We participated in TIPS-FM (Toronto International Program to Strengthen Family Medicine and Primary Care) for two weeks in Toronto in June 2019. This program enabled us to learn many important factors for developing family medicine. Based on Canadian family medicine, which has a long history, we were able to review the missions of family medicine in Japan, and gained further insight into multilayered essentials on the patient-, community-, and global-levels.

This study examined and improved the quality of inter-professional moral case deliberation (MCD) in a home-based medical care clinic by altering the MCD process and evaluating it using the REFLECT rubric. After altering the MCD process, four of the five main evaluation items in the questionnaire were shifted to a higher evaluation level employing a scaled evaluation. The free-entry field revealed future tasks. This report suggested that improving the quality and assessment of MCD using REFLECT promotes the reflection skills of clinical teams.

This paper describes a clinical review of cases of gastric cancer treated surgically at the Department of Surgery of the Shirakawa Kosei General Hospital, the core medical institution in the southern part of Fukushima Prefecture.
During the period of 20 years from January 1981 through December 2000, a total of 1, 132 cases were operated on for gastric carcinoma. Surgical resection cases totaled 1, 023 (resection ratio: 90.4%); curative resection cases, 894 (curative resection ratio: 79.0%); 5-year survival rate for resection cases, 68.3%; and 5-year survival rate for curative resection cases, 75.6%. When the cases were divided into those treated during the first half of the 20 years nad those treated during the latter half of the 20 years, the number or resection cases was smaller during the latter than during the first half but the resection ratio was larger. The early stomach cancer cases in terms of the degree of progress, histological classification, depth and metastasis to lymph nodes have been increasing and the 5-year survival rate has been on the rise.

During the period of 25 years from January 1978 through December 2002, a total of 808 colorectal cancer cases were operated on in Shirakawa Kosei General Hospital. The number of sugical resection cases came to 713 (ratio : 88.25%). Curative resection was performed on 593 cases (ratio : 73.4%). The total number of cases was broken down into 446 cases of cancer of the colon and 369 cases of cancer of the rectum (7 multiple cancer cases included). By sex, male cases numbered 329 and female cases 379. Clinically or histologically, many cases were diagnosed as stage IIIa or stage II cancer. The 5-year-survival rate for the resection cases was calculated at 67.2% and that for the cure resection cases, at 79.5%.
Excision ; Malignant Neoplasms ; Colorectal Cancer ; Cases ; Review of

The patient, a 71-year-old man, was admitted to our department with fever from unknown causes. Ultrasonic examination of the abdominal regions revealed abnormal multiple low-density echo legions (that could be) associated with splenomegaly. For diagnostic purposes, splenic puncture was performed with the aid of an ultra-sound imaging device. Pale yellow-green pus was obtained from the lesions. Based on this finding, we made a diagnosis on the case as multiple abscess of the splean. The patient underwent intensive chemotherapy. However, he dontinued to have a high fever. On the ninth day from hospitalization, splenectomy was performed. Since then, his fever has subsided. Abscess of the spleen is a rare disease. It is generally classified into two types: one is a multiple type, and the other, a solitary type. Multiple splenic abscess mostly occurs as one of the abnormal conditions during the course of a primary disease, which is often severe. Our case, however, did not exhibit any sign of a primary disease.

A 56- year-old woman visited our hospital complaining of right hypochondralgia. X-ray and endoscopic examinations revealed Borrmann 2 type gastric cancer in the anterior wall of an upper part of the stomach. Ultrasonography showed an echogenic mass in the suprarenal area. The mass which had septal formation within it, was about the same in density as fat on computerized tomography, and was hypovascular fed by the right inferior adrenal artery on angiography. These findings suggested that the mass might be adrenal myelolipoma. After total gastrectomy and right adrenectomy were done, histopathological study confirmed that the case is adrenal myelolipoma associated with Borrmann 2 type gastric cancer. In Japanese literature, only 54 cases of surgically resected adrenal myelolipoma have been reported, and this is the second case of adrenal myelolipoma associated with gastric cancer.

Objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.529 (Omicron) was first detected in Japan in November 2021. In Osaka, public health centres subsequently increased active case finding and encouraged self-isolation. This study investigated the effectiveness of these countermeasures. Methods: Cases targeted for analysis were persons who had neither recently travelled abroad nor had contact with foreign tourists but tested positive for SARS-CoV-2 between 24 November 2021 and 4 January 2022 and were suspected or confirmed to have the Omicron variant. We performed a descriptive analysis and calculated the reproduction number (R) for each generation using the branching process method. Genomic sequencing data were analysed to plot a haplotype network. Results: A total of 251 cases were analysed. The median age was 30 years, and 46% (115/251) were in their 20s or younger. The first Omicron case in Osaka was detected on 21 December 2021. Local public health centres conducted health monitoring and contact tracing. We analysed R, using information from six clusters, including 42 pairs with a clear relationship between the case and the infected contact (infector–infectee pairs); the clusters had 19, 21 and 2 cases in each subsequent generation. The basic R (t = 0) was estimated to be 3.2, and subsequent generations (t = 1, 2) of R decreased to 1.1 and 0.1, respectively. The haplotype network showed that these cases constituted a monophyletic group with others detected around Osaka, indicating that these case-related clusters had been contained and were not involved in the nationwide Omicron waves. Discussion: Active case finding and self-isolation were found to be effective in limiting the spread of an emerging novel variant.