Destination after discharge from a senile dementia therapy ward before and after the implementation of long-term care insurance in Japan

Background: In Japan a new long‐term care insurance (LTCI) system, the so‐called ‘Kaigo‐Hoken’, was started in April 2000. The present study analyzes the change in the type of destination after discharge from a senile dementia therapy ward before and after the implementation of LTCI at Fukuoka Prefectural Onga Hospital, Japan. Methods: The present study examines data from 199 inpatients discharged from the Fukuoka Prefectural Onga Hospital that had been diagnosed with dementia and met the DSM IV criteria for Alzheimer's type, vascular dementia or other type of dementia. For the purposes of comparison two periods were defined, ‘the first period’ was defined as the period from 1 April 1999 to 31 March 2000, before LTCI was implemented, while ‘the second period’ was defined as the period from 1 April 2000 to 31 March 2001, after LTCI had started. Subject data was analyzed on the basis of where the subject had resided pre‐admission and their destination after discharge using the following classifications: nursing home or geriatric care facility, hospitalization, home and death. Results: While the certification rate of inpatients regarding long‐term care increased slightly in the second period, no significant change was observed based on where the subject had resided pre‐admission and their destination after discharge between the first and second periods. Conclusions: While LTCI is essential for Japan, it is necessary that people with dementia in senile dementia therapy wards are encouraged to return to their homes under the care and support of LTCI.     

Vaccination against the cat flea Ctenocephalides felis felis

Non-chemical control of haematophagous parasites is a desirable goal. We report here on the use of concealed antigens from the major digestive organ of the cat-flea as vaccine components. Rabbits were immunized with various antigens from cat flea midguts, and immunoglobulin from these rabbits was fed to cat fleas in an artifical feeding system. Antibody produced against soluble antigens from the midguts of fed fleas was able to kill fleas in this system. Dogs were then immunized with various antigen preparations, and challenged for a week with live fleas. Significantly fewer live fleas were recovered from dogs immunized with fed midgut supernatant, and recovered live female fleas produced significantly fewer eggs. This study indicates the possibility of vaccination as a means of control of flea, and possibly other blood sucking insect populations.     

Liver transplantation in a case of hypoproteinemia and coagulopathy

A female infant with hypoproteinemia and coagulopathy associated with hypertyrosinemia was successfully treated with living-related liver transplantation (LRLT). On the 12th day of life plasma amino acid analysis revealed a marked elevation of tyrosine, so the patient was fed on a low-tyrosine and low-phenylalanine diet. However, hepatosplenomegaly. hypotonia, alopecia, eczema and psychomotor delay did not improve and recurrent episodes of disseminated intravascular coagulation (DIC) caused her condition to deteriorate. Liver biopsy on the 230th day revealed marked fatty change accompanied by mild to moderate cholestasis. Therefore. LRLT from her father was performed on the 286th day resulting in improvement of all the aforementioned signs and symptoms. Despite a thorough examination, no diagnosis of a known disorder could be established. However, her elder brother had also been born with severe hypoproteinemia and coagulopathy, and died of DIC on the second day of life. Thus, the disorder is designated as a new entity, namely ‘congenital hypoproteinemia and coagulopathy associated with hypertyrosinemia’.     

A Small Polyp of Brunner's Gland Hyperplasia Causing Hemorrhage

Abstract: A rare case of a small Brunner's gland hyperplasia (BGH) of the duodenum which represented hemorrhage is presented. An 84-year-old male was admitted because of tarry stool and anemia. Endoscopic examination revealed a small, subpedunculated duodenal polyp with blood and clots on its surface, which was considered responsible for the tarry stool. The lesion was polypectomized without any complications. Since complications of BGH including bleeding and obstruction, are more likely to occur as the size of the lesion increases, small BGH lesions tend to be regarded as benign and are left alone in clinical settings. The present case showed the possibility that such a seemingly harmless small polyp may eventually lead to massive hemorrhage. (Dig Endosc 1999; 11: 52–54)     

Decreased cyclosporin A absorption after treatment with GoLytely lavage solution in rats

Abstract— Recently we observed a case in which the cyclosporin A absorption decreased after treatment with GoLytely lavage solution in a kidney transplant patient. In this study, we confirmed the decrease of the blood concentration of cyclosporin A after oral administration by GoLytely (Macrogol 3350) based on experiments with rats. The peak blood cyclosporin A concentration, and the area under the blood drug concentration-time curve from 0 to 24 h in the GoLytely-administered group were significantly lower than the control group. In the case of gastrointestinal dysfunction such as diarrhoea, or in treatment with laxatives such as GoLytely lavage solution, whole blood cyclosporin levels must be carefully monitored, and intravenous cyclosporin A may be more suitable for providing adequate immunosuppression.     

High dose chemotherapy including paclitaxel (T-ICE) combined with peripheral blood stem cell transplantation for male germ cell tumor. Preliminary report

AIM: To evaluate the feasibility and usefulness of high dose chemotherapy including paclitaxel (T-ICE) combined with peripheral blood stem cell transplantation (PBSCT) for male germ cell tumor. METHODS: Five male patients with advanced germ cell tumor underwent 1-6 courses of high dose chemotherapy including paclitaxel (T-ICE; 175 mg/m2 of paclitaxel, 1250 mg/m2 of carboplatin, 1500 mg/m2 of etoposide and 7.5 g/m2 of ifosfamide) with PBSCT after 2-3 courses of induction chemotherapy (PEB or VIP). RESULTS: In all patients, serum marker levels decreased to within the normal range by T-ICE. Two patients underwent resection of residual tumor. In one patient, viable cancer cells were detected in resected lymph node tissue and adjuvant chemotherapy was then performed. Although the follow-up period was short (7-15.5 months), four of the five patients (80%) showed no evidence of recurrent disease. No significant differences in side-effects were noted between T-ICE and conventional high dose ICE, which was previously performed in 39 patients at the Division of Urology, Kobe University Graduate School of Medicine, Japan. CONCLUSIONS: High dose chemotherapy, including T-ICE, combined with PBSCT showed an almost identical degree of side-effects as seen in previous high dose chemotherapy without paclitaxel. Although 80% of the patients showed no evidence of disease so far, the efficacy of T-ICE should be evaluated with more patients and longer follow up.     

Injuries of school-aged children in Japan: Causes and costs

Injuries of school-aged children were presented from several data sources. About 80000 schools, from nurseries to upper secondary schools, operate in Japan and are attended by 24.3 million students. About 97% of these young people are insured by the insurance system of the School Safety Division of the National Stadium and School Health Center of Japan. Annual injuries and illnesses total 1.08 million, 1039 cases being impedimentary and 191 causing death. The average incidence of injury and illness is 4.6%, a rate that has been increasing every year since 1960. The activity at the time of injury, the impairment incurred, and the part of the body injured differ with the type of school and depend mainly on the developmental stage of the child. Minor injuries occur at the rate of about 47 cases in elementary schools and 14 in lower secondary schools versus one benefit-applied injury at a school safety center. The cost of injuries under the control of schools totaled US$124 million per year in 1990. The average amount of benefits per injured student per month was US$63.     

Endoscopic Diagnosis of Intestinal Lipomas

A retrospective endoscopic study of 11 patients with intestinal lipomas was conducted. The patients included 2 with duodenal—, 2 with small intestinal—, and 7 with large intestinal lipomas. Endoscopically, in addition to features common to all submucosal tumors, lipomas often present characteristic findings including a yellowish surface color and softness of the tumor. The yellowish color was noticed in the 6 patients whose tumors were 10 mm and more in size. In the 2 patients with lipomas in the small intestine, the yellowish color was diminished by hemorrhages, inflammation and fibromusculosis in the lamina propria mucosa due to mechanical irritations such as peristalsis and intussusception. Thus, the appearance of the yellow color was related to the size of the tumors and the histological changes in the overlying mucosa. Endoscopic palpation with biopsy forceps aids in making a diagnosis of lipomas; and the cushion sign was noticed in 3 of 4 patients who underwent the palpation. The naked fat sign is pathognornonic but was observed in only 1 patient with a duodenal lipoma, in which the fat tissue was exposed by denuding the mucosa with the biopsy forceps. Scopic biopsies revealed lipomas in 3 patients. Careful observation of the color and palpation during the endoscopic examination are important for making a correct diagnosis and avoiding the unnecessary resection of lesions.