Purpose: No standard therapies are available for the elderly with breast cancer and they tend to refuse to undergo treatment because of complications and shorter-life expectancy. In this study, feasible therapies were examined by evaluating cases we had experienced in our hospital. Methods: We report the results of a study on 12 seniors with breast cancer at age 80 and over in regard to preoperative examinations, operative procedures, histopathological examinations and adjuvant therapies. Results: Preoperative examinations were performed before mammography, ultrasonography (US), computed tomography, enhanced MRI of breast and fine-needle aspiration cytology. Though it was necessary to get their consent for biopsy under local anesthesia, we could perform US-guided core needle biopsy without their objections resistance. The first half of patients underwent mastectomy with lymph node dissection, whereas the second half had less invasive surgeries, such as partial resection of the breast and sentinel lymph node biopsy (SLNB). Histological checks revealed invasive carcinoma in 11 cases and the hormone receptor positive in 11 cases. Adjuvant therapy was performed with endocrine and fluoropyrimidine drugs orally administered. Irradiation to the remaining breast after partial resection was omitted by administering endocrine drugs. Conclusions: Elderly cases were apt to shun undergoing surgery, chemotherapy and radiation therapy, but they were treated with curative therapy by proposing less invasive partial resection, SLNB and adjuvant therapy. We should not omit lymph node dissection and adjuvant therapy just because the patients are elderly. However, less invasive and curative treatment based on the guideline should also be taken into full account.

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　　Procalcitonin (PCT) is a diagnostic marker of severe bacterial infection and sepsis. Sepsis can lead to shock, multiple organ dysfunction syndrome, DIC and death, thus making the early diagnosis of sepsis very important. Many markers (e.g., CRP, blood culture, endotoxin) of infection largely lack in clinically important property. Therefore, clinical PCT-level measurement has been accepted worldwide in the last five years. Our hospital reports PCT within 30 minutes after the collection of blood samples all day long. In this study, we assess the clinical utility of PCT for early diagnosis and treatment with specimens tested by both PCT and blood cultures. PCT assay and blood culture demonstrated the diagnostic concordance rate stood at 58.96%. We presume that the cause of its discrepancy is a lack of sensitivity of blood culture and an increase in PCT by the invasiveness of other factors. On the other hand, patients with PCT‹0.5 ng/mL are unlikely to suffer from severe bacterial infection and sepsis. Thus, PCT could be one of Vital Signs and useful for early diagnosis in the emergency care.

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In recent years, the unique nature of medical profession, overwork and increased medical lawsuits, have significantly complicated medical profession. In this stressful work environment, the shortage of nurses in most medical institutions has brought problems on staff turnover prevention to the forefront and increased the need for a variety of support measures to be taken to help counteract this high turnover. In order to create a better working environment in our hospital, we have begun grappling with the delivery of mental health care for our staff. 　　In this report, we have checked new and inexperienced nurses in a questionnaire survey and recorded the findings over time. Immediately after their assignment, there was a very high incidence of physical and mental fatigue. It was revealed, however, that there were signs for improvements in fatigue as they had entered their second year of employment. That said, however, we found that there still remained a high degree of depression and a low degree of self-efficacy. 　　Recognizing that being a nurse is a task with a high work load in a stressful work environment, we would like to reiterate the importance of creating a support system of ongoing education and stress management.

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The initial case was a man in his 50s. He received 2 cans a day of ProSure^®, while undergoing radiation and chemotherapy with carboplatin and docetaxel for adenocarcinoma in the lung. His body weight rose from 62.4 kg on admission to 63.7 kg before discharge, CRP decreased from 3.08 mg/dl to 0.48 mg/dl, and albumin fell from 3.6 g/dl to 3.5 g/dl. The second case was a man in his 60s. He was diagnosed as having squamous cell carcinoma in the lung and administered with 2 cans a day of ProSure^® and antibiotics. One-and-a-half months later, he underwent chemotherapy with carboplatin and S-1 and radiation. His body weight stood at 47.0 kg on admission and 47.2 kg before discharge, CRP dropped from 15.45 mg/dl to 3.26 mg/dl, and albumin was retained at 2.6 g/dl to 2.7g/dl. The administration of ProSure^® brought about improvements in the nutritional status and anti-inflammatory effects in the patients with chemotherapy.

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　　This case is a 56-year-old woman. With multiple bone metastases, she was referred to the Department of Palliative Care on the same day as core needle biopsy had just been performed in the Department of Surgery. Aggressively increased oxycodone was administered to relieve her significantly severe pains by bone metastases. After relief of the pains, cancer chemotherapy of EC and weekly PTX regimens were performed parallel to palliative care. In this case, chemotherapy could be performed after the pains had been sufficiently relieved with closer cooperation between the palliative care doctor and the attending surgeon. It is important for patient-focused medical care to be delivered by both the attending doctor administering cancer treatment and the palliative care doctor working for relief of the symptoms, while they are striving to foster their tie-up.

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A 39-year-old man was admitted to our hospital with right lower abdominal pains. Physical examination revealed focal tenderness in the right lower quadrant abdomen. Abdominal CT scan demonstrated heterogeneous increased fat density in the right greater omentum. That said, we diagnosed the disease as idiopathic segmental infarc- tion of the greater omentum. 　　He underwent conservative management with antibiotics and analgesics. 　　With his abdominal pains dramatically resolved, the patient was discharged from our hospital ten days after hospitalization. The standard treatment for the idiopathic segmental infarction of the greater omentum has not been established. We report this case together with a review of some literature.

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It has recently become a practice to focus attention on the necessity of therapies for the functions of eating, including exercises for swallowing and training for eating, for patients with difficulties in eating or swallowing. With the remunerations for healthcare under the National Health Insurance Scheme revised in April 2006, the limits put on the frequency of computation for patients in less than three months after onset were removed, and it became a practice to assess the degrees of devotion to inpatients. With our ward designed for specific types of rehabilitation, we have thus far provided functional therapies for eating to patients with disorders in eating or swallowing. But those therapies have been provided to them in a self-centered and haphazard manner because of a lack of knowledge on the part of caregivers while the methods were not standardized. On the basis of a fact-finding survey recently conducted on consciousness about therapies for the functions of eating, we have analyzed the present situation and formulated a record which would enumerate methods and steps to cope with items about which staffers feel apprehensive and the items on which attention should be focused. We also held study meetings on techniques for salivary gland, intraoral and facial massage, compiled an illustrated booklet designed to introduce those steps, and made it accessible in an exclusively designed van. As a consequence, it became feasible to make perpetual use of a standardized functional therapy for dysphagia, and this methodology made it possible to continuously provide a standardized functional therapy for dysphagia, eventually leading to the recovery of the intraoral environment and the maintenance and recovery of intraoral functions, and enabling patients with disorders in their eating or swallowing to enhance their pleasure of eating food and enhance their confidence.

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The removal of aspiration objects is often required for aspiration, which takes place at the time of a video fluoroscopic examination of swallowing (VF) for the assessment of dysphagia rehabilitation. We report our approach against correspondence for aspiration at VF. 　　As subjects for this report, we sampled 6 patients (average age: 78.3±3.0, four males and two females) from 19 patients, who had aspiration of barium sulfate or meal with barium contrast medium at the time of VF form October 1, 2009, to March 31, 2011. For the first step of correspondence for aspiration at VF, we dealt with coughing, huffing, suction and postural drainage under the guidance of a Speech-Language-Hearing Therapist and, depending on the case, a Physical Therapist who dealt with chest physical therapy. When expectoration was found impossible, we checked to see if it was necessary to perform biphasic cuirass ventilation with a clinical engineer. We assessed the chest X-ray films and existence or non-existence of expectoration immediately after aspiration, and fever, inflammatory response, respiratory symptoms and gastrointestinal symptoms one week after the examination, and retrospectively checked the influence of aspiration. 　　As a result, three patients had residue as revealed on chest X-ray films, and the three remaining patients had none. For the former three patients, we intervened in a team approach and succeeded in removing the residue from two patients (one with initial correspondence, and the other with execution by the Physical Therapist). Though two patients had fever and inflammatory response one week later, It was hardly possible that aspiration at the time of VF became a direct cause. No patient had either the respiratory or gastrointestinal symptom. 　　Correspondence for aspiration was attained by establishing a team approach system. Even if a patient had heavy aspiration, it was not reflected on chest X-ray films, depending on the case, and therefore deliberation was required for correspondence.

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