Background & Objective : Difficulties associated with feeding and swallowing in cases of dementia have increased rapidly. Percutaneous endoscopic gastrostomy (PEG) has been performed in dementia patients in Japan. However, recently, there have been controversies about PEG nutrition in cases of elderly patients with dementia. Subjects & Methods : Twenty-nine elderly patients with dementia underwent PEG at our facility ; the average age of the patients was 81.8 years. After PEG, short-and long-term follow-ups were conducted by administering questionnaires to the patients' families by mail, interview, or telephone. Results : Responses received for the short-term follow-up questionnaire revealed that families of 27 patients (93%) were satisfied with PEG tube placement ; 2 NG patients died 3 months after PEG. Responses received for the long-term follow-up questionnaire revealed that 17 of 19 patients died at an average time of 3 years and 2 months after PEG. All families said that they were happy that the patients' deaths were from natural causes. The families of the 2 survivors said that they were presented joyful times at the meeting. Conclusion : PEG nutrition for elderly dementia patients in a geriatric health services facility is a useful and valuable means to achieve satisfaction of patients' families. The author offer to choose PEG nutrition even if for elderly dementia.

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Objectives : This study aimed to identifying features of nursing care provided for breast cancer patients during the course of radiotherapy following breast-conserving surgery and improve the quality of nursing care. Subjects and Methods : Subjects were certified nurses in breast cancer nursing (CN) and non-specialist nurses working with breast cancer patients (NS). An anonymous survey questionnaire on nursing care and other practices provided before, during, and after radiotherapy was conducted by postal mail and the results were compared between CN and NS. Results : Valid responses were obtained from 40 CN (41.2%) and 102 NS (56.7%). Significant differences between CN and NS were observed for 15 of 27 (55.6%) care items before radiotherapy, 18 of 18 (100%) items during radiotherapy, and 9 of 20 (45.0%) items after radiotherapy. Among the items with significant differences, significantly more NS than CN performed all nursing care items during the course of radiotherapy, except for one item provided before radiotherapy. Conclusion : These results demonstrate that it is necessary to facilitate enhanced collaboration and coordination between CN and NS providing nursing care for breast cancer patients in order to improve the quality of nursing care delivered to patients.

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Adult intussusceptions account for 5-10% of all intussusception cases and are considered rare, whereas they are most commonly encountered in children. Among adult cases, idiopathic intussusceptions are pretty rare. A 36-year-old male was admitted to our hospital with abdominal pain. His body temperature was 37.0°C, the white blood cell count was 14,000/μl and CRP 0.01mg/dl. A standing abdominal X-ray showed slight niveau formation. Computed tomography demonstrated the multiple concentric ring sign. His condition detoriorated and a laparotomy was performed. Intraoperatlvely, a mass measuring six centimeters in diameter was seen in the left side of the hepatic flexure of the transverse colon. The diseased intestine was reducted with Hutchinson's maneuver. No lesions or malignancy were found, however an ileocecal resection was performed to prevent recurrence of the intussusception. The resected specimen showed congestion and wall thickening. Pathological examination of resected specimen showed marked congestion and hemorrhage with coagulation necrosis. The patient's postoperative course was uneventful and he was discharged from our hospital on the 10th postoperative day. After nineteen months' follow up, no recurrence of the intussusception has been seen. Reduction of the bowel followed by minimum bowel resection should be considered to prevent recurrence of the intussusception and to avoid short gut or adhesional ileus.

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Reconstruction after esophagectomy may represent a serious problem when a previous gastric resection has been performed. The colon is frequently used, but the marginal artery is of insufficient caliber to maintain the viability of a transposed colon. Three-dimensional computed tomography (3D-CT) provides abundant information about a patient's anatomy without requiring an arterial puncture. We present a case in which 3D-CT was used. A 68-year-old man who had previously undergone a gastrectomy was diagnosed with esophageal cancer. 3D-CT showed that the left colic artery was straight and long and had a solitary branch from the inferior mesenteric artery. The vascular pedicle of the left colon was found during the operation to be in accord with the 3D-CT evaluation. The patient underwent a transthoracic esophagectomy, followed by reconstruction using left colon interposition. No anastomotic leakage or necrosis of the reconstructive colon occurred.

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A 68-year-old woman diagnosed as having sigmoid colon cancer underwent sigmoidectomy (with D3 lymphadectomy) in February 2009. The pathological diagnosis was moderately differentiated tubular adenocarcinoma, ss, ly1, v1, n1, stage IIIa. Adjuvant chemotherapy with capecitabine was administered for 6 months after the surgery. She presented to our outpatient clinic in December 2009 (10months after sigmoidectomy) complaining of discomfort in the anal region. A protruding tumor measuring 2 cm was noted at the 3-o'clock position of the anus. Examination of biopsy specimens revealed moderately differentiated adenocarcinoma of the subepithelial layer, leading to a suspicion of metastasis of the sigmoid colon cancer. After obtaining informed consent, local excision was performed. The tumor was found to be a moderately differentiated adenocarcinoma with pathological features similar to those of the primary lesion ; therefore, anal metastasis was diagnosed. Because of concurrent hepatic and inguinal node metastases, she has been initiated on chemotherapy. We report an extremely rare case of metachronous anal metastasis after surgical treatment for sigmoid colon cancer. In this patient, the metastasis is highly likely to have occurred via arterial or lymphatic vessels.

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A 78-year-old man had a history of living in China for 4 years during the Second World War. In July 2010, he had sudden pain in the left lower quadrant, and visited a local clinic. Computed tomography revealed barium leakage from the intestine, and perforative peritonitis was suspected. He was thus referred to our hospital. Upon arrival, his abdomen showed board-like rigidity, with tenderness and Blumberg's sign in the left lower quadrant. Generalized peritonitis due to gastrointestinal perforation was diagnosed, and emergency surgery was performed. Many diverticula were present in the sigmoid colon in which a perforation had occurred. An approximately 10-cm section of the contaminated site including the perforation was resected, followed by end colostomy, and barium diffusely adhering to the peritoneum was removed expediently. Intraoperatively, the patient had a blood pressure reduction, considered to be septic shock, and endotoxin adsorption therapy was performed. On hospital day 3, his blood pressure stabilized. He subsequently showed steady recovery, and was discharged from the hospital on day 35. Histopathological examination of the resected specimen revealed many calcified oval foreign bodies measuring 40 to 70μm in diameter from the submucosal to the subserosal layer, which led to a diagnosis of old schistosomiasis japonicum . Although the eggs were not associated with active inflammation, the sites with many numerous eggs showed tissue fragility with bleeding and inflammation, suggesting that these conditions in addition to the presence of diverticula may have affected the perforation. In recent years, imported cases of schistosomiasis japonicum have sporadically been reported, and there are also still reports of old schistosomiasis japonicum like our present case. Therefore, we describe this case with a brief discussion of the relevant literature.

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A 64-year-old woman, with more than a 20 year history of polycythemia vera (PV), developed portal hypertension, myelofibrosis and extramedullary hematopoiesis accompanied by massive ascites. Portal hypertension resulted not only from infiltration of the liver sinusoids by hematopoietic cells but also from nodular regenerative hyperplasia of the liver. Wright-stained smears of ascites samples consisted of mesothelial cells and macrophages. However, cultures of mononuclear cells from the ascites showed the presence of hematopoietic progenitor cells including megakaryocyte colony formation and burst forming units. The JAK2-V617F mutation was positive in granulocytes. Contrary to other reports, radiation therapy was not effective and severe myelosuppression continued for more than one month. We present the unusual clinical course for this case of PV and discuss the pathophysiology of refractory ascites.

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An 86-year-old woman was diagnosed with gastric cancer extending from the cardia to the lower body on gastrointestinal endoscopy. At surgery, it was found that the third portion of duodenum was not fixed to the retroperitoneum and the ligament of Treitz had not formed. Malrotation was diagnosed because the small intestine was located on the right side of the abdomen and the large intestine was located on the left. Ladd's ligament was not present. A total gastrectomy and Roux-en Y reconstruction were performed, but no procedure for malrotation was done. Malrotation is rare in adults and is found incidentally at surgery for malignant tumors. Careful preoperative examination of images is necessary to make the diagnosis. There is no standard opinion regarding the addition of a procedure for malrotation, and this depends on the surgeon's judgment.

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A 66-year-old man underwent gastrointestinal endoscopy and computed tomography, which revealed a gastric submucosal tumor, 4 cm in diameter, growing outside the posterior wall of the upper body of the stomach. The tumor was diagnosed as a gastrointestinal stromal tumor (GIST) based on endoscopic ultrasonography fine needle aspiration (EUS-FNA). Surgery was indicated based on the tumor size. A laparoscopic partial gastrectomy was performed by the glove method with a single 4 cm incision at the umbilicus. The tumor was round and growing out of the posterior wall of the upper body of the stomach, with no adhesions to surrounding organs. The tumor was resected using an linear stapler. Immunohistochemically, the tumor was a low-risk gastric GIST, and the surgical margins were negative.
Single-incision laparoscopic surgery is generally more complicated than conventional laparoscopic surgery. In this case, however, the surgery was performed without technical difficulty. As there are no scars other than the wound necessary for tumor extraction, single-incision laparoscopic surgery for gastric GIST is a treatment option with good cosmetic results and high patient satisfaction.

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Background and Objective : The present study analyzed published research regarding illness-related ‘uncertainty’ experienced by patients and their families and clarified and verbalized ‘uncertainty’ content and expression in order to obtain nursing suggestions regarding managing uncertainty as an issue of adaptation. Subjects and Methods : Japana Centra Revuo Medicina was searched for original articles published between January 2001 to July 2011 using the key words "uncertainty" and "nursing". Content analysis was conducted on the 35 articles that had similar research topics and that investigated patients and families as subjects. Results : The following five categories of research content were extracted : uncertainty due to 1) ‘lack of confidence in somesthetic perception’, 2) ‘inability to assess situation because of lack of relevant information’, 3) ‘lack of future prospects’, 4) ‘inability to predict disease state or treatment outcome’, and 5) ‘inability to extract meaning of life from anxieties about imminent death’. The category of ‘uncertainty due to inability to assess situation because lack of relevant information’ had the heaviest weighting. Conclusion : The present findings suggest that provision of relevant information and listening to uncertainties are important issues for enabling patients and families to accept uncertainty and move toward adaptation.

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Objectives : To collect concrete examples of significant childbirth experiences in order to establish supportive care for mothers who have experienced the preterm birth of a low-birth-weight infant. Methods : Data were collected during semi-structured interviews conducted on mothers who had experienced the preterm birth of a low-birth-weight infant from Aug. through Nov. of 2005. Participants provided free responses to questions regarding their childbirth experiences. The collected data were categorized using a content analysis method based on the method proposed by Berelson. Results : The following seven core-categories of significant childbirth experiences were extracted : "feeling anxiety or relief due to requiring medical care following the awareness of the possibility of preterm birth", "feeling anxiety or relief due to relying on professionals in preparing for preterm birth", "feeling anxiety following self-assessment of health-related behaviors due to one's high-risk status during pregnancy", "feeling anxiety or relief due to the delayed growth process in a low-birth-weight infant", "loss of control of one's own childbirth due to the need to undergo an emergency Caesarean section in the early phase of pregnancy", "feeling anxiety due to minor drawbacks immediately after preterm birth and the subsequent delay in direct contact with the infant", and "burden of husband's emotions and behaviors in preparing for preterm birth". Conclusions : The categories comprising concrete examples of significant childbirth experiences identified in the present preliminary report may be useful for exploring supportive care for the emotional instability of mothers who have experienced the preterm birth of a low-birth-weight infant.

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The present study aimed to investigate the utility of a dietary habit check sheet developed by the authors as a method of self-reviewing dietary habits. Dietary habit characteristics were extracted from the completed check sheets of 42 university nursing students, which were then analyzed from the perspective of appropriateness of self-evaluations and awareness changes aimed at dietary improvements based on individual realizations regarding dietary habits. The results revealed 11 balance patterns across the four Kagawa food groups with some deficiency of groups 1, 3 and 4and a tendency towards excessive intake of group 2 observed overall. Application of the check sheet increased students' interest in dietary habits and enabled them to evaluate dietary habit characteristics, such as imbalanced food group intake, and to analyze dietary habit imbalances by reviewing their specific dietary situation and to investigate the cause of the imbalance. Furthermore, the check sheet provided motivation for dietary habit improvement and elicited specific improvement measures. Reasonable appropriateness of self-evaluation as confirmed by extracted dietary habit characteristics and ease of check sheet use were reported for about 80% of students. The present findings suggest that the dietary habit check sheet provided motivation for lifestyle adjustment.

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