The Ministry of Health, Labor and Welfare on March 1, 2008, made public a guideline for putting in order hospitals expected to play central roles as strongholds in fighting cancer. The guideline called on these major hospitals to tabulate critical pathways in collaboration with community medical facilities and share the tables among them. In preparation for this collaborative project, we made a questionnaire survey to sound out the practitioners in the Ama area on this.  The survey found that opinions of some respondents differed widely from what the hospitals thought should be. Those which replied that they were ready to accept cancer patients accounted for 52.6% of the respondents. Some facilities, which said they were going to take care of cancer patients in any stage, were not capable of palliative care. It was also found that there were many facilities who did not like to accept patients referred to them from hospitals. From these findings, we thought more efforts should bemade to establish closer cooperation between clinics and hospitals.

Like the "day hospices" for cancer patients in England, Japanese day care services may be an effective resource for home-based palliative care. A questionnaire survey was done to investigate what medical services are available to cancer patients in existing day care centers in Japan. Methods: In November 2004, the questionnaire was sent to 108 day care centers in Okayama Prefecture, and there were 49 responses. Results: Out of the 49 day care centers, 36 had been used by cancer patients, 28 (56%) of those centers actually had cancer patients attending at the time of survey, and 4 (8%) of those centers provided special programs for cancer patients. The results of the questionnaire showed that day care centers should provide the following services to enhance domiciliary palliative care for cancer patients: 1) medical palliative treatment; 2) medically supervised special day care services, such as bathing; 3) resting periods to meet the client's needs; 4) medical function support therapy, such as stoma-care, parenteral nutrition, and infusion; and 5) psycho-social support for the patients as well as their families. Conclusion: Existing day care centers in Japan could be effective in functioning as day hospices, similar to those that exist in England.

Purpose: Morphine is often administrated through a nosogastric catheter in palliative medicine. As adhesion to the catheter and its stoppage is problematic, adhesion of morphine granules in a nosogastric-tube was investigated. Methods: We investigated it in three following conditions. (1)four morphine products, which were three morphine granules (Pacif®, MS-twicelon® and Kadian®) and a morphine fine granule (Morphes®). (2)four different suspensions of composition, which were water, milk, enteral nutrition liquid and jellied suspension liquid. (3)two sizes of nosogastric catheter (10.5Fr and 13.5Fr). Each morphine product at a dose of 30mg was diluted by each suspension of 20mL in a cup, and injected into each size of nosogastric catheters using a syringe. And the catheter was flushed by the same suspension of 20mL. We counted the granule that adhered to the cup, the syringe and the catheter. Results: As for Pacif® and MS-twicelon®, jellied suspension liquid significantly decreased the number of morphine granules adhered than any of the other suspensions (One-Way Factorial ANOVA and Scheffe's F test: p<0.05) in both sizes of catheters. Only jellied suspension liquid made Kadian® pass the both catheters, but they were obstructed by Kadian® diluted in the other suspensions. Morphes® diluted in water had a tendency to adhere compared to those in milk, enteral nutrition liquid or jellied suspension liquid. Additionally, using the jellied suspension liquid, the maximum dosing of Pacif®, MS-twicelon® and Kadian® were 240mg, 90mg and 60mg, respectively. Conclusion: When administering morphine granules through a nasogastric-tube, using jellied suspension liquid is recommended. Palliat Care Res 2008; 3(2): 101-107

A cyanotic baby boy was given a diagnosis of single right ventricle, double outlet right ventricle, hypoplastic aortic arch, mitral atresia, atrial septal defect and pulmonary-ductus-descending aorta trunk. On day 4, extended aortic arch anastomosis and pulmonary artery banding were undertaken. At age 70 days, severe cyanosis and respiratory distress appeared and advanced rapidly. Angiography revealed critical subaortic stenosis and pulmonary hypertension, and the patient required urgent Damus-Kaye-Stansel anastomosis with concomitant right modified Blalock-Taussig shunt. Patients with single ventricle and hypoplastic aortic arch are a high-risk subgroup of progressive subaortic stenosis after initial pulmonary artery banding, and therefore need careful observation and may require early relief of subaortic stenosis.

A vascular access catheter has been widely used for hemodialysis patients in an emergency when an arteriovenous shunt get clogged and cannot be reopened or when patients have no arterio-venous fistula. However, it often causes deterioration in activities of daily living (ADLs) and other troubles. Therefore, we place the catheter into the internal jugular vein in the neck to minimize the risk of complications and patients' inconvenience. Nevertheless, free spaces tend to be created between the dressing agent and skin because the articular excursion is wide in the neck. Although the CDC (Centerfor Disease Control and Prevention) guidelines recommended that the dressing tapes should be changed once every seven days, we change the tapes every two or four days to avoid peeling-off. In this study, we examine the difference in fixation ability between two types of tapes;standard size (10×12 cm) and 1/4 cut-size (5×6 cm). Our results showed that there were significant differences in peeling-off area between the two tapes. The smaller-sized tape had better adhesion to the skin so that you could not peel it off easily. Furthermore, the smaller one stuck fast to the catheter and needed less replacement. Consequently, the skins seemed to be more protected.
Catheter ; Blood vascular ; SIZES ; Access ; Fixation - action

A 6-year-old boy who had been found to have hypertrophic obstructive cardiomyopathy presented with severely limited symptoms of heart failure due to progressive left ventricular outflow obstruction. Cardiac catheterization revealed the peak systolic pressure gradient of 87mmHg at left ventricular outflow, and systolic anterior motion of the anterior mitral leaflet with concomitant mitral regurgitation was observed by echocardiography. Transaortic septal myectomy was performed using transesophageal echocardiography guidance before, during and after surgery. Although the patient needed permanent pacemaker implantation for postoperative complete heart block, the procedure reduced the left ventricular outflow obstruction and relieved his symptoms.

A baby girl with a low birth weight was given a diagnosis of congenital bicuspid aortic stenosis and mitral valve prolapse. At the age of 40 days, she underwent balloon aortic valvotomy, but significant aortic regurgitation appeared afterwards. Another surgical intervention became necessary by the age of 20 months (weight, 5.7 kg), because of intractable heart failure mostly caused by exacerbated mitral regurgitation. We performed a leaflet extension valvuloplasty for the small bicuspid aortic valve using an autologous pericardium treated by glutaraldehyde. The mitral valve was replaced with an ATS-16AP valve. Although her postoperative course was complicated with mitral paravalvular leakage and poor left ventricular function, she was discharged from hospital 6 months post operatevely. Leaflet extension valvuloplasty is a surgical option for infants with a small aortic annulus, but the procedure could be the only solution in cases when Konno or Ross techniques are not suitable.

A 62-year-old woman was admitted to our hospital because of dextrocardia on her chest X-ray film. She had been in good health though the X-ray abnormality had been pointed out from her childhood. Echocardiogram, magnetic resonance imaging, and cardiac catheterization revealed situs inversus, congenitally corrected transposition of the great arteries, and severe tricuspid valve (systemic atrioventricular valve) regurgitation with mild systemic ventricular dysfunction. The surgeon stood on the patient's left side during the operation. On cardiopulmonary bypass, the tricuspid valve, facing almost dorsally, was exposed through a superior transseptal approach. Tricuspid valve replacement with a mechanical valve was performed with leaflet preservation. Systemic ventricular function is preserved at one year after operation.

  A vascular access catheter has been widely used for hemodialysis patients in an emergency when an arteriovenous shunt get clogged and cannot be reopened or when patients have no arterio-venous fistula. However, it often causes deterioration in activities of daily living (ADLs) and other troubles. Therefore, we place the catheter into the internal jugular vein in the neck to minimize the risk of complications and patients' inconvenience. Nevertheless, free spaces tend to be created between the dressing agent and skin because the articular excursion is wide in the neck. Although the CDC (Centerfor Disease Control and Prevention) guidelines recommended that the dressing tapes should be changed once every seven days, we change the tapes every two or four days to avoid peeling-off. In this study, we examine the difference in fixation ability between two types of tapes;standard size (10×12 cm) and 1/4 cut-size (5×6 cm). Our results showed that there were significant differences in peeling-off area between the two tapes. The smaller-sized tape had better adhesion to the skin so that you could not peel it off easily. Furthermore, the smaller one stuck fast to the catheter and needed less replacement. Consequently, the skins seemed to be more protected.

This study aimed to evaluate dynamic balance capability, bathyesthesia, and the composite compensation of bathyesthesia and visual sense for dynamic balance assessed by use of force plates and to examine their correlation to age in a cross-sectorial manner. Participants of this study were 147 healthy people (55 men, 92 women). To evaluate dynamic balance capability, we evaluated the index of postural stability (IPS), which is the logarithmic value of the ratio of the area of stability limits to the area of postural sway, with participants standing on a hard surface with eyes opened. To measure bathyesthesia, we evaluated the modified index of postural stability (MIPS), i.e., the IPS with participants standing on a soft surface with eyes closed. As for the composite compensation index of bathyesthesia and visual sense for dynamic balance, we calculated the rubber IPS Romberg ratio (MIPS/IPS). The correlation coefficients (Spearman’s rho) of IPS, MIPS and MIPS/IPS to age were −0.666 (p < 0.001), −0.697 (p < 0.001) and −0.600 (p < 0.001), respectively. These results suggest that dynamic balance capability and bathyesthesia decline with advancing age, and the composite compensation of bathyesthesia and visual sense for dynamic balance strengthens with advancing age.