Background and Aims: Male rectal cancer patients experience postoperative anxiety regarding bowel, urinary, and sexual function impairment. These patients must cope with various physical and psychosocial issues. The purpose of this study was to explain the process of accepting postoperative functional impairments among male rectal cancer patients.
Methods: Fourteen male rectal cancer patients who had undergone surgery 6 or more months beforehand were assessed through semi-structured interviews. Data were analyzed using the grounded theory approach.
Results: Simultaneous bowel, urinary, and sexual dysfunction mutually impeded male rectal cancer patients' activities and negatively affected their self-esteem alongside a feeling of lost masculinity. However, patients learned to understand their condition while exploring coping techniques for these three major impairments on their own terms. Patients adopted one of two coping methods, positive acceptance or acceptance with resignation, depending on support structures and the effectiveness of these established coping methods.
Conclusion: Patients' acceptance of the impairment of three major bodily functions should be characterized as a single structure, rather than focusing on accepting bowel dysfunction alone. Support programs should be structured based on the processes characterized through this study along with patient readiness.

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Purpose/Objectives: This study was aimed at developing a reliable scale for assessing the self-care agency of cancer patients under treatment.
Design: A cross-sectional study was performed.
Methods: The study involved patients with cancer who were receiving care on an outpatient basis at 4 hospitals in the Kanto/Shinetsu Districts of Japan. The items of the Self-care Agency Scale for Cancer Patients under Treatment (SAC) were developed using a qualitative study. The main research variables that were analyzed were obtained from a temporary questionnaire, the Self-Care Agency Questionnaire for Patients with Chronic Illness, and the Functional Assessment of Cancer Therapy General. After an item analysis, the construct validity was assessed using a confirmatory factor analysis, followed by an analysis of the scale's reliability and criterion validity.
Findings: A convenience sample of 303 cancer patients was utilized. The fitness indices for the scale were as follows: Goodness of Fit Index (GFI)=0.911; Adjusted GFI=0.878. The Cronbach α coefficient was 0.900. The SAC was developed as a secondary factor model that included 3 factors and 15 items. The results of evaluation using this scale were significantly correlated with those of extermal standards.
Conclusions: The SAC's construct validity, criterion validity, and reliability were all confirmed.

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Background and Objectives: A new type of Tsutsugamushi disease (TD) was recognized in the northern mountainous area of Gunma Prefecture in the 1980s. The aim of this study was to clarify the epidemiological features of TD infection in Gunma Prefecture and the Tone-Numata health and medical service area (HMSA). Methods: We investigated the occurrence rates of TD in the general, agricultural, and elderly (aged >60 years) populations; the age, occupation, and contact area of patients; changes in temperature; and TD serotypes. Results: (1) Occurrence rates of TD in Japan and Gunma Prefecture decreased until 2002, but those in Gunma increased from 2007. (2) TD rates were higher in the Agatsuma HMSA than in the other HMSAs in Gunma. In Tone-Numata HMSA, the number of TD patients has recently increased and accounts for 20-50% of the total in Gunma Prefecture. (3) The occurrence rate in the agricultural population increased in the Tone-Numata HMSA, and was higher in this population than in the total population of HMSAs. (4) Mean temperature in Tone-Numata HMSA has increased in recent years. (5) Almost all TD infections occurred in October and November in agricultural areas on river terraces. (6) Some TD infection has extended in the Tone-Numata HMSA, and some TD cases were caused by a new serotype (Kawasaki). Conclusions: In Gunma Prefecture, TD occurrence rates have increased via an increase in cases in Tone-Numata HMSA. Likewise, the increase in TD infections in the Tone-Numata HMSA has been affected by the increased rates found in agricultural areas and a rise in mean temperature. The activity of Tsutsugamushi larva may have extended and increased in agricultural areas on river terraces. Considering the serotypes and months of occurrence of TD, TD in Gunma Prefecture is probably caused mainly by "Futogetsutsugamushi" (Leptotrombidium pallidum) (Karp, Gilliam type). Finding types suggest this is mixed with the Kawasaki serotype common in the south Kanto and Kyushu regions. Local residents in agricultural areas that have a high risk of TD should be given education on preventive measures.

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Objectives: Management of acid-base disorders requires accurate and rapid diagnosis, but the current Step-by-Step method is complicated. This approach was designed to resolve this issue. Methods: The assessments were performed by ΔAG, bicarbonate gap (BG) and CO₂ gap (CG), and calculated results were divided into normal, increased, or decreased gap. Analysis by combining each division of these gaps was named ABC-Gap method. To study metabolic components, coordinates were set where ΔAG and BG were taken on the horizontal and vertical axes, respectively. Coordinates with borderlines drawn between normal and abnormal revealed that ΔAG and BG were independent variables. The resulting graph showed 7 partitions which included all pathologic conditions of metabolic components. The validity of this framework constructed through mathematical logic was tested by applying patient data. Results & Conclusions: Patients' diagnoses agreed with the partitions where the points were plotted according to their ΔAG and BG, so the theoretical validity and clinical usefulness of ABC-Gap method was confirmed. As respiratory components are just added to metabolic ones, it is clear that this method simplifies management and enables comprehensive analysis of metabolic acid-base disorders.

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Perilymphatic fistula (PLF) is defined as an abnormal leakage of perilymph from the inner ear to the middle ear. High pressure of the middle ear destroys the connection between the stapes and vestibular window. We report two cases of PLF caused by sniff. One case complained fluctuating hearing loss, and was diagnosed with PLF before operation because Coclin-tomoprotein (CTP) detection test was positive. Hearing loss improved after surgery. The other case complained of severe vertigo and hearing loss, and was suspected with PLF because air embolisms were detected in the inner ear. The intraoperative CTP detection test was negative. We believe this may be due to complete depletion of the perilymph through the fistula, causing irreversible hearing loss even after surgery. The CTP detection test is useful in diagnosing PLF, but test results must be interpreted based on the timeline of the disease process. Development of a faster method of diagnosis and education of health care providers about this rare disease are desirable.

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We report a case of a 73-year-old woman who had undergone left nephrectomy for renal cell carcinoma 16 years prior and was found to have a pancreatic tumor by computed tomography when she suffered from subileus. Computed tomography and magnetic resonance imaging revealed a pancreatic tumor showing early enhancement in the arterial phase. We suspected the tumor to be a metastasis from the renal cell carcinoma. Therefore, we performed distal pancreatectomy and splenectomy. The postoperative course was uneventful, and the histopathological diagnosis was a metastatic pancreatic tumor from clear-cell type renal cell carcinoma. Patients with a history of renal cell carcinoma should therefore undergo long-term follow-up.

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Purpose: The purpose of this study was to elucidate trends and current situations in end-of-life care for patients with amyotrophic lateral sclerosis (ALS) on non-invasive positive pressure ventilation (NPPV), who elect not to undergo tracheostomy positive-pressure ventilation (TPPV). Methods: We reviewed the literature using several search methods. We initially searched journal articles published between 2001 and 2015 using the Japan Medical Abstracts Society (ICHUSHI) database and PubMed, using the search terms ALS and/or NPPV. We then searched books, guidelines, comments, or readings that address how to palliate respiratory distress, and other related articles using two search engines: Yahoo! JAPAN and Google Scholar. We conducted searches several times for ten months between January and October 2016. The search terms were ALS, non-invasive positive-pressure ventilation (NPPV) /NIV, withdrawing NPPV to death, terminal care, end-of-life care, and several combinations of these words. Results: Thirty-four related original and research articles were analyzed. Palliative care during the end of life was addressed in two articles. Palliative care was described for 7 of 20 identified patients in books and journal articles. Furthermore, only a few guidelines and books were found to describe end-of-life care. Conclusions: The number of patients who use NPPV is increasing. NPPV cannot palliate respiratory failure for patients with aggravated ALS. In our findings, palliative end-of-life care for such patients who choose to remain on NPPV as maximum medical treatment for respiratory failure has received little focus. Development of palliative care at the end-of-life for ALS patients on NPPV is needed.

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