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Volume 70, Issue 4
Displaying 1-13 of 13 articles from this issue
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ORIGINALS
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Hiromi KIMURA, Midori NISHIO, Kayoko KOGA2021 Volume 70 Issue 4 Pages 325-333
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSThe aim of this study was to clarify the current status of depression among healthy community-dwelling elderly people and to examine the association between depression and their sense of purpose in life. A self-administered questionnaire survey was conducted with 213 elderly people who attended a public lecture at University A. The outcome measures were the Geriatric Depression Scale (GDS), the K-1 Scale for the Feeling That Life Is Worth Living Among the Aged (Ikigai Scale), the Social Support Scale for the Elderly (Social Support Scale), and a basic checklist (Frailty Scale). Using a cut-off of 4/5 points on the GDS, respondents were divided into a non-depressive group (≤ 4 points) and a depressive group (≥ 5 points). Each variable was compared between the two groups. Multiple regression analysis was performed to examine factors associated with depression. Among the 213 people who received the survey, 196 responded (response rate: 92.0%) and 185 provided valid responses after excluding those with missing data (valid response rate: 86.9%). Of these 185 respondents, 80 were classified into the non-depressive group (35 men, 45 women) and 52 into the depressive group (14 men, 38 women), which showed a significant sex difference. Mean age was 73.2 (SD 6.9) years in the non-depressive group and 76.1 (SD 7.74) years in the depressive group, which also showed a significant difference. The Ikigai Scale score was significantly higher in the non-depressive group compared with the depressive group. The Ikigai subscale scores for “self-realization and will”, “sense of life fulfillment”, “will to live”, and “sense of existence” were significantly higher in the non-depressive group. In the multiple regression analysis, factors associated with depression were sense of life fulfillment (β=－0.36), health status (β= 0.24), will to live (β=－0.17), age (β= 0.24), negative support (β=0.18), and healthy habits (β=0.12). These results suggest that depression is associated with self-realization, sense of life fulfillment, will to live, and sense of existence, indicating the importance of activities that create a sense of purpose in life for preventing depression in the community-dwelling elderly people.View full abstractDownload PDF (781K) -
Kaeko MURAKAMI2021 Volume 70 Issue 4 Pages 334-343
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSThis study investigated how elderly people living alone in a marginal community can be supported, focusing on their relationships within the community. Types of support that make use of the community were also examined. Semi-structured interviews were conducted with 5 elderly people living alone in a marginal community in a mountainous area. The interviews were analyzed using a grounded theory approach. The analysis results revealed the following five factors: “ability to adapt to lifestyle”, “health-related anxiety and coping”, “joy in life”, “being supported by the community”, and “hope for passing things on to the community and taking action”. The participants utilized the positive attitudes that they had cultivated in the past. This study clarified the processes through which the participants maintained a balance with their own self-reliance and reached the decision to continue living in the area for as long as possible despite facing anxiety about their health and coping with health issues. To continue to live in the marginal community, the participants adopted preventive health behaviors. They also created their own mutual support networks by and for local residents. However, to assist the participants, there is a need for supporters to expand health-promotion activities from these networks to the entire community. Therefore, forms of assistance that utilize community interaction are essential for supporters.View full abstractDownload PDF (958K) -
Kimie FUJIKAWA, Maki HAYASHI, Akihito UEZATO2021 Volume 70 Issue 4 Pages 344-353
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSThe purpose of this study was to clarify social and psychological factors supporting elderly men aged 75 or older who live alone in five towns or villages designated as depopulated areas by the Ministry of Internal Affairs and Communications in the Tohoku, Kanto, Shikoku, and Kyushu regions. Semi-structured interviews were conducted with 21 elderly men who lived alone, were capable of self-selection and self-determination, and had no communication disorder. Transcripts of the interview were subjected to content analysis. Results showed that the psychological factors supporting these men could be grouped into 3 core categories: “finding a sense of purpose in life”, “carefree lifestyles without being obsessed with time”, and “a communitybased life”. Social factors were divided into two core categories: “acceptance of change in relationships with their children” and “ties with the local community”. The community in the study area became smaller due to depopulation and the aging of residents. Hence, there are limitations to supporting each other among local residents and the potential for them to become socially isolated Maintaining mental health can be regarded as having a large influence on continuing to live alone when the elderly men recognize their physical decline and have to face aging. For them to continue living in the community as they wish until the end, this study’s findings suggest that it is necessary to foster cooperation between the government and professionals who can care for emotional and spiritual needs and to establish a support system for mental health.View full abstractDownload PDF (822K)
RESEARCH REPORTS
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Heisuke HIROWATARI, Shigeru TODA, Mai FUJIKURA, Keita KURODA, Mayuko B ...2021 Volume 70 Issue 4 Pages 354-359
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSThis study was undertaken to elucidate the usefulness and problems of autologous blooddonation for the patients with low-lying placenta. Seventy-eight women with low-lying placentawho gave birth in our institution were retrospectively analyzed. Autologous blood donation wasperformed in 58 patients (74%). The median volume of donated blood was 300 mL. Patients withor without autologous blood donation showed no significant difference in the distance betweenthe edge of the placenta and the internal os of the uterus. Median blood loss due to intrapartumhemorrhage was 1183 mL. All 7 patients with blood loss of more than 2000 mL had donatedautologous blood. The donated blood was transfused in 9 of the 58 patients (16%) who underwentautologous blood donation. No patients underwent allogenic blood transfusion. Althoughautologous blood donation was expected to be useful for avoiding allogenic blood transfusion inthese patients with low-lying placenta, the high discard rate suggests the need for a strategy toselect those patients at high risk for blood loss requiring transfusion.View full abstractDownload PDF (704K) -
Mai YOSHIIKE, Tomoaki MIYATA, Ayano HARA, Masahide SUGIYAMA, Keisuke S ...2021 Volume 70 Issue 4 Pages 360-365
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSTrifluridine (FTD) / tipiracil hydrochloride (TPI) has been approved for the treatment of colorectal cancer, but its dose-limiting toxicity is neutropenia. Elderly patients are at high risk of febrile neutropenia and should be monitored carefully when administering FTD / TPI. In this study, we retrospectively investigated the incidence of adverse events, dose reduction, and number of administered courses in 8 old-old patients treated with FTD / TPI for colorectal cancer. The results showed that severe neutropenia of Grade 3 or higher occurred in 5 of the 8 patients. Six patients had a dose reduction, but 5 of them were able to continue treatment for at least 3 courses. The frequency and severity of adverse events, including neutropenia, appears to be higher in old-old patients, so it is important to take appropriate measures.View full abstractDownload PDF (709K) -
: Dermoscopic Analysis and Foot Crushing Experiment Using a Stink BugManabu MAEDA2021 Volume 70 Issue 4 Pages 366-371
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSSkin damage caused by stink bugs was categorized into three types: I) pigmentation, II) bites, and III) ulcer/erosion due to accidental ingestion. Dermoscopic examination of type I damage revealed two types: amorphous and homogenous/diffuse pigmentation. The amorphous type was seen in 4 cases and involved the fingers, arm, and back, as well as the foot of an infant. The homogenous/diffuse type was seen in 6 cases, which all involved the foot except for 1 case involving a finger. These different types were thought to arise from different degrees and durations of crushing stink bugs. The diffuse type was attributed to high pressure between the foot and stink bug. Eruptions had characteristic colors of yellow, orange, or brown. The pigmented skin was exfoliated after several days in 2 cases. A crushing experiment using a stink bug revealed pigmentation on the foot, which disappeared naturally within 1 week. Examination of the pigmentation by the tape stripping method showed that pigmentation affected several layers of the stratum corneum.View full abstractDownload PDF (1512K) -
Yukako TANAKA, Mayumi SATO, Keiko AOISHI2021 Volume 70 Issue 4 Pages 372-381
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSThis study investigated the difficulties that single caregivers face while providing home health care for a parent while continuing to work. Semi-structured interviews were conducted with 9 single caregivers who balanced working while providing home health care for more than 3 months for a parent discharged from the hospital. The interview contents were inductively analyzed. One core category with 2 factors was extracted, revealing the characteristics of difficulties that single caregivers face while balancing work and providing home health care. The factor [psychological stress associated with care] had the categories [opportunity to provide care] and [an environment where there is no one to take over caregiving. The factor [care reporting system of persons experienced in providing care] had the categories [presence of a person to talk to about troubles] and [areas to watch and respite system]. For single caregivers providing home health care for a parent for 3 months while continuing to work, the care burden was found to increase over time. The presence of a person whom they could talk to when they experienced difficulties influenced their ability both to provide care and to continue working. Establishing a system that allows for cooperation between medical institutions, the workplace, and society is necessary so that single caregivers can more easily provide care for a parent while continuing to work.View full abstractDownload PDF (822K)
CASE REPORTS
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Koji TAKAHASHI2021 Volume 70 Issue 4 Pages 382-386
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSAn 86-year-old man diagnosed with distal cholangiocarcinoma was treated with uncovered biliary metal stent placement. The metal stent was occluded due to growth of the tumor into the stent. Although he underwent placement of two additional plastic stents in the metal stent, the plastic stents were also rapidly occluded. He was admitted and underwent transpapillary exchange of the plastic stents. Five days later, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed using a plastic stent. The patient had no recurrence of cholangitis thereafter and was discharged 42 days after EUS-HGS.View full abstractDownload PDF (1756K) -
Akihiro SEKIMOTO, Yasuhiro KURUMIYA, Keisuke MIZUNO, Ei SEKOGUCHI, Gen ...2021 Volume 70 Issue 4 Pages 387-394
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSPrimary mesenteric neuroendocrine tumor is extremely rare. Here we describe 2 cases of this disease. Case 1 was a 66-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. There has been no recurrence as of 25 months after surgery. Case 2 was an 80-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who also underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. This is recurrence-free as of 36 months after surgery. Several cases of primary mesenteric neuroendocrine tumor have been reported, but most have been treated with open surgery. To date, there has been only 1 case of primary mesenteric NET that was resected in a pure laparoscopic procedure. In all 3 cases (including our 2 cases), the largest tumor diameter was 4 cm. It appears that laparoscopic surgery can be used to treat primary mesenteric neuroendocrine tumor of small size (＜ 4 cm) with minimal invasion.View full abstractDownload PDF (3586K) -
Takayuki KUGA, Masatoshi SHIGETA, Yuka YANO, Ryunosuke SAKAMOTO, Takik ...2021 Volume 70 Issue 4 Pages 395-401
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSA woman in her 80s was being treated for dementia. She lived in a four-generation household of 8 people. Her grandchild contracted COVID-19 and was admitted in another hospital. The 7 other family members were close contacts of the grandchild, and all of them except the woman with dementia developed COVID-19 within 3 days of onset in the grandchild. The woman’s PCR test for SARS-CoV-2 was negative. Her family thought that she could not live alone, but she was denied admission to other hospitals. Finally, she was admitted to our COVID-19 ward with her other family members at the family's request. After admission, she stayed in a room with family members, and COVID-19 treatment for her family and her care were performed with strict infection control measures in place. On hospital day 11, she and 5 family members had negative PCR test results for SARS-COV-2 and were discharged. With the growing number of dementia patients in Japan's aging society, there is the possibility that similar situations will occur increasingly often. This case suggests that recommended infection control measures are effective for preventing the spread of COVID-19 to people staying in the same room.View full abstractDownload PDF (1085K) -
Akira MIZUNO, Shinya KOIKE, Koichiro TAGAMI2021 Volume 70 Issue 4 Pages 402-406
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSAn 86-year-old woman visited our hospital at 20:00 with the chief complaint of right hip joint pain that had started at around 19:30. The abdomen was soft and slightly bloated, and there was tenderness in the right hip joint. Computed tomography (CT) revealed protrusion of the small intestine through the right obturator foramen, and right-sided impacted obturator hernia was diagnosed. Intestinal necrosis was unlikely because her symptoms had started only a short time earlier, so manual reduction was performed. The right hip joint pain was rapidly alleviated, and CT confirmed release of the incarcerated bowel. Elective laparoscopic repair was then performed. Hemorrhagic ascites in the abdominal cavity, but no obvious intestinal ischemia, was evident. Intestinal dilation was relieved, enabling us to perform surgical maneuvers in a good surgical field. The postoperative course was favorable, and there has been no recurrence as of 2 years 11 months after surgery. Obturator hernia is common in elderly women, who often have several comorbidities. Avoidance of emergency surgery by manual reduction is therefore significant, and laparoscopic surgery that enables assessment and treatment of the contralateral side is beneficial.View full abstractDownload PDF (1851K) -
Ryosuke OSADA, Takashi IMAI, Sayaka YASAKI, Kota TAKANO, Masami NOIKE, ...2021 Volume 70 Issue 4 Pages 407-413
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSSome serious infections due to Group A streptococci (Streptococcus pyogenes, GAS) manifest as primary peritonitis, which traditionally and commonly leads to the selection of laparotomy for initial treatment. We encountered a case in which laparoscopic surgery proved effective in treating primary peritonitis due to GAS. The patient was a 30-year-old woman transported via ambulance to our hospital with complaints of fever, abdominal pain, diarrhea, and vomiting on day 5 after a miscarriage. Diagnostic laparoscopy was performed under a presumptive diagnosis of acute generalized peritonitis. Accumulation of purulent ascites was found in the peritoneal cavity, but no primary lesion was identified. Peritoneal lavage and drainage were performed, and the surgery was concluded. Postoperatively, GAS were detected in blood, ascites, and vaginal discharge cultures, and primary peritonitis due to GAS was diagnosed. Antibiotics were switched to ampicillin sodium and clindamycin phosphate, and her condition started to improve. When primary peritonitis due to GAS is suspected, laparoscopic surgery can be considered for initial treatment.View full abstractDownload PDF (1192K) -
Mikako KAWAHARA, Atsushi NISHIMURA, Jun HASEGAWA, Chie KITAMI, Shigeto ...2021 Volume 70 Issue 4 Pages 414-418
Published: 2021
Released on J-STAGE: December 25, 2021
JOURNAL FREE ACCESSA woman in her 80s who had difficulty walking due to back pain was admitted to our hospital. Until two months earlier, she had been able to live independently in daily life. She was not severely constipated, did not take laxatives, and had not received an enema or undergone stool extraction. She had no abdominal symptoms, such as abdominal pain or distension. Surprisingly, however, computed tomography showed lower rectal perforation with subcutaneous emphysema in the pelvic retroperitoneum, hip, and left inguinal region. Therefore, we urgently performed abdominoperineal resection to save her. The lower rectum is a relatively uncommon site of perforation in the large intestine, and nontraumatic cases are rare. Elderly patients in particular may have only atypical symptoms and thus require careful attention.View full abstractDownload PDF (1481K)
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