[Medical team's struggle with financial abuse in the corresponding -Limitation of the adult guardianship system: A case report].

Upon diagnosis of dementia, a 93-year-old woman was unable to manage her finances. Her nephew illegally spent her money, which was considered as financial abuse.The public office forcibly admitted her to our hospital as a legal measure. After five years, she attained the terminal stage owing to eating disorders.While the medical team was preparing for end-of-life care, the patient's guardian of adult had sent informed consent form to perpetrator who was accused of financial abuse because the guardian had no authority of decision-making.On learning about the whereabouts of his aunt, the perpetrator contacted the medical team which then attempted to resolve the conflict of opinions.However, obtaining the family's consent emerged into an exhaustive and stressful process for the staff.In the present system, wherein the guardians of adult have no authority over medical treatment policy, they should, at least, participate in the discussion of future opinions and cooperate with a constructive attitude.In contrast, the medical team should offer better information to the guardians of elderly patients to devise a proper treatment plan.

Selection bias in evaluating of influenza vaccine effectiveness: a lesson from an observational study of elderly nursing home residents.

Selection bias is of critical concern in the study of influenza vaccine effectiveness when using an observational study design. This bias is attributable to the inherently different characteristics between vaccinees and non-vaccinees. The differences, which are related both to vaccination and signs of clinical disease as an outcome, may lead to erroneous estimation of the effectiveness. In this report, we describe how selection bias among elderly nursing home residents may lead to a spurious interpretation of the protective effect of influenza vaccine. Our results should be a lesson in the importance of regarding selection bias when assessing influenza vaccine effectiveness.

Prognostic indicators estimated by (99m)Tc-GSA in acute liver damage.

A prognostic estimation formula of acute liver damage was evaluated by using clinical data and technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin ((99m)Tc-GSA) scintigraphy in order to determine operability for orthotopic liver transplantation (OLT). Forty-six patients hospitalized for acute liver damage were divided into survival (n=35) and non-survival (n=11) groups. Univariate and multivariate analyses were used to identify significant factors that affected prognosis. Logistic regression analysis was performed to predict prognosis with effective factors. Ten independent factors with significant differences were identified and further analyzed for significance by logistic regression analysis. Among the 10 factors, age and LHL15/HH15 were identified as having meaningful differences for predicting convalescence. The following formula was developed: A negative value for R indicates non-survivals, and a positive value indicates survivals. The mortality rate was calculated as=1/(1+e(R)). The sensitivity was 0.909, specificity was 1.000, and accuracy was 0.978. The reliability of this formula was as good as that of another formula presented previously by the Intractable Liver Diseases Study Group of Japan. The use of (99m)Tc-GSA for estimating the prognosis of acute liver damage is useful, especially before the onset of hepatic encephalopathy.

Clinicopathological study of hepatic nodular lesions in patients with alcoholic liver cirrhosis.

BACKGROUND: There have been few reports concerning the occurrence of hepatocellular carcinoma (HCC) in heavy drinkers not sensitized by hepatitis B virus (HBV) or hepatitis C virus. With current advances in diagnostic methods, hypervascular tumors are often discovered on imaging findings in alcoholics, and it is important to differentiate them from HCCs. METHODS: The subjects were 16 alcoholics who had hepatic nodules and were hepatitis B surface antigen negative and hepatitis C virus antibody negative and were classified into two groups: (1) the HBV group with hepatitis B surface antibody and/or hepatitis B core antibody and (2) the alcoholic group without these antibodies. Computed tomography (CT), magnetic resonance imaging, and tumor biopsy were conducted for all subjects, and digital subtraction angiography or CT during arterial portography and CT during arteriography were performed for all but one case. RESULTS: In the alcoholic group, there were no significant differences in the clinical features between the presence and absence of HCC. All nodules in the HBV group were HCCs, whereas in the alcoholic group, 6 of 16 lesions were HCCs and the others were hyperplastic nodules. Limited to the hypervascular tumors in the alcoholic group, on magnetic resonance imaging T1-weighted images, hyperplastic nodules showed hyperintensity, whereas HCCs were iso- or hypointense. CONCLUSION: HCCs can occur at a high rate in alcoholics, especially in those with HBV-associated antibodies. The patients with alcoholic liver cirrhosis sometimes have hypervascular tumors that are not cancer but hyperplastic nodules, and care must be taken in their treatment.

[Influenza virus].

Influenza virus is highly infectious and transmitted from human to human by droplet infection. Therefore, once the virus is brought into a hospital, this can lead to a severe outbreak of influenza among medical workers and inpatients, resulting in the failure of hospital functions. The fundamental protective measures against in-hospital infection include stopping the outbreak of influenza and minimizing the spread of infection when mass infection of influenza occurs in a hospital. Thus, it is vital that the infection control committee in each hospital prepares specific countermeasures against influenza infection reflecting the realities. As one such countermeasure, it is recommended is to give influenza vaccination to medical workers and patients before the illness becomes epidemic. Further, once an outbreak of influenza occurs in a hospital, administration of anti-influenza drugs to high-risk patients also needs to be considered.