On this paper, I described the history of mental health and mental welfare policies in Japan, from 1900 to 1997. about 100 years.
Mentally ill detention law was implemented in 1990. This law allowed the mentally ill to be detained and cared at home. In 1919, Mental hospital law was introduced due to much criticism on the conditions of the private care. The law encouraged hospitalization of the mentally ill.
Then, in 1950 after five years from the end of the second world war, Mental Health law (MHL-1) replaced the above two laws. This act, which was setup by the members of the Congress, promised to provide adequate medical treatment and protection of the mentally ill.
Two years after the MHL-1, the government established the National Institute of Mental Health (NIMH), which became the research base for prevention of mental disorders and improving mental well-being of the population. In 1954, the government conducted the first nationwide survey on mental health and it was estimated that the numbers of the mental disorders were around 1.3 million. The second national survey was conducted in 1963. The estimated numbers were 1.24 million, in which 80 percent were said to be able to return to the society through rehabilitation.
Following these developments, MHL-1 was amended in 1965, allowing home care for the disordered. In the same year, to improve research strength on day care management, the social rehabilitation department was established within the NIMH.
After 22 years of service, MHL-1 was revised to become MHL-2 in 1987. The aims of this revislon were;
1. To improve the citizens mental health
2. To protect the rights of the mental disorders
3. To promote rehabilitation of the mental disorders
The law legitimized rehabilitation center for the disordered and helped to make the trend from hospital care to rehabilitation care. It also stated the able citizens' responsibilities to help these rehabilitation processes. For the human rights protection, the law emphasized on the importance of imformed consent and the mistreated patients were able to appeal to the Mental medical care committee which had been set up for this purpose.
After studying the “midterm opinion on community mental health care policy”, “mid term opinion on the patient with treatment difficulties” and “Future tasks on mental health policy”, Public Health Committee (Ministry of Health) initiated the revision of the MHL-2 in 1993. The revision has contributed the shift of the public opinion on the mental disorder care, that is, from care in rehabilitation center to care in community. This has helped the rehabilitation process of the mental disorders, though the emphasison the citizens' mental well-being has been relatively taken back.
Furthermore, in 1993, Basic law of the Disabled was also enacted. This law recognizes mental disorder as a type of diability and also recognizes the importance of the welfare implications along with health and medical treatment.
Following this move, MHL-2 was extensively revised and became. Mental health and the welfare of the mentally disordered law (commonly known as “Mental health and welfare law”). Meanwhile, Community care act was introduced in 1994.
In conclusion, the official policy on the mental disorders has been moving gradually towards community care. To support this trend, mental health, psychiatric treatment and the welfare policy on the mental disorders need to be well, coordinated. The issue of two mental emergencies, that is, medical emergency and social emergency will be a major pressing concern. These are the issues that should be tackled in future.

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Hypercalcemia and hypocalcemia are frequently encountered in general clinics and observed in association with a variety of apparently unrelated disorders. Since there are no specific symptoms suggestive of calcium abnormalities, measuring serum calcium is the first step toward the diagnosis. In this review article, I first summarize fundamental mechanisms regulating calcium and bone metabolism, with special reference to outstanding achievements in the field of bone and mineral research that were made in the year of 1997. I also provide some clues to the proper evaluation of serum calcium that are necessary for the accurate diagnosis of calcium abnomalities.

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Gene analysis of clinical patients with malignant diseases has been widely used. Prediction of prognosis would be one of the biggest expectations of such analysis. Due to technical problems, however, the materials for the analysis have generally been restricted to surgical or autopsy specimens. In order to ascertain the feasibility of detecting p 53 gene mutations in a cytological diagnostic setting, we screened gene mutations in tumor specimens obtained by diagnostic examinations such as fiberoptic bronchoscopy and thoracentesis. We examined 54 cytologically positive specimens from 42 patients with primary lung cancer using the polymerase chain reaction/denaturing gradient gel electrophoresis technique. p 53 gene mutations were found in 19 of 42 (45%) patients with lung cancer. We conclude that cytological specimens by bronchoscope or thoracentesis can be used for detection of p 53 gene mutations.

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When estimating the severity of the hepatic dysfunction, a molecular ratio of branched chain amino acids (BCAA) to tyro Sine (Tyr) is as useful as Fisher's ratio becomes conventional recently. As it is well known that the amino acids are metabolized also in the muscle, an examination of BTR, BCAA and Tyr in the muscular atrophic diseases is essential to correctly evaluate the data in daily clinical works. In Duchenne muscular dystrophy (DMD), BCAA and Tyr are lower than normal control and other muscular atrophic diseases. Thel ower value of Tyr is correlated with the lower body mass index (BMI) and body weight in DMD patients. In the muscle wasting disorders, we should assess the value of BTR, BCAA and Tyr carefully.

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This retrospective study was performed to elucidate the incidence and cause of so-called airway tube trouble which is directly related to endotracheal intubation. Were viewed 7174 anesthesia records and tube trouble was documented in 59 patients (0.8%). Among these, cuff leakage was most prevalent and was observed in 22 patients. Most of the cuff damage occured during endotracheal in tubation. In 9 patients, obstruction of McGill type endotracheal tube was observed and this was related to the rotation of patient head. Under one-lung anesthesia, hypoventilation, which originated from malpositioning of the endobronchial tube, occured in 9 patients. Airway obstructions induced by kinking of endotracheal tube and herniation of the over-inflated cuff were observed in 5 and 3 patients, respectively.
These results suggest that most of the airway trouble is preventable by careful placement of the endotracheal tube, proper cuff inflation and head positioning, and by understanding characteristics of the specially. made endobronchial tubes.

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To investigate the relationship between blood pressure control and cardiovascular accidents (CVAs), a prospective study was performed in 526 hypertensive patients who registered to 13 hospitals belonging to the National HoSpital Association for Circulation Research. After excluding the patient who had previous CVA, final 283 patients were analysed statistically. CVAs were observed in 17 patients (6%) during this 5 year's observation. Higher incidence of CVAs were observed in the group with high systolic and diastolic blood pressure (P=0.0061). J-curve phenomenon was not observed. Serum creatinin level was lowered significantly after 5 years' treatment.
Cancer was found in 11 patients during this 5 year, and surprisingly the rate of cancer incidence was significantly lower in the group with Ca-antagonist treatment than that without Ca-antagonist (1.1% vs 7.8%, P=0.0017) and the relative risk was as less as 14%. Farther investigation will be needed to get accurate conclusion.

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Percutaneous transvenous mitral commissurotomy (PTMC) is effective for mitral valve stenosis (MS) without severe invasion in comparison with open mitral commissurotomy. On the other hand, PTMC induces complications such as mitral regurgitation (MR) for which additional therapyis often required. We report a case in which mitral valvere placement was required for MR that was developed after treatment of MS with PTMC. Valvar lesion must be carefully evaluated by ultrasound cardiography or other examinations to decide the indication of PTMC. MVR should be considered in case that have severe subvalvar lesion, especilly.

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We report a cases of Wernicke's encephalopathy which were triggered by glucose-electrolites infusion without vitamines. Case was a 52 year old male who was referred to us because of mild conscious disturbance and gait disturbance. He was administered with gucose-electrolites infusion and developed coma, tetraparesis, and total ophthalmoplegia. Intentional administration of vitamin B1 should have been done although he had been prescribed usual meal. He was treated with massive vitamin B1 therapy and fully recovered. In addition to the typical image of Wernicke's encephalopathy, he showed acute cerebellar swelling on CT and MRI. In image of ^99mTc-HMPAO-SPECT, there was high accumulation of RI in the cerebellum and the thalamus, which was probably due to hyperemia. These phenomena were speculated to be influenced by very rapid decrease of thiamine and the vulnerability of the cerebellum as well as the thalamus.

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We tried to organize medical networks. Medical instruments, lectures and clinicopathological conference in our hospital were available to general practitioners in our district. Family doctors affiliated with our hospital. So, we gave better service.
Number of patients and examinations in our hospital was increased.

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