Currently, there are more than 53,000 beds in kaifukuki rehabilitation wards throughout Japan. The development of kaifukuki rehabilitation wards is proceeding smoothly in terms of quantity. It is suggested that, with this development, the activities of daily living of patients will significantly improve, leading to an increase in the likelihood of patients returning home when a large unit of daily rehabilitation training is provided via one of these kaifukuki rehabilitation wards. The tasks remaining to be completed for the optimal realization of the kaifukuki rehabilitation wards are to reduce the disparity in the number of beds among prefectures, to realize a mature team approach to the rehabilitation program, to encourage full-time ward physicians of the rehabilitation department to exercise leadership, to enhance subacute medical services, to enhance human resources such as nurses and rehabilitation specialists and to improve the education and training system for the staff. Other major tasks remaining are to strengthen the cooperation between kaifukuki rehabilitation wards and acute hospitals, by which such rehabilitation wards will become capable of actively accepting patients from an early stage, and to establish cooperation between kaifukuki rehabilitation wards and the home care system.

Objective : To elucidate the availability and applicability of the information contained in health insurance claims to pharmacoepidemiological studies with particular reference to the computerization of insurance claims submitted by dispensing pharmacies.
Data Sources : Outpatient insurance claims of two health insurance societies based in the Kanto region. The survey, funded by the Federation of Health Insurance Societies, was undertaken as part of a demonstration project to develop methodologies for insurers to evaluate the clinical performance of providers.
Study Selection : Disease-specific, provider-specific and clinical procedure specific comparison of the per-claim cost. All claims from pharmacies were matched with the prescribing hospitals or clinics to capture the entire medication.
Data Extraction : All claims were reviewed by trained reviewers and procedure specific costs were classified into five disease categories to obtain the best estimate of disease-specific cost.
Results : Inter-provider variations were assessed based on overlapping of the overall average and the confidence interval of the doubled standard error after adjusting for age. Contrary to popular belief, academic medical centers showed significantly lower medication cost than clinics for the treatment of acute upper respiratory infection. Prescription pattern to favor high cost antibiotics accounted for higher per-claim medication cost of clinics with concentration of high cost claims.
Conclusion : Based on the authors' experience and methodologies developed, computerization of insurance claims will achieve consistency, efficiency and timelines which are of utmost importance for pharmacoepidemiological studies. On the other hand, insurers may preempt the claims review and reimbursement organizations by appealing to the pharmacy claims through electronically matching the prescribing claims. The nature of evidence sought by both pharmacoepidemiological researchers and insurers, whether it be for the purpose of post-marketing survey or cost cutting, would eventually converge.

We describe a ruptured internal iliac artery aneurysm associated with sigmoid colon infarction. The patient was referred to our hospital complaining of lower abdominal pain. Computed tomography scan demonstrated a massive hematoma with a ruptured left internal iliac artery aneurysm. Hypovolemic shock prompted immediate laparotomy, endoaneurysmorrhaphy of the ruptured aneurysm, and resection of the recto-sigmoidal colon. During treatment for ruptured internal iliac aneurysm, we should consider potential colon infarction.

Using atomic absorption spectrophotometry, we measured serum mineral (Fe, Cu, Z n, Mg, Ca, K, Na) concentrations in blood of male athletes participating in a triathlon competition held at Nakajima, Ehime in 1989. The athletes were divided into a young group (n=9, 24.2±3.6 yr) and a middle-aged group (n=9, 49.3±4.4 yr) . Blood samples were taken on the day before the competition, at the finish, on the following day and for eight days after.
Immediately after the race, the concentrations of iron, calcium and potassium were increased significantly in sera taken from both groups, and those of copper and zinc were found to be increased only in the young group. In the middle-aged group, serum magnesium and sodium concentrations were decreased significantly. On the day after the race, most of the serum mineral concentrations had returned to values similar to those measured before the race, although the serum sodium concentration in the middle-aged group was still below the previous value, and this low level persisted for eight days after the race in both groups.
Noticeable differences between the young and middle-aged groups were that recovery of increased iron concentration in serum tended to be prolonged in the middle-aged group, and the concentrations of serum copper and zinc were higher than those in the young group throughout the measurement period, with only small changes evident before and after the race. By contrast, serum potassium concentration in the middle-aged group was lower than in the young group throughout the measurement period.

Background
The Pacific Islands is an area with one of the world's highest prevalence of obesity and diabetes. The Republic of the Marshall Islands (RMI) is an independent country of the Micronesian that extends along latitude 4 to 18 degrees north. In the past, several studies reported regarding the prevalence of diabetes among the people of the Pacific Islands. However, there is no report yet with respect to diabetes in Majuro, the capital of RMI. In RMI, diabetes and obesity are also recognized to be a serious problem, but the present state of affairs prevents an understanding of the situation.
Objectives
The purpose of the present study was to investigate the present situation and the prevalence of diabetes and obesity in Majuro.
Methods
The participants were Marshallese visited our thyroid cancer-screening program. Among those participants who undertook thyroid cancer screening, the Body Mass Index (BMI) and hemoglobinA1c (HbA1c) levels were taken of 850 participants. Participants with an HbA1c level of 6.5% or more were put into the diabetes group and participants with a BMI of 30 and over were the obese group. Prevalence was adjusted using the Majuro population based on 1999 national census and using world standard population of Segi.
Results
The age-adjusted prevalence of diabetes in aged 20 years and over in Majuro was 22.1%. After standardization, the prevalence was 31.0%.
Conclusion
The results suggest there is a high rate of diabetes in RMI similar to other pacific islands. It could be concluded, based on this research, that there is a crisis situation with regards to diabetes in the RMI. There is also a need for epidemiological research to be on a random sample of the population.

This study was designed to evaluate the perioperative outcome of dialysis patients undergoing cardiac surgery, who were managed with our perioperative dialysis program. Between April 1994 and August 1999, 11 patients (7 men and 4 women with a mean age of 57.3±10.3 (36-73)) with hemodialysis (HD, n=8) and peritoneal dialysis (PD, n=3) underwent cardiac surgery. The duration of dialysis was 5.6±4.3 years. Operation included mitral valve replacement (n=1) and isolated coronary artery bypass grafting (n=10). Patients with HD had single hemodialysis on the day before operation. Patients with PD were maintained on PD in the usual manner until the day before surgery. Intraoperative hemofiltration during extra-corporeal circulation and normokalemic non-depolarizing cardioplegic solution were used in all patients to avoid post-operative hyperkalemia. All HD patients had dialysis on the first post-operative day (POD 1), and then every other day. PD patients had PD soon after arriving at the ICU. Levels of serum creatinine, urea nitrogen, acid-base balance were successfully controlled within acceptable ranges. No patients required emergency HD or any post-operative managements for hyperkalemia in the ICU. Six of 8 HD patients required an increase in vasopressor because of a tendency toward hypotension and 4 of 8 patients suffered from atrial fibrillation during the initial HD on POD 1. Eight of 11 patients could be extubated on the first POD. No hospital death occurred. The use of normokalemic cardioplegic solution was useful to avoid post-operative hyperkalemia. Our perioperative dialysis programme successfully managed the perioperative clinical course of dialysed patients undergoing cardiac surgery.

This present study was conducted among the nine centers of Akita prefectural Welfare Federation of Agricultural Cooperatives. This applied to women over 30 years of age, and carried out following to the standard method of the Japan Cancer Society.
The total of women examined by the first screening from April 1983 to January 1985 amounted to 15903, of which the number of women over 60 years of age was only 7 per cent of the total. According to the type of screening, the number of women slightly more in the center screening than in the local screening. However, in both types of screening, the number of women examined by the combination method, for example, anemia or uteric cancer, was much higher than that of the mass screening for breast cancer alone.
The second screening rates indicaded a marked difference of 0.4 to 21.7 per cent depending on the location of the center. The over-all average for the second screening was 3.8 per cent. As a result of the second screening, breast cancers were detected in 12 cases (0.07%). The breast cancer detection rate increased with age. It is notable that the breast cancer detection rate for women over 60 years of age was 5 times higher than for women over 40 years of age. Among other diseases detected in the second screening were mastpathy (233 cases), fibroadenoma (15 cases), mastitis (40 cases) and others.
As far the stage distribution and screening history for detected breast cancers, 60 per cent of all cancer cases were diagnosed as stage I, and 70 per cent were the initial screening. Seven out of 12 cases were aware the breast lump themselves before the first screening. From this point of view, it was suggested that every women should be educated in order to perform selfexamination.

We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (p <0.001). When the subjects were classified into three groups, a significant difference (p<0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.

Based on two years working of “the enlarged working group for the curriculum of chemistry for medical education”, a provisional plan of the curriculum of chemistry for medical students is proposed. The article is consist of four sections; namely A: general problems, B: “chemistry” as a general education, C: purpose and specific problems of the general education for medical students, D: a provisional plan of the curriculum of chemistry for medical students.
The main part D is consist of three subsections: namely (1) a plan of the curriculum of physical and inorganic chemistry, (2) a plan of the curriculum of organic chemistry, (3) a plan of the curriculum of experiments.

Background/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs. Methods: POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up. Results: A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin. Conclusions In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.