Recently, laparoscopic surgery is accepted as a minimally invasive surgery. It could be applied to most of the benign gynecologic disorders. It greatly contributes to patient's QOL in reducing postoperative pains and complications and in shortening hospital stay. It is effective not only in decisive surgery but also in function-preserving surgery in gynecology.
Laparoscopic surgeries have been increasing in numbers at Kyoto National Hospital Department of Obstetrics and Gynecology, reaching 229 surgeries in the year 1997 (50.9% of all the gynecologic surgeries). Indications of laparoscopic surgery are benign uterine diseases, benign ovarian diseases, endometriosis, pelvic adhesion, ectopic pregnancy, and others. We regard laparoscopic surgery for endometriosis very important, since, as one of the function-preserving surgeries in gynecology, the result could reflect the quality of the surgery. Four year-cumulative pregnancy rates were 80% and 40% in groups where endometriosic lesions were completely removed and not, respectively (p=0.02408). Laparoscopic surgery was as well effective in reducing endometriosis-associated dysmenorrhea and dyspareunia.
Improvements in operative technique and equipments would further expand the indications of laparoscopic surgery.

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We reviewed 23 operative reconstructions in 22 patients with ileo-femoral arterial obstruction. Non-anatomical bypass cases were selected more frequently in elderly patients than that in middle aged ones. However, 6 cases of 14 non-anatomical group had some local reasons to be selected, is vascular reoperation, post-laparotomy and route infection. Ages of this group were younger than that of the non-anatomical group without local reasons.
The five years patency rates of anatomical and non-anatomical groups were 83 and 59% respectively, but significant differences was not observed between both groups. The non-anatomical bypass is useful for hi-elderly person, cases with local problems, and especially for limb-salvage.

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The present study was designed to clarify the incidence of vasospastic angina in outpatients with anginal symptoms. From the patient history data taken on an outpatient basis, anginal symptoms were present in 464 (25.1%) among 1850 consecutive individuals above 40 years of age. Of these patients with anginal symptoms, further diagnostic studies including coronary angiography were performed in 322. Best efforts were made to obtain recordings of the 12 lead electrocardiogram during chest pain. The ergonovine provocation test was performed during cardiac catheterization in 197 of 221 (89.1%) patients without a critical degree of stenosis in coronary arteries (≥75%, AHA) and also in 8 of 60 patients with critical coronary stenosis. Patients that had had a prior myocardial infarction were not included in this test. Developement of ergonovine-induced focal coronary constriction of more than 90% associated with ischemic change in the ST segment (more than 0.1mV) on the EGG was defined as a positive response for coronary spasm. As a consequence, prior myocardial infarction was found in 41 patients and angina pectoris in 106, including 55 patients with vasospastic angina in which documented ST elevation during chest pain or a positive ergonovine test was noted. The overall incidence of vasospastic angina was 17.1% (55/322).

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An epidemiological study on the terminal care of the elderly was performed with focusing on the medical economics of the hospitalized patient's death.
The rate of hospitalized patient's death among total death cases in this area is over 80 percent and higher in a city area (Meito-ward, Nagoya city) than in a suburban area (Nisshin city).
In 1996, the number of the elderly hospitalized patiens's death in national sanatorium Higashinagoya hospital was 167 (male 105 and female 62), taking 76 percent of all death.
The top two causes of death were malignancies (31.8%) and infections of respiratory organ (22.2%).
The average admission period of the dead was 35.8±17.2 (Mean±lSD) days, showing the increasing tendency.
The analysis of medical economics revealed that the average daily health insurance score was 3202±1630 (Mean±lSD) and cases with the scores over 5000 were only 13.8%.
The average daily (score) of short term (within a week) admission cases was significantly higher than the longer admission cases.
The average daily admission fee with respect to the underlying diseases were not significantly different in every disorder including malignancies.
In the emerging integration between geriatric medicine and welfare, the terminal sites of human life began to shift from hospitals to homes and care institutions, future policies in the terminal care of the elderly should make a new and rapid stride with a special emphasis on the district features and medical economics.

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A case of elderly-onset systemic lupus erythematosus presenting with bilateral pleural effusions associated with atypical lupus erythematosus cell is reported. An 81-year old man was admitted to our hospital for evaluation and treatment of bilateral pleural effusions. On admission, thrombocytopenia and proteinuria were noted. Although the pleural fluid was exudative, cytologic examination, bacterial culture and acid-fast stain were all negative. Several autoantibodies such as antinuclear antibody, antideoxyribonucleic acid (DNA) antibody, anti-double stranded anti-DNA antibody, platelet-associated IgG were positive, and serum levels of complements and immune complexes were low and high, respectively. In addition, antinuclear antibody, anti-DNA antibody and immune complexes were detected in the pleural fluid. The Papanicolaou smear of the pleural fluid showed scattered cells resembling to LE cells. Based on these results, a diagnosis of lupus pleuritis was made and prednisolone 30 mg/day was administered. The pleural effusions disappeared in about 2 weeks

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Two cases of knee joint tuberculosis diagnosed after total knee arthroplasty have been reported. The preoperative diagnosis of case 1 was rheumatoid arthritis and case 2 was osteoarthritis. After the operation, tuberculosis was diagnosed from a culture of discharged pus taken from the sinus that had developed postoperatively in case 1 and by the pathological analysis of synovium obtained during the operation in case 2. It was predicted that careful attention to the family history and pathological history as well as cautious examination of plain radiographs could diagnose both of the two cases correctly before the operation. Fortunately, inf lamation of the affected knee disappeared with the use of antituberculous drugs and debridement of involved lesions in case 1 and by use of only antituberculous drugs in case 2. These results suggest a possibility that joint tuberculosis can be treated sufficiently by chemotherapy and debridement even if artificial materials are in existence.

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We report a 71-year-old Japanese man who had severe muscle weakness including dysphagia and erythema with edema. On admission, elevated serum creatine kinase and myoglobin values were demonstrated. Electromyogram showed myopathic findings. Magnetic resonance imaging (MRI) of his thigh muscles showed hyperintensity of T2-weighted images and normal T 1-weighted images. Muscle biopsy was done at the MRI-guided area of the right vastus lateralis muscle, resulting negative histological findings. The examination of muscles by MRI is recommended for an additional tool for the diagnosis of dermatomyositis when muscle biopsy findings was negative.

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We are making an offer drugs information for outpatient in pharmacy of our hospital from April 1997, in accordance with revision of the law of pharmacist.
We introduced system drugs information are printed a sheet of paper, cause be linked with printing system of the medicine's packing paper. But this system was not in very good drugs information at first because of limited capacity of letter's area. Accordingly we appended drugs information, a side effect, reciprocal action and attention of living on individual drugs as long as this system isrebuilted. We have offering all drug information make use of a sheet of paper by reason of revision from October, and looked over the drug information.
And we gathered information by questionnaires to grasp useful rate, understanding rate and satisfying rate of the outpatients before and after revision.
In analysis of each department pediatrics, surgery and brain surgery was below the average.
In the comparison before and after revision, useful rate was 7 percent decrease but satisfying rate was 2 percent increase.
In form of the system, 78 percent of patient answered that system after revision is much better than that system before revision.
And of the patient stop taking a drug in one's own discretion, virtually all answered that have consult with a doctor or pharmacist about a drug.

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We studied the leprosy control program in the Kingdom of Morocco where a national leprosy hospital and 14 regional leprosy services are participating. They have close relationships with local health centers therefore most of the leprosy control activities and general health services are performed simultaneously. AMAAF, the NGO in this country, has been serving medical and non-medical supports for leprosy patients and their family members, resulting in a great improvement of their social status.
The guideline of the treatment of leprosy in this country is composed of unique multidrug therapy and subsequent DDS monotherapy. No relapse case has been found for 16 years since the introduction of this regimen. The prevalence declined steeply from 0.75-1.5%, estimated in 1980, to 0.4/10, 000 in 1997. This reduction is considered to be achieved by the decreased infectious sources that was brought about by the voluntary seeking for medical care of leprosy patients encouraged by the decreased social stigma. Although the current prevalence rate is well bellow the elimination prevalence' of 1/10, 000 on the national level, there are many residual areas especially in the mountainous legions where the prevalence is very high. The current anti-leprosy activities should be continued and intensified especially in these areas. The successful result of leprosy control program in Morocco suggests the possibility of this program to be a model for another western African countries, some of which have still high prevalence of leprosy.

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A 37-year-old man with an asymptomatic mass in the superior mediastinum of the right side was admitted to our hospital. Chest CT and MRI revealed a mediastinal cystic mass between the superior vena cava and thoracic vertebrae. Preoperative laboratory data including thyroid hormone, parathyroid hormone and tumor markers were normal. Video-assisted thoracoscopic surgery (VATS) was performed and the mediastinal cystic mass was completely resected after the serous fluid in the cyst was aspirated. Histological examination showed parathyroid cells in the cyst wall and the diagnosis of mediastinal non-functioning parathyroid cyst was made. VATS is a useful technic for the diagnosis and treatment of benign mediastinal mass.

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