Clinical path for mFOLFOX6 describing criteria for reduction and suspension of drugs

Clinical path for executing mFOLFOX6 in an outpatient chemotherapy room was settled on for the aim of standardization and common information with medical staffs about mFOLFOX6. The feature of this clinical path is described doses of drugs, results of laboratory examination, criteria for deciding adverse effects, common adverse effects and management, criteria for reduction and suspension of oxaliplatin and 5-fluorouracil. Patients before induction of the clinical path were compared with patients after that about relative dose intensity (RDI), reasons why treatments were suspended and progression-free survival (PFS). Fifty eight patients after induction were significantly higher RDI of oxaliplatin than 108 patients before induction (p=0.04). There were no significant differences about a frequency of suspension due to adverse effects (p=0.18) and PFS (p=0.74). The clinical path that we settled on was considered useful not only for common information with medical staffs but also for standardization.     

Contribution of out-of-hospital factors to a reduction in cardiac arrest mortality after witnessed ventricular fibrillation or tachycardia

Background

Mortality rates in Osaka for cardiac arrest after witnessed ventricular tachycardia (VT) or ventricular fibrillation (VF) have decreased dramatically. We sought to estimate the contribution of changes in out-of-hospital care to this decrease.

Methods

We applied a previously validated statistical model, IMPACT, to data obtained from the Utstein Osaka Project, which registers all cardiopulmonary arrests in Osaka. The outcome was death within the first month after the arrest. Sensitivity analysis was conducted by simulating an increase in the use of public access defibrillators (PADs).

Results

From 1999 through 2008, age- and sex-adjusted standardized 1-month mortality fell from 88.6% to 57.1%. There were 105 fewer deaths than expected in 2008 (295 deaths). The IMPACT model explained 62.5% of the decrease (67 deaths) in the 1-month mortality. The main contributors to the decrease in mortality were an increase in the use of biphasic waveform defibrillators, and a shortened time to first shock. These were partly offset by an increase in the administration of epinephrine by emergency medical services personnel. According to the simulation, an increase in PAD use from 1.9% to 34.4% would reduce mortality from the observed 57.1% to 49.5%.

Conclusions

Modeling suggests that improvement in out-of-hospital care accounted for approximately 60% of the decline in deaths following witnessed VT or VF arrests in Osaka between 1999 and 2008. Increased usage of PADs could further improve these outcomes.     

Bilateral vocal cord paralysis caused by laryngeal mask airway

The laryngeal mask airway (LMA) is regarded as a safer supraglottic airway for general anesthesia compared with conventional endotracheal tubes. We report a case of bilateral vocal cord palsy temporarily observed after using the LMA, which required urgent tracheotomy. Severe swelling of the arytenoid suggested that bilateral recurrent laryngeal nerve palsy was caused by prolonged compression on the pyriform fossa. One month later, vocal cord movements were fully recovered. It should be noted that bilateral vocal cord palsy is a possible complication associated with use of the LMA.     

Threshold temperatures of diencephalic neurons responding to scrotal warming

Neurons in the rat's thalamus and hypothalamus abruptly change their firing rates from minimum to maximum, or vice versa, with increase in scrotal temperature of 1°C or less (switching response). The threshold temperature of the switching response was compared in pairs of neurons simultaneously recorded from the right and left thalamus or from the right thalamus and the left hypothalamus. In dynamic conditions in which scrotal skin was gradually warmed at rates of 1–7°C/min, the threshold temperatures of each neuron pair differed by only 0.4°C or less. The threshold temperatures of static responses of each pair of neurons, which was determined with step changes in scrotal temperature, fell in a range less than 0.8°C. Scrotal wariming produced desynchronization of cortical EEG which was monitored during unit recordings. The change in EEG occurred at about the same scrotal temperature at which the switching responses of the diencephalic neurons were elicited.     

Three patients with hemophagocytic syndrome who developed acute organic brain syndrome

INTRODUCTION: We describe three patients with hemophagocytic syndrome (HPS) who developed acute organic brain syndrome. All three presented with high-grade fever and twilight state, and were admitted to our hospital. After admission, delirium developed in all three. As delirium improved, various other psychiatric symptoms, including hallucinations, agitation, hypoactivity, affective lability and insomnia, were noted. DISCUSSION: When treated with steroid hormones, immunoglobulin and neuroleptics, all patients demonstrated improvement in their psychiatric symptoms, as well as in their general condition and laboratory findings. Ultimately, they all recovered and were discharged. CONCLUSION: It needs to be noted that organic brain syndrome might be observed at the onset of HPS. Consequently, early diagnosis and treatment for psychiatric symptoms, as well as for HPS, are crucial.     

A case report of juxtaglomerular cell tumor incidently found with a tumor hemorrhage

A 17-year-old man was admitted to our hospital with a chief complaint of right flank pain. Both computed tomography and magnetic resonance imaging demonstrated a tumor hemorrhage in a mass located at the upper pole of the right kidney. He had a high blood pressure of 220/100 mmHg associated with high serum renin activity (36.2 ng/ml/hr). Partial nephrectomy was performed and histopathological examination revealed a juxtaglomerular cell tumor. Postoperatively, his blood pressure was markedly improved and the serum renin activity immediately fell into the normal range. Previously, 32 cases of juxtaglomerular cell tumor have been reported in the Japanese literature, and to our knowledge, this is the first case was found with a tumor hemorrhage.     

Activation of central warm-sensitive neurons and the tail vasomotor response in rats during brain and scrotal thermal stimulation

The effects of preoptic and hypothalamic thermal stimulation on tail skin temperature were observed at different scrotal temperatures. The threshold hypothalamic temperature for tail vasodilation at a scrotal temperature of 40°C was significantly lower than that at a scrotal temperature of either 25°C or 33°C. The effects of scrotal thermal stimulation on tail skin vasodilated by higher hypothalamic temperatures were observed. Cooling the scrotum from 42 to 30°C invariably caused a rapid fall in tail temperature, whereas scrotal cooling from 30 to 25°C did not cause any significant change. Cooling of either the left or right half of the scrotum caused a similar fall in tail temperature. The temperature characteristics of the preoptic hypothalamic thermo-sensitive neurons were determined at scrotal temperatures of 32, 36 and 26°C. The firing rate of warm-sensitive neurons at a given hypothalamic temperature was highest at a scrotal temperature of 36°C, while that of cold-sensitive neurons was lowest at that temperature. The scrotal temperature range over which the number of neurons activated by scrotal warming increased rapidly was between 36 and 39°C when hypothalamic temperature was held at 36–37°C.     

Systematic cognitive behavioral approach for oral hygiene instruction: a short-term study

OBJECTIVE: Determine whether a six-step behavioral cognitive method is more effective than traditional oral hygiene instruction. METHODS: Thirty-eight patients with chronic periodontitis were randomly assigned to two groups. The control group was given traditional oral hygiene instruction for 20 min. The intervention group received counseling by Farquhar's six-step method for 10 min after traditional oral hygiene instruction. In both groups, oral hygiene instruction was given once a week, and performed three times in total for 3 weeks. Clinical characteristics, deposition of dental plaque, frequency and duration of brushing, frequency of interdental cleaning and scores based on scale of "self-efficacy for brushing of the teeth" were compared in both groups. RESULTS: There were no differences between the two groups in clinical, demographic, behavioral and self-efficacy characteristics at the baseline examination. However after the third visit, the intervention group had a significantly higher self-efficacy, lower plaque index, longer brushing duration and higher frequency of inter-dental cleaning than those of the control group. Multiple regression analysis showed significant association of toothbrushing duration with self-efficacy for brushing of the teeth (p<0.001). CONCLUSION: The six-step method might be more effective for enhancing self-efficacy and behavioral change of oral hygiene than traditional oral hygiene instruction alone. PRACTICE IMPLICATIONS: Dentists and dental hygienists can use the six-step method for effective oral hygiene instruction.