This article describes the end of life of seven people with amyotrophic lateral sclerosis (ALS) under the care of a hospice. The reasons for admission to hospice were for the management of distressing symptoms and the support of families who were unable to continue care at home because of the increased burden of care and/or illness of families. The sufferings experienced by the patients with ALS included disability due to muscle weakness(100%), pain(100%), discomfort (100%), dyspnea (71%), difficulties in communication (71%), drooling (43%), insomnia (43%), loneliness (43%), swallowing difficulties (28%), clenching the mucosa inside the cheek (28%), anxiety (28%), the perception of being a burden to the family (28%), and concerns as to why they had developed ALS (28%). Opioid medication was effective in the management of dyspnea, pain and discomfort. The results showed that special attention should be paid to frequent changing of the patient's position during nursing care, including the passive movement of joints and massage. The use of communication aids was essential to allow people with ALS to communicate effectively and, together with support of joy of the patients and family, the quality of life could be improved. End of life care within a hospice is a useful alternative option for persons with ALS, extending hospice care in Japan from people with advanced cancer to other disease groups. Palliat Care Res 2010; 5(2): 137-143

STUDY DESIGN: Retrospective analysis using magnetic resonance imaging (MRI). PURPOSE: To identify MRI features that could discriminate benign from malignant vertebral fractures. OVERVIEW OF LITERATURE: Discrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators. METHODS: Totally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis. RESULTS: The chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2–548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0–229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5–21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005–4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=−3.88×(i)−3.05×(ii)−3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture. CONCLUSIONS: Although each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.
Diagnosis ; Discrimination (Psychology)* ; Humans ; Logistic Models ; Magnetic Resonance Imaging* ; Multiple Myeloma ; Neoplasm Metastasis ; Osteoporosis ; Retrospective Studies ; Spinal Fractures ; Spine

OBJECTIVEYoung women being underweight is a public health problem in Japan. The aim of this study was to investigate this problem by measuring lymphocyte count as an indicator of nutritional status.

METHODSThe subjects were 114 women aged 20-39 who participated in an annual health checkup for residents in a city in Aichi, Japan. Data from a questionnaire, physical examination, and blood tests were analyzed in relation to women who were severely underweight [body mass index (BMI) /= 25 kg/m(2)).

RESULTSLymphocyte count tended to be lower with a decrease in BMI. The prevalence of low lymphocyte count of <1,500/mm(3) increased in underweight women. In women who had restricted food intake for weight loss, leukocyte count, and total serum protein, and lymphocyte count were lower. A multivariate logistic regression analysis showed the association of low lymphocyte count to being severely underweight [odds ratio (OR): 1.95; 95% confidence interval (CI): 1.07-3.56] and to restricted food intake for weight loss (OR: 3.73; 95% CI: 0.91-15.30).

CONCLUSIONThis study suggests that being severely underweight and on restricted food intake for weight loss in adult women can be risk factors for low lymphocyte count, an indicator of malnutrition. It is important for young women to maintain BMI >17.5 kg/m(2) and not to restrict food intake when of normal weight or underweight in order to prevent malnutrition.