Purpose: In Kasugai City Hospital, we have introduced palliative care clinical pathway with a focus on decision-making support on the intention of recuperation location in addition to symptom relief. In this study, it is intended to explore the factors that make it difficult to home discharge of cancer inpatients with the intention of discharged home on the basis of the information on the clinical pathway. Methods: The subject patients were cancer inpatients who had expressed the intention of the discharge to the home during period from June 2014 to August 2015. We examined the medical records of the target patient retrospectively. Logistic regression analysis was performed in order to clarify the factors that make it difficult to home discharge. Results: Of 43 patients, 25 patients (58.1%) were discharged from the hospital to the home. As a result of logistic regression analysis (multivariate analysis), delirium and living alone have been extracted as the predictive factors that makes it difficult to home discharge. Conclusion: Delirium and living alone have been suggested as the factors that makes it difficult to home discharge of patients who wish to home discharge. Early detection and early treatment of delirium are important, and early collaboration between the hospital discharge support department and palliative care team for the living alone patient is also necessary.

  Komono Town is a well-known spa and health resort in Mie Prefecture. Komono Town has been seeking ways to promote the activities of hot spring area and health resources in surrounding areas. As part of these efforts, Komono Town has developed town-walk programs to promote the health of local residents. In this study, focusing on effect of walking on relaxation, we compared levels of stress hormones and emotional scores obtained before and after walking.

  After giving their informed consent, adult participated in two walking programs, each for a distance of approximately 7 km. Salivary cortisol levels were measured before and after intervention. In addition, the Mood Check List-Short form. 2 (MCL-S.2) and a Visual Analog Scale (VAS) were used to rate emotions before and after intervention.

  In both programs, walking tended to lower levels of salivary cortisol than resting. Low levels of cortisol, an adrenocortical hormone released during a state of predominantly sympathetic nervous activity, are thought to reflect mental relaxation; our result implies that the walking program enhanced relaxation in subjects. In addition, both MCL-S.2 and VAS rating showed that the subjects tended to feel better, more relaxed and less anxious after intervention.

  These findings suggest that the walking programs are beneficial human body thorough, for example, enhanced relaxation.

BACKGROUND/AIMS: Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. METHODS: Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival. RESULTS: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. CONCLUSIONS: m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.
Aged ; Aged, 80 and over ; Alloys ; Carcinoma/*complications ; Cholestasis/etiology/*therapy ; Digestive System Neoplasms/*complications ; Drainage ; Equipment Design ; Feasibility Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; *Prosthesis Failure ; Recurrence ; Reoperation ; *Stents/adverse effects ; Time Factors

  【Introduction】One of the effects of the hot spring provides worm temperature. This effect raises temperature, and temperature control function operates and causes increase of the bloodstream. This time, these changes examined the thing by the size of the bathtub and the spring quality of the hot spring.   【Subjects and Methods】The subjects were 10 healthy adult men (mean age: 25.2 years). They bathed for 10 min in bathtubs at 42°C. The enforcement used plunge bath (approximately 1,700 L: simple alkaline hot spring) and home bathtub (approximately 300 L: hot water, 0.1% artificially chlorinated spring). Measurement item of the maximum arterial blood flow rate using the Ultrasonic Rheometer Smart Doppler 45, deep body temperature using the deep body temperature monitor core temperature CM-210, I compared each value 10 min during the bathing, and during a 10-min, 20-min, 30-min resting period after bathing, furthermore, I found the conjugation on each condition resting period after bathing.   【Result】The rise in deep body temperature and maximum arterial blood flow rate showed the result that a hot spring of the plunge bath was more meaningful than the value of the home bathtub after 10 min of bathing. The deep body temperature of the hot spring of the plunge bath significantly rose from bathing 3 min after. In deep body temperature with the resting period after bathing, in the hot spring of the plunge bath, a meaningful rise was maintained in hot water 13 min for population chloride spring 16 min of the home bathtub for 15 min.  【Discussion】In thinks that a population spring let you maintain a temperature rise that it disturbs a drop of the water temperature by abundant quantity of water in the plunge bath that hot spring plunge bath had a bigger deep body temperature rise, maximum arterial blood flow rate than home bathtub, and the deep body temperature rise in the home bathtub was continued.

The patient was a 52-year-old woman who had undergone laparoscopic colectomy with lymph node dissection and inferior mesenteric artery preservation for cancer of the descending colon. Functional end-to-end anastomosis was performed using a linear stapler. Colonoscopy at the 1-year follow-up revealed a type 2 tumor at the anastomotic site. She was diagnosed with anastomotic recurrence. We performed laparoscopic high anterior resection with inferior mesenteric artery dissection. Rectal resection preceded mobilization of the mesocolon because of severe adhesion around the anastomotic site. Laparoscopic surgery for anastomotic site recurrence is an option under the condition that the initial surgery was laparoscopic.

  Komono Town is a well-known spa and health resort in Mie Prefecture. Komono Town has been seeking ways to promote the activities of hot spring area and health resources in surrounding areas. As part of these efforts, Komono Town has developed town-walk programs to promote the health of local residents. In this study, focusing on effect of walking on relaxation, we compared levels of stress hormones and emotional scores obtained before and after walking.  After giving their informed consent, adult participated in two walking programs, each for a distance of approximately 7 km. Salivary cortisol levels were measured before and after intervention. In addition, the Mood Check List-Short form. 2 (MCL-S.2) and a Visual Analog Scale (VAS) were used to rate emotions before and after intervention.  In both programs, walking tended to lower levels of salivary cortisol than resting. Low levels of cortisol, an adrenocortical hormone released during a state of predominantly sympathetic nervous activity, are thought to reflect mental relaxation; our result implies that the walking program enhanced relaxation in subjects. In addition, both MCL-S.2 and VAS rating showed that the subjects tended to feel better, more relaxed and less anxious after intervention.   These findings suggest that the walking programs are beneficial human body thorough, for example, enhanced relaxation.

Here, we report 3 cases of conservatively treated ischemic colitis with hepatic portal venous gas. In Case 1, an 84-year-old man visited the emergency department because of fatigue, vomiting, and upper abdominal pain. In Case 2, a 72-year-old man was hospitalized for rehabilitation in another hospital following cervical spine trauma. He had diarrhea and mesogastric pain for 2 days and was transferred to our hospital. In Case 3, an 89-year-old woman visited the emergency department because of upper abdominal pain and vomiting. In all cases, we diagnosed the illness as ischemic colitis with hepatic portal venous gas based on computed tomography findings, and the vital signs of all patients were stable. They were treated conservatively. They were able to resume oral intake and were discharged or transferred to another hospital. Hepatic portal venous gas has been considered a poor prognostic sign of severe diseases such as intestinal necrosis. However, recently, reports of cases treated conservatively have been increasing. Conservative treatment may be selected for ischemic colitis associated with hepatic portal venous gas taking into account the patient’s general condition.

A 14-year-old girl (Case 1) with respiratory distress during exercise was referred to our department after a pancreatic mass was detected by computed tomography (CT). Contrastenhanced CT scan showed a low-density mass measuring 2.5 × 2 cm in the body of the pancreas. Low signal intensity was seen on T1-weighted magnetic resonance imaging (MRI) and high signal intensity on T2-weighted MRI. We suspected solid-pseudopapillary neoplasm (SPN) of the pancreas and performed laparoscopy-assisted spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 13. A 15-yearold girl (Case 2) with abdominal pain and fever was referred to our department after an abdominal cystic mass was detected by ultrasound examination. Contrast-enhanced CT showed a 4-cm well-circumscribed mass. Higher signal intensity was seen on T2-weighted MRI. We suspected SPN of the pancreas and performed laparoscopic spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 8. Laparoscopic or laparoscopy-assisted surgery should be considered for SPN of the pancreas.

A 48-year-old woman with a history of recurrent alcoholic pancreatitis was found to have a pancreatic pseudocyst. In November 20XX, she visited the emergency department due to sudden abdominal pain. Contrast-enhanced computed tomography showed a pancreatic pseudocyst with a maximum diameter of 67 mm and ascites. A ruptured pancreatic pseudocyst was suspected and abdominal paracentesis was performed. The amylase level in the ascitic fluid was high (3444 IU/L), leading to a diagnosis of acute generalized peritonitis due to rupture of a pancreatic pseudocyst. Intraoperative findings revealed 500 mL of ascites mixed with pancreatic juice and turbid cyst contents, and distal pancreatectomy was performed. The postoperative course was favorable, and the patient was discharged on hospital day 14. Rupture of pancreatic pseudocyst is rare. In this case, it was promptly diagnosed and successfully treated with emergency surgery.

The purpose of this study was to compare the results of open surgery and laparoscopic surgery for acute appendicitis in adults. In 2013, we primarily selected open surgery for acute appendicitis, but in 2017 we opted to select mainly laparoscopic surgery. We compared between 92 patients who had undergone open surgery in 2013 and 88 patients who underwent laparoscopic surgery group in 2017. There was no difference in age, sex, body mass index, white blood cell count, C-reactive protein, or perforation rate on computed tomography between the two groups. The laparoscopic surgery group had significantly longer operation time but significantly lower blood loss and postoperative complication rate. In particular, laparoscopic surgery was advantageous in terms of hemostasis for moderate bleeding. The results suggest that laparoscopic surgery may be more useful in adult appendicitis than open surgery.