Along with hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), which performs the work of the kidneys, is used in treating chronic renal failure. CAPD (hereafter referred to as PD) can be conveniently done at the patient's home.Other advantages of it include less adveres effects on the cardiovascular system as homeostasis of body fluid is maintained;less dietary restriction;reduction in the frequency of outpatient treatment;availability of a system suited to the patient's lifestyle;and being comparatively easy to return to work. Nonetheless, home PD patients remain at risk of peritonitis, exit-site infection, and undernutrition due to protein-losing enteropathy. Moreover, patients may feel that they have gotten wary of taking care of themselve. Recently, we have come upon a case of end-stage renal failure in a 59-year-old articular rheumatic who was unable to exchange dialysis bags because her finger joints were deformed. So, we applied a PD system using the SMAP method to the patient with the result that she became able to manage to operate the PD by herself.Our patient wished to take it upon herself to perform PD using a UV-F twin-bag system. Ordinarily, bags have to be exchanged four times a day and every time bags are exchanged, several clamping procedures are required. It was impossible for her to exchange bags because of deformed finger joints. To make the impossible possible, a supplementary device for exchanging bags had to be fixed. It was also necessary for her to learn how to manipulate the newly attached device in addition to the existing device. With the SMAP method, there is plenty of time before PD gets started. So it was possible to examine the self-management method thoroughly and learn the trick of operating the new device. Our experience showed that PD by the SMAP method is useful to articular rheumatic patients with finger joint deformities.
PUPILLARY DISTANCE ; Patients ; Peritoneal Dialysis, Continuous Ambulatory ; Fingers ; Joints

Objectives : The present study investigates the effects of body iron stores upon indices of biosynthesis and destruction of red blood cells (RBC) induced by a single session of cycling exercise.
Design : Eight sedentary female students were divided into groups depending on their body iron stores : normal (C group, n=5) and iron deficient (D group, n=3) . Blood samples were collected at five time points of before (pre), immediately after (0 hours), then 1, 3 and 6 hours after exercise (248±31 kcal, 70% V0₂ peak level) . Osmotic fragility and serum haptoglobin (hp) concentration served as of for degradation, and δ-aminolevulinate dehydratase (ALAD) activity, erythropoietin concentration and number of reticulocytes served as indices of RBC biosynthesis.
Results : A single session of cycling exercise did not affect the level of RBC, hemoglobin, hematocrit, serum iron, ferritin, transferrin saturation, hp and osmotic fragility in either groups. The δ-ALAD activity increased at 3 (p<0.05) and 6 hours (p<0.01) after exercise compared with that at 0 hours in the C group. In contrast, δ -ALAD activity in the D group was significantly lower at 3 hours after exercise than that of C group (p<0.001) . Reticulocytes and erythropoietin concentration increased gradually in the C group after exercise, but not in the D group.
Conclusions : A single session of cycling exercise under our experimental conditions enhanced RBC biosynthesis indicated by δ -ALAD activity, whereas exercise-induced hemolysis was not evident. Body iron stores affect the δ -ALAD activity induced by a single bout of cycling exercise.

Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.
To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.
When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.
A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.

  An inquiry was made into the health of 10 one-time asbestos workers now living in the southern part of Akita Prefecture who had taken screening tests for asbestosis on a regular basis. The purpose of this study was to provide pertinent information and better health support to these people at high risk of developing asbestos-related diseases. The average number of years they served as asbestos workers was 11.1±2.12 years and 29.8±4.64 years had passed sincefirst exposure. All the subjects were found to have had no idea about guarding against exposure to asbestos while at work. Neither had they been told to protect themselves from this fibrous mineral by their employers. What motivated them to take examinations for asbestosis was news reports provided by newspapers and other mass media about pulmonary disorders caused by earlier contact with asbestos fibers. Half of the subjects did not know anything about qualifications for receiving the health card for retired asbestos workers. They expressed apprehensions about their health. One subject said, “I may be taken ill anytime,” another said, “The psychological burden of always taking meticulous care of my health is overwhelming,” and still another said, “There is no way of knowing whether I am suffering from asbestosis because there is no symptom.” The latest statistics showed that the number of officially acknowledged victims of asbestos-related pulmonary diseases is increasing across the nation together with the incidence of mesothelioma. To allay the anxiety of former asbestos workers about their health, this study suggested that as the responsibilities of the medical profession, we should (1) get acquainted with the relief system and related laws, (2) help the patients maintain their quality of life by following up the their problems over a long period of time, and (3) continue research activities and make the results public so as to contribute to the relief of the patients.

In the health and welfare policy of the 21st century, the building of healthy communities in rural areas has become an urgent task. The working out of an effective strategy and supportive activities by the Japanese Association of Rural Medicine have become important. We analyzed the situation, outcome, and problems of the health projects which have been continued for the past 40-50 years in Takasu?cho in Hokkaido, Masuda-cho in Akita, Matsumoto City in Nagano and Izumo City in Shimane Prefectures. The supportive actions by hospitals and universities were assessed as a model of community-academia collaboration.

We have reported that many chrysanthemum- and lettuce-growers have dermatitis caused by juice of the leaves of these plants and that this dermatitis is caused by an allergic mechanism. In arecent questionnaire on the cause of this dermatitis, half the farmers answerd that it was due to agricultural chemicals. Therefore, we tested the farmers by skin patch tests with several widely used chemicals. In the tests, daconil gave the strongest reaction, results being positive in 60% of the farmers. Daconil was very irritative and phototoxic, the percentage of positive reactions in the patch test with 800 times diluted daconil solution of the concentration commonly used being about 30% after 48 hours and about 60% at 48 hours after peeling off the patch.
The parcentage of positive reactions in the skin patch test with several fractions of chrysanthemums on chrysanthemum-growers were significantly higher than non-farm-workers. Similary, tests with allergen extracted from lettuce showed a significantly higher percentage incidence in lettuce -growers than in other subjects. The patch test with 4000 times diluted daconil solution showed ahigher incidence in farmers than in other subjects. Therefore, 4000 times diluted daconil solution seems to cause allergic contact dermatitis in farmers, and as farmers reported, dermatitis seems to be caused by allergy to farm products, and the irritability, phototoxicity and allergenicity of TPN (Daconil).

Objective: We conducted a questionnaire survey to comprehend the situation regarding the collection, provision, and utilization of drug safety information at hospitals.  In addition, we asked pharmaceutical companies how they select medical institutions to provide drug safety information.  We also investigated the current situation of information provision to Tokyo Medial Center by pharmaceutical companies.
Method: A questionnaire was mailed to all hospitals in Japan.  The survey was conducted between January 13 and February 10, 2011.  Moreover, we asked thirteen pharmaceutical companies by telephone and e-mail about the implementation status of the provision of information and performed a survey at Tokyo Medical Center on the current situation of information provision by pharmaceutical companies regarding revisions to precaution sections in package inserts.
Results: The results of the questionnaire survey (response rate: 41.2%) showed that the major information sources for hospitals were medical representatives (77.8%), Drug Safety Update (50.3%) and direct mails (49.3%).  Furthermore, in the case of drugs prescribed exclusively for extramural dispensing, fewer hospitals responded that medical representatives of the pharmaceutical companies provided drug safety information and more hospitals responded that they did not obtain any drug safety information at all, compared with drugs listed in the hospital formularies.
Conclusion: To minimize the risks of drugs, healthcare professionals must collect a wide range of drug safety information and must utilize this information in their medical practice.  Therefore, it is important that pharmaceutical companies and regulatory authorities make an effort to provide suitable information dissemination to medical institutions.  Furthermore, medical institutions must also strengthen their systems for collecting drug safety information and providing such information to healthcare professionals.

OBJECTIVESTo investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in children and its relationship to metabolic syndrome, insulin resistance, and waist circumference (WC).

METHODSThis was a population-based cross-sectional, case-control study. Cases were selected among students of a primary and junior high school, respectively, and age- and sex-matched control subjects were selected randomly (ratio of cases to control subject was 37:113).

RESULTSOf the 846 students, aged between 6 and 15 years, enrolled in the study and screened by ultrasonography, 37 children were diagnosed as having NAFLD (score >/= 1). There was a significant sex difference in the prevalence of NAFLD(P = 0.003). The trend test revealed a strong dose-response relationship (P < 0.001) between pediatric NAFLD and the number of the proposed components of pediatric metabolic syndrome in Japan (MetS-JC), such as a clustering of the components of MetS-JC. Additionally, the linear trend of the odds ratios (ORs) with increasing percentile of the homeostasis model assessment-insulin resistance (HOMA-IR) was statistically significant (P < 0.001). However, when WC was added to the logistic model, the ORs were no longer significant, whereas WC turned out to be an independent risk factor for NAFLD regardless of the HOMA-IR index.

CONCLUSIONThe prevalence of NAFLD in children and adolescents is closely related to metabolic syndrome, insulin resistance, and WC.

We report on a case of severe generalized pain due to fibromyalgia syndrome, which was successfully treated with a variation of byakkoto. A 65-year-old Japanese woman had severe generalized pain which grew worse in warm environments, such as during the summer or when bathing. She also had pollakidipsia. We utilized a variation of byakkoto on the assumption that she was suffered from high inner heat. Her severe generalized pain resolved with this therapy. Although bushi-zai and saiko-zai are common prescriptions for fibromyalgia syndrome, byakkoto-variations may also be effective in cases where conditions are worsened by heat effect.
Fibromyalgia ; Pain ; Treated with ; Generalized aches and pains ; Syndrome

Lower limb skin ulcers due to arteriosclerosis obliterans are severe ischemic lesions, and if preservation therapies such as antiplatelet and anticoagulant treatments are not effective, lower limb amputation may be necessary.We report the case of 73 year-old male patient suffering from intermittent claudication and skin ulcers on the heel of the left foot, who was successfully treated with keishibukuryogan and daisaikoto prepared in hospital. This case suggests that improvement of micro circulation with the addition of keishibukuryogan and daisaikoto to anticoagulant and antiplatelet therapies, safely promoted an improvement of ischemic lesions due to arteriosclerosis obliterans.
Skin Ulcer ; Intermittent Claudication ; Hospitals ; seconds ; Lower