This paper is describing the history of mental health welfare system routed from the psychiatric patient protective law in 1900 and the law of psychiatric hospital as well as the current mental health welfare policy and diverse social support systems. It is indicated that there is a lack of research regarding to the comprehensive evaluation for the community mental health welfare services. The research related to the social support is only focusing on the individual support, clinical report, or problem statement. Therefore, the author discussed that study of mental health welfare policy should be aimed at effectiveness of the social support system through analyzing community environmental factors for people with mental illness.

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We experienced 3 cases having upper gastrointestinal complaint for long time after left hepatectomy. We therefore hypothesized that left hepatectomy may be related to this complaint. We compared the incidence of the complaint between 10 left hepatectomized patients and 10 right hepatectomized patients operating at same period. This complaint occurred in 5 of 10 patients with left hepatectomy, but in only one patient with right hepatectomy. Upper gastrointestinal barium study revealed that displacement of the stomach was carried out to the upper part in 2 patients who had severe dyspepsia. We therefore compared the position of the pylorus using computed tomography between 5 symptomatic patients and 5 non-symptomatic patients having left hepatectomy. The vertical distance between the pylorus and the gastric fundus in symptomatic patients was significantly smaller than that in non-symptomatic patients. Since the deformity of the stomach may be due to the large dead space after left hepatectomy, we performed the fixation of the greater omentum to the abdominal wall to keep the gastric position after left hepatectomy in 5 patients. As a result, no patients complained upper gastrointestinal symptoms. We think the fixation of greater omentum to the abdominal wall after left hepatectomy is useful to maintain the good postoperative course.

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A 7-year-old female was admitted to our hospital for the treatment of funnel chest. We performed an operation using Nuss procedure, not conventional procedure. Good cosmetic result was obtained because chest wall deformity was corrected properly with this procedure and surgical wound was small and not worrisome. She discharged at 10th day after the operation. Nuss procedure may be good treatment for funnel chest.

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A 57-year-old woman was admitted to our hospital because of constipation and narrowing of the stool. The colonoscopy demonstrated rectal stenosis and multiple elevated lesions of the rectum, but the rectal mucosa was smooth. A biopsy was performed and histological studies revealed a concentration of poorly differentiated adenocarcinoma cells with signet ring cells at the lamina propia mucosae and submucosa. Because the epithelium showed no atypia, we explored the origin in the sense that might be metastatic tumor. Coexisting gastric cancer type 4, which was diagnosed by gastrointestinal endoscopy, was considered to the primary lesion. If we detect rectal stenosis with multiple elevated lesions, it is important to consider the possibility of metastatic cancer since a histological study for metastatic cancer of the rectum was frequently negative.

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The extraction of impacted mandibular third molar is a frequently performed as minor oral surgery. We report a case of the extraction of impacted mandibular second and third molars by sagittal splitting method.
A 31-year-old woman referred to our hospital because of the pain and the swelling of right mandibular angle. She was diagnosed as pericoronitis of second and third molar of the right mandible. Panoramic radiograph revealed that the second molar was impacted in the lower region of the mandible. We judged that it was difficult to extract this tooth by a normal method. Then, we extracted by sagittal splitting of the lateral cortical bone under general anesthesia. The course after the operation was good and the paresthesia of right mental region did not appear.

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A 73-year-old man admitted in our hospital suffering from ileus.
He had three times of abdomen operation previously. He had ileus attack three times the last two months. Intussusception was suspected from CT image and operation was done. Upon laparotomy, there was a cystic lesion with an enterolith in small intestine, 140 cm distal to the ileocecal region. The enterolith was oval shaped, 5.0×3.8cm in dimension. This cystic lesion was duplication of the alimentary tract because of having muscular layer. This duplication with enterolith caused a stenosis on neighboring small intestine. Enterolith in duplication of small intestine is very rare in Japan. The computed tomography is valuable for diagnosis of the cause of ileus.

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A 74-year-old man was admitted to our hospital with dyspnea and systemic generalized edema. Liver enzymes were slightly elevated and severe anemia was present. The tumor (7cm diameter) in the left lateral segment of liver was revealed at the ultrasonography. Cholangiocellular carcinoma or hemangiosarcoma was suspected from CT images, but after MRI hepatocellular carcinoma, hepatocellular adenoma, metastasis of malignant melanoma or angiomyolipoma was also included in differential diagnosis. Due to huge tumor size and thin peritumor tissue and not to cause tumor cell dissemination, ultrasonographic percutaneal needle biopsy was not performed. At the operation needle biopsy was done. Rapid histological study was reported as hepatocellular adenoma. Left lateral lobectomy of liver was done. There are a few reports about hepatocellular adenoma in Japan. Some of them also had difficulty in differential diagnosis. Needle biopsy during operation should be considered as one of the useful methods to decide the resection area of the liver.

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A 59-year-old man admitted to our hospital suffering from lower abdominal and back pain. Acute appendicitis was suspected from the results of blood test, computed tomography. Appendectomy was done. The histological diagnosis was Goblet cell carcinoid of vermiform appendix. Eight days later, ileocecal resection was done. Goblet cell carcinoid of vermiform appendix is a rare disease in Japan. It has both the characters of carcinoid and adenocarcinoma, and has poorer prognosis than argentaffin carcinoid and argyrophil carcinoid have. It is important to investigate the specimen macroscopically and microscopically at the treatment for appendicitis, considering the hidden carcinoid, although it is rare.

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