The Effectiveness of Confirming Inhalation Volume and Inhalation Practice before Administrating Laninamivir Octanoate / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>We evaluated the risk of shortness of inhalation when using laninamivir without inhalation practices.</p><p><b>Method: </b>We counted the number of attempts required by each patient to sound the whistle. We classified the patients into the following categories: ①Sound rang in the first attempt; ②Sound rang within 3 attempts; ③Sound rang with in 5 attempts; ④Sound rang within 10 attempts; ⑤The whistle did not sound. We assessed the following: 1. the rate of patients younger than 10 years of age assessed category ② or less,; 2. the rate of patients of teen-age, and 3. the rate of patients of 20 years of age or older, assessed category ③ or less.</p><p><b>Results: </b>We examined 56 patients, and we found that the rate for 1. was 7/11= 63.6%, for 2. was 4/33= 12.1%, and for 3. was 2/12= 16.7%.</p><p><b>Conclusion: </b>We found that more than 60% of patients younger than 10 years of age and more than 10% of patients of 10 years of age or older were at risk of shortness of inhalation when using laninamivir without inhalation practices. And we propose other medication if patients cannot sound the whistle within about 5 attempts.</p>

Utility of Over-the-Scope Clipping for Closure of a Persistent Post-Percutaneous Endoscopic Gastrostomy Fistula under Long-Term Steroid Therapy

A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.

Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm: Evaluation of Possible Causes of Aneurysm Formation

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.