Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics
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Nihon Ronen Igakkai Zasshi · Mar 2000
Case Reports[A senile case of acute necrotizing myopathy presenting prolonged severe muscle paralysis due to high dose glucocorticoid and muscle relaxant].
An 82-year old man was admitted with dyspnea, productive cough and wheezing. In addition to antibiotics (meropenem trihydrate 0.5 g/day), glucocorticoids (hydrocortisone 1.250 mg, methylpredonisolone 4.250 mg) were administered for the severe bronchospasms. Since his respiratory condition deteriorated, he underwent mechanical ventilation using a muscle relaxant (vecuronium bromide, total dose 776 mg) in combination with high dose glucocorticoid. ⋯ Acute necrotizing myopathy was diagnosed due to high doses of glucocorticoid, muscle relaxant, or both. He required about 3 months to be weaned from the mechanical ventilation, and another 3 months to leave the hospital. Based on our experience, we should consider acute myopathy as an adverse effect of glucocorticoids, muscle relaxants or both in elderly patients who require mechanical ventilation.
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Nihon Ronen Igakkai Zasshi · Aug 1999
[An analysis of questionnaires about geriatric medicine/medical education sent to members of the Japanese Society of General Medicine].
Geriatric medical care can be viewed as general medical care for the elderly. We conducted a survey of members of the Japanese Society of General Medicine who belong to a university hospital, on their views of geriatric medicine/medical education. The questionnaires consisted of six categories of items about: (1) the physician's career; (2) whether the physician performs geriatric research in his/her laboratory; (3) whether the physician has an interest in geriatric medicine or medical education; (4) the physician's views on geriatric medicine or medical education; (5) of what pre- and post-graduate medical education on geriatric medicine should consist, from the physician's point of view: and (6) the physician's ideas about geriatric medicine/medical education in view of general medicine. ⋯ Out of nine items, the top three most important aspects of post-graduate medical education on geriatrics for clinical and social medicine, were (1) studying the medical care and welfare of the elderly, (2) assessing the impaired life function of the elderly, and (3) studying pharmaco- therapy. Out of 6 items, the top three most important aspects of a practical exercise in post-graduate medical education in geriatrics were (1) providing general care to the elderly, (2) giving rehabilitation guidance and (3) providing psychological support for the elderly. Furthermore, 20 of the respondents (22.5%) have performed geriatric medical research on either the activities of daily life of the elderly or living wills, both of which seem to reflect the health and life of elderly people.
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Nihon Ronen Igakkai Zasshi · Jun 1999
Review[Pathophysiology of established urinary incontinence (UI) in the elderly and an ameliorative method for disuse syndrome including UI seen in the bed-ridden elderly--using prone position and its variations].
Multipathology is the physical characteristics of the elderly, and their established urinary incontinence (UI) is usually based on multiple causal diseases and types of UI. Decubitus voiding (urination and defecation) inevitably causes UI and fecal incontinence (FI). Difficulty in controlling UI and FI seen in bed-ridden elderly results in long-term use of diapers and indwelling catheters, which eventually leads to the progression of disuse syndrome and decline of ADL (activity of daily living). ⋯ These are not supine or Fowler (semi-reclining) positions, but normal sitting, or prone and its variation forward-tilting positions. The latter two positions, which ameliorate UI and FI in the bed-ridden elderly, have been found to improve all of the pathologies including the disuse syndrome as well. The Seikatsudai (Life rack), which provides a forward-tilting position, not only has such an effect, but also offers the possibility to make the bed-ridden elderly more independent in their lives.
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Nihon Ronen Igakkai Zasshi · Dec 1998
Case Reports[Spinal subarachnoid hemorrhage presenting as disturbance of consciousness with severe hypoglycorrhachia].
We report the case of an 84-year-old woman with spinal subarachnoid hemorrhage who presented with disturbance of consciousness and nuchal stiffness, bloody cerebrospinal fluid and severe hypoglycorrhachia. Initially, it was difficult to determine whether this was a case of spinal subarachnoid hemorrhage, purulent meningitis, or hemorrhagic encephalitis, because of the nuchal stiffness, disturbance of consciousness and severe hypoglycorrhachia. It is known that intracranial subarachnoid hemorrhage is accompanied by mild hypoglycorrhachia, but descriptions of glucose levels in cerebrospinal fluid in cases of spinal subarachnoid hemorrhage are rare. ⋯ Furthermore, spinal subarachnoid hemorrhage is frequently accompanied by disturbance of consciousness. Therefore, sudden back pain or lumbago might not be interpreted as indicators of spinal subarachnoid hemorrhage, because patients, particularly elderly patients, may lose consciousness. We emphasize that the possibility of spinal subarachnoid hemorrhage should be considered in patients with disturbance of consciousness or hypoglycorrhachia even if they do not complain of sudden back pain.