RESUMEN
Our hospital is located in a mountainous region of Toyota City, Aichi Prefecture. In the sphere covered by our health services, about 34% of the population is 65 years or older. The graying of the community has been progressing rapidly in the past years. Many elderly people do not have a car. Only available means of transport for them are community bus servicers operated once or twice a week. The situation makes them feel disinclined to go to take physicals or visit the hospital for health screening. When we happen to detect gastrointestinal cancer in aged persons, it is often in an advanced state or too late for surgical removal, or a relapse. For some of such cases, we consider the possibilities of chemotherapy.<br> Between April 2005 and June 2010, we performed laparotomies (including exploratory operations) on people aged 70 or older with gastrointestinal cancer. Of the patients excluding those with severe cognitive impairment and those in failing health, 25 patients underwent S-1monotherapy postoperatively. The results were no less favorable than those of the cases of younger patients who had received S-monotherapy or other forms of chemotherapy for gastrointestinal cancer. Although this comparison was not adequate because the number of cases of elderly patients was too small, our hospital regards S-1 monotherapy as one of the chemotherapeutic regimens beneficial to old people with gastrointestinal cancer and helpful in maintaining the patient's qualuty of life.
RESUMEN
Necrotizing fasciitis has a very high acute mortality. Diabetes mellitus often underlies the disease. In this paper, we report two cases of necrotizing fasciitis caused by sacral decubitus, which were successfully treated with withdrawal of pus through radical excision, cleansing and debridement. The patients were: a 74-year-old man with a history of diabetes and depression (case 1) and a 82-year-old man with a history of diabetes and spinal injury which resulted in paraplegia (case 2). In either case, a wide area extending from the buttocks to lower back was cut open for drainage, washing and debridement at an early stage after the onset of necrotizing fasciitis, and broad-spectrum antibiotics were administered. Due to preoperative general health conditions, underlying diseases such as diabetes mellitus and postoperative diapedesis of protein, the patients' nutritional status critically deteriorated after surgery. Consequently, measures were taken to control diabetes and provide nutritional care. These efforts were crowned with success. It was found that early healing of surgical wound necessitated using pressure dispersion type mattresses and turning, on a regular basis, of the bed-ridden patients with decreased mobility, in addition to putting them in rehabilitation.
RESUMEN
Moist wound healing for wound treatment has been becoming wide-spread for several years. Open wet-dressing therapy (OWT) is one of the useful therapies at a hospital in a mountainous area where many elderly find it difficult to go to hospital frequently the past. At our department of surgery we also heal pressure ulcers, so we regard Wound bed preparation as important, too. Choice of appropriate types of dressing materials based on concept of Wound bed preparation and Moist wound healing, OWT and information of them enable us to decrease the frequency of hospital visits by the elderly in the mountainous area. It is important for the community in the mountainous area to inform Wound bed preparation, Moist wound healing and OWT for the purpose of safety management of OWT.
RESUMEN
The changes of hemodynamics during bathing in patients with heart diseases were studied by invasive methods using a Swan-Ganz catheter and UCG. As a population, we have used 37 peatients with heart disease, ages 20 to 76 (average age 52.9). There were 26 cases of myocardial infarction, 5 cases of valvular disease, 5 cases of cardiomyo pathy, and 1 case of VSD. Bathing was done with tap water in a Hubbard tank, for 10 minutes at 40°C and for 5 minutes at 43°C in a supine position. Arterial pressure, heart rate, pulmonary arterial pressure, pulmonary wedge pressure, right atrial pressure, cardiac output, stroke volume and stroke work index were increased during bathing and decreased after bathing. Systemic vascular resistance and pulmonary arteriolar resistance were decreased during bathing. Their changes were marked with a bath of 40 to 43°C. These findings suggest that preload may be increased during bathing, and preload and afterload reduced after bathing. Hydrostatic pressure, autonomic nervous reflexes or endocrine system were thought of as possible reasons for the increase in pulmonary arterial pressure. Because pulmonary arterial pressure, pulmonary wedge pressure and right atrial pressure increased during bathing even though systemic vascular resistance and pulmonary arteriolar resistance decreased, increase in venous return was thought of as the biggest possibility. And because the patients with low cardiac function could not control the extent of increase in venous return, pulmonary arterial pressure increased markedly in patients with low cardiac function. The patients with myocardial infarction were classifed into a group showing elevation of pulmonary arterial pressure (PAP) and a group showing no elevation of PAP. The group showing elevation of PAP, compared with that without PAP elevation, included many cases of severe myocardial infarction deter-mined by Forrester's classification, Killip's classification and Peel's prognostic index at admission to hospital. Among these patients showing PAP elevation, there were more cases having low physical work capacity and low ejection fraction at discharge from hospital than among the patients without PAP elevation.