Diabetic nephropathy has become the most common single cause of end-stage renal disease (ESRD) and the cost for treatment of diabetic patients with ESRD is increasing. A lot of basic and clinical investigations have been performed so far. Clinical-practice guidelines have been published based on the results of such investigations. However, ESRD due to diabetic nephropathy is still increasing. The strategy for the prevention of diabetic nephropathy is as follows; (1) Data of Japanese diabetic patients should be accumulated. (2) The mass examination system for diabetes should be improved. (3) As it is not so easy to achieve the recommendations of clinical-practice guidelines, medical care system for the diabetic patients should be improved. (4) Basic investigations to elucidate the mechanism of diabetic nephropathy should be promoted to develop new therapies. (5) A guideline for aged diabetic patients should be prepared separately. Japan National Hospitals network, HOSPnet, should play an important role in decreasing diabetic patients with ESRD.

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Until near 1980s the mortality and survival rates after hepatectomy for hepatocellular carcinoma (HCC) were dismal in Japan. But the recent management strategies including preoperative assessment of hepatic functional reserve and technological advances unproved the results of surgical treatment, Early detection due to radiological advancements also contributed to the improved prognosis and a 5-year survival rate of 40% to 50% has been reported in recent series. However, because of biological tumor characteristics and combined chronic liver diseases the rate of recurrence is still very high. Vascular invasion and intrahepatic metastasis are the most important biological characteristics of HCC and related tumor recurrences. Multicentric occurrence is also important as another type of recurrence especially in cirrhosis, Hence prevention and effective management of recurrence are undoubtly the most significant strategies to improve the overall survival. Although multidisciplinary treatment modalities contributed to the improved prognosis, long term prognosis is still unsatisfactory. Therefore the eradication of hepatic virus infections (HBV, HCV) and the treatment of chronic liver disease before its turns into cirrhosis and cancer seem to e essential.

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We tried early detection of relapse of leprosy in our leprosarium, having about 300 inhabitants at that time. Six cases of LL and 2 cases of BL were found to have relapsed in a period of 2 years. The age of the relapsed cases ranged from 59 to 91 years old and the quiescent period ranged from 13 to 40 years. The clues to early detection of relapse were such symptoms as skin lesions without pain or itching, slightly abnormal sense on a particular skin lesion, and increased serum level of Mycobacterium leprae (M, leprae) specific anti-PGL-I antibody. Relapse was confirmed by positive result of slit-skin smear. One case occurred of a positive skin smear without any subjective or objective symptom of leprosy, but was accompanied by the development of herpes zoster. In this case, decreased immunity may have accounted for the relapse.
Drug-resistance-related mutations of M. leprae were checked for in 5 cases and the bacilli harvested from 4 cases presented resistant mutants against 1 or 2 drug(s).
Chemotherapy was started with selected regimens considering age, complications and drug resistance. After starting chemotherapy, all the cases presented good clinical courses. They got negative BI in a rather short period and the leprosy reactions seen in 3 cases were not severe. Since early treatment is crusial for the prevention of leprosy-related disability, we should make our greatest effort to find early cases of relapse.

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Higashiowari National Hospital of Mental Disorders is a participating institution in the Aichi psychiatric emergency system, despite its small number of doctors. We have attempted to standardize the treatment of psychiatric emergency, and developed the Higashiowari hospital guidelines for acute psychiatric treatment with the aim of providing safe, efficient and high quality medical care. These guidelines may be summarized by the following 7 points: 1) A weekly round of visits by the director in order to supervise the medical care of patients individually, 2) clarification of standards for hospitalization, 3) speedy examination of physical problems, 4) checklists for strict observance of the Law for Mental Health and Mentally Handicapped Persons' Welfare, 5) use of flunitrazepam for acute management of agitated patients, 6) introduction of clinical pathways including psychosocial education and social skills training, 7) guidelines for the treatment of patients with substance use disorders. The function of these guidelines was analyzed by using statistic data from the Higashiowari acute phase ward.

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Intraoral symptoms have been reported as somatic symptoms of patients with eating disorders. In order to elucidate the actual states, we performed research including taking medical histories, intraoral diagnoses, saliva tests, bacteriological examinations, etc on a patient group with eating disorders (female, 51 subjects) and a control group (female, 64 subjects). The results are as follows.
1. Thirty-six subjects had experiences of anorexia as an abnormal eating habit. And 42 subjects had experiences of hyperorexia. Among them, 33 subjects had experiences of self-induced vomiting.
2. We checked for oral lesions that have been pointed out by specialists of eating disorders. Among such lesions, it has been suggested that cervical caries and cervical parenchymatous losses are useful observation for an early detection of eating disorders.
3. Periods of sickness, self-induced vomiting and irregular eating habits during hyperorexia periods, abnormal eating habits such as excessive consumption of sugar in hyperorexia, low saliva flow and occurrences of dryness in oral cavities during anorexia periods were inferred to be factors causing caries in patients with eating disorders.
4. It has been suggested that oral symptoms as somatic symptoms of patients with eating disorders provide important information for the detection of eating disorders. Thus, it is presumed that dentists should assume a heavy responsibility for and be active in treatment, prevention and early detection of eating disorders, which are burgeoning.

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Although the incidence of Crohn's disease is increasing, its pathogenesis remains unclear and no curative therapy has been established. We have asked for presentations at the symposium from various fields in order to encourage interdisciplinary collaboration in the medical treatment of Crohn's disease. Regarding treatment, basically madical treatment plays a key role. Pharmacotherapy and enteral feeding treatment are two pillars. In pharmacotherapy, 5ASA drugs and steroids play key roles. However, the dosage of immunosuppressive agents must be carefully considered because there is a problem of side effects resulting from chronic administration of steroids. And a new therapy, the target of which is a cytokine, has been developed. Enteral feeding treatment is a superior therapy, but it is hardly used in Europe and America because there is a problem with regard to maintenance of the quality of life. A dietitian gave a presentation on a method of ingesting orally administered jellied ED. According to that report, restrictions of night administration are largely decreased, and patients can take ED at schools and places of work. Therefore, this method is popular with patients. I think that we should try this method for cases in which there is no stenosis. Regarding the reason for surgical treatment, stenosis was the top reason at 70%. In 32% of the cases undergoing multiple operation, there were lesions in small intestine In addition to pharmacotherapy to avoid reoperation, the importance of enteral feeding treatment was shown. Regarding Crohn's disease, the cause is unclear. It is intractable and young people develop this disease, Therefore, I think long-term supports of patients is necessary. However, due to personnel changes of medical workers at national hospitals, difficulty in maintaining medical and psychological support sometimes results. It is assumed that this point will need to be addressed in the future.

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Clinical Obstetric Information Network (COIN) started in 1996 to establish large-scale database for clinical perinatal research.
1. Participants were 40 national hospitals (Fukuyama, Hakodate, Hirosaki, IMCJ, Kanazawa, Kobe, Kochi, Kumamoto, Kure MC, Kyoto, Kyushu MC, Maizuru, Mie-chuo, Mito, Nagano, Nagasaki MC, Nagoya, Nara, NCVC, Nishi-saitama-chuo, Okayama MC, Osaka, Osaka-minami, Otake, Saga, Sagamihara, Saitama, Sendai, Shibukawa, Snimonoseki, Takasaki, Tochigi, Tokyo MC, Tokyo Disaster MC, Tosei, Toyohashi, Yamanaka, Yokohama, Zentsuji) in 2001.
2. Total number of mothers were 15, 674 cases, 1, 477 (9.4%) cases of those were preterm deliveries. Maternal transfers were 1, 227 cases (7.8%), postpartum hemorrhages were 4, 218 cases (26.9%), and blood transfusion was performed for 60 cases (0.4%). Maternal mortality rate was 12.5 (per 100000 live births).
3. Total number of neonates were 15, 926 cases, 1, 490 (9.4%) cases of those were preterm between 28-36 weeks, and 109 cases (0.7%) were between 22-27 weeks. Early neonatal deaths were 41 cases g mortality rate was 2.6 (per 1000 live births). Fetal deaths after 22 weeks were 78 cases rate was 4.9 (per 1000 total births). Perinatal mortality rate was 7.4 (per 1000 total births)..

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We herein report a case of synchronous multiple five gastric carcinoma including three Epstein-Barr virus (EBV)-associated lesions.
A 41-year-old male was admitted to our hospital because of epigastralgia and substantial body weight loss. A gastrointestinal endoscopic study revealed two advanced carcinomas and three protruted lesions of the stomach. A biopsy proved these lesions to be malignant, thus total gastrectomy, splenectomy with Roux en Y esophago-jejuno-stomy and lymph node dissection were performed. Histologically, a protruted lesion in the cardia was poorly to moderately differentiated adenocarcinoma, a Borrman type 3 lesion in the antrum was signet ring cell carcinoma, and three protruted lesions in the body were well differentiated adenocarcinoma. Three protruted lesions only were stained positively by in situ hybridization using an antisense EBER probe. All lesions were stained positively by immunohistochemical staining for p53, and were negative for bcl-2. Tests for microsatelite instability (MSI) of lesions were all negative. Although we could not clear it might suggested that the mechanism of carcinogenesis of three polypoid lesions with positive EBER was different from the other two advanced lesions. It is still unclear the relation between carcinogenesis and the period of EBV in f ection and thus further investigation is called for.

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