Objective: Analyze different types of wars and their victims from children' s point of view, and explain the influential factors on children' s mental health.
Method: Used references containing the subject of mental and physical health damage as well as covering the sufferings and developmental problems of children in war chosen from publications from the past 30 years on wars and children.
Result: The type of damage or victims differs depending on the type of war as to which weapons are used or strategies are taken. Therefore, the type of damage/sufferings from wars is divided into two categories (conventional wars/high technology wars), differentiating by types of weapons in war. Low intensive wars are also added as a special type of wars. Children' s war victims are found in all aspects of life: high mortality, victims of injuries and other physical damage, victims of massacres of family or local area people, victims of shortages in clothing, food or residence, victims of destruction of social infrastructures of education, medical services or health services, an increase in number of victims from infectious diseases, or victims of war-caused mental disorders.
Discussion: How to decrease children's victims or prevent children from war sufferings are suggested in light of three points: how to decrease victimization of children during war, how to prevent children from post war sufferings, and how to avoid exposing children to war.

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To improve the survival rate of Japanese breast cancer patients, a multidisciplinary strategy for breast cancer treatment is needed. A research group sponsored by MHWL Japan published EBM Guideline for Breast cancer treatment recently.
In the future, based on this report, Japanese society of breast cancer is planning a new guideline for breast cancer. We summarized the recent topics of breast cancer treatment based on EBM. In adjuvant setting, anthracyclines containing regimens brought significantly higher survival than CMF. In addition, endocrine therapy contributed to survival improvement. In metastatic setting, anthracyclines containing regimens must be recommended as the first choice, and taxanes may be the second choice. Third line chemotherapy has not been decided by EBM; commonly capecitabine and vinorerubine were used. For HER2 positive breast cancer, Trastuzumab may be useful.

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This article reviews the present status and perspectives of radiation oncology in Japan. Radiation therapy accelerators and related machines have made remarkable development, and now the radiation therapy treatment planning computer plays a principal and indispensable role in the planning and in the throughout process of radiation therapy in each facility. As to the structure, there is a remarkable increase in the patient population receiving radiation therapy, and this will continue to increase because the proportion of population receiving treatment in Japan is still far less than that in Western countries. Installation of machines and the supply of staff cannot keep up with the increase of patients receiving radiation therapy as now. It is necessary indeed for patients to receive good quality medical care, and it is necessary to assure and maintain good quality in the field of radiation oncology in Japan. Several related issues are pointed out with possible answers to them.

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We analyzed the improvement in hospital management with the progression of critical path of the operation for primary lung cancer, especially noting the relationship between hospital stay and medical reward. One hundred twenty operated cases of primary lung cancer from September 2000 to June 2003 were selected to compare the number of patients, duration of drainage, postoperative hospital stay, total hospital stay and medical reward per day among three groups for each one year period using without critical path, with induction critical path and revised critical path.
The results showed the increasing number of patients, shortness of the duration of drainage, postoperative hospital stay, total hospital stay and the increasing medical reward per day. The comparison of the background of each group revealed the recent progression of thoracoscopic surgery. However, because exclusion of the factor of thoracoscopic surgery also showed the same results as the previous analysis, it is indicated that the progression of the critical path is resulting in improvement of staff consciousness and technical capability, which is contributing to hospital management.
The relationship between the hospital stay and medical reward had a significant correlation and the increasing of a slant is recognized with the progression of our critical path. These might result from the high cost of thoracoscopic surgery compared to open surgery and positive impact on the length of hospital stay. Regarding the postoperative adjuvant therapy, the medical reward gradually reduces with the length of the hospital stay. The analysis of the relationship between the hospital stay and medical reward could also be very useful to compare the differences in each disease and institution.

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Recent advances and moves toward specialization in medicine also brought similar trends in the area where clinical nursing is practiced. The Japanese Nursing Association has been involved in the education of certified nurses and nursing specialists for a few years and it now conducts tests for nursing certification. Those nursing specialists who were certified by the Association enter nursing practice, engage in more specialized nursing activities, bring about changes in patient-related nursing problems to produce a more desirable outcome, contribute to shortening of the mean length of a patient's stay in the hospital, and reduce medical expenditures, and so forth. Thus their contributions lead to decidedly constructive changes.
At the National Hospitals and Sanatoria, nursing education departments affiliated with National College of Nursing, Japan were approved last year as places of advanced studies for certified nurses; and specialized educational programs have been started. However, these facilities have yet to improve their educational systems and organizational structures. The present symposium focused on the National Hospitals and Sanatoria that are to become independent administrative institutions in 2004. It was intended to define the problems and objectives so that we will have a clear idea when these nursing specialists and certified nurses are introduced to these facilities and be aware of how they will conduct their duties there and develop professionally.
The following topics were presented at the symposium by their respective panelists: (1) “The status of training of nursing specialists and certified nurses in Japan and future objectives” by Ms. Keiko Okaya, Executive Director, Japanese Nursing Association; (2) “Advantages such as economic gains when nursing specialists are introduced to medical facilities” by Prof. Katsuya Kanda, Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo; (3) “Details of activities and methodologies introduced into health facilities and future prospects for training nurse specialists and certified nurses, from a viewpoint as a nursing specialist” by Ms. Noriko Kawana, Lecturer, Liaison Psychiatric Nursing, St. Luke's International Hospital; and (4) “How nursing administrators should introduce nursing specialists and certified nurses to national hospitals and utilize their services in hospital management?” by Ms. Yoko Koyama, Director, Department of Nursing, National Osaka Hospital.
Each lecturer introduced abundant material on the assigned subject, resulting in their sessions running over the allotted time. Each lecture was truly substantial and there was hardly enough time allowed for each session. The topics selected were far-reaching and timely vis-a-vis the current scene of medical practice; and the lecturers were all leading authorities in their field. Therefore the content of the talks was abundant and timely, leaving little time for questions and answers. Indeed it was a gainful symposium for all.
Based on the details given by each lecturer, the audience-the nurses of National Hospitals and Sanatoria-should decide where and how they ought to allocate nursing specialists within their organization and develop a system to utilize their services. It is certain that the introduction of these personnel is a definite plus in raising the quality of nursing. At the National College of Nursing, Japan, on the other hand, courses should be prepared to meet the needs of various medical facilities and cooperate in the training of nursing specialists and certified nurses so that the quality of clinical nursing will be further improved.
The talks given by two of the lecturers at the Symposium are introduced in “IRYO (Japanese Journal of National Medical Services).”

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A 54 years old female with hypertrophic obstructive cardiomyopathy (HOCM) was admitted to our hospital. She had a family history of hypertrophic cardiomyopathy and had been treated for 11 years by her family doctor with β blockade. Her subjective symptoms had gotten worse in the last year. The pressure gradient of left ventricular outflow tract detected by cardiac catheterization was 140mmHg at rest. Temporary atrio-ventricular pacing did not decrease the pressure gradient. Intravenous administration of varapamil and disopyramide was effective. However, the effect of oral administration of βblockade with those medicines did not decrease the pressure gradient enough. Subjective symptoms have continued and she was re-admitted. Since her religious dogma did not permit her to accept blood transfusion, surgical treatment was rejected and percutaneous transluminal septal myocardial ablation (PTSMA) was selected. The pressure gradient and subjective symptoms decreased markedly after PTSMA. Medical insurance is not available for this treatment. Advancement of technology decreased the acute complications, but long-term prognosis remains unknown. So medical indications should be closely monitored, since it is thought that this treatment is effective in only certain patients.

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