The Kitakanto Medical Journal
Online ISSN : 1881-1191
Print ISSN : 1343-2826
ISSN-L : 1343-2826
Volume 55, Issue 3
Displaying 1-17 of 17 articles from this issue
ORIGINALS
  • Yoichi Hoshino, Akira Hasegawa, Masahiko Kurabayashi
    2005 Volume 55 Issue 3 Pages 221-224
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Background & Aims : Left-sided pleural effusion (PE) is one of the features of acute aortic dissection (AD). The present study was undertaken to clarify the relation between the presence of PE and the time interval from the onset of dissection, and the laterality of PE. Methods : We retrospectively studied patients with a confirmed diagnosis of acute AD who had undergone multidetector-row CT (MDCT). The presence of PE and its laterality in patients with acute AD were evaluated by MDCT. The relationship between the presence of PE and the time interval from onset to CT scan was evaluated. Results : Twelve patients underwent MDCT within 7 hours of the onset of acute AD. PE was observed only in three patients (25%) who had undergone MDCT more than 4 hours after the onset. The average time from symptom onset to CT scan was longer in patients with PE than in those without PE (343±86 vs. 120±80 minutes ; P=0.002). The laterality of PE varied among three patients. Conclusions : The current study reveals the incidence of PE to be 25% within 7 hours of the onset of acute AD and suggests the presence of PE to be dependent on the time interval since onset. Furthermore, we observed no patterns regarding the laterality of PE.
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  • Eiko Inoue, Kaoru Mine, Yayoi Saito
    2005 Volume 55 Issue 3 Pages 225-234
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Objective : Characteristics of the experience of clinical practice perceived and interpreted by students were studied to evaluate the effects of on-site practicing. Methods : 390 experiences extracted by a qualitative inductive method from reports of clinical practice in rehabilitation nursing submitted by 5 third-year students of a nursing junior college were analyzed. Results : The experience of clinical practice perceived and interpreted by the students were classified into 44 sub-categories, which were further integrated according to the similarities of their meanings and contents into 5 core-categories : “Curiosity toward patients as people”, “intention to understand patients and its confusion”, “control of confusion and spontaneous support”, “tentative support based on immature analytical thinking and search for its meaning”, and “support based on analytical thinking and self-reflection”. Conclusions : The experiences perceived and interpreted by the students indicated the development of their self-consciousness from people to students and to care providers associated with changes in their attitude to studying.
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  • Kaoru Mine, Eiko Inoue, Yayoi Saito
    2005 Volume 55 Issue 3 Pages 235-241
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Objective : The nurses' perception of patient education was studied to clarify how they understood and evaluated objectives of patient education. Methods : Our original questionnaire (Cronbach's internal cohesion : α value=0.90) was distributed to medical organizations in 4 prefectures to be answered by 2,049 nurses at these organizations. Results : Valid responses were obtained from 1,240 nurses (effective response rate 60.4%), and four factors of objectives of patient education were extracted by factor analysis. The perceived objectives of patient education were classified into the following four types according to the proportions of the four factors : “self-objectification type” (59.0%), “QOL-improvement type” (16.1%), “knowledge behavior correction type” (6.1%), and “subjective transformation type” (6.0%). No significant difference was observed in the frequency of these types according to the subjects' attributes such as the age, duration of career, occupational type, and occupational rank. Conclusions : There were four types in the nurses' understanding of the objectives of patient education. The results suggest the necessity of teaching the variability of objectives of patient education depending on the situation in basic courses of nursing.
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  • 1. Organ-specific Indication Rates Based on Quantitative Evidence
    Izumu Hasegawa, Yoichiro Shinohara, Fumitaka Mogi, Minato Nakazawa, Hi ...
    2005 Volume 55 Issue 3 Pages 243-249
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Background : The number of deaths from cancer is increasing, but surgery and chemotherapy are not indicated for all cancers. Heavy ion radiotherapy is a new radical therapy for patients with primary carcinomas. However, heavy ion radiotherapy can only be conducted at 3 institutions in the world. An evidence-based estimation of the need for heavy ion radiotherapy is required. Subjects and Methods : The results of a clinical trial at the National Institute of Radiological Sciences (NIRS) were statistically compared with the cancer registry data for Gunma Prefecture, and the organ-specific indication rates for heavy ion radiotherapy were determined. Results : The organ-specific indication rates ranged 0% to 47%, with an indication rate of 47% for spleen cancer and 23% for liver cancer. Conclusion : It is expected to proceed the heavy ion radiotherapy, to adequately deploy the facilities over the country.
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  • 2. Annual Cancer Incidence in Gunma Prefecture and Projected Number of Heavy Ion Radiotherapy Candidates
    Yoichiro Shinohara, Izumu Hasegawa, Fumitaka Mogi, Minato Nakazawa, Hi ...
    2005 Volume 55 Issue 3 Pages 251-255
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Background : In 2009, Gunma University will begin to offer heavy ion radiotherapy for the treatment of cancer. This paper estimates the number of heavy ion radiotherapy candidates in Gunma Prefecture. Subjects and Methods : The number of heavy ion radiotherapy candidates in Gunma University was calculated by determining (the number of cancer patients in Gunma Prefecture) × (the percentage of heavy ion radiotherapy candidates, as reported in another paper). The actual number of cancer patients in Gunma Prefecture was estimated by dividing the number of registered cases by the registration rate. The registration rate was calculated using the DCN% to I/D ratio, where DCN% is the proportion of patients killed by cancer but not registered until the arrival of death information, and I/D is the ratio of incidence to death. Results : The number of heavy ion radiotherapy candidates in gunma prefecture was expected to be 655 per year. Conclusion : Because of the low registration rate of the cancer registry and the shortness of clinical trials, the reliability of the present estimate is insufficient, however the present results support the need for heavy ion radiotherapy facility in Gunma University.
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  • Kiyohiro Oshima, Toru Takahashi, Yutaka Hasegawa, Satoshi Ohki, Taro N ...
    2005 Volume 55 Issue 3 Pages 257-261
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Purpose : The purpose of this study was to examine the incidence, clinical features, treatment and outcome of patients with gastrointestinal complications after cardiovascular surgery in our hospital. Patients and Methods : Between January 1992 to February 2004, 835 patients were operated with cardiopulmonary bypass (CPB) at Gunma University Hospital. Of these, 12 (1.4%) patients had postoperative gastrointestinal complications. The mean age of 12 patients was 59 years old ranging from 7 to 71. Valve replacements were performed in six patients, CABG in three, and others in three. Results : Gastrointestinal bleeding occurred in seven patients. Six of them recovered with non-surgical procedure, and one died of hemorrhagic shock following an emergency operation. Acute cholecystitis occurred in three patients and all of them were successfully managed by percutenous transhepatic gall bladder drainage (PTGBD). Two patients with gastrointestinal perforation underwent an emergent operation, however, both of them died of sepsis. The total mortality rate of 12 patients was 25%. Conclusion : The occurrence of gastrointestinal complications after cardiovascular surgery with cardiopulmonary bypass is low, however, is frequently fatal. Preoperative careful evaluation of patients is required for the postoperative management of those complications.
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CASE REPORTS
  • Noriko Doki, Tohru Sakura, Takuma Ishizaki, Takumi Hoshino, Satoru Tak ...
    2005 Volume 55 Issue 3 Pages 263-268
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    A 24-year-old male with acute myeloid leukemia was admitted to our hospital in December 2001. After undergoing induction chemotherapy, he achieved a complete remission. He then received three courses of consolidation chemotherapy, and was discharged in May 2002. He relapsed in January 2003, and was given two courses of induction chemotherapy ; he achieved complete remission once again.
    We searched for an HLA-matched donor, but none could be found either among his family or in the Bone Marrow Bank. An unrelated umbilical blood unit with a sufficient number of nucleated cells could not be found. The nested polymerase chain reaction with sequence-specific primer (PCR-SSP) typing demonstrated the presence of inherited paternal antigens (IPA) in the mother's peripheral whole blood. After considering the phenomenon of feto-maternal immunological tolerance, we decided to perform a haplo-identical allogeneic peripheral blood stem cell transplant. The patient underwent conditioning with total body irradiation (TBI) and treatment with cyclophosphamide (CY). For graft versus host disease (GVHD) prophylaxis, he was given tacrolimus and methotrexate. The infused CD34-positive cells provided 3.1×10 (6) cells per kg. The patient and his mother had a three-loci HLA mismatch. Engraftment was obtained on post-transplant day 12, and acute GVHD grade3 (skin, stage3 ; liver, stage 3 ; gut, stage 3) occurred on the same day.
    He developed aspergillus pneumonia on day 195, and Carinii pneumonia on day 293, but he improved with treatment. He is currently doing well, with only mild chronic GVHD of the skin and mouth nineteen months after undergoing the stem cell transplant.
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  • Seiichi Kakegawa, Mitsuhiro Kamiyoshihara, Yoshimi Ohtani, Kimihiro Sh ...
    2005 Volume 55 Issue 3 Pages 269-272
    Published: 2005
    Released on J-STAGE: July 07, 2006
    JOURNAL FREE ACCESS
    Right pneumothorax had occurred twice in 2 months in a 41-year-old female, related to the onset of menstruation, suggesting catamenial pneumothorax. At the initial operation, a thoracoscope revealed the presence of “blue berry spots” and several fistulae in the central tendon of the diaphragm. Neither bulla nor bleb was found on the right lung. A partial resection of the diaphragm including these lesions was performed by thoracoscopic procedure using an endostapeling and a cutting device. The patient was followed with hormonal therapy for only one month at her request. Six months after the initial operation, right pneumothorax recurred. Diaphragmatic hernia was observed at the second operation. The herniated organ was a part of the liver. The defect of the diaphragm was repaired by a direct suture, and covered with a Poly Glycolic Acid mesh to prevent relapse. The patient has been asymptomatic for 8 months after the second operation under hormone therapy.
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