The effectiveness of arthroscopic synovectomy (A-S) for the knee of rheumatoid arthritis (RA) patients was assesssd by comparing the severity of synovial proliferation on MRI before and after the surgery. Twenty-five patients (30 knees) were studied. The mean duration of RA was 6 years and 7 months and the mean age at the time of A-S was 49.0 years. The mean follow-up period was 19 months (range: 6-39 months). The preoperative Larsen's classification from grade I to IV was 8, 13, 6, and 3 knees, respectively. Synovial proliferation was evaluated by the modified Takeuchi's classification (MRI score). The MRI score was investigated in relationships with the radiographic grade, wet weight of excised tissue, treatment score for RA knees of the Japanese Orthopaedic Association (JOA score), and the CRP value. The MRI score, JOA score, and CRP all significantly improved during follow-up. The radiographic grade showed less progression, the JOA score improved more, and CRP was lower during follow-up in patients with a postoperative MRI score less than 5. The wet weight of excised tissue showed no related with the MRI score. These results suggest that the effectiveness of A-S can be determined by evaluation of improvement of the MRI score.
The first Health Services Facility was started in 1988, to provide the elderly with medical care services in Japan. The facilities have encouraged home care and their numbers have been increasing rapidly. In order to examine the effects of the facilities on medical expenditure for the elderly, cross-sectional and follow-up surveys were conducted with epidemiological analyses of the data from all 47 prefectures in 1990, 1993 and 1996. Multiple regression models were performed using several costs that used medical expenditure for the elderly as the explanatory variables. Furthermore, correlation coefficients between the changes in admission rates, duration of hospitalization, and the change of the numbers of beds in the facilities were calculated. The results are as follows. 1) There was a positive correlation between the cost of the facilities and medical expenditure for the elderly, but the effects have been decreasing with increased construction. 2) There was no relationship between the numbers of beds in the facilities and admission rate to the hospitals, but there was a correlation with the duration of hospitalization.
One hundred ten elderly with disabilities in institutions or receiving home care were selected and informed. This study focused on oral malodor and discusses consent was obtained the relationship between oral malodor and the state of dental health and oral hygiene in the elderly with disabilities. ADL of the elderly with disabilities (rank J, A, B, C, settled by National Health Administration in Japan) were 8.2% at rank J, 28.2% at rank A, 42.7% at rank B and 20.9% at rank C, respectively. The incident rate of swallowing pneumonitis, fever and bedsores were low. Accordingly, physical and mental conditions were comparatively preferable. Tooth and periodontal conditions were comparablye to nationwide results. 1. The elderly in poor ADL had marked oral malodor compared with those in good health. 2. The elderly who required assistance to eat or had special dietary requirements had marked oral malodor. 3. The elderly who had normal oral functions and the ability to take care of their own oral hygiene had markedly less oral malodor. 4. The elderly who had poor oral hygiene exhibitings thick tongue coating and positive results in a Candida albicans culture test, had marked oral malodor. 5. Using, the multivariate statistical analysis of Hayashi methods II, the coefficient of correlation between the state of oral malodor and 27 variables was obtained. 1) The study obtained trustworthy values that discriminate analysis 92.7% and correlation ratio is 0.53. 2) The variables related to severe oral malodor, extracted by the multivariate statistical analysis in descending order, were: “low level of ADL in gargling and denture brushing”, “cigarette smoking”, “speech disabilities”, “unsatisfactory mastication”, “need for special dietary care”, “oral druyness”, “gingivitis”, “soft diet of side dish”, “living in a special institution caring for the elderly”, “thick tongue coating”, and “a positive Candida albicans culture test”, respectively. 3) The items related with comparatively comfortable or bearable oral malodor, extracted by the multivariate statistical analysis in descending order were: “satisfactory mastication”, “home care”, “healthy or poor eyesight”, “difficulty in mastication”, “being able to independently remove, dentures”, “a negative Candida albicans culture test”, “no oral dryness”, “independents in selecting diet”, “comfortable gingival condition”, “being dependent on others for tooth-brushing” and “preferable tongue coating”, respectively. 4) For the effective preventive countermeasures of oral malodor, ADL of oral health, caring circumstances and hygiene of gingiva/tongue should be focused on rather than dental hygiene itself.
Japan is facing serious social problems in the guise of rapidly increasing medical costs for the elderly and regional gaps of medical costs among prefectures, resulting from an aging society with a low birth rate. This study examined the relationship between care-related factors and medical costs in all 47 prefectures. Eighteen indices were examined as care-related factore in the elderly themselves, at their homes, and in their communities. The medical cost for inpatients was used as an index of medical costs for the elderly because the highest correlation was observed in this group Nine indices were selected as care-related factors by correlation analysis. To clarify what indices are associated with medical costs for inpatients, stepwise multiple regression analysis was performed using these nine indices. Three indices accounted for 67.8% of the correlation of medical costs for inpatients and the percentage of aged people who lost their spouses (women aged more than 60) had the strongest positive correlations, while percentage of people who had their own houses had the strongest negative correlations with medical cost for inpatients.
In June 1997, an outbreak of enterohemorrhagic Escherichia coli O157 occurred at a hospital of Okayama City, Japan. E.coli O157 was isolated from 86 patients (40 males and 46 females). Ages ranged from 14 to 96 years old with a mean of 53 years old. All the infected patients (59 asymptomatic carriers) were investigated in this study. The median duration of shedding (from starting therapy), among the 83 patients who received antimicrobial therapy, was 6 days. This result has paticular importance for taking appropriate measures during outbreaks among adults who have other diseases. Other factors (age, sex, etc) that might have affected the duration of shedding were also investigated, but were not found to be influential. Among the infected patients, elderly people, females and patients who had other diseases became symptomatic, and in paticular, patients who had severe malignancy became symptomatic. All asymptomatic carriers received antimicrobial therapy and no newly affected cases and no side effects among those patients were observed. These results indicate that antimicrobial therapy for asymptomatic carriers in facilities that have a large number of susceptible people is useful.
A case of an adenoma of the nipple was reported. A 44-year old woman presented with bloody nipple discharge. No breast mass or skin involvement was observed. Ultrasonography revealed low echoic dilated duct and high echogenic mass inside. Cytological examination revealed a cluster of cells showing papillary growth. Microdochectomy was performed and histological examination revealed the mass being adenoma of the nipple. Clinical importance to avoid over-surgery and co-operation of surgeons and pathologists were discussed.
A Case of hyperestradiolemia induced by Tamoxifen was reported. A 37-year old woman presented with right breast mass 3 days after delivery. The tumor, 1.2×1.0cm, was diagnosed to be cancer and quadrantectomy with axillar lymph node sampling was performed. Metastasis to the sampled lymph node (1/1) was observed. ER was negative but PgR was positive. Postoperative irradiation (50Gy) with adjuvant chemotherapy consisting of Epirubicin, CBDCA and 5FU was performed. After 2 months of Tamoxifen administration (20 mg/day), she developed vaginal bleeding and bilateral ovarian cysts with elevated serum level of estradiol (777 pg/ml). Tamoxifen for another month made the size of ovarian cysts larger and the concentration of estradiol higher (787 pg/ml). By discontinuing Tamoxifen, bilateral ovarian cysts disappeared and the level of estradiol recovered to normal in 3 months. The importance of careful observation of the hormonal environment of premenopausal breast cancer patient on Tamoxifen was discussed.