The national hospitals and sanatoria will be changed to the hospital group of Japan Agent System in April 2004. The Network Hospitals for Respiratory Diseases consists of 54 national sanatoria throughout Japan, and each hospital has a long history as tuberculosis sanatorium. Though it is yet unclear what the Network Hospitals for Respiratory Diseases should be, it is possible and useful to have an idealistic vision for ourselves.
In this symposium, in the first half, a director (a doctor) of a hospital, a director of nursing, and a director of a pharmacy presented their professional opinions. In the second half, only 2 themes among the many subjects dealing with our network were discussed. The first one was about the present and future of information technology (IT) which is now making progress in the medical field. The second theme was about what diseases we should treat and research after the elimination of TB in our network hospitals. The 5 participants conducted a fruitful discussion. We strongly believe that the audience, most of whom were staff from the many sanatoria nationwide, came away with much information helpful for their work and a better understanding of the direction toward which our network and each hospital, as a member of the Japan Agent System, must go to.

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The goal of the symposium was to update current quality management aspects in the various Clinical Laboratory fields and also to indicate the future concerns of medical technologists.
At the symposium, four technologists from the clinical chemistry laboratory introduced several updates such as ISO15189, standardization, TW2003, and improved statistical methodologies. One transfusion laboratory technologist explained the future trend of transfusion and emphasized that technologists should be coordinators in transfusion procedures. A bacteriology laboratory technologist emphasized the importance of participation in the infection control program. A qualified infection control nurse emphasized the importance of the bacteriology laboratory and encouraged hospital people to share the laboratory's data, especially infection-related information.
The presentations made by the six expert technologists and one expert nurse had such concepts in common as quality management, standardization, and sharing of data and methodologies. In addition, their presentations were strongly supported by their professionalism. These daily efforts in the laboratories give excellent evidence of the bright future for medical technologists.

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Purpose:
Percutaneous endoscopic gastrostomy (PEG) tends to lead to tube feeding and various complications occur in patients with neuromuscular disease. We attempted to clarify the conditions that accompany PEG for chronic neurological and muscular disease and associated complications.
Methods
We examined 55 cases with complications of PEG in patients with chronic neurological and muscular disease between 2000 and 2003.
Results:
We observed the following complications.
1) Respiratory insufficiency.
Intraoperative respiratory depression caused by a sedative was found in 8 of 9 cases.
2) Troubles during the procedure and tube exchange.
a) Intra-stomach bleeding, liver centesis, and a transfixed transverse colon.
b) Evulsion of the tube when changing body position and gastric perforation caused by compression from the bumper.
c) False insertion to the abdominal cavity during reinsertion, bumper left in a gastric wall, bumper fall caused by evulsion, and mucosal artery bleeding due to evulsion distress during exchange. Impacted duodenum by the tube tip and apoplexy of gastric mucosa artery by decompression of a bumper.
3) Self-evulsion by patients with a cognitive disorder.
4) Infection.
Peritonitis spread from a gastrostomy site infection without abdominal symptoms. Pseudomembranous colitis was caused by preventive administration of an antibiotic drug.
5) Digestive symptoms.
a) Gastroesophageal ref lux (GER) induced pneumonia.
b) Gastric ulcer/diarrhea.
6) Abdominal wall trouble.
Gastric juice leaked into the abdominal wall, causing necrosis and an ulcer.
To prevent such complications, we recommend prompt postoperative use of the sedative antagonist, while for intraoperative salivary aspiration prevention, intensive absorption during the operation is effective. We recommend to PEG for ALS patients at the mild stage of dysphagia. We should confirm visceral localization using a pre-operative examination, such as abdominal, CT, or echo. Confirmation with an endoscope is expected at the time of the first tube exchange. For patients with a cognitive disorder, we attempt to identify at-risk patients, and use a nonseparate cloth and abdominal bandage for preventive treatment by superior limb depression.
Summary
Many of these complications can be prevented by proper risk management by trained medical staff. For example, a neurologist who understands the disease state of the patient should consult a gastrologist and surgeon during an operation. Adequate cooperation will result in a safe PEG procedure.

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clinical obstetric information network (COIN) started in 1996 to establish large-scale database for clinical perinatal research.
1. 23 national hospitals participated in 2003: Fukuyama, Hamada, IMCJ, Kanazawa, Kobe, Kofu, Kure MC, Kyushu MC, Kyushu CVC, Mie-chuo, Mito, Nara, Nishi-saitama-chuo, Oita, Okayama MC, Osaka MC, Osaka-minami, Sagamihara, Sendai, Takasaki, Tokyo MC, Yokohama MC, Zentsuji.
2. Total number of mothers was 9, 916 cases: 977 (9.9%) preterm deliveries; 701 (7.1%) maternal transfers; 2, 723 (27.5%) postpartum hemorrhages; and blood transfusions were performed for 52 cases (0.5%). Maternal mortality rate was 9.8 (per 100, 000 live births).
3. Total number of neonates was 10, 121 cases: 1, 006 (9.9%) preterm between 28-36 weeks, and 73 (0.7%) were between 22-27 weeks. Early neonatal deaths were 13 cases; mortality rate was 1.3 (per 1, 000 live births). Fetal deaths after 22 weeks were 52 cases; rate was 5.1 (per 1, 000 total births). Perinatal mortality rate was 6.4 (per 1, 000 total births).

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