Background and Aim : Traditionally, a right upper-quadrant incision (RUQ) has been used for Ramstedt's pyloromyotomy in patients with hypertrophic pyloric stenosis, but a circumumbilical incision (UMB) was introduced by Tan and Bianchi. This technique produces an undetectable scar after the operation, but some concern exists regarding the safety and morbidity of the myotomy.
Materials and Methods : Since 1997, UMB or RUQ have been performed in 41 patients according to the parents' preference. We reviewed the patients' records to clarify whether or not UMB is superior to RUQ with respect to appearance after the operation and complications. Items examined were patiints' demographics and laboratory data on admission, operative time and the incidence of complications. Results : There was no difference between the UMB and RUQ in patients' demographics or laboratory data. The operative time for the UMB was about twice that for the RUQ. Complications (serosal tear in 5 cases, wound infection in 2 and incomplete myotomy in one) occurred with the UMB, but no complication occurred with the RUQ. Out of 8 sequelae in the UMB, six were associated with a lack of skill in junior pediatric surgeons, and serosal tears occurred when delivering the pyloric mass from the abdominal cavity. All resultant scars were hardly visible in the case of UMB, but were noticeable in the RUQ.
Conclusions : The UMB approach offers a cosmetically superior scar, but is difficult for junior surgeons to perform smoothly. An intraabdominal pyloromyotomy should be carried out if the pyloric mass is not delivered.

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Background and Aim : The objectives of this study are to describe home nursing care for terminal cancer patients and identify the conditions that enable home terminal care.
Materials and Methods : Home nursing records, patient records at outpatient clinics and inpatient charts were analyzed and visiting nurses were interviewed. The data thus obtained was then compared with literature references.
Results : In two out of five cases, the patients personally decided to receive home terminal care. In the other three cases, the decision was made by the patient's family. The longest period of terminal illness spent at home was 7 months, while the shortest was two months. Home nursing was provided for periods of between nine days and 5.5 months. Two patients died at home and three patients died in the hospital. Hospital deaths were selected by two patients because of unendurable pain and by the family in one case where the patient could no longer receive adequate care at home. Visiting nursing services include medical care, hygiene care, advice on care by caregivers, health management of the family and service coordination. Visiting nurses prepared for the death of the patient in accordance with the wishes of the patients and their families. The patients and families depended on the visiting nurses, and the visiting nurses gave the patients and their families a sense of security because of their connection with the hospital.
Conclusions : The following conditions are recommended for home terminal care.
1. The patient should have good pain control, and have hope in life while accepting death.
2. A caregiver who is close to the patient, should be present.
3. Family members must be able to accept the patient's death and their willingness to give care must be supported by other people.
4. Family members must be willing to learn how to care for the terminal patient, and the visiting nurses must be capable of teaching care skills.
5. A collaborative relationship between the hospital and other community resources, must be exists.

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Background : Many patients of chronic diseases in Japan use folk medicine in addition to the Western medicine. The situation has caused much controversy in the clinical fields regarding its advantages and disadvantages. The purposes of this study are to identify the situation where hepatoma patients use alternative folkmedicine. Methods : We conducted questionnaire survey of 500 chronic liver disease patients. The numbers of responders were 413 (82.6%), who were then analyzed. This paper reports the result of 69 hepatoma patients 46 male, 23 female, average age 67.3 (SD ± 8.5) years old. Results : About seventy percent of patients had used folk medicine some time in the past up until the time of survey. The folk medicine they had used includes “Indian Saffron” (64.6%), “Megusuri-no-ki” (41.7%) and Chorella (22.9%). The purposes of the use are to promotion of health (33.3%) and to improvement of symptoms (27.1%). Only 14.5% of them had consulted their doctor on folk medicine before using them. The authors studied the relationship among frequency, gender, age, and satisfaction to the medicine, perception of severity, religion and truth telling status. The frequency was 85.7% for the patients younger than 65, 71.4% for those between 65-74, and 38.5% for those over 75. There is a significant negative correlation between age and frequency (p<0.01). Another significant positive correlation the authors identified is between perception of severity and frequency (p<0.001). Conclusions : Many of hepatoma patients were found to be on folk medicine at one time or other. It is our responsibility as medical professions that we show guideline concerning use of alternative folk medicine so that patients can better coordinate Western medicine and folk medicine.

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Background and Aims : To examine the actual condition of information gathering and nurses' records and determine the thinking process of nursing staff during the recording of information about the sense of touch.
Methods : The subjects were 28 nurses. Participation observations and inquiries by interviews were carried out, to determine the relationship between the purpose of the nurse touching the body of the patient, as also the process of recording the sense of touch.
Results and discussion : (1) The purposes of touch was classified into 4 groups : “as a part of intentional observation, ” “as an assistant for observation, ” “as a part of nursing care, ” and “as a spontaneous act without giving any thought.” A significant relationship was noted between the part of the body touched and the purpose of touching the patient. (2) The rate of the collected information was 20.0% ; it was the frequency of pulse alone that was recorded at the rate of 100%. (3) There were five steps in the thinking pattern during the process of recording the sense of touch : “evaluation of the sense of touch for clinical information, ” “comparison with past information on the sense of touch, ” “displacement into other data, ” “the order of priority, ” and “record.” The thinking patterns were classified into 10 groups. (4) Three of these patterns showed complete lack of information, but the rest were recorded as information on sense or integrated by integrating the information with other information or utilizing it as an assistant.

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A transsternal bilateral thoracotomy (clamshell incision) was successfully performed in a 69-year-old male. The patient had bilateral metastatic lung cancer from a primary colon cancer. An inframammary incision was made while the patient was in a supine position. The chest was entered via the 4 th intercostal space ; right segments 3, 4 and 8, and the left upper lobe were resected. Postoperative pain was well controlled using an epidural block. This procedure provides a sufficient surgical field enabling manipulation throughout the entire thoracic space and the mediastinum using a single operative field. Thus transsternal bilateral thoracotomy is a useful procedure for one-stage surgeries in patients with bilateral lung tumors.

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A case of a patient with poorly controlled diabetes who developed severe cheek cellulitis from a slight trauma with a toothpick is reported. A 64-year-old male with uncontrolled diabetes meillitus (DM) received a slight trauma to his cheek while using a toothpick. The inflammation probably originated from the slight trauma, and extended to the lower lip the mouth floor and the submandibular area. The patient was treated by surgical incision followed by drainage, systemic antibiotic treatment, and DM control.
The following report describes the clinical symptoms and the treatment of infections in poorly controlled DM patients.

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