Nihon rinsho. Japanese journal of clinical medicine
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Number of elderly patients undergoing surgery is increasing in Japan owing to the increasing population over 65. Developments of less invasive surgical techniques and advances in perioperative care may also contribute. ⋯ Postoperative complications in the elderly, including pneumonia, aspiration, myocardial infarction, delirium, cognitive dysfunction and cerebral infarction are described. Management and preventive strategies of postoperative complications are also discussed.
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Many factors such as the environmental conditions (temperature and humidity etc.), a nutritional status, the degree of fatigue, a moisturizing state of the body, clothes, the sensitivity to coldness are involved in an outbreak of hypothermia. Children, aged persons and the presence of an underlying disease are also risk factors related to the occurrence of hypothermia. ⋯ Frostbite develops when tissue is exposed to -4 degrees C of coldness or lower. The extent of injury is determined by the magnitude of coldness.
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Sudden death during bathing accounts for 10 to 15% of all out-of hospital cardiac arrests in Japan. Surveys in Tokyo revealed 1,085 victims of accidents during bathing transported by ambulance from October 1999 to March 2000. 53% of them were cardiac arrest and 25% were those who needed rescue from bath tub because of consciousness disturbance (rescued group). ⋯ The current hypothesis of the accidents during bathing is a unique type of heat illness exposed by high water temperature(41-43 degrees C). Geriatric population is vulnerable to the bathing induced heat illness.
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Review
[Characteristics of elderly heat illness patients in Japan--analysis from Heatstroke STUDY 2010].
Heatstroke Surveillance Committee of the Japanese Association for Acute Medicine (JAAM) collected the clinical data of 1,775 heat illness patients transported into 94 Emergency Medical Centers or Emergency Departments throughout Japan from 1 July to 31 August 2010 (Heatstroke STUDY 2010). Seven hundreds and four elderly patients' data revealed that 541 cases (80%) suffered from classical heatstroke in the ordinary life and the morbidity and mortality were much higher than those of exertional heatstroke patients. ⋯ Forty nine patients (6.9%) were the victims of classical heatstroke and multiple organ failure include heart failure was the major cause of heat related death in acute phase after admission. No one died in exertional heatstroke group.
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Review
[Clinical diagnosis and treatment of anti-NMDA (N-methyl-D-aspartate) receptor encephalitis].
Recent clinical management of anti-NMDA receptor encephalitis is reviewed. This illness is required the management of the neurological emergency. Typical symptoms of anti-NMDA receptor encephalitis develop in several stages that progresses from psychosis, memory deficits, seizures, and language disintegration into a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and respiratory instability. ⋯ The disorder predominantly affects children and young adults, occurs with or without tumor association. The presence of a tumor (usually an ovarian teratoma) is dependent on age and sex, being more frequent in women older than 18 years. Anti-NMDA receptor encephalitis should be treated with tumor resection and immunotherapy (corticosteroids, intravenous immunoglobulin, or plasma exchange) responded faster to treatment and less frequently needed second-line immunotherapy (cyclophosphamide or rituximab, or both).