journal article

A 88-year-old man who underwent abdominoperineal resection for rectal cancer 40 years earlier. The patient visited our hospital because of abdominal pain and vomiting. An abdominal CT scan showed an abdominal incisional hernia with a 23×15mm orifice in the midline of lower abdomen. The patient diagnosed with severe aortic valve stenosis on echocardiography. We performed elective surgery under intravenous anesthesia using ketamine and local anesthesia. The patient was discharged on postoperative day 8, and the postoperative course was uneventful. No recurrence has occurred 16 months after the operation. In conclusion, our strategy for patient with severe aortic valve stenosis is safe and effective.

Anaplastic large cell lymphoma(ALCL)is a rare peripheral T-cell lymphoma. According to anaplastic lymphoma kinase(ALK)expression, the World Health Organization classifies ALCL into two subtypes:ALK-positive or ALK-negative. Anthracycline-based combination chemotherapy is a standard frontline treatment for ALK-positive ALCL, with a long-term event- free survival rate of 60%-70%. For the salvage treatments of relapsed or refractory cases, the efficacies of brentuximab vedotin or ALK inhibitor have been established. We undertook a phase II clinical trial to investigate the efficacy and safety of alectinib, which is a second-generation ALK inhibitor, for relapsed or refractory ALK-positive ALCL. Ten patients were enrolled, and objective responses were documented in eight patients(80%),with six complete responses. Allogeneic hematopoietic stem cell transplantation(allo-HSCT)has also been reported to be one of curative treatments for relapsed or refractory ALCL. However, a high rate of treatment-related mortality was observed in allo-HSCT because of the myeloabrative conditioning regimen. We have reported the efficacy of the reduced-intensity conditioning(RIC)regimen for relapsed or refractory ALCL including the patients who did not obtain complete remission at allo-HSCT. The RIC regimen might be able to improve the outcomes of allo-HSCT by reducing treatment-related mortality.

A 69-year-old deaf-mute man received 6 cycles of R-CHOP therapy for diffuse large B-cell lymphoma(DLBCL)of the stomach. Although he showed a complete response to this therapeutic regimen, the patient developed intractable diarrhea upon completion of chemotherapy. He was diagnosed with cytomegalovirus(CMV)enteritis and was administered ganciclovir and foscarnet;however, CMV infection persisted. We suspected immunodeficiency other than that associated with chemotherapy-induced immunosuppression. Further examinations revealed a decrease in the CD4^+ T lymphocyte count and positive results on anti-human immunodeficiency virus(HIV)antibody testing, which confirmed HIV infection, and he was diagnosed with acquired immunodeficiency syndrome(AIDS).Antiviral therapy was initiated, and the HIV-RNA viral load became undetectable;however, the CD4^+ T lymphocyte count recovery was insufficient. Despite the clinical presentation of an AIDS-indicator disease, diagnosis of HIV infection was delayed, which may be attributable to deaf-mutism and the patient’s advanced age that may have led to bias among the medical staff and prevented prompt diagnosis of HIV infection.

Forensic pathologists perform autopsies and external examinations of deceased bodies to judge the cause of death. Forensic autopsies are only carried out in a small percentage of all deaths, and are performed for cases in which the cause of death is unknown and because many of these cases have background social problems. Therefore, both the cause and circumstances of death are important to those in related fields, and it is particularly significant to share information from forensic autopsies and to discuss prevention of recurrence in similar cases with persons involved in these fields. This report provides an overview of the forensic autopsies performed at our department in 2021. In the near future, we intend to share these cases through participation in workshops and conferences with related clinical departments, health and welfare workers, and medical scientists, so that this forensic autopsy information can be used effectively.

The number of children requiring medical care is on the rise, reducing childcare burdens and establishing support systems' urgent undertakings. Public health nurses at public health centers are in a position to shoulder these responsibilities. This study aimed to clarify the activities performed by public health nurses at public health centers for children requiring medical care based on the content of support in individual cases. Interview surveys covering a summary of support and community resources were conducted for four individual cases. Analysis was performed using the practical competencies framework required of public health nurses at public health centers.As a result, 260 activities of public health nurses were organized into 79 codes and 39 categories and categorized according to the framework of practical competencies required of public health nurses at public health centers. Public health nurses at public health centers were found to provide direct support, categorized into“interpersonal support competency,”based on the prerequisite that patients require 24-hour medical care, and characterized by connecting medicine and welfare to manage the family unit. Public health nurses also provide indirect support, categorized into“community support competency,”“policy competency,”and“management competency,”in which they were understood to be attempting to build a care system through individual support.

This study aimed to evaluate the effects of care incorporating passive motion exercise of the ankle plantar dorsiflexion on lower extremity hemodynamics and comfort using physical methods for deep vein thrombosis(DVT)prevention. We recruited 16 healthy women, aged 20-40 years old, using a simple random allocation crossover design. We categorized them into three groups:intermittent pneumatic compression was performed continuously(IPC group);the patients underwent passive exercise of ankle dorsiflexion and plantar flexion(ankle exercise group),and IPC was removed(IPC removal group).We evaluated lower extremity hemodynamics, coagulation and fibrinolysis, autonomic nervous functions, and subjective sensation during each intervention.The ankle exercise group showed a decrease in the maximum blood flow velocity in the femoral vein and deoxygenated hemoglobin. Three coagulation and fibrinolysis complexes, namely, fibrin monomer complex, thrombin-antithrombin complex, and plasmin-alpha2-plasmininhibitor-complex, showed no change among the three groups. One autonomic nervous function, the high-frequency component, remained lower in the IPC group than in the other two groups after 15 minutes. Subjective sensation was highest in the IPC group.The ankle exercise group did not show exacerbation of lower limb venous stasis and coagulability, suggesting that a nursing intervention reduces discomfort that occurs with continuous use of IPC.