Laparoscopy allows 10 to 15 times greater magnification of intra-abdominal tissues, organs, and vessels than an open approach. Laparoscopic surgery also improves visualization of the intra-abdominal organs for all surgeons involved in the operation, especially of the retroperitoneal organs, including the pancreas, neighboring vessels, duodenum, adrenal gland, and kidney. In this respect, laparoscopic pancreatic surgery is obviously superior to an open approach, where the ribs and organs anterior to the pancreas obstruct the operative field. Improved visualization also enables precise dissection using forceps. With regard to laparoscopic surgery for pancreatico-biliary malignancies, it is especially important to create a good operative field when dissecting the lymph nodes and pancreatic nerve plexuses where cancer cells easily infiltrate, and to perform R0 resection, which increases long-term survival in patients with pancreatico-biliary malignancies. Additionally, laparoscopic surgery is very useful in educating future healthcare professionals, because it provides the same visual field to all surgeons involved in the operation. The disadvantages of laparoscopic surgery over an open approach include the limited range of motion and the limited sense of touch, because laparoscopy is performed using a number of forceps inserted through trocars. Endoscopic surgeons must determine the most appropriate operative method for each patient, assessing whether laparoscopic pancreatectomy is suitable or not through a full understanding of the advantages and disadvantages of laparoscopic procedures. To date, we have performed laparoscopic pancreatectomies in more than 200 patients. The objective of this overview is to provide a better understanding of how far laparoscopic pancreatectomy has been standardized, based on our major experiences and a review of the literature.

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We surveyed seven teenagers who gave birth without visiting antenatal clinics. Although six of the seven had been aware that they were pregnant, they had not felt able to talk with their parents about their pregnancies.

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Castleman' s disease, also known as giant lymph node hyperplasia or angiofollicular lymph node hyperplasia, is a rare and poorly understood disease characterized by massive growth of lymphoid tissue. We report a case of peripancreatic Castleman' s disease of the hyaline vascular type. A 56-year-old man with a history of back pain was referred to the Gastroenterological Center in our hospital. A surveillance abdominal computed tomography (CT) scan demonstrated a well-circumscribed enhancing mass measuring 3.2×3.1 cm within the body of the pancreas. A nonfunctioning pancreatic endocrine tumor was suspected; therefore, surgery was performed. Only tumor enucleation was performed, because the tumor appeared well circumscribed and encapsulated on intraoperative ultrasonography findings. Histopathological examination showed that the tumor was composed of multiple lymph follicles with concentric layers of mantle zone cells, showing an "onion skin" appearance and atrophic germinal centers. The germinal centers had penetrating arterioles with hyalinized vessel walls. This is a benign disease and good prognosis is obtained by simple tumor enucleation. In this case, it was difficult to diagnose Castleman' s disease before surgery. Surgical excision is a diagnostic as well as curative method for management of this disease. Moreover, we could remove the tumor without resecting any other organs by using intraoperative ultrasonography.

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This paper seeks to address the question how the textual structure of a paragraph can be better described as multilayered than as linear or two-dimensional. In order to explore the possibility of analyzing paragraph development in terms of textual layeredness, conventional prescriptive criteria for paragraph writing is examined. Then, a few examples of paragraphs are discussed in order to show that it is more truthful to describe the multi-faceted functions of a paragraph in a multilayered image of its structure. A model layout is given based on an excerpt from a popular handbook for writers.

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Japan is a country at the forefront of the super-ageing society. Currently, Japan has the longest life expectancy in the world with an average of 83 years of age, and in 2015, twenty-five percent of population will be over 65 years of age. Zaitaku (home care) Medicine, which was developed in Japan, is a style of home care and medical practice that integrates medicine and welfare. In an era where external environment is changing so rapidly, Zaitaku Medicine can become a powerful tool in solving the problems that arise from future unprecedented society. Zaitaku Medicine is important because, in a super-ageing society, the goals of medicine change dramatically from curing diseases and saving lives to that of supporting daily life and living of patients. We are living in times where medicine will share the same goals as welfare. Medicine and welfare will no longer be coordinated, but rather become integrated with each other. Zaitaku Medicine is deeply rooted in the ideas of Primary Health Care (PHC) and Aging in Place (the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level), and places emphasis on Death education. While medical treatment in hospitals is lead by doctors and done intensively, Zaitaku Medicine places patients and their families at its center, and its ideas correspond with the values of Bioethics, which began as a patients’ rights movement. The spirit of Bioethics later evolved to concept of values such as Informed Consent and American Hospital Association Statement on A Patient’s Right Bill (1972), and also includes the value of Health for All (a PHC strategy of WHO to promote health). With that respect, the value of Zaitaku Medicine and Bioethics is deeply connected with PHC. In order for patients to achieve “life with dignity”, a coined opposite term for “death with dignity”, Death education for medical students is indispensable. Other requirements include shifting emphasis to the community and daily life, constructing a new type of care and system that incorporates medicine and welfare and implementing coordination between specialists. Zaitaku Medicine is exactly what will serve as the foundation for these measures. The new 21st-century model of medicine and its systems will be lead by Japan’s Sanya district, which is the microcosm of future Japan.

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