I showes the result of treatment of malignant diseases in digestive organs for last 20 years on our hospital.
  In Niigata prefecture, esophageal and gastric cancer cases are higher more than Japanese mean frequency of them.
  We have about 200 cases of gastric cancer every year. Out of them, operable cases have been decreased gradually, because of increase in cases done EMR (endoscopic mucosal resection).
  In operation method, total gastrectomy and pyloric resection cases decreased due to improve patient's QOL. Anticancer chemo-therapy into inoperable patients were done by new anticancer drugs, especially, combination therapy of TS-1 and paclitaxel is most effective compared of other drugs and combinations, that is, 13 months in mean survival time were performed.
  Number of cases of esophageal cancer has been increasing slowly, however, operable cases were not increasing, because of increasing of EMR. Presently, frequency of operation, EMR and chemotherapy with irradiation is almost similar.
  Number of cases in colon cancer has been increasing yearly, following colonofiberscopy (CF) with EMR or polypectomy (PP).
  Almost of advanced colon cancers were operable with laparostomy, however, before several years, laparoscopic colectomy (LAC) was performed, then, it reached to 40% among operable cases. By LAC, hospital period was shortened about a half of laparostomy.
  Number of cases of hepatocellular carcinoma (HCC) has been not increasing, so, cases of hepatic resection was stationary, because of TAE (transarterial embolization), RFA (radiofrequency ablation) and PEIT (percutaneus ethanol injection therapy) performed actively.
  Out of them, 5 year survival rate of lower biliary tract cancer patients were more higher than upper ones.
  Hereafter, based on above results, we have to make a effort to form a system of a cancer therapy, from prevention, diagnosis, and therapy to terminal care.

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  A workshop on the present circumstances surrounding infection control and prevention of nosocomial infections was held on the occasion of the 56th Assembly of the Japanese Association of Rural Health (JARM).
  Hospital-acquired infection poses a challenge for medical institutions. Many members of the JARM work in various types of hospitals and facilities large and small. Types of infectious agents also vary. As a matter of fact, the way to meet this challenge may be different from one medical institution from another. The purpose of this workshop was for participants to exchange views and information about infection control and prophylactic measures against the infections.
  Six presenters shared their experience in this session.
  Dr. Shunji Ando from Tsurumi Hospital (Oita) expounded on the preventive measures against legionellosis and tuberculosis taken by his hospital. According to his presentation, legionellois does not rank among the most common hospital-acquired infections but it mainly occurs as a community-acquired one. The previously reported incidence of nosocomial legionellosis was in fact caused by the contamination of the water supply system of the hospital. Dr. Ando held that pulmonary tuberculosis is still an important disease as a hospital-acquired infection and old inpatients are at high risk for developing pulmonary tuberculosis. He draw the attention of the participants by saying that most patients with tuberculosis treated in his hospital were students from Southeast Asian nations.
  Mr. Kaoru Ohe (pharmacist, manager of ICC) from Showa Hospital (Aichi) gave a presentation on the measures taken by his hospital against the infection with multidrug-resistant bacteria He explained tht they included the making of flowcharts which should be utilized after detection of pathogens in order to carry out the surveillance. In addition, he said, the Infection Control Committee (ICC) in the hospital prepared a manual on prevention by isolation and use of the barrier techniques.
  Ms. Taeko Kubota (ICN) from Toride General Hospital (Ibaraki) spoke about the activities of the Infection Control Team (ICT) and infection control nurses (ICNs) for infection control and prevention of in-hospital infectious diseases with multi-drug-resistant microorganisms. She also talked about three instances in which ICT and ICNs played important roles in the prevention of nosocomial infections. In one instance, ICT members searched out the evidence of methicillin-resistant Staphylococcus aureus (MRSA) which caused the infectious disease in patients after the installation of the operating panel of a mechanical ventilator.
  Dr. Masami Egawa from Bange General Hospital (Fukushima) reported his experience in managing in-hospital infections with multiple-drug-resistant Pseudomonas aeruginosa (MDRP). Some members of the ICT in his hospital identified a bucket for collecting stored urine as the source of MDRP infections about four months after the outbreak. He also mentioned Norovirus infections that spread in the nursing care facility attatched to his hospital. In light of his experience, he said, it was very difficult for a facility accommodating many elder people with dementia to prevent Norovirus from spreading, once a patient was infected with this virus.

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  Obesity is an important public health problem in Japan and many other countries. There is a need for simple and reliable anthropometric measurement tools for visceral obesity to facilitate the prevention of metabolic syndrome (MS). Although studies have so far suggested waist circumference (WC) is the best indicator of visceral obesity, there is no reportof predictive value for improvement of MS. We conducted to analyze the relationship between anthropometric measurements and metabolic disorders in an interventional study of 358 subjects who participated in our program for visceral obesity based on health education and self-determination from 2000 to 2006. The intervention induced significant decreases in calorie intake and increases in physical activity of the participants, and resulted in significant decreases of 1.7 kg (3% of body weight at the baseline) of weight and 2.4 cm (3%) of WC, but body fat percent using bioelectrical impedance analysis found their body fat percentage increased 0.5% at the baseline. Weight-loss was significantly associated with improvement of metabolic measurements by our intervention. Weight and body mass index (BMI) showed the highest correlation coefficient for improvement of metabolic measurements, while WC and body fatpercentage showed lower values for improvement of metabolic measurements. In conclusion, weight-loss is the suitable indicator for the evaluation of the educational program, and 3-7% weight-loss for three months is recommended to improve visceral obesity and MS.

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  Having provided chemotherapy at its outpatients clinics since 2002, the Saku Central Hospital in February 2006 established a Chemotherapy Center for Patients Discharged from Hospital. At this center, pharmacists check doctors' prescriptions, review all medications patients have been taking and dispense the prescriptions in a sterilized state. In addition, they are assigned on a daily basis to collect information on, and give guidance to, the patients. At the outpatient clinics, the length of time that can be set aside for the tabulation of information from patients' case records and for contact with the patients is inevitably likited. Given this situation, we began case study meetings in order to share information about patients between pharmacists in charge of guidance on the control of drugs at the time of their hospitalization and those who are in charge of chemotherapy at the Center. Later, these case study meetings were joined by physicians and nurses who thought it necessary to share information, thus leading to the establishment of a Conference at the Center. At this conference, pharmacists introduce information about patients at the time of their hospital admission and a discussion begins with the participation of various hospital staff members to solve given problems. By so doing, it has become possible to come to grips with the conditions of inpatients, enabling us to shift to services at the Center smoothly and give proper guidance when a medication produces undesirable effects. We consider the Conference signifies a step forward to the practice of medical care by teams.

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