Nihon Rinsho. Japanese Journal Of Clinical Medicine[JOURNAL]
Sun
200 papers
[Benefits and controversies points of expanding minimum invasive surgery].
Tatsugami K
Nihon Rinsho · 2017 Apr · PMID 30549855
Change by aging, which varies among individuals, influences physical and mental condi- tion, and social activity. Especially, illness accelerates the decreases of them in old adults. Surgical treatment for elderly patien...
Change by aging, which varies among individuals, influences physical and mental condi- tion, and social activity. Especially, illness accelerates the decreases of them in old adults. Surgical treatment for elderly patients might put a burden on their conditions and decrease activity of daily living if patients had adverse event and prolonged hospitalization. Because inadequate treatment is also associated with decreasing quality of life, it is necessary to pro- vide the adequate and effective treatment adapted to them. In this session, treatment for benign prostatic hyperplasia and robot-assisted surgery for cancer are described for instances of benefit and controversies points of minimum invasive surgery for elderly patients.
[Urological surgery in elderly and the perioperative management].
Noguchi M, Tobu S
Nihon Rinsho · 2017 Apr · PMID 30549854
Perioperative delirium and depression are characteristic of in elderly patients undergoing urological operation. The treatment for urological disease is stagnant, exchanged or inter- rupted by these complications. Furthe...
Perioperative delirium and depression are characteristic of in elderly patients undergoing urological operation. The treatment for urological disease is stagnant, exchanged or inter- rupted by these complications. Furthermore, these complications may course to other more complications. Age, preoperative cognitive status, activities of daily living function, renal function and other factors were known for the risk factor of perioperative delirium. However, these complications should be managed immediately, prevention of these complications is most important. To prevent these complications, preoperative physical, mental and cognitive evaluation are done, measures for the complications will be contemplated. The control for sleep disturbance, pain and anxiety are important to prevent and manage for the periopera- tive delirium and depression.
[Ageing-related bladder functional and biological changes].
Aizawa N
Nihon Rinsho · 2017 Apr · PMID 30549853
One of the major global demographic trends is the rapid ageing population, and the num- ber of people with ageing-related diseases has been increasing. In the urological field, ageing-related lower urinary tract symptoms...
One of the major global demographic trends is the rapid ageing population, and the num- ber of people with ageing-related diseases has been increasing. In the urological field, ageing-related lower urinary tract symptoms (LUTS), especially detrusor hyperactivity with impaired contractility (DHIC), are commonly observed among elderly patients. However, such ageing-related LUTS and their backgrounds widely vary by individual. Previous reports using functional- and biological-investigations in rodents revealed the possible relationship between ageing and individual factors related to bladder function, which were hormonal fac- tors, intrinsic changes (fibrosis and denervation) and oxidative stress, etc. Here, I reviewed involvement of such factors on ageing-related LUTS including DHIC.
[Lower urinary tract dysfunction and comprehensive geriatric assessment in the elderly].
Yoshida M
Nihon Rinsho · 2017 Apr · PMID 30549852
In the elderly, various factors except the urological abnormality of lower urinary tracts often participate in the lower urinary tract dysfunction. The elderly person often causes the change of the general systemic funct...
In the elderly, various factors except the urological abnormality of lower urinary tracts often participate in the lower urinary tract dysfunction. The elderly person often causes the change of the general systemic function (basic ability for daily living activity, a cognitive func- tion, emotion or feeling). In addition, the condition such as frailty and sarcopenia are ob- served in considerably high rate in the elderly. Such conditions may have an influence on the lower urinary tract dysfunction and adversely lower urinary tract dysfunction may cause the aggravation of a systemic function. Therefore, in the medical care of the elderly with lower urinary tract dysfunction, we have to take care of not only urological disease but also general systemic condition. In this review, I describe characteristic conditions in the elderly such as frailty and sarcopenia, and introduce the comprehensive geriatric assessment, which is the necessary tool for evaluation and treatment of lower urinary tract dysfunction in the elderly.
[Epidemiology of urologic diseases in the aging population].
Kobayashi K, Masumori N
Nihon Rinsho · 2017 Apr · PMID 30549851
Japan is an aging society. In general, an elderly population has urological diseases. Therefore, to understand the epidemiology of urological diseases is clinically very important. In a 15-year-longitudinal community-bas...
Japan is an aging society. In general, an elderly population has urological diseases. Therefore, to understand the epidemiology of urological diseases is clinically very important. In a 15-year-longitudinal community-based study of Japanese men, prostate volume in- creased and lower urinary tract symptoms deteriorated. Many elderly Japanese females have pollakisuria. The 2015 cancer statistics suggest that the most common cancer in Japanese males is prostate cancer. Urothelial carcinoma develops in a relatively elderly population. The erectile function of aging Japanese men demonstrated an age-related decline in the community-based study, with erectile rigidity declining over a 15-year period.
[Present status and future prospect of urological diseases in the elderly].
Homma Y
Nihon Rinsho · 2017 Apr · PMID 30549850
Most urological diseases are common in the elderly. Indolent cancer is a clinical dilemma in management of renal and prostate cancers, which are often incidentally found in the eld- erly. Bladder cancer usually needs uro...
Most urological diseases are common in the elderly. Indolent cancer is a clinical dilemma in management of renal and prostate cancers, which are often incidentally found in the eld- erly. Bladder cancer usually needs urological intervention somehow even in highly aged pa- tients to prevent massive hematuria and clot retention. Voiding dysfunction and erectile dys- function affect negatively quality of life thus should be properly evaluated and managed. Ultrasound-assisted prompted voiding precludes pad/diaper-related bladder disuse syn- drome, reducing urinary incontinence prevalence in the elderly with impaired physical or cognitive function. Preventive measures and innovative technology along with understanding of elderly-specific mentality should improve health status of urological organs in the elderly.
Rubinstein-Taybi syndrome.
Kosaki R
Nihon Rinsho · 2017 Mar · PMID 30566799
Rubinstein-Taybi syndrome (RTS) is characterized by moderate to severe intellectual disability, distinctive facial features, and broad thumbs and great toes. RTS is caused by haploinsufficiency of CREBBP or EP300 gene.
Rubinstein-Taybi syndrome (RTS) is characterized by moderate to severe intellectual disability, distinctive facial features, and broad thumbs and great toes. RTS is caused by haploinsufficiency of CREBBP or EP300 gene.
Fecal microbiota transplantation.
Mizuno S, Kanai T
Nihon Rinsho · 2017 Mar · PMID 30566798
Various strains of microorganisms inhabit the human intestinal tract, and disturbance of intestinal flora, dysbiosis, is thought to be pathogenesis of various diseases. Inducing symbiosis of intestinal flora has therapeu...
Various strains of microorganisms inhabit the human intestinal tract, and disturbance of intestinal flora, dysbiosis, is thought to be pathogenesis of various diseases. Inducing symbiosis of intestinal flora has therapeutic potential for gastrointestinal diseases, but there are limited therapeutic options including probiotics.'Previous reports suggested that fecal microbiota transplantation (FMT) was a very useful choice in treatment for recurrent Clostridium difficile infection. FMT for ulcerative colitis (UC) patients is proposed as a potential treatment for resolving dysbiosis. There is some debate as to whether FMT for UC patients is effective or not. It remains a challenge for future research to make more sophisticated and convenient methods of FMT.
Clinical development of new drugs for inflammatory bowel disease.
Matsuoka K, Watanabe M
Nihon Rinsho · 2017 Mar · PMID 30566797
Following the success of anti-TNF antibody reagents, the development of new therapies for inflammatory bowel disease is mainly based on molecular targeted drugs. Among them, the effectiveness of therapeutic agents target...
Following the success of anti-TNF antibody reagents, the development of new therapies for inflammatory bowel disease is mainly based on molecular targeted drugs. Among them, the effectiveness of therapeutic agents targeting lymphocyte migration and proinflammatory cytokines has been successful. The anti-a4β7 integrin antibody, vedolizumab, has already been used in the treatment of both ulcerative colitis and Crohn's disease in Europe and the United States. The anti-interleukin 12/23 p40 subunit, ustekinumab, was recently approved for use in the treatment of Crohn's disease in the United States. Other than those drugs, various molecular targeted drugs are currently under development. Despite the emergence of these new therapeutic agents, it is most important to appropriately use basic therapeutic drugs in the treatment of inflammatory bowel disease.
Genetics of inflammatory bowel disease in Japanese.
Kakuta Y, Endo K, Kinouchi Y
Nihon Rinsho · 2017 Mar · PMID 30566796
Several genetic studies have identified >200 susceptibility loci for inflammatory bowel disease (IBD), mostly shared between ulcerative colitis (UC) and Crohn's disease (CD). By analyzing the genetic background associate...
Several genetic studies have identified >200 susceptibility loci for inflammatory bowel disease (IBD), mostly shared between ulcerative colitis (UC) and Crohn's disease (CD). By analyzing the genetic background associated with disease sub-phenotypes, colonic Crohn's disease located intermediate between Crohn's disease with ileal involvement and UC. However, these loci were analyzed mainly in Caucasian IBD, less is known about IBD genetics in other population including Japanese. Recently, a SNP array designed specifically for the Japanese population were developed. To clarify Japanese-specific genetic background of IBD, a genome-wide association study of Japanese IBD with this kind of population specific array is needed to be performed.
Prospects for stem cell-based mucosal regeneration therapy in inflammatory bowel disease.
Okamoto R, Watanabe M
Nihon Rinsho · 2017 Mar · PMID 30566795
Recent advances in the treatment of inflammatory bowel diseases has raised its therapeutic goal up to completely repairing the damaged intestinal tissue and achieve "mucosal healing". To improve and further facilitate th...
Recent advances in the treatment of inflammatory bowel diseases has raised its therapeutic goal up to completely repairing the damaged intestinal tissue and achieve "mucosal healing". To improve and further facilitate the tissue repair process in inflammatory bowel disease patients, stem cell based therapy using mesenchymal stem cells is under development. Also, transplantation of ex-vivo cultured intestinal stem cells is another regenerative therapy that may become an alternative choice to treat refractory ulcers in inflammatory bowel disease patients. Therefore, the present review summarizes the present achievement as well as future prospects of stem cell based therapy in inflammatory bowel disease.
Colitis-associated cancer in inflammatory bowel disease and effective endoscopic surveillance programs.
Shinagawa T, Hata K, Watanabe T
Nihon Rinsho · 2017 Mar · PMID 30566794
Patients with longstanding inflammatory bowel disease, such as ulcerative colitis and Crohn's disease are well known to have at high risk of developing colorectal cancer. Oxidative stress-induced DNA damage from chronic...
Patients with longstanding inflammatory bowel disease, such as ulcerative colitis and Crohn's disease are well known to have at high risk of developing colorectal cancer. Oxidative stress-induced DNA damage from chronic inflammation is considered to cause various genomic and epigenomic changes in the intestinal mucosa (e.g., TP53 mutation, microsatellite instability and the methylation of the CpG islands) and the accumulation of such changes may lead to the development of dysplasia in the normal mucosa, which finally grows to become carcinoma. This model of carcinogenesis is called "the dysplasia- carcinoma sequence" of colitis-associated cancer. Surveillance colonoscopy with random biopsy has previously been recommended for the detection of early-phase tumors, which are generally faint and difficult to identify. However, targeted biopsy with chromoendo- scopy has been proposed because of its less invasive nature and cost effectiveness. A randomized controlled trial comparing random and targeted biopsy methods was conducted in Japan and targeted biopsy was shown to be almost comparable to random biopsy in terms of the rate of dysplasia detection. To enable more effective surveillance colonoscopy, the appropriate selection of high-risk patients and biopsy methods are important to allow lesions to be correctly detected.
Osteoporosis in inflammatory bowel disease.
Matsuura M
Nihon Rinsho · 2017 Mar · PMID 30566793
Patients with inflammatory bowel disease (IBD) are at increased risk for osteoporosis and fracture. This is considered to be relevant to IBD-related risk factors, including intestinal inflammation, low nutrient status an...
Patients with inflammatory bowel disease (IBD) are at increased risk for osteoporosis and fracture. This is considered to be relevant to IBD-related risk factors, including intestinal inflammation, low nutrient status and the use of corticosteroids, in addition to general risk factors, such as age, gender and BMI et al. A recent meta-analysis suggests that bisphosphonate is effective and safe for the treatment of low bone mineral density and reduce risk of vertebral fractures in patients with IBD. With recent advances in medical treatment for IBD, the number of elderly IBD patients is expected to increase in future. Prevention and treatment of osteoporosis associated with IBD is essential for improving QOL of patients with IBD.
Hepatitis B virus reactivation in inflammatory bowel diseases.
Kanmura S, Moriuchi A, Hamamoto H … +1 more , Ido A
Nihon Rinsho · 2017 Mar · PMID 30566792
Immunosuppressive therapy is a standard treatment for inflammatory bowel disease. However, immunosuppressive therapy is associated with severe side effects such as serious infection. In particular, hepatitis B virus (HBV...
Immunosuppressive therapy is a standard treatment for inflammatory bowel disease. However, immunosuppressive therapy is associated with severe side effects such as serious infection. In particular, hepatitis B virus (HBV) reactivation is a concern because it often leads to severe or fatal hepatitis. Screening for HBV infection using the the Japan Society of Hepatology guidelines for the management of Hepatitis B Virus infection published by the drafting committee prior to immunosuppressive therapy or chemother- apy is recommended. Observing the guidelines can prevent severe hepatitis.
Venous thromboembolism.
Fujiya M
Nihon Rinsho · 2017 Mar · PMID 30566791
Venous thromboembolism frequently occurs in patients with inflammatory bowel diseases (IBD) in western as well as Japan because of the alterations of congealing fibrinogenolysis system due to the refractory enteritis. Ag...
Venous thromboembolism frequently occurs in patients with inflammatory bowel diseases (IBD) in western as well as Japan because of the alterations of congealing fibrinogenolysis system due to the refractory enteritis. Aging, disease activity, colorectal lesions, admission, central venous catheter and operations are risk factors for the development of venous thromboembolism. Aggressive treatments including preventive and therapeutic anti-coagulation are recommended in western countries. In Japan, it is needed to establish a consensus concerning the therapeutic strategy for venous thromboembolism in IBD patients.
Recent advances in IgG4-related disease, autoimmune pancreatitis and sclerosing cholangitis.
Okazaki K, Uchida K
Nihon Rinsho · 2017 Mar · PMID 30566790
Recently, a novel concept of IgG4-related disease (IgG4-RD), which shows increased serum IgG4/IgE levels, abundant infiltration of IgG4+plasmacytes and lymphocytes, fibrosis, and steroid responsiveness, has been worldwid...
Recently, a novel concept of IgG4-related disease (IgG4-RD), which shows increased serum IgG4/IgE levels, abundant infiltration of IgG4+plasmacytes and lymphocytes, fibrosis, and steroid responsiveness, has been worldwide accepted. The international consensus diagnostic criteria suggested the existence of two subtypes of autoimmune pancreatitis (AIP) : type 1 related with IgG4, and type 2 related with a granulocytic epithelial lesion. Before the IgG4-era, most of IgG4-SC cases were misdiagnosed as primary sclerosing cholangitis (PSC). Now, type 1 AIP and IgG4-sclerosing cholangitis (IgG4-SC) are defined as pancreatic and biliary manifestations of IgG4-RD, individually. Inflammatory bowel disease is often associated with type 2 AIP and PSC, but not Iwith type 1 or IgG4-SC. Steroid treatment is effective for IgG4-RD, but the long-term outcome still remains unclear.
Clinical features of inflammatory bowel disease of the elderly onset.
Hokari R, Shirakabe K, Watanabe C
Nihon Rinsho · 2017 Mar · PMID 30566789
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. IBD of the elderly is common with prevalence rates. Genetical background involve less in the pathophysiology older-onset of IBD. Re...
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. IBD of the elderly is common with prevalence rates. Genetical background involve less in the pathophysiology older-onset of IBD. Response to drug therapies appears to be similar in elderly patients and younger patients. Corticosteroid treatment carries additional risk for elderly patients. In addition, poly-pharmacy and malignancies need to be taken into account. Pre-existing comorbidities and nutrition are important indicators of surgical outcomes. This article will review management of IBD in the elderly.
Management of children and adolescents with inflammatory bowel disease.
Yoden A
Nihon Rinsho · 2017 Mar · PMID 30566788
Crohn's disease and ulcerative colitis in children have more extensive disease with more severe disease course, more earlier progression of disease, and more longer disease course than adult IBD. Children with IBD often...
Crohn's disease and ulcerative colitis in children have more extensive disease with more severe disease course, more earlier progression of disease, and more longer disease course than adult IBD. Children with IBD often require rapid treatment escalation both for induction and maintenance of remission, due to more severe disease activity. The goals of treatment of IBD in children and adolescents are to eliminate symptoms with minimal complications, avoid drug-induced short- and long-term adverse effects, optimize growth and nutrition, decrease the psychosocial burden of the disease with psychosocial support, and restore quality of life, not only at the diagnosis, also during treatment. Many children present in the pre- or peri-pubertal period and pubertal delay is important component. The aim of this article is to help to adult gastroenterology physicians caring for children with IBD.
Surgical treatment for ulcerative colitis.
Ikeuchi H, Uchino M, Bando T
Nihon Rinsho · 2017 Mar · PMID 30566787
Operative procedures for ulcerative colitis have become standardized and its is considered unlikely that they will undergo major modifications in the future. Several studies have shown that the numbers of individuals ind...
Operative procedures for ulcerative colitis have become standardized and its is considered unlikely that they will undergo major modifications in the future. Several studies have shown that the numbers of individuals indicated for surgery for colitis- associated cancer/dysplasia are increasing. However, for elderly patients, the procedure and timing of surgery remain controversial, while it is important to keep in mind postoperative quality of life factors when selecting the procedure in those cases. Furthermore, the determination for surgery in severe cases should be made earlier for elderly as compared to younger patients. On the other hand, surgical treatment for refractory pouchitis has yet to be established. Surveillance colonoscopy is necessary for patients with persistent chronic inflammation, as inflammation-associated cancer is likely. In addition, it is important to keep in mind postoperative aggravation of gastroduodenal lesions, though that is less frequently encountered.
Surgical treatment for Crohn's disease.
Koganei K, Tatsumi K, Futatsuki R
Nihon Rinsho · 2017 Mar · PMID 30566786
Surgery has important role in the management for Crohn's disease, although medical treatment had been developed in recent years. Surgical indications are as follows, massive bleeding, perforation, cancer, abscess, stenos...
Surgery has important role in the management for Crohn's disease, although medical treatment had been developed in recent years. Surgical indications are as follows, massive bleeding, perforation, cancer, abscess, stenosis with obstruction, internal and external fistulas, severe anorectal disease, and medical failure. The principle of surgery is a minimal resection of intestine responsible for uncontrolled symptoms and repair of involved organs such as intestine, urinary bladder and abdominal wall. Strictureplasties are an effective alternative for stenosis which preserve the intestine. Seton treatment is often employed for complex perianal fistula. Surgery relieves the refractory symptoms well and should be employed at optimal time for the patients with severe symptoms which impaired their quality of lives.
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