Acupuncture treatment was undertaken for 153 cases with dysurea after radical operation for carcinama of uterine cervix. Eighty-four percent of the patients were forties, fifties or sixties. Seventy percent of them underwent acupuncture treatment within two weeks after the operation. The treatment consisted of one or combination of the following methods: direct current acupuncture, in situ acupuncture, low-frequency electro-acupuncture and SSP. Acupoints considered to facilitate metabolism in the pelvic cavity and to be related to diurea were selected. The treatment group (fifty cases) had 19.7 days on which average residual urine was less than 50ml, whereas the control group 24.6 days. “Remarkable effect” and “effect” were obtained with SSP in seventy-seven percent of the cases, and with low-frequency electro-acupuncture in seventy-three percent. With the latter, “no effect” was obtained in only two percent of the cases. SSP therapy was effective and gained patients' favor because it gave no anxiety.

We report a case of an overlapping ulcerative colitis and aortitis syndrome. A 28-year-old woman with ulcerative colitis in the region from the rectum to the sigmoid colon developed left anterior cervical pain. A cervical contrast-enhanced computed tomography and an arch aortography showed diffuse narrowing of the left common carotid artery and segmental stenosis of the left subclavian artery involving the orifice of the vertebral artery, which defined the diagnosis as aortitis syndrome. HLA was positive for BW 52, which is frequently found in patient with this type of overlapping syndrome. Treatment with prednisolone was begun at an initial dose of 20mg/day, with gradual tapering to 5mg/day at 11 months later, when her symptoms had subsided and laboratory findings of inflammation had disappeared. One year later, she became apathetic in mental activity, and had a poor memory. She also complained of numbness on the left side of her face. Angiography confirmed the progression of the left common carotid narrowing causing the deterioration of her cerebral ischemic symptom. A saphenous vein bypass graft was placed between the right subclavian artery and the left common carotid artery. The postoperative course was uneventful and she had complete symptomatic relief and recovered active ordinary life. Postoperative angiography revealed the well functioning bypass graft.

Post-traumatic stress disorder (PTSD) is a pathological response to trauma characterized by frequent recollections, recurrent nightmares, and flashbacks of the traumatic event(s). To date, the precise mechanisms underlying the development of PTSD remain unknown. Several studies have suggested that antiepileptic drugs, such as gabapentin and lamotrigine, may be effective in the treatment of PTSD symptoms. We report on a 15-year-old Japanese female junior high school student who developed PTSD symptoms following repeated teasing from male classmates. Additionally, we underscore the beneficial effects of treatment with gabapentin and lamotrigine on flashbacks and nightmares. This patient developed PTSD symptoms after repeated teasing from male classmates at school. Her flashbacks and nightmares were treated with a combination of gabapentin and lamotrigine. After recovery, treatment with lamotrigine alone controlled her symptoms. Our observations suggest that a process of sensitization may be involved in the development of PTSD symptoms. Additionally, gabapentin and/or lamotrigine were effective in the treatment of flashbacks and nightmares in this patient. Thus, doctors should consider using these anti-epileptic drugs as an alternative approach to treating PTSD symptoms.
Adolescent ; Anticonvulsants ; Asian Continental Ancestry Group ; Dreams ; Female ; Humans ; Male ; Stress Disorders, Post-Traumatic*

In the present study, surveys regarding the philosophy of learning were administered just after the entrance ceremony to all students entering the Fujita Health University School of Medicine in 2005 and then, once more, to the same students during the last term of the fourth year, so that the data could be subsequently analyzed. The 87 fourth-year students who completed the surveys were divided into 3 groups(top, middle, and bottom thirds)on the basis of their examination scores in the previous years.
1) Results of the fourth-year survey suggested that students in the middle or bottom third did not develop a "learning-centered campus lifestyle" during their 4 years of medical studies, although the first-year survey indicated that most students in all 3 thirds had desired such a lifestyle.
2) The image of a physician had changed somewhat for students in middle or bottom third but not for students in the top third.
3) Attendance rates in all years of medical study were lower for students in the bottom third than for students in the middle or top third. Moreover, the motivation to study and attend lectures showed a downward trend over time for students in the bottom third.

At the Fujita Health University School of Medicine, about 30% of medical students are admitted on the basis of recommendations.To evaluate the performance of these students after admission, a placement test was given to all new students just after the entrance ceremony to examine basic academic abilities.The scores were compared with the number of absences from lectures and with examination results for the first and second years.
1) The 398 students admitted from 2002 through 2005 were classified into three populations: 126 recommended students, 137 students who scored in the top half on the entrance examination, and 135 students who scored in the bottom half.
2) Scores on the placement test were highest for the top-half students, intermediate for the bottom-half students, and lowest for the recommended students.Scores on examinations in the first and second years were highest for the top-half students, intermediate for the recommended students, and lowest for the bottom-half students.
3) The average number of absences from lectures in the first and second years tended to be lower for recommended students than for the top-half or bottom-half students.
4) The examination scores in the second year were correlated with scores in the first year, and the average number of absences in the second year correlated with those in the first year.
5) These results indicate that the motivation of students in each classification to study in the 1st year is, in addition to their basic academic abilities obtained in high school, an important factor affecting their performance in the second year and beyond.

Purpose：This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. Methods：We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. Results：The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. Conclusion：This study demonstrated the current state of home palliative care by specialized home care clinics.

Objectives:To determine the factors influencing death or the cessation of palliative care in home-based setting among patients with cancer. Methods:We included 352 terminally ill patients with cancer who received home-based palliative care from six specialized palliative care clinics. We reviewed the medical charts when patients died at home or chose to stop home care. Results:A total of 82％ of participants died at home, and 18％ chose to stop home care. Multiple logistic regression analysis revealed five independent factors that affected cessation of home-based palliative care:patient and informal caregiver preferences for the place of death not to be at home［odds ratio, 10.1（95％ Confidential interval, 2.5-40.9）and 51.9（11.9-226.6）, respectively］or uncertain preferences［5.0（1.3-19.4）, 10.8（2.3-50.5）］;anxiety and depression among informal caregiver［4.1（1.2-13.9）］;lower frequency of informal care［6.8（2.0-23.4）］;and history of admittance to hospital during home care［11.6（4.0-33.9）］. Conclusion:We revealed independent factors influencing death or the cessation of palliative care in home-based settings among patients with cancer. Our findings suggest the importance of providing support for decision making about the place of death and hospital admission, and psychosocial support for informal caregiver to ensure home death consistent with patient preference.

Pancreatic cancer is the fifth leading cause of cancer-related death in Japan. Surgical treatment is the effective way to achieve a long survival. Because of the development of surgical procedure and perioperative management, pancreatic surgery becomes safer. However, it still includes a certain number of morbidities and mortalities. It is important to perform safe operation for long survival. We herein introduce our operative procedure for pancreatic surgery including pancreaticoduodenectomy (PD) and distal pancreatectomy. In patients undergoing PD, leakage from the pancreatic anastomosis remains an important cause of morbidity and contributes to prolonged hospitalization and mortality. Recently, a new end-to-end pancreatojejunostomy technique without the use of any stitches through the pancreatic texture or pancreatic duct has been developed. In this novel anastomosis technique, the pancreatic stump is first sunk into deeply and tightened with a purse string in the bowel serosa. We modified this method in an end-to-side manner to complete the insertion of the pancreatic stump into the jejunum, independent of the size of the pancreas or the jejunum. Since April 2013, we have performed this new anastomosis technique in 36 patients. The breakdown of preoperative diagnosis of 36 patients were 13 pancreatic cancers, 8 extrahepatic bile duct cancers, 7 intraductal papillary mucinous neoplasms and so on. Of 36 PD, 32 were subtotal stomach preserving PD (SSPPD), and the rest were SSPPD combined with left hemihepatectomy or distal pancreatectomy, and middle pancreatectomy. The concentration of amylase in discharged fluid through an abdominal drain decreased day by day. According to the ISGPF definition, pancreatic fistula (PF) was observed in 4 patients (11%). Of 4, only 1 case had grade C PF. This case had a hemorrhage from pancreatic cut end. This occurred probably because the pancreatic cut end was not compressed by the intestinal wall with this technique. This case had reoperation and the hemostasis of pancreatic cut end was secured. The other severe complications were not observed. This new method can be performed safely and is expected to reduce the occurrence of leakage from PD. The development of PF following distal pancreatectomy is an unsolved problem. We introduce a simple technique, the parallel suturing technique, which prevents severe PF by hand-sewn closure of the pancreatic stump. After standard distal pancreatectomy in the described cases, the main pancreatic duct was secured. The stump of the pancreatic remnant was closed with three nonabsorbable monofilament sutures. The three sutures were positioned about 3 mm proximal to the cut end of the pancreas and tied parallel to the pancreatic stump. Ascites fluid was collected through a drain tube, and its concentration of amylase was measured on days 1, 2, 3, and 4 postoperatively. PF was diagnosed according to the ISGPF classification. On postoperative day 4, three patients were categorized as having grade A PF, six were diagnosed with no PF, and the drain tubes of the remaining three were removed on day 3. This simple technique may effectively lighten the severity of PF following distal pancreatectomy. It may have a particular advantage in patients with a wide pancreatic stump.