Objectives : The aim of this study is to see the wishes of the patients who self-presented to the university hospital. Methods : The number of the patients who had the first contact to the Gunma University Hospital without referrals were obtained, and the patients wishes for access to specialists, the specific demands in the specialists and whether or not the patients had consulted to the other medical care before the presentation were studied using the data from the patients presented to the department of the General Medicine, Gunma University Hospital. Results : Of the patients who visited without referrals, 11.6% had no request to consult to the specialists. Of 1104 patients who wanted to go to specialists, 64.9% had no idea for the specific demands in the specialists. Of 2051 patients attended to the Department of the General Medicine, 48.9% had previous consultation before the presentation. Conclusions : The patients who self-presented to the university hospital have not necessarily the wishes for the consultation to the specialists. Many patients cannot decide which specialist should be consulted. From patients' view of medical care, the referral to specialists is not necessarily worked well.

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Objective : Temporomandibular joint luxation occurs due to various causes such as bruises and other external forces, as well as excessive opening of the mouth during eating, yawning, dental treatment, or oral intubation procedures for general anesthesia. As onset is sudden and thus has a significant psychological impact on patients, early and appropriate treatment is necessary. In order to elucidate the actual condition of treatment for temporomandibular joint luxation, we conducted a clinical statistical investigation of patients with temporomandibular joint luxation who were treated at our department. Subjects and Methods : Clinical data were investigated and analyzed for a total of 191 joints in 137 patients who were diagnosed with temporomandibular joint luxation after visiting our department during 14 years and five monthes from January 1993 to June 2007. Results : Patients included 54 men and 83 women, with an age range of 3 to 99 years (mean age, 47.2 years). Pathology was classified into acute (n=26), habitual (n=98 ; 35 men, 63 women), and old (n=13). Luxation frequently developed due to dental treatment and yawning. Although the treatment method varied depending on the pathology, favorable results were obtained with non-invasive and invasive reduction.

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Background and Aims : A Women's Health Clinic, which is a new type of outpatient care and service specifically for women, was set up in Gunma University Hospital in April of 2005. This study was conducted to explore both the trends and issues of the clinic.
Methods : We gathered information from 42 women who had visited the clinic between June 2006 and February 2008, and who had agreed to answer the questionnaires designated for this study. The questionnaires were administered by female doctors of the clinic who then analyzed the statistics of the results.
Results : Many of the participants were in their forties (26%) or fifties (26%) who visited the clinic with either gynecological (56%) or internal (40%) medical problems. Eighty-four % of the participants had consulted another doctor before coming to the clinic. Kampo treatment was prescribed for 53% of the participants at the first visit. Satisfactory results were achieved among participants.
Conclusion : Female patients, who visited the Women's Health Clinic, wanted consulting a female doctor, had multiple complaints and were left undiagnosed.

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Objective : This study was conducted to identify the relationship between outcome assessment and care implementation in patients with dementia before and after clinical training of nursing students.
Subject & Method : Subjects were 38 nursing junior students at "A" university who agreed to participate in the study and their 38 elderly patients with dementia. The students filled out "outcome assessment for dementia care" on conditions of their elderly patients with dementia before and after clinical training.
Results : Cronbach's alpha coefficients for 26 items of the outcome assessment were 0.85 for the first time and 0.83 for the second time. "Related symptom (behavioral disorder)" was maintained at the highest level in the outcome change rate. "Communication" and "participating in a hobby/life worth living" were improved and "dressing" was maintained, while "continuing familiar life" was worsened and "role and implementation" was least maintained. "Looking at the patient's eyes when talking" was the highest in care implementation.
Conclusion : In clinical training, "communication" in patients with dementia could be improved, and better care environments improve symptoms.

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The case was a 37-year-old Malian male who was thought to have contracted malaria in Mali and then manifested fever with sore throat, watery diarrhea in Japan. His full blood count on admission revealed anemia and thrombocytopenia. He presented with Plasmodium falciparum parasitemia of 0.008% and was successfully treated with maximum dose of mefloquine. Spread of drug resistant malaria in the endemic areas has made malaria control more difficult. Japanese physicians must start to treat malaria immediately and select the appropriate drug in consideration for drug resistant malaria.

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The patient was an eighty-year-old female. She underwent a Percutaneous Endoscopic Gastrostomy (PEG) in 1999 and has taken her daily nutrition through this until April 2007. She experienced a fever of 39°C in May 2007 and was admitted to this hospital for further examination. Computed Tomography (CT) taken at the time of her admission showed pneumonia in the right lung. Furthermore, there was a moderate amount of fluid collected in the esophagus and esophageal dilatation was also observed. The patient eventually died of recurrent aspiration pneumonia. When patients are observed to have fluid collected in the esophagus and esophageal dilatation on CT, then the existence of gastroesophageal reflux disease must be suspected and a careful nutritional strategy must be established in a timely manner.

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Lichtenstein concluded that eosinophilic granuloma, Hand-Schuüller-Christian disease, and Letterer-Siwe disease were essentially based on the same pathogenesis and grouped these three lesions within the category of histiocytosis X.
This grouping is based on the assumption that the three entities are all associated with involvement of the reticuloendothelial system (reticulum cells of the bone marrow, spleen, lymph nodes, liver, and histiocytes and macrophages of connective tissue). But lately, electronmicroscopic observations showed a number of proliferating histiocytic cells in these diseases and these cells seemed to be Langerhans cells characterized by the presence of Birbeck granules which many authors tend to refer to as Langerhans cell histiocytosis.
We clinically studied five patients (two men and three women) with Langerhans cell hystiocytosis in the oral and maxillofacial region who had a medical examination in our department between 1992 and 2007. The patients were 10 months to 65 years of age at the time of their first visit to our department. One patient died from another disease during the course of the study and four patients remain alive.

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