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Journal of Rural Medicine: JRM

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[This corrects the article on p. 38 in vol. 12, PMID: 28593016.].
November 2017: Journal of Rural Medicine: JRM
Yusuke Watanabe, Kohei Ono, Kenichi Sakakura, Hideo Fujita
Acute symptomatic deep vein thrombosis (DVT) is usually managed by intravenous heparin and oral warfarin. Recently, direct oral anticoagulants (DOAC) have been introduced for the treatment of acute DVT. DOAC may be useful for very elderly patients who live in rural areas, where medical resources are limited. An 83-year-old woman presented to our clinic with left leg edema. Contrast enhanced computed tomography showed massive deep vein thrombosis in her left internal iliac vein. We diagnosed her with acute deep vein thrombosis...
November 2017: Journal of Rural Medicine: JRM
Larry Nichols
In a rural mountainous region on a Friday, a 78-year-old man was seen in his physician's office for leg edema and diagnosed with new onset atrial fibrillation. He was discharged home to start medications for atrial fibrillation and heart failure. He was hospitalized the next day with septic shock due to pneumococcal pneumonia. The new onset of atrial fibrillation requires a trigger acting on a vulnerable substrate. These triggers include acute conditions such as alcohol intoxication, myocardial infarction and pulmonary embolism...
November 2017: Journal of Rural Medicine: JRM
Katsuhito Ihara, Tatemitsu Rai, Shotaro Naito, Takayuki Toda, Sei Sasaki, Shinichi Uchida, Noriaki Matsui
Systemic lupus erythematosus is an autoimmune disease associated with mild valvular regurgitation. However, there have been no detailed reports of infective endocarditis in patients with systemic lupus erythematosus. Here, we describe a case of a 55-year-old woman without any cardiac abnormalities who was diagnosed with lupus nephritis by renal biopsy; she contracted infective endocarditis while receiving immunosuppressive therapy. Our case emphasizes that special consideration of the occurrence of infective endocarditis, and its early diagnosis and treatment are mandatory for patient survival...
November 2017: Journal of Rural Medicine: JRM
Ryuichi Ohta, Akira Shimabukuro
Objective: Parsonage-Turner syndrome is a peripheral neuropathy characterized by acute onset shoulder pain, myalgia, and sensory disturbances. The present report discusses a rare case of Parsonage-Turner syndrome and highlights the importance of accurate history recording and thorough physical examination for the diagnosis of the disease in rural areas. Patient: A 28-year-old woman presented to our clinic with acute bilateral shoulder pain and difficulty moving her right arm. A diagnosis of Parsonage-Turner syndrome was suspected based on the progression of symptoms, severity of pain, and lack of musculoskeletal inflammation...
November 2017: Journal of Rural Medicine: JRM
Makoto Nakao, Hideki Muramatsu, Eriko Yamamoto, Yuto Suzuki, Sousuke Arakawa, Ken Tomooka, Yusuke Sakai, Kouhei Fujita, Hidefumi Sato
An 81-year-old man was referred to our hospital with bilateral multiple patchy opacities on chest radiography. His chief complaints were a few months' history of intermittent mild cough and slightly yellow sputum. Chest computed tomography (CT) showed non-segmental air-space consolidations with ground-glass opacities. Amyloid deposition with organizing pneumonia (OP) was seen in transbronchial lung biopsy (TBLB) specimens from the left S8. Three months later, the infiltration originally seen in the left lower lobe was remarkably diminished, and new infiltrations in the lingual and right lower lobes were detected on chest CT...
November 2017: Journal of Rural Medicine: JRM
Akira Tempaku
Background: Chronic subdural hematoma (CSDH) is often found in the elderly owing to slight head trauma and is associated with several neurological disorders. Neurological deficits are cured by a simple surgical removal of the hematoma; however, these deficits persist if there is insufficient hematoma removal. It is rare for patients to continue having neurological disorders once the hematoma is removed. Case report: A 61-year-old woman presented with gait disturbance. She was diagnosed with a subdural hematoma through head computed tomography...
November 2017: Journal of Rural Medicine: JRM
Ryoko Takeuchi, Hirotaka Mutsuzaki, Yukiyo Shimizu, Yuki Mataki, Hiroshi Kamada
Objective: This study aimed to evaluate the effectiveness of soft-tissue release on hip subluxation and dislocation in cerebral palsy as well as activities of daily living after surgery. Patients and Methods: Soft-tissue release was performed in 13 patients (19 hips) with cerebral palsy. Of them, 10 had spastic quadriplegia and three had spastic diplegia. Mean ages were 8.6 years at surgery and 13.8 years at the last investigation. The mean follow-up period was 5.2 years. Hip subluxation and dislocation severities were analyzed before and after surgery and at the final investigation as migration percentage on radiographs...
November 2017: Journal of Rural Medicine: JRM
Hiroki Kubota, Katsuhiro Fukuta, Kenji Yamada, Masahito Hirose, Hiromichi Naruyama, Yoshimasa Yanai, Yasuyuki Yamada, Hideki Watase, Noriyasu Kawai, Keiichi Tozawa, Takahiro Yasui
Objectives: To evaluate the efficacy of tegafur-uracil (UFT), a prodrug of 5-fluorouracil, plus cisplatin and dexamethasone in patients with docetaxel-refractory prostate cancers. Methods: Twenty-five patients with docetaxel-refractory prostate cancer were administered oral UFT plus intravenous cisplatin (UFT-P therapy) and dexamethasone. Treatment responses were assessed monthly via prostate-specific antigen (PSA) level measurements. Treatment-related adverse events and overall survival were also assessed...
November 2017: Journal of Rural Medicine: JRM
Taku Naiki, Keitaro Iida, Noriyasu Kawai, Toshiki Etani, Ryosuke Ando, Takashi Nagai, Yutaro Tanaka, Shuzo Hamamoto, Takashi Hamakawa, Hidetoshi Akita, Yosuke Sugiyama, Takahiro Yasui
Background: We evaluated the effectiveness of gemcitabine and paclitaxel therapy in patients with metastatic urothelial carcinoma for whom two lines of sequential chemotherapy had been unsuccessful. Methods: A total number of 105 patients who had previously received first-line chemotherapy consisting of gemcitabine and cisplatin or carboplatin, were treated with second-line gemcitabine and docetaxel therapy between June 2006 and May 2015. Of these patients, 15 with an Eastern Cooperative Oncology Group Performance Status of 0 or 1 were administered gemcitabine and paclitaxel as third-line treatment from 2013 after failure of the second-line therapy...
November 2017: Journal of Rural Medicine: JRM
Tomoyuki Shimada, Masayuki Takahashi, Yuki Shimizu, Masaji Hashimoto
Objective: Routine, population-based mammographic screening for breast cancer has been implemented nationally in Japan for the past decade. The objective of this study was to evaluate the knowledge of the general public and of nurses concerning breast screening practices in Japan, especially with regards to the benefits and risks of breast cancer screening. Methods: In 2014, a questionnaire regarding the benefits and risks of breast cancer screening was administered to women who underwent breast cancer screening and to registered nurses...
November 2017: Journal of Rural Medicine: JRM
Ryuichi Ohta, Makoto Kaneko
Objective : To explore how rural physicians practicing in the remote islands of Okinawa, Japan experience and manage their negative emotions. Materials and Methods : We conducted semi-structured interviews with doctors who had worked in a clinic on a remote island in Okinawa prefecture for 2 years. The interviews were conducted using an Internet video conferencing system, and were recorded and transcribed. The transcribed data were then analyzed using the Steps Coding and Theorization method as a framework...
November 2017: Journal of Rural Medicine: JRM
Kayo Tokeji, Hirotaka Mutsuzaki, Yukiyo Shimizu, Ryoko Takeuchi, Yuki Mataki, Yasuyoshi Wadano
Objectives: This study was performed to elucidate the characteristics of amputees in our hospital. We also evaluated whether the causes and characteristics of the amputations influenced the patients' prosthetic walking ability. Materials and Methods: We retrospectively examined 47 amputees in our hospital from December 1996 to April 2016 with respect to the causes and levels of amputation. Of 28 lower limb amputees from April 2008 to April 2016, 22 received prostheses and were divided into 2 groups according to the cause of the amputation, as follows: the internal cause group (e...
November 2017: Journal of Rural Medicine: JRM
Toshiki Katsura, Megumi Fujimoto, Miho Shizawa, Akiko Hoshino, Kanae Usui, Eri Yokoyama, Mayumi Hara
Objective: This study aimed to examine the factors influencing the requirement of a certificate of long-term care using a basic checklist and items listed in the Special Health Checkup. Method: This study included 7,820 individuals living in Uji city, who were selected from among 8,000 elderly individuals who, in 2008, underwent a specific health checkup (hereafter referred to as the 'specific health checkup for the old-old elderly individuals') for those aged 75 years and above. They answered questions from basic checklists at the time, and 180 individuals were excluded as they had already qualified for requiring the certificate of long-term care at the time of the checkup...
November 2017: Journal of Rural Medicine: JRM
Ryoko Takeuchi, Hirotaka Mutsuzaki, Yukiyo Shimizu, Yuki Mataki, Kayo Tokeji, Yasuyoshi Wadano
Objectives: To investigate the details of patients' status on admission and at discharge at our hospital, to compare the ambulatory group and non-ambulatory group at discharge, and to assess the factors associated with ambulatory ability at discharge in patients aged ≥ 90 years with proximal femoral fractures (PFFs). Patients/Materials and Methods: Twenty patients admitted to our hospital for rehabilitation after surgery for a PFF were evaluated retrospectively. The rate of regaining ambulatory ability, presence of dementia, body mass index, serum albumin level, hemoglobin level, lymphocyte count, and functional independence measure (FIM) were assessed on admission and at discharge...
November 2017: Journal of Rural Medicine: JRM
Ryuichi Ohta, Akira Shimabukuro
Objective: To clarify the scope of practice on rural islands of Okinawa. Patient: A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours. Discussion: In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care. Conclusion: This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa...
May 2017: Journal of Rural Medicine: JRM
Ryuichi Ohta, Akira Shimabukuro, Mitsuyo Kinjo
Objective: To report the first case of ciguatera-associated rheumatoid arthritis in Japan. Patient: A 53-year-old man presented to our clinic with morning stiffness and pain in the fingers and wrists. Results: For six months, he had suffered from chronic pain in both hands and shoulders caused by ciguatera poisoning. He was referred to a local general hospital and diagnosed with RA. Conclusion: When synovitis becomes evident in chronic ciguatera poisoning, reevaluation is necessary, including investigation of chronic arthritis, which might be associated with the onset of RA...
May 2017: Journal of Rural Medicine: JRM
Fumiko Sunada, Naoki Morimoto, Mamiko Tsukui, Hidekazu Kurata
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic method and treatment approach for biliary diseases. However, biliary cannulation can be difficult in some cases. We performed ERCP in a 97-year-old woman with abdominal pain resulting from acute cholangitis caused by choledocholithiasis and observed difficult biliary cannulation. Eventually, the patient was successfully treated with the rendezvous technique. We could not cannulate the biliary duct during ERCP twice. Therefore, we placed a percutaneous transhepatic gallbladder drainage (PTGBD) tube without intrahepatic dilation...
May 2017: Journal of Rural Medicine: JRM
Mayumi Ohnishi, Sebalada Leshabari, Joel Seme Ambikile, Kazuyo Oishi, Yuko Nakao, Mika Nishihara
Objectives: The factors associated with quality of life (QOL) and anthropometric measurements as outcomes of food consumption were examined among school-age children in Tanzania. Methods: A cross-sectional study was undertaken in September 2013 in Tanzania. Anonymous self-administered questionnaire surveys were conducted in the Kiswahili language among primary school children in the fifth and/or sixth grade aged 10-14 years. The survey probed sociodemographic characteristics such as age, gender, living with family members, number of meals/snacks per day, food consumption in the previous 24 hours, and QOL, as well as anthropometric measurements (height and weight)...
May 2017: Journal of Rural Medicine: JRM
Hirotaka Mutsuzaki, Ryoko Takeuchi, Yuki Mataki, Yasuyoshi Wadano
Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to 12 months after TKA, including intraoperative knee ROM after implantation, and to clarify a target ROM for rehabilitation after TKA. Patients and Methods: In total, 39 knee joints in 26 patients with osteoarthritis who underwent TKA (retaining the posterior cruciate ligament) were evaluated...
May 2017: Journal of Rural Medicine: JRM
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