Parkinson disease (PD) is a neurodegenerative diesese, characterized by various neurological symptoms including resting tremor, bradykinesia, rigidity, and pulsion. It is estimated that there are as many as 120, 000 patients with PD in Japan. Lewy bodies (LBs), intracytoplasmic neuronal inclusion bodies, are identified in subcortical nuclei, including substantia nigra, of Parkinson disease. “Diffuse Lewy body disease (DLBD)” is an entity in which LBs are diffusely distributed in various neural tissues, including neocortex, resulting in that the patients demonstrate several symptoms, like dementia, as well as parkinsonism. There seem to be more than 200, 000 patients with DLBD in Japan. Among patients with DLBD, “pure form”, which lacks Alzheimer's pathologic changes, appears to have about 20, 000 patients. “Pure form” of DLBD shares common clinical and pathologic features with PD, therefore, this entity could be considered as a subtype of PD. As PD is believed to occur due to multiple pathogenic factors, an additional factor may cause “pure form” of DLBD in some patients with PD.

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The infection control relevant to transmissible spongiform encephalopathies WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies (TSE) (Geneva, Swizerland, 23-26 March 1999) waspresented. As TSE agents exhibit an unusual resistance to conventional chemical and physical decontamination methods, therefore special precautions are indispensable. Central nervous system and eye carry high infectivity titer. Single-use instruments are strongly recomended and the safest method is to discard and destroy them by incineration, but if they are not available, re-usable instruments must be decontaminated according to this guideline.

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We reported a patient with Creutzfeld-Jakob disease. The patient was a seventy-eight year-old woman, who had rapidly progressive dementia with myoclonus and fell into the condition of akinetic mutism. An electro-encephalogram showed periodic synchronized discharge. A diffusionweighted MRI showed high-intesity legions in the cerebral cortex and basal ganglia. In the liquor, 14-3-3 protein was detected. We diagnosed her as Creutzfeld-Jakob disease. She had fallen into respiratory and circulatory failure by acute pneumonia and her family members hoped that lifesustaining therapy would be available for her. We had informed them about the disease and conferred continuously together about terminal care for the patient. As a result of the conference, they decided against life-sustaining therapy.
Infection control guidelies for prion diseases have been exhibited, but many unkuown things still remain concerning infectivity of organs and secretions. And no guideline exists concerning the terminal care for the patients, which would depend on the decision of a patient or family member. We think that it would not be the best selection to accept life-sustaining therapy requested by family members of the patient with Creutzfeld-Jakob disease in the terminal stage. On the other haud, we can not simply refuse a request of the family because we do not have all the answers for managing the patients. Therefore, it is necessary for us to have a well-organized and well-informed talk with the family of the Creutzfeld-Jakob disease patient.
It is important for us to stay informed, and treat the patients with a reliable protection protocol.

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This is an unusual case of CJD manifested its symptoms just after an operation of a chronic subdural hematoma. Before the operation it would be impossible to suspect the exsistence of CJD, and even after the operation it was also difficult to diagnose the disease. However, a close clinical observation and the diffusion weighted MRI of the brain enabled the prompt diagnosis of CJD, and at that time EEG did not yet show any periodic synchronous discharges. The initial symptoms of the patient showed a marked laterality and the brain lesions appeared in MRI were diffusely scattered but dominantly on the left (hematoma) side of the brain. This case also suggests the importance of the preparation of guidelines for surgical treatments to the CJD patients or persons at risk based on a well designed and integrated infection control protocol.

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We report a 69-year old female patient who was suspected of having Creutzfeldt-Jakob disease (CJD) because of subacute dementia and myoclonus-like involuntary movement of lips and four limbs. One year after onset, however, the progression stopped. The clinical course and laboratory findings excluded trophic disturbances, degenerative diseases, paraneoplastic neurological deficits or intravascular malignant lymphoma. After she temporarily showed attitudes like decorticate rigidity and lost her communication ability, amelioration was observed. The condition has been unchanged for these 6 months. Brain MRI indicates only slowly progressive atrophy, whereas EEG observations show amelioration with time.

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Many accidents in medical practice have recently been reported as an important social problem. In order to solve this problem, booklets of medical risk management were published from the Hospital Service Policy Division at the Ministry Health and Walfare, and a prevention system against medical accidents is now being established at each National Hospital, According to the Heinrich's Law, there are about 300 near-miss cases and 29 small incidents behind one serious accident. An investigation of many near-miss cases is necessary to prevent accidents in medical practice.
This symposium were composed of one keynote lecture and presentation of 3 attendants. A keynote lecture showed the importance of analysis of near-miss cases as well as accidents. An analysis of the relationship between occurrence of accidents and each patient's condition was also important for the prevention of the medical accidents. Three discussants showed the importance for staffs to understand detailed clinical inf ormations, and of activities of medical risk managers in the hospital. Good comunications among clinical staffs were also emphasized.

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