Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 58, Issue 5
Displaying 1-18 of 18 articles from this issue
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Contents
  • Gender Differences in Secondary Prevention After Coronary Revascularization: Analysis of Diabetic Patients with Multivessel Disease
    YUKI YONEDA, KAN KAJIMOTO, KATSTUMI MIYAUCHI, TAIRA YAMAMOTO, HIROTAKA ...
    2012 Volume 58 Issue 5 Pages 409-415
    Published: October 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.409
    JOURNAL FREE ACCESS
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    Objective: Analyses based on the results of various clinical studies have shown a gender difference in the significance of lifestyle and risk factors that cause progression of atherosclerosis. However, there have been few investigations of gender differences in secondary prevention of the most severe form of atherosclerosis, which follows coronary revascularization in diabetes patients with multivessel coronary artery disease. Methods: the subjects were 493 diabetic patients (394 males and 99 females) with multivessel disease who underwent coronary artery revascularization at our hospital between 2002 and 2008. Death from all causes, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were compared between men and women. Kaplan-Meier survival analysis was performed with univariate analysis of each endpoint. The multivariate Cox proportional hazard model was then used to calculate the hazard ratio. Results: The mean age of the women was 70 years, significantly higher than the 64 years for men. During a mean follow-up period of 2.6 years, no gender differences were seen in all-cause deaths, cardiac deaths, or MACCE on multivariate analysis. Conclusions: This study demonstrated that there were no gender differences related to long-term outcome at any of the end points in secondary prevention of severe coronary artery disease in diabetes patients.
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  • CLINICAL OUTCOME IN HEMODIALYSIS PATIENTS FOLLOWING COMBINED SURGERY FOR AORTIC STENOSIS WITH CABG
    AKIE SHIMADA, TAIRA YAMAMOTO, SATOSHI MATSUSHITA, HIROTAKA INABA, KENJ ...
    2012 Volume 58 Issue 5 Pages 416-421
    Published: October 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.416
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    Objective : Chronic hemodialysis (HD) is a risk factor for coronary artery disease and aortic stenosis (AS), which is known to progress rapidly in HD patients. As HD patients are living longer in Japan, patients with both coronary artery disease and AS are increasing. However, patients undergoing combined aortic valve surgery and coronary artery bypass grafting (CABG) are widely considered to be at increased risk of poor outcomes. In this study, the outcomes of patients who underwent combined surgery for AS with CABG were examined. Materials and Methods : Seventy-five HD patients who underwent isolated CABG (n = 64) or combined CABG with aortic valve surgery (n=18) were enrolled. The patients' background characteristics and clinical outcomes were analyzed retrospectively. Results : There were no differences in age, sex, or pre-operative comorbidities (hypertension, diabetes, or stroke) between the groups, except that hyperlipidemia was more prevalent in the isolated CABG group. There were no differences in postoperative stroke, respiratory failure, atrial fibrillation, or wound infection. Two patients in the isolated CABG group and one in the combination CABG with aortic valve surgery group died in hospital. Additionally, no differences were seen in cardiac mortality between the groups. Conclusions : In HD patients, perioperative complications and long-term cardiac mortality did not differ between patients who underwent combined surgery for AS with CABG and those who had CABG surgery alone. Since the symptoms of AS progress rapidly in HD patients, combined surgery should be done without hesitation.
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  • Analysis of the Effects of Alleviating Adverse Events and Improving Completion in Colorectal Cancer Patients with Postoperative Adjuvant Chemotherapy with PSK
    KIICHI SUGIMOTO, RINA TAKAHASHI, SHUN ISHIYAMA, MASAKI HATA, HIROHIKO ...
    2012 Volume 58 Issue 5 Pages 422-430
    Published: October 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.422
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    Objective: It is well known that anti-cancer drugs generate reactive oxygen species and lipoperoxides in cancer patients, and that these free radicals can give rise to adverse events. It has been reported that free radical effects might be attenuated by antioxidants. Recent reports have indicated that Protein-bound polysaccharide K (PSK) exhibits antioxidant effects in addition to its anti-tumor effects. However, there have been few reports investigating whether the antioxidant effects induced by PSK can actually alleviate the adverse events of anti-cancer drugs. In an attempt to alleviate the adverse events and improve completion of oral anti-cancer drugs, we performed a randomized, controlled trial of oral UFT/LV plus PSK as postoperative adjuvant chemotherapy for stage II and III colorectal cancer. Materials: Fifty patients who had undergone curative resection of high-risk stage II or stage III adenocarcinoma of the colon and rectum between May 2008 and May 2010 were enrolled in this study. Methods: Patients were randomly assigned to the UFT/LV treatment (PSK (-) ) and the UFT/LV plus PSK treatment (PSK (+) ) groups at a 1:1 ratio. The PSK (-) group received UFT (300 mg/m2/day) and LV (75 mg/day), starting 4-8 weeks after surgery and continuing for 6 months or until the diagnosis of tumor recurrence. The PSK (+) group received PSK (3.0g/day) every day in addition to the UFT/LV treatment. Patient backgrounds, adverse events, completion of oral administration, laboratory test, stress indices, such as Reactive Oxygen Metabolites Test (d-ROMs Test) and salivary chromogranin A, and NK cell population were analyzed. Results: Nine patients (36.0%) and 11 patients (44.0%) had overall adverse events in the PSK (-) and PSK (+) groups, respectively. There was no significant difference in the incidence of adverse events between the PSK (-) and PSK (+) groups. Twenty-two patients (88.0%) and 23 patients (92.0%) completed oral administration of anti-cancer drugs in the PSK (-) and PSK (+) groups, respectively. There was no significant difference in completion of oral administration between the two groups. In laboratory tests, no significant differences were observed between the two groups. There was no significant difference in the d-ROMs Test between the two groups. Similarly, no significant difference was observed in the salivary chromogranin A. The NK cell population in the PSK (+) group was significantly higher than that in the PSK (-) group (p = 0.03). Conclusions: There were no significant differences in the incidence of adverse events between the PSK (-) and PSK (+) groups. In addition, completion of oral administration was high in both groups, and therefore no effects of PSK to alleviate adverse events and improve completion of oral administration of anti-cancer drugs were recognized. In the future, it will be necessary to investigate whether or not PSK can reduce adverse events and improve the completion of oral administration of anticancer drugs when PSK is combined with other regimens with a higher incidence of adverse events or a lower completion rate.
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  • DO ACADEMIC RANKINGS BASED ON COMMON ACHIEVEMENT TESTS PREDICT THE RESULTS OF GRADUATION EXAMINATION RESULTS ?
    YUICHI TOMIKI, TAKASHI DAMBARA, TAKAO OKADA, MASAKO NISHIZUKA, KAZUO K ...
    2012 Volume 58 Issue 5 Pages 431-435
    Published: October 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.431
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    Objectives : This study examined differences in medical students' test scores before and after clinical training by comparing the results of common achievement tests (Computer Based Test : CBT and Objective Structured Clinical Examination : OSCE) with those of the graduation examination. Materials : The subjects were 462 students (male : 308, female : 154) who entered the Juntendo University Faculty of Medicine between 2002 and 2006 and sat for common achievement tests as well as the graduation examination. Methods : Based on the results of the common achievement tests (CBT and OSCE) conducted for 4th grade students, students were ranked into four percentile groups of 25% each. Also, based on the graduation examination conducted for 5th grade students, students were ranked into 4 similar groups to examine the association between students' academic rankings before clinical training and the results of the graduation examination. Results : The results of the graduation examination were well correlated with those of the CBT and academic standings in the 5th grade, and both showed correlation coefficients of 0.61 (p< 0.01). Of the 125 students ranked between 1st and 25th place for the CBT, 76 students (60.8%) ranked within the top 25 for the graduation examination. However, of the 86 students who ranked below 76th place, only 43 students (50.0%) again ranked below 76th place for the graduation examination. Comparing with the CBT, the accuracy rate of the graduation examination increased by 7.4% as a whole, but it increased only in students who ranked in the upper places for the CBT, and that of the students who ranked in the lower places for the CBT decreased. Conclusions : There was an association between the results of the graduation examination and those of the CBT conducted during the second half of the 4th year. The accuracy rate of the graduation examination increased as a whole after students experienced clinical training;however, the accuracy of the graduation examination for students who ranked in the lower places on the CBT decreased, with no improvement in the academic rankings, suggesting a greater need for educational intervention for students who ranked in lower places.
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  • METHOD FOR DETECTING DEEP VENOUS THROMBOSIS AT VENOUS VALVE POCKET FOR PROPHYLAXIS OF PERIOPERATIVE PULMONARY THROMBOEMBOLISM
    TAKAYUKI KOMATSU, KAZUHIKO OHSAWA, TOSHIHIRO KIKUCHI
    2012 Volume 58 Issue 5 Pages 436-440
    Published: October 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.436
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    Aim : We investigated methods for detecting deep venous thrombosis (DVT) at the valve pocket for the prophylaxis of perioperative pulmonary thromboembolism (PTE). Subjects : We applied the original standardized guidelines for the prophylaxis of perioperative PTE to 433 patients over a period of 6 months: of these 433 patients, 17 were classified under the highest risk group. Methods : Lower extremity venous ultrasonography (LEVUS) was performed on these 17 patients. Results : DVT was detected in the lower extremities in 9 patients, of which 5 had DVT at the valve pocket. Conclusions : This study suggests that LEVUS is useful for detecting DVT at the valve pocket. Further investigation into early detection and treatment for small DVT is needed.
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  • A CASE OF PERFORATION OF THE APPENDIX BY A FISH BONE
    NORITOSHI YOSHIDA, IKUO WATANOBE, TOSHIROU MARUYAMA, ATSUSHI IHARA, SH ...
    2012 Volume 58 Issue 5 Pages 441-444
    Published: October 31, 2012
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.58.441
    JOURNAL FREE ACCESS
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    A 63-year-old man was admitted to our hospital with right inguinal pain, and abdominal CT scan showed an abscess of the ileocecal area and linear high density in the lower part of the cecum. We suspected the presence of a foreign body such as a fish bone, and an emergency operation was carried out. A fish bone was found in the abscess adjacent to the perforated appendix. In Japan, many cases of perforation of the appendix by fish bone have been reported, but preoperative diagnosis is very difficult. We must assume the presence of a fish bone if a linear high density is detected on CT scan, and careful clinical assessment is required.
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