Kikusui, situated in the northwestern part of Kumamoto Prefecture, is famous for its remains of ancient Japan and at the same time known as a town blessed with the natural environment. As is the case with many other rural areas in this country, graying in population has been progressing at a fast clip here in recent years. To cope with the situation, Kikusui Town has taken uponitself to implement a comprehensive geriatric health care scheme since 1973 that covers not the physical aspect alone but also the mental aspect of the lives of the senior members of the population. During the period, the social welfare council and the societies of old people linked up with public health nurses. Later, the town hospital and its health control center joined with them to establish a home visit system to take care of the aged at home with the support of the government. Further, a nursing home for old people was built on the premises of the town hospital and started the day care services to back up the home care system. Various programs for home care were carried out in the main by visiting nurses. From the standpoint of the medical institution, cooperation with welfare workers was vital. Moreover, it was important for the residents of Kikusui Town to participate in this project. In the present paper, we will report on how the home care system for old people came into being.

We report a case in which feelings of abdominal distension and discomfort of the abdominal wall caused by malignant ascites were relieved by ultrasound-guided rectus sheath block. Case report: A 59-year-old man developed gastric cancer with malignant ascites and experienced feelings of abdominal distension, but no nausea, dyspnea, poor mobility, or limb edema. Symptom control was inadequate with diuretic therapy and abdominal paracentesis. Feelings of distension improved temporarily with ultrasound-guided rectus sheath block. A percutaneous catheter was then used to administer an infusion of 0.25% ropivacaine triweekly until his death 20 days later. Conclusion: Feelings of abdominal distension is one of various symptoms of severe ascites and is difficult to manage. Ultrasound-guided rectus sheath block can be used to relieve this symptom on a case-by-case basis.

We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. Case report: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh^-1 with 0.1% ropivacaine. Conclusion: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315