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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　メタボリックシンドローム (MS) の主原因は内臓脂肪型肥満とされ，ウエスト周囲径が内臓脂肪型肥満の最もよい指標とされている。しかし，内臓脂肪型肥満の経時的な改善指標としてウエスト周囲径が体重やbody mass index (BMI) よりもすぐれた指標であるか否かについては報告がない。このため，教育介入試験において，体重，BMI，ウエスト周囲径，体脂肪率と，摂食量，生活活動量および脂質代謝や糖代謝などのMSに関連する指標の変化との関連を解析した。対象は，2000～2006年に健康教育介入による3か月間の肥満改善プログラムを修了した358人 (男性91人，女性267人) である。参加者は3か月間で体重を1.7kg (介入前値比3%)，ウエスト周囲径を2.4cm (3%) 減少し，体脂肪率を0.5% (2%) 増加させた。体重変化量とBMI変化量は男性0.99，女性0.98と極めてよく正相関し，体重変化量とウエスト周囲径変化量とは男性0.60，女性0.58，体重変化量と体脂肪率変化量とは男性0.45，女性0.38であった。介入により体重やウエスト周囲径が減少していたのに，体脂肪率は有意に上昇していた。平均体重減少量4.4kgの群では，総コレステロール，HDLコレステロール，中性脂肪，血糖，インスリン，HOMA-IRが有意に改善していた。以上のことから，MSの保健指導での肥満指標としては代謝指標の改善をより反映することから体重がウエスト周囲径や体脂肪率よりも優れていた。また，3か月間に体重3～7%の減少で，肥満関連代謝異常に顕著な改善が認められることが明らかになった。

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　佐久総合病院では，2002年より外来化学療法を行なってきたが，2006年2月，通院治療センターを新たに独立させた。薬剤師は，プロトコールに基づいた処方鑑査，薬歴管理，無菌調製を行なうとともに，曜日担当制で患者情報収集や指導を行なっている。しかし，外来では入院中に比べ，カルテからの情報収集や患者と接する時間は限られる。そこで，入院による化学療法から外来化学療法に移行した症例について，入院時に薬剤管理指導を担当した薬剤師と，外来化学療法を担当する薬剤師の患者情報共有化を目的に，症例検討会を開始した。その後，情報共有化の必要性を認識した医師，看護師も加わり，通院治療センターカンファレンスを立ち上げるに至った。カンファレンスでは，薬剤師が入院時の患者情報を提示し，多職種による話し合いを行ない，情報の共有化と問題解決の方向性を見出している。このことにより，患者の入院中の状態が把握でき，外来治療への移行がスムーズに行なえるようになった。また薬剤師としては，副作用発現時の対応などについて，より適切な指導が行なえるようになった。通院治療センターカンファレンスは，チーム医療の実践に向けて大きな一歩となったものと考える。

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