Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
-
The long-term prognosis of immunoglobulin A nephropathy is poor. Treatment is intended to achieve complete remission in the early stage or to preserve renal function in the advanced stages. In Japan, aggressive steroid pulse therapy following tonsillectomy (tonsillectomy-pulse therapy) has recently been used to treat early IgA nephropathy and has achieved favorable outcomes. However, steroid doses are sometimes limited because of adverse reactions s and the efficacy of tonsillectomy-steroid pulse therapy has not been established in patients with renal dysfunction. In our current treatment protocol, the total steroid dose has been significantly reduced through the use of the immunosuppressant mizoribine in combination with tonsillectomy-steroid pulse therapy for the treatment of active IgA nephropathy in patients with renal impairment. ⋯ Steroid pulse therapy in combination with mizoribine following tonsillectomy is effective in improving urinary findings and preserving renal function in the treatment of IgA nephropathy, which remained active in patients with renal impairment (estimated glomerular filtration rate ≥20 and <60 mL/min/1.73 m(2)).
-
The Utstein-style guidelines have been used in various countries around the world, because they are suitable for evaluating regional emergency medical systems (EMSs) for patients who have an out-of-hospital cardiac arrest (OHCA). This report examined the present status of treating OHCA in Saga Prefecture and examined policies that can contribute to improving the rate of the return of spontaneous circulation (ROSC). ⋯ The Utstein-style guidelines were used to clarify differences in the ROSC rate in Saga Prefecture, thus making improvements in regional EMSs possible. Improvements in the quality of oral instruction and a reexamination of the oral instruction manual are expected to improve the ROSC rate, in parallel with education in basic life support for lay person and in advanced cardiac life support for medical personnel. In addition, it is important to reaffirm the effectiveness of CPR and encourage the participation of lay person by providing instructions by telephone from an ambulance that is en route to the scene.