Recently, laparoscopic surgery, which is lower invasive than conventionally laparotomy, has been introduced for the treatment of perforated gastro-duodenal ulcers. However, the laparoscopic closure is difficult for a beginner, and makes operation time extend. The degree of low invasiveness and the degree of surgical difficultness in a laparoscopically assisted closure were not clear, we compared them between twelve patients who underwent laparoscopically assisted closure and thirteen patients who underwent conventional closure. There was no difference in a background factor among both groups. In the laparoscopically assisted group, hospital stay and postoperative resumption of oral ingestion were significantly short (p<0.01), and WBC and CRP was a significantly low at 7^th day after the operation. There were no significant differences in amount of bleeding, operation time, postoperative complications and relapse rate. These findings suggest that the laparoscopically assisted surgery is less invasive without surgical difficultness than conventional closure.

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We report the outcomes of Complex Decongestive Physiotherapy (CDP) for a breast cancer patient with postoperative lymphedema. CDP is a representative conservative treatment for lymphedema andis conducted by combination of four kinds of physical therapies. These are : skin care, manual lymph drainage (MLD), bandage and exercise.
The patient was a sixty-year old woman, five years postoperative after mastectomy. She had Grade II edema in her left arm. We practiced MLD once a week, and also educated her about skin care, self-massage and exercises and advised her to keep wearing the crepe bandage. Seven months later, the swelling was reduced in her arm, as measured by arm circumferences. Her subjective feelings of malaise and notion that her arm was bodily detached from her (not part of her) disappeared. Her condition improved and as she continued to do the self-care, we decided to finish her interventions at outpatient setting.
More research is required about CDP for patients with lymphedema, focusing on the usefulness and effectiveness to improve their quality of life. And we need to try to establish adequate support systems for them.

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