Quality in healthcare is a concept ultimately determined by the satisfaction of the patient, or more broadly stated, society's needs. Improvement in quality begins with the review of health care organizations, in the degree to which their current role and function can and do meet these needs.
Recent trends in quality evaluation have been along the lines of patients satisfaction, as well as structure, process, and outcome oriented aspects of health care delivery. Quality entails not only the science of medicine itself, but also health care delivery, as well as social and individual concerns.
In 1990, Japan Hospital Quality Assurance Society was founded. The secretariat is located at this department. Currently, more than 60 hospitals participate for the development of standards and survey to the hospitals.
The quality improvement effort has slowly begun to put the concept into practice. The public's growing concern is directed toward holding healthcare organizations accountable for the services they provide. The healthcare field, in turn, is recognizing the needs and merit of voluntary commitment to quality, and are placing emphasis on identifying pressing society needs, and developing effective leadership.
Moving the entire healthcare field in the direction of continuous quality improvement will be the key to the survival into the 21st century.

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Mouse bone marrow cell-stimulating activity has been found in the supernatants of mouse parenchymal liver cells. In order to clarify the character, we attempted to purify the activity by a four-step purification procedure involving concentration and chromatographies on DEAE-cellulose, Sephacryl S-300, and Superose 6. By DEAE-cellulose chromatography, the activity was found to be eluted stepwisely with 0.1 M (Peak 1) and 0.2 M (Peak 2) NaCl. Gel filtration revealed that the activities in Peak 1 and Peak 2 had molecular weights of 170, 000 and 600, 000, respectively. Both preparations of the activity finally obtained derived the cells which spread over the plastic dish from mouse bone marrow cells, but did not stimulate the proliferation of IL-3/GMCSF dependent cell line, 1C2. These results suggest the presence of the bone marrow cell-stimulating activities, which are different from GM-CSF and IL-3, in the parenchymal liver cell supernatants.

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The studies on Chilaiditi's syndrome reported in Japan have been mostly case reports on one or two cases. There have been studies on 356 cases in all. We have selected 262 cases with detailed data takes from the above 356 cases, together with 116 further cases of Chilaiditi's syndrome that we have encountered up to 1990, i. e. since our previous report in 1965. We also investigated roentgenograms, complications, interpositions and age distribution.
The syndrome was mostly found in middle-aged and elderly patients of 50 years or older. More male patients were involved than female, however this is not necessarily true if the total number of patients under study is taken into account. Among the complications, gastric and duodenal diseases (ulcer and carcinoma) were most frequently found, accounting for 20.6% of the total reported cases in Japan. In our own study, the percentage was as high as 33.7% because radiography with contrast medium was positively conducted on the digestive tract. Of the interpositions, the colon accounted for 93.1% of our cases, and 72.9% of the total reported cases in Japan. The involved sites were mostly the right hepatic flexure of the colon and the transverse colon. From the reports by other researchers in the past and our data from 1965, 1975 and 1977, it appears that the incidence is about 0.003-0.03%.
There were no subjective symptom specific to Chlaiditi's syndrome, and there may be various factors accounting for the occurrence of the syndrome. The symptoms were primarily based on the underlying diseases, and Chilaiditi's syndrome merely indicates the condition where the digestive tract interposes between the diaphragm and liver. Therefore, we regard this as a radiographical sign rather than a syndrome, and we propose that this should be called “Chilaiditi's sign”. We also emphasize that the digestive tract must be strictly examined if this sign is to be noted.

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A spark sound was generated in the canine bronchus and sound waves were observed on the surface (skin) and on each layer (pectoralis major muscle, intercostal muscle and parietal pleura) of the chest wall. The sound wave observed on the surface of the chest wall was 5-10 ms in duration, 400-500 Hz in dominant frequency and 0.6-1.2 ms in the duration of the initial deflection. Reverse dispersion of the waves, i. e., the later components of the wave having longer periods, was also recognized. These characteristics of the wave were similar to those of time-expanded wave-form of crackle, i. e., discontinuous adventitious lung sounds, in clinical cases. Both the spark sound and the sound wave observed on the visceral pleura were of short duration, being 0.7 ms and 1 ms, respectively. Therefore, the main component of the sound wave observed on the chest surface was considered to reflect the physical properties of the chest wall itself. The analysis of place relationship within the chest wall suggested that transmission of the sound across the chest occurred not as a surface wave but as a longitudinal wave, therewith traversing the chest wall directly from the sound source. The arrival time of the sound was well correlated with the distance between the sound source and the positions of the pickups on the surface of the chest wall. Assuming that the medium between the source and these positions was homogeneous, the sound velocity was calculated to be 60.0m/sec. The sound velocities in the lung and in the chest wall were 71.5 and 29.6 m/sec, respectively. Further studies will be necessary to clarify the theory of the sound transmission through the living tissue as a viscoelastic body.

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Effect of indomethacin on post-ischemic changes of CA1 neurons was studied in the hippocampus of the Mongolian gerbil. The gerbil was employed because due to poor development of posterior communicating artery ischemia could be easily induced in the forebrain simply by occluding bilateral common carotid arteries. Indomethacin (5 mg/kg, i. p.) was administered 30 min before the occlusion. The occlusion lasted for 5 min, while the cranial temperature was maintained at 37.5C. Following the occlusion, the gerbils were divided into four groups. In one group, the temperature was not controlled. In the remaining three groups, the temperature was kept at 35.5C, 37.5C and 39.5C, respectively. Seven days after the occlusion neuronal density was assessed on histological sections stained with hematoxylin eosin.
It was found that in all groups indomethacin was effective in preventing delayed neuronal death regardless of the difference in the cranial temperature. However, delayed neuronal death was the least in the lowest temperature group. The drug also prevented the post-ischemic hyperhermia observed in the temperature non-controlled group.
These results indicate that indomethacin has its own pharmacological action to prevent delayed neuronal death.

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Given the increasing incidence of colon cancer in recent years, it is important to establish a diagnostic system for early detection and introduce it into clinical practice.
A double contrast examination that uses a disposable tip and tube with an enema reservoir filled with 200 ml of 60 w/v% barium sulfate, known as SCG (screening colonography) was used in this study. In order to assess its utility SCG was performed on 1, 554 patients, and 2, 004 patients were examined by a within 24 hours combination of sigmoidoscopy and SCG by way of screening for colon cancer.
Given the brief duration of SCG, which ranged from 10 to 13min in most patients in the study, the efficiency of the examinations was considered to be rather high. Furthermore, the barium reached the cecum in as many as 98.7% of the patients. Overall, SCG proved to have an excellent diagnostic capability. Sigmoidoscopy-SCG, on the other hand, detected colon cancer in 114 patients (5.7%) and colon polyps in 658 patients (32.8%). The rates of detection of colon cancers and polyps were higher in the patients who tested positive in immunological fecal examinations for occult blood. Judging from our results, it may be said that for many patients receiving thorough physical checkups to screen for colon cancer, our system will provide for efficient screening whereby patients are first examined for fecal occult blood and those who test positive undergo sigmoidoscopy and SCG within the same day.

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