Background: Constipation causes substantial morbidity worldwide. Methods: This survey assessed constipation-related factors in Japan using the Japanese version of the Irritable Bowel Syndrome Quality ...of Life (IBS-QOL-J) instrument. We also examined the relationship among laxative type, Bristol Stool Form Scale (BSFS) scores, and treatment cost. Finally, we examined differences in satisfaction scores according to laxative type, treatment type, treatment cost, and BSFS score. Results: IBS-QOL-J was higher among those taking salt and/or irritation laxatives. Those paying >JPY 5000 (USD 50.00) had the lowest IBS-QOL-J. IBS-QOL-J was significantly lower among those with a BSFS score of 1 or 2 (severe constipation). Conclusions: This study’s findings suggest that a variety of factors, including treatment type and cost, are associated with defecation satisfaction. Those who had hard stools, used multiple laxatives, or spent more on treatment were less satisfied. Future strategies should target therapies that do not require multiple laxatives with lower treatment costs. Adequate defecation with a small number of appropriate laxatives at minimal cost appears to improve defecation satisfaction. It is desirable to identify appropriate laxatives and improve dietary habits and exercise routines. It is also necessary to stop blindly increasing laxative usage and properly diagnose constipation disorders such as anatomical abnormalities other than functional constipation.
Purpose
The benefits of parenteral nutrition and hydration (PNH) in patients with advanced cancer remain unknown. Therefore, we conducted a prospective multicenter cohort study to assess the effects ...of PNH on survival in patients with malignant bowel obstruction (MBO).
Methods
The present study was a secondary analysis. Data on primary nutritional administration routes during the first week of admission to palliative care units, i.e., parenteral nutrition and parenteral hydration, were obtained. Data on the averaged calorie sufficiency rate/total calorie intake (75% ≤ or 750 kcal/day ≤ , 50–75% or 500–750 kcal/day, 25–50% or 250–500 kcal/day, and < 25% or < 250 kcal/day) were also obtained. Participants with MBO were included and divided into two groups: PNH-high (25% ≤ or 250 kcal/day ≤) and PNH-low (< 25% or < 250 kcal/day). We performed time-to-event analyses using the Kaplan–Meier method, log-rank test, and univariate and multivariate Cox regression analyses.
Results
Patients were divided into the PNH-high (n = 68) and PNH-low (n = 76) groups. A significant difference was observed in survival rates between the two groups (log-rank P < 0.001). Median survival times were 35.5 (95% CI 27–44) and 17.5 (95% CI 13–21) days, respectively. In the multivariate-adjusted model, a significantly lower risk of mortality was observed in Cox’s proportional hazard model in the PNH-high group (HR 0.55 (95% CI 0.36–0.83), P = 0.005) than in the PNH-low group.
Conclusion
The present results indicated the beneficial effects of PNH for prolonging survival in advanced cancer patients with MBO in palliative care units.
A 46-year-old woman was admitted to the Plastic and Reconstructive Surgery Division of Ehime University Hospital for swelling and pain in both breasts. Approximately 10 years earlier, in June 2010, ...she had undergone bilateral breast augmentation surgery with hyaluronic acid. Computed tomography showed a shadow under the pectoralis major muscle and a breast abscess in the pectoralis major due to a foreign body was suspected. Puncture was performed under ultrasound guidance, but a bacteriological culture of the abscess was negative. Surgery was performed under general anesthesia and a white cystic lesion covered with a thin capsule was found in the pectoralis major. A histopathological examination revealed a foreign body reaction, and biochemical analysis showed that a small amount of hyaluronic acid remained. In breast reconstruction using a large amount of highly cross-linked hyaluronic acid, there is a high possibility that foreign substances containing hyaluronic acid will persist, so careful interviews and examinations are necessary.
