Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 55, Issue 2
Displaying 1-21 of 21 articles from this issue
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Contents
  • Several Substances in Cerebrospinal Fluid as Parameters of Central Nervous System Disorders
    KENICHIRO KANEKO
    2009 Volume 55 Issue 2 Pages 117-122
    Published: June 30, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.117
    JOURNAL FREE ACCESS
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    For diagnosis, determining the severity and prognosis of central nervous system (CNS) disorders, measurement of various parameters in the cerebrospinal fluid (CSF) is more clinically useful than the measurement of serum parameters. We measured the levels of four substances [neuron-specific enolase (NSE), 2', 5' -oligoadenyl acid synthetase (2-5AS) activity, neopterin and matrix metalloproteinase 9 (MMP-9)] in CSF as unique parameters of CNS disorders. 1) NSE levels were significantly higher in neonates with severe bran damage and in children with bacterial meningitis than in controls. NSE levels remained high in those with poor neurological prognosis. These findings suggested that NSE could be a marker of neuronal damage. 2) 2-5 AS activity was markedly increased in children with viral infection of CNS (aseptic meningitis). This marker was useful for establishing an early diagnose and for predicting whether the illness would be prolonged. 3) Neopterin levels were significantly elevated in children with bacterial and aseptic meningitis, so it was considered useful for evaluating inflammation of the CNS. 4) MMP-9 levels were abnormally increased in children with bacterial meningitis, but were low in children with other inflammatory diseases of the CNS. These findings indicated that MMP-9 would be a useful marker for establishing a definite diagnosis of bacterial meningitis and for assessing clinical prognosis.
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  • Orthopedic procedures that I have experienced.
    HISASHI KUROSAWA
    2009 Volume 55 Issue 2 Pages 123-127
    Published: June 30, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.123
    JOURNAL FREE ACCESS
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    Orthopedics covers patients from newborns to the elderly and pathogeneses from disease to injury. This lecture includes 1) knee sports injury and 2) osteoarthritis of the knee, which affects the elderly. Today, surgery for anterior cruciate ligament (ACL) injury is often performed. Dr. Nakajima Hiroyuki and I developed N-test, which is the provocative test for ACL instability. In early 1980s, we also developed the first arthroscopic technique for ACL reconstruction. These two techniques are currently indispensable for surgery for ACL injury. Japan currently has the highest longevity worldwide. Many people develop disabilities affecting their ADL because of disorders in motor organs several years before their death. One such disorder is osteoarthritis of the knee. We have developed exercise therapy for this disorder and have proven its efficacy in several trials. We will continue to develop new diagnostic and therapeutic methods for OA of the knee in cooperation with Sportology studies in our University.
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  • Clinical importance of detecting micrometastasis of esophageal cancer in lymph nodes by staining with anti-cytokeratin antibody
    TAKAO ANDO, MASAHIKO TSURUMARU, YOSHIAKI KAJIYAMA, YOSHIMI IWANUMA, NA ...
    2009 Volume 55 Issue 2 Pages 128-135
    Published: June 30, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.128
    JOURNAL FREE ACCESS
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    Objectives : Esophageal cancer has a poor prognosis with a high recurrence rate even after radical surgery. Postoperative recurrence may be observed even in cases resected at an early stage and the involvement of a minute metastatic lesion that cannot be detected by traditional histological methods is suspected in recurrent cases. In this study, minute metastases from esophageal cancer to surgically resected lymph nodes were detected by immunohistological staining method with anti-cytokeratin antibody (CK13). The clinical significance of this method is discussed. Subjects : The subjects were 28 patients with differentiated squamous cell carcinoma who did not undergo preoperative treatment prior to radical esophagectomy with three field lymph node dissection and whose prognosis was predictable. These subjects were selected from 80 patients with esophageal cancer who underwent surgical resection in the Department of Gastroesophageal Surgery, Juntendo University Hospital in 2000. Methods : After a conventional histopathological examination, 3,289 surgically resected lymph nodes sliced at a thickness of 3μm were stained with CK13 for microscopy to analyze prognostic factors. Results : Of the 3,289 lymph nodes, 102 from 20 patients were recognized as metastatic on HE staining. Staining with CK13 demonstrated an additional 19 micrometastatic lesions in 11 patients, and lymph node metastasis was detected with CK13 but not with HE staining (p0) in 1 case (6.9%). Multivariate analysis was conducted with covariates of depth of tumor invasion, number and size of metastatic lymph nodes, lymphatic invasion or venous invasion, tumor differentiation, maximal diameter of the tumor, and tumorous location as potential prognostic factors. This analysis showed that micrometastasis and size of the metastatic lesion in the lymph node were independently correlated with prognosis. Conclusions : Micrometastasis from esophageal cancer to lymph nodes should be considered similar to metastasis detected by HE staining. Therefore, such a finding may be an important index when considering additional postoperative treatment.
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  • Probiotic Supplementation Dramatically Decreases Infection Deaths in Extremely and Very Low Birth Weight Infants
    HIROAKI SATO, MASAKI DAIGO, KAZUHIRO OHZEKI, HIKARU UMEZAKI, AYAKO KUD ...
    2009 Volume 55 Issue 2 Pages 136-141
    Published: June 30, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.136
    JOURNAL FREE ACCESS
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    Objective: To investigate whether daily supplementation with the probiotic Bifidobacteria (B. breve) reduces infection-related mortality in extremely low birth weight (ELBW) and very low birth weight (VLBW) premature infants. Patients and Methods: We conducted a retrospective investigation of the effect of B. breve supplementation on two groups of premature infants; one group received B. breve supplementation and one did not. The non-supplemented group was comprised of 309 premature infants (126 ELBW and 183 VLBW) who were admitted to the Neonatal Intensive Care Unit (NICU) during a 6-year period (1994-1999). The B. breve supplemented group was comprised of 434 premature infants (210 ELBW and 224 VLBW) who were admitted to the NICU during a different 6-year period (2001-2006). Infants in the supplemented group were given B. breve at a daily dose of 1 x 109 CFU (M-16V, Morinaga, Japan, freeze-dried preparation). The B. breve supplement was dissolved in either raw mother's milk or in a mixture of preterm formula and mother's milk, starting several hours after birth and continuing until discharge from the NICU. The non-supplemented infants were fed a similar regimen that did not include, B. breve supplementation. Infection-related mortality was defined as the death of an infant after 3 days of age after a diagnosis of severe infection or sepsis based on clinical features and laboratory data. The infants were diagnosed irrespective of blood culture results when abnormalities of white blood cell counts, differentials, and serial levels of CRP≥2.0mg/dl were found. Results: The infection related mortality was significantly reduced in ELBW infants and in all infants weighing less than 1,500g at birth in the B. breve supplemented group. Conclusion: Daily supplementation with B. breve in infants weighing less than 1,500g at birth was a very effective method for reducing the infection-related mortality in these premature infants.
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  • An alumna survey of female physicians
    YUKA YAMAZAKI, EIJI MARUI
    2009 Volume 55 Issue 2 Pages 142-147
    Published: June 30, 2009
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.142
    JOURNAL FREE ACCESS
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    Objective Despite an increase in the number of female physicians in Japan, there is a tendency for them to leave their positions due to conflicts with child rearing, which results in a progressive physician shortage. The objective of this study was to investigate the conditions around female physicians leaving work, their current work status, and factors affecting work status. A survey was conducted with alumnae of Juntendo University (Tokyo), which has constantly had cohorts of around thirty female medical students per year since 2002. Methods: A questionnaire was mailed to all 646 female physician alumnae graduated from our university by 2007. The main question items are about the following : “number of years since graduation, ” “specialty field, ” “work status, ” “marriage and childbirth, ” “child rearing, ” “special treatment as a woman, ” and “levels of satisfaction of profession and life.” For statistical analyses we used χ2 tests, Mantel-Haenszel tests and factor analyses to grasp overall tendency. Results: The response rate was 38.2%. Regarding years since graduation, more than 31 years was the longest, and less than 5 years was the shortest. The rate of leaving work was 6.5%, and the rate of working full-time was 84.8%. Those who changed work status due to child rearing conflicts comprised 78.0%. Female physicians who are mothers tended to report that they had received ''special treatment as a woman, '' and also tended to leave academic medicine and to practice part-time. On the other hand, compared with single doctors, they showed significantly higher ''levels of satisfaction of profession and life.'' Those whose years since graduation were longer than 21 tended to select so-called minor fields as their specialty, and few of them selected surgical fields. Among those whose years since graduation were shorter than 21, some reported that they had received discriminatory treatment. Conclusions: The rates of leaving work and part-time work in this study were not very high. In order to obtain more specific rates of leaving work, it would be necessary to conduct a census-like survey focusing on cohorts who are in their 30s and 40s, and who are in the middle of child rearing.
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