[On the present and future of Japanese Leprosariums--the case of Oshima-seishoen Sanatorium].

In all thirteen national sanatorium in Japan, the number of patients have gradually declined year by year. Although it has been long discussed about maintenance and utilization of facilities in the future, clear and specific plans are still not sufficient. Especially Oshima-seishoen sanatorium, Oshima island is an isolated island located off the coast of Takamatsu port. It is very different from the other Leprosy sanatoriums in that there are no general population other than patients and officials of the sanatorium. So it is very difficult to have outlooks of the future of this sanatorium. In the conversation with the patients, two serious concerns have been raised. Whether patients will be provided support and treatment throughout life. The other one is whether the government would manage the ossuary permanently under the responsibility for the isolation policy of leprosy patients. These two points are also written in promotion measures of Oshima formulated by "Meeting to consider the future of Oshima", that was established in 2013 proposed by Takamatsu city authorities. In the situation of aging of patients accelerating, I considered that to promise these two points are the top priority.

Ischaemic complications 20 years after harvesting of a radial forearm flap in a patient with scleroderma.

We present the case of a 67-year-old woman with scleroderma who had progressive necrosis of the finger together with severe pain 20 years after harvesting of a radial forearm flap. After reconstruction of the radial artery the ulceration of her right middle finger healed spontaneously within a month, and the pain disappeared.

Rubinstein-Taybi syndrome (RTS) with postaxial polydactyly of the foot: 4-year follow-up until improvement of dysbasia.

Rubinstein-Taybi syndrome (RTS), also known as 'broad thumbs syndrome' or 'broad thumb-hallux syndrome', is a malformation syndrome characterized by the triad of broad thumbs or first toes, a peculiar facial expression called 'comical face' and mental retardation. Although various malformations are combined with the triad, polydactyly is rare. We treated a male patient with RTS complicated by postaxial polydactyly of the foot. His clinical course was different from typical patients with polydactyly, especially in the aspect of walking development. Osteoplasty-combined surgery, which was ideal for anatomical reconstruction, was performed on the patient at 2 years and 11 months of age. A 4-year follow-up period was required until there was an improvement of dysbasia.