We investigated the usefulness of the method of producing sedation with midazolam and reversing with antagonist flumazenil in upper gastrointestinal endoscopy. Twenty-five adult outpatients underwent diagnostic upper gastrointestinal endoscopy 3 min after having an intravenous injection of 5 mg of midazolam for sedation, and received 0.25 mg of flumazenil intravenously 5 min after the removal of the endoscope. Blood pressure, heart rate, and percutaneous arterial oxygen saturation (SpO2) were measured, recorded, and compared at nine points : 1 min before midazolam injection, 2 min after midazolam injection, 1, 3, and 5 min after the insertion of the endoscope, 1 and 3 min after the removal of the endoscope, 1 min after flumazenil injection, and their awakening time at which they are easily able to respond to verbal commands. Fifteen minntes after their awakening, we asked those patients about their memory during the endoscopy and evaluated their pain with the Visual Analogue Scale (VAS). A significant decrease in systolic blood pressure was noted 2 min after midazolam injection. But the systolic blood pressure measured 1 min after the insertion of the endoscope significantly increased when compared with the level 2 min after midazolam injection. Then it gradually started decreasing. Although the systolic blood pressures 1 min after flumazenil injection and at their awakening time increased slightly, the levels were significantly lower than those 1 min before midazolam injection. The heart rate increased to the maximum 1 min after the insertion of the endoscope. Then it gradually started decreasing. The heart rates 1 min after flumazenil injection and at their awakening time decreased significantly when compared with those 1 min after the insertion of the endoscope. SpO2 significantly decreased from 97.6±1.6% 1 min before midazolam injection to 95.7±2.5% 2 min after midazolam injection and remained depressing around 95% during the endoscopy. However, SpO2 recovered 96.6±2.0% at their awakening time. Two patients had a vague memory but all the rest had no memory recollection at all of what happened during the examination. VAS was 20 mm for one patient and 0 mm for another patient. We showed the clinical usefulness of the method of antagonizing with flumazenil after upper gastrointestinal endoscopy performed on patients given an i.v. injection of midazolam, because this method might provide a minimal circulatory change due to some protection against hemodynamics stress in response to manipulation of the endoscope, anterograde amnesia, and disappearance of pain. However, we should take care of respiratory depression of the patient during endoscopy.
Minute of time ; Midazolam ; Injections ; Flumazenil ; Awake

[Objective] The purpose of this study is to examine the relationships between shoulder's function and damage for handball players. Subjects were nine female handball players with dominant shoulder pain.[Methods] Clinical diagnosis was done from the medical doctor's opinion and MRI. Then, the shoulder joint movement was measured with X rays.[Results] Most of them had admitted a lot the impingement syndrome and the subacromial bursitis. The trunk rotation angle at zero-positions was significantly larger in the symptomatic shoulder (dominant shoulder) than in the asymptomatic shoulder (nondominant shoulder). That is, it was obvious that the damage of the shoulder changed tilting angle of scapula medially.[Conclusion] It is reported that the damage of the shoulder causes abnormality to the “scapulohumeral rhythm” by the previous research. But, these results, suggested to need to understand not only “scapulohumeral rhythm” but also movement to the position of the scapula, when the shoulder joint function was observed for the handball player mainly composed of throwing motion.

Based on progress in home visits for rehabilitation and health guidance since 1979, the trend after the Nursing Care Insurance Law was enforced in 2000 was investigated. In home visits for rehabilitation, cooperation with many related organizations is required, and reorganization of the network built before the enforcement of the said Law is needed. The role of each home visiter for rehabilitation is being formed and cooperation with care managers is being strengthened. The tendency that the participation of the local government may decrease can't be denied. Connection with the hospital and the local government should be maintained, and a new community-based network needs to be built.
Rehabilitation aspects ; Community ; Management ; network ; Encounter due to convalescence

A follow up study was made on patients who were admitted into our hospital because of stroke or fracture of the neck of the thighbone before and after the Nursing Care Insurance Law was enforced. The study found that there was a salient tendency for the number of days the patients stayed in hospital to increase and for the rate of discharge from hospital to the patients home to decrease.
As the nursing care insurance system came to stay, one local government after another was pulling out the functional training work which had been conducted as one from of the rehabilitation projects. In place of municipalities, nursing care service contractors were taking on such health service work as home visits for rehabilitation, and outside visits for nursing and rehabilitation. In the future, it would be necessary to establish a network enouth to promote health and welfare services including the provision of medical and rehabilitation equipment and the repair of houses.