[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

Calcium-alkali syndrome is a triad of hypercalcemia, metabolic alkalosis, and renal insufficiency. Originally recognized as an adverse reaction to treatment of peptic ulcer with milk and alkali, this syndrome has recently been observed in patients with osteoporosis taking calcium and/or vitamin D. The intake of an absorbable alkali, such as magnesium oxide, for constipation can promote calcium reabsorption. Herein, we report two cases, both characterized by decreased renal function and dehydration. We then studied the laboratory data of patients taking vitamin D. Between eight patients with simultaneous administration of magnesium oxide and eight without, no significant differences were noted in the levels of modified calcium, the cystatin C-based estimated glomerular filtration rate, or the urine calcium/creatinine ratio. In the treatment of osteoporosis, clinicians should be aware of the possibility of calcium-alkali syndrome, since predictive markers are currently unavailable.

View full abstract

The purpose of this study is to clarify the ethical conflict experienced by nurses dealing with children (persons) with severe motor and intellectual disabilities (SMID) and to survey the actual state of their awareness of nursing ethics. Accordingly, a questionnaire survey was conducted on 92 nurses working in the children (person) with SMID ward at A center. As a result, it was found that 65% of the respondents did not feel they “had knowledge" of nursing ethics and did not fully understand the 4 principles of ethics with respect to the awareness of nursing ethics. In addition, as to ethical conflict, a high incidence of conflict existed in items such as “equality" and “differences according to staff," and the contributing factors thereto may be differences in interpretations of equality and individual ethical values. From the foregoing, it was pointed out that in order to deepen the understanding of nursing ethics and to reduce the frequency of ethical conflict, uniformity in ethical values is vital. To that end, the need for continuous fundamental nursing ethics education on an organizational level as well as the necessity of establishing the custom of holding timely ethical conferences were indicated.

View full abstract

COVID-19 vaccine is considered to be effective as prophylaxis of COVID-19 infection, but a little has been known about the safety of the vaccination in children (people) with severe motor and intellectual disabilities (SMID). We retrospectively investigated adverse events that occurred after COVID-19 vaccination in children (people) with SMID. We included 136 people who were staying in our facility to evaluate adverse events that occurred after the first and the second vaccination. Serious adverse event did not occur in any of these people. The rate of people who experienced adverse events after the first vaccination was low as indicated by the incidence of 4.4% or lower, while the incidence of each adverse event was higher after the second vaccination than that after the first vaccination except for injection site swelling. Besides, there was a trend that adverse events more frequently occurred in females, and comparison between the young and the elderly showed that more people in the group of the young experienced pyrexia after both the first and second vaccination. Furthermore, we compared the adverse events between children (people) with medically dependent severe disabilities and those with sub-medically dependent severe disabilities who have higher healthcare needs and other people. As a result, there was no significant difference in the frequency of the adverse events including pyrexia and epileptic seizure between these people. Based on above results, it was considered that COVID-19 vaccine can be provided in children (people) with SMID as relatively safely as it is done in healthy people.

View full abstract

The patient was a 70-year-old male. The grade of severe motor and intellectual disabilities (SMID) was evaluated as 6 according to Oshima’s classification. He was hospitalized due to cerebral palsy and incomplete paralysis/contracture of the bilateral lower limbs. On April X-4 (at the age of 66 years), ultrasonic bone density testing of the calcaneus bone showed a marked decrease in the bone mineral density. To prevent fracture, the administration of a vitamin D preparation was started. On July 1, X (at the age of 70 years), high fever occurred. Various examinations led to a diagnosis of complicated pyelonephritis due to left hydronephrosis caused by (upper, middle and lower) ureteral stones, and bilateral renal small calculi. Fluid and antibiotic therapies resulted in pyretolysis. The patient was referred to a department of urology for aggressive lithotripsy, but it was impossible due to body movement restrictions. Treatment was scheduled later at an institution that has an extracorporeal shock wave lithotripter. During the waiting period, from July 10 the patient was instructed to drink water, and a sodium citrate/potassium preparation (2.0 g/day) was administered. Two weeks later, left lower ureteral stones were excreted, and hydronephrosis and urinary tract infection improved. After 10 months, only a left distal ureter stone had decreased in size, slight hydronephrosis remained, and bilateral small calculi were decreased in number and size. Treatment is being continued to eliminate the stone. In Japan, the incidence of urolithiasis in aged population increase, and the risk of stones may increase in this population as elderly individuals may be often administered vitamin D to prevent osteoporosis. Patients with SMID may benefit from water intake and administration of citric acid as initial treatment options for stone disease as many of them may not tolerate aggressive treatments.

View full abstract

The case of an infant who required tracheostomy, nighttime mechanical ventilation, and gastrostomy for a giant lymphangioma of the neck and was able to transition to her home in a medically underserved area in Aomori prefecture with close cooperation in the community is presented. The patient was an 11-month-old girl with a lymphangioma of the neck. She developed dyspnea following an upper respiratory infection six months after birth, for which her previous doctor performed an emergency tracheostomy and gastrostomy. The important points in transitioning to home were: (1) airway management; (2) management of home medical devices; (3) moving from a medical model to a daily living model; and (4) arranging a community support system. Prior to discharge from the hospital, hospital and community support teams were organized. To transition to home while maintaining safety and quality of life in daily living, understanding and cooperation with respect to the special characteristics of the child’s disease and medical care are essential. It is important to continuously focus on cooperative work not only in medical care, but also in childcare and education with a medium to long-term perspective.

View full abstract

Mesenteric phlebosclerosis (MP) is a chronic ischemic disease caused by venous return impairment associated with fibrous thickening and calcification of superior mesenteric vein. MP has been shown to be associated with the use of herbal medicine (gardenia fruit) containing geniposide for a long period time. We present two patients with MP associated with gardenia fruit. A 25-yeat-old female and a 31-year-old male with severe motor and intellectual disabilities had been given herbal medicine containing geniposide for 7 years and 11years respectively. Although the both patients had no symptoms that suggested colonic dysfunctions, computed tomography revealed linear calcifications extending from the cecum to the hepatic flexure of the colon, as well as mesenteric vein and its branches. Long-term use of herbal medicine containing geniposide may be associated with the onset of MP, suggesting that clinicians should keep this disease in mind as a potential complications.

View full abstract

Heated humidified high-flow nasal cannula (high-flow therapy) (HFNC) has become an indispensable respiratory therapy in acute-phase treatment. There have also been reports on the use of this therapy on chronic respiratory diseases, breathing difficulties in the terminal phase, and respiratory impairment of children (persons) with severe motor and intellectual disabilities (SMID). HFNC was introduced on a child with SMID for obstructive hypoventilation, central hypoventilation and dysphagia, and a marked improvement in symptoms was seen. The treatment was continued for 5 years thereafter. The possibility of HFNC being an extremely effective treatment for impaired respiratory conditions consisting mainly of slight organic upper airway stenosis and upper airway stenosis caused by the accumulation of secretion from dysphagia was indicated. For continuous long-term use of HFNC, suitable assessment of the respiratory conditions of cases, selection of appropriate devices as well as flow setting and use time setting are needed.

View full abstract

[in Japanese]

View full abstract