Objective : The 2014 Medical Treatment Reward Revision in Japan newly defines the oral intake recovery rate and requires a change of more than 35% to calculate various additions and subtractions. We calculated the recovery rate in various diseases and clarified some inherent problems. Methods : From April 2012 to March 2014, we retrospectively investigated the age, sex, removal rate from nasal nutrition or gastric fistula, oral intake recovery rate and days until removal of 286 inpatients with nasal nutrition or gastric fistula for dysphagia. Results : The removal rates for stroke, brain injury, oral and laryngopharyngeal cancer and other diseases were nearly always more than 50% because the disease did not cause dysphagia directly or the rehabilitation was effective for treating the remaining dysphagia. But the removal rates for neurodegenerative disease, complications due to stroke and brain injury in the chronic phase and respiratory disease did not reach 35% because the previous dysphagia progressed or actualized. Almost all oral intake recovery rates did not extend to 35% for exclusion of oral intake recovery within one month. Conclusion : The criteria of oral intake recovery rate needs to be reviewed in respect to setting goals to match the patient's underlying disease and to evaluate the possibility for early rehabilitation.

The purpose of this study was to investigate the occurrence of gastrointestinal complications and intestinal stasis after a videofluoroscopic examination of swallowing. Of 121 inpatients who underwent videofluoroscopic examinations from October 2008 to March 2009 and September to October 2009, we analyzed 33 patients who underwent abdominal X-ray four days after their videofluoroscopic examination. Six of 33 patients (18.2%) suffered gastrointestinal symptoms. Three patients had diarrhea, two had vomiting, and one had abdominal distention. The incidence of gastrointestinal complications after videofluoroscopic examination was estimated to be two of 33 patients (6.1%) because we assumed that two of the six patients' condition was related to their videofluoroscopic examination and that the other four were related to other factors. One of two patients with a poor general condition developed pneumonia after vomiting. There was no relationship between the incidence of gastrointestinal complications and the patient's background. Intestinal stasis as detected by X-ray was identified in 25 of 33 patients (75.8%). There was more barium sulfate intake in the patients who had intestinal stasis than the patients who had no intestinal stasis. There was no relationship between intestinal stasis and the incidence of gastrointestinal complications. Our findings suggest that the risk of gastrointestinal complications after videofluoroscopic examination is low except in patients with a poor general condition.

Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.

At the 45th Japanese National Acupuncture and Moxibustion Conference, Kitakoji et al. of the Research Committee's Urology Group reported the results of controlled clinical trials, using the envelope method, on the effectiveness of acupuncture for urinary dysfunction. This was presented as a case in which the “Guidelines and Recommendations for clinical Trials in Acupuncture” were applied in actual clinical research. A controlled investigation was carried out by the Information and Evaluation Group, Research Section, Aichi Regional Association, at multiple institutions (9 hospitals and clinics) on the effectiveness of the zhongji (cv-3) point for urinary dysfunction, using the envelope method of Kitakoji et al. Although the zhongji (cv-3) point was not found to be effective against urinary dysfunction, we were able to demonstrate that it is possible to conduct controlled clinical trials at multiple institutions based on soft data.

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

No abstract available.
Crohn Disease* ; Food, Formulated* ; Humans ; Infliximab*

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.
Asian Continental Ancestry Group ; Colectomy ; Colitis, Ulcerative ; Colorectal Neoplasms ; Consensus ; Crohn Disease ; Disease Management* ; Disease Progression ; Early Intervention (Education) ; Epidemiology ; Expert Testimony ; Gastrointestinal Tract ; Hospitalization ; Humans ; Inflammatory Bowel Diseases* ; Japan* ; Prevalence ; Prognosis