Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 53, Issue 2
Displaying 1-28 of 28 articles from this issue
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  • Research Activities in Chemistry Seminars
    MASAO TSUKADA
    2007 Volume 53 Issue 2 Pages 154-160
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.154
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    In the general education program students can take any seminar they choose. Students prepared six papers in the chemistry seminar under my guidance. Three papers were on the Belousov-Zhabotinsky reaction, related to the chemical demonstration in my class. One paper was on buffer solutions, which has been one of the themes of my lectures. Another paper was on the subject of rates of reaction, related to laboratory experiments, and there was one additional paper. These papers were summarized and the research was incorporated as part of the introduction in the first year education program.
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  • Reflecting on organ pathology of the pancreas
    KOICHI SUDA
    2007 Volume 53 Issue 2 Pages 161-168
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.161
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    The pancreas is a parenchymal/ glandular organ, and consists of two fused pancreatic anlagen, from which the pancreatic duct opens into the duodenum, merging with the common bile duct. Histopathological features are composed of developmental anomalies, inflammation, fibrosis, and neoplasms, based on the organ structure as the acinar-ductal system and anatomical relationships with the neighboring or surrounding organs.
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  • Morphological study on coronary ostial and clinicoangiographic analysis of isolated coronary ostial stenosis
    TATSUJI KANOH
    2007 Volume 53 Issue 2 Pages 169-182
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.169
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    A morphological study of coronary ostia was performed in 70 autopsied human hearts, with particular attention being focused on the funnel-shaped structure, aging changes, and relation to atherosclerosis. The following results were obtained : 1) The ostium is particularly well-defined and forms a funnel-shaped structure. 2) The structure is predominantly a double circular shape on the right and comet-shaped on the left. 3) The funnel-shaped structure of coronary ostia is characterized by a longitudinal smooth muscle arrangement in the inner layer and circular one in the outer layer. 4) Including overhang formation, coronary sclerosis of the ostium appears mainly on the upper margin of the funnel-shaped structure of the right ostium and at the upper right margin of the left. 5) In ischemic heart disease, along with changes in coronary arteries themselves, changes in the ostia of these arteries should be paid close attention. Ostial stenosis of the coronary artery in the absence of distal vessel obstructions, isolated ostial stenosis, is a rare form of coronary artery disease. In a previous review of the international literature, the incidence of coronary ostial stenosis varied between 0.13% and 2.7%. Among 7,500 patients undergoing selective coronary cineangiography at Juntendo University Hospital and Juntendo Urayasu Hospital from 1975 to 1990, five women (0.07%) were diagnosed as having “isolated coronary ostial stenosis”, of which the cause is unknown. Atherosclerosis, particularly early premature atherome, congenital coronary anomaly, fibro-muscular dysplasia, Takayasu's aortitis, humoral factors, spasm, and iatrogenic events have been considered as its causes. In contrast to usual atherosclerotic coronary artery disease, patients with isolated coronary ostial stenosis of unknown etiology were characterized as being middle-aged, premenopausal, slender females having few coronary risk factors, experiencing severe angina pector is with marked ischemic ECG changes, having no collateral vessels among the distal coronary arteries, and a good operative prognosis. Clinical and angiographic profiles of isolated ostial stenosis with unknown etiology suggest that this group may represent a distinct entity. different from the more common atherosclerotic left main trunk lesion.
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  • Fourteen Years' Experience at Juntendo Shizuoka Hospital
    TAKEO MAEKAWA
    2007 Volume 53 Issue 2 Pages 183-192
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.183
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    Fourteen years have passed since I was appointed to Juntendo Shizuoka Hospital. This report traces the history of my work. My objectives at Shizuoka Hospital are 1) to provide safe and reliable medical services, 2) to receive referrals and treat both outpatients and inpatients, and 3) to broaden my surgical experience. Regarding surgical experience, I had performed about 400 operations per year before I came to this hospital. Since my appointment, however, the number of operations has increased annually, reaching a total of 748 operations in 2000. In 2002, the Shizuoka Cancer Center was opened in the eastern region of Shizuoka Prefecture. Perhaps because of this new facility, the number of operations has remained stable at about 700 per year. Our hospital is a tertiary critical care center. Many patients who require emergency surgery have been transferred to our hospital. About 30% of all surgical patients undergo emergency surgery. I describe my experience with patients who have been brought by ambulance to our hospital because of colonic perforation and describe the effects of seat belts on gastrointestinal and mesenteric injuries due to traffic accidents.
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  • Mechanisms and management of intractable pruritus
    KENJI TAKAMORI
    2007 Volume 53 Issue 2 Pages 193-199
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.193
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    Pruritus is the predominant symptom of skin disease and can be defined indirectly as a sensation that leads to a desire to scratch. Patients with dry skin such as chronic renal disease and atopic dermatitis often complain of intense itching and excessive scratching. However, the precise mechanisms of itch in these diseases is poorly understood. We investigated the mechanisms and treatment of itch in these diseases. The mechanisms of itching in hemodialysis patient have not yet been fully elucidated. Recently the mu opioid system has been suggested to be one of the major pathways involved in itch sensation. We examined the endogenous opioid system in hemodialysis patients demonstrating uremic pruritus and found that the kappa opioid system contributes to itch sensation along with the mu opioid system. A novel kappa opioid agonist TRK-820 expressed remarkable antipruritic action in antihistamine-resistant uremic pruritus patients. These findings also suggest that kappa opioid agonist is a promising antipruritic drug to treat various pruritic dieases. Pruritus is a major symptom in atopic dermatitis. Antihistamines are generally unhelpful in atopic dermatitis pruritus. In atopic dermatitis skin, increased densities of intraepidermal neurites are observed, suggesting that the neuritogenesis in the epidermis is related to itching and sensitive skin. We showed that nerve growth factors (NGF, amphiregulin) and gelatinase are involved in the elongation of nerve fibers to the epidermis. We found the abnormal expression of opioid system in epidermal keratinocytes in atopic dermatitis suggesting that the epidermal opioid system is associated with the modulation of pruritus. PUVA therapy normalized the abnormal expression of opioid system in keratinocytes and decreased densities of intraepidermal neurite formation. These findings suggest that the cause of intractable pruritus of atopic dermatitis is the increase in epidermal nerve fibers along with abnormal expression of the opioid system in keratinocytes.
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  • The relationship between mental health status and psychosociological factors among Chinese postgraduate students in Japan
    BIN MA
    2007 Volume 53 Issue 2 Pages 200-210
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.200
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    Objective : Problems regarding the mental health status of Chinese students in Japan have been receiving growing concern. The aims of this study were to clarify the mental health status of Chinese postgraduate students in Japan and to examine the psychosociological factors related to it. Materials : The subjects studied were 267 Chinese postgraduate students who live in the Kanto, Tohoku, and Hokkaido regions of Japan. Methods : The investigation was carried out using an unsigned self-describing questionnaire. It was performed from May to June 2005. The questions dealt with demographic information, the mental health status (General Health Questionnaire (GHQ) for neurosis and Self-Rating Depression Scale (SDS) for depression), and psychosociological factors (daily life irritation, selfesteem, trait anxiety, and emotional support network) of the subjects. At first, we compared the mental health status by sex, and then examined the relationship between the mental health status and psychosociological factors. Finally, we tried to estimate the causation mechanisms linking the mental health status and psychosociological factors by covariance structural analysis. Results : The prevalences of neurosis symptoms (GHQ) and depression symptoms (SDS) among the subjects were high. Both rates among the women were higher than among the men. An increase in the personal unease factor (decline of feelings of self-esteem, characteristic uneasiness) was shown in daily life irritation and the insufficiency of the emotional support network. Through these results, a causal structure model regarding mental health and psychosociological factors was obtained, using covariance analysis. Conclusions : In this study, it became clear that a decline in the mental health status of Chinese postgraduate students in Japan has appeared conspicuously. The women showed higher rates of both neurosis symptoms (GHQ) and depression symptoms (SDS) than the men. In addition, the emotional support network relieves daily life irritation, reduces the personal unease factor, and brings about a positive effect on mental health.
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  • Levels of DNA of CMV, EBV, and HHV-6 in HIV-positive Subjects
    KENTARO KUBO, TOSHIO NAITO, AKIHIRO INUI, NAOMI MATSUMOTO, EIICHIRO SU ...
    2007 Volume 53 Issue 2 Pages 211-216
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.211
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    Objective : Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6) are all herpes group DNA viruses, most of which are known to be acquired in early childhood and remain as latent infections through out life. It is widely known that, in the state of immunodeficiency that results from human immunodeficiency virus (HIV) infection, CMV causes opportunistic infections such as retinitis and pneumonia. However, there have not been many reports on the kinetics of EBV and HHV- 6, which also have latent infectivity. In this study, we measured and analyzed the levels of DNA of these three viruses in HIV-positive subjects. Materials : Subjects comprised 51 untreated HIV-positive patients who visited our outpatient clinic between April 2001 and October 2005, excluding AIDS patients who had already developed opportunistic infections. Methods : Using real-time PCR, we quantified the DNA of CMV, EBV, and HHV-6 in their peripheral venous leucocytes, and compared the results with those in healthy controls. Measurement and Results : HIV-positive patients had a significantly higher rate of EBV positivity than healthy controls (64.7% vs. 9.8%, respectively : P<0.0001), but there was no correlation between EBV positivity and the number of CD4 cells. The rate of CMV positivity tended to be higher than in healthy controls (9.8% vs.0%, respectively : P =0.0564), and the number of CD4 cells in CMV-positive subjects was significantly lower than in controls. HHV-6 was detected in only one HIV-positive patient, and it was not detected in HIV-negative patients. Conclusions : HIV-positive subjects who exhibited low CD4 cell counts had high rates of CMV infection, indicating that the activation of CMV may lead to such symptoms as pancytopenia, weight loss and general fatigue, even in patients who do not have obvious opportunistic infections. The rate of EBV positivity was significantly higher in HIV-positive patients than in controls, but was not correlated with the number of CD4-positive cells, suggesting that factors other than a decline in the CD4-positive cell count are involved in the process of EBV activation. Moreover, there was no significant difference in the HHV-6 positivity rate between HIV-positive subjects and healthy controls.
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  • Serum levels of complement regulatory proteins in patients with IgA nephropathy
    KISARA ONDA, HIROYUKI OHI, MARIKO TAMANO, ISAO OHSAWA, YASUHIKO TOMI ...
    2007 Volume 53 Issue 2 Pages 217-225
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.217
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    Objective : IgA nephropathy (IgAN) is the most common chronic glomerulonephritis. Although the glomerular deposition of complement components is well known, evidence of serological complement activation is inconclusive in patients with IgAN. We hypothesized that serum levels of complement components and regulatory proteins in patients with IgAN are correlated with its pathogenesis. Materials & Methods : In the present study, complement components in 50 patients with IgAN and 50 healthy volunteers were measured. C5, C1 inhibitor, factor B, C4 binding protein, factor H, and factor I levels were measured by single radial immunodiffusion. Mannose-binding lectin and properdin were measured by the enzyme-linked immunosorbent assay. Correlations of complements in serum with clinical gradings for IgAN, i.e., the good prognosis group, relatively good prognosis group, relatively poor prognosis group, and poor prognosis group, were evaluated. Results : CH50, C4, factor B, properdin, factor I, and factor H levels in IgAN patients were significantly higher than those in healthy controls. There were significant correlations between C4 and C1 inhibitor, and between C5 and C4 binding protein in patients with IgAN. In the poor prognosis group, C4 binding protein was significantly higher than in other groups of IgAN. Conclusion : In IgAN, hypercomplementemia with increased complement regulatory proteins occurs. C4 binding protein analyses can be used to predict the disease prognosis of IgA nephropathy patients.
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  • Promotion of community-centered interdisciplinary collaboration for early discharge of geriatric acute care patients
    Awareness among nurses
    NAOKO ARAGA, NAOKO SAKAMOTO, YOSHIMI KASAI, SHINOBU YAMAGUCHI
    2007 Volume 53 Issue 2 Pages 226-233
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.226
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    Objective : To investigate the awareness and current status of community-centered interdisciplinary collaboration among healthcare professionals in a geriatric acute care hospital. We sought to acquire data for the development of possible measures to promote early hospital discharge among geriatric acute care patients. Materials : Subjects comprised 245 nurses working in a geriatric acute care hospital. Methods : A questionnaire was designed and distributed in a hospital to be completed by the respondents. The responses were collected in a drop-off box within the hospital. Results : A total of 198 responses were collected; the response rate was 80.8% (98.5%). Nurses interact with patients and their families throughout their hospital stay, and therefore play a central role in the promotion of early hospital discharge. For these reasons, the study analysis focused on nurses. The results revealed that current nursing activities for community-centered interdisciplinary collaboration primarily involved sending summaries, and conferences were the least common of the activities. Interest in community-centered interdisciplinary collaboration was extremely high among nurses, despite their limited knowledge of community resources and systems. Nurses whose awareness of community-centered interdisciplinary collaboration was high had a greater knowledge of community resources and systems, and they, in turn, had more experience referring patients to community-based support services. Conclusions : 1. Nurses have a high level of interest in community-centered interdisciplinary collaboration and the condition of discharged patients. 2. Knowledge of community-centered interdisciplinary collaboration is relatively low among nurses. 3. There is almost no association between nurses' knowledge level of community-centered interdisciplinary collaboration and the number of years working as a nurse. 4. Nurses who have a high level of knowledge of community resources and systems refer patients to community support services at a higher rate than those whose knowledge level is low. There is a need to increase awareness of community-centered interdisciplinary collaboration in the nursing profession, along with making full use of the Interdisciplinary Team Discharge Planning Room, to develop measures for promoting early hospital discharge among geriatric acute care patients.
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  • Long-term results after vitrectomy for diabetic macular edema
    NORIKO HATANO, TOSHIRO SAKUMA, MASATOSH KIYOKAWA, ATSUSHI MIZOTA, MINO ...
    2007 Volume 53 Issue 2 Pages 234-242
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.234
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    Objective : To evaluate the long-term efficacy of vitrectomy for diabetic macular edema. Materials and Methods : Between February 1999 and August 2005, we performed vitrectomy on 75 eyes of 50 cases with diffuse-type diabetic macular edema. Vitreous detachment was absent in all cases. All cases were followed up for more than one year. Visual acuity, foveal retinal thickness, and the status of hard exudates deposits were evaluated before and after operations. In addition, the relationship between HbA1c and renal function and visual outcome were examined. Results : Visual acuity improved by two lines or more in 36 eyes (49.3 %), remained unchanged in 20 eyes (27.4 %), and deteriorated in 17 eyes (23.3 %). A significant improvement was observed three months after the operation (p < 0.05), and improved visual acuity remained until one year after treatment. Retinal thickness started to improve from one month after the operation, and showed a continual decrease in thickness (p < 0.01). Foveal hard exudates were observed in 40 eyes (54.8 %) before the operation. Although the amount of hard exudates increased after the operation, such a phenomenon disappeared in 67 % of the better visual outcome group, 22 % in the unchanged group, and 30 % in the deteriorated group. The reasons for deteriorated visual acuity were deposits of hard exudates in 8 eyes, remaining edema in 4 eyes, macular atrophy in 3 eyes, and optic nerve atrophy caused by neovascular glaucoma in 2 eyes. There were no significant relationships between HbA1c, renal function, and visual acuity changes. Conclusions : Vitrectomy can be considered effective for the long-term treatment of diffusetype diabetic macular edema without posterior vitreous detachment.
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  • Correlation between reduced susceptibility to vancomycin and clinical outcome in MRSA blood stream infections
    HUI-MIN NEOH, SATOSHI HORI, MITSUTAKA KOMATSU, TOYOKO OGURI, FUMIHIKO ...
    2007 Volume 53 Issue 2 Pages 243-250
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.243
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    Objective : The aim of this study was to determine whether the clinical outcome of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia was correlated with vancomycin susceptibility of the corresponding strains. Methods : A retrospective study on MRSA bacteraemia was performed at a teaching hospital between January 1998 and October 2005 by linking vancomycin susceptibility profiles of patients' isolates with hospitalization data. Results : A total of 20 out of 209 MRSA bacteraemia patients were treated with vancomycin for at least 5 days with adequate trough levels, and fulfilled the study's inclusion and exclusion criteria. Twenty-two S. aureus isolates from these patients' blood cultures were identified as MRSA, including two hetero-VISA from separate patients and two VISA with vancomycin MIC of 4mg/ L from one patient. Between patients who showed a “good” vancomycin response and those who did not, there was a significant difference (p <0.01) in their corresponding MRSA vancomycin susceptibility, expressed by the “area under the curve” (AUC) of population analysis. Significant correlations were found between AUC and the initial vancomycin therapeutic response parameters of “days till afebrile” (r= 0.828, p<0.01) and “days till CRP≤30% of maximum” (r= 0.627, p<0.01). Conclusion : Our study results warn healthcare personnel that early consideration should be given to cases with a poor vancomycin treatment response that could indicate the involvement of MRSA with reduced susceptibility to vancomycin.
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  • Effect of telmisartan in hypertensive patients with diabetes mellitus
    SAKIKO MIYAZAKI, SATOSHI KOJIMA, TADASHI MIYAZAKI, HIDEMORI HAYASHI, T ...
    2007 Volume 53 Issue 2 Pages 251-256
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.251
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    Objective : Telmisartan, an angiotensin II type 1 receptor blocker (ARB) with partial peroxisome proliferator-activated receptor gamma (PPAR- γ) activity, is expected to improve insulin sensitivity. We retrospectively investigated the effect of telmisartan in hypertensive patients with diabetes. Patients : This study comprised 66 hypertensive patients (39 men and 27 women, aged68.4±9.4years) with diabetes mellitus who received telmisartan (20mg-80mg/day) in our hospital. Methods : Systolic and diastolic blood pressures, HbA1c, and BMI were compared between before and 6 months after treatment with telmisartan. No patient was treated with insulin. During this period, antidiabetic drugs were not changed in any patient. Results : Telmisartan reduced systolic and diastolic blood pressures significantly (p<0.01). Although BMI was not changed, HbA1c was significantly improved (p<0.01). In 36 patients who had undergone replacement of other ARBs or ACE- I with telmisartan, either systolic or diastolic pressure decreased significantly (p<0.01).In addition, HbA1c was improved but it was not significant (p=0.06). Conclusion : Telmisartan improved not only blood pressure but also gluco-metabolic control without weight gain. This improvement of diabetic control may be related to its PPAR- γ activity.
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  • Depression and Coping due to Stagnation in Athletic Achievement
    NOBUYUKI NAKAJIMA, YASUYUKI YAMADA
    2007 Volume 53 Issue 2 Pages 257-267
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.257
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    Objective : The purpose of this study was to examine depression and coping relating to the stagnation of game results in order to clarify the influence of such a stagnation on depression in Japanese sports university students. Participants : Participants in this study comprised 545 Japanese sports university students. The valid response rate of this study was 89%. The total number of valid data sets was 487 (321 males and 166 females). The participants' sports were track and field, swimming, basketball, volleyball, and so on. The average age of participants was 19.84 (SD=1.23) years old. Methods : This study was carried out with Japanese sports university students in 2004. The questionnaire of this study was composed of items relating to the degree of the stagnation of game results, an Athletic Stressor Measure (for Stagnation of Results Situations), and a Self-Rating Depression Scale (SDS). Results : In the results of comparison of the “stagnation” and “non-stagnation” groups in SDS (t-test), it was proven that the score for the “stagnation” group was significantly higher for “melancholy (p<.01)”, “trouble with sleep (p<.05)”, “fatigue (p<.001)”, “decreased psychomotor activity (p<.05)”, “hopelessness (p<.05)”, “indecision (p<.05)”, “low self-evaluation (p<.001)”, “aeriality (p<.001)”, and “dysphoria (p<.001)” than those for the “non-stagnation” group. In fact, “avoidance orientation” coping in males and females and “obsession with honor orientation” coping in females showed significant positive correlations with some of these SDS items (r≥.20, p<.05), and other coping factors showed significant negative correlatios with certain items (r≤-.20, p<.05). Conclusions : (1) This study showed that depression in SDS, such as “fatigue, ” “hopelessness”, “lowness of self-evaluation”, and so on, occurred under the situation of the stagnation of game results. (2) The “avoidance orientation” coping in males and females and “obsession with honor orientation” coping in females had a negative effect on depression in SDS. (3) The “prompting of self-confidence orientation” coping and “acceptance” coping in males and “problem solving orientation” coping and “changing to positive thought orientation” coping in females had a positive effect on depression, especially in SDS.
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  • Four therapeutic cases of RS3PE syndrome
    NAOYA NAKAJIMA, YUKIKO FUKUDA, KWANG-SEOK YANG, MIYOJI AIBA, HIROSHI T ...
    2007 Volume 53 Issue 2 Pages 302-305
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.302
    JOURNAL FREE ACCESS
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    RS3PE syndrome (Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome) is one of the disorders which present as polyarthritis. It is important to be aware of RS3PE syndrome when encountering elderly patients with polyarthritis who are negative for rheumatoid factor. We report 4 cases of RS3PE syndrome. All cases shared common clinical findings, such as acute onset, symmetrical polyarthritis, pitting edema of the hands and feet, and being negative for rheumatoid factor in serum. Treatment with corticosteroid was very effective in all cases. However, two patients showed a deteriorated clinical condition during the tapering of corticosteroid. Corticosteroid should be tapered off cautiously in patients with RS3PE syndrome.
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  • Three cases of adenocarcinoma in Barrett's epithelium in patients with reflux esophagitis
    KOH MORICHIKA, KAZUHISA ISHI, TAKAYUKI HASHIMOTO, MASAKO KUSANO
    2007 Volume 53 Issue 2 Pages 306-309
    Published: June 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.306
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    We investigated the pathogenesis of reflux esophagitis for six years. We report three cases of adenocarcinoma arising in Barrett's epithelium in patients with high grade reflux esophagitis. In all cases, gastric endoscopy demonstrated a large amount of gastric juice (bile in particular) caused by duodenogastric reflux due to pyloric incompetence in the stomach. We considered that Barrett's adenocarcinoma was induced by bile acid in Barrett's epithelium with reflux esophagitis.
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