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<p>A 69-year-old woman had dysphagia, hoarseness, and asthma-like symptoms such as cough and wheeze. Inhaled corticosteroids and long-acting β<sub>2</sub> stimulants was not effective. Gastrointestinal endoscopy showed compression of the esophagus wall from outside. Enhanced computed tomography (CT) showed thoracic descending aortic aneurysm compressing esophagus and left lower lobe bronchus. Immediately thoracic endovascular aortic repair (TEVAR) was performed. After surgery, significant improvement of hoarseness and asthma-like attack was obtained at the time of 1 month after surgery. This is the first reported case of TEVAR which improved compression symptoms of both esophagus and bronchus due to thoracic aortic aneurysm in Japan.</p>
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In this paper the evidence necessary to justify interventional prevention for cancer is discussed. In Japan, to date few trials with a design of RCT have been conducted in the field of cancer prevention. However, as it has been shown that preventive measures such as cancer screening and chemoprevention generally cause some harm and they are not always effective in reducing mortality, there should be evidence from good-quality RCTs showing that they do more good than harm before any new cancer screening and cancer prevention measures are implemented as public health services.
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We encountered 4 nonagenarian cases of ruptured abdominal aortic aneurysm (RAAA). They were 2 men and 2 women aged between 90 and 94. Two cases were saved but two were lost. The percentage of success in this age group was low but there was no statistical inferiority. The serum hemoglobin levels on admission were low and they had a tendency towards acidosis in spite of fairly good blood pressure. The causes of death were hemorrhagic shock and intestinal necrosis. We have to treat more carefully and vigorously to secure elderly surgical cases of RAAA. One patient died of cerebral infarction after discharge. We recommend that the patients of RAAA in nonagenarians should undergo surgical operations except in cases of severe shock or cardiopulmonary arrest.
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Objective: The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking. Methods: We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia. Results: The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia. Conclusions: We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.
Asunto(s)
HipercolesterolemiaRESUMEN
<p><b>OBJECTIVE</b>The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking.</p><p><b>METHODS</b>We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia.</p><p><b>RESULTS</b>The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia.</p><p><b>CONCLUSIONS</b>We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.</p>