Differences in plans for living at home between temporary residents of a health-care facility for the elderly and their family caregivers in Japan

Aim: Older residents in Japan requiring rehabilitation often reside in health‐care facilities for the elderly (HCFE) prior to being discharged to home. The return home can be very stressful for both the elder and family caregiver. The purpose of this study was to clarify the differences in plans for home life between the residents of a HCFE who were scheduled for discharge home and their family caregivers. Method: Semistructured interviews were conducted with eight pairs of elders and caregivers. Results: Differences were seen in several areas, including dietary preferences, recognition of the elder’s independence, preconceptions or not knowing about the elder’s pleasurable activities, and the way of care. Conclusions: Differences with regard to enjoyable activities for the elderly arose from a lack of understanding of the lives of the elderly on the part of their families.     

Nonulcerative Lesion Detected by Endoscopy as an Early Expression of Gastric Malignancy: --Retrospective Observation of 72 Cases of Gastric Carcinoma--

To evaluate the endoscopic criteria for early malignant findingsof gastric carcinoma more precisely, a retrospective examinationof endoscopic pictures of 72 patients with gastric carcinomawas carried out. The patients had received endoscopic examinationsrepeatedly for years and proceeded finally to surgery on thebasis of a diagnosis of carcinoma by gastric biopsy. The macroscopicas well as microscopic findings of the resected specimens werecompared with the previous endoscopic observations. Ulcerative lesions were predominantly found at the initial endoscopyin patients whose final diagnosis was the lie type of earlygastric cancer or IIc-like advanced cancer. These patients usuallyreceived endoscopic examinations repeatedly and their lesionswere diagnosed as malignant by the adopted criteria of earlygastric cancer 2 to 6 yr after the initial examination. In contrast, nonulcerative lesions were observed more frequentlyat the initial examination in patients with the final diagnosisof the IIa+IIc type of early gastric cancer or Borrmann typeof advanced cancer. In most of those patients endoscopic examinationwas not carried out so frequently, and in some of those whohad been closely followed the malignant findings appeared rathersuddenly with tumorous formation as well as deeper invasionduring less than a few years from the previous examination atwhich the tumor had been considered benign. These data indicate that the nonulcerative lesions which wereconsidered benign could be the early expression of gastric carcinoma.It should be stressed that nonulcerative lesions such as "irregularerythematous change, discoloration, flat granular change" and"simple mucosal depression" observed in some parts of the stomachwould be important site for the detection of early gastric carcinoma,and that these lesions need to be biopsied more frequently.     

Signet-ring cell carcinoma of the prostate effectively treated with maximal androgen blockade

Primary signet-ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72-year-old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.     

Monoclonal Gammopathy in Adult T-Cell Leukemia/ Lymphoma: A Report of Three Cases

Adult T-cell leukemia/lymphoma (ATL/L) is clustered in southwesternJapan, especially in the Nagasaki and Kagoshima areas. It wasshown that this clustering correlated with the presence of antibodiesto antigens of a new C-type RNA leukemia virus. Surface markeranalysis of neoplastic T-cells of ATL/L patients shows the helper/inducerphenotype (Leu-1⁺, Leu-2a^– and Leu-3a⁺). On the other hand, the association between T-cell malignancyincluding ATL/L and monoclonal gammopathy is very rare. Threeunique cases of ATL/L with monoclonal gammopathy are reported.Yet the meaning of an M-component in T-lymphocytic proliferationremains uncertain. The relationship between the leukemia virus,ATL/L-cells and monoclonal gammopathy is discussed.     

Pathogenesis of Ochratoxin A- and Concanavalin A-Induced Exencephalies in Mice

Abstract Early morphogenetic changes of exencephaly induced by ochratoxin A (OA) were compared with those induced by concanavalin A (Con A) in mice in order to examine possible differences in the pathogenesis of neural tube defect. OA and Con A were administered to pregnant mice on day 7 of gestation, and the process of neural tube closure of embryos was observed at different times from 6 to 72 hours after treatment by SEM and light microscopy. In OA-treated embryos, the cranial neural folds in the fore- and midbrains did not elevate and remained in the biconvex shape. The cellular changes were found in the neuroepithelium and surface ectoderm. Neural crest cells, which appeared at the lateral edges of the neural folds, were also involved in degeneration. In Con A-treated embryos, the neural folds in the mid- and hindbrains elevated to assume the V shape, but remained wide open. The main cellular change was a degeneration of the primary mesenchyme underlying the neuroepithelium, resulting in a paucity of the supporting mesenchymal tissue.
These findings suggest that the exencephalies produced by either OA or Con A are primarily due to non-closure of the neural tube, but that the pathogenesis differs with each agent. Failure of neural tube closure in OA-treated embryos appears to result from damage of the neuroepithelium and neural crest cells, whereas that in Con A-treated embryos from damage of the primary mesenchyme.     

Observations Questioning a Protective Role for Breast-feeding in Severe Rotavirus Diarrhea

ABSTRACT. To investigate whether breast-feeding protects children against rotavirus diarrhea (RVD), we compared rates of breast-feeding by age and enteric pathogens among 2 276 children with diarrhea 0-4 years of age who attended a diarrhea hospital in Bangladesh. Infants 0-5 months were less likely to be breast-fed than children 6-11 months of age suggesting that some protection against diarrhea with all agents was associated with early breast-feeding. In every age group studied, breast-feeding was more common among children with RVD than among children with non-RYD whereas it was less common among children with cholera and shigellosis. Twenty percent of breast milks consumed by infants less than 1 year of age had high levels of neutralizing activity (>320) to the Wa strain of rotavirus but this activity did not appear to be protective since the 30 infants with RVD consumed milk which had titers that did not differ significantly from those consumed by 44 infants with diarrhea of other cause. Despite the prolonged breast-feeding which is common in Bangladesh, the mean age of hospitalization with RYD is approximately the same as in countries where the duration of breastfeeding is quite short. None of these 3 independent observations support a protective role for breast-feeding against rotavirus diarrhea after the first months of life.     

Dispersion of Filtered P Wave Duration by P Wave Signal-Averaged ECG Mapping System:

INTRODUCTION: Although it is desirable to know drug efficacy before initiating antiarrhythmic therapy, there have been no methods for this evaluation. P wave signal-averaged ECG (P-SAECG) is useful to detect subtle changes in disturbance of atrial conduction. The purpose of this present study was to test whether P-SAECG mapping system would give any information on the efficacy of disopyramide on the prevention of paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: P-SAECG was performed before disopyramide treatment, at 3 hours after a single dose of oral disopyramide (200 mg), and after 4 weeks of disopyramide treatment (300 mg/day). After measuring the filtered P wave duration by the vector magnitude and mapping methods, we calculated filtered P wave duration dispersion, difference between the maximal and minimal filtered P wave duration within 16 chest leads at these three time points. Filtered P wave duration and filtered P wave duration dispersion before treatment were longer in 32 patients with symptomatic PAF than in 31 healthy volunteers. Disopyramide was effective for suppression of PAF in 17 patients and ineffective in 15 patients after 4 weeks of treatment. Filtered P wave duration was similarly prolonged at 3 hours in the two groups, whereas filtered P wave duration dispersion at 3 hours after the disopyramide administration behaved differently; it decreased in all of the effective group and increased in all of the ineffective group. The effective patients were prospectively followed with the same treatment for 6 months. In 16 (94%) of these 17 effective patients, no PAF was documented and they remained to be asymptomatic. CONCLUSIONS: Thus, measuring filtered P wave duration dispersion with the P-SAECG mapping method after a single administration may predict the long-term efficacy of disopyramide in patients with PAF.