Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 57, Issue 6
Displaying 1-20 of 20 articles from this issue
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Contents
  • What is palliative care ?
    -The actual situation and the future-
    SHIGEKO OKUNO
    2011 Volume 57 Issue 6 Pages 570-581
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.570
    JOURNAL FREE ACCESS
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    Modern medicine tends to focus on only continuing the life of the person as the main object their effort, and conceals death. Palliative care focuses on relieving suffering and achieving the best possible quality of life for patients and their family caregivers and grief caring for caregivers after patient's death. Although palliative care should be started from the early stage of diagnosis with medical treatment, medical professionals tend to perceive palliative care as the alternative to life-prolonging or care rather than as a simultaneously delivered adjunct to disease-focused treatment. It is the author's opinion that it is not possible to fully treat dying patients only by using scientific methods. Nowadays, a mutual understanding about how to spend the last days between a patient, his family and his medical staff is extremely important.All parties should be open-minded and willing to discuss all kinds of problems. For a dying person, the death is, in the most cases, the first experience for him or her. The author argues that one basis of a mutual understanding and discussion about death between medical staff, patients, and their families can be through arranging “advance directives.” In conclusion, it is health professionals' responsibility to study both life and death, and take the initiative to study these topics even more humbly and eagerly than patients.
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  • Radiation therapy in palliative care for patients with malignant diseases
    KEISUKE SASAI
    2011 Volume 57 Issue 6 Pages 582-587
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.582
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    Radiation therapy is one of the most useful treatment modalities for malignant diseases in both curative and palliative intent. The therapy is less invasive in comparison with surgical operation. Therefore, it can maintain the quality of life of patients and the function of tumor-bearing organs. The primary goal of palliative therapy is to improve quality of life. To achieve this purpose, we need to decrease or eliminate symptoms related to malignant diseases such as pain, and improve or maintain function for the duration of the patient's life. Radiation therapy cannot only relieve symptoms but also eradicate the tumor itself. This is very different from other palliative treatment modalities. Radiation therapy can treat many symptoms directly related to tumors : pain, bone metastasis, myelopathy due to spinal cord compression, brain metastasis, superior vena cava syndrome, and so on. Although an optimal dose and fractionation schedule is still not clear, we treat these patients with short radiation courses of 30 Gy/10 fractions, 24 Gy/6 fractions, 20 Gy/4-5 fractions, or 8 Gy/1 fraction. The vast majority of patients with these symptoms can be managed successfully with radiation therapy. However, in the palliative setting, multimodality treatments are mandatory, as in curative treatment settings.
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  • The fundamentals and clinical medicine of psycho-oncology
    MAMIKO MIYATA
    2011 Volume 57 Issue 6 Pages 588-593
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.588
    JOURNAL FREE ACCESS
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    Psycho-oncology is palliative care of cancer patients, their families, and caregiving staff. There are areas of expertise for intervention in response to psychogenic conditions caused by psychiatric symptoms. The term psycho-oncology comes originally from oncology, psychiatry, and psychology. Today, philosophy and sociology are included in this field. Two research projects aimed to examine mental health in cancer patients and focus on the impact of cancer and outcomes of mental and psychological factors. The characteristics of the normal course of reactions and psychiatric symptoms in patients with cancer have been summarized. Spiritual pain encompasses total pain and various aspects of psycho-oncology. Finally, the Juntendo Urayasu Hospital Palliative Care Team has conducted extensive research, and the future prospects of clinical care based on the results are described.
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  • The management of cancer pain
    KEISUKE YAMAGUCHI, MASAKO ISEKI, SHIGEKO OKUNO, EIICHI INADA
    2011 Volume 57 Issue 6 Pages 594-601
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.594
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    In recent years, the paradigm of palliative care in cancer medicine has shifted from care of terminally ill patients to earlier intervention. During the past 10 years, various new drugs and interventions have been introduced mainly for pain control, which is one of the major problems in the area of palliative medicine in cancer. According to the aim of the Cancer Control Act established in 2006, patients will be able to access easily integrated high-quality cancer care by oral opioids and drug therapy. Early and accurate detection of patients' problems is a key issue for providing supporting with efficient and timely management. Since the release of the World Health Organization guidelines, cancer pain treatment using a 3-step analgesic ladder has been disseminated in Japan. All medical staff should be aware of the importance and essence of palliative care in cancer medicine. Further systematic and continuous education for medical staff is necessary.
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  • Disaster of nuclear power plant and radiation exposure
    YUTAKA NAOI
    2011 Volume 57 Issue 6 Pages 602-609
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.602
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    The Great East Japan Earthquake that occurred on March 11, 2011, caused a disaster at the Fukushima Nuclear Power Plant, and this led all of Japan to consider the prospective risk of radiation. This radiation hazard affected not only the inhabitants of Fukushima but also the entire nation, owing to the circulation of contaminated food across Japan. Consequently, paranoia spread across the country, and it was not based on accurate information and knowledge regarding radiation. Moreover, several other nations also feared being affected by radiation from Fukushima. As radiologists, we are often exposed to radiation, but understand the usefulness and risk of radiation. We have been educated to reduce radiation exposure. Moreover, we have worked hard to minimize patients' radiation exposure. However, most people, including healthcare professionals, have not been educated about radiation. Those dealing with radiation, including healthcare professionals, are required to receive radiation safety education annually. The provision of this education has been undertaken by the Ministry of Health, Labour and Welfare. At Juntendo University, radiation safety education is conducted once a year, but it attracts only a few attendants. I presume that none of you were interested in the issue of radiation and that you did not regard radiation to be a significant hazard either. After the Great East Japan Earthquake, I attempted to spread awareness about radiation among healthcare professionals. I explained the situation around the Fukushima Nuclear Power Plant disaster and improved the healthcare professionals' knowledge of radiation. In addition, I briefly discussed background radiation exposure in daily life, radiation exposure as an occupational hazard, and medical exposure to radiation. I wish to address the subject of radiation from a larger perspective.
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  • Anti-proteinuric and anti-oxidative effects of a calcium channel blocker; benidipine in elderly hypertensive patients with chronic kidney disease
    -Stratified-analysis study in untreated hypertensive patients-
    KATSUHIKO TAKARA, HITOSHI SUZUKI, YUSUKE SUZUKI, SATOSHI HORIKOSHI, YA ...
    2011 Volume 57 Issue 6 Pages 610-616
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.610
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    We previously reported that benidipine may reduce the urinary protein/creatinine (UP/cre) ratio and have anti-oxidative effects in hypertensive patients with chronic kidney disease (CKD). In this stratified analysis study, we evaluated the long-term effects of administration of benidipine alone in untreated hypertensive patients. Thirty-four hypertensive patients with CKD untreated with calcium channel blocker (CCBs) were administered benidipine and followed up for one year. Blood pressure, UP/cre ratio and lipid peroxide (LPO) level were measured before and after administration. Systolic and diastolic blood pressure decreased from 155.4±17.8/91.5±12.2 mmHg before administration to 133.1±17.6/77.3±10.3mmHg at 1 year after treatment (respectively, p<0.001). The UP/cre ratio decreased significantly from 1.50±1.50 g/g creatinine (g/g cre) before treatment to 0.79±1.06 g/g cre after administration (p=0.012). The percent change in the UP/cre ratio was significantly greater in patients aged 65 years or older than in those less than 65 years old (83.3% vs. 40.6%, p=0.042). The LPO level decreased significantly from 1. 39±0.67 nmol/dl to 0.89±0.23 nmol/dl after administration (p=0.023). In the present study, even when the tests were limited to untreated patients, benidipine reduced the UP/cre ratio more in elderly hypertensive patients with CKD. These results suggest that benidipine may have beneficial anti-proteinuric effects. Administration of benidipine also reduced the LPO level in untreated hypertensive patients with CKD, suggesting benidipine may have beneficial effects on anti-oxidative stress.
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  • An analysis of 611 patients with drug overdose
    MANABU SUGITA, TOMOHISA NOMURA, HAJIME SEKII
    2011 Volume 57 Issue 6 Pages 617-623
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.617
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    Objective : Patients with drug overdoses often have a history of psychological illness, and few hospitals provide emergency care for these patients. We believe the necessity for hospitalization is a key factor for those hospitals. If there are some predictable factors for hospitalization, it is possible to deliver adequate levels of hospitalization for patients with drug overdose by using those factors. Materials and Methods : We retrospectively analyzed 611 patients with drug overdose who were admitted to our hospital in the last 4 years. The patients' background and patient information were obtained from emergency services before the patients arrived at our hospital, and the content of the diagnosis, treatment and outcome were examined and analyzed. The relativity of hospitalization was statistically analyzed on the basis of patient background, patient information, and hospitalization. Results : No patients died, and 289 patients (47%) required hospitalization. No difference in the severity of drug overdose was observed in male and female patients. Factors associated with a high hospitalization rate were old age (p=0.0006), severe disturbance of consciousness (p=0.0001), and severe overdose (p<0.0001). No significant differences were observed in cases with a history of psychiatric consultation, referral to the hospital more than 3 hours after drug overdose and presence of attending personnel. Conclusions : Hospitalization of patients with drug overdose was associated with severe disturbance of consciousness, old age, and severe overdose. In contrast, hospitalization was not associated with a history of psychiatric consultation, referral to the hospital within 3 hours after drug overdose or an absence of attending personnel. For those patients, necessity of hospitalization is not an appropriate reason for refusing admission. The treatment of drug overdose is not difficult if specific knowledge is available. Extensive dissemination of specific knowledge of the treatments of drug overdose is important for prompt delivery of care for patients with drug overdose.
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  • Dietary Factors Alter the Oxygen Affinity of Hemoglobin
    HIROSHI SAKURAMOTO, JIN UCHIMARU, HISASHI NAITO, TTOSHIAKI WAGA, SATOS ...
    2011 Volume 57 Issue 6 Pages 624-629
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.624
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    Objective: In a previous report, we suggested that the oxygen affinity of hemoglobin (Hb) regulates the level of erythropoiesis, tissue O2 consumption, physical activity, and behavior in mice. Here, we explore the possibility that dietary factors alter the oxygen affinity of Hb. Material and Methods: A blood sample was collected from a healthy volunteer. Then, the hemolysate was mixed with various plant extracts, and P50 was measured with the HEMOX-ANALYZER in vitro. Allium sativum extract was also administered orally to healthy volunteers, and the P50 and blood concentrations of 2, 3-diphosphoglycerate (2, 3-DPG) were measured. Results: Based on screening test, various plant extracts produced changes in P50 in vitro. We selected a candidate extract, Allium sativum, and it increased P50 significantly in vitro. Furthermore, P50 was significantly increased 2 hours after the single administration of Allium sativum extract in vivo. P50 was increased significantly at 2 and 3 weeks after the start of the once-daily administration of Allium sativum extract, while the blood concentrations of 2, 3-DPG were decreased in vivo. Conclusions: The oxygen affinity of Hb is altered by dietary factors including Allium sativum.
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  • Retrospective analysis of cases with fungemia detected in bloodstream and catheter cultures at Juntendo University Hospital
    YUKO YAMAMOTO, TAKESHI MORI, TOYOKO OGURI
    2011 Volume 57 Issue 6 Pages 630-637
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.630
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    Objective : We conducted research to investigate underlying diseases, species of fungi, sites of indwelling catheters and prognosis of patients diagnosed as having fungemia based on the results of blood and central venous catheter cultures at Juntendo University Hospital between January 1994 and December 2003. Materials and methods : Among 203 patients diagnosed as having fungemia, we retrospectively reviewed 169 patients and 176 episodes, excluding 34 patients whose samples were considered to have been contaminated. Fisher exact test was performed to determine the factors of candidemia-associated mortality. Results : The number of episodes slightly increased year by year. Among them, we noticed that men were more frequently affected. (69.3%) than women, predominantly those who were over 50 (81.2%). In most cases, the underlying disease of patients was a solid cancerous tumor (45.5%), and esophageal cancer was the highest episodes, 26.3%, among them. Candida albicans was isolated most frequently (n=66, 37.5%). Compared with previous reports, C. parapsilosis. (n=44, 25.0%). was identified relatively more frequently than in other reports. Factors independently associated with mortality were antibiotic therapy before candidemia, with C. albicans identified as the causative agent of candidemia, and respirator use. Trichosporon species, which were the next most common species after Candida spp., were identified in 3 episodes. It is necessary for clinicians to pay attention to deep-seated trichosporonosis in immunocompromised patients.
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  • Timing of residents career path decisions
    -Findings from a questionnaire survey conducted after the completion of early clinical training-
    YUICHI TOMIKI, TSUTOMU SUZUKI, TOSHIAKI SHIMIZU, HIROYUKI KOBAYASHI, K ...
    2011 Volume 57 Issue 6 Pages 638-643
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.638
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    We examined when residents (doctors in postgraduate clinical training) started to consider, and then, decided on their career paths. Most residents started to consider their career paths in the first half of the second year of clinical training, and made decisions in the latter half of the second year. More than 90% indicated that the experience of early clinical training influenced their decision-making process, and 40% changed their career paths. “The actual experience of clinical training” was cited as the primary reason for their decisions. It is assumed that residents will accelerate the timing of their career decision-making due to changes in the clinical training program in 2010.
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  • A case of primary aldosteronism with hypokalemia and headache treated by laparoscopic adrenalectomy
    YOHEI SASAKI, ISAO OHSAWA, JUNICHIRO NAKATA, NORIYOSHI KOBAYASHI, TATS ...
    2011 Volume 57 Issue 6 Pages 644-649
    Published: December 31, 2011
    Released on J-STAGE: November 11, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.644
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    Primary aldosteronism (PA) is a common cause for secondary hypertension, affecting up to 5-10% of the hypertensive population. Sustained hyperaldosteronism can lead to cerebrovascular, cardiovascular and renal complications. We present a case of a 43-year-old man with hypokalemia and headache. CT imaging of the adrenal glands and adrenal venous sampling (AVS) were performed, and he was diagnosed with aldosterone-producing adenoma in the left adrenal. The patient was treated with laparoscopic adrenalectomy. Appropriate primary care and a following detailed examination may help to make an early diagnosis and to determine suitable therapy.
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