Histories of the development of the national registry of the cardiac surgery in the United States and the United Kingdom who were preceders in this field were reviewed, and the points at issue in Japan were discussed.
In the circumstances of continuous rising fee for medical treatment, both governments released only the raw motality data for coronary artery bypass grafting to deal with the on-going social problem of this operation whether it was mandatory or not. These governmental actions stimulated to develop the project of the national database registry by the society of thoracic surgeons of these countries. This registry was sufficient enough to collect data to identify factors that affected operative motality and longterm results based on the preoperative risk stratification. Consequently, the propagation of this national database caused the improvement of the surgical results in these countries.
Although the national registry of the cardiac surgery was not performed in Japan, the Consigned Cooperative Cardiovascural Research of the Public Welfare in this field were begun in 1996, the abstract of the Research was described here, and the points at issue in Japan were discussed.

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HOSPnet is a largest information network system in Japan connecting among central office of the Ministry of Health and Welfare, regional medical affairs bureau, and all national hospitals and sanatoriums. The national hospitals are requested to build the medical networks in their given field by means of medical practices, clinical research, education and training, and informational export, and these will not be possible without active use of HOSPnet. Nevertheless, it is difficult to say that the characteristics of HOSPnet is well appreciated. In this symposium, several leading examples such as drug information system, local cooperation among hospitals and clinics using electrical medical recording system, and virtual obstetrics research center by constructing nationwide data base were presented. It was clarified in all examples that organic informational connection among the hospitals could generate a great work even though the contribution of each part was limited. It was also pointed out that hospital information system is important not only as the source of information but also to extension of HOSPnet. Standardization of the data master was also strengthened. One of the specific characteristics of HOSPnet is that it is an intranet and good for the maintenance of security, indicating that HOSPnet is ideal as the network for medical inf-ormations, It should be noted that horizontal connection and rapid exchange of information among the hospitals are fundamental in the leading examples, but these are feasible at all institutions if they try with enthusiasm. It is no doubt that the information community organically connected by HOSPnet will be constructed with preparation of hospital information systems. It would be appre-ciated that this largest information network may change the future medicine in Japan.

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In this report we present a family with late onset of parkinsonism, characterized by clinical features of freezing gait, wearing-off phenomenon, dementia, and frontal lobe atrophy. The father was said to have the same disease as his sons who showed Parkinson's symptoms starting at late 60's. Anti-Parkinson's drugs showed an improvement in their Parkinsonian symptoms, but only to a slight degree. A marked wearing-off phenomenon followed after the combination therapy of several anti-Parkinsonian drugs.
In recent years heredof amilial cases of Parkinson's disease and/or parkinsonisms drew attention in conjunction with gene mutations, and the Parkinson-related proteins, a-synuclein and the Parkin, were found to be related to chromosome 4q in one of the autosomal dominant types of parkinsonism, and to chromosome 6q 25-27 in autosomal recessive juvenile parkinsonism, respectively. Although most of the cases of familial parkinsonism including familial cases of diffuse Lewy body disease are unknown etiology yet, a peculiar cases with balloned neurons were reported by Mizutani with 17-chromosome linked parkinsonism and f rontotemporal dementia.
The cases presented here are such one of familial cases as yet to be determined the etiology, but from a clinical point of view we suspected this family to have parkinsonism of the type described by Mizutani.

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Recent advances of molecular biology have led to understanding pathophysiology of many dis-eases and developing new therapeutic approaches. It is necessary to study DNA samples from pa-tients and other individuals for the genetic approach. However, genetic studies or DNA examina-tions have special features compared with other medical examination since they could provide for information of relatives as well as the tested individual. Genetic study may also be used for diag-nosis of genetic carrier. Therefore, it is necessary to consider ethical and legal issues and to protect privacy of the individuals and their family when genetic study is performed. For this reason, National Cardiovascular Center established “Guideline for collection and storage of human samples on molecular examinations and research”. The institutional review boared on ethical issues approved this guideline in November 1998. Following this guideline, Genetic Study Laboratory was established in Central Clinical Laboratory of National Cardiovascular Center. Also, “Guideline for collection and storage of normal human samples on molecular research” was established and approved by the in-stitutional review board on ethical issues in October, 1999. Further efforts to resolve several issues for better operation on these studies will be made.

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