The aim of this study was to determine the relationship between age and changes in serum lipid levels during a period of 4 years in a Japanese fishing village.
Total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were measured in inhabitants (53 males and 130 females) of the Chibu Village on Oki Island, Shimane in 1988 and again in 1992. The subjects were divided into four age groups of respectively, 40-49 years (n=30), 50-59 years (n=35), 60-90 years (n=65), and 70 years or over (n=53).
TC and TG levels did not change in any age group over the 4-year interval. However, the HDL-C level increased significantly in men aged 40-49 years, women aged 50-59 years, and women aged 60-69 years.
There are no differences of TC in men and women in 1988 and 1992. TG in men aged over 70 years was significantly lower than that in women aged over 70 years in 1988, but TG in men aged 40-49 years was significantly higher than that in women aged 40-49 years in 1992.HDL-C in men aged 40-49 years in 1988 and 50-59 years in 1992 was significantly lower than that in women aged 40-49 years in 1988 and 50-59 years in 1992.
The body mass index (BMI) was significantly positively correlated with TC in 1988, and positively correlated with TG and negatively correlated with HDL-C in both 1988 and 1992.
In this small Japanese fishing village, we found TC and TG did not increase with age, but HDL-C increased with age. Our results suggest that high TG and low HDL-C are important factors in causing obesity.

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A pilot study of the Doppler renal arterial flow pattern was done on 34 patients (68 kidneys) with benign prostatic hypertrophy, 14 patients (28 kidneys) with hydronephrosis and 22 patients (37 kidneys) with reflux nephropathy. Renal scintigraphy was also performed besides the color Doppler scanning.
Results:
Mean minimum blood flow values were significantly smaller in all the subjects than those in normal control groups with one of the three diseases respectively
In patients with reflux nephropathy, minimum blood flow values were extremely low, suggesting the severe scars and scarce blood flow. A high correlation was found between uptake rates measured by renal scintigram and minimum blood flow. This fact suggests that the blood flow scan can reveal the profile of the renal function.
We conclude that the color Doppler sonography is useful in a routine initial examination and a simple follow-up test for detecting renal dysfunction in some urological diseases.

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External decompression was performed on four patients with head trauma and one patient with meningioma. Cranioplasty was done for correcting sknll defeets in these parients later using. Eight ceramic bones. Ceramic bones were made on 3-dimenssional solid models with cranial defects reconstructed based on data of computed tomography scan. The artifical bones conformed to the acutual cranial defects perfectly. Ceramic bone was thought to be suitable for correcting big cranial defects in cosmetic respects. Two complications were observed in these patients during the average follow-up period of ten months. One complication case was infection of artificial bone, and the other was post-operative epidural hematoma. When the size of articial bone was big or the shape of that was strongly curved, we had to pay attention to the tacking of dura during operation.

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To investigate the actual situation of obese infants in rural districts and the onset of obesity, we performed a longitudinal study of obesity incidence in day nursery infants aged from 2 to 6 years. The subjects were 124 males and 96 females. The degree of obesity was determined in accordance with Murata's index. Our findings were compared with the results of a similar investigation composed of 113 male and 95 female infants in an urban district of Hokkaido.
The obesity incidence was slightly higher among the rural infants than their urban counterparts, regardless of sex, but the difference was not significant (p<0.05). On this longitudinal study it was showed that the obesity incidence in males leaps at 3 and 4 years of age.
Based on these findings, we should encourage parents and infants, especially in early infancy, to have proper exercise and follow good health practice.

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In distal digit replantation, venous repair is difficult or technically imposible. Postoperative venous congestion following replantation was treated with the application of medical leech. No infection was developed and no patients were required to undergo transfusion. The use of medical leech is safe and effective method of providing temporary venous drainage in replanted digits.

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The liver mitochondrial redox state (the liver mitochondrial free NAD+/NADH ratio), which indicates hepatic energy charge, is known to parallel the ketone body ratio (acetoacetate/3-hydroxybutyrate) in liver tissue. Since the ketone body ratio in arterial blood was reported to correlate with that in liver tissue; the arterial ketone body ratio (AKBR) has been widely accepted as a useful measure of the liver function reserve. The liver mitochondrial redox state is known to decrease with the oxidation of ethanol in alcohol abusers. To evaluate whether AKBR reflected the effect of alcohol intake on the liver, AKBR was measured in normal controls (n=8), and patients with alcoholic liver injuries (n=14) and chronic active hepatitis (n=15). The mean AKBRs in the normal control subjects, in patients with chronic active viral hepatitis, and in those with alcoholic liver disease were 1.68±0.77, 2.22±1.02, and 1.55±0.79, respectively. Though the AKBR in patients with alcoholic liver disease tended to be lower than the other groups, there was no significant difference in AKBR among those three groups. In conclusion, this study demonstrated that AKBR was doubtful as an accurate parameter to estimate the changes in the liver mitochondrial redox state by alcoholic intake.

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Indications are that Japan is growing old at a faster pace than in any other nation. In 1993, people aged 65 years and over accounted for 13.5% of the nation's population, and in Nagano Prefecture the rate stood at 17.9%, far higher than the national average. In our district, Minamisaku, it was 22.0%, greater than the prefectural average. As aging goes on at a rapid clip, the number of the bed-ridden is on the upswing.
The Saku Central Hospital has instituted a system of home-visit health care since 1988 with the Department of Internal Medicine playing a pivotal role. The Department of Dentistry and Oral Surgery has also commenced a home-visit dental care program since 1990
The patients to whom home-visit care is delivered have a variety of basic diseases. The attention has focused on their treatment. In many cases, their indifference to oral hygiene was responsible for the ailments. Since the mouth is an inlet for bacteria and other pathogenic microorganisms, it is important to keep the mouth clean so as to prevent the deterioration of basic diseases. That biting may be done with dentures and other prosthetic devices suggests a feasibility of improving quality of life and working for a better health? Because some reports argue that chewing stimulates the brain, thus helpful in preventing senile psychosis, and because eating is one of the pleasures for the bedridden, the role played by us, dentists, is large. Here we report the present status of home-visit dental care delivered by our department from 1990 to 1995

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With the aim of increasing efficiency of paper work attendant on traveling health screen-ings, notifying examination results expeditiously and dispensing with individuals' health sheets, an on-the-spot input system using portable personal computers has been introduced through cooperation from 10 town and village offices. Every examinee is given an interview chart (ticket?) with a bar cord containing his or her ID number printed on it. At each examination unit, the bar cord is read by PC and the identity of the examinee and items for examination (required) are confirmed. Measurements of height and weight, and results of urinary and visual acuity tests are inputted by a bar-cord handy terminal. For blood testing and stool examination for occult blood, the numbers of samples are automatically registered into the PC at the reception desk by way of an optical transmission unit. For ECG and ophthalmoscopy (fundus-copy), reference numbers are given at the interview server. Information gained in the interview is entered into the PC at the interview room and then the information-packed floppy disc is sent the reception desk for storage in the PC. Film numbers of stomach and breast X-rays are also registered into the PC at the reception desk. Thus, all the information is stored by the PC at the reception desk. After checking and confirmation are done, a daily report is made. Upon return to the hospital, all the data are transmitted to the hospital's central computer through the in-house network (local area network). Before the introduction of the new system, the registration of the data garnered by a one-day mass health examination in the out-of-hospital setting took about 10 days, but it is now done within the day. It has also become possible to report the results of examination in two weeks.

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We have provided home health care to 42 patients with terminal cancer over the past five years. The pancreas was the most common site of the primary cencers (9 cases). The average age of the dead was 74.6 years, which was younger than that from heart failure or brain infarction. The average duration of stay of home was 60.1 days. The average frequency of visit to a patient's home was 15.8 times. In 52.4% of the cases, morphine were administered for pain control. The average dose was 48.2 mg per day, and term of administration was 30.6 days. In most cases, those who looked after the patients were daugh-in-laws or wives.
In some cases, a local government lent a bed to a patient. Of the patients 21.4% were fold by their physicians what they are up to were. In conclusion, home health care of cases of terminal cancer will be more important in the future. Pain control by morphine, support for those who look after the patients by frequent visits, practical use of the welfare system and full-time medical care system which meets patients' need are thought to be necessary.

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A 58-year-old man, who was under treatment for urticaria with emedastin fumarate for seven days, was admitted to our hospital because of jaundice. On admission, laboratory data showed the cholestatic type of liver dysfunction, AST 106 U/1, ALT 274 U/1, T-Bil 6.8 mg/dl, γ-GTP 857IU/1, and ALP 807IU/1. Anti-mitochondrial antibody (AMA) was positive with titer of 1: 80, whereas anti-pyruvate dehydrogenase (PDH) antibody was negative. Histologically, mild lymphocytic infiltration in portal area was noted. There was no fibrosis or cholangitis. A lymphocyte stimulation test for emedastin fumarate was positive and the diagnosis of drug-induced liver injury was established. Administration of the drug was immediately withheld followed by an immediate improvement in the most of the liver function tests, whereas both AMA and γ-GTP were constantly abnormal for the following two years. Anti-PDH antibody was still negative. The second biopsy of the liver showed minimal expansion of the portal area with fibrosis and mild lymphocytic infiltration. Pseudo-ductular formation and vanished bile ducts were also confirmed although no granulomas were found. These findings were atypical for primary biliary cirrhosis. This seems to be a rare case of drug-induced liver injury with long-standing anti-mitochondrial antibody without primary biliary cirrhosis as an underlying disease.

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We reported four cases of agricultural chemicals poisoning treated in our hospital during the past two years. These comprised two Paraquat poisoning and two Sumition poisoning cases. One Paraquat poisoned patient and one Sumition poisoned patient died of respiratory failure. The survivor of Paraquat poisoning had drank more Paraquat solutions than the dead case. However, the patient vomitted many times, and received medical treatment promptly, including gastric lavage, hemodialysis, and hemoperfusion.
While on the other hand, it took a long time before starting of hemodialysis and hemoper-fusion on the dead case of Sumition poisoning. Because the poison was unknown when the patient was sent to our hospital. Our experience suggesuted that every time we examine a case of agricultural chemical poisoning, we have to treat a patient intensively from the beginning.

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