Backgrounds & aims : The number of children with chronic conditions who receive care at home, particularly those who are dependent on medical technology are rapidly increasing. Systematic studies about nursing practice during the transition of technology-dependent children from hospital to home are very limited in Japan. This study explored the nursing practice supporting the transition of technology-dependent children from hospital to home. Methods : Qualitative descriptive design was used. Data were collected via semi-structured interviews from 15 nurses in three different settings : nurses of inpatient pediatric units ; nurse discharge coordinators ; and home care nurses. Results : Nursing practices unique to each of the three settings were identified ; hospital primary nurses advocated for the parents ; nurse discharge coordinators assumed the mediating role ; home care nurses respected and monitored parents' way of care. Promoting parents' self-efficacy was a key role common in hospital and home care nurses. The roles of the nurse discharge coordinators in dealing with this pediatric population were newly reported. Conclusions : Nursing practices of each setting were identified. The findings are expected to guide the nurses to recognize and appreciate their roles for each other which in turn would enable development of nurse-to-nurse collaboration for successful transition.

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Purpose : It has been reported that exercise reduces activation of cytotoxic microglia, thereby, ameliorating neurodegeneration in Alzheimer's disease. We aimed at studying if that is also the case in spinocerebellar ataxia (SCA) model mice. Method : We quantified numbers of IbaI-positive microglia and/or CD68-positive cytotoxic microglia in the cerebellum of wild type (WT), SCA type1 knock in (SCA1-KI), SCA type3 transgenic (SCA3), heterozygous Staggerer (+/sg ) and homozygous Staggerer (sg/sg) mice with or without exercise. Rotarod test was used for exercise. Result : Proliferation of IbaI-positive microglia was found in SCA3 and sg/sg mice without exercise. Exercise differentially changed the number of IbaI-positive microglia in SCA3 and sg/sg. The number was decreased in SCA3 mice, whereas, increased in sg/sg mice after exercise. CD68-positive cytotoxic microglia, which was selectively found in sg/sg, was also increased in sg/sg mice after exercise. Conclusion : Exercise differentially affected numbers of microglia in SCA model mice. Thus, exercise might not always suppress activation of cytotoxic microglia. It is advisable to search for an optimal type of exercise that fits well with a patient to accomplish suppression of cytotoxic microglia.

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Background and Purpose : Although the first choice of medical treatment for a primary gastrointestinal stromal tumor (GIST) is surgical excision, active treatment against recurrence leads to improved treatment outcomes among patients with a GIST. Since the establishment of GIST treatment guidelines in 2008, the principle treatment of recurrence has been imatinib administration. Patients with recurrent GIST in our department underwent clinicopathological examination and treatment evaluation. Results : Seven patients (3 men and 4 women) with a mean age of 61.9 years were analyzed. The primary tumor sites were the stomach (n=1), duodenum (n=1), small intestine (n=4), and rectum (n=1). Risk classification results were middle (n=2), middle to high (n=2), and high (n=3). All patients with a first recurrence also had hepatic metastases, and the period to the first recurrence ranged from 14 to 77 months. Three patients underwent excision of the recurrent lesions, and four patients underwent imatinib administration. Five of the seven patients had re-recurrence/resistance ; this included three of the four patients who had received imatinib. One patient was changed to sunitinib treatment, and two patients underwent excision of local resistant sites and continued imatinib treatment. Two patients died, and five patients have been alive for a long time period. Conclusions : Imatinib administration is the first treatment choice for GIST recurrence. However, if the disease becomes resistant, sunitinib may be effective in systemic cases and excision followed by the continuation of imatinib may be effective in localized cases.

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Objective : This study was conducted to improve the survival of an auxiliary liver constructed using a small intestinal segment packed with liver microfragments and the co-insertion of greater omentum. Design : Male Wistar rats (300-400 g) 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 greater omentum and liver microfragments obtained from the left liver of the same individual rat to accelerate the blood flow to the auxiliary liver. Groups of 2-8 rats were killed at various intervals, and the viabilities of the liver grafts were analyzed histologically. Results : The engrafted liver microfragments were reorganized in the segmental intestine and exhibited an almost normal histological structure of the liver even after 60 or 90 days although the grafts became completely necrotic when greater omentum was not included in the grafts. However, a notable number of cases were lost because of the twisting of the intestinal graft. Conclusions : The co-insertion of greater omentum with the liver microfragments extended the survival of the engrafted liver tissue. However, the development of a technique to prevent graft twisting is needed to further improve the survival rate.

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The purpose of this study was to examine the effect of a nursing training program that utilizes Emotional Intelligence theory for mid-career nurses, and to consider the ideal method of developing human resources in the future.
The research participants were comprised of 17 mid-career nurses undergoing leadership training. Using a battery of 2 tests, consisting of the emotional intelligence scale (EQS) and a questionnaire on faculty leadership and membership, the change in emotional skill and skills of leadership and membership were measured before and after the nursing training program.
As a result, the subjects demonstrated a significant gain in all three of the aspects that constitute emotional skills : intra-personal aspect, inter-personal aspect, and situational aspect. Again, a significant difference in skills of leadership and membership was evident, with gains in the three areas of leadership, relations with staff members, and feeling affiliation with one's workplace.
In the future, to enhance the skills of ‘self-insight’ and ‘situational control, ’ which are vital in the effective application of emotion, it is important to carefully select the nursing training program and for the person in charge of the training to take the role of mentor.

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A 52-year-old woman was admitted to our hospital with six month's history of colicky right lower abdominal pain. Colonoscopy revealed ileo-colic intussusception induced by a 4 cm submucosal tumor of ileum with overlying ulceration of the mucosa. Enhanced computed tomography demonstrated the presence of ileo-colic intussusception and further showed that the leading point of intussusceptions was fat attenuation of 4cm in diameter. We diagnosed ileo-colic intussusception caused by the ileal lipoma and was treated by laparoscopic ileocecal resection. We found the invagination and an egg-sized tumor at the leading point during laparoscopic operation. The resected specimen contained a round yeallowish submucosal intraruminal mass, which was histopathologically identified as an intestinal lipoma. Recently, it has been reported that intussusception caused by small intestinal lipoma can be diagnosed preoperatively and treated with similar approach and technique for laparoscopic surgery for colon resection. Therefore, laparoscopic surgery for intussusception caused by small intestinal lipoma is recommended as less invasive procedure.

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A 73-year-old female was admitted to our hospital because of headache, high fever, nausea, stiff neck, somnolence, and urinary retention. Lumbar puncture showed marked pleocytosis. The cerebrospinal fluid and blood culture showed the presence of Streptococcus agalactiae. DWI revealed high-intensity lesions in the occipital horns of the bilateral intraventricles. Diffuse high-intensity lesions were also observed in the subarachnoid space. FLAIR, T2-weighted, and contrast-enhanced T1-weighted images showed no abnormal lesions. We considered that DWI detected intraventricular and subarachnoid debris and pus caused by bacterial meningitis. We diagnosed her as pyogenic ventriculitis resulting from bacterial meningitis. The patient was treated with antibiotics and steroids. She had recovered completely 1 month after the onset of symptoms, with the exception of persistent dysuria, and the lesions had disappeared on follow-up DWI. These findings suggest the usefulness of DWI for detecting pyogenic ventriculitis and focal subarachnoid lesions.

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Pulmonary tumor thrombotic microangiopath (PTTM) presents with severe manifestations and rapid progression and is difficult to diagnose ante mortem. We report a case of gastric adenocarcinoma diagnosed with PTTM before death. Chest XR and CT showed ground-glass shadows in the bilateral lung fields, gastric adenocarcinoma was demonstrated by gastrointestinal fiber scopy and biopsy, and poorly differentiated carcinoma cells were detected in the pulmonary arterial blood by pulmonary wedge aspiration cytology on cardiac catheterization. After diagnosis of PTTM, prednisolone therapy of 30 mg/day was started. Dyspnea and hypoxemia were improved on the next day of administration of prednisolone. Although PTTM is rare, it should be considered the differential diagnosis of pulmonary hypertension and progressive respiratory failure with diffuse ground-glass shadow on chest radiographies. Furthermore, administration of prednisolone should be considered one of the treatment for the dyspnea by PTTM.

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A 78-year-old man was admitted to our hospital due to thoracic injury following fall at climbing. He complained of dyspnea and thoracic pain. Computed tomography (CT) showed subcutaneous and mediastinal emphysema, and pneumothorax. We diagnosed tracheal rupture of the membranous portion of the lower trachea. Tracheotomy and thoracic drainage were performed emergently. Postoperative progress was good. The tracheal tube was removed on the 20^th day and discharged on 30^th day. When suspected of the rupture of the lower trachea, we have to keep airway management immediately. It might be possible to take the conservative treatment according to the area and form of tracheal damage of each case.

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An inflammatory fibroid polyp (IFP) is a relatively rare disease that is classified as a nonepithelial tumor-like lesion. We herein report our experience with a case of a small intestinal IFP of submucosal tumor type that was complicated with adult intussusception. The case is a 41-year-old woman with a chief complaint of abdominal pain. Abdominal pain started to occur since around September 2011, and she had repeatedly visited a neighborhood clinic. Although she had been prescribed laxative drugs and followed up, abdominal pain recurred in early January 2012. Four days later, the symptom deteriorated and vomiting also occurred. Thus, she visited the neighborhood clinic and then referred to our hospital. On examination at her visit, a mass was palpated at the slightly upper right side of the umbilicus, and tenderness was detected at the same site. Computed tomography and ultrasonography revealed intestinal dilatation at the oral side of the mass, intestinal invagination at the site of the mass, and a concentric layered structure. Intussusception was diagnosed, and emergency surgery was performed. During laparotomy, a submucosal tumor of 40×40×30mm in size was detected in the jejunum 150cm from the ligament of Treitz and revealed to be the front end of invagination. An approximately 25cm portion of the small intestine, including the invaginated segment, was resected. The postoperative course was favorable, and the patient was discharged 10 days after the surgery. The postoperative pathological diagnosis was an IFP. To date, one year and five months have passed after surgery and no recurrence has been observed.

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A 74-year-old man had been followed for hepatic cirrhosis C. In January and May 2006, abdominal computed tomography (CT) examinations revealed an enhanced lesion in S3/6 segments and he was diagnosed as having hepatocellular carcinoma (HCC). The patient was treated with radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE). In August 2007, an intraabdominal mass lesion (12 cm in diameter) was detected using CT. We suspected the lesion to be a peritoneal recurrence of HCC, a gastrointestinal stromal tumor, an angiosarcoma or a malignant fibrous histiocytoma. Because the lesion was solitary, tumor extirpation was performed in September 2007. A histological examination of the resected nodule revealed the peritoneal dissemination of the HCC. This case seems to be a rare example of RFA-related peritoneal dissemination. Here, we describe this case and include a discussion of the relevant medical literature.

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