Introduction: We report a very rare case of paraneoplastic chorea due to lung cancer that was ameliorated by administering tetrabenazine, the only agent used for treating the chorea of Huntington disease. Case: A 92-year-old woman was diagnosed with lung cancer but only followed up, based on advanced age and her own wishes. Given the absence of treatments such as chemotherapy, the lung cancer was not histologically diagnosed. During follow-up, involuntary movements appeared and paraneoplastic chorea was diagnosed. Therefore, she could not live alone and was admitted to a nursing home. Triple combination therapy with valproic acid, tiapride hydrochloride and risperidone was started, and showed efficacy for her symptoms. The symptoms showed amelioration but persisted in the upper extremities, face and neck. A neurologist suggested to her family that tetrabenazine, the only medication used for Huntington’s chorea, might be effective. After admission to our hospital, her family requested tetrabenazine. As both she and her family were suffering mental distress because “she was trapped in a body that moved regardless of her will”, we initiated tetrabenazine at a dose of 12.5 mg/day. After starting tetrabenazine, chorea of the upper extremities, face and neck almost disappeared. Moreover, her speech became clear and she spoke normally with her family. Discussion: Tetrabenazine is a drug receiving insurance reimbursement only for Huntington’s chorea, but was effective in this case. In our view, this treatment palliated the patient’s physical distress and the mental distress that she and her family were experiencing due to her paraneoplastic chorea.

We present what is believed to be the first report of heterogeneous carcinoma arising from breast ductal adenoma. A 57-year-old woman presented with a nodule in her right breast. Histological examination of a vacuum-assisted biopsy specimen revealed epithelial tubular proliferation and papillary apocrine epithelium. The myoepithelial cells lining the tubules were confirmed by immunohistochemistry. The nodule had increased in size 18 months later and tumorectomy was performed. The surgical specimen revealed proliferating apocrine epithelium with sheet-like and cribriform architecture within a mammary duct. Some myoepithelial cells showed irregular proliferation around the tubular epithelium. All three components, including apocrine, myoepithelial and glandular cells, showed prominent nuclear atypia and significant mitotic activity. The patient was diagnosed with malignant transformation of ductal adenoma. The malignant potential of ductal adenoma has not previously been discussed, but this heterogeneous carcinoma could represent a serious pitfall in the diagnosis of ductal adenomas.

Gait disturbance is a serious problem in Parkinson's disease (PD). Exercise therapy is used to alleviate this complaint. We investigated the effects of a videotaped arm swinging-based home exercise program on gait in PD patients. The subjects included 25 outpatients aged between 55 and 77 years (average age 68.9 years) with PD in Hoehn and Yahr stages II-IV. We prepared a master video tape in which a trainer was shown to be performing an arm swinging exercise or steps in synchrony with a metronome. The exercise menu consisted of 4 parts : arm swinging in a seated position, arm swinging in an upright position without stepping, arm swinging with stepping, and walking on the floor or taking a walk. The patients performed the arm swinging exercise while watching a video tape everyday for a period of 3.4 weeks. Of the 25 patients, 22 completed the exercise program. Following the program, these patients showed significant improvements in their walking times for a 20m walk (10 m, return, 10 m) (before/after=29.6/24.3 sec, p=0.002) and in the step length (before/after=43.7/50.1 cm, p<0.001). Frozen gait was a negative factor to complete the programs. Improvement of gait speed after the exercise was related with less frequency of cadence. Loss of arm swinging in PD may be associated with a disturbance in the internal rhythm formation process. Arm swinging exercises are one of the exercise methods that use rhythmic cues. This study suggests that a videotaped arm swinging-based home exercise therapy is effective in such patients.

Objective：The objective of this study was to apply Least Absolute Shrinkage and Selection Operator （LASSO）logistic regression to detection of adverse drug reaction （ADR） signals using an electronic health records database as a comprehensive and quantitative method to supplement the current pharmacovigilance activities in Japan.

Design：case-control study

Methods：We analyzed data from 40767 inpatients using a single-institution hospital database and identified two ADRs, suspected pancreatitis and thrombocytopenia, using abnormal laboratory test results. LASSO logistic regression analysis was applied to detect ADR signals with adjustment for age, sex, comorbidities and medical procedures. The positive predictive value （PPV） was calculated using reference standard of known drug-ADR associations based on drug product labels.

Results：The number of case group was 6735 for suspected pancreatitis and 11561 for thrombocytopenia. The number of ADR signals detected using LASSO logistic regression was 27 for suspected pancreatitis and 40 for thrombocytopenia. The calculated PPV was 3.7% for suspected pancreatitis and 55.0% for thrombocytopenia.

Conclusion：LASSO logistic regression analysis efficiently detects ADR signals by adjusting for confounding factors such as comorbidities and medical procedures. The false positive signals may contain unknown signals and further signal assessment will be needed.

In atrioventricular (AV) discordance, a morphologic tricuspid valve functioning as a systemic AV valve often becomes incompetent and needs to be replaced. However, mitral valve replacement concomitant with tricuspid valve replacement is unusual in the disease. Here, we report a case of successful double AV valve replacement long after functional biventricular repair in AV discordance. A 32-year-old man with AV discordance was admitted with orthopnea. He had undergone the Rastelli procedure at age 10 and removal of the deteriorated conduit valve at age 24. Preoperative examinations revealed not only tricuspid but also mitral regurgitation. Both deteriorated valves were replaced with mechanical valves. In AV discordance after Rastelli procedure, a non-valved conduit may accelerate mitral deterioration because pulmonary hypertension from tricuspid regurgitation increases the afterload of the pulmonary ventricle.

Background: Little information has been collected on the prevalence of hypertension in different rural parts of Japan, using similar methods for sample selection and based on similar diagnostic criteria, and epidemiological studies are urgently needed in each Japanese rural county to determine the baseline against which future trends in risk factor levels can be assessed in order to be able to plan appropriate preventive strategies. Objective: To study the prevalence and its relationship to risk factors of hypertension without controlled drug treatment in rural populations. Materials and Methods: Three cross-sectional surveys were conducted in the Akita (north), Gifu (middle) and Fukuoka (south) regions during 2004-2005 using study subjects (n=1778) aged 40-79 years who participated in a health check-up program. Blood pressure was measured by a trained nurse. Information concerning their history of hypertension and lifestyle was obtained by self-administered questionnaires. Results: When comparing the three regions, the prevalence of hypertension (≥140/90 mmHg) without controlled drug treatment demonstrated a significant difference among males (16.8%, 22.1% and 12.7% in Akita, Gifu and Fukuoka, respectively; p<0.05). However, no significant difference was seen among females (14.4%, 16.0% and 16.5% in Akita, Gifu and Fukuoka, respectively). According to a multivariate logistic regression analysis for these two groups in each of the three regions, the odds ratio (OR) showed that obesity (body mass index≥25 kg/m2) was strongly associated with the Hypertensive (-) group among females in two regions (ORs of 2.32 for both Akita and Fukuoka). Physical inactivity (average daily physical activity energy expenditure<300 kcal), alcohol drinking (alcohol intake≥44 g/day and/or frequency of drinking≥5 days/week), cigarette smoking (Brinkman index≥400) and a stressful lifestyle were not significantly associated with the Hypertensive (-) group among these rural populations. Conclusions: Therefore, hypertension in females in rural Japan may be controlled by a reduction in body weight.
Hypertension induced by pregnancy ; Risk Factors ; Japanese language ; Prevalence aspects ; Three

Objective: To examine relationships between fast eating habit and overweight. Design: Cross-sectional study. Setting: Four rural areas in Japan. Subjects: A total of 2,239 adults (782 men and 1,457 women) who participated in a health check-up program. Measurements: Body mass index (overweight 25.0) and the habit of eating quickly (validated brief-type self-administered diet history questionnaire). Statistical analysis: A covariance analysis was used to examine an independent relationship between the habit of eating quickly and overweight. Results: 21.1% of males and 21.4% of females were found overweight. 40.3% of males and 34.7% of females reported that they were in the habit of eating quickly. The multivariable adjustment included age, total energy intake, fat energy balance, alcohol intake, smoking status, physical activity level, and survey area. After adjusting for these variables, the habit of eating quickly was positively related with overweight in both males and females.Conclusion: The habit of eating quickly was independently related with overweight, and to control of the eating behavior would thus be essential for Japanese rural residents in order to reduce their body weight.

To investigate the influence of long-distance running on bone metabolism, we measured bone metabolism markers in eight healthy young men before and 4 months after the start of training program of 10 km running. Measurements were then taken the day before a marathon race, immediately after, and 1 day, 2 days and 5 days after.
As a result of exercise, the levels of serum osteocalcin (OC), a bone formation marker, and urinary deoxypyridinolin (D-Pyr), a bone resorption marker, decreased significantly. After the marathon race, the OC level decreased further corresponding to an increase of hydrocortisone right after the race. However, from the day following the race, the OC level showed a slight increase. D-Pyr showed an increasing tendency immediately after the race, and the levels of OC and D-Pyr increased significantly 5 days after the race.
Bone formation and resorption decreased as a result of light, low-frequency endurance exercise. However, both of them increased after intense physical stress. From this result, it is suggested that the intensity and frequency of exercise affect bone metabolism differently, even though the type of exercise load is similar.

Objective : To examine the association between the combination therapy of calcium antagonists with angiotensin converting enzyme (ACE) inhibitors and underlying diseases for hypertensive patients.
Design : Cross-sectional survey of the drug utilization.
Methods : This survey included 603 hypertensive patients who had visited Toyama Medical and Pharmaceutical University Hospital, Toyama, Japan more than twice from January to June in 1996 and received the prescriptions of calcium antagonists and/or ACE inhibitors. Main outcome measure was the combined medication of calcium antagonists with ACE inhibitors. Underlying diseases under consideration were diabetes mellitus (DM), hyperlipidemia (LIPID), ischemic heart disease (IHD), chronic heart failure (CHF), and ischemic stroke (STROKE).
Results : Out of 603 hypertensive patients, 57.5% received only calcium antagonists, 23.7% received only ACE inhibitors, and 18.7% received both of them. Patients with either IHD or CHF tended to receive the combination therapy as compared to DM or LIPID. Although men tended to receive the combination therapy, a gender effect might be a confounder for the association. Logistic regression showed a 33% increase (P=0.265) in frequency of the combination therapy in patients with IHD after adjusting for age and gender.
Conclusion : Some underlying diseases were associated with more frequent prescriptions of the combination therapy for hypertensive patients, especially with ischemic heart diseases. This result should be regarded as an exploratory stage although the pattern of antihypertensive drug use could be reasonably explained from the pharmacological sense.

As regards to low back pain of agricultural worker, there are many problems still as to a syndrom of “Nofusho” in rural medicine, a disease in ocupational medicine and clinic of orthopedic.
Agricultural worker who complained of low back pain varies with their country and farm products, and it tend to increase with adding to their age. Further, the female rate of low back pain showed slightly high tendency than the made rate, 8.5-12.5 % of male, 6.5-13.4 % of female always complained of low back pain.
According to the findings of roentogenographic examination of back bone, the deformed vertebrae was found clearly, especially, low back pain caused by a trauma of soft tissue and iscogenic pain showed in farmers. Therefor, it is necessary to be improved working posture and condition.
In comparrison with non-farmer, it is located in order of truck drivers. bus drivers and repairmen.