Nihon rinsho. Japanese journal of clinical medicine
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The modern hospice movement had its formal beginnings in the UK with the opening of St. Christopher's Hospice in 1967. The hospice principles were integrated into palliative care. ⋯ Although there was a rapid increase of government-approved palliative care units in Japan, consultation services started recently by hospital-based palliative care teams. Home-based palliative care is in an early phase of development. This paper reviews the history, present situation, challenges of palliative care in Japan in addition to an overview of palliative care in the UK, Australia and the USA.
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Many hematologists believe that anti-tumor drugs and platelet transfusion are enough for the treatment of disseminated intravascular coagulation (DIC) associated with myelogenous leukemia. In this paper, showing the pathophysiology of 3 types of DIC, I insisted the necessity of anticoagulant therapy to avoid the bleeding death or ischemic organ damage before achieving the hematological remission, because myelogenous leukemia is now a curable disease. In addition, I introduced the new Japan-made weapon to DIC, recombinant thrombomodulin, which complexes with thrombin and regulates the coagulation activity by efficient activation of protein C. Using two different natural anticoagulant systems, antithrombin and protein C pathway, we can more effectively improve DIC treatment and alleviate symptoms in DIC patients.
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Functional somatic syndromes are defined as several related syndromes that are characterized more by symptoms, suffering, and disability than by structural or functional abnormality. These syndromes include irritable bowel syndrome, tension-type headache, chronic fatigue syndrome, and fibromyalgia. ⋯ To elucidate the pathogenesis of functional somatic syndromes, it is important to focus on gender-related factors, comorbidities of depression and anxiety, physiological responses like autonomic nervous function and hypothalamic-pituitary-adrenal axis, and patient-doctor relationship. Based on recent literatures, mood state and somatosensory amplification are suggested to play an important role in the psychopathological mechanism of functional somatic syndromes, and genetic and environmental factors need to be considered as well.
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Current treatment of insomnia with hypnotics, GABA(A) receptor modulators, induces various side effects, including cognitive impairment, motor disturbance, dependence, tolerance, hang-over, and rebound insomnia. Ramelteon (Rozerem) is an orally active, highly selective melatonin MT1/MT2 receptor agonist. Unlike the sedative hypnotics that target GABA(A) receptor complexes, ramelteon is a chronohypnotic that acts on the melatonin MT1 and MT2 receptors, which are primarily located in the suprachiasmatic nucleus. Ramelteon has demonstrated sleep-promoting effects in clinical trials, and coupled with its favorable safety profile and lack of abuse potential or dependence, this chronohypnotic provides an important treatment option for insomnia.