PTSD and related traumatic disorders have recently attracted wide social concern in Japan. Precipitated by the Japanese hostage crisis in Peru, the National Center of Neurology and Psychiatry launched a research team, which in 2001 published a practical manual for trauma care for use in various types of trauma evoking incidents. The diagnosis of PTSD should be carefully done with reference to the diagnostic criteria such as DSM-IV, especially in court trials.
Resilience should be much emphasized. Most victims show acute stress reaction, some develop ASD and some of them, PTSD. In the long term, attention should be paid to social maladjustment including alcohol and drug abuse, and suicide. Stigmatization of the victims hampers social recovery.

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Many scientific advances in the pathophysiology of allergic airway inflammation and related anti-inflammatory drugs have improved our understanding of asthma and our ability to manage it effectively.
However, some asthmatic children refuse to follow our instruction and do not show the expected efficacy from treatment. A questionnaire was sent to their parents to ask about any psychosocial factors related to their asthmatic attacks, the character of their child, the psychosocial environment of their family, and other psychosomatic disorders and life change points, and to their pediatrician to ask about any psychosomatic factors related to their asthmatic attacks. These data suggest to us that asthmatic children and their family could be treated more effectively if we use a questionnaire based on the psychosomatic approach including information on the psychosocial factors related to their asthma.

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It is clear that use of reperf usion therapies has let to impressive reductions in mortality from acute myocardial infarction (AMI). However, only 30 to 40% of patients with AMI received these therapies, because many patients do not arrive on the hospital in time to benefit with them. We established the hospital network system of cardiac emergency care by five hospitals to reduce the pre-hospital time delay in patients with AMI. In this study, we tested the effects of the hospital network system of cardiac emergency care on pre-hospital time delays in patients admitted to our hospital with AMI before and after starting on hospital network system. After starting on hospital network system, the percentage of patients with AMI directly transferred to the hospital by ambulance was significantly increased from 10% to 34%. However, the median time from onset of AMI to hospital arrive was not changed from 3.1 hour to 3.5 hour. The most frequent reason of the pre-hospital delay was the patient's decision delay such as they did not realized their chest pain as being life-threatening. In a future work, we have to address to educate the patients with coronary risk factors about symptoms of AMI and the need to get the hospital quickly.

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We have treated 141 ruptured and 76 unruptured aneurysms with Guglielmi detachable coils (GDC). Seventy-nine SAH patients (78%) and all of the non-SAH patients were independent upon discharge. Symptomatic vasospasm was reported in 15.2% of patients. The permanent morbidity rate is 3.8% and one patient was dead (0.9%). Although the long-term results remain to be determined, embolization with GDC is a safe and promising treatment for cerebral aneurysms.

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The spread of computed tomography (CT) brought the frequent further examinations of the solitary pulmonary nodules (SPN). To aim the evaluation of initial data on examinations of SPN for differential diagnosis, we studied retrospective cases. Thirty-one cases of SPN less than 20mm in diameter were compared in clinical findings and CT image findings and were examined the diagnostic procedures in recent three years in National Sanyo Hospital. The 31 patients consisted of 14 males and 17 females ranging 44 to 79 years old, median 65 years old. The causes of SPN were lung cancer (11 patients), cryptococcosis (4 patients), tuberculoma (3 patients), non-tuberculous mycobacteria (2 patients), pneumoconiosis (2 patients), pneumonia scar (one patient), hamartoma (one patient), and unknown (7 patients). There were no significant differences in laboratory findings between lung cancer and the others. CT findings showed significant differences in four categories. All patients underwent fiberoptic bronchoscopy (FB) examinations and 12 patients were determined the diagnosis in initial FB. Five patients were established their diagnosis using videoassociated thoracoscopic surgeries.

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We studied HCV endemicity in National Kuryu-Rakusenen Sanatorium in 2001. 286 cases that received a routine medical checkup were examined.
The prevalence of anti-HCV antibody was 65.3%. A significantly higher prevalence was found in males (71.1%) than in females (58.6%). Among antibody positive cases, HCV subtype was sequenced in 60 cases. We assumed 3 other cases to have viremia, because of their high titer of antibody, although we failed to find HCV genome. These 63 cases accounted for 22.1% of all studied and 33.9% of antibody positive cases. HCV genotype of II/1b was most frequently found (77.8%), similar to the general population in Japan.
Cases having past history of lepromatous or near-lepromatous leprosy had significantly higherprevalence of antibody (71.2%) when compared to the cases classified as tuberculoid or near-tuberculoid leprosy (47.9%).
From the clinical records up to and including 1975, cases having hand motor dysfunction and cases which received frequent skin-smear examination or prolonged wound care, were more prone to have HCV antibody.
Our study suggested that; during the period when people didn't have enough understanding about infection through various medical practices, HCV infection might have spread among the people who were disposed to develop wounds.

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A team-medical-care is really indispensable, because diseases have been getting more diversified and medical technology has been getting more specialized. In fact, some groups are obtaining dramatic effects by its use on the critical-path, nationally guided medicine and so on. Under the circumstances, the aim of this symposium is to clarify what we nutritionists have to do as one of a team-medical-care members. A doctor, a pharmacist, a nurse and two nutritional managers analyzed the status quo and proposed several ideas. Each presenter mentioned as follows:
The doctor's point of view (Kaise): Nutritional managers should change what they do from serving meals to patients to giving them nutritional instruction. They should give patients an appropriate knowledge on their nutritional state. He put an emphasis on these two points.
The pharmacist's point of view (Uenishi): When a pharmacist cooperated with a nutritional manager, patient's condition got better. She stressed the importance of mutual corporation.
The nutritional manager's point of view (Tanaka): He introduced a newly revised law on nutritionists and showed us their roles in a team-medical-care. Furthermore, he said, "We nutritionists need broad ranged activities to exchange opinions with doctors, to participate in the daily ward-round and meeting. He added that nutritionists played an important role in critical-path and NST.
The nurse's point of view (Kobayashi): She showed the present situation in her hospital that doctors, nurses, nutritionists and others exchange necessary information and work based on it. So, a nutritionist should actively participate in the conference and the ward-round. However, the instruction for nutrition is evaluated very low under the current system, she pointed out.
Supplementary remark by the nutritional manager (Nishino): Nutritional managers who belong to the office-section at present have to be transferred to the medical-section because they are engaged in medical treatment. We will be able to work smoothly by the revised system.
The above reports showed that it almost became definite what we nutritionists should do now. That is, (1) to keep close connections with other section members by participating the daily ward-round and meeting. (2) to have knowledge to assess and correct the distorted nutritional state of patients. (3) to shift our work from serving meals to patients to giving them instruction on nutrition. We should be strongly motivated to work actively as one of medical-care members. And we should devote ourselves to support patients. Finally, our positive efforts will be highly appreciated in a medical-care-team as a result.

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Hormone resistance and hypersensitivity are generally caused by abnormalities of hormone receptors. They are characterized by discrepancy between clinical manifestations and serum hormone values. In hormone resistance, clinical findings due to increased serum hormone are not recognized. On the other hand, in hormone hypersensitivity, clinical findings due to decreased serum hormone are not recognized. Patients with resistance and hypersensitivity to cortisol, aldosterone, LH, FSH, TSH, ACTH and insulin have been reported. We also reported patients with cortisol resistance, cortisol hypersensitivity and insulin hypersensitivity.

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