Along with the depressed Japanese economic situation in recent years, the management of hospitals was become more difficult. To improve management methods and detect problems in the management of a university hospital, a comparative analysis of the income and expenditures in the management of a university hospital in 1995 was conducted. Another hospital was analyzed for comparison. The two hospitals have similar characteristics, such as the number of employee, the number of beds, and the other medical facilities. However, the basic function of the two hospitals differed. Results of the comparative analysis showed that the total number of inpatients and outpatients, the daily per capita income from inpatients and outpatients, the average income from each bed, the bed utilization rate, the per capita income from each employee, and the per capita income of each doctor at the university hospital were lower than at the other hospital. The medical expenditures in some departments of the university hospital were quite high.

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Effects of polyunsaturated fatty acids (Sun balance, S) and an extract of oyster (Dino balance, D) on blood ethanol and acetaldehyde concentrations after intake of whisky (corresponding to 0.3g ethanol/kg) were investigated in eight healthy volunteers (four men and four women ; age, 24.8±2.4 years ; height, 163.9±9.2cm ; weight, 54.6±8.9kg, mean±SD) with a placebo-controlled, double-blind, cross-over design and a wash-out period of more than 1 week. Six capsules of S and 18 tablets of D or placebo capsules and tablets were administered to volunteers with 100ml water. After 30 minutes, whisky was drunk within 5 minutes. Blood samples were taken at 0, 15, 30, 45, 60, 75, 90, 120, 150, and 180 minutes. Concentrations of ethanol and acetaldehyde in blood were measured with liquidgas chromatography. Average concentrations of ethanol at 30 and 60 minutes were significantly less in the active group than in the placebo group (p<0.05) . If ethanol is assumed to be eliminated by zero-order kinetics, the regression line was highly correlated with the concentration-time curve (r=0.963±0.038, n=16) . No significant differences were observed in the average concentrations of acetaldehyde between the groups because of the wide variability in data ; however, acetaldehyde concentrations in the active group tended to be lower. As to ethanol pharmacokinetics in the active group, mean tmax was significantly increased from 41.3 ±17.5 minutes to 56.3±25.0 min (p =0.018), the mean area under the curve was significantly decreased from 30, 613.4±12, 135.6 min·μg/ml to 23, 448.7±8, 985.1 min·μg/ml (p=0.026), and the mean slope (k₀) of the regression line in the elimination phase decreased significantly from 1.99±0.60 μg/ml/min to 1.65±0.67μg/ml/min (p=0.007) . No significant differences were observed in the pharmacokinetic parameters of acetaldehyde between the groups. The area under the curve in the active group tended to be less the in the placebo group. Adverse reactions to alcohol, especially headache, drowsiness, perspiration, and tachycardia, were less in the active group. Treatment with D and S may inhibit both absorption of ethanol from the intestines and biotransformation of ethanol to acetaldehyde, so that accumulation of smaller amounts of acetaldehyde can be anticipated.

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The early detection and treatment of hypertension have been promoted in Japan as important strategies for the prevention of cerebrovascular diseases. However, because the subjective symptom of hypertension are mildpreventive measures may be difficult to implement. Therefore, we studied epidemiologically the relation between the subjective symptoms of hypertention and blood pressure measurements in 1224 elderly persons (421 men and 803 women) who continuously underwent medical examinations for the elderly which have been offered for 7 years from 1987 through 1993 by Kasagake town in Gunma Prefecture, Japan. The average age of subjects in this study was 54.3 years for men and 52.8 years for women. The average incidence rate for subjective symptoms of hypertension was 2.7% for persons aged 49 years or less, 5% for persons aged 50 to 59 years, and 6.3% for persons aged 60 years or more. The symptom that appeared most often in subjects with hypertension was“headache and dullness” (7.8%), followed by“insomnia” (6.4%) ; “numbness in the hands and feet” (6.1%), and“fatigue” (6.1%) . A comparison of the average incidence rate of subjective symptoms in subjects with hypertension and those with normal blood pressure according to age group showed no significant differences in subjects aged 49 years or less, while the incidence rate of a“feeling of strangulation”was significantly higher only in subjects aged 50 to 59 years. In hypertensive subjects aged 60 years or more, the rates of“palpitation, ”“headache or dullness, ”and“fatigue”were significantly higher than in normotensive subjects. We studied the relationship of the regression coefficient of the cumulative incidence rate of high blood pressure and that of subjective symptoms over 7 years in the different age groups. We classified the relationship into three types, A, B, and C. Type A showed a significant difference between the regression coeffcients of the cumulative incidence rate of high blood pressure and that of subjective symptoms. Subjective symptoms included“feeling of strangulation, ”“breathlessness, ”“suffocation at night, ”and“edema with talking and tongue.”Type B did not show a significant difference between the coefficient of cumulative incidence rate of subjective symptoms and that of high blood pressure, and both rates increased almost in parallel. The subjective symptoms were“palpitation, ”“dizziness and dizziness on standing up, ”and“general fatigue”in subjects aged 49 years or less; “headache and dullness”in subjects aged 59 years or less; “numbness in hands and feet”in subjects aged 50 to 59 years; and“insomnia”in subjects aged 40 years or more. Type C showed a significant difference between the coefficient of the cumulative incidence rate of subjective symptoms and that of high blood pressure, and the rate of subjective symptoms was higher than that of high blood pressure in the first observed year. The subjective symptoms were“palpitation, ”“dizziness and dizziness on standing up, ”and“general fatigue”in subjects aged 50 to 59 years; “heada he and dullness”in subjects aged 60 years or more; and“numbness in hands and feet”in subjects aged 59 years or less. Most subjective symptoms changed from type B to type C. however, as age increased, the cumulative incidence rate of subjective symptoms became less than that of high blood pressure. In subjects aged 49 years or less the rate of“palpitation”correlated well with the increase of the cumulative incidence rate of high blood pressure.

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Autosutures for anastomosis of the intestinal tract are of three kinds. Anastomosis with staples have a danger of postoperative stenosis because the staples remain after anastomosis is achieved. A nonsuture device produced by AKA-2 uses a compression ring that is excreted rectally after anastomosis. Although the danger of postoperative stenosis is low, the risk of anastomotic leakage is high if the compression ring is released early.
The biofragmentable anastomosis ring being used for the Valtrac suture device disintegrates within 21 days after use. Furthermore, blood flow that is necessary for wound healing is preserved in the anastomosis with Valtrac. Therefore, stenosis due to anastomotic leakage or reaction to a foreign substance does not occur in the early postoperative period.
Valtrac sutures were used during the past 18 months in 20 patients with cancer of the large intestine. Neither anastomotic leakage nor postoperative stenosis occurred in any of these patients. Postoperative management was identical to that when staples are used. These results suggest that Valtrac is as safe as other types of autosutures. However, one possible disadvantage is that because this device does not have a center rod as does a stapler, it cannot be used in the lower part of the rectum.

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