Since 1994, our clinic has had monthly study meetings for those who looked after bedridden patients in their homes. As of June 1996, we have gotten together 39 times and a total of 168 persons have participated (mean 4.8). We have discussed the welfare system (3 times) and diseases such as bed sore and lumbago (16 times), visited participants' homes and demonstrated medical equipment (4 times each) and talked about general affairs (12 times). In home health care, a role of those who look after bedridden patients in their homes is very important. Social and medical systems should support them. We think ther meetings could continue to support them morally and psyehologically.

A 16-year-old female who complained of hoarseness and left back pain. An abnormal shadow in the left superior mediastinum was observed in chest X-ray films. Thoracic aortogram revealed elongations of the aortic arch and two sacculated aneurysms located in the minor curvature of the arch. She was operated by median sternotomy and left collar incision. The left vagal nerve laid between the two aneurysms. The proximal aneurysmal wall seemed to be of normal thickness, but the distal aneurysmal wall was so thin that the intraluminal blood stream was visible. Aneurysmectomy and insertion of a Dacron patch were successfully performed under cardio-pulmonary bypass with selective cereberal perfusion. The postoperative course was uneventful.

A 61-year-old man, who had previously undergone quadruple coronary artery bypass graft surgery, was successfully treated for proximal descending aortic aneurysm using hypothermic circulatory arrest via a left thoracotomy. Preoperative angiograms revealed that the left internal thoracic artery bypass graft to the LAD was patent, and that the aneurysm was located at the descending aorta just distal to the left subclavian artery. Operative procedures were as follows. A left thoracotomy incision was made through the 4th intercostal space. The common femoral artery and vein were cannulated, and the venous cannula was positioned in the right atrium. The patient was cooled by partial cardiopulmonary bypass until the EEG was isoelectric (24°C rectal temperature), and then circulation was arrested. Left ventricular decompression was not performed. After opening of the aneurysm, proximal anastomosis was performed first at the aorta just distal to the left subclavian artery. Another arterial cannula, connected to the Y-shaped arterial line, was inserted into the graft, and perfusion to the brain was restored through this cannula. Distal anastomosis was then completed, and routine cardiopulmonary bypass was reestablished. After the heart was defibrillated, the patient was rewarmed to 34°C before discontinuing the bypass. Circulatory arrest time and total cardiopulmonary bypass time were 17 minutes and 139 minutes, respectively. Postoperative recovery was uneventful.

A total of 194 cases of liver cirrhosis, which had been treated in our hospital during the past 5 years, were calssified by the causes into the following four groups:(I) hepatitis B virus, (II) alcoholic, (III) special origins, and (IV) reasons unknown. They each accounted for 23.2%, 35.6%, 1.5% and 39.7%, of the total.
Their clinical features and prognosis were examined. To be noted is the finding that many patients in group IV had had blood transfusions. This suggests that non A non B hepatitis viruses might be involved in the occurrence of the liver disease. On the whole, the five-year survival rate was 45.6%. There was not any significant difference among the four groups. However, prognoses were poor in groups II, I and IV, in that order.
As regards the cause of death, rupture of esophageal varice and hepatic failure showed a gradual decline, but complications of hepatocellular carcinomas sharply increased. Especially, in group I, this mortality was as high as 31.1%.

We have provided home health care to 42 patients with terminal cancer over the past five years. The pancreas was the most common site of the primary cencers (9 cases). The average age of the dead was 74.6 years, which was younger than that from heart failure or brain infarction. The average duration of stay of home was 60.1 days. The average frequency of visit to a patient's home was 15.8 times. In 52.4% of the cases, morphine were administered for pain control. The average dose was 48.2 mg per day, and term of administration was 30.6 days. In most cases, those who looked after the patients were daugh-in-laws or wives.
In some cases, a local government lent a bed to a patient. Of the patients 21.4% were fold by their physicians what they are up to were. In conclusion, home health care of cases of terminal cancer will be more important in the future. Pain control by morphine, support for those who look after the patients by frequent visits, practical use of the welfare system and full-time medical care system which meets patients' need are thought to be necessary.