Incidence of and risk factors for incisional hernia after closure of temporary ileostomy for colorectal malignancy.

PURPOSE: Incisional hernia is a major complication after stoma closure and can cause uncomfortable symptoms. In this study, we evaluated the risk factors for hernia formation with the aim of reducing the incidence of incisional hernia. METHODS: A total of 134 oncology patients underwent closure of a temporary loop ileostomy between May 2004 and December 2013. The incidence of incisional hernia was determined by routine follow-up computed tomography scanning every 6 months. The relationships between patients' characteristics, including age, sex, obesity, diabetes mellitus, surgical site infection, chronic obstructive pulmonary disease, hypertension, hypoalbuminemia, smoking, and presence of a midline hernia and the occurrence of incisional hernia were retrospectively evaluated. RESULTS: The median follow-up time was 47 months (range 8-130). Hernias occurred in 23.9% of patients (32/134). The median time to detection of hernias was 8 months (range 2-39). The Chi-squared test revealed significant differences in obesity (P = 0.0003), hypertension (P = 0.0057), and incisional hernia history (P = 0.0000) between patients with and without incisional hernia. Multivariable analysis and univariate analysis revealed that hypertension and the presence of midline incisional hernia were risk factors for incisional hernia. CONCLUSIONS: Hypertension and the presence of a midline incisional hernia were the major risk factors for incisional hernia after loop ileostomy closure. These risk factors can be addressed before planning surgery.

[Factors in continuation of home health care for patients with intractable neurological diseases].

OBJECTIVE: This study was carried out to elucidate factors related to difficulty in continuing home health care and to investigate problems of the corresponding support system for patients with intractable neurological diseases. SUBJECTS AND METHODS: Subjects were 139 cases of amyotrophic lateral sclerosis (ALS), 376 cases of spino-cerebellar degeneration (SCD) and 1,048 cases of Parkinson's disease (PD) who were collected from the nationwide survey of health and social service needs of the patients with intractable diseases in 1995. Factors and problems related to limited activity due to diseases and necessity for medical care were analysed. The need for facilities of long-term care was also studied. RESULTS: The characteristic conditions of patients with ALS were shorter duration of the illness, higher percentage of conditions requiring medical care and disorders of swallowing or respiration and full nursing care in daily life compared with the other two diseases. The characteristics of PD were higher percentage of female and older age in both patients and their family caregivers. The proportion of cases for whom health care was judged to be prone to difficulty was 23.0% in ALS, 10.9% in PD and 7.2% in SCD, respectively. Regarding the factors related to difficulty in continuing home health care, conditions requiring medical care, the need for full nursing care in daily life, and the duration of the illness were recognized in ALS. In SCD, 5 factors, including conditions requiring medical care, the need for full nursing care in daily life, patients age greater than 65 years, the duration of the illness, and patients being nursed by their sons or daughters were detected. In PD, 4 factors, such as conditions requiring medical care, the need for full nursing care in daily life, the patients being nursed by persons other than the spouse, and the need of nursing care were found. CONCLUSION: These results suggest the necessity of social functions of medical care, nursing and family support that can be supplied at home effectively according to symptoms in progress, and the need for facilities of long-term care of patients for whom continuation of home health care may become difficult, which will work as a support system for long-term care of patients with intractable neurological diseases.

[Public health nurses' disaster responses for intractable neurological patients at home].

OBJECTIVE: This paper describes the 1995 Hanshin-Awaji Earthquake experience of the local public health nurses. The purpose of the study was to identify problems regarding assistance of intractable neurological patients at home during and after the earthquake and to discuss ways to improve future local disaster responses by public health nurses for those patients. METHODS: Approximately 2 hours of a group interview of public health nurses from 2 public health centers in Kobe City was conducted in August, 1996. Interview data was collected via audio-tape and transcribed. The data was organized according to phases of the earthquake. The acute phase of the earthquake disaster ended within 72 hours. The data was then analyzed to identify problems in assisting intractable neurological home patients in order to discuss disaster responses by public health nurses. RESULTS: There was a delay in confirming the safety of and providing needed assistance for intractable neurological patients at home by public health nurses. During the first 3 days after the earthquake, the majority of public health nurses were unable to commute to work due to the shutdown of transportation systems. In addition, nurses, who were able to come to work, were preoccupied with treating earthquake casualties and distributing medical supplies. Other factors associated with the delay included the following: lack of a registration list for intractable neurological patients at home; lack of close contacts between public health nurses and patients, and between public health nurses and patient support groups; and sparing nurses for guiding volunteers and for coordinating between shelters and hospitals. CONCLUSION: Measures to improve future disaster responses are as follows: a) teaching patients and their families how to safeguard against disaster; b) preparing registration lists; c) establishing support networks and cooperating with network members; and d) upon disaster, assigning some nurses to assess the needs of patients.

[Basic study of CA549, a new tumor marker for breast cancer, and evaluation of its clinical usefulness].

We performed basic and clinical studies of IRMA kits for serum CA549 antigen and examined the immunological correlation between CA549 and CA15-3 antigens. Satisfactory results were obtained in the basic studies of CA549 assays, such as the reproducibility and the dilution test. Many patients with breast cancer had elevated serum CA549 concentrations and significant correlation was observed between serum CA549 and CA15-3 values. Anti-CA549 antibody completely inhibited the binding of 125I-labeled anti-CA15-3 antibody to its antigens. These results suggest that CA549 and CA15-3 antigens have similar immunological characteristics.