Background and Aim: Surgical emergencies comprise a wide range of illnesses, including acute abdomen, and affect a wide range of age groups. These cases require, emergency attention, including emergency surgery, even when medical resources are limited.

Methods: We retrospectively investigated 144 surgical emergencies in our department from March 1, 2020, to March 31, 2021.

Results: Appendicitis (66 cases) and cholecystitis (23 cases) were common among patients who underwent emergency surgery; their ages ranged from 6-96 years, with those in their 80s accounting for 22％ of the total number of cases. Fourteen patients in their 60s and 80s were taking antithrombotic drugs. There were no perioperative deaths. About 10 emergency surgeries are performed monthly, with more surgeries on Mondays and Fridays of the week. More than half of the cases on Mondays were direct visits or ambulance admissions. Most of the cases on Fridays were referred from other hospitals.

Conclusions: We reported emergency surgeries safely performed in the elderly and patients taking antithrombotic drugs. This indicated the need for appropriate treatment including emergency surgery according to each case.

Purpose: Palliative care is poorly provided to people dying of amyotrophic lateral sclerosis (ALS) . This study aimed to clarify the circumstances of morphine use in patients with ALS who were treated with morphine in the final stage of their lives, the responses of patients and their families, and the views of home visiting nurses on the use of morphine.

Methods: Semi-structured interviews were conducted with four home visiting nurses having experience in supporting patients with ALS using morphine.

Results: Morphine was primarily administered for respiratory distress, for 0.5 to 7 months. All patients recognized the positive effects of morphine and were treated at home until the end of their lives. While some families were positive about morphine use, others were reluctant to use it but changed their minds after use. Four categories were extracted from home visiting nurses’ views, such as confirmation of morphine effect and approval of morphine use, and the importance of providing explanations to patients and their families.

Conclusion: The use of morphine for treating the symptoms of ALS was effective in alleviating respiratory distress and improving quality of life. Challenges to providing better home-based palliative care with morphine use include improving awareness among physicians and nurses regarding safe management of morphine by reinforcing education and training, and organizing the homecare support system for the management of morphine use at home.

Purpose: Oncologists should inform young patients about fertility issues during cancer treatment and support their serious decision-making on fertility preservation. In the present study, we investigated current status of the cooperation within an oncofertility team for younger patients with breast cancer at our cancer center lacking for reproductive specialists.

Methods: Patients younger than 40 years old who underwent breast surgery from January 2013 to December 2019 at Saitama cancer center were examined. Subjects of clinicopathological factor and the status of fertility preservation were identified from the clinical records.

Results: 168 patients aged 26-39 (median 36) years old were included, of which 30(20%) were classified as ER negative and HER2 negative cancer. 69% of patients with invasive carcinoma underwent chemotherapy. 39% of unmarried patients, 68% of married without a child and 23% of married and having children required fertility. 8 patients underwent reproductive technology following the diagnosis of breast cancer.

Conclusions: A considerable number of patients with breast cancer turned out to be requiring fertility. It is important to establish and make good use of the oncology-reproduction network in this cancer center having the advantage of professional oncology team.

Purpose: The objective of the present study is to evaluate the influence of omitting the intraoperative frozen section analysis (FS) of the sentinel lymph nodes in breast cancer surgery.

Methods: Study 1. The influence of omitting FS in 454 patients who underwent sentinel lymph node biopsy from January 2008 to December 2009 was investigated. We also analyzed the influence of omitting FS in 308 patients who were eligible for omitting complete axillary lymph node dissection after a positive sentinel node biopsy based on the ACOSOG Z-0011 criteria. Study 2. We applied SNB without FS from July 2015 to December 2016 and investigated the safety of this method in 207 patients.

Results: Study 1. The rate of suggested necessity for the 2nd axillary surgery was 3.2% in Z-0011 eligible group. Study 2. The rate of 2nd axillary surgery was 2.4% and regional recurrence occurred only in 1 (0.5%) patient.

Conclusion: In the present study, the essence of SNB and the final diagnosis did not change by omitting FS. The rate of 2nd axillary surgery was small enough by applying the Z-0011 criteria and we could safely accomplish the purpose of SNB without FS.

Purpose: The objective of the present study was to evaluate the value of multidisciplinary treatment with surgery for locally advanced breast cancer.

Methods: We retrospectively analyzed clinicopathological features of 136 stage Ⅲ-breast cancer patients who underwent breast surgery from January 2012 to December 2016.

Results: Objective responses of primary systemic therapy were observed in 86% of patients and the rate of pathological complete response was 15%. 13 (10%) local, 24 (18%) regional and 36 (26%) distant recurrences occurred during the follow -up period. The 5-year relapse-free survival rate was 65%. Kaplan-Meier survival analyses showed a significant difference in relapse-free survival by pathological lymph-node stage. Multidisciplinary treatment with systemic therapy, large skin resection and a rhomboid flap reconstruction was effective in a patient with skin invasion.

Conclusions: It is necessary to select an optimal treatment according to the stage and biology of each patient with advanced cancer. Multidisciplinary treatment with new pharmacotherapy and ingenuity of surgery was considered effective in locally advanced breast cancer.

Aims: To clarify the extent of implementation and longitudinal changes in the difficulty of utilization of practical teaching elements (6 categories, 24 elements) incorporating community and home health care perspectives into hospital nursing, and suggest methods to promote their utilization.

Methods: A questionnaire survey of clinical instructors and teachers who participated in a” Workshop on Practical Teaching Elements for Community-based integrated Nursing” was conducted at two time-points: immediately after the workshop and three months later.

Results: A total of 16 participants responded, of whom 44% had less than 5 years of practical teaching experience. After three months, more than 80% indicated that they practiced 22 teaching elements. For all 24 teaching elements, the difficulty of utilization increased after 3 months. Descriptions about the difficulties in practical teaching included “students’ and instructors’ lack of knowledge and learning problems” and “difficulty in changing the status of awareness about community-based integrated nursing”.

Conclusions: The understanding of the meaning of each of the teaching elements was deepened by participation in the workshop, which increased the realization of difficulties in actual practice. In order to promote utilization, it is necessary to add a concrete explanation for each element.

Aims: This study aims to clarify parents’ feelings with regard to bringing up their preschool-age children with autism spectrum disorder, focusing on how they feel about their children’s enrolment in school/preschool.

Methods: A free description type questionnaire survey was conducted with 22 parents of preschool-age children diagnosed with autism spectrum disorder and data were analyzed using Berelson’s content analysis.

Results: Feelings about childcare were classified into nine categories: burden of everyday care, anxieties about childcare, feeling sorry for the child, pain brought by lack of understanding from others, positive feelings about childcare, joy from discovering changes in the child, alleviation of childcare burden through receiving support, desire for treatment and intervention services, and longing for opportunities to interact with others in similar situations. Feelings about their children’s enrolment in school/preschool were classified into six categories: anxieties regarding situations that may occur in group settings, anxieties about support provided by the school/preschool, being at a loss for whether to choose regular or special needs classes, anxieties about others’ understanding of their children, expectations for their children’s development/autonomy, and demands and expectations for school/preschool.

Conclusions: Parents have various anxieties as well as expectations with regard to their children’s enrolment in school/preschool because it presents a new environment their children must adapt to.

Objective: Recovery orientation refers to an attitude of believing that one can recover from mental illness. A modified Japanese version of the Recovery Knowledge Inventory (RKI-mJ), which assesses the recovery orientation of professionals, was prepared in this study with permission from the original authors.

Methods: An anonymous questionnaire survey of nurses and public health nurses with experience in supporting people with mental illness was conducted via the internet. The questionnaire comprised the RKI-mJ, which assesses recovery orientation, as well as questions about participant attributes and details of experience in interacting with people with mental illness.

Results: The current study obtained 183 responses (response rate, 28.2 %). Seven components were yielded using the principal component analysis of the RKI-mJ. The yielded components were components 1 severity of mental symptoms and recovery, 2 process and responsibility of recovery, 3 decision-making in recovery, 4 support and risks to recovery, 5 people to whom recovery support is directed,　6 active effort toward recovery, and 7 expectation for recovery. Each component was composed of three to five items, except for components 6 and 7, which had only one item.

Conclusion: The component structure of the RKI-mJ was different from that of the original version. Nevertheless, five components important for recovery support were yielded. Additional assessment of the constituent items is needed, because components 6 and 7 were composed of only one item each.

Objective: This study aimed to identify the process by which continuing peer support activities supported the recovery of persons with mental illness.

Methods: Semi-structured interviews were conducted with 12 peer supporters belonging to an outpatient mental health facility. The peer supporters were asked how their ways of daily living and thoughts changed through the peer support activities, and the content was integrated using the KJ method.

Results: The content as stated by peer supporters was integrated into six categories: “I could maintain good conditions,” “I could understand people around me,” “I want to help my peers,” “I want to continue working,” “I want to contribute to society,” and “I was able to accept myself.” According to the subject narratives, working freed them from their own worries and symptoms, and they learned to understand others as they came to realize that they had a lot in common in terms of their individual worries. They then followed the process of continuing to engage in peer activities that were helpful for their peers, finding a goal of contributing to society, and ultimately learning to accept themselves while co-existing with illness.

Discussion: In this process, it was suggested that the recovery of people with mental illness was supported by their intention to share and make good use of their own experiences with their peers.

　　A 72-year-old man visited our hospital with complaints of loss of appetite, abdominal pain, and weight loss. Physical examination revealed a painless mass in the upper left abdomen. A blood test revealed renal dysfunction and mild liver damage. Abdominal CT showed a mass lesion with a major axis of about 20 cm on the greater curvature side of the gastric corpus, a large number of soft shadows in the abdominal cavity, and a 30 mm-sized tumor in the liver S6. Upper gastrointestinal endoscopy revealed an ulcerative lesion deeper than UL III on the posterior wall of the curvatures of the middle body of the stomach. As a result of biopsy, immunohistochemical staining was positive for c-kit and weakly positive for CD34, so the diagnosis was gastric GIST. Since peritoneal dissemination and liver metastasis were observed, we judged that surgery was not indicated. On the 10th day of hospitalization, gastric perforation due to tumor self-destruction developed, so partial gastric resection including the main tumor was performed by emergency surgery. After the operation, administration of imatinib was started. CT examination 6 months after the operation revealed dissemination and liver metastasis almost disappeared. Disease control is maintained 12 months after surgery.

　　A male patient in his 80s presented with acute left inguinal and femoral pain and a painful subcutaneous nodule sized approximately 6 cm. Enhanced computed tomography showed a ruptured left deep femoral artery aneurysm. Accordingly, the patient underwent resection of the aneurysm and reconstruction of this artery. His postoperative course was uneventful. In daily clinical practice, deep femoral artery aneurysms are rarely diagnosed in emergency rooms.

　　A 63-year-old man presented with a one-month history of right lower abdominal pain. He had a fever. Physical examination showed a 15-cm immobile mass in the right lower quadrant with redness and tenderness, but without rebound or guarding. Computed tomography showed an abdominal wall abscess in contact with the body of the appendix. We surmised that the abscess had formed due to appendicitis. Percutaneous drainage was performed. However, the right lower abdominal pain and inflammation of the appendix persisted, so, we performed an appendectomy. We found the omentum and terminal ileum were adhered to the abdominal wall, and the body of the appendix was adhered to the abdominal wall in the omentum. A fistula between the abdominal wall abscess and the body of the appendix was suggested. On histopathology, a pseudo-diverticulum and evidence of a confined neuroendocrine tumor lesion around the diverticulum were found. An abdominal wall abscess formation due to perforated appendiceal diverticulum was diagnosed. An abdominal wall abscess is extremely rare. Also, we review the literature about the association between appendiceal diverticulum and appendiceal neoplasm.

　　We experienced a case of quad fever after spinal cord injury. The patient, a 17-year-old male, had cervical spinal cord injury with cervical dislocation and fracture by sports accident. He developed hyperthermia 14 hours after admission, which continued in spite of using antipyretics and axillary/inguinal ice packs cooling. He had no evidence of infection and other cause of fever. On day 12, temperature exceeded 42℃. Blood, urine and sputum culture were negative. Identifying the cause of hyperthermia was difficult, but extracorporeal cooling pad device （Arctic Sun^TM） was successfully used to normalize his body temperature. Quad fever is defined as a condition of uncontrollable hyperthermia with no identifiable cause that develops after spinal cord injury. Diagnosis of quad fever was made after excluding infectious or noninfectious causes of fever. The mechanism, pathogenesis and treatment are not well understood. Antipyretics and common cooling procedure are often ineffective and the condition may be fatal. Arctic Sun^TM might be effective for Quad fever.

Objective: By reviewing the literature, we will clarify what students have learned in lectures and exercises in fundamental of nursing by educational method.

Methods: Using the keywords of “undergraduate nursing education,” “nursing techniques,” “fundamentals of nursing,” “lectures,” “practices,” “nursing students,” and “learning,” we searched original papers on nursing published between 2010 and 2020. We narrowed the search down to 12 cases that provided details of learning for literature examination.

Results: We organized the details of learning in the 12 cases based on different teaching methods, as follows: five cases of “learning from lectures and practices that utilize case studies,” four cases of “learning from instruction by clinical nurses and others,” and three cases of “other.”

Conclusion: Through case studies, the students learned about individualized nursing. They also learned about clinical practice from clinical nurses. Promoting the awareness of students via case studies and instructing them on practical nursing by clinical nurses led to clearer images of nursing among the students.