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Background: Prognosis of spontaneous urticaria in association with early treatment remained unclear. In this study, we retrospectively studied the prognosis of acute spontaneous urticaria in relation to age and treatments in a local clinic of dermatology., Methods: Out of 5000 patients who visited an office dermatology clinic, clinical records of patients with spontaneous urticaria were extracted. Their prognosis and the relation to age and treatments were analyzed by the Kaplan-Meier method and generalized Wilcoxon test., Results: Among 386 patients diagnosed as spontaneous urticaria, 284 patients (73.6%) had begun treatments within a week after the onset. The non-remission rates of them after one week, four week and one year from the onset were 26.8%, 15.0% and 6.7%, respectively. The non-remission rate of patients who were 20-years-old or younger by one year after the onset of urticaria, was significantly lower than that of patients older than 20-years-old. No apparent relations between the remission rate and sex or the use of steroids was detected. However, the non-remission rate of urticaria that was treated with a standard dose of antihistamine was lower than that treated with additional medications., Conclusion: Most patients who began treatments within one week from the onset remitted shortly. However approximately 7% of them continued to suffer from symptoms for more than a year. Such prolongation tends to be seen among patients who required other medications in addition to standard dose of antihistamine.

Objective: Various guidelines recommend that the risks of diabetes mellitus, dyslipidemia, and lithium intoxication should be appropriately managed by regular monitoring of blood sugar and serum lipid levels in patients treated with atypical antipsychotics, and regular monitoring of serum lithium concentrations in patients treated with lithium carbonate. However, in Japan, these recommendations are not always observed. The present study used a database, constructed from research on medical policies performed in 2006, to investigate the frequencies of blood sugar, serum lipid, and serum lithium monitoring in psychiatric outpatients in Japan., Methods: This database contained the health insurance claims of 3,674 psychiatric outpatients extracted from the 47 prefectures throughout Japan. The present study examined two subordinate surveys: 1) the frequency of monitoring blood sugar and serum lipid levels in those on atypical antipsychotics during a period of one month (February) in 2006; 2) the frequency of monitoring the serum lithium concentration in those on lithium carbonate, also obtained during February 2006., Results: In Survey 1, the subjects were 228 male and 271 female recipients, with an average age of 45.1 years; 86.8% of these subjects suffered from psychosis. In Survey 2, the subjects were 70 male and 64 female recipients, with an average age of 49.9 years; 57.5% of these subjects suffered from mood disorder and 36.6% suffered from psychosis. In Survey 1, the blood sugar level, HbA1c, and urinary sugar were monitored in 28 (5.6%), 5 (1.0%), and 8 (1.6%) subjects, respectively. At least one of these three tests was performed in 32 subjects (6.4%). The serum lipid level was monitored in 40 subjects (8.0%). In Survey 2, no serum lithium concentrations were measured. The frequency of monitoring the serum lithium concentration per month was estimated to be below 2.2%., Conclusions: The Maudsley Prescribing Guidelines recommend that both blood sugar and serum lipid levels should be monitored at least once a year (equivalent to a measurement frequency of 8.3% per month). Survey 1 revealed that, although the actual frequency of monitoring the serum lipid level agreed with the recommendation, that of monitoring the blood sugar level was lower than recommended. However, when compared with the results of a study in the U.S.(equivalent to a measurement frequency of 2-17% per month), the frequency of monitoring the blood sugar level was not that low in Japan. The frequency of monitoring the serum lithium concentration per month was estimated to be below 2.2%. The guidelines and package inserts recommend that the serum lithium concentration should be monitored once every 2-6 months. Therefore, the frequency of monitoring the serum lithium concentration in psychiatric outpatients treated in Japan was considered to be too low from the standpoint of medical safety.

All 2,184 outpatient surgeries consisting of 18 surgical procedures were carried out for 1,383 subjects in four years from 2008 to 2011 at my clinic. The number of subjects undergoing office surgery ranged from 397 cases down to 308 cases per year with an annual average of 346 cases. The subjects broken down by the main surgical procedures performed comprised 780 cases of myringotomy, 276 cases of coagulator ablation of the nasal mucosa, 94 cases of removal of a foreign body in the external auditory canal and 92 cases of insertion of the ventilation tube: these 4 procedures accounted for about 90% of the total number of patients in my practice. The range indications of the other 14 procedures not only included the ear, nose and throat, but had spread to the salivary gland, the skin and the temporomandibular joint, which demonstrated the necessary skills and flexibility of an otorhinolaryngologist. Infants and children between 0 and 11 years old consisted about 60% (827/1,383), especially infants between 0 and 5 years old accounted for more than 40% (563/1,383), and so suggested the raison d'être of pediatric otorhinolaryngology surgery. On the other hand, subjects over the age of 70 accounted for 123 of 1,383 cases (8.9%), and there were three subjects over the age of 90, the oldest patient being 99 years old. The male to female ratio was 867:516, giving a sex ratio of 1.68. Recently in Japan under the universal healthcare system, we must emphasize that office surgery, completing the treatment without hospitalization, not only maintains one's expertise as an otorhinolaryngologist and has improved the quality of local healthcare, but also has contributed to the reduction of medical expenses.

The importance of early detection and intervention for psychiatric disorders, such as schizophrenia, is beginning to attract attention based on the results of imaging and psychosocial studies. Unfortunately, Japan still lags markedly behind Western countries and Australia in respect of early detection and intervention. We conducted a collaborative questionnaire survey of mental health among junior and senior high school students, and found that education on psychiatric disorders is not provided in schools and that the detection of these disorders is delayed due to the lack of awareness and accurate information. Early detection and treatment of psychiatric disorders takes more time than regular outpatient care, and an early psychosis outpatient clinic was established at our institution as a special outpatient clinic. The early psychosis outpatient clinic managed by me cannot be involved in visiting schools to carry out educational activities due to manpower problems and other reasons. However, through individual cases, I am aware that cooperation with schools is as important as cooperation with patients' families, not only to treat psychiatric symptoms, but also to check whether students are viewed with discomfort by classmates due to adverse effects of treatment, such as extrapyramidal symptoms. My aim is to improve the mental health of as many children as possible through future activities.

Until the Japanese Leprosy Prevention Law was abolished in 1996, leprosy patients, regardless of their severity, had to be treated by accredited doctors. The majority of them had to be confined in a sanatorium to be treated, since only few hospitals/sanatoria had outpatient clinics for leprosy patients. This de facto confinement limited their occupational, social, financial, and family options, but no clear criteria/guidelines allowing discharge existed. The importance of leprosy outpatient clinics was almost never debated until 1962, when Tofu Association (a foundation established in 1952 to support the confined patients) and the National Suruga Sanatorium planned the opening of the clinic. This clinic looked after total of 4,977 patients until the abolishment of the Law. Since 1996, 349 persons consulted the clinic as of 2010. The importance of the continuation of these clinics is beyond dispute, even in low-endemic countries. However, the diminishing number of patients and demands in this country makes the management difficult. Thus, coordination with the local clinics and dermatologists is inevitable.

In the present study, we investigated whether counseling at an outpatient asthma clinic improved asthma symptoms, adherence and patient satisfaction: The asthma control test (ACT) and asthma control questionnaire (ACQ) were used to assess subjective symptoms, 10-item version of the drug attitude inventory (DAI-10) was used to determine medication adherence, and 8-item Japanese version of the client satisfaction questionnaire (CSQ-8J) was used to ascertain patient satisfaction. All scores of inhalation technique, PEF (peak expiratory flow) value/predicted PEF value (%), ACT, ACQ and DAI-10 in 26 patients with asthma increased after counseling at the outpatient asthma clinic compared to those before counseling. The average CSQ-8J score of 28 points (highest possible score: 32 points) indicated that the patients were satisfied with services provided by this clinic. These results indicate that counseling provided by pharmacists at the outpatient clinic is a valuable way improving subjective symptoms, lung function and medication adherence. These results also indicate that counseling at the asthma clinic by pharmacists improves the quality of life of patients with asthma.

Objective: To elucidate the characteristics of oldest-old patients with dementia in a Japanese memory clinic., Methods: We evaluated 365 consecutive patients with dementia who were referred to the Memory Clinic of Niigata Rehabilitation Hospital, Niigata, Japan over 4-year period. More than 85% of the patients lived in the communities within 15 km from the hospital. The mean (+/- SD) age at examination was 79.3 +/- 6.9 years, and according to this criterion the patients were classified into 4 groups: young (age less than 65 years), younger-old (65-74 years), older-old (75-84 years), oldest-old (85 years or more). In each patient group, we evaluated the rates of the major dementias and compared the demographic and clinical characteristics of the patients with Alzheimer's disease (AD)., Results: The rates of major dementias in all the patients was as follows: AD, 74.5%; dementia with Lewy bodies (DLB), 13.7%; frontotemporal lobar degeneration (FTLD), 3.0%; vascular dementia (VD), 5.5%, and other dementias, 3.3%. The number of patients included in the young group was 9; in the younger-old group, 75; in the older-old group, 203; and in the oldest-old group, 78. The rates of major dementias in each old group was as follows: in the younger-old group, 74.7% for AD, 9.3% for DLB, 6.7% for FTLD, 5.3% for VD and 4.0% for other dementias; in the older-old group, 73.4% for AD, 15.8% for DLB, 1.5% for FTLD, 5.9% for VD, and 3.5% for other dementias; and in the oldest-old group, 78.2% for AD, 14.1% for DLB, 2.6% for FTLD, 3.9% for VD and 1.3% for other dementia. The AD patients in the oldest-old group showed a significantly higher rate of female (younger-old, 64.3%; older-old, 79.2%; and oldest-old, 85.3%; chi2 = 7.9, p < .05), a poorest mean of the score on the Alzheimer's Disease Assessment Scale (younger-old, 18.5 +/- 10.4; older-old, 19.2 +/- 9.3; and oldest-old, 22.8 +/- 7.6; F = 3.5, p < .05), and a poorest distribution on the Clinical Dementia Rating (chi2 = 13.9, p < .05)., Conclusions: The rates of the major dementias were similar in the younger-, older-, and oldest-old groups except for the higher rate of FTLD and the lower rate of DLB, respectively, in the younger-old patients. The cognitive and overall dementia severity status of the oldest-old patients with AD referred to the memory clinic was poor than that of the younger- and older-old patients.

In Japan, about 40% of all the parturients give birth in small obstetrician's clinics. There is no anesthesiologist in most clinics. The labor analgesia is not performed or is performed by the obstetrician in many facilities. In this paper the author reports labor analgesia by one anesthetist in a small obstetric clinic in Japan. The management of labor analgesia of this hospital is as follows; 1) The anesthesiologist explains the method and risks of labor analgesia to the patient in the outpatient clinic. The induced labor is recommended to the parturients who request labor analgesia. 2) The combined spinal-epidural analgesia (CSEA) is provided for labor analgesia with a local anesthetic of low concentration and fentanyl. 3) CSEA is usually administered upon the request of a parturient and continued till the end of the delivery. Adequate pain relief and high satisfaction were ascertained by the questionnaire to the parturients who had received labor analgesia in this hospital. The number of parturients who request labor analgesia is increasing. However, it is difficult or almost impossible to provide labor analgesia by one anesthetist for 24 hours and 365 days.

Background: Our clinic provides various reconstructive surgeries but does not have facilities for patient admission, but there is a hospital providing satisfactory post-operative treatments in our area., Methods: During the past 3 years, 276 patients received reconstructive mammoplasty under general anesthesia at our clinic. Their post-operative conditions immediately after the recovery were evaluated with the Modified Post-Anesthesia Discharge Scoring System (MPADSS). After observation for 4 to 5 hours in a recovery room, all the patients were transferred to another hospital by car., Results: The score was 9 or 10 points in 45% of the patients. This indicates that the patients can be transferred to another hospital without problems. Twenty percent of patients had 6-7 points. These patients had mild bleeding, pain and/or unsteadiness/nausea/vomiting while walking. Among the 256 patients who were transferred to another hospital by car, one patient vomited in the car and 5 patients had nausea after the transfer. The other 20 patients whose score was 7 or lower were transferred by special vehicle with a stretcher and their conditions did not aggravate at all., Conclusions: At present, it is dangerous to perform all breast reconstructive surgeries as a day surgeries. A system is indispensable in which patients are transferred after surgery to another hospital with over-night stay facilities enabling observation.

Segawa Neurological Clinic for Children was founded in 1973, and specializes in neurological disorders that start in childhood. In thirty-one years since the foundation, about 16,000 patients visited this clinic. The ages of the first visit to this clinic of the patients are mostly below 15 years. The main diseases are epilepsy, autism, mental retardation with various etiologies, Tourette syndrome, and other neurological disorders. Most of the diseases follow a chronic course and require long term follow-up. In this clinic those patients who need the continuous follow-up are seen even after reaching to adulthood. The average age of patients who were seen in the clinic during 2003 was about 21 years of age (20.77 +/- 14.28), suggesting that many of the patients are followed in this clinic for 20-30 years. The etiologies and pathophysiologies of most of these diseases are not fully understood. Therefore, the treatments based on the causes are difficult. The pathophysiologies of these diseases are modified by the ages. For example, some patients with epilepsy develop psychiatric symptoms in adulthood, and require the consultation by psychiatrists. The long-term follow up of certain disorders and evaluations of the disorders at different ages up to the adulthood have lead to new scientific discoveries. Examples include age-dependent symptoms observed in Segawa disease, psychiatric symptoms developing in frontal lobe epilepsy cases, alterations of behaviors in autism and Tourette syndrome. This knowledge suggests insights for the early prevention of later adverse outcomes. Social awareness and understanding of these neurological problems occurring in childhood are essential. The medical economic base for child neurology is another challenging and urgent issue to be solved. The importance of child neurology in the life-long neurology is stressed.

Objectives and Methods: The present study was performed to assess the current status of erectile dysfunction (ED) and so-called male climacteric disorders in male ambulatory patients through a self-administered questionnaire survey throughout Japan. The survey was especially focused on the relationship between ED, depression, and benign prostatic hyperplasia, the effect of ED on quality of life, and current status of ED treatment., Results: The total number of completed questionnaire forms was 6,112 from 447 outpatient clinics. ED was strongly correlated with prostate disease, diabetes mellitus, and heart disease. Patients evaluated as ED by the shortened version of International Index of Erectile Function, IIEF-5, accounted for 81% of the evaluable replies. Thirty-two percent of these patients had either severe or moderate ED. Severity of ED was related to depression, dysuria, and perceived poor health condition. The proportion of ED patients who had received some ED treatments was 10%. Among ED patients, 22% of them were willing to receive pharmacotherapy for ED and the need was significantly high in patients with severer ED., Conclusions: ED is one of the symptoms frequently observed among male ambulatory patients. Physicians should be encouraged to ask their patients about their ED, in order to identify their unmet need for treatment.

We treated 346 patients with otitis media with effusion (OME) and 30 (127 episodes) with recurrent acute suppurative otitis media at our outpatient clinic in the 6 years from October 1994 to September 2000. Of these, children under 15 years old numbered 185, mostly boys at a ratio of 1.4: 1.0, while patients aged 15 years or older numbered 161, mostly females at a ratio of 1.3: 1.0. In children, 24 were excluded due to a lack of diagnostic follow-up, 65 (40%) patients improved in conservative management of medication with and without repeated tubal inflation, 79 (49%) improved by paracentesis, and 18 (11%) recovered with the use of pressure equalization tubes (grommets). Of cases aged 15 years or older, follow-up was not possible in 28. Three (2%) were free of OME by conservative treatment, 116 (87%) improved by paracentesis, and 9 (7%) by using tubes. The mean durations of tube insertion was 11.3 months in children and 7.2 months in adults, but 5 adults (4%) continue being treated of this writing. Bilateral cases were 30% of children and 8% of adults with 73% of children affected bilaterally having persistence or recurrence. Acute purulent otitis media progressed to OME in 22% of children but only in 3% of patients aged 15 or older. In 36% of children and 26% of patients aged 15 or older, acute upper respiratory tract infection coincided with or predisposed to OME. Rhinosinusitis was seen in 19% of children and 14% of adults. Coincident allergic rhinitis was seen in 14% of children and 12% of adults with OME. Nasopharyngeal infection and allergy are likely related to OME development. The peak incidence of OME was similar to that of recurrent suppurative otitis media in children, so a seminal precipitating factor appears to result in these 2 conditions.

The achievements of the Outpatient Clinic Center in Saitama Cancer Center from April 1999 to March 2000 were reanalyzed, and their characteristics are discussed. Outpatients used the Outpatient Clinic Center a total of 9,862 times. The treatments and procedures were 923 blood transfusions, 4,308 infusions without anticancer drugs, and 4,409 consultations from outpatients. In addition, a total of 4,036 chemotherapies were performed in this outpatient setting. Fifty-seven percent of the chemotherapies done by the Pulmonary Section contained the new agents of docetaxel, irinotecan, vinorelbine and gemcitabine (206, 187, 72 and 135 times, respectively). Irinotecan began to be used in outpatient settings after the use of the Oral Alkalization and Control of Defecation was initiated (Proc ASCO 18: 492a, 1999). These drugs were safely given to outpatients. No paclitaxel was used in our Outpatient Clinic Center because of the difficulty of its premedication in Japan, indicating the necessity of development of a new and simple premedication.

An anonymous questionnaire survey was conducted among persons who had undergone screening for AIDS at public health centers under the auspices of 7 local government bodies (Hokkaido, Metropolitan Tokyo, Aichi Prefecture, Osaka Prefecture, Kobe City, Saga Prefecture, Okinawa Prefecture). There were 1,230 replies, for a response rate of 46.8%. Questions in the survey pertained to general knowledge of AIDS, information desired by the recipients, desired ways to foster awareness, and a desirable examination system. A comparison was made in terms of gender, marriage status (married, single) and age (less than 40 years of age, more than 40 years of age), respectively. The survey results were as follows. 1. Concerning the infection route, accurate response rate was low with regard to the mother-child infection, mosquito transmission, and use of contaminated needles. 2. Desired methods to promote AIDS awareness expressed among replies were given in the following order or frequency: "information via radio and TV," "spread of knowledge through telephone consultation," and "holding an AIDS Week or similar kinds of campaigns." 3. Information sought by respondents frequently included AIDS treatment, pathology, and spread. This trend was most obvious among those under 40 years of age. 4. As for the AIDS examination system, replies most often reflected the hope that the examination site would be the Public Health Center, the charge would be gratis, and that one could be examined at night during the week, and on days off. 5. For those undergoing examination where there was no actual concern of possibility of HIV infection, single persons, accounted for around 80% of the overall. 6. More than half of those who had been examined mentioned having experienced concerns about maintaining confidentiality at the time they were examined.

To examine the frequency of psychiatric patients who visit outpatient clinic of non-psychiatrists in Japan, a mailed questionnaire survey was conducted of 200 non-psychiatrists randomly selected from the 703 registered members of the Kawasaki-city Medical Association, Kanagawa prefecture. Responses from 124 or 62% were received and data for 112 male respondents were analyzed. 1) The median number of psychiatric patients treated per month by respondents was 4, and the median proportion of the total outpatients that were psychiatric patients was 0.7%. 2) Sixty-one internists saw significantly greater numbers and proportions of psychiatric patients than the other 51 doctors. 3) The internists saw a higher proportion of mild anxiety, depression, alcohol-drug dependency and psychosomatic problems among all psychiatric patients than did other doctors. 4) For the internists a significant inverse correlation was observed between the total number of outpatients and the proportion of psychiatric patients. This was the result of a group of physicians who saw a relatively small number of outpatients but had a higher proportion of psychiatric patients among outpatients.