Background & Aims : The purpose of this study was to investigate the influence of pregnancy on breast cancer prognosis by analyzing clinical and pathological features of young patients with breast cancer in relation to last birth. Method : A total of 622 young breast cancer patients under 35 years of age undergoing surgical treatment between 1960 and 1990 at Cancer Institute Hospital were included in this study. The patients were classified into four groups ; group A patients who were diagnosed during pregnancy or within one year after delivery, group B patients who were diagnosed from one to three years after delivery, group C patients who were diagnosed three years or more after delivery, and group D patients who were nulliparous. All four groups were examined from the viewpoint of clinical and pathological findings with regard to age, disease duration, first childbirth, clinical stage, histopathological type, lymph node metastasis, and survival. Furthermore, nuclear grade and immunohistochemical staining of both estrogen receptor (ER) and factor-VIII were examined in early-stage breast cancer patients. Result : The incidence of early-stage (0, I and II) breast cancer was significantly (p<0.05) lower in group A (69%) than in groups C (88%) and D (85%). The incidence of nodal involvement decreased from group A (61%), B (59%), C (51%) to D (43%) in that order. The incidence of nodal involvement in group D was significantly (p<0.05) lower than that in groups A and B. The positive rate of estrogen receptor increased from group A (50%), B (56%) to C (72%) in that order. Disease-free survival was significantly (p<0.05) more favorable in group D than in groups A and C. The similar result was obtained in patients with clinically early-stage breast cancer. Conclusion : Patients who developed breast cancer during pregnancy or within less than one year postpartum have a poor prognosis among patients under 35 years old. Patients having no childbirth history generally have a high risk factor of developing breast cancer, however, breast cancer patients without childbirth history under 35 years old result in a favourable prognosis.

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Background and Aims : The treatment for postoperative pleural dissemination of thymic tumors has not established yet. On the other hand, tumor dormancy therapy (TDT) is widely recognized. The aim of TDT is not to eradicate a malignant tumor but to stop tumor proliferation. The purpose of this study is to clarify the usufullness of intraarterial injection chemotherapy for pleural dissemination of thymic tumors as TDT. Methods : Intraarterial injection chemotherapy was performed for five postoperative pleural dissemination cases with two types of agents including Cisplatin, and another agent, such as Adriamycine, VP-16 or docetaxel as TDT. Injection chemotherapy was repeated two to ten times every four weeks. Results : The effects of injection chemotherapy were partial response (PR) in one patient, stable disease (SD) in two and progressive disease (PD) in two. Three patients are alive with pleural dissemination. The average survival time after the occurrence of pleural dissemination is 5.5 years (longest 10 years). Two patients died of distant metastasis. Side effects of chemotherapy were grade 1 or 2 leukopenia. Conclusion : Injection chemotherapy may be the treatment of choice for postoperative dissemination of thymic tumors.

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Background and Aims : The purpose of this study was to identify conditions to support independent living and care prevention for home care clients from care manager's perspectives. Methods : We asked 67 care managers attending training for leaders in "Gunma" prefecture to fill in the questionnaire about cases with successful support of independent living and care prevention. The subjects for analysis were 35 of those cases whom we obtained their consent. The questionnaire included client background, outcomes, services the clients used and contents of the care plan. The care managers did a group work on the factor analysis. Result : Most of the clients with successful support of independent living and care prevention were clients with mild dementia before being bedridden. Musculoskeletal disorders were the most common primary diseases. Also, the primary caregiver's health and relationship with the client were good in many cases with better outcomes. All the clients used welfare aids. Outcomes included care level, walking, withdrawal, bathing, willingness, continuous living at home, excretion and improvement of fall. The care provider's conditions was a major followed by care managers. The care provider's conditions included improvement of the services, utilization of the welfare aids based on the client condition, staff calling to clients, home visit care and appropriate rehabilitation.The client and family conditions cooperation among family and client's willingness. Communication between the client/family and home care agency, combination of effective services and adjustment of the volume were revealed to be the care manager's conditions. Conclusion : It is necessary to perform care management and to provide services considering these conditions.

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Background and Aim : In recent years, patients with suicide have increased. The purpose of this study was to analyze the suicide attempts in Emergency Room of Gunma University Hospital. Subjects and Methods : From January 1 2004 to December 31 2004, we investigated the medical record of patients with suicide attempts, and examined the sex, age, way of hospital visiting, instrument for suicide and medical outcome of the patients. Results : During the period, 4068 cases were treated in emergency room. Of these, 47 cases were suicide attempts and four patients were repeaters. The highest incidence of the patients with suicide attempts was seen in the 20's in both men and women and higher was 50's in men and 30's in women. Concerning the instrument for suicide, 27 cases were excessive use of the drugs and poisons, 15 cases were self-injury with a knife, 4 cases were hanging oneself and 1 case was attempted death-leap. Conclusions : It's important to collaborate closely with psychiatrist in the medical care of suicide attempt patients. Today, increasing incidence of suicide in the middle-aged and older persons is one of the crucial social problems to solve.

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Background and Aims : We compared the effects of transdermal estradiol and oral conjugated equine estrogen on pulse wave velocity, skin elasticity, and bone mineral density in postmenopausal women. Methods : In a 12-month trial, 26 postmenopausal women (Transdermal group) received a transdermal estradiol, 17 (Oral group) received an oral conjugated equine estrogen, and 23 (Control group) did not receive either hormone. In each subject, we measured pulse wave velocity, skin elasticity, and bone mineral density before and 12 months after the start of the study. Results : In the oral and control groups, pulse wave velocity was not changed, but in the transdermal group, pulse wave velocity was significantly decreased. Skin elasticity and bone mineral density were significantly increased in the transdermal and oral groups, respectively. In the control group, however, skin elasticity was not changed and bone mineral density was significantly decreased. Conclusion : Transdermal estradiol may have a beneficial effect on cardiovascular system in postmenopausal women. Both hormonal therapy might be useful to an improvement in degenerated skin elasticity and an enhancement of bone mass.

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Background and Aims : A study meeting focusing on the nursing process was held for the purpose of making manipulative nursing more widespread in China, and the level of understanding and degree of interest in manipulative nursing were discussed. Methods : A questionnaire survey was conducted among 23 nursing staff members with clinical experience of at least 5 years, who were working at a hospital in Tozan-shi of Hebei (Kahoku-sho), China. Results : One of the items in the lecture contents, about which 18 (78.3%) of the 23 subjects showed the highest level of understanding, was "5 stages of the nursing process" . Sixteen (69.6%) of the 23 responded that, "The 5 stages of the nursing process can be used to in clinical practice". The levels of understanding concerning "diagnostic nursing" and "a diagram of information relations" were the lowest. Sixteen (69.6%) of the 23 responded that they understood well "the advantages of clinical application of the nursing process", whereas only 5 (21.7%) responded that the nursing process "can be used in clinical practice". Conclusion : Even though nursing staff members can understand the outlines of the nursing process, it is difficult for them to apply the nursing process to actual cases.

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Background and Aims : The purpose of this study was to analyze the relevance of parameters at admission for predicting improvement of activities of daily living (ADL) in patients with subacute stroke. Methods : Forty-two patients with subacute stroke were analyzed retrospectively. FIM were measured at admission and discharge and improvement of ADL was indicated as ?? FIM (FIM at discharge-FIM at admission). Age, the period from onset to admission, the period of hospitalization, severity grade, higher brain dysfunction and brain CT findings were analyzed as predictive factors. Results : The period from onset to admission, apraxia, affective incontinence and swallowing disorder were inversely correlated with ?? FIM. There were no significant correlations between ?? FIM and the other factors. Conclusion : It was suggested that rehabilitation in the early phase and assessment of higher brain dysfunction result in improvement of ADL prognosis for subacute stroke patients.

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Backgrand and Aims : The objective of this study is to identify improvement points of a pillow Yukou company is currently developing for subjective evaluation on hearing and sleeping with one's own style pillow and its application to nursing. Methods : The subjects of the study were 31 healthy persons, and we asked them to participate in a questionnaire survey after using "one's own style pillow" and their own pillow for 7 consecutive days. The questionnaire consists of subjective items including background conditions effecting on sleep, easiness to get to sleep and feeling of deep sleep using the pillow, height and texture of the pillow, and healing feeling. Result : feeling of deep sleep, the height and texture of the pillow, comfortableness, and feeling of healing were better in the one's own style pillow, especially there were significant differences in the texture, comfortableness, and feeling of healing compared with their own pillow from the first day. In contrast, more people felt difficult to handle the one's own style pillow than their own pillow. Conclusion : This own style pillow has high subjective effect. It suggests that improvement of this pillow could be applied to use for post-operative patients as a comfortable pillow. When the height was adjusted, small paimers fell. Infants and the elderly may put them into their mouth by accident, an improvement is necessary.

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A case of severe ulcerative colitis of the entire colon, initially diagnosed after the Niigata-ken-Chuetsu earthquake, is presented. A 42-year-old woman underwent a colonoscopic examination after a positive immunochemical test for fecal occult blood in 2003. The colonoscopic examination showed no abnormal lesions. After the Niigata-ken-Chuetsu earthquake in Oct., 2004, she suffered frequent diarrhea. She was transferred to our hospital because of bloody diarrhea, rectal bleeding, abdominal cramps, and fever. Active ulcerative colitis (UC) was diagnosed on colonoscopy, which showed severe ulcers with bleeding from the rectum to the ascending colon, and the diagnosis of severe UC was confirmed microscopically by biopsy. She was treated with intravenous prednisolone (PSL), oral 5-aminosalicylic acid (ASA), and granulocytapheresis (GCAP). After one course of granulocytapheresis, the colonoscopic findings, abdominal cramps, and fever improved slightly, although the bloody diarrhea continued. Azathioprine as an immunosuppressant was added to the PSL and ASA and a second course of GCAP was performed. She responded to the treatment well, with no adverse events, and this led to disease remission. She has been in remission for one year, and has resumed her job.

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