Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 58, Issue 2
Displaying 1-18 of 18 articles from this issue
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Contents
  • Clinical Manifestation and Classification of Japanese patients with Inherited Keratinizing Disorders
    AYAKO IKEJIMA, YASUSHI SUGA, YUKI MIZUNO, KUNITAKA HARUNA, KENICHI TAN ...
    2012 Volume 58 Issue 2 Pages 135-142
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.135
    JOURNAL FREE ACCESS
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    Objective: Inherited keratinizing disorders are a spectrum of relatively rare skin diseases with a variety of congenital defects in the keratinizing process. In this study, we evaluated patients with inherited keratinizing disorders in the Tokyo urban area from the clinicians' viewpoint. Patients: We retrospectively evaluated 77 cases of inherited keratinizing disorders (male/female: 43/34 cases, mean age at first visit: 20.2 years) who visited our institution in the past 5 years. Methods: The cases were classified into 3 major groups; ichthyoses, palmoplantar keratodermas (PPK), and macular- and punctuate-type keratodermas. Definite diagnoses were achieved according to the clinico-pathological features and genetic analyses. Results: The ichthyoses group (48 cases: 62.3%) consisted of dominant ichthyosis vulgaris (IV: 13 cases), X-linked ichthyosis (XLI: 16 cases), lamellar ichthyosis (LI: 4 cases), and bullous/nonbullous congenital ichthyosiform erythroderma (BCIE and NBCIE: 3 cases each). PPK groups (21 cases: 27.3%) included Vörner-type (7 cases) and Nagashima-type (9 cases). Macular/punctuate-type keratodermas (8 cases: 10.4%) included 4 cases of Darier's disease. The discrepancy between percentages above and reported incidence of each disorder most likely resulted from the increasing tendency of visits in patients with severe symptoms. The therapeutic approach was application of topical moisturizers, in combination with topical vitamin D3 analogue, steroid, and antibiotics/antifungal agents. In addition, some cases were treated with oral retinoids and antihistamines. Conclusions: Although genetic analysis is necessary for definitive diagnosis, this simplified classification based on clinical features and morphological changes seems to be useful for clinical diagnosis and first-line aid for patients. The establishment of guidelines for diagnosis, therapy and patient care of inherited keratinizing disorders in Japan is urgently needed.
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  • Effect of Ablation Speed in the Endovenous Laser Ablation Using Pulsed 1,320 nm Laser
    MICHIAKI SUEISHI, NAOKI SAKAKIBARA, ATSUSHI AMANO
    2012 Volume 58 Issue 2 Pages 143-150
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.143
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    Objectives: The present study evaluated the significance of LEED under different ablation speeds based on histopathology and mid-term results. Materials and Methods: A total of 97 endovenous laser ablations (EVLAs) were performed by 1,320 nm pulsed YAG laser to incompetent great saphenous veins (GSVs). LEED was fixed by 120 J/cm, and ablation speeds were selected as 0.5 mm/sec in the low-speed group (n=42) and 1 mm/sec in the high-speed group (n=55). System parameters were set by power output of 6 W, peak power of 343 W, pulse width of 350 nsec and frequency of 50 Hz. In the high-speed group, ELVA was repeated twice with the same parameter after high ligation. Results: Mean diameter of GSV was 9.4mm and high ligation was performed in 87 legs (90%). Mean LEED was 120 ± 3 J/cm in the low-speed group and 119 ± 11 J/cm in the high-speed group. No laser-related complications occurred for any procedures. All treated GSVs were occluded by thrombus formation one month after EVLA. Negative remodeling rate shown by proportion of veins that shrunk more than 50% to total ablated veins was observed in 6% of the high-speed group and 48% of the low-speed group after one month. These values were 11% and 62% after 3 months, while both groups showed equivalent shrinkage of 70% and 75% after 6 months and 98% and 100% after 12 months, respectively. Conclusions: LEED is a standard parameter to obtain successful EVL;however, ablation speed affects the GSV shrinkage in mid-term observation. A low speed of 0.5 mm/sec with LEED of 120 J/cm accelerated the healing of ablated GSV without any complications.
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  • MORPHOLOGICAL ANALYSIS OF HUMAN BODY EXPRESSION IN THE MUSCLE MAN FIGURES IN “FABRICA” OF VESALIUS
    HIROHIKO AKUTSU, TADASHI SAWAI, TATSUO SAKAI
    2012 Volume 58 Issue 2 Pages 151-160
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.151
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    Objective : The anatomical figures of muscle men in Vesalius' “Fabrica” (1543) were analyzed to evaluate their morphological accuracy concerning anatomical distortion and the proportion of length and width of the body parts. Materials and Methods : Among the 14 anatomical figures of muscle men in “Fabrica”, we used three figures depicting the most superficial muscles of the anterior, lateral and posterior aspects. The anatomical figures of superficial muscle men in Albinus' “Tabulae” (1747) were used as controls. In the first approach to evaluate the anatomical distortion, we identified the landmarks of the skeleton to reconstruct the constituent bones by removing individual muscles one by one. The obtained figures of reconstructed skeleton of “Fabrica” were superimposed on the figures of muscle men to compare with those of “Tabulae” superimposed. In the second approach to evaluate the proportion of size, we measured the length and width of parts of the trunk, upper limbs and lower limbs, obtained relative values to the body height, and compared them between “Fabrica” and “Tabulae”. Results : The reconstructed skeleton of “Fabrica” appeared to be orthodox, but exhibited several serious distortions including barrel-shaped bony thorax with tapered upper and lower ends and extremely strange shapes of the bony pelvis resulting from contradicting portraits of muscles attaching the pelvis. In the morphometric analysis, the width of muscle men in “Fabrica” was generally larger in any body parts than in “Tabulae”, and were most conspicuously larger in the forearm. The length of individual body parts was variously different between “Fabrica” and “Tabulae” without any tendency of increase or decrease depending on the body parts. Conclusions : The anatomical figures of muscle men in “Fabrica” were thought to be created first by drawing outlines on the basis of observations of living men and then by adding portraits of individual muscles. The muscle men in “Fabrica” became thick because of the thickness of subcutaneous fat contained in living man as well as due to the appeal for stout human figures in the art of the era.
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  • CYTOKINE KINETICS IN PROLONGED LOW INTENSITY RUNNING AND THE EFFECT OF WHEAT GLUTEN HYDROLYSATE
    TOMOKO KAJISA, MASAYUKI WATANABE, MAKOTO OHTA, AKIO IMANISHI, RYUZO HI ...
    2012 Volume 58 Issue 2 Pages 161-167
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.161
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    Objective : To determine cytokine kinetics in prolonged low-intensity running and the effect of periodical wheat gluten hydrolysate (WGH) administration. Participants : Sixteen male runners who participated in a 24-hour running race. Methods : Participants were assigned randomly into group W (n=8), which consumed WGH (3g) every hour, and group P (n=8) which consumed indigestible dextrin at the same interval. Blood was sampled one hour before, and six hours and 12 hours afterthe start of the race. Then, cytokines (IL-6, TNF-α, and TGF-β1), glutamine (Gln), and creatine kinase (CK) were measured. Results : In group P, at 12 hours after the start of the race, compared to pre-race levels, IL-6 and CK increased and TNF-α decreased, while TGF-β1 was unchanged (p>0.05). Plasma Gln decreased significantly (p<0.05). On the other hand, in group W, at 12 hours after the start of the race, compared to one hour before, Gln levels were stable, and CK levels were constantly lower than that of group P. Furthermore, TNF-α (p<0.01) and TGF-β1 (p<0.05) levels decreased significantly. Conclusions : After prolonged low intensity running, IL-6 and CK levels increased while TNF-α and Gln levels decreased. From this result, the preceding increase of IL-6 levels may suppress the increase of TNF-α level. On the other hand, in group W, Gln levels were stable, and TNF-α and TGF-β1, which is regarded as a marker of fatigue, decreased significantly. Moreover, IL-6 and CK levels, which are closely related to inflammation, were lower than that of group P. Thus, in prolonged low intensity running, periodical WGH intake may have an anti-inflammatory effect and reduce fatigue.
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  • USEFULNESS OF SERUM PROTEINS AS EARLY MARKERS OF GLOMERULAR INJURY IN PATIENTS WITH TYPE 2 DIABETIC NEPHROPATHY
    KENSUKE SAITO, YASUHIKO TOMINO
    2012 Volume 58 Issue 2 Pages 168-172
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.168
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    Objectives : The objectives of the present study are 1) to determine whether the serum levels of urea nitrogen (UN), uric acid (UA), creatinine, albumin (ALB), transthyretin (TTR), retinol binding protein (RBP), cystatin C or beta-trace protein (BTP) are markers of glomerular injury in patients with type 2 diabetic nephropathy and 2) to elucidate whether these serum proteins can be used forclinical classification of this disease. Materials and Methods : Serum samples from 82 patients with type 2 diabetic nephropathy were obtained from Juntendo University Hospital, Tokyo, Japan. They were classified into five groups according to the Report of the Ministry of Health and Welfare of Japan as follows : Stage I (normoalbuminuric stage), Stage II (microalbuminuric stage), Stage IIIa (macroalbuminuric stage without renal dysfunction), Stage IIIb (macroalbuminuric stage with renal dysfunction), and Stage IV (renal failure stage). Among these patients, 22 were in Stage I, seven in Stage II, 19 in Stage IIIa, 14 in Stage IIIb, and 20 in Stage IV. Levels of serum ALB, TTR, RBP, cystatin C and BTP were measured by a nephelometric assay using the BN II analyzer (Siemens Healthcare Diagnostics, Marburg, Germany). Results : Changes in serum levels of cystatin C and RBP between Stage 2 and Stage 3a were greater than those of the other markers. Serum cystatin C should be used as an early glomerular injury marker. Changes in serum levels of creatinine and cystatin C in Stage 3a, Stage 3b and Stage 4 were greater than those of the other markers. Serum creatinine should be used as a marker of late glomerular injury. Conclusions : It appears that serum cystatin C is a good marker for the identification of early glomerular injury while serum creatinine is a marker of late glomerular injury in patients with type 2 diabetic nephropathy.
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  • Evaluation of Anti-p53 Antibodies as a Molecular Marker for Breast Carcinoma
    KAZUYOSHI SUGIYAMA, MASAKI FUKUNAGA, MASARU SUDA
    2012 Volume 58 Issue 2 Pages 173-177
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.173
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    Serum autoantibodies against p53 (p53Ab) have been identified in patients with various tumors and are used as one of molecular markers. Here we examined the possible application of p53Ab for diagnosis of breast cancer. We collected sera from 141 patients with breast cancer and determined the p53Ab level by enzyme-linked immunosorbent assay with MESACUP anti -p53 test ELISA kit. The positive rate of p53Ab was greater than those of current molecular markers, breast cancer antigen -225 (BCA225), carcinoembryonic antigen (CEA), and carbohydrate antigen 15-3 (CA15-3). We found no significant relationships between the p53Ab level and patient's clinical characteristics including age, tumor size, and metastasis. Further, the value of p53Ab did not correlate with other serological tumor markers and expression levels of hormonal receptors (estrogen receptor and progesterone receptor) and HER2. The sensitivities of BCA225 and CEA were relatively low in early stages and increased in a stage-dependent manner while the positive rate of p53Ab was sustained from early to late stages at a high level (14.6% and 15.4%, respectively). Combinations of p53Ab with BCA225, CEA, and CA15-3 improved the positive rate to 20.6%, 21.2%, and 26.7%, respectively, which were greater than the positive rate obtained by combinations of other serological markers. Thus, serum p53Ab is a useful molecular marker of breast carcinoma and we recommend the combination assay with other serological markers for clinical diagnosis.
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  • TWO CASES OF ENTEROVESICAL FISTULA DUE TO COLORECTAL CANCER INVASION WHICH DISAPPEARED WITH PREOPERATIVE CHEMORADIOTHERAPY
    HIROHITO KOBAYASHI, KOSUKE KITAMURA, TOSHIHIRO TAI, SAINOSUKE MIZUKAMI ...
    2012 Volume 58 Issue 2 Pages 178-182
    Published: April 30, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.178
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    We report two cases of enterovesical fistula due to colorectal cancer invasion that disappeared with preoperative chemoradiotherapy. The first case was diagnosed as vesicorectal fistula due to rectal cancer, and the second case was sigmoid colon cancer. In both cases, we performed colectomy as a two-stage operation after chemoradiotherapy and colostomy. Intraoperative inspection showed adhesion of the colon and bladder, but did not detect a fistula in both cases. Therefore, we considered excision of the bladder unnecessary. In past reports, most cases of enterovesical fistula due to colorectal cancer were treated by colectomy and partial or total resection of the bladder. However, our cases did not require excision of the bladder by performing preoperative chemoradiotherapy.
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