Objectives-Ethical issues have recently been raised regarding the appropriate care ofpatients in persistent vegetative state (PVS) in Japan. The purpose of our study is to study the attitudes and beliefs ofJapanese physicians who have experience caringfor patients in PVS. Design and setting-A postal questionnaire was sent to all 317 representative members of the J7apan Society ofApoplexy working at university hospitals or designated teaching hospitals by the Ministry of Health and Welfare. The questionnaire asked subjects what they would recommend for three hypothetical vignettes that varied with respect to a PVS patient's previous wishes and the wishes of the family. Results-The response rate was 65%. In the case of a PVS patient who had no previous expressed wishes and no family, 3% of the respondents would withdraw artificial nutrition and hydration (ANH) when the patient did not require any other life-sustaining treatments, 4% would discontinue ANH, and 30% would withhold antibiotics when the patient developed pneumonia. Significantly more respondents (17%) would withdraw ANH in the case of a PVS patient whose previous wishes and family agreed that all life support be discontinued. Most respondents thought that a patient's written advance directives would influence their decisions. Forty per cent of the respondents would want to have ANH stopped and 31 % would not want antibiotics administered if they were in PVS.Conclusions-Japanese physicians tend not to withdraw ANHfrom PVS patients. Patients' written advance directives, however, would affect their decisions. (7ournal ofMedical Ethics 1999;25:302-308)
Smokingis the most commoncause of secondary polycythemia and mayinduce leukocytosis.We studied the relationship between hematopoietic growth factors and erythrocytosis and leukocytosis. Two sets of healthy male volunteers, consisting of 177 and 202 (age: 19-59 years) were each divided into four groups according to whether or not they smokedat least one package daily and their leukocyte count. Serum erythropoietin (Epo) concentration and granulocyte-colony stimulating factor (G-CSF) concentration were measured in the 177 and 202 volunteers, respectively. The meanserum Epoconcentration was lower in smokers than in nonsmokers(p=0.01 in the subjects without leukocytosis and p=0.107 in those with leukocytosis, respectively). After 3 smokers stopped smoking, the Epo concentration increased 2 weeks later, and remained constant for 20 weeks. Smokers tended to have a higher meanserum G-CSFconcentration than nonsmokers in the subjects without leukocytosis. Neither Epo nor G-CSFis the main etiology of smokers' polycythemia, and Epo production may be down-regulated by an elevated red-cell volume. (Internal Medicine 36: 680-684, 1997)
A 62-year-old man was admitted with swelling of the penis caused by long term use of a penis enlarging ring. For the previous 20 years, he had noticed small pruritic nodules on his penis. He had no micturitional or ejaculatory impairment. The penis had a diameter of 6 cm, a length of 10 cm, and was covered with thickened skin. The penis and the scrotal skin were covered with scattered, small, hemispheric nodules and papules ranging in size from 2 mm to 1 cm. Pathologic examination of the biopsied specimen from a nodule revealed enlargement of the lymphatic vessels of the dermis and fibrosis. This was compatible with lymphedema due to chronic strangulation by the ring. Scar resection and full thickness skin grafting was performed to prevent malignant changes in the lesions.
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