Success in Treatment of Pulmonary Fibrosis Caused by Paraquat: Report to Two Cases / 日本農村医学会雑誌

We report two cases of farm chemical poisoning which were treated successfully. Two elderly men separately swallowed down paraquat/diquat solutions in an attempt to kill themselves, and resultantly developed pulmonary fibrosis. After steroid therapy, clinical symptoms desappeared, although a slight degree of abnormality remained on chest X-rays. Case 1: a 57-year-old man; the amount of ingestion, 100 ml; hospitalized 2 hours after ingestion; shock, (-); urinary PQ reactoin, (2); serum PQ level, 1.14 ug/ml; pulmonary injury at first examinatoin, (-); pulmonary manifestation of symptoms, at day 3 after hospitalization; minimum Pao<SUB>2</SUB>, 67.6 mmHg. Case 2: a 65-year-old man; the amount of ingestion, one gulp; hospitalized 27 minutes after ingestion ; shock, (-); urinary PQ reactoin, (3+); serum PQ level, 6.6ug/mg; pulmonary injury at first examination, (-); pulmonary manifestation of symptoms, at day 5 after hospitalization; minimum Pao<SUB>2</SUB>, 58.3mmHg. For treatment, gastrointestinal lavage, forced diuresis and direct hemoperfusion were performed in both cases. Steroid pulse therapy was followed by repeated oral administration of large doses of steroid.<BR>Hepatic and renal disorders were transient. Pao<SUB>2</SUB> was normal when the patients were discharged. The primary reasons we could save their lives are probably that the amount of PQ ingestion was relatively small, hemodialysis was performed repeatedly at early stages, and that large amounts of steroid were used immediately after the onset of pulmonary fibrosis.

In Search of a Way of Obtaining Informed Consent Inpatients' Replies to a Qestionnaire on Medical Care / 日本農村医学会雑誌

High-quality terminal care cannot be given without good communication and understanding among patients, their family members and health as well as medical professionals.Recently, we have taken a questionnaire survey on new inpatients in our hospital to sound them out on their thinkings about hospital care, and examined the findings along with the validity of survey.Many respondents including those contracting either benign or malignant diseases wished to be keptposted on what they are really up against and to partake in the decision-making process before treatment plans are put into practice. The recent questionnaire survey has proved to be worthwhile as a tool to know the wishes of hospitalized patients and suggested an effective way to promote the practice of obtaining informed consent before specific test and therapautic procedure.