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Volume 232 (2014)
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Volume 232, Issue 1
January
Displaying 1-9 of 9 articles from this issue
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Regular Contribution
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Naomi Miyamoto, Hideaki Senjyu, Takako Tanaka, Masaharu Asai, Yorihide ...Article type: Regular Contribution
2014 Volume 232 Issue 1 Pages 1-8
Published: 2014
Released on J-STAGE: January 09, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLAir pollution in Japan caused respiratory disease, such as chronic bronchitis and asthma, in many individuals in the 1960s. Although air pollution has decreased, many victims of air pollution-related respiratory disease are limited in their activities of daily living because of respiratory symptoms. The purpose of this study was to evaluate the efficacy of pulmonary rehabilitation in victims of air pollution-related chronic bronchitis or asthma. Subjects were enrolled in a 12-week (2-week inpatient followed by 10-week outpatient) pulmonary rehabilitation program. The program comprised conditioning, strength training, endurance training, and patient education. We assessed the Modified Medical Research Council (MMRC) dyspnea grade, pulmonary function, peripheral muscle force, incremental shuttle walk distance (ISWD), and physical activity at baseline and immediately after the program. Twenty-nine subjects (mean age 74.2 ± 10.1 years, 11 males) completed the program, including 11 subjects with COPD and 18 subjects with asthma. Following rehabilitation, the participants (n = 29) showed significant improvements in MMRC dyspnea grade, vital capacity % predicted, quadriceps force and ISWD (all P < 0.05). Sub-group analyses revealed that all these variables were significantly improved in subjects with asthma. In contrast, subjects with COPD showed significant improvements only in quadriceps force and ISWD (both P < 0.05). Thus, pulmonary rehabilitation is an effective method of improving exercise capacity and dyspnea in officially acknowledged victims of air pollution-related asthma. In conclusion, we recommend that patients with chronic bronchitis or asthma, resulting from exposure to air pollution, are referred for pulmonary rehabilitation.View full abstractDownload PDF (465K) Full view HTML -
Liang Chai, Hongyan Liu, Zhili Zhang, Feng Wang, Qingying Wang, Shuiho ...Article type: Regular Contribution
2014 Volume 232 Issue 1 Pages 9-19
Published: 2014
Released on J-STAGE: January 16, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLPharyngolaryngeal cancer is one of the most common head and neck cancer worldwide, and the early diagnosis and prognosis prediction are still difficult because of lacking in reliable cell markers. Although the expression of CD44 has been reported to correlate with poor prognosis of pharyngolaryngeal cancer in most literatures, some controversies still exist. Since the limited patient numbers within independent studies, here we performed a meta-analysis to clarify the correlations between CD44 expression and clinicopathological features and prognosis in pharyngolaryngeal cancer. A search of PubMed, ISI Web of Science and China National Knowledge Infrastructure databases (up to June 2013) was performed. Nineteen studies with 1,405 patients met the inclusion criteria. The expression of pan-CD44, including all variant isoforms, was detected in 58.0% (14.1-79.2%) specimens, while CD44-v6 (variant isoform 6 of CD44) was expressed in 54.8% (12-79.2%). In pooled analysis, CD44 expression was significantly associated with larger tumor size (T category, RR (relative risk) = 1.21, 95% CI: 1.01-1.46), lymph nodes metastasis (N category, RR = 1.94, 95% CI: 1.38-2.73) and poor prognosis [3-year overall survival (OS): RR = 0.70, 95% CI: 0.53-0.91; 5-year OS: RR = 0.66, 95% CI: 0.66-0.94]. In the stratified analysis of CD44 isoforms, high expression of CD44-v6 was related with a poor 5-year OS rate (RR = 0.53, 95% CI: 0.37-077). We propose that CD44 expression is associated with tumor size, lymph node metastasis, and poor prognosis in pharyngolaryngeal cancer patients.View full abstractDownload PDF (1017K) Full view HTML -
Takuma Kimura, Teruhiko Imanaga, Makoto MatsuzakiArticle type: Regular Contribution
2014 Volume 232 Issue 1 Pages 21-26
Published: 2014
Released on J-STAGE: January 18, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLPromotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And “communications just between the doctor and the patient without the family” (doctor-patient communication without family, “DPC without family”) is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor’s stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient’s malignant tumors.View full abstractDownload PDF (449K) Full view HTML -
Keiko Tanabe, Koji Tamakoshi, Saya Kikuchi, Jun MurotsukiArticle type: Regular Contribution
2014 Volume 232 Issue 1 Pages 27-33
Published: 2014
Released on J-STAGE: January 28, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLIn recent years, there has been an increase in the number of infants with very low birth weight (VLBW, i.e., weight less than 1,500 g) in Japan. However, the effect of VLBW on subsequent behavioral development and mental health remains unknown. Subjects enrolled were 57 individuals (13.4 ± 1.9 years old) with VLBW (VLBW group), including 23 small-for-gestational-age (SGA) infants (i.e., the SGA/VLBW group) and 34 appropriate-for-gestational-age (AGA) infants (the AGA/VLBW group). The control group was 29 individuals born AGA at term. We used the questionnaires, the Pupil Rating Scale Revised (PRS) to screen for learning disabilities and the Children’s Depression Inventory (CDI) to examine the presence of depression. The PRS score in the VLBW group was significantly lower than that of the control group (p < 0.001). Suspected learning disabilities (LD, defined by a score below 65 points on the PRS) were found in 6 out of the 56 subjects in the VLBW group (10.7%), whereas none were found in the 29 control subjects (p = 0.074). The frequency of suspected LD children was higher in the SGA/VLBW group (4 out of 22 evaluated infants, 18.2%) than that in the AGA/VLBW group (2/34, 5.9%). The frequency of suspected LD in the non-verbal field was significantly higher (p = 0.02) in the SGA/VLBW group (18.2%) than in the AGA/VLBW group (0%). However, CDI score did not significantly differ between groups. These findings suggest that VLBW and fetal growth restriction may pose a risk for LD among adolescents with VLBW.View full abstractDownload PDF (446K) Full view HTML -
Kosuke Yasukawa, Kyoko NomuraArticle type: Regular Contribution
2014 Volume 232 Issue 1 Pages 35-42
Published: 2014
Released on J-STAGE: January 29, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLPrevious studies from the US have found that female physicians often experience gender-based discrimination related to professional advancement. In Japan, female physicians are underrepresented in leadership positions but little is known about the prevalence of gender discrimination. We investigated the perception and prevalence of gender-based career obstacles and discrimination among Japanese physicians. The study was based on surveys of alumnae from 13 medical schools and alumni from 3 medical schools. In total, 1,684 female and 808 male physicians completed a self-administered questionnaire (response rate 83% and 58%). More women than men had the perception of gender-based career obstacles for women (77% vs. 55%; p < 0.0001). Women with part-time positions were more likely to have the perception of gender-based career obstacles than women working full-time (OR 1.32, 95% CI: 1.01-1.73). More women than men reported experience of gender discrimination related to professional advancement (21% vs. 3%; p < 0.0001). Factors associated with experience of gender discrimination included age (p < 0.0001), marital status (p < 0.0001), academic positions (p < 0.0001), subspecialty board certification (p = 0.0011), and PhD status (p < 0.0001). Women older than 40 years were more likely to experience gender discrimination compared with younger women (OR 5.77, 95% CI: 1.83-18.24 for women above 50, and OR 3.2, 95% CI: 1.48-7.28 for women between 40 and 49) and women with PhD were more likely to experience gender discrimination (OR 4.23, 95% CI: 1.81-9.89). Our study demonstrated that a significant proportion of Japanese women experienced gender-based discrimination and perceived gender-based career obstacles compared with male physicians.View full abstractDownload PDF (527K) Full view HTML
Case
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Yujin Kudo, Hiroyuki Miura, Eiji Nakajima, Hidenobu Takahashi, Akiko A ...Article type: Case
2014 Volume 232 Issue 1 Pages 43-46
Published: 2014
Released on J-STAGE: January 30, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLChylothorax results from various causes, such as malignancy, trauma, or infection. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a multisystemic syndrome that is associated with plasma cell disorder. Pleural effusion is a common manifestation of POEMS syndrome, but the association of POEMS syndrome with chylothorax has not been reported. We report on a 61-year-old female patient who initially presented with dyspnea and bilateral leg edema. Importantly, the patient had normal renal function. Her chest X-ray and computed tomographic imaging showed bilateral pleural effusion, and her chest drainage revealed chylothorax. Detailed examination failed to reveal the definitive cause of the chylothorax. She received several treatments for chylothorax, namely, a low-fat diet or fasting, total parenteral nutrition, a somatostatin analog (octreotide), thoracic duct ligation by video-assisted thoracic surgery, and pleurodesis. However, further examination revealed endocrinopathy, monoclonal plasma cell disorder, peripheral neuropathy, and elevation of the serum level of vascular endothelial growth factor. The patient’s condition was consequently diagnosed as POEMS syndrome. Eventually, her chylothorax was controlled by pleurodesis, and she was transferred to another hospital for stem cell transplantation. Herein, we report on the apparent first case of POEMS syndrome with chylothorax. In some cases of idiopathic chylothorax, the underlying primary disease may be latent, such as in the present patient. POEMS syndrome is rare, but this syndrome should be included in the differential diagnosis of chylothorax with unexplained etiology.View full abstractDownload PDF (657K) Full view HTML
Regular Contribution
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Hua-Fen Chen, Chung-Yi Li, Siu-Pak Lee, Yam-Ting Kwok, Yiu-Tong ChuArticle type: Regular Contribution
2014 Volume 232 Issue 1 Pages 47-54
Published: 2014
Released on J-STAGE: February 01, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLLong-term follow-up and comparison of serial changes in the one-year mortality after stroke are important in assessing the quality of stroke management. This study determined the one-year survival rate and prognostic factors of hospitalized hemorrhagic and ischemic stroke patients from 1991 to 2008 in a teaching hospital in Taiwan. We also evaluated the improvements in the one-year mortality after stroke during an 18-year study period. Patients admitted for cerebral hemorrhage (n = 3,678) and cerebral infarction (n = 16,010), identified from an in-patient electronic database, were linked to the National Death Registry of Taiwan. Actuarial analysis was used to determine the one-year survival rates, and Cox proportional hazard regression model was used to investigate the predictors for the one-year mortality of stroke patients. For patients with cerebral hemorrhage and infarction and who were admitted from 1991 to 2008, the one-year survival rates were 71% and 84%, respectively. In addition, stroke patients who also suffered from myocardial infarction, chronic renal illness, and pneumonia and had high Charlson comorbidity index scores showed increased risks of mortality due to cerebral hemorrhage and infarction. Compared with the patients admitted from 1991 to 1996, those admitted from 1997 to 2002 and from 2003 to 2008 showed 15%-20% and 20%-25% reduction in one-year mortality risk in cerebral hemorrhage and infarction, respectively. This result demonstrates the continuous quality improvement of stroke management in the hospital from 1991 to 2008. Further reduction in one-year mortality can be achieved by early recognition and prompt treatment of certain comorbidities.View full abstractDownload PDF (399K) Full view HTML -
Makoto Tanaka, Motoyasu Sagawa, Katsuo Usuda, Yuichiro Machida, Masaka ...Article type: Regular Contribution
2014 Volume 232 Issue 1 Pages 55-61
Published: 2014
Released on J-STAGE: February 01, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLTo expand postoperative residual lungs after pulmonary lobectomy, thoracic drainage with two chest tubes has been recommended. Several studies recently demonstrated that postoperative drainage with one chest tube (PD1) was as safe as that with two chest tubes (PD2). However, most of the patients in those studies underwent lobectomy by standard thoracotomy. Although the number of pulmonary lobectomies by video-assisted thoracic surgery (VATS) has been increasing in recent years, there have been no reports that compared PD1 with PD2 after pulmonary lobectomy, including that by VATS. To elucidate whether postoperative management with PD1 is as safe as that with PD2, we conducted a randomized controlled trial. Lung cancer patients who underwent lobectomies with mediastinal nodal dissection in our hospital were assigned to one of two groups: one chest tube placed in PD1 group and two chest tubes placed in PD2 group. A total of 108 patients were registered in the study. There were no significant differences in the age, gender, pathological stage or histological type between two groups. Since the residual lung expansion was good in both groups, there were no patients who needed thoracentesis. There were no significant differences in the number of cases with pleurodesis, the amount/duration of drainage or the pain of the patients between two groups. In conclusion, since PD1 has advantages in saving cost and time and in low risk of transcutaneous infection, PD1 is appropriate after pulmonary lobectomy by VATS and by open thoracotomy.View full abstractDownload PDF (465K) Full view HTML -
Jun Suzuki, Yusuke Takata, Hiromitsu Miyazaki, Izumi Yahata, Yasuhiko ...Article type: Regular Contribution
2014 Volume 232 Issue 1 Pages 63-68
Published: 2014
Released on J-STAGE: February 01, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLOsteoma of the internal auditory canal (IAC) is an uncommon benign bone tumor. Its imaging features may be similar to other IAC lesions, such as vestibular schwannomas that are benign and usually slow-growing but sometimes life-threatening tumors. Thus, detecting IAC lesions and differentiating osteoma from other IAC lesions are both important clinically. We report a case of misdiagnosis of an IAC osteoma as an IAC schwannoma based on magnetic resonance (MR) imaging using the three-dimensional constructive interference in steady state (CISS) sequence instead of T1-weighted MR imaging with gadolinium. We also review 17 cases of IAC osteomas reported in the past 22 years. A 61-year-old female was admitted to our department with IAC lesion incidentally discovered by the CISS sequence. The lesion was diagnosed as an IAC schwannoma, and was followed up annually under “wait and scan” management. Follow-up T1-weighted MR imaging with gadolinium showed no enhancement of the tumor, and additional computed tomography (CT) of the temporal bone showed a solitary pedunculated bony lesion, resulting in the diagnosis of IAC osteoma. The CISS sequence is useful for detecting small IAC lesions, such as vestibular schwannomas. However, the CISS sequence has limitations for qualitative diagnosis and can misdiagnose osteomas as schwannomas. Use of the CISS sequence without T1-weighted MR imaging with gadolinium for the screening of a lesion of the IAC and cerebellopontine angle should consider the possibility of IAC osteomas, and temporal bone CT or T1-weighted MR imaging with gadolinium should be performed when an IAC lesion is detected.View full abstractDownload PDF (553K) Full view HTML
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