The term "eHealth" refers to the use of digital data -transmitted, stored and retrieved electronically- in support of health care, both at local sites and at a distance. Several years ago, the World Health Organization proposed to develop programs for eHealth, including tele-consultations, tele-referrals, forward-storage concepts (e.g., tele-radiology and tele-prescriptions) and electronic patient records, to improve early diagnosis of thyroid diseases and follow-up of patients who have developed thyroid cancer after exposure to radioactive fallout following the accident at the Chernobyl Nuclear Power Plant, the World Health Organization and the Sasakawa Memorial Health Foundation, in cooperation with the Ministry of Health in the Republic of Belarus, have established and promoted a project entitled "Medical Relief for Children Affected by the Chernobyl Accident through the Development and Implementation of Health Telematics," to achieve these goals. In this communication, I review the current state of eHealth and the development of the health telematics project in Belarus.

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Graves' disease is characterized by overstimulation of the thyroid gland with agonistic autoantibodies against the thyrotropin (TSH) receptor, leading to hyperthyroidism and diffuse hyperplasia of the thyroid gland. Our and other laboratories have recently established several animal models of Graves' hyperthyroidism with novel immunization approaches, i.e., in vivo expression of the TSH receptor by injection of syngeneic living cells co-expressing the TSH receptor and major histocompatibility complex (MHC) class II or genetic immunization using plasmid or adenovirus vector coding the TSH receptor. This breakthrough has provided important insights into our understanding of the pathogenesis of Graves' disease. New findings obtained include that (i) professional antigen-presenting dendritic cells appear to be crucial for disease initiation, (ii) the free A subunit of the receptor is likely the main autoantigen for stimulating antibodies, (iii) non-MHC genes as well as MHC genes albeit less significant may be linked to disease susceptibility, (vi) certain infectious pathogens may have a negative impact on disease development, and (v) Graves' disease is not simplistically a T helper type 2 (Th2)-dominant autoimmune disease as previously considered; indeed TSH receptor-specific Th1 immune response appears to be critical for disease pathogenesis. Further studies with these models will hopefully lead to not only better understanding of the pathogenesis of Graves' disease but also the development of new approaches for treatment and ultimately prevention of Graves' disease in the future.

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Delayed gastric emptying (DGE) is one of the most frequent and unpleasant postoperative discomforts in patients who were given pylorus-preserving pancreatoduodenectomy (PPPD). To prevent DGE after PPPD with the modified version of Traverso's reconstruction procedure, we have used retrograde tube-gastrostomy technique. In our method, a 16-Fr gastrostomy tube with several pores was inserted in the retrograde direction from the jejunal stump into the gastric fundus, by leading the catheter tip through the jejuno-jejunal anastomosis, the efferent jejunum and the pylorus. Between January 1996 and September 2003, 51 patients underwent PPPD for periampullary malignancy in our department. DGE after PPPD was observed in 12 patients (23.5%); 2 of the 19 patients (10.5%) with retrograde tube-gastrostomy technique and 10 of the 32 patients (31.3%) with conventional tube-gastrostomies. Because of effective internal drainage of gastric juice to the efferent jejunum by this method, the external gastric drainage from the gastrostomy tube was extremely small when compared to conventional tube-gastrostomies, resulting in reduction of postoperative venous infusion and hypochloremia. Oral intake was also started earlier after surgery, and the postoperative hospital stay was shortened. In conclusion, the retrograde tube-gastrostomy technique was found easy to perform and beneficial to the patients undergoing PPPD.

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Renal tumors are considered to be composed of several distinct subtypes with different cell origin. In this study, we tried to find useful immunohistochemical and lectin histochemical patterns for the differential diagnosis and the origin of the tumor relative to the components of the nephron. Typical cases of clear cell carcinoma, granular cell carcinoma, chromophobe cell carcinoma, collecting-duct carcinoma, papillary carcinoma and oncocytoma, as well as sufficient margin of normal renal parenchyma were stained immunohistochemically and lectin-histochemically, using antibodies and lectins reported to show differences in reactivity. Non-neoplastic epithelial cells showed specific reactivity according to the nephron segments. Some of our staining results tended to differ from those reported earlier by other investigators. Neoplastic lesions showed specific immunoreactivities and the staining results were similar to those of the normal nephron segment, suggesting the origin of the respective tumors. Our results suggest that testing the immunoreactivity pattern using a panel of antibodies and lectins is useful for the differential diagnosis of renal neoplastic lesions.

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The concept of gender identity disorder has developed rapidly since the 1950s. Recently, gender identity disorder has drawn attention in the medical field as well as in society. To elucidate issues associated with individuals with gender identity disorder, we examined the demographic background, and medical and social problems in outpatients of the Gender Clinic of the Neuropsychiatry Department at Nagasaki University Hospital from January 1, 2003 to February 28, 2005. Of 27 individuals observed during this period, 3 were diagnosed with gender dysphoric syndrome, and the remaining 24 were diagnosed with gender identity disorder according to the ICD-10. Patients of female to male (FtM) and of male to female (MtF) were 15 and 9, respectively. Women in their twenties comprised 50% of the study subjects and about 30% of the study subjects were from outside Nagasaki prefecture. The subjects showed an active attitude to receiving therapy for solving their problems. Many subjects had disclosed their problems to family members and friends on the occasion of important life events such as graduation from high school or a birthday. Feelings of gender dysphoria were frequently experienced from infancy, and in MtF these feelings were occasionally first experienced in adolescence. Obstacles to social adjustment were more frequently observed in MtF than in FtM. The results of the present study suggest the need for early diagnosis and early intervention to immediately reduce unnecessary suffering and to increase the likelihood of improving quality of life.

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To elucidate the association between epilation and cancer mortality in Nagasaki atomic bomb survivors, cancer mortality was determined for a total of 9,356 survivors (3,591 males and 5,765 females) from 1 January 1970 to 31 December 1997. The subjects included individuals other than those in the Life Span Study (LSS) cohort of ABCC-RERF. Information on acute injury was obtained from a survey that was conducted at the time of application for a health handbook. The association between epilation and cancer mortality was evaluated by the Cox proportional hazards model, including factors such as gender, age at the time of the bombing, attained age, radiation dose and epilation. Epilation was found in 81 (2.3%) males and 148 (2.6%) females. No significant difference in the frequency of epilation was observed by gender or age at the time of the bombing. The hazard ratio of cancer mortality in those with epilation compared to those without epilation was 1.06 (95% confidence interval: 0.72-1.54). Similar to the study of the LSS cohort, no significant effects of epilation on cancer mortality were observed in the present study. The results indicated that the cancer mortality was significantly higher in those exposed to atomic bombing younger as was reported by LSS studies. However, the effects of radiation dose on cancer mortality have not been observed in the present study.

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We report a case of a 64-year-old woman with hypertension. She had dizziness and palpitation without heart failure although she was taking amlodipine. Urine levels of epinephrine and norepinephrine were high and both atrial and ventricular premature contraction were frequently seen. Valsartan, angiotensin II type 1 receptor antagonist, decreased these catecholamine levels and suppressed arrhythmias in the present case without the use of other drugs such as beta-blockers or anti-arrhythmic agents. In conclusion, valsartan is one option that can be used to prevent arrhythmias as well as to control blood pressure in hypertensive patients.

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Video-assisted thoracoscopic surgery (VATS) for a large, midesophageal diverticulum was successfully performed in a 77-year-old male who had dysphagia for one year. Postoperatively, the patient was well without any complications and was relieved of dysphagia. The VATS diverticulectomy was considered to be minimally invasive and constituted a good indication especially for patients of advanced age showing symptomatic esophageal diverticulum.

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