Therapeutic procedure

Medicine, Kampo ; Recent ; Therapeutic procedure

Progress in chemotherapeutic strategy has significantly decreased side effects of the drugs used and greatly added to survival rates for ovarian cancer. On the other hand, the occurrence of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) has been reported after long-term chemotherapy. We encountered a case of therapy-related MDS that developed as a consequence of chemotherapy. A 59-year-old woman (gravida 2, para 2) stage IIIc ovarian cancer received three courses of paclitaxel and carboplatin therapy (TC) prior to primary surgery, and 16 courses of weekly TC as adjuvant chemotherapy. She exhibited pacritaxel-associated hypersensitivity reactions in the last course, so that chemotherapy was discontinued. Following three mouths of remission, a sudden rise in her tumor markers and an increase in the size of her pelvic lymphonode were discovered on PET-CT. She recieved multiple courses of chemotherary of docetaxel/carboplatin, weekly docetaxel, docetaxel/briplatin and Gemcitabin/Irinotecan between four months. In 30 months after diagnosis, complete blood count showed hemoglobin 7.7 g/dl; white cell count 4,310/μl; and platelet 7.9×104/μl. A bone marrow examination revealed MDS. She then decided against further chemotherapy, opting instead for palliative care. Fortunately, up to the present, she has not developed AML.
Therapeutic procedure ; Chemotherapy-Oncologic Procedure ; Carboplatin ; Ovarian Cancer ; L

Having provided chemotherapy at its outpatients clinics since 2002, the Saku Central Hospital in February 2006 established a Chemotherapy Center for Patients Discharged from Hospital. At this center, pharmacists check doctors' prescriptions, review all medications patients have been taking and dispense the prescriptions in a sterilized state. In addition, they are assigned on a daily basis to collect information on, and give guidance to, the patients. At the outpatient clinics, the length of time that can be set aside for the tabulation of information from patients' case records and for contact with the patients is inevitably likited. Given this situation, we began case study meetings in order to share information about patients between pharmacists in charge of guidance on the control of drugs at the time of their hospitalization and those who are in charge of chemotherapy at the Center. Later, these case study meetings were joined by physicians and nurses who thought it necessary to share information, thus leading to the establishment of a Conference at the Center. At this conference, pharmacists introduce information about patients at the time of their hospital admission and a discussion begins with the participation of various hospital staff members to solve given problems. By so doing, it has become possible to come to grips with the conditions of inpatients, enabling us to shift to services at the Center smoothly and give proper guidance when a medication produces undesirable effects. We consider the Conference signifies a step forward to the practice of medical care by teams.
Central ; Hospitals ; Chemotherapy-Oncologic Procedure ; Information ; Therapeutic procedure

I showes the result of treatment of malignant diseases in digestive organs for last 20 years on our hospital.In Niigata prefecture, esophageal and gastric cancer cases are higher more than Japanese mean frequency of them.We have about 200 cases of gastric cancer every year. Out of them, operable cases have been decreased gradually, because of increase in cases done EMR (endoscopic mucosal resection).In operation method, total gastrectomy and pyloric resection cases decreased due to improve patient's QOL. Anticancer chemo-therapy into inoperable patients were done by new anticancer drugs, especially, combination therapy of TS-1 and paclitaxel is most effective compared of other drugs and combinations, that is, 13 months in mean survival time were performed.Number of cases of esophageal cancer has been increasing slowly, however, operable cases were not increasing, because of increasing of EMR. Presently, frequency of operation, EMR and chemotherapy with irradiation is almost similar.Number of cases in colon cancer has been increasing yearly, following colonofiberscopy (CF) with EMR or polypectomy (PP).Almost of advanced colon cancers were operable with laparostomy, however, before several years, laparoscopic colectomy (LAC) was performed, then, it reached to 40% among operable cases. By LAC, hospital period was shortened about a half of laparostomy.Number of cases of hepatocellular carcinoma (HCC) has been not increasing, so, cases of hepatic resection was stationary, because of TAE (transarterial embolization), RFA (radiofrequency ablation) and PEIT (percutaneus ethanol injection therapy) performed actively.Out of them, 5 year survival rate of lower biliary tract cancer patients were more higher than upper ones.Hereafter, based on above results, we have to make a effort to form a system of a cancer therapy, from prevention, diagnosis, and therapy to terminal care.
Therapeutic procedure ; Number ; Excision ; Digestive ; seconds

Intestinal anisakiasis is rarely diagnosed because it is thought to be uncommon and is poorly recognized. It produces severe abdominal pain and an inflammatory reaction often resulting in reactive intestinal obstruction, which is sometimes treated with an unnecessary laparotomy as acute abdomen or intestinal obstruction. We reported a 58-year-old female with acute intestinal obstruction caused by intestinal anisakiasis, which resulted in a self-limiting clinical course. The diagnosis was based on a history of recent ingestion of raw fish and abdominal computed tomographic findings of partial thickening of the intestinal wall accompanied by focal luminal narrowing with ascites. In spite of the severity of the abdominal pain, the bowel obstruction induced by inflammation and edema was resolved with conservative treatment after three weeks. Accordingly, intestinal anisakiasis was considered in the differential diagnosis of intestinal obstruction, which can be treated with conservative therapy.
Intestinal Obstruction ; Acute ; Intestinal ; Therapeutic procedure ; Due to

Background: Necrotizing fasciitis is a rare but severe condition associated with high mortality. We encountered a patient with severe and rapidly progressing necrotizing fasciitis. Patient: A 40-year-old male was hit by a tractor and received a wide laceration wound spanning the length of his posterior thigh. Soon after the accident, the wound was washed and debridement was performed. Two days postoperatively, we observed septic changes in the wound and diagnosed this condition as necrotizing fasciitis. Consequently, the patient's leg was amputated at the thigh. The patient, however, developed toxic shock syndrome after the amputation. Endotoxin adsorption using a polymyxin B-immobilized fiber column was performed for 2 days. Finally, a hip joint amputation was performed after 11 days, following which the patient's general condition gradually improved. Discussion: Treatment for necrotizing fasciitis should be initiated promptly. Early debridement is associated with a significant decrease in mortality. In severe conditions, endotoxin and cytokine removal by blood purification is one of the most effective treatments. Although group A streptococci are widely known as "flesh-eating bacteria," we should also consider a wide variety of pathogenic organisms to be the probable cause of severe necrotizing fasciitis. Conclusion: Management of necrotizing fasciitis requires careful investigation as well as an aggressive therapeutic approach, which may include urgent surgical intervention. In addition to surgery, endotoxin adsorption therapy should be considered.
Patients ; Fasciitis ; Endotoxins ; Therapeutic procedure ; Amputation

Medicine, Kampo ; Viral ; Acute ; Therapeutic procedure ; Gastroenteritis

In Kampo medicine, chronic dermatitis is considered to be associated with unstable interaction among Ki, Ketsu and Sui. Urticaria is resistant to standard treatments in modern western medicine, so we applied a Kampo approach to improve imbalance among Ki, Ketsu and Sui. In this paper, we report three cases of chronic urticaria treated with Kampo medicines, i.e., main prescriptions with goshakusan for urticaria with anemia, keishikaryukotsuboreito for urticaria with stress, and bukuryoshigyakuto for cold urticaria with stress. We examined changes in palmoplantar sweating in response to the treatments to evaluate improvement in the circulation of Ki.The importance of Ki, Ketsu and Sui in chronic diseases was emphasized by Nangai Yoshimasu and Gonzan Goto as early as the Edo period. Urticaria is regarded as being due to disturbances of Ketsu and Sui that are often caused by systemic Ki disorders. Therefore, we consider that it is important to improve Ki stagnation in “spleen”, “lung” and “kidney” in the treatment of urticaria.
Urticaria ; Medicine, Kampo ; Systemic ; Dermatologic ; Therapeutic procedure

Medicine, Kampo ; Pulmonary evaluation ; Therapeutic procedure ; Geriatrics