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.
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.