Hand hygiene is an important infection control method to prevent healthcare-associated infections, but its compliance is not enough. We introduced a "hand hygiene improvement program" to encourage ...active involvement among nursing administrators, and analyzed the effect of this program on alcohol based hand rub (ABHR) usage rate and incidence rate (detection number /1,000 patient days) of methicillin-resistant Staphylococcus aureus (MRSA). In this program, ABHR usage rate (L/1,000 patient days) was set to 15 in the general ward and 30 in the critical division as the work improvement objective of the nursing department, and obliged each nurse manager to achieve the goal. Also, at the nurse managers' conference, monthly ABHR usage rate and detection number of MRSA (cases/month) were reported. Furthermore, link nurse and infection control team collaborated to support goal-achievement. As a result, ABHR usage rate in general wards increased significantly from 9.3 in 2013 before introduction to 17.5 in 2015 after introduction (p<0.05) of program. The incidence rate of MRSA at the same time decreased significantly from 0.52 to 0.37 (p<0.05). Likewise, ABHR usage rate in the critical division also increased significantly from 41.9 in 2013 to 78.8 in 2015 (p<0.05). The incidence rate of MRSA at the same time showed a decreasing trend from 1.84 to 1.63. These results suggest that it was effective to set the promotion of hand hygiene as the purpose of the nursing department and the entire organization tries actively under the involvement of the nurse manager who has a central role, and this program is useful for improving hand hygiene.
A 10-year-old male patient with xeroderma pigmentosum had a recurrent, pigmented, conjunctival tumor. Conjunctival malignant melanoma was diagnosed from the histopathological examination of the ...resected biopsy specimens. To our knowledge, this case of conjunctival malignant melanoma in a patient with xeroderma pigmentosum may be the second such report in the literature. We believe that malignant melanoma must be considered with squamous cell carcinoma in the differential diagnosis of conjunctival tumors in patients with xeroderma pigmentosum. Fontana-Masson and S-100 staining techniques helped diagnose this conjunctival malignant melanoma.
Coronary angioplasty is reported to be feasible and safe in patients with coronary spasm and fixed stenosis. However, the long-term results are not positive. We compared the results of coronary ...angioplasty in 20 patients with variant angina versus 17 patients with non-variant angina among 231 consecutive patients with vasospastic angina. Coronary angioplasty was performed successfully in all 37 patients without any complications. Stenting for coronary dissection or recoil was performed in 8 patients, directional coronary atherectomy was selected for ostial lesion of left anterior descending coronary artery stenosis in 2 patients, and standard balloon angioplasty was performed in 27 patients. There were no clinical differences between the two groups. The restensois rate in patients with variant angina was similar to that in patients with non-variant angina (30% vs 29%, ns). There was no relationship between the provoked spasm and restenosis. During the follow-up period, no major complications were observed in patients with variant angina or those with non-variant angina. In conclusion, full medication with calcium channel antagonists and isosorbide dinitrate, and treatment by coronary angioplasty including the use of new devices, were useful treatments for patients with coronary vasospasm and significant organic stenosis. There was no difference concerning the results of coronary intervention between the patients with variant angina and those with non-variant angina.
The thymidylate synthase (TS) inhibition rate was measured after tegafur (FT) administration (1.5 g/day, at least 10 days) in 7 sigmoid colon cancer patients. The TS inhibition rate decreased as the ...interval between the time of the last administration and the time of the tumor resection increased longer. This study provides basic data for considering methods of drug administration and assessment of modification, for example, by leucovorin.
There are many patients with vasospastic angina who have minor atherosclerosis, and in Japan the majority of them are male. No data exist concerning sex differences in patients with coronary spastic ...angina, so the present study sought to clarify the clinical characteristics between male and female patients with vasospastic angina. Between April 1991 and June 1998, 204 consecutive patients were diagnosed with vasospastic angina and of these, 26 (12.7%) were female. An acetylcholine test was performed with incremental doses of 20, 50, and 80μg injected into the right coronary artery and 20, 50, and 100μg into the left coronary artery. Ergonovine was injected in a total dose of 40μg into the right coronary artery and 64μg into the left coronary artery. Coronary spasm was defined as 99% or more luminal narrowing accompanied by ischemic changes on ECG. Compared with male patients, female patients had less organic stenosis (12 vs 33%, p<0.05), less history of smoking (15 vs 85%, p<0.01), and fewer focal spasms (31 vs 64%, p<0.01). There were no other differences between the 2 groups. In conclusion, Japanese female patients with vasospastic angina had the characteristics of diffuse provoked spasm, less organic stenosis, and less history of smoking, but only 1 in 10 of all patients with vasospastic angina are female.
Cardiovascular effects of cervical epidural analgesia produced with 7ml of 2% mepivacaine solution were studied in two groups: group 1 (n=8) had an average analgesic level of C5 to T5 and group 2 ...(n=7) of T1 to T10. In group 1, the heart rate decreased by 14%, but mean arterial pressure, cardiac index, and right ventricular ejection fraction remained unchanged. Central venous and pulmonary capillary wedge pressures increased by 71% and 35%, respectively. In group 2, heart rate, mean arterial pressure and cardiac index decreased by 19%, 20% and 39%, respectively. Central venous pressure increased by 96% but pulmonary capillary wedge pressure and right venticular ejection fraction remained unchanged. These results suggest that cervical epidural analgesia, especially with a caudal spread of the block, depresses cardiac performance.
The incidence of provoked coronary spasm with the standard single spasm provocation test has been relatively low in patients with rest angina. The present study examined the clinical usefulness of a ...newly designed spasm provocation test, an intracoronary injection of acetylcholine (ACh) following an ergonovine (ER) test, in patients with rest angina who demonstrated low disease activity and atypical chest pain. Triple sequential spasm provocation tests were performed in 24 patients with atypical chest pain who had no ischemia and in 40 patients with rest angina who had distinct ischemia. Initially, an ACh test (20-100μg) and then an ER test (40-64μg) were performed and then, if no spasm was provoked, an intracoronary injection of ACh was given after the ER test to evaluate coronary spasm. Coronary spasm was defined as total or subtotal occlusion. In the 24 patients with atypical chest pain, no spasm was provoked by intracoronary injection of either ACh or ER, but coronary spasms were induced in 2 patients using the new method, with the remaining 22 not experiencing spasm (specificity of new method, 92%). In the 40 patients with rest angina, intracoronary injection of ACh induced coronary spasm in 22 patients (group I) and 6 (group II) demonstrated spasm with intracoronary injection of ER. Coronary spasm was not induced by either the ACh test or the ER test in 12 patients (group III). The intracoronary administration of ACh after the ER test provoked spasm in 11 of 12 patients. Diffuse spasms were provoked in 10 of 11 patients. In patients with rest angina, the frequency of chest pain attacks in 1 month experienced by patients in group III (0.8±0.8) was significantly lower than that of patients in group I (7.0±5.3, p<0.01) or II (3.5±2.3, p<0.05). No serious or irreversible complications related to this new combined method were observed. In conclusion, this method was safe and reliable for the induction of coronary spasm in patients with rest angina who may have low disease activity.
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