This study aimed to explore the adaptation process of fathers to the loss of their baby in the perinatal period and clarify father’s care needs. We conducted semi-structured interviews of 12 fathers who had experienced a perinatal loss of their baby and analyzed data using a modified grounded theory approach（M-GTA）for adaptation process, and by categorizing the interview data for father’s care needs.

The M-GTA analysis on adaptation process extracted six categories and 38 concepts. Fathers were shocked by the unexpected death and felt emotional distance from their wife. They tried to come to terms with their grief and give support to the wife in their own way. Through conducting the father’s role, they were lead to a sense as a father. Once they recovered from the grief and saw their wife well-adjusted, they started to restructure their family and adapted themselves to daily life. They needed grief counselling and support to have a sense of father. They required information on pregnancy and delivery as well as how to support their wife. Nurses need to provide moral support for the fathers to allow them to be able to express their emotion and assist them having a sense of father and playing a role as a caregiver to their wife.

This study aimed to clarify the care currently provided to fathers who had experienced a perinatal loss of their baby and what midwives think they need to learn for their perinatal loss care. We conducted an anonymous self-administered questionnaire survey to 318 midwives with experience of perinatal loss care working at obstetrics in general hospitals. A total of 197 valid responses were analyzed. Out of 29 care items, the items provided by less than 30% of midwives and by a sole midwife were；referral to a counselor, providing information about genetic counseling, referral to post-discharge support contact, continued support after discharge, and referral to self-help group. In addition, less than 60% of midwives explained father’s grief process and only 50% conducted this process alone. Many midwives provided information on how to support the grieving mother, however, only 20% performed it constantly. Ninety percent of midwives had difficulty providing care to fathers but understood the need for quality care for fathers. Ninety-six percent of midwives hoped to learn about fathers’grief process and the required care as well as useful techniques by undertaking perinatal loss education. The study suggests the needs to conduct education to midwives about fathers’grief process and necessary care and to assist fathers to support the grieving mothers. The study also suggests that midwives need support to develop their skill of providing perinatal loss care by undertaking relevant, enriching education.

We experienced a case of postoperative ruptured pseudoaneurysm of the gastroduodenal artery, which could be successfully managed by means of transcatheter arterial embolization.

A 58-year-old man underwent pancreaticoduo-denectomy with a modified Child’s reconstruction for advanced pancreas head carcinoma（T4N1M0StageⅣA）．On the 21th day after the operation, suddenly he had an abdominal pain and had a rapid decrease in blood pressure to 60mmHg mark. Emergency endoscopy faild to reveal any sources of bleeding. CT revealed a large amount of hematomas and coagulations in the abdominal cavity and the gastrointestinal tract. Contrastenhanced CT and angiography also showed a pseudoaneurysm on the stump of the gastroduodenal artery, which had no extravasation and was successfully embolized using microcoils. Thereafter his clinical course was uneventful and was discharged on 20 days after TAE. A right hepatic artery branched off from SMA in this case, so there were no appearance of liver abscess or liver infarction after TAE. This case had no clinical symptom of postoperative ruptured pseudoaneurysm. So we probably should perform CT examination at short interval after PD for early diagnosis and early treatment of unruptured pseudoaneurysm. An acute abdomen after PD should be considered possibly due to rupture of the pseudoaneurysm of the celiac artery branches. The cooperation closely among surgery and internal medicine and interventional radiology should be necessary to treat ruptured pseudoaneurysm.

We experienced a 2cm less of breast cancer with isolated cerebellum metastasis. A 61-year-old woman was referred for nausea and gait disturbance. CT（computed tomography）scan and MRI（magnetic resonance imaging）for the brainsystem revealed a mass in the cerebellum. MMG（Mammography）and US（ultrasonography）revealed a mass 1.5cm in diameter, but which was not diagnosed on needle biopsy. Subsequent PET（positron emission tomography）revealed abnormal accumulation of the left breast and the left axilla and CT revealed multiple lung metastases. We diagnosed a breast cancer with metastasis of the lung and the left axilla and the cerebellum. We decided to treat it from life-threatening lesion in order. At first, the cerebellum metastasis was removed surgically and received cyber knife therapy. 5 weeks after the surgery, she was administered four cycles of the combined chemotherapy of EC（epirubicin/cyclophosphamide）regimen. She achieved clinical PR（partial response），but a mass shadow of the breast cancer in US was remained after the chemotherapy. We tried the needle biopsy again, and scirrhous carcinoma was diagnosed pathologically. Then, a partial mastectomy with SLN（sentinel lymph node）biopsy was performed over 4 weeks after chemotherapy. To date, there was no subsequent growth of metastatic tumors, and good control was obtained. In general, chemotherapy alone against metastatic brain tumor is not effective because of the Blood Brain Barrier, but operation followed by combination therapy of chemotherapy and radiation may prolong survival time.

We experienced a case of human fascioliasis. A 54-year-old female was refered to our hospital with low grade fever and remarkable hypereosinophilia. The laboratory findings included white blood cell 11500/?l with 59% eosinophils and elevated levels hepato-biliary enzyme. Two weeks later, computed tomography demonstrated migrating low-density areas and liver biopsy revealed eosinophilic abscess and granulation. The diagnosis was made by the serological test and eggs in the feces were negative. Treatment with triclabendazole resulted in disappearance of the abnormal liver radiographic findings, and a reduced blood eosinophilic level. This parasitic disease is a neglected infectious disease. We conclude it is necessary to keep in mind that hypereosinophilia and migrating liver abscess are suggestive of human fascioliasis.