Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 56, Issue 6
Displaying 1-15 of 15 articles from this issue
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Contents
  • Stress and cardiovascular diseases
    stress induced myocardial dysfunction, “Takotsubo cardiomyopathy” as a newly recognized cardiac disorder
    HIROMASA SUZUKI
    2010 Volume 56 Issue 6 Pages 520-528
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.520
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    There is close relationship between stress and cardiovascular diseases. The detrimental effects of stress on the cardiovascular system have been documented through research in animal models and humans. Extensive epidemiological data show that chronic job stress and cardiovascular reactivity in response to stress are associated with hypertension, arrhythmia, coronary heart disease, and stroke. Acute and rapidly reversible left ventricular (LV) dysfunction triggered by emotional stress has recently been recognized. In 1990, Japanese physicians first recognized a syndrome characterized by abrupt chest pain, ST-segment elevation and transient LV apical aneurysm with normal coronary arteries. They proposed the term “Tako-tsubo” (Japanese for octopus trap) cardiomyopathy based on the peculiar appearance of a rounded bottom and narrow neck on the end-systolic LV appearance. This cardiomyopathy mimics acute myocardial infarction. However, coronary angiography does not demonstrate significant stenosis, while the apex shows ballooning, which usually resolves in a few weeks. Cardiac biomarkers do not increase to the level typically seen in acute myocardial infarction or myocarditis with similar degrees of LV dysfunction. The syndrome most commonly affects postmenopausal women after experiencing a profound stressful event such as the unexpected death of a close relative or terrible accident. Interestingly, the incidence of Takotsubo cardiomyopathy increased sharply in elderly women living near the epicenter immediately after the Mid-Niigata prefecture earthquake in 2004. The prognosis of this entity is generally favorable, but some patients require intra-aortic balloon pumping because of cardiogenic shock. Although many questions remain, for example, concerning the role of this acute stress-induced syndrome and pronounced elderly female predominance, physicians should consider this newly recognized disorder in patients with chest pain and a stressful event, especially elderly women.
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  • Stress and respiratory disease
    RYO ATSUTA
    2010 Volume 56 Issue 6 Pages 529-536
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.529
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    In recent years, there has been a trend toward increased psychological stress due to changing social environments and systems. Stress affects various diseases, and can cause the disease state to become more prolonged and severe. A series of diseases that occur as a result of stress are called psychosomatic disorders, which are defined as “a disease condition in which onset and psychosocial factors are closely linked and no organic or functional impairment is seen, excluding physical symptoms that accompany other mental disorders such as neurosis or depression.” In recent years, psychosomatic disorders have been increasing. Respiratory diseases in which psychosomatic medicine should be considered include bronchial asthma, nervous (psychogenic) cough, and hyperventilation syndrome. Bronchial asthma in particular has shown an increase in recent years similar to the rise in psychosomatic disorders. As with physical stress, mental stress also plays a large role in prolonging disease and making it more intractable, and physical and mental stress have become major social problems together with psychosomatic disorders. Herein, we analyze the causes, diagnosis, and treatment of bronchial asthma and psychosomatic disorders.
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  • Stress and gastrointestinal diseases
    MARIKO HOJO, SUMIO WATANABE
    2010 Volume 56 Issue 6 Pages 537-542
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.537
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    Gastroduodenal ulcer, ulcerative colitis, chronic pancreatitis, and functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome and functional dyspepsia are typical gastrointestinal diseases associated with stress. Acute gastric mucosal lesion and gastroduodenal ulcer appear to be associated with physical and psychological stressors, respectively. Chronic long-term stress increases the risk of exacerbation in ulcerative colitis, and the patient's sense of pain from chronic pancreatitis also appears to be increased by stress. Stress is known to induce physical abnormalities such as abnormal motility and visceral hypersensitivity of the gut, while physical abnormality also produces stress. This relationship is called the “brain-gut axis”. FGID patients often display more severe symptoms of physical abnormality in response to stress than healthy individuals. Currently, corticotropin releasing factor has attracted attention as a promising substance to control the brain-gut axis, although the mechanism underlying the brain-gut axis remains to be elucidated.
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  • Stress and coping
    YOSHIE SAKAI
    2010 Volume 56 Issue 6 Pages 543-549
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.543
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    In order to maintain mental and physical health, it is necessary to improve stress coping skills. Cognitive -behavioral therapy (CBT), originally developed as psychotherapy for depression, is also effective in various other mental disorders such as anxiety disorder and alcoholism. In addition, a number of controlled trials have suggested that CBT may reduce general distress in various physical diseases. Moreover, according to several recent studies indicating that CBT has an impact on lifestyle issues such as smoking and obesity, it is expected that CBT may contribute to preventing mental and physical disease. Stress management programs that use a cognitive-behavioral therapy approach are expected to extend into various fields such as education and industry in the future.
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  • Effects of Cyclooxygenase-1 or -2 Inhibitors on Expressions of ATP2A2 and ATP2C1 in Cultured Normal Human Keratinocytes
    RYOHEI SUGIMURA, NOBUYASU MAYUZUMI, SHIGAKU IKEDA
    2010 Volume 56 Issue 6 Pages 550-557
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.550
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    Background: Darier's disease (DD) and Hailey-Hailey disease (HHD) are autosomal dominantly inherited skin disorders characterized by the loss of adhesion between epidermal cells and by abnormal keratinization. DD is caused by mutations in ATP2A2, encoding the sarco/endoplasmic reticulum Ca2+ ATPase type 2 isoform (SERCA2), and HHD arises from mutations in ATP2C1, a homologue of Golgi secretory pathway Ca2+ ATPase (SPCA1). Clinically and histologically, these diseases have common features. Exposure to UVB irradiation exacerbates the skin lesions of both diseases and expressions of ATP2A2 and ATP2C1 mRNA are suppressed by UVB irradiation in cultured normal human keratinocytes. UVB irradiation also induces Cyclooxygenase -2 (COX-2) mRNA expression. Objectives: To examine the effects of COX-1 and COX-2 on ATP2A2 and ATP2C1 mRNA expression. Methods: We used quantitative reverse transcriptase-polymerase chain reactions to examine the effects of celecoxib (a COX-2 selective inhibitor), SC-560 (COX-1 selective), and apigenin, (which is known to prevent UVB-induced COX-2 expression) on UVB-induced suppression of ATP2A2 and ATP2C1 mRNA in vitro. Results: Celecoxib and apigenin increased and SC-560 decreased the levels of UVB-induced suppression of ATP2A2 and ATP2C1 mRNA. Conclusions: These findings suggest that COX-2 suppresses the expression of ATP2A2 and ATP2C1 mRNA, while COX-1 might play an important role in the gene-regulating mechanism of ATP2A2 and ATP2C1 and is required to maintain the homeostasis of Ca2+ in keratinocytes.
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  • Effect of a leukotriene receptor antagonist in children with food allergy
    YOKO YAMAKAWA, YOSHIKAZU OHTSUKA, KIYOTAKA OHTANI, TOHRU FUJII, SATORU ...
    2010 Volume 56 Issue 6 Pages 558-563
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.558
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    Background : Although the efficacy of leukotriene receptor antagonists (LTRA) for bronchial asthma has already been established, their effect on food allergy remains unclear. In this study, we investigated the efficacy of LTRA in children with food allergy. Methods : This retrospective review examines 65 children with food allergy aged between 3 and 36 months (mean : 14±9.6 months). Thirty-two children comprised a dietary control group that avoided any antigenic foods that had previously induced any adverse reaction. The remaining 33 children, designated the LTRA group, were treated with LTRA in addition to maintaining dietary control. Clinical symptoms and laboratory data before and one year after the trial were compared between the groups. Results : Peripheral eosinophil count, serum IgE, interleukin (IL) -4, IL-5, IL-6, and eosinophil cationic protein (ECP) levels in children with food allergy were above standardized values in both groups. Although both dietary controlled and LTRA groups showed clinical improvement with decreased eosinophil count (p<0.05 and <0.001, respectively), only children treated with LTRA showed a significant decrease in serum IgE (p<0.01); controls conversely exhibited a significant increase in serum IgE (p<0.01). Furthermore, the LTRA group also showed a significant decrease in serum IL-4, IL-5, and ECP levels (p<0.05 for each). Conclusion : Early intervention with LTRA in food allergy between 3 to 36 months of age may be effective in regulating eosinophil count and serum IgE, IL-4, IL-5, and ECP levels. These data support the potential effectiveness of early LTRA treatment to prevent the further development of food allergy in young children.
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  • Histopathological Examination of Stenosis After Stent Implantation in Porcine Arteries
    MASAHIRO OHTSUKI, MATAICHI OHKUBO, TAKESHI FURUKAWA, KEN TAKAHASHI, MA ...
    2010 Volume 56 Issue 6 Pages 564-571
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.564
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    Background: Stenotic changes after stent implantation for coarctation of the aorta remain a major problem. There are only a few studies examining pathological vascular changes of the great arteries after stenting in the pediatric population. Aim: Using immunohistochemistry, we investigated the involvement of chronic inflammation in in-stent stenosis of abdominal great arteries after stent implantation in juvenile pigs. Methods: Five pigs, aged 4-5 weeks with body weights ranging from 8-10 kg, were used for this study. Stents were implanted in the abdominal great artery. Abdominal arteries with stents were later collected and stained with hematoxylin and eosin. Immunological staining was also performed for the intima, using vascular endothelial growth factor (VEGF), interleukin-8 (IL-8), cyclooxygenase 2 (COX-2) and peroxisome proliferators activated receptor gamma (PPARγ) antibodies. Results: Only one of five samples showed stenotic change due to neointimal proliferation. Neutrophil recruitment in the neointima was confirmed by H & E stain at the site of stenosis. VEGF, IL-8, COX-2 and PPARγ expressions in the neointima were also increased at the site of stent implantation compared with those in normal tissue. Conclusion: Our data suggest that chronic inflammation is involved in the pathogenesis of instent stenosis after stent implantation. Management of inflammation may be important toprevent stenotic change after stenting in pediatric cardiology.
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  • Outcomes of Laparoscopic-Assisted Surgery for pSM Colorectal Cancer
    ZHIGANG GAO, YOSHIHIKO TASHIRO, KIICHI NAGAYASU, KOICHIRO NIWA, SEIGO ...
    2010 Volume 56 Issue 6 Pages 572-580
    Published: December 31, 2010
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.56.572
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    Objective: This study was performed to evaluate short-term surgical outcomes and oncologic efficacy of laparoscopic-assisted colectomy (LAC) for colorectal cancer with pathological submucosal invasion (pSM). Patients and methods: Consecutive patients who underwent elective LAC for pSM colorectal cancer at one institution between October 1994 and December 2006 were enrolled in the study. Data collection included the patients' general characteristics, and the surgical, pathological and oncological results. Results: A total of 120 patients with pSM colorectal cancer underwent LAC during the study period. The group included 40 males and 80 females, and had an average age of 59 years old (range, 31-80). The surgeries included 28 partial colectomies, 8 ileocecal colectomies, 10 right hemicolectomies, 40 sigmoid colectomies, 16 anterior resections, 17 low anterior resections, and 1 abdominoperineal resection. The mean surgical duration was 227 min (range, 147-535 min) and the mean blood loss volume was 33ml (range, 2-910ml). There were no major intraoperative complications. Conversion to open surgery was required in 3 cases (2.5%). There were no deaths during surgery or within the first 30days postoperatively. Anastomotic leak occurred in 2 cases (1.7%), ileus in 6 (5%), and wound infection in 4 (3.3%). The reoperation rate was 3.3%. An average of 11 lymph nodes were harvested (range, 3-40), and in 106 cases (88%), there were no detectable lymph node metastases, 11 (9.5%) had metastasis in 1 lymph node, 1 (0.8%) had metastases in 2 lymph nodes, and 2 (1.7%) had metastases in 3 lymph nodes. The number of harvested lymph nodes correlated with the category of lymph node dissection. However, the category of lymph node dissection did not correlate with intraoperative blood loss or surgical duration, and extensive lymph node dissection did not significantly increase the incidence of intraoperative or postoperative complications. The mean follow-up period was 4.8years, during which there was no local recurrence or port site metastasis. Distant metastasis was observed in 3 patients (2.5%) and lung metastasis was apparent in all of these patients. The 3-year disease-free survival rate was 99.2% (119/120). Conclusion: Laparoscopic-assisted colorectal resection for SM colorectal cancer is safe and effective. LAC with extensive lymph node dissection for SM colorectal cancer does not compromise the short-term surgical outcome.
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