The following report illustrates a rare case of dysphagia caused by secondary adrenal insufficiency in a patient with isolated ACTH deficiency. A 76-year-old man with progressive appetite loss, weight loss and general fatigue was hospitalized due to dehydration, aspiration pneumonia and hypoglycemia. He was unable to stand and walk by himself. His serum cortisol and ACTH levels were both low. An endocrinological examination resulted in a diagnosis of isolated ACTH deficiency. Following the administration of 15mg of glucocorticoids daily, his symptoms diminished without dysphagia. Furthermore, we investigated his swallowing function using a videofluoroscopic examination of swallowing (VF). The VF showed an impaired laryngeal movement as well as an upper esophageal opening and severe aspiration without a delay in his swallowing reflex. Oral intake was judged to be impossible, but his swallowing function gradually improved and he was able to resume eating all of his meals 2 months after treatment. Dysphagia is not a common symptom in ACTH deficient patients but a few similar cases have been reported. The swallowing function of the patients in these cases was not evaluated in detail, so we evaluated this case according to the results of the VF and the patient's process of recovery. Careful monitoring of swallowing function and appropriate treatment for both dysphagia and adrenocortical failure are required for the recovery of such patients. In conclusion, practitioners should be wary of isolated ACTH deficiency in elderly patients with progressive weight loss and dysphagia.

Aims: To verify the significance of medical and dental cooperation over the past 10 years in Haramachi Red Cross hospital, which does not have a dental department. We will also investigate the situation of inpatients' oral cavities in our hospital. From these results, we will discuss future activities about medical and dental cooperation.

Methods: We analyzed questionnaire and the field survey data related to medical and dental cooperation. We also compared the current oral assessments by a dentist and the past assessments without a dentist.

Results: A dental hygienist has participated in NST (Nutrition Support Team) rounds at our hospital since 2005. From then, we started oral assessments for inpatients and we recommend for patients to visit a dentist before surgery or chemotherapy. Furthermore, we have held oral care seminars for medical staff. As a result, medical staff have demonstrated an improvement in awareness and technique for oral care. Since 2013, a dentist from the Agatsumagun Dental Association has started oral assessments for preoperative inpatients at our hospital. However, we found that the frequency of problems in their oral cavities and that of postoperative pneumonia have not decreased.

Conclusion: Medical and dental cooperation is effective for our hospital. We think that it is important not only to promote medical and dental cooperation, but also to perform a dental checkup and educate the general population on periodontal disease.

PURPOSE: The purpose of this study was to construct a measurement instrument for climacteric symptoms among Korean and Japanese women. METHODS: From Dec. 1st of 2003 to March 30th of 2004, in-depth interviews were made with 26 women (15 in Jinju, Korea and 11 in Nagasaki, Japan) aged from 45 to 59 years who had not taken hormone replacement therapy to relieve the climacteric symptoms. A draft questionnaire with 45 items was constructed on the basis of the interview data and literature review. Three obstetricians, three PhDs in nursing science, and a chief nurse who was exclusively in charge of the climacteric management, examined the draft questionnaire to evaluate content validity. After deletions 39 items remained for a preliminary questionnaire. A survey was conducted by using a convenient sampling method in Jinju of Korea and Nagasaki of Japan during the period from April 1st, 2004 to July 10th, 2005. RESULTS: Factor analysis identified 4 factors, which were "mental and psychological symptoms", "physical symp-toms", "loss of autonomic nervous system symptoms", "sexual symptoms". These four factors explained 46.9% of total variance. CONCLUSIONS: The results demonstrated that climacteric symptom scale was multidimensional, and the reliability and validity of the scale was supported.
*Climacteric/ethnology ; Factor Analysis, Statistical ; Female ; Humans ; Japan ; Korea ; Middle Aged ; *Nursing Assessment ; *Questionnaires ; Reproducibility of Results