Interactions of household composition and required care level with functional and cognitive status among disabled Japanese elderly living in a suburban apartment complex

Aim: In the forthcoming super‐aging society, the appropriate assessment of functional and cognitive conditions of disabled elderly people will become increasingly significant in providing care services. Care level and household composition would be key factors to assess function. There might also be an interaction between the two factors with the function. The present study examined the associations of household composition and care level with functional and cognitive status among the disabled elderly living in a suburban apartment complex with a high rate of aged residents (39% in 2009). Methods: Participants were 190 disabled elderly persons aged 65 years and over who lived in the apartment complex. Cross‐sectional data were collected between May 2009 and August 2010, including care level, household composition, basic activities of daily living (BADL), instrumental activities of daily living (IADL) and the independence level in relation to cognitive status. Lower scores meant less independence in BADL and IADL, and as determined by the cognitive/independence scale. Results: Approximately half of the participants lived alone. Generalized linear model procedure showed significant interactions with the BADL score and cognitive/independence scale between household composition and care level. Scores for BADL and the cognitive/independence scale in groups receiving a higher care level were lower; however, the slope of the trend for the elderly living alone was more gradual than for the elderly living with others. Conclusion: It is important for health‐care providers to assess in detail the status of the disabled elderly considering both their household composition and care level in planning and providing assistance for them. Geriatr Gerontol Int 2012; 12: 538–546.     

Effect of biological factors on latency of pattern-reversal visual evoked potentials associated with cathode ray tubes and liquid crystal display monitors in normal young subjects

Documenta Ophthalmologica - Owing to several factors, peak latencies of pattern-reversal visual evoked potentials (p-VEP) are delayed when viewing liquid crystal display (LCD) monitors compared to...     

ACC/AHA classification of coronary lesions reflects medical resource use in current percutaneous coronary interventions

Objectives : The purpose of this study was to investigate the association between ACC/AHA type classification of coronary lesions and medical resource utilization. Background : It is not known whether the classification of coronary lesions by the ACC/AHA system reflects the consumption of medical resources in current percutaneous coronary interventions (PCI). Methods : We identified coronary artery lesions treated with PCI from our PCI database between January 1, 2009 and December 31, 2009. Lesions were classified into type A, type B1, type B2, and type C according to the ACC/AHA definition. Total PCI cost, total contrast volume, and total fluoroscopy time were compared among the groups. Results : A total of 447 lesions were analyzed. The number of type A, type B1, type B2, and type C lesion were 75 (16.8%), 98 (21.9%), 145 (32.4%), and 129 (28.9%), respectively. Total PCI cost for type A, type B1, type B2, and type C lesions were $7,262 ± 1,397, $8,126 ± 1,891, $9,126 ± 3,128, and $13,243 ± 4,678, respectively (P < 0.0001). Total contrast volume and fluoroscopy time were also stratified according to the order of type A, type B1, type B2, and type C lesions (P < 0.0001 for total contrast volume; P < 0.0001 for total fluoroscopy time). Conclusions : Total PCI cost, total contrast volume, and total fluoroscopy time were clearly stratified according to the order of type A, type B1, type B2, and type C lesions. Lesion classification by the ACC/AHA system reflects medical resource use in current PCI. © 2011 Wiley Periodicals, Inc.     

Effects of aliskiren-based therapy on ambulatory blood pressure profile, central hemodynamics, and arterial stiffness in nondiabetic mild to moderate hypertensive patients

J Clin Hypertens (Greenwich). 2012;00:000–000. ©2012 Wiley Periodicals, Inc. Aliskiren is a direct renin inhibitor that exerts its effect at the rate‐limiting step of the renin‐angiotensin system. This study was performed to examine the beneficial effects of aliskiren‐based antihypertensive therapy on the ambulatory blood pressure (BP) profile, central hemodybamics, and arterial stiffness in untreated Japanese patients with mild to moderate hypertension. Twenty‐one Japanese nondiabetic patients with untreated mild to moderate essential hypertension were initially given aliskiren once daily at 150 mg, and the dose was titrated up to 300 mg as needed. After 12 weeks of aliskiren‐based therapy, the clinic, ambulatory, and central BP values as well as brachial‐ankle pulse wave velocity (baPWV) were all significantly decreased compared with baseline (clinic systolic BP, 151±11 mm Hg vs 132±11 mm Hg; clinic diastolic BP, 91±13 mm Hg vs 82±9 mm Hg; 24‐hour systolic BP, 144±12 mm Hg vs 133±11 mm Hg; 24‐hour diastolic BP, 88±8 mm Hg vs 81±9 mm Hg; central BP, 162±16 mm Hg vs 148±14 mm Hg; baPWV, 1625±245 cm/s vs 1495±199 cm/s; P<.05). These results show that aliskiren, as a first‐line regimen, improves the ambulatory BP profile and may have protective vascular effects in Japanese nondiabetic patients with untreated mild to moderate essential hypertension.     

A case of multiple metastatic malignant melanoma with the largest lesion in the ileum and no skin lesion

We report the case of a 72-year-old woman with malignant melanoma and multiple metastases; the largest tumor was in the ileum. The patient experienced general fatigue and bloody feces for 1 month before consulting a nearby clinic. Blood tests revealed anemia, and fecal occult blood was positive, but no abnormalities were detected using gastrointestinal endoscopy and colonoscopy or the skin of the entire body. Computed tomography images of the chest, abdomen, and pelvic region, and positron emission tomography–computed tomography images of the entire body revealed multiple nodules in the ileum, left mammary gland, left thyroid, right inguinal lymph node, and on the fascia of the right thoracic area and right buttocks. The tumor in the left mammary gland was excised and immunohistochemical analysis revealed that the excised tissue was positive for HMB45, melan-A, and MITF, but negative for S-100 protein. Diagnosed with melanoma with multiple metastases, the patient underwent four cycles of dacarbazine, nimustine hydrochloride, and vincristine (DAV) plus interferon beta chemotherapy and one cycle of dacarbazine, nimustine hydrochloride, cisplatin, and tamoxifen (DAC-Tam) chemotherapy. Two series of embolizations of the artery feeding the ileum tumors, as well as a series of plasma and red blood cell transfusions, were performed for ileum tumor hemorrhage. The patient was hospitalized eight times, for a total of 204 days during the 1-year survival period before her death from respiratory failure.     

Successful endoscopic dilatation of a severe stricture of the cervical esophagus after definitive combined chemotherapy plus radiotherapy for esophageal cancer

We describe an improved endoscopic technique for antegrade dilatation of a cervical esophageal stricture performed with the use of using a guide wire, an endoscopic retrograde cholangiopancreatic-duct (ERCP) catheter, and a balloon dilator. The patient was a 55-year-old woman who had a cervical esophageal stricture associated with definitive chemoradiotherapy for advanced esophageal squamous cell carcinoma. Endoscopy showed the stricture was located at the esophageal orifice. The membranous stricture was punctured with an ERCP catheter, and balloon dilators were passed through the stricture under C-arm fluoroscopy. This technique is considered useful for managing severe strictures of the cervical esophagus after combined chemotherapy plus radiotherapy for esophageal cancer.