[Usual Relationship to Support Sudden Discharge-Coordination Starting from Pre-Discharge Support Considered through a Case Report of Supporting a Patient with ALS].

Due to promotion of home medical care, the number of patients who highly depend on medical care is increasing. Therefore, the role of pre-discharge conferences where a care manager is involved starting from pre-discharge support has become more important. In addition, in a usual relationship, cooperation between the hospital staff and the home care support team is crucial. Among home care workers, the word "coordination" has generally been used for a long time to prepare for the transfer of patients from a hospital to home. However, there is a considerable gap between healthcare and caregiving; consequently, it is difficult to actually create coordination between them because the terms to be used and the contents mastered by personnel in each field are different. In this paper, we report a case of successful coordination for smooth transfer of a patient with ALS from a hospital to home, by creating a homecare team in which all members work together based on the information obtained from a hospital social worker.

Non-invasive objective evaluation of radiotherapy-induced dry mouth.

BACKGROUND: Dry mouth is a common complaint in patients undergoing radiotherapy. Here, we employed the oral moisture meter Mucus III to evaluate dry mouth in head and neck tumor patients before and after they underwent radiotherapy. METHODS: We recruited 17 newly diagnosed patients with pharyngeal squamous cell carcinoma or unknown primary squamous cell carcinoma, who received head and neck radiation therapy at Tokyo University Hospital in 2008-2010. The primary sites were the epipharynx (n = 1), oropharynx (n = 6), or hypopharynx (n = 5); it was unknown in five cases. Salivary function was assessed by a dry mouth questionnaire, resting saliva test, chewing gum test, and Mucus III, before (n = 17), immediately after radiotherapy (n = 10), and at 3 (n = 9) and 12 months after radiotherapy (n = 11). RESULTS: The questionnaire, resting saliva test, and chewing gum test at 3 and 12 months after radiotherapy indicated a significantly decreased resting and stimulated whole saliva flow rate than prior radiotherapy (P < 0.05 and P < 0.001). In contrast, Mucus III results showed significant worsening of xerostomia at 12 months after radiotherapy (P < 0.05). CONCLUSION: Mucus III has been proven to be an objective diagnostic tool for patients with serious dry mouth, such as in patients with Sjogren's syndrome. However, we did not find a perfect correlation between Mucus III and other objective (resting saliva and chewing gum) and subjective (questionnaire) measures of dry mouth. To precisely diagnose radiotherapy-induced dry mouth, further improvement to the method is needed.

Recurrent hoarseness due to inflammatory vocal fold lesions in a patient with Crohn's disease.

Crohn's disease is a chronic inflammatory bowel disease characterized by discontinuous chronic inflammation that may affect virtually all organs, including the head and neck. Laryngeal involvement in Crohn's disease is very rare, and only 9 cases have been reported. All 9 patients complained of difficulty in breathing due to edema and ulceration from the larynx to the hypopharynx. The present patient was a 31-year-old woman who had experienced the intestinal symptoms of Crohn's disease starting 20 months earlier and complained of hoarseness, sore throat, and odynophagia. The hoarseness worsened gradually because of limited ulceration of the vocal fold without edema. We describe the first case in which limited ulceration occurred on the vocal fold without airway involvement.

Objective and non-invasive evaluation of dry mouth.

OBJECTIVE: This study was designed to evaluate the moisture checker (MucusIII), a new device for measuring moisture of the oral submucosa. METHODS: Defective salivary secretion was induced by sialoadenectomy (n=8), while the remaining five guinea pigs underwent sham surgery (control group). We measured the unstimulated salivary flow rate, wetness of the oral mucosa using the oral tester (L-SALIVO) and moisture of the submucosa of the tongue using MucusIII. All tests were performed before (baseline) and 1 month after surgery. RESULTS: Sialoadenectomy significantly reduced both the salivary flow rate and the tester reading at 10 and at 30s (p<0.01). The vale due to the MucusIII as significantly reduced in animals with sialoadenectomy (p<0.01). CONCLUSION: The MucusIII is a device for objective evaluation of the moisture of the oral cavity.