JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE
Online ISSN : 1349-7421
Print ISSN : 0468-2513
ISSN-L : 0468-2513
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Volume 57, Issue 2
Displaying 1-8 of 8 articles from this issue
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ORIGINAL
  • Clinical Featues and Role of Helicobacter pylori Infection in Children with Idiopathic Thrombocytopenic Purpura
    Yuji MIYAJIMA, Yuma KITASE, Toshihiko SUZUKI, Naoko HAYASHI, Masahiko ...
    2008 Volume 57 Issue 2 Pages 59-65
    Published: July 30, 2008
    Released on J-STAGE: October 06, 2008
    DOIhttps://doi.org/10.2185/jjrm.57.59
    JOURNAL FREE ACCESS
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      We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×104/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×104/μl received treatment, but most children with platelet counts above 2×104/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×104/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.
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REPORT
  • Review of Emergency Transport by Heliambulance
    Daigo SHIRAI
    2008 Volume 57 Issue 2 Pages 66-70
    Published: July 30, 2008
    Released on J-STAGE: October 06, 2008
    DOIhttps://doi.org/10.2185/jjrm.57.66
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      Kawakami village with a population of 4,700 is located in the easternmost corner of Nagano Prefecture. It borders on Gunma, Saitama, and Yamanashi Prefectures. In the village, there are only two medical facilities, our Kawakami Clinic and Kimura Branch Clinic. None of them have any inpatients' wards. Therefore, patients who need hospitalization without delay have to be transported in an ambulance car to the Saku Central Hpspital, a general hospital about 35 km from our clinic.
      In order to transport the emergency patients quickly, we began to used a helicopter on July 2005. A total of 75 cases who were transported by ambulance or helicopter from our clinic to the Saku Central Hospital from July 2005 to December 2006 were the subjects of the present study. The hour they were sent, their conditions, disease severity and transport from were examined, based on the reports filed by the committee which is supposed to judge disease severity, emergency degree and so on. It was found that 17 cases, which occupied 23% of the total number of transported cases, were transported by helicopter. Patients with internal diseases made up 76% and patients requiring surgical treatment 24%. Those patients with mild, moderate, serious and dangerous illnesses accounted for 12%, 41%, 29% and 18%, respectively. One case died three days after hospitalization. The other cases were discharged or transferred to other hospitals within two months. The rate at which we used the helicopter was low, so we could not say it was a common means of transport. In the cases of external trauma, it was difficult to decide which means of transport should be used, ambulance or helicopter.
      Further examination and discussion with the staff members of the emargency services and support hospital are needed to improve the emergency medical services as primary care.
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CASE EPORTS
  • Successful Treatment of a Case of Chronic Respiratory Failure due to Pulmonary Fibrosis Associated with Collagen Disease by Administering Intravenous Drip Injection of Immunosuppressant: Importance of House Call and Home Care for Patient Receiving Oxygen Therapy
    Mitsuya ONO, Akihiro KITAZAWA, Jun'ichi CHO
    2008 Volume 57 Issue 2 Pages 71-74
    Published: July 30, 2008
    Released on J-STAGE: October 06, 2008
    DOIhttps://doi.org/10.2185/jjrm.57.71
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      The patient was a 61-year-old man. He was diagnosed as having dermatomyositis-pulmonary fibrosis in February 2005. Immediately home oxygen therapy (HOT9L/min.) and home visiting care were commenced. Since the patient had difficulty in breathing due to chronic respiratory failure, cyclophosphamide, an immunosuppressant drug, was given to him intravenously when a physician made house calls. The results were satisfactory.
      The Community Care Department of our hospital has a staff of physicians who exclusively provide home medical services and keep track of patients' health state systemically. Nurses in the Home Visit Care Station and the Home Care Support Center provide health services in patients' homes including nursing care and care of caretakers.
      The physician who visited the patient's home in this case belonged to the Department of Internal Medicine as a specialist of collagen diseases teamed up with the community care department staff to give home medical treatment using the immunosuppressant drips. This was a good example of the successful home medical treatment and care for a patient who was unable to go to hospital because of chronic respiratory failure.
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  • Physical Therapy for Compound Knee Ligament Injury After Simultaneous Reconstruction of Anterior and Posterior Cruciate Ligaments
    Keisuke SAKURADA, Seiji SHIMADA, Miyoko KISHINO, Yoshihisa SATOU, Kana ...
    2008 Volume 57 Issue 2 Pages 75-82
    Published: July 30, 2008
    Released on J-STAGE: October 06, 2008
    DOIhttps://doi.org/10.2185/jjrm.57.75
    JOURNAL FREE ACCESS
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      We performed physical therapy on a patient who had undergone simultaneous reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) for compound knee ligament injury. The physical therapy program was designed based on Tooyama's concept published in 1996 and our own regimens for postoperative therapy for separate ACL and PCL reconstructions.
      The results of our physical therapy were as follows: In four months after the surgery, the range of knee motion had been fully recovered. In 16 months postoperatively, the knee ligament had become stable. Knee extention strength had been restored 87% and its flexion strength 103%. The functional ability test found that knee performance was good.
      Worthy of note were the following three main features of this physical therapy: (1) To minimize stress on ligament until the minimum recovery level of recovery is expected after reconstruction, muscular workout to make quadriceps and hamstrings contracted simultaneiusly was performed so as not to induce contractions of only hamstrings; (2) We kept the chief physician posted on the recovery status of the knee motion range since mobilized arthroscopy might have been required because of knee contracture; (3) Knee coodination training was performed to enhance knee functional ability.
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MATERIAL
  • Improvement of Meals for Patients with Dysphagia
    Saori FUKAMI, Tetsuaki SHUMIYA, Chinatsu YAMADA, Kyoko HASEGAWA, Kazuh ...
    2008 Volume 57 Issue 2 Pages 83-88
    Published: July 30, 2008
    Released on J-STAGE: October 06, 2008
    DOIhttps://doi.org/10.2185/jjrm.57.83
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      To prevent protein-energy malnutrition in elderly inpatients with dysphagia, weexamined the current meals for them in detail. The thickeners seemed to be a ploblem. Changes of viscosity over time and temperature were reduced when a starch thickener was changed to a xanthan gum thickener. When a gelatinizer was added to soft meals to allow cutting into shape, etc., the meals looked better were less sticky, more cohesive, and easier to eat. Thus, the smooth texture required of meals for dysphagia patients was obtained. When conventional mixed meals were changed to soft meals, there was an improvement of appearance and the meals became more palatable.
      The change of food intake after these improvements was investigated in five inpatients who had difficulty in swallowing. Food intake was increased in four of these five patients after these improvements, suggesting that their appetite might have been increased by improvement of the appearance and palatability of their meals. We will continue making improvements of these meals in hopes that patients can eat solid food again as early as possible.
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REGIONAL MEETINGS
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