Prophylactic treatment ; Iron

Since the Infection Control Team (ICT) was organized in 1999, our hospital has been engaged in evidence-based operations against nosocomial infections. The ICT's major activities included guidance in preventive measures against infections, surveillance involving continuous environmental monitoring, proposition as regards prescription of antibacterial medicines, and consultation with clinicians about prophylaxis. The team comprising physicians, nurses, pharmacists and clinical laboratory technicians has made expert propositions to clinicians. To be concrete, the team members, with the liaison clerk playing a central role, met with physicians in charge or with other staff members of the hospital, studied the infection cases in question, and presented the study findings to the clinicians. Fundamentally, therefore, it is not that the ICT intervenes in the affairs of the clinical department by way of directions but that it presents clinicians with the ideas gained through discussion between ICT members and physicians and other hospital staffers. While cementing a relationship of mutual trust between hospital employees, the ICT is expected to engage in nosocomial infection prevention activities by joining forces transdeoartmentally.
Clinical ; Hospitals ; Infection Control ; seconds ; Prophylactic

We retrospectively investigated the prevalence of influenza virus type A infection and the efficacy of Kampo medicine as a prophylactic for handicapped residents at our social welfare institution, during the 2004/5 flu season. Upon studying a nationwide surveillance report for said season, we supposed that it had been difficult to prevent mass infection at our welfare institution with the usual preventive methods, because type B had prevailed for most of the season, and because of the differing type A (AH 3) antigenicity which prevailed late-season, for which there were no type A vaccines.43 of 90 (47.8%) residents given flu vaccinations twice, and 25 of 110 (22.7%) of staff members given flu vaccinations once contracted type A influenza between March and May of 2005. Interestingly, residents who had been administered Hozai for either short-term health problems or chronic disease, demonstrated a low influenza prevalence, there being a statistically significant difference (p<0.05) between our “Hozai” and “non-Hozai” groups. Furthermore Juzentaihoto, known to enhance immune function, seemed beneficial because of its low associated morbidity rate, and only 2 of 8 residents administered it contracted flu. No difference was observed, however, between generalized “Kampo treatment” and “non-Kampo treatment” groups.We consider that certain Kampo medicines may be useful for the prevention of influenza infection, in institutionalized handicapped residents with short-term health problems. Immunological enhancements, and the influence of Hozai are discussed here.
Medicine, Kampo ; Seasons ; Infection as complication of medical care ; Influenza ; Prophylactic

PURPOSE: The purpose of this study was to investigate decision patterns to reduce the risks of BRCArelated breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and riskreducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. MATERIALS AND METHODS: The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. RESULTS: Of the 992 patients, 220 (22.2%) were carriers of BRCA pathogenic variants. About 92.3% (203/220) had a family history of BC and/or OC,which significantly differed between BRCA1 and BRCA2 carriers (p < 0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 of the 83 carriers (71.1%) with BC and the 39 of 79 unaffected carriers (49.4%) underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5%) of patient choice. The rate of RR surgery was significantly higher after 2013 than before 2013 (46.3% [74/160] vs. 31.6% [6/19], p < 0.001). CONCLUSION: RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.
Breast ; Breast Neoplasms ; Female ; Humans ; Korea ; Male ; National Health Programs ; Ovarian Neoplasms ; Prophylactic Surgical Procedures

Women with BRCA1/2 mutations have a high risk of breast cancer and may opt for risk-reducing mastectomy (RRM). We report a 38-year-old Japanese woman who was diagnosed as a BRCA2 mutation carrier. She underwent prophylactic bilateral skin-sparing mastectomy (SSM) with excision of the nipple and preservation of the areola skin. It is unclear whether a bilateral RRM leads to better survival compared with intensive surveillance. The oncological risk associated with the presence of remnant breast glandular tissue after SSM or nipple-sparing mastectomy has been obscure. We report the first case of RRM for a Japanese BRCA mutation carrier and provide a literature review on risk management for BRCA mutation carriers with a focus on the concepts and procedures of RRM.
Adult ; Asian Continental Ancestry Group ; Breast ; Breast Neoplasms ; Female ; Humans ; Mastectomy* ; Mastectomy, Subcutaneous ; Nipples ; Prophylactic Surgical Procedures ; Risk Management ; Skin

BACKGROUNDProphylactic para-aortic nodal dissection (PAND) has no proven benefits for potentially curable advanced gastric cancer. However, the value of therapeutic PAND for involved para-aortic nodes (PANs) in patients with locally advanced gastric cancers has not been determined yet.

METHODSBetween 1998 and 2010, 157 gastric cancer patients with 1-3 involved PANs underwent extended D2 (D2+) lymphadenectomy plus PAND (PAND group, n = 69) or extended D2 lymphadenectomy alone (non-PAND group, n = 88). The clinicopathologic features and prognostic data were compared between the two groups. A propensity score-adjusted analysis was used for a balanced comparison.

RESULTSThe rate of PAN metastasis was 40.6% (28/69) in the PAND group. The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group (43.7% vs. 31.8%, P = 0.044). Compared to the non-PAND group, the death hazard ratios in the PAND group were 0.45 (95% CI 0.274-0.739; P = 0.002) and 0.536 (95% CI 0.328-0.861; P = 0.0097) by multivariate analysis without and with propensity score adjustment respectively. Recurrence rate at 5 years was 39.1% in the PAND group and 43.2% in the non-PAND group (P = 0.628).

CONCLUSIONExtended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.

Adult ; Aged ; Female ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Prophylactic Surgical Procedures ; methods ; Stomach Neoplasms ; surgery ; Treatment Outcome ; Young Adult

Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations:• Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy.• Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve.• Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended.• Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.
Endocrinology ; Fallopian Tubes ; Female ; Genital Diseases, Female ; Gynecology* ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Obstetrics* ; Ovarian Neoplasms ; Ovarian Reserve ; Prophylactic Surgical Procedures ; Reproductive Medicine ; Salpingectomy* ; Sterilization