[in Japanese]

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Aim: This study evaluated the safety and efficacy of laparoscopic surgery in elderly colorectal cancer patients.
Methods: A total of 270 colorectal cancer patients over 75 years old who had undergone laparoscopy-assisted colectomy (LAC, 81 patients) or open colectomy (OC, 189 patients) between 2000 and 2009 were retrospectively analyzed regarding clinicopathological and surgery-related factors, perioperative course and pre- and postoperative complications.
Results: Early cancers or smaller tumors were treated more frequently by LAC than by OC. LAC tended to take a longer operative time but was similar to OC in terms of the degree of lymph node dissection and number of lymph nodes. The LAC group showed less blood loss, earlier ambulation, earlier eating and drinking, earlier passage of flatus and feces, a shorter hospital stay and lower postoperative leukocyte count (days 1 and 3) and CRP (day 3). The LAC group was similar to the OC group in preoperative complications (80.2% vs. 81.1%) but less postoperative complications (6.7% vs. 12.2%). The postoperative complications were mainly deliria and respiratory complications, but there was no anastomotic leakage or operative deaths.
Conclusions: LAC was relatively safe in elderly patients and is associated with earlier postoperative recovery. The abdominal wall damage caused by surgery was considered one reason for the delay of patient recovery. LAC showed reduced damage and better postoperative course. These results indicate expanded indications of LAC for elderly colon cancer patients.

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Aim: Fish oil is associated with decreased arteriosclerosis, cardiovascular disease and the prevention of cellular aging. Most studies of n-3 PUFA (polyunsaturated fatty acid) have been conducted in patients under 80 years of age, and there are few studies of subjects ≥80 years of age. This study investigated the relationship between eicosapentaenoic acid (EPA) or arachidonic acid (AA) and arteriosclerosis in elderly patients ≥80 years of age.
Method: We enrolled 150 patients ≥80 years of age (average, 85±4 years) not taking EPA that presented or were admitted to our hospital. Their EPA or AA levels were measured to investigate the relationship between EPA or EPA/AA and cardiovascular disease or cerebrovascular disease. In addition, we investigated whether the ratio of EPA/AA was associated with estimated glomerular filtration rate (eGFR).
Results: The mean EPA level was 55.9±34.5 μg/dL, the mean AA level was 145.1±45.4 μg/dL and the mean EPA/AA was 0.40±0.24 (mean±SD). There were no significant differences between the EPA/AA and EPA values in patients with cardiovascular disease and those in patients without cardiovascular disease. Moreover, there were no significant differences between the EPA/AA and EPA values in patients with cerebrovascular disease and those in patients without cerebrovascular disease. There were no statistically significant correlations between EPA/AA or EPA and eGFR.
Conclusion: Individuals may achieve a peak value of EPA or EPA/AA in their 70s and there is little change in those levels in patients aged over 80. No relationship was identified between EPA/AA and arteriosclerosis in subjects aged over 80 compared with those under 80 years of age.

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Aim: According to Erikson's theory of ego development, generativity represents one task of adulthood. Generativity is defined as a concern for establishing and passing on well-being to future generations. The present study aimed to characterize the relationship between staff member generativity and perceived job competence in elderly nursing homes, and to determine the professional value of elderly care.
Methods: A total of 367 care staff at 13 nursing homes for elderly people participated in the present study, the design of which was a questionnaire survey. The survey addressed topics related to generativity and perceived job competence. Path analysis was conducted to examine the relationship between generativity and perceived job competence.
Results: Perceived job competence was related to age (β=0.19, p<0.01) and occupational period (β=0.14, p<0.05), and generativity was related to perceived job competence (β=0.67, p<0.001). These results also suggest that perceived job competence promotes generativity development.
Conclusions: The development of staff generativity in nursing homes may yield work satisfaction and elevated vocational identity.

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Aim: We investigated the association of the presence and the location of deep venous thrombosis (DVT) with D-dimer value in acute intracerebral hemorrhage (ICH).
Methods: We analyzed the data regarding DVT in patients with ICH. Based on an ultrasonographic examination 2 weeks after the occurrence of ICH, the patients were divided according to the presence/absence and the location of DVT, i.e. no evidence of DVT (n-DVT), calf DVT (c-DVT), and proximal DVT (p-DVT). D-dimer value was measured 2 weeks later and compared among the groups.
Results: The numbers of patients with n-DVT, c-DVT and p-DVT were 27, 19, and 2, respectively. Univariate analysis indicated that D-dimer values were significantly different between patients with n-DVT and c-DVT and between patients with n-DVT and p-DVT (p<0.05, respectively). The cut-off value for estimating the presence of DVT and p-DVT was 3.9 μg/mL and 18.5 μg/mL, respectively.
Conclusion: D-dimer value assessment after 2 weeks may be associated with the presence and the location of DVT in patients with ICH.

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Aim: A characteristic condition of pre-frail elderly people is decreased mobility, which is associated with vitamin D levels and renal function. The aim of this study was to examine the association between physical fitness improvement and vitamin D levels, vitamin D supplements, and renal function in pre-frail elderly people.
Methods: We conducted a longitudinal study in 2 towns from June 2006 to December 2009. Subjects consisted of 177 community-dwelling pre-frail elderly people aged 65 years and over (mean±standard deviation [SD]: 76.4±5.5 yrs) who attended a nursing care prevention program for 3 months. An interview was conducted based on a questionnaire. Serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D(25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)₂D), creatinine, and calcium were measured. eGFR (ml/min/1.73 m²) was calculated using a new formula. Alfacalcidol 1 μg/day was administered to subjects for 3 months, and we assumed that the elderly who took vitamin D (VD) of more than 80% of the recommended daily allowance to be the VD group. Walking ability, balance, and muscle strength physical fitness tests were performed.
Results: The prevalence of eGFR <60.0 ml/min/1.73 m² was about 24.3%, and that of 25(OH)D <75 nmol/L was 86.4%. Pre-eGFR level and vitamin D supplementation with FR, pre-eGFR and pre 25(OH)D ≥45 nmol/L were associated with improvement in the timed up and go (TUG) test, pre-25(OH)D level (<50 nmol/L, ≥50 nmol/L) was associated with the tandem stance test, pre 25(OH)D level (<67.5 nmol/L, ≥67.5 nmol/L) was associated with the alternate step and 5 chair sit-to-stands tests, and post 1,25(OH)₂D (<44 pg/ml, ≥44 pg/ml) was associated with the tandem walk tests.
Conclusions: These results suggest that the assessment of renal function and maintenance of appropriate vitamin D levels are important for the independent living of pre-frail elderly people. Ideally, a 25(OH)D level greater than 67.5 nmol/L is preferable.

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Aim: The purpose of this study was to examine the effects of a Tai Chi Yuttari-exercise based care prevention program aimed at frail elderly people on new care-need certification and mortality.
Methods: Participants were elderly individuals (≥65 years of age) who lived in Kitakata City and who had experienced a fall in the past year but were not receiving support or long-term care. Those who agreed to participate in the exercise program were the intervention group (n=34), and those who did not participate were the control group (n=84). The intervention program was carried out once a week for a total of 15 times during the period spanning December 5, 2006 to March 22, 2007. In the intervention group we measured and analyzed changes in physical functions and administered a questionnaire before and after the intervention. We confirmed any deaths and determined whether certification for long-term care had been issued to the participants, in March 2010.
Results: New care-need certification was issued to 2 participants (6.3%) in the intervention group and 19 (24.1%) in the control group. Logistic regression analysis revealed that participants in the intervention group tended to require less new certification than those in the control group (p=0.098). There was no significant difference in the number of deaths between the intervention (2 participants; 5.9%) and control (5 participants; 6.0%) groups. We observed significant changes between pre- and post-intervention on several variables, including motor fitness scale, maximum walking speed over 10 meters, functional reach test, ability to stand after a long period of sitting, and maximum one step width.
Conclusion: The Tai Chi Yuttari-exercise based intervention program for frail elderly people reduced the need for new care-need certification and was useful as a care prevention program.

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A 75-year-old man with chronic gastritis and gastro-esophageal regurgitation syndrome was admitted to our hospital complaining of continuous productive cough, and an abnormal shadow was noted on a chest X-ray film. Chest computed tomography revealed a nodule 2.8 cm in diameter with a regular margin on the right apex. Fiberoptic bronchoscopy was performed, but did not yield a definitive diagnosis. We suspected primary lung cancer, and therefore, lung partial resection was performed under thoracoscopic surgery. The intraoperative pathological findings revealed inflammatory granuloma with necrosis, and pulmonary dirofilariasis was finally diagnosed.
Pulmonary dirofilariasis is an important differential diagnosis in elderly patients with a chest abnormal nodular shadow. Lesions have been reportedly observed in the peripheral portion of the right lower lobe in many previous reports. However, in this case, a nodular lesion was noted in the right apex.

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