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Volume 64, Issue 2
Displaying 1-10 of 10 articles from this issue
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ORIGINAL
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Mutsumi FUJII2015 Volume 64 Issue 2 Pages 107-113
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSFacial nerve injury is a severely disfiguring complication of temporal bone fractures. We retrospectively reviewed the records of 768 patients diagnosed with basilar skull fractures in various emergency hospitals including our hospital. Of these, 282 patients had temporal bone fractures. Forty-one out of the 282 patients (14.5%) had facial nerve palsy: 7 patients with immediate facial palsy, 33 with delayed-onset facial palsy (DFP), and one with delayed-onset dysgeusia but without facial motor palsy. The onset date of DFP was defined as the day when a doctor noticed the appearance of facial palsy on the daily round. Of the 33 DFP patients, 25 (75.8%) were men. They ranged in age from 7 to 84 years (39.7±20.6 years). The median onset time of DFP was day 6. Facial nerve dysfunctions were classified by the House-Brackmann (HB) facial grading system. The patients were managed conservatively with steroids and facial rehabilitation in principle. We periodically monitored the improvement of facial palsy. In this study we judged the patients had recovered from facial nerve palsy when the HB grade of facial never function was improved to II. After we excluded patients who underwent facial nerve decompressive surgery (n＝1) and had only mild DFP less than grade III (n＝3), the remaining 29 (DFP) patients were enrolled for subsequent follow-up analysis (7＝HB grade III, 15＝HB grade IV, 7＝HB grade V, and 0＝HB grade VI). Twenty seven patients (93.1%) recovered within one year, but two severe DFP patients did not show a valid recovery. A log-rank test showed that there was a statistical difference in recovery period between moderate (HB grade III and IV) and severe facial palsy groups (HB grade V) (p＝0.024). The median period for recovery was 50 days in the moderate group and 93 days in the severe group. Although 28.6% (2/7 patients) of severe DFP did not achieve the recovery with the conservative management alone, we conclude that nonsurgical treatment is strongly recommended for patients with moderate DFP.View full abstractDownload PDF (388K) -
Report I:Factors in Evaluation of Functional Capacity and Depression-pronenessMasashi SUGIURA, Tomihiro HAYAKAWA2015 Volume 64 Issue 2 Pages 114-124
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSThe subjects of this study were people 65 and older, who live in a mountainous region in the Province of Mikawa, Aichi Prefecture. To determine the factors pertaining to their ability to perform the basic activities of daily living, we used the TMIG index of competence for rating functional capacity and the geriatric depression scale for assessing mental health status, and carried out a logistic regression analysis to examine how the 37 items in the questionnaire survey on senile dementia were related to the functional capacity in the old people. To the index of competence, (To the ability to perform daily activities,?) answers to these questions -“Is there anything you have to do every day,” “Do you have farm work to do,” “Do you have any hobbies,%rdquo; “Are you willing to work hand in hand with others as a volunteer,” and “Do you have someone to talk to” - were closely related, with the odds ratio calculated at 2.0 or above (p‹0.001). Also in mental health status, the odds ratio came to 2.0 or over (p‹0.001) in similar items. These findings suggested that a sense of purpose, a role to play and involvement in community affairs could be the essentials of life for the senior citizens. In the not- too-distant future, it will become necessary to build a system based on the idea that healthy old people are supposed to take care of, and support, their contemporaries who are frail mentally and physically.View full abstractDownload PDF (422K) -
Koji SHIMABUKURO, Seiichi ENDO, Yasuko NISHIDA, Yoshihide SAGAWA, Kaor ...2015 Volume 64 Issue 2 Pages 125-130
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSAdhesion formation after abdominal surgery is a commonly recognized entity. Many studies have shown that women giving birth by cesarean section are at the risk of developing complications related to the postoperative formation of adhesions including ileus, bowel obstructions, impaired fertility, and chronic abdominal pain. Among several adhesion barriers, one that has been tested in randomized, controlled trials is the hyaluronic cid-carboxymethylcellulose (HA/CMC) membrane (Seprafilm®: Genzyme, Cambridge, MA, USA). This bioresorbable membrane serves as a mechanical barrier between surgically damaged tissues and resorbs afterwards. At our institution, we have used HA/CMC in cesarean sections. We report our experience with this patient population using placement of HA/CMC. This study enrolled 45 women who had undergone cesarean sections twice or more who had received HA/CMC during the previous cesarean section between January 2013 and November 2014. The incidence of adhesions to the area of abdominal wall incisions and uterine surface, intestinal obstructive symptoms, and adverse events were studied. The incidence of adhesions to midline incisions was 4.4% (n＝2). The filmy adhesion by major omentum was detected in these two cases. The incidence of adhesions to uterine surface was 2.2% (n＝1). The moderate thickness adhesion was detected at the left side of the vesico-uterine peritoneal incision by pelvic peritoneum which did not affect the operative procedure. No symptoms related to intestinal obstructions such as abdominal pains, nausea and vomiting were observed. No adverse events were observed. These three cases had fever which had nothing to do with HA/CMC applications but was attributable respectively to influenza infection, mastitis, phlebitis associated with a needle procedure. HA/CMC was considered a useful adhesion barrier membrane for use in cesarean sections as an adjunct intended to reduce the incidence of postoperative adhesions between the abdominal wall and the underlying viscera such as omentum, small bowel, and between the uterus and surrounding structures.View full abstractDownload PDF (456K) -
Hiroaki SHIBAHARA, Masahito MURAMATSU, Takahisa NIWA, Daisaku NISHIMUR ...2015 Volume 64 Issue 2 Pages 131-139
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSObjective: To elucidate the appearance of skin moisturization (cold and clammy skin) in dying period and related factors. Methods: Patients were observed prospectively with skin moisturization using the clinical pathway for end-of-life care (Liverpool Care Pathway Japanese version [LCP]) by nurses in the palliative care unit. Results: Of 213 patients placed on LCP, 48 (22.5%) indicated skin moisturization, which was observed mostly in summer and in the morning. It appeared 45.8 hours before death on the average. By multivariate analysis, the administration of non-steroidal anti-inflammatory drugs (NSAIDs) was an independent related factor. Conclusions: Compared to our previous retrospective study, the appearance of skin moisturization was higher in frequency and earlier in the dying period, and the administration of NSAIDs was an independent related factor.View full abstractDownload PDF (458K) -
Sense of Community and Living EnvironmentHanae SUMIDA, Toshiki KATSURA, Akiko HOSHINO, Kanae USUI2015 Volume 64 Issue 2 Pages 140-154
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSThis study was carried out to clarify the effects of the sense of community and living environment on elderly citizens’ mental health. We conducted a self-administered questionnaire survey targeting 820 men and women aged 65 and over, who were a member of “A” seniors’ club or participant of a daily service event organized by “A” Council of Social Welfare. Valid responses came from 577 people, who were enrolled in this study. Univariate and multivariate analyses revealed that elderly citizens’ life satisfaction was positively correlated with “subjective sense of well-being”, “hypertension”, “junior high school district”, “love for the region”, “social supports&rdqul;, and “no medical problems”, and negatively correlated with “neuroticism” and &ldqip:stress”. In addition, risk factors for depression were “single life”, “neuroticism”, and “stress”, whereas improvement factors were “subjective sense of well-being”, “hobby”, “fine views”, and “sociability”. Our findings showed that elderly adults’ mental health status was associated with various factors such as their “love for the region” “living environment with fine views”, “subjective sense of well-being”, and “personality”. These results suggested that community networks could favorably affect elderly people’s mental health.View full abstractDownload PDF (430K)
RESEARCH REPORT
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Takuya SHIRAISHI2015 Volume 64 Issue 2 Pages 155-160
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSBackground and Purpose: As the population in Japan is rapidly graying, elderly pneumonia patients are increasing. Even if elderly patients undergo the same treatments as younger patients, their outcomes would be all too often disappointing. This would make it difficult for doctors to judge whether they should continue to give medical treatment or not. So, we decided to examine relationships between frailty and outcomes of treatments of pneumonia in elderly patients in a rural area. Methods: Participants were elderly patients aged 75 years or older who were treated for pneumonia in our clinic between April 2014 and January 2015. Clinical course, disease severity classifications and frailty of the patients were investigated. Results: Seven patients (three men and four women;mean age 87.7 years) were analyzed. As frailty advances, some patients died in hospital or were discharged to more to an institutional care facility. Conclusion: Frailty may have been related to their bad results after pneumonia treatments. We may be able to predict their out-of-hospital health state by presence or absence of frailty.View full abstractDownload PDF (263K) -
Takuya KOIKE, Satoru KONO, Risa SHIOMI, Makoto ARAI, Masashi TAKAHASHI ...2015 Volume 64 Issue 2 Pages 161-165
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESS[Purpose] We introduced subcutaneous suture with a synthetic absorption thread and examined its efficacy on surgical site infection after pancreaticduodenectomy (PD). [Method] In hour hospitals, PD was performed in a total of 69 cases from March 2006 through March 2014. They was divided into two groups-one consisting of 31 cases in which the skin wounds with staplers (non-subcutaneous suture group), and the other consisting of 38 cases in which surgical wounds were closed with subcutaneous sutures (subcutaneous suture group), and the incidence of surgical site infection (SSI) were compared between the two groups. [Result] Incidence of surface SSI occurred in eight cases (21.0%) in the non- subcutaneous suture group and three cases (9.7%) in the subcutaneous suture group (p＝0.17). The incidence of SSI was decreased in the subcutaneous suture group than in the non-subcutaneous suture group, but no statistically significant difference was observed between the two groups. However, taking into account the advantages such as the reduction of patient’s medical expenses, and the burden of ward duties, further examination with an additional number of patients was thought to be necessary.View full abstractDownload PDF (298K)
CASE REPORT
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Kazuhiro ISHIHARA, Chika TAKAO, Hidenori TANAKA, Harumi TAKAHASHI, Sat ...2015 Volume 64 Issue 2 Pages 166-171
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSThe patient is a women in her 60s. After medical examinations, she was told that the result of fecal occult blood reaction testing was positive. Moreover, colonoscopy found type 2 cancer in her sigmoid colon. The patient underwent sigmoidectomy. The 3D dissection of lymph node and colorectal side-to-end anastomosis were performed. Pathologically, the case was diagnosed as moderately differentiated adenocarcinoma (stage II). Adjuvant chemotherapy was not given. During follow-up observation, the tumor marker levels were elevated above normal. A work-up revealed a recurrence of the cancer on the abdominal wall. The lesion was surgically removed with a margin of about 2 cm from the tumor secured. Pathological diagnosis of this recurrent case was not inconsistent with the previous diagnosis of sigmoid colon cancer. As the relapse was thought to be due to the implantation of cancer cells in the abdominal wall, we need to follow the surgical procedure with scrupulous care and exercise the utmost precaution to protect incision wound on the abdominal wall.View full abstractDownload PDF (508K)
NURSING RESEARCH REPORT
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Koki HOTTA, Syoko ABE, Yuka NAGAOKA2015 Volume 64 Issue 2 Pages 172-179
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSAlarms in ambulatory monitoring of electrocardiography (ECG) sound in our cardiology ward too frequently. To investigate the incidence and causes of inadequate alarms, we examined 3,699 alarms in a total of 100 inpatients during a period of 7 days retrospectively. Of the alarms, 49% was related to extreme bradycardia, 31% to extreme tachycardia and 10% to trained ventricular premature beats. Alarms were set off because of correct detection of cardiac abnormalities (50%), poor electrode-to- patient contact (17%) and wrong diagnosis (12%), and body movement of patients (11%). To reduce false alarms in ambulatory ECG monitoring, we though it would be necessary to (1) change electrodes once a day, (2) wipe the sweat from the patient’s chest surface, (3) stick electrodes away from movement sites, (4) tape down lead wires to prevent them from pulling on the electrodes, (5) select sticking sites to get enough QRS voltage (›1mV), and (6) set adequate threshold of heart rate to make alarms.View full abstractDownload PDF (734K)
MATERIAL
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Masashi SUGIURA, Yoshio SHIRAI, Tomihiro HAYAKAWA2015 Volume 64 Issue 2 Pages 180-186
Published: 2015
Released on J-STAGE: August 13, 2015
JOURNAL FREE ACCESSWe have embarked on a project to help old people finding something to live for. The project was worked out as we found that more than half of the elderly we queried said that they preferred to stay at home rather than go out because there was nothing to do. Years ago, an ad hoc committee, comprised of hospital employees, was organized to think up how to use facilities in our hospital effectively for the benefit of the health of the stay- at-home elderly. Based on the ideas proposed by the committee, a total of eight health classes came into existence. They included the exercise class with an aim to prevent locomotive syndrome, the brain training course for maintaining or improving cognitive abilities, the beauty salon dealing with cosmetic treatments and the karaoke club. Each club had a membership of 10 to 30 persons. More than 80% were women. The average age was around 75 years. The club dues range from \0 to \500. Later on, some clubs raised fees, but the number of participants remained almost the same. Many participants in the one-year brain training course had their cognitive abilities improved significantly. It has been found that there are many people living far from the hospital wish to join these clubs but their wish remains unfulfilled. This is one of the tasks we have to tackle with together with the problem that there are too few male participants. In any way, as part of our efforts to revitalize regional communities, we think that it is important to expand our project from now on to have activities built into the daily lives of the elderly.View full abstractDownload PDF (434K)
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