Aim : To find whether there were characteristic clinical or imaging findings in retroperitoneal fibrosis (RPF) confined in the pelvic cavity.
Methods : Literature review was performed using MEDLINE with key words of [retroperitoneal fibrosis and pelvis] and [pelvic fibrosis].
Results : In addition to our 68-year-old Japanese woman, 13 cases were found, in which computed tomography (CT) or magnetic resonance imaging (MRI) confirmed that the mass lesions were confined in the pelvic cavity. The pelvic RPF (age range, 29-69 y.o. ; seven male) showed variable symptoms and clinical presentation suggestive of gynecological, urological or colonic diseases. CT usually revealed an ill-defined well-enhanced mass lesion, which may be associated with fascial thickening. On MRI the pelvic masses showed low signal intensity on T1-weighted images and high or mixed signal on T2-weighted images. In nine of 14 patients the presacral or retrorectal spaces were involved, and the remaining patients had RPF around the bladder. In seven patients, imaging-guided needle biopsies were employed. Good prognoses were reported in all 11 patients, in which corticosteroid therapy were given.
Conclusion : Pelvic RPF may show different symptoms and clinical features from typical paraaortic RPF, but shows similar imaging findings. The imaging-guided biopsy is the choice for histopathological diagnosis.

View full abstract

Background and Aims : Sentinel lymph node navigation is expected to reduce the need for lymph node dissection in cancer surgery. We studied whether the sentinel lymph node concept is applicable to oral cancer. Patients and methods : Subjects were 7 patients with oral squamous cell carcinoma undergoing primary resection and neck dissection between April 2002 and July 2003. They were injected with ^99mTc labeled phytate surrounding primary lesion for tracers preoperatively. Preoperative lymphoscintigraphy and intraoperative identification by gamma probe were done to detect sentinel lymph nodes. Dissected lymph nodes were examined histopathollogically and nuclear-radiologically. Results : Sentinel lymph nodes were recognized at the submandibular region in all patients, and additional nodes at the cervical region in 3 cases. Metastatases were identified in 3 cases, one of whom had multiple metastases downstream from the sentinel lymph node. Another had further metastasis outside the dissection area. Conclusion : Sentinel lymph nodes are detected as described above and the sentinel lymph node concept is reasonable for oral cancer application.

View full abstract

Background and Aims : These measures, however, give stress to the patients in their daily life. This study aims at identifying the way to make it easier for them to adapt after being discharged from the hospital. To identify the problems the patients face in adapting to their daily life after discharge from the hospital. Methods : Thirteen patients (5 male and 8 female) who received allogenic bone marrow transplantation or periferal blood stem cell transplantation and who have not shown any loss of survival of the graft. Qualitative study using quasiconstitutive interview. Interviews were performed for 30 minutes to 1 hour in a private room to keep privacy of the patients. The conversations (one for a patient) were tape recorded with the patients' permission and transcribed. Analytical method : Record of the interview was analysed and words and behaviors suggesting problems in daily life were coded. The similar codes were then categorized. Results : The Difficulty daily life after discharge from the hospital, Five categories are interrelated as shown in the figure and they can be used to make a model of problems. The patients tend to have negative feelings toward themselves. Factor by Construct daily life after discharge from the hospital, Five categories are interrelated. Conclusion : On the other hand, the experience of transplantation has made them realize importance of life and try to live positively. They have to be supported so that they can be confident in living in the society.

View full abstract

Background and Aims : We studied breast cancer patient reactions during the radiation therapy and nursing support. Patients and Methods : Six breast cancer patients undergoing radiation treatment agreed to participate. We obtained data from nursing records, semi structured interviews, and treatment records. We coded patient response using qualitative induction and categorized them. Results : We categorized feelings before radiation treatment as “acceptance of cancer and radiation treatment,” “agony from cancer and radiation treatment,” “emotional healing/support by family and friends,” and “hope for recovery and medical advances.” During the radiation treatment, categories were : “acceptance of the radiation treatment into everyday life,” “agony from radiation treatment,” “feelings of security through communication with others,” and “hope and anxiety for the future,” At the end of radiation treatment, categories were : “hope for the future and a sense of security,” “agony from symptoms, side effects, and recurrence,” “thankfulness for others' support,” and “a demand for medication and more educated people working in this medical field.” Conclusion : We found that we need more information and advanced techniques to provide sufficient medical support for breast cancer patients who are having difficulties in radiation treatment.

View full abstract

Background and Objective : To determine the influence of introducing the electronic chart system on nursing information, the amount of information and its contents were evaluated on the basis of nursing records used before and after introduction of this system. Subjects and Methods : The nursing records were analyzed at the hospital into which the electronic chart system had been fully introduced. The subjects of the analysis were SOAP-formed nursing records on attribute-matched surgical patients. The data collected from 13 postoperative patients before introduction of the electronic chart system were compared with those obtained after the introduction. Results : There was no quantitatively significant difference between before versus after introduction in terms of diagnostic nursing care, related factors, nursing design, or time-course problems. According to the NANDA (North American Nursing Diagnosis Association) classification of 13 areas, the proportion of the data collected mainly in 4 areas before introduction was significantly higher than after introduction. The related factors were described by a unified expression before introduction, while being described by various expressions afterwards. Conclusion : There was apprehension about the possibility of the process of making diagnoses being stereotyped by the introduction of this chart procedure, but it was considered that indications for a list of candidate diseases to be diagnosed and selection with decision-making tended instead to expand logical thought processes and to be useful for making a plan which pays specific attention to databases.

View full abstract

Objective : This study was designed to clarify characteristics of the events recognized by nursing staff members and of their clinical decision-making according to their perceptions of patients' abnormalities. Methods : Episodes of abnormalities perceived in patients by nursing staff members were extracted through group-system discussion involving 15 such staff members of the surgical ward, and the contents were analyzed. Results : The events perceived by the nursing staff members included abnormal drowsiness, changes in facial expression, slow reactions, hypo-activities, unexpected symptoms, incoherent words, and offensive odors apparently associated with a physical disorder. Thus, the contents were non-verbal signs based on several observations made by the nursing staff while providing nursing care. The findings for clinical decision-making at the time of perception of abnormalities included “sensation that has not previously been experienced”, “unusual sensation”, and “sensation of inconsistency of information about the patient”. It was revealed that both the analytical decision regarding data and experience on “the patient” and the non-analytical decision based on nursing experience of “such a patient” were put to practical use. Conclusion : The nursing staff members perceived patients' abnormalities from subtle non-verbal signs and made clinical decisions by freely using the analysis based intuitively on their logical analyses and experience.

View full abstract

Background and purpose : Cancer patients received outpatient chemotherapy were surveyed to clarify their anxiety. Methods : The subjects were 81 patients (33 males and 48 females) aged 58.6±10.0 years who were receiving outpatient care at a outpatient center of a hospital and consented to the survey. The STAI questionnaire was used for the survey. Results : The anxiety score was significantly higher in the females than in the males, in the breast cancer patients than in the non-breast cancer patients, and in those aged less than 60 years than in those aged 60 years and above. It was also higher in the patients 1 year or more after the diagnosis than in those less than 1 year after the diagnosis and in those with poor PS than in those with good PS. Conclusions : The situational anxiety score was higher in cancer patients undergoing outpatient chemotherapy than in healthy adults. Factors of a high anxiety score included 5 clauses. Identification of the contents of anxiety, selective support for patients with factors that are likely to increase the anxiety score, and systematization of practical support procedures and their effective execution are required.

View full abstract

Background and Aims : The purpose of this study was to evaluate bacteremia after allogeneic stem cell transplant (before engraftment). We retrospectively reviewed the incidence and the timing of bacteremia, including the clinical course, complications, and associated clinical risk factors. Between January 1997 and September 2004, 117 patients received allogeneic stem cell transplants at our hospital.
Methods : All patients were kept in HEPA-filtered rooms (class 100) and inhaled amphotericin B. Of these, 100 were given oral polymyxin B sulfate (PL-B), amphotericin B, acyclovir, and sulfamethoxazole trimethoprium, while 17 were given vancomycin hydrochloride in addition to this prophylaxis.
Results : Among the 117 patients, 18 patients (15.2%) developed bacteremia. Cause of bacteremia were oral mucosa (6 patients), intestine (4 patients), catheter (2 patients), unknown (6 patients). Among 18 patients, blood culture isolated gram-positive organisms (10 patients), gram-negative organisms (6 patients), anaerobic bacterium (1 patient), Candida (1 patient). Bacteremia contributed directly to death in 3 caused by gram-negative organisms (pseudomonas, stenotrophomonas) and candida.
Conclusions : While bacteremia mortality was low, that caused by gram-negative organisms was fatal.

View full abstract

A 49-year-old woman was admitted because of hyperglycemia. On a delivery at age 29 iron deficiency anemia was indicated. She was injected with 40mg of saccharated ferric oxide every two weeks until age 40. At age 35 menopause occurred. Serum ferritin increased (4,300ng/ml). An abdominal computed tomogram (CT) showed increased hepatic CT density. Iron deposition in the parenchymal cells of the liver was shown in a biopsy specimen. Secondary hemochromatosis was diagnosed. Her gonadotropin release decreased. After 30 months serum ferritin had decreased gradually to the normal range after daily 1,000mg injection of deferoxamine mesilate. Although the hepatic CT density decreased, gonadotropin release and insulin release were not improved.

View full abstract

A 55-year-old man sent to the emergency room for accidental chest injury by a nail was found in transthoracic echocardiography and computed tomography to have had the nail penetrate the right ventricle and cause a large amount of pericardial effusion, resulting in cardiac tamponade. Following emergency pericardiocentesis, he was immediately transferred to the operating room. After sternotomy and pericardiotomy, the nail was removed and bleeding was controlled by finger compression without cardiopulmonary bypass support. The right ventricular wound was repaired with a single stitch. His postoperative course was uneventful and he was discharged on postoperative day 11 in good condition. Penetrating cardiac injuries often cause cardiac tamponade, thus reguiring prompt diagnosis and emergency surgical repair.

View full abstract

Bronchopleural fistula is one of the major complications in chest surgery, and remains a serious disorder associated with high mortality for general management. Some clinicians report that fibrin grue embolization may become the treatment of choice. However fibrin glue spillage sometimes results in re-fistulation. We recentry experienced a case for the treatment of bronchopleural fistula due to pleural metastasis of breast cancer, which was treated with a combination of the coil occlusion method and fobrin glue embolization.

View full abstract

The patient was a 52-year-old female who was diagnosed with postmenopausal lymphangioleiomyomatosis (LAM). Although she was placed on a treatment of luteinizing hormone releasing hormone agonist (LHRH-A) for two months, she could not tolerate this therapy due to adverse reactions. For the subsequent 6.5 years, her clinical course was carefully monitored and the results of clinical observation, pulmonary function tests and a CT of the chest showed no clear signs of aggravation. Our literature review yielded two patients who were left untreated although their clinical progress was slow and mild. The possibility was suggested that some patients with postmenopausal LAM could be carefully observed.

View full abstract

A 64-year-old male with right upper abdominal pain had been treated with an H₂-blocker for three months as a gastric ulcer recurrence with no response. An abdominal US identified a large cystic tumor in the left lobe of the liver. Tumor markers were all normal ; hepatitis serology tests were all negative, although liver function tests were elevated slightly. A CT scan showed a well-defined cystic tumor with a thick, heterogeneously enhanced wall. Selective celiac artery angiograms showed displacement of the common hepatic artery, and an avascular area. As a malignant tumor was suspected, a left lobectomy of the liver was performed. The tumor measured 17×15×12cm and contained central cystic degeneration filled with 280 ml of dark red fluid. Microscopic findings revealed anaplastic spindle cell proliferation, and immunohistochemical examination was positive for α-smooth muscle actin. A thorough survey did not detect a primary tumor in any other organ. Therefore, primary hepatic leiomyosarcoma was diagnosed. Only 80 cases have been reported. We reviewed the available literature.

View full abstract

Case 1 : Adenocarcinoma of the lung, stage IA, was diagnosed in a 66-year-old man without smoking history. Though the tumor was removed by right middle lobectomy, the metastatic tumors were recurred in the right lower lobe. Gefitinib was administered after EGFR mutation was found in the primary tumor. The tumor almost disappeared after 2 months of administration. Case 2 : Adenocarcinoma of the lung, stage IV, was diagnosed in a 73-year-old woman without smoking history. Though the systemic chemotherapy was performed, tumor was not reduced at all. Gefitinib was administered after EGFR mutation was found in the tumor specimen from transbronchial lung biopsy. The primary tumor shrank, and metastatic and disseminated tumors disappeared after 1 month of administration. Case 3 : Adenocarcinoma of the lung, stage IV, was diagnosed in a 51-year-old man with smoking history. Though the systemic chemotherapy was performed, tumor was not markedly reduced and progressed again. Gefitinib was administered after EGFR mutation was found in the tumor obtained from CT-guided precutaneous transthoracic lung biopsy. Gefinitib was stopped after 3 weeks due to interstitial pneumonitis. However, metastatic tumors in the mediastinal lymph nodes shrank.

View full abstract