1.Natural History of Chronic Intestinal Pseudo-obstruction and Need for Palliative Care
Kosuke TANAKA ; Hidenori OHKUBO ; Atsushi YAMAMOTO ; Kota TAKAHASHI ; Yuki KASAI ; Anna OZAKI ; Michihiro IWAKI ; Takashi KOBAYASHI ; Tsutomu YOSHIHARA ; Noboru MISAWA ; Akiko FUYUKI ; Shingo KATO ; Takuma HIGURASHI ; Kunihiro HOSONO ; Masato YONEDA ; Takeo KURIHASHI ; Masataka TAGURI ; Atsushi NAKAJIMA ; Kok-Ann GWEE ; Takaomi KESSOKU
Journal of Neurogastroenterology and Motility 2023;29(3):378-387
		                        		
		                        			 Background/Aims:
		                        			Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. 
		                        		
		                        			Methods:
		                        			From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. 
		                        		
		                        			Results:
		                        			Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2 , 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. 
		                        		
		                        			Conclusion
		                        			CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired. 
		                        		
		                        		
		                        		
		                        	
2.Multidisciplinary Team Workshop on Child Abuse for University Students and Graduate Students in Medical Education
Noboru KOBAYASHI ; Fumihiko KAWASAKI ; Takashi MASUZAWA ; Hiroaki OKAWA ; Kyoko MINAMIYAMA
Medical Education 2010;41(3):195-199
		                        		
		                        			
		                        			1) To become physicians who care for patients as human beings, medical students must know about child welfare. A serious problem in the fields of medicine and welfare is child abuse. Collaboration is needed to support children and families, but many challenges exist.
2) The goal of our Multidisciplinary Team Workshop, which started in 2006 and targets students in a wide range of fields, is to educate future practitioners about the necessity of multidisciplinary collaboration.
3) More than 80% of the participating students felt the workshop was useful, and the participation of medical students increased the significance of the workshop for students from other disciplines.
		                        		
		                        		
		                        		
		                        	
3.Evaluation of Antiplatelet Therapy with Aspirin and Trapidil in Patients with Prosthetic Heart Valve Replacement.
Noboru MURATA ; Masato KUME ; Satoshi KOBAYASHI ; Koji MORIYASU ; Hideo YOKOKAWA ; Makoto YAMADA ; Makoto FUNAMI ; Tosihiro TAKABA ; Toshitaka FURUKAWA
Japanese Journal of Cardiovascular Surgery 1993;22(2):113-117
		                        		
		                        			
		                        			Twenty six adult patients who underwent prosthetic heart valve replacement and treated anti-thrombogenic therapy, were divided into 2 groups. One was administered Warfarin alone, another was administered Warfarin plus Aspirin (162mg/day) as antiplatelet therapy. Trapidil (300mg/day) was administered to all of the patients. Platelet aggregation, plasma level of TXB2 (stable metabolite of thromboxane A2), and 6-keto-PGF1 (stable metabolite of PGI2) were measured before and 1, 3, 6 months after Trapidil therapy. Platelet aggregability suppressed in both 2 groups. Plasma TXB2 level, and TXB2/6-keto-PGF1 ratio showed a tendensy to decrease (p<0.05) 6 months after administration. In the Aspirin plus Trapidil group, platelet aggregability, serum TXB2 level, and TXB2/6-keto-PGF1 ratio are significantly lower than that in the Trapidil only. These results suggest that Trapidil is clinically useful for antiplatelet agent, but the combined Aspirin plus Trapidil therapy is more efficacious than the Aspirin or Trapidil single therapy.
		                        		
		                        		
		                        		
		                        	
4.The actual condition of patients treated by acupuncture in Ibaragi Prefecture.
Shigeru KAMIYAMA ; Hiroshi IWATUKI ; Fumi ODA ; Keiji KASUYA ; Masaoshi SATO ; Ryuji SEKI ; Haruo TAKAHASHI ; Shigeo TOKARI ; Misa TSUKADA ; Tsuneyoshi TOMIZAWA ; Teruo NANAKAWA ; Hiroshi NANAKAWA ; Hiroaki HASHIMOTO ; Muneo HIRASAWA ; Noboru FUJIEDA ; Shigeyoshi HORIGUCHI ; Uichi YAMADA ; Toshikazu MIYAMOTO ; Hideo KOBAYASHI ; Hidetoshi MORI ; Kazushi NISHIJO
Journal of the Japan Society of Acupuncture and Moxibustion 1987;37(2):145-151
		                        		
		                        			
		                        			We investigated the actual condition of patients treated by acupuncture and moxibution in Ibaragi Prefecture.
Subjects were 1823 patients (846 men, 977 women) under the treatment of 14 acupuncture clinics in September to November, 1985.
We prepared the evaluated list that consisted of 11 levels of activities of daily life and 8 degrees of pain.
In every treatment, we wrote down the patient's clinical progress in relation with the list.
The following results were obtained
1. There were many patients in thier forties and fifties.
2. There were many patients who received only one treatment.
3. The chief complaints were low back pains (509 patients), shoulder discomfort (273) knee joint pain (132), etc.
4. Most of the patients could still go on with thier daily lives in spite of the pains.
5. The effects of treatment were rated as follows; better 69.5%, no change 23.9%, worse 5.9%.
		                        		
		                        		
		                        		
		                        	
5.Collection Method and Specificity Analysis of Korean HLA Anti-Body Sera.
Jin Oh CHUNG ; Jong Ryur CHAE ; Dong Hak SHIN ; Noboru KOBAYASHI ; Takeoh JUJH
Journal of the Korean Pediatric Society 1980;23(2):98-103
		                        		
		                        			
		                        			In order to obtain a reliable test result of the HLA detection of major histocompatibility antigen, it is very significant to get complete result by using excellent anti-sera. so far no standard sera for HLA type has been seen in Korean people. Because we have been unable to find Korean specific antigen in Korea, we have performed screening test on the 150 pregenancy women in order to find an excellent Korean anti-HLA anti-body sera. To get panel lympocyte reaction, 20 healthy Korean and 34 healthy japanese who were well aware of HLA type were given microlymphocyte toxicity test of Thrasaki method. The result showed the the 10percent of the 150 persons had anti HLA sera. Of 10 percent, 2 persons indicated having P 50. it is estimated that there are unknown A, B locus blank and antigen still seisted among many Koreans and we are ging to screen about 2,000 more persons in the future.
		                        		
		                        		
		                        		
		                        			Asian Continental Ancestry Group
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Histocompatibility Antigens
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Korea
		                        			;
		                        		
		                        			Mass Screening
		                        			;
		                        		
		                        			Sensitivity and Specificity*
		                        			;
		                        		
		                        			Toxicity Tests
		                        			
		                        		
		                        	
            

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