An accurate diagnosis of Parkinson’s disease (PD) is a prerequisite for therapeutic management. In spite of recent advances in the diagnosis of parkinsonian disorders, PD is misdiagnosed in between 6 and 25% of patients, even in specialized movement disorder centers. Although the gold standard for the diagnosis of PD is a neuropathological assessment, neuroimaging has been playing an important role in the differential diagnosis of PD and is used for clinical diagnostic criteria. In clinical practice, differential diagnoses of PD include atypical parkinsonian syndromes such as dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, caused by a striatal dopamine deficiency following nigrostrial degeneration. PD may also be mimicked by syndromes not associated with a striatal dopamine deficiency such as essential tremor, drug-induced parkinsonism, and vascular parkinsonism. Moreover, difficulties are associated with the clinical differentiation of patients with parkinsonism from those with Alzheimer’s disease. In this review, we summarize the typical imaging findings of PD and its related diseases described above using morphological imaging modalities (conventional MR imaging and neuromelanin MR imaging) and functional imaging modalities (^99mTc-ethyl cysteinate dimer perfusion single photon emission computed tomography, ¹²³I-metaiodobenzylguanidine myocardial scintigraphy, and ¹²³I-FP-CIT dopamine transporter single photon emission computed tomography) that are clinically available in most hospitals. We also attempt to provide a diagnostic approach for the differential diagnosis of PD and its related diseases in clinical practice.

Background Dysfunction of the lower urinary tract is the most commoncomplication of radical hysterectomy (RH). However, there are no establishedtreatment protocols for postoperative underactive bladder (PUB). We developedour own new program for the treatment of underactive bladder (UB) after RH andevaluated it retrospectively.

Methods In this program, there are five steps for patients to followaccording to their urinary condition. The first step is the administration ofurapidil 30 mg, voiding six times at a predetermined time each day, and cleanintermittent catheterization (CIC) after each voiding. As the patient’scondition improves, the number of CICs is reduced, and the medication isstopped. The last step includes voiding six times at a predetermined time eachday. When the volume of residual urine (RU) is less than 100 mL, patients moveon to the next step. When the volume of RU exceeds 100 mL, patients return tothe previous step.

Results Of the 75 patients who visited our department, 41 wereeligible for this program. Twenty-two patients visited our department because ofurinary retention (UR), and 19 patients were admitted because of increased RU.The mean RU volume was 276.3 mL (range, 150–550 mL). After completing theprogram, 39 (95.1%) patients no longer required CIC. The mean time to withdrawalof CIC was 25.1 weeks (range, 1–72 weeks). Thirty-six patients no longerrequired medical treatment, including urapidil, for PUB. Of the 5 patients whohad persistent PUB after treatment, 2 patients continued CIC and urapidil, andthree patients continued urapidil alone.

Conclusion The present results demonstrate that the program of CICin combination with urapidil is effective for the management of PUB afterRH.

Background In this study, we aim to highlight the transformation of self-image in patients with type 1 diabetes after diagnosis. Our objective in examining the self-image of these patients is to provide practical insights for nursing, as well as a basic reference for understanding patients.

Methods The participants were 15 patients (2 men and 13 women) over 20 years of age who visited an outpatient setting to treat type 1 diabetes and had no serious complications, and who agreed to participate in the study. Semi-structured interviews were conducted 1–2 times, with a duration of 60–75 minutes per person, from February 2016 to March 2017. We drew on Krippendorff’s (1999) content analysis to carry out our analysis.

Results We identified a total of 107 codes. The self-image of patients with type 1 diabetes was categorized into 8 subcategories and 4 categories. The 4 categories were ‘the wavering of a self-image that is distinct from the past,’ ‘loss of former self-image,’ ‘discovery of a new self-image,’ and ‘developing a new self-image.’ Ultimately, we were able to extract a fifth core category, ‘acquisition of a new self-image.’

Conclusion The self-image of patients with type 1 diabetes transformed from a negative to a positive one; ultimately, patients acquired a new self-image that was congruent with their ideal self-image. Our results showed that the new self-image that patients acquired through various experiences influenced motivation for treatment and continuation of self-care. When caring for patients with type 1 diabetes, it is crucial for healthcare professionals be aware of the meaning that patients derive from their disease and related difficulties, as well as to provide care while considering patients’ self-image.

Background Pediatric chronic renal disease only shows abnormal values in a urinalysis in the initial stage, and subjective signs and symptoms are rare. If adolescents with chronic renal disease face a disease crisis combined with the usual developmental crisis, this may cause psychosocial maladaptation. We analyzed psychosocial adaptation in Japanese children with chronic renal disease in order to identify factors influencing healthy adaptation.

Methods Ten children and adult patients with chronic kidney disease attending Tottori University Hospital, Japan in 2016 participated in a semi-structured interview (a modified version of the grounded theory approach) comprising questions about episodes since disease onset and thoughts/feelings at onset.

Results Twenty-four concepts extracted from the data were sorted into 5 categories. These concepts and categories were expanded on an orthogonal axis with time and self-esteem in order to establish an adaptation model for children with chronic kidney disease. Category names are as follows. (Cat. 1: Emotional impact on being informed of disease, Cat. 2: Social challenges of treatment and resulting identity diffusion, Cat. 3: Emotional conflict on school return, Cat. 4: Resilience and related factors, Cat. 5: Re-establishment of identity).

Conclusion Since pediatric chronic renal disease has few manifestations, it is difficult for patients to accept. Children facing a chronic disease crisis plus adolescent developmental crisis may show identity diffusion. In order for children to re-establish their identity and adapt to society, factors supporting resilience are important. Key factors include school life, interactions with friends, counseling by adult mentors and family acceptance. Healthcare professionals need to provide age-appropriate information on renal disease and support patients.

Background Therapeutic value of lymph node dissection along the superior mesenteric vein (14v) and the posterior surface of the pancreatic head (13) remains unclear in gastric cancer patients.

Methods We reviewed 355 patients with advanced gastric cancer in the lower third of the stomach who had undergone gastrectomy at our hospital.

Results The frequency of lymph node (LN) metastasis was 10.2% and 7.4% in stations 13 and 14v, respectively. The frequency of station 13 metastasis was 26.8% for T3/T4 tumors with group 2 LNs metastasis and 1.4% for all other tumors. The frequency of station 14v metastasis was 22.2% for T3/T4 tumors with group 2 LNs metastasis and 1.8% for all other tumors. The therapeutic values for dissecting LN stations 13 and 14v were 1.9 and 0.9, respectively, similar to the therapeutic value for group 2 LN dissection.

Conclusion Because metastasis to stations 13 and 14v occurs frequently in patients with T3/T4 gastric cancer located in the lower third of the stomach who also have metastasis to group 2 LNs, stations 13 and 14v should be dissected in these patients.

Portal vein stenosis, which results in serious clinical conditions such as gastrointestinal variceal bleeding and liver failure, is caused by hepatobiliary pancreatic cancer or major postoperative complications after hepatobiliary pancreatic surgery. In recent years, portal vein stenting under interventional radiology has been applied as a more useful treatment method for portal vein stenosis than invasive surgery. We herein report the successful use of a vascular stent for portal vein stenosis after pancreatoduodenectomy. A 66-year-old man with distal cholangiocarcinoma underwent subtotal stomach-preserving pancreatoduodenectomy with resection of the portal vein because of direct invasion to the main portal vein at our hospital. The portal vein was reconstructed without a venous graft. He developed jejunal bleeding near the pancreatojejunostomy on postoperative day (POD) 2. Although embolization of the responsible vessel achieved hemostasis, an intraoperatively inserted drainage tube was needed for a long period of time postoperatively because the embolized afferent jejunum was perforated. He was discharged on POD 39 after removal of the drainage tube. On POD 282, he was readmitted with melena and severe fatigue. Computed tomography revealed an obstruction of the reconstructed portal vein and varices at the hepaticojejunostomy site. We diagnosed variceal bleeding and performed percutaneous transhepatic stenting in the obstructed portal vein. The patient was discharged in good clinical condition on day 15 after stenting. In conclusion, portal vein stenting is a useful and less invasive therapy for portal vein stenosis.

The standard procedure for remnant gastric cancer after esophago-proximalgastrectomy is total resection of the remnant stomach considering blood supply.However, sometimes surgery may be too invasive due to severe adhesion in thethoracic and mediastinal cavity. The blood supply to the remnant stomach dependson the right gastroepiploic artery and the right gastric artery. Therefore,preservation of the proximal region of the remnant stomach is thought to beanatomically impossible. We report a case of remnant gastric cancer thatdeveloped more than 12 years after lower thoracic esophagectomy plus proximalgastrectomy for Siewert Type I squamous cell carcinoma. We used intra-operativeindocyanine green (ICG) venous-injection to evaluate blood flow and distalgastrectomy of the remnant stomach was performed by preserving the proximalstomach in the thoracic cavity through an abdominal approach. There were nocomplications of the remnant stomach or the anastomosis to the jejunum aftersurgery. In this case, we focused on the blood supply by collateral circulationthrough the anastomotic line from the remnant esophagus. After confirming bloodsupply with intra-operative evaluation using ICG fluorescence, less-invasivedistal gastrectomy was successfully performed. As the intra-operative ICG-basedevaluation for blood supply is a simple and safe method, it might be useful fordetermining the resection margin of various organs and be effective for theintroduction of less invasive surgery. Here, we report a case and a review ofthe literature.