A Case of a Primiparous Woman Who Had Been Treated With Multimodal Therapy for Ovarian Dysgerminoma in Childhood / 日本農村医学会雑誌

Pregnancy and childbearing are important issues for female survivors of childhood, adolescent, and young adult (CAYA) cancer. Here, we report the case of a 38-year-old primiparous woman who had been treated with multimodal therapy for ovarian dysgerminoma in childhood. During junior high school, she had been admitted to our hospital complaining of abdominal distension, fever, and dyspnea. A massive abdominal tumor was found, and she was referred to a university hospital for treatment. Ovarian tumors suspected to be ovarian dysgerminoma were diagnosed, and right oophorectomy with lymph node dissection was performed. The left ovary was preserved. Postoperative histologic examination revealed ovarian dysgerminoma with class V ascites cytology, indicating Stage IIIc disease. The postoperative course was uneventful. Following surgery, she received bleomycin, etoposide phosphate, and cisplatin chemotherapy. Menarche occurred 12 years after surgery. She visited a gynecology clinic 24 years and 9 months after surgery because of suspected pregnancy. Pregnancy was confirmed, and she gave birth by vaginal delivery at a gestational age of 35 weeks + 1 day. Both the patient and child are now in good health. Fertility is an important consideration for CAYA cancer survivors. In cases of CAYA cancer, it is important to make treatment decisions together with patients with due consideration given to survival and fertility.

Venous Thromboembolism in Patients with Gastrointestinal Cancers / 日本農村医学会雑誌

Venous thromboembolism (VTE) is a common complication in patients with cancer, particularly those with gastrointestinal cancers. In addition, patients with distant metastasis of gastrointestinal cancer often require palliative surgery. Here we report on the current status of VTE in patients with gastrointestinal cancers at our hospital, where we treated 20 patients with gastrointestinal cancers who developed VTE between January 2009 and December 2018. Nine patients had gastric cancer, 6 had colorectal cancer, 3 had biliary cancer, and 2 had pancreatic cancer. Fifteen of the 20 patients had distant metastasis as well. Median survival was 9 months, but VTE was not the direct cause of death in any patient. Although many of these patients had advanced cancer with distant metastasis, 16 still required gastrointestinal surgery. Our findings indicate that gastrointestinal surgeons need to be proficient in the diagnosis and treatment of VTE in patients with malignancy.

Clinical Experience and Lessons of Coronavirus Disease 2019 (COVID-19) Treatment Early in the Pandemic at a Public Regional Core Hospital / 日本農村医学会雑誌

Coronavirus disease 2019 (COVID-19) has spread rapidly in Japan. The purpose of this study was to report the clinical experience of our COVID-19 patients early in the pandemic and lessons from our experience. An outpatient fever clinic was established on April 7. Admission of COVID-19 patients was started on July 23. Between April 7 and September 30, there were 364 walk-in outpatients and emergency patients with fever. Polymerase chain reaction test for SARS-CoV-2 RNA or COVID-19 antigen test were performed in all patients, and all results were negative. Twenty patients with COVID-19 were admitted to a newly established dedicated COVID-19 ward. They were discharged well. There were no cases of nosocomial infection at our hospital. Length of hospitalization was correlated with serum ferritin level at admission, serum CRP level at admission, and age. More than half the patients experienced psychological stress, and COVID-19 specialized nurses experienced some stress. It is essential to set up the medical system for COVID-19 according to the trends of the disease. Creation of our original database and our “problem notebook” were useful for treatment and care of COVID-19 patients as well as for mental care of nurses.

A Case of an Elderly Dementia Patient in Close Contact With COVID-19 Patients Who Was Hospitalized With Family Members With COVID-19 in the COVID-19 Ward / 日本農村医学会雑誌

A woman in her 80s was being treated for dementia. She lived in a four-generation household of 8 people. Her grandchild contracted COVID-19 and was admitted in another hospital. The 7 other family members were close contacts of the grandchild, and all of them except the woman with dementia developed COVID-19 within 3 days of onset in the grandchild. The woman’s PCR test for SARS-CoV-2 was negative. Her family thought that she could not live alone, but she was denied admission to other hospitals. Finally, she was admitted to our COVID-19 ward with her other family members at the family's request. After admission, she stayed in a room with family members, and COVID-19 treatment for her family and her care were performed with strict infection control measures in place. On hospital day 11, she and 5 family members had negative PCR test results for SARS-COV-2 and were discharged. With the growing number of dementia patients in Japan's aging society, there is the possibility that similar situations will occur increasingly often. This case suggests that recommended infection control measures are effective for preventing the spread of COVID-19 to people staying in the same room.

Effects of Highly Concentrated Enteral Nutrition on Nutritional Status and Bodyweight Maintenance in Chemotherapy-Treated Patients with Gastrointestinal Cancer / 日本農村医学会雑誌

The purpose of this study was to evaluate the effects of highly concentrated enteral nutrition (ENORAS®, Otsuka Pharmaceutical Factory, Tokushima, Japan; hereinafter, ED) on the maintenance of nutritional status and bodyweight in chemotherapy-treated patients with gastrointestinal cancer who received ED between July 2019 and January 2020. For 21 patients (15 men and 6 women, age range: 57-87 years old), we investigated serum albumin level, cholinesterase level, lymphocyte count, hemoglobin level, and bodyweight at baseline and after receiving ED. None of the patients showed any differences in albumin level, cholinesterase level, lymphocyte count, hemoglobin level, or bodyweight before and after receiving ED. Survivors had significantly favorable changes in cholinesterase level compared with non-survivors (p=0.0258). The group that received ED for 30 days or longer tended to show more favorable changes in bodyweight than the group that received ED for less than 30 days (p=0.0696). The group with stage I-III disease had more favorable changes in albumin level than the group with stage IV disease or recurrence (p=0.0932). Our results suggest that the ED is useful for helping to maintain nutritional status and bodyweight in chemotherapy-treated patients with gastrointestinal cancer.

Questionnaire Survey of Medical Staff and Community Dwellers on End-of-life Care / 日本農村医学会雑誌

We conducted a questionnaire survey of 525 persons regarding end-of-life care (EoLC) between November and December 2017. A total of 495 individuals responded (response rate 94.3%). Respondents were grouped into either a medical staff (MS) group or community persons (CP) group. Significant differences were found between the MS and CP groups in implementing a family conference about EoLC (p＜0.05), but not in preparing documents about personal preferences for EoLC. There were significant differences between the groups in medical treatments in EoLC, for example, total parenteral nutrition, enteral nutrition via percutaneous endoscopic gastrostomy, and mechanical ventilation with intubation (p＜0.05). It is important that medical treatment in EoLC should meet the requirements of patients and their families. This study revealed differences in some aspects of EoLC between the MS and CP groups. Individuals should be supported in personally making decisions about their own EoLC.

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.