Background : Kikuchi's disease (KD) is a benign disease in young adults, and we studied its clinicopathological characteristics. Method : From April 2004 through October 2012, 10 cases of KD were diagnosed. Their clinical manifestations and pathological findings were studied. Results : There were 6 male and 4 female cases. The ages were 17 to 45 years old, with a median of 32. Nine cases had only one-sided cervical lymphadenopathy without spontaneous pain. Fever was observed in 7 cases. The titer of LDH was slightly elevated but that of CRP was in the normal range in 8 cases. Pathological findings of lymph nodes showed many large lymphoblasts, plasmocytoid dendric cells, and histiocytes containing fragments of karyorrhectic nuclear debris. Polymorphonuclear leukocytes were absent. Conclusions : We should pay attention to KD when a patient has lymphadenopathy on one side of the neck with fever in young adults, and must perform lymph node biopy to differentiate from malignant lymphoma.

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Objective : The aim of the present study was to clarify the characteristics of patients at recovery-care hospitals in an average secondary medical region transferred from acute-care hospitals and their discharge destinations, in order to promote region-based total medical care. Participants and Methods : A retrospective survey was conducted using the medical records of 265 patients transferred in fiscal 2007 and the data were investigated stratified by discharge destination using descriptive statistics. Results : The mean age of the patients was 76.5 years. Of the total, 47.1% had cerebrovascular diseases, 41.6% applied for long-term care insurance, and 91.3% received discharge planning. The discharge destination was an institution for 40.0% of the patients, including a health care facility for 18.9% of these patients. Patients whose non-home discharge destinations were located within the secondary medical region for their residences accounted for 77.4%, and those who went to a welfare facility accounted for 50.0%. Comparison of the patient characteristics between home and non-home discharge destinations revealed significant differences in the admission rate to a recovery-care ward, length of hospitalization at the original hospital, total length of hospitalization, medical treatment, activities of daily living (ADL), cognitive function, and number of family members. Conclusion : It is necessary to improve home care support services and other institutions, as well as improve the ADL, prevent progression of dementia, provide support for long-term care insurance application and share patients' information among in-hospital staff, in addition to providing medical treatment.

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Purpose : Chemotherapy was administered to patients with stomach cancer with Virchow's metastasis, and surgical resection of the stomach was performed in patients whose Virchow's metastasis had disappeared on computed tomography. These cases of excision were clinicopathologically investigated. Methods : From 2005 through 2012, four patients underwent surgical stomach removal after chemotherapy for stomach cancer with Virchow's metastasis. All cases were clinicopathologically examined. Results : Chemotherapy comprised mainly the fluoropyrimidine S-1 and was given for 6 to 11 months. Stomach resection was combined with lymph node dissection, including sampling of the para-aortic lymph nodes. Invasion was mucosal and submucosal, and no lymph node metastases were present in two of the four patients. These patients had no recurrence after the operation ; one survived for 4 years and 9 months, and the other survived for 8 months after the operation. In two patients, invasion was serosal and subserosal, and lymph node metastases were found pathologically ; both patients died of recurrence. One died 1 year after the operation, and the other died 8 months after the operation. Conclusion : In patients with stomach cancer and the disappearance of Virchow's metastasis on computed tomography after chemotherapy, we can expect long-term survival. Because cancer often persists at the original site even when it disappears from the lymph nodes, the original lesion should be surgically removed. When no lymph node metastases are found pathologically, long-term survival is possible, but an accumulation of future cases is necessary to verify this.

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Objective : To elucidate the process by which cancer survivors acquire new roles through the activities of self-help groups (SHG). Subjects and Methods : Semi-structured interviews were conducted on 10 cancer survivors participating in SHG, and the data were analyzed using the modified grounded theory approach (M-GTA). Results : The process by which cancer survivors acquire new roles through the activities of SHG began with "a growing interest in other cancer survivors". Survivors continued to engage in activities while attaining "realization of enjoyment and interactions with cancer survivors", and thereby developed "role awareness for contributing to society". Cancer survivors also had "a permanent pain associated with cancer". Conclusion : The suffering resulting from the diagnosis of cancer triggered an interest in SHG. In addition, cancer survivors were constantly in search of more in-depth and detailed information, and SHG played an important role in the exchange of information. It is important for nurses to promote interactions while providing support that enables SHG to serve as a source of accurate information

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Objective : Liver transplantation is an effective method for the treatment of hepatic failure, but donor shortage remains problematic. This study was conducted to develop an effective auxiliary liver capable of compensating for the donor shortage. Design : Male Wistar rats (300-400g) were used. A jejunal segment (2-3 cm) was isolated together with a feeding pedicle. After the removal of the mucosa, the intestinal segment was filled with liver microfragments obtained from the left liver of the same individual rat. Groups of 3-5 rats were killed at various intervals and the viability of the liver graft was analyzed histologically. Results : Within 10 days after transplantation, the confluence of the transplanted liver tissue was restored and the tissue exhibited a normal hepatic architecture. However, the confluent and enlarged liver tissue gradually became necrotic, and nearly 70% of the liver tissue had been lost at 40 days after transplantation. After 10 months, almost all the liver tissue had become necrotic, although the intestinal segment remained viable. Conclusions : This method has the potential to construct an effective auxiliary liver ; however, further improvement to obtain sufficient blood flow will be required to maintain the transplanted liver tissue.

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A 76-year-old female patient with diabetes was referred to our hospital for evaluation of a 1-week history of left abdominal pain with loss of appetite. Laboratory data showed markedly elevated neutrophils. Abdominal X-ray showed massive gas and fluid collection in the left pararenal space, resembling an intestinal obstruction. Abdominal computed tomography revealed renal parenchymal gas and fluid and led to the correct diagnosis of emphysematous pyelonephritis. Based on these findings, this patient was immediately transferred to the intensive care unit. She underwent emergent nephrectomy and was discharged 28 days after surgery without complications.

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A 54 year-old woman with no subjective symptoms was admitted to our hospital because chest radiograph abnormality became worse. A chest radiograph and a chest computed tomography showed multiple nodules with cavity lesion of left upper lobe and consolidation with cavity lesion of lingular lobe. Fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) demonstrated that consolidation of lingular lobe was high-uptake sturucture (max standard uptake value (max SUV) : 10.3). Transbronchial biopsy was performed for consolidation in the left lingular lobe. The biopsy specimen showed epithelial cell granuloma with caseation. A culture of bronchial lavage was positive for Mycobacterium avium (M. avium). We treated her with antituberculosis chemotherapy. After treatment, the area of consolidation in left lingular lobe had decreased FDG uptake (max SUV : 3.9). We considered that FDG-PET was an effective procedure for decision of therapeutic initiation and monitoring of therapeutic response in pulmonary M. avium infection.

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A 49-year-old man visited the Department of Urology at our hospital with hematuria and pollakisuria. He was diagnosed with a rectal carcinoma and bladder invasion and was referred to the Department of Surgery. We performed a low anterior resection and partial resection of the bladder with a D3 lymph node dissection. The pathological diagnoses were tub1, SI, int, INFb, ly1, v0, N1, H0, M0, P0, and Stage IIIa, and the resection margin of the bladder was free. However, the patient continued to have hematuria 1 year and 9 months after the operation. A computed tomography scan showed a tumor from the bladder to the prostate. We suspected bladder carcinoma and performed a biopsy. The pathological diagnosis was a well differentiated adenocarcinoma, and we considered it a recurrence of the rectal carcinoma. We resected the bladder and prostate with an iliopelvic lymphadenectomy. The residual tumor did not histologically exist in the last cystectomy margin but was located on the other side apart from the margin. Based on the histology, the bladder tumor was considered a recurrence of the rectal carcinoma by intravesical peritoneum dissemination.

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A 55-year-old woman has been receiving prednisolone, the immunosuppressive medication for non-specific interstitial pneumonia since January 2001. Her respiratory symptoms had been stable until October 2009, when she started to experience the exacerbation of dyspnea on exertion due to pulmonary arterial hypertension (PAH). After treatment with bosentan and sildenafil was initiated, the pulmonary vascular resistance was significantly improved. On the contrary, dyspnea was rather aggravated. Every episode of severe dyspnea and hypoxemia occurred after she took bosentan and sildenafil. We reasoned that either bosentan or sildenafil, or both of these medications caused exacerbation of the mismatching of ventilation and perfusion of the regions of the lung by dilating constricted vessels, which had been contributing to the balanced ventilation and perfusion. Our case led us consider that treatment of PAH may aggravates dyspnea and hypoxemia by increasing a mismatching of ventilation and perfusion of the lung in the patients with abnormal ventilation and perfusion balance at baseline.

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Objective : The objective of this study is to clarify the characteristics and construct of empowerment in cancer patients and to examine the utility of the concept in relation to patient support. Method : Thirty seven literatures were extracted between 2000 and 2010 in the following five fields : nursing, public health, social science, psychology, and pedagogy. An analysis was conducted employing Rodgers' concept analysis approach. Results : The concept of empowerment in cancer patients comprised the following 6 attributes : [existence of motivation], [awareness and reinforcement of inner strength], [acquisition of problem-solving abilities], [self-directive and independent activities], [reframing], and [construction of partnership and interaction]. And 4 antecedents, 5 consequences are extracted from the analysis. Conclusion : We defined the concept of cancer patient empowerment as "a process of gaining the ability to reframe thoughts about cancer, treatment, and life through the enhancement of active and independent behavior, acquisition of problem-solving abilities, and recognition and reinforcement of intrinsic strength, on the basis of the patients' motivation, and realized through the interaction within the partnerships constructed between the cancer patients and people surrounding the patient." This concept can be utilized for the research and practice in the field of cancer care, which aims to support cancer patients in acquiring the power to live their normal lives with cancer.

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