マンモグラフィ ケンシン ニヨル ニュウガン シボウリツ ゲンショウ コウカ ト ホンポウ ノ ニュウガン ケンシン ノ カダイ

In Japan, breast cancer screening had been done by physical examination alone. Mammographic screening has been effective for women aged over 50 years in Japan.When mammographic screening is introduced to the screening for breast cancer, how to control the quality of screening is an important problem and it seems necessary to control the qualities of imaging and data analysis. In the Japan Association of Breast Cancer Screening, a central committee on quality control for mammographic screening was established with cooperation of related medical societies. This committee including the education/training subcommittee and facility/image assessment subcommittee was the first system for the cancer screening since such system has not been established in the cancer screening of other organs in Japan

テンイソウ デ ホルモン ジュヨウタイ ノ ヘンイ オ ミトメタ ニュウガン ノ 1レイ

A 44 year old woman visited the hospital with complaint of the right breast tumor which she left for two years. She presented with a large mass of８．５cm in diameter with skin invasion, right axillar lymph nodes, multiple liver, and bone metastases. Core needle biopsy of the main tumor revealed an invasive ductal carcinoma（scirrhous carcinoma）with nuclear grade 2 with ER（＋）,PgR（＋）, HER2（－）. The patient was treated with hormone therapy for three and a half year.The extensive mediastinum lymph nodes metastasis and multiple lung metastasis and a new tumor in the right thyroid lobe were appeared. The liver metastasis also increased in size and number.The therapy switched to chemotherapy with paclitaxel. Although the reductive effect was appeared in the breast mass, lung metastasis and liver metastasis, the thyroid and mediastinal lymph node metastases increased in size aggressively. The cytology of needle biopsy specimen from the thyroid tumor was consistent with breast cancer metastasis. Histopathology of the biopsy specimens from the mediastinal lymph node and the liver metastases also consist with breast cancer metastases, but ER and PgR receptor status converted to negative in mediastinal lymph nodes

Analysis of cases applying shiatsu massage for nursing care

東洋医学の１つの手法である指圧を看護ケアに取り入れた論文の検討を行ない，その効果と問題点を明らかにすることを目的に，『医学中央雑誌』（WEB版ver．３）を使用して１９９３年から２００３年まで１０年間に，看護師による指圧の影響が明らかにできた論文を抽出した．その結果１０論文が得られた．１０論文の内訳は排便障害（便秘）の軽減および排ガスの促進５件，癌化学療法実施時の副作用（嘔気・嘔吐等）の軽減３件，癌性疼痛の軽減１件，リンパ節郭清後に発生した浮腫の軽減１件であった．それぞれの論文に共通して言えることは，患者が指圧について肯定的に捉える場合は，その効果が非常に大きいことであった．さらに指圧の圧迫部位，圧迫の強さ，頻度など，まだ一定の手技と効果が得られていないため，追試験を重ねる必要性が示唆された．Shiatsu massage is one of the common therapeutic methods in oriental medicine, and is considered to be useful for supporting conventional medicine. However, there has been little evidence for its effects. In this report, papers dealing with the application of shiatsu massage to nursing care are extracted from literature, in order to clarify the effects and problems of this method as a nursing care. Papers containing studies of shiatsu massage by nurses as a nursing care were extracted from literature by using the Japan Centra Revuo Medicina (WEB issue, version 3), and those published during 10 years from 1993 to 2003 were analyzed. It was found that the relaxation effects by shiatsu massage were reported for various symptoms. Among these, 10 papers were analyzed in detail, which described the effects on relief of the following symptoms ; dysphasia (constipation) (5 papers), nausea and vomiting at cancer chemotherapy (3 papers), pain from cancer (1 paper), and edema generated after lymphadenectomy (1 paper). It was found from these papers that shiatsu massage is effective for patients who have positive thinking to this therapy. On the other hand, the necessity of further experiments was indicated because of the lack of common methods and effects in this therapy ; for example, position, force, frequency, etc., should be optimized

Neither gynecomastia nor galactorrhea is a common side effect of neuroleptics in male patients

Gynecomastia is known to be a side effect of neuroleptics. The authors investigated the prevalence of gynecomastia and galactorrhea in a group of regularly neuroleptic-treated male patients. Methods : Gynecomastia was defined as a palpable, discrete button of firm subareolar tissue measuring at least 2 cm in diameter. The subjects were 100 male patients who were taking neuroleptic-treatment regularly. Each patient gave informed consent for the research involved in this study. Results : (1) Palpable gynecomastia was present in 2% of the patient group, but not at all in the normal group. (2) Galactorrhea was not present in either patient or normal group. (3) The mean level of the serum prolactin in the group of patients without gynecomastia was significantly higher than that in the normal group, but there was no significant difference in blood luteinizing hormone, follicle-stimulating hormone, testosterone (T), estradiol (E 2) or T/E2 ratio between the groups. (4) The mean level of the T/E2 ratio in the patients with gynecomastia was tended to be higher than that in the group of patients without gynecomastia. Conclusions : Overall, theseresults seem to indicate that (i) gynecomastia is not popular in the Japanese population, and (ii) in male patients, neither palpable gynecomastia nor galactorrhea is a common side effect of neuroleptics. To clarify the relation between gynecomastia and neuroleptic treatment, large prospective studies are required

Self-evaluation study of nursing students’ recognition of their degree of achievement of educational goals in clinical practice

臨地実習指導における教育的な介入への示唆を得ることを目的に，３年課程短期大学３年次学生を対象に，臨地実習開始前・中期・終了後に，国立大学医療技術短期大学部看護学科協議会臨地実習委員会A グループが作成した「臨地実習固有の学習内容」を用いて，学生の臨地実習固有の学習内容に対する到達度の認識に対する調査を行った．その結果，以下の結果が得られた． ①自己評価得点は，実習開始前と比べて終了時に自己評価が有意に上昇したもの（以下上昇群）と，上昇しなかったもの（非上昇群）の２群に大きく分類できた． ②上昇群のうち，段階的に評価が上昇した項目は７項目であった． ③学生は，認知領域は高く自己評価し，学習内容に到達したと認識していた． ④学生は１４項目は終了時に至っても，到達レベルに達していないと自己評価しており，それらの項目は，コミュニケーションや看護過程，理論との照合など看護を深める取り組みに関する内容であった． 以上のことから，教育的な介入として，学生がコミュニケーション技術を有効に用いながら，看護過程を展開し，看護実践を深めることができるように，カンファレンスを有効に活用し，場面を捉えて，学生の学習状況にあわせて，丁寧に指導を行うことが必要であると考えられた．学年進行に伴う到達レベルの詳細な明示など，学生の成長を長期的な視点に立って支援することの必要性が示唆された．Objectives : The purpose of this study was to : assess the nursing students’ recognition of their achievement of their educational goals in clinical practice ; and discuss the clinical teaching interventions of nursing education by means of self-evaluation for the students at a 3-year nursing junior college. Methods : We used the self-evaluation questionnaire (62 questions). Self-evaluation was performed three times : the first was before clinical practice (hereinafter first evaluation), at the middle point of clinical practice (middle evaluation) and after the clinical practice (final evaluation). Results : １．There ware 2 patterns in self-evaluation scores. One was rise, and the other was not rise by comparison between first evaluation and final evaluation. ２．Only 7 scores were improved among 62 questions. They were classified cognitive domain, and they were recognized by the nursing students to be achieved of their educational goals. ３．In the final evaluation there were 14 items for which they had not achieved their educational goals. They were the following items : comparing their clinical practice experience with nursing theory, performing clinical practice while thinking about the nature of nursing and using communication skills, and the process of nursing diagnosis. Conclusions : Nursing students need educational intervention. That is, they need teachers to teach them, or to think with them, how to use the nursing process to overcome patients’ problems in each clinical situation by means of communication skills. It is also important to make effective use of conferences at school to so that student’s can shore experiences

Ultrasonographic evaluation of leg muscle and fatty tissue thickness in postoperative patients with gastrointestinal disease

術後の健康回復の促進に向けた看護ケアの基礎的資料を得るため,超音波診断装置(周波数は7.5MHz)を用いて,開腹による胃あるいは大腸手術を受けた患者を対象に,手術経過に伴う下肢の筋組織厚および皮下脂肪厚の変化を明らかにした.術前,術後離床日,術後10日目,術後20日目の合計4回,下肢の大腿直筋上,大腿二頭筋上,長指伸筋上,ヒラメ筋上にプローブを当て,組織厚を測定した.開腹による胃または大腸手術を行なった患者のうち,合計4回の測定結果が得られた16名を分析対象とした.4箇所の測定部位の筋組織厚および皮下脂肪厚をそれぞれ合計し,筋組織厚総和および皮下脂肪厚総和を算出し,術前値との比較を行なった.その結果,下肢の筋組織厚総和は,術後離床日,術後10日目,術後20日目に有意な減少を認めた.一方,下肢の皮下脂肪厚総和は,術後には有意な減少を認めず,ほとんど変化しないことが明らかになった.胃手術群と大腸手術群の比較においては,胃手術群は,術後10日目から術後20日目にさらに減少し,回復の傾向を示さなかったが,大腸手術群は,術後10日目から術後20日目に下肢の筋組織厚が回復の傾向を示した.よって,開腹術後患者,特に胃手術患者に対して,より細やかな看護観察と栄養評価,および食事摂取量を増やす看護介入の必要性が示唆された.In order to obtain basic data for use in postoperative nursing care intended to promote the recovery of patients after surgery, the authors examined postoperative changes in lower limb muscular tissue thickness and subcutaneous fat thickness by ultrasonography (7.5 MHz) in patients who underwent open surgery of the stomach or large intestine. The ultrasound probe was placed on the skin above the following muscles: quadriceps femoris, biceps femoris muscle, extensor digitorum longus, and soleus. Measurements were taken on 4 occasions: before surgery, and on the 1st, 10th and 20th day after postoperative mobilization. Of all patients who underwent open surgery of the stomach or large intestine, 16 patients were selected for analysis and ultrasonic measurements. Muscular tissue and subcutaneous fat thicknesses at each of the four sites of measurement were totaled to yield measures of total muscular tissue and total subcutaneous fat. Postoperative and preoperative parameters were then compared. The total lower limb muscular tissue thickness at each of the 4 postoperative measurement points was significantly less than the preoperative thickness, whereas the total lower limb subcutaneous fat thickness showed no significant decrease after surgery and remained almost unchanged from the preoperative value. Comparing patients undergoing different types of surgery, leg muscular tissue thickness showed a tendency to recover on the 10th and 20th day after surgery in the colorectal surgery group, while the gastric surgery group showed further decreases in this parameter on the 10th and 20th day, with no trend towards recovery evident over the timeframe investigated. These results suggest the necessity of active nursing intervention for patients after open gastric surgery.G

Relationship between mammary gland structures during pregnancy and breast-feeding

Study Purpose Diagnostic indices for prediction of breast milk production and assessment of care necessary for mammary gland structure during the pregnancy period were investigated. Methods Development of mammary gland during the pregnancy period was examined via ultrasound methodology. Each subject underwent three measurements once per trimester. Quantity of post-partum breast milk production was also measured ; furthermore, the relationship between mammary gland image and production quantity was evaluated. Results and conclusion As previously reported, mammary gland reaches a certain level of development during the course of pregnancy. Four distinct types of developmental pattern were observed. Mammary gland exhibited remarkable development up to the 15th week of pregnancy in comparison with non-pregnant adult females in type 1. In type 2, mammary gland displayed significant development from the 16th to the 35th week of pregnancy. In types 3 and 4, mammary gland tissue development, which was apparent from 35 weeks, was characterized by gland thickness of > 20 mm and < 20 mm, respectively. Among these four types, type 1 mammary gland demonstrated the largest level of breast milk production. Therefore, we suggest that understanding with respect to mammary gland structure during pregnancy contributes toward individual support in breast-feeding following childbirth

A case report of secretory carcinoma of the breast in elderly

A 67-year-old woman was seen at the hospital because of a tumor in the area of the right breast. On physical examination, the tumor was elastic hard and movable. A core needlebiopsy revealed malignant findings' invasive ductal carcinoma. Mastectomy for right breast was performed. Pathological diagnosis was secretory carcinoma. The immunoprofile data were negative for ER, PR, and HER2, and were positive for the S-100, EMA, Adipophilin. She has been free from recurrence and metastasis so far. Secretory breast carcinomas are rare tumors, low-grade triple-negative carcinomas. Distant metastases from secretory breast carcinomas and local recurrence are extremely rare. Standard treatment has not been deciderd yet. We report a case of secretory carcinoma of the breast together with some bibliographical comments

Bilateral male breast cancer with male potential hypogonadism

<p>Abstract</p> <p>Background</p> <p>Male breast cancer is a comparatively rare disease, and simultaneous bilateral male breast cancer is considered to be an extremely rare event. Risk factors are said to be genetic factors and hormonal abnormalities due to obesity or testicular diseases.</p> <p>Case presentation</p> <p>The patient was a 47-year-old Japanese male. His family had no history of female breast cancer. This patient also had hypospadias and hormonal examination indicated the presence of primary testicular potential hypogonadism, and these hormonal abnormalities seemed to be present since childhood or the fetal period. The bilateral breast cancer developed in this man at a comparatively young age, and histopathological studies of multiple sections showed that there was almost no normal epithelial cell in the ducts, while the ducts were almost completely filled with breast cancer cells.</p> <p>Conclusion</p> <p>It is thought that male breast cancer is caused by an imbalance between estrogen and testosterone. We cannot rule out the possibility that the breast cancer developed due to the effect of the slight elevation of estrogen over a long period of time, but the actual causative factors in this patient were unable to be definitively identified. In the future, we hope to further elucidate the causes of male breast cancer.</p