Multiple endocrine neoplasia type 2 (MEN2) is an autosomal, predominantly hereditary disease characterized by medullary thyroid carcinoma, pheochromocytoma, and primary hyperparathyroidism; it is classified into type 2A, type 2B, and familial medullary thyroid carcinoma (FMTC). The last decade has seen improvements in the treatment and management of MEN2 in Japan. The establishment of a Japanese MEN database and the publication of a MEN clinical guidebook have played an important role in promoting effective management of the disease in our country. Our knowledge of MEN2 has expanded greatly, and in this review, I summarize our understanding of the disease based on recent discoveries.

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Basic research has produced a wealth of knowledge regarding the molecular mechanisms of cancer development, and antineoplastic agents that target specific molecules have been developed. These agents have the potential to revolutionize cancer management in terms of the risk/benefit ratio of treatment. This review article provides general concepts of pharmacokinetics and pharmacodynamics data of molecularly targeted agents, e.g. erlotinib. Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor that has been used to treat nonsmall cell lung cancer and pancreatic cancer.

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Laparoscopic incisional hernia repair with mesh is widely performed in Western countries as a treatment that is considered more reliable than conventional open repair. However, this procedure is not common in Japan. We report our experiences with this procedure using a new type of mesh (Ventralight ST ^TM, Medicon, Osaka, Japan). This procedure is indicated for almost all patients with incisional hernia but was difficult to perform for patients with giant hernia of the flank after nephrectomy. The procedure is performed with the patient in the supine position and 4 or 5 ports. One port is a 12-mm port, and the others are 5-mm ports. First, the 12-mm port is inserted in the left hypochondrium by the optical method. After pneumoperitoneum is established, we observe the abdominal cavity with a 5-mm flexible endoscope and insert the other ports, while dissecting peritoneal adhesions as necessary. We measure the hernia and trim the mesh to secure at least a 3-cm overlap with the normal abdominal wall. We insert the mesh through the 12-mm port, lift it to make tight contact with the abdominal wall by means of a transfixed thread, and fix the mesh with spiral tackers. We have performed this procedure for 14 patients. The mean operative duration was 127 minutes, and the average postoperative hospital stay was 5.9 days. There were no complications except for seroma, and the patient satisfaction was extremely high. In conclusion, laparoscopic incisional hernia repair with mesh is a useful and promising treatment that will, we believe, be introduced in many institutions in Japan.

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Purpose:To report a case of severe dry eye associated with high myopia by combination therapy with diquafosol tetrasodium and sodium hyaluronate enabled the wearing of hard contact lenses (HCL) and improved symptoms.Case: The patient was a 76-year-old woman for whom sodium hyaluronate was prescribed because ophthalmic dryness and a foreign-body sensation made her unable to wear HCL. The symptoms, however, did not improve, and she consulted our clinic. Because she strongly wished to wear hard contact lenses, I prescribed topical administration of diquafosol tetrasodium and sodium hyaluronate.Result: With this treatment the objective findings and symptoms improved, and the patient was able to wear HCL.Conclusion: Patients with severe dry eye should avoid wearing HCL, but combination therapy with diquafosol tetrasodium and sodium hyaluronate may allow the wearing of hard contact lenses in special cases, such as this case.

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A 67-year old woman underwent bilateral oophorectomy for the treatment of ovarian cancer (serous adenocarcinoma, pT3cN0M0 Stage IIIc) in 2012, and postoperative chemotherapy was started. Ten months after operation, the serum level of CA125 was elevated (57.6 U/mL). Eighteen months after operation, an abdominal CT scan showed a mass in the spleen, 15 mm in diameter. Twenty three months after operation, splenic mass had increased to 24 mm in diameter. We diagnosed solitary splenic metastasis from ovarian cancer, and performed laparoscopic splenectomy. The pathological diagnosis of the splenic tumor was serous adenocarcinoma compatible with metastasis from ovarian cancer. She was discharged on 5^th postoperative days and underwent another adjuvant chemotherapy. Since solitary splenic metastasis from ovarian cancer is rare. The laparoscopic splenectomy is a safe and effective for the management of splenic tumors.

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Survival time data analysis and the proportional hazard model are explained. In particular, through concrete examples that appear in medicine, hypothesis testing and interval estimation with the software package SPSS are described.

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This study was conducted to examine how a patient discharge support training course for nurses changed the actual patient support process. We asked 11 chief nurses who joined the course to complete a questionnaire three times: before, during, and after the course. Significant changes were observed over time in their responses to 17 of the 24 questionnaire items that have a direct bearing on the patient discharge support process. The items that showed no significant differences were those that required working with other health professionals, including doctors and nurses. The results suggest that education on collaboration among health professionals and encouragement of teamwork should be explored to improve patient discharge support.

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