Purpose : The aim of this study is to examine incidence and severity of radiation-induced esophagitis during thoracic radiation therapy for esophageal cancer and lung cancer, and to explore appropriate nursing-intervention for relieving the symptoms. Methods and Patients : Subjects were 53 patients with esophageal cancer (n=39) or lung cancer (n=14) who were treated with radiation therapy and admitted in radiation oncology unit in a university hospital. We collected data of incidence of esophagitis, daily swallowing score, grades of dysphagia (CTCAE ver. 3), and use of mucosal protectant retrospectively using patient's medical charts. Results : More than half of esophageal cancer patients had symptoms before starting treatment. A similar pattern of change in the swallowing score and the grades of dysphagia was observed in both diseases, but patients with esophageal cancer had slightly higher score and grades in earlier days from start of radiation therapy. Conclusion : Early intervention may improve symptoms from radiation-induced esophagitis of patients with esophageal cancer and lung cancer, and maintain their condition during radiation therapy successfully. Further research is necessary for identifying adequate nursing intervention methods for radiation-induced esophagitis.

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Objectives : To clarify life and death perceptions is subjects diagnosed with terminal disease, we analyzed related research. Methods : We retrieved articles from 1999 to 2009 from the Japanese-language academic database Japana Centra Revui Medicina, using keywords "life and death view" and "patient," or "disease experience," and analyzed the contents of 42 matching articles. Results : Based on contents related to "life and death view," we derived four categories - "wanting to live to the fullest, even if only just surviving," "hoping to maintain relationships with those around them until death," "ambivalence is wish for death versus hope to escape," and "fear and loneliness die to inescapable death." Conclusion : Our results of indicate a pressing need for better symptom management, assistance is independence, reinforcement of relations ships between subjects and family members, and the provision of chances for subjects to discuss their impending deaths.

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Purpose : The aim of this study was to develop ODAYAKA serenity scale (OS) for elderly persons with dementia and to assess its reliability and validity. Subjects and Methods : The subjects were 122 elderly people 65 years of age and over with dementia who were using an elderly care facility. Nurses and nursing care workers with experience caring for dementia patients were asked to complete the sentence, "My image of a serene elderly person with dementia is____" and after extracting scale evaluation items from the replies obtained and having them weighted by dementia experts, we prepared a draft OS composed of 48 items in 5 domains. We used 3 survey forms in this study : the draft OS, a QOL evaluation scale (AD-HRQL-J), and a behavior and mood disturbance scale (BMD). Results : Based on the results of a factor analysis, we prepared a 25-item scale in 4 domains, and it consisted of 9 items related to "interaction with people around them," 7 items related to "expression of their own individuality," 6 items related to "satisfaction and vigor," and 3 items related to "enjoyment of activities." The correlation coefficients were 0.79 with the AD-HRQL-J and 0.74 with the BMD, and the correlation coefficient with both test methods was 0.97. The Cronbach α coefficient for the scale as a whole was 0.96, and the α coefficients according to the domains were 0.92 for "interaction with people around them," 0.90 for "expression of their own individuality," 0.86 for "satisfaction and vigor," and 0.89 for "enjoyment of activities." Conclusions : The reliability and validity of the OS were verified.

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Aims : The purpose of this study was to elucidate experiences of ALS patients who had undergone percutaneous endoscopic gastrostomy (PEG) placement and their families in relation to the gastrostomy and find the continuing care between the hospital and community. Methods : Semi-structured interviews were conducted with six amyotrophic lateral sclerosis (ALS) patients who underwent gastrostomy to elaborate on their experiences with PEG at the hospital and leading to their discharge. Results : There were changes for more positive attitudes in accepting PEG. The following were cited as the major reasons for such changes : (1) Switch to more appropriate gastrostomy tube ; (2) Improvement in the troublesome aspects ; and (3) Realization of the need for the PEG. On the other hand, the following were extracted as the troublesome experiences related to the procedure : [skin trouble], [leakage of nutrition formula], [malfunctioning of the equipment], [difficulties with self care] and [insufficient information], etc. Conclusions : It is considered necessary to select appropriate types of gastrostomy tube and offer adequate guidance through the cooperation of multiple disciplines in and out of the hospital. Health professions need to prepare for changes of physical function in daily activities associated with exacerbation of the disease so that ALS patients may have an adequate understanding of the procedure and be capable of accepting continuing care.

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Purpose : The aim of this study was to identify the characteristics of the peripheral neuropathy of patients undergoing outpatient chemotherapy and to assess nursing support. Subjects and Methods : The subjects were 84 patients attending the outpatient chemotherapy center of hospital A. We surveyed the peripheral neuropathy items in a self-recorded notebook for a maximum of 43 days from the day of treatment until the day before the 3rd course of treatment. Results : FOLFOX (fluorouracil, oxaliplatin) : Symptoms of peripheral neuropathy developed in a high proportion of the patients, 81%. The peak occurred 4 days after treatment, and the symptoms tended to persist till the next treatment. TXL (paclitaxel) : Symptoms developed in 59.1%, and the peak occurred about 4 days after treatment. Their Grade was low, and they tended to persist. FEC (fluorouracil, cyclophosphamide, epirubicin hydrochloride) : Symptoms developed in 44%. Their Grade was low, but some of them became so severe that they caused Grade 3 impairment of everyday living. TXT (docetaxel) : Symptoms developed in 43.8%, and many of them were Grade 1. Conclusion : The results suggested that it is necessary to emphasize pain relief during the peak of the peripheral neuropathy, and to propose specific management tailored to the patient's life.

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A 70-year-old woman suffered from hypoglycemic symptoms three or four hours after glucose intake for three months. At this time, the patient felt she had perspired more than in previous years. A diffuse elastic goiter without tenderness was palpable. Transient hyperthyroid state with little uptake by 123I-thyroid scintigram was shown and diagnosed as silent thyroiditis. Oral glucose ingestion test (OGTT) showed normal glucose response but high insulin response and hypoglycemia occurred at 240 minutes. We diagnosed reactive hypoglycemia for glucose intake. The frequency of hypoglycemia reduced after the glucose intake decrease. Hypoglycemia did not occur after glucose intake in the euthyroid state. Then OGTT showed a borderline pattern and delayed hyperinsulinemic response. Reactive hypoglycemia may have been the result of transient hyperthyroid state in the background of the pre-diabetic stage.

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A 56-year-old woman was admitted due to fever, thirst, polydipsia, polyuria, posterior cervical pain and lumbago. Hyperglycemia and urine white blood cell elevation were detected. Computed tomography showed left perirenal abscess. Urine culture and blood culture revealed Escherichia coli. We diagnosed perirenal abscess followed by pyelonephritis due to untreated diabetes mellitus. We used 6g of ampicillin-sulbactum daily and from the 10th day 4g of sulfamethoxazole-trimethoprim for perirenal abscess, and 180mg of loxoprofen sodium daily for posterior cervical pain in addition to a diabetic diet and insulin therapy for diabetes mellitus. Although the patient's fever normalized and lumbago improved, posterior cervical pain level increased and bilateral 1, 2 and 3 finger-numbness occurred from the 18th day. Cervical magnetic resonance imaging showed cervical 4, 5 and 6 vertebra inflammation induced spine compression. Removal of the cervical abscess and fixation of the vertebra were performed at the 27th day. Treating diabetes mellitus is important for the prevention of severe infection.

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Injury of the thoracic aorta is the most common arterial injury associated with a widened mediastinum on a chest radiograph after trauma. Injury to the internal mammary artery (IMA) due to blunt trauma is rare. Patients with IMA injury usually have a fracture of the chest. We report a patient with bilateral IMA owing to blunt injury caused by a traffic accident. However, the patient did not have a fracture of his chest. Nausea and vomiting were present because the oesophagus and heart were compressed by a mediastinal haematoma. X-ray and multidetector computed tomography are valuable for identification of IMA injury but the most effective tool is angiography.

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Clinical nursing practice involves complex and multiple aspects of care. Describing clearly nursing practices leads to future nursing care development, making it useful to analyze the elements of such care. We analyzed nursing care based on the Interaction Model of Client Health Behavior (IMCHB) advocated by Cox. We engaged in the case of a patient who suffered from stress and negative feelings about the necessity to start insulin treatment and surgical tumor removal. After nursing care enabling the patient to accept insulin introduction, he could conduct diabetic self-management, and change his attitude toward surgery. As previous studies indicate, our case study also verified the finding of Cox's IMCHB, which claims that emotional support, health information, decisional control, and professional/technical competencies are effective to change patient's behavior. In addition, it became clear that comprehending a patient's recognition of and attitude toward his illness was crucial to conduct effective care.

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An 80-year-old woman with aplastic anemia admitted for general fatigue was found in laboratory testing to have escalated pancytopenia. CA19-9 and CEA serum concentrations were within normal limits. Gastrointestinal examination showed type 2 cancer of the gastric antrum, that biopsy indicated was moderately differentiated tubular adenocarcinoma. Computed tomography (CT) showed no metastatic lesion. We conducted distal gastrectomy with standard D2 lymph node dissection. The histopathological diagnosis was adenosquamous carcinoma, judged based in Japanese classification of gastric carcinoma (2nd English edition) to be stage pT3 (SE) pN0 H0 P0 CY0 M0, fStage II. The woman remains alive without recurrence in the 15 months after surgery.
Granulocyte colony-stimulating factor (G-CSF) serum concentration is often elevated in those with aplastic anemia. G-CSF is assumed to confer growth advantages in several carcinoma types, including adenosquamous gastric carcinoma, and aplastic anemia may promote adenosquamous gastric carcinoma occurrence.

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