Improvements in health by consultations using mobile videophones among participants in a community health promotion programme

We conducted a health promotion programme using mobile videophones and examined changes in the participants' health conditions, health practices and their subjective sense of health. The subjects were volunteers (mean age, 59 years) recruited from a community-based health promotion group. A focus group interview was conducted to evaluate the quality of the programme. All subjects expressed concerns about lifestyle-related diseases. The subjects participated in group activities at least twice a month under the supervision of public health professionals. Six of them participated in mobile care in addition to group activities (mobile care group) and the other eight subjects (control group) participated in the regular group activities. Three consecutive health examinations were carried out at intervals of 12 weeks. There were significant reductions in low-density lipoprotein cholesterol (P = 0.01) and health locus of control internal score (P = 0.05) in the mobile care group. The subjects who used mobile phones were highly accepting of the use of the device for further health consultations. There is potential for wider application of mobile videophones in health promotion programmes for people who have concerns about lifestyle-related diseases and are seeking healthier lifestyles.     

Prognostic value of the Tei index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty

Cardiac systolic (left ventricular ejection fraction) and diastolic (mitral inflow velocity pattern and/or mitral deceleration time) function were reported as predictors of clinical outcome or left ventricular remodeling in patients with acute myocardial infarction (AMI). Recently, a new index (Doppler-derived index combining systolic and diastolic myocardial performance; Tei index) for combined systolic and diastolic ventricular function has been reported to be a useful and convenient method for evaluation of global ventricular function. We therefore investigated the usefulness of the Tei index by echocardiography for evaluation of infarct size and clinical outcome in patients with AMI treated by successful primary angioplasty. We analyzed 10 age-matched control subjects and 43 consecutive patients with first AMI treated by successful primary angioplasty. The Tei index of the AMI patients was significantly greater than that of the control subjects (0.630 ± 0.106 vs 0.375 ± 0.036, P 0.0001). Also, the Tei index showed a significant positive correlation with peak creatine kinase values and ^99mTc-tetrofosmin scores. Moreover, multiple logistic regression analysis showed that the Tei index 0.70 (P = 0.0313, odds ratio = 14.14) was the only significant explanatory factor for cardiac death or developed congestive heart failure. The Tei index combining systolic and diastolic myocardial performance reflects infarct size and might be a predictor of clinical outcome in patients with AMI treated by successful primary angioplasty.     

A case of primary mediastinal choriocarcinoma in which FDG-PET was performed for the evaluation of the treatment]

A 61-year-old man visited another hospital with chief complaints of dry cough, appetite loss and body weight loss. On chest X ray film and CT, right supraclavicular and mediastinal lymph nodes were swollen. For further examination, he was referred to our hospital and diagnosed as primary mediastinal choriocarcinoma. We conducted surgery after four cycles of chemotherapy using cisplatin, etoposide and bleomycin. After chemotherapy, residual tumors were found on chest CT. In FDG-PET some parts of the residual tumors seen on CT showed much less uptake and the others showed similar uptake. Histologically the areas showing similar uptake contained more viable cells, and the other areas showing less uptake almost completely consisted of necrotic tissue. We believe FDG-PET can be useful to evaluate the viability of tumors after chemotherapy in extra gonadal choriocarcinoma in the mediastinum.     

Hydration with magnesium and mannitol without furosemide prevents the nephrotoxicity induced by cisplatin and pemetrexed in patients with advanced non-small cell lung cancer

Background

The aim of this study was to examine the effect of hydration with magnesium and mannitol without furosemide on the nephrotoxocity accompanying combination chemotherapy using cisplatin and pemetrexed in patients with advanced non-small cell lung cancer (NSCLC).

Methods

Fifty patients with NSCLC who received cisplatin plus pemetrexed, using either old hydration protocol including normal saline with mannitol and furosemide, or a new one including normal saline with magnesium and mannitol without furosemide were retrospectively analyzed. Nephrotoxicity was compared between patients treated using the old protocol and those treated with the new protocol. Univariate and multivariate analyses were performed to identify the independent factors associated with protection against nephrotoxicity in patients with NSCLC who received cisplatin plus pemetrexed.

Results

Thirty patients received the old hydration protocol, while 20 patients were treated using the new hydration protocol. The patients treated using the new hydration protocol showed a significantly greater increase in creatinine clearance (P=0.0004) and a decrease in the serum creatinine level (P=0.0148) after one course of chemotherapy compared with those treated using the old hydration protocol. There were no differences in the chemotherapeutic response or overall survival between the groups (P=0.572). The new hydration protocol with supplemented magnesium with mannitol without furosemide was an independent factor for the protection against nephrotoxicity induced by cisplatin and pemetrexed in patients with advanced NSCLC [HR 0.232 (95% CI: 0.055-0.986), P=0.039].

Conclusions

These results demonstrate that the new hydration protocol comprising supplementation with magnesium without furosemide could prevent the nephrotoxicity induced by cisplatin and pemetrexed without affecting the treatment outcome.KEY WORDS : Lung cancer, cisplatin, magnesium, nephrotoxicity, pemetrexed     

Control of the inflow and outflow system during liver resection

Control of blood loss is a serious problem during liver resection. Bleeding from the inflow system can be controlled by the Pringle maneuver. The time limit for clamping is up to 10-15?min. A shortcoming of the Pringle maneuver is that it causes blood congestion in the portal vein. To avoid this problem other techniques have been developed including selective vascular occlusion and selective clamping of segmental branches. Bleeding from the outflow system is closely related to central venous pressure (CVP). Lowering the CVP reduces blood loss; in particular, keeping CVP <5?cmH(2)O by anesthesiological management is a simple and effective way to reduce blood loss. CVP remains high in some cases despite anesthesiological efforts, but in these circumstances other techniques are available including inferior vena cava clamping below the liver and intraoperative blood salvage.     

Feasibility of postoperative adjuvant chemotherapy of cisplatin plus vinorelbine for completely resected non-small-cell lung cancer: A retrospective study in Japan

BackgroundThe efficacy of postoperative adjuvant cisplatin (CDDP)-based chemotherapy, such as the combination of CDDP and vinorelbine (VNR), has been established for surgically resected non-small-cell lung cancer (NSCLC). However, the optimal treatment schedule and dosage for CDDP and VNR are unknown. We evaluated patient compliance with and the safety of adjuvant chemotherapy of CDDP at 80 mg/m² administered on day 1 plus VNR at 25 mg/m² administered on days 1 and 8, every 3 weeks.MethodsMedical records of 100 surgically resected NSCLC patients, treated with a combination of CDDP and VNR at the Shizuoka Cancer Center between February 2006 and October 2011, were retrospectively reviewed.ResultsEighty-three (83%) patients completed the planned 4 cycles of CDDP plus VNR and 59 (59%) received the planned doses. Sixty-eight percent of the patients experienced a decreased neutrophil count (grade 3/4 toxicity); 1%, a decreased platelet count; and 4%, febrile neutropenia. No treatment-related deaths were noted in this study. Univariate analysis of the factors influencing patient compliance with this adjuvant chemotherapy showed that neither patient characteristics nor surgical procedure was significantly associated.ConclusionsOur results indicated that adjuvant chemotherapy with CDDP at 80 mg/m² administered on day 1 plus VNR at 25 mg/m² administered on days 1 and 8, every 3 weeks, was feasible for surgically resected NSCLC cases.     

Effect of combined cardiovascular risk factors on individual and population medical expenditures: a 10-year cohort study of national health insurance in a Japanese population.

BACKGROUND: Although obesity is required for some criteria defining metabolic syndrome, clustering of other risk factors also indicates an increased risk of cardiovascular disease. Whether the relationship between cardiovascular risk factor clustering and medical expenditures differs with body mass index (BMI) requires investigation, especially in a population with a low prevalence of obesity such as that in Japan. METHODS AND RESULTS: A 10-year cohort study of 4,478 Japanese National Health Insurance beneficiaries aged 40-69 years in a community between 1990 and 2001 was carried out in the present study. The clustering of cardiovascular risk factors showed a positive and graded relationship to personal medical expenditures in participants who are overweight (BMI > or =25.0) and normal weight (BMI <25.0). The individual medical expenditures per month were 1.7-fold higher for participants with 2 or 3 risk factors and overweight than for those without these factors (26,782 vs 15,377 Japanese yen). Differences in the geometric means were similarly significant after adjustment for other confounding factors. However, the excess medical expenditures by risk clustering of normal weight categories within the total medical expenditures were higher than those of overweight categories because more participants were of normal weight. CONCLUSIONS: Cardiovascular risk factor clustering and being overweight can be a useful predictor of medical expenditures in a Japanese population.