We reviewed 632 cases which had undergone ultrasonograpy for thyroid disorders.(1) The sonographic examination found nodular lesions in 157 cases (including 52 solid tumor cases) and diffuse enlargement in 38 cases. No abnormalities were found in the remaining437 cases.(2) Further examination revealed that the cases of nodular lesions included 7 thyroid cancer cases (6 papillary carcinomas and 1 follicular carcinoma), 2 cases of hyperthyroidism, and 3 cases of hypothyroidism.(3) Diffuse enlargement cases included 5 cases of overactive thyroid (1 subacute thyroiditis and 5 Graves' diseases), 2 cases of underactive thyroid (chronic thyroiditis). Assays for antithyroid autoantibodies showed positive results even in the 31 cases of normal thyroid function.(4) Four in 7 cases diagnosed as thyroid cancer and 5 in 12 cases diagnosed as thyroid dysfunction (4 of 5 cases were elderly people 60 years of age or over) were screened by ultrasonography.
We concluded that ultrasonography is a valuable diagnostic procedure for early detection of not only thyroid malignancies but also disordered thyroid function. Abdominal sonography is often used for screening. The use of ultrasound for the thyroid gland is recommended as a standard procedure in the regular health screening program.

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We investigated environmental conditions in plastic houses and collected basic physiological data which might help to prevent what is called “plastic house syndrome.” The results of the study is summarized as follows
1. The internal environment is closely related to the changes in external temperarure as well as the size, type, direction of house, and growing crops. Also, physiological responses were defferent according to the conditions of the internal environment and hardness of work. The current investigation confirmed that working conditions in single-type small plastic houses were worse than in multiple-type houses with same crops.
2. A major facter of physiological stress for the greenhouse workers was the sudden change in temperature (16-23°C) between the inside and outside of the plastic house during the winter season.
3. Since the temperature within the single-type small plastic house rises up to 50° during spring months, workers experienced more severe thermal load and mental stress from prolonged work.
4. It was suggested that an improved type with a resting room might help to reduce the physiological stress and buffer the sudden change of working enviroment. Thus, it is recommended to provide a resting room whose temperarure is intermediate between external and internal temperatures, so that workers might be able to adjust themselves to the environment when they follow the safety procedures.
5. It is safe to conclude that the temperature in the resting area should be kept half way between outdoor and room temperatures, even though there must be some variation with the type of house and crops. According to the current investigation, therefore, a resting area should keep the temperature between 13-16°C 28-31°C during winter and spring, respectively.

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We estimated the medical expense of treating patients with diabetes mellitus under the health insurance system in Japan. The expense was summed up to 5.07 million yen for a patient who developed NIDDM at the age of 40 and died at the age of 75 without diabetic complications throughout his life. If he had diabetic retinopathy, neuropathy, hypertension and hyperlipidemia, and needed insulin injection, the cost would have increased 2.4 times to 12.32 million yen. It was also estimated at 25.22 million yen for a patient who developed IDDM at the age of 20 and died at the age of 70 without diabetic complications. If the patient had with diabetic retinopathy, neuropathy and hypertension and needed hemodialysis because of nephropathy for 20 years, the figure would have reached a whopping sum of 76.17 million yen. From the viewpoint of medical economy, more effort to prevent diabetic complications should be made.

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Using the 1983-87 data on deaths from pesticide poisoning (in 1986, the fatalities hit an all-time high in Japan), we analysed the geographical differences in the rate of incidence in Fukuoka Prefecture by the standardized mortality ratios (SMRs). The SMRs were compared with the controls of local health centers separately.
The number of deaths from pesticide poisoning were 10, 753 (male: female ratio 3: 2) according to the vital statistics in Japan during the 5 years, and 81% of them was attiributed to suicide and 15% was to accidental exposure.
Fukuoka Prefecture had 351 deaths (223 males and 128 females) from pesticide poisoning, most of them being at age 40 to 50.
Seventy-one percent of the deaths from pesticide were suicide, and the percentage of suicide was higher in females (77%, 99/128) than in males (68%, 151/223).
A study of the SMRs of pesticide poisoning showed that the rates are higher in rural areas (including the Chikugo district) than urban areas (including the Fukuoka City and Kitakyushu City) both in males and females. A similar pattern was observed in the distribution of SMRs of suicide by pesticide.
It was made clear that the higher the mortality from pesticide poisoning, the higher the rate of suicide by pesticide. The easy access to pesticides in rural areas may have contributed to the high incidence of suicide by pesticide. Therefore, it is absolutely necessary for all users to exercise strict rigilance against the misuse of pesticides.

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We studied 494 patients with lung cancer who had been treated in our hospital from January 1985 through December 1994. Of the total number of cases, 20.4% were stage I; 4.5%, stage II; 12.1%, stage IIIA; 23.8%, stage IIIB; and 34.3%, stage IV. The 5-year-survival rate of patients with non-small cell lung cancer (NSCLC) was 61.0% in stage I, 43.4% in stage II, 21.2% in stage IIIA, 0% in stage IIIB and 0.9% in stage IV. The 3-year-survival rate and median survival time (MST) of patients with small cell lung cancer was 10.3% and 13.7 months in limited disease, and 0% and 4.8 months in extensive disease.
By histologic type, the 5-year-survival rate of patients with NSCLC was 19.7% in squamous cell carcinoma, 19.5% in adenocarcinoma and 5.3% in large cell carcinoma. The 5-year-survival rate of patients who were discovered by health screening was 39.4%; by subjective symptoms, 9.8%; and during the observation of other diseases, 14.7%. The 5-year-survival rate and MST of the patients with NSCLC treated in the Department of Internal Medicine of our hospital (stage III or IV) from 1985 through 1989, and from 1990 through 1994, were 1.9% and 7.4 months in the former period, and 3.7% and 9.9 months in the latter. Approximately 75% of the cases of lung cancer treated in our hospital were stage III or IV disease, and prognosis was very poor. Therefore, prevention and detection in the early stage of lung cancer are important.

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A clinical study was carried out on 336 patients diagnosed with nasal allergic symptoms in Otolaryngological Clinic of Obihiro Kousei Hospital from April 1993 to July 1995. The diagnosis was made based on their history, numbers of eosinophils in the peripheral blood and nasal secretion and the results of the radioallergosorbent test (RAST).
House dust and mites were the most frequent allergens, as reported by almost all clinics in Hokkaido. On the other hand, in this Tokachi district, pollinosis allergens include birch pollinosis in 98 patients (40.8%), orchard grass pollinosis in 66 patients (27.5%), regweed pollinosis in 75 patients (31.6%) and timothy pollinosis in 77 patients (32.1%).
It seems that Pecatnres are due to the local characteristics such as cllimate, geographical features and plant distribution in the Tokachi area.

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Koumimachi Clinic attached to Saku Central Hospital is located in an underpopulated rural area. We have annually performed a close medical examination by upper gastrointestinal endoscopy since 1982. Since 1986, it has been done early in the morning. In 1995, a total of 1, 513 radiographic examinations were performed and 555 cases were examined by upper gastrointestinal endoscopy. Two cases of gastric cancer-one being early stage and the other, advanced stage-were detected. Despite the busy season all the farmers who had been advised to have the endoscopic examination attended because it was performed early in the morning. The early morning examination was performed in cooperation with Saku Central Hospital, Naganoken Kouseiren Health Screening Center, and public health nurses of local governments. Without such cooporation, any health care project could not be carried out a rural area.

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A 42-year-old female suffered annulo-aortic ectasia (AAE) and mitral regurgitation associated with Marfan's syndrome was successfully treated by a modified Bentall procedure combined with mitral valve replacement (MVR) under continuous warm blood cardioplegia (CWBC). With the patient under total cardiopulmonary bypass and myocardial protection with CWBC, MVR with 27 mm mechanical valve was first done, followed by the total replacement of the aortic root with a composite graft made of vascular graft and an aortic mechanical valve. Anastomosis of the composite graft to the aortic valve annulus was made to guarantee a watertight closure using numerous interrupted mattress sutures and three pieces of Teflon felt strips to the annulus. Both coronary arteries were reconstructed by means of the “Interposition Graft Method” which interposes two short grafts between the composite graft and both coronary ostia. In spite of long time aortic cross clamp (235 min), cardiac function was recovered excellenthy and a peak CK-MB value was very low (23 IU/L) in the early postoperative period. Thus, CWBC provided a satisfactory myocardial protective effect. It was suggested that the modified Bentall procedure combined with MVR using CWBC was an effective therapy for a patient with AAE and mitral regurgitation associated with Marfan's syndrome.

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Reports laparoscopic deroofing of liver cysts have drawn our attention recently. A laparoscopic approach has advantages as minimal access surgery, but has the possibility of causing complications by hemorrhage and bile leakage. In this paper, we described three surgical cases of symptomatic giant liver cysts. In case 1, hemorrhage occurred when we resected the cyst wall by electrocautery with the aid of a laparoscope. Therefore, in case 2, we resected the cyst wall with an endoscopic stapling device (ENDO GIA) for complete hemostasis and control of bile duct, because the peritoneal surface of the cyst was overlaid by thin parenchymal tissue. In case 3, we resected the cyst wall with laparoscopic coagulating shears (LCS), because the peritoneal surface of the cyst was mainly extrahepatic. This device reduces the risk of hemorrhage and damage to the liver. These patients were asymptomatic after operation and developed no signs of recurrence. We suggest that the laparoscopic deroofing of liver cysts with these devices, a simple, safe procedure, may become a primary method of treating symptomatic liver cysts.

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A case of primary tracheobronchial amyloidosis in a 29-year-old woman was reported. 3-D reconstruction imaging by CT well delineated bronchial irregularity and narrowing. SPECT with ^99mTc-MDP and Ga-citrate demonstrated radionuclide activity consistent with the sites of calcified deposits.

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