Tumor lysis syndrome (TLS) is an oncological emergency characterized by various metabolic abnormalities, such as hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia. Although TLS is rare in solid tumors, it has been reported in various cancers and sarcomas. It can be caused by chemotherapy, radiotherapy, surgical procedures. TLS in solid tumors may be lethal when it once develops. Hence, prophylaxis is considered important in medium risk diseases. We experienced the case that serum lactate dehydrogenase (LDH) level had elevated drastically a month prior to the onset of TLS in hypopharyngeal cancer. It is suggested that monitoring of LDH may be helpful for predicting the onset of TLS.

To assess the indications and clinical outcome of minimally invasive coronary artery bypass grafting with mini-sternotomy and cardiopulmonary bypass (MICS-CABG) for patients with multiple coronary artery disease, left main trunk stenosis and/or concomitant heart diseases, we examined results in 17 patients (mean age 62.5 years) who underwent MICS-CABG. The average number of distal anastomoses was 2.2 anastomoses/patient. The category of the coronary lesions was the left main trunk in 6 patients, triple vessel disease in 7, double vessel disease in 3, and left anterior descending artery stenosis with aortic regurgitation in 1 patient. Each operative procedure through the mini-sternotomy was easily and completely performed in all patients. By means of postoperative coronary angiography, full patency without stenosis in all grafts was recognized in 95.0%. Immediately after the MICS-CABG, all patients showed quick recovery of respiration, and postoperative admission duration significantly decreased compared with standard CABG with full sternotomy. The above results suggest that MICS-CABG is one of the procedures of choice for patients with multiple coronary artery disease, left main trunk stenosis and/or concomitant heart diseases.

Sound management of hospital in Japan in general has become more and more difficult with frequent reductions in the fees officially paid to medical institutions for medical examinations and treatments, and this current situation obviously necessitates a more efficient way of hospital management and ardent efforts at improvement on the part of our hospital as well. The Division on Nursing has set the goals to implement thoroughgoing cost-management strategies and to strengthen cooperation with other divisions. For this purpose we visited the hospital wards jointly with other personnel from the Divisions of Medical Materials and Dispensary to check inventories of medical materials and to make them optimum. As a result, it was found that medical materials were often improperly placed, stored excessively, or returned inaccurately. The instructions for redefining the proper quota of the medical materials per ward, putting them in order and returning them properly in case of excess facilitated direct communication and cooperation between divisions, and resulted in inventory reduction and thus the annual costs of returning them. These efforts successfully inspired each staff member to participate voluntarily in the management of our hospital, which eventually led to reasonable inventory control of medical materials. It would be important for each division, while demonstrating its specialty, to realize the importance of cooperation to reach far greater achievements.
Hospitals ; Materials ; seconds ; cooperation ; Medical

Objectives: A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.

Methods: Subjects were 18 cancer inpatients who received FST for breakthrough pain in their pharmacological cancer pain management. Changes in the pain score and the occurrence of adverse effects (nausea, vomiting and somnolence) were compared before and after FST administration.

Results: The pain score before FST administration was 6.4±2.4, and this was significantly improved to 3.4±2.8 at 30 min after administration (p<0.01). Somnolence occurred significantly more often 30 min and 2 h after FST administration than immediately before administration (p<0.05). There were no differences in the occurrence of nausea and vomiting before or after FST administration. Nine patients receiving FST therapy developed xerostomia, but there were no significant changes in the pain score or occurrence of adverse effects while they had xerostomia.

Conclusion: It is essential to observe the oral condition to judge whether FST therapy is indicated, and FST should be administered after providing sufficient oral care. The results indicate the possibility of increased occurrence of somnolence as an adverse effect.

The domestic production of moxa used in Japanese moxibustion therapy has decreased. Therefore, it is assumed that improved productivity of moxa and cultivation of Artemisa princeps Pamp. (Yomogi) is necessary for stable production of moxa. In this study, the production rate of moxa processed from green leaves, its chlorophyll content, maximum temperature of combustion, morphology, and yield of families collected from 127 domestic spots were investigated. They were evaluated to determine which family was suitable for use in moxibustion. As a result of principal component analysis on the morphological evaluation, 22 families were extracted as they were easily harvestable and were produced over a large area. They had a high productivity rate for moxa, and contained more than the standard weight in dry leaves among all the families. It was confirmed that these extracted families included families that have not been used so far in addition to families collected in conventional areas. These results suggest that production using extracted families can improve the domestic production of Artemisa princeps of moxa.

Methods: A total of 24 patients with postsurgical chronic pain and/or numbness Numeric Rating Scale (NRS) scores of ≥4 were enrolled. All patients underwent spine or spinal cord surgery at Keio University Hospital and received daily administration of DLX for more than 3 months. The mean postoperative period before the first administration of DLX was 35.5±57.0 months. DLX was administered for more than 3 months at a dose of 20, 40, or 60 mg/day, and the degree of pain and numbness was evaluated using the NRS before administration and 3 months after administration. Effectiveness was defined as more than a 2-point decrease in the NRS score following administration. Results: In terms of the type of symptoms, 15 patients experienced only numbness, eight experienced both pain and numbness, and one experienced only pain. Of the 24 patients, 19 achieved effective relief with DLX. DLX was effective for all patients with postsurgical chronic pain (n=9), and it reduced postsurgical chronic numbness in 18 of 23 patients. No significant difference was observed in background spinal disorders. DLX was not effective for five patients who complained only of postsurgical chronic numbness. Conclusions This study reports the effectiveness of DLX for postsurgical chronic neuropathic disorders. Although DLX reduced postsurgical chronic pain (efficacy rate=100%) and numbness (78.3%) in certain patients, further investigation is needed to determine its optimal use.

Methods: This study included 42 patients with ASD (two men and 40 women; 112 segments; mean, 68.5±8.4 years; and mean follow-up, 31.6±17.0 months) who underwent LIF and posterior correction surgery. The concave slot of the LIF cage was filled with an autologous iliac crest bone graft (IBG), and the convex slot with a porous hydroxyapatite/collagen (HAp/Col) composite was soaked with bone marrow aspirate. Endplate injury, the gap between vertebral endplate and cage in the coronal or sagittal plane, and fusion status were evaluated using computed tomography multiplanar reconstruction at 12 months after surgery. Moreover, the associated risk factors for pseudoarthrosis were analyzed. Results: Fusion at LIF segments were observed in 71.4% segments at 12 months after surgery. Fusion on the concave slot (autologous IBG side), convex slot (porous HAp/Col composite side), and both concave and convex slots were observed in 66.1%, 37.5%, and 36.6% of patients, respectively. Moreover, pseudoarthrosis was observed in 28.6% at 12 months after surgery. Consequently, logistic regression analysis of the fusion at the LIF segment revealed that the gap between the LIF cage and endplate in the coronal plane (p=0.030; odds ratio, 0.183; 95% confidence interval, 0.030–0.183) was significantly associated with pseudoarthrosis at the LIF segments. Conclusions ASD surgery fusion rate using LIF cages was 71.4% at 12 months after surgery. The fusion rate was higher on the concave slot filled with autologous IBG than on the convex slot filled with a porous HAp/Col composite. The gap in the coronal plane was a risk factor for pseudoarthrosis at the LIF segment.

Results: In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93–1.00). Conclusions The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.