For severe acute respiratory syndrome (SARS), methodologies are yet to be established for prompt diagnostic testing, treatment and prevention by means of vaccination. Such being the situation, it is necessary to implement stringent measures in preventing the transmission of this infectious disease based on a correct understanding of its epidemiological characteristics. The pathways of transmission are by droplet and by contact. Risk factors include social contacts with SARS cases within a radius of 2 meters or household contacts, badly ventilated rooms, touching contaminated objects and surfaces, exposure to body fluids. The major clinical symptoms of the acute respiratory disease include, like influenza, fever, chill, tiredness (malaise), muscle aches, trepidation, nausea and headache. Compared with patients who contract influenza, SARS patients often had dyspnea and diarrhea, but rarely complain of pharyngalgia and pituita. A close correlation has been noted between the stage of SARS and its infectivity, capability. During the incubation period, which lasts 2 to 10 days, the disease is asymptomatic and reportedly almost no infectious. But there is general agreement among experts that SARS becomes highly infectious when it enters the lower airway infection period and begins to produce such symptoms as fever and dry cough, dyspnea.
As the main points of the measures to prevent SARS from spreading, we would like to refer to triage and prevention of cross infection. A triage system should be adopted as the need arises. Under the system, patients suspected to have SARS are separated from other patients and given priority in medical treatment. Standard precautions should not be forgotten. The use of alcohol-based hand rubs and the wearig of surgical masks are effective means to cut off the route of infection. These efforts would make it possible to effectively prevent the infectious diseases like SARS from being spread form person to person and thus protect the public from the pandemic.

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As a health care measure for the people in the prime of life, the Ministry of Health and Welfare (now the Ministry of Health, Labor and Welfare) of the Japanese government started off the first 5-year program for the senior citizens in 1983 with the enforcement of the Law Concerning Health and Medical Services for the Aged, followed by the second five-year program in 1988 and the third eight-year program in 1992. The screening project for colon cancer was incorporated in the third program with a target set of holding an increasing rate of morbidity at zero in a year-to-year comparison. The response rate to colon cancer screening (the ratio of the number of participants responding to colon cancer screening to the total number of qualified persons) was also to be raised steadily to reach a target of 30% in 1999. In Gifu Prefecture, the total number of examinees in 1999 increased twice the figure in 1992, but the response rate was 14.8%, which was only about half the target and below the national average of 15.3%. The detection ratio of colon cancer and the early cancer ratio in the prefecture were much the same as the national average. It could be taken that there is nothing wrong as far as the precision of screeming and management are concernd. To decrease the rate of mortality from cancer of the colon, the most important is to raise the response rate. For this purpose, we would like to propose that the cost should be covered by national health insurance in those health screening projects approved of by the competent authorities.

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We investigated the current status and problems of cancer pain relief, sedation for cancer pain and uncontrolled symptoms in patients with recurrent gastric cancer. The subjects of this study were 59 patients with recurrent gastric cancer undergoing palliative treatment in the Department of Surgery of our hospital. We retrospectively examined the modality of cancer pain relief, use of sedation and the reason for sedation. Outpatient treatment lasted 0-682 days (mean ; 195.3 days) and hospitalization 1-117 days(mean ; 32.1 days). Nonsteroidal antiinflammatory drugs were used for all patients. Morphine was administered to 50 patients (84.7%). Analgesic effects were seen in all patients. No servere adverse events occurred. Sedation was used in 33 (55.9%) for general fatigue (28) and/or restlessness (17). We concluded that analgesia was sufficient and safe with nonsteroidal antiphlogistic and pharmaceutical morphines, but about half of the cases required sedation.

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We investigated the usefulness of the method of producing sedation with midazolam and reversing with antagonist flumazenil in upper gastrointestinal endoscopy. Twenty-five adult outpatients underwent diagnostic upper gastrointestinal endoscopy 3 min after having an intravenous injection of 5 mg of midazolam for sedation, and received 0.25 mg of flumazenil intravenously 5 min after the removal of the endoscope. Blood pressure, heart rate, and percutaneous arterial oxygen saturation (SpO₂) were measured, recorded, and compared at nine points : 1 min before midazolam injection, 2 min after midazolam injection, 1, 3, and 5 min after the insertion of the endoscope, 1 and 3 min after the removal of the endoscope, 1 min after flumazenil injection, and their awakening time at which they are easily able to respond to verbal commands. Fifteen minntes after their awakening, we asked those patients about their memory during the endoscopy and evaluated their pain with the Visual Analogue Scale (VAS). A significant decrease in systolic blood pressure was noted 2 min after midazolam injection. But the systolic blood pressure measured 1 min after the insertion of the endoscope significantly increased when compared with the level 2 min after midazolam injection. Then it gradually started decreasing. Although the systolic blood pressures 1 min after flumazenil injection and at their awakening time increased slightly, the levels were significantly lower than those 1 min before midazolam injection. The heart rate increased to the maximum 1 min after the insertion of the endoscope. Then it gradually started decreasing. The heart rates 1 min after flumazenil injection and at their awakening time decreased significantly when compared with those 1 min after the insertion of the endoscope. SpO₂ significantly decreased from 97.6±1.6% 1 min before midazolam injection to 95.7±2.5% 2 min after midazolam injection and remained depressing around 95% during the endoscopy. However, SpO₂ recovered 96.6±2.0% at their awakening time. Two patients had a vague memory but all the rest had no memory recollection at all of what happened during the examination. VAS was 20 mm for one patient and 0 mm for another patient. We showed the clinical usefulness of the method of antagonizing with flumazenil after upper gastrointestinal endoscopy performed on patients given an i.v. injection of midazolam, because this method might provide a minimal circulatory change due to some protection against hemodynamics stress in response to manipulation of the endoscope, anterograde amnesia, and disappearance of pain. However, we should take care of respiratory depression of the patient during endoscopy.

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This paper describes the clinical characteristics of 14 cases of malignant melanoma treated in our department during a period of five years from 1997 to 2001 and their prognosis. Excluding one case whose stage could not be defined, five cases recognized at the early stage have survived, and six cases out of eight at the progressive stages were dead within one year after their first visit. When it came to the clinical characteristics, nine cases were primary cutaneous melanomas and five cases were metastatic carcinomas. Acral lentiginous melanomas, histopathologically the most common type of melanoma in Japan, were found in seven cases of the total 14 (50%). Most of the patients were aware of the primary lesions but left them untreated. Generally speaking, malignant melanoma grow rapidly and prognosis is poor because the cure rate by chemotherapy is low. To realize earlier detection and treatment, we thought it is crucial to educate the public, have the general practitioners understanding more about the malignancy of the skin neoplasm and to build up a collaborative relationship between medical professionals.

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Increasing medical knowledge and improved hemodialysis techniques have permitted longer survival in patients receiving hemodialysis. However, the risk of cardiovascular disease, which is mainly caused by atherosclerosis, substantially increases in proportion to the longer survival of hemodialysis patients. At present, cardiovascular disease is a major cause of morbidity and mortality. The present study was designed to investigate the relations between electrocardiographic abnormalities (e.g. ischemic change, left ventricular hypertrophy, arrhythmia and conduction block) and the progression of atherosclerosis, the atherosclerotic risk factors (e.g. diabetes, hypertension, hyperlipidemia and smoking) and aortic calcification in patients on maintenance hemodialysis. Pulse wave velocity (PWV) was used as the index of atherosclerosis. PWV levels were singficantly higher in ischemic change (1,993±99cm/s), left ventricular hypertrophy (2,103±120cm/s), arrhythmia (2,015±120cm/s), and condition block groups (2,014±119cm/s) than in the nomal group (1,627±69cm/s). Also, PWV levels corrected by diastolic blood pressure in all abnormal groups were significantly higher. Serum Creactive protein levels in all abnormal groups also tended to be higher than those in the normal group. With regard to atherosclerotic risk factors, the incidence of diabetes and hypertention tended to be higher in abnormal groups. Especially the incidence of hypertension was significantly higher in ischemic change (66.7%), left ventricular hypertrophy (50.0%) and conduction block groups (55.6%) than that in the normal group (16.7%). These results suggest that the electrocardiographic changes are related to the progression of atherosclerosis, and among atherosclerotic risk factors, hypertension most affects the electrocardiographic changes in patients on maintenance hemodialysis.

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On the nursing front, there is no limit to demands for care services. Although efforts are being made to train the staff, letters from former inpatients showed that they left the hospital with a lot of discontent. To have them leave the hospital pleasantly, we have started holding an interview with the inpatients just before they are discharged since 2000. To grasp the results of the interviews accomplished during the 2-years period after the implementation of this program, we carried out a survey by distributing questionnaires to the nursing staff. At the same time, we conducted a survey on expatients and analyzed what they actually told the interviewers. It was found that about 60% of the outgoing patients were interviewed.
More than 89% of the ex-patients surveyed said that they could calm themselves after they realized the nurses understood what it is to be painful. Asked if they want the interview to be continued, 94% answered in the affirmative. Meanwhile, many nurses said that what the patients told them was encouraging and gave them an incentive to carry out their duty. Some said that they were given an opportunity to reflect on their past conduct. All in all, we found that the interviews had the healing effect on the nursing staff as well as the patients.

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The conventional management of scalp laceration has its drawbacks. Most patients complain of scalp itching, sticky hair and pain at the time of dressing change, because the washing of the hair is restricted and the wound is covered with gauze before the patients have their stitches removed. In this paper, we report the results of trial given to a new management method. The wound was exposed to the air two days after suturing and washing the hair was allowed at the same time. The trial involved 40 outpatients with scalp laceration. There were no complications of wound infection or delayed healing due to this method. And also most patients (90%) said they felt comfortable. Thus, as an alternative management of scalp laceration this method proved useful for comfortable wound treatment.

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