Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 58, Issue 4
Displaying 1-18 of 18 articles from this issue
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Contents
  • MECHANISM OF INVASION AND METASTASIS OF BREAST CANCER
    FUMIYUKI TAKAHASHI
    2012 Volume 58 Issue 4 Pages 288-292
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.288
    JOURNAL FREE ACCESS
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    The ErbB/HER pathway and epithelial mesenchymal transition (EMT) play important roles in tumor invasion and metastasis of breast cancer. Recently, it has been reported that EMT is also involved in the resistance to chemotherapy. This review highlights the biological role of HoxB9 and BTG2 in the development of breast cancer. Overexpression of HoxB9 and loss of BTG2 promote tumor growth and metastasis of breast cancer through activation of the ErbBR pathway and EMT. The expression rates of these genes might serve as useful biomarkers in the treatment of patients with breast cancer.
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  • PENTRAXIN 3 : A NEW BIOMARKER OF INFLAMMATION IN ACUTE CORONARY SYNDROMES-FROM BENCH TO BEDSIDE
    KENJI INOUE
    2012 Volume 58 Issue 4 Pages 293-302
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.293
    JOURNAL FREE ACCESS
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    Pentraxin 3 (PTX3) has been called a “brand-new protein in a traditional family” because the pentraxin family includes C-reactive protein (CRP) and serum protein A (SAP), and the past three years have seen numerous clinical papers published. Unlike CRP, PTX3 is expressed in atherosclerotic lesions that predominantly involve macrophages, neutrophils, dendritic cells, or smooth muscle cells. Interestingly, among more than 6,000 human genes pitavastatin suppresses PTX3 gene expression most markedly in human endothelial cells. Therefore we expect PTX3 to be a new biomarker for inflammatory vascular disease. To be an ideal biomarker, PTX3 must satisfy the following criteria : 1) the ability to standardize the assay and to control the variability of the measurement;2) independence from established risk factors;3) association with cardiovascular disease clinical end points in observational studies and clinical trials;4) presence of population norms to guide interpretation of results;5) ability to improve the overall prediction beyond that of traditional risk factors. If these criteria can be met, PTX3 may be useful as a new biomarker in inflammatory vascular disease.
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  • HOME MEDICAL CARE A TO Z
    YASUNORI ISHIGAKI
    2012 Volume 58 Issue 4 Pages 303-310
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.303
    JOURNAL FREE ACCESS
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    The population of Japan is rapidly aging, and in order to keep pace with the health care demands related to this demographic shift, reform of the health care system is essential. Home medical care was formally recognized in the 1980s. Medical care administered in the home is fundamentally different from medical treatment performed in a hospital setting. The latter is aimed at lifesaving, while the former is focused on improvement of quality of life. When terminal patients live out their remaining days at home, 24-hour medical assistance is essential. In this setting cooperation with nurses is required, and the home care physician must be knowledgeable about palliative care and risk management in home medical care. In addition, the physician needs to be more familiar with the patients' lifestyle than a clinic-based doctor. This article was created to clearly explain the essentials of home medical care.
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  • A CLINICOPATHOLOGICAL STUDY OF 32 CASES OF APOCRINE CARCINOMA OF THE BREAST
    IKUKO ABE, ATSUSHI ARAKAWA, JUN YASUDA, SATOKO TOMIYAMA, MITSUE SAITO, ...
    2012 Volume 58 Issue 4 Pages 311-318
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.311
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    Objective : We investigated 32 patients (34 lesions) with apocrine carcinoma (AC) of the breast for estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (Her2), and Ki67 expression. We analyzed the histological features of AC and their contribution to the diagnosis and treatment of AC. Materials : Thirty-two patients with histopathologically confirmed AC (two bilateral, 34 lesions in total) were identified among 1,910 primary breast cancer patients at the Department of Breast and Endocrine Surgery, Juntendo University School of Medicine, between January, 2006 and December, 2010. Methods : Optical microscopic study, immunohistological study, and ultrasonographic study were conducted. Results : Four patients with lymph node metastasis had invasive carcinoma : 1 was AC with ductal carcinoma, and 3 were AC without ductal carcinoma. These 4 patients were strongly positive for Ki67 according to the Ki67 labeling index (LI). According to the intrinsic subtype classification, 1 lesion was classified as Luminal A, 4 were Her2-negative and Luminal B, 1 was Her2-positive and Luminal B, 7 were Her2-rich, and 21 were triple-negative lesions. Among the 12 AC lesions found to be complicated by ductal carcinoma, 1/1 was Luminal A, 2/7 were Her2-rich, and 9/21 were triple-negative. Meanwhile, 5 of the 12 AC lesions complicated by ductal carcinoma were strongly positive for Ki67 LI. Conclusions : Three patients with invasive AC without ductal carcinoma in the present study had lymph node metastasis. These 3 patients tended to have relatively high Ki67 LI values, indicating that they may have had a high latent malignancy. Patients with this type of lesion may require more careful postoperative follow-up in the future, and treatment with conventional treatments, such as chemotherapy and hormone therapy, is recommended.
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  • LOSS OF AUTOPHAGY ENHANCES DIETHYLNITROSAMINE-INDUCED LIVER INJURY
    MIHEGULI ABUDOXUEKE, SHUNHEI YAMASHINA, KENICHI IKEJIMA, MASAAKI KOMAT ...
    2012 Volume 58 Issue 4 Pages 319-324
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.319
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    Objective : Previous reports indicated that mitochondrial dysfunction is essential for the development of liver injury due to diethylnitrosamine (DEN). On the other hand, autophagy, which is a major catabolic pathway, plays a critical role in removing protein aggregates, as well as damaged or excess mitochondria in order to maintain intracellular homeostasis. The aim of this study was to clarify if autophagy is linked to liver injury due to DEN. Methods : DEN was administered intraperitoneally (10mg/kg) to male C57BL/6mice (wild type) and conditional Atg7-knockout mice, which have autophagy-deficient livers. Mice of both genotypes were sacrificed 24 and 48 hours after administration of DEN. Liver tissues embedded in paraffin were cut and stained with H&E. TUNEL-staining was performed to evaluate apoptotic cells. Serum ALT value was measured to evaluate liver damage. Moreover, expression of caspase-3 and 7 were detected by Western blot analysis. Results : Serum ALT levels before administration of DEN were not significantly different between wild-type mice and conditional Atg7-knockout mice. Serum ALT levels at 48 hours after administration of DEN were elevated to about 7-fold in conditional Atg7-knockout mice but not control mice. Autophagy deficiency enhanced the number of TUNEL-positive cells and activation of caspase-3 and 7 in the liver after administration of DEN. Conclusions : Our data indicates that loss of autophagy enhances apoptosis of hepatocytes and liver injury due to DEN. These findings suggest that autophagy plays a pivotal role to prevent the excessive cell death of hepatocyte in DEN-induced liver injury.
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  • Serum Low-Density Lipoprotein Levels Predict Mid-Term Outcomes of Diabetic Patients After Off-Pump Coronary Artery Bypass Surgery
    TOMOAKI IZAWA, KAN KAJIMOTO, TAIRA YAMAMOTO, KATSUMI MIYAUCHI, HIROTAK ...
    2012 Volume 58 Issue 4 Pages 325-329
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.325
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    Objective: Metabolic disorders, such as higher low-density lipoprotein cholesterol (LDL-C) levels and diabetes mellitus are associated with an increased risk of adverse events in the secondary prevention of coronary artery disease. These metabolic disorders are also associated with adverse events after coronary artery bypass surgery. However, few reports describe the relationship between postoperative outcomes and preoperative serum levels of mediators including levels of fasting blood sugar (FBS), hemoglobin A1c (HbA1c) and LDL-C. This study assesses the impact of metabolic makers, including LDL-C, on midterm outcomes of patients with diabetes after off-pump coronary artery bypass surgery. Patients: We enrolled 350 diabetic patients who underwent isolated off-pump coronary artery bypass surgery at our institution between 2003 and 2007. Methods: Predictors of all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were identified using the Cox proportional-hazards model adjusted for LDL-C, HbA1c, FBS and other risk factors at baseline. Results: During 2. 7 ± 1. 6 years of follow-up, 27 patients died (including six cardiac deaths) and 25 developed major adverse cardiac and cerebrovascular event. Multivariate analysis revealed associations between increased LDL-C and all-cause death (hazards ratio [HR], 1. 01;95% confidence interva [l CI], 1.00-1. 03;p=0. 0333), cardiac death (HR, 1. 05;95% CI, 1. 02-1.09; p = 0. 0001) and MACCE (HR, 1. 02;95% CI, 1. 01-1. 03;p = 0. 0054). However, increased FBS and HbA1c were not associated with survival and MACCE. Conclusions: Higher LDL-C level, but not FBS or HbA1c, was an independent predictor of all-cause death, cardiac death and MACCE in diabetic patients after off-pump CABG.
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  • OCCURRENCE OF PANCREATIC DUCTAL CARCINOMA DURING FOLLOW-UP OF BRANCH DUCT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE PANCREAS
    YASUSHI TAKAHASHI, JINKAN SAI, MASAFUMI SUYAMA, SUMIO WATANABE
    2012 Volume 58 Issue 4 Pages 330-333
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.330
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    The development of ductal adenocarcinoma during follow-up of branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas was investigated. Eighty-nine patients with branch duct type IPMN who had no symptoms, no mural nodules, and main pancreatic duct<5mm on imaging findings were followed up for more than 1 year (median follow-up, 94 months;range, 12-216 months). Ductal adenocarcinoma occurred in 3 (3.4%) patients during follow-up, including 2 (2.2%) patients with carcinoma distant from the IPMN lesion. In the follow-up period of branch duct IPMN, special attention should be paid to the occurrence of ductal adenocarcinoma not only in the IPMN lesion, but also in areas distant from the IPMN lesion.
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  • PROPHYLACTIC EFFICACY OF AZITHROMYCIN FOR SURGICAL SITE INFECTION IN BREAST SURGERY : A RANDOMIZED, CONTROLLED TRIAL
    YOSHITOMO ITO, MASAKI FUKUNAGA, MASARU SUDA, YOSHINORI HIRASAKI, MARIE ...
    2012 Volume 58 Issue 4 Pages 334-339
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.334
    JOURNAL FREE ACCESS
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    Background : In clean-contaminated operations such as breast surgery, antimicrobial agents are administered to prevent surgical site infection (SSI), caused mainly by Gram-positive cocci. It is considered that a single preoperative administration of penicillin or first-generation cephalosporin antibiotics within 30 minutes before the start of operations is effective for prevention of SSI. Azithromycin (AZM), an antimicrobial agent targeting Gram-positive cocci, might be available for prophylactic use in breast surgery. Purpose : The aim of this study was to investigate the clinical effects of azithromycin administered as prophylaxis against postoperative infection in breast surgery. Patients and methods : Thirty-nine patients who underwent breast surgery were enrolled in this study. All patients were randomly assigned to receive a single oral administration of AZM (2g/day) or intravenous antimicrobial injection of cefazorin (CEZ). The risk of SSI occurrence is considered equal in the groups, without regard to differences in the operation methods, because breast surgery is categorized as a clean operation in the CDC guidelines. Results : The incidence of SSI in breast surgery was 0% in both groups. Adverse events of administered drugs consisted of 3 cases of diarrhea and one case of elevation of transaminase in the AZM group, and one case of elevation of transaminase in the CEZ group. All patients with adverse events were mildly symptomatic and recovered without further treatment. Measurement of AZM concentration revealed that all patients in the AZM group exceeded the minimum inhibitory concentration (MIC) against Methicillin-susceptible Staphylococcus aureus (MSSA) or Staphylococcus epidermidis. Conclusions : Our results confirmed that AZM is effective for prevention of SSI in breast surgery.
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  • A Case of Kawasaki Disease Complicated with Acute Pancreatitis After Steroid Pulse Therapy
    HIROKI SUGANUMA, AYAKO KAMATA, TAKAHIRO NIIZUMA, KEIJI KINOSHITA, KAOR ...
    2012 Volume 58 Issue 4 Pages 344-347
    Published: August 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.344
    JOURNAL FREE ACCESS
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    A 2-year-5-month-old boy fulfilled the diagnostic criteria for Kawasaki disease (KD) on the second day of illness, and intravenous immunoglobulin (IVIG) administration was immediately started. The response was insufficient and additional IVIG and intravenous methylprednisolone pulse (IVMP) administration was performed. The IVMP was effective. However, 6 days after administration, serum amylase level, serum lipase and elastase I increased and acute pancreatitis was diagnosed. The cause of pancreatitis in the present patient was likely related to the histological inflammatory changes in the pancreas due to severe vasculitis and cholestasis, as well as the influence of IVMP. Careful observation is required for patients with KD who have abdominal pain after IVMP.
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