With recent policy changes in higher education in Japan, it has become increasingly uncertain wheter Japanese medical schools will be able to maintain their level of research activities. This is especially so in local universities like Shinshu University. Here we analyzed recent academic activity at Shinshu University School of Medicine (SUSM) based on the number of original articles published in English and their Impact Factors (IFs, by Journal Citation Reports). All English articles registered at SUSM from 2001 to 2004 were individually confirmed on the PubMed web site. Clinical papers were classified according to the evidence levels. The number of faculty members who took sabbatical leave and the duration of each sabbatical were also analyzed for the period from 1999 to 2005. Between 2001 and 2004, a total of 1,472 original articles were published by researchers at SUSM : 425 in 2001, 358 in 2002, 407 in 2003, and 282 in 2004. Total IFs were 1136.0, 1088.5, 1174.0, and 878.5 for the corresponding years. A decrease in the number and IFs of publications is apparent for 2004. The number of randomized comparative studies was 11 out of 1,472 (0.75%). The senior institute responsible for the article on the PubMed web site was SUSM for 62% of the work, but was other institutes for the rest (38%), and the mean IFs of the articles were significantly higher for the latter papers than the former. Sabbatical leave was clearly diminishing both in numbers and in duration from 2004 onwards. These results show that research at SUMS is not growing, and facilitation of collaboration with other institutes is indispensable for faculty development and revitalization of research activities.

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For empiric therapy against bacterial infections, it is most important to select antibiotics on the basis of statistical analyses of drugresistance of the bacteria isolated in a hospital or a region. In this study, we examined the drugresistance of Enterococcus species isolated at Shinshu University Hospital from January 2001 to June 2005. E. faecalis and E. faecium comprised 80.5% of the total number of Enterococci, and there was no distinct trend for resistance to increase in each Enterococcus species. More than half of E. faecium were resistant to PCG and ABPC, while most of E. faecalis were susceptible to them. Enterococci with high-level resistance to vancomycin had not been isolated in the hospital. Vancomycin may be useful in the treatment of patients severely infected with Enterococci.

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Primary effusion lymphoma (PEL) is a rare subset of non-Hodgkinʼs lymphoma that predominantly grows in body cavities as neoplastic effusions without a contiguous tumor mass. Most PEL cases occur in an immunocompromised state, such as AIDS. We report a case of PEL complicated by not only AIDS but also liver cirrhosis. A 48-year-old man was referred to our hospital because of pleural effusion, ascites and emaciation. Cytologic study and CT revealed the existence of lymphoma cells in the effusion, without mass lesion, leading to a diagnosis of PEL. He was also diagnosed as having AIDS and hepatitis B liver cirrhosis. A large amount of HHV-8 DNA was found in the pleural effusion. Lamivudine and HAART treatment were given for the HBV and HIV infection respectively. Chemotherapies with CHOP, EPOCH, or DeVIC were refractory for PEL, and the patient died of hepatic failure and cerebral hemorrhage. This is the first report of an AIDS patient complicated by PEL and liver cirrhosis.

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Remnant stomach cancer after proximal gastrectomy is rare. We report a case with remnant stomach cancer who had undergone proximal gastrectomy 11 years earlier. Total resection of the remnant stomach was performed, and the pathologic diagnosis was pT3 (se), por2, scirrhous type, INFγ, ly2, v1, pN1 (4d, 6). The patient died of carcinomatous peritonitis 5 months after operation.
We also reviewed 19 cases of remnant stomach cancer after proximal gastrectomy in the Japanese literature ; many of these cases could not receive curative surgery due to advanced carcinoma. We recognized the importance of early detection and that periodic examination of the remnant stomach should be performed.

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[in Japanese]

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