Recently, palliative care has been provided by a team of health professionals organized within a core hospital in an area. But, the operation is limited because of shortages of doctors and nurses. Under the circumstances, the leaders of the palliative care team have to take it upon themselves to give education, conduct a survey, and enlighten community members on the idea of palliative care. Teamwork is most important for palliative care. In future, cooperation between the palliative care team and small-scale medical institutions including private practitioners will be more important.

Sagamihara Kyodo Hospital (hereinafter, “Kyodo Hospital”) was first opened with 20 beds in August 1945 by what was then called the Kanagawa Agricultural Association, with the aim of providing access to medical care to medically underserved village areas in the northern part of Kanagawa Prefecture. With the growth of the city of Sagamihara, the hospital shifted to become an acute care hospital, reaching a total of 545 beds in 1979. It has obtained numerous designations such as “designated cancer care hospital”, “designated clinical training hospital”, and “community medical support hospital”, and has developed into the central hospital for secondary emergency care in Sagamihara. In this Presidential Symposium, I will discuss the efforts of Kyodo Hospital to provide secondary emergency care in Sagamihara and the role the hospital has played in emergency medicine in the community.(View PDF for the rest of the abstract.)

We report a case of female urethral cancer. A 67-year-old female complained of a pain in the left buttocks. Magnetic resonance imaging (MRI) revealed a urethral tumor, which invaded the bladder wall and left buttocks tissue. Transurethral resection was performed. Histopathological examinations revealed squamous cell carcinoma of the urethra. The case was diagnosed as stage D4 urethral cancer according to the Grabstald's classification. Radiotherapies with a total dose of 57.5 Gy were performed on the primary and invaded sites. However, she died 6 months after the radiotherapy.
Female ; seconds ; Carcinoma, Squamous Cell ; Procedures on Urethra ; Primary

  A 55-year-old male complained about urinary frequency, micturition pain, and right abdominal pain. Ultrasonography, computed tomography, and magnetic resonance imaging revealed severe vesicorectal fistula which was induced by either bladder carcinoma or rectal carcinoma. Total pelvic exenteration was performed. Histopathological examination revealed rectal adenocarcinoma with invasion of the urinary bladder. Twelve months after the surgery, the patient exhibited no sign nor symptom of local recurrence or metastatic disease.

　　Case 1: A woman in her 70s was carried into emergency department of our hospital. Apparently she had dyspnea. Acute pulmonary heart was suspected. Electrocardiography S I Q III T III-pattern. The patient was diagnosed with popliteal vein vascular aneurysm by ultrasonography. Case 2: A man in his 60s, was referred to our hospital for treatment of lower extremity swelling and pain. Like Case 1, the male patient was suspected of having deep vein thrombosis and femoral artery aneurysms by ultrasound inspection and also diagnosed with pulmonary thromboembolism based on CT findings. We were able to rescue these two patients by rapid medical cooperation. Ultrasonography was particularly useful for diagnosis and morphological evaluation of blood vessels.

　　[Purpose] We introduced subcutaneous suture with a synthetic absorption thread and examined its efficacy on surgical site infection after pancreaticduodenectomy (PD). [Method] In hour hospitals, PD was performed in a total of 69 cases from March 2006 through March 2014. They was divided into two groups-one consisting of 31 cases in which the skin wounds with staplers (non-subcutaneous suture group), and the other consisting of 38 cases in which surgical wounds were closed with subcutaneous sutures (subcutaneous suture group), and the incidence of surgical site infection (SSI) were compared between the two groups. [Result] Incidence of surface SSI occurred in eight cases (21.0%) in the non- subcutaneous suture group and three cases (9.7%) in the subcutaneous suture group (p＝0.17). The incidence of SSI was decreased in the subcutaneous suture group than in the non-subcutaneous suture group, but no statistically significant difference was observed between the two groups. However, taking into account the advantages such as the reduction of patient’s medical expenses, and the burden of ward duties, further examination with an additional number of patients was thought to be necessary.

BACKGROUND: Following the increase in the number of children with food allergies, support systems are now required for school lunches, but a large-scale factual investigation has not been carried out. OBJECTIVE: We evaluated the features of elimination diet due to food allergy and the support system in kindergartens and schools. METHODS: A prefecture-based questionnaire survey regarding measures for food allergies in school lunches of all kindergartens, public elementary schools, and public junior high schools (631 facilities) was conducted in Oita Prefecture, Japan. RESULTS: The recovery rate of the questionnaire was 99.5%, which included 106,008 students in total. A total of 1,562 children (1.5%) required elimination diets. The rate of children on elimination diets in kindergartens and elementary/junior high schools that required medical certification by a physician was 1.2% (324 among 27,761 children), which was significantly lower than the 1.8% of children (1,227 among 68,576 students) on elimination diets at the request of guardians without the need for medical certification (p < 0.0001). A total of 43.9% of the kindergartens and schools said that they would contact guardians if symptoms were observed after accidental ingestion, while a low 8.1% stated that they provided support to children themselves, including the administration of adrenaline auto-injectors. CONCLUSION: Medical certification reduces the number of children requiring elimination diets, but it has not been adequately implemented. Furthermore, waiting to contact guardians after symptoms are observed may lead to the delayed treatment of anaphylaxis. Cooperation between physicians and teachers is desired to avoid the overdiagnosis and undertreatment of children with food allergies.
Anaphylaxis ; Certification ; Child ; Diet ; Eating ; Epinephrine ; Food Hypersensitivity ; Humans ; Japan ; Lunch ; Medical Overuse