The number of breast cancer in Japan has increased rapidly. Also, the number of cases of the early breast cancer detected by mass screening or health examination have increased. For the diag-nosis of early breast cancer, physical examination, mammography, ultrasound and fine-needle aspiration cytology are used routinely with the combination of these modalities. The current imaging diagnosis to chniques are effective for the detection and diagnosis of nonpalpable breast cancer. In Japan Surgical procedures for breast cancer have changed markedly during the recent 15 years and the modified radical mastectomy has been regarded as the standard operation at the present time. According to the concept that breast cancer is systemic disease with micrometastasis and the emphasis on the postoperative quality of life of the patients, breast-conserving surgery has been performed for 29% of the patients in Japan, 1997. From the psychological and cosmetic point of view, immediate breast reconstruction has been practiced to be 101 patients in our hospital for the five years. The choice of surgical procedures for early breast cancer should be determined by each patient on the practice of informed consent.

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For the purpose of establishing the optimal therapeutic programs for spinal diseases, the authors evaluated the gait disturbance of the patients measuring ground reaction force (GRF).
94 cases of representative spinal diseases were studied GRF evaluation indices as well as clinical evaluation score (JOA score) before and after therapeutic interventions.
The gait analysis based on GRF provided accurate, objective, quantitative evaluation of the intervention effects, that was considered a reliable guide for the development of optimal therapeutic programs, such as improvement of surgical indications, orthosis designs, rehabilitation excercise prescriptions etc. Furthermore, follow-up monitoring of postoperative process can be available in detail.
Pre- and postoperative GRF findings of 3 repesentative spinal cases are presented.

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Purpose
In children with Duchenne muscular dystrophy (DMD), the time of virgin gait is delayed and the gait disturbance gradually aggravates, resulting in abasia at an age of 12-13 years. Thus, these patient are forced to live their daily lives using a wheelchair. Even if they become unable to walk freely, keeping upright posture would produce favorable effect on their cardiopulmonary function. Therefore, it seems important to clarify whether gait analysis is useful for rehabilitation and orthotic treatment or not.
Methods
Gait analysis was made in 33 children with DMD, who were in a range of 4-14 yeras old. the ground reaction force during free walking with rare feet was determined 3-5 times using large force plate. After normalization for body weight and strige length, the data were analyzed in repects of vertial, lateral and bacf forth components of reaction force (fz, fx and fy) and compared with the ground reaction forces of the respective control groups by age.
Conclusion
1. The gait analysis in respect of the back-forth component of the ground reaction force showed that the duration of body supporting on both feet was about 2 times longer in the DMD children than the normal ones.
2. The walking posture of DMD children were most stable at an age of 7-9 years based on the gait analysis data.

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Hip brace is one of the conservative treatments for osteoarthritis of the hip. The brace consists of a quadrilateral socket at the ischial portion and a condylar socket with a prominent at the shelf of the medial condyl. So the body weight can be transmitted partially through the bar between the two sockets. The braces were applied to five nurses, a female teacher and an female clerk. They had unilateral osteoarthritis with initial stage. Average age was thirty-one years old.
Hip pain was 20 points to 30 points, averagely 23.6±3.8 points before treatment started and 30 points to 40 points, averagely 35.7±3.5 points at the examination according to JOA hip score. The advantages of this brace were the effect of eliminating pain and stabilizing effect for all cases. In questionnaire, however, demerits such as troublesome for getting on or taking off, the feeling of pressure and uncomfortable sensation were complained and these implied demand for more improvement.
Gait analysis was performed with or without the brace using gait evaluation system of force plate at the National Murayama Hospital. Reappearance, smoothness and impact as the factors of gait were improved. Gait speed and step increased, and gait width decreased as the factor of distance and time while the brace was applied. In conclusion, improvement of gait feature and increase of stabilization were proved objectively.

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To perform rehabilitation critically after a lower leg surgery, we underwent gait analysis periodically for each patient. The patients are 2 cases of total hip joint arthroplasty-3 cases of total knee joint arthroplasty-1 case of high tibial osteotomy and 1 case of acetabular fracture. The gait analysis was performed on the force plate, touching the parallel hand bars, bridging the force plate, in either one or two weeks, Z (vertical) direction force, Y (forward) direction force, X (medial-lateral) direction force, gait cycle time, stance phase time (ratio to sound side stance phase), single support time (ratio to stance phase time) are measured. Finally, Z (vertical) direction force and gait cycle time are good parameters for post operative recovery process. Secondaly, stance phase time and single support time are relatively good parameters.

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Patients with severe knee osteoarthritis (OA) who can't be anesthetized because of severe general condition have to select the orthosis. Efficacy of G- II OA brace for such patients has been recommended. We evaluated dynamic characteristics of this orthosis by cineradiography. Five patients on or off-brace stood in front of the image tube of cineradiography system and were required to step with their toes on the floor. Twenty-forty pictures of the knee every 1/30 minutes during heel-on to off were measured at 5 points of medial eminentia and bilateral edges of the tibia and femur. We obtained instabilities of lateral thrust in the fluctuation of the eminentia, medial subluxation of the femur in the distance between medial border of the tibia and femur. In the condition of offbrace these instabilities increased according of the lord.
Three cases on-brace showed the reposition of the femur and the increase of lateral thrust.
Dynamic study of the severe OA of the knee by cineradiography revealed that G-II OA brace gave reposition of medial joint. These will be one of the factor that knee pain is subsided.

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The purpose of this study was to establish and evaluate the therapy for the osteoarthritis of knee. Anthropometric measurement, physical fitness and gait pattern were compared between the patients with osteoarthritis of knee (OA, n=14) and control group (Cont, n =60). There were significant differences between 2 groups in body weight, body mass index, muscle thickness and girth of quadriceps (OA>Cont), leg extension power, leg strength, gait velocity and gait stride (Cont >OA). Significant relationship was not observed between leg strength and muscle thickncss of quadriceps in OA, but in Cont. There were significant relationship between leg extension power and gait velocity, stride in both groups. These results suggest the pain may be a limiting factor for the gait pattern.

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Although there had been many studies on Therapeutic Electrical Stimulation (TES) for the hemiplegic gait, universal TES method has not been established yet. In this study, we focused on the immediate effect of TES mainly for ankle dorsi-flexors, and analyzed the parameters of TES effect. The analysis was made on five hemiplegics with spasticity of ankle planto-flexors by using the system of gait motion analysis before and just after TES. TES was applied on common peroneal nerve by using surface electrodes, and induced the motions of ankle dorsi-flexion and eversion. All five cases showed the increase in some parameters such as gait velocity, stride length, cadence, hip flexion angle, knee flexion angle and ankle dorsi-flexion angle. Especially, angle and angle velocity of hip flexion showed the increase in all cases, and it was speculated that TES effect was seen more mainly in the proximal part of the lower extremity than the distal part. The afferent TES effect induces the change in activity of proximal muscles. The afferent TES effect were thought to be more were thought to be more essential for the estimation of TES effects and decision of TES methods than the efferent effect.

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Health professionals often come in contact with blood and other body fluids of patients, and blood-related viral infections caused by syringes or sharp instruments such as scalpels and needles have become a major problem. In the period between January 1996 and December 1997, there were 58 needlestick injuries (including cuts) at our hospital. The personnel involved included 20 physicians, 32 nurses, two technicians, three nursing aides, and one nursing student. Needlestick injuries were most prevalent in May and June and the majority occurred in personnel (43 out of 58) with less than 5 years of working sxperience. The left hand was injured in 63.8% (37 out of 58) of the cases and the right hand in 32.8% (19 out of 58). Most injuries happened in the morning [62.1% (36 cases) ver-sus 37.9% (22 cases) in the afternoon]. Various instruments were involved in the accidents, with 16 injuries (27.6%) occurring while recapping used needles.
The patients involved included 26 males (mean age: 60.7 years), 24 females (mean age: 64.5 years), and three children (female). Five injuries occurred during handling of used blood collection needles. Eight out of 50 patients (16.0%) were positive for HBs antigen and 26 out of 46 (56.5%) were positive for anti-HCV antibody. The positive rate for either of these viruses was 73.9% (34 out of 46), but none of the health personnel was found to be infected with either virus.
Needlestick injuries caused by syringes or blood collection needles accounted for the majority of blood contamination injuries and the most frequently affected injuries site was the hands. Therefore, it is necessary to develop measures to prevent injuries to the hands in order to decrease accidental contamination.

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