Kagoshima prefecture is one of the prefectures in Japan where there are many elderly people living alone or only with their spouses. In 1994, we carried out a survey of the inhabitants who are candidates for care at home in the entire Airagun. The results showed that many inhabi-tants requested care at home.
In intractable neurological diseases, there are often no appropriate treatment methods even after admission, and the course is frequently chronic. Treatment at home combined with persons who care for the patient and in corporation with other welfare resources may improve the patient's QOL.
Therefore treatment at home is a major choice. In particular, in amyotrophic lateral sclerosis and Parkinson's disease, care at home while symptoms are stable is appropriate in terms of extending the activities of daily life and the QOL of the patients and family. We have performed continuous treatment at home according to our plan for the past 4, 5 years in our Minamikyusyu national hospital.
In our hospital, the care system are composed of three projects. One is practical work of treatment at home. Second is education for home nursing and home helpers who care for the patients and third is research about home care. This treatment was favorably accepted by the patients and families without major problems. Therefore utilization of social resouces is important in addition to the health of the persons who care for the patients.

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Liver transplantation is the only established method for the treatment of irreversible hepatic impairment. However, a shortage of liver grafts is a major problem, so increased attention has been paid to hepatocyte transplantation as one measure for solving this problem. Hepatocyte transplantation is performed to support liver function in patients with hepatic impairment and it is now being considered for gene therapy because hepatocytes can maintain many genes at high levels. In particular, for the treatment of metabolic dysfunction arising from deficiency of proteins spe-cifically produced in the liver, total liver replacement is not considered necessary and gene therapy by hepatocyte transplantation is expected to be effective. This mechanism of grafting by hepatocytes is not yet well understood. However, it will come to be better known by utilizing recent advances in various scientific fields such as cell technology, and a reliable method of hepatocyte transplanta-tion will become established in the near future.

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Relationships between gene polymorphisms in the renin-angiotensin system and cardiovascular diseases remain controversial, though several polymorphisms in these genes have been extensively investigated. In the present study, we analyzed 120 patients with myocardial infarction (MI) in the National Hiroshima Hospital to clarify whether or not the angiotensinogen (AGT) T235 variant is associated with increased risk for MI. The allele frequency of T235 in the MI patients and the control subjects were 0.88 and 0.75, respectively (p<0.05). The odds ratio for MI between individuals with threonin homozygote compared with those with the other genotypes was 1.75 (p=0.0021) Distrbution of the polymorphism in the control group was not departed from the Hardy-Weinberg equilibrium, These data indicate AGT gene T235 variants is a risk factor for MI. Medical services of this hospital cover an area of agriculture, which may be able to account for differences of this study form the previous reports from Japan.

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We examined 21 diabetic patients with foot ulcer and gangrene, including 3 patients with gas gangrene, between 1994 and 1996. These pateints were well treated and prevented an amputation of the diseased extremities. The risk factors for severe ulcers and gangrenes were listed as follows over 60 years old, 10 years duaration of diabetes mellitus, over 200 mg/dl of FBS and over 10% of HbA1C.

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Recently the child care has faced to crucial problems because of the dispayability and the decrease in child population. Compared with the adult care, the child care has some characteristic features;the pediatric department is not subdivided, the condition of the children is changeable, the big differences due to age, the physiological, social and psychological susceptibility to the surroundings, which request the broad special knowledge and the total comprehension to the therapists.
Because most of the intractable diseases cannot be cured during childhood, the medical care should continuously be given in adolescence, adulthood and parenthood. On the other hand, some congenital diseases are expected to be controlled from the fetus to the neonate as they can be diagnosed before birth. From these, the “Seiiku” Medical Center should aim “Seiiku”, that is to say, the comprehensive medical care for the life cycle from the fetus to parenthood. In addition, the children's hospitals will generally be expected to take care of the patients according to the idea of “Seiiku” and develop themselves through the network with the “Seiiku” Medical Center.
In this symposium, we discussed adout the following points;(1) the analysis of the present condition and the problems of the pediatric and perinatal care in the general hospital, and the proposal regarding the relevant direction and the role of the national hospitals in the future;(2) the analysis of the therapy for the pediatric chronic and intractable disease, and the cooperation with the fields of education, welfare and health and the leadership in these areas;(3) the coordination between“Seiiku” medical care and the adult care;(4) the outline of the National “Seiiku” Medical Center that will open in the 21st century, and (5) the nursing in the “Seiiku” medical care that may be developed from the general pediatric nursing.
We hope that, in this symposium, we could considerably clarify the problems regarding the pediatric medical care in our country and the methods to develop “Seiiku” medicine in the future.

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We report two cases of DIC with sudden fever of unknown orgin at the latter period of preg-nancy.
Case 1 is a woman who admitted with preterm labor on 29w2d of pregnancy and had an attack of fever on 33w5d. The data of blood study indicated AT-III 20.6 ng/dl, FDP 42.4 μg/dl and PLT 8.3×10⁴/μl. Suspected with DIC, we operated the patient immidiatery and the fever reduced. The treatment was lifesaving for the patient and the baby.
Case 2 is a woman who admitted with twin pregnancy and preterm labor on 30w5d of preg-nancy and had an attack of fever on 33wld. The data of blood study indicated AT-III 16.6 ng/dl, FDP 26.4, μg/dl and PLT 10.6×10⁴/μl
Suspected with DIC, we operated the patient immidiatery and the fever reduced. The treatment was lifesaving for the patient and the baby.

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A case of a 54-year-old woman with psoriasis vulgaris (PV) who developed primary biliary cirrhosis (PBC) is reported. Liver dysfunction was at first pointed out in 1982 and despite vari-ous medications such as Strong Neo Minophagen-C, Shosaikoto (TJ-9), the transaminase level has persisted slight elevation. She was referred to our hospital in 1989. PBC was diagnosed because of positive for anti-mitochondrial antibody and elevation of IgM, more elevation of serum alkaline phosphatase and gamma-glutmyl transpeptidase than transaminase. Liver biopsy demonstrated the finding of non-suppurative destructive cholangitis with prominent lymphoid cell aggregates in portal areas which were regarded as Scheuer's stage I. Although both PV and PBC are considered as autoimmune disease respectively, their association is extremely rare. To our knowledge, this is the third reported case in the literature.

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Hepatocellular carcinoma (HCC) is more common in Japan and is still increasing in occurrence. Our hospital is located in Itano Country, Tokushima Prefecture, wherein hepatitis C virus infection is prevalent with a high mortality from liver cirrhosis and HCC. Detecting and treating HCC in early stage is critical to the prognosis of patients, in that HCC nodule less than 2 cm are known to show more favorable outcome. To detect smaller HCC, we introduced a computer-assisted reg-istration system for the patients with chronic liver diseases from July 1995. The patients registered were regularly checked with laboratory and imaging examinations. Within 2.5 years, 351 patients were recorded in this registration system. In total, 49 patients including 21 (43%) with tumors less than 2 cm were found to have HCC during this period. Among 21 patients, 18 (86%) were included in the group registered. Therefore, we concluded that our registration system for the patients with chronic liver diseases are effective to detect smaller HCC.

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We examined physical and social states of 128 juvenile onset cases out of 1672 SMON. The on-set age of under ten years were eight patients, ages eleven to twenty were fifty one, and twenty one to twenty five were sixty nine. There were no significant difference in the clinical picture between those patients with juvenile onset and those with adult onset. However, high ratio of spasticity and low ratio of severe disablity of locomotion were seen in juvenile onset groups. And, those patients of onset age under ten years have a tendency of severe physical states, i.e., visual disorder and dis-abled locomotion activity. Although juvenile onset SMON have adapted to their disabilities without unsatisfied feeling for the life, high ratio of unmarried person seems to cause some problem in socio-welfare in future.

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