We propose that there is an entity “neuro-Sweet disease” that is like neuro-Behcet disease, but with more benign recurrent encephalitis and mucocutaneous symptoms, characterized by neutrophilic dermatitis without vasculitis, an association with HLA-B 54, and a high responsiveness to corticosteroid therapy. From a therapeutic point of view, it is important to note the existence of such corticosteroid-effective cases, since the therapy may aggravate sym

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Introduction of behavioral medicine is necessary to embody the patient-oriented comprehensive treatment in the field of highly specialized medicine. Behavioral medicine given birth from reflection on the conventional biomedicine adopts bio-psycho-social model which is comprehensive medical model. In the United State, psychosomatic medicine that originated from psychoanalysis has turned down whilst behavioral medicine generated from behavioral science has been rapidly developing. Behavioral medicine is a patient-oriented medicine which encourages self-care treatment, and suitable to the treatment of chronic disease such as life-custom diseases, but in Japan it has not so prevailed as psychosomatic medicine. For the treatment of multi-factorial diseases such as life-custom diseases and allergic diseases, not only pharmacological treatment or psychological treatment but also more comprehensive treatment using behavioral medicine should be applied. Behavioral medicine intervention program for a group of atopic dermatitis showed compatible and long term effects on both the improvement of adherence and the reduction of psycho-physiological burden for the treatment. It contributed to the reduction of medical cost mainly generated from pharmaceutical remedy. It seems to be necessary for a highly specialized medical center to found a department of behavioral medicine in order to explore behavioral intervention programs for various chronic diseases by cooperating with specialists and improve the quality of medical care in Japan of 21^st century.

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From the beginning of July to the end of September 1999, nine newborn infants in our Perinatal Center showed MRSA infection. Examination of MRSA colonization of all the infants who were born during these 3 months revealed that 59 (61%) of 96 infants were colonized or infected with MRSA. 65 (90.3%) out of 72 MRSA strains obtained from the infants were typed as II AR2B6+, using conventional epidemiological methods such as phenotype, coagulase, anti-microbial susceptibility and TSST;and genotype methods such as DNA restriction length polymorphism. These results strongly suggested nosocomial infection. An infection control committee composed of 5 outside experts was formed to investigate the causes of the MRSA infection and to advise on future eradication and infection management The recommendations and proposals of the committee were as fol-lows: (1) Surveillance of environmental MRSA by applying the air-sampling method in addition to the test of fall-down pathogens, and monitoring of colonization from nasal carriage on every five days. (2) Improvement of hospital equipment and routines;by setting a strict route with a hand-washer between the delivery and neonate room;by installing an isolation ward for infected infants;and by performing scheduled sanitation with a contamination test. (3) Improvement of nursing procedures to establish the one care/one hand-wash rule;to change gowns for different zones from the delivery to neonate room;to use a new bath towel for each individual neonate;and to thoroughly educate all members of staff. We re-opened the delivery care on December 21 st 1999.
To date, this new management system has proved satisfactory in the reduction of the MRSA colonization ratio.

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In order to investigate the recent clinical course of subacute myelo-optico-neuropahty (SMON), neurological symptoms, activities of daily living, global severity and complications were analyzed in 194 SMON patients who were annually examined by the members SMON Research Committee from 1990 to 1999. Visual disturbance, weakness and spasticity of the lower extremities, upper border of the superficial sensory disturbance and severity of paresthesia did not show any significant changes in the ten years. Gait disturbance, however, tended to exaggerate slightly. Ratio of patients who had motor disturbance of the upper extremities became slightly higher. Ratio of patients who showed urinary and/or fecal incontinence also became higher in the ten years. In studying the complications, incidence of cataracta and vertebral diseases was markedly increased, and that of hypertension, joint diseases, bone fracture and cerebrovascular diseases was slightly increased. In global severity, ratio of the patients who were judged as extremely severe and severe was increased from 18.0% in 1990 to 28.4% in 1999. As a contributing factor to the global severity, “SMON plus complications” was gradually increased from 22.7% in 1990 to 45.4% in 1999. On the contrary, “SMON only” was gradually decreased.
It is concluded that clinical symptoms and activities of daily living of SMON patients rather worsened mainly due to various complications in the recent ten years.

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We investigated what kind of methods would be adopted for the assessment of fetal well-being in 21 facilities belonging to clinical obstetrics information network. Cardiotocography and ultrasonography were mainly used when carrying out the assessment of fetal well-being during pregnancy. In addition, Doppler ultrasound played an important role as one of the assessments of fetal well-being. Though more than half facilities actually adopted E3 or hPL to assess fetoplacental function, the progress of cardiotocograph and ultrasonograph made it possible to assess fetal conditions on real-time processing. In connection with it, the effectiveness of E3 and hPL should be revalued. For the purposeof the assessment of fetal well-being during delivery, All the pregnant were equipped with cardiotocograph in the facilities investigated.
As part of a large-scale perinatal study, we will precisely prognose fetal condition through the assessment of fetal well-being. In order to reduce sequela such as neonatal asphyxia, death and cerebral palsy, we will construct national-scale database in the future.

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The preliminary results of the currently established cord blood bank in Kure National Hospital have been reported. Seventy-eight cord blood (CB) samples were collected during delivery of the placenta. Among 78, we used the first 25 umbilical cord bloods for the technique acquisition. Twenty-five fresh CB samples had a mean volume of 62ml. After volume reduction, the respective CB units contained 508×10⁶ uncleated cells (NC), 204×10⁶ mononucleated cells (MNC), 64×10⁴ CFU-GM, 18×10⁴ BFU-E and 2×10⁶ CD 34+cells. Therefore, the overall recovery for NC and MNC was 67% and 59%, respectively. On the other hand, 53 fresh CB samples for the clinical use had mean volume of 72ml, After volume reduction, the respective CB units contained 615×10⁶ NC, 309.0×10⁶ MNC, 78×10⁴ CFU-GM and the overall recovery for MNC was 79%. Results of these 53 cord bloods are better than those of the first 25 units used for technique acquisition. Bacterial contamination of collections has been reduced from 23% of 25 units to 3.8% of 53 units. The results of NC, MNC, CD34 positive cell, CFU-GM and BFU-E counts are good enough for clinial use

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Two cases of catamenial pneumothorax were described. Case 1. A 50-yesr-old female had experienced two episodes of right pneumothorax. Each episode was apparently related to the onset of menstruation suggesting catamenial pneumothorax. Right thoracoscopy revealed multiple blue berry spots in the central tendon of the diaphragm. Partial resection of the diaphragm including these lesions were performed under Video Asisted Thoracoscopic Surgery (VATS). The remaining lesions were covered by Poly Glycolic Acid felt. Case 2. A 45-yesr-old female had experienced three episodes of rightpneumothorax. One of the episodes was apparently related to the onset of menstruation suggesting catamenial pneumothorax. Right thoracoscopy revealed multiple blue berry spots in the central tendon of the dia phragm and a bullae on the right apex. Partial resection of the diaphragm including these lesions and bullectomy were performed under VATS. We consider that VATS is a useful method for treatment of catamenial pneumothorax.

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To construct large-scale database for clinical perinatal research, Clinical Obstetric Information Netwrk (COIN) started in 1996.
1. Participants were 36 national hospitals (Chiba, Fukuyama, Hamada, Hirosaki, IMCJ, Kanazawa, Kasumigaura, Kobe, Kochi, Kof u, Kure, Kyoto, Kyushu MC, Maizuru, Mie-chuo, Minami-kyushu-chuo, Miyakonojo, Nagoya, Nara, Narashino, NCVC, Oita, Okayama, Osaka, Osaka-minami, Otake, Sagamihara, Sendai, Shibukawa, Shimonoseki, Takasaki, Tochigi, Yamaguchi, Yamanaka, Yokohama, Zentsuji) in 1999.
2. Total mothers were 13, 193 cases, 1, 182 (9.0%) of those were preterm deliveries. Maternal transfer were 705 cases (5.3%), postpartum hemorrhage were 3, 26lcases (24.7%), and blood transfusion were 43 cases (0.3%). Maternal mortality rate was O (per 100, 000 live births).
3. Total neonates were 13, 374 cases, 1, 184 (8.9%) of those were preterm between 28-36 weeks, and 82 cases (0.6%) were between 22-27 weeks. Early neonatal death were 39 cases, mortality rate was 2.9 (per 1, 000 live births). Fetal death after 22 weeks were 93 cases, rate was 6.9 (per 1, 000 total births). Perinatal mortality rate was 9.8 (per 1, 000 total births).

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