1.Assessment of switching ratio in 8 cases treated by Oxycodon switched from oral to injection
Palliative Care Research 2014;9(4):514-518
Extended-release Oxycodone tablet has been available for cancer pain treatment since 2003 in Japan. After pure oxycodone injection became available in 2012, we have tried to switch from oral to injection when oral intake becomes difficult because of bowel obstruction, nausea or drowsiness due to progression of the disease. There is no evidence regarding the ratio of switching from oral to injection at present in Japan. We always pay attention to avoid patients drowsiness because of an overdose of opioid, because there is not enough time left for cancer patients in the terminal stage, and drowsiness takes away from the patient’s good QOL. We switched Oxycodone from oral to injection in 8 cases from June to December in 2012. At first, we assess if the patient is well controlled by oral oxycodone or not. If the patient is not relieved from the pain enough, we switch oxycodone from oral to continuous subcutaneous injection with a dose of around 75% at first. After that we titrate the dose little by little up to an appropriate level. We were able to evaluate 5 patients out of 8 because there were 3 patients with consciousness disorder. As a result, we were able to decrease dosage to 46.4% on average.
2.A Surgical Case of Severe Mitral Regurgitation with Idiopathic Hypereosinophilic Syndrome
Taro Hayashi ; Teruo Yamashita ; Yutaka Okita
Japanese Journal of Cardiovascular Surgery 2009;38(1):17-21
Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic disease, but frequently associated with the eosinophil-infiltrated end organ (cardiac, hematologic, cutaneous, neurologic, pulmonary, splenic and thromboembolic) failure. Mechanical valve replacement for valvular heart disease in cases of IHES has the potential of thromboembolic accidents in the early post-operative period, even though the strict anti-coagulant therapy was performed. We reported a younger IHES case with congestive heart failure due to severe mitral regurgitation who underwent mitral valve repair instead of replacement. In this case, only the lateral scallop of the posterior mitral leaflet was involved with endocarditis due to the eosinophyl infiltration, with no other symptoms, i.e., initial hyperplasia and thrombus in the left ventricle that were detected in the most cases with IHES endocarditis. Mitral annuloplasty with the complete ring was simply performed because of the presence of sufficient intact anterior leaflet. The eosinophil count had been strictly controlled with imatinib mesilate in addition to the anti-coagulant therapy, and any thromboembolic event had been detected post operatively. In case of valvular heart disease due to IHES endocarditis, valve repair should be firstly attempt and imatinib mesilate is very useful and effective for preventing from post-operative thromboembolic accidents in FIP1L1-PDGFRα gene positive cases.
3.CHANGES IN BONE METABOLISM MARKERS ASSOCIATED WITH LONG-DISTANCE RUNNING
NAOKI MUKAI ; TOMOO ISHII ; HIROSHI KAMADA ; YUTAKA MIYANAGA ; KOICHIRO HAYASHI
Japanese Journal of Physical Fitness and Sports Medicine 1999;48(1):179-185
To investigate the influence of long-distance running on bone metabolism, we measured bone metabolism markers in eight healthy young men before and 4 months after the start of training program of 10 km running. Measurements were then taken the day before a marathon race, immediately after, and 1 day, 2 days and 5 days after.
As a result of exercise, the levels of serum osteocalcin (OC), a bone formation marker, and urinary deoxypyridinolin (D-Pyr), a bone resorption marker, decreased significantly. After the marathon race, the OC level decreased further corresponding to an increase of hydrocortisone right after the race. However, from the day following the race, the OC level showed a slight increase. D-Pyr showed an increasing tendency immediately after the race, and the levels of OC and D-Pyr increased significantly 5 days after the race.
Bone formation and resorption decreased as a result of light, low-frequency endurance exercise. However, both of them increased after intense physical stress. From this result, it is suggested that the intensity and frequency of exercise affect bone metabolism differently, even though the type of exercise load is similar.
4.The Effect of Community-Based Early Exposure in Medical Education
Yoshiko TOBIMATSU ; Michio HONGO ; Shogo YAMADA ; Noriaki OUCHI ; Yutaka HAYASHI ; Yotaro SHINOZAWA ; Kazuhisa TAKEUCHI ; Yutaka KAGAYA ; Keisei FUJIMORI ; Seiichi ISHII
Medical Education 2005;36(1):55-60
The purpose of this study was to investigate differences between first-year (n=97) and second-year medical students (n=102) in their reactions to a community-based early clinical exposure program. Questionnaires completed after their participation in the program showed that first-and second-year students did not differ in their interest in practical training in nursing homes and wards of the university hospital or in a presentation given by a family member of a cancer patient who had died in the hospital (Chi square test, p<0.05). However, second-year students were more likely to report that they understood the family's presentation well, whereas first-year students were more likely to report they could communicate with elderly or disabled persons. Several facilities in the community criticized the students' attitudes toward practical training. We believe the reason for the criticism was insufficient advance preparation.
5.Cases Report of Bronchial Asthma Attack Successfully Treated with Kampo Medicine
Katsumi HAYASHI ; Nobuyasu SEKIYA ; Takahiko TODO ; Ryosuke OBI ; Yutaka SHIMADA ; Katsutoshi TERASAWA
Kampo Medicine 2004;55(3):325-329
Bronchial asthma is manifested pathophysiologically by a narrowing of air passages with eosinophilic inflammation, and clinically by paroxysmal dyspnea. Usually, the treatment of asthma is governed by the Japanese guidelines for the prevention and control of bronchial asthma. We report two cases of bronchial asthma attack successfully treated with Kampo medicine. For their safety, the patients were hospitalized with informed consent, and evaluated carefully by means of various measures, such as pulse oximeter and peak expiratory flow rate.
In both cases, no application of additional occidental agents was made, except those used before current episode.
However, while modern Western medicine now sweeps over in the treatment of bronchial asthma attack, it is suggested that the Kampo medicine is comparable, in cases where the patients are hospitalized with informed consent, and evaluated carefully. Nevertheless it is proper that the therapy should be intensified in accordance with the guidelines in case of deterioration against the Kampo treatment.
6.Effects of High Concentration Mineral Water Bathing on Deep Body Temperature and Circulatory Function.
Yutaka HORIKIRI ; Megumi SHIMODOUZONO ; Xiao Jin WONG ; Kazuhiko SUDOU ; Kikuwaka HAYASHI ; Nobuyuki TANAKA ; Kaiichi OBARA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 2000;63(4):181-186
The effects of high concentration mineral water bating (31.16g/kg, mainly composed of Na, Ca, Mg chloride and sulfate) were studied in 13 healthy men (44.9±16.3y.o.). The subjects took 41°C, 10min bathing and kept warmth by a blanket for 30min. Blood pressure (BP), Heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and sublingual temperature by electric thermista as deep body temperature were measured during and after bathing. Skin blood flow by LASER doppler flow meter and venous partial gas pressure and pH were also measured.
Sublingual and forehead temperature was increased significantly by +1.4°C after 10min bathing and +0.9°C increase continued even after 30min. Diastolic BP and TPR were significantly decreased, and HR and CO were significantly increased by +20bpm and +2.7l/min, respectively. Significant increase of skin blood flow was also demonstrated. Significant increase of venous pO2 (+20 Torr) and decrease of pCO2 (-8.0 Torr) suggested the improvement of peripheral oxidative metabolism due to increased CO.
High concentration mineral water bathing was highly effective than simple water bathing probably due to the thick coating effect by binding concentrated minerals with skin furface protein.
7.Application of Mohs paste for patients with easy-bleeding superficial malignant tumor regarding control of bleeding
Yuko Ohi ; Masahiro Oana ; Yutaka Hayashi ; Akinori Aikawa ; Fumio Yamazaki ; Shizuyo Ishimaki ; Michiaki Suzuki ; Yuriko Kondo ; Miwa Yamamoto
Palliative Care Research 2009;4(2):346-350
In Palliative care, we meet patients with easy-bleeding superficial malignant tumors, such as head and neck cancer, skin metastasis of all kinds of cancer and unresectable breast cancer. But it is not easy to control bleeding even though we use various means, and many doctors have difficulties in stopping bleeding. We report a case with a recurrent tumor of pharyngeal cancer that showed easy-bleeding and discharged massive exudates. Although she received several alcohol local injections because of bleeding of the tumor, she needed a dressing change over 5 times in a day. It made her QOL worse. In this case, we used Mohs paste and after using it, the surface had been fixed and dried up, resulting in a decrease in bleeding, exudate, frequency of dressing change and bad odor. Mohs paste was made of distilled water, zinc chloride, zinc starch and Glycerol. Zinc chloride changes to zinc ion by water in the wound and makes protein cohere and thereafter tissues, vessels and cell membrane of bacteria are fixed chemically. We could stop bleeding for 15 days with only 20 minutes contact with Mohs paste, and massive exudates and bad odor decreased. Mohs paste, which is made in your hospital pharmacy with cheap materials, can be used for bleeding or massive exudates repeatedly if there is not a thick blood vessel anatomically under the tumor. It was effective to improve her QOL. Palliat Care Res 2009; 4(2): 346-350
8.Report of the second workshop on continuing medical education.
Arito TORII ; Hiroshi KIKUCHI ; Toru ITO ; Tsutomu IWABUCHI ; Kenichi UEMURA ; Michio OGASAWARA ; Kenichi KOBAYASHI ; Shouichi SUZUKI ; Masahiko HATAO ; Shigeru HAYASHI ; Yutaka HIRANO ; Motokazu HORI ; Susumu TANAKA
Medical Education 1987;18(2):97-106
10.Continuing Medical Education in Universities. Questionnaire Analysis of Present Status. (The 2nd Report).
Kenichi KOBAYASHI ; Tsutomu IWABUCHI ; Hiroshi KIKUCHI ; Masahiko HATAO ; Shigeru HAYASHI ; Yutaka HIRANO ; Hiroshi HAMADA ; Takao NAKAGI ; Kazuo SAITO ; Osamu NISHIZAKI ; Ryoichi NISHIMURA ; Arito TORII
Medical Education 1992;23(1):50-54