Purpose: We aimed to evaluate the entrance skin dose (ESD) during radiofrequency catheter ablation (RFCA). Methods: The X-ray fluoroscopic mode (70 kV, 7.5 p/s, 13.0 × 13.0 cm) was evaluated at C-arm angles of 45° left anterior oblique and 35° right anterior oblique. The bed height was raised by 4 to 8 cm from the bed base-point position (BP, 0 cm). Fluoroglass dosimeters were placed in three lines at 5-cm intervals on the surface of the phantom. The maximum skin dose conversion factors were calculated as the ratio of the calculated and the actual maximum skin doses. Results: At heights of 6 and 8 cm, calculated ESDs had peak values of 93.0 ± 0.2 and 74.5 ± 2.7 mGy, respectively, whereas the actual maximum skin doses were in the range of 47.4 ± 0.2 to 59.5 ± 0.2 mGy. The maximum skin dose conversion factors were 0.79, 0.87, 0.53, 0.64, and 0.72 at bed heights of 0, 2, 4, 6, and 8 cm from the BP, respectively. Conclusion: A maximum skin dose conversion factor should be taken into consideration when determining the maximum skin dose in overlapping irradiation fields.
Objectives: This study aimed to identify the process by which patients with recurrent and/or progressive cancer who have recognized approaching death discover hope, and to examine the form of nursing assistance to help discover hope best suited to these patients. Methods: Semi-structured interviews were conducted with 16 patients suffering recurrent and/or advanced cancer, and their responses were analyzed qualitatively and inductively, using the modified grounded theory approach (M-GTA). Results: The process by which recurrent and/or advanced cancer patients came to recognize approaching death and discover hope consisted of "the experience of confronting the self to deal with emotional conflicts and having faith in their own power" and "the experience of acknowledging that their ordinary daily lives represent hope for their remaining time." Furthermore, "the driving force to discover hope" was found to have supported the entire process. Conclusion: Nursing providing hope allows patients to discover hope through their own emotional conflict with their own strength. Our study suggests the importance of staying close to patients to provide emotional support during this process.
Acquired hemophilia A (AHA) is a rare coagulation disorder caused by autoantibodies against coagulation factor VIII (FVIII). We report herein a case of AHA whose severe bleeding were successfully managed during the perioperative period of the surgery for chronic subdural hematoma by using recombinant activated factor VII (rFVIIa). A 54-year-old man was hospitalized due to cardioembolic MCA (middle cerebral artery) occlusion. He experienced severe and persistent urethral bleeding after urinary injury by urethral catheterization during the hospitalization, and the laboratory test showed significant prolonged APTT. He was referred to our hospital to examine the cause of APTT prolongation. FVIII activity was markedly decreased to 8.0% and FVIII inhibitor was high as 2.0 BU/ml, therefore he was diagnosed as having AHA. The immuno-suppression treatment with prednisolone 0.5 mg/kg was immediately started. He developed left subdural hematoma with significant midline shift in CT scan on the 9th hospital day. The urgent surgery was performed under the management to prevent severe bleeding by rFVIIa and no severe bleeding occurred. He achieved complete remission on the 19th hospital day after then. Although AHA relapsed during tapering of prednisolone, he achieved remission again by increasing prednisolone.
We report 2 cases of lymph node infarction. Case 1: A 71-year-old female with generalized lymphadenopathy was admitted. The biopsied lymph node showed lymph node infarction. She was diagnosed with malignant lymphoma with CD20 (+) by immunohistochemical studies. On the 11th hospital day, severe anemia with mild elevated indirect bilirubin appeared. A diagnosis of cold agglutinin disease was made. On the 15th hospital day, CHOP therapy was given and, after 5 days, Rituximab therapy was started. After the treatment with 8 cycles of R-CHOP therapy, she maintained complete remission (CR). Case 2: An 81-year-old female was admitted because of anorexia, lt-pleural effusion, and lymph node swelling in the rt-supraclavicular area. She had acute myelogenous leukemia but achieved CR by chemotherapy. Leukemic infiltration to the pleural effusion and tuberculous pleurisy were ruled out by pleural effusion cytology. More than half of the biopsied lymph node demonstrated infarction. A diagnosis of myeloid sarcoma was made by immunohistochemical studies. After 3 cycles of chemotherapy, the lymph node swelling disappeared. Four bone marrow aspirations revealed CR in the course of the disease. However, she died from severe anorexia. We should consider malignant lymphoma when a biopsied lymph node shows infarction, and immunohistochemical studies are essential.