1.Attitudes and Opinions of Medical Students in Clinical Years Towards Ethical Issues in Japan.
Atsushi ASAI ; Mayuko SAITO ; Tatsuya SAKAI ; Takuro SHINBO ; Tsuguya Fukui
Medical Education 1998;29(4):221-225
We reviewed essays on clinical ethics written by 94 5th and 6th-year medical students on rotation at the Department of General Internal Medicine of Kyoto University Hospital. Issues regarding brain death, medical decisions concerning the end of life, and informed consent and truth telling were each identified as ethically important by one-third of the students. Approximately 90% of the students expressed a desire to learn more about ethical issues, including actual ethical decisions made by physicians in Japan, cross-cultural differences, medical decisions concerning the end of life, and informed consent. Most students were extremely sensitive to issues of informed consent and truth telling relevant to the patients they cared for.
2.The Number of Lives Saved and Quality-adjusted Life Years Prolonged by Ticlopidine Hydrochloride over the Past 20 years in Japan
Tsuguya Fukui ; Kenji Maeda ; Mahbubur Rahman ; Takeshi Morimoto ; Mayuko Saito ; Kunihiko Matsui ; Takuro Shimbo
General Medicine 2006;7(2):61-70
PURPOSE: Ticlopidine hydrochloride, an antiplatelet agent, is believed to have saved life years in many patients with ischemic cerebral vascular diseases in Japan. But severe adverse events have also been reported. The current investigation aimed to compare two hypothetical cohorts treated with and without ticlopidine in terms of risks and benefits of ticlopidine treatment using Markov model.
METHODS: We conducted Markov decision analysis to estimate the number of lives saved and the increase in quality-adjusted life years (QALYs) over the past 20 years by ticlopidine in Japan. Two cohorts of 60-year-old male patients with previous histories of cerebral infarction, one of which treated with ticlopidine and the other not treated with ticlopidine, were compared with respect to the number of deaths and quality of life (QOL) . Data incorporated were the probabilities of the recurrence of cerebral infarction and the associated mortality, adverse events of the drug, and the utility of health status treated with ticlopidine.
RESULTS: Approximately 1, 630, 000 patients were estimated to be on ticlopidine for variable periods of time during the past 20 years in Japan. With treatment, 17, 130 lives were saved, while 1, 338 patients died because of cerebral bleeding, agranulocytosis, severe hepatic dysfunction, or thrombotic thrombocytic purpura, resulting in a net benefit of 15, 792 lives saved by ticlopidine over the past 20 years. In terms of QOL, there was a total increase of 382, 191 QALYs. Sensitivity analyses showed that the older the patients when ticlopidine therapy was started, the smaller the benefits that were gained by treatment.
CONCLUSIONS: Ticlopidine is considered to have made a great contribution in savingmany lives and improving QALYs in the past 20 years in Japan. This kind of analysis based on Markov model can be employed to demonstrate effectiveness of drugs and medical technologies in terms of population health outcomes.
3.Otsujito Found Effective in Enterocutaneous Fistula after Trying Other Kampo Treatments
Tomoko SUZUKI ; Takuro SAITO ; Nobutoshi SOETA ; Akiyo KANEKO ; Chifumu ISEKI ; Yoshiro SAHASHI ; Hiromi KOMIYA ; Masao SUZUKI ; Taiga FURUTA ; Tadamichi MITSUMA
Kampo Medicine 2017;68(2):127-133
Otsujito is a well-known Kampo medicine for treatment of hemorrhoidal diseases. In the current report, we present end results for a case of enterocutaneous fistula treated with Kampo medicine in accordance with traditional “sho” indications.
An 81 year-old female developed abdominal wall-intestinal fistula right immediately following partial colectomy due to ischemic sigmoid colic perforation 12 years previously. Two years later, she had a fistulectomy and repair using intraperitoneal mesh for abdominal recruitment. Eight years after repair of the enterocutaneous fistula, she had peritonitis caused by the tardive intraperitoneal mesh infection. Since then, she has had frequent repeated ileus and received conservative treatment for two years. Several local operations and abdominal drainages were performed after transfer to Aizu Medical Center. Kigikenchuto was provided for wound healing for approximately 1 year, and one fistula was finally identified. Otsujito dramatically decreased the leakage of intestinal juice and closed her enterocutaneous fistula.
Angelicae Radix as an anti-inflammatory agent, and Cimicifugae Rhizoma as originally indicated, may have played pivotal roles in this case with Otsujito.
4.A Case of Intractable Gastrocutaneous Fistula Successfully Treated with Local Negative Pressure Closure
Takuro KUMAGAI ; Manami NAITO ; Ken SAITO
Journal of the Japanese Association of Rural Medicine 2024;72(5):402-407
A 71-year-old woman underwent gastrostomy due to malnutrition resulting from impaired esophageal peristalsis due to scleroderma. However, the gastrostomy tube was removed due to worsening of difficult-to-treat dermatitis around the gastrostomy. An intractable gastrocutaneous fistula with persistent gastric juice leakage and peri-gastrostomy dermatitis was treated with fistulotomy and local negative pressure closure therapy under local anesthesia. Spontaneous closure of an intractable fistula after gastrostomy removal can be difficult due to underlying malnutrition and exposure to leaking gastric juice, among other factors. The present case suggests that fistulectomy followed by local negative pressure closure therapy for an intractable fistula after gastrostomy removal can enable oral intake in the early postoperative period and also facilitate wound management.
5.Clinical Experience of Enteral Feeding Catheter Placement via the Diaphragm During Esophagectomy and Gastric Tube Reconstruction via the Posterior Mediastinal Route
Masashi ZUGUCHI ; Reijiro SAITO ; Yusuke SAITO ; Kazuki FUSEGAWA ; Daisuke ISHII ; Takuro KUMAGAI ; Yasuhi KAWAHARADA ; Yosuke KUBOTA ; Yoshitaka ENOMOTO ; Katsu HIRAYAMA ; Megumi ZUGUCHI ; Ken SAITO
Journal of the Japanese Association of Rural Medicine 2021;69(5):510-515
Simultaneous creation of an enterostomy for enteral nutrition during esophagectomy has been useful in our experience, but bowel obstruction associated with intestinal fistula remains a problem. Therefore, in this study, we retrospectively reviewed 18 patients with esophageal cancer who underwent transdiaphragmatic transgastric tube enteral feeding catheter placement during gastric tube reconstruction via the mediastinal route after esophagectomy from November 2012 to March 2014. The catheter was guided from the gastric tube into the gastrointestinal tract, with the tip placed in the jejunum distal to the ligament of Treitz. From the gastric tube, the catheter was guided along the diaphragm to the anterior abdominal wall through the extraperitoneal route. No bowel obstruction associated with catheter placement has been observed in any of the patients from the time of surgery to this writing. Also, the procedure enabled jejunostomy use for more than 5 years, similar to conventional jejunostomy. We experienced 1 case of catheter deviation into the mediastinum. Overall, transgastric tube enteral feeding catheter placement for reconstruction of the posterior mediastinal gastric tube was useful for avoiding intestinal obstruction associated with jejunostomy. However, there may be a risk of catheter displacement into the mediastinum.