[A case report:the progress of fascioliasis from hepatic phase to biliary phase]

This is a case report of fascioliasis that progressed from the hepatic to the biliary phases over 2 years. A woman in her late 60s ate Zingiber mioga from the field, which was followed by abdominal pain that occurred 1 month later. Although CT and MRI studies revealed an increase in blood eosinophils as well as multiple hepatic nodules, they vanished quickly. After 2 years, an MRCP study revealed multiple flat lesions, which were diagnosed as adult fascioliasis. Definitive diagnosis was provided by enzyme-labeled antibody method using fasciola-specific antigen. Triclabendazole was administered once to complete the treatment.

[Comparison of the amount of nursing and caregiving at home for cancer patients and for patients with cerebrovascular disease]

OBJECTIVE

This study was carried out to qualify and quantify the amount of care estimated to be needed by the nurse and home-helper, the amount actually being given and the amount demanded by patient with cancer or cerebrovascular disease under condition of nursing and caregiving at home.

METHODS

Fifty-five patients with cancer and fifty-five with cerebrovascular disease registered at Visiting Care Stations in Aichi, Nagano and Tokyo, under nursing services of visiting workers dispatched by the respective station during the test period, were studied. A survey was conducted from September-December 1998 for cancer patients and from January-May 1999 for cerebrovascular disease patients. During the same periods, surveys of visiting nurses and home-helpers were conducted on the kinds and amount of service actually given and estimated to be needed, with questionnaire completed using a self-entry system. Addition of surveys was conducted with a visiting nurse's home-interviewing system. Items surveyed were sex, age, stage of disease, services given by family members and/or by visiting nursers and home-helpers, and the mean person-hours for each service.

CONCLUSION

1. The amount of excess burden placed on the families of patients with cerebrovascular disease was significantly greater than with cancer patients (P < 0.01, rank sum test). 2. Demands on nurses by cancer patient families were greater than those on home-helpers (P < 0.01, rank sum test), for daily attendant care, counseling and guidance, and coordination. 3. Demands from families of cerebrovascular disease patients on home-helper were greater than those on nurse, for daily attendant care, assistance in medical treatment, and counseling and guidance.

Gastric inhibitory polypeptide secretion after radical pancreatoduodenectomy

To elucidate the role of gastric inhibitory polypeptide (GIP) in the alteration of insulin secretion following pancreatoduodenal resection, in which the main sources of GIP are removed, plasma levels of GIP were measured for 180 minutes after oral glucose administration, both before and after radical pancreatoduodenectomy in nine patients with periampullary cancer. Fasting plasma levels of GIP remained much the same before and after surgery, and were not different from those in normal controls. The levels of GIP after glucose ingestion were significantly greater in the preoperative patients than in normal controls throughout 180 minutes. After pancreatoduodenectomy, the postglucose levels significantly diminished but remained within normal limits. Changes in plasma levels of insulin early after glucose ingestion in these patients, however, were significantly less both before and after surgery than in normal controls, and were not concomitant with the initial increase in plasma GIP. On the other hand, plasma levels of insulin greatly increased immediately after glucose ingestion in accordance with a rapid elevation of plasma GIP in 11 gastrectomized patients in whom the duodenum and the pancreas were preserved intact and who served as the control group. Thus, the diminution in GIP secretion following pancreatoduodenectomy may relate to the lack of main sources of this gut hormone and not to factors involved in the reconstruction of the alimentary tract. We conclude that the impaired insulin secretion following oral glucose ingestion in patients before and after pancreatoduodenectomy does not relate to the secretion of GIP.