Investigating the medication status prior planning surgery could be very important in the clinical setting. Patients are usually admitted to the hospital the day before the surgery in order to shorten the hospital stay. If we check the patient's preoperative medication history after admission, some patients might not be able to undergo surgery due to the potential presence of some medications that must be discontinued prior to surgery. Those incidences should be eliminated for all patients. In the Public Tomioka General Hospital, we routinely examine medication and supplement usage history and determine which medicine if any must be discontinued prior to surgery. With the increasing number of preoperative evaluations on medication (623 items in fiscal 2009, 1,577 items in fiscal 2013), there are concerns that additional preoperative tasks may affect the other tasks of the Pharmacy Department, such as dispensing time for medications. We investigated the correlation between the number of cases in whith the preoperative medications were checked and the total dispensing time for medications during the three months from August to Octorber, 2013. The dispensing time for medications was not correlated with the number of cases in which the preoperative medications were checked. Without setting up a special department, such as the Pharmaceutical Care Clinic, we may be able to evaluate preoperative medications within our routine work in the Pharmaceutical Department.
Herein, we report a 77-year-old female with Kasabach-Merritt syndrome (KMS). At admission, extensive subcutaneous hemorrhages were seen in the body trunk and extremities. A fist-sized hemangioma was palpated in the left thigh. The laboratory data showed anemia, coagulopathy and renal dysfunction. She was diagnosed as having KMS caused by left thigh hemangioma and hyperfibrinolytic type disseminated intravascular coagulation (DIC). After the treatment with recombinant thrombomodulin (rTM) and tranexamic acid (TA), coagulation disorders and bleeding tendency was improved immediately. The hemangioma was irradiatied 30 Gy and observed only with the oral administration of TA, without relapse of DIC. rTM administration was useful and safe on disease control in acute phase of hyperfibrinolytic type DIC.
Low levels of white blood cells (WBC) were identified in a 60-year-old male, and he was diagnosed as having myelodysplastic syndrome (MDS) refractory anemia with excess blasts-1 (RAEB-1). On the International Prognostic Scoring System he was scored at Intermediate-1 (IPSS Int-1). He was treated with anabolic steroids, immunosuppressants, and vitamin D·K, but the platelet count decreased. At 66 years of age, the platelet count had decreased to 32,000 (/μL), and the patient was diagnosed as having refractory cytopenia with multilineage dysplasia (RCMD), IPSS Int-1. We considered that observation and blood transfusion would not improve his prognosis, so azacitidine was administered following which recovery of the platelet levels and improvement of the bone marrow were subsequently observed. He has been treated with azacitidine for 45 courses, and the same treatment is currently maintained with the patient, now 70 years of age, in good condition. Our results suggest that we should examine the effect of azacitidine in lower-risk-MDS which have been treated unsuccessfully with conventional therapy.
A 54-year-old male diagnosed with sigmoid colon cancer associated with urinary bladder invasion was referred to our department. Due to invasion into the ileum, we performed a sigmoidectomy with resection of the bladder and ileum, and reconstructed the colon using end-to-end anastomosis. The pathological diagnosis was T4b, N0, H0, P0, M0, stage II. After the operation, suture complications resulted in massive emphysema. Patient elected for conservative treatment, but we were unable to insert a central venous catheter due to subcutaneous emphysema, and so implemented nutritional management using peripheral venous nutrition and elemental diet. Total parenteral nutrition is generally required as conservative treatment for colon post-operative suture failure. However, the low-residue of the elemental diet turned nutritional management into a treatment option, its wound-healing effects have been the subject of some focus in recent years.
We performed a thoracoscopic extended thymothymectomy on a patient, a man in his forties, with a thymoma accompanied by a slightly elevated anti-Ach receptor antibody (0.5nmol/L, normal range <0.2) level without symptoms of myasthenia gravis. Here, we report the surgical method, focusing on its technique. First, the patient was placed in a left semi-lateral position under general anesthesia using a double-lumen tube. Then, the thymic tumor was removed, and thymic tissue was detached from the anterior mediastinum and inferior pole of the thymus on the right side via three-port-thoracoscopic surgery in the right chest wall. Next, the thymic tissue from the bilateral inferior poles of the thyroid gland to the superior mediastinum was detached by pushing the upper mediastinal organs using cotton swabs. After turning the patient over, we then detached the left-side thymic tissue through four ports. Finally, the thymus, including the anterior mediastinal fat, was removed under thoracoscopic view. The surgical procedure was completed in 5h, with hemorrhage less than 50g. The postoperative pathological diagnosis was invasive thymoma, type B1. There was little postoperative pain due to the port sites. The postoperative course was uneventful and the patient was discharged five days after surgery.
Objective: This paper aims to identify differences in activities of interest to elderly people living within the community due to whether or not they are homebound and their background circumstances. Method:T The subjects were 42 elderly people (aged over 65 years) residing in the community who agreed to participate in the study. We visited each subject's house and conducted a survey using an original questionnaire. With regard to their JICE scores, participants were divided into two groups based upon whether they were homebound or not, and their responses to survey items investigating their circumstances (daily life autonomy, household composition and means of transportation) were analyzed using the Mann-Whitney U test to compare the two groups. Results:T The homebound group was comprised of 12 people (4 homebound and 8 pre-homebound) and the non-homebound group was comprised of 30 people. Comparing the JICE scores between the two groups, the homebound group scored lower than the non-homebound group in the areas of "driving", "contact with the opposite sex", and "listening to the radio" (p<0.05). Conclusions:T It was found that there were differences in the activities of interest due to whether or not the elderly person was homebound, the person's level of autonomy, and methods of transportation. To prevent the elderly who reside within the community from becoming homebound, it is important to: 1. devise activities that incorporate the interests of the elderly, 2. ensure the elderly are involved in developing programs (to enable them to interact with community and neighbors), and evaluate programs to ensure their effectiveness.
Objective: To examine relationships among the reaction time, dominant eye, and number of gazes/target region when performing a mental rotation task. Methods: A total of 12 (5 males and 7 females; mean age: 21.3±1.7) healthy university students, 5 and 7 of whom were right- and left-eye dominant, respectively, performed a mental rotation task, and their reaction times, numbers of gazes, and target regions were recorded using an eye-mark recorder. During the task, an image of a hand was presented, and the students inferred the side of the hand from it. Results: The reaction time was shorter and number of gazes was lower in the left- compared to right-eye dominant group. The reaction time was correlated with the total number of gazes in each target region; the lower the number of gazes, the shorter the reaction time. There were no marked differences in the target region between the 2 groups. On analysis using the VAS, no correlation was observed between the difficulty/fatigue level and reaction time/dominant eye. Discussion: The dominant eye markedly influenced the visual recognition of objects, suggesting that visual information processing in the brain, rather than visual input, is responsible for differences between right- and left-eye dominant groups.