We successfully performed thoracoscopic resection of small pulmonary nodules in seven patients by placing needles adjacent to the target nodules under computed-tomographic guidance. Placement of individual needles was completed in all the patients within 10 to 50 minutes (average : 37 minutes). At the time of placement of the needles, pneumothorax developed in two patients and convulsions in one. Excisional biopsies of individual nodules required 39 to 66 minutes (average : 41 minutes). This technique also appears to be useful for thoracoscopic biopsies of peripheral pulmonary nodules that would be difficult to identify by endoscopic probing forceps.

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For over ten years now, the incidence of low-birth-weight infants has been on the increase in Japan. In this connection, it is believed that while intensive maternal and child health guidance and improvement of perinatal medical care have led to a decrease in spontaneous or perinatal fetal death, the incidence of low-birth-weight infants is increasing. However, there was a time lag of over ten years between the observertion of decreare in the stillbirth rate and increare in the incidence of low-birthweight infants. Furthermore, the increase in number of low-birth-weight infants in recent years has far exceeded the decrease in the number of stillbirths. Advanced age at childbirth is thought to be one of the causes of the increase in number of low-birth-weight infants, however, the incidence of low-birth-weight infants born of young mothers has also increased in recent years. Thus, the increased incidence of low-birth-weight infants can not be explained by the above-mentioned cause alone.

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The degree of hemiplegia in 28 patients with cerebrovascular diseases (19 with cerebral infarction and 9 with cerebral hemorrhage ; 65.9± 10.2 years of age) were assessed by Brunnstrom classification to compare with the skin surface pH. The skin surface pH in the forehand of both upper limbs was determined by compact pH meter. The patients with severe hemiplegia showed a significantly greater difference in the skin surface pH between the paralyzed and healthy limbs and a trend toward an increase in the skin surface pH of paralyzed and healthy upper limbs. Thus, the difference in skin surface pH between the paralyzed and healthy limbs is suggested to be useful for evaluating the grade of hemiplegia. The difference in pH might be derived from sweating dysfunction due to vasomotor dysfunction and autonomic nerve palsy, and from buffer system dysfunction on the skin surface due to corneal and epidermal atrophy, and vascular rarefaction, in the paralyzed and healthy limbs.

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We analyzed the factors influencing the QOL, i.e., those influencing the patients' ability to conduct the daily activities of life, and environmental factors, in cerebrovascular disorder patients cared for at home to determine the future directions of nursing support for home-based care. We interviewed 60 patients, ranging in age from 40 to 65 years, cared for at home for one year or more after discharge from a general hospital in T prefecture. The questionnaire items included those evaluating the QOL determinants after cerebral stroke, ADL determinants (as measured by Barthel Index), determinants of the ability for the daily activities of life according to ROKEN, social support evaluation, and perception of “self-esteem” that reflects subjective evaluation of the QOL. Correlation analysis between two variables was conducted using the QOL evaluation score as the dependent variable. The following results were obtained.
1. The patients' QOL scores were correlated more strongly with the scores for determinants of the ability for the daily activities of life, including social activity, than the ADL scores.
2. The QOL scores were significantly higher in persons who were engaged in some occupation and housekeeping than in those who were not.
3. The perception level of “self-esteem” was significantly correlated with the QOL scores with a p value of 1 %.
4. In regard to social support, emotional support was more strongly correlated with the QOL scores than technical support.
When we care for patients who have already accepted their disability with the aim of improving their QOL, it would seem important to develop in the patients a sense of value, such as self-esteem and the need for creation of a new meaningful life. It is also necessary to improve their ability to cope with their suffering and anxiousness from the standpoint of professional nursing support, and to provide emotional support by adjusting the surrounding environment including the family, to improve the patients' QOL.

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The purpose of this study is to identify the abilities required of public health nurses and to investigate the challenges in their education. The subjects were six administrator public health nurses working in health centers and seven administrator public health nurses working in the municipalities of six prefectures. They were interviewed concerning regarding their views on the abilities required of public health nurses after implementation of the community health law within the framework of existing results of such studies. The following new findings were identified ; ability to protect the rights of the users under conditions of home care, ability to present design programs, ability to improve systems for performing research, and common ability as an administrator. Additionally, they clarified that the support of municipalities was available to public health centers for all business, and that there was a difference between nurses at public health centers and municipalities on the ability required for planning education and in-service training. The importance of improving basic education on the method of community diagnosis and information collection and analysis was pointed as the challenge in the education of public health nurses. Also, it was suggested that effective methods of education according to each person's capability were necessary, because it was recognized that the learning differed according to the abilities.

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A sixty-two year old man who presented with edema and ascites was diagnosed as having a large hepatocellular carcinoma metastasizing to the left adrenal gland. Transcatheter arterial embolization (TAE) was performed for the primary lesion and concentrated red blood cells were transfused 2 days after the TAE because of anemia. One week after the TAE, the blood hemoglobin level suddenly decreased from 9.3 to 5.7g/dl and total bilirubin increased from 2.4 to 13 mg/dl. The appearance of jaundice first suggested hepatic failure after TAE, but the hemoglobinuria and elevated serum lactate dehydrogenase were suggestive of hemolysis. The delayed-type hemolytic reaction was thought to have occurred because the patient's antigen profile of red blood cell on Kidd system was Jk (a+ b-) and anti-Jkb was detected in the serum. Prednisolone administration resulted in improvement of the symptoms, including hemolysis and jaundice. Delayed type hemolytic reactions are rare but should be kept in mind even if the patient has a poor hepatic functional reserve. The adrenal metastasis was not treated by TAE because of the presence of a common supply artery with the left kidney, but the patient survived for 7 months after the TAE without any complications except esophageal varices which was treated with endoscopic ligation. Thus functional reserve of the liver should be first considered as a prognostic factor even if the patient is in an advanced stage of HCC. Metastatic lesions should not be treated when the treatment does not ensure control of the primary lesion and the hepatic functional reserve is poor.

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Patients undergoing surgery such as total removal of the bladder and construction of ileostomy for bladder cancer are often in a state of dual crisis both pre-and post operatively, that is, being informed of the diagnosis of cancer and need to accept a stoma. Nurses give care to these patients aimed at increasing their quality of life, by helping them to accept their stoma and facilitating their self-care abilities, so as to enable early recovery to their own social life.
Case analyses of two ileostomy patients was conducted in relation to the quality of life. The results were as follows :
1. Patients need psychological nursing care depending on their level of acceptance of a stoma, because they lose one of their body parts which might change their image, due to the operation.
2. Patients need nursing care that compensates for their limitations, because their self-care abilities are decreased or they realize their own limitations which may lead to lowering of their quality of life, due to the operation.
3. It is very important to give nursing care to support the patient's families depending on their situations, because support from the families of surgical patients may influence the quality of life after the operation.
4. Nursing care may need to be aimed at minimizing the effect of the operation on the patient's life style, because it may become a stress factor and lower the patient's quality of life.
5. Postoperative nursing care for elderly patients based on their physiology may lead to improvement of the patient's quality of life.
6. Whether the patients are informed or not, the relationship between the notification of cancer and the QOL may have influence on factors such as the kind of cancer treatments.

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The effect of rehabilitation on bone metabolism was examined in a patient with cerebral hemorrhage who recovered and could walk within three months after the initial diagnosis. Along with her recovery, the increased urinary calcium excretion decreased markedly but urinary phosphorus did not change. Urinary pyridinoline and deoxypyridinoline, which are suitable makers of bone resorption, and serum osteocalcin, which is a marker of bone formation, increased until 4 weeks, decreased until 8 weeks, and then increased again. The serum PTH level increased slightly until 10 weeks and then decreased. These findings indicate that bone resorption increased in the supine state but bone formation is facilitated with walking, suggesting that rehabilitation is useful for patients with cerebrovascular disease from the viewpoint of bone metabolism.

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