1.Causes of New Onset Fever among Hospitalized Patients and Predictors for In-Hospital Mortality in a Teaching Hospital in Japan
Kohta Katayama ; Manami Suzuki ; Yukiko Seki ; Nanami Mori ; Yasuharu Tokuda
General Medicine 2015;16(2):84-89
Background: New onset fever is a common symptom among hospitalized patients and it may be a manifestation of fatal illnesses such as infection. However, its epidemiology and predictors for mortality have not been fully determined in a Japanese teaching hospital.
Methods: We investigated adult patients with new onset elevated temperature of 37.5 degrees Celsius or greater the 3rd day after admission during a 4-month study period. Only the first, single episode per patient was analyzed. We determined the causes of fever among these patients with new onset fever. We also analyzed predictors for in-hospital mortality among these patients. These predictors were based on multivariable adjusted logistic regression using demographics, vital signs at the time of fever onset, baseline diseases, and basic laboratory data.
Results: From a total of 2,271 admitted patients, 126 patients (5.6%) developed fever. Among these febrile patients, 98 (78%) had infectious diseases with a prevalence of 4.3% in all admitted patients. The most common cause of infection among those patients was respiratory tract infection, followed by urinary tract infection. Causes for non-infectious fever included neoplastic diseases, inflammatory diseases, and drug fever. In-hospital mortality was associated with lower mean blood pressure <60 mmHg with odds ratio (OR) of 12.7 (95% CI, 1.3–121), tachycardia >90/min with OR 4.1 (95% CI, 1.2–13.5), tachypnea >20/min with OR 10.0 (95% CI, 2.8–35.2), and neoplastic disease with OR 4.1 (95% CI, 1.3–13.1). Infection as a cause of fever was not associated with mortality.
Conclusion: The majority of inpatients with new onset fever had infectious diseases, however fever was also caused by neoplastic diseases, inflammatory diseases and drug fever. Abnormality of vital signs and neoplastic disease were related to in-hospital mortality.
2.A Case of Extremity Pain Onset During Rainy Season Successfully Treated Using Byakujutsubushito
Yukiko MORI ; Kunihiko SUZUKI ; Tetsuro OIKAWA ; Toshihiko HANAWA
Kampo Medicine 2015;66(3):250-255
The patient was a 45-year-old woman who began suffering from pain in her extremities 1 year and 6 months previously, and who received Oketsu-reducing Kampo. Her pain disappeared in a year. Six months after her treatment ended, she visited our hospital again complaining of the same symptom. Due to strong signs of Oketsu, we prescribed her a Kampo that reduces Oketsu, but her pain largely persisted. On re-examination, we noticed that her condition had occurred during the rainy season on both instances and speculated that high humidity and strong ‘wind' may be the reason. Therefore, Byakujutsubushito was prescribed for her, and her pain disappeared in 2 weeks. However, in the following rainy season, she visited us again complaining of the same pain, and Byakujutsubushito was again administered, and that relieved her from pain in 11 days. Although it is stated that Byakujutsubushito is useful for the treatment of pain resulting from dampness and ‘wind', there are very a few reports on this in the Kinkiyoryaku text. Nowadays, we live in air-conditioned spaces, and high humidity results in ‘cool wind’ and exterior dampness. Frequent movement in and out of such spaces worsens extremity pain, and we believe that the incidence of this condition is increasing. And we believe that Byakujutsubushito is one of the most useful formulations for the treatment of this condition that occurs during rainy season.
3.Retrospective Analysis of Characteristics of Mengen
Yukiko MORI ; Tomoyuki HAYASAKI ; Go ITO ; Tetsuro OIKAWA ; Toshihiko HANAWA
Kampo Medicine 2014;65(2):79-86
Mengen is an acute symptom that sometimes occurs after administration of a Kampo formula. It is a shortterm phenomenon and its onset indicates that the patient's clinical course will improve rapidly. It is important to distinguish it from other adverse events, which are not temporary. However, to date, detailed analysis of mengen characteristics such as its frequency, time of onset after Kampo administration, and duration have not been reported. Therefore, we report a precise analysis of mengen characteristics through a literature review of case reports published between 1945 and 2009 in Japan, and retrospective analyses of the cases in our institute.
The literature review revealed that 42% patients developed symptoms of mengen within a day of administration, and 79% developed symptoms within 3 days. In terms of mengen duration, the symptoms persisted for 1 day in 35% cases and 3 days in 63% cases. A diagnosis of mengen proved difficult in 39% cases that presented with atypical symptoms.
Overall, the retrospective analysis of the cases in our institute revealed that 11 patients (7.7%) developed mengen, among 143 patients treated with Kampo between May 2010 and November 2011.
4.Clinical Characteristics of Cases Treated with Kinkiyoryaku-Described Hontonto, Including Two Case Reports
Yukiko MORI ; Hiroshi ODAGUCHI ; Tetsuro OIKAWA ; Toshihiko HANAWA
Kampo Medicine 2014;65(4):302-308
Case 1 was a 24-year-old female suffered from the feeling that her throat was obstructed ; this occurred after she had to talk loudly in front of many people. Case 2 was a 51-year-old female who complained of a palpitation attack ; this occurred after she underwent a hysterectomy. We diagnosed these symptoms as “hontonki.” Hontonki is a case of symptoms rising from the lower abdomen into the chest and throat with feelings of anxiety. When these symptoms appeared, the patients felt as if death were upon them, but when they disappeared, the patients soon felt healthy. There are certain medicines that can be used to treat hontonki. We administered Kinkiyoryaku hontonto (i.e. hontonto as described in Kinkiyoryaku) to them, and it was very effective.
We undertook a retrospective analysis of these two cases, along with 8 other cases successfully treated with Kinkiyoryaku hontonto at our hospital over the last 11 years. We found the common clinical characteristics of hontonki events were paroxysmal symptoms with feelings of anxiety. There are some differences between the clinical characteristics of Kinkiyoryaku hontonto from those of Chugobikyuho hontonto (hontonto as described in Chugobikyuho). The cases of Kinkiyoryaku hontonto are not kyosho (hypofunction) as those of Chugobikyuho hontonto are. Either they have heat symptoms or they do not have coldness, and they have shoulder stiffness or headache as some of the other oketsu symptoms.
5.Usefulness of Senkito when Taken only During Pain in Cluster Headaches
Yukiko MORI ; Yukari GONO ; Tetsuro OIKAWA ; Hiroshi ODAGUCHI ; Toshihiko HANAWA
Kampo Medicine 2016;67(3):274-279
This report describes a case of cluster headaches that was successfully treated with Senkito. The patient was a 46-year-old female. She had been having attacks of cluster headaches that had continued for 3 days at the change of seasons since she was 30 years old. During an attack, she took a triptan preparation and non-steroid anti-inflammatory drug (NSAID), but they were not effective. Recently, the attacks had been increasing in frequency and continued for 1-2 weeks. She visited our hospital for Kampo treatment. We diagnosed her as having oketsu and kiutsu ; therefore, we prescribed tsudosan, and the frequency and strength of the attacks decreased. Even if NSAIDs were effective for headaches, they were not consistently effective. We re-examined her and found she had inside biryokotsu, which is tenderness in the orbital part of the frontal bone. We diagnosed her headache as including biryokotsu pain. We prescribed Senkito as required for her biryokotsu pain. It was very effective and the headache vanished after only 30 min. Generally, the potency of Kampo medicines with few structural components is higher than that of those with many structural components. Senkito has only five structural components ; therefore, we concluded that Senkito is effective not only for everyday use but also for use when required. Senkito is one of the most effective formulations for treatment of biryokotsu pain,especially the patient with inside of biryokotsu tenderness.
6.3.Revision of Procedures for Appropriate Management of Revlimid® and Pomalyst® (RevMate®)and Iss
Shoken KITAGAWA ; Yukiko TAKANO ; Masato ITO ; Hiromi KATSUMATA ; Sawa MORI
Japanese Journal of Pharmacoepidemiology 2017;22(1):19-28
RevMate®is one of risk minimization activities in Japanese RMPs of Revlimd®and Pomalyst®, of which indications are hematological malignancy including multiple myeloma. This is a proper management procedure approved by Japanese health authorities in order to prevent exposure to pregnant women because these agents are derivatives of thalidomide. RevMate® was revised in 2015 after the discussion in MHLW's Taskforce and its operation started from April 2016. Due to this revision of version 5.0, the manufacture no longer receives the patient name, and this and other information must be managed by the hospital. In addition, with regard to the same objective in the format used in the management procedure(TERMS®)of thalidomide drug products, unification was attempted concerning the name of the format and
the notation of confirmation items. Physician becomes to make judgment to omit explanation of some RevMate® requirements based on the patient's level of their understandings to RevMate®.Periodical survey sheet regarding compliance with RevMate® requirement filled by a patient is to be submitted directly to a physician on his/her visit instead of sending it to the manufacturer by mail under previous procedures. A representative person of the manufacture is required to visit the hospital periodically and confirm filing condition of the survey sheets and compliance check lists of RevMate® for every prescription as well appropriately at the hospital. Furthermore, RevMate® was revised to add clear role description of relevant pharmacists and nurses for in-patients and its strict drug-handling procedures at bedside as version 5.1, as we received four reports from hospitals of medication error of our drug to the another patient in the hospital within 2016. After getting approval of additional indications for Revlimid® from March 2017, RevMate® of version 5.2 started. In the view of implement RevMate® as strict “risk minimization activities” to prevent pregnant women from exposure, we will continue to solve each problem recognized from the actual operation, constantly keep basics in mind by providing necessary training to our employees about thalidomide drug problem etc. In addition, we appreciate the understanding and support from the patient, patient family, Healthcare Professional, etc. involved in this procedure without incompleteness as well as non-compliance with procedures caused by habituation. Including all these, we consider it is important to endeavor as a manufacture continuously in the future.
7.HOME BASED EXERCISE EFFECTS ON COGNITION IN THE SEMI-INDEPENDENT ELDERLY
FUKI NAKAYAMA ; TAKURO TOBINA ; MAKOTO AYABE ; YUKIKO DOI ; YUKARI MORI ; TATSUO YAMADA ; AKIRA KIYONAGA ; HIROAKI TANAKA
Japanese Journal of Physical Fitness and Sports Medicine 2011;60(4):379-386
This study sought to determine whether aerobic exercise training affects cognitive functioning among semi-independent (> 75 years) and independent elderly people. Seventy-six semi-independent and independent elderly subjects were divided into the following groups: semi-independent control (n = 16); semi-independent training (n = 13); independent control (n = 22); independent training (n = 25). During the 12-week intervention, subjects in both training groups performed a bench-stepping exercise at the intensity of the lactate threshold. Subjects were assessed at baseline and post-intervention using the Frontal Assessment Battery test (FAB), the Modified Mini-Mental State Exam (3MS), and a bench-stepping test of aerobic capacity. During the intervention, FAB scores improved only in the semi-independent training group (p = .002), while 3MS and MMSE scores improved in both the semi-independent training (p = .032 and p = .004) and independent training groups (p = .001 and p = .013). FAB and 3MS scores were higher in the semi-independent training (p = .001 and p = .002) compared with the semi-independent control group after the intervention. Finally, post-intervention scores for FAB, and 3MS in the semi-independent training group almost reached the baseline levels of the independent control and independent training groups. These results indicate that moderate intensity bench-stepping exercise training can improve cognitive and frontal lobe functioning in semi-independent elderly people, almost to the level exhibited by independent elderly people.
8.Factors Supporting Continuation of Recuperation at Home of a Respirator Wearing Patient
Chihiro MIZUTA ; Yukiko NAKAGAWA ; Kumiko KATO ; Yoshifumi NARITA ; Tsukasa SAITO ; Masaki MORI
Journal of the Japanese Association of Rural Medicine 2004;53(4):685-691
Two years have passed since a patient who started to use the respirator for a tuberculosis sequela and chronic respiratory failure at home. During this period, the patient got several short-term admissions into the hospital. After his first discharge, the patient and his family felt anxiety about recupration at home. It was the first time for us to provide home care services to a respirator wearing patient. However, the shift to recuperation at home was realized as an understanding was reached between physicians who decided upon care home and the patient's wife who wished “to live with the husband together”. The patient is now playing a role as a father and as a husband, and he is leading a full life. In this study, the personal and familial circumstances of the patient, decision-making about home care and community support were analized. We coucluded that there were several important factors for successful recuperation at home:specification of contents of concrete medical support to a patient and a family;an immediate suitable action at the time of change of a patient's condition;taking periodic rests of a patient and a family;and a good family relationship.
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9.A Total Surface-bearing Prosthesis for a Below-the-knee Amputee due to Carcinoma arising from a Burn Scar
Toshiki MORI ; Kazuto AKABOSHI ; Yukiko KOBAYASHI ; Yuko TAKAO ; Masaaki NAGATA ; Meigen LIU
The Japanese Journal of Rehabilitation Medicine 2009;46(9):583-587
Severe burn injuries often result in significant long-term physical complications with scarring and contractures, but cancers associated with chronic burn scars are relatively rare. We report a case of a 58-year-old man with skin cancer arising from a healed burn scar. He initially suffered from an extensive fire burn on both lower limbs as a child. The burn scars extended from his upper thighs to his toes bilaterally and caused severe contractures which immobilized the ankles in plantar flexion. Two years ago, he noticed a small ulcerated lesion on the right heel and self-treated it with topical ointments. However, the ulcer increased in size and became malodorous. He presented to a clinic with a large, ulcerated, tumorous lesion, and histology proved it to be squamous cell carcinoma. He subsequently underwent a right below-the-knee amputation, and the previous scars presented on the stump. Thus the patient received a total surface bearing prosthesis with an Icelandic roll-on silicone socket system, which is ideal for patients with extensive scarring at the stump because it may reduce prosthesis-induced stump injuries by evenly distributing the patient's weight in the socket. After he left the hospital, he walked so far with the prosthesis every day that small ulcers often developed at the right popliteal fossa. However, he did not take care to treat these lesions properly, so we had to educate him on how to treat them. Patients such as these will often require education for self-management, family involvement and regular follow-up to monitor scar ulceration and watch out for any malignant transformation.
10.Three Asymptomatic Cases of Suspected Drug-Induced Liver Injury Possibly Caused by Scutellariae Radix
Tetsuro OIKAWA ; Yukari GONO ; Tomoaki FUKUDA ; Tomoe HORIKAWA ; Hiromitsu HOTTA ; Yukiko MORI ; Tadaaki KAWANABE ; Tatsuya ISHIGE ; Hiroshi ODAGUCHI ; Akino WAKASUGI ; Toshiyuki OKUTOMI ; Toshihiko HANAWA
Kampo Medicine 2015;66(3):212-217
Case reports of drug-induced liver injury caused by Kampo medicines are on the rise, but most of them are noted for related symptoms such as jaundice. Usually, severe liver injury is detected by chance upon routine medical checkup. Recently, we noted 3 cases of suspected drug-induced liver injury caused by orengedokuto, saikokeishikankyoto and bofutsushosan. In these 3 cases, maximum ALT was under 100 IU/l and no symptoms related to liver injury were observed. Early detection by blood test was useful, and appropriate treatment quickly improved and normalized the abnormal values associated with liver injury. We should always be alert for drug-induced liver injury caused by Kampo medicines, especially when prescribing formulations that include Scutellariae Radix. We also emphasize the importance of scheduling blood tests when prescribing these formulations.