A new conceptualization for Mikulicz's disease as an IgG4-related plasmacytic disease

Mikulicz's disease (MD) has been included within the diagnosis of primary Sjögren's syndrome (SS), but it represents a unique condition involving persistent enlargement of the lacrimal and salivary glands characterized by few autoimmune reactions and good responsiveness to glucocorticoids, leading to the recovery of gland function. Mikulicz's disease was recently reported to be associated with elevated immunoglobulin G4 (IgG4) concentrations in the serum and prominent infiltration of plasmacytes expressing IgG4 into the lacrimal and salivary glands. The following features were used for diagnosis: (1) visual confirmation of symmetrical and persistent swelling in more than two lacrimal and major salivary glands; (2) prominent mononuclear cell infiltration of lacrimal and salivary glands; and (3) exclusion of other diseases that present with glandular swelling, such as sarcoidosis and lymphoproliferative disease. These features are not observed in most SS cases. The complications of MD include autoimmune pancreatitis, retroperitoneal fibrosis, tubulointerstitial nephritis, autoimmune hypophysitis, and Riedel's thyroiditis, all of which show IgG4 involvement in their pathogenesis. Mikulicz's disease thus differs from SS and may be a systemic IgG4-related plasmacytic disease

ターミナルケア教育における読後課題レポートの分析

本稿は、死生観の探求を目的にした、読後の課題レポートを、過去3年間にわたり分析した結果をまとめたものである。対象は、本学介護福祉学科の4～6期生165名で、学生の選択した本は闘病記が多く、記述内容は、(1)生(2)死(3)ターミナルケア(4)医療(5)人間などに分類された。その結果、読書によるターミナルケアの学習は、学生が生や死について考える動機づけにつながり、死生観の形成には読書が大いに役立つことが示唆された。This paper is a summary of the result that analyzed the problem report of after reading to search for the outlook of life and death for the past three years. The object was 165 people per 4-6 term of this caring welfare subject, had a lot of struggle against disease records of the book that the student had selected, and the content of the description was classified by (1) life (2) death (3) terminal care (4) medical treatment (5) man etc. As a result, the study of the terminal caring by reading caused the life and the motivation about which it thought by dying and attaching by the student, and was suggested that reading be useful very much in the formation of the outlook on life and death

Evaluation and Clinical Validity of a New Questionnaire for Mikulicz's Disease

Objectives. The characteristic features of Mikulicz's disease (MD) are diffuse enlargement of the lacrimal and submandibular glands, elevated levels of serum immunoglobulin (Ig)G4, and abundant infiltration of IgG4-positive plasmacytes into both glands. No disease index is available to properly evaluate MD, so we developed a functional assessment of MD, the Mikulicz's disease activity questionnaire (MAQ), and evaluated its clinical efficacy. Methods. We selected 18 patients who were either being treated for MD or who had presented with recurrence. The patients completed a self-assessment and were scored according to the MAQ sheet during each visit between December 2009 and August 2011. Assessment items were in regard to increases or decreases in lacrimal and salivary gland enlargement and severity of sicca symptoms. Results. On the first visits, MAQ scores were high, but scores decreased rapidly as treatment progressed. When doses of glucocorticoid were reduced, some patients showed increased scores. Dry-symptom scores increased initially. MAQ scores for patients with recurrent MD gradually increased over several months before relapse. However, some patients displayed no elevation in MAQ scores due to relapses at other sites. Conclusion. MAQ score can be used to quantify flares and treatment response and is useful for functional assessment of MD

Noninvasive assessment of the cardiac baroreflex Response to downward tilting and comparison with the phenylephrine method

AbstractOBJECTIVESWe studied the relation between changes in systolic blood pressure and RR interval during downward tilting in comparison with assessment of baroreflex sensitivity (BRS) measured by the phenylephrine method (Phe-BRS) and with measures of heart rate variability (HRV).BACKGROUNDThe method most extensively used for assessing BRS involves bolus injections of phenylephrine. Several noninvasive methods proposed to assess BRS have not been widely applied in the clinical setting.METHODSSixteen healthy male volunteers were studied (mean age ± SD 27.5 ± 4.6 years). Arterial blood pressure using tonometry and electrocardiogram was simultaneously recorded. After 20 min of 70° upright tilting, the table was returned to supine position at a speed of 3.2°/s. Subsequently, BRS was assessed using an intravenous bolus injection of phenylephrine (2 to 3 μg/kg). Heart rate variability under resting conditions also was analyzed.RESULTSIn all subjects, a beat to beat systolic blood pressure increase associated with corresponding RR interval lengthening was observed during downward tilting as well as during phenylephrine administration. During both testing procedures, these two variables showed linear correlation, and the slope of regression line during downward tilting (DT-BRS) correlated significantly with Phe-BRS (r = 0.79, p = 0.0003). The DT- and Phe-BRS also correlated significantly with the high frequency component of resting HRV (r = 0.70, p = 0.0023 for DT-BRS; r = 0.58, p = 0.0185 for Phe-BRS).CONCLUSIONSWe conclude that in a small homogeneous group DT-BRS provided an assessment of reflex cardiac vagal function comparable to that obtained by the phenylephrine method

Clinical Study Evaluation and Clinical Validity of a New Questionnaire for Mikulicz's Disease

Objectives. The characteristic features of Mikulicz's disease (MD) are diffuse enlargement of the lacrimal and submandibular glands, elevated levels of serum immunoglobulin (Ig)G4, and abundant infiltration of IgG4-positive plasmacytes into both glands. No disease index is available to properly evaluate MD, so we developed a functional assessment of MD, the Mikulicz's disease activity questionnaire (MAQ), and evaluated its clinical efficacy. Methods. We selected 18 patients who were either being treated for MD or who had presented with recurrence. The patients completed a self-assessment and were scored according to the MAQ sheet during each visit between December 2009 and August 2011. Assessment items were in regard to increases or decreases in lacrimal and salivary gland enlargement and severity of sicca symptoms. Results. On the first visits, MAQ scores were high, but scores decreased rapidly as treatment progressed. When doses of glucocorticoid were reduced, some patients showed increased scores. Dry-symptom scores increased initially. MAQ scores for patients with recurrent MD gradually increased over several months before relapse. However, some patients displayed no elevation in MAQ scores due to relapses at other sites. Conclusion. MAQ score can be used to quantify flares and treatment response and is useful for functional assessment of MD

介護福祉士養成の「ターミナルケア教育」に関する一考察

本研究は、全国の介護技術担当教員を対象とした「介護福祉士養成におけるターミナルケア教育の現状」に関する調査結果をもとに考察したものである。調査の結果、回答が得られた175すべてにおいて、何らかの形で「ターミナルケア教育」は実施されているが、その内容、時間数はさまざまであり、教員の授業に対する満足度は低い傾向にあった。「ターミナルケア教育」の重要性を認めながらも、現行カリキュラムにおける限界が大きいことも指摘され、この状況下で効果的授業をどう構築していくのか検討課題である。また、体系化も視野に入れた、ターミナルケア教育の充実が求められることが示唆された。This research is based on a survey result of the current situation of terminal care education in care and welfare field. The survey has revealed that among the 175 answers, terminal care education is currently administered in some ways, but it varies in its content and hours of classes. It was clarified that most of them are not quite satisfied with the present curriculum of terminal care education. It is important to suggest improvements for more effective-teaching of this subject

A看護系大学卒業生におけるリカレント教育に対する学習ニーズ : Institutional Research (IR) からの分析

現在，わが国では急速な社会変容の時代に入り，大学を始めとした教育機関では，社会人の再教育の必要性からリカレント教育としての戦略的プログラムやその継続的展開が求められている。本研究では，A看護系大学を卒業して1～3年となる卒業生に対する調査から，リカレント教育の拡充へ向けた示唆を得ることを目的に卒業生の学習ニーズについて検討した。その結果，有効回答38件の内，卒業生の21.1％が既に進学しており，15.8％が将来的な進学などの展望を持ち，その多くは高度実践看護師への学習ニーズを有していた。また，卒業生が在学時に身についた能力と社会で求められていると思う能力の間には，多くの項目でギャップが存在しており，自分の力量不足を認識していることが示唆された。卒業生による大学生活の満足度と「看護研究（卒業研究・卒業論文）」および「サークル活動」の取り組みには有意な相関がみられ，教員や学生間における密接で深い関りが大学生活の満足度に重要な役割を果たす可能性が示唆された。学生と大学が互恵的関係を築き，卒後も大学を活用できる環境を整備することが，ひいては地域の保健医療福祉の質の向上に寄与していくと考えられ，大学には学習機会の拡充が求められている