In order to assess the influence of habitual alcohol consumption on hepatic and pancreatic function, and on the disposal of carbohydrate and lipid, determination of serum hepatic and pancreatic enzyme levels, and serum glucose, insulin and triglyceride on oral glucose challenge was made in relation with the amount of consumed alcohol.
1. GOT, GPT and γ-GTP levels increased correlated with daily alcohol consumption, and γ-GTP was the most sensitive marker for alcohol consumption.
2. Habitual alcohol consumption reduced serum amylase and increased elastase 1 and trypsin, while the excursion of these enzyme levels remained within normal range. Because people with elastase 1 or trypsin levels beyond normal range was found more frequently than with amylase, the former two pancreatic enzymes might be better marker of alcoholic pancreatic injury than the latter one.
3. Alcohol dependency in daily caloric requirement elevated serum glucose and triglyceride in fasting and 2 hours after glucose challenge. Hyperinsulinemia after glucose challenge might indicate that moderate daily alcohol consumption induces insulin resistance resulting in deteriorated glucose disposal.

The future of Japanese agriculture depends a great deal on the young adult. In this study, preventive health strategies for young people living in a farming area are discussed. The following is a summary of the conclusions we have arrived at.
1. There is much to be desired in their eating habits. Hence, the necessity of drawing up adequate guidelines and educational programs.
2. Young men must be dissuaded from smoking cigarettes and drinking a lot.
3. There is too much stress in living and working environments.
4. Overworking must be avoided.
5. Individuals must realize the importance of protecting and promoting their own health.

Today, well over 160, 000 patients undergo dialysis throughout Japan. The number of patients who are newly required to receive it is increasing year by year. Given that situation, our hospital has annually held a seminar since October 1994 for patients with renal diseases. The purpose is to slow the deterioration of renal function and to delay the introduction of dialysis by encouraging the patients to acquire a habit of taking high calory, low protein food.
This seminar must have help the patients get more knowledgeable about morbidity and learn the benefit of low protein rice-based diet. Now that three years have passed since the opening of the course, we reviewed the outcome, comparing the effects of old and new restrict diets.
A difference began to appear 9-2 months after the lst seminar between the seminar participants and the non-participants (control group) who received guidance only at the outpatient ward. The average rate of decrease in the serum creatine level of those participants who eated lowprotein rice was 0.029 and that of those participants who did not eat the restricted food was 0.166 (p<0.05), compared with 0.262 in the control group. We concluded that the difference is ascribable to the effect of the seminar. We would like to contribute to the well-being of the patients by enriching the content of the seminar and continuing to hold it.

Epidemiological investigations were made on carcinoembryonic antigen (CEA) levels in 3, 259 rural inhabitants and 3, 200 urban inhabitants. Abonormally high CEA levels were found in 12.0% of male rural inhabitants and 6.8% of male urban inhabitants. For women, the percentage was 2.4% in rural areas and 1.6% in urban areas. Correlations between high CEA levels and age were noted in men. However, cigarette smokers had higher CEA levels than non-smokers in both rural and urban areas irrespective of age. Smokers' CEA levels were higher rural areas than in urban areas. These disparites in CEA levels between rural and urban inhabitants were studied, but remain unaccounted for.

Objective: To investigate the role of postgraduate clinical training at the emergency department of Tenri Hospital in teaching the diagnostic process in the general outpatient department.
Method: Patients seen by 11 first-year residents at the emergency department were consecutively registered with summary sheets. Further information was added, and an analysis was performed of: 1) the distribution of chief complaints in the emergency and general outpatient departments and 2) initial diagnoses and the diagnostic process in the emergency department and the final diagnoses.
Results: The distributions of chief complaints in 89 cases in the emergency department and in 183 cases in the general outpatient department were closely correlated (p=0.0016). Diagnoses in the emergency department were correct in 58% of cases. Treatment was incorrect in 3% of cases.
Conclusion: The distributions of chief complaints in the emergency and general outpatient departments were similar. In our hospital the emergency department plays a major role in postgraduate clinical training by teaching the diagnostic process for the general outpatient department. Clinical management, including decision making for further tests and consultation, in the emergency department by first year residents did lead to any major adverse events.

A Valsalva aneurysm filled with thrombi can be difficult to diagnose, because it mimics a cardiac tumor. Both cardiac magnetic resonance imaging (MRI) and transesophageal echocardiogram (TEE) were performed on a patient who showed a low-echoic mass located between the atrial septum and the non-coronary sinus. Based on MRI findings allowing tissue characterization and the accurate location of the mass and the TEE findings of an irregular surface of the mass and a partial defect in the edge of the non-coronary sinus, we diagnosed the mass as a thrombosed Valsalva aneurysm that had perforated the inter-atrial septum. The operative findings coincided with the preoperative diagnosis. Both MRI and TEE are useful for diagnosing this condition.
Aneurysm ; Atrial Septum ; Echocardiography ; Heart Neoplasms ; Humans ; Magnetic Resonance Imaging ; Sinus of Valsalva

Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.

Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.