We developed a problem-oriented simulation system for medical diagnosis which works on personal computers without special equipment. In this simulation system the history of illness can be presented by voice, and physical findings are presented audiovisually through the student's actions, in a manner that closely resembles an actual medical examination. The laboratory findings are also presented through the student's actions. Students compile a database with information that they collect, create a problem list, and devise an initial diagnostic plan for the patient's most important problem. This computer-assisted system will help medical students learn diagnostic strategies in a simulated clinical setting. We believe that this system is a promising method that will facilitate problem-oriented learning in the virtual multimedia environment with special convenience for medical students to share time and facilities and to lower costs.

We experienced a case that right massive pleural effusion was successfully controlled with Denver shunt from the right chest cavity to right femoral vein. A 80-years-old woman had received hemodialysis due to chronic renal failure twice in a week. She was diagnosed as right breast cancer and underwent right breast conserving surgery at December, 2008. In postoperative follow-up duration, she had difficulty in breathing and visited to the emergency room in our hospital. She was diagnosed as respiratory failure due to right massive pleural effusion from the X-ray result and the blood gas analysis. There was no pleural effusion within the left chest space. No malignant cell was detected in the effusion. We thought that diuretics and shunt tube from the right chest cavity to the abdominal cavity would be ineffective because of her chronic renal failure, and for that reason, we placed the shunt tuve from the chest cavity to the right femoral vein. Respiratory failure and the quality of life were successfully improved for about 7 months by using it. Palliat Care Res 2011; 6(1): 301-307

This study was conducted to examine the prevalence of undernourished elderly in community-dwelling elderly people, and to analyze the correlation between under-nutritional status and health status and physical fitness of the elderly.The subjects comprised 1758 residents (757 men and 1001 women) aged 70 or over living in Itabashi-ku, Tokyo, who took part in an interview and biochemical blood examination as part of the “OTASHA-KENSHIN”. In this study, we set the ‘under-nutrition group’ as serum albumin level ≤ 3.8 g/dL (normal group serum albumin level ≥ 3.9 g/dL). Based on this standard, 124 subjects (72 men and 52 women) were found to be undernourished. Physical fitness was measured by handgrip strength, knee extension power, and walking capability (usual and maximal walking speed).The prevalence of undernourished elderly was significantly higher in men than in women, and in those living alone or with a spouse compared with those living with children. It became clear that the lifestyle and health status of the under-nutrition group was generally poor compared with those of the normal group. Handgrip strength and knee extension power were significantly lower in the under-nutrition group than in the normal group of men. Although usual and maximal walking speed tended to be lower in the under-nutrition group, there was no significant difference. In women, a significant difference in handgrip strength, knee extension power, and walking capability was not seen between the two groups.These results suggest that an intervention program for the undernourished elderly living in the community should target an improvement not only of nutrition but also of physical fitness.

We report a case of hemangiopericytoma of the soft palate of 60-year-old patient, who noticed a mass of the soft palate and experienced difficulty in speaking. We found a pediculate, hard, elastic mass measuring 38 mm (cross-sectional diameter). Computed tomography (CT) scans and dynamic magnetic resonance imaging (MRI) confirmed irregularly shaped mass and revealed a heterogeneous internal composition, consistent with vascular tumors. We excised the tumor under general anesthesia. Histopathological diagnosis was based on positive immunoreactivity of CD99 and vimentin and weak, positive staining of CD34. Three and half years following tumor excision, there is no recurrence or metastasis.
12E7 Antigen ; Antigens, CD ; analysis ; Antigens, CD34 ; analysis ; Articulation Disorders ; etiology ; Cell Adhesion Molecules ; analysis ; Deglutition Disorders ; etiology ; Follow-Up Studies ; Hemangiopericytoma ; complications ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Palatal Neoplasms ; complications ; Palate, Soft ; pathology ; Tomography, X-Ray Computed ; Vimentin ; analysis

Oxycodone controlled-release (CR) tablets are used as a first-line opioid analgesic for cancer pain. However, use of oxycodone CR tablets is associated with toxicities such as drowsiness and constipation, leading to deterioration of the quality of life (QOL), especially in patients with gynecologic cancer. In contrast, fentanyl has a superior toxicity profile while still showing a strong analgesic effect. Although fentanyl has been approved for switching from opioid, there have been no Japanese studies of patients with gynecologic cancer who were switched to transdermal fentanyl after experiencing toxicity during therapy with oxycodone CR. More importantly early introduction of palliative therapy for pain has not been adopted routinely in the management of gynecologic cancer. Thus, it appears that treatment for patients with gynecologic cancer remains unsatisfactory at present. We conducted research into improvement of the toxicity profile and pain control with the aim of improving QOL for patients with gynecologic cancer. We showed that pain, drowsiness, and constipation could be significantly improved in gynecologic cancer patients as a result of switching to transdermal fentanyl therapy at an early stage.

Background: High heart rate (HR) has been associated with an increased risk of cardiovascular disease and mortality due to all causes. The present study was conducted to examine the effect of exercise adherence on longitudinal changes in resting heart rate among a population of community-dwelling elderly.Methods: The subjects were 133 men and 209 women aged 65 and older who participated in a baseline survey in August 1992 and were subsequently followed annually for 8 years. Resting HR was measured in the sitting position. The independent variable was the longitudinal change in differences of HR (Δ) from 1996 to 2000. Dependent variables were age, heart rate, smoking habit, TMIG index of competence score, and states of exercise adherence during the period 1992-1996.Results: Multiple regression analysis showed that heart rate in 1996 and smoking in men, and heart rate, TMIG index of competence score, and exercise adherence during the period 1992-1996 in women were significantly associated with longitudinal change in HR.Conclusion: Exercise adherence reduced the increase in HR of elderly women. These results suggest the importance of exercise adherence in elderly women.

Introduction: There has been no case report in which hyperpigmentation developed on the skin area where a transdermal fentanyl patch was applied in a patient. Case report: A 43-year-old man with recurrence of postoperative rectal cancer was treated by cetuximab plus irinotecan and panitumumab plus FOLFIRI. For cancer pain, transdermal fentanyl patch (Fentos®) was administered, and radiation from behind was performed. Hyperpigmentation then appeared on the chest and the abdominal skin sites where the patches were applied. The hyperpigmentation nearly disappeared four months after the fentanyl patch was discontinued. Discussion: The cause of the pigmentation was possibly due to post inflammatory hyperpigmentation secondary to contact dermatitis. It was desirable to conduct patch test and skin biopsy for making an accurate diagnosis. Conclusion: We should pay a careful attention to hyperpigmentation of the skin where a transdermal fentanyl patch is applied.

Purpose: The review of the published reports was performed with the aim of systematic collection and integration of information related to "signs and symptoms" along with their changes among patients after upper gastroesophageal surgeries. Methods: The PubMed and the Japanese healthcare literature database were searched by the following keywords:"gastric cancer" "esopha∗ cancer" "surgery" and "symptom" As a result, 37 articles related to gastric or esophagus cancer were identified. The data were extracted according to each sign and symptom, and were evaluated and discussed. Results and Conclution: Standardized instruments for gastrointestinal symptoms included evaluations about dysphagia, difficulty in swallowing, reflux etc. The incidence of signs and symptoms, or postsurgical recovery processes are different among individual patients. Healthcare professionals should support patients continuously and systematically so that patients can take appropriate health maintenance behavior according to their signs and symptoms.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.