We experienced 20 patients with distal bile duct carcinoma from May, 1997 to December, 2007. The male/female ratio was 11/9 and the average age was 69.6 years. The operative procedures were as follows : pancreaticoduodenectomy (PD), 9 ; pyrolus preserving pancreaticoduodenectomy (PPPD), 8 ; subtotal stomach preserving pancreaticoduodenectomy (SSPPD), 2 and hepatico-jejunostomy without resection, 1. We performed a clinicopathological study on 16 patients with distal bile duct carcinoma, excluding 3 operation-related deaths and 1 unresectable case. The cumulative survival rate was 70％ at 3 years and 11％ at 5 years. The 3-year survival rates at fStageII, fStageIVa and fStageIVb were 100％, 80％ and 0％, respectively. Log-rank analysis revealed that pathological pancreatic and duodenal invasion and curative resectability may be prognostic factors, while lymph node metastasis and perineural and stump invasion did not affect prognosis. Six recurrences in the 11 curative resection cases (54.5％) were observed ; therefore, postoperative systemic chemotherapy is warranted to curtail recurrence in advanced distal bile duct carcinoma.
This study aims to examine whether work status is the only basis for determining the provision of disability pensions in cases of mental illness, and considers the validity of this criterion and ways to improve the system. We collected 178 decisions of the Examination Committee of Social Insurance due to "Mental Illness" over a period of 11 years (1994 to 2004), and investigated the relationships among three factors : activity of daily living (ADL), work status, and pension benefits. We also examined the 21 working subjects separately. We found a significant relationship between ADL and pension benefits and between work status and pension benefits. No significant relationship was found between ADL and work status. In 6 of the 21 working subjects, the disability pension decision was made solely by focusing on work status. Despite this focus on work status, the working disabled cannot always compensate for their reduced income and the extraordinary expenditure incurred due to their disability. Further, because these decisions can go against the trend of encouraging the disabled to work, we suggest that it is not appropriate to focus solely on work status in determining pension benefits and propose ways to improve the system.