To clarify the state of cooperation between the community medical training institutes of Iwate Medical University and community comprehensive support centers, a questionnaire survey was conducted in February 2017. Of the respondent institutes, 33 (82%) reported conducting visiting medical care and its equivalent, 13 (32%) reported being involved in management councils of community comprehensive support centers, and 31 (77%) reported participating in community care conferences. Of the community comprehensive support centers surveyed, 40 (85%) had management councils, and community care conferences were found to be held in 46 regions (98%). The community medical training institutes of Iwate Medical University showed a high participation rate in meetings related to comprehensive care as well as a high implementation rate of home healthcare, such as visiting medical care and nursing. As the medical institutes require further improvement in the participation rate in community care conferences and the community comprehensive support centers need to fulfill demand for manpower, close cooperation among them is a future task to be addressed.
A gastrostomy tube must be exchanged periodically, and this replacement process sometimes leads to gastrocutaneous tract disruption. We retrospectively reviewed the medical records of all patients who underwent the replacement of a gastrostomy tube over a 5-year period at one hospital in Japan. We collected each patient's demographics, current and past medical history, nutritional status, tube type, exchange method, and the duration of the original tube placement procedure. A total of 1,279 gastrostomy tubes were exchanged in 328 adults. We uncovered 10 cases (0.78%) of tract disruption; in all cases, tract disruption occurred during the initial tube replacement. We decided to focus our attention on 46 patients who had a gastrostomy tube inserted at our hospital, and on whom we later performed a replacement of the initial tube. Of those 46 patients, tract disruption led to hospital admission in seven cases (15.2%). A history of diabetes was confirmed in five of the seven cases, and a significant difference was recognized at p‹0.05. We determined that it is important to check for a history of diabetes before the initial tube is replaced in order to avoid gastrocutaneous tract disruption.
Ex utero intrapartum treatment (EXIT) is a technique used to administer surgical procedures while maintaining uteroplacental circulation before delivery of a fetus during cesarean section. We describe a patient who underwent the EXIT procedure under general anesthesia with desflurane.
The patient was a 32-year-old woman. At 22 weeks of gestation, the fetus was diagnosed with congenital high airway obstruction syndrome (CHAOS), and the patient was scheduled for EXIT at 36 weeks and 0 days gestation. General anesthesia was induced by propofol, fentanyl, and suxamethonium. The expiratory concentration of desflurane was adjusted to 15% at the beginning of surgery to induce uterine relaxation, but hypotension, increased airway pressure, and decreased bispectral index levels were observed. Ephedrine and phenylephrine were administered intravenously for hypotension. Tracheotomy was performed on the fetus within approximately 15 minutes of hysterotomy. Uterine relaxation during EXIT was favorable and the fetal heart rate was stable at 100–120 beats per minute. Desflurane was terminated after completion of EXIT, and anesthesia was maintained intravenously. No post-procedural complications in the mother were observed after extubating.
We have described a patient who safely underwent EXIT despite complications observed in the maternal cardiorespiratory dynamics.