Psychotropic drugs for terminally ill patients with respiratory disease

Utilization of psychotropic drugs including hypnotics, sedatives, and parenteral morphine for terminally ill patients with respiratory disease has not been reported precisely. To better understand these drugs for dying patients with respiratory disease, we focused on the last month of life of them. A chart review, which was focused on symptoms and managements, in the last month of life of 337 patients who died of respiratory disease between April 2000 and March 2005 were performed. Hypnotics were prescribed in 35.8% and 23.2% of patients with malignant and non-malignant disease, respectively. Sedatives such as haloperidol and midazolam were utilized in 34.4% of patients with malignant disease, and 30.4% of those with non-malignant disease. Sixty-seven percent of patients with malignant and 22.4% of those with non-malignant disease had parenteral morphine. In patients with malignant disease, three of the main reasons for administration of morphine were pain, dyspnea, or terminal restlessness. In all of the patients with non-malignant disease, however, parenteral morphine was prescribed for the treatment of dyspnea. Our results showed that psychotropic drugs and parenteral morphine are required in some of terminally ill patients with respiratory disease. Although careful individualization of medication is appropriate, guideline for the prescribing psychotropic drugs for these patients will be required.     

Percutaneous osteoplasty with use of a cement-filled catheter for a pathologic fracture of the humerus

Percutaneous osteoplasty has been used for pathologic fractures of long bones as an adjunct to orthopedic surgery. The present report describes a case of percutaneous osteoplasty with a cement-filled catheter and cement augmentation as the principal therapy to unite a painful pathologic fracture of the humerus. After the procedure, the patient experienced immediate pain relief and improved limb mobility. Percutaneous osteoplasty with this method holds promise as a treatment for pathologic fractures of the humerus that are not amenable to surgical repair.     

Study on internal structure of zygomatic bone using micro-finite element analysis model--differences between dentulous and edentulous dentition in Japanese cadavers

The purpose of this study was to analyze changes in the internal structure of zygomatic bone using a micro-finite element analysis model (muFEA) and compare angular orientation of trabeculae against compressive force in edentulous and dentulous jaws. Twenty zygomatic bones from dentulous jaws and 20 zygomatic bones from edentulous jaws harvested from Japanese male cadavers were used. From 2-dimensional slice images, we reconstructed 3-dimensional (3D) structure by the volume rendering method using micro-computed tomography (micro-CT). To analyze mechanical properties, all voxels were converted to muFEA models. The angle between the strongest direction of trabecular bone and the axial loading direction (angle alpha) was then determined using the muFEA models. In the 3-D reconstruction images, trabecular density in dentulous jaws was higher than that in edentulous jaws at all loci. Trabeculae in dentulous jaws showed a plate-like structure. The muFEA modeling revealed that the angle of the trabeculae at the Jugale in edentulous jaws was lower than that in dentulous jaws. This suggests that the internal structure of trabeculae is influenced by occlusal force in zygomatic bone from edentulous jaws.     

Epidemiology of multiple myeloma

Death rates due to multiple myeloma are increasing by every year in Japan since 1970. 1,896 men and 1,889 women were died, during 2005. Crude mortality rates are also rising since 1970 and reach 3.04 per 100,000 and 2.89 per 100,000 among men and women, respectively in 2005. Age-adjusted mortality rates (using the 1985 Japan Standard) reach 1.5-1.6 per 100,000 in 1995 and persist its value till now.