神経線維腫症1型（neurofibromatosis type 1;NF1）は，全身の皮膚に多発する結節性病変（神経線維腫）と色素斑（Café-au-lait spots）を特徴とする遺伝性疾患でvon-Recklinghausen病と呼称され，原因遺伝子は第17染色体長腕上のNF1遺伝子で優性遺伝形式を示し，近年，高発癌性遺伝病として認識されている．今回，NF1および完全内臓逆位症に合併した検診発見非触知乳癌で10年後の対側異時性両側乳癌を発生した1例を経験した．双生児の姉にも乳癌が発生し，NF1家系内に発生した双生児乳癌，異時性両側乳癌，内臓逆位症を合併した稀な症例と考えたので報告する．
<b><i>Background/Aims:</i></b> Aspiration pneumonia is a common cause of death among the elderly (≥90-year-old) in nursing homes. Studies suggest that its incidence could be reduced by oral care interventions. We aimed to evaluate the efficacy of a new oral care intervention: wiping plus oral nutritional supplements (ONS). <b><i>Methods:</i></b> This prospective observational study was conducted in 252 patients (age 88.0 ± 6.5 years) in 75 nursing homes, rehabilitation hospitals, and other care facilities. Patients were randomly divided into an intervention group (<i>n</i> = 74) and a control group (<i>n</i> = 107), whose members received conventional oral care. Body mass index, activities of daily living (Barthel index), and complete blood count and biochemistry parameters were measured at 2, 4, 6, and 8 months. <b><i>Results:</i></b> The cumulative incidence of pneumonia at 8 months tended to be lower in the intervention than in the control group (7.8 vs. 17.7%, <i>p</i> = 0.056) and was significantly lower for men in the intervention group (<i>p</i> = 0.046). <b><i>Conclusions:</i></b> Our new intervention “wiping plus providing ONS” method appears to help prevent aspiration pneumonia, thereby reducing mortality risk. In this study, we disseminate information on how this method is used in Japan.
The daily consumption of iodine in Japan is higher than in most countries, and there are few reports on iodine metabolism and variance of habitual iodine ingestion in an iodine-sufficient area. To elucidate the patterns of short-term urinary iodine excretion (UIE) and long-term variability of habitual iodine intake, the urinary iodine excretion process after a high dietary iodine load of 3 mg was observed in eight Japanese adults under strict supervision with complete urine collections for three days. In addition, estimated UIE and dietary iodine intake (DII) were assessed in 24 university students using repeated spot urine samples of ten consecutive days and a food frequency questionnaire in each of the four seasons. Approximately 50, 75 and 90% of orally ingested iodine was excreted into the urine at 8, 13 and 22 hours after ingestion, respectively. Almost an equal amount of ingested iodine in meals was cleared within 33.5 h after eating with a maximum excretion rate at 3-4 h. There was a high fluctuation in the UIE and DII in the university students. The intra- and inter-individual crude coefficients of variation were 123 or 294.7% for UIE, and 58.3 or 88.7% for DII, respectively, indicating a higher variance of habitual iodine intake than in other countries. The frequency of occurrence for UIE above 3 mg was every 43 days. Rapid renal clearance of iodine and high variability as well as low frequency of dietary iodine intake might prevent people from being exposed to an excess iodine intake over the long term in Japan.
