While our society enjoys longevity with advances in medicine, the birth rate has been rapidly declining, which can be a serious threat to our future. It is the time when we should focus on medical care for those who will create the future of our society.
Pediatrics and obstetrics have been developing independently. Although we have achieved the lowest infant mortality rate in the world, our current medical system may not be able to deal with complicated medical problems in the new fields, such as fetal medicine, multi-disciplinary pediatric critical care and teenagers' psycho-social issues. On the other hand, our maternal mortality rate is still relatively high among developed countries.
With these backgrounds, the concept of “Seiiku medicine” has emerged, which covers from fetuses to those of reproductive age. It has been decided that a new national center for “Seiiku medi-cine” (National Medical Center for Child Health and Human Development (tentative name)) will be opened in Tokyo in 2001. This institution should be not only a medical center for mothers and children, but also an institution dealing with artificial conception, obstetrics, fetal medicine, neonatal and pediatric medicine, adolescent medicine and other medical and social issues concerning our future. This national project will hopefully encourage the development of “Seiiku medicine” and contribute to health and welfare of the next generation of our society.

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Extracranial carotid artery stenosis is increase in number and is increasingly more common among Japanese stroke. Carotid endarterectomy is an effective surgical option for the prevention of stroke in patients with severe stenosis of extracranial carotid artery. Carotid endarterectomy is that atheromatous plaque is dissected and removed directly, and has an effect for stroke prevention not only by improving of decreased cerebral blood flow but also by removing an embolic source. Indications, preoperative evaluations, intraoperative monitoring, operative technique and perioperative management are important factors of decrease in mortality and mobility of carotid endarterectomy.

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This study was undertaken to see the fate of the block-graft-bones transplanted into the intervertebral space in lumbar-spinal-anterior fusion from the accumulated images of bone-scintiscan using ^99mTc-HMDP and also from changes in these images over time.
On the bone-scintigrames for the graft in the lumbar-spine, the up-take of Tc-HMDP was thick in the graft-host j unctional area within 2 weeks after grafting, spread to the entire graft-bone and decreased gradually to the normal level.
In the case of satisfactory bone-union, the accumulation remained a little at the center of the graft-bone 1 year after operation, and returned to the normal level within 2 years. In the case of unsatisfactory union, the accumulation showed a tendency to an increase or non-decrease over time, and even more than 3 years after operation. the accumuration did not decrease and was shown by high density on the bone-scintigrams.
The fate of block-graft-bones can be classified into 3 groups and 6 types according to the process of accumulation on bone-scintiscan.
In the cases where the uptake was seen on the boundary between the graft-bone and the recipient 1 month after grafting or the accumulation did not decrease between 3 months and 6 months after, the delay in bone-union or non-union was noted. The period of 3 months to 6 months after grafting is important for the graft-bone to acquire a dynamic strength as a new bone.
The incorporation of the graft is accelerated by making cross-shaped holes in the graft-bone.

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Retroperitoneal fibrosis shown in a patient with advanced gastric cancer was markedly improved by chemotherapy (5'-DFUR+MMC). In addition, fibrosis that appeared when human pancreatic cancer cells and isolated pancreatic acinar cells of normal rats were cultured was reduced by administration of anti-cancer drugs (MMC and 5-FU, respectively). The above results suggest that anti-cancer drugs are useful for the treatment of retroperitoneal fibrosis even at low doses.

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A clinicopathologic study was undertaken in six cases of ischemic hepatitis. All cases are male and aged 53 to 74 year-old. They have such underlying diseases as lung cancer, interstitial pneumonia, mitral regurgitation, lung tuberculosis respiratory failure due to post tuberculosis and congestive heart failure due to hypertension, respectively. Peak value of biochemical examinations through the course were as follows; GOT 1, 128 to 6, 120IU/L (ave. 3, 116±2, 079IU/L), GPT 605 to 3, 790IU/L (ave. 1, 842±1, 308IU/L), LDH 2, 043 to 10, 990IU/L (ave. 5, 018.3±3, 151.9IU/L), BUN 24.6 to 58.9mg/dl (ave. 39.8±12.1mg/dl), T. Bil. 0.7 to 1.0mg/dl (ave. 3.1±1.9mg/dl), respectively. In spite of remarkable those data, they normalized with the treatment for circulatory disturbance within 21.6 days in GOT, 28 days in GPT, 15.8 days in LDH, 7.8 days in BUN, respectively. In not all the cases arterial blood gas was hypoxemia. Microscopically, the lesions showed chronic passive congestion, such as centrilobular necrosis, pooling of red blood cells in the central vein and its adjacent dilated sinusoids in two cases and centrilobular necrosis in one case. Outcome depended on the underlying disease and not on the liver injury, namely one case died of DIC after nine days and other two cases died of respiratiry failure after 32 days and two and a half months, respectively.

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In 1993 lung-cancer became the most major cause of death for Japanese males. The number of lungcancer patients has been increasng in the country and is expected to reach 80, 000 by the year 2000, making it urgent to establish effective cures for the disease. The goal of this symposium is to report the situation regarding lung-cancer treatment in Japan.
First, an analysis of 35, 000 cases by the National Chest Hospital Study Group for Lung-Cancer shows that 5 years survival rate is on the increase and is currtentry about 22%. This is largery due to a significant improvement in the resected cases, whose survival rate is 47% while that of the non resected cases remains as low as 4.7%.
Second, mass survey has made an invaluable contribution to detection of early lung-cancer. With introduction of CT scanners to the field over the past few years, detection rate of stage I patients reportedly jumped from 50% to 80%.
Third, the results of surgical resection to aged patients in stage I have turned out to be as favorable as those of younger patients.
Fourth, indication of the thoracoscopic surgery for lung-cancer was expanding still further.
Next, althouh simultaneous employment of radiotherapy and chemotherapy is known to be effective, the equipments installed in national hospital is not enough for this purpose.
Last, palliative care for the terminal stage patients was also discussed.
In summary, issues around lung-cancer treatment in Japan have been briefly discussed at this symposium, namely an analysis of accumulated cases, mass screening, clinical evaluation of resected cases, thoracoscopic surgery, the role of radiotherapy and chemotherapy and palliative cares.

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Subjects were inpatients of our hospital whose main diagnoses were mental retardation. Patients with comorbid epilepsy were excluded, 26 of 73 inpatients were studied. Subjects were divided into 2 groups according to their severity of abnormal behavior. Our result suggested that mood stabilizers were prescribed more frequently in the severely-abnormal-behavior group than moderately-abnormal-behavior group in severely mentally retarded inpatients.

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Treatment of patients with recurrent breast cancer involving sternal chest wall is one of the most difficult treatment of recurrent breast cancer. We report a case of chest wall resection for solitary recurrent breast cancer involving sternum. A 40-year-old woman who had modified radical mastectomy for right breast cancer (TlaNOMO-St I) on June 23, 1993, was admitted to the hospital because of a mass in the anterior chest wall on Feb 23, 1995. Since fine needle aspiration cytology of this tumor was positive, she underwent chest wall resection for recurrent breast cancer involving sternal chest wall on March 15, 1995. Microscopic examination revealed the tumor invaded the sternum, ribs, parietal pleura and right brachiocephaic vein. She received adjuvant radiotherapy and chemoendocrine therapy, nevertheless, she died of liver metastasis eight month later after operation. Although a consensus of opinion regarding the treatment of local relapse does not exist, aggressive rather than palliative therapeutic approaches have been supported by most authors as an attempt to achieve local control and to improve survival. We thought that her poor prognosis was caused by a short disease free interval and tumoral invasion to the wall of right brachiocephalic vein.

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We compared 8 patients of hepatitis C who had open heart surgery for congestive heart failure with 14 patients of hepatitis C without heart disease. The heart disease group included 5 patients with mitral stenosis, 1 with mitral regurgitation and 2 with ventricular septal defect and laparoscopy was performed at about 19 years after open heart surgery. Laparoscopy revealed a marked hepatomegaly, diffuse shallow excavations and furrows and white markings in the central venous area on the liver surface and a marked splenomegaly in patients with heart disease. Histlogical liver examination revealed the frequency of central venous fibrosis were significantly higher in patients with heart disease compared to that in patients without heart disease. Serum GOT/GPT concentration ratio was significantly higher in patients with heart disease compared to without heart disease.
These results suggest that to make a detailed diagnosis of hepatitis C with congestive heart failure, it is important to observe the liver surface by laparoscopy and to obtain histological findings by liver biopsy specimen in addition to common liver function tests.

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We report a 57-year-old male who developed liver dysfunction while on the treatment with oxatomide, orally anti-allergic agent. He was admitted to our hospital because of nausea and jaundice after 35-day-treatment of oxatomide. Laboratory findings showed liver dysfunction with intra hepatic cholestasis (total bilirubin 7.44mg/dl, direct bilirubin 6.71mg/dl, GOT 163, GPT 232, Alp 1502, r-GTP 232). CT and ultrasonic examination did not reveal any abnormality without hepatomegaly. antibodes to hepatitis virus A, B, C and HB virus antigen were negative. Leukocytosis and eosinophilia were notable. Diagnosis of drug induced liver dysfunction was given. Oxatomide is an anti-histamine drug that inhibit both the release and the effects of chemical mediators. It has been considered to be a safe and effective drug for patients with various kinds of allergies. However it would seem appropriate that pre scribers bear in mind the possibility of this drug may induce liver dysfunction in certain patients.

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Home medical services have been promoted in recent years. We treat many patients for chronic respiratory failure with home oxygen therapy. But there are some patients with severe respiratory failure who are impossible to stay home because of medical and social factors.
We have experienced three patients of chronic respiratory failure who were impossible to live at home. They have stayed in our hospital more than one year of their terminal illness. During the long stay in hospital without improvement of their symptoms, they developed mental symptoms. Psycological approach was instituted. The family support was important and efficacious. The present hospital system in Japan is not appropriate for long-term terminal care of chronic respiratory failure. The more adequate care systems for patients with terminal stage of severe respiratory failure considering family support like a hospis is desirable.

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