Conclusions : On remote islands and in other remote areas, obstetrician-gynecologists are expected to be comprehensive practitioners who can provide both medical and surgical care to a certain degree. Though remote-island healthcare forces physicians to practice and live under difficult conditions, many or those surveyed find it rewarding. In the future, enhancing both practice and living environments will make it easier to dispatch physicians for remote island healthcare, thus leading to improvement in the quality of services.
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  • Clinical study of human adjuvant disease
    HOU ZEN, TORU FUKAZAWA, KWANG SEOK YANG, YASUO KUMAGAI, HIROSHI HASHIM ...
    2006 Volume 52 Issue 4 Pages 580-587
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.580
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    Objective : The concept of human adjuvant disease has been a focus of discussion in recent years. We reviewed the characteristics of 21 patients with symptoms and signs of connective tissue diseases who had undergone cosmetic surgery that involved foreign substances such as silicone and paraffin. The relationship between cosmetic surgery and the incidence of human adjuvant disease was studied. Subjects : The subjects were 21 patients with symptoms and signs of connective tissue diseases after cosmetic surgery who were treated at the Division of Rheumatology of Juntendo University Hospital between January 1980 and December 2004. The patients were between 27 and 75 years of age (mean : 61.3±10.0years), and there were 19 women and 2 men. Methods : (1) The patients were classified into two groups, group I consisted of 14 patients satisfying the published criteria for definite connective tissue disease, while group II consisted of 7 patients diagnosed as having human adjuvant disease who had 1 or more features of connective tissue disease, but not enough to be classified in group I. We compared groups I and II in terms of the interval between cosmetic surgery to symptom onset, clinical and laboratory findings. (2) We compared our subjects and another group of 29 human adjuvant disease patients reported by Kumagai in 1989 in terms of clinical characteristics. (3) We also compared the incidence of each connective tissue disease in group I with the incidence of these diseases in Japan. Results : (1) There was no significant difference between the 2 groups regarding the interval between cosmetic surgery and onset. The autoantibody positive rate was higher in group I than in group II. (2) Our study and that by Kumagai showed that human adjuvant disease might be related to systemic sclerosis, and our data suggested that human adjuvant disease is also related with Sjören's syndrome. (3) Systemic sclerosis and Sjören's syndrome in group I showed a higher incidence than the incidence reported in the general population in Japan. Discussion : These findings suggest that cosmetic surgery is related to systemic sclerosis and Sjören's syndrome. However, interval between cosmetic surgery and onset was long, and there is no experimental evidence indicating that foreign substances play a role in the induction of immunologic disorders ; therefore, the relation between human adjuvant disease and cosmetic surgery is not clear. It will be necessary to analyze the immune response of patient lymphocytes or macrophages to foreign substances in the future.
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  • Variability of bladder dysfunction in post radical hysterectomy effect of pelvic autonomic nerve preservation with
    without postoperative radiation therapy
    MASANORI HASHIMOTO, MASAAKI SUZUKI, KATSUYUKI KINOSHITA
    2006 Volume 52 Issue 4 Pages 588-595
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.588
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    Objecttive : To demonstrate an improved method for radical hysterectomy procedures to prevent post-operative variable bladder dysfunction. This study presents the results of a Urodynamic Study performed in subjects who underwent radical hysterectomy to clarify the efficacy of the new surgical method. Materials : Participants in this study consisted of 40 Stage 1B cervical cancer patients. These 40 participants were divided into two categories. The control group, consisting of 21 patients, underwent surgery by the established procedure. The experimental group was treated by our improved surgical method for retaining pelvic autonomic nerve function after radical hysterectomy. The groups were further divided into those who received radiation therapy and those who did not require radiation therapy. Methods : Two UDS (Urodynamic Study) methods were chosen to estimate bladder function; cystometry and uroflowmetry. The cystometry measurement parameters indicate bladder pliancy at the point of maximum desire to void. The uroflowmetry measurement parameters indicate the time required from post-surgical dysfunctional urinary flow pattern to the recovery of a normal pattern. Initial cystometry and uroflowmetry measurements were established pre-operatively. Further measurements were taken 1, 3, 6, 12, and 24 months post-operation. Measurements and Results : Four groups were divided as indicated in the methods section above. The non-radiated group who underwent our improved surgical method showed significantly better quality of improvement in cystometry measurements compared to those treated by the established method on measurements obtained 24 months post-operatively. Even the group requiring post-op radiation showed significantly better results at the 1 and 24 month points. At the 24 month point, the group receiving radiation therapy showed the lowest level of pliancy improvement, indicating a tendency for a longer recovery time than this study allowed. Irrespective of radiation therapy, the groups undergoing our improved surgical method achieved a quicker recovery from the post-op dysfunctional pattern to a normal urinary flow pattern. A ten-year post-op recurrence rate survey indicated that there was no significant difference in recurrence rates between the two groups. Conclusion : The new surgical method with improvements in retaining pelvic autonomic nerve function following radical hysterectomy shows significantly better results in bladder pliancy and post-op urinary flow pattern recovery. Post-surgical radiation therapy factors severely affect the recovery time, however, the new method indicates a tendency toward better quality improvement in bladder pliancy and post-op urinary flow pattern recovery.
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  • Report on th faculty development at Juntendo University under the newly established postgraduate medical education cariculum for medical practitioners--summary and overview of this 8th annual intern workshop of Juntendo University--
    TAKASHI DAMBARA, TOSHIAKI SHIMIZU, HIROYUKI KOBAYASHI, TSUTOMU SUZUKI, ...
    2006 Volume 52 Issue 4 Pages 596-602
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.596
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    At Juntendo University Hospital, the “Annual Intern Workshop of Juntendo” has been held in Kasumigaura, Ibaragi Prefecture as “Faculty Development” for interns and attending doctors, and professors managing the postgraduate medical education since 1999. The Japanese Government has newly established the postgraduate medical education curriculum for medical practitioners under the Ministry of Health, Labor and Welfare in 2004. After changing the medical education system, this Annual Workshop has continued to be held cooperatively by our 3 Juntendo University hospitals in Hongo, Shizuoka and Urayasu. We reviewed the workshops for the past 8 years and reported on the 8th Annual Workshop held on September 2-3, 2006.
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  • Overview of medical education for graduates of Juntendo University
    TAKASHI DAMBARA, TOSHIAKI SHIMIZU, HIROYUKI KOBAYASHI, NAOKI MITSUHASH ...
    2006 Volume 52 Issue 4 Pages 603-607
    Published: December 22, 2006
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.52.603
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    In Japan, graduates of medical schools since 2004 should receive medical education as a general practitioner for 2 years or more. This postgraduate education program has been revised by the Japanese Government and is administered by the Welfare and Labor Ministry. Before beginning this education program, the new selection system (Residency Electronic Information System : REIS) of the Foundation for Promotion Medical Training has been introduced to match medical students and hospitals with each other. This matching system permits every medical student to know the education program of each hospital on the Web site and to apply to every hospital approved by the Welfare and Labor Ministry. Conversely, hospitals can register medical students who will be acceptable. More than ninety-five percent of students have been matched to appropriate hospitals. This spring, 124 doctors will be promoted to the next step of the postgraduate residency course such as postgraduate school, clinical specialty, advanced general practice and basic science in Juntendo University. We report an overview of the medical education for graduates of Juntendo University.
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