Clinical Study of Mamushi Viper Bites in 35 Cases / 日本農村医学会雑誌

Mamushi is a species of pit viper distributed throughout Japan excluling the Ryukyu Islands and sighted from spring to autumn. It is estimated that about ten people dies in a year. It is important in the rural medicine because a lot of people are bitten in mountains and fields. A total of 35 cases of mamushi viper bite were treated from 1999 to 2006 in our hospital. The patients were 17 men and 18 women ranging in age from 7 to 80 years old (average: 60). Local swelling and pain were manifest in all the cases. Sixteen patients had systemic symptoms, and toxic effects commonly appeared in the eyes. The blood tests revealed elevated CPK levels in 24 patients (69%). The elevation correlated to the seriousness of the clinical symptoms. In accordance with our manual for mamushi viper bites, all patients were hospitalized after incision for exclusion of the toxin. The median length of time before the worst symptoms began to subside was 3 days. The median length of hospitalization stays was 7 days. It took long before the patients fully recovered. The severity of envenomation was different from patient to patient and one case needed intensive care. The median of treatment period was 31 days. The quick and appropriate primary care for the mamushi viper bits is important to prevent serious complications.

Perioperative Management to Prevent Postoperative Pulmonary Embolism in General Surgical Patients / 日本農村医学会雑誌

Recently, the incidence of pulmonary embolism (PE) after surgery began to increase in Japan and to prevent PE has become essentially important. During the period between July 2003 and August 2004, we placed 203 general surgical patients under our perioperative management using intermittent pneumatic compression (IPC) and compression stockings (CS). We evaluated the effect of our management on the prevention of postoperative PE in those patients. The incidence of PE, prognosis, complications, patient's complaints, cost-benefit were examined. No fatal PE occurred. One patient with low SpO2 had a chest pain and dyspnea but pulmonary scintigrams revealed no PE. Two other patients had contact dermatitis by CS and another patient using an epidural catheter suffered temporary paraplegia after heparin injection. The government has approved a fee for PE prophylaxis since April 2004. Our management using IPC and CS for PE prophylaxis after surgery proved to be an effective in reducing the risk of PE. However, we must take the atmost care in injecting heparin into patients with epidural catheters.

Evaluation of Quality of Life in Patients with Breast Cancer Treated with Chemotherapy / 日本農村医学会雑誌

Recently the evaluation of health-related quality of life (QOL) in cancer patients has become important in carrying out a treatment strategy. During a period between June and August 2004, we studied the QOL in 16 breast cancer patients with or without chemotherapy. The regimens of chemotherapy were EC (n=6), AT (n=1) and CMF (n=1). We made the Functional Assessment of Cancer Therapy Scale-General (FACT-G) in all patients. The patients treated without chemotherapy were superior to those with chemotherapy with respect to physical and emotional well-being (p<0.05). There were no differences in social well-being and relationship to families between the two groups. The patients treated without chemotherapy made significantly higher scores in the basic activities of daily living than those with chemotherapy (p<0.05). Compared with patients receiving chemotherapy, patients treated without chemotherapy had better quality of life (p<0.05). We concluded that it was important for us to assist in decision making about treatment and supportive care needs.

Revision of Medical Care System as I See It / 日本農村医学会雑誌

It is said that medical care is a social application of medicine to the benefit of community or individual. In step with progress in medicine, medical care has been made all the more complicated. Moreover, the system supporting medical care has fallen behind the times when its surroundings have been changing drastically. This situation could be ascribed to the institutional fatigue that the system itself is suffering from after a long period of existence. It also can be pointed out that there have been revolutionary changes in traditional Japanese cultural values together with the awareness of people concering health. However, the primary factor that lies behind need of reform is financial difficulties. At present, in connection with deregulation of medical care, the introduction of mixed medical care and the entry of joint-stock corporations are taken up for discussion as topics of the day. In the meantime heated debates are being held over the subjects of institutional reform including the setting up of medical care for the aged as part of the fee-for-service system and reconstruction of the network of providers of health care and services. Moreover, the institutions that are engaged in the practice of medicine are expected to tackle a broad range of tasks- -catching up with ever-progressing information technology, disclosure of information, and strengthening of safety measures against medical accients, among many others. However, these are not the issues which have cropped up in recent years. Many have been brought up and discussed from an angle a little different from what it is today. It is now high time for us to discuss these issues through and through in light of actual situations while looking back on the history of medical care and its system. In this paper the author shall dwell on the development of the nation's medical system and point out some problems confronting us today with the use of some materials thus far presented by the Japan Medical Association. His view is based on his personal experience in hospital management and with the Japan Medical Association.