Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 53, Issue 3
Displaying 1-28 of 28 articles from this issue
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Contents
  • What should we do to control hospital infection?
    KEIICHI HIRAMATSU
    2007 Volume 53 Issue 3 Pages 350-351
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.350
    JOURNAL FREE ACCESS
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    The history of hospital infection has been closely associated with the history of hospital itself. Owing to such shrewd observer/researchers as Semmelweis, the basis for infection control was founded in the 19th century. After the advent of the antibiotic era in the mid-20th century, the threat of pathogenic microorganisms has dwindled away to nothing more than a shadow to be expelled by antibiotics. However, such absolute faith in antibiotics has already diminished, and again we must confront the harsh reality of pathogenic microorganisms.
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  • The role of Bacteriology as basic medicine in infection control.
    TERUYO ITO
    2007 Volume 53 Issue 3 Pages 352-362
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.352
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    Basic medicine may play a fundamental role in clinical medicine. Here I report the role of bacteriology in infection control, especially, focusing on how new strategies for the prevention of disease are established, from three perspectives based on : i) studies of antibiotic resistance, ii) the genetic bases for methicillin resistance, and iii) the genome project and development of a microarray based on the genomic sequences of S. aureus.
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  • The Role of the Microbiology Laboratory in Controlling Nosocomial Infections
    SHIGEMI KONDO
    2007 Volume 53 Issue 3 Pages 363-371
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.363
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    The department of clinical microbiology laboratory plays various roles in the many different aspects of nosocomial infection control. These roles include providing information concerning the prevalence of hospital pathogens, surveillance for nosocomial infection, and educating medical staff. It is very important for the department of clinical laboratory to provide clinicians with microbiological information as quickly as possible, since useful information from microbiological tests is required for adequate clinical diagnosis and treatment of infectious disease. In order to provide reliable information for microbiological tests, it is necessary to control the quality of clinical specimens. Since a large quantity of data has been accumulated on the database in the microbiology laboratory, clinical microbiologists will be the first to become aware of nosocomial infection spread. Well designed statistical data are necessary for appropriate empiric therapy and nosocomial infection control.
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  • Robust infrastructures and management systems for hospital infection control at Juntendo University Hospital
    SATOSHI HORI
    2007 Volume 53 Issue 3 Pages 372-378
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.372
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    Every hospital should be covered by a hospital infection control committee. A hospital infection control committee is a core structure with responsibility for preventing and controlling any infections acquired in the hospital. The membership of the committee should include the infection control team, the chief executive, the director of nursing, the chief administrator, the chief medical manager, and representatives of the patient safety department, clinical laboratory department, occupational health department, pharmacy department, catering service department, estate department, product distributing department, and hotel service department. Each member is expected to contribute to the success of infection prevention and control in hospitals.
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  • The hospital architecture to prevent hospital-acquired infection
    AKIRA ITO, YUICHI SAKIMURA, SYOICHI MORIMOTO, MAYUMI AMINAKA, KEIICHI ...
    2007 Volume 53 Issue 3 Pages 379-389
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.379
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    To examine the method of operating and maintaining facilities where infection control measures had been considered, a questionnaire survey was conducted among the doctors and the nurses at Juntendo Hospital. Actual usage conditions in the outpatient section, the operating room, sterilization area, and each ward were determined by responses to the questionnaire survey. Attitudes to ward the architectural space and infection control among the doctors and the nurses were clarified. The improvements of certain factors in the building environment and building equipment were clarified. Especially, the medical staff expressed dissatisfaction with rooms, air conditioning facilities, basins, the pedestrian bridge, elevators, and the tools and materials circulation route. The garden, the library, the store, and the restaurant, etc. were shown to be necessary facilities for patient recuperation environmental enhancement.
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  • Effective infection control; How important is a cooperative relationship among healthcare departments?
    MEGUMI IKEDA
    2007 Volume 53 Issue 3 Pages 390-396
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.390
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    Healthcare-associated infections caused by drug-resistant organisms such as MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant enterococci) and MDRP (multidrug-resistant Pseudomonas aeruginosa) have become a serious problem since the third-generation cephalosporins were used on 1980' s. Most automatic susceptibility testing systems determine the MIC of glycopeptides against certain gram-positive cocci between 16 and 24 hours. However, our microbiology laboratory added the optional criteria of measuring the MIC at 48 hours to identify heterogeneously glycopeptide-resistant strains. In 2005, a VanB type VRE strain was isolated from the urine of an inpatient. This article discusses early recognition and infection control strategy based on a cooperative relationship among healthcare departments, which successfully controlled the healthcare-associated spread of VRE transmission in this case.
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  • Significance of healthcare-associated infection surveillance
    MAYUMI AMINAKA
    2007 Volume 53 Issue 3 Pages 397-403
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.397
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    Components of an infection control program for healthcare-associated infection prevention ; include 1) setting and recommending policies and procedures, 2) healthcare-associated infections surveillance, 3) Direct intervention to prevent transmission of infectious diseases, 4) occupational health and safety, 5) facilities management, 6) education and training of healthcare workers, and 7) resources. Especially, healthcare-associated infection surveillance is a very important and indispensable component of an infection control program. In this part, an outline of healthcare-associated infection surveillance is presented.
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  • Requirement of clinical assistance for healthcare-associated infections
    KEN KIKUCHI
    2007 Volume 53 Issue 3 Pages 404-409
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.404
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    Infectious disease services for healthcare-associated infections consist of four factors : clinical assistance, infection control, education, and research. Of these, the established clinical assistance system for infectious diseases is the most important for every hospital, from the perspective of promoting the diagnostic procedures and reduction of medical expenses. In this paper, the ideal system for infectious disease services in Japan is discussed.
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  • The patterns of subjective definitions of health among the general population
    --from the perspective of health promotion--
    NORIO SHIMANOUCHI
    2007 Volume 53 Issue 3 Pages 410-420
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.410
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    This study considers the challenges facing research into the patterns of subjective definitions of health among the general population. The medical definition of health is have based on science and evidence-based viewpoints, whereas the general population subjective definitions of health that may be unscientific and narrative-based or based on folk knowledge and individual experience. It is very important to better understand the definitions of health used by the general public. In order to develop an effective health promoting service system for the general public, we must understand that people have their own definitions of health based on their own subjective viewpoints. In this study we divided people's answers about their definition of health into six groups as follows ; (1) physical well-being oriented answers such as “no disease, good physical condition, ” (2) mental well-being oriented answers such as “feeling happy, happy home, having a basic sense that life is worth living,” (3) social well-being oriented answers such as “being able to work, good social relations,” (4) physical and mental well-being such as “physical and mental well-being,” (5) physical, mental, and social well-being oriented answers such as “being in good condition, including feeling fit, positive mental attitudes, and good human relations.” (6) spiritual well-being such as “being able to love other persons, being to be able to live positively” The subjective definitions of health appear to be associated with age, sex and the historical times. The definition has also been expanded from physical well-being alone to include mental, social and spiritual well-being with the progression of historical times. We must also be aware that people come to acquire their own subjective definition of health through the process of health socialization.
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  • Interferons elicete anti-tumor effects through induction of TRAIL on human peripheral T cells
    MASAKUNI ISHIKAWA, YOSHIYUKI TAKEI, KENICHI IKEJIMA, NOBUYUKI ENOMOTO, ...
    2007 Volume 53 Issue 3 Pages 421-427
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.421
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    TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) is a proapoptotic member of the TNF family of type II membrane proteins, which constitutes one component of T cell cytotoxicity. TRAIL has been reported to induce apoptosis in several tumor cell lines including kidney carcinomas. However, it is not known whether TRAIL could mediate killing of hepatocellular carcinomas. Recent studies demonstrated that TRAIL is expressed on human T cell clones in response to interferons (IFNs). This study was therefore conducted to determine if IFNs could elicit tumoricidal effects on a hepatoma cell line through regulation of TRAIL expression on peripheral blood T (PBT) cells. Fresh human PBT cells, obtained from healthy volunteers, were cultured in RPMI1640 medium (3.5×106cells/ml) containing 10%FCS, 100 (g/ml streptomycin and penicillin. PBT cells were prestimulated for 12 hr on plates coated with anti-CD3/TCR monoclonal antibody (10μg/ml) in the presence or absence of IFNs (α or β;200IU/ml). After washing with culture medium, the cells were used as effector cells. Surface TRAIL expression on human PBT was analyzed with flow cytometry. The human hepatoma cell line Hep G2 was cultured in Dulbecco's modified Eagle Medium plus 10%FCS, 100μg/ml streptomycin and penicillin. Tumoricidal effect of PBT cells was determined by release of LDH into the culture media. Freshly isolated PBT cells did not express a detectable level of TRAIL on their surface. However, after stimulation with IFN-α or β for 12-48 hr in the presence of anti-CD3 monoclonal antibody, a rapid and remarkable TRAIL expression was induced. Co-culture with PBT cells that were not stimulated with anti-CD3 or IFNs resulted in moderate increases in LDH release. In marked contrast, IFNs augmented the cytotoxic activity of anti-CD3-stimulated PBT cells against Hep G2 cells, as evidenced by 3-4 fold increases in LDH release after co-culture for 24 hr with anti-CD3 plus IFN- stimulated PBT cells. These increases were significantly (-70%) suppressed by inclusion of a neutralizing anti-TRAIL antibody (10μg/ml) in culture media, indicating that the IFN-enhanced cytotoxicity was predominantly mediated by TRAIL. The results indicate that IFN can augment the cytotoxic activity of CD3-stimulated PBT cells against Hep G2 cells by enhancing TRAIL-mediated cytotoxicity. This finding may lead to identifying a new mechanism of the anti-tumor effect of IFN against hepatocellular carcinoma.
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  • Clinical significance of sharp wave transients on neonatal EEG
    MASAKO SAITO, KEIKO KUREMOTO, KEIICHI TAKAHASHI, SHINICHI NIIJIMA
    2007 Volume 53 Issue 3 Pages 428-437
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.428
    JOURNAL FREE ACCESS
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    Objective : We investigated sharp wave transients (SWTs) on neonatal EEG to differentiate those found on EEG showing a normal pattern from those on EEG showing an abnormal pattern.Materials and Methods : One hundred twenty seven EEG recordings from 126 neonates were classified into normal, dysmature and disorganized patterns according to background EEG. The numbers of SWTs per minute and amplitudes and frequencies of SWTs were comparatively analyzed among these patterns. Results : Sixty-seven recordings were diagnosed as normal patterns, 32, as disorganized patterns and 40, as dysmature patterns. The abundance of SWTs per minute (SWTs/mim) was significantly greater in neonates with a disorganized pattern (disorganized pattern group) (0.928±0.681) than in those with normal pattern (normal pattern group) (0.634±0.381) (p<0.01). SWTs/min at C and T were significantly greater in the disorganized pattern group than in the normal pattern group (p<0.05). In the dysmature pattern group, the rate SWTs/min was high in all regions, but not significantly greater than those in the other groups. SWTs /min with amplitude over 150μ V at F and those with amplitude over 100μ V at C and T were significantly greater in the disorganized pattern group than in the normal pattern group (p<0.001, 0.05, 0.05, respectively). SWTs /min with a frequency ranging from 4 to 7 Hz at C and T were significantly greater in the disorganized pattern group than in the normal pattern group (p<0.05). Conclusions : There were significantly more contribute SWTs at C and T in the disorganized pattern group. This finding may significanly to reading neonatal EEGs.
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  • Factors related to health promotion for young-old elderly in K-ward, Yokohama City
    KAZUSHI FUNAYAMA, ITUKO HORIGUTI, AIKO TUJIMOTO, EIJI MARUI
    2007 Volume 53 Issue 3 Pages 438-445
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.438
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    Objective : This study examined the current state of health promotion among young-old elderly residents in Yokohama City K Ward. Subjects and Methods : We conducted a focus group interview survey. A total of 37 people (19 men and 18 women) were intentionally extracted from independent young-old elderly residents in Yokohama City K Ward. Groups of about ten males or females were established from these individuals, making four groups in total. Each group was interviewed for about 90 minutes regarding items related to health care. Responses were analyzed by the author who conducted the interviews and two people who had analytical experience of the focus group interview. Results and Conclusion : As a result, health behavior and social participation in a regional exchange were closely related in the young-old elderly. It was shown that health care could become an obstruction although friendship and social activity were critical factors for women. For men, it was suggested that the retirement from work become an important opportunity for health promotion. After retirement from the familiar interpersonal relationships in the company, it was thought that men needed assistence to facilitate conversion to life in local society, and this being done smoothly influenced health behavior and social participation. In the development of future health promotion programs, it was considered necessary to provide support based on these findings.
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  • The development of a coil for vascular occlusion using atelocollagen
    --Vascular tissue change after prolonged coil detainment in long-term animal experiments--
    MASAHIKO KISHIRO
    2007 Volume 53 Issue 3 Pages 446-457
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.446
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    Objective : When a metal coil is used for coil embolectomy for patent ductus arterious or major collateral vessels, the long-term effect on the subject is an issue of concern. The development of a collagen coil made from atelocollagen that promotes self-organization after detainment but seems to heve negligible long-term effect was attempted, and histological changes in the coil and blood vessel by were examined animal experiments. Materials and Methods : Twelve mongrel adult dogs weighing 9.8-12.0kg were used. The collagen coil was endoscopically implanted in adult the blood vessel (renal artery, carotid artery, vertebral artery) of an adult dog. Over the time course from 1 week to 5 years post detainment, blood vessels were collected, and the state of obstruction was observed, and the changes in the vascular lumen and coil were histologically examined. Measurement and Results : A radiopaque collagen coil was produced for use in vascular occlusion and was able to be implanted successfully. After detainment for 5 years, the collagen coil was harvested and examined. The coil remained histologically complete and had induced perfect self-organization. Atelocollagen was an efficient material for the collagen coil and multiple factors seemed to be involved in the balance between the in vivo absorption rate and rate at which new organization was generated. Conclusions : A coil for the vascular occlusion made from atelocollagen was successfully produced, and achieved perfect self-organization over a 5-year period of implantation. It seems that this experimental result indicates the possibility of a substitute for metal coils.
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  • Educational challenges for proper disposal of domestic medical waste at home-visit nursing care stations
    AYAKO KUDO, KEIKO INATOMI, SHIHOKO SAKUMA
    2007 Volume 53 Issue 3 Pages 458-467
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.458
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    This study emphasizes the educational challenges regarding proper disposal of domestic medical waste at home-visit nursing care stations based on the actual conditions of how visiting nurses and responsible officials of facilities deal with domestic medical waste disposal. We mailed constitutive questionnaire forms to 703 visiting nurses and 345 responsible officials. The questionnaire focused mostly on 4 points. 1) Disposal conditions of domestic medical waste 2) Methods and contents of guidance on medical waste management 3) Awareness and management regarding infectious medical waste 4) Requests made to the government, business enterprises and facilities. Followings are the results from the surveys. 1) Disposable materials that visiting nurses bring back include syringes, needles, infusion sets, TES-TAPEs, Cut-needles. 2) Twenty-five percent of personnel had participated in at least one workshop on medica waste disposal. 3) Thirty-four percent of the responsible officials had sent staff members to workshops. 4) Manual preparation on medical waste disposal and opportunities for studying infectious diseases have been requested from facilities. 5) Visiting nurses and responsible officials of facilities have requested the government and business enterprises to promote greater diffusion of knowledge. As indicated above, our study has demonstrated that few of the responsible officials send staff members from their facilities to workshops even though staff who have participated to those workshops recognized the workshops as effective. Hence, the diffusion of knowledge on domestic medical waste disposal among visiting nurses and manual preparations for infectious medical waste management based on the disposal systems of each municipality and facility are urgent challenges to be addressed.
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  • Difficulties in raising children experienced by mothers of infants
    SHINOBU YAMAGUCHI, EIJI MARUI, SUSUMU SAITO, NAOKO ARAGA
    2007 Volume 53 Issue 3 Pages 468-476
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.468
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    Purpose : To determine the prevalence of mothers having difficulties in raising their infants and elucidate the relationship between such emotional experiences and the mothers' attributes. Subjects : The subjects were all mothers (n=910) with infants and resided in one of the two cities in Chiba Prefecture. All subjected gave informed consent to the current study prior to participation. Method : In October 2005, a postal survey was conducted using an anonymous questionnaires. To locate those mothers experiencing disquiet as described above, a questionnaire regarding support in child-rearing (for infants), which was prepared by Japan Child and Family Research Institute was employed. Results : There were 390 effective responses. Seventy-six mothers (21.0%) reported difficulties in raising their child. Among these, 16 (4.4%) expressed Difficulties in raising in both categories I and II and were ranked 5. Among those mothers without difficulties in child-rearing (79.0%), 45.0% professed to be totally free of such experiences. Among the effects of 7 maternal attributes such as age and family members, a correlation with a history of pregnancy complications was noted (p<0.05). There was correlation with any of 7 attributes related to the child such as sex and health status. Conclusion : About 21% of mothers reported sense of difficulty in child-rearing, which was an increase over that in the 2000 report. Especially the number of mothers having a strong sense of difficulties increased and a correlation with pregnancy complications was noted. It is urgent that we make an effort to ease difficulties in child rearing. For such a purpose, it is necessary to develop both a universal scale to measure these difficulties and a method for preventing their exacerbation.
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  • Physiological changes of the deep vein in lower limbs during pregnancy
    YINGHUA LI, YASUSHI NAKAMURA, SHIGERU ITOH, KATSUYUKI KINOSHITA
    2007 Volume 53 Issue 3 Pages 477-484
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.477
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    Objective : Pregnancy is considered to increase the risk of deep vein thrombosis (DVT). However, it is not easy to detect women at higher risk of DVT before and after conception. Therefore, this study investigated physiological changes in the lower limbs during and after pregnancy as basic data to prevent DVT. Material : One hundred and sixteen pregnant women and 10 non-pregnant women were investigated in the present study. One hundred twenty examinations were totally performed. Method : The diameter of vessels and blood flow velocity of the superficial femoral (FV) and popliteal vein (PV) in the bilateral limbs were measured with ultrasound in all cases. To assess the physiological changes during pregnancy, four periods during pregnancy were defined in the present study. These were between 6 and 10 weeks (early (e) stage), between 20 and 24 weeks (middle (m) stage), between 30 and 34 weeks (late (1) stage), and after 36 weeks of gestation. In addition to these periods, the postpartum period was examined on the 3rd day after delivery. In each period, 30 examinations were performed. The mean value was calculated in each period and hemodynamic changes in both limbs were assessed during and after pregnancy. Significant difference was defined as p<0.05. Result : In the early stage, the diameters of the two veins had not yet changed, but the diameters gradually increased after 20 weeks of gestation. These changes in both veins were significant compared with those in non pregnant women (FV; non-preg. vs. m-stage, 1-stage; p<0.001, PV; non-preg. vs. m-stage, 1-stage; p<0.001. In comparison between the right and left side, diameters of both vessels on the left side were significantly increased only during the late stage of pregnancy (FV; It vs. rt, p<0.01 PV : lt vs. rt, p<0.001. In the assessment of blood flow, flow-velocity in both vessels was significant slower after 20 weeks of gestation compared with that in the non-pregnant state, but there was no significant differences on comparison between the right and the left vessels throughout pregnancy. After delivery, diameter and flow velocity immediately returned to that in the non-pregnant state. There were no patients with DVT in the present study. Conclusion : It was confirmed that the left limb showed a higher risk of DVT than the right limb according to changes in the diameters of FV and PV during pregnancy. Pregnancy induced slow venous velocity but there were no significant changes between the right and left limbs in normal pregnancy. Therefore, it is likely that not only the diameters of the vessels but also measurement of flow-velocity with ultrasound equipment is important to detect pregnant women with a higher risk of DVT.
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  • Intestinal Behcet's disease diagnosed with recurrent stomatitis and growth retardation in an 11-year-old boy.
    AYAKO KAMATA, KAORU OBINATA, HIROKI SUGANUMA, HARUNA BABA, TAKAHIRO NI ...
    2007 Volume 53 Issue 3 Pages 506-510
    Published: September 30, 2007
    Released on J-STAGE: November 12, 2014
    DOIhttps://doi.org/10.14789/pjmj.53.506
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    We reported a boy with recurrent aphthous stomatitis and growth retardation since 9 years old. Since he had complained of abdominal pain and diarrhea, colonoscopy was performed. The findings included multiple patchy ulcers mainly in the terminal ileum, and dysfunction of Bauhin valve. Neither skin eruption nor uveitis was recognized. The patient's father had distinctive symptoms of Behcet's disease, and human lymphocyte antigens were positive for B51. According to these findings, the patient was diagnosed as having intestinal Behcet's disease. The intestinal type of Behcet's disease is more commonly found in childhood. For pediatric patients with recurrent stomatitis, growth retardation and chronic abdominal symptoms, Behcet's disease should be considered in the differential diagnosis. recurrent stomatitis, growth retardation, intestinal Behcet's disease
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