Background & Aims : Evaluation of the extent of breast cancer lesions is important for selecting the appropriate surgical procedure or to determine the surgical margin. We aimed to assess the diagnostic accuracy of nipple-centered radiate multiplanar reconstruction (NRMPR) images using multidetector row helical computed tomography (MDCT), comparing it with conventional mammography. Methods : Our subjects were 26 breast cancer patients with a total of 29 lesions who sequentially received contrast-enhanced MDCT imaging for preoperative evaluation. We measured the maximum diameter of the breast cancer in the direction toward the nipple on NRMPR images and mammography. All data were correlated with histopathological mapping of the specimens. Results : The tumor extent measured on NRMPR images and in pathological examinations ranged from 12.4 to 66.0mm (average, 28.0mm) and 10 to 70mm (average, 27.9mm), respectively. The correlation coefficient of the two measurements was 0.898. On mammography, two lesions were not clearly identified. The correlation coefficient of mammography and pathological measurements was 0.554. Conclusions : The addition of NRMPR images to mammography provides more information to evaluate breast cancer extension toward the nipple. Potentially, it provides a clue for selecting the appropriate surgical procedure or surgical resection margin for breast cancer.

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Aim : The purpose of this study was to prospectively compare for clinical outcomes between single- and double-bundle anterior cruciate ligament reconstruction. Methods : One hundred fifty-three patients who underwent anterior cruciate ligament reconstruction using hamstring tendon were included. Single- or double-bundle reconstruction was performed for 94 (S group) or 59 patients (D group), respectively. At 2 years after surgery, the manual knee laxity test, anterior stability with KT-1000, range of motion, muscle strength and Lysholm score were evaluated. Second-look arthroscopy was performed for each knee. Results : The mean side-to-side difference of the KT 1000 value after surgery was 3.8mm in S group and 3.1mm in D group, which was not significant different. However, the percentage of less than 5mm of anterior knee laxity was significantly larger in D group. Other clinical results were not significantly different between the groups. Conclusions : Clinical outcomes were similar after single- and double-bundle anterior cruciate ligament reconstruction using hamstring tendon.

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Objectives : To investigate whether the EASE program might be effective for improving the self-efficacy for exercise and also improving the motor behavior in patients on hemodialysis. Methods : First phase (6-week) intervention using only an exercise check sheet, and second phase (6-week) intervention using methods documented in the EASE program, including peer learning, step-by-step, and self monitoring techniques were performed. To assess the effect of these interventions, the self-efficacy for exercise and change in the mean motor point were assessed. Results : During the first phase, the self-efficacy for exercise improved significantly during the intervention as compared with that at the baseline, but decreased significantly again after the intervention as compared with the initiation of the intervention. During the second phase, no significant difference was found, although a tendency towards increase of the self-efficacy score was observed at the end of the second phase as compared with that at the end of the first phase. Significantly greater increase of the exercise point was noted during the second phase than during the first phase. Conclusion : Our results indicated, based on the results of comparison of the self-efficacy and motor behavior, that implementation of the second phase of the EASE program could improve the self-efficacy, which still remained low at the end of the first phase, and the motor point.

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Objectives : To define patient education in dialysis nursing care and identify the required items for such education by reviewing the published literature. Methods : The keywords used for the search included "dialysis" and "patient education". Web version of Japana Centra Revuo Medicina and PubMed were used for the searches of the Japanese and foreign literature, respectively. A narrative review was undertaken for extraction of the main elements and categorization. The patient education was defined after evaluation of the main elements. Results : Fifty-five studies from Japan and 9 studies from overseas were evaluated. As a result, one hundred sixty-six cords, 16 sub-categories and 7 categories of items were extracted from the literature. These items were then evaluated to define patient education in dialysis nursing care. Conclusions : Our evaluation demonstrated that "providing information and technique specifically related to dialysis and renal diseases" and "involvement based on acceptance of the disease and dialysis " were identified as factors required in the patient education in dialysis nursing care.

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A 49-year-old semi-conscious woman was admitted due to fever and dehydration. Disseminated intravascular coagulation (DIC), renal dysfunction and diabetic ketoacidosis were detected. Whole body computed tomography showed multiple nodular lesions in bilateral lungs and kidneys indicating septic emboli, and intrauterine lesions. We diagnosed multiple organ failure followed by intrauterine infection due to untreated diabetes mellitus. Vaginal discharge and blood culture revealed Klebsiella pneumoniae. We used multi-antibiotics for sepsis, respirator at low tidal volume ventilation, 200mg of sivelestat sodium hydrate and 300mg of hydrocortisone for respiratory failure, gabexate mesilate and anti-thrombin III for DIC, transfusion for bleeding from uterus and regular insulin aiming for a blood glucose range of from 80 to 140mg/dl. When we extracted the myoma uteri, the patient's fever subsided and the C-reactive protein became negative. Treating diabetes mellitus is important for the prevention of severe infection.

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Aggressive angiomyxoma (AA) is a rare soft tissue tumor that involves the vulvar and perineal regions of afflicted individuals. It is a slow-growing and locally infiltrating tumor that is characterized by an increased risk of local recurrence. In this report, we describe the case of a large AA in a 39-year-old woman. She was admitted to our hospital with a pelvic tumor, which was discovered during a gynecologic checkup, and magnetic resonance imaging revealed its presence traversing from the pelvic diaphragm to the perineum. The tumor was completely excised using an abdominal approach, and the pathological diagnosis was that of AA. The patient had an uneventful recovery and no evidence of recurrence exists 12 months after surgery. Long-term follow-up and careful monitoring, however, are necessary because AA is slow-growing. As AA is usually reported as a vulvar tumor, the present case is a rare incidence in which the AA grew largely into the pelvic cavity.

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A 65-year-old woman was admitted to our hospital after aspirating a peanut. Bronchoscopic examination revealed obstruction of the right basal bronchus. Use of clamps achieved incomplete removal. Hemoptysis appeared after a few days. Computed tomography (CT) of the lung revealed consolidation in the right lower segment. Methylprednisolone and antibiotics improved symptoms, but chest CT revealed persistent consolidation. Consolidation improved after bronchoalveolar lavage (BAL) of the right basal bronchus during bronchoscopic re-examination. BAL is useful in treating pneumonia resulting from an aspirated foreign body.

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A 52-year-old man presented with right lower abdominal pain and was hospitalized on suspicion of acute appendicitis. Inflammatory markers were elevated slightly on laboratory examination. Computed tomography of the abdomen showed a high-density linear foreign body in the small intestine.
An emergency operation was performed with a diagnosis of small bowel penetration of a foreign body. On laparoscopic examination, part of the ileum was red. The injured ileum was taken out through a minimal incision, and a V-shaped foreign body was removed from the ileum. Based on the patient's dietary history, we believe that the foreign object was a chicken bone.
The laparoscopic approach for foreign bodies in the digestive tract can observe the abdominal cavity extensively and remove the object with a minimal incision. This could become the first-choice treatment for removing foreign objects in the digestive tract depending on the patient's condition.

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