As a result of introducing swallowing rehabilitation at a special nursing home for the elderly, a resident became able to take food orally for the first time in about 4 years since having a PEG tube inserted. Further, the resident's FIM, FG, and DSS values improved to some extent. While nutritional care using the PEG tube is recognized as a long-term enteral nutritional therapy, the tube is mostly used as a “PEG tube for survival” and scarcely used as a “PEG tube for eating”, which indicates a PEG tube for supporting oral ingestion. The result indicates that it is preferable to use the PEG tube “for eating” in addition to its use as an option for long-term enteral nutritional therapy. The result also indicates the need to conduct, with the cooperation of nurses and nursing care workers, the nutritional care and regular follow-ups of all nursing home residents, as well as to maintain and improve the residents' swallowing function and their activities of daily living (ADL) by continuing swallowing rehabilitation, oral care, and measures against gastroesophageal reflux disease.

Objective: It is important to ensure the quality of preparation in hospital pharmacies.  Therefore, we evaluated the quantitative method of preparation and the stability of allopurinol for external use in a new dosage form.
Methods: The new dosage form utilized two kinds of ointment, white petrolatum and hirudoid soft ointment, and liquid.  Allopurinol was extracted from these preparations by the liquid-liquid partition method, and assayed by high performance liquid chromatography.  A stability test was conducted for six months in the case of the ointments and one month in the case of the liquid.
Results: Good linearity was obtained, in the range of 30˜670 μg/mL (r²≥0.999).  The recovery of allopurinol added to the two kinds of ointment was 97.7-102.0%, and the relative standard deviation was less than 3.0%.  It was observed that the quantity remained relatively constant for one month, and increased after three months.
Conclusion: A quantitative method for the preparation of allopurinol in ointment, using white petrolatum and hirudoid soft ointment, was evaluated.  The results confirmed that allopurinol was stable for one month in ointment and liquid.

Objective : To evaluate the efficacy and safety of botulinum toxin type A (BTXA) in Japanese patients with post-stroke lower limb spasticity in a multicenter, randomized, double-blind, single dose, placebo-controlled study (double-blind phase) followed by an open-label, multiple dose extension (open-label phase). Methods : One hundred and twenty patients with lower limb spasticity were randomized to receive a single treatment with BTXA 300 Units (U) or placebo into lower limb muscles in the double-blind phase. Patients who met the re-injection criteria received up to 3 repeated treatments of BTXA into lower limb muscles with at least 12 weeks between treatments in the open-label phase through 48 weeks. Results : In the double-blind phase there was significant improvement from baseline spasticity in the Modified Ashworth Scale (MAS) ankle score between the BTXA 300U and placebo groups, with a mean difference in the area under the curve (AUC) of -3.428 (p=0.006, t test). The MAS ankle score further decreased from baseline in all repeat treatment cycles of BTXA in the open-label phase. No clinically relevant difference was noted in the frequency of treatment-related adverse events between BTXA-treated and placebo-treated patients during the study period. Conclusions : BTXA reduced spasticity in lower limb muscles from the first treatment with continued long-term efficacy. BTXA is safe and effective for the long-term treatment of post-stroke lower limb spasticity.

Objective : To evaluate the efficacy and safety of botulinum toxin type A (BTXA) in Japanese patients with post-stroke upper limb spasticity in a multicenter, randomized, double-blind, single dose, placebo-controlled study (double-blind phase) followed by an open-label, multiple dose extension (open-label phase). Methods : One hundred and nine patients with upper limb spasticity were randomized to receive a single treatment with either a lower dose (120-150 Units ; U), higher dose (200-240U) BTXA or placebo into upper limb muscles in the double-blind phase. These treatments were administered to improve wrist and finger flexion for all patients and thumb flexion in patients with thumb spasticity. Patients who met the re-injection criteria received up to 3 repeated treatments of BTXA (200-240U) into their upper limb muscles with at least 12 weeks between treatments in the open-label phase through 48 weeks. Results : In the double-blind phase there was significant improvement from baseline spasticity on the Modified Ashworth Scale (MAS) wrist score between the higher dose BTXA and placebo groups, with a mean difference in the area under the curve (AUC) of -6.830 (p<0.001, t test). The MAS wrist score further decreased from baseline in all repeat treatment cycles of BTXA in the open-label phase. No clinically relevant difference was noted in the frequency of treatment-related adverse events between BTXA-treated and placebo-treated patients during the study period. Conclusions : BTXA injections reduced spasticity in the upper limb muscles from the first treatment with continued long-term efficacy. Our results suggest that BTXA injections are safe and effective for the long-term treatment of post-stroke upper limb spasticity.

BACKGROUND/AIMS: A flexible spectral imaging color enhancement system was installed in new capsule software for video capsule endoscopy. Contrast image capsule endoscopy (CICE) is a novel technology using light-emitting diodes selected for the main absorption range of hemoglobin. We assessed the feasibility and diagnostic effi cacy for small bowel surveillance in patients with polyposis syndromes. METHODS: Six patients with polyposis syndromes, four with familial adenomatous polyposis and one each with Cowden syndrome (CS) and Cronkhite-Canada syndrome (CCS) were examined using CICE. We conducted three evaluations to assess the effect on the numbers of the detected polyps; compare polyp diagnostic rates between adenoma and hamartoma; and assess polyp visibility. RESULTS: The numbers of detected polyps and diagnostic accuracy did not differ signifi cantly between pre-contrast and contrast images. However, 50% of the adenomatous polyps displayed enhanced visibility on contrast images. CICE contrast images exhibited clearly demarcated lesions and improved the visibility of minute structures of adenomatous polyps. Hamartomatous polyp micro-structures in patients with CS and CCS were more clearly visualized on contrast than pre-contrast images. CONCLUSIONS: CICE is an effective tool for enhancing the visibility of polyps in patients with polyposis syndrome.
Absorption ; Adenoma ; Adenomatous Polyposis Coli ; Adenomatous Polyps ; Capsule Endoscopes ; Capsule Endoscopy ; Hamartoma Syndrome, Multiple ; Hemoglobins ; Humans ; Intestinal Polyposis ; Polyps

Objective: In the treatment of patients with schizophrenia, pro re nata (PRN) drugs are commonly prescribed for medical indications such as agitation, acute psychiatric symptoms, insomnia, and anxiety. However, high-quality evidence supporting the use of PRN medications is lacking, and these drugs are administered on the basis of clinical experience and habits. Therefore, the actual use of psychotropic PRN drugs and its influence on the patients’ outcomes need to be investigated. Methods: This study included 205 patients who underwent inpatient treatment for schizophrenia. We investigated the prescription of psychotropic drugs before admission and at discharge, as well as the dosing frequency of PRN drugs during hospitalization. We also examined the influence of psychotropic PRN drug use on hospitalization days, antipsychotic polypharmacy, and readmission rates. Results: Patients who used psychotropic PRN drugs during hospitalization had significantly longer hospitalization days (p = 7.5 × 10−4 ) and significantly higher rates of antipsychotic polypharmacy (p = 2.4 × 10−4 ) at discharge than those who did not use psychotropic PRN drugs. Moreover, a higher number of psychotropic PRN drugs used per day was associated with higher readmission rates within 3 months of discharge (p = 4.4 × 10−3 ). Conclusion Psychotropic PRN drug use is associated with prolonged hospitalization, antipsychotic polypharmacy, and increased readmission rates in inpatients with schizophrenia. Therefore, psychiatric symptoms should be stabilized with regularly prescribed medications without the extensive use of psychotropic PRN drugs. Moreover, a system for monitoring and reexamining PRN drug use needs to be established.