Many studies have indicated that parenting stress is an important factor causing child abuse. The purpose of the present study was to reveal the association between mothers' concern about child rearing and the stress they suffer from in the practice. The study subjects were 222 mothers with children of two kindergartens aged 3-6 years, and the study was conducted from October to November 2004. We analyzed the responses from 152 mothers, who were aged from 23 to 43 years with the mean (standard deviation) of 33.9 (4.0) years. The mothers were asked in a self-administered questionnaire their attributes, and whether they suffer from child-rearing stress. Those who responded "yes" were asked to write about their anxieties and worries in child rearing freely in the specified space of the questionnaire. Furthermore, the Japanese version of the Parenting Stress Index (PSI) was used to investigate parenting stress. Approximately half of the valid responses (75/152) provided descriptions of worries/anxieties regarding child rearing, and we classified their description using KJ method. The PSI score was significantly higher in those who wrote "Difficult to control myself" than in those who did not (p=0.02) and was significantly higher in those who wrote "Don't feel confident with child rearing" than in those who did not (p=0.03). In the present study, among 75 mothers who wrote about worries and anxieties in child rearing, approximately half of them wrote about worries and anxieties regarding parents themselves, which were significantly associated with some of the PSI subscales. Notably, the mothers whose writings were classified as "Don't feel confident with child rearing" felt depressed, had insufficient social support, and had low self-evaluation for their parental capability. In conclusion, the present study suggested the importance of screening based on surveys about depression, social support and stress management.

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An 88-year old man was admitted to our hospital because of severe respiratory disturbance and fever, but no sputum. We found diffuse reticular shadow on chest X-ray, and detected influenza virus antigen from nasopharyngeal swab. Primary influenza pneumonia was suspected and oseltamivir was prescribed. Data were improved after adding steroid; however, hemoptysis appeared on day 9, and the patient died 2 days later. We suspected the recurrence of primary virus pneumonia with alveolar damage, but Staphylococcus aureus was cultured from the hemosputum after his death despite oral administration of antibiotics. Subsequent secondary bacterial pneumonia as well as severe primary influenza virus pneumonia was finally suspected in this case. It was a rare case that not only fulminant primary virus pneumonia but also different type of severe influenza pneumonia were found in one patient. We need to observe influenza patients carefully, even if antibiotics were administered.

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A 49-year-old man was admitted to our hospital complaining of a large hepatic tumor with edema in the lower extremities. The patient had suffered from hypertension and bronchial asthma in his twenties and from cutaneous flushing in the face in his thirties. Echocardiography revealed tricuspid valve regurgitation and marked dilatation of the right ventricle. In an exploratory laparotomy, a 15 cm-size hepatic tumor was located in the right lobe with multiple satellite lesions in both lobes of the liver. Peritoneal disseminations were present. The tumor was histologically and immunohistochemically diagnosed to be a carcinoid tumor. The levels of serum serotonin and urinary 5-hydroxyindoleacetic acid (5-HIAA) were found to be significantly high. Imaging modalities and intraoperative findings showed no evidence of any tumors elsewhere. These findings led us to the diagnosis of a primary hepatic carcinoid tumor with carcinoid syndrome and carcinoid heart disease. The patient has been treated with hepatic artery embolization, oral chemotherapy and octreotide acetate. After six months of such treatment, the hepatic tumor has decreased slightly in size, and the levels of serum serotonin and urinary 5-HIAA have dropped.

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Extensive intestinal aganglionosis is rare and very difficult to diagnose and treat. The condition is often fatal. A 6-month-old boy who had undergone ileostomy for extensive intestinal aganglionosis was referred to our department. We applied an aganglionic right colon onlay patch to the aganglionic intestine to enhance absorption of water and electrolytes. Three months after the ileocolostomy, the definitive operation, a Swenson-type procedure, was performed. The mesocolon to the onlay patch could be divided because blood supply was adequate from the ileal mesentery via the intestinal wall. Postoperatively, the onlay patch segment appeared normal on colonoscopy and bowel habit was improved. Although the patient still requires parenteral nutrition support due to the short bowel, the right colon onlay patch procedure enables him to be cared for at home and provides an opportunity for normal growth and development.

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