For the period of 13 years from 1979, a total of 1, 711 patients (1, 027 males and 684 females) with Hymenoptera stings underwent treatment in our hospital's departments of dermatology and emergency care. It follows that nearly 132 patients with Hymenoptera stings received treatment at our hospital each year. The number of such patients was great particularly during the period from July to October, when the wasps buzz around in the most brisk manner. Many of the victims were among nine-year-olds and younger boys, and among males in their thirties, forties and fifties. Paper wasps and hornets were responsible for about 70% of the stings. The parts which the stingers attack are mostly exposed parts-hand, face, arm and head in that order. A serious loss of consciousness was observed among 3.3% of the patients. The number of those with systemic reactions was significantly greater in males than in females. The incidence of systemic reactions was higher for those patients with head stings than for those with hand-arm stings.
In 1991 alone, there were eight cases in which anaphylactic shock occurred. The ratio of males to females stood at 7: 1, all in the middle and older age brackets. The incidence was high in the summer months of August and September, mostly on the head and neck. Symptoms appeared in a very short time, several to 15 minutes after the sting. There were seven cases positive in hymenoptera venom specific IgE antibody (RAST). Presumably, the allergic mechanism that the patients had is responsible for the severe response.

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Fifty cases of spontaneous pneumothorax treated in our hospital between 1988 and 1993 were reviewed. Forty-three cases were males and 7 cases were females. Treatments were broken down into rest cure for 11 cases and chest tube drainage for 39 cases. Of the chest tube drainage therapy cases, 30 could attained complete remission, but the remaining 9 cases required thoracotomy. In either case, the recurrence rates after the first pneumothorax and second attacks were 39% and 36%, respectively.
Stature and roentgenologically determined lung sizes were also examined in 34 male patients with spontaneous pneumothorax in comparison with those of 30 healthy men, who were age-matched control subjects. Among the significant findings was that the patients were much taller than the controls. The lungs were also significantly elevated in the patients compared with those of the controls. These results indicate that the patients liable to spontaneous pneumothorax are tall with their lungs housed high in the thorax compared to the ordinary people.

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In mid-May 1988 ocular troubles occurred in many children in several schools. We suspected them to be victims of a mass outbreak of allergic conjunctivitis induced by grass pollen from clinical and epidemiological observation. We have investigated the matter and taken measures to solve the problem.
The schools in which ocular troubles occurred are in an urbanized rural region in Kanagawa Prefecture. An on-the-spot study found the schools are surrounded by rice fields. When the troubles occurred in May the grass for cattle grew densely on the fields and was just in full bloom. This grass, known as Italian ryegrass (Lolium multiflorum), was planted eleven dairy farmers who borrowed the fields.
Some data were collected from the health records in the schools. And some were collected by the questionnaires taken when children came to the nurse's office of the school to treat their conjunctivitis. It was irevealed that similar troubles had occurred around mid-May every year. In other seasons, the incident of conjunctivitis is sporadic. More than 100 children suffer from acute allergic symptoms every year. Inflammation manifests itself from late morning to early afternoon in windy warm days in mid-May and about half of the cases occur when they were outdoors. Symptoms of which children most frequently complained were eye itching and hyperemia in the conjunctiva. Other symptoms include tearing, nasal discharge, eye pain and swelling. Over 50% of the children suffered from them. In serious cases sclera was swollen forward as compared with cornea and looked like geratin. A sticky discharge was found in about 20% of the patients.

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Kikusui, situated in the northwestern part of Kumamoto Prefecture, is famous for its remains of ancient Japan and at the same time known as a town blessed with the natural environment. As is the case with many other rural areas in this country, graying in population has been progressing at a fast clip here in recent years. To cope with the situation, Kikusui Town has taken uponitself to implement a comprehensive geriatric health care scheme since 1973 that covers not the physical aspect alone but also the mental aspect of the lives of the senior members of the population. During the period, the social welfare council and the societies of old people linked up with public health nurses. Later, the town hospital and its health control center joined with them to establish a home visit system to take care of the aged at home with the support of the government. Further, a nursing home for old people was built on the premises of the town hospital and started the day care services to back up the home care system. Various programs for home care were carried out in the main by visiting nurses. From the standpoint of the medical institution, cooperation with welfare workers was vital. Moreover, it was important for the residents of Kikusui Town to participate in this project. In the present paper, we will report on how the home care system for old people came into being.

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In recent years, high doses of morphine have come to be used to relieve pain in terminal cancer patients, but not all the patients are treated by this pain intervention method because of a poor understanding of terminal care. The authors have organized a terminal care confernce in order to solve this problem in our hospital.
The conference has been held 8 times over the past 18 months.
Cases of good pain control by high doses of morphine were demonstrated, and cancer pain control manuals were prepared for distribution to the medical staff.
After such activity, the total dosage of morphine in the hospital a year showed a sixfold increas.

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A 70-year-old man had annular erythema on the area extending from the right scapular region to the right axillary region, where he got tick bites on June 20, 1991. The erythema occurred soon after the bites and spread gradually to become as large as 20 square cm within 25 days. He also felt fatigue. An electrocardiogram revealed an atrioventiricular nodal block. We treated the patient with amoxycillin (750 mg daily) for 35 days. He has been now free from any symptoms over one year. Although repeated serological tests could not detect an antibody to Borrelia burgdorferi, typical erythema chronicum migrans and cardiac manifestation strongly suggested that the case could be diagnosed as Lyme disease.

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An 78-year-old woman visited our hospital with the chief complaints of abdominal pain, nausea, vomiting and diarrhea. She was operated on for gastric ulcer when she was 56 years old and complained of abdominal discomfort after operation. One day she wished to take Confrey (Symphytum officinale), but she took digitalis leaves (Digitalis purpurea) by mistake. On admission she was drowsy and the systolic blood pressure was 60 mmHg on palpation. Electrocardiograms showed bradycardia, irregular AV-nodal rhythm and ST depressions and T wave inversions with the shortening of the QT interval. Serum levels were potassium, 6.4 mEq/1 ; BUN, 34.4 mg/di ; creatinine, 1.5 mg/di ; digoxin, 2.0 ng/ml (therapeutic level, up to 2.0 ng/ml); and digitoxin, 111ng/ml (therapeutic level, up to 25 ng/ml). Hemodynamic data showed HR, 49 beats/min ; CO, 2.81/min; CI, 2.31/min/m²; SV, 57 ml/beat and SI, 47 ml/beat/m² on administration of dopamine 7μg/kg/min. So VVI pacing was started at 70 bpm and CO increased to 3.6 1/min after pacing. But unfortunately she died of ventricular fibrillation. The digitalis leaves resemble the Confrey leaves and it is easy to mix up these two plants. Although this is a rare case, digitalis intoxication can be life-threatening. So we should prepared ourselves for the treatment of patients poisoned with digitalis and other poisonous herbs.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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