Established practice guidelines for the treatment of diabetes in Japan do not currently provide satisfactory glycemic control and outcomes. One of the most important problems facing the fewer than three thousand specialists who must treat 16.2 million diabetic patients is the lack of a strategic approach to the provision of care to all diabetes patients in Japan. Recently, local area diabetes care networks are being advocated as a model for diabetes care. The current article describes the various problems associated with establishing a diabetes care network among general practitioners in the Inba region of Chiba, and reviews the more general problems in providing diabetes care on a national basis.

抄録全体を表示

The association between cerebrovascular diseases and depression has been recognized for many years. Studies have found much information about the pathogenesis and treatment of post-stroke depression in the West since the 1970s. On the other hand, the concept of vascular depression was introduced in 1997, as the prevalence of silent cerebral infarctions detected by MRI scans in patients with late-onset depression is higher than that in non-depressed patients. This paper gives an outline of the clinical findings about vascular depression including post-stroke depression.

抄録全体を表示

Psychiatric disorders following traumatic brain injury (TBI) have negative influence on the recovery from TBI (e.g., they worsen the effect of rehabilitation, psychosocial function, activity of daily living, quality of life, relations with family members, etc.). Although psychiatric disorders are frequent complications of TBI (e.g., mood disorder 6∼77%, anxiety disorder 11∼70%, psychotic disorder 2∼20%, and problematic behavior 11∼90%), most of them are misdiagnosed and not treated adequately. Treatment of psychiatric disorder following TBI is not different from treatment of primary psychiatric disorder. TBI patients, however, are more sensitive to the side effects of medications, and therefore we should treat them by (1) starting low and going slow, (2) setting an adequate therapeutic trail with regard to dosage and duration of treatment, (3) frequent assessment during the treatment period, and (4) paying attention to adverse effects and drug interactions. Since psychiatric disorders may worsen the recovery process from TBI, successful treatment is especially important for TBI patients. It is essential for clinicians to be aware of any psychiatric disorders following TBI and to treat them properly.

抄録全体を表示

A 32-year-old man with a history of adult-onset asthma and a high level of P-ANCA and eosinophilia was referred to our hospital because of renal insufficiency. Renal and skin biopsy specimens confirmed a diagnosis of Churg-Strauss Syndrome (CSS). Treatment with steroid therapy alone including methylprednisolone pulse therapy was unsatisfactory, so additional treatment with cyclophosphamide was started. Three days later, he presented with convulsions and consciousness disturbance. MRI of the brain demonstrated bilateral whitematter abnormality that was characteristic of reversible posterior encephalophathy syndrome (RPES). Since the activity of CSS was still high, immunosuppressive therapy was continued combined with antihypertensive therapy. His consciousness was soon recovered and MRI findings improved later. RPES is an uncommon complication of CSS. In this case RPES might have been associated with CNS vasculitis.

抄録全体を表示

In the field of reconstructive surgery, the flap developed as an outcome of the quest for suitable sites for reconstruction and greater operative safety and quality. Over time, new flaps such as “perforator flaps” were developed, and a need arose for a system to categorize these flaps. We proposed a new flap classification method based on the operative techniques necessary for their use. Initially, we classified all flaps according to whether vascular anastomoses were needed or not in the operation. Flaps that did not require vascular anastomoses were classified as “Non-anastomosed pedicles” (N), and those that did were dubbed “Anastomosed pedicles” (A). In the case of combined flaps, we notated the number of pedicles in the following way: Type N₀A₁, Type N₁A₁, etc. Our sequence of notation is: 1. pedicle type; 2. vascular name or tissue name of the pedicle; 3. component of the flap; 4. other important information about the flap. These are compartmentalized using a slash (/).

抄録全体を表示