Quality of life from the viewpoint of patients with dementia in Japan: nurturing through an acceptance of dementia by patients, their families and care professionals

The quality of life (QoL) of patients with dementia was investigated from the patient's viewpoint, and the role of an acceptance of dementia in maintaining important and distinctive elements of QoL was analysed by questionnaire and interview methods. The subjects of the present study were 18 patients, 21 family members and eight members of staff at a day-care facility in Japan. Patients with dementia hoped to maintain an 'ordinary' way of life. Living peacefully, living together, living healthily and helping each other were considered by patients with dementia to be the important elements of their QoL. Living happily in the present is important, but hopes and expectations for the maintenance of human values in their future lives are of greater importance in their estimation of QoL. Through recognizing these needs, a culture and understanding of 'living with dementia' can be nurtured. A dynamic process involving the mutual acceptance of dementia in the relationships between patients with dementia, their families and care professionals enabled elderly people to surmount their initial troubles, and to recoup and activate their former humane attitudes. Positive thinking reappeared and new forms of relationships emerged. The patients, their families and the care professionals came to understand each other better and gained the sense of 'living together'. The process began with 'confronting' the situation and progressed to the final stage of 'acceptance': the patient with dementia was confronted with the dementia itself, the family was confronted with the elderly person as a human being, and the care professional was confronted with her or himself. At first, the care professionals had felt a sense of social responsibility for delivering justice, but they had gradually noticed that they were themselves relieved of the strain resulting from these attitudes. Acceptance of dementia by the care professional was important in carrying forward this dynamic process, which helps to ensure the desired QoL for the patient with dementia.     

Inguinal neurectomy for nerve entrapment after open/laparoscopic hernia repair using retroperitoneal endoscopic approach

Background Inguinal neuralgia after open and laparoscopic hernia, repair occurs in about 0.5% of treated patients. If the pain and the functional inability persist, it is possible that the genitofemoral nerve and ileoinguinal nerve are involved in entrapment, and surgical treatment is a possible option. This paper reports a personal endoscopic retroperitoneal approach for ileoinguinal and genitofemoral branches neurectomy.Methods A 12-mm trocar is inserted into the lower retroperitoneum and insufflated to create a work space. Neurectomy is performed under endoscopic guidance.Results Six patients were treated using this technique. The operating time was 55 min, and all patients were completely pain-free after surgery. All patients were discharged the first day after operation and there were no complications.Conclusion This retroperitoneal endoscopic approach is proposed as a new surgical technique for treating inguinal entrapment neuralgia. It is simple and feasible.     

Pelvic motion during total hip arthroplasty with translateral and posterolateral approaches

We devised a special instrument to assess intraoperative pelvic motion and used this device to measure intraoperative pelvic motion in three dimensions. A total of 100 total hip arthroplasties (THAs) were performed using this device. Two approaches were utilized: 52 THAs were performed with the posterolateral approach and the remaining 48 with the translateral approach. The average angle of pelvic tilt in the THAs with the translateral approach was less than that with the posterolateral approach. The average internal rotation angle was 1.75° with the translateral approach and 14.25° with the posterolateral approach. With the posterolateral approach, the internal rotation of the pelvis frequently occurred during retraction of the femur using a Hohmanns retractor placed at the anterior rim of the acetablum, with flexion and internal rotation of the affected hip.     

Transatrial resection of a left ventricular thrombus after acute myocarditis

A mobile and pedunculated left ventricular thrombus developed after acute myocarditis in a 49-year-old woman. Surgical removal is recommended for cases such as this, especially when the ventricular thrombus is pedunculated or mobile. The thrombus was successfully removed by left atriotomy. There was no evidence of recurrent thrombus formation on the 50th day after surgery.     

Mutagenicity test systems for the detection of chromosome aberrations in vivo

In mutagenicity testing of pharmaceuticals it is advisable, whenever possible, to use in vivo mammalian systems where the pharmacokinetic properties of a drug would be more or less similar to those in man. However, although there are a number of different genetic endpoints which are important in mutagen testing, sufficiently validated, practical and well documented in vivo test systems exist only for stuctural chromosome aberrations.This paper provides an overview of existing in vivo test systems for the detection of chromosome aberrations. Emphasis has been laid on the functions, advantages and limitations of the three tests recommended in the guidelines of the European Community; first, the metaphase analysis assay, and, as alternatives, the micronucleus test and the dominant lethal test.These three test are then also discussed from the viewpoint of our own practical experience. Chemical Substances Mentioned: Trisethylenemelamine (TEM), Trenimon, Cyclophosphamide, Mitomycin C, Colchicine, Benzimidazol carbamate, Azathioprine     

A new surgical approach to the third ventricle with interruption of the striothalamic vein

Summary In the removal of tumours that develop within the third ventricle, most approaches are not entirely satisfactory. Therefore, a new approach has been devised: transfrontal exposure of the anterior portion of the frontal horn; coagulation and section of the striothalamic vein in order to open up the roof of the third ventricle; use of a blunt spatula introduced in the foramen of Monro and pushed backwards under the choroïd plexus. This approach has been used in ten cases. Postoperative mortality has been nil; the surgical approach has not apparently been responsible for any sequelae. It is simple and gives a good view of the third ventricle.     

Evaluation of the Isoconversional Approach to Estimating the Hoffman‐Lauritzen Parameters from the Overall Rates of Non‐Isothermal Crystallization of Polymers

Summary: The isoconversional approach proposed by Vyazovkin for evaluating the Hoffman‐Lauritzen parameters from overall rates of non‐isothermal crystallization was critically applied to two new and fast crystallizing polymers, poly(propylene terephthalate) and poly(butylene naphthalate), which are used for the production of fibers. Non‐isothermal crystallization data were corrected for the effect of the thermal lag and the effective activation energy as a function of temperature was calculated using the method of Friedman. The estimated Hoffman‐Lauritzen parameters, U* and K_g, were consistent with corresponding values from isothermal crystallization experiments obtained either from DSC measurements or using polarized optical microscopy (POM). It was found that the proposed method could simulate the experimental data very well, and the temperature interval under consideration did not allow the detection of any critical breakpoints denoting regime transitions.

Dependence of the effective activation energy on average temperature for PPT.     

Transumbilical approach for shunt insertion in the pediatric population: an improvement in cosmetic results

Objective In spite of the recent interest in endoscopic third ventriculostomy, ventriculoperitoneal (VP) shunt is still the gold standard in treating non-obstructive hydrocephalus in children. The peritoneal cavity remains the optimal site for cerebrospinal fluid (CSF) diversion. Shunt insertion and re-interventions carry a high risk of inaesthetic abdominal scars and long-term morbidity. We report a technique of transumbilical shunt insertion, which provides better cosmetic results and without many more complications. This approach has been performed for a long period in a wide variety of intra-abdominal conditions by pediatric surgeons.Methods Between March and October 2003, we inserted 12 VP shunts in children. For eight consecutively treated children the follow-up is more than 3 months. All the shunts were inserted through the umbilicus. These eight children are the subjects of this study. Indications for shunting were: communicating hydrocephalus (6 cases), subdural hematoma (1 case), and hygroma associated with an arachnoid cyst (1 case). The population consisted of 7 boys and 1 girl, ranging in age between 6 weeks and 47 months (mean age: 15 months), and their body weights varied between 2,110 g and 18,000 g (mean weight: 8,470 g). All children were examined twice a day for 3 days, and wounds were examined daily to check for the absence of sepsis or dehiscence. Clinical controls were performed 1 month after discharge. The operating surgeon was invited to comment on any difficulties encountered in making or closing this incision afterwards.Results The average length of clinical follow-up was 6 months (range 4–7 months). One infection of the VP shunt occurred. It was treated with external drainage and antibiotics. After 1 week, a second VP shunt was inserted using the same technique without particular difficulty and with a nice cosmetic result. Concerning the seven other children, the cosmetic results were optimal, with no puckered abdominal scars or wound dehiscence, and with no perioperative or long-term complications related to the umbilical approach.Conclusion At this early follow-up, umbilical incision for shunt insertion is a safe and easy technique. It provides an optimal cosmetic result, even in cases of re-intervention. This minimally invasive surgery does not require long specialized training. We have not shown an increase in complications associated with a learning curve. Longer follow-up is needed to evaluate the risk of infection.     

Three part posterior fracture dislocation of the hip without fracture of the femoral head: review of literature and a case report

This case report describes a rare posterior dislocation of the hip with fractures of the ipsilateral femoral neck and greater trochanter, without fracture of the femoral head, in a young adult male following a railway accident. This patient was managed within 6h of injury by open reconstruction. This unusual injury has not been reported previously. Cases of posterior fracture dislocation of the hip with a fracture of the femoral neck without fracture of the femoral head were reviewed from the literature. Mechanism of injury, controversies regarding operative procedures and appropriate surgical approach are discussed. The authors also believe that this injury pattern merits inclusion in the existing classification system of fracture dislocation of hip for management and prediction of outcome.