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Volume 68, Issue 2
Displaying 1-15 of 15 articles from this issue
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ORIGINAL
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Reiji OOMURA, Motoi SUGIYAMA, Nana OONO, Kouiti WAUKÈ, Tomoji KIRIOKA, ...2019 Volume 68 Issue 2 Pages 113-119
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSA recovery rehabilitation ward is a ward where aggressive rehabilitation is provided to enable patients to return to their former level of activities of daily living (ADL). Our hospital is actively engaged in rehabilitation medicine as provided by various therapists including physical, occupational, and speech-language-hearing therapists and nurses on the ward. So, management of the patient's schedule and information sharing among members of this multidisciplinary team can be a challenge. We therefore introduced a patient schedule that provides an overview of the management plans for all patients, a rehabilitation schedule board that helps with confirming each patient's schedule and is kept in the bedside cabinet, and the ADL panel where information on ADL status and target is recorded.As a result of using the patient schedule, it became easy to make adjustments in rehabilitation duration for the patient and to reduce the stress from overscheduling.Using the rehabilitation schedule board has enabled us to now check the schedule at the bedside, and the patients can plan activities cognizant of their daily routine.Using the ADL panel allows nurses and therapists to share ADL information and also allows the patients to confirm their present status and targets.Information sharing is vital in rehabilitation medicine multidisciplinary teams on recovery rehabilitation wards where the various roles affect the patient, and using the patient schedule, rehabilitation schedule board, and ADL panel is useful for achieving this.View full abstractDownload PDF (2091K) -
Tomo TAKENAGA, Yasuo AKIBA, Keisuke TAGUCHI, Yujiro MITO, Takanori YOS ...2019 Volume 68 Issue 2 Pages 120-126
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSIn Japan, there are no predetermined guidelines on the management of pregnant women at 41 weeks of pregnancy. In our hospital, pregnant women at 41 weeks of pregnancy are candidates for induction, but induction may result in emergency caesarean section, atonic bleeding postpartum hemorrhage, and neonatal emergencies with admission to the Neonatal Intensive Care Unit (NICU). Therefore, we conducted a retrospective investigation to determine which cases are likely to end in such events. Our hospital recorded a total of 3,492 deliveries during the period 2013-2015. Of these, 382 pregnancies were delivered at 41 weeks. We compared the labor induction group and the spontaneous delivery group. The rate of emergency caesarean section for multiparas was 1％ and was as high as 21％ for primiparas, so we focused on primiparas in this study. The 258 primiparas from among all 382 cases were divided into the induction group (n＝122) and the spontaneous group (n＝136). Compared with the spontaneous group, the induction group had older primiparas, more body weight gain during pregnancy, and a high risk of emergency caesarean section. There was no significant difference in the proportion of neonates admitted to the NICU. In the analysis focused on the induction group, the rate of emergency cesarean section increased as the number of cases requiring induction and the number of elderly primiparas increased. With the recent increasing age of primiparas, it is necessary to educate women on the risks of weight gain during pregnancy.View full abstractDownload PDF (695K) -
Takahiro HOMMA2019 Volume 68 Issue 2 Pages 127-133
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSOur hospital had stocked some blood products for emergencies because the distance to the nearest blood center. The rate of wastage of blood products at our hospital was far higher than the national average. To resolve this problem, a blood products delivery vehicle stocked with spare blood products was stationed in our hospital. This enabled easy access to required blood products. The Maximal Surgical Blood Order Schedule and Surgical Blood Order Equation helped to considerably reduce the frequency of blood product orders and decreased wastage of blood products.View full abstractDownload PDF (1133K)
RESEARCH REPORT
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Akifumi MIZUTANI, Chinami SUZUKI, Junichi KUBO, Kimihito SATO2019 Volume 68 Issue 2 Pages 134-140
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSSodium glucose co-transporter 2 (SGLT2) inhibitors typically have various secondary effects in addition to the hypoglycemic effect. Therefore, we examined their effectiveness and other secondary effects. We targeted 86 patients with type 2 diabetes treated with SGLT2 inhibitors for the first time from June 2014 to the end of March 2017 at our hospital. Mean body mass index (BMI) was 28.69±4.91kg/m2. Body weight, BMI, and levels of hemoglobin A1c (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GTP), estimated glomerular filtration rate (eGFR), triglyceride (TG) and uric acid (UA) were significantly lower,while hematocrit (HCT), blood urea nitrogen (BUN), creatinine (Cre), and high-density lipoprotein cholesterol were significantly higher 2 months after than before administration of SGLT2 inhibitors. A significant negative correlation was observed between HbA1c, body weight, AST, ALT, γ-GTP, BUN, low-density lipoprotein cholesterol (LDL-C), and change in UA before and 2 months after administration of SGLT2 inhibitors. HbA1c was lower in patients with high HbA1c before treatment, and weight loss was noted in patients with increased body weight before treatment. These results suggest that SGLT2 inhibitors may be highly effective in patients with type 2 diabetes with uncontrolled obesity. In addition, potential risk factors for cardiovascular events and deranged liver function test values were identified, and there was a possibility that long-term SGLT2 inhibitor use could induce cardiovascular events, but with possible improvement of fatty liver. However, because it was observed that HCT was elevated and renal function was impaired, it may be necessary to administer rehydration therapy in the initial stages of treatment and to continuously monitor renal function.View full abstractDownload PDF (867K) -
Chinami SUZUKI, Junichi KUBO, Kimihito SATO2019 Volume 68 Issue 2 Pages 141-147
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSIndices for dose regulation for irinotecan (CPT-11) toxicity are diarrhea, reduction in neutrophil (NEUT) count, and level of UDP-glucuronyltransferase (UGT), which is involved in conjugation of the active metabolite SN-38. An association with the glucuronosyltransferase (UGT) 1A1 gene polymorphism has been reported. Therefore, we investigated UGT1A1 gene polymorphism and the incidence of side effects in patients who received FOLFIRI±αat our institution from November 2008 to March 2017. UGT1A1 genetic testing was performed, and 25 cases treated with FOLFIRI±αwere included. Age, sex, height, weight, and body surface area (BSA)were analyzed. UGT1A1 genotype was determined as follows:*1/*6 heterozygous (*6 he genotype), *1/*28 heterozygous (*28 he genotype), homozygous, and compound heterozygous (compound genotype). We also investigated the combination drugs (classified as he genotype) and wild type. In addition, the initial dose of CPT-11/5-FU bolus, initial relative dose intensity (RDI) (％), and blood toxicity in the first course were investigated. Mean age was 70.4±8.6 years, UGT1A1 genotype was*28 he in 5 cases, *6 he in 6 cases, and wild type in 14 cases. There were no cases of compound he or homo type. There was no significant difference between the initial dose and the initial RDI. Reduction in leukocyte count was seen in 2 cases with Grade(G)3*6 he and in 2 cases with G4*28 he. Platelet count was reduced in 2 cases with G4*28 he, 2 cases with G4*2 he, 2 cases with G4*28 he, and in 2 cases with*6 he. In this study, there was no significant difference in the initial dose and initial RDI for*6 he, *28 he, and wild type. However, *28 he and *6 he showed hematologic toxicity of G3 or more. Also, the frequency of the he genotype tended to be higher than that of wild type. Thus, it is necessary to clarify the significance of weight loss in the he type in future.View full abstractDownload PDF (676K) -
Fumitaka OHASHI, Soshu TANAKA, Yuta OCHI, Takuya MARUYAMA, Haruka GOTO ...2019 Volume 68 Issue 2 Pages 148-154
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSIn hemodialysis, an adsorbent is used to remove phosphorus from the blood.Because phosphorus adsorbents contain iron, they may cause iron excess, and appropriate management is thus required.In recent years, the use of sucroferric oxyhydroxide (SO), which has become available, is said to be associated with lower iron absorption and is less likely to cause iron excess, as compared with conventional ferric citrate hydrate (FCH). However, in clinical trials of SO conducted in Japan, serum ferritin (Ft) and transferrin saturation (TSAT) tended to increase, and this may cause iron excess similar to FCH. Therefore, we report here on the phosphorus adsorption effect and the influence on iron-related benefit of SO.Among 12 patients, iron-related abnormalities were observed in 3 patients and adverse events such as diarrhea and nausea were observed in 7 patients.In 8 patients who continued taking SO for up to 24 weeks, serum phosphorus (P) decreased, Ft and TSAT increased, Hb, Fe, Ca did not change significantly, and the dose of erythropoiesis-stimulating agents (ESA) decreased. The rate of change of Ft was greater in 5 patients with iron deficiency than in 3 patients with non-ferrous deficiency. SO administration tended to decrease P and improve iron deficiency.In addition, there was a decrease in the dose of ESA, suggesting the possibility of contributing to pharmaceutical cost reduction.Conversely, in patients with iron deficiency, iron-related abnormalities were observed in 3 patients, and about half had adverse events with subjective symptoms 4 weeks after the start of treatment with SO.Therefore, the administration of SO takes into account the effects on iron-related values as well as FCH, it is thus considered important to adjust the dose of SO or ESA depending on the condition while monitoring clinical laboratory values and adverse events from the beginning of administration.View full abstractDownload PDF (769K) -
Hiroo NOGUCHI, Toshinobu YAMADA2019 Volume 68 Issue 2 Pages 155-163
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSThis report describes a local epidemic of pertussis in Kita-Akita City, Akita, Japan between December 2015 and September 2016 that mainly affected primary school children. There were 138 patients with clinically suspected pertussis;diagnosis was confirmed in 74 patients by laboratory tests. In total, 62 patients with typical symptoms and laboratory findings satisfied the legal criteria in 2018. A table of incidence over time in the local educational institution suggested that contagion occurred in the classroom first, in the home next, and then spread in the community last. Epidemiological information was shared among local clinics and hospitals, health centers, and educational committees. The epidemic lasted about 10 months. Pertussis usually presents with cold-like symptoms and the classical symptoms develop gradually. Before 2017, the legal criteria for registering cases in an epidemic survey was a duration of illness over 14 days. Twenty-six (35％) patients visited the clinic before day 6 of illness, and for most patients, cough stopped before day 14 of illness. Pertussis may not usually be a common disease, but it can be diagnosed and treated rapidly in a local epidemic situation by ensuring appropriate specific laboratory testing and by collecting epidemiological information.View full abstractDownload PDF (1295K) -
That Enable Caregivers to Continue Providing Home CareYoshiko NAKANE, Hisae NAKADA, Yuko OOTSUKI2019 Volume 68 Issue 2 Pages 164-173
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSThe purpose of this study was to identify factors that enable female caregivers in a depopulated agrarian region to continue providing home care and to obtain basic data to aid in determining the type of support these caregivers need to continue providing such care. Semi-structured interviews were conducted with 5 women who had been providing in-home care for a person with care needs aged 65 years or older in a depopulated agrarian region for at least 1 year. Data were analyzed using Mayring's approach to qualitative content analysis.Six categories were identified through the analysis:“effective use of in-home services”,“caregiver's ability to make time”,“having a family support system”,“having supportive people around”,“acquisition of caregiving knowledge and skills”, and“transportation options in the sparsely populated area”. These results indicate that professionals should support female caregivers in sparsely populated villages by promoting formation of friendships between caregivers and devising support methods that take into consideration local circumstances.View full abstractDownload PDF (825K) -
Takanobu SASAKI, Takao TERUYA, Fusahiro HIRANO, Shinyu KISE, Kazuhiko ...2019 Volume 68 Issue 2 Pages 174-179
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSWe retrospectively evaluated 21 patients with resected lung metastases from head and neck cancers (oral cavity, pharynx, larynx, and others) in our department between April 2009 and December 2016. The 5-year overall survival after lung resection was 56.7％ and median survival time was 21 months, which was good compared with findings in the literature. Tumor size of lung metastatic lesion≥2.0cm was a significant prognostic factor (p＝0.0157). No independent prognostic factors were identified in multivariate analysis. Aggressive resection was suggested to contribute to prognosis, especially for pulmonary metastasis with diameter<2.0cm. These findings may have wide implications for social medicine.View full abstractDownload PDF (724K)
CASE REPORT
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Hiromi SHINOHARA, Yuhei ICHIKAWA, Minoru MURAKAMI, Kousuke OSAWA, Itar ...2019 Volume 68 Issue 2 Pages 180-184
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSA woman in her 80s developed a feeling of abnormal sensation in her face and excessive salivation. She was diagnosed with right facial nerve paralysis and was admitted to a local hospital. On admission, serum creatinine level was 0.54mg/dL and estimated glomerular filtration rate was 79mL/min/1.73m2. She was started on oral valacyclovir at a dose of 3,000mg/day to treat the right facial nerve paralysis. However, 5 days after starting oral administration, she developed generalized fatigue, vertigo, and vomiting. Serum creatinine level rose to 4.99mg/dL with mild disturbance of consciousness, so she was transported to our hospital on suspicion of acyclovir-induced encephalopathy. We performed hemodialysis for 3 consecutive days to remove the acyclovir from the circulation, which subsequently improved all her symptoms. She was later diagnosed with allergic tubulointerstitial nephritis based on renal biopsy.After discharge from our hospital, laboratory data showed a serum creatinine level of 0.67mg/dL. We later confirmed that the serum acyclovir level before the first hemodialysis session had been very high (11.9μg/mL).View full abstractDownload PDF (1154K) -
Fumitake KOBAYASHI, Tadahiro KARASAWA, Toshikazu YOSHIDA, Wataru ADACH ...2019 Volume 68 Issue 2 Pages 185-191
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSEdwardsiella tarda causes enterocolitis, which does not need to be treated in many cases. However, in immunocompromised hosts, the disease becomes severe resulting in soft tissue abscess. In such cases, removal of the lesion is required at an early stage. An 83-year-old woman presented to the emergency department with a chief complaint of fever, which was initially treatment as complex urinary tract infection. Further evaluation revealed she had E. tarda sepsis and that the bacteria was highly likely to originate from an abscess of the uterine adnexa. Because we thought a complex surgery was necessary, we transferred her to a regional core hospital. However, she recovered with only administration of antibacterial agents at that hospital.Then, 1 year and 4 months later, she was admitted to our hospital again. We made a diagnosis of disease recurrence. She did not improve with antibacterial therapy this time, so she was transferred to the other regional core hospital and underwent surgery. Histological examination revealed an appendiceal carcinoma in the abscess lesion. This case suggests that when E. tarda bacteremia is diagnosed, its focus and the root cause should be investigated.View full abstractDownload PDF (2453K) -
Masatsugu ISHII, Shoko OOSUGI2019 Volume 68 Issue 2 Pages 192-197
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSA 77-year-old woman was admitted to our hospital complaining of nausea and vomiting. Computed tomography scan showed a torus lesion, which indicated indigitation caused by small bowel tumor. We performed an emergency operation because of suspected indigitation with ischemia. We had planned laparoscopic ileus release. At surgery, we found the small bowel lesion with congestion suspicious of small bowel tumor. We removed the lesion via an umbilical wound and performed partial small bowel excision to avoid bowel overexposure. The postoperative course was uneventful, and the patient was discharged on hospital day 14. In this case of food ileus, it was difficult to rule out indigitation of small bowel tumor caused by swallowing a mushroom whole.View full abstractDownload PDF (1690K)
REGIONAL MEETING
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2019 Volume 68 Issue 2 Pages 198-204
Published: 2019
Released on J-STAGE: September 26, 2019
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2019 Volume 68 Issue 2 Pages 205-211
Published: 2019
Released on J-STAGE: September 26, 2019
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2019 Volume 68 Issue 2 Pages 212-214
Published: 2019
Released on J-STAGE: September 26, 2019
JOURNAL FREE ACCESSDownload PDF (675K)
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