[in Japanese]

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[in Japanese]

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The purpose of this study was to clarify the specialized home care support provided by Dementia-related Disease Medical Center （Medical Center）and their collaboration with Community General Support Center（General Center）． We targeted the expert staff of both Center in Kumamoto Prefecture. Semi-structured interviews were performed and data were analyzed in a qualitative and descriptive way. The extracted home care supports were triage, handing over patients to Medical Center, timely intervention, construction of community cooperation system, expert medical care, arrangement for patient’s transition to home, and assistance to select a best living place. Emerged items on collaboration with General Center were categorized into three；the roles of Medical Center, construction of day-to-day cooperation between Medical Center and General Center, the role of General Center. It was revealed that Medical Center provides home care support to people with dementia by playing their specialized roles such as triage, timely intervention, and expert medical care, as well as construction of community cooperation system. For the achievement of the required home care support, it is important that Medical Center pursues their specialized and expected roles. This study suggests that a policy measure is necessary to assist General Center to develop a community cooperation system.

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We held medical seminars for high-school students who hope to become physicians to increase their motivation and to encourage them to enter Yamaguchi University. The seminars were held two or three times a year at hospitals in six locations in Yamaguchi prefecture between 2011 and 2014, and consisted of observation of facilities in hospitals, physician lectures, experience of medical practice, and Q&A sessions with physicians and medical students. A total of 210 high-school students participated in 11 seminars. The questionnaires for the participants showed 89.9% of the participants rated the seminars“very good”and 91.4% responded,“my motivation was strengthened”．Of the seminar participants, 20 of 69 high-school graduates entered the Yamaguchi University School of Medicine. The follow-up survey showed that the percentage of medical school students studying at Yamaguchi University was 69.0%（20/29）for seminar participants and 45.5%（46/101）for non-seminar participants. The results suggest that the medical seminars were as effective as expected in encouraging high-school students to become physicians and to enter Yamaguchi University.

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We report a case of angiosarcoma treated with combination chemotherapy（MAID：mesna, adriamycin, ifosfamide, dacarbazine）．A 67-year-old man presented with an ulcerated, dark-red nodule and erythematous plaques on the scalp and upper left face. A skin biopsy of the lesion confirmed angiosarcoma. He was treated with MAID combination chemotherapy every 3 weeks due to unresectable tumor. After completing the fifth cycle, the lesion was decreased in size. MAID combination chemotherapy may offer a promising treatment option for angiosarcoma. Further investigations are necessary to confirm the efficacy of MAID combination chemotherapy for angiosarcoma.

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A 66-year-old man was admitted because of chest burning sensation. Endoscopic examination revealed mass lesion at the middle esophagus. Endscopic biopsies revealed squamous cell carcinoma. Preoperative CT and PET showed swollen lymph nodes of the bilatetal hilar lesions, mediastinum, abdomen and right supraclavicular lesion. The supraclavicular lymph nodes was extirpated. Noncaseating epitheloid cell granulous could be seen in the specimen, suggesting sarcoidosis. Chemotherapy using FP（Cisplatin and fluorouracil）regimen reduced accumulation of the PET, but multiple lymph node swellings being not changed. However, the patient underwent esophagectomy with D2 dissection. The resected specimen showed metastasis in only one lymph node, but noncaseating granuloma were seen in some lymph nodes. The patient discharged on 19th days after the operation, and he received 5 times of adjuvant chemotherapy using weekly FP（Nedaplatin+ fluorouracil）regimen. The coexistence of esophageal carcinoma and sarcoidosis and sarcoid reaction is rare, but when regional lymphadenopathy is newly found by radiological examination such as PET-CT, the possibility of systemic sarcoidosis and sarcoid reaction should be considered. In addition, we must not misdiagnose the findings as the advanced stage of esophageal cancer. Differential diagnosis by using the detailed examination is important.

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Antineutrophil cytoplasmic antibody（ANCA）associated vasculitis is characterized by systemic necrotizing vasculitis. We reported a case of ANCA positive refractory otitis media started with otitis media with effusion. The patient complained of progressive hearing loss, which was not improved by treatments with antibiotics. Therefore, the patient entered our hospital. The patient was diagnosed as otitis media with ANCA associated vasculitis（OMAAV），because the serum MPO-ANCA was detected in the first examination in our hospital. After the administration of steroid, her symptoms were sufficiently improved. It is known that otitis media with ANCA associated vasculitis can be secondary associated with polyneuritis and brain hemorrhage. Therefore, the treatment for OMAAV should be performed in cooperation with the internal departments.

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