Patients who need self-injection of insulin are educated beforehand to handle vials and syringes without bacterial contamination. However, not a few of them forget what they were told about the sterile technique during a long period of injection at home. Since 1988 a pen-typesyringe, which is considered to be more potent against bacterial contamination because of its mechanical structure, has become available in Japan. The aim of this study is to detect the percentage of contaminated vials in the patients' home and to compare traditional vials with pen-type vials in terms of potency against contamination. Two hundred eight vials were collected from 168 patients. Four traditional vials out of 163 (2.4 %) and 1 pen-type out of 45 (2.2%) were contaminated. Propionibacterium acnesgrew up from 2 vials, staphylococcus epidermidis from 2 vials and unidentified gram (+) rods from 1 vial. The patients using contaminated vials were from 30 to 65 in their age, enough skillful to handle syringes, good or poor in the control of DM and without disturbed vision. Thus, the contamination may have been derived from their technical deterioration after several years of injection at home. Therefore, re-education to keep their sterile technique should be given to them at appropriate intervals at the out-patient clinic.

We estimated the medical expense of treating patients with diabetes mellitus under the health insurance system in Japan. The expense was summed up to 5.07 million yen for a patient who developed NIDDM at the age of 40 and died at the age of 75 without diabetic complications throughout his life. If he had diabetic retinopathy, neuropathy, hypertension and hyperlipidemia, and needed insulin injection, the cost would have increased 2.4 times to 12.32 million yen. It was also estimated at 25.22 million yen for a patient who developed IDDM at the age of 20 and died at the age of 70 without diabetic complications. If the patient had with diabetic retinopathy, neuropathy and hypertension and needed hemodialysis because of nephropathy for 20 years, the figure would have reached a whopping sum of 76.17 million yen. From the viewpoint of medical economy, more effort to prevent diabetic complications should be made.

Purpose: This study aimed to examine the effects of 4 main types of gastrectomy for proximal gastric cancer on postoperative symptoms, living status, and quality of life (QOL) using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Materials and Methods: We surveyed 1,685 patients with upper one-third gastric cancer who underwent total gastrectomy (TG; n=1,020), proximal gastrectomy (PG; n=518), TG with jejunal pouch reconstruction (TGJP; n=93), or small remnant distal gastrectomy (SRDG; n=54). The 19 main outcome measures (MOMs) of the PGSAS-45 were compared using the analysis of means (ANOM), and the general QOL score was calculated for each gastrectomy type. Results: Patients who underwent TG experienced the lowest postoperative QOL. ANOM showed that 10 MOMs were worse in patients with TG. Four MOMs improved in patients with PG, while 1 worsened. One MOM was improved in patients with TGJP versus 8 MOMs in patients with SRDG. The general QOL scores were as follows: SRDG (+39 points), TGJP (+6 points), PG (+3 points), and TG (−1 point). Conclusions The TG group experienced the greatest decline in postoperative QOL. SRDG and PG, which preserve part of the stomach without compromising curability, and TGJP, which is used when TG is required, enhance the postoperative QOL of patients with proximal gastric cancer. When selecting the optimal gastrectomy method, it is essential to understand the characteristics of each and actively incorporate guidance to improve postoperative QOL.