Here we report the results of a long-term analytical study on the utilization of antihypertensive and antibacterial agents, which was performed using the Integrated Medical Information System (IMIS) developed by Kochi Medical School. The results indicate clear (increasing or decreasing) patterns in the numbers of patients and the dosages. Specifically, the total amount of antibacterials recently prescribed is significantly lower than in the year analysis began (1983). This reduction provides evidence of a steady improvement in the quality of medication and is particularly important for macrocosmic evaluation of the primary focus of our study, which was the “proper use of drugs”. Furthermore, the results also showed medication prescribed by non-specialists to be less inventive than that prescribed by specialists. This study highlights the importance of reforming institutions providing medical treatment from the perspective of effectively utilizing medical resources (by employing specialist personnel) and the proper use of medications. Because non-specialists prescribe medication in numerous medical facilities throughout Japan, these issues must be seriously considered.

The working group on the education of general medicine, Japan Society for Medical Education, has defined general medicine as a discipline which includes following three areas; 1) basic clinical skills which incorporate humane health care, 2) comprehensive community and family medicine and 3) general internal medicine which provides integrated services to solve clinical problems at any level. It has also issued a proposal on undergraduate education of general medicine at university hospitals. The working group now propose a detailed sample curriculum which describes the instruction in three areas mentioned above. Overview, General Instructional Objective (GTO), Specific Behavioral Objectives (SBOs), Learning Strategies (LS) and Evaluation are included in this sequence.

The frequencies of the urinary complaints oa the outpatients (male 188, female 339, average age 59.2+14.9) of the five acupuncture clinics were surveyed. The elder patients showed the higher frequencies of the urinary complaints. The frequencies of the complaints were as follows: nocturia (25.8%), urinary urgency (17.7%), stress incontinence (16.3%), sense of residual urine (15.2%), protracted micturition (12.0%), and retarded micturition (11.3%), respectively. The nocturia was accompanied with the majority of the other urinary complaints. These results suggest that the survey of the patient's complaint of nocturia is useful.

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

Shiunko, topical herbal ointment, has been used in Japan for hemorrhoid and skin wound such as scratch, incision and burn. We report two cases of radiation dermatitis with erosion, which have a good outcome after treatment with shiunko. Case 1 was 72-year-old man with radiation dermatitis of bilateral inguinal region caused by postoperative irradiation for bilateral inguinal lymph node metastases from penile cancer. Re-epithelization was observed in erosion on the 10th day after applying shiunko. It showed earlier recovery from radiation dermatitis than the cases treated with topical external medicine of azulene and/or steroid. Case 2 was 60-year-old man with the perianal radiation dermatitis with pain caused by pelvic radiotherapy for recurrence of advanced rectal cancer after chemotherapy. Shiunko gave rapid relief from anal pain and the patients felt no pain on the day subsequent to applying shiunko. Shiunko hastens analgesic effectiveness and improvement of wound caused by radiotherapy.

We report a case of a 57-year-old woman with radiation proctitis (RP) treated by shiunko (SK) enema with promising outcomes. The patient underwent interstitial brachytherapy for anterior vaginal vault recurrence of uterine cancer. Nine months after the treatment, she had anal pain and was diagnosed with RP by clinical course and colonoscopy. The rectal ulcer was so severe that a surgeon proposed permanent stoma formation as one option, given eventual risk of rectovaginal fistula. The patient rejected stoma formation and opted for Kampo medicine. Though she took keishibukuryogankayokuinin for blood stasis at first, her anal pain and rectal bleeding gradually worsened. Thereafter, she mainly used SK enema, kyukikyogaito and magnesium oxide. Anal pain and rectal bleeding decreased after applying SK to the rectal wall per rectum. Magnetic resonance imaging (MRI) and colonoscopy findings of the rectal ulcer also improved. SK effectively reduced anal pain and rectal bleeding as well as stimulated tissue repair in our patient, and therefore SK is worth considering in the treatment of RP.