Introduction
 Maternal mortality ratio is widely used to provide a general sense of size of the problem of maternal deaths. However, it cannot be used to measure progress of maternal health programme on an annual basis and to compare geographic areas, because of its wide range of errors. This research estimates maternal mortality in six districts by using “unmet obstetric need” indicator in Tambacounda region, Senegal and describes possible application of the indicator to monitor, evaluate and facilitate maternal mortality reduction.
Methods
 We used data on caesarean sections performed in seven health facilities in Tambacounda and Kaolack regions in 2005, and calculated rates of the intervention for the residents of Tambacounda. We estimated maternal mortality ratios for selected severe obstetric complications in six districts by calculating the number of deficits for the caesarean sections for absolute maternal indications, which were the number of women who developed life-threatening events but could not receive the appropriate interventions for the diseases.
Results
 The rates of caesarean sections for all indications and for absolute maternal indications in the six districts ranged from 0.3 to 2.0% and from 0.1 to 0.9%, respectively. The estimated maternal mortality ratio for the absolute maternal indications in Tambacounda region was 651 (95%CI 554-761). Statistically significant differences in the ratios were observed between Koumpentoum district (maternal mortality ratio 966, 95%CI 741-1239) and Goudiry (877, 588-1260), and Kédougou (249, 119-457) and Bakel (296, 128-584).
Conclusions
 This study method enabled us to distinguish the difference in maternal mortality ratios for the selected severe obstetric complications between the small districts. It implies that the “unmet obstetric need” indicator can be used to compare geographic areas, to monitor trends, and to evaluate programme impact as well as baseline data to establish necessary measures to decrease maternal deaths.

In hemodialysis patients, muscle cramps in the lower extremities are frequently seen. In order to prevent the occurrence of these cramps, Shakuyakukanzo-to was administered to five patients that frequently suffered from muscle cramps during dialysis. Before receiving dialysis, a dose of 2.5g was given to each of the five patients. The rates of efficacy were: effective for 2 patients, slightly effective for 2 patients and not effective for 1 patient. No severe side effects such as increases in serum potassium levels were observed. The results therefore suggested that Shakuyakukanzo-to is useful in the prevention of muscle cramps during dialysis.

Systemic lupus erythematosus is an autoimmune disease associated with mild valvular regurgitation. However, there have been no detailed reports of infective endocarditis in patients with systemic lupus erythematosus. Here, we describe a case of a 55-year-old woman without any cardiac abnormalities who was diagnosed with lupus nephritis by renal biopsy; she contracted infective endocarditis while receiving immunosuppressive therapy. Our case emphasizes that special consideration of the occurrence of infective endocarditis, and its early diagnosis and treatment are mandatory for patient survival. We propose that echocardiography should be performed before treating patients with systemic lupus erythematosus who have an uncertain cardiac status.

It has been made known that there isn't any significant regional difference in the frequencies of cases of viral hepatitis C by subtypes in our country. In the present study we investigated the subtypes in hepatitis C virus carring patients without blood transfusion history in the southern region of Ibaraki Prefecture to clarify the occurrence ratio of each subtype of the virus. The results of interferon therapy were also examined in those patients with chronic hepatitis C. The frequencies of subtypes 2, 3 and 4 were found to be 71%, 16% and 10%, respectively. Although these ratios were the same as the national average, a significantly high frequency (P>0.01) of subtype 3 was observed in the patients from Tsuchiura in the region, suggesting that there may have existed some particular source of infection other than blood transfusion. The effectiveness of interferon therapy was significantly higher (P>0.01) in the patients with subtype 3 (75%) than in those patients with subtypes 2 and 4 (23% and 43%, raspectively), suggesting that interferon is a remedy specific to subtype 3.