Malignant pleural effusion is characterized by fluid buildup between the lung and the chest wall due to cancer cells in the pleura. Most cases are caused by lung cancer, breast cancer, ovarian cancer, or malignant lymphoma. Urothelial carcinoma is a rare cause of malignant pleural effusions and is difficult to diagnose by cytological examination. We report a case of malignant pleural effusion due to urothelial carcinoma. An 80-year-old man presented with right back pain. After close examination, he was diagnosed with ureteral cancer. During the course of treatment, a unilateral pleural effusion was found, and cytological and histological examinations were performed on suspicion of malignant pleural effusion. Cytological examination revealed numerous round-to-ovoid cells with irregularly enlarged nuclei. Immunohistological studies were performed on cell block specimens, and urothelial carcinoma was diagnosed. Cytological examination of malignant pleural effusions may require estimation of the primary site. It is important to take a multifaceted approach that considers not only the cytological findings but also the clinical findings and medical history.

　　Evaluation of the attitude of patients according to behavior modification stage when they were admitted to hospital for our diabetes educational program and various parameters after they discharged were reviewed.　　We examined the 106 people (53 males and 53 females, average age 66.0 years) who were admitted to our hospital for diabetes education during the period from October 2009 to February 2012. We examined HbA1c levels and measurements taken during the stay in hospital, and 1 month, 3 months, 6 months, 9 months, and 12 months after leaving hospital. Compared with the measured values in the hospital, HbA1c levels measured each month showed a significant improvement (p<0.05). By evaluation of the value according to behavior modification stage, we recognized a rebound tendency in precontemplation groups. The evaluation of patients’ attitude by occupation according to stage of behavior modification revealed a difference more than 2 stages by approximately 10%. From these result, it was speculated that the patient self-management skills made a significant impact on glycemic control after hospital discharge.　　Diabetes educational hospitalization is supported by team members who vary in specialty. It is expected that we can provide higher-quality medical care by each specialist and supporter with a good knowledge.　　Assessment difference of behavior modification stage may appears by each specialty staff member and by changes in physical condition and feeling of the patients. In addition, these causes may change further by difference in the way each specialist deals with the patients. Therefore, we considered it was important to share information and have the mutual confirmation of the evaluation. Now, team medical care is regarded as important. It was suggested that cooperation among the staff members would lead to better medical treatment, and to improvement in patients’ QOL.

　　Procalcitonin (PCT) is a diagnostic marker of severe bacterial infection and sepsis. Sepsis can lead to shock, multiple organ dysfunction syndrome, DIC and death, thus making the early diagnosis of sepsis very important. Many markers (e.g., CRP, blood culture, endotoxin) of infection largely lack in clinically important property. Therefore, clinical PCT-level measurement has been accepted worldwide in the last five years. Our hospital reports PCT within 30 minutes after the collection of blood samples all day long. In this study, we assess the clinical utility of PCT for early diagnosis and treatment with specimens tested by both PCT and blood cultures. PCT assay and blood culture demonstrated the diagnostic concordance rate stood at 58.96%. We presume that the cause of its discrepancy is a lack of sensitivity of blood culture and an increase in PCT by the invasiveness of other factors. On the other hand, patients with PCT‹0.5 ng/mL are unlikely to suffer from severe bacterial infection and sepsis. Thus, PCT could be one of Vital Signs and useful for early diagnosis in the emergency care.