We undertook a nursing project, based on psychiatric advice, with drug administration as supplemental treatment. The mental states of almost all patients became favourable in this project. We report 5 cases of mental states that improved in our project, according to psychiatrist's interview, and have tried to develop a project based on our experiences. Case 1. This patient lost his role as a husband because he was deserted by his wife and children. His mental state was improved by our active consultation with his family. Case 2. This patient was troubled by his nephew who had a mental disorder. In this case, it was necessary to find the cause of the mental problem as soon as possible. Case 3. This patient had no confidence in the medical staffs and the treatment. We discussed the treatment with him and he came to have the same opinion in favor of it. His skepticism was removed in this way. Case 4. This patient had had frequent physical complications which caused a mental disorder. In this case, the treatment of his complications led to his mental improvement. Case 5. This patient had had an inferiority complex concerning his figure and disease. He showed mental symptoms when he expressed affection for some woman. It was important that we gave him treatment suitable to his age. These 5 cases are only a few of the patients with various mental problems. It is important for us to nurse the patient with recognition of the changes in their mental states and with sufficient understanding of the causes.

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The total number of dialysis patients in the Shinseikai group amounted to 542 by May 31, 1986. The mean age was 50 and mean time on dialysis was 6 years and 11 months, the longest time on dialysis was 16 years and 10 months. Of these, 160 patients had been under dialysis over 10 years. The mean age was 48.2 years and mean time on dialysis was 12 years and 11 months. Furthermore, 267 cases and 88 people who had an operation due to some trouble were on dialysis more than ten years. This figure amounts to 11.4% of the total cases of shunt operation performed (2, 351 cases, 768 people) in last 8 years.
The mean age of these patients was 49 years, and the majority of alients were on dialysis treatment for less than 11 years; out of 101 cases (56 people) the patients under dialysis treatment for more than 15 years were only 9 cases (6 people). Reformation of internal & external shunt was the commonest operation with 160 cases (72 people), followed by the declotting of internal shunt in 101 cases (38 people), vessel dilation in 70 cases (30 people) and artificial graft in 47 cases (39 people). The types of complications were mostly vascular stenosis in 210 cases (79 people) and internal shunt obstruction in 102 cases (36 people) cases and some of the cases had a multiple complications. Infection, in the third place with 16 cases (13 people), covered approximatery 6% of the total cases. There were 2 diabetic cases (1 person) and 13 SLE cases (2 persons).
As for the shunt types, 175 cases (70 people) had internal shunt, 86 (31 people) had external shunt, 117 cases (42 people) had artificial graft internal shunt, and 32 cases (12 people) had artificial graft external shunt. The constructed regions were: upper arm on 143 cases (40 people), forearm on 102 cases (54 people), and others in 18 cases (9 people).
In 80% of the cases, the opertion time was less than 90 minutes. The shortest operation time was 4 minutes and the longest was 235 minutes. The mean time was 52.3 minutes.
In order to maintain the blood access for long-term dialysis patients, the following conditions should be considered; (1) operation by a specialist, (2) excellent staff and materials, (3) strict daily control of shunt, (4) thorough education for the staff and the patient, (5) refraining from artificial graft with short term hemodialysis patients, and (6) preferably eary operation for complications.

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