To determine the relation between the postsynaptic regulatory system and changes in cytosolic Ca²⁺ ( [Ca²⁺] i) and pH ( [pH] i) levels under extracellular acidosis, we tried to quantify the fluorointensity of [Ca²⁺] i and [pH] I in cultured cerebellar granule cells by colored image integration employing an image analyzing system. Moreover, in order to evaluate the presynaptic neuronal function, changes in dopamine (DA) transmission evoked by high -K was measured by a fast cyclic voltammetry method.Under neutral conditions (pH 7.4), the increases in [Ca²⁺] i levels induced by high-K were classified into high and low potential cell groups, and the ratio was 3: 1 in each cell culture. In the high potential cell group, a sustained increase of [pH] i induced by high K was seen. In the low potential cell group, a transient increase followed by a decrease in [Ca²⁺] i levels was observed. When the extracellular pH was acidified to 6 . 6, the increase of [Ca²⁺] i induced by high-K was significantly suppressed in both cell groups. Furthermore, a reduction of [pH] i appeared in both cell groups after the high-K treatment. Under acidosis, the inhibitory effects of Ca antagonists on changes in [Ca²⁺] i and [pH] i levels induced by high -K were lessened compared to those seen under neutral condition. The present results show that changes in [Ca²⁺] i and [pH] i levels induced by high -K can be classified into two groups, and that these changes were completely sup-presssed by acidosis. Moreover attenuation of the high -K evoked excessive amounts of DA release was also detected under acidosis. However, these suppression induced by acidosis were recovered when acidosis was returned to neutral condition. These results suggest that changes in pH, particularly acidosis, retard synaptic transmission and transduction potentiated by extraordinary depolarization.

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Sudden death is one of the most common causes of death of heart diseases. Heart rate variability (HRV) was analyzed to relate to the pathophysiological state and the prognosis of various heart diseases. Eighty six patients with left ventricular dysfunction (less than 40% of left ventricular ejection fraction) were studied with HRV obtained from 24 hours ambulatory electrocardiogram. Although the patients showing abnormal values of HRV revealed worse prognosis than those with normal HRV, the cause of death of the patients with abnormal HRV was not necessarily sudden cardiac death. Among thirty seven patients with acute myocardial infarction, non-survivors during the initial admission showed lower HRV than the survivors. However, cardiac sudden death was not related to lower HRV. A patient with cardiopulmonary arrest on arrival due to heart attack showed persistent low HRV and a patient with cardiopulmonary arrest on arrival due to ashtma attack did not show low HRV. These data suggest that HRV relating to prognosis of heart disease reflects the circulatory condition, and do not indicate the disturbance of autonomic nervous system associated with sudden cardiac death.

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Sixty five year-old male, with diabetes mellitus, hypothyroidism, and cardiac hypertrophy, caught a severe tetanus. He exhibited severe muscle spasms, autonomic nervous system dysfunction, and pneumonia. He was treated with mechanical controlled ventilation for 37 days together with nitroglycerin, chrolpromazine, lidocaine, dantrolene etc. It was characteristic in this case that dopamine concentrations in serum and urine increased markedly, but epinephrine and norepinephrine concentrations did not.

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My music therapy awakens vital activities unique to the living body. The up/down movement on a trampoline and the maintenance of an anti-gravity position stimulate and activate higher brain and instinctual functions to sustain life through the interaction with music, play, and surrounding people. As a result, disordered functions are re-habilitated and recovered.
Why are patients able to walk or jump rope after music therapy? And why are these same patients able to improve to the point where they can walk firmly or increase the number of rope jumping in the following week, rather than only walking or jumping during therapy? This is the result of music and body actions, which soften muscle rigidity and reduce unnecessary muscle tension.
In this way, patients acquire the ability to jump rope or walk probably as a result of“motor directions being transmitted along other paths, or rehabilitation of the original circuits.”The common factor in both cases is the activation of as a result of an increase in the level of dopamine or a better balance with other neurotransmitters, which creates smoother transmission. Thus, the continuous rehabilitation of a patient's functions is the result of smoother production and transmission of neurotransmitters.
Therapy is possible when experiences of good feelings, enjoyable spaces, favorite music, and favorite people are accumulated unconsciously. This method to activate the body is said to increase the natural healing power. I believe that the adoption of music therapy would also be meaningful as a method to alleviate pain in terminal cancer patients after becoming familiar with the characteristics of their pain.

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It is now accepted that the use of cardiopulmonary resuscitation (CPR) must be carefully considered, especially for terminally ill and elderly patients. Awareness of the do-not-resuscitate (DNR) principle among Japanese doctors is very high (96 percent) . Nevertheless, futile CPR is often performed at the time of death in terminal lung cancer patients. We recently introduced a standard-ized DNR order form at our university hospital in an attempt to avoid futile CPR. Forty-eight (63.2 percent) of 67 inpatients had received DNR orders before death. Patients were consulted about DNR orders in only 5.4 percent of cases, but surrogates were consulted in all cases. No CPR was permitted in 35.4 percent of orders. This study found that CPR was perfomed much less often after the introduction of the DNR order form (40.7 percent of cases) than before (90.7 percent) in patients who died of lung cancer. This finding might reflect both educational efforts and greater awareness of DNR by the introduction and use of DNR order forms and DNR guidelines. Moreover, advance directives for medical care and the designation of surrogate decision makers to guide medical care after a patient has become incompetent have not yet been advocated in Japan. Medical opinions on the appro-priateness of CPR for certain patients should now be openly discussed. We continue to strive for concrete measures, such as the introduction of DNR order forms, to establish improved terminal care and to give all patients the equal opportunity to benefit from medical care.

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The points of new emergency medical service system for disaster are as follows: (1) Dissolution of the delay of primary action; (2) Strengthen the action of distinct areas; (3) Support of the action taken by residents mainly; Usual training and preparedness.
From point of these views, the followings are required: (1) Preparation of main hospitals for disaster; (2) Preparation of information system for disaster and emergency medical service; (3) Strengthen the functions of health centers regarding disaster medicine; (4) Cooperation with transportation organization.
To replete and strengthen the emergency medical service system for disaster, it is important and essential to collaborate with residents, medical experts, persons who concern into emergency medicine. This collaboration should be promoted vigorously.

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After the enactment of the International Peace Cooperation Law in 1992, Japan Self Defense Forces has dispat-ched contingent and personnel to Cambodia to take part in the UNTAC, to Mozambique in the ONUMOZ, to the Golan Height in the UNDOF, and to Zaire to take part in the humanitarian international relief operations. Japan Self Defense Forces also dispatched units to the disaster area at the time of the Great Hanshin-Awaji Earthquake and dispatched for rescue activities in the sarin gas attack on Tokyo subway systems. Through these activities, the international peace cooperation assignment and the disaster relief dispatch assignment are added to the mission of the national defense.
The international cooperation is based on the article 100 of the Self Defense Law and the disaster relief dispatch is based on the article 83.
The activities of the Self Defense Forces in the domestic and oversea areas and legal framework are explained in this article.

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Japanese Red Cross society is a brunch of International Red Cross, cooperate the general support worth living refugee or defend human rights. I in vestigate about the“Large number of suffered Japanese repatriation”when they staying foreign country.

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AMDA, the Association of Medical Doctors of Asia, based in Okayama city, has 18 country chapters. It is an international medical non-governmental organization (NGO), founded in 1984, working for an improvement in health and related area in Asian and other local commu-nities. The AMDA projects include humanitarian assistance to victims of natural disasters and war refugees through medical care, as well as giving medical advices to foreign residents in Japan. It has as its motto“Better Quality of Life for Better Future”a goal to be realized by means of“mutual understanding, mutual assistance.”When an emergency occurs, a group is formed consisting of doctors and coordinators from AMDA country chapters and is sent to the site. NGOs are able to make a quick and flexible response to disaster. In order to do this, NGOs should strengthen partnership to activate mutual assistance.

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Japan Medical Team for Disaster Relief (JMTDR) is a volunteer-based medical team organized to offer medical service for disaster victims abroad. The team was established in 1982 as a part of Japan Disaster Relief (JDR), which consists of rescue, medical and rehabilitation (life line reconstruction) teams, and is a kind of govermental organization under the control of Japan International Cooperation Agency (JICA) . When it takes action in response to the request of the goverment of the afflicted country, an expeditionary team is picked up from the resistered members; consisting 179 physicians, 216 nurses, and 121 coordinators. The team is dispatched within 24 hours after the request. Since 1982 JMTDR has dispatched its members for 34 times to Asia, Middle East, Africa and other developing areas and offered a good quality of service. In comparison with NGO's, JMTDR as an official organization has the advantage of budget, security, and accessibility to go in and out of a foreign country. Though there are still some problems to be solved like shortening the response time not from the request but from the outbreak of the disaster, JMTDR is one of the most successful organizations to help disaster victims.

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We analysed 206 patients of out-of-hospital cardiopulmonary arrest with acute myocardial infarction who were transfered to our hospital from April 1992 to March 1996. They were consistent with 132 males and 74 females and mean age is 62.7 in male patients and 67.5 in female patients and total is 64.4. Among the 206 patients with acute myocardial infarction, CPR was successful in 53 patients and unsuccsessful in 153 patients. Witnessed patients in the 153 unsuccessful CPR patients were 103 cases. Electrocardiograph of those 103 patients observed by paramedics were followings, cardiac standstill in 68 cases, ventricular fibrillation in 26 cases and electromechanical dissociation in 9 cases. It has been suggested that the most common cause of prehospital death with acute myocardial infarction is due to ventricular fibrillation, but our results showed that many of the patients who died immediately after the onset of cardiac event would expire by acute pump failure with cardiogenic shock. without ventriculare fibrillation.

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