This paper presents the case of a man in his 70's with local advanced bladder cancer with hospital-developed Fournier's gangrene. The patient was hospitalized at the palliative care unit, and drainage with incision of the scrotum for symptom relief was performed to relieve severe pain. The patient experienced pain only during changing of the wound's dressing and no pain at rest after the operation. Furthermore, he reached his birthday and spent time in peace with his family. Fournier's gangrene is the necrotizing fasciitis of perineal and anal lesions, in which inflammation progresses rapidly in wide lesions, and it is associated with a high mortality rate. For Fournier's gangrene in a terminally ill patient, current agreement might depend on the patient's goal of treatment. The drainage provided for spiritual care of the patient and his family as well as pain relief. In conclusion, local drainage for Fournier's gangrene can be feasible as a choice of palliative treatment. Palliat Care Res 2011; 6(2): 340-343

Footballer 's ankle is anterior bony spur or anterior impingement symptom of the ankle with anterior ankle pain, limited and painful dorsiflexion. The cause is commonly seen in athletes and dancers, and is probably due to repetitive minor trauma. The condition was firstly described by Morris; McMurray reported good results from excision of the spurs, naming it footballer' s ankle. Opening resection of osteophytes of the anterior tibial and superior talar is an effective treatment for anterior impingement of the ankle.
Adult ; Ankle Injuries ; etiology ; Athletic Injuries ; etiology ; Football ; Humans ; Male

A main symptom of chronic fatigue syndrome (CFS) is fatigue which continues for more than 6 months and does not improve with rest, leading to a marked decrease in quality of life. Other problems include fever, sleep disorder, and headache. Etiologically, a preceding viral infection, immunological disorder, and changes in the central nervous system, especially in hippocampus have been reported. However, the precise pathogenesis of CFS has not been elucidated, and neither diagnostic markers nor effective treatments have yet to be discovered. Here, we report a case of CFS, successfully treated with Kampo medicines.
The patient was a 16-year-old high school student, who had received medical therapy for one year under the diagnosis of CFS. His chief complaint was a continuing fever and strong malaise after influenza infection. At his visit to our outpatient clinic, we confirmed that his symptoms met the criteria for CFS. A combination treatment with Kampo medicine (sanoshashinto) and duloxetine improved his malaise and fatigue in 4 weeks, but fever and anorexia remained. The addition of hochuekkito to the combination dramatically ameliorated his symptoms. This case suggests that Kampo medicines would contribute to the effective treatment of CFS, which is refractory to Western medicines.

Introduction: Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) and the previous reports show that may reduce nausea by inhibition of the serotonin 5-HT3receptor. Case report: A 38-year-old woman with advanced renal cancer with distant metastases was administered by sunitinib and oxycodone. Refractory nausea and vomiting developed during the course and mirtazapine at a daily dose of 1.875 mg was begun. The patient's nausea improved during the next day, and furthermore, by increasing the daily dose to 3.75 mg, vomiting was also improved on the third day. The therapy could be continued without withdrawal of sunitinib and oxycodone due to digestive symptoms. Although somnolence might be induced at a daily dose of 15 mg, the present low-dose mirtazapine could improve digestive symptoms without somnolence. Conclusion: We conclude that low-dose mirtazapine is one effective option for refractory nausea and vomiting during administration of sunitinib and oxycodone.

Conventional footplates place physical burden on helpers due to various incidents with the footplates and the need to bend over to operate the footplate. Therefore, we examined the introduction of a semi-automated retractable footplate with a ratchet mechanism (hereafter, semi-automated retractable footrest) and investigated its safety and convenience. Both patients and staff reported that the semi-automated retractable footrest was useful. We also found that the semi-automated retractable footrest was free of incidents, reduced physical burden, and enabled helpers to avoid contamination of their hands. However, we also found aspects of the semi-automated retractable footrest that need to be improved.

BACKGROUND: Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. METHODS: A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. RESULTS: The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1+/-3.74 kg/m2). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. CONCLUSIONS: Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.
Body Mass Index ; Comorbidity ; Diabetes Mellitus ; Humans ; Mammary Arteries ; Mediastinitis ; Mortality ; Omentum ; Postoperative Complications ; Rectus Abdominis ; Retrospective Studies ; Risk Factors* ; Staphylococcus aureus ; Sternotomy ; Surgical Flaps ; Thoracic Surgery ; Wound Infection* ; Wounds and Injuries

Purpose: This study was performed to compare the characteristics of home palliative care for elderly patients with cancer between age groups. Methods: The clinical records of 1,032 patients with cancer who received home medical care from June to November 2013 were reviewed retrospectively. Patients were classified as non-elderly (<65 years old), young-old (65-74 years), old-old (75-84 years), or oldest-old (≥85 years), and these groups were compared with respect to demographic characteristics, patient/family problems, outcomes, and medical care and services provided. Results: There was a higher percentage of patients with no caregiver in the oldest-old group than in the other groups (18%, p=0.014), while the young-old and oldest-old groups had a higher percentage of problems related to caregiving such as caregiver burden or absence of a caregiver (32% and 33%, p=0.002, respectively). In addition, the percentage of patients who required visiting nurses and care was higher in the old-old group (86% and 30%, respectively) and oldest-old group (89% and 35%, respectively) compared with the other two groups. Conclusion: Problems related to caregiving, such as caregiver burden or absence of a caregiver, were greater in the old-old and oldest-old groups, and a higher percentage of patients required visiting nurses and care in those two groups.

We investigated the actual condition of patients treated by acupuncture and moxibution in Ibaragi Prefecture.
Subjects were 1823 patients (846 men, 977 women) under the treatment of 14 acupuncture clinics in September to November, 1985.
We prepared the evaluated list that consisted of 11 levels of activities of daily life and 8 degrees of pain.
In every treatment, we wrote down the patient's clinical progress in relation with the list.
The following results were obtained
1. There were many patients in thier forties and fifties.
2. There were many patients who received only one treatment.
3. The chief complaints were low back pains (509 patients), shoulder discomfort (273) knee joint pain (132), etc.
4. Most of the patients could still go on with thier daily lives in spite of the pains.
5. The effects of treatment were rated as follows; better 69.5%, no change 23.9%, worse 5.9%.

Objective: This study investigated the association between use of sedatives in terminal cancer patients near death who were receiving home care and the home care period. Methods: We conducted a retrospective review of the medical records for 1032 cancer patients who received home palliative care from 17 specialized home care clinics between June and November 2013. We checked the use of sedatives within 48 hours before death at home, and we compared the home care period between patients with and without sedation. Results: The sedatives used were diazepam (n, %: 100, 52%), flunitrazepam (29, 15%), bromazepam (27, 14%), midazolam (26, 13%), and phenobarbital (20, 10%). The median home care period (median [quartiles]) was 26 [13, 63] days and 25 [10, 64] days (Adj p=0.79) for the patients with and without sedatives, respectively. Conclusion: Among terminal cancer patients near death receiving home care, 24% were administered sedatives, with more than half of those patients receiving diazepam. There was no association between use of sedatives and the home care period.