ABSTRACT
The incidence of cerebral infarction due to Takayasu's arteritis is relatively low, and there are few reports on rehabilitation for this condition. We report the case of a patient with Takayasu's arteritis, repeated expansion of cerebral infarction, and subclavian steal syndrome who required careful observation at the start of ambulation. A 17-year-old male was diagnosed with Takayasu's arteritis complicated by subclavian steal syndrome eleven months ago. He was admitted for the treatment of cerebral infarction in the right side of the middle cerebral artery. One day after admission, the area of the infarction expanded. Next day, after he started ambulation (16 days after admission), the area of the infarction further expanded despite ongoing medical treatments, including corticosteroid and immunosuppressant administration. Cerebral blood flow scintigraphy showed stenosis of right middle cerebral, right internal carotid, right common carotid, brachiocephalic, left subclavian, and left vertebral arteries.These arterial stenosis progressed in the two weeks following admission. Thereafter, he complained of dimmed vision more frequently when he raised his body to an upright position. The rehabilitation schedule had to be carefully adjusted according to his symptoms. Two and a half months later, angiographic examination showed development of adequate collateral circulation from the bilateral intercostal arteries to both vertebral arteries. After we confirmed the collateral circulation, we allowed him to use a wheelchair. The confirmation of collateral circulation by image analysis is important in order to decide the time to start ambulation in patients with Takayasu's arteritis (early phase) along with repeated cerebral ischemia.
ABSTRACT
The incidence of cerebral infarction due to Takayasu's arteritis is relatively low, and there are few reports on rehabilitation for this condition. We report the case of a patient with Takayasu's arteritis, repeated expansion of cerebral infarction, and subclavian steal syndrome who required careful observation at the start of ambulation. A 17-year-old male was diagnosed with Takayasu's arteritis complicated by subclavian steal syndrome eleven months ago. He was admitted for the treatment of cerebral infarction in the right side of the middle cerebral artery. One day after admission, the area of the infarction expanded. Next day, after he started ambulation (16 days after admission), the area of the infarction further expanded despite ongoing medical treatments, including corticosteroid and immunosuppressant administration. Cerebral blood flow scintigraphy showed stenosis of right middle cerebral, right internal carotid, right common carotid, brachiocephalic, left subclavian, and left vertebral arteries.These arterial stenosis progressed in the two weeks following admission. Thereafter, he complained of dimmed vision more frequently when he raised his body to an upright position. The rehabilitation schedule had to be carefully adjusted according to his symptoms. Two and a half months later, angiographic examination showed development of adequate collateral circulation from the bilateral intercostal arteries to both vertebral arteries. After we confirmed the collateral circulation, we allowed him to use a wheelchair. The confirmation of collateral circulation by image analysis is important in order to decide the time to start ambulation in patients with Takayasu's arteritis (early phase) along with repeated cerebral ischemia.
ABSTRACT
In order to intervene in the management of pain of cancer from an early stage. Our palliative care team (PCT), including pharmacists, makes the ward rounds (screening rounds) of the patients receiving opioids at our hospital. The purpose of this study was to analyze the effects of screening rounds activity by the PCT and its current problems, and to explore how to resolve the problems. We retrospectively studied the records of 196 patients who had receivede interventions by the PCT, with regard to intervention status and prescription proposal (228 subjects) about drug therapy by us. Study groups were as follows: 103 patients to whom interventions were deliveed at the request of medical doctors (intervention request group) and 93 patients who had interventions by the PCT after PCT-screening rounds (screening group). PCT-screening rounds caused to increase the number of interventions by the PCT. After PCT-screening rounds, the cases of intervention started by the request of medical doctors, who had given no heed to PCT intervention, also increased in numher. In this study, some problems with palliative intervention were also brought to light. Even in the screening group where the PCT largely intervened, 33% of prescription proposal by the PCT was ignored. This problem may be, at least in part, due to inadequate communication between PCT and ward staff through an electronic medical recording card, leading to poor relationship between PCT and ward staff. In the future, the PCT needs to work cooperatively with ward staff through direct communication such as medical conference to perform better intervention.