Purpose : The purpose of this study was to determine how frequently cancer patients would be missed if primary care clinics do not participate in the Japanese National Cancer Survey, and to describe the characteristics of those cancer patients who would be missed.
Methods : This research is a case series study. We collected cancer patients who were identified in Ryuocho-Kokuminkenkouhoken Clinic and Yuge medical clinic for 26 years and were registered in the Shiga Cancer survey. We then extracted the records of those cancer patients who would be potentially missed from the national cancer registry and investigated the background.
Results : The total number of cancer patients registered was 441. Of these, 28 (6.3%) patients who did not admit to the hospitals may be missed from the national cancer registry ; ten patients had their cancer diagnosed at an advanced stage and died at home without hospital admission. Two further cases had treatment for cancer (endoscopic resection) completed in the primary care clinic without hospital admission. Twelve patients only attend the hospital outpatient clinic for investigation and died at home without admission. And four patients received only CT scan examination and didn't attend the hospital outpatient clinic and died at home without admission.
Conclusion : Primary care clinics that deal with the cancer patients treated completely in the clinics or home terminal care should participate in the Japanese National Cancer survey.

A 59-year-old woman has presented symptoms of fatigue since January 1996. Atypical coarctation due to aortitis syndrome had been diagnosed 8 years earlier. Her upper-limb blood pressure was 200mmHg and antihypertensive drugs were administered. An aortogram showed severe stenoses of the aorta at the level of the diaphragm and renal artery. A computed tomogram showed extensive calcification of the aorta below the origin of the left subclavian artery. She underwent a bypass operation with a 16-mm-diameter prosthetic graft from the ascending aorta to the infrarenal abdominal aorta. She has progressed well after the bypass and her upper-limb blood pressure is almost normal.

This study clarified practices in end-of-life care for non-malignant chronic illness patients by expert nurses in general hospitals. Interviews with 7 chronic illness specialist nurses on practice cases were conducted, and final labels were elicited using a qualitative synthesis method（KJ method）. As patients’ conditions deteriorated, nurses defined the necessary interactions to support patients’ decision-making for living their own way of life and accompany patients and families based on their experience, and using patients’ restoration of self-esteem, sense of satisfaction, and acceptance as indices. In general hospitals, measures to cope with pain for patients not receiving life-prolonging treatment were insufficient;and while it was difficult to agree on care between medical professionals and to maintain care in other facilities, expert nurses grasped patients’ wishes on a daily basis and made arrangements for them to permeate through family and community care systems. In end-of-life care in treatment settings, it is necessary to be supportive so that the family and medical professionals can continue the patient’s care. Medical professionals who have been involved from the initial diagnosis stage need to improve their awareness and support skills as medical professionals to be involved purposefully from an early stage to the final stage.

This time the statistics for injuries and disorders due to sports in the five-year period up to 1985 were taken, evaluated and compared with those of the last five-year period. The following results were obtained :
1. There were 1, 300 cases of injuries and disorders due to sports in the five-year period up to 1985, which was 4.4% of the total number of outpatients in the department of orthopaedics.
2. Sex : There were more male patients, but the rate of female patients has been increasing lately.
3. Age : Patients in their teens or twenties accounted for about 70%.
4. Body Side : There was no significant difference between incidence of injury on the right side of body or the left, but cases of injuries on both sides have been increasing recently.
5. Kind of Sport : The largest number of trauma were due to skiing, although the number of trauma resulting from playing tennis has been high in the past five-years of investigation.
6. Time of Injury ; Most patients were injured during practice, followed by recreation and game.
7. Position of Truma : Most cases were injuries to their knee joints from skiing.

This time the statistics for injuries and disorders due to sports in the five-year period up to 1985 were taken, evaluated and compared with those of the last five-year period. The following results were obtained :
1. There were 1, 300 cases of injuries and disorders due to sports in the five-year period up to 1985, which was 4.4% of the total number of outpatients in the department of orthopaedics.
2. Sex : There were more male patients, but the rate of female patients has been increasing lately.
3. Age : Patients in their teens or twenties accounted for about 70%.
4. Body Side : There was no significant difference between incidence of injury on the right side of body or the left, but cases of injuries on both sides have been increasing recently.
5. Kind of Sport : The largest number of trauma were due to skiing, although the number of trauma resulting from playing tennis has been high in the past five-years of investigation.
6. Time of Injury ; Most patients were injured during practice, followed by recreation and game.
7. Position of Truma : Most cases were injuries to their knee joints from skiing.

A 69-year-old man was referred to our hospital because of a right upper mediastinal mass observed on chest roentgenogram. Computed tomography showed a dissecting aneurysm of the right subclavian artery and dissection of the ascending aorta. Furthermore, the ascending aorta was dilated. We subsequently reconstructed the right subclavian artery with a bypass graft and replaced the ascending aorta. Two-thirds of the aortic arch was placed in deep hypothermic circulatory arrest with retrograde cerebral perfusion. His postoperative course was uneventful with no neurological complications. While subclavian artery aneurysms are relatively rare in comparison to other peripheral artery aneurysms, subclavian artery aneurysms with aortic dissections are even rarer. The most important concerns during subclavian artery aneurysm repair are the method of surgical approach and the maintenance of sufficient cerebral flow. We suggested that deep hypothermic circulatory arrest with retrograde cerebral perfusion might prove useful in cases involving an intramural thrombus adherent to cerebral vessels. Therefore, patients with subclavian artery aneurysms must undergo extensive preoperative evaluation.