We should decide the dose in renal insufficiency according to an attachment document, estimated by Cockroft-Gault's formula. It is better not to decide the dose only byexcretion route. In addition, we should not administer the nephrotoxic drugs, especially NSAIDs, to renal insufficiency.
Also, it is necessary to pay enough attention to the overdose of drugs, which do not cause renal toxicity but cause dangerous side effects to the central nervous system.
Many attachment documents have a lot of lacks in the mention for renal insufficiency and need to be improved.

Senile patients with heart disease were evaluated in order to study the correlation between their mental and physical activities in daily life. Mental activity was classified using Hasegawa's dementia scale, and physical activity was measured by the number of steps per day recorded with a passimeter. It was found that;
1) Hasegawa's dementia score was positively related to the number of steps.
2) Hasegawa's dementia score was significantly increased after walking training for 1 year.
Thus it is suggested that appropriate physical exercise is necessary for maintaining or increasing mental activity in aged patients with circulatory disease.

Patient compliance with presciibed drug regimens may be improved by finding out incom-pliant patients and exhorting them to take their medicines, but it's not an easy task. We telephoned those who had not shown up at the pharmacy within 7 days after the preparation of their drugs to come and receive the dispensed drugs. When the dispensed drugs had to be disposed of after a long misplacement, we prepared a “patient compliance report” to inform the attending physicians about noncompliance by attaching it to the patient's visit history. Further, of when they visited the hospital again we gave guidance about drug compliance at the window to those whose dispensed drugs had been disposed.
We contacted 63 patients by telephone during the 3-month period from January to March 1995 of the patients who left their drugs at the pharmacy, and found 30.6% of them had some compliance problems. Telephone calls were effective for reducing the proportion of the patients whose dispensed drugs were disposed of to 0.03% from 0.11%, the percentage worked our during the 5-month period from August to December 1994 during which no telephone call was made. We reported 19 drug disposal cases to the physicians by means of the “patient compliance report”. All the physicians appreciated it as they were brought to a realizatopn of the drug compliance rate of their patients.
As there were some patients who did not know that their drugs were prescribed, we considered how to cope with the left dispensed drugs would not be a question of the pharmacy alone. It should be handled as a problem of the whole hospital from the stage ofconsultation to payment.

Objective : The purpose of this clinical research was to create an assessment for patients with muscle disease who wish to continue driving by investigating their motor function and driving experience. Methods : Twenty-four patients with muscle disease who visited our hospital from December 2009 to April 2010 were enrolled in our research. For patients who were still driving, physiatrists evaluated their motor functions, examined simulated driving motions and recorded their driving capabilities and techniques, their ability to get into and out of the vehicle and their ability to store and remove their wheelchairs. Patients no longer driving were asked why they had given up driving. Results : Fifteen patients who continued driving had enough upper limb strength and could simulate driving motions, though the location and degree of their muscle weakness were variable. Five of fifteen drove with the aid of a hand-operated brake and accelerator. Seven needed personal assistance: three to get into and out of the vehicles, six to store and remove wheelchairs. The nine patients who had stopped driving reported that the primary reason for discontinuing driving was that they recognized their muscles were insufficient to control the vehicle. Conclusions : We propose to evaluate muscle strength and to test simulated driving motions when assessing patients with muscle disease. A hand-operated brake and accelerator is efficient for patients with lower limb muscle weakness. However, since no efficient automobile modifications are available for those patients who cannot get into and get out of their vehicles or store and remove their wheelchairs by themselves, we suggest arranging personal assistance for such patients.

Left ventricular hypertrophy in patients with aortic valve disease has long been recognized as a significant risk factor for aortic valve replacement. Higher operative mortality in such patients has been attributed to poor myocardial preservation. In these patients improvement of left ventricular subendocardial blood flow during reperfusion seems to be mandatory to avoid subendocardial injury. Therefore, we attempted to increase subendocardial blood flow during reperfusion by terminal warm blood cardioplegia (TWBCP) followed by controlled aortic root reperfusion (CARR) in patients requiring isolated aortic valve replacement. The patients with TWBCP and CARR had a tendency towards severe left ventricular hypertrophy and more advanced NYHA function class compared to those with hypothermic cardioplegia alone. Nevertheless, the patients with TWBCP and CARR showed significantly better recovery of left ventricular function, i.e., spontaneous recovery of beating and higher cardiac index as well as left ventricular stroke work index, despite significantly less catecholamine support. These resuls suggest that TWBCP followed by CARR may offer significant benefits over unmodified reperfusion during aortic valve replacement for patients with severe left ventricular hypertrophy.