Objectives: To analyze initial treatment results for robot-assisted laparoscopic radical prostatectomy (RALP).

Subjects: 153 patients who underwent RALP in our hospital from June 2014 to December 2017.

Results: We performed nerve-sparing surgery in 108, lymph node dissection in 81, and procedures to prevent inguinal hernias in all patients. 94.8% patients were released from our hospital in postoperative days 7. The median hemorrhage volume was 65 cc. Although there were two cases of postoperative hemorrhage, there were no cases of urinary retention, symptomatic lymphoid cyst, or rectal, ureteral, or obturator nerve injury. However, one patients needed antibiotics therapy for peritonitis caused by small intestine damage. There were five cases of postoperative inguinal hernias. The positive margin rate was pT2;18.5%, pT3; 58.8%, respectively. However, recent positive margin rates are lower. The median number of lymph nodes removed was 16 and metastasis was observed in 3 cases. The overall 12- and 24-months PSA-failure-free survival rates were 89.9 and 83.6%, respectively. Positive margin, Gleason group, and initial PSA level were significantly associated with PSA-failure. The 1-, 3-, 6-, 9-, 12-, 24-month postoperative continence (0-1 pad per 24hr) rates were 56%, 86%, 93%, 95%, 95%, and 93%. Nerve-sparing surgery and small prostate were independent predictive factors for good urinary continence.

Conclusion: We conducted RALP safely, and our results are mostly consistent with those of contemporary series. On the other hand, we need to continue to accumulate experience safely in order to improve outcomes of cases requiring extensive resection and to train operators.

A 46-year-old woman presented with an abnormal thickening and calcification of the pleura; positron emission tomography showed lesions with significantly high uptake in the pleural masses. The patient had undergone talc pleurodesis for pleural effusion due to advanced stage IV ovarian cancer 27 months prior. Because there were no other malignant findings, pleurectomy including the lesion area was performed as salvage surgery. Postoperative histological findings showed talc pleurodesis-induced granulomatosis (pleural talcoma). This case demonstrates the need to consider pleural talcoma when positron emission tomography shows a high uptake lesion after talc pleurodesis. It is sometimes difficult to distinguish pleural talcoma from malignant diseases with dissemination.

A 63-year-old man was transferred to our hospital after sudden onset of left hemiparesis and dysarthria. After admission, his neurological symptoms aggravated from National Institutes of Health Stroke Scale (NIHSS) score 8 to 12. Magnetic resonance angiography showed no visualization of the right internal carotid artery from the cervical segment and hypoperfusion in the horizontal portion, but demonstrated visualization of the peripheral portion of the right middle cerebral artery. Therefore, we selected acute revascularization for the right internal carotid artery occlusion at the cervical segment. After emergency carotid artery stenting, cerebral angiography detected occlusion of the right middle cerebral artery. Clot extraction by the direct aspiration first pass technique was performed, which achieved successful recanalization of thrombolysis in cerebral infarction (TICI) grade 3. He was discharged with modified Rankin Scale score 1. The therapeutic approach for internal carotid artery occlusion or severe stenosis, including the indications for acute carotid artery stenting, remain controversial. Intracranial revascularization achieved favorable clinical outcome in the present case of right internal carotid artery occlusion with progression of symptoms after admission, with occlusion of the right middle cerebral artery following emergent carotid artery stenting.

A female patient in her sixties visited our hospital with her right abdominal hernia (Spigelian hernia), which was discovered by health screening, and was subjected to laparoscopic mesh repair. The hernia orifice was 5 cm in diameter, and the content was mainly the cecum. The right colon was mobilized in order to fix it into the normal abdominal cavity, and polypropylene mesh was fixed with tucker. The operation time was 2 hours and 2 minutes, and the amount of bleeding was small. The postoperative recurrence has not been observed. Spigelian hernia is a rare type of abdominal wall hernia, and obesity and weakening of the abdominal wall due to aging contribute to its onset. Here we report a rare case of a giant Spigelian hernia with some literature review.

We report a case of bilateral chylothorax following neck lymph node dissection for left cervical lymph node recurrence after papillary thyroid carcinoma. An 83-year-old woman developed dyspnea 3 days after surgery. Bilateral pleural effusion was identified on imaging, and thoracentesis was performed. The large amount of chyle in the pleural fluid confirmed the diagnosis of chylothorax. The pleural effusion did not decrease with conservative treatment, but it resolved after ligation of the thoracic duct.

Metaplastic breast cancer (MBC) is a rare and clinically aggressive tumor with a poor prognosis. We report a case of MBC involving an 85-year-old woman who presented our hospital with a left breast mass of 18 mm in size. Core-needle biopsy revealed poorly differentiated epithelial cells and an osteoid-like appearance which characterized by high nuclear grade and high mitotic activity, so metaplastic breast cancer was suspected. We informed her and her family about this result, but they declined therapy for this disease because of her age. After 8 months, the tumor enlarged to 70 mm. There were also skin redness and local pain. It was not until then that she agreed to surgery and underwent mastectomy and axillary lymph node dissection. Histologically, the tumor consisted of poorly differentiated adenocarcinoma, pleomorphic and chondroid metaplasia,and it was diagnosed as metaplastic carcinoma with mesenchymal differentiation (chondroid differentiation). Immunohistochemical staining was positive for vimentin, CKAE1/AE3 and S-100 protein and negative for estrogen, progesterone receptor and HER2. She did not wish further treatment, so neither adjuvant chemotherapy nor radiation therapy was performed. Four years have passed after surgery, and she is alive without recurrence.

During the terminal phase of breast cancer, management of local lesions is frequently difficult. Local recurrence of breast cancer is not life-threating, but subsequent distant metastasis is frequent, and the metastasis is an adverse prognostic factor requiring systemic treatment. However, in some cases, systemic treatment or radiation therapy is not possible, and surgery is the only available treatment for the local recurrence. In this study, we present three cases of repeated local recurrence without other treatment options, and discuss the role of palliative surgery in local recurrence of breast cancer. Surgery is indicated when 1) the prognosis after surgery is expected to be at least three months; 2) performance status (PS) is 2 or better; 3) there is no significant deviation in CRP, serum albumin, or hemoglobin levels, 4) the patient is expected to be out of bed the day after surgery and 5) the patient’s hospital stay is expected to be about one week.

Purpose: This study describes the expectations of participants in a seminar on home care services, and whether those expectations differed depending on where they would choose to receive end-of-life care.

Methods: About 265 individuals participated in a seminar on integrated community care and answered a survey, which included questions on participants’ socio-demographics and expectations for home care services. The participants were divided into those who would choose to spend their end-of-life at home and those who would choose a different place. For comparison, x²and Mann–Whitney U tests were used.

Results: Of the home care services with a mean expectation level of 3.4 or above, the most expected services with a level of 3.77 were ‘providing emergency contact information’ and ‘reducing the caregiving burden on the family’. Compared to participants who choose a different place, those who preferred their home had higher expectations for ‘psychological well-being’, ‘avoiding hospitalization’, ‘using desired services’, and ‘using services at desired times and frequencies’.

Conclusion: While the participants’ expectations for home care services were high, differences were demonstrated between those who choose to receive end-of-life care at home and those who preferred a different place in 4 items.

Purpose: To evaluate the effectiveness of the Holistic BPSD Care System® (the System) for patients with severe Behavioral and Psychological Symptoms of Dementia (BPSD).

Subjects and Method: Subjects were 10 elderly inpatients with dementia in Hospital C (acute-care hospital), with a daily independence level of III or higher, and a Neuropsychiatric Inventory - Questionnaire (NPI-Q) carer distress score of 10 or higher. An individualized action plan(AP) was implemented alongside the system. Participants were evaluated at the time of admission and at 1, 3, and 5 weeks post-admission. BPSD was evaluated with NPI-Q.

Outcome: The NPI-Q score severity of all subjects significantly improved from 13.5±2.1 at admission to 8.7±5.6 one week post-admission (p=0.027). About 70% of the patients were discharged or transferred within 3 weeks.

Conclusion: Our results suggest that patients with severe BPSD require individualized AP in the Holistic BPSD Care System®.

Objective: This study aimed to identify the state of family nursing science and identify effective teaching methods of family nursing science in undergraduate nursing education by reviewing examining the literature .

Methods: A search on the literature was conducted using the Japan Medical Abstract Society website, CiNii, and medical online databases of scientific articles using the keywords “family nursing science,” “undergraduate nursing education,” and “teaching methods.”

Results: Approximately one-third of training institutions were found to offer family nursing science as a subject. The teaching staff acknowledged the need to teach family nursing science; however, at present, it is not established as a subject. Teaching methods for family nursing science included case studies and exercises that incorporated role playing, which were found to be effective; however, it was reported that there were problems in understanding theoretical theory.

Conclusion: Our study revealed that in order to establish family nursing science as a subject, coordinated efforts are required. Upon adopting role playing with case studies as teaching methods, cases that help students understand the developmental stages of families and families with various social backgrounds need to be devised.

The purpose of this study was to clarify the awareness and current status of community-based integrated nursing education among diploma nursing school teachers in order to obtain suggestions in regard to nursing education strategies for training nursing students to be aware of and capable of practicing community-based integrated nursing. The participants were teachers with at least 3 years of teaching experience at 26 diploma nursing schools in two prefectures in the Kanto area. We conducted an anonymous questionnaire survey by postal mail. Responses were obtained from 68 teachers in 14 schools (response rate: 70%). Regarding awareness, about 90% of the teachers answered that they “strongly agreed” to that “hospital nurses need to think about each patient's life after discharge” and that “every nursing teacher, regardless of his/her specialty, needs to instruct students to think about each patient's life after discharge.” The survey items in educational situations based on community-based integrated nursing for which less than 50% of the respondents answered “do frequently” regarded : local health and medical welfare services, home care support systems, multidisciplinary collaboration, and outpatient nursing. In addition, various educational difficulties on teachers', students', and practical training facility were clarified. In order to enhance community-integrated nursing education, we suggested to train teachers at nursing schools in community nursing knowledge and engage with the community.