Our hospital is located in a mountainous region of Toyota City, Aichi Prefecture. In the sphere covered by our health services, about 34% of the population is 65 years or older. The graying of the community has been progressing rapidly in the past years. Many elderly people do not have a car. Only available means of transport for them are community bus servicers operated once or twice a week. The situation makes them feel disinclined to go to take physicals or visit the hospital for health screening. When we happen to detect gastrointestinal cancer in aged persons, it is often in an advanced state or too late for surgical removal, or a relapse. For some of such cases, we consider the possibilities of chemotherapy.
  Between April 2005 and June 2010, we performed laparotomies (including exploratory operations) on people aged 70 or older with gastrointestinal cancer. Of the patients excluding those with severe cognitive impairment and those in failing health, 25 patients underwent S-1monotherapy postoperatively. The results were no less favorable than those of the cases of younger patients who had received S-monotherapy or other forms of chemotherapy for gastrointestinal cancer. Although this comparison was not adequate because the number of cases of elderly patients was too small, our hospital regards S-1 monotherapy as one of the chemotherapeutic regimens beneficial to old people with gastrointestinal cancer and helpful in maintaining the patient's qualuty of life.

The primary purpose of this study was to investigate whether the baseball pitchers have asymmetric characteristics of muscle thickness (MT) in upper extremities, trunk, and lower extremities because of repetitive pitching. The secondary purpose of this study was to investigate the relationship between MT and ball speed. Twenty-six college baseball pitchers participated in this study. Twenty-six sites were selected to quantify the asymmetric characteristics of MT. The MT was measured by a B-mode ultrasound. The ball speed, measured by a radar gun, was used to quantify the pitching performance. The MT of forearm, subscapula, and chest in dominant side (pitching side) were significantly greater than those in nondominant side, and the MT of abdomen, lateral abdomen, and anterior thigh in nondominant side were significantly greater than those in dominant side. On the other hand, the MT of forearm in both sides and the MT of lateral abdomen in dominant side were significantly and positively correlated with ball speed. These results suggest that asymmetric muscle thickness in upper extremity, trunk, and lower extremity in baseball pitchers resulted from repetitive pitching, and the MT of forearm and lateral abdomen are related to the ball speed.

Moist wound healing for wound treatment has been becoming wide-spread for several years. Open wet-dressing therapy (OWT) is one of the useful therapies at a hospital in a mountainous area where many elderly find it difficult to go to hospital frequently the past. At our department of surgery we also heal pressure ulcers, so we regard Wound bed preparation as important, too. Choice of appropriate types of dressing materials based on concept of Wound bed preparation and Moist wound healing, OWT and information of them enable us to decrease the frequency of hospital visits by the elderly in the mountainous area. It is important for the community in the mountainous area to inform Wound bed preparation, Moist wound healing and OWT for the purpose of safety management of OWT.

Necrotizing fasciitis has a very high acute mortality. Diabetes mellitus often underlies the disease. In this paper, we report two cases of necrotizing fasciitis caused by sacral decubitus, which were successfully treated with withdrawal of pus through radical excision, cleansing and debridement. The patients were: a 74-year-old man with a history of diabetes and depression (case 1) and a 82-year-old man with a history of diabetes and spinal injury which resulted in paraplegia (case 2). In either case, a wide area extending from the buttocks to lower back was cut open for drainage, washing and debridement at an early stage after the onset of necrotizing fasciitis, and broad-spectrum antibiotics were administered. Due to preoperative general health conditions, underlying diseases such as diabetes mellitus and postoperative diapedesis of protein, the patients' nutritional status critically deteriorated after surgery. Consequently, measures were taken to control diabetes and provide nutritional care. These efforts were crowned with success. It was found that early healing of surgical wound necessitated using pressure dispersion type mattresses and turning, on a regular basis, of the bed-ridden patients with decreased mobility, in addition to putting them in rehabilitation.

During exercise at high temperatures, body temperature increases impairing exercise performance and resulting in heat illnesses. Water ingestion during exercise is a simple and practical strategy to prevent hyperthermia. In the present study, we examined the effects of water ingestion interval on thermoregulatory responses during exercise in a hot, humid environment (32t, 80% relative humidity) . Eight male university students performed a 60-min cycling exercise (60% of the maximal O₂ uptake) under four separate conditions; no drinking (ND), water ingestion (mineral water) at 5 (D5), 15 (D15), and 30 (D30) min intervals. The total volume of water ingestion (TWI) was identical during D5, D15, and D30, and equal to the amount of fluid lost in sweat during ND. TWI was divided equally by the number of drinking times in each experiment. During exercise, both rectal and mean skin temperature were lower in D5 than those in the other conditions (p<0.05) . There was no significant difference in total sweat loss between the four conditions, however, evaporative sweat loss and sweat efficiency (evaporative sweat loss total sweat loss) were significantly (p<0.05) higher in D5 than those in the other conditions. These results suggest that the shorter water ingestion interval increases evaporative sweating and attenuates higher body temperature during exercise in a hot, humid environment.

This study was to investigate the effects of balance exercises on among static, dynamic and reactive balance ability in community-dwelling older women. Participants comprised 26 community-dwelling older women in Japan, randomized for age and gait speed to the exercise group (n=13) or the control group (n=13). The exercise group performed structured balancing exercises on the sponge and the G ball, once weekly for 24 weeks. The control group performed stretching exercises once per month. Static balance ability was assessed by measuring postural sway and standing on one leg; dynamic balance ability was assessed by measuring functional reach, timed up and go, and gait; and reactive balance ability was assessed using the EquiTest. We also measured knee and ankle strength using an isokinetic machine.At baseline, the two groups were well matched in physical characteristics and in all balance ability and strength tests. After 24 weeks, step length of preferred speed walking (p=0.049) only improved, and peak torque of knee flexion (p=0.050) tended to improve in the exercise group. Any correlations were not found between step length of preferred speed walking and knee flexion strength.These results suggest that these structured balance exercises are effective in improving dynamic, but not static or reactive balance ability. Improvements in dynamic balance ability were not dependent on improved muscle strength.

The aim of the present study was to measure the amount of nerve growth factor (NGF) present in saliva, and investigate the relationship with aging, gender, and number of retained teeth. The subjects were 93 healthy volunteers (35 males and 58 females) aged 18-87 years. Stimulated saliva was collected during gum chewing, and saliva secretion per minute and NGF concentration per unit volume were measured by enzyme-linked immunosorbent assay. We found that NGF in saliva was measurable in all subjects. The mean NGF concentration in saliva was 55.70 ± 38.27 pg/ml, and no relationship was found between NGF concentration and aging, gender, and the number of retained teeth. The mean NGF amount in saliva was 84.38 ± 71.06 pg/min. The NGF amount in saliva decreased with age, especially for the group aged 70 years and older. It was higher in male than female subjects, and was significantly higher in the group without tooth loss compared to the edentulous group. In addition, regarding the relationship between the saliva flow rate per minute and NGF amount in saliva, the latter increased significantly with a rise in the former. These results indicate that the NGF amount in saliva is influenced by aging, masticatory function, and saliva amount. It is speculated that human salivary glands play an important role in the synthesis and expression of NGF.

To assess the changes in attitudes toward smoking after the smoking-prevention classes presented by Kumamoto Tobacco-Free Forum, this study administered a questionnaire survey to first-year junior high school students before and after a smoking-prevention class at a junior high school. The questionnaire that was used to pre and post comparison comprised thirteen items, ten from the Kano Test for Social Nicotine Dependence (KTSND-Youth) and three as follows: “I think I will be a smoker in the future,” “I think I will smoke about once,” and “What do you think of people around you who smoke tobacco?” The results of this pre- and post-class questionnaire indicate that attitudes toward seven items improved in a statistically significant way. These included four from KTSND-Youth: “Smokers cannot stop even if they want to,” “Smoking is adult-like and cool,” “Smoking is enjoys taste and a fragrance,” and “If it’s a place with an ashtray, it’s okay to smoke.” The smoking-prevention classes significantly decreased total KTSND-Youth scores. Furthermore, the analysis has clarified that the KTSND-Youth items: “Smoking is adult-like and cool” and “Doctor and school teachers say, ‘Tobacco is no good too much”, as well as the item “What do you think of people around you who smoke tobacco?” are significantly influencing factors for the item “I will be a smoker in the future.” These results indicate that the smoking-prevention classes presented by Kumamoto Tobacco-Free Forum were effective for decline in social nicotine dependence of the first-year students in junior high school.

Objective : To provide efficient medical care to patients taking warfarin by developing a system for sharing prothrombin time-international normalized ratio (PT-INR) monitoring data between clinic and pharmacy ; and to verify the functionality of this system.
Methods : Before a clinic appointment, patients visited a pharmacy to self-monitor PT-INR levels with the rapid measuring device Coagucheck. Pharmacists noted the following on a form shared between the clinic and the pharmacy : 1) compliance, 2) side effects, 3) diet, and 4) PT-INR. On the basis of this information, they noted their opinions on the appropriate warfarin dose. Each patient submitted the form to the clinic doctor, who then prescribed warfarin on the basis of the information recorded. After the consultation, the patient took this prescription to the pharmacy to obtain the required medication, and received from the pharmacist the dosage information based on the doctor's instructions. Thus, the sequence of the patient's visits was pharmacy-clinic-pharmacy.
Results : From one pharmacist's report, it was apparent that one patient whose PT-INR level was outside the target range was occasionally skipping a warfarin dose because of a misunderstanding about the treatment. The pharmacist recorded the patient's information on the form to inform the doctor. After consultation with the doctor, the pharmacist gave a detailed explanation on the purpose of taking warfarin. As a result, patient compliance improved and the PT-INR reached the target level after one month.
Discussion : Development of this system revealed that patients can receive appropriate warfarin treatment when information on PT-INR becomes available during clinical consultation and compliance is achieved. The system for sharing the patient's self-monitored PT-INR data between clinic and pharmacy is considered beneficial for the patient.