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Hatsukaichi, Japan

In home palliative care, care managers play an important part. But we suspect that care managers, who don't have a medical license, may feel an anxiety. So, we investigated if these care managers felt an anxiety, and would like to report a role of nursing staffs in home palliative care. Method: We surveyed care managers who were working in the western part of Hiroshima. The number of care managers was 199. And 129 of them(86.9%)filled out the questionnaire. We used c 2 -test and analyzed the difference of an anxiety between nursing staffs and the others. Results: The care managers felt an anxiety about the patient's condition and the therapy rather than nursing staffs. Conclusion: Nursing staffs play an important role by doing a therapeutic management for terminal cancer patients, an explanation for the family of patients, and a cooperation with other staffs.

Ishitobi T.,Hiroshima University | Hyogo H.,Hiroshima University | Tokumo H.,JA Hiroshima General Hospital | Arihiro K.,Hiroshima University | Chayama K.,Hiroshima University
Hepatology Research | Year: 2014

Aim: Oxidative stress plays a pivotal role in the transition from simple steatosis to non-alcoholic steatohepatitis (NASH). Probucol is a lipid-lowering agent with strong antioxidant properties, and is reported to be effective for the treatment of NASH in several studies. The aim of the present study was to evaluate the efficacy of probucol for the treatment of NASH with dyslipidemia. Methods: Twenty-six patients with biopsy-proven NASH accompanied by dyslipidemia were treated with 500mg of probucol daily for 48 weeks. Body mass index, visceral fat area, liver function tests, serum lipids, fibrosis markers, ferritin, adiponectin, leptin, urinary 8-hydroxy-2'-deoxyguanosine (U-8OHdG) and elasticity were measured periodically during the study. Follow-up liver biopsy was performed in 18 patients. Results: Serum levels of aminotransferases, total cholesterol and U-8OHdG significantly decreased (P<0.01). Levels of hemoglobin A1c (HbA1c), the Homeostasis Model of Assessment - Insulin Resistance index and serum levels of ferritin, type IV collagen 7S and hyaluronic acid significantly decreased (P<0.05). The serum levels of adiponectin tended to be increased. Liver stiffness significantly decreased from 8.8±6.8 to 6.6±4.0kPa (P<0.01). Non-alcoholic fatty liver disease activity scores were significantly improved from 4.2±1.4 to 3.4±1.6 (P<0.05) and fibrotic stages tended to be improved from 1.6±0.8 to 1.3±1.1, respectively. No adverse effects of this treatment were noted. Conclusion: Probucol improved clinical and histological findings probably through its ability to reduce insulin resistance and oxidative stress. Probucol therapy was safe and effective for Japanese NASH patients with dyslipidemia. © 2013 The Japan Society of Hepatology.

Sakamoto S.,Hiroshima University | Kiura Y.,Hiroshima University | Kajihara Y.,Itsukaichi Memorial Hospital | Shibukawa M.,JA Hiroshima General Hospital | And 5 more authors.
Neurosurgical Review | Year: 2013

The treatment for patients with near occlusion of the cervical internal carotid artery (ICA) is controversial. The aim of this study was to examine the results of carotid artery stenting (CAS) as a surgical treatment for ICA near occlusion. Between April 2008 and September 2012, 14 patients (all men; mean age, 75.4 years) with ICA near occlusion were treated with CAS. This represents 5.2 % of a total of 267 patients treated with CAS during the study period. All patients were treated with CAS using an embolic protection device. The proximal balloon protection method was performed in five patients, and the dual protection method using a proximal balloon and distal filter protection was used in nine patients. We examined the change of stenotic lesion, hyperintensity spot in diffusion-weighted imaging (DWI), and perioperative complications after CAS. All near occlusions were successfully dilated. Among 2 of 14 patients, DWI showed 1 and 4 hyperintensity spots. Transient and persistent complications, including neurological deficits, did not occur in any patients. In this small number of cases, CAS using the proximal or dual embolic protection method seems to be a safe and beneficial treatment for ICA near occlusion. © 2013 Springer-Verlag Berlin Heidelberg.

Migita T.,Hiroshima University | Mukaida K.,Hiroshima Prefectural Rehabilitation Center | Kobayashi M.,JA Hiroshima General Hospital | Hamada H.,Hiroshima University | Kawamoto M.,Hiroshima University
Acta Anaesthesiologica Scandinavica | Year: 2012

Background Malignant hyperthermia (MH) is a potentially fatal complication of general anesthesia triggered by volatile anesthetics. In animal studies, sevoflurane has been reported to be a weak triggering agent. The aim of this study was to evaluate the clinical severity of sevoflurane-induced MH compared to isoflurane. Methods From the Japanese MH database containing information for 520 MH cases since 1961, we analyzed 147 cases classified by the MH Clinical Grading Scale (CGS) as 'very likely' or 'almost certain', accumulated from 1990 to 2009. Sevoflurane without succinylcholine (S-SCh (-) group) was given to 48 cases, and isoflurane without succinylcholine (I-SCh (-) group) was given to 30. Variables studied were outcome, CGS score, CGS rank, the first MH sign, and time from induction to onset of MH (occurrence time). Clinical signs and maximum laboratory data from six processes of the CGS were also analyzed. Each of the Mann-Whitney U-test or the unpaired t-test was used for group comparisons. Results Mortality was 8.3% in the S-SCh (-) group and 10.0% in the I-SCh (-) group (P = 0.803). The CGS scores were 53.4 (SD, 12.2) and 52.3 (11.7) (P = 0.691), respectively. The five processes of the CGS did not differ between groups. Median occurrence times were 72.5 minutes (range, 36.3-127.5) and 65.0 minutes (30.0-131.3), respectively (P = 0.890). Conclusion There were no clinically apparent differences between MH triggered by sevoflurane and isoflurane, and thus no evidence to support the postulate that sevoflurane is a weak or weaker MH triggering agent. © 2011 The Authors Acta Anaesthesiologica Scandinavica.

Norimatsu Y.,Ehime Prefectural University of Health Sciences | Funakoshi M.,JA Hiroshima General Hospital | Kamei T.,Yamaguchi Grand Medical Center | Kawano R.,Kawano Medical Clinic | Kobayashi T.K.,Imperial Gift Foundation Inc.
Diagnostic Cytopathology | Year: 2011

We report a case of neuroendcrine (NE) carcinoma in the right breast of a 67-year-old female, ultrasonography revealed a lesion composed of irregular hypoechoic masses and mammography showed asymmetric breast tissue. Histopathologic examination of the surgical sample showed a solid to nested proliferation of plasmacytoid cells that showed immunocytochemical positivity for chromogranin A, synaptophysin, CD56, and estrogen receptor. Our case was diagnosed as solid NE carcinoma. Though the findings of fine needle aspiration cytology reflected the histological features, we were not able to cytopathologic grounds only to predict the NE nature of this tumor. We performed immunocytochemistry using Chromogranin A, Synaptophysin, and CD56 on our cytologic smear retrospectively with positive results for all of the markers. When the cytopathologic examination of a given breast neoplasm is suggestive of NE differentiation, immunocytochemical staining for NE markers is generally useful for a correct preoperative diagnosis. An acurate preoperative diagnosis of NE carcinoma on FNAC can be achieved based on its distinctive cytomorphologic and immunocytochemical features. © 2010 Wiley-Liss, Inc.

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