Purpose : We performed spleen-preserving distal pancreatectomy (SPDP) for low-grade malignant pancreatic tumors. Specifically, we have performed six cases of pure laparoscopic (PL) SPDP after having conducted hand-assisted laparoscopic SPDP in our department. Here, we report details of the procedure and the results of the operation. Method : Using pure laparoscopic surgery, we resected six low-grade malignant pancreatic tumors. We investigated operating time, blood loss, complications, opioid consumption, and hospital stays. Results : The mean operating times were 5 h 31 min for PL SPDP. Mean blood loss was 302 mL. Postoperative complications consisted of pancreas juice leakage in one patient and ischemic colitis in one patient. Average opioid consumption was 12.6mg and the average hospital stay was 21.3 days. No postoperative death occurred. Conclusions : If we perform PL SPDP after having performed HALS SPDP, PL SPDP may be appropriate for low-grade malignant pancreatic tumors.

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Objectives : The purpose of the present survey was to clarify the daily life of breast cancer survivors in the extended stage following successful early treatment interventions. Methods : We carried out semi-structured interviews for 19 breast cancer survivors in the extended stage of survival and analyzed their social interaction and individual psychological features using the modified-grounded theory approach. Results : Some positive and negative underlying survivors' intentions were found out by inductive and qualitative analytical approaches. Extracted processes for living as survivors were followings ; "finding out value in their residual life by changing their severe experiences as cancer survivors into affirmative experiences", "anxiety regarding uncertainties in their residual life as cancer survivors" and "vitality supporting their life in the future". The process of changing the individual value of life as survivors may be related with positive intentions in their daily life through realizing their practical situation as cancer survivors who had some fears regarding their prognoses. The positive impact on vitality for living as survivors may be due to continuous supportive interactions with their family and surrounding breast cancer survivors, and may be also due to their hope for the future based on their confident experiences as survivors. Conclusions : It was suggested that nursing support strategies including providing individualized useful medical information, educational interventions for acquiring coping skill, psychological supportive care and continuous appropriate medical care would be necessary for survivors in order to encourage positive intentions in their daily life and also toward their future.

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The aging society is rapidly growing in Japan, and more elderly patients are requiring emergency medical treatment. Recent developments in abdominal emergency medicine have been remarkable. However, elderly patients are often unable to undergo the same medical treatments as younger patients. Palliative care is offered for even benign illnesses in elderly patients in our department after considering the patient's condition and background. Such medical treatment is called "silver care." We herein present cases of "silver care" and propose the necessity of "silver care" as a future medical treatment in Japan.

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A 37-year-old man with longstanding bipolar disorder ingested flunitrazepam 60 mg, brotizolam 7.5 mg, and etizolam 7 mg. He was immediately transferred to hospital. The patient arrived in the emergency department 60 min after ingestion of the drugs.
Benzodiazepine is an antipsychotic, which is increasingly used in preference to older antipsychotic agents. Limited data are available concerning the toxic effects of benzodiazepine after deliberate overdose. A patient presented to our institution after massive benzodiazepine ingestion, and required prolonged ventilatory support because of the development of a coma and respiratory depression. Serum benzodiazepine concentrations were orders of magnitude higher than those associated with therapeutic doses, and remained elevated for several days after ingestion. The patient made a full recovery with only supportive care, despite having initial serum drug concentrations. Our findings indicate the potential for benzodiazepine ingestion to cause a coma, which may persist for several days after the overdose.

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A 60-year-old woman with nonproductive cough and dyspnea on effort was admitted to our hospital. In addition, she had arthralgia, swelling and morning stiffness of fingers. A chest radiograph and a chest computed tomography showed ground-glass opacities and reticular opacities of bilateral lower lobes. In the bronchoalveolar lavage fluid (BALF), not only the percentage of lymphocytes but also that of neutrophils and eosinophils were increased. We assumed that alveolitis might be active by the BALF findings. Thus, video-associated thoracoscopic surgery (VATS) was performed. We diagnosed as idiopathic nonspecific interstitial pneumonia (NSIP) by the VATS findings and no etiology. We treated her with oral corticosteroid therapy. Her symptoms and image findings were improved by treatment. It has been found that the percentage of lymphocytes might be increased in the BALF findings of idiopathic NSIP. However, the percentage of neutrophils and eosinophils of the BALF are occationally increased.

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The purpose of this study was to understand the actual conditions of the dietary habits and to examine issues of junior high school students in a town in Gunma, Japan. In 2012, we conducted an anonymous self-reported questionnaire of all 163 students attending the junior high school in that area. Survey contents were as follows : Eating habits (such as taking breakfast and vegetables, food preferences), and food culture (such as awareness of food culture, taking locally produced foods). The survey resulted in a 64.4% response rate. It was shown that 100 students (95.2%) took breakfast almost every day. Only 6 students (5.8%) took five or more servings of vegetables per day. 34 students took breakfast with their family (32.4%) and 86 students took dinner with their family (81.9%). Less than 40% of the students knew about locally produced food (n=37, 35.2%) or took those products often (n=40, 38.1%). With the results of the survey's data, certain issues have been raised, and new procedures have been implemented. Dietary habits and issues are as follows : further promotion regarding taking breakfast, communication with the family while taking meals, promotion of increasing the daily vegetable intake, and understanding of food culture.

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