Validity of the orthopedic POSSUM scoring system for the assessment of postoperative mortality in patients with pressure ulcers

In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O-POSSUM), which gives a predictive mortality rate for the first 30 postoperative days, may be useful for assessing systemic status, but have yet to be sufficiently validated for patients with pressure ulcers. To assess the validity of POSSUM and O-POSSUM, 71 procedures on 50 cases were retrospectively statistically analyzed using receiver operating characteristic curves and goodness-of-fitness testing with the Hosmer–Lemeshow χ² test for logistic regression modeling. POSSUM and O-POSSUM showed satisfactory discriminatory power in receiver operating curve analysis. The validity of the values obtained by POSSUM and O-POSSUM was also confirmed. O-POSSUM was superior to POSSUM in both analyses. O-POSSUM is useful in assessing the systemic status of patients with pressure ulcers. Some patients with pressure ulcers show extreme systemic conditions. Assessment of systemic status with O-POSSUM contributes to daily clinical practice and future studies of treatments for pressure ulcers.     

Questionnaire survey in Japan for sperm cryopreservation before chemotherapy

Questionnaires were mailed to 104 urological departments in universities, colleges, and cancer centers in February 2008. Ninety institutions returned answers to the questionnaire. Sperm cryopreservation before chemotherapy was performed in 24 institutions (26.7%) mainly in the gynecological department, whereas the others introduced the candidates to other institutions including private hospitals and clinics. Fifty-eight institutes gave information about fertility preservation routinely to young patients with testicular cancer before chemotherapy. Urological doctors in 57 institutions (63%) had no experience in consultation of patients with hematological/pediatric malignancies for fertility-preservation. Among 24 institutions performing sperm cryopreservation before chemotherapy, 18 preserved motile sperm even if during chemotherapy, as well as before chemotherapy but 2 institutions replied that patients during chemotherapy were contra-indication for sperm cryopreservation. For the patients with azoospermia, 2 institutions replied they tried to preserve testicular sperm before chemotherapy. The fee for sperm cryopreservation was free in 10 institutions. This nation-wide questionnaire survey clarified that the systems and indications for sperm cryopreservation before chemotherapy were different among institutions.     

Combustion Synthesis of Porous TiC/Ti Composite by a Self-Propagating Mode

Porous titanium carbide (TiC) and TiC/Ti composites were synthesized by self-propagating high-temperature synthesis (SHS). Titanium and carbon powders were blended by various Ti/C blending ratios. The heat of reaction between titanium and carbon was high enough to induce the self-sustaining reaction of TiC formation on condition that some processing parameters (Ti/C ratio and porosity of the precursor) were appropriately selected. When the Ti/C blending ratio was high, the excess amount of titanium absorbed the heat of reaction. Consequently, the heated zone was not heated up to the ignition temperature. On the other hand, when the Ti/C ratio was low, high thermal conductivity of the precursor prevented an ignition of the heated side of precursors. The pore morphology was controlled by changing the Ti/C ratio and the preheat temperature.     

Pneumonitis induced by the drug ougon]

We report a case of drug-induced pneumonitis associated with the herbal medications Sho-saiko-to and Ouren-gedoku-to. A 62-year-old man experienced fever and dry cough after using Ouren-gedoku-to for 2 months. He was admitted to our hospital because a subsequent 5-day course of Sho-saiko-to for suspected bronchitis aggravated these symptoms and caused exertional dyspnea. Chest X-ray films revealed a ground-glass appearance in both lower lung fields. Cessation of these medications improved the patient's clinical and X-ray findings. Bronchoalveolar lavage showed an increase in lymphocytes with a decreased CD 4/CD 8 ratio. While drug-induced lymphocyte stimulation tests gave negative results, challenge tests for Ouren-gedoku-to and Sho-saiko-to were both positive. A diagnosis of drug-induced pneumonitis was made. Our findings suggested the involvement of Ougon, the only common ingredient in the two medications.     

Use of complementary and alternative medicine by patients with urologic cancer: a prospective study at a single Japanese institution

Objectives We prospectively evaluated the prevalence and predictors of complementary medicine (CAM) use among Japanese patients with urologic cancer 1 year after diagnosis.Patients and methods A total of 349 patients with newly diagnosed urologic cancer answered a self-administered questionnaire on CAM use 1 year after diagnosis. General-health-related quality of life (GHQL) of the patients was also assessed at diagnosis and 1 year after diagnosis using the Medical Outcome Study Short Form-36 (SF-36). The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of several variables including GHQL at baseline and 1 year after treatment on the prevalence of use of CAM were evaluated.Results A total of 164 respondents (47%) admitted using some type of CAM, of which 73 (45%) had used multiple types. Health food, in particular extract from Agaricus blazei, was the most common type of CAM used. CAM users had significantly lower scores for social function, general health perception, and vitality domains than CAM non-users 1 year after diagnosis. This tendency was more marked in users of multiple types of CAM.Conclusions Health food, including extract from A. blazei, was the most commonly used CAM in Japan. The prevalence of CAM use did not differ between patients with prostate cancer and those with urologic cancer other than prostrate cancer. CAM users, especially those who used multiple types of CAM, had lower GHQL scores than non-users of CAM.     

Nephrotoxicity of once-daily cyclosporine A in minimal change nephrotic syndrome

Background  

Although once-daily cyclosporine (CsA) therapy may have greater nephrotoxic-sparing effects than standard twice-daily therapy, little information is available in children with steroid-dependent minimal change nephrotic syndrome (MCNS) regarding histological analysis after long-term once-daily administration.     

Aggressive transformation and extramedullary tumor formation in IgA-lambda multiple myeloma

A 52-year-old woman complained of lower back pain and gluteal pain in April 1997, and was found to have anemia, hypercalcemia and renal disorder. In September of the same year, she was diagnosed as having IgA-lambda myeloma (stage IIIA). VMMD-IFN therapy was started in November, 1997, and this resulted in improvement of the M-protein level, and relief of the pain in the lower back and gluteal region. A second course of VMMD-IFN therapy was also effective. In April 1998, however, the back pain worsened, and in July the patient suffered a fall and fractured her left femur. Upon readmission to our hospital, the level of M-protein was lower, and high fever, hypercalcemia, renal disorder, elevation of the LDH level, anemia and thrombocytopenia were observed. Bone marrow examination revealed 30% atypical large-sized CD19-, CD38+, CD56+ myeloma cells and chromosomal abnormalities. Although the symptoms were improved temporarily after a third course of VMMD therapy, disease aggravation occurred again, and extramedullary masses appeared on the head, face and pelvis. VAD therapy was performed without effect, and the patient died about 2 months after recurrence. This was a comparatively rare case of fulminant multiple myeloma occurring in the terminal stage.