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Shinjo T.,Shakaihoken Kobe Central Hospital | Morita T.,Seirei Mikatahara General Hospital | Miyashita M.,University of Tokyo | Sato K.,University of Tokyo | And 2 more authors.
Journal of Palliative Medicine | Year: 2010

Objectives: The aim of this study is to clarify the actual experiences and preferences of the bereaved family for the care of their deceased family member. Methods: At 95 palliative care units in Japan, a cross-sectional nationwide survey of the bereaved families of cancer patients was performed in 2007. Results: Of the 670 questionnaires sent to bereaved families, 492 were returned (response rate of 76%). The overall requirement to improve the end-of-life care was rated as follows: improvement needed (42.7%) and no improvement needed (58%). In total, 9.4% of the families reported that they experienced problems with the deceased body after leaving the hospital, including a change in the facial appearance (8.5%), stains on the body (8%), and an odor emanating from the body (4%). Regarding the preferences for treatment procedures, over half the families preferred not to have traditional procedures performed in which the deceased's hands are joined with a band, the jaws are tied with a band around the face to close the mouth, and the body is wrapped in a sheet. The most preferable treatment procedure was to have makeup applied lightly and moderately. Maintaining the appearance of the deceased body was related to the overall care evaluation of end-of-life care. Conclusions: As the preferences for the care of deceased bodies are changing, end-of-life care needs to be improved with respect to culture, religious views, and the wishes of the patient and their family. © 2009, Mary Ann Liebert, Inc.


Hisanaga T.,Tsukuba Medical Center Hospital | Shinjo T.,Shakaihoken Kobe Central Hospital | Morita T.,Seirei Mikatahara General Hospital | Nakajima N.,Tenshi Hospital | And 6 more authors.
Japanese Journal of Clinical Oncology | Year: 2010

Objective: The aim of this study was to evaluate the efficacy and safety of octreotide for malignant bowel obstruction in a multicenter study. Methods: Terminally ill patients diagnosed with inoperable malignant bowel obstruction were treated with octreotide 300 μg/day. The primary endpoint was the overall improvement rate of subjective abdominal symptoms. The degrees of nausea, vomiting, abdominal pain, distension, anorexia, fatigue, thirst and overall quality of life were evaluated by the self-rating scores selected from the MD Anderson Symptoms Inventory and Kurihara's Face Scale. Results: Forty-nine patients were enrolled in the study, and 46 patients received study treatment, including 17 gastric, 13 colorectal, 7 ovarian and other cancers. The median survival time was 25 days. The number of vomiting episodes significantly correlated with the MD Anderson Symptoms Inventory nausea and vomiting scores (P , 0.001) before octreotide treatment. Of 43 patients evaluable for efficacy, the scores of all the MD Anderson Symptoms Inventory items except abdominal pain and the number of vomiting episodes improved during the first 4 days of octreotide treatment (P< 0.0062). The MD Anderson Symptoms Inventory scores were decreased in 59-72% of patients, and overall quality-of-life scores improved in 56% of patients. No serious adverse events were observed. Conclusions: The high improvement rate in abdominal symptoms suggested the efficacy of octreotide in terminally ill patients with malignant bowel obstruction. © The Author (2010). Published by Oxford University Press. All rights reserved.


Yagi K.,Shakaihoken Kobe Central Hospital | Kano G.,Shakaihoken Kobe Central Hospital | Shibata M.,Shakaihoken Kobe Central Hospital | Sakamoto I.,Shakaihoken Kobe Central Hospital | And 2 more authors.
Pediatric Blood and Cancer | Year: 2011

A 3-year-old male presented with Chlamydia pneumoniae infection-related hemophagocytic lymphohistiocytosis (HLH). The patient developed an episode of HLH with severe skin eruption following C. pneumoniae pneumonia. Symptoms responded to steroid/cyclosporine A therapy, but the patient slowly lost consciousness and developed systemic flaccid paralysis. He was diagnosed with encephalitis/myelitis by brain and spinal MRI. Neurological symptoms and signs gradually resolved. We thought that the immune response to C. pneumoniae infection triggered the development of HLH, associated with unusual neurological complications. This report describes a novel case of C. pneumoniae-associated HLH and with poliomyelitis like flaccid paralysis. © 2010 Wiley-Liss, Inc..


Shimoyama N.,Jikei University School of Medicine | Gomyo I.,Saito Yukoukai Hospital | Gomyo I.,Red Cross | Katakami N.,Institute of Biomedical Research and Innovation Hospital | And 4 more authors.
International Journal of Clinical Oncology | Year: 2015

Background: Breakthrough cancer pain typically has a rapid onset and relatively short duration. Due to this temporal profile, it may not be adequately relieved by oral opioid analgesics. The sublingual fentanyl orally disintegrating tablet is a formulation by which fentanyl can be rapidly absorbed across the oral mucosa producing rapid-onset analgesia, and which may be effective for breakthrough pain treatment. Methods: A multicenter, randomized, placebo-controlled, double-blind comparative study was conducted to evaluate the efficacy and safety of the sublingual fentanyl tablet at optimized doses for breakthrough pain treatment in cancer patients treated with strong opioid analgesics at fixed intervals. The optimal dose was determined by open-label dose titration. The efficacy and safety of a 12-week extended treatment were also evaluated. Results: Eleven of 42 subjects who received the sublingual fentanyl tablet experienced adverse drug reactions. Common reactions were somnolence, constipation, nausea, and vomiting. No serious adverse reactions occurred. Sublingual fentanyl tablets at optimal doses and placebo were administered to 37 subjects in a double-blinded manner. A significant analgesic effect of the sublingual fentanyl tablet was present compared to placebo at 30 min after administration. The sublingual fentanyl tablet was also effective and safe during extended treatment, in which changes in basal opioid doses as well as sublingual fentanyl tablet doses were made as needed. Conclusion: Sublingual fentanyl tablets at doses determined by titration were effective and safe for breakthrough pain treatment in cancer patients treated with strong opioid analgesics at fixed intervals. Extended treatment up to 12 weeks was also effective and safe. © 2014, Japan Society of Clinical Oncology.


Shirakawa T.,Kobe University | Haraguchi T.,Kobe University | Shigemura K.,Kobe University | Morishita S.,Kobe Century Memorial Hospital | And 6 more authors.
International Journal of Urology | Year: 2013

Objectives: Silodosin is a novel drug that is highly selective to subtype alpha 1A and, since 2006, has been used in Japan for treating benign prostatic hyperplasia. This study aimed to compare the clinical effects of the alpha-adrenoceptor antagonist, silodosin, with those of naftopidil in patients presenting lower urinary tract symptoms associated with benign prostatic hyperplasia. Methods: This was a randomized, open-label, controlled multicenter study carried out in Japan. Overall, 121 participants with lower urinary tract symptoms associated with benign prostatic hyperplasia were randomized to receive silodosin (4mg twice daily) or naftopidil (50mg once daily) for 4 or 8 weeks. Patients were divided into four groups: the alpha-blocker-naive groups received silodosin (35 patients) or naftopidil (33 patients) and the drug-switching groups changed from tamsulosin to silodosin (26 patients) or naftopidil (27 patients). The outcomes parameters were the International Prostate Symptom Score, quality of life, maximum urinary flow rate and post-void residual urine volume. P<0.05 was considered statistically significant by using the Wilcoxon signed-rank and rank-sum tests, and analysis of covariance. Results: In all the groups, silodosin and naftopidil significantly improved the total International Prostate Symptom Score and quality of life. However, silodosin obtained significantly better improvement in total International Prostate Symptom Score in the alpha-blocker-naive patients at 4 and 8 weeks. The maximum urinary flow rate and residual urine did not change significantly in all the treatment groups. Conclusions: The present study confirms the clinical usefulness of silodosin in the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. © 2012 The Japanese Urological Association.


Wani I.,Smhs Hospital | Kitagawa M.,Shakaihoken Kobe Central Hospital | Rather M.,Smhs Hospital | Singh J.,Smhs Hospital | And 2 more authors.
Cases Journal | Year: 2014

Introduction: Torsion of the vermiform appendix is a rare disorder, which causes abdominal symptoms indistinguishable from acute appendicitis and is found by chance during the laparotomy. Case presentation: We report a case (a 76-year-old male) suffering of torsion of the vermiform appendix with fecalith. It was twisted 540 degrees in an anti-clockwise direction. Appendectomy was done. Conclusion: Appendiceal torsion may be assocated with the presence of fecalith. This case is the oldest one among the patients with appendiceal torsion reported to literature. © 2008 Wani et al; licensee BioMed Central Ltd.


Shinjo T.,Shakaihoken Kobe Central Hospital | Okada M.,Shakaihoken Kobe Central Hospital
Journal of Palliative Medicine | Year: 2013

"Death rattle" is a term used to describe the noisy sound produced by dying patients caused by the oscillatory movements of secretions in the upper airways. Antimuscarinic drugs, including atropine, scopolamine (hyoscine hydrobromide), hyoscine butylbromide, and glycopyrronium, have been used to diminish the noisy sound by reducing airway secretions. We report on the effectiveness of sublingual atropine eyedrops in alleviating death rattle in a terminal cancer patient. We present a 58-year-old man with pancreatic cancer who was admitted to our hospital because of severe dyspnea, cough, and death rattle with excessive bronchial secretion as a result of multiple lung metastases. We administered 1% atropine eyedrops sublingually to obviate the need for subcutaneous infusions and to prevent somnolence. On the basis of our experience, we conclude that atropine eyedrops, administered sublingually for distressing upper respiratory secretions, may be an effective alternative to the injection of antimuscarinic drugs, or as an option when other antimuscarinic formulations are not available. © Mary Ann Liebert, Inc.


Shinjo T.,Shakaihoken Kobe Central Hospital | Okada M.,Shakaihoken Kobe Central Hospital
Journal of Palliative Medicine | Year: 2010

Certain physical signs can be useful in predicting impending death. We present four terminally ill patients with malignancy who developed petechiae on their bilateral palms and fingers during the week prior to their deaths. Drug-induced eruption, injury, and mechanical stimuli were thought to be unlikely causes of the petechiae. While the phenomenon has not previously been reported, we speculate palmar petechiae may be a clinical cutaneous sign of systemic deterioration in terminally ill patients. © Copyright 2010, Mary Ann Liebert, Inc. 2010.


PubMed | Shakaihoken Kobe Central Hospital
Type: Case Reports | Journal: Journal of palliative medicine | Year: 2013

Death rattle is a term used to describe the noisy sound produced by dying patients caused by the oscillatory movements of secretions in the upper airways. Antimuscarinic drugs, including atropine, scopolamine (hyoscine hydrobromide), hyoscine butylbromide, and glycopyrronium, have been used to diminish the noisy sound by reducing airway secretions. We report on the effectiveness of sublingual atropine eyedrops in alleviating death rattle in a terminal cancer patient. We present a 58-year-old man with pancreatic cancer who was admitted to our hospital because of severe dyspnea, cough, and death rattle with excessive bronchial secretion as a result of multiple lung metastases. We administered 1% atropine eyedrops sublingually to obviate the need for subcutaneous infusions and to prevent somnolence. On the basis of our experience, we conclude that atropine eyedrops, administered sublingually for distressing upper respiratory secretions, may be an effective alternative to the injection of antimuscarinic drugs, or as an option when other antimuscarinic formulations are not available.


PubMed | Shakaihoken Kobe Central Hospital
Type: Case Reports | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2014

Pulmonary veno-occlusive disease (PVOD) is a rare chronic lung disease that is difficult to diagnose due to non-specific clinical findings. Little is known about the pathogenesis of PVOD. Reported herein is the case of an 11-year-old girl who initially presented with bat-wing shadows on chest radiography. This finding, coupled with prominent hemosiderosis in bronchoalveolar lavage fluid, initially led to a misdiagnosis of idiopathic pulmonary hemosiderosis. Oral prednisolone dramatically improved signs and symptoms initially, but her condition then gradually deteriorated during maintenance therapy with corticosteroids and other immunosuppressants. PVOD was suspected but not confirmed owing to a lack of hallmark radiographic findings and contraindications for lung biopsy. Three years later, while arranging for lung transplantation, the patient experienced sudden onset of fatal massive pulmonary edema. PVOD was confirmed at autopsy. This case provides insights regarding an unfamiliar presentation of PVOD and may help physicians to avoid diagnostic pitfalls.

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