To clarify what are contributing factors associated with the place to die (home or hospital) in a rural area, we investigated several background factors of 107 patients who died at home or in hospital after receiving home care service during the period of four years from July 1995 to June 2000. The subjects were divided into two group those who died at home (39 cases, 36%) and those who died in our hospital (68 cases, 64%). The ratio of deaths at home increased every year, and reached a half of those who died after receiving home care service. The average age in those who died at home were 87.1±9.5 years, that was higher than that of those who died in our hospital (82.2±9.8 years). There was no difference betwe two groups about sex, basic diseases and the time required to get to the hospital by car. Death at home was more preferred by patients, whereas death in the hospital was preferred by patients' families. The level of activities of daily living (ADL) in those who died at home was lower compared with that in those who died in the hospital. Those who died at home significantly had lesser complaints (pain, dyspnea and so on) and had more care-givers in the family, than those who died in the hospital. These results revealed that the major factors in death at home are: 1) low level of ADL, 2) preference to death at home expressed by patients, 3) presence of additional care-givers, and 4) no complaint of symptoms from patients.

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We evaluated changes in respiratory mechanics--expiratory tidal volume (Ve), inspiratory peak airway pressure (PIP), compliance of the total respiratory system (compliance), and partial pressure of end-tidal carbon dioxide (PETCO2)- in two groups of aged patients under general anesthesia and mechanically ventilated in supine position. One group (group I) was composed of patients 65-74 years old and the other group (group II) of patients 75-92 years old. We compared preoperative respiratory function (% Vital capacity, FEV 1.0% and spontaneous tidal volume) and respiratory mechanics. All the patients were ventilated with a tidal volume (Vm) of 10, 13m1/kg, a respiratory rate of 8 breaths per minutes, an IE ratio of 2.0, and a fresh gas flow rate of 2.51/min. We found that, with increasing age, respiratory mechanics and PETCO2 changed significantly. And there was a significant difference between Vm of 10 and 13m1/kg in 2 groups for each parameters and % Vital capacity and compliance, FEV1.0% and PIP were significantly correlated.
Implication: Vm of 13 ml/kg for group I is physiologically superior to Vm of 10m1/ kg in pulmonary mechanics. But for group II, Vm of 10 ml/kg was physiologically superior to Vm of 13 ml/kg because of their high PIP and low PETCO2.

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[Background]: Fluticasone propinate (FP), an inhaled steroid agent, has greater clinical efficacy in bronchial asthma than Beclomethasone dipropionate (BDP), but it has been reported that the rate of oropharyngeal candidiasis becomes high. In this study, we evaluated the medium-term pharyngeal candidiasis rate in elderly patients after BDP was replaced with FP in maintenance therapy.
[Method]: A total of 53 elderly patients 65 and over, who had previously received stable maintenance therapy with BDP, were switched to treatment with half doses of FP, and they were taught to gargle again.
Eight weeks and six months later, pharyngeal swabs were taken for culture and assessment of candidiasis. These results were compared with those of 24 patients 64 and below. We also measured the inspiratory peak flow rate with inhaled FP.
[Results]: Eight weeks later, candidiasis appeared in 11 patients in the advanced age group (20.8%), which was significantly high compared with only one patient in the age group under 65 (4.2%). Although the pharyngeal candidiasis of 8/11 patients became negative by teaching them thoroughly how to gargle with povidone-iodine, candidiasis appeared in another seven patients six months later, bringing the total up to 10/53 (18.9%).
[Conclusion]: The appearance rate of pharyngeal candidiasis in the elderly patients, who changed for FP, was unexpectedly high. It was suggested that the frequncy of gargling after inhaling FP and the inspiratory peak flow rate when FP is inhaled could be big influential factors. When we use FP, it may be important to give medium and long term-persistent instructions to patients.

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Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.
To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.
When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.
A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.

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A 73-year-old man was admitted to the hospital on March 31, 2000 because of nonsustained ventricular tachycardia (VT). In 1983, he was diagnosed as having apical hypertrophic cardiomyopathy (APH). Electrocardiograms showed high amplitude of R waves and giant negative T waves (GNT), and left ventriculography (LVG) revealed spade like configuration. He stopped medication without leave six months after the diagnosis. The latest ECG showed a decrease in amplitude of R waves, no signs of GNT, ST elevation in precordial leads, and an increase in QRS duration. LVG demonstrated midventricular obstruction, apical aneurysm, and the intraventricular pressure gradient in systolic phase was 56 mm Hg. No stenotic lesion was observed in coronary arteriography. Early diastolic paradoxic flow from the apical chamber toward the outflow of the left ventricle was detected by pulsed Doppler echocardiography. VT was successfully treated with beta-blocker and amiodarone, but he needed hospital treatment again one month later because of congestive heart failure. During the follow-up of APH, the decrease in amplitude of R waves and disappeasance of GNT, ST elevation, and the increase in QRS duration in electrocardiograms, and the detection of early diastolic paradoxic flow by echocardiography could be the predictors of developing apical aneurysm and/or left ventricular dysfunction.

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Eosinophilic gastroenteritis (EG) is characterized by infiltration of eosinophils into the wall of the digestive tract, and the clinical spectrum seems to depend on the predominant site of eosinophilic infiltration of the wall.
We experienced four cases of EG, and two of them (Cases, 1 and 2) manifested massive ascites, suggesting the principal lesion is located on the serous coat. Case 3 manifested abdominal pain and vomiting, and muscle layer involvement of the duodenum was detected by ultrasonography and CT scan. In case 4, epigastralgia was a main symptom. An endoscopic examination revealed marked redness and erosion of the gastric mucosa associated with massive infiltration of eosinophils. In this case, mucosal involvement seemed to be the main lesion because hypertrophy of the gut wall thickness was not found by ultrasonography and CT scan.
Although the pathogenesis of this disease is obscure, allergic mechanism may play an important role. Three cases had histories of allergic diseases, and steroid therapy resulted in prompt disappearance of symptoms.

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