Recent studies on the epidemiology and control of Guatemalan onchocerciasis, chiefly made by the Guatemala–Japan Cooperative Project on Onchocerciasis Research and Control, are reviewed. Epidemiological features of Guatemalan onchocerciasis are summarized as to characteristic altitudinal distribution of endemic areas, disease manifestation, vector taxonomy, biology and transmission dynamic of the disease. Extensive insecticide studies in the field and laboratory demonstrate that the characteristic situations of Guatemalan streams where Simulium ochraceum, the main vector of onchocerciasis, breeds require ingenious methods of larviciding. Finally, the feasibility of an area vector control is indicated by the successful control operation in the San Vicente Pacaya Pilot Area, in which a new fixed-dose larviciding method was applied.

[Background]: Fluticasone propinate (FP), an inhaled steroid agent, has greater clinical efficacy in bronchial asthma than Beclomethasone dipropionate (BDP), but it has been reported that the rate of oropharyngeal candidiasis becomes high. In this study, we evaluated the medium-term pharyngeal candidiasis rate in elderly patients after BDP was replaced with FP in maintenance therapy.
[Method]: A total of 53 elderly patients 65 and over, who had previously received stable maintenance therapy with BDP, were switched to treatment with half doses of FP, and they were taught to gargle again.
Eight weeks and six months later, pharyngeal swabs were taken for culture and assessment of candidiasis. These results were compared with those of 24 patients 64 and below. We also measured the inspiratory peak flow rate with inhaled FP.
[Results]: Eight weeks later, candidiasis appeared in 11 patients in the advanced age group (20.8%), which was significantly high compared with only one patient in the age group under 65 (4.2%). Although the pharyngeal candidiasis of 8/11 patients became negative by teaching them thoroughly how to gargle with povidone-iodine, candidiasis appeared in another seven patients six months later, bringing the total up to 10/53 (18.9%).
[Conclusion]: The appearance rate of pharyngeal candidiasis in the elderly patients, who changed for FP, was unexpectedly high. It was suggested that the frequncy of gargling after inhaling FP and the inspiratory peak flow rate when FP is inhaled could be big influential factors. When we use FP, it may be important to give medium and long term-persistent instructions to patients.

We report a case of surgical treatment for idiopathic nonspecific inflammatory aneurysms of the abdominal aorta (AAA) with high-dose steroid therapy. The patient was a 35-year-old man who underwent steroid therapy (30 mg/day prednisolone) for idiopathic nonspecific inflammatory AAA and right common iliac artery aneurysm (CIAA) for 5 months. However, the sizes of the aneurysms were slowly increasing, and they were sacculated types, so surgical replacement was performed. Before the operation we continued to give 30 mg/day prednisolone, because decreasing the medicine made the c-reactive protein (CRP) value rise. Perioperatively the therapy continued, and the postoperative course was uneventful. With appropriate steroid therapy, replacement of idiopathic nonspecific inflammatory aneurysms of the abdominal aorta can be performed. It is also important to follow up the patient from long-term, to monitor for pseudoaneurysms from anastomosis or new aneurysms.

The main cause of senile pruritus is said to be dryness of the skin. Therefore, we treated patients with xerosis senilis, a common dry skin condition, using an oral preparation of Toki-inshi and a bath preparation containing licorice extract. The effectiveness of these treatments was determined by measuring changes in the water content of the epidermal horny layer over time using an electrical measuring device. The ability of the skin to retain moisture was expressed as the degree of dryness of the skin, and the results compared with the untreated group.
When the bath preparation was used, the skin dryness improved quickly, but the effects soon disappeared when the treatment was stopped. When Toki-inshi was administered orally, the improvement was slower than with the bath preparation, but the effects did not disappear immediately when the drug was withdrawn as in the case of the bath preparation. However, since there was not necessarily agreement between improvement in skin dryness and alleviation of pruritus, factors other than skin dryness might be involved.

Pulmonary vein isolation procedure was performed for atrial fibrillation associated with mitral valve disease in twelve patients. This simple procedure consisted of only isolation of the four pulmonary veins. Combined mitral valve surgery consisted of mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty. Ten patients returned to a sinus rhythm. Two patients required DDD pacemaker implant for sick sinus syndrome. Left atrial contraction was detected in eight cases by trans-esophageal echography. Compared with the maze procedure, this operation was less invasive and preserved atrial appendage, helping to maintain normal secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.

Paraquat (1, 1'-dimethy1-4, 4'-dipyridylium dichloride) was administered to Wister rats orally at100mg/kg, 50mg/kg and 25mg/kg.
Death generally occured in1-5days, many animals of the group administered at 100mg/kg died within 24 hours.
Loss of body weight began on the second day after paraquat ingestion.
The lung became the organ of highest concentration of paraquat, that reached maximum level with in 2 hours and was eliminated approximately 62-82% 24 hours later.
Biochemical studies gave high levels of serum LDH and GOT, but no abnormalities were detected hematologically.
Histopathological examinations has shown that the lung was the target organ of the paraquat poisoning. At the early stage, there were atelectasis, pulmonary edema and disintegration of the alveolar epithelium. These were followed by an infiltration of fibroblasts and glandular proliferation of the terminal bronchiolar epithelium. Parenchymal damages of the heart, liver and kidney were most dominant in 24 hours after paraquat ingestion, from which animals recovered subsequently.

The rate of mortality from paraquat poisoning is high and the principal manifestation of toxicosis is pulmonary impairment.
In this study, we measured the concentration of paraquat in the urine, blood, and some organs in 10 patients with acute paraquat poisoning in order to study the relationships of the kinetics in the body to the concentration in the lungs and to the pulmonary impairment.
The concentration of paraquat dichloride in the blood stream rapidly decreased in the first 24 hours. The half life was about 0.5 hour, within 2 hours (case 3) after intoxication, about 1 hour after 5 hours (case 5), about 2 hours after 10 hours (case 6) and after 24 hours (case 6) was prolonged to over 26 hours.
Therefore, it was suggested that half life was subsequently prolonged with the passage of time.
There were indications that renal disturbance appeared in about 5 hours after oral intake.
Accumulations of paraquat were seen in the organs examined. The largest amount within 24 hours after exposure was recognized in the lungs, and the largest amount after 271 hours was seen in the skeletal muscle. The concentration of paraquat in the lungs was higher than the concentration levels in the blood at death in all the cases.
Although excretion of paraquat from the lungs was very slow. it became faster with DHP and HD. However, excretion from the skeletal muscle was slow, Excretion from the other organs excepting the kidney was considered to be constant, being proportional to the blood concentration levels.
The pathologic examination of the lungs found congestive edema in 6 cases, which became severer with the lapse of time. Partial pulmonary fibrosis was recognized only in long-term survival cases.
The cause of irreversible pulmonary impairment was considered to be the effect of the small amount of paraquat remaining in the lungs which exceeds the concentration in the blood.

By use of 18 varieties of pesticide and six of their breakdown products, experiments were conducted to cause mutation and reversion in S. typhimurium TA98 and TA100 within a range of 0.01ug-100 ug/plate.
The results showed that Captan had mutagenic effects on TA98 and TA100. However, when S-9 mix was added, the number of revertant colonies ceased increasing.
Ethylenthio urea caused mutations in TA98. When S-9 mix was added, revertant colonies increased about twice the number in the control. In the absense of S-9 mix, the result was the same.

We report a case of surgical treatment for pseudoaneurysm 4 years after Patch-and-Glue Repair of left ventricle free wall rupture (LVFWR) due to acute myocardial infarction (AMI) in 2004 in a 74-year-old woman, she had been followed in our hospital. And 2 years later, echocardiography and MRI showed a pseudoaneurysm at the repair spot which was growing very slowly. Since we found a thrombus in the pseudoaneurysm, a redo operation was performed in 2008. The pseudoaneurysm was successfully extirpated, under cardiopulmonary bypass. The infracted area had degenerated to scar tissue and we could suture tightly without worrying about a fissure in the wall. We can use Patch-and-Glue Repair to rescue the LVFWR patients due to AMI in the acute stage because it is possible to remove the pseudoaneurysm in the future, on pseudoaneurysm excision in a firmly infarcted area is possible in the chronic stage.

Spontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.