Survey of Oral Care for Cancer Patients on Chemotherapy, and Measures to Improve Nurses’ Assessment and Nursing Care Abilities / 日本農村医学会雑誌

Oral mucositis is reported to occurs in 40% of cancer patients on chemotherapy, suggesting the need for early oral care intervention in such patients. However, the oral care depends on each nurse and there has been no special document on the oral care for patients in the Respiratory Medicine and the Hematology/Oncology Ward, in which are managed around 100 regimens of chemotherapy per month. Here, to develop an oral care assessment sheet (OC sheet), we conducted a questionnaire survey of 24 ward nurses on oral care for chemotherapy patients and evaluated their assessment abilities using an oral care assessment test that was compliant with the items of the Eiler’s Oral Assessment Guide. The questionnaire survey revealed that nurses performed certain observations and/or interventions without basis and confidence, and that they did not always have patients’ cooperation while assessing their oral condition. They also tended to give inconsistent instructions. Use of the OC sheet enabled nurses to provide early oral care interventions and to confirm the utility of the chosen intervention. Test scores after the introduction of the OC sheet were significantly higher than before, indicating that use of the OC sheet improved nurses’ assessment and nursing care abilities.

A Case of Spindle Cell Type Medullary Carcinoma of the Thyroid Diagnosed by Immunocytochemistry / 日本農村医学会雑誌

　　We report a case of spindle cell type medullary carcinoma of the thyroid in a 77-year-old man. Fine needle aspiration cytology showed numerous spindle cells without inflammation and hemorrhage. The spindle cells were uniform and exhibited no malignant features. Immunocytochemistry was positive for carcinoembryonic antigen and calcitonin, and the tumor was diagnosed as spindle cell type medullary carcinoma. There are various histological subtypes of medullary carcinoma, and diagnosis by cytomorphology alone is difficult. Preservation with LBC fixative was helpful for diagnosis by immunocytochemistry in this case.

Problem in Epidermal Growth Factor Receptor Gene Mutation Detection Using Trans-Bronchial Lung Biopsy Samples / 日本農村医学会雑誌

　　Epidermal growth factor receptor (EGFR) gene mutation examination is now performed in most medical institutions in order to select the molecular targeted medicine for lung cancer. It became clear that the positive rate of the biopsy material was lower than that of the surgical sample in this hospital. The cause was attributed to false negatives due to low tumor cell content in biopsy specimens. We investigated the presence of the mutation using surgical samples and preoperative biopsy specimens from the same patients in 13 cases. Furthermore, we investigated the tumor cell content of the biopsy specimens by cell counting. Results showed that 3 of 6 biopsy specimens that were associated with positive surgical samples were judged to be negative. The tumor cell content was less than 5% in all negative cases. Regarding EGFR gene mutation examination, we should carefully determine tumor cell content when using biopsy specimens.

Task of Service Training Committee for Improvement of House Staff’s Attitude Toward Service and Its Quality / 日本農村医学会雑誌

　　With the aim of revamping hospital service as a pillar of our hospital reform movement, the Service Training Committee came into being in 2012.　　A questionnaire survey was conducted on the entire personnel and tenant suppliers (the entire personnel, tenants and contractors’ employees?). About 80% (705 people) of those queried replied. More than 90% of the respondents were of the view that an improvement in the manner of reception should enhance not only the prestige of the hospital, the evaluation its medical treatment and patients&rsauo; degree of satisfaction, but also hospital employees’ degree of satisfaction and their quality of life.　　On the other hand, some respondents said that there was much to be desired in the way hospital employees exchange greetings with their colleagues and in the manners or the language they use when they speak to patients.　　Most of the hospital staff seemed to understand the importance and meaning of service and hospitality very well. It was clear that the hospital employees were willing to join in our drive to improve the quality of service. They also understood the problems they should address to in earnest.　　We thought it was our task to make use of their positive attitude toward the quality improvement of service. What we have in view is to create a hospital culture that makes it seem natural to provide a high-quality service to visitors and patients. To this end, we will develop various activities and hold workshops.

Usefulness of Rapid Immunostaining in Intra-Operative Diagnosis of Sentinel Lymph Node Metastasis of Breast Cancer / 日本農村医学会雑誌

　　In breast cancer cases, intra-operative diagnosis of sentinel lymph node metastasis has been performed widely. It is diagnosed at present by HE staining, but more objective methods are needed. In this study using 166 examples, we compared the methods using rapid immunostaining with the genetic examination. In rapid immunostaining, we recognized metastasis using cytokeratin which was an epithelial cell marker used in the serial sections for frozen histological diagnosis. In conclusion, because metastasis could be diagnosed accurately and pathologist&rsqup;s stress would be reduced, rapid immunostaining is useful for intraoperative diagnosis.

Detection of HER-2 Protein and DNA Amplification in Breast, Stomach and Colon Cancers / 日本農村医学会雑誌

　　We investigated the detection situation of the HER-2 examination that was performed to investigate the adaptation of the molecular targeted medicine trastuzumab for mammary and gastric cancers. The HER-2 positive rate was higher in biopsy specimens than in surgical specimen. In gastric cancer, the positive rate was significantly high when it was of the papillary type, histologically. In comparison with mammary cancer, the percentage of FISH positive was high in 2＋ cases. In addition, as the results of trial investigation showed, HER-2 positive cases ware few in colon cancer.

Detection of High Risk Type HPV by Means of Clinichiptm in Patients with Cervical Dysplasia / 日本農村医学会雑誌

　　It is known that uterine cervical cancer is caused by persistent infection with high-risk type of HPV (human papilloma virus). We have run HPV genotyping tests on patients since November, 2011. In 111 cases so far examined, HPV types 16, 52 and 58 were detected with high frequency, but type 18 was with low frequency. This trend was comparable to nationwide tendency. Type 52, 56 and 58 were detected from the patients of advanced age frequently. There weredifferences in HPV infection rate between cytology-negative cases and positive cases, but there was not the difference in HPV typing by cytology-negative and positive patients. Furthermore, it was made clear that the superinfection of HPV who significantly related to the development of tumor. In the cytology negative patients who were followed up because of dysplasia, there are many who are negative for high risk HPV. Therefore, HPV genotyping examination may help physicians determine the relative priority for treatment.

A Case Report of Inguinal Endometriosis / 日本農村医学会雑誌

  A 41-year-old woman, gravid 3, para 3, was admitted to the Department of Obstetrics and Gynecology at Tsuchiura Kyodo General Hospital, complaining of a tender, gradually enlarging mass in the right inguinal region during menses. Examination found the mass was about 2 cm in diameter, which protruded slightly (on lying position?). During menstrual periods, the mass enlarged and the pain intensified, but between menses, the mass decreased in size and the pain subsided. The case was diagnosed as inguinal endometriosis and then a preoperative GnRH analog therapy was given for six weeks to make a good operative local condition. Surgery was performed under general anesthesia and a mass about 4.0×3.0 cm in diameter near inguinal ligament was removed. The cut surface revealed small hemorrhagic areas or spaces. Microscopic examination of the dissected mass confirmed the diagnosis of inguinal endometriosis. It was found that the patient had a moderate inguinal swelling on the first visit to the hospital as an outpatient 7 days after operation, but the swelling disappeared shortly afterword. She has been receiving a post-operative GnRH analog therapy for 3 months to maintain a good local condition. The authors concluded thatthe appearance of a lump in the inguinal region and objective changes of the lesion in relation to the menstrual cycle should be considered as the symptoms of endometriosis.

Prevalence of non-alcoholic fatty liver disease in children and relationship to metabolic syndrome, insulin resistance, and waist circumference

<p><b>OBJECTIVES</b>To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in children and its relationship to metabolic syndrome, insulin resistance, and waist circumference (WC).</p><p><b>METHODS</b>This was a population-based cross-sectional, case-control study. Cases were selected among students of a primary and junior high school, respectively, and age- and sex-matched control subjects were selected randomly (ratio of cases to control subject was 37:113).</p><p><b>RESULTS</b>Of the 846 students, aged between 6 and 15 years, enrolled in the study and screened by ultrasonography, 37 children were diagnosed as having NAFLD (score >/= 1). There was a significant sex difference in the prevalence of NAFLD(P = 0.003). The trend test revealed a strong dose-response relationship (P < 0.001) between pediatric NAFLD and the number of the proposed components of pediatric metabolic syndrome in Japan (MetS-JC), such as a clustering of the components of MetS-JC. Additionally, the linear trend of the odds ratios (ORs) with increasing percentile of the homeostasis model assessment-insulin resistance (HOMA-IR) was statistically significant (P < 0.001). However, when WC was added to the logistic model, the ORs were no longer significant, whereas WC turned out to be an independent risk factor for NAFLD regardless of the HOMA-IR index.</p><p><b>CONCLUSION</b>The prevalence of NAFLD in children and adolescents is closely related to metabolic syndrome, insulin resistance, and WC.</p>

A Retrospective Study of 25 Cases of Thymic Epithelial Tumors Treated in Tsuchiura Kyodo General Hospital / 日本農村医学会雑誌

Thymic epithelial tumors are treated with reference to the Masaoka staging system. In 1999, the World Health Organization published a histologic classification of thymomas. The WHO classification was revised in 2004. There is a general consensus that it is as important a prognostic factor in primary thymoma and thymic carcinoma patients as the Masaoka staging system. In the present study, a total of 25 cases of thymic epithelial tumors (21 thymoma cases and 4 thymic carcinoma cases) treated from 1991 through 2005 in our hospital were reclassified based on the new WHO classification. The thymoma cases consisted of four at Masaoka's stage I, 11 cases at stage II and six cases at stage III, whereas according to the WHO classification they were categorized into seven B1 type tumors, eight B2 type, four B3 type and two unclassifiable cases. Of the four thymic carcinoma cases, one belonged under Masaoka's stage II, another under stage III and two under stage IV. One thymic carcinoma case resulted in death. There were no fatalities from thymomas. Most of the thymomas at Masaoka's stage III came under WHO type B2 and B3, showing a high incidence of local infiltration. Since either the WHO classification or the Masaoka staging system is an important factor for determining the course of treatment, we concluded that both should be utilized clinically.

Therapeutic effect of the cordless mini TENS on shoulder stiffness and painful diseases / 全日本鍼灸学会雑誌

The therapeutic effect of a cordless mini TENS on shoulder stiffness and painful diseases and patients' favorite intensity of stimulation were studied. Effect of this apparatus on peripheral circulation was also examind using a laser Doppler measuring instrument. The 114 cases with shoulder stiffness used the TENS only once (SS group), and the 53 cases continuasly (SC group). The 65 cases with painful diseases used the TENS only once (PS group) and the 53 cases continuasly (PC group). A great majority of the patients prefered stimulation with moderate frequency and high intensity. Effectiveness was seen in 76% of SS group and 87% of SC group, and in 75% of PS group and 91% of PC group. Peripheral circulation was significantly increased after the stimulation of the apparatus.