We report 3 cases of sudden death while the students are at school. In Japan 120-150 cases, mainly related to sports, are reported in a year. In Gifu Prefecture (population: 2, 000, 000), only 1 or 2 cases probably occur in a year. While here in Mizunami City (population: 40, 000), we had 3 cases for the last 10 years. This is a higher occurrence rate than in other cities.
The 1st case was caused by brain-stem bleeding; the 2nd, rupture of the wall of the aorta associated with Marfan syndrome, and the 3rd, fatal arrythmia related to Wolff-Parkinson-White syndrome.
Measures to prevent the incidence are summed up as follows:
(1) Teachers, school doctors and hospital staffs should have closer contact
(2) We should critically review the standards for cardiac disease management and make a thorough examination of the heart at the time of regular health screening by several ways, such as UCG, Holter ECG and treadmill ECG, to find high-risk students.
(3) 60% of the cases of sudden death were of cardiac origin, and 40% were due to central nervous system disorder, bronchial asthma etc., so we should also watch over these conditions.

22q11.2 deletion syndrome (22qDS) resulting from a microdeletion of 22q11.2, is usually diagnosed in the postnatal period, and generally manifests as various combinations of cardiac defects, hypoparathyroidism, facial dysmorphism, palate deformity and cellular immunodeficiency. We report a case of a 32-year-old woman presenting with seizures and hypocalcemia, who was diagnosed with 22qDS, along with a literature review of adult cases. Physicians should recognize the 22qDS in adults presenting with any combinations of hypocalcemia, hypothyroidism, cardiac defects and psychiatric disorders. Pathognomonic facial dysmorphism or short stature can be the key to diagnosis.

A 24-year-old man with systemic lupus erythematosus (SLE) had received long term steroid therapy 10 years prior to this admission. He presented with sudden-onset chest pain. Enhanced CT scan showed the presence of an aortic arch aneurysm 63mm in maximum diameter and a hematoma surrounding the anterior mediastinum. The diameter of the descending thoracic aorta was also dilated to 5cm. We performed ascending and total arch replacement on December 8, 2005. From the 11th postoperative day, he developed fever, indicating mediastinitis. Open drainage was carried out for one week resulting in gradual lysis of fever and the levels of WBC and CRP returned to normal values. The omentum was transplanted to close the defect in the mediastinum. The rest of the postoperative course was uneventful. He was discharged from the hospital last January 25, 2006. Although close medical follow-up was implemented, he had severe chest pain in the morning on June 9, 2006. Enhanced CT showed an expanding descending aortic aneurysm 60mm in diameter. Since antihypertensive therapy was effective, we considered an elective operation. On the 3rd hospital day, he complained of a severe back pain wherein he rapidly progressed into a state of shock. He died due to rupture of the descending aortic aneurysm. We needed emergency operation or endovascular stent graft therapy because of the risk of rupture.

We performed extraanatomic bypass from the thoracic aorta to bifemoral arteries for 4 aortoiliac occlusive disease (AIOD) patients (including 2 dialysis patients) with severe calcification of abdominal aorta and 5 high aortic occlusion (HAO) patients between January 2001 and September 2006. The average age was 69 years old (range 46-80) including 6 men. Two HAO cases were in the acute phase, one of whom had accompanying lower limb paralysis. Two of the AIOD cases showed small aorta syndrome. The mean operation time was 145min and intra- or postoperative bleeding was very low. We lost one peritoneal dialysis patient with AIOD in the 2nd postoperative week, due to infection from the CAPD tube. Perigraft seroma which is a complication of the artificial blood vessel itself was seen in 3 patients but graft patency was 100 percent at 2 years postoperatively.

Animals ; Glutamic Acid ; analysis ; toxicity ; Guinea Pigs ; Microscopy, Immunoelectron ; Vestibule, Labyrinth ; chemistry

Two hundred and thirty adipose tissues were collected from inpatients, who had undergone an operation and an autopsy in the Saku Central Hospital from 1980 to 1982. Organochlorine pesticides were extracted from the adipose tissues and determined by gas-liquid chromatography with an electron-capture detector.
The mean value was 1, 429 ppm for total BHC among males, and 1.665 ppm among females, 4.893 ppm and 3.791 ppm for total DDT, 1.082 ppm and 0.782 ppm for PCB, respectively. Regression analysis between the total BHC residue and the ages of patients indicated a positive correlation for both sexs. As for the relation between the rate of obesity and the residues, low rates of obesity (-10%--19%) were most significantly correlated with high values of total BHC, total DDT and PCB.
We also discussed relations between cancerous diseases and the residues.

To demonstrate delayed neuro-toxicity of organophosphate, we administered 13 types of organophosphorous pesticide to hens. Initially, a screening test was performed with nine varieties of the chemical product. Later, four types were given to the fowls. Those hens dosed with S-Seven and Surecide developed ataxia and other neurophatic symptoms in the lower limbs.
After 50 days of observation, all the hens were killed and anatomized. Phathohistological examination revealed various changes in the hens that developed neuropathic symptoms: atrophy, diminution and disappearance of nerve cells in the anterior horn of the spinal cord ; edematous changes in the myelin; swelling of the neuroglia ; atrophy and vaculolar degeneration of liver cells; and necrobiosis of nepaticlobures.
It was found that these changes are closely related with the development of ataxia and doses of the chemical.
It was also found that the pathotistological changes occurred to a less extent in those hens which did not develop toxicoses.

We investigated the content of NO₃-N in the well water of the eastern, middle and nothern districts of Nagano Prefecture. The NO₃-N content seasonally changes and takes on the pattern of a high in summer and a low in winter.
Rain is considered to dilute the contaminated well water, but it lets NO₃-N flow from the soil into the.well water, when the rain is poured by a typhoon. As a result, a high content of NO₃-N is measured in the well water.
The water sample of 25 out of 85 wells in Matsukawa Town exceeded the tolerance level of NO₃-N (10 ppm, but 44.3 ppm in terms of NO₃^-).
By crop area, the amount of NO₃-N was highest in the fruitgrowing area, which was followed in order of the vegetable-growing area, the flower-growing and the rice planting area.
We consider that the contamination of well water is caused both by chemical fertilizers and the less absorbility of the soil.

We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.