Background : Although unintentional weight loss is a frequently encountered problem in care settings, little is known about when it starts. The authors observed body weight longitudinally in an elderly population and examined its association with mortality. Methods : Body weight was monitored in residents who lived in a nursing home for the elderly in Tokyo between fiscal years 2002 and 2004, with the final observation date set at October 2008 for survivors and at the date of death for those who died. The 3-year period before the final date was divided into six periods. A linear regression coefficient was calculated as the rate of weight change for each period and compared between survivors and those who died. Results : In the mortality group, significant weight loss was seen from 24 months before death : -0.42kg, -0.62kg, -0.90kg, and -1.78kg in 19-24 months, 13-18 months, 7-12 months, and 1-6 months before death, respectively. In the survival group, there was no significant change in any period. Logistic regression analysis showed that weight change adjusted by sex, age, dementia, and BMI was significantly associated with mortality. The weight loss was large in residents with dementia. Conclusions : Weight loss began 2 years before death. The findings suggest the importance of daily weight measurements to detect changes associated with mortality.

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Background & Aims : De Quervain's disease is known as a representative disease that causes wrist pain, however, its epidemiology remains unclear. The purpose of this study was to elucidate the prevalence of de Quervain's disease among the general population and to identify its risk factors. Methods : The subjects participated in the examinations consisted of 402 people (total of 804 hands), including 157 males and 245 females with mean age of 64.1 years. We recorded the subjects' background and medical history and then performed physical examinations. We determined the prevalence of de Quervain's disease and conducted a statistical analysis to investigate their background factors. Results : De Quervain's disease was present in 3.7% (15/402 people) and the prevalence by age group was 9.8% in their forties, 3.6% in their fifties, 1.8% in their sixties, 3.9% in their seventies, and 3.7% in their eighties. The prevalence was significantly higher in females than in males. No difference was found in terms of the mean age, hand dominance, height, weight, heaviness of labor activity and presence of medical complication. Conclusions : In the general population, 3.7% of 402 people had de Quervain's disease, and its risk factor was identified to be females.

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Purpose : The aim of this study was to compare non-contrast 3T renal MRA with that of 1.5T unit. Methods and Materials : We performed renal MRA in twelve volunteers using a 1.5T and 3T unit. For renal MRA, 3D SSFP sequence was used. For quantitative evaluation, ROI was set on the aorta, main stems of bilateral renal arteries, and IVC, measuring flow signal at each point. Signal intensity ratio (SIR) of renal artery relative to the parenchyma and IVC were calculated. For subjective analysis, two readers evaluated visual quality. Results : SIR of the both renal artery on 3T MRA were significantly higher than those on 1.5T (p<0.01). On subjective analysis, the mean visualization score of renal main stem showed no statistically significant difference. However, the scores of the peripheral branches on 3T was significantly higher than those of 1.5T bilaterally (p<0.05). IVC showed significantly lower signal ratio on 3T relative to that on 1.5T. Conclusion : 3T MRA showed superior demonstration of renal arteries compared with 1.5T MRA. The intraparenchymal peripheral branches are especially well demonstrated on 3T MRA. Decreased venous signal on 3T system contributed to the selective arterial demonstration.

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Aims : Our purpose is to describe how nurses care for the families of terminal cancer patients in a general Japanese hospital ward. Subjects and Methods : Subjects were general-ward nurses at A Hospital with at least three years of cancer nursing experience. Semi structured interviews were transcribed for inductive qualitative analysis. Ethical considerations were approved by the hospital's ethical committee. Results : The 19 nurses interviewed had 3-20 years of experience in cancer nursing. The 5 core categories were "clinical wisdom, knowledge, and art as a basis for family support", "establishment of mutual trust with a family", "clarification of situation/problems within a family", "caring for the family as a whole", and "self-evaluation of clinical practice." Conclusion : Experience in family nursing with terminal cancer patients brought sense to care and motivated nurses to care better for families. Our findings suggest that it is necessary to have a chance to review their experience to increase family nursing quality.

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Objectives : By developing and implementing of "art therapy" sessions for older persons with dementia, we hoped to (1) identify therapy effects, (2) characterize subjects' works, (3) determine positive and negative responses to therapy, and (4) promote interventions to which subjects responded positively. Subjects and Methods : Subjects were five women diagnosed with Alzheimer disease (n=5 ; mean age, 86±5.9 years) living at "H" Dementia Group Home who agreed to take part. We conducted 12 weekly "art therapy" sessions of 60 minutes each for three months. We used Uchida's outcome measures for dementia care, and BEHAVE-AD for assessment. We also evaluated subjects' works. We collected and categorized data on their responses. Results : (1) Assessment showed improvement in BPSD, caretaker's stress and fatigue, fulfilling interests and purposes in life and making a positive contribution. Positive therapy responses included production volunteerism and admiring another person's work, thereby showing favorable behavior and expression. (2) Their works featured vivid colors, high abstraction, bold design, and attractive simplicity. (3) Subjects responded positively to "unconventional" representation rather than realism with simple processes using high-intensity primary colors, familiar "livingware materials" using fabric, and the chance to select color and materials. (4) "I can't do it" behaviors changed from negative or passive to positive and active through producing work. Conclusions : Art therapy was effective in older persons with dementia. Reactions, words, and behavior by participants during therapy shared with caretakers enable better daily support and develop potentials of those with dementia. Caretakers should encourage the elderly to do what they can in daily care by assessing therapy results. Caretakers should also carefully consider selecting subjects and intervention, while recognizing needs for a calm atmosphere.

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Aims : The purpose of this study was to describe how elderly cancer patients were experiencing feelings of hope during their treatment periods in order to reconsider appropriate nursing care for them.
Methods : Three participants participated in this study, all of whom were in-patients at our hospital, aged 65 and older, who had been diagnosed as having cancer, and were able to communicate with researchers. The data collected during the semi-constructive interviews about their hope, were analyzed using qualitative analysis. Results : It was found that the evolution of the patient's core idea of 'hope' was based on their values, which had matured along with their increasing years. When participants had completed all treatment, they gained new insights, which was 'health', as one of the aspect of their hope. On the other hand, when participants were undertaking treatment, they had some fear of the treatment, and also found it difficult to have hope itself. Conclusion : This study found that hope among elderly patients with cancer was influenced by their values. It was also found that conditions of undertaking treatment could be an important factor for those patients. Nurses needed to perceive elderly patients' values, and to provide information regarding treatment in order to relieve their fears.

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A 53-year-old man was admitted to our hospital because of lumbago. Gastrointestinal endoscopic examination performed on admission did not reveal any gross gastric abnormalities. Lumbar radiography and bone scintigraphy revealed multiple bone osteoblastic changes. Chest radiography showed right pleural effusion. The findings of the chest computed tomography and cytological examination of the pleural effusion were strongly suggestive of lung cancer. The patient was refractory to chemotherapy, and he died of cancer and disseminated intravascular coagulation. The autopsy revealed absence of primary lung cancer and the presence of tumor emboli in the right lung field. Swollen perigastric lymph nodes, tiny signet-ring cell carcinoma at the posterior wall of the stomach corpus, and severe vascular invasion were also observed at autopsy.
Therefore, signet ring cell carcinoma of the stomach should be considered as a possible diagnosis in early-stage gastric cancer patients who develop osteoblastic metastasis and pleural effusion.

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A 63-year-old male presented with abdominal discomfort. Gastrointestinal endoscopy showed advanced gastric cancer type 2, which was diagnosed as moderate to poorly differentiated adenocarcinoma. Computed tomography (CT) showed a solitary liver metastasis about 5cm in diameter in the left lobe. The patient was treated with oral S-1, 80mg/m²/d for 21 d, followed by a 14-d rest, and cisplatin (CDDP), 60mg/m², on day 8. The dose of S-1 and CDDP was reduced to 80% after one course because of side effects. After seven courses of treatment, CT and magnetic resonance imaging showed reduction of the liver metastasis to 2 cm in diameter in the lateral segment. A distal gastrectomy, lymph node dissection, and hepatic lateral segment resection were performed. Five months postoperatively, the patient is doing well and shows no sign of recurrence.

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A 70-year-old woman visited the hospital repeatedly with intermittent abdominal pain and distention. Eight months after the first medical examination, she was admitted to the hospital due to abdominal distention and vomiting. Abdominal computed tomography showed a whirl-like pattern encircling the superior mesenteric artery. A strangulated ileus was diagnosed and emergency surgery was performed. Intraoperative observation found no retroperitoneal fixation on the right side of the abdomen, leading to a diagnosis of midgut volvulus with intestinal malrotation. Because the strangulated bowel showed marked edema, and motility was extremely poor, it was resected. The patient's postoperative course was uneventful. This patient experienced chronic symptoms, with recurrent twisting and recovery. We suggest that intestinal malrotation be considered in the diagnosis of chronic abdominal symptoms.

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A 69-year old woman was found in 2009 screening mammography to have a solitary 1.0 cm left-breast mass but physical examination found no lump. Aromatase inhibitor had been administered for five years since 2002 after contralateral mastectomy due to right-breast cancer. Following local excision, microscopic examination showed almost all carcinoma cells with scirrhous infiltration with apocrine features of eosinophilic cytoplasm. The tumor was diagnosed as metachronous bilateral apocrine breast carcinoma. Lymph node dissection was refused. Immunohistochemically carcinoma cells showed staining negative for estrogen receptor, progesterone receptor and HER2. The only adjuvant therapy done was postoperative remnant-breast radiation.

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The Purpose of this study was to examine the support of the physical therapy education in Mongolia. The agreement between faculties of Graduate School of Health Sciences, Gunma University and Health Sciences University of Mongolia (HSUM) was assumed to be a base, and the first new establishment of department of physical therapy and the education for physical therapists were supported in Mongolia. Concretely, advice to the physical therapy curriculum and the lecture and practice of the specialized subjects were done. The curriculum of HSUM was composed referring to the curriculum of Gunma University based on the specified rule of the Ministry of Health, Labour and Welfare in Japan. Moreover, charge subjects of Gunma University were centered on the lecture and practice of the kinesiology and the evaluation based on the demand from HSUM. Therefore, it was physically difficult to take the content concerning the clinical skills and interventions. The first students of department of physical therapy in HSUM graduated on May, 2011. However, it is thought that it will be necessary to continue mainly the support of education to the clinical thought process and clinical skills in the future.

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Objective : Effects of oral exercise as a population approach can be enhanced through regular and ongoing support. This study aimed to consider directionality required to facilitate and maintain such support. Subjects and Methods : The subjects were day-care users (n=15) who underwent a 6-month group oral exercise intervention, and day-care staff (n=22) who instructed the exercise sessions. In post-intervention surveys, day-care users were interviewed concerning their impressions of oral exercises and (un) willingness to continue with exercise. Anonymous questionnaire surveys were performed among day-care staff regarding the contents of oral exercises and changes observed in the day-care users after intervention. An investigation period : September, 2008. Results : Most of the day-care users rated oral exercise as "neither good nor poor". Although they were not self-motivated enough to do exercises voluntarily, they were willing to continue in the company of other day-care users. Approximately half of the day-care staff stated that they enjoyed the exercise sessions, while perceiving that the day-care users were also enjoying them. These staff observed various changes in the day-care users after intervention. Conclusion : To maintain oral exercise sessions, it is imperative to enhance motivation among day-care staff, and develop a program based on the actual situation of these staff members.

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