We performed a retrospective study of clinical records for 40 patients who were diagnosed with acute exacerbation of COPD with bacterial pneumonia; 20 patients were treated with systemic corticosteroids whereas 20 patients did not receive systemic corticosteroids. The results showed that systemic steroids significantly shortened the length of hospital admission. However there was no significant difference between the two groups regarding adverse events, such as a relapse of pneumonia and hyperglycemia. In conclusion, systemic corticosteroids might be beneficial for acute exacerbation of COPD with acute bacterial pneumonia without severe adverse events.
According to the Japanese Classification of Gastric Carcinoma, 14th edition, Group 2 lesions are defined as material for which the diagnosis of neoplastic or non-neoplastic lesions is difficult. We evaluated the relationship between Group 2 lesions assessed by gastric biopsy using magnified narrow band imaging （M-NBI） and the final diagnoses. In our hospital, from May 2010 to May 2013, there were 118 cases diagnosed with Group 2 lesions by gastroendoscopic biopsy. Among them, there were 53 lesions from 49 cases with both M-NBI results and final diagnoses. The final diagnoses of these 53 lesions were 13 non-tumor lesions （24.5％）, 11 lesions （20.8％） with adenoma, and 29 lesions （54.7％） with carcinoma. There were 18 lesions （34.0％） with Helicobacter pylori infection, 29 lesions （54.7％） without Helicobacter pylori infection including those after eradication, and 6 lesions （11.3％） considered unclear. Out of 33 lesions suspected to be carcinoma by endoscopy with M-NBI, 25 were confirmed as carcinoma on final diagnosis Forty-one lesions （77.4％） were followed up within three months. The accuracy of diagnosis by endoscopy was high, indicating the effectiveness of magnifying endoscopy with NBI. It has been reported that non-cancerous epithelia can be found on the surface of gastric cancer after Helicobacter pylori eradication, thus making diagnosis more difficult; this may have accounted for one of the causes of the Group 2 diagnoses. This study highlights that all Group 2 lesions must be appropriately followed up.
Methicillin-resistant Staphylococcus aureus （MRSA） is an important pathogen associated with nosocomial infections. Because physicians have a restricted choice of effective anti-MRSA therapies, the mortality rate owing to bacteremia caused by MRSA is 20%-50%. Japanese guidelines for the treatment of MRSA infections were published in 2013. Although the guidelines suggest first-line treatment agents according to the focus of infection, there have been no reports regarding the trends in the prescription of anti-MRSA agents. This study was undertaken to evaluate the trends in the prescription of anti-MRSA agents over 6 years. We studied anti-MRSA agents that had been prescribed to inpatients at our facility from April 2010 to March 2016. Data on anti-MRSA agents were retrospectively reviewed with regard to the first-line treatment agent, consumption, and period in each year. The first-line treatment agent of choice was vancomycin （VCM; 70%）. Because it has been a standard drug for treating MRSA infections for more than 50 years, the use of VCM against many adaptation diseases has been approved. An increase in daptomycin （DAP） prescription has been observed over time. DAP is a new anti-MRSA drug approved in 2011. Because DAP is not inferior to VCM in the treatment of S. aureus-associated bacteremia and infective endocarditis, the guidelines recommend using DAP as the first-line treatment agent against bacteremia and infective endocarditis caused by MRSA. In this study, we determined the current trends in the prescription of anti-MRSA agents and found an increase in the prescription of DAP as the first-line treatment agent.
The purpose of this study was to clarify characteristic attitudes of young people, ranging from ages 18 to early twenties, towards sexual minorities. The relationship between the cognitive awareness of sexual minorities among young people and their characteristic attitudes was also investigated. We conducted a questionnaire survey among the 439 first year students （males 137, females 300, na 2） of A University to gather information using an online questionnaire system in order to preserve participants’ privacy and to yield a high response rate. To obtain reliable results, we referred to the research report of Kamano et al ［“National questionnaire survey on attitudes towards sexual minority” （2016）］, with which our data were compared in order to assess the characteristic attitudes of young people in relation to other age groups. The survey results indicated that our participants have greater awareness and better knowledge of sexual minorities than those of the national questionnaire survey. It also shows that our participants have higher tendencies to avoid discrimination against sexual minority. These results can be interpreted to be due to the higher educational backgrounds of our participants. Another factor that differentiates our participants and can influence the results is the fact that their majors are related to healthcare. Based on the characteristics of our participants, our results cannot be generalized to represent the characteristics of typical young people in a straightforward manner. However, we believe our results might be considered to foresee the future, when the knowledge of healthcare is spread throughout the society. This is the first report of this study which extends over three years in which the survey of the first-year students of A University will be conducted every year.
Recently, partial glossectomy is the first-line treatment for many patients with early stage tongue cancer, because the functions, including swallowing, mastication and articulation, can be preserved. However, partial glossectomy has some problems, such as local recurrence and late-stage lymph node metastasis. Also there are various discussions regarding neck dissection and postoperative irradiation. In this study, we report the results of a retrospective study on 28 early stage tongue cancer patients who underwent partial glossectomy at our center between 2002 and 2013. We assessed tumor stage （T classification）, depth of tumor and degree of differentiation, and also examined the tumors for the presence of muscle invasion and vascular invasion. Furthermore, we evaluated the relationship between irradiation and recurrence in irradiated cases, and also investigated the cervical lymph node recurrence cases and death cases. Our results showed that late-stage cervical lymph node metastasis was frequently observed in patients who had tongue cancer with vascular invasion. As previously reported, vascular invasion was a risk factor for late-stage cervical lymph node metastasis, but muscle invasion alone was not. Many patients had a recurrence within about half a year. Therefore, our results suggest that it is desirable to frequently monitor whether the patient has developed metastasis during the year after surgery.
Polyvinyl chloride （PVC） is widely used as a material in medical devices. Di（2-ethylhexyl）phthalate （DEHP） has been the main plasticizer to impart flexibility to PVC products. However, DEHP leaches out of PVC products into fluid, especially fat containing fluid, because DEHP is lipophilic and does not chemically bind to PVC. DEHP is a reproductive and developmental toxicant in rodents and human as well. Therefore, administration sets, enteral feeding sets, and irrigation sets have currently been altered to ones without DEHP. But some enteral feeding sets like gastrostomy sets still contain DEHP. Exposure to DEHP should be prevented for under developing youngsters since they are sensitive to it. The purpose of this study is to determine the amount of DEHP released out of PVC tubes in clinical practice. Standard enteral feeding formulas, RacolⓇ（EN Otsuka Pharmaceutical Co., Ltd.）, ENSUREⓇ Liquid （Abbot Japan Co., Ltd.）, ENSUREⓇ H （Abbot Japan Co., Ltd.）, and an infant formula, HagukumiⓇ （Morinaga Milk Industry Co., Ltd.） were passed through gastrostomy-connecting tubes containing DEHP at low （8ml/h, 12hours） and high speed （100ml/h, 2hours）. We determined the concentration of DEHP in each sample using high-performance liquid chromatography. The mean cumulative amount of DEHP, when the sample was administered at high speed for 2 hours, ranged from 31µg to 66µg. Based on these experimental findings, administering 1,000 ml of any one of the tested formulas to an infant weighing 5kg would result in a sum intake of DEHP higher than the tolerable daily intake for that age （25µg/kg/day, 3–12mo, the European Chemicals Bureau, 2004）. In addition, a higher concentration of DEHP was detected in the formulas which passed through the tubes at low speed compared to those administered at high speed. Furthermore, the concentration of DEHP in high-fat containing formula is higher than in low-fat formula. This study indicates the need to either administer children’s formula using DEHP-free enteral feeding sets or complete the feeding within as short a time as possible if using PVC tubes containing DEHP.
Since malignant tumor of the larynx is generally epidermoid cancer, a malignant larynx tumor would rarely occur with other histologic types. It is reported that the incidence rate for non-epidermoid cancer of the larynx and adenocarcinoma of the larynx may occur in approximately 0.8-5％ and 0.7％ cases, respectively. Adenosquamous cancer is a malignant tumor identified as cancer tissue with a mixture of adenocarcinoma with a gland duct structure within identical tumor tissue and epidermoid cancer with cornification tendency and intercellular bridge. In addition to a literature review, we report the positive outcomes following total laryngectomy, bilateral radical neck dissection, and postoperative chemoradiation for a case of adenosquamous cancer of the larynx （T3N2cM0）. The case is a male patient （age 57） who visited our institution for hoarse voice as the chief complaint. The histopathological laboratory results larynx biopsy, revealed a gland duct structure in tissue as a result of glandular cancer. Furthermore, aspiration biopsy cytology for cervical lymph node resulted in a diagnosis for Class V/glandular cancer due to an increase in nuclear chromatin and malignant cells with an increased nucleo-cytoplasmic ratio. We also conducted total laryngectomy and bilateral radical neck dissection due to the diagnosis of adenosquamous cancer （cT3N2cM0）. The histopathological laboratory finding of the resected specimen, revealed increases in nuclear chromatin and malignant cells with a mixture of cells holding a gland duct structure with an increased nucleo-cytoplasmic ratio and squamous epithelium. A diagnosis of laryngeal cancer （adenosquamous cancer） pT3N2cM0 was made. Concurrent chemoradiotherapy （CCRT） was conducted as a postoperative treatment ［radiation therapy was given to the cervical region at 60Gy （2Gy/day）］ and docetaxel was also administered in chemotherapy 60mg/m2 on Day 1 and Day 28. To date, we have not seen any recurrence/metastasis of tumor, even though it is a short follow-up period so.
A 58-year-old man underwent laparoscopic cholecystectomy for cholelithiasis in June 2012. No problems occurred after surgery and the patient was discharged. In June 2014, the patient began experiencing pain in the upper abdomen, for which he consulted our department. A blood test revealed an elevated inflammatory reaction and jaundice. Abdominal contrast computed tomography showed cystic duct remnants and stones. The patient was diagnosed with cystic duct remnant syndrome caused by remnant cystic duct stones. Because the patient was anticipated to have a high degree of adhesion in the peritoneal cavity due to a previous surgery, endoscopic lithotripsy was performed. The patient’s condition was good after excretion of the stones and he has been progressing well without relapse of symptoms since his discharge from hospital. Cystic duct remnant syndrome is a relatively rare disease in which it is nonetheless feasible to provide minimally invasive treatment by endoscopy. We hereby report this case together with a discussion of the literature.
Here we report the four cases of mediastinal goiter surgery in the one year and 10 months from the opening of our center through July 31, 2016, and also include bibliographical consideration. The proportion of the mediastinal goiter in all of the thyroid surgeries was 5.9％. The age of the patients was between 56 and 68 years old, with an average age of 61.8 years, and the ratio of male to female patients was 1：3. All patients underwent needle aspiration biopsies, and 3 cases were found to be normal or benign, and one case was indeterminable. Surgical stress increases when tumors grow, thus, we chose surgical treatment for all of the cases. Surgery was performed using neck dissection in all of the cases. We consulted with the departments of thoracic surgery and cardiovascular surgery to prepare for the cases, including preparing for difficulty in enucleation or unexpected bleeding. Postoperative recurrent nerve paralysis was not observed in any of the cases; surgical procedure change, such as sternotomy, was not required in any of the cases. Postoperative pathological diagnosis showed adenomatous goiter in three patients and follicular adenoma in one patient, and all of them were benign. It was possible to perform surgery with neck dissection in all of the cases. We think it is necessary to consult with the departments of thoracic surgery and cardiovascular surgery when preparing for cases, such as those with malignant tumors, difficulty in enucleation or unexpected bleeding.