[Considering the Role of Home Care Support Clinics at a Pre-Discharge Conference].

In this study, we considered the role of home care support clinics for patients who wanted to go back to their homes from a hospice, duringa pre-discharge conference. The subjects of our study were 8 patients, of which 7 of them had cancer. Two patients died after the conference. These patients were discharged from the hospice three days after the conference and caregivers from the home care support clinics visited their homes 24 hours after their discharge. The clinic has a role to fulfill in terms of medical treatment and support, based on their life style and power of caregiving. We considered an advancedmeetingwith family or caregiver benefits in the conference. Further, the clinic has a role of establishinga relationship with each multi-disciplinary care unit and cooperate with them as soon as possible when needed.

[Aiming at the Spread of Palliative Care in Community Health Care-Consideration of Human Resource Development from the Viewpoint of the Home Physician and Support Hospital].

Palliative care for cancer patients requires information sharing, including prognoses, to fulfill the wishes of the patient and patient's family as well as to avoid wasting time. It is necessary to recognize the importance of the pre-discharge conference and home medical care to realize the wishes of the patient and the patient's family.

[End-of-Life Decision Making Support in Palliative Homecare].

Advance care planning is important in end-of-life decision making in home-based palliative care for both cancer patients and non-cancer patients.

Prevalence of chronic kidney diseases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels.

BACKGROUND: Cardiovascular diseases, osteoporosis, and depression are identified comorbidities of chronic obstructive pulmonary disease (COPD), but there have been few reports of chronic kidney disease (CKD) as a comorbidity of COPD. The objective of this study was to investigate the prevalence of CKD in COPD patients using estimated glomerular filtration rate (eGFR) based on creatinine (Cr) and cystatin C (Cys) levels. METHODS: The prevalence of CKD and the values of various CKD-related parameters were compared between 108 stable COPD outpatients (COPD group) and a non-COPD control group consisting of 73 patients aged 60 years or more without a history of COPD or kidney disease. CKD was defined as an eGFR less than 60 mL/min/1.73 m(2). RESULTS: The Cr level was significantly higher in the COPD group, but eGFR based on serum Cr (eGFRCr) was not significantly different between the two groups (73.3±25.3 vs 79.7±15.5 mL/min/1.73 m(2)). The Cys level was significantly higher and eGFR based on serum Cys (eGFRCys) was significantly lower in the COPD group (60.0±19.4 vs 74.0±13.5 mL/min/1.73 m(2), P<0.0001). The prevalence of CKD evaluated based on eGFRCr was 31% in the COPD group and 8% in the non-COPD group with an odds ratio of 4.91 (95% confidence interval, 1.94-12.46, P=0.0008), whereas the evaluated prevalence based on eGFRCys was 53% in the COPD group and 15% in the non-COPD group with an odds ratio of 6.30 (95% confidence interval, 2.99-13.26, P<0.0001), demonstrating a higher prevalence of CKD when based on eGFRCys rather than on eGFRCr. CONCLUSION: CKD is a comorbidity that occurs frequently in COPD patients, and we believe that renal function in Japanese COPD patients should preferably be evaluated based not only on Cr but on Cr in combination with Cys.

Relationship between Oral Flow Patterns, Nasal Obstruction, and Respiratory Events during Sleep.

STUDY OBJECTIVES: Sleep breathing patterns are altered by nasal obstruction and respiratory events. This study aimed to describe the relationships between specific sleep oral flow (OF) patterns, nasal airway obstruction, and respiratory events. METHODS: Nasal flow and OF were measured simultaneously by polysomnography in 85 adults during sleep. OF was measured 2 cm in front of the lips using a pressure sensor. RESULTS: OF could be classified into three patterns: postrespiratory event OF (postevent OF), during-respiratory event OF (during-event OF), and spontaneous arousal-related OF (SpAr-related OF). Postevent OFs begin at the end of airflow reduction, are preceded by respiratory arousal, and are accompanied by postapneic hyperventilation; during-event OFs occur during nasal flow reduction; and SpAr-related OFs to OF begin during stable breathing, and are preceded by spontaneous arousal but are rarely accompanied by apnea/hypopnea. Multivariate regression showed that nasal obstruction was predictive of SpAr-related OF. The relative frequency of SpAr-related OF events was negatively correlated with the apnea-hypopnea index. The fraction of SpAr-related OF duration relative to total OF duration was significantly greater in patients with nasal obstruction than in those without. CONCLUSION: SpAr-related OF was associated with nasal obstruction, but not respiratory events. This pattern thus functions as a "nasal obstruction bypass", mainly in normal subjects and patients with mild sleep disordered breathing (SDB). By contrast, the other two types were related to respiratory events and were typical patterns seen in patients with moderate and severe SDB.

[Clinical Utility of Tapentadol].

Tapentadol(TP)is a new strong opioid analgesicthat has both m-opioid receptor(MOR)effects and norepinephrine reuptake inhibitor(NRI)effects. In comparison with the existing strong opioid analgesics, the mechanism of action suitable for palliation of neuropathic pain is expected to be better for TP. The analgesic effect and side effects of this drug were tested in 10 cases of exacerbation of neuropathic pain at our hospital, and the sedative response rate was 70%. The main side effects were somnolence 44.4%, nausea 33.4%, and constipation 11.1%. The side effects on the digestive system were considered minimal. Although it is speculated that opioids would be useful as an outpatient treatment, few case reports are available regarding their use for cancer pain; therefore, further investigation is necessary. Generally, numerous social issues that would increase the likelihood of drug adherence failure must be addressed in order to expand the use of strong opioid analgesics such as TP. Both the patients and the healthcare worker should be involved when addressing these issues in Japan, and the measures should include instructions for appropriate reporting and for using such drugs.

[Cell-free and concentrated ascites reinfusion therapy(CART)].

The cell-free and concentrated ascites reinfusion therapy(CART)is a useful palliative maneuver in a patient suffering from ascites. I think that home medical care cooperation is essential to diffuse at home CART.

Efficient establishment of pig embryonic fibroblast cell lines with conditional expression of the simian vacuolating virus 40 large T fragment.

The pig is an important animal for both agricultural and medical purposes. However, the number of pig-derived cell lines is relatively limited when compared with mouse- and human-derived lines. We established in this study a retroviral conditional expression system for the Simian vacuolating virus 40 large T fragment (SV40T) which allowed us to efficiently establish pig embryonic fibroblast cell lines. The established cell lines showed high levels of cell proliferation and resistance to cellular senescence. A chromosome analysis showed that 84% of the cells had the normal karyotype. Transient expression of the Cre recombinase allowed us to excise the SV40T fragment from the genome. The development of this research tool will enable us to quickly establish new cell lines derived from various animals.

[The change in home palliative care].

A promotion of home palliative care at our clinic has been built with many factors including a home medical care desired by patient's family, governance of the law, progress of medical measures and an improvement of medical cooperation.

[Is home palliative care for head and neck cancer patients a possibility ?].

It is likely that home palliative care for head and neck cancer patients could be treatable at general hospitals or clinics whereas combined joint efforts by medical cooperation from specialists, who are specialized in understanding of the singularity and how to cope with the symptoms, are existed.

[Experimental inhalation therapy with nebulized tiotropium in COPD patients unable to use the Handihaler].

BACKGROUND: We report the efficacy and safety of experimentally nebulized tiotropium use. We identified 19 elderly very severe COPD (GOLD stage IV) inpatients unable to use tiotropium in the Handihaler by themselves from January 2008 through May 2009. The contents of an 18 microg capsule of tiotropium were dissolved in 5 ml saline and nebulized via a nebulizer. RESULTS: Nebulized tiotropium improved the symptoms of all COPD patients, and the ADL scores of 12 COPD patients. All COPD patients tolerated nebulized tiotropium well, although mild dry mouth was reported by a single COPD patient. CONCLUSION: Tiotropium therapy for COPD patients is recommended in all GOLD stages. Our report showed that COPD patients (GOLD stage IV) who had difficulties using a tiotropium Handihaler benefitted from nebulized tiotropium. This helped them to continue their COPD therapy and was demonstrated to be an effective and well tolerated treatment option.

Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome.

BACKGROUND AND OBJECTIVE: Several features of OSA syndrome suggest that it is a manifestation of the metabolic syndrome (MS). In this study, we investigated the prevalence of the MS among male Japanese patients with OSA, as well as the relationship between OSA in non-obese patients and components of the MS other than obesity (hypertension, dyslipidaemia and glucose intolerance). METHODS: The study included 416 Japanese men who were diagnosed as having OSA by polysomnography. Among these, 101 non-obese patients were selected and the severity of OSA, as well as the prevalence of hypertension, dyslipidaemia and glucose intolerance, was assessed. RESULTS: The MS was associated with OSA in 218/416 patients (52.4%). A significant increase in the prevalence of the MS was associated with increased severity of OSA, as categorized according to AHI. In the non-obese patients with OSA (mean age 57.6 years, BMI 22.7 kg/m(2), AHI 34.3 events/h), hypertension, dyslipidaemia and glucose intolerance were identified in 70 (69.3%), 43 (42.6%) and 20 patients (19.8%), respectively. At least two of these factors were identified in 40 patients (39.6%). Non-obese patients with severe OSA had a significantly higher prevalence of two or more of these factors (33/59 patients, 55.9%). CONCLUSIONS: Although Asians are generally less obese than Caucasians, the prevalence of the MS was high among Japanese patients with OSA, and even among non-obese patients, OSA was associated with risk factors for the MS.

Tuberculous retropharyngeal abscess associated with spinal tuberculosis well controlled by fine-needle aspiration and anti-tuberculous chemotherapy.

We present a rare case of a tuberculous retropharyngeal abscess (RPA) associated with spinal tuberculosis (TB) (Pott's disease). A patient presented with RPA and collapse of the second cervical vertebra. Fine needle aspiration was performed through the pharynx, not only for diagnosis but also for reduction of the abscess. Tuberculous RPA was diagnosed by microbiological tests of the aspirated fluid from the abscess, which was likely to be extended from Pott's disease. Anti-TB chemotherapy after the aspiration proved effective, resulting in the resolution of the abscess. Early diagnosis and treatment are essential in order to prevent life-threatening complications.

[The medical cooperation in home palliative care--a design of cooperation with the visiting nursing station].

In home palliative care on site, the trinity of cooperation in "medical-nursing-patient" care is essential. It is necessary to cooperate with the visiting nursing station and to give special considerations in the areas of sharing information, understanding of the difference between in-patient and out-patient and the management of mental health of the caregivers.

[The medical cooperation in home palliative care with regard to "hospital-medical office and hospital-hospital disease cooperation"].

In the medical cooperation of home palliative care, it often happens to be one-way cooperation. Therefore, it is necessary to have a capability of "home medical support hospital" with functions like helping the patient and his family to prepare for a home care transition and a way to cope with emergency situations.

[How to use rescue-dose in home hospice care].

In home hospice care, we must try to control steady pain, to give guidance about medication, and to calm anxiety once out of the hospital. We think that it may be important to consult on the issues related to rescue-dose drugs, selection of the drug from the stand point of QOL, and to counsel on behalf of the patient and family.

[Breast cancer and home care].

In the case of home care treatment of breast cancer patient, it is necessary to consider both social and medical problems based on the characteristics of breast cancer and associated its problems.

[An undesirable process at a sudden change in home palliative care].

Patients under home palliative care may occasionally meet an undesirable end because the family would call an ambulance in the case of a sudden change. It may be caused by lack of family education, a short period under home care, or an administrative proceeding. So, we must be careful in home palliative care.

[Frostbite due to accidental fall of a portable liquid oxygen device--report of a case].

We experienced a case of frostbite due to the accidental fall of a portable liquid oxygen device. We think this accident occurred because medical staff have little understanding of an oxygen device. We must use medical instruments safety.