Objective: The benefits of combining cancer screenings with clinical surveys have become increasingly obvious as cancer morbidity and mortality have steadily increased. This paper discusses a study on the current status of and issues surrounding breast cancer screening in a clinical survey. The study also investigated the patients' awareness of the benefits of breast cancer screening. A secondary aim of the study was to promote mammographic screening.
 Subjects and Methods: During the 72 months between April 1999 and March 2005, a total of 36,505 women underwent clinical surveys in our hospital. In October 2002, mammographic examination was included as an optional part of the routine physical examination. We evaluated the results of breast cancer screening with or without mammographic examination and used a questionnaire to investigate the patients' awareness of the benefits of breast cancer screening.
 Results: Compared with the pre-2001 results, the detection rate of breast cancer significantly increased after 2003 when physical examination was combined with mammographic examination. Our study also found that both elderly patients and those residing in the suburbs of Sapporo City tended to choose physical examination alone rather than combining it with mammographic examination. An analysis of the questionnaires collected from these patients indicates they had a poor understanding of and lacked awareness of the benefits of mammographic examinations during breast cancer screenings.
 Conclusions: The inclusion of mammographic screenings with clinical surveys was found to be significantly useful in the detection of breast cancer. Further continued education is needed for women, particularly the elderly and residents in the suburbs, so they understand the benefits of breast cancer screening by mammographic examination for the early detection of breast cancer and, consequently, decreased mortality of the disease.

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 Background: Paraquat has been a matter of grave concern around the world, including Japan, in light of high mortality rates and numerous fatalities.
 Method: We undertook a cross-sectional survey of pesticide poisoning by collecting data for 6 years, from 1998 to 2003, from 102 hospitals affiliated with the Japanese Association of Rural Medicine. From these cases, we analyzed those with exposure to paraquat.
 Results: There were 79 paraquat poisoning cases, including 71 cases of suicide. Of the suicide cases with 5% paraquat and 7% diquat products, more than 80% resulted in suicide deaths. All people who used 24% paraquat products completed suicide. The outcomes of these cases were related to age and volume of ingestion. The prognosis line proposed by Proudfoot in 1979 continues to explain the final outcome of almost all cases even though more than 25 years have passed since it was first proposed. More than 80% of fatalities died within the first three days of ingestion.
 Conclusion: Numerous lifesaving methods have been proposed by physicians around the world. However, almost all of these methods treat pulmonary disorders in the sub-acute and subsequent periods and seem unable to effectively decrease mortality rates. It is necessary to take administrative measures to reduce paraquat concentrations in products and, furthermore, to impose strict restrictions on its distribution.

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 Objective: Recently, holmium laser enucleation of the prostate (HoLEP) has been established as one method of endoscopic surgery for the treatment of benign prostate hyperplasia (BPH). The purpose of our study was to assess initial clinical experiences with HoLEP at our hospital.
 Patients and Methods: A retrospective analysis was conducted of 28 patients with obstructive symptoms due to BPH who underwent HoLEP during the 13 months between February 2004 and March 2005.
 Results: The mean age of the patients was 67.4 years (range 59 to 78 years). The mean enucleation tissue weight was 24.3 g (range 2 to 95 g), and the average operation time was 94.1 minutes (range 40 to 268 minutes). The mean duration of postoperative catheterization was 3.4 days (range 1 to 6 days). The mean urine flow rate improved, and each patient's satisfaction for voiding, measured on a 5-point scale, was good. There were no major complications during the operations except one case, which was completed with TUR-P because of uncontrollable bleeding. No patients required transfusions. Long-term complications included five cases of stress incontinence (19%), four of urethral stricture (14%), and three temporary retention, two of which required re-catheterization (10%).
 Conclusion: HoLEP can be performed without major intraoperative complications. It is an effective treatment for obstructive symptoms due to BPH. However, there are many postoperative problems that must be resolved, including stress incontinence and urethral stricture because of our lack of experience, with HoLEP.

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 (Objective) Neoadjuvant hormonal therapy (NHT) before radical prostatectomy promotes the downstaging of primary lesions. A retrospective analysis was conducted of the relationship between NHT durations and positive surgical margin rates, as well as between positive surgical margin rates and three types of prostatectomy (antegrade radical prostatectomy, retrograde radical prostatectomy, and laparoscopic radical prostatectomy (LRP)).
 (Materials and Methods) This study was a retrospective analysis of 257 patients treated with radical prostatectomy during the three years between April 2002 and March 2005. Of the 257 patients, 190 were treated by NHT. NHT durations were classified into “not conducted,” “<1 month,” “1-3 month,” “3-6 month” and “>6 month,” and the relationship between positive surgical margin rates and NHT durations was investigated. Seventy-four patients underwent antegrade radical prostatectomy, 131 were treated with retrograde radical prostatectomy, and 52 underwent LRP. Positive surgical margin rates were investigated according to the types of prostatectomy, as well as according to prostate-specific antigen (PSA) levels upon diagnosis.
 (Results) Positive surgical margin rates were 53.8% in the “not conducted” and “<1 month” groups, 38.8% in the “1-3 month” group, 32.4% in the “3-6 month” group, and 10.7% in the >6 month” group. Positive surgical margin rates after open surgery (antegrade and retrograde) tended to decrease when NHT durations were longer, while those after LRP tended to increase inversely. No correlation was observed between PSA levels upon diagnosis and positive surgical margin rates or between presurgical PSA levels and NHT durations.
 (Conclusion) Positive surgical margin rates were not significantly different when patients were treated with NHT for 1-3 months, but they tended to decrease when NHT was for >6 months. However, positive surgical margin rates after LRP increased when NHT continued for longer periods of time. This may the result of fibrous adhesion in the vicinity of the prostate due to long-term NHT which made the surgical margins unclear.

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Objective: The purpose of the present study is to clarify the efficacy of etidronate and vitamin K₂ in sustaining bone mineral density (BMD) in patient with hip fracture by monitoring metabolic bone markers and BMD during the 36-week period after fracture.
Materials and Methods: Forty-seven hip fracture patients from 51 to 93 years old (77.2±9.6) were randomly divided into three groups: 14 patients in the intermittent cyclical etidronate-treated group (group E), 16 patients in the vitamin K₂-treated group (group K), and 17 patients in the control (group C). Drugs were administered to patients in groups E and K six weeks after their operations. Blood and urine samples were obtained just before the start of drug administration and at 12, 24, and 36 weeks thereafter. Urinary type I collagen C-terminal telopeptide (uCTx), pyridinoline (PYR), deoxypyridinoline (DPD), serum CTx (sCTx), osteocalcin (OC_N-mid), and undercarboxylated osteocalcin (ucOC) were measured. The contra-lateral proximal femur and lumbar spine BMDs were measured at baseline and at 36 weeks.
Results: Deoxypyridinoline at 12 weeks and OC_N-mid at 36 weeks after treatment were lower in group E than those in group C. N-mid osteocalcin and ucOC at 24 and 36 weeks were lower in group K than those in group C. Although femoral neck BMD in groups C and E decreased compared to the baseline values at 36 weeks, femoral neck BMD in group K tended to increase. Specifically, in group K the BMD of Ward's triangle increased significantly after treatment. Bone mineral density of the lumbar spine in each group did not change significantly during the 42 weeks following hip fracture.
Conclusion: Vitamin K₂ prevented further bone loss in the contralateral proximal femur. The administration of vitamin K₂ to patients with hip fractures in the early period after fracture is potentially useful in preventing a second hip fracture on the contralateral side.

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Background: Details about the progression of chronic kidney disease (CKD) have yet to be clarified in Asia. We investigated the progression rate of CKD in Japanese patients treated with combination therapy.
Methods: This study was conducted with patients with non-diabetic CKD. Their dietary protein intake (DPI) was 0.6 to 0.9 g/kg/day. Angiotensin-converting-enzyme inhibitors or angiotension-II-receptor blockades were regularly prescribed. The rate of loss of kidney function was defined as the decline in creatinine clearance (CCr) per month. Factors correlating with the rate of loss of kidney function and CCr were analyzed by regression analysis, and CCr prediction formulae were then developed by multiple logistic regression analysis.
Results: Thirty-eight patients were enrolled in this study (male 19, female 19) and observed for 71.0 months. Their average age was 57.7 years old. The average CCr and the rate of loss of kidney function were 38.2 ml/min/1.73 m² and 0.410 ml/min/1.73 m²/month, respectively. The loss of kidney function was accelerated by urinary proteine excretion and hypoalbuminemia. Values for the CCr prediction formulae were calculated using serum creatinine concentration, weight, and age, and the formulae showed that the rate of loss of kidney function in younger males was faster than that in the elderly or females. The differences among the formulae in the loss of kidney function were greatest in the younger males.
Conclusions: We found that the loss of kidney function varies according to patients' age and background. To slow the progression of CKD, future strategies should take the different characteristics of each age group into account.

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Objective: The object of this study was to assess the outcomes of surgical treatment of stage pT1a and pT1b1 cervical cancer.
Method: The medical records of 59 patients at our institution with pT1a and pT1b1 cervical cancer who underwent an operation as their primary treatment between January 1996 and September 2006 were analyzed retrospectively.
Results: Ten patients underwent an operation which was less aggressive than the current operative modality at our institution. Three patients had recurrence. No patients had recurrence resulting from insufficient operations. No patients had any histologic subtype of adnexal metastasis in the resected specimens. Two of the five patients with squamous cell carcinoma and lymph node metastases at the initial operation had recurrence. Only one patient had a histologic subtype of adenosquamous carcinoma. The patient with adenosquamous carcinoma had recurrence.
Conclusion: The results suggest that the surgical procedure did not affect prognosis in the cases we analyzed by surgical modalities. The current evidence suggests that a patient in an early stage can undergo less aggressive surgery than the current operative modality requires.

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 We report on two cases of diamniotic dichorionic pregnancy with delayed delivery of the second twin. Case 1 was a 29-year-old woman with a twin pregnancy at 19 weeks and 0 day presenting with a preterm rupture of the membranes (PROM) of the first twin. The patient was treated with ritodrine and systemic broad-spectrum antibiotics. Six hours after admission, the first twin was delivered stillborn without complication. At 23 weeks and 5 days, preterm labor resulted in and the second twin being delivered stillborn at a weight of 564 g. The interval between the first and second delivery was 33 days. Case 2 was a 30-year-old woman with a twin pregnancy at 15 weeks and 4 days presenting with amniotic fluid leakage. PROM was found, and she was treated with ritodrine and systemic broad-spectrum antibiotics. The next day, the first twin was delivered stillborn. At 26 weeks, due to adverse effects, ritodrine was changed to isoxsuprine and magnesium sulfate to control uterine contractions. At 33 weeks and 5 days, onset of labor was observed, and 11 hours after the cessation of treatment with isoxsuprine and magnesium sulfate, a viable female fetus was delivered by spontaneous vaginal delivery, weighing 1,806 g. The mother developed atonic bleeding of the uterus immediately after delivery.
 The interval between the first and second twin deliveries was 33 days in case 1 and 127 days in case 2. The longer interval resulted in better fetal outcome, but it also may have increased the risk to the mother.

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