The case was a man in his 80s, who had been in home care with primary hepatocellular carcinoma before hospitalization. He suffered nausea and appetite loss. However, hypercalcemia in laboratory data, brain metastasis on head CT and MRI, and intestinal obstruction or dilatation on abdominal CT, were not revealed. Upper gastrointestinal endoscopy detected no mechanical abnormality after admission to hospital and medical treatment with 3.75mg/day of mirtazapine was started. The dietary intake increased on the following day of the administration and nausea and appetite loss were improved, so the patient was discharged. In conclusion, low-dose mirtazapine was considered to be one of the effective therapeutic agents for nausea from unknown causes in cancer patients.

This study aimed to clarify the differences in cardiorespiratory and metabolic responses to body mass-based front lunge and squat exercises with relation to muscular activity. Seven healthy adult males performed 200 times body mass-based squat and front lunge exercises. During the exercises, oxygen uptake, heart rate (HR), blood lactate concentration (La), ground reaction force were measured. Oxygen uptake was divided by body mass (VO₂). VO₂ and HR was normalized to maximal VO₂ (%VO₂max) and maximal HR (%HRmax) obtained from an incremental load test. Electromyograms (EMGs) during the two exercises were recorded from the vastus lateralis (VL), rectus femoris, vastus medialis (VM), biceps femoris, gluteus maximus (GM). EMG amplitudes during both exercises were normalized to those during maximal voluntary contraction, and expressed as relative value (%EMG_MVC). Time that cardiorespiratory parameters became stable was 4-6 min in both exercises. VO₂, %VO₂max, metabolic equivalent, were higher in the front lunge than the squat. No significant differences in HR, %HRmax and La were found between both tasks. %EMG_MVC in VL, VM and GM were higher in the front lunge than the squat. These current findings indicate that 1) body mass-based squat and front lunge exercises are physiologically of more than moderate intensity, and 2) the cardiorespiratory responses to body mass-based front lunge are greater than those to body mass-based squat. This may be due to the difference in muscular activities of VL, VM and GM during the tasks.

In this study, we investigated a surface electrode stimulation method to support laryngeal elevation in patients with pharyngeal dysphagia, from the viewpoint of functional electric stimulation (FES). Informed consent was obtained from 15 healthy men and 4 patients with pharyngeal dysphagia. Digastric and stylohyoid muscles were stimulated by silver-textile surface electrodes covering the muscle belly. Laryngeal elevation by the electrical stimulation (ES) during liquid (water, 3ml) swallowing movement was measured by digital video camera. The laryngeal elevation trajectory demonstrated a hysteresis loop. The elevation distance of the larynx increased with a rise of stimulus strength. Laryngeal elevation by ES was 76.0% in the normal subjects and 86.6% in patients when measured during liquid swallowing. Applying FES for laryngeal elevation may assist in improving the swallowing reflex.

  The patient was a woman in her 80s, who was referred to the palliative care team in our hospital for pain due to bone metastases from lung cancer. Although gabapentin and ifenprodil tartrate were administrated in addition to opioids and loxoprofen sodium, and the dose of opioids was increased, pain was not relieved remarkably. A switch from gabapentin to pregabalin brought remarkable pain relief. Before the internal use of pregabalin, the patient was often seen lyiing in bed because of pain. However, by pregabalin, she began to walk, pushing her wheelchair and smile often. Her ability to perform the basic activities of daily living was improved. The switch from gabapentin to pregabalin was one effective option when an analgesic adjuvant for cancer pain was chosen.

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on ¹²³I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.

This study aimed to determine the relationships between the torque generating capacity of the lower extremity muscles and either running or jump performance in primary and junior high school boys. A total of 102 primary and junior high school boys participated in this study. Muscle thicknesses (MTs) of the knee extensors and plantar flexors were determined using ultrasonography. Muscle volumes (MVs) of the knee extensors and plantar flexors were estimated using MTs and limb lengths. The isometric joint torques (TQs) for knee extensors and ankle plantar flexors were measured using myometer. MV and TQ were divided by body mass (MV/BM and TQ/BM, respectively). Running velocity was measured using a non-motorized treadmill. The counter movement jump (CMJ) and squat jump (SJ) were performed on a matswitch system. The flight time was measured and used to calculate the heights of CMJ and SJ using the following equation; height (cm) = g × (flight time)² /8/10. As the result of multiple regression analysis, age, MV/BM and TQ/BM were selected as predictors of running velocity in the primary school boys, whereas TQ and lean body mass in junior high school boys. In the primary school boys, TQ/BM and body fat mass was selected as significant contributors for SJ and CMJ performances, whereas, in the junior high school boys, TQ and the percent of body fat for SJ performance and MV/BM and TQ for CMJ performance. Thus, the present results indicate that the relationships between torque generating capacity of the lower extremity muscles and either running or jump performance differ between primary and junior high school boys. It may be assumed that, for running and jump performances, muscle mass and strength become determinant factors in junior high school boys, whereas their values relative to body mass in primary school boys.

A 72 year-old man underwent coronary angiography (CAG) with a diagnosis of unstable angina pectoris, and 90% stenosis of the LMT was found. Since idiopathic interstitial pneumonia (IIP) had been diagnosed previously, percutaneous transluminal coronary angioplasty (PTCA) was performed. However, his unstable angina recurred after about 2 months restenosis of the LMT to 90% was shown by CAG, and coronary artery bypass grafting (CABG) was performed. In the preoperative chest X-ray, diffuse granular opacities were seen in both lower lungfields, and Velcro rales were heard by ausculation. A spirogram could not be obtained because of his unstable angina, but the PaO₂ was a reasonable 70mmHg when breathing room air. In consideration of the age of the patient, a double coronary artery bypass grafting using a saphenous vein graft (SVG) was performed to minimize duration of anesthesia. His PaO₂ showed a transient decrease after the end of cardiopulmonary bypass (CPB), but the perioperative hemodynamics and respiratory status were stable and extubation was performed on the 1st postoperative day. No aggravation of his IIP occurred postoperatively and he was discharged on the 29th postoperative day.

A total of 961 patients underwent coronary artery bypass grafting (CABG) between 1982 and 1991, and we investigated perioperative cerebral infarction. The average age of operation in these case was 65±4 years. There was 9 patients with hypertension, 7 with diabetes mellitus and 5 with hyperlipidemia. Concerning cerebral infarction, there were 3 patients with multiple infarction, 6 with infarction of the mid cerebral artery area, 1 with infarction of posterior cerebral artery area, 1 with infarction of posterior cerebral artery area, 1 with infarction of pons and 1 with infarction of the ophthalmic artery. The courses of infarction involved atherosclerosis, hypoperfusion during cardiopulmonary bypass, thrombosis due to arterial fibrillation and thrombus on the left ventricular wall. Three patients who had critical cerebral infarction died after CABG. We consider that avoid perioperative cerebral infarction preoperative atherosclerosis, thrombus and to choose the proper procedure of the operation.

Coronary artery bypass grafting using hypothermic circulatory arrest and ventricular fibrillation without aortic cross clamping in 6 patients with severely calcified aortas is described. The use of hypothermic circulatory arrest or ventricular fibrillation has not been established in coronary artery bypass grafting. We recently used aortic no-touch technique in 6 patients. All patients were supported and cooled with cardiopulmonary bypass, and circulatory arrest was performed in 3 patients. With the exception of one hemodialysis patient, 5 patients survived without neurological deficit. We think the aortic no-touch technique is safe and reliable in coronary artery bypass grafting with severe calcified aortas.

Anjo Kosei General Hospital is a large-scale hospital having 692 beds and located in the central part of Aichi. When the hospital moved into the present adress in April 2002, we introduced an electronic chart system that was not common in Japan at that time. Hospital management changed dramatically because until then we were using exclusively papers, and had not possessed even an electronic ordering system. It was also true in the field of medical office work. We hereby report the changes in routines after the introduction of the electronic chart system and its usefulness.The characteristics of our medical work system are as follows.(1)Data refrieval function (Data Ware House)(2)Credit control system(3)Receipt imaging functionWe are evaluating the various effects of the system from seven points of view as follows.(1)Basic data of medical care(2)Staff placement and personnel expenses(3)Work accuracy and efficiency(4)Patients service(5)Storage space reduction(6)Paper reduction(7)In-house questionnaire survey
Work ; Hospitals ; chart ; System ; Reduction (chemical)