This study was conducted to identify regional characteristics of salubrious aspects of social capital in a rural community. For this purpose, group interviews took place with three groups, each consisting of six to nine people aged 65 and older in Village A and what those interviewees said with reference to social capital were analyzed qualitatively and descriptively. A total of 610 views were extracted and organized into 141 codes, from which 20 codes that seemed to characterize the rural community in general were sampled and were divided into four categories and eight subcategories. The four categories were made up of “communing with nature,” “maintaining a relationship of trust among community members,” “regarding social norms highly,” and “encouraging social intercourse among individuals and families, and networking.” The benefits of social capital in the village to the health showed characteristics of Japanese rural communities - close links among community members who have communed with nature. There were plenty of indications showing a solidarity type of social capital based on a shared territorial bond strengthened in the milieu of a rural community where people had kept cultivating lands from generation to generation. There were also indications that a growing number of people had become aware of the need to strengthen networking from the viewpoint of a bridge type of social capital. The present study has afford us useful hints for maintaining the health of the aged in rural areas as well as for building a community very pleasant to live in.

View full abstract

【Objectives】A study was carried out to examine the relationships between community consciousness and the health of the middle-aged in a rural area, and to explore how to support their effort to promote health through behavioral modification. 【Methods】A questionnaire survey was conducted on 2,336 people, aged 30-64, in town A. We received effective responses from 763 people (32.7% valid response rate). The investigative tool Self-administered questionnaires were sent out by asking them about their identity, community consciousness (attitude toward community, relationships with neighbors, social participation), physical health (health conditions, health behaviors, attitude toward health actions), and mental health (life satisfaction, depression). An analysis was made to find the relationship between the subjects’ attitude toward community and physical or mental health. In addition, we performed a multivariate analysis with physical health and mental health as the objective variables and the items, in which a significant difference was mainly observed in a univariate analysis, as the explanatory variables. 【Results】Respondents with a higher score on the attitude toward community scale also had higher scores for health condition, health behaviors, and attitude toward health actions. Those people with higher scores on the attitude toward community scale had higher life satisfaction scores and lower depression scores. 【Conclusion】These results revealed a close association between community consciousness and the health of the middle-aged in the rural area. It is necessary to interpret the assessment in consideration of the fact that in rural areas community consciousness is generally high and contributes to healthy support of the middle-aged.

View full abstract

　　The present study was undertaken to ascertain whether a system of collaboration using an electronic communication network between a university hospital and a local medical institution would be effective or not in treating patients for refractory skin ulcers. The subjects were 26 refractory skin ulcer patients aged 75 and older on the waiting list for surgery from April 2013 through March 2014. Clinical photographs were emailed to a plastic and reconstruction surgeon at the department of dermatology, Shimane University Hospital. After chatting on-line between sender and receiver, a treatment program was decided upon for each case, and surgery was performed in the local hospital on nine cases of burn scar, seven cases of bedsore, three cases of ischemic limb, one case of malignancy and six cases of injury. Perioperative management was also taken upon by the local hospital. An alteration was made in surgical modality for two cases (7.7%) of burn scars. Initially, a local pattern flap operation was scheduled, but actually a free skin grafting procedure was carried out. There were no cases where serious complications occurred. Reoperation was necessary for only one case (3.8%) where the surgical closing of a wound had been performed. Our study found that the cooperation between a university hospital and a local medical facility using an electronic network could be effective in diagnosing and treating refractory skin ulcers in the aged.

View full abstract

　　In Toyota where our hospital plays a role of a municipal health provider, population will increase slightly, but aging will quickly progress in coming 20 years. In this paper, we envisaged the picture of future health services to be provided by our hospital based on the age-specific population movement date by the five-year age categories in the “Regional Population Projection for Japan: 2010-2040”, which was worked out on trial by the National Institute of Population and Social Security Research. The population was divided into four ranks, “juvenile”, “production-age”, “young-old”, and “old-old”. We assessed the types of prevailing disease in the year 2025 when the ages of all baby boomers are expected to exceed 75 years. 　　The population in Toyota will slightly decrease along with a decrease in the number of people in juvenile and production-age ranks until 2035. In contrast, the population of those in the young-old and the old-old group population ranks will increase by 1.2 times and 2.4 times, respectively. Since about 12% of the old-old group is expected to be inpatients of our hospital, with the increase in the old-old group, the number of the patient to be discharged from our hospital will also increase. In the year 2025 when the number of obstetrics patients as well as new born infants will decrease in proportion to the reduction in the population. On the other hand, all types of neoplasm, cardiovascular disease, digestive disease, respiratory disease, and injury, which are common in the old-old group, will increase. 　　Given that almost 80% of the patients discharged from our hospital are Toyota residents, the total number of patients to be discharged from our hospital in 2025 could be 20,000. When the average length of hospital stay in 2012 is applied to calculate the rate of the hospital bed occupancy rate, it would be 105% in 2025. It means that shortage of sickbeds will occur in our hospital. To cope with their problem, it will be necessary to shoten the length of hospitalization.

View full abstract

　　A 32-year-old woman underwent the laparoscopic ovarian cystectomy. During the operation, adrenaline was injected into her right ovary, because the amount of bleeding decreased. Soon after the injection, ventricular tachycardia occurred and her blood pressure increased to 190/125. The use of lidocaine induced the electrocardiogram to return to normal and brought down the blood pressure to a normal range. The operation was finished without hitch. 　　Vasopressin has both an excellent hemostatic effect and cardiovascular side effects, and is often used at many medical facilities in Japan. But the treatment with vasopressin is neither covered by health insurance nor the relief system for sufferers from adverse drug reactions. 　　So we usually use adrenaline which is insurable at laparoscopic operations. Adrenaline has also a hemostatic property, and causes severe cardiovascular adverse events such as ventricular tachycardia when used together with halogenated inhalation anesthetic. The Japanese Society of Anesthesiologists concludes that no serious side effects will arise from using adrenalin and sevoflurane or isoflurane based on its own findings. 　　We had a case with ventricular tachycardia which occurred after an adrenaline local injection. But we recommend a careful use of adrenaline for local injection during a laparoscopic operation.

View full abstract

　　It usually takes several days to detect slow-growing bacteria by a blood culture system. Moreover, even if the microbial growths are detected in blood samples, they will escape our notice at a microscopic examination using Gram’s stain. Consequently, the results are often regarded as false positive. 　　This paper reports case of malignant lymphoma in which bloodstream infection caused by slow-growing spirillum was observed. The patient in chemotherapy for malignant lymphoma, complained of repeated fever. Repeated blood cultures were taken and occasionally positive signals, which mean increased CO2 concentrations in the culture bottle, were detected by BACTEC 9240 (Becton Dickinson). However, routine microscopic examination with Gram’s stain did not detect any bacteria. Thus, the results of BACTEC were thought to be false positive. Thereafter, the bacterial culture period was extended. Finally, a spirillum, suspected of one of Helicobacter species, was observed microscopically. The detected spirillum was regarded as Helicobacter canadensis with 98.08% homology, using polymerase chain reaction with the 16S rRNA method and basic local alignment search tool (BLAST). 　　H. canadensis is one of new species isolated from humans with diarrhea. This bacterium is considered to cause a zoonotic infection. There have been some case reports that this bacterium infected immunosuppressive patients, so we should exercise caution against such conditions. Moreover, we should keep vigilant against the spread of slow-growing bacteria when there are discrepancies in findings between blood culture system and microscopic examination. It is useful to extend the culture period to detect such slow-growing bacteria.

View full abstract

　　Case 1: A woman in her 70s was carried into emergency department of our hospital. Apparently she had dyspnea. Acute pulmonary heart was suspected. Electrocardiography S I Q III T III-pattern. The patient was diagnosed with popliteal vein vascular aneurysm by ultrasonography. Case 2: A man in his 60s, was referred to our hospital for treatment of lower extremity swelling and pain. Like Case 1, the male patient was suspected of having deep vein thrombosis and femoral artery aneurysms by ultrasound inspection and also diagnosed with pulmonary thromboembolism based on CT findings. We were able to rescue these two patients by rapid medical cooperation. Ultrasonography was particularly useful for diagnosis and morphological evaluation of blood vessels.

View full abstract

　　This paper reports three cases of malignant afferent loop obstruction after choledochojejunostomy. In the first case, a 75-year old woman, who had undergone left hepatectomy for bile duct cancer with bile duct resection, was admitted for Roux en Y reconstruction after choledochojejunostomy because of emesis. The local recurrent tumor caused occlusion of the duodenum and afferent limb, and bypass surgery was performed after transintestinal drainage. In the second case, a 57-year-old man, who had undergone pancreaticoduodenectomy for pancreas cancer, was hospitalized with a high-grade fever and epigastric pain. Exploratory laparotomy revealed widespread carcinomatosis causing afferent loop obstruction, and bypass surgery was performed. In the third case, a 60-year-old woman with paraaortic lymphnode recurrence of gallbladder cancer was admitted as she had afferent loop syndrome. Transintestinal drainage was performed. All these three patients were discharged. Bypass surgery for selective patients turned out to be an effective palliative treatment for malignant afferent loop obstruction.

View full abstract

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.

View full abstract

　　Hospital A, nestled among hills, plays a central role in providing health services in the region with a population of about 150,000. Designated as a secondary emergency care hospital, it has no independent emergency care team, but has made every arrangement to provide emergency medical services around the clock: In the daytime on weekdays, clinical department physicians and nurses, and in the night time and on holidays, one doctor and two nurses on duty are in charge. Nurses on night duty and on holidays vary in clinical experience and ability to cope with emergencies. Apparently, they are struggling to maintain their presence of mind when they are receiving patients requiring immediate attention or when they are answering to emergency telephone calls. In May 2012, the hospital moved to the place within easy access of the main road and a heliport was built. It was expected that the number of patients rushed to the hospital in ambulances would increase. Against this background, there arouse an urgent need for every paramedic and nurse to make an right assessment of the conditions of the patients promptly and sort them rightly according to the emergency of their need for care. To meet this need, we started to work on standards of triage categorization and practice according symptoms, and classification of severity. Moreover, to develop the ability of the staff to deal with the emergencies, study meetings were held and case reviews took place.

View full abstract

　　The Tsurumi Hospital introduced a state-of-the-art, multifunctional cancer radiation therapy system in April 2011. When a new building was completed. The cancer radiation therapy started in September of the same year. Our hospital as a cancer treatment hospital provides high-quality care, and can deliver radiation therapy of high performance and high precision in safety, and aims to be trusted by society and patients. In a cancer radiation therapy, it is important to work in teams made up of doctors, radiological technologists and nurses having a high degree of professionalism. In such circumstances radiological technologists have to play various roles and shoulder responsibility. For example, they have to take responsibility for dose distribution creation and calculation of monitor units according treatment plans, systems, positioning radiography, creating a fixture and immobilizer, verification of irradiation, setup of patient, quality assurance and quality control of related equipment for the radiotherapy system, explanation to the patient, medical safety and radiation maintenances etc. Since the introduction of the cancer radiation therapy system, radiological technologists have had to carry out work required for radiation therapy such as verification of creating specifications, determination of equipment, procedures based on the relevant laws and regulations, acceptance test, acquisition of clinical data, commissioning and verification of treatment dose. This paper describes the role and practice of radiological technologists to lead a cancer radiation therapy, based upon our experience.

View full abstract