Syncope caused by several factors, one of them is micturition syncope. Micturtion syncope generally recognized that alcohol drinking men who lost his consciousness after awaking from midnight sleeping, during or post standing urination, lose consciousness by vaso-vagal reaction accompany with urination. Here we experienced a 28-year-old female who showed micturition syncope. For 10 min of syncope, no response observed. According to personal history, 9 times for 9 months occurred. Syncope always occurred after urination while o'clock in a day was not definite. Autonomous and EEG response were normal, nothing happened by standing up test, and no hypotension status detected. Valsalva test and Aschner test were negative. Before urination, blood pressure (bp) was 140/90mmHg and heart rate was 103/min, when starting urination, heart rate decrease to 78/min, finished urination and stood up, the bp lowered 33mmHg. ECG showed alternative rhythms of usual and ventricular premature contraction, and returned to normal rhythm after 1 min. This alternative systole and lowered blood pressure might be the cause of micturition syncope.

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Hospitalized patients suffered from decubitus receive patiently the doctor's medication, nursing of nurses, and cares by helpers. Briefly, the medical level of the hospital represents in the wound healing of decubitus patients (40 out of 52 patients). We surveyed and analyzed patients' decubitus in Showa Hospital. Cerebrovascular disease and dements patients carried decubitus frequently. An age's 70 to 79 years old patient suffered highly and less than 1-month patients occupied 64% of them. The long medicated cases showed low serum albumin levels. Showing high cure rate of 58.3% patients exhibited more than normal level of serum albumin (3.5g/dl), however, low cure rate of 13.6% patients indicated low albumin level (3.0 g/dl). These results suggested that low level of serum albumin delayed the wound healing of decubitus.

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From 1998 to 2001, the patients suffered from food poising by bacteria was 74.6%, and the pathogenic Escherichia coli occupied 9.4% of them in Japan. In our group home built near the Showa hospital, pathogenic Escherichia coli O25, O86a, O8, O1, O18, and O26 were found in the stools of residents. Escherichia coli O1, O18, and O26 found in the each 3 worker. Diarrheagenic O25, O86a, O1, and O18 had no infection from patients to other residents. O86a, O25, O1,O18, and O26 produced no verocytotoxin. Most of them no detected after treatment with antibiotics and bifidobacterium, except 84 years female feces showed that the infected strains changed by medication of antibiotics from MRSA, O25, O86a, O8, MRSA, and disappeared. Effective procedure taken were thorough washing of hands, cooking by heat, and isolation of sever and complex case of the 84 years female.

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Our nursing and medication ward consists of 60 beds and the average care level was 4.3. One of the patients claimed us to go toilet alone. We investigated her urination trouble to lead urinate alone. She had trained her muscle for 3 months to walk alone by raising muscular strength. As a pity result, the patient could not go toilet alone. However, she could get a desire to live, made smiles every day, and improved the appetite. In addition, the staffs improved their skills to support patient cares, and how to solve the patient considerations through her care.

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The B3 ward filled with the bad smells. Because almost dementia patients need excretion, bathing, wearing, and washing hairs assistances. We investigated how to decrease the bad smells, and introduce 2 methods to measure the smells. One was to measure our nose as sensuous viewpoint, by using simile marks by dividing 6 levels from grim to smile face marks. One more method employed was to measure smells by machine. As a result, the bad smell decreased in the whole B3 ward.

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Replace diaper, loading wheel-chair or stretcher, bathing the patients became heavy burdens for hospital staffs. We investigated total 10 nurses and care workers of EMG, when move a patient to lay over on a stretcher with shift up apparatus or not, measuring which muscle contracted severely or tenderly.

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We created gymnastics to strengthen lower limbs muscle while keeping sitting on wheel chairs and estimated the advancement of their walking function. Many other daycare customers eagerly offered us to permit attendance of muscle power up training. Ordinal gymnastics was performed by individual rehabilitation, group gymnastics, Japanese writing exercise (brush writing), flower arrangement, 10m speed walking, standup speed measurement, and walking exercise. Newly created muscular power gymnastics riding on wheel chairs was accomplished for lower limbs by extension exercise, up down foot neck movement, open-shut movement, knee up by toe standing position, and toe up down movement. All the attendance feelings enter our heart with a voice "I wanna walk more!" We realize fully about daily rehabilitation was very important to improve their walking.

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It is very important to increase the activity of dairy life (ADL) for a patient with physical disability depending on operation. We tried to make an individual patient rehabilitation plan that was performed for the post total hip arthroplasty. Before this report, no nurse took part in rehabilitation plan. Through our efforts the ADL and QOL improved by nursing care plan. It was very effective for a patient that a nurse participated in rehabilitation positively by helping walking and gymnastics at recovery ward corridor. We confirmed further whether he could walk around his home almost freely by trying a few times of visiting his house. As a result, a patient's muscular power increased satisfactorily and that accelerated the socially return home.

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Registered dietitian and occupational therapist cooperatively cared a patient who occurred cerebral infarction with left side paralysis, so that he could live independent daily life. In this patient, intake of salinity inclined remarkably and he suffered from hypertension before the hospitalization. We trained him to change his eating habits, to use less salt, and to expand cooking menus. As a results, he achieved the one hand cooking and standing. Thus he succeeded to change his eating habits (except 1/2 salt taste used be is not enough), and got the confidence in rehabilitation, went into the society.

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The senior citizens living at home alone are increasing year by year because of coming very old patient's society. Then the home medications with care plans are spreading rapidly. We investigated to increase QOL (quality of life) by managing the proper medication as a project team. We played in the active team to give medicine correctly according to patient prescriptions, cooperating with visiting nurse, care manager, home helper and visiting pharmacist. To a diabetic patient who was confirmed low medicine compliance, asked visiting home helpers and visiting home nurse to check his taking of medicine correctly or not every day. For a cirrhotic patient who mostly took LIVACT Granules which contains branched chain amino acids (Leucine, Isoleucine, Valine) as protein source, we taught her the LIVACT contains not enough nutrition and asked registered dietician to give her individual lecture to eat properly nourishing food.

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In 2004, nutrition support team (NST), was introduced for nutritional status management at Showa Hospital. Terminal aged nursing and care facilities had many patients who showed serum albumin (<3.5 g/dl), body mass index (BMI<19.8), and % loss of body weight (< 2%/week) recognized as require nutrition support. Pharmacist roles were to present information about nutritious medicines, to inform long term non-checked nutrition with TPN (total parenteral nutrition) or enteral nutrition (EN), to make a table of All routes of Nutrition Support (ANS: TPN, EN and PPN (Peripheral Parenteral Nutrition)), to teach clean management of ANS, to advice proper nutritious prescriptions, and to offer the ward pharmacist ANS information. Anorexia induced by medicine was treated by slow dripping into digestive system, introduce low nutrition with osmotic pressure, food fiber containing enteral nutritious medicine, and heat up to body temperature the nutrition bags. We round wards once a month however it is difficult to find out all the above questionnaires. The trouble between NST and physician in charge may be the main problems and another is how to educate NST the hospital stuffs.

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The causes of the aged fractures were divided as three categories. Category 1 is muscle and visual power loss, 2 is defense movement failure that cause slipping and falling down, 3 is osteoporosis. Category 1,2 causes fractures of neck femur and forearm. Category 3 causes fractures of vertebrae. The other fractures find after X-ray photograph shows aged fracture characteristic, those never be found in youth. We research the records of fracture and sorting them by points and causes about the films during one and half years, because uncertain fractures occurred many times recently. As a result, uncertain fractures were 66% in every fracture. As backgrounds, fracture occurred frequently on female and the occurrence was proportionally increased to dementia levels increase. Diaper change caused fracture? A patient performed no turn in bed showed costal fracture. These rare cases taught that we have to pay attention the same levels of carefulness as slipping or falling down to the patients.

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Some patients kept away from portable x-ray camera when taking photographs in our hospital ward, they said "I was irradiated!" even at their far stand points. Most people were afraid of irradiation and felt anxiety about taking X-ray photographs. For one reason that miserable Chernobyl nuclear power plant accident occurred on April 26, 1986. However, taking x-ray photographs is no risky as they anxiously think. So we investigated into the influence of irradiation by taking a chest and abdominal x-ray photographs. In fact, a portable x-ray camera emitted little radiation. Taking photographs with portable camera was almost no risk, if the people near the camera keep away from 2 meter at chest and 3 m at abdominal setting. From these points of view, the visitor need not go out from the room except merely want to leave with anxiety.

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Aged guardians system started with nursing care insurance system in 2000. Aged guardian system that a family court assigned guardians for the patient suffered from personality changes or loss of decision-making to support by solving their troubles, helping by managing their property, and settling contracts. We had experienced several cases during this 4 years after enforcement of this guardian system. As a result, we could establish a new way of applying to the court through this report.

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Nursing care insurance system started in April 2000. Change from measure to agreement in a welfare society, customers require self determination in a contractual agreement field. According to this change, Japan National Council of Social Welfare effected enterprise for community welfare and right protection to live independently by helping registered customers. Some of our hospitalized patients who have dementia cannot perform own judgment perfectly, difficulty of daily money management, of setting contract welfare service system, and of independent life activities, spend their hospital lives with anxiety. So we started to use the enterprise wisely and experienced several cases.

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We have been desired to eat delightfully and thought to spend our lives nicely that is the thought all through the ages. To live happily, we began to survey nutritious status of the patients at nursing and care ward. The survey indicated that 16 patients ate less than 70% of the meal, and the other 26 ate more than 70% of the served. Those 16 patients whose caloric intake was less than 1200 was determined as low eating patients, because 1200 caloric intake equivalent to basal metabolic ratio. Four patients could not increase their eating because of anorexia and too much quantity of the food. From this study, we registered, licensed dietitian should understand the patient's nutritious status and dish of favorites, temperature, variety, cooking, tasting etc. then serve foods after discussion with medical stuffs.

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Both working parents have to pay great attention to their child suffered from a disease required some cares. Day nursery for kid's disease might be a expected dream of daytime care for the worker carrying a suffered child. The president of Akane Medical Corporation think over this problem about 10 years ago, and founded a day nursery for disease kids. Mrs. Yoshinaga began to take care and nursing of disease children almost with no manual and gradually increased stuffs cared finally 752 kid's patients at 2003 A.C., for their family, for polishing the day nursery, and for nursing children courteously. The ordinal symptoms were vomiting, diarrhea, anorexia, fever, cough, constipation etc. and nursing and feeding had been planned individually. Egg, milk, and white of an egg were removed frequently from their food, however skim milk, fat, wheat powder, green tea, tomato, chicken meet, gelatin, soybean, and soy sauce did not used some time for the food allergy child.

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Questionnaire about meals was distributed each patient, and according to their opinions, we made a new special eating environment plan. Apr: fuki (butterbur), baby bamboo, May: igi-leave dango (steamed wheat bowl carrying sweet bean homogenate inside), July: somen nagashi (Japanese noodle in running water), Aug: snowed ice day, Sep: eat dangos looking full moon, Oct: zenzai day (boiled azuki beans with sugar and a few dangos), Nov: panned soba (buck wheat) and wheat noodle, Dec: rolled sushi, inari (sushi rice wrapped with a thin slice-fried bean curd), Jan: mochi tsuki (crushing tenacious rice), Feb: kakimochi day (burn slice mochi dried), pizza day, Mar: ohagi day, etc. were chosen and group cooking or eating only. After performing the plan, questionnaire was taken and good evaluations were described in them. Through this setting they begun to enjoy home life, and self-determination, and/or self-support phenomenon appeared. Those suggested that setting menu and environment gave patients smile and increase self-activities.

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Eating is a very important instinct to maintain health in our lives. The satisfaction obtained by tasting, temperature of hot or cold, decorating, group eating, and familial eating mood. The aim of our facilities for the handicapped was to live like a family, and then we obtained questionnaires from customers, office workers, and stuffs. We could get the customers needs by learning from the questionnaires. As results, we could plan for individual programming for the rehabilitation, and succeeded to felt them heart relaxation.

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MSW (medical social worker) service occurred naturally from the process of eliminating anxiety of patients and their family in the advancing process of highly professional medicine. Especially MSW required to set speedy goal for a patient from enter to leave the recovery rehabilitation ward after discussing with doctors and surrounding medical stuff team. The ideal relational co-medication between hospital and hospital or hospital and physician's office MSW insist on his family circumstance and must not act into burst out his family by hearing acute phase hospital, economical problem possibility of familiar care etc. Main service of recovery rehabilitation ward was to set the patient into his home or regional clinic smoothly and more the patient and his family felt comfortable by the proper support. This feeling occurrence was very important for subacute phase recovery rehabilitation ward.

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In the recent reports, apoptosis participate in nervous system during oogenesis and occurrence of degenerative diseases, therefore we investigated about doxorubicin dependent apoptosis in neuronal PC12 cells (pheochromocytoma clone). A toxic model of neuronal degeneration can be produced by doxorubicin, which impairs DNA-dependent RNA synthesis and produces subacute neuronal death. Anti-cancer antibiotics bleomycin, alkyl agent cyclophosphamide, topoisomerase inhibitor etoposide, and metabolic competitor 5-fluorouracil induce apoptosis in some cancer cell lines. We proved that doxorubicin induced apoptosis in neuronal PC12 cells.

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