The Saku Central Hospital started a joint undertaking for home health care with four village offices of Minamisaku-gun, Nagano Prefecture, from 1988. From 1995, the joint project was taken over by its satellite institution, Koumimachi Clinic. During the year, care services were provided in patients' homes by a full-time visiting nurse 665 times. She helped physical therapist with rehabilitation 228 times, attended many meetings related to health care with local people and public health nurses, and held case conferences about patients. The joint undertaking for home health care with local goverments may be important for better home health care.

  Our hospital is the only general hospital in Akitakata City, Hiroshima Prefecture. It plays an important role as a core hospital in enhanceing the quality of medical care, welfare, and health care in this region. With the advent of the super-aging society, the needs of aged patients are complicated and diverse. Accordingly, the problems and needs of patients have become difficult to cope with by medical treatment alone. To cope with the current situation, in April 2010, we established the Department of Outpatient Nursing Care, which is managed by nurses certified as palliative care and dementia care specialists, aiming to support medical treatment and lives for patients. The Department of Outpatient Palliative Care specializes in caring for patients with diseases such as cancer as well as their families, and the Department of Outpatient Memory Care specializes in caring for dementia patients and their families. These departments intend to provide not only medical treatment to people in our community but also support patients so as to enable them to spend the rest of their lives in peace. Here, we report our nursing care activities.

We have provided home health care to 42 patients with terminal cancer over the past five years. The pancreas was the most common site of the primary cencers (9 cases). The average age of the dead was 74.6 years, which was younger than that from heart failure or brain infarction. The average duration of stay of home was 60.1 days. The average frequency of visit to a patient's home was 15.8 times. In 52.4% of the cases, morphine were administered for pain control. The average dose was 48.2 mg per day, and term of administration was 30.6 days. In most cases, those who looked after the patients were daugh-in-laws or wives.
In some cases, a local government lent a bed to a patient. Of the patients 21.4% were fold by their physicians what they are up to were. In conclusion, home health care of cases of terminal cancer will be more important in the future. Pain control by morphine, support for those who look after the patients by frequent visits, practical use of the welfare system and full-time medical care system which meets patients' need are thought to be necessary.

The number of patients with pancreatic cancer (PC) is currently increasing in both Korea and Japan. The 5-year survival rate of patients with PC 13.0%; however, resection with minimal invasion (tumor size: ≤10 mm) increases the 5-year survival rate to 80%. For this reason, early detection is essential, but most patients with early-stage PC are asymptomatic. Early detection of PC has been reported to require screening of high-risk individuals (HRIs), such as those with a family history of PC, inherited cancer syndromes, intraductal papillary mucinous neoplasm, or chronic pancreatitis. Studies on screening of these HRIs have confirmed a significantly better prognosis among patients with PC who were screened than for patients with PC who were not screened. However, to date in Japan, most patients with early-stage PC diagnosed in routine clinics were not diagnosed during annual health checks or by surveillance; rather, PC was detected in these patients by incidental findings during examinations for other diseases. We need to increase the precision of the PC screening and diagnostic processes by introducing new technologies, and we need to pay greater attention to incidental clinical findings.

BACKGROUND/AIMS: The relationship between the appearance of an ulcer and postoperative bleeding after gastric endoscopic submucosal dissection (ESD) is not well understood. To explore this potential relationship, we retrospectively analyzed the short-term healing process of ESD. METHODS: A total of 520 consecutive lesions in 434 patients seen between January 2004 and December 2009 were retrospectively investigated. At the second-look endoscopy, which occurred between 1 and 8 days after ESD, artificial ulcers were categorized into 6 patterns according to Forrest's classification: spurting bleeding, oozing bleeding, non-bleeding visible vessel, adherent clot, black base/spot, and clean base. From these data, a short-term healing model of the artificial ulcer was generated. RESULTS: Ulcer base changed gradually from a bloody to a clean one. The bleeding or non-bleeding visible vessel categories, which occurred in approximately one quarter of the ulcers within 3 days of ESD, were rarely observed 4 days after ESD. CONCLUSIONS: Ulcers that occur after gastric ESD heal in line with a specific time course, and it appears that most healing occurs without massive bleeding.
Endoscopy ; Glycosaminoglycans ; Hemorrhage ; Humans ; Retrospective Studies ; Stomach Neoplasms ; Ulcer

We performed combination therapy with modified oxaliplatin/l-LV/5-FU (mFOLFOX) in a patient with recurrent colorectal cancer who had peritonitis carcinomatosis. In this patient, mFOLFOX therapy resulted in disappearance of ascites and a decrease in carbohydrate antigen 19-9 (CA19-9), and improved quality of life (QOL) of the patient. This 62-year-old man was diagnosed with ascending colon cancer and metastatic cancer of the liver. Right hemicolectomy and right hepatic lobectomy were performed. We had started to treat with TS-1 in ambulatory care, however, he had peritonitis carcinomatosis with massive ascite reservoir on CT and peritoneal dissemination after a half year postoperatively. Furthermore, his ECOG Performance Status (PS) was rated as level 3. Therefore, we performed puncture of ascites and palliative mFOLFOX6 therapy. After ten courses, ascites and abdominal induration had disappeared and PS recovered to level 1. At present, CPT-11/l-LV/5-FU (FOLFIRI) are being administered for peripheral neuropathy and metastatic tumor associated with mFOLFOX6. The patient is spending his daily life satisfactory after FOLFIRI without abdominal swelling or ascites, and thus mFOLFOX6 may be an option for palliative therapy against massive ascites in patients with advanced colorectal cancer. The usefulness of palliative mFOLFOX6 therapy for patients with massive ascites should be evaluated in a well-designed clinical trial.Palliat Care Res 2008; 3(2): 316-320

Effects of taurine on the functions of the body and metabolism with 3km running upon taking a diet, which is constituted of lowest possible amount of carbohydrate and highest possible amount of fat and protein, were investigated in 25 male and female subjects of age thirties by double blind test method. The results were as follows
1) Taurine administration (T. A.) proved to inhibit the degree of increase in heart rate and increase the maximal degree of pulse pressure in response to 3 km running.
2) T. A. proved to inhibit the degree of increase in serum creatine kinase isozyme MB (CK-MB) activities and CK-MB/CK ratio.
3) T. A. proved to inhibit the decrease of serum total protein values immediately before running and in the following morning. Similar trends in terms of the particuler times were observed, too, in the case of the degree of decrease of serum triglycerides values.
4) T. A. seemed to accelerate the utilization of saturated fatty acids especially.
5) Three kilometer running seemed to increase in serum taurine concentrations from several hours after running to the morning immediately after running.

Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.
Constriction, Pathologic ; Embolism, Air ; Hemorrhage ; Pneumonia, Aspiration ; Stomach Neoplasms ; Ulcer ; Venous Thromboembolism

A 53-year-old man was suspected of having an esophageal neoplasm. An endoscopic examination including Lugol chromoendoscopy suggested an esophageal squamous cell neoplasm limited to the lamina propria. A targeted biopsy showed atypical squamous cells, and an endoscopic submucosal dissection was performed 22 days after the previous endoscopy. Although a single 40 mm unstained area was observed by preoperative Lugol chromoendoscopy, intraoperative endoscopy revealed a 25 mm iodine-unstained area, with small unstained areas scattered on the oral side. We included the small unstained areas in the extent of the resection through assessment by preoperative endoscopy. Histopathologically, the tumor extent appeared to coincide with the preoperative assessment. Tumor cells were found in the basal-parabasal layers of the mucosa, in which small unstained areas were scattered, although the superficial layers exhibited well-differentiated cells containing glycogen in the cytoplasm. Although Lugol chromoendoscopy, which can induce chemical esophagitis, is widely used, re-epithelialization after mucosal damage by preoperative iodine staining may complicate the intraoperative demarcation of tumors.
Biopsy ; Cytoplasm ; Endoscopy ; Esophageal Neoplasms ; Esophagitis ; Glycogen ; Iodine ; Mucous Membrane ; Neoplasms, Squamous Cell ; Re-Epithelialization

PURPOSE: The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. METHODS: Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. RESULTS: A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. CONCLUSIONS: The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.
Asian Continental Ancestry Group ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Informed Consent ; Medical Records ; Reproducibility of Results ; Thorax ; Tokyo ; Surveys and Questionnaires