Hiroshima General Hospital dates back to 1947. Initially it was known as the Saiki Hospital affiliated with the Agricultural Association of Hiroshima Prefecture. It had 60 sickbeds and four departments-internal medicine, surgery, otolaryngology and dentistry. In those days, there were a large number of atomic bomb survivors in this medically underserved province of Saiki, so that the hospital was extremely busy treating these hibakushas. With the increase in the number of patients, the hospital kept expanding. It was not until 1979 when the number of beds increased to 270 that the hospital was reorganized and assumed the present name. Since then, it has continued to expand and its medical facilities improved. Having been accredited with the type B general hospital by Japan Council for Quality Health Care, it has now become the nucleus of the health care system in the western part of Hiroshima Prefecture, with 570 beds.
By way of illustrating how our hospital has been involved in community health care, we will take a look at the trend of the number of emergency cases admitted at night or on holidays. Up until 1998, the annual number of such cases had stood at somewhere around 4,000 but in 2003 the figure exceeded 10,000. For routine physical checkups, electrocardiograms are used. In 1975, 1,800 patients underwent ECG tests and in 2000 the number leapt to 27,000. This author has taken it upon himself to interpret all these ECG records.
The Department of Cardiology in our hospital had made it a rule to conduct noninvasive testing in diagnosis. In 1984, the x-ray examination system to make a diagnosis of circulatory troubles was introduced. In 1988 when the Department of Cardiovascular Surgery was set up, it started employing percutancous transluminal coronary angioplasty (PTCA) procedures and other interventional techniques. At first, coronary artery imaging was preformed on not more than 40 cases annually, but now the number of such cases surpasses 500. Interventional treatment is given to well over 130 cases, 85% of which have stents implanted. The initial success rate of intervention is 90.3% and the rate of restenosis was 35.8%. The cases of A-C bypass grafting performed at the department of cardiovascular surgery are increasing in number. Now the use of skeletonized artery bypass graft surgery with extracorporeal circulation at normal temperature has become standard procedure. By the use of the multi-detector row helical CT (MDCT), we are now studying coronary bypass patency and imaging quality. Except for some cases, it has become possible to obtain three-dimensional reconstruction images comparable to angiocardiographic images in terms of quality. We expect that MDCT will replace catheterization and become a standard noninvasive diagnostic procedure in the foreseeable future.
We will adopt new thechniques and new therapeutic methods positively but not blindly placing too much confidence in state-of-the-art technology. Based on the fundamental principles of our hospital, we will devote ourselves to medical care, putting the needs of patients before everything else.

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As regards the chronic disorders brought about by pesticides to human bodies, attempts have been made to review theses that have been published both at home and abroad in the last several years on the basis of epidemiological studies. The chronic disorders that are found to have something to do with pesticides are neurological disorders (Parkinson's disease, peripheral nervous symptoms, poor coordinations and abnormal deep tendon reflexes), mental disorders (mild cognitive dysfunction and neurosis), pulmonary and bronchial disorders, hematopietic disorders (aplastic anemia), thyroid disorders, ocular disorders, immune disorders, natal disorders and birth defects (teratism, spontaneous abortion, complete transposition of the great arteries and cryptorchism), disorders in childhood growth (disorders in social development and attention deficit disorders, among others), genital disorders (reduction in fertility, erectile dysfunction (ED) and oligozoospermia), oncogenesis and carcinogenesis (childhood cancer, leukemia, non-Hodgkin lymphoma, multiple myeloma, others and pulmonary, mammary, cystic, pancreatic, and prostatic cancers).
The findings of epidemiological studies do not necessarily produce casual relationships but, as identical findings have come out in many epidemiological studies, it may be argued that they produce findings the casual relationship of which is considerably suspicious. The working of pesticides as chemicals to stir incretion (the working similar to that of estrogen), the working of dioxin contained as a byproduct and the impairment of DNA have something to do with causes to chronic disorders.
With not only acute poisoning by pesticides but also chronic disorders, the greatest adverse impacts fall on farmers who are directly engaged in the spraying of pesticides. When it comes to genital disorders, birth defects and tumorigenesis, among others, the spraying of insecticides and the extermination of white ants in and out of the houses ought to be taken into full account.

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Methods of writing a scientific paper and forming a working hypothesis were lectured. The concept mapping method has the possibility of evaluating learners' organization of knowledge in research. We tried an application of concept mapping to the research process of nursing. Concept mapping would clarify the conceptual framework, and develop research ability and problem-solving capability.

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After reviewing studies on weight cycling, we concluded that methodology left much to be desired and that the following matlers should be taken into reconsideration :
1. There is as yet no established definition of the term “weight cycling”. Consequently, different definitions of weight cycling are used in different studies.
2. The definition of weight cycling lacks any standard. Consequently, different criteria of weight change are used in different studies.
3. Weight cycling is assessed by cycles of loss and regain of body weight. For the purpose of elucidating the correlation between weight cycling and health body weight is preferable to BMI as a weight change variable.
4. Providing a relevant measure for weight cycling encompasses many components. The body weight collected by direct measurement is most reliable. However, an interval of measurement of body weight differs in different studies.
5. In light of the standards of population-based epidemiological research, the studies are generally of small-to-modest size.
6. Few studies have been able to differentiate between intentional and unintentional weight changes.

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Accelerated atherosclerosis has come to pose a great threat to the lives of hemodialysis patients. In the present study, to determine the characteristics of atherosclerosis in long-term survivors on maintenance hemodialysis (mean age : 57±3 years, mean duration of hemodialysis : 279±11 months), the reference to clinical, biochemical and physiological parameters pertaining to atherosclerosis were examined and the results were compared with those in age-matched short-term hemodialysis patients (mean age : 55±2 years, mean duration of hemodialysis : 23±3 months). Although hypertension is regarded as one of cardiovascular risk factors together with diabetes, smokings and hyperlipidemia, our study found that the incidence of hypertension was significantly lower in long-term survivors on hemodialysis (16.7%) than in short-term hemodialysis patients (83.3%). However, no significant differences in biochemiacal data and carotid artery intima-media thickness were found between the two groups of hemodialysis patients. Levels of pulse wave velocity (PWV) in both short-term hemodialysis patients (1912±165 cm/sec) and long-term survivors on hemodialysis (1627±97 cm/ sec) were significantly higher than those in age-matched healthy subjects (1382±44 cm /sec). The levels of PWV in long-term survivors on hemodialysis tended to be lower than those in short-term hemodialysis patients, although the difference was statistically not significant. These results suggest that atherosclerotic alterations have already advanced in non-dialyzed patients with end-stage renal disease. The relatively lower levels of PWV in long-term survivors on hemodialysis may reflect the higher incidence of cardiovascular-related complications in those patients with highly accelerated atherosclerosis who die or may drop out during hemodialysis treatment.

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2000年9月に筆者が当科に赴任して以来, 2002/2003は3回目のインフルエンザ・シーズンであった。過去2シーズン同様, 積極的にインフルエンザ対策に取り組み, これを総括した。予防面では, ワクチンの接種料金の値下げを柱として, 接種人数の増大を図った。診断面では, 1種類の迅速診断キットが安定して使用でき, 検査精度の維持に貢献した。治療面では, 巷の抗インフルエンザ・ウイルス剤不足に振り回されることなく, 従来どおりの診療が遂行できた。インフルエンザ脳症やそれに準じた重症例には遭遇しなかった。年末の約2か月間, ワクチン接種に力を注いだ結果, 年明け後のシーズン最盛期にも受診患者数は増加せず, 一般外来診療および病棟運営は混乱なく平常どおりに行うことができた。このことから, 対インフルエンザ戦略の基本はワクチン接種を中心とする予防にあると再認識した。

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