All issues
Volume 60 (2011)
- Issue 6 Pages 693-
- Issue 5 Pages 591-
- Issue 4 Pages 507-
- No.3
- Issue 2 Pages 59-
- Issue 1 Pages 1-
Volume 60, Issue 5
Displaying 1-8 of 8 articles from this issue
- |<
- <
- 1
- >
- >|
ORIGINAL
-
Sanae AOKI, Naoyuki MIYASAKA, Yoko TAMARU, Takafumi TSUKADA, Akiko FUR ...2012 Volume 60 Issue 5 Pages 591-596
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSTwin pregnancy is increasing as infertility treatment is widely given nowadays using assisted reproductive technologies. Twin pregnancy is a risk factor for some complicated pregnancies and it may also cause a hard labor. Although cesarean delivery is frequently indicated in many hospitals in Japan for twin pregnancy in view of the risk of vaginal delivery of the second baby, we have tried vaginal delivery of twin pregnancy in a certain situation. We studied the methods of twin delivery, its outcomes and the early neonatal condition.
We found 251 twin deliveries (4.6%) in a total of 5,464 deliveries after 22 weeks of pregnancy from January 2005 to December 2009 in the delivery record. Forty-six percent of women pregnant with twins delivered their babies after 33-36 weeks of pregnancy and 41% after 37 weeks of pregnancy. Sixty-five percent delivered by Cesarean section, 33% by vaginal delivery, and 2% vaginally for the first baby and by Cesarean section for the second baby. Fifty percent of the Cesarean deliveries were performed as patients so desired. Ninety women pregnant with twins chose vaginal delivery in which 92% (64/69) of vertex/vertex presentation and 86% (18/21) of vertex/ breech presentation succeeded in vaginal delivery. Neonatal outcome was assessed in 90 vaginally deliveried babies by use of the Apgar scoring system. One-minute Apgar scores of 0-3 (severe asphyxia) were given to 4.5% (8/180) of babies and scores of 4-6 (moderate asphyxia) to 3.3% (6/180) of babies. The incidence meant that a mother had 8.9% and 6.7% of high risk of severe and moderate asphyxia of her babies. But severe asphyxia decreased to 1.7% (3/180), moderate asphyxia to 1.1% (2/180) of babies on the assessment of 5-minute Apgar scores that reflected long-term neonatal outcome. Eleven cases were second babies of all 14 cases of asphyxia on the assessment of 1-minute Apgar scores. In the vaginal delivery group, 5 cases of umbilical cord prolapsed and 3 cases of placental abruption occurred in second babies. In conclusion, twin delivery should be attempted at the birth center where neonatologists and anesthesiologists are available 24 hours as extra-emergency Cesarean delivery can be performed because of the high incidence of emergency Cesarean delivery of second baby (5.6%) and asphyxia of neonates delivered vaginally.View full abstractDownload PDF (378K)
REPORTS
-
Takeshi HASEGAWA, Takashi MIYAKE2012 Volume 60 Issue 5 Pages 597-601
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSOur hospital is located in a mountainous region of Toyota City, Aichi Prefecture. In the sphere covered by our health services, about 34% of the population is 65 years or older. The graying of the community has been progressing rapidly in the past years. Many elderly people do not have a car. Only available means of transport for them are community bus servicers operated once or twice a week. The situation makes them feel disinclined to go to take physicals or visit the hospital for health screening. When we happen to detect gastrointestinal cancer in aged persons, it is often in an advanced state or too late for surgical removal, or a relapse. For some of such cases, we consider the possibilities of chemotherapy.
Between April 2005 and June 2010, we performed laparotomies (including exploratory operations) on people aged 70 or older with gastrointestinal cancer. Of the patients excluding those with severe cognitive impairment and those in failing health, 25 patients underwent S-1monotherapy postoperatively. The results were no less favorable than those of the cases of younger patients who had received S-monotherapy or other forms of chemotherapy for gastrointestinal cancer. Although this comparison was not adequate because the number of cases of elderly patients was too small, our hospital regards S-1 monotherapy as one of the chemotherapeutic regimens beneficial to old people with gastrointestinal cancer and helpful in maintaining the patient's qualuty of life.View full abstractDownload PDF (236K) -
Kosuke SHUNO, Hisa NAITO, Hiromi KUROBE, Minako IMAI, Naoya TAJITSU, H ...2012 Volume 60 Issue 5 Pages 602-614
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSOur hospital with 723 sickbeds takes care of acute diseases. The volume of documents was enormous, exceeding 3,500 titles each month. Paper work chronically puts too heavy a burden on physicians. Although an electronic system of storing medical records has been employed for years and about a half of documents are now processed electronically, there still remains a lot of paper work requiring hand writing.
To lighten the work load of physicians, a type of computer software to make it easy to imput and output patients' medical history has become available recently. The features of the software are as follows:
(1) having about 600 formats,
(2) capable of inputting patients' personal information automatically,
(3) capable of retrieving disease names, dates of hospital admission and discharge, surgical procedures, etc. from the cemtra;computer system with electronic cards, and
(4) capable of outputting medical date and printing them.
By dint of these functional capabilities, it has been made easy to issue the written opinions of physicians regarding the nursing care insurance and the medical certificate for life insurance money.
With the revision of the schedule of medical service fees in April 2008, some points were given to physicians' desk jobs. Thanks to the new point system, we could assign five clerks to assist physicians with the paper work. They draw up documents and input non-medical data into the computer.
The deployment of the clerical workers and the introduction of the computer software has shortened the time required for documentation by about 4 days from 11.2 days to 7.2 days. Responding to a questionnaire survey taken 6 months after the start of the new system, eight out of 10 doctors said that the strain on them was eased.View full abstractDownload PDF (1600K)
CASE REPORTS
-
Taizo YAMAMOTO2012 Volume 60 Issue 5 Pages 615-621
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSFor a female patient with lower back pain and stress urinary incontinence, a trunk stability exercise program was initiated. When the conventional exercise to contract pelvic floor muscles was done, the patient held her breath and tried hard to adduct and extend the hip joint. She could draw in the navel by activating transversus abdominis muscle in a relaxing position during sling exercise therapy. At the initial stage of the trunk stability exercise, the intra-abdominal pressure was adjusted by the contraction of transversus abdominis muscle and pelvic floor muscles, and by the movement of the diaphragma as had been expected. Also in the initial stage of sling exercise therapy, the unloaded body weight attached with elastic cords supported the pelvis so that she can lift her body with the shape of the lumber region maintained correctly. According to the progressive ladder principle in the sling exercise, elastic cords support gradually reduced, hip joint movement was added, and the sling on the leg changed distally. Thus, the patient suffering from stress urinary incontinence could be managed successfully by the trunk stability treatment with sling exercise therapy.View full abstractDownload PDF (840K) -
Takafumi TSUKADA, Naoyuki MIYASAKA, Takanori YOSHIDA, Kotoi TSURANE, M ...2012 Volume 60 Issue 5 Pages 622-626
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSA 41-year-old woman, gravid 3, para 3, was admitted to the Department of Obstetrics and Gynecology at Tsuchiura Kyodo General Hospital, complaining of a tender, gradually enlarging mass in the right inguinal region during menses. Examination found the mass was about 2 cm in diameter, which protruded slightly (on lying position?). During menstrual periods, the mass enlarged and the pain intensified, but between menses, the mass decreased in size and the pain subsided. The case was diagnosed as inguinal endometriosis and then a preoperative GnRH analog therapy was given for six weeks to make a good operative local condition. Surgery was performed under general anesthesia and a mass about 4.0×3.0 cm in diameter near inguinal ligament was removed. The cut surface revealed small hemorrhagic areas or spaces. Microscopic examination of the dissected mass confirmed the diagnosis of inguinal endometriosis. It was found that the patient had a moderate inguinal swelling on the first visit to the hospital as an outpatient 7 days after operation, but the swelling disappeared shortly afterword. She has been receiving a post-operative GnRH analog therapy for 3 months to maintain a good local condition. The authors concluded that the appearance of a lump in the inguinal region and objective changes of the lesion in relation to the menstrual cycle should be considered as the symptoms of endometriosis.View full abstractDownload PDF (695K) -
Fumi KURITA, Naoyuki MIYASAKA, Takanori YOSHIDA, Kotoi TSURANE, Mayumi ...2012 Volume 60 Issue 5 Pages 627-630
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSWe report a case of new-onset depressive disorder in a patient with a history of rectal endometriosis treated with GnRH analog and no previous psychiatric history. This medical history allowed us to suspect the possibility of a link between GnRH analog and depression. It also highlighted the need to screen patients treated with GnRH analog for depression.
The patient was 41-year-old woman who had been diagnosed with rectal endometriosis. She was referred to the Gynecology Department of Tsuchiura Kyodo General Hospital. The subjective symptoms included cyclic abdominal pains and rectal bleedings. The patient had undergone total abdominal hysterectomy and left salpingo-oophorectomy for endometriosis two years before. She was started by her first gynecologist on GnRH agonist (nafarelin acetate) and the symptoms disappeared soon. But several weeks after the initiation of the GnRH agonist treatment, she began to feel depressed and hopeless. She visited a psychiatric hospital and diagnosed as having depression. She was given anti-depressive drugs and inpatient treatment at the psychiatric hospital. Her clinical course was reviewed by her second gynecologist, and she was suspected to have developed depressive disorder by GnRH analog treatment. She stopped taking GnRH analog medication and started progestin (Dinagest) therapy. She became soon free of depressive disorder and then anti-depressive drugs with rectal endometriosis well controlled. This case also suggested Dinagest is a recommended drug for rectal endometriosis.View full abstractDownload PDF (233K)
REGIONAL MEETINGS
-
2012 Volume 60 Issue 5 Pages 631-652
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSDownload PDF (818K) -
2012 Volume 60 Issue 5 Pages 653-686
Published: January 31, 2012
Released on J-STAGE: June 06, 2012
JOURNAL FREE ACCESSDownload PDF (899K)
- |<
- <
- 1
- >
- >|