Background: There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan.
Methods: We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG.
Results: The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no.
Conclusions: Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG.

Objective: Routine, population-based mammographic screening for breast cancer has been implemented nationally in Japan for the past decade. The objective of this study was to evaluate the knowledge of the general public and of nurses concerning breast screening practices in Japan, especially with regards to the benefits and risks of breast cancer screening.

Methods: In 2014, a questionnaire regarding the benefits and risks of breast cancer screening was administered to women who underwent breast cancer screening and to registered nurses. The questionnaire was distributed to 1,649 women and 1,905 registered nurses.

Results: Completed questionnaires were returned by 1,552 (94.1%) of the screened participants and 1,710 (89.8%) nurses. The majority of the screened participants and registered nurses believed that screening prevented or reduced the risk of developing breast cancer (86% and 62%, respectively); that screening reduced the mortality risk of breast cancer by more than 50% (69% and 60%, respectively); and that 10 years of regular screening for 50-year-old women could prevent ≥ 10 breast cancer deaths per 1,000 women (62% and 61%, respectively).

Conclusions: Women in the target population and registered nurses were aware that earlier diagnosis led to better prognosis, but demonstrated misconceptions regarding other aspects of the benefits and risks of breast cancer screening. In Japan, all women should be educated on both the benefits and risks of breast cancer screening to enable them to make an informed decision on whether to participate in the mammographic breast cancer screening program.

Continuing medical education for the general practitioners has been activery performed. The former committee for continuing medical education of the Japan Society for Medical Education reported the objectives of continuing medical education for general practitioners. The present committee proposed learning strategies for continuing medical education for general practitioners in accordance with specific behavioral objectives of the curriculum.
It was postulated that appropriate learning strategies are necessary for physicians to provide holistic medical care in their communities, in addition to improving their medical knowledge and skills.
Learning strategies in the curriculum were also coordinated with the continuing medical education system of the Japan Medical Association.

The aim of this study is to clarify the definition and recognition on continuing medical education for administrators (or leaders for residents) of 80 university hospitals and 266 clinical training hospitals as designated by the Ministry of Health and Welfare, using the questionaire consited of 5 main questions, as following:
1) On the curriculum (program) of continuing medical education in their hospitals.
2) On the continuing medical education system of Japan Medical Association.
3) On the continuing medical education activity of the specified academic societies.
4) On guide of continuing medical education for the residents.
5) On definition of continuing medical education.
Answers to a questionaire were returned from 227 institutions (65.6%)
Analyzing the results, present situation of program curricula for continuing medical education in hospitals, participation to continuing medical education system of Japan Medical Association and Academic Societies, and consideration on continuing medical education as a hospital leader were comprehensible.

　　Among visceral artery aneurysms, those arising in the region of the pancreatic duodenal artery due to celiac artery stenosis are rare. We report a surgical case with stenosis caused by dissecting celiac artery aneurysms and multiple aortic aneurysm rupture in the pancreaticoduodenal region. A 72-year-old man with a history of distal gastrectomy for gastric cancer was carried into our hospital by ambulance for acute abdominal pain. CT scans showed dissected aneurysms of the root of the celiac artery and hepatic artery as well as massive retroperitoneal hematoma around the pancreaticoduodenum and intraperitoneal hemorrhage. Arteriography of the superior mesenteric artery revealed multiple aneurysms of the pancreaticoduodenal artery that might have caused rupture. In the late phase, retrograde flows in the gastroduodenal, hepatic, celiac, and splenic arteries from the pancreaticoduodenal artery were contrast-enhanced. Because it was thought that transcatheter arterial embolization or surgical aneurysmectomy for pancreaticoduodenal aneurysms could prevent blood flow in all circulating branch arteries of the celiac artery, leading to extensive organ ischemia, the gastric pouch, spleen, entire pancreas, and gallbladder were resected. The patient has been doing well.

　　Pancreatic neuroendocrine tumors, relatively rare cancers, mostly arise in the pancreatic parenchyma with infrequent involvement of the main pancreatic duct. Now and then, however, case reports have been published on pancreatic neuroendocrine carcinoma in which the main pancreatic duct is obstructed by tumor cells with severely fibrous stromal cells. Here, in this paper, we report a case of pancreatic neuroendocrine carcinoma with obstruction of the main pancreatic duct. A 59-year-old man complained of right upper abdominal pain. Magnetic resonance cholangiopancreatography and fat-suppressed T1-weighted magnetic resonance imaging showed gallbladder stones, a low-intensity-area measuring 8 mm in diameter in the pancreatic body, and club-shaped dilatation at the distal end of the pancreatic duct. The patient was thus diagnosed with a tumor in the pancreatic body and cholecystolithiasis, and underwent distal pancreatectomy and cholecystectomy. HE-staining showed tumor cells with eosinophilic cytoplasm and nuclear atypia. The infiltrative growth of the cells with severe fibrosis caused stenosis of the pancreatic duct. Based on the positive results of immunohistochemical staining for chromogranin A and synaptophysin and the Ki-67 index, the tumor was finally identified as pancreatic neuroendocrine carcinoma. The patient has been under follow-up with no additional treatment for >3 years since the surgery, without evidence of tumor recurrence.