Most doctors in community hospitals are clinicians and differ in many ways from physician-scientists in university hospitals. However, conversion from clinician to clinician-educator requires various innovations and endeavors such as the establishment of clinical clerkship, dissemination of EBM, progressive disputation, sufficient accountability, cooperation with co-medical. Undergraduate medical education in community hospitals should be focused on primary care, general internal medicine and emergency medicine. Achievement in our hospital is discussed.

INTRODUCTION: The introduction of the mass screening (MS) program measuring urinary catecholamine metabolites at six-months of age for detecting neuroblastoma has resulted in the increase in both number and incidence of patients detected less than one year of age in Japan. The prognosis for infantile neuroblastoma is well known to surpass that for older patients. The prognosis of patients detected by MS has been outstanding. However, in Japan, there has been no consentient guideline of optimal therapeutic management for infants with favorable prognosis. There has been a continuing controversy on the selection of appropriate therapy for neuroblastoma infants, especially those detected by MS. In Japan, based on prognostic factors including N-myc amplification as well as clinical stage, patients with advanced disease receive a consistent therapeutic regimen. In contrast, neuroblastoma infants with favorable biological characteristics and clinical outcome have received variable therapeutic regimens at individual institutions. Resulting from an urgency to assess the status and enforce a consentient as well as an optimal management plan for neuroblastoma infants, the survey and the analysis on a total of 537 cases, including 355 cases detected by the MS program, were conducted and led us to the conclusion that neuroblastoma infants in Japan had been treated comparatively intensive despite excellent prognosis, and further that adjuvant chemotherapy should be avoidable or minimized for patients with such excellent outcomes. Finally, a nationwide prospective study (#9405) has been commenced in Japan to standardize and to optimize therapy for neuroblastoma infants. In the present paper, retrospective considerations and current stategy for neuroblastoma infants in Japan will be discussed.
Chemotherapy, Adjuvant ; Humans ; Incidence ; Infant* ; Japan* ; Mass Screening ; Neuroblastoma* ; Population Characteristics ; Prognosis ; Retrospective Studies

In step with the widespread use of antimicrobial agents in medical treatment, microbial substitution and emergence of new drug-resistant bacteria have become life-threatening problem today. Both have resulted from the postopreative practice of administering prophylactic medication and long-term, desultory drug administration. Drug-resistant microbes can occur easily with the inadequate use of drug. Therefore, our hospital has held in check the incidence of drug-resistant microbial infection by letting ICT members make the rounds of the wards and go over the notifications of the prescription of specific antimicrobial agents and the reports on drug-resistant bacteria. At the begiing, the notification and the report were filed separately. Recently, the information obtained from thses two channels has become easier of access because all the necessary data appear on the same screen at once by using patients' IDs. We believe that the streamlining of work and putting two kinds of data together have proved very usefull for infection control, as it has become possible to keep careful watch over the use of specific antimicrobial agents and the detection of drug-resistant microorganism simulataneously. By sharing the information obtained by us with all the rest on the hospital staff, we will continue to make efforts along this line and contribute toward the prevention of the outbreak of nosocomial infections as well as community-acquired ones.
Microorganism ; Pharmaceutical Preparations ; Medical Surveillance ; microbial ; Bacterial

In April, 1995, 392 teaching hospitals were surveyed by questionnaire regarding status quo of general medicine in Japan. Independent department of general medicine was established in 11 university and 16 non-university teaching hospitals (11.6% of the respondents). There were another 23 hospitals-3 universtiy and 20 non-university hospitals-in which general medicine was practiced at other department. Therefore, 50 hospitals (21.5% of the respondents) had a group of physicians practicing general medicine in one way or another.
Many problems surrounding general medicine, however, were raised, especially about conceptual gaps between generalist physicians and specialists or patients. It is mandatory for clinicians and educators in general medicine to make the concept of general medicine explicit in understandable words for other specialists and lay people. In addition, high quality practice, education and research products are essential to attract more doctors of younger generation.

A 60-year-old male was diagnosed as having sarcoidosis four months previously because of bilateral hilar lymphadenopathy seen on a chest X-ray, uveitis, and elevation of serum angiotensin converting enzyme. In summer, the patient suffered from hypercalcemia, hypercalciuria, and renal dysfunction. Renal biopsy showed interstitial nephritis with gallium scintigraphy demonstrating high uptake in the bilateral hilum, eyes, and kidneys. Corticosteroid treatment was effective in remarkably improving the renal disorder and radiographic abnormalities.
The calcium metabolic abnormalities and the granulomatous interstitial nephritis showed a marked response to corticosteroid therapy, so that immediate administration of corticosteroid may be justified even in cases without histological evidences. Gallium scintigraphy is suggested to be useful in noninvasive examination in acute stage of sarcoidosis.

A 76-year-old woman with a sudden onset of chest and back pain was admitted to our hospital. Computed tomography (CT) showed a giant thoracoabdominal aortic aneurysm. Therefore, the patient underwent emergency operation. Under a left anterolateral thoracotomy and pararectal laparotomy with left heart bypass, we performed graft replacement of the thoracoabdominal aorta and reconstruction of the celiac artery, superior mesenteric artery and renal arteries. The left lung was tightly adhered to the aneurysm because of the contained rupture. Copious pulmonary bleeding and air leakage occurred due to thrombectomy of the aneurysm. During the operation, critical air leakage was repaired using the remaining aneurysmal wall. The postoperative course was uneventful. The patient was discharged 16 days after surgery. Copious air leakage due to lung injury was a potentially life-threating condition in the postoperative course of this case of thoracoabdominal aortic aneurysm. Surgical treatment of critical air leakage due to lung injury is very important in thoracic surgery.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.

We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.