In this study, we developed a trial management system to analyze data collected in the NCCHD (National Center for Child Health and Development) database related to pregnant women enrolled in the birth cohort study. We used this data to conduct an epidemiological study to determine the relationship between maternal weight gain and low birth weight. As results, 1) birth weight is significantly related to the weight gain of pregnant women, 39.6% of pregnant women do not meet the Japanese Ministry of Health, Labor and Welfare criteria for appropriate weight gain. 2) Grouping by BMI, there is a significant difference in birth weight among the groups. Higher BMI was associated with higher birth weight. Less weight gain during pregnancy was associated with lower birth weight. 3) Positive pregnancy smoking history was associated with lower birth weight. As our next study topics, we plan to consider inclusion of various factors such as life-style, nutrition, spouse, and so on. In addition, EMR (Electronic Medical Record) data is useful for cohort study to collect detailed patient data for following-up long-term period and to allow labor saving and cost reduction. In the near future, we might expect to apply this method to large size data if we can build a shared network system for clinical data around NCCHD.

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We detected amyloid in the alimentary tract of four cases from July, 1990 to October, 2005. Mucosal changes such as redness, erosion, ulcer, or bleeding were seen in these cases, although amyloid was detected even from normal mucosa. Typical endoscopic features of massive amyloid deposition in AA amyloidosis was a fine granular appearance or an oedema-like mucosa, while that in AL amyloidosis was multiple polypoid protrusions or a thickening of the mucosal fold. However, the amyloid deposition in many cases was not extensive and the mucosal changes were slight. We conclude that, in order to diagnose amyloidosis at early stage, an endoscopic biopsy should be performed when a slight mucosal change or even normal mucosa, such as our cases, is observed.

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[in Japanese]

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An 18-year-old man with a respiratory disorder caused by Werdnig-Hoffman disease underwent a tracheotomy, followed by artificial respiratory management. Due to gradual worsening of tracheal stenosis caused by an abnormal shape of the thorax, the upper part of the sternal manubrium was removed with good result. This method is considered effective to lessen the effects of tracheal stenosis in cases of abnormal thoracic shape and to prevent fistula formation between the trachea and brachiocephalic artery.

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We report a case of perforative peritonitis caused by mistakenly ingested PTP (press through package). A 94-year-old man complaining of abdominal pain, vomiting and diarrhea was admitted. He was diagnosed as having enteritis and was treated conservatively. However, his symptoms did not improve. An abdominal CT (with 3 D-reconstruction imaging) showed resembling PTP in the sigmoid colon as well as free air. We performed an emergency operation after diagnosing of perforative peritonitis. Since abscess formation and fibrous adhesion were seen at the sigmoid colon, we resected the lesion and performed a colectomy and a colostomy. PTP was found in the abscess and was thought to be the cause of the perforation. In general, gastrointestinal foreign bodies such as coins, toys, dentures and PTP frequently are ingested in error by children and senior citizens. Approximately 90% of them lodge in the esophagus. Of the remaining, 80-90% of them discharge naturally, 10-20% of them are taken out endoscopically, and 1% of them require surgical removal. Since foreign bodies are often ingested by mistake, it is difficult to ascertain this scenario only by cheking hearing the patient's medical history.
Therefore, perforation caused by ingesting a foreign body should be always suspected in an older patient who shows symptoms of peritonitis. Furthermore, it is very important to carefully examine clinical data such as symptoms, medical history and radiography. In addition, 3D-reconstruction imaging of CT is thought to be very useful to detect mistakenly ingested foreign body.

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In Mie Prefecture the populations of infants and females in childbearing age will decrease and after ten years it will be much severe. To help the intact survival of all new born infants who will be human resources in the future of Mie, a neonatal ambulance transportation system and a perinatal medical information network have been created in collaboration with the local government of Mie prefecture and the Mie-chuo medical center. Three years' overview of the medical efforts is summarized. Two hundred seventy four newborn babies have been transported by the neonatal ambulance “Sukusuku-gou” in the past three years from April, 2003 to March, 2006. Forty percent of these infants required respiratory care with artificial respiration or endotracheal intubation during transportation. Infants transported by the “Sukusuku-gou” showed lower Apgar score than those transported by an ordinary ambulance, however, there were no difference in the results of blood gas examinations after transportation. It seemed that the effective treatment in the doctor car during transportation resulted in good prognosis. On the other hand, infants given birth in early gestational age after emergency maternal transportations were more critical than infants under ambulance transportation in terms of immature labor. The mortality rates of extremely low birth weight infants, very low birth weight infants, low birth weight infants and mature neonates with severe illness who were hospitalized in a general or a regional perinatal mother and child care center in the year 2005 were 20%, 1.9%, 0.6%, and 0.4%, respectively. Among 879 newborn infants hospitalized in these 5 centers, 187 infants received artificial ventilation and 13 neonates (1.5%) were died with disease. The mortality rates of infants, neonates and so on in Mie Prefecture are gradually improving from 2003 and are now lower than those of the nation average. To obtain intact survival of all newborns, is the primary goal of Mie prefecture.

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