Objectives: We evaluated the usefulness of a cooling system and the use of denture adhesive (DA) as a gap filler in preparing thin serial sections with a sliding microtome.
Methods: We prepared paraffin blocks alone (i.e., no patient sample) and initially examined how DA affected paraffin block cooling by the cooling apparatus. Then, we examined how thin serial sections could be prepared using the cooling system installed in the sliding microtome.
Results: With DA, differences in the block surface temperature between 0-5 min and between 0-20 min after cooling were significantly larger than that without DA, although the block temperature (20 min) was not significantly different with or without DA. Additionally, the cooling system installed in the microtome enabled the generation of 1μm-thick serial sections.
Conclusions: In daily pathology practice, we typically pre-cool blocks using an ice plate or a cooling equipment, but we do not cool the block during sectioning. This condition sometimes leads to difficulty in preparing serial sections. To solve this problem, a cooling system was installed in the microtome.

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Background & Aims: To clarify the background characteristics of patients with chronic obstructive pulmonary disease (COPD) and the introduction status of COPD action plans (AP) at visiting nursing stations (hereinafter stations) in Gunma Prefecture. Methods: We conducted an anonymous self-administered questionnaire survey by mail, targeting 187 stations. The managers at these stations answered the questionnaire regarding the status at the time of the survey.
Results: Seventy-nine stations returned the questionnaires (return rate 42.2%); 45 stations (57.0%) had patients with COPD. All patients were over 65 years old; 80% of them required assistance. Twenty stations had patients with an AP. The contents of AP were different every stations. Patients with an AP had higher care practice scores compared to those without an AP on “providing inhalation instruction to patients receiving inhalants” and “teaching how to respond to exacerbations” (p<0.05). The stations that had patients with COPD were associated with higher“number of full-time nursing stuff” (p<0.01), higher“total number of users” (p<0.01), and higher “charging additional medical fees for around-the-clock services” (p<0.05). Conclusions: In order for patients with COPD to continue living in the community, it is necessary to prepare an AP that takes into consideration the patient's characteristics individuality at the station.

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Aims: The purpose of this study was to describe current nursing practice of hospital nurses for patients discharged to their homes, and the longitudinal change of these practices in four years. Methods: A questionnaire survey was conducted on nurses at eleven hospitals of the prefecture in 2014 and 2018. Results: There were 2,136 responses (response rate 73.3%) in 2014, and 2,399 in 2018 (77.8%). “Understanding living conditions at home” and “documenting patient instructions in nursing summaries” were frequently practiced, while “utilization of social resources”, “understanding residential area and housing floor plans”, and “consulting doctors on decreasing number and dose of drugs” was low. The rates of nursing activity practiced were related to age, years of experience, position in nursing, and training in home care nursing. Conclusions: The rates of nursing activities practiced increased significantly in nurses whose positions were higher, and in institutions with low rates in the first survey. We hope to continue further assessment to show nursing activity rates based on experience level and roles of nurses.

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A male patient in his fifties underwent ascending colostomy due to anastomosis leakage following transverse colectomy. He developed right lower abdominal pain and was diagnosed with prolapsed, edematous, and completely incarcerated end colostomy. It was not possible to restore the end colostomy to a normal position. Consequently, he received emergency end stoma resection and ileum-descending colon anastomosis. Remarkably, the patient's condition improved without any further complications, and he was discharged 14 days postoperatively.

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A 50-year-old man was admitted to our hospital complaining of left flank pain. Computed tomography revealed a left ureterolith and also an incidental mass in the transverse colon. Although the flank pain subsided after spontaneous passage of ureterolith, colonoscopy revealed a dark red protruding lesion in the transverse colon mimicking a submucosal tumor, which was a suspicion for hemangioma. To prevent bleeding and obstruction caused by the lesion, we performed elective surgery. Intraoperatively, there was an extramural hemangioma extending into the adjacent omentum in the transverse colon near the hepatic flexure. We performed partial resection of the transverse colon under laparoscopic assistance to include the whole lesion. Histopathological examination showed proliferation of veins with hyperplasia of elastic tissues. The lesion was diagnosed as a venous hemangioma. In the past reports, the majority of colonic hemangiomas were histopatholigically classified as cavernous hemangiomas. Most of these were symptomatic, with the most frequent symptom being intestinal bleeding. We report an extremely rare case of venous hemangioma, which was diagnosed incidentally.

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Goodpasture's syndrome (GPS) is an autoimmune disease in which antibodies attack the glomerular basement membrane in lung and kidney, and is characterized by alveolar hemorrhage and rapidly progressive glomerulonephritis. Reccurence of this disease is rare due to the high success rate of remission induction and maintenance therapy. We report a 52-year-old man with GPS who had undergone steroid therapy and hemodialysis, and was in remission. Oral steroid use became increasingly difficult due to his nausea and vomitting. He was admitted to our hospital because alveolar hemorrhage recurred. Early intervention such as immunosuppressive therapy, plasma exchange therapy and careful management of his respiratory status enabaled his safe discharge. When immunosuppressive therapy is stopped shortly after induction of remission, GPS will occasionally relapse, and it is necessary to keep this possibility in mind.

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We report the case of a 24-year-old male patient with skin bridges at two points between his penile glans and foreskin. He had undergone neonatal circumcision in the United States of America. We successfully performed surgical dissection of the two skin bridges, restored the cosmetic features and resolved discomfort. In Japan, neonatal circumcision is not performed routinely; therefore, complications as in this case are rarely seen.

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