The Showa University Journal of Medical Sciences
Online ISSN : 2185-0968
Print ISSN : 0915-6380
ISSN-L : 0915-6380
Volume 16, Issue 4
Displaying 1-9 of 9 articles from this issue
  • Naokuni YASUDA, Makoto WATANABE, Osamu NAKASHIMA, Toru OHNAKA, Akira T ...
    2004 Volume 16 Issue 4 Pages 267-273
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    The aim of this study was to assess analysis of variance of clinical pathways for large bowel cancer patients using the scoring system physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), which predicts postoperative morbidity and mortality. Large bowel cancer cases performed in our department between January 2002 and March 2004 were studied. These were divided into three groups : group one consisted of 48 patients without variance ; group two consisted of 13 patients without variance and with complications ; and group three consisted of 13 patients with variance. The average postoperative complication risk predicted by POSSUM was 34.4%. Observed complications were recorded in 26 out of 74 patients (35.1%), and variance developed in 13 of these 26 patients. There were no differences in the PS and OSS scores between patients with and without variance. Predicting the occurrence of variance using POSSUM is difficult as many factors can influence the development of variance. Therefore, POSSUM is unlikely to be a suitable scoring system for predicting which patients will develop variance.
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  • Hiroaki UEDA, Masaki OZAWA, Hiroyuki KAYANO, Kitaro KAWAMURA, Hiromi A ...
    2004 Volume 16 Issue 4 Pages 275-282
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    We evaluated the usefulness and safety of dobutamine stress echocardiography (DSE) for the detection of significant stenosis in the Infarcted area and also for assessment of the infarct-related coronary artery. We performed DSE in 93 patients with both acute and old myocardial infarction. The development of myocardial infarction involved the left anterior descending coronary artery (LAD) in 39, the left circumflex coronary artery (LCX) in 26, and the right coronary artery (RCA) in 28 patients. 1-vessel disease was observed in 60 patients, 2-vessel disease in 23, and 3-vessel disease in 10. DSE had a sensitivity of 82.5% and specificity of 73.6% for detecting significant stenosis (>75%) of infarct-related coronary arteries. The sensitivity and specificity of DSE in detecting significant stenosis classified by infarct-related coronary arterial branches were 85.0% and 68.5% for the LAD, 83.3% and 95.0% for the LCX, and 78.6% and 50.0% for the RAD, respectively. There were no complications such as angina pectoris or myocardial infarction associated with DSE that required treatment. In conclusion, our results suggest that DSE is a useful and safe method for detecting significant stenosis, even in the infarcted area.
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  • Yoshiko NAKAJIMA, Masahiko AYAKI, Eiichi NISHIMURA, Toshu INOUE, Hitos ...
    2004 Volume 16 Issue 4 Pages 283-288
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    We have developed a simplified method for evaluation of the inhibition effect by intraocuolar lens (IOL) optic edge on migration of lens epithelial cells (LEC) between the posterior capsule and IOL. A sharp-edge acrylic IOL and a round-edge polymethylmethacrylate (PMMA) IOL were placed on a collagen type IV membrane in the bottom of a culture chamber. A suspension of cultured porcine LECs was disseminated around the IOL and we observed each quadrant of the optic edge on days 3, 7, 14, and 28 to record the number of points where LECs migrated beneath the IOL. There was significantly more outgrowth of LECs beneath the PMMA IOL compared to the acrylic IOL on days 3, 7, and 14. These in vitro observations of the inhibitory effect of LEC migration were consistent with clinical observations. Our method is simple and easy, and does not require any computer software for image analysis.
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  • Masanori MUKAI, Takanori SHIBATA, Tetsuzo SUGISAKI
    2004 Volume 16 Issue 4 Pages 289-299
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    IgG4 is the predominant subclass of glomerular IgG in idiopathic membranous nephropathy (MN) . To investigate the role of IgG4 in MN we measured the levels of serum IgG4 anti-IgG antibodies in patients with various glomerular diseases.
    The level of serum IgG4 anti-IgG antibodies (U / ml) was assessed by solid-phase enzyme-linked immunosorbent assay (ELISA) in serum samples from patients with various glomerular diseases; MN (n = 27), IgA nephropathy (IgAN) (n =15), lupus nephritis (LN) (n =15), and minimal change nephrotic syndrome (MCNS) (n =15) . Thirteen normal human serum (NHS) samples were obtained from healthy volunteers (HVs) . In addition, the serum IgG4 level (mg/ml) was determined by subclass specific ELISA in the same samples. IgG4 anti-IgG 1 antibodies were elevated in MN patients. However, there was no significant difference in this level between MN and the other disease groups. In all groups of patients, the levels of the serum IgG4 anti-IgG 1 antibodies increased with serum IgG4 concentration. Only the slope of the regression line for MN patients was higher than those for the other groups (MN, 42.241; IgAN, 11.148; LN, 19.795; MCNS, 18.326; HVs, 21.244) . When the serum IgG4 anti-IgG 1 index [IgG4 anti-IgG 1 antibodies (U / ml) / IgG4 (mg/ml) ] in patients with MN, IgAN, LN or MCNS was compared with NHS, the index increased significantly only in patients with MN (MN = 38.6 ± 20.5 (mean ± SD) (P<0.01 vs NHS) ; IgAN =17.1 ± 11.7; LN = 22.2 ± 14.1; MCNS = 23.7 ± 13.9, and NHS = 23.6 ± 10.6. Our results suggest that IgG4 anti-IgG antibodies (particularly IgG4 anti-IgG 1 antibodies) may be involved in immune-deposit formation in MN.
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  • Hironori NAKAMURA, Toshio MOROHOSHI, Kozo KITAZAWA, Kasumi SATO, Junic ...
    2004 Volume 16 Issue 4 Pages 301-309
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    Myofibroblasts expressing α -smooth muscle actin (SMA) have been implicated in the pathogenesis of tubulointerstitial fibrosis. However, the relationships between myofibroblasts, CD44 and hyaluronic acid (HA) are poorly understood. This study aimed to examine the tubulointerstitial expressions of α -SMA, CD44 and HA and to determine whether these expressions correlate with tubulointerstitial fibrosis in IgA nephropathy ( IgAN) . Renal biopsy specimens from 31 patients with IgAN were examined by immunohistochemistry to analyze the protein expressions of α -SMA, CD44, HA, CD68, collagen type (Col) I, Col III, and Col IV. Stained biopsy sections were scored semiquantitatively. The tubulointerstitial fibrosis was also evaluated quantitatively using an image analyzer. The relationship between the pathological and clinical data was also studied. The extent of tubulointerstitial fibrosis is associated with a reduction in renal function. The expression of α -SMA in the tubulointerstitium correlated with the expression of CD44 and the interstitial deposition of HA. Double-staining immunohisto-chemistry revealed CD44-positive myofibroblasts in interstitial lesions. Moreover, CD44-positive cells were localized in the areas of HA deposition. These results suggest that CD44-positive myofibroblasts play an important role in the pathogenesis of tubulointerstitial fibrosis in IgAN, through several mechanisms including a CD44-HA interaction.
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  • Masaaki TANAKA, Hideto OYAMADA, Takashi MAKINO, Katsuji OGUCHI, Kazuma ...
    2004 Volume 16 Issue 4 Pages 311-317
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    The ryanodine receptor (RyR) is an intracellular calcium ion (Ca2+ ) release channel. The C-terminal region of RyR was proposed to contain the transmembrane segments that form the channel into the endoplasmic reticulum (ER) while the large N-terminus, termed the “foot”, was thought to be the cytoplasmic region of the protein. In order to confirm this proposed structure of RyR1, we have generated RyR1 mutants that were serially deleted from the 3' to the 5' terminal which were tagged to enhanced green fluorescent protein (EGFP) in Chinese hamster ovary (CHO) cells. The C-terminal deleted clones which lacked a putative transmembrane region and a small N-terminal portion which was further deleted to the N-terminal Thr184 were retained in the cytoplasmic region even after being permeablized by absolute methanol, the same as full-length RyR1. These results suggest that there are also sequences for ER retention within the N-terminal region (between Met1 to Thr184) of RyR1.
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  • Hidetoshi ONDA, Yasuko HASEBE, Takako NAKANISHI-UEDA, Toshihiko UEDA, ...
    2004 Volume 16 Issue 4 Pages 319-327
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    The purpose of this study was to investigate the effect of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor simvastatin on oxygen-induced retinal neovascularization in the neonatal rat. Neovascularization was induced by maintaining Sprague-Dawley neonatal rats in 80% oxygen from birth to day 12 (P12), interrupted daily by 30 minutes in normal atmosphere, followed by a progressive return to 80% oxygen. On P12, the rats were placed in normal atmosphere. The rats were treated once daily with intraperitoneal injection of simvastatin (5 ml / kg body weight) or distilled water (C) from P6 to P17. The concentration of the simvastatin solution was 0.2 mg/ ml (H-SV) or 0.02 mg/ ml (L-SV) . On P18, rats were sacrificed and the retinal samples were collected. Retinal neovascularization was scored and avascular areas of total retinal area (%AVAs) were measured in ADPase stained retinas. Neovascularization and AVAs in the retina were observed in oxygen-exposed animals, but not in control animals that remained throughout the experiments under normal atmosphere. The NV scores were 4.2 ± 0.7 in C (n=19), 4.3±0.7 in L-SV (n=21), and 5.3 ± 0.9 in H-SV (n=19) . There were no significant differences between C and L-SV and H-SV. The %AVAs were 19.7±3.7% in C (n=19), 18.2±4.2% in L-SV (n=21), and 16.6±3.8 % in H-SV (n=19) . VEGF concentrations were significantly inhibited by L-SV and H-SV treatments at 72hr (P15) after the end of oxygen exposure (p<0.05 for both) . These results indicate that simvastatin inhibited VEGF production at 72 hr after oxygen exposure, but did not reduce the NV score or % AVAs.
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  • Eriko SAKURAI, Mariko IWASE, Norimitsu KURATA, Tomoko NAGAI, Hayato HI ...
    2004 Volume 16 Issue 4 Pages 329-338
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    Amoxapine is a tricyclic antidepressant used for the treatment of psychotic depression. Psychotic depression is generally refractory to medical treatment and plural medicines are usually prescribed concurrently. The cytochrome P450 (CYP) enzyme has been implicated in the metabolism of several psychotropic drugs, and has clinical relevance relating to drug-drug interactions between psychotropic drugs and other common medicines. This study investigated the effects of amoxapine on the activities of CYP1A2, CYP2C9, CYP2C 19, CYP2D6 and CYP3A4 using human liver microsomes. Amoxapine inhibited both CYP2D6 and CYP3A4 with apparent Ki values of 25.4 and 41.3 ACM, respectively. The calculated Ki value for amoxapine was higher than the common therapeutic concentration range in plasma. Our study also revealed that inhibition of CYP2D6 and CYP3A4 enzyme activity by amoxapine is based on a competitive mechanism. Based on the Ki values observed in this study and the therapeutic amoxapine concentration in the blood, we conclude that amoxapine would not cause the severe drug-drug interaction mediated by CYP enzymes.
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  • Kenji SHIMAMOTO, Takakazu HIGUCHI, Hiraku MORI, Haruo NIIKURA, Mitsuhi ...
    2004 Volume 16 Issue 4 Pages 339-347
    Published: 2004
    Released on J-STAGE: September 09, 2010
    JOURNAL FREE ACCESS
    Red blood cell (RBC) transfusion to patients with autoimmune hemolytic anemia (AIHA) is usually avoided due to the likelihood of destruction of transfused RBCs, but this has not been thoroughly investigated in a clinical setting. In this study, we evaluated the efficacy and safety of 24 RBC transfusions given to eight warm-type AIHA patients on nine occasions. AIHA patients with severe hemolysis and an enhanced but insufficient compensatory erythroid response, or with mild to moderate hemolysis and an impaired reticulocyte response, received RBC transfusions. ABO- and Rhmatched RBCs, which were incompatible according to standard compatibility tests, were given on all but one occasion. In all cases, RBC transfusion ameliorated anemia and anemia-related symptoms and maintained the hemoglobin level without aggravating hemolysis. Acute and delayed transfusion reactions were not observed except on one occasion when a delayed hemolytic reaction was suspected. In conclusion, this study clearly demonstrates that RBC transfusion to AIHA patients is generally safe and effective and justifies its use when judged necessary.
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