Invited Review Articles
Sudden Death of Adults in Japan
HIDEAKI TOYOSHIMA, SEIJI HAYASHI, NAOHITO TANABE, KUNIO MIYANISHI, TADASHI SATOH, YOSHIFUSA AIZAWA and TOHRU IZUMI
pg(s) 81- 95
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Epidemiological features, risk factors and preventive methods of sudden death (SD) derived from studies the authors have performed since 1987 together with colleagues in Niigata University School of Medicine were reviewed. When SD was defined as death occurring within 24 hours of the onset of symptoms, the annual incidence was 145/100,000 for people aged 15 years and older in Niigata Prefecture. The incidence increased sharply along with the advance of age, while the proportion of SD to natural death due to circulatory diseases was higher in younger people. Though diseases of the circulatory system made up approximately 90 percent of all causes of death, SD due to ischemic heart disease was less frequent in Japan than in western countries. SD showed various patterns in seasonal and "within-a-day" occurrences according to sex, age and cause of death. The months of the highest SD occurrence differed by occupation and matched the busiest work periods. A decrease in sleeping hours and mental stress experienced during the preceding week were related to the occurrence of both sudden death and non-fatal acute myocardial infarction. People having structural circulatory diseases were shown to be predisposed to SD when stress occurred, because fatal arrhythmia is easily induced by the above factors in such people. Health examinations were shown to have preventive effects, though limited, against SD. Differences in the resuscitated rates in cases where a witness was present and where one was not indicates that educating people about correct resuscitation methods is important to minimizing SD.
Molecular Neurosurgery Using Gene Therapy to Treat Malignant Glioma
JUN YOSHIDA
pg(s) 97-105
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In the last decade, the prognosis of brain tumor patients has dramatically improved due to recent advances in microsurgical techniques and the development of functioning neuroimaging, computer-assisted neuronavigation, endoscopic surgery, intravascular surgery and radiosurgery. According to a report by the Committee of Brain Tumor Registry of Japan, the ten year survival rate of patients with benign brain tumors (meningioma, neurinoma and pituitary adenoma) is more than 95%. In contrast, patients with glioma (which constitute 33% of primary brain tumor cases) still have a poor prognosis, especially in the case of malignant (anaplastic astrocytoma and glioblastoma). This poor prognosis is related to the fact that malignant glioma cells aggressively infiltrate into normal brain tissues, making total removal of the tumor impossible. The median survival time of glioblastoma patients is less than 2 years, despite multimodality treatment with extensive surgical resection and adjuvant therapies using radiation and immunochemotherapy. In order to overcome this formidable neoplasm, the effectiveness of molecular neurosurgery using gene therapy has been investigated since 1992. In this paper, molecular genetic studies and the current state of gene therapy for malignant brain tumors are described, and the future direction of this fascinating approach is discussed.
Herpesvirus Genes: Molecular Basis of Viral Replication and Pathogenicity
YUKIHIRO NISHIYAMA
pg(s)107-119
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Herpesviruses possess large DNA genomes which contain from approximately 80 to 200 genes. These viral genes are divided into two groups based on whether they are essential or nonessential (dispensable) for virus growth in cell culture: the essential gene products include a set of replication proteins which accomplish the viral DNA replication, while the dispensable gene products include those important in influencing pathogenesis. This article briefly reviews the results of studies relating to the functions and roles of the gene products of human herpesviruses, particularly products associated with the herpes simplex virus.
Invited Article
Disaster-readiness of Medical Facilities in Aichi Prefecture
KAZUNOBU YAMAUCHI, SATOSHI MIZUNO and ZHIXING XU
pg(s)121-128
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One month following the Great Hanshin Earthquake of January 17, 1995, we conducted a survey of 173 hospitals in Aichi Prefecture to pinpoint problems related to their actual disaster-readiness and the medical backup systems in place to deal with such disasters. This study revealed that staff at 50% of the surveyed hospitals could reach the hospital within an hour, but that communication is almost entirely dependent on phone lines, suggesting that cordless/portable/mobile phones, radio systems, Internet, communications satellites and the like should be studied in the days to come for possible use as effective communication alternatives in times of disaster. Whereas 92% of the surveyed hospitals had manuals dealing with fire outbreaks, other areas were less well represented. For example, only 36.9% of surveyed hospitals had manuals for earthquakes, 31.7% had manuals for power outages and 14.2% had manuals to deal with flooding and water disasters. New manuals must be developed incorporating the key points garnered from experience (especially Hanshin) and be ready for use immediately. It is the time for each hospital to seriously rethink the measures it should take to deal with disasters.
Original Papers
Macromotion of the Femoral Component in Artificial Hip Joint
YUKIHARU HASEGAWA, TOSHIKI IWASE, KOUICHI KAWAMOTO, SEIKI IWASADA and HISASHI IWATA
pg(s)129-133
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Macromotion of the femoral component was analyzed in seven loose hips associated with six patients utilizing the manual compression and distraction test. The mean vertical and varus movement of these hips were 6.4 mm and 1.2 degrees, respectively. Out of a total 120 cementless total hip arthroplasties, there was no macromotion in the control group of six patients with moderate to severe thigh pain. There was also no relationship between macromotion and the severity of thigh pain. Micromotion or rotational instability, which could not be analyzed by conventional stress radiograms, may contribute substantially to thigh pain.
Human Blood Lactate and Ammonia Levels after Supramaximal Uphill and Downhill Running
HIROSHI ITOH, TETSUO OHKUWA, YOSHIHIKO YAMAZAKI and MIHARU MIYAMURA
pg(s)135-142
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The purposes of this study were 1) to confirm whether there is a difference in the levels of blood lactate and ammonia after supramaximal uphill and downhill running for the same short duration and 2) to examine the relationship between peak blood lactate levels and work/lean body mass (LBM), as well as the relationship between peak blood ammonia levels and work/LBM following supramaximal uphill and downhill running. Eight healthy, untrained male subjects performed supramaximal uphill and downhill running on a motor-driven treadmill for about 70 sec. Though there was a significant difference (p < 0.05) in running speed and work/LBM between supramaximal uphill and downhill running, no significant difference was found in exhaustion time or heart rate. Both the peak blood lactate and ammonia concentrations were significantly lower after downhill running than after uphill running (p < 0.05). Although there was no significant relationship between peak blood ammonia levels and work/LBM following either uphill or downhill running, significant linear relationships between the peak blood lactate levels and work/LBM were observed following uphill running (r = 0.74, p < 0.05) and downhill running (r = 0.72, p < 0.05). These results suggest that the differences in the blood lactate and ammonia concentration between supramaximal downhill and uphill running of the same duration may be due to the total recruitable muscle mass during exercise, and that peak blood lactate can be used as an index of anaerobic work capacity for untrained subjects under these running conditions.
An Examination of the Close Relationship between Lymphatic Vessels and Nerve Fibers Containing Calcitonin Gene-related Peptide and Substance P in Rat Skin
KANSHO YAMADA and TAKESHI HOSHINO
pg(s)143-150
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The distribution of nerve fibers containing either calcitonin gene-related peptide (CGRP) and substance P (SP) was investigated in rat skin with special reference to their relationship to the lymphatic vessels. These nerve fibers exhibited a similar distribution pattern but the former were more numerous than the latter. In the dermis and subcutaneous layers, thin nerve fibers containing CGRP or SP were in abundance, and were observed running along the blood vessels as well as freely in the tissue. Nerve fibers with these peptides were often located close to lymphatic capillaries, and innervated lymphatic vessels in the subcutaneous layer, reaching smooth muscles of the tunica media. These findings suggest that some CGRP and SP may directly drain into lymphatic vessels when released under noxious stimulation from nerve fibers around the lymphatic vessels. When discharged from nerve fibers in the vicinity of blood vessels, both peptides may also drain into the lymphatic vessels after causing blood vascular dilation and an increase in permeability producing edema. These peptides may then be transported to the draining lymph nodes where they can modulate the functions of the immune system.
Case Reports
Giant Cell-rich Osteosarcoma: A Case Report
KEIJI SATO, SHIGEKI YAMAMURA, HISASHI IWATA, HIDESHI SUGIURA, NOBUO NAKASHIMA and TETSURO NAGASAKA
pg(s)151-157
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This report discusses a rare case of giant cell-rich osteosarcoma. The patient, a 19-year-old male, was diagnosed with a metadiaphyseal osteolytic lesion when he consulted a local doctor complaining of motion pain without swelling. Radiography revealed a geographic osteolytic lesion, cortical thinning and ballooning without obvious cortical destruction. However, a fine onion skin-like periosteal reaction was observed on the lateral side of the femur. The transitional none was narrow and endosteal scalloping was also noted. Needle biopsied material clearly showed nuclear atypism of the stromal tumor cells with numerous osteoclast-like giant cells. Using a combination of pathological examination, radiography, computed tomography (CT) and magnetic resonance imaging (MRI), a diagnosis of giant cell-rich osteosarcoma was reached. After chemotherapy, resection and limb salvage surgery with an autogeneous autoclaved bone graft, a vascularized fibular graft were performed, and the patient has shown excellent limb function without local recurrence or distant metastasis during the past 72 months.
Solid Variant of an Aneurysmal Bone Cyst (Giant Cell Reparative Granuloma) of the 3rd Lumbar Vertebra
KEIJI SATO, HIDESHI SUGIURA, SHIGEKI YAMAMURA, MITSURU TAKAHASHI, TETSURO NAGASAKA and TOSHIAKI FUKATSU
pg(s)159-165
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A 9-year-old girl with a solid variant of an aneurysmal bone cyst in the 3rd lumbar vertebra showed a good response to low-dose radiation as the only treatment. The solid variant of aneurysmal bone cyst is thought to be a reactive response to intraosseous hemorrhage and is also called giant cell reparative granuloma or giant cell reaction. These lesions in the jaw and the short tubular bones of the hands and feet frequently recur after surgery. Aneurysmal bone cysts of the spine also show a fairly high recurrence rate after incomplete resection or radiation therapy. However, 7 previous cases of the solid variant of aneurysmal bone cyst in the spine and this case did not show recurrence after a mean follow-up period of 45 months. This difference in behaviour suggests that the solid variant should be recognized before surgery as being distinct from conventional aneurysmal bone cysts, especially in the spine.
Abstracts
Annual Research Meeting for Graduate Students: Nagoya, December 1995
pg(s)167-193
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