Schwannomas are benign tumors of neuroectodermal origin and can be found in any part of the body. Although schwannomas are common in the head and neck region, they are rare in the auricle. Auricular schwannomas are rarely symptomatic but the mass itself or a surgical procedure to remove it may disrupt the complicated structure of the auricle. We report a rare case of auricular schwannoma with a literature review and describe the surgical technique used in this case.

Schwannomas are benign tumors of neuroectodermal origin and can be found in any part of the body. Although schwannomas are common in the head and neck region, they are rare in the auricle. Auricular schwannomas are rarely symptomatic but the mass itself or a surgical procedure to remove it may disrupt the complicated structure of the auricle. We report a rare case of auricular schwannoma with a literature review and describe the surgical technique used in this case.

　　Since February, 2012, Anjo Kosei Hospital has embarked upon a new scheme for efficiently handling narcotics during surgical operations. For the purpose pharmacists are allowed to enter the operating room for a while. At the same time, the implementation of digital record keeping for narcotics management tasks has started, making it possible to simplify the handling of a great number of patients. By reviewing the effects on narcotics handling and hours billed, we could determine the effectiveness of operating room pharmacist-led narcotics management at Anjo Kosei. Out of narcotics prescriptions (n＝647) handled in the operating room for one month, 84.7% (548/647) was accounted for by prepared narcotics and 99.8% (646/647) by post-operation management. The introduction of the digital record system resulted in a reduction from 53.3±9.6 minutes to 39.6±6.3 minutes for narcotics preparation, and a reduction from 66.8±16.1 minutes to 41.1±13.5 minutes for post-operation management (p<0.01). It has added to the work efficiency and simplification of operations. Moreover, due to the intervention of pharmacists in the operating room, 92.3% of narcotics prescriptions was performed using the new management system within a relatively short time (80.8±18.4minutes). These data show that the introduction of the new scheme has resulted in more efficient management of narcotics at Anjo Kosei.

OBJECTIVESTo estimate the degree to which low back pain (LBP) deprives the Japanese adult population of their quality of life (QOL) in terms of quality-adjusted life-years (QALYs).

METHODSA questionnaire survey was conducted among participants of health examinations at five healthcare facilities in Japan. Age- and sex-specific mean values of the EQ-5D score were calculated for (1) those who reported LBP and interference with daily activities (IDA) due to the pain (n = 251), (2) those who reported LBP but no IDA (n = 955), and (3) those who reported no musculoskeletal pain (n = 2887). To estimate the loss of QALYs due to LBP in the Japanese adult population, we multiplied the age- and sex-specific mean differences of the EQ-5D scores between the LBP with (or without) IDA group and the no pain group by the corresponding age- and sex-specific numbers of people with LBP with (or without) IDA in Japan.

RESULTSAmong the entire Japanese adult population of 103 million people, 11,800,000 (4,910,000 men and 6,890,000 women) were estimated to suffer from LBP, and 2,403,000 (976,000 men and 1,427,000 women) people were estimated to encounter IDA due to the pain. The loss of QALYs due to LBP in the Japanese adult population was estimated at 947,000 (9.18 per 1000 population). The loss of QALYs due to IDA in the LBP people was estimated at 139,000 (1.35 per 1000 population).

CONCLUSIONSThe estimated loss of QALYs due to LBP suggests that LBP substantially deprives the Japanese adult population of their QOL.

Surveillance of nosocomial infection is the foundation of infection control. Nosocomial infection surveillance data ought to be summarized, reported, and fed back to health care personnel for corrective action. Using the Japanese Nosocomial Infection Surveillance (JANIS) data, we determined the incidence of nosocomial infections in intensive care units (ICUs) of Japanese hospitals and assessed the impact of nosocomial infections on mortality and length of stay. We also elucidated individual and environmental factors associated with nosocomial infections, examined the benchmarking of infection rates and developed a practical tool for comparing infection rates with case-mix adjustment. The studies carried out to date using the JANIS data have provided valuable information on the epidemiology of nosocomial infections in Japanese ICUs, and this information will contribute to the development of evidence-based infection control programs for Japanese ICUs. We conclude that current surveillance systems provide an inadequate feedback of nosocomial infection surveillance data and, based on our results, suggest a methodology for assessing nosocomial infection surveillance data that will allow infection control professionals to maintain their surveillance systems in good working order.

Although the Outpatient Cancer Chemotherapy (OCC) Unit was established with in Anjo-Kosei Hospital in 2006, its real worth remains to be elucidated. To address this, the following subjects were examined;effective usage of hospital beds changes in the number of outpatients given to chemotherapy, length of hospitalization, the number of patients transferred by ambulance to the hospital, hospital occupancy rate, and the number of frequently used chemotherapy regimens.Since the establishment of the OCC Unit, the number of patients transferred by ambulance has increased and length of hospitalization has gradually decreased, accompanied by the increase in the number of outpatients treated at the OCC Unit. Additionally, no significant change was observed in the hospital occupancy rate. Furthermore, of the frequently used chemotherapy regimens, nine regimens were available for 62.4% of the total number of outpatients of the OCC Unit.These results indicated the useful effect of the establishment of the OCC Unit on the usage of hospital beds, and provided significant information helpful in promoting the effective and safe chemotherapy for outpatients in the OCC Unit.
Chemotherapy-Oncologic Procedure ; Unit ; seconds ; Outpatients ; Malignant Neoplasms

Lithium, prescribed for bipolar disorder, is known to induce thyroid dysfunction, most commonly hypothyroidism. Thyrotoxicosis due to lithium-induced painless thyroiditis is a rare complication. We have previously reported that the serum concentration of immunosuppressive acidic protein (IAP), an α1-acid glycoprotein, increased during the acute phase of subacute thyroiditis, but was within the normal range in patients with painless thyroiditis. In the present case, a 31-year-old woman, receiving long-term lithium therapy for bipolar disorder, had a recurrent episode of painless thyroiditis, and her serum IAP was increased. The pathogenic mechanism for lithium-associated painless thyroiditis may differ from that of autoimmune conditions.
Thyroiditis ; Lithium measurement ; Lithium ; PROTEIN.IMMUNOACIDIC ; Painless

OBJECTIVESTo determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS).

METHODSUsing the JANIS database for the period between June 2002 and June 2004, 21,895 eligible patients aged ≥16 years, hospitalized in 28 participating ICUs for ≥24 hours, were monitored until ICU discharge. Adjusted hazard ratio (HR) with 95% confidence interval (CI) for the incidence of sepsis was calculated using Cox's proportional hazard model. Standardized mortality ratio (SMR) was calculated on the basis of the crude mortality in patients without nosocomial infection (NI) for respective APACHE II categories. Mean LOS for survivors was assessed by two-way analysis of variance with adjustment for APACHE II.

RESULTSSepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. A significantly higher HR for the incidence of sepsis was found in men (1.54, 95% CI: 1.14-2.07), APACHE II ≥21 (2.92, 95% CI: 1.92-4.44), ventilator use (3.30, 95% CI: 1.98-5.49), and central venous catheter use (3.45, 95% CI: 1.90-6.28). SMR was determined to be 1.18 (95% CI: 0.82-1.21) in NI patients without sepsis and 2.43 (95% CI: 1.88-3.09) in NI patients with sepsis. Mean LOS for survivors was calculated to be 11.8 days (95% CI: 11.3-12.4) in NI patients without sepsis and 15.0 days (95% CI: 13.3-17.0) in NI patients with sepsis compared with 3.8 days (95% CI: 3.8-3.9) in patients without NI.

CONCLUSIONSSepsis is not very common in Japanese ICUs, but its development leads to further increases in mortality and LOS in patients with NI.

OBJECTIVESTo examine the relationships between body image, body satisfaction and dieting behavior in the context of pubertal changes in Japanese preadolescents.

METHODSA cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.

RESULTSThe percentages of those who perceived themselves fat, wanted to be thinner, and had tried dieting, which increased with body mass index (BMI), were significantly higher in girls than in boys (34.2% vs. 20.0%, 58.0% vs. 26.0%, and 17.3% vs. 5.7%, respectively). Independent of sex and BMI, those who wanted to be thinner and those who had tried dieting were more frequently observed in those who perceived themselves fat, and those who had tried dieting were more frequently observed in those who wanted to be thinner. Pubertal changes were significantly associated with dieting behavior, but their relationships to body image and body satisfaction differed between sexes; for boys, those who perceived themselves fat were more frequently observed in those without pubertal changes; whereas for girls, those who wanted to be thinner were more frequently observed in those with pubertal changes.

CONCLUSIONSDieting behavior of Japanese preadolescents was associated with whether they perceived themselves fat and wanted to be thinner, sometimes independent of whether they were actually overweight. Pubertal changes might induce a positive perspective of growing fat among boys and a desire to be thinner among girls, with the consequence that dieting behavior would be reinforced in those with pubertal changes.

OBJECTIVESTo analyze the path to dieting behavior in Japanese preadolescents.

METHODSA cross-sectional study of dieting behavior among 5,244 preadolescents (2,452 boys and 2,792 girls aged 12-13) born in Toyama prefecture.

RESULTSWhile increasing with body mass index (BMI), the percentage of those who had tried dieting was higher in those who perceived themselves fat than in those who perceived themselves thin or average. Of those who wanted to be thinner, 16.1% of boys and 26.8% of girls had tried dieting. Path analysis in nonobese subjects (2,116 boys and 2,334 girls) showed that (1) body image was primarily based on BMI, (2) body image led to body dissatisfaction, and (3) body dissatisfaction led to dieting behavior. Pubertal changes had a significant effect on body image (path coefficient <0)for boys and body satisfaction (path coefficient >0) for girls, in addition to that on BMI. Maternal BMI had a significant effect on BMI but not on body image, body satisfaction, or dieting behavior.

CONCLUSIONSBody image and body satisfaction play important roles in the path to dieting behavior in Japanese preadolescents. Pubertal changes may reinforce dieting behavior, but the mechanism may differ by sex.