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.
Cisplatin (CDDP) was administered to a 49-year-old dialysis female patient with advanced uterine cervical cancer. Analysis of the pharmacokinetics of CDDP in the patient with renal failure and at hemodialysis were compared with that of patients without renal impairment. CDDP at 30 mg was administered by drip infusion. The samples were ultrafiltrated and measured its concentration of both free (F-P) and total CDDP (T-P) by atomic absorption method. The effect of hemodialysis on the concentration of CDDP was analyzed. For the control, three patients without renal impairment were administered CDDP using the same method and its concentration was measured. The T-P clearance registered no difference between dialysis patients and controls, but F-P clearance in the HD patient was almost 5-fold lower than those in control patients, showing that F-P exposure to HD patients was 5-fold greater as a consequence of delayed disposition. The protein binding rate of CDDP was more gradual than that of the controls. The T-P and F-P removal rates positively correlated to the shunt side blood F-P.
A 51-year-old male was admitted because of eyelid edema and anosmia, which developed in 1985. He showed bilateral cervical lymphadenopathy, with nodes larger than 2 x 2cm, and remarkable eyelid edema. Anemia, hyperimmunoglobulinemia with hypo-albuminemia (no M-protein) and liver dysfunction were found. Bone marrow, renal function, urine analysis and LDH level were normal. Cervical lymph node biopsy showed interfollicular proliferation of plasma cells without any malignant appearance. On day 3 of oral prednisolone (PD), anosmia abruptly improved and from day 7, eyelid swelling, cervical lymphadenopathy and gammopathy subsided gradually. Since PD was tapered off, no relapse has been observed thus far. (Internal Medicine 31: 549-552, 1992)
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