We founded the Intractable Disease Care Center in Shinshu University Hospital in June 2009. By the end of May 2013, we had conducted 304 house-call medical visits responding to the requests of 108 patients with intractable neurological diseases. We have counseled them on their problems and provided medical information to primary care doctors and supporters such as home-care nurses, public health nurses or care managers. We also have arranged hospitalization for respite care. This multidisciplinary medical care has helped patients and their families to understand the disease, resulting in a reduction of anxiety and promoting cooperation among supporters. In arranging for the respite care, it is important to facilitate cooperation between hospitals and public administration based on the status of home care in the local region. To further facilitate the home care, we need to develop a new system to share continually the patientʼs information among medical institutions and supporters, using information and communication technology.

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The aim of this study was to evaluate the optimal timing of reoperation for patients with biliary atresia (BA). Twelve patients with BA underwent reoperation after hepatic portoenterostomy (HPE) between May 1993 and November 2011 at our institution. They were divided into two groups. Group A patients showed no benefit from the reoperation. Group B patients became jaundice-free after the reoperation. Medical records were retrospectively reviewed. Six of the twelve patients became jaundice-free after reoperation (Group B). No significant differences were seen in jaundice-free ratio (JFR), body weight at reoperation and the interval between HPE and reoperation. The serum total bilirubin (T.bil) and direct bilirubin (D.bil) levels before reoperation in Group B were significantly lower than those in Group A. T.bil and D.bil levels before reoperation were these important to determine the timing of reoperation. It is difficult for a case to become jaundice-free when the T.bil level is over 9.0mg/dl or the D.bil level is over 7.5mg/dl.

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