Aim: We investigated the rate of bloodstream infections in elderly malignant disease patients whose totally implantable central venous device (CV ports) had been removed for any reason at our hospital.
Methods: We evaluated 22 elderly malignant disease patients who had had their CV ports removed for any reason between May 2014 to April 2015.
Results: The patients were 12 males and 10 females between 62 and 86 years of age with a median age of 75.5 years. The catheter tip cultures were positive in 6 out of 22 cases (27.3%). Gram-positive cocci were detected in 5 cases, and gram-positive bacilli were detected in 1 case. Five of these 6 cases (83%) found to have positive catheter tip cultures were cultured at the time of death. In addition, 5 of the 13 catheters removed at the time of death resulted in positive culture results (38%). The positive culture ratio correlated well with the ratio of death and the age in cases of hematopoietic tumors.
Conclusion: In cancer patients, the CV port is frequently used for the delivery of anti-cancer medicines. However, CV port infections are underestimated and typically not recognized in a timely manner. Patients suspected of having a CV port infection should be closely observed and the catheter removed immediately. However, it is very difficult to decide to discontinue a CV port, since its removal may render patients more susceptible to blood stream infections due to their poor general health and old age. CV port use should be considered in such cases to prevent future blood stream infections.
Aim: This study aimed to clarify the relationship between hypertension and nocturnal waking among community-dwelling elderly individuals.
Subjects and Methods: The survey was performed by asking questions related to the basic attributes, lifestyle, sleep conditions and the health status of 422 elderly individuals who belonged to elderly clubs. The subjects were divided into a hypertension group and a non-hypertension group. The data were analyzed using Spearman's rank correlation coefficient and a logistic regression analysis.
Results: Two hundred of the 422 elderly individuals responded to the questions (response rate: 47.4%). The rate of obesity in the hypertension group was significantly higher (p=.01) than that in the non-hypertension group. The logistic regression analysis revealed that hypertension was associated with the BMI (OR=1.148, 95%CI: 1.022-1.289) and the number of nocturnal waking episodes (OR=1.449, 95%CI: 1.015-2.067). In the hypertension group, the number of nocturnal waking episodes was significantly correlated with age (rs=0.232), and the performance of volunteer activities was associated with a decreased number of nocturnal waking episodes (rs=-0.356).
Conclusions: It was shown that nocturnal waking and obesity were strongly associated with hypertension. The performance of volunteer activities was also correlated a decrease in the number of nocturnal waking episodes. Further studies should be performed to investigate the relationship between hypertension, the number of nocturnal waking episodes and sympathetic nerve activity. A greater number of physiological activities should be evaluated and the volunteer activities in which the elderly people participated should be precisely analyzed.
Aim: The aim of the present study was to investigate the prevalence of sarcopenia in outpatients attending a geriatric and memory clinic and to investigate its relationship with falling.
Methods: We investigated the prevalence of sarcopenia (according to the EWGSOP criteria) among 283 outpatients that were all ≥65 years of age, and who attended the geriatric and memory clinic at Kyorin University Hospital. We also examined comorbidities, CGA items, and fall-related measures, and analyzed the relationships between these factors and sarcopenia.
Results: Seventy men (60.9%) and 88 women (52.4%) were diagnosed with sarcopenia. The sarcopenic men were older, had lower BMI values, and had a higher prevalence of dementia. The sarcopenic women had lower BMI values, and a higher prevalence of dyslipidemia. ASMI was not associated with walking speed or fall-related measures, whereas grip strength and walking speed were associated with each other and both were associated with fall-related measures. Ninety-one patients (32.2%) experienced a fall in the previous year. The prevalence of sarcopenia and ASMI among fallers and non-fallers did not differ to a statistically significant extent, whereas the fallers had lower grip strength and walking speed. A multiple logistic regression analysis revealed that weak grip strength in men and slow walking speed and the presence of diabetes in women were significant risk factors for falling.
Conclusions: The frequency of sarcopenia in outpatients attending the geriatric and memory clinic was higher than that in the community-dwelling elderly individuals. Falls were more related to the patients' muscle strength and walking speed than their muscle mass or the presence of sarcopenia itself.
Introduction: Familial amyloid polyneuropathy (FAP) is a rare hereditary disorder caused by mutations in the transthyretin (TTR) gene. Tafamidis is a TTR stabilizer able to prevent TTR tetramer dissociation, and several studies have demonstrated its safety and efficacy at slowing the progression of neuropathy in FAP caused by the TTR Val30Met mutation. However, nerve conduction study (NCS) and electromyography (EMG) results have yet to be reported in relation to FAP progression during tafamidis therapy.
Case presentation: A 71-year-old man was admitted to the hospital because of severe numbness and walking difficulties. He did not complain of any autonomic dysfunction or visual disturbance, and he had no family history of neuromuscular disorders. A NCS and EMG indicated length-dependent axonal sensorimotor polyneuropathy. A sural nerve biopsy revealed amyloid deposits, and genetic testing demonstrated a TTR Val30Met mutation. We diagnosed the patient with FAP and treated him using tafamidis therapy. One year later, the patient is still on tafamidis therapy, and his symptoms have shown no significant change. The NCS showed no changes in the compound muscle action potential amplitudes of the left ulnar nerve, while EMG showed the fibrillation/positive sharp wave to have disappeared from the patient's upper limb. We conclude from these findings a slowing of the neurologic progression.
Conclusions: Tafamidis was effective in slowing the neurologic progression over one year in a FAP patient with the TTR Val30Met mutation, and NCS and EMG were useful for assessing this therapeutic effect.
An 88-year-old woman with a history of stomach perforation and lumbar compression fracture was admitted to our hospital with a chief complaint of continuous vomiting, which she had experienced since the previous day. She showed vomiting, spontaneous pain and tenderness from the epigastric fossa through the left flank. In addition, she had marked kyphosis. On a CT scan, although the fornix was located in the abdominal cavity, the antrum and body had escaped into the thoracic cavity. A large volume of gastric content was observed. The patient was diagnosed with upside-down stomach from gastric volvulus and a hiatal hernia. Although we recommended surgery, the patient and her family did not agree with it. Thus, conservative therapy was selected. The patient's symptoms showed a significant improvement after the placement of a nasogastric tube, fasting and fluid therapy. After stabilization, an endoscopic examination was performed. The release of the gastric volvulus was confirmed and the nasogastric tube was removed. We instructed the patient to perform postprandial repositioning, which was based on the running shape of the digestive tract with the goal of achieving the passage of food and preventing a relapse of vomiting. The patient was instructed to first place herself in the right lateral decubitus position and then the prone position after eating. There was no recurrence of vomiting after the patient resumed eating. She was therefore discharged from our hospital. Upside-down stomach is usually an indication for surgery. However, in elderly patients, the fixation of the stomach to the abdominal wall has been reported to occur after endoscopic reduction, and conservative treatment was thus selected in this case.
We herein reported a case in which postprandial repositioning was used to treat upside-down stomach.