ABSTRACT
Introduction: We report a case of intractable nausea of a terminal malignant lymphoma patient with diabetes, which improved by sublingual administration of asenapine. Case: A 78-year-old man suffering from diffuse large B-cell lymphoma with diabetes presented intractable nausea and vomiting. Those symptoms were thought to be due to masses and nodules in the right frontal lobe and the cerebellum, and/or due to edema in the peripheral brain parenchyma. Because it was difficult to take medicines orally, we selected injections to control those symptoms. However, the combination of metoclopramide, haloperidol, and hydroxyzine injections failed to relieve nausea. Olanzapine is effective against nausea but is contraindicated for diabetic patients, so asenapine, one of the multi-acting receptor-targeted antipsychotics the same as olanzapine, was expected alternatively. The patient was administrated asenapine sublingually 5mg once a day before bedtime. This administration of asenapine remarkably improved his nausea. Discussion: Sublingual asenapine dose may be an effective therapeutic option for intractable nausea.
ABSTRACT
An 84-year-old woman treated for tuberculosis in childhood presented to our emergency department with chronic cough and massive hemoptysis. Contrast-enhanced computed tomography (CT) on admission revealed a bronchial-pulmonary artery fistula (BPAF) for which she underwent bronchial artery embolization (BAE) and developed hemoptysis postoperatively. Contrast-enhanced CT on admission revealed a connection between the right coronary and a bronchial artery, suggesting coronary-to-bronchial artery communication. Hemoptysis persisted despite coiling of a branch of the right coronary artery. Therefore, we were consulted to perform thoracic endovascular aortic repair (TEVAR), which we performed as a semi-emergency. She did not show hemoptysis or paraplegia postoperatively and was discharged on postoperative day 40. TEVAR is effective for a BPAF in patients in whom BAE cannot control hemoptysis.
ABSTRACT
Objective: In this study, we aimed to develop a new system that can centrally manage and share drug information, and also evaluated its usefulness.Methods: Using PHP v5.3.3 as the programming language and MySQL v5.1.73 as the database, we built a web application that constantly runs on the server. Various drug information was registered in this system, and its usage status was analyzed based on the access log.Results: The system was accessed 31,678 times during the survey period (October 1 to December 31, 2019). The information sought included: basic drug information (ordering category of drugs, dosage forms and strengths, drug price, etc.) (13,962 times, 44.1%),question and answer records (7,221 times, 22.8%), pharmaceutical documents (package inserts, interview forms, documents regarding compatibility of injections, etc.) (7,172 times, 22.6%), notifications regarding new and discontinued drugs (727 times, 2.3%), websites (676 times, 2.1%), PreAVOID reports (663 times, 2.1%), pharmaceutical safety information (525 times, 1.7%), information regarding off-label drug use (409 times, 1.3%), and bibliographic information and guidelines (323 times, 1.0%). Among the users (62 pharmacists), 59.7% accessed the system only via a personal computer (PC), 38.7% via a PC and smart device (smartphone or tablet),and 1.6% via only a smart device. The median number of accesses to this system was significantly higher in pharmacists in charge of wards (190 [9-1,435]) or drug information (3,750 [2,957-5,548]) than dispensing pharmacists (68.5 [3-193]) (p＜0.001).Conclusion: This system allowed the central management and sharing of various drug information on the web, permitting access regardless of device type. Since this system was frequently used by pharmacists in charge of wards or drug information, this system was considered particularly useful in hospital pharmacist ward services and drug information services.
ABSTRACT
<p>ImmunoglobulinG4 (IgG4)-related sclerosing disease can occur in various organs, rarely in cardiovascular lesions. We report a case of IgG4-related cardiac tumor which was concomitant with aortic dissection. A 72-year-old woman visited our hospital with chief complaints of difficulty swallowing and weight loss. A tumor was found in the pericardium adjacent to the left ventricle on echocardiography, and a dissecting aneurysm of the ascending aorta with a maximum of 60 mm in the short diameter was noted on contrast CT. There had been no episodes related to the onset of aortic dissection such as chest pain, and chronic dissection was also identified on diagnostic imaging. A tumor biopsy was performed via a left lateral thoracotomy for tumor tissue diagnosis. Histopathologically, the tumor showed no malignant findings and we identified infiltration of IgG4-positive plasmacytes. The IgG4 level in blood exceeded the reference level, but no findings of IgG4-related disease were observed in other organs. Coronary artery CT showed the left circumflex branch of the coronary artery to run over the tumor. It was thus judged to be difficult to surgically resect the tumor. Oral steroid administration was started to reduce the size of the tumor. However, due to an enlarging trend of the aortic aneurysm involving the ascending aorta on CT at 1 month, the patient underwent ascending aorta replacement. Although infiltration of IgG4-positive plasmacytes was found in the outer lining of the resected arterial wall, the association between IgG4 and the onset of aortic dissection was unclear.</p>
ABSTRACT
In 2011, we reported the usefulness of a database（DB）that was established by the members of a palliative care team（PCT）. Since then, we updated DB depending on the requests of PCT. We revised DB mentioned below. We developed a form for keeping a record of PCT members’care for patients, their family members or others, and a record of recommendation for each problem list. We also updated another form so that the evaluation of Support Team Assessment Schedule of Japan（STAS-J）had been showed sequentially, added an entry form of Palliative Prognostic Index, and extracted data required by Japan Society for Palliative Medicine in order to evaluate the activity of PCT. The database could be used by many hospitals, because it was created by the commercially available software.
ABSTRACT
A 62-year-old man underwent replacement of the ascending aorta for a Stanford type A acute aortic dissection. The proximal stump was reinforced with using internal and external PTFE felt strips, fibrin glue and cellulose fibers. However, hemolytic anemia and hematuria occurred postoperatively. ECG-gated reconstruction CT demonstrated that the hemolytic anemia was induced by collision of red blood cells on the inverted felt strip of the proximal anastomosis. The patient underwent a reparative procedure 1 week subsequent to the initial operation. During reoperation, half of the inner felt strip used for proximal stump fixation was found to be turned up and protruding into the inner lumen. An incision was made in the synthetic graft and the inverting felt material was removed as much as possible, and then a bovine pericardial patch was used as a means of covering the internal felt strip. Here, we report a rare case of hemolytic anemia at the site of an inverted inner PTFE felt strip used for reinforcement of proximal anastomosis. We found that an ECG-gated reconstruction CT is particularly useful in diagnosing this complication around a beating heart.
ABSTRACT
Ruptured abdominal aortic aneurysm (AAA) associated with horseshoe kidney is an extremely rare condition. A 76-year-old man with lung cancer treated by radiotherapy was transfered to our hospital for emergency surgery of a ruptured AAA. Preoperative abdominal CT revealed an AAA 70 mm in diameter, massive hematoma in the retroperitoneal space and horseshoe kidney with a huge renal cyst. Because the patient was in serious condition, we performed emergency operation immediately after arrival at our hospital. The AAA was replaced by a straight prosthtic graft without division of the renal isthmus, however one aberrant renal artery was sacrificed. The postoperative course was uneventful with no evidence of renal dysfunction. In cases of ruptured AAA in a state of shock, emergency operation is first priority. Even though we could do only minimal preoperative examinations, the surgery of the ruptured AAA with horseshoe kidney can be performed safely, if an accurate perioperative judgement for the treatment of abberant artery and renal isthmus is made.
ABSTRACT
Tracheo-innominate fistula (TIF) is an uncommon life-threatening complication of tracheostomy. We report a 36 year-old man with post-tracheostomy TIF which was successfully repaired. After temporary control of bleeding, he was transported to our hospital by an ambulance helicopter. Emergency surgery was performed. The tracheal fistula was closed by direct suture and it was covered by sternocleidomastoid muscle flap. After sufficient irrigation, ascending aorta-innominate artery bypass was performed using 8 mm Dacron graft through a right pleural cavity. The postoperative course was uneventful. The patient was discharged from our hospital after 30 days of operation. He has been in good condition for 3 years after surgery. Reconstruction of the innominate artery with vascular prosthesis is feasible even is cases of TIF. However, preventive measures are extremely important to avoid long-term complications such as graft infection or recurrence of TIF.
ABSTRACT
<b>Objectives</b><br> Vietnam, where leprosy used to be highly endemic, through governmental implementation of MDT in 1983 and nationwide disease control efforts, has achieved WHO's leprosy elimination goal at a national level since 1995. <br> However, a number of patients who suffered from leprosy prior to the governmental control programme remain institutionalised. Although these patients have severe physical disabilities, social services provided to improve their quality of life appear inadequate.<br> The purpose of this study is to report the findings of an investigation of the current state of leprosy and to clarify the problems of leprosy control in Vietnam.<br><b>Methods</b><br> 402 leprosy patients from two leprosy hospitals and four leprosy resettlement villages in Vietnam were investigated their disabilities on upper limb, inferior limb, and facial appearance. And their disabilities classified according to the WHO classification scheme for disabilities in leprosy patients.<br><b>Results</b><br> The group “Visible deformity or damage present” (G2) made up 70.1% of the study participants; the group “Anaesthesia present, but no visible deformity or damage” (G1) made up 18.9%; the group “No anaesthesia, no visible deformity or damage” (G0) made up 10.9%. More than half of those with visible physical disabilities were in their 60s or 70s. The level of disability of pre-MDT leprosy sufferers was significantly more severe than that of the post-MDT group.<br><b>Conclusions</b><br> The effect of MDT for prevention of occurrences of physical disability was reaffirmed, but for many patients who contracted the disease prior to the implementation of MDT in Vietnam, the after-effects of leprosy are ongoing and they are forced to live in resettlement villages due to their disability. Vietnam has reduced the prevalence rate, but there are still a number of former patients who are not receiving adequate help. Providing help that is needed to raise their quality of life is the next step.
ABSTRACT
<b>Purpose</b>: We developed a database that can be shared by the members of our palliative care team (PCT) before the conference and ward round (CR) to make these activities more efficient. <b>Methods</b>: The database was developed using Microsoft Access®. The condition of patients was evaluated using a Japanese version of the Support Team Assessment Schedule (STAS-J). The database allows any member of the team to input patient information. We also developed a form that allows us not only to share the information but to continuously observe the progress of the patients. To evaluate the advantages of the database on CR, we compared the number of patients observed in one CR and the number of CR's per patient before and after the introduction of the database. <b>Results</b>: The number of patients observed in one CR and the number of CR's per patient were significantly increased after the introduction of the database. <b>Conclusion</b>: The database had positive effects on CR by making the patient information available in advance and by allowing continuous evaluation of patients. Palliat Care Res 2011; 6(1): 209-215
ABSTRACT
In this study, we examined the feasibility of using subzonal cell injection with electrofusion for interspecies somatic cell nuclear transfer (iSCNT) to produce sei whale embryos and to improve their developmental capacity by investigating the effect of osmolarity and macromolecules in the culture medium on the in vitro developmental capacity. Hybrid embryos produced by the electrofusion of fetal whale fibroblasts with enucleated porcine oocytes were cultured in modified porcine zygote medium-3 to examine the effects of osmolarity and fetal serum on their in vitro developmental capacity. More than 66% of the whale somatic cells successfully fused with the porcine oocytes following electrofusion. A portion (60~81%) of the iSCNT whale embryos developed to the two- to four-cell stages, but no embryos were able to reach the blastocyst stage. This developmental arrest was not overcome by increasing the osmolarity of the medium to 360 mOsm or by the addition of fetal bovine or fetal whale serum. Our results demonstrate that sei whale-porcine hybrid embryos may be produced by SCNT using subzonal injection and electrofusion. The pig oocytes partly supported the remodeling and reprogramming of the sei whale somatic cell nuclei, but they were unable to support the development of iSCNT whale embryos to the blastocyst stage.
Subject(s)
Animals , Cloning, Organism/veterinary , Culture Media , Embryo, Mammalian , Karyotyping , Nuclear Transfer Techniques/veterinary , Oocytes , Swine/embryology , Whales/embryologyABSTRACT
A 63-year-old man suffered from multisystem trauma including pelvic bone fracture and lung contusion caused by a traffic accident. Chest CT revealed mediastinum and periaortic hematoma. Because of hemorrhagic complications, a emergency operation was avoided, and conservative therapy was decided on. Though his blood pressure was controlled strictly, re-bleeding appeared. An urgent operation was performed 4 days after the injury. Under partial cardiopulmonary bypass, the aortic isthmus disruption was resected and replaced with an artificial graft. The postoperative course was uneventful. In cases of traumatic aortic disruption with multisystem trauma, the delayed operation is more common than urgent operation. However, there is always the possibility of rupture. It is extremely important to appropriately judge the timing of the operation.
ABSTRACT
A 53-year-old woman with atrial septal defect (ASD) and atrial fibrillation (AF) with idiopathic thrombocytopenic purpura (ITP), was scheduled to undergo ASD closure and the maze procedure. Because steroid therapy was not effective, high-dose γ-globulin administration (400mg/kg/day) was performed for 5 days before surgery. The platelet count increased from 5.4×10<sup>4</sup>/mm<sup>3</sup> to 14.0×1<sup>4</sup>/mm<sup>3</sup>. ASD patch closure and modified bilateral appendage preserving (BAP) maze procedure were performed. No hemorrhagic tendency was recognized. The postoperative course was uneventful, and the sinus rhythm was recovered. The maze procedure become possible in this ITP patient with preoperative administration of high-dose γ-globulin.
ABSTRACT
A preparticipation examination for athletes should be performed to prevent severe athletic injury by examining physical characteristics related to various injuries. The general joint laxity test has been included among the check-up items considering as relating factor of joint injury. Authors investigated the relationship between the score of general joint laxity for freshmen examination and the incidence of major joint injury, during the succeeding 5 athletic seasons, in eighty-seven collegiate American football players.<BR>Significant higher scores were observed in athletes affected by shoulder injury, and slightly higher scores in those affected by knee joint injury. But, the scores were similar between athletes with and without elbow or ankle injury.<BR>The degree of laxity was associated with shoulder and knee joint injury in a comparison of incidence of these injuries among tight, medium and lax groups.<BR>Authors concluded that general joint laxity is related to the incidence of shoulder and knee joint injury.
ABSTRACT
A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Subject(s)
Diabetes Mellitus, Type 1 , Diabetes Mellitus , Urinary Tract InfectionsABSTRACT
A 75-year-old man with severe mitral valve regurgitation and 80% stenosis of the right internal carotid artery was referred to us for surgical treatment. He had a history of ipsilateral cerebral artery thrombosis 28 months previously. Although preoperative percutaneous transluminal carotid angioplasty with stenting (PTCAS) was performed, 60% stenosis of the artery still remained. He underwent mitral valve repair 2 months after PTCAS due to cardiac symptom progression. Intraaortic balloon pumping was used to maintain higher pressure during the extracorporeal circulation of the heart surgery. He recovered uneventfully and without any cerebral complications.
ABSTRACT
The purpose of this study is to investigate the degenerative change of the cervical spine in American football (AF) players. The subjects were 27 collegiate AF players who had an annual radiological examination of the cervical spine. X-ray films of the lateral view were read by digital scanner and the anterior and posterior height of each spine (C 3-C 6) was measured. The subjects were divided into two groups based on experience of AF in high school (inexperienced and experienced) or the position played (lines and backs) .<BR>Although the anterior height did not change from the first grade to fourth grade, the posterior height of C 4, C 5 and C6 significantly increased (P <0.05) . The experienced group showed a faster increase in the rate of posterior height than the inexperienced group. Also, the backs group showed a faster increase in the rate of posterior height than the lines group. The increased posterior height, which sometimes includes bony spur, results in kyphotic change of cervical alignment and impingement of the cervical nerve root. The faster growth rate in experienced or backs groups suggests that higher mechanical stress to the cervical spine and younger start of AF caused degeneration.
ABSTRACT
A 12-year-old girl had relative graft stenosis following the reconstruction of type A interrupted aortic arch. At 25 days after birth she underwent ascending aorta-descending aorta bypass with a 7mm knitted Dacron graft, ligation of the patent ductus arteriosus and pulmonary artery banding. She had patch closure of a ventricular septal defect (VSD) as well at 20 months of age. At age 12 catheterization was carried out, because she had headache and dizziness on exertion. The pressure of the ascending aorta was 163/79mmHg and the pressure gradient between the ascending and the descending aorta was 65mmHg. Aortography revealed severe stenosis of the graft, which might have occurred according to her growth. An extra-anatomic bypass was placed between the right axillary and the right common iliac artery through the intrapleural and preperitoneal route with a 10mm Dacron graft. Six months later, the blood pressure was 108/63mmHg in the upper extremities, the pressure gradient between the upper and lower extremities was reduced to 18mmHg, and headache and dizziness had disappeared.
ABSTRACT
Injury of the anterior cruciate ligament (ACL) occurs frequently in female gymnasts and basketball players. However, there is no effective method for preventing ACL injury. Recently, a fatigue phenomenon of the ligament tissue has been considered to be the main causative factor in ACL injury.<BR>The present study was done to investigate the relationship between knee laxity and general joint looseness in 34 female college basketball players at an orthopedic medical check-up.<BR>Knee laxity was evaluated in terms of the anterior displacement (AD) value measured by a KT-2000 knee ligament arthrometer at 20 lb. General joint looseness was evaluated in terms of the general joint laxity (GL) score including six major joints and the spine.<BR>There was a significant correlation between the AD value and GL score, the correlation coefficients being 0.48 (p<0.01) at the right knee and 0.54 (p<0.01) at the left knee.<BR>The ACL of athletes with a higher AD would always be exposed to higher anterior stress than in athletes with a lower AD, thus possibly leading to a fatigue state. Therefore, we consider that athletes with a high AD are at greater risk of ACL injury. Our results suggest that the easy GL test is an effective screening method for differentiating those with a high AD and a greater risk of ACL injury.