Although we had already more than two hundred thousand patients with dialysis at the end of 1999 in Japan, the number of patients will be expected to increase year by year, over thirty thousand per year. The first cause of diseases leading to chronic renal failure (CRF) is diabetic nephropathy, the second chronic glomerulonephritis, the third nephrosclerosis, and this tendency will continue because of the growth of life-style related diseases. The rate of patients with hemodialysis more than ten years is 25 percents and the complications during long-term therapy have been increasing. On the other hand, the radical therapy against CRF, kidney transplants have been performed seven hundreds a year, and this situation has caused medical, social and financial problems. Although the long-term effective management to diagnose exactly and to treat to control the aggravation of disease has been requested in preliminary and secondary renal diseases, the evidence based medicine has not been established in Japan. The renal patients data base and the pathological conference system built by the policy-based medical service network of renal disease will play an important role in the field of the daily medical treatment and clinical research in the national hospitals.

View full abstract

In sixteen type II chronic respiratory failure patients whose body weight were less than 90% of ideal body weight, high density liqued diet (YHFPF) of 400 kcal a day were drunk for one month. Though body weight, body mass index (BMI) and % ideal body weight significantly increased, the deterioration of the hypercapnia was not observed without recognizing the change in the arterial blood gas or pulmonary function test after the YHFPF administration. Both prealbumin, retinol binding protein and transferrin that are rapid turnover protein significantly increased, and the improvement on the nutritional state was indicated. Other blood and biochemical markers did not change, and Fisher's ratio, CD₄/CD₈, leptin did not change. Slight loose passage were recognized in three patients. It was indicated that YHFPF is enough usable for nutrition improvement of the chronic respiratory failure patients without deterioration of arterial blood gas, blood and biochemical examinations.

View full abstract

National hospitals and sanatoria have their strong mission for providing policy-based medical services. To construct nationwide medical service network for endocrine and metabolic diseases, twenty-seven hospitals (at the time of April, 2000) have been appointed as the constituents and several other hospitals have joined as the collaborative centers. Endocrine and metabolic diseases are not uniform and many medical specialists from various fields of medicine are needed to actively manage the patients. One of the major intractable diseases to be overcome is diabetes mellitus and its complications. In the present symposium, we discussed the general frameworks of the endocrine-metabolism-network and controversial issues about subdivided topics of medical treatment, clinical research, education and training. We have proposed the future directions of the medical service network for endocrine and metabolic diseases, and stressed the importance of supporting the basic frameworks, such as talented medical staffs.

View full abstract

The Sakura National Hospital is now in preparation to become a Semi-National Center for kidney disease, which can offer a medical service as a policy-based medical service. Renal biopsy provides important information not only for a diagnosis but also for a choice of therapy and prognosis, and helps to achieve an evidence-based medicine for kidney disease.. So we have begun, in July, 2000, a supporting system for renal biopsy, which includes a pathologic diagnosis and consultation as well as a preparing support for light microscopy, immunohistochemistry and electron microscopy. Since January, 2001, an automatic machine for immunostaining and in situ hybridization has been available. We have dealt with 74 renal biopsies for 9 national and public facilities and are now making arrangements according to the policy-based medical service.

View full abstract

A 60 years old female with hypothyroidism due to Hashimoto disease admitted to our hospital. Electrocardiogram showed low voltage in all leads and chest roentogenogram showed cardiomegaly and right pleural effusion. Echocardiogram revealed marked left ventricular symmetric hypertrophy and moderate hypertrophy of right ventricular free wall with moderate pericardial effusion. After administration of levothyroxine sodium, biventricular hypertrophy and pericardial effusion gradually decreased as her thyroid hormone level elevated to the normal range. Many reports of myxoedema heart were published and some of them showed that the administration of thyroid hormone improved ventricular hypertrophy. But symmetric hypertrophy of left ventriculum like this case is very rare.

View full abstract

SUMON is an abbreviation of subacute myelo-optico-neuropathy and is a neurotoxic disease caused by chinof orm which the patients took for their gastrointestinal symptoms. It was prevalent throughout Japan towards the end of 1960s. Total 11, 127 SMON patients were confirmed.
It can be said that SMON is the first illness for which the Japanese Government officially took the strategies in research and treatment of intractable diseases.
In this paper, a short review was made on the history of SMON research, epidemiology, pathogenesis, therapy, the author's own clinical cases and the recent activities of the SMON Research Team in Japan.

View full abstract

Ministry of Health and Welfare announced on Nov. 13, 2000 that the National Hospitals and Sanatoriums should be open for all the Creutzf eldt-Jakob disease (CJD) patients struggling against the high barrier for hospitalization. In this context we sent a questionaire to 35 member hospitals of policy-guided medical service network asking about the current situation and facing problems regarding the hospitalization of CJD patients, All the hospitals have replied, In Jan, 2001, there were 14 CJD inpatients, A total of 40 CJD patients were admitted from fiscal 1998 to 2000. The maximum number of the inpatients would be 82 and the number may be increased up to 110 or more if all the problems such as a shortage of isolation room are all settled. Only 3 hospitals answered that the local medical service network for intractable disease patients was functioning at the pref ectural level. Seventeen hospitals were able to perform autopsy of CJD patients, A bedside manual of CJD was highly requested from many hospitals.

View full abstract