Severity factors of Mamushi (Agkistrodon blomhoffii) bite

The factors determining the severity of a Mamushi ( Agkistrodon blomhoffii ) bite were analyzed based on the findings of our 34 cases and those appearing in the published work. It was not possible to forecast the final severity at the time of the patient's arrival and by the initial blood examination data. The maximal creatinine kinase (CK) values elevated proportionally with the time from the bite, and the relation approximated the equation of y = 300χ, where y represents the maximal CK value and χ indicates the time from the bite to the peak of CK level. In the severe cases which required intensive care, the level of the CK deviated remarkably from this line, and could be grossly distinguished from the non-severe cases. The maximal white blood cell (WBC) count also gradually increased in concordance with the time from the bite, and in addition, the WBC count of most of the severe cases exceeded 20 000/µL. This evidence suggests that the rate of the CK value elevation in relation to the time from the bite can be a useful indicator of the severity of a Mamushi bite, and the WBC count also reflects the severity.     

Myxoid leiomyosarcoma of hte esophagus

A 34-year-old male patient with epigastralgia was found to have an esophageal submucosal tumor based on an endoscopic evaluation 6 years previously. Because an unusual appearance composed of a heterogenous solid area and a cyst area on the endoscopic ultrasonogram and the increased size of the tumor on esophagograms over the past 3 years were suggestive of a malignant character, an operation was thus indicated. The tumor, which measured 3.5 × 2.5 × 2.0 cm in size, was enucleated using videoassisted thoracic surgery and was diagnosed to be a very rare myxoid leiomyosarcoma with a thorough pathologic examination. To our knowledge, this is only the second case of esophageal myxoid leiomyosarcoma reported in the literature. We thus consider this case, which demonstrated an unique appearance on an endoscopic ultrasonogram, to possibly be beneficial to the overall diagnostic analysis of esophageal submucosal tumors.     

Mid-term report on the project "Disaster nursing in a ubiquitous society" in the academic years 2003 and 2004

Aim: This is the mid‐term report of the project titled “Disaster nursing in a ubiquitous society”, funded by the Japanese Government. The purpose of this project is to develop the self‐care abilities of communities and individuals to independently regenerate and recover from the consequences of disasters. Methods: The methods utilized in this project were questionnaires sent by post or placed on websites, and interviews. The participants in our research were people with special needs in the case of a disaster, nursing professionals, ordinary people, and other professionals. Results: During 2003 and 2004, there were activities that progressed according to the original plans, activities that progressed at a faster rate than foreseen in the original plans, and newly expanded research activities that were conducted. New academic knowledge gained from the project activities includes five factors for disaster preparedness, six common issues related to health, care, training, and others, six categories of necessary factors in nursing activities, the clarification of the support needs of care‐providers, and the clarification of specific groups with unique needs including children, pregnant and postpartum women, elderly people, people with chronic conditions, cancer patients, and care‐providers. Conclusions: The growing recognition of our center as a global base of disaster nursing is indicated by the fact that we receive numerous requests from Japan and abroad, that our suggestions influence some governmental policies, and that we take initiatives in promoting the concept of disaster nursing throughout the world. It is necessary to disseminate the results of this project, to develop further knowledge, to clarify future challenges related to disasters, and to contribute to the preparedness of people and communities.     

Postoperative changes in acute phase protein in patients with esophageal cancer]

Thirty-three patients with esophageal cancer were studied to assess the relationship between nutritional state and the acute phase protein responses. Blood samples taken preoperatively and days 1, 4, 7 and 14 after operation were analyzed for C-reactive protein, fibrinogen, alpha 1-antitrypsin, alpha 1-acid glycoprotein and haptoglobin. Significant Spearman's coefficients were found between percent of ideal body weight (IBW) and alpha 1-acid glycoprotein (r = -0.42), between prealbumin and alpha 1-anti-trypsin (r = -0.55), and between retinol-binding protein and alpha 1-antitrypsin (r = -0.51). Postoperatively, the levels of C-reactive protein, fibrinogen, alpha 1-anti-trypsin and alpha 1-acid glycoprotein were significantly lower in the poorly nourished group than in the other groups. The changes of acute phase proteins in the immediate postoperative period were affected by the preoperative nutritional state, and were less marked in the poorly nourished patients. Between two groups of patients in whom lymph node dissection was carried out in 2 or 3 areas, no significant differences were observed in the acute phase protein responses postoperatively. The measurement of acute phase proteins is very important in assessing the body defense capacity of the patient, but it should be noted that the changes may be affected by several factors including malnutrition.     

Suppressive effect of cocoa powder on atherosclerosis in Kurosawa and Kusanagi-hypercholesterolemic rabbits

We investigated the suppressive effect of cocoa powder (cacao polyphenol content: 7.8%) on atherosclerosis in a spontaneous familial hypercholesterolemic model, Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits. Six-month dietary administration of cocoa powder had no effects on body weight, hematology or blood chemistry parameters or a lipid profile in KHC rabbits. Antioxidative activity of low-density lipoprotein (LDL) was observed in the 2nd month and 3rd month of administration. Thiobarbituric acid reactive substances (TBARS), the marker of lipid peroxidation, in plasma were decreased in the cocoa powder treated group from the 2nd month of administration during the study period compared to that in the control group. The area of atherosclerotic lesions in th aorta was significantly smaller in the cocoa powder group (30.87%) than in the control (52.39%). Tissue cholesterol content also tended to decrease. Distensibility of the aortic wall was improved significantly in the cocoa powder treated group due to decreases in fatty streaks and intimal thickening compared to that in the control group. These results suggest that cocoa powder has suppressive effect on development of atherosclerotic lesions. We consider that antioxidative activity of polyphenols rich in cocoa powder may be a key factor for the anti-atherosclerotic effect.