Introduction: This study examined the effectiveness of the modified Hospital Elder Life Program (HELP) for preventing delirium, which was adjusted to be used in acute internal medicine wards at general community hospitals in Japan.Methods: The pre-intervention group consisted of 751 patients aged 70 years or older hospitalized at Nishiyodo Hospital and Amagasaki Medical Co-op Hospital between January and July 2013. The post-intervention group consisted of 775 patients aged 70 years or older hospitalized between March and July 2017 and between October and December 2017. To address risk factors for delirium, a multicomponent intervention (modified HELP) consisting of the following was implemented: handing out pamphlets, orientation to maintain activity levels, sleep improvement, early initiation of rehabilitation, provision of glasses, hearing aids, and dentures, and the termination of continuous intravenous infusion. The Delirium Screening Tool was used to calculate the percentage of inpatients who developed delirium.Results: Of the 751 patients in the pre-intervention group, 108 (14.4%) developed delirium and 88 (11.4%) of the 775 patients in the post-intervention group exhibited delirium (odds ratio: 0.70; 95% confidence interval: 0.48-1.01; p=0.06).Conclusion: The modified HELP, adjusted for use in Japan, did not significantly reduce the rate of delirium during hospitalization. Therefore, a more universal intervention method is needed in the future.

We report two cases of numbness and pain of neuropathy due to ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis successfully treated with Ogikeishigomotsuto. The first case was a 57-year-old female who complained of high fever, painful skin eruptions of the lower limbs, and proteinuria. Although the severe pain was reduced with steroid therapy, neuropathy-related numbness and pain remained widespread in her lower limbs. After we prescribed Ogikeishigomotsuto, most of her pain disappeared while her degree of numbness diminished by almost half in two weeks. In addition, her steroid therapy could be tapered off without adverse effect. The second case was an 82-year-old female with fever and myalgia. Although myalgia of the upper arm disappeared with steroid treatment, walking became difficult due to numbness from the lower legs, to the soles of her feet. With Ogikeishigomotsuto administration, she became better able to walk because her legs had warmed up, and the range of her numbness had decreased. These cases suggest that Ogikeishigomotsuto may be effective against numbness and neuropathic pain due to ANCA-associated vasculitis.
Numbness ; Pain ; Peripheral neuropathy ; Antineutrophil cytoplasmic antibody measurement ; Vasculitis

A new fogging disinfection method was evaluated as a means of disinfecting ward rooms and operating theaters. A temporary room was established where the disinfection effect of fogging was examined. Based on the results, an automatic fogging disinfection unit was developed. This unit was then used in the disinfection of operating theaters, where its safety and effectiveness were examined. To evaluate the results of disinfection, bacterial culture tests were performed on the floor, walls and other areas of the operating theater, and the number of colony forming units was used as an index of effectiveness. Benzalkonium chloride, alkyldiaminoethylglycine, sodium hypochlorite, glutaral and acidic electrolytic water were used for the operating theaters. The average disinfection effect was 90% or better for all disinfectants, except acidic electrolytic water. The newly developed automatic fogging disinfection unit enables safe and effective disinfection, and may be suitable for disinfecting ward rooms and operating theaters.
Disinfection ; Pulmonary evaluation ; Unit ; Automated ; Water

An 81-year-old patient, who had a postinfarction left ventricular aneurysm with thrombus underwent left ventricular aneurysmectomy with right coronary artery bypass grafting (CABG). Preoperative examination showed 99% stenosis of the left coronary artery (#7) and 90% stenosis of the right coronary artery (#3). The operation was performed because angina was not improved and formation of thrombus was suspected on the wall of the aneurysm. The operation was performed under cardiopulmonary bypass and by antegrade and continuous retrograde cardioplegia. The aneurysm was resected and a relatively fresh thrombus which was detected on the endocardium of the aneurysm was extracted. The left ventricle was closed by direct linear suture with felt reinforcement. Because the area of resection included part of the left anterior descending artery, only right CABG (#3) with a saphenous vein was done. Weaning from bypass was very easy and the postoperative course was uneventful.

A descending thoracoaortic aneurysm excluded by stent-grafting had expanded during a period of one and a half years. There was no endoleakage but there was shortening of the stent-landing on both proximal and distal sides. Aneurysm seemed to be pressed by blood pressure through the graft in TEE. The aneurysm was replaced by an artificial graft through a left heart bypass. Because ESP diminished during the operation, VIth intercostal arteries were reconstructed immediately, and CSF drainage was performed. Following this procedure there was no paraplegia.

Boi-ogi-to is frequently prescribed to relieve pain for osteoarthritis in the therapy of Kampo formulation. However, it has been pointed out that the evaluation of this formulation differs among the patients. It is often showed lower effectiveness and/or non-effectiveness in the patients with advanced roentgenographic deformity, obesity, and suffering from more severe pain.
We thought that it was resulted from ingoring the abdominal-sho (symptom). Therefore, in this study, we defined the abdominal-sho of Boi-ogi-to as “frog abdominal-sho”, and administered Boi-ogi-to to 17 patients with osteoarthritis of the knee who had frog abdominal sho. As a result, in the patients with frog abdominal-sho, the formulation was moderately or even better effective in relieving pain in 77% of these patients. It was acknowledged that the effect was independent of the severity of pain, the degree of obesity, and whether the roentgenographic deformity was slight or moderate.