ABSTRACT
<b>Background:</b> There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan.<br><b>Methods:</b> We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG.<br><b>Results:</b> The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no.<br><b>Conclusions:</b> Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG.
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
In order to know the present state of mass survey for large-bowel cancer in rural areas, we gathered the results of colorectal screening in 1989 from 45 hospitals or cancer detection center related to agricultural cooperatives of all over Japan.<BR>In all of the 45 institutions, method of screening was fecal occult blood test, and in most of them, the stool study was immunological, of one day, and without meal restriction. Methods of further precise examination such as barium enema, total colonoscopy, sigmiodoscopy, or proctoscopy, solely or combined, were employed depending to the facilities.<BR>The total number of examinees were 194, 834, and 8, 523 (4.4%) had a positive reaction for occult blood. Further precise examinations were performed in 4, 351 (59.7%) examinees, and 148 cases of large-bowel cancer were detected. The detective rate of cancer in total examinees was 0.08%. Among these 148 cases of colorectal cancer, 43 cases (51.8%) were in early stage. Examinees in their fifties were the most in number, and both the rate of positive reaction and the rate of cancer detection were increased as the age gets older.