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This article provided a short review on the assessment of quality of life (QOL) among patients with ulcerative colitis. Quantitative approach with psychometric measures has empirically showed that psycho-social aspects of patient's QOL are often affected by her clinical, psychological, and social conditions. Although the control of disease activities plays a pivotal role for improving patient's QOL, more holistic approach such as psychoeducational intervention should also be considered to enhance patient's self-efficacy and sense of control. Besides, qualitative research suggests that helping patient's narrative reconstruction through enhanced communication with the physician may be the most powerful tool that the physician can provide for improving patient's QOL.

There are two ways for a bacterium to acquire antimicrobial-resistance: 1) Horizontal transfer of resistance gene(s) from outside, 2) Mutation of its own chromosome. The former case includes conjugation, transduction and transformation. Resistance genes usually locate on transposon or integron and have inverted or direct repeats on both sides, or link to a special sequence at one side. A target of an antibiotic is an essential enzyme for the bacterium to survive, and the corresponding gene is located on the chromosome. The mutation of the essential gene may cause resistance to antimicrobials by decreasing the affinity of enzyme to the drug. The mutation of genes for drug influx or efflux also causes antimicrobial resistance.

Many classifications of vasculitis syndrome have been proposed. The American College of Rheumatology (ACR) proposed criteria for classification of vasculitis in 1990. In 1994, the nomenclature of systemic vasculitides was proposed by Chapel Hill International Consensus Conference. In this conference, the nomenclature of systemic vasculitides was discussed and confirmed by the committee consisted of 16 investigators from 6 countries. The classification of systemic vasculitides was proposed in concern with the size of involved artery and also with the appearance of antineutrophil cytoplasmic antibodies (ANCA). In Japan, Research committee of intractable vasculitis syndrome, Survey and Research on Specific Diseases, the Ministry of Health and Welfare of Japan proposed diagnostic criteria for vasculitis syndrome. The criteria for ANCA related vasculitis syndrome, temporal arteritis and antiphospholipid syndrome were proposed and a nation-wide survey has been undertaken in this committee (Chairman: Hiroshi Hashimoto). In this review, we describe a recent classification of vasculitides and recent topics on Takayasu arteritis, temporal arteritis, Wegener's granulomatosis and Churg-Strauss syndrome.

Recently plasmapheresis has been performed for connective tissue disease. Double-filtration plasmapheresis (DFPP) has mainly been performed for rheumatoid arthritis (RA) and systemic lupus erythematosus (SEL) since 1980. In DFPP, autoantibodies and immune complex are removed by the second filter. The adaptation of plasmapheresis is commonly for cases (1) which are resistant to some medications, (2) which have a high titer of antibodies or immune complex, (3) in which the medication must be decreased or stopped because of side effects and complications, or (4) which are in the acute active phase. We suggest DFPP to be useful as a treatment for connective tissue disease.

The target of an antibiotic is any essential enzyme for bacterial growth and quantitative or qualitative alteration of the enzyme or its substrate may cause resistance to the drug. Thus, the alteration of DNA gyrase and/or topoisomerase IV may result in resistance to fluoloquinolones, and alteration of beta-subunit of RNA polymerase may cause rifampicin-resistance. The cell wall synthesizing enzymes which cross-bridge peptidoglycan units are called PBPs and their alteration cause resistance to beta-lactams, and the alteration of the substrate D ala-D ala to D ala-D lactate causes vancomycin-resistance. In other drug-resistances, various instances of alteration of enzymes are known. Drug-resistances are also brought about by decreased permeability of the drug. Some instances are described.

It is an established fact that systemic vasculitis can occur during the course of SLE as well as other rheumatic diseases. The principal disorders of SLE are found to be associated with small arteries. However, clinical evidence of arterial disease in SLE patients varies considerably from patient to patient. Clinical manifestations of lupus vasculopathy including vasculitis and microangiopathy were described. Regarding systemic vascular lesions in SLE, the prognosis for the patients with thrombosis and vascular involvement of medium-sized arteries was the most grave. Treatments including steroids, immunosuppressants, plasmapheresis, anticoagulants, etc. are used according to causative factors which result in lupus vasculopathy.

Historically, various types of antibiotic-associated diarrhea have been recognized. In the 1950-1960s, multi-resistant Staphylococcus aureus was implicated to be major cause of antibiotic-associated diarrhea, especially pseudomembranous enterocolitis. In the late 1970s, a new type of antibiotic-associated diarrhea, which is characterized by pseudomembranous colitis and lack of fecal multi-resistant S. aureus, usually following lincosamide administration, was recognized. Many studies have revealed the pathogenic roles of Clostridium difficile in these patients. Recent emergence of methicillin resistant S. aureus (MRSA) provokes another type of antibiotic-associated diarrhea. We have tried to isolate S. aureus and C. difficile from 150 faecal samples of patients with antibiotic-associated diarrhea. S. aureus alone was isolated from 32 (21.3%) samples. C. difficile alone was isolated from 51 (34.0%) samples, and, both were detected in 23 (15.3%) samples. 90.9% of S. aureus were MRSA. Comparing the clinical features of these cases, patients with both C. difficile and MRSA showed more serious clinical features. The patients who had undergone laparotomy were accompanied by shock and meteorism, more often than patients without laparotomy. The management of antibiotic-associated diarrhea due to MRSA is discussed.

Effect of plasmapheresis for patients with rheumatoid arthritis. Plasmapheresis for rheumatoid arthritis (RA) was performed more than ten years, but efficacy of plasmapheresis was not done. In this paper, we discussed efficacy, indications and procedures. We have many procedures of plasmapheresis, 1) plasma exchange, 2) double filtration plasmapheresis, 3) cryofiltration plasmapheresis, 4) immunoadsorption plasmapheresis, 5) salt-amino acid coprecipitation plasmapheresis, 6) lymphocytapheresis, 7) lymphocyte-plasmapheresis, 8) photopheresis. Indications of plasmapheresis for RA are 1) malignant RA, 2) high activity of RA, 3) positive circulating immune complexes, 4) patients can't take steroid hormone or anti-inflammatory drugs. Efficacy of plasmapheresis for RA was not done, then, we must have controlled study about efficacy of plasmapheresis for RA.