Studies were performed on 44 cases of hepatocirrhosis found by laparoscopy and 75 cases resulting in death from hepatocirrhosis in order to shed light on the etiology of this disease.
Thanks to progress in radiographic diagnosis, it has become possible to detect minute tumors in the liver. In our hospital, six patients have been diagnosed as having less than 5 cm tumors in the liver. The diagnositic procedures that had led to the detection of the lesions were reviewed.
Furthermore, the treatment methods of liver cancer were analyzed using the ten cases.

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A total of 164 patients who had been admitted into our hospital with cirrhosis of the liver over the past five years were classified according to the origins of this particular disease based on the results of HBs antigen and HBs antibody tests.
Exeessive alcohol consumption was largely responsible for the incidence of the scourge in men, while in women, unknown causes accounted for the majority of the cases.
The cases in which HBs antigen tests were positive represented only 8.3% Although an overwhelming 53.8% of the consecutive HBs antigen positive cases were complicated hepatoma, the percentage of the complications as against the total was as low as 14.1%.
Of those cases which can be blamed on alcoholism, very few developed into cancer. A malignant new growth in cases of NANB liver cirrhosis was a rarity.
The early detection of hepatoma in the cases of HBs antigen positive liver cirrhosis and the early treatment of esophageal varices in the cases of alcohol-induced liver cirrhosis could lead to the improvmment of the prognosis.

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During the 15-year period between January 1971 and December 1985, our department performed surgical operations on 44 patients for cancer of the gallbladder, 22 for bile duct cancer, 53 for cancer of the pancreas and 10 for cancer of Papilla Vateri.
Resectability was 52.3% for gallbladder cancer, 54.5% for bile duct cancer, 13.2% for pancreatic cancer and 100% for cancer of Papilla Vateri. Curative resection rate were 20.5%, 18.2%, 1.9% and 80%, respectively.
Cancer of the pancreas was the lowest both in resectability and curative resection rate, and none of the patients survived longer than two years.
Some of the patients with gallbladder cancer in Stages I and II survived longer. Many of bile duct cancers were not curatively resected because cancer cells were positive in surgical margins of bile duct. In the cases of cancer of Papilla Vateri, prognosis was fairly good.

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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%.

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We analyzed epidemiological features and therapeutical results of liver cirrhotic patients and those complicated with hepatocellular carcinoma or esophageal varicosity, who had been admitted to our hospital during the past five years from January, 1979, to December, 1983.
1. A total of 128 patients with liver cirrhosis were experienced during the five years, consisting of 98 males and 30 females. In males, the incidence of the disease rapidly increased in the fourties (26.5%), and reached a peak in the fifties (38.5%). In females, the incidence of the disease tended to increase until the seventies.
2. According to the classification by cause, HBV-induced cirrhosis accounted for 31.3%(40 cases); alcoholic, 20.3%(27) and unknown, 48.4%(61). The mean ages were 55.9 years for the patients with HBV-induced cirrhosis, 52.5 years for those with alcoholic cirrhosis, and 60.1 years for those with unknown cirrhosis.
3. Of the 128 patients, 66 died: a largest portion of 40.9% of the deaths resulted from hepatocellular carcinoma; 37.8%, from liver insufficiency; 12.1%, gastrointestinal bleeding, and 9.2%, other causes.
4. Of 41 hepatocellular carcinomas, 30 were complicated with liver cirrhosis (the complication rate of liver cirrhosis was 73.2%). By cause, HBV-induced complication accounted for 40%(16 cases); alcoholic, 14.9%(4) and unknown, 16.4%(10).
5. The excision rate of hepatocellular carcinoma was a low about 5%. In the cases where the carcinomas were not excised, lasting arterial infusion, TAE and/or one shot of arterial infusion were performed; however, their outcomes were not satisfactory because of the complicatdon of liver cirrhosis and/or advanced cancer.
6. A complication of esophageal varicosity was observed in 60 cases (46.8%), of which 16 received surgical treatment (preventive operation for 9; scheduled operation, 6 and emergency operation, 1). Operative death occurred in 4 cases, while delayed death appeared in 5. In deciding application of operation to each case, pre-operative complete evaluation of liver functions seems to be important.

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We evaluated the therapeutic results of cancers in the bile duct, the pancreas head region and the liver and cirrhosis.
The former two types were examined in a total of 49 cases: 10 cholecystocarcinomas, 18 cholangiocarcinomas, 6 papillocarcinomas, and 15 pancreas head cancers. Radical surgery was performed in only 9 cases: 1 cholecystocarcinoma, 1 cholangiocarcinoma, 5 papillocarcinomas and 2 pancreas head cancers. The surgical success rate was satisfactory 83%(5/6) for papillocarcinoma, yet showed 18.4% overall.
Liver cancer and cirrhosis were examined in 102 cases: 78 cirrhoses and 24 livercancers. Of the former, 15% were viral cirrhosis, 44% alcoholic, 1% specific and 40% unknown. Ofthe latter, 29% were viral liver cancer, 29% alcoholic and 42% unknown.
Treatment of these cancers, with the exception of one type, was unfavorable. To increase the surgical success rate, cancers will have to be discovered earlier using such recent, highly-advanced technological means as endoscopy, ultrasonography, angiography and computerized tomography. At the same time, radical surgery should be actively applied in a broader range of cases.
In cirrhosis, bleeding in the upper digestive tract and complicating liver cancer are increasing in frequency due to prolonged life expectancy. How to manage this increase remains subject for further study in the future.

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During the past five years, 141 cases of liver cirrohosis were hospitalized intoour clinic. The mean age of these patients was 57.8 years old, and the ratio of male to female was 2.8 to 1. HBs antigen was positive in 16 cases, and among the patients without HBs antigen 49 cases of heavy alcoholic drinker were found. Seventy patients with liver cirrhosis were dividedinto a compensatory group and a decompensatory group according to three clinical findings, ascites, hepatic encephalopathy and bleeding from gastrointestinal tract. It was suggested that five items of biochemical data for liver function were very important on discriminating these two groups. The five items were cholinesterase, indocyanine green test, albumin, prothrombin time and erythrocyte count.
Next, we studied clinical findings of eight patients with minute hepatocellular carcinoma hospitalized into our clinic during the past five years. About a definition of minute hepatocellular carcinoma, we have defined that the tumor size should be less than 3 cm in diameter. Six of these patients were male, and average age was 56.7 years old. Of these patients, five were complicated by liver cirrhosis, and only one revealed positive HBs antigen in serum. The serum alpha-fetoprotein level showed more than 400 ng/ml in three patients. And we have thought that ultrasonographic examination is most effective to diagnose minute hepatocellular carcinoma in various diagnostic imaging methods. Most of patients exhibited a decreased functional reserve in the liver, but six patients underwent hepatic resection. After operation, one patient died of acutehepatic insufficiency on the 8th day, and one died of the recurrence of tumor on the 11th month. Otherfour patients have been alive now.

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587 cases with liver cirrhosis were examined for the etiological classification. HBsAg and anti-HBs were detected by RIA in 321 of 587 cases. Group I was classified as Hepatitis B virus related liver cirrhosis cases who showed positive HBsAg or high titre of and-HBc. Group I was further devided to 2 subgroups, i. e, I a was nonalcoholic group and I b was alcoholic group. Group II was alcoholic liver cirrhosis cases whose daily alcoholic intake were at least 90g of ethanol for 5 years or more. Group III was miscellaneous specific type liver cirrhosis such as PBC, lupoid hepatitis, hemochromatosis and shistosomiasis. Group IV was unclassified liver cirrhosis cases. Frequency of each groups are 28.9% of group I, 19.7% of group II, 6.4% of group III and 45% of group IV. Freqency of group I was gradually decreased every years, but real number of cases in group I showed no changes. Number of cases in group II and IV were gradually increased.

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The physical work load of farmers and dust conditions in the harvesting process of chrysanthemums were investigated for two households (seven workers for A and three for B household, respectively) at mid March in 1984.
The total working hours a day of each household were 3225 min (460 min as average per a worker) for A and 1954 min (652 min) for B, being allotted more times to males than females. However, all of the house keeping hours were carried out only by females.
The intensity of each working load of farmers was not so heavy, as “light” and “moderately heavy” by Christesen's criteria and energy expenditure a day was calculated 2895-3604 kcal for males and 2155-2295 kcal for females.
In this working process farmers were enforced to keep careful handling with chrysanthemums and fixed body posture for 4 to 6 hours a day. Particulary, the working posture of sorting and bundling chrysanthemums may cause over strained load to the muscle and joint of the lower back and legs.
The dust concentrations of the sorting room were not so high. However, the farmers were exposed a large quantity of cilia of chrysanthemum leaves, calculated 37-259 pieces/cm² on the slide grass a day. The numbers of cilia varied with amounts of handling chrysathemums.
It was suggested that the cilia of chrysanthemums may be the most important allergen to the immediate type of allergy of the chrysanthemum growers.

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We have reported the case of a female farmer who seemed to die from the effect of Paraquat and the result of examination on pulmonary function in Paraquat Sprayer. This investigation was executed in volunteer of male and female. The mass survey indicated that the impairment in peripheral airway was recognized in groups using Paraquat.
We newly examined non-smoking females in age from 40 to 59 who were selected unintentionally at each women's section of Agricultural Co-Operation. The items of investigation are pulmonary function, atrial blood gas analysis, blood examinations, urinary examinations, X-ray examinations and the interview about health and the situation under which agricultural chemicals are used. Paraquat are still used in large quantitie, but there are a lot of farmers who do not know very well how to dilute Paraquat and use the protecter of agricultural chemicals.
Values of maximum expiratry flow at 25% vital capacity (V₂₅) of such of groups mentioned above among Paraquat sprayers were significantly lower than those of control.

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This paper reports on studies carried out regarding noise and vibration on a tractor and a binder which are the most commonly used for agricultural purposes. 1) The sound levels on both of a tractor and a binder were over 100 dBA, and the level on binder was larger about 6 dB than that on tractor. The 1/3 octave band sound pressure levels on a tractor exceeded the permissible criteria for 8 hr in the frequency range of 315 Hz and those on a binder exceeded it for 2 hr in the range of 630 Hz. 2) The vibration level on the handlebars of a tractor was the highest in the Y direction (117. 5 dB) and that under the seat was the highest in the vertical direction (97.5dB). The 1/3 octave band vibration acceleration levels for a tractor in the Y direction exceeded the exposure guideline for 4 hr in the frequency range of 16 to 50 Hz and those under the seat in the vertical direction exceeded the permissible criteria for 8 hr in the frequency range of 31.5 Hz. 3) The vibration level on the handlebars of a binder was the highest in the Z direction (114.1 dB) for the metal handlebars and (112. 1 dB) for the rubber grips. The band levels on a binder in the Z direction exceeded the guideline for 4 hr in the frequency range of 50 Hz and from 16 to 25 Hz. 4) We confirmed that there was sufficient danger of to hearing due to noise and vibration hazards in using both a tractor and a binder continuously for long periods of time in comparison with the exposure guideline and permissible criteria.

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As the aging of the agricultural population has accelerated, the number of farm accidents has increased at an alarming rate.
According to the statistics collected by the Ministry of Agriculture, Forestry and Fishery, the total population of farm workers in Japan is 6, 400, 000 and the population of farm werkers over the age of 50 is 68%. The number of the farm workers who were involved in farm accidents and lost their lives was 5, 049 between 1971 and 1983. In the past three years the averaged death rate of the aged farm workers has between 70% of the total farm casualties, and 42% of them have been caused by “delayed reaction” on the part of those using farm machines. It should be noted that the accidental deaths which occur on farms occur most frequently to aged farm workers. Why do they make such deadly errors while operating farm machines? It is a very important problem we have to be concerned with when we try to reduce deadly farm accidents and increase safety among farm workers.
Machine manufacturers are constantly making improvements in the performance and safety of their farm machines. Yet the number of machine hazards nevertheless has not been reduced. Taking the situation seriously, it becomes incumbent upon us to encourage machine manufactures to investi gate carefully the causes of machine hazards and to co-ordinate and promote safety, especially from the standpoint of Man-Machine interface. Furthermore, it is also very important to find out defective farm machines.
In the future it is not hard to predict that the aging of the agricultural population will accelerate even more in Japan. The relation between aged farm workers and farm equipment will therefore become a major theme for any accident-prevention program. Increasing safety on the farm is as important as increasing health on the farm. Both lead to the welfare of farm workers. For this reason investment in farm safety is of vital importance to the nation.

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A 54 year old female with bilateral traumatic pulmonary cyst due to agricultural accident is reported.
She was run over by a tractor and admitted to our hospital in forty minutes after injury.
Her X-ray film on 7 th day revealed bilateral pulmonary cyst and intrapulmonary hematoma.
But, these abnormal shadows disappeared completely on 70 the day after injury.
We consider that operative treatment for the traumatic lung cyst or intrapulmenary hematoma is not need unless we can find the conditions that give a positive support to thoracotomy.

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The rise of the average age of the population in Shimane Prefecture has become more and more conspicuous in these years. According to the estimation of the future population the aging phenome-non in Shimane Prefecture is going about fifteen years ahead of the average of Japan. Therefore it is significant to perform a community experiment of the comprehensive health care for the elderly in this prefecture, in the sense that its results will offer many useful experiences to other districts of Japan, where the aging of the population is proceeding a little more slowly.
We carried out an experiment called “the Service Package System for the Bedridden Elderly”, in Sada-cho, Shimane Prefecture in cooperation with Sada-cho, Izumo Health Center and Izumo Medical Association. It is an improvement on the health care system for the bedridden elderly and their family, which has been performed in Scandinavian countries.
The results of our experiment obviously showed the existence of many problems stemming from the lack of integration among different fields such as health care, medical care, social welfare, working and cultural life. To establish the comprehensivehealth service system for the elderly and their family the integration of these fields is most urgently demanded.

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