This is the third report of the findings of the investigation we made in Tokushima Prefecture as part of a joint research project designed to work up measures against the problems of the elderly with urinary incontinence in rural areas. The project, led by Dr.Kazunori Sugiyama, was commissioned by the National Mutual Insurance Federation of Agricultural Cooperatives (Zenkyoren).
The two previously published reports dealt with (1) independence of the elderly in rural community and urination trouble and (2) urinary incontinence in the elderly populace of a rural area.
Of the elderly men living at home, 20.5% was found to have urinary incontinence and a further 14.4% complained about difficulty in urinating. Those who registered an IPSS count of 10 or over accounted for 20.1% of the urinary incontinent persons. The IPSS showed a tendency to go up with advancing age. To be noted was the fact that there is a regional difference in the average score. It was lower in the mountain villages than in the flat-land farming areas. This suggested that the incidence of prostatic hypertrophy may be low in the mountain villages than in the flat-land areas.
In prostate examination, the use of IPSS is helpful in screening for enlargement of the prostate to some extend. More clinically dependable tools are ultrasonography, cystourethroscopy (cystoscopy) and uroflowmetry. However, whether these tools should be introduced for first-line screening is debatable.
In contrast, blood tests that measure levels of PSA and PAP are not only effective but also feasible for mass screening. Thus, the authors would like to recommend their immediate implementation in health screening programs for the elderly.

A 75-year-old male visited Fuchu general hospital on foot because of possible acute mushroom poisoning. He had no symptom on admission. He twice ate some toxic mushrooms for lunch and for dinner on the previous day with his wife, who was found dead in her bed on the morning of his admission. A legally ordered autopsy was held on his wife, and a-amanitin was detected in her liver, brain and blood samples. Detection of a-amanitin in blood samples has never been reported in the literature. His liver and kidney failure rapidly progressed. He died on the 10th hospital day despite intensive treatment including hemodialysis and plasma exchange. On histological examination, his necropsy liver specimen revealed massive liver necrosis and new growth of pseudocholangioles, which apparently bore testimony to acute toxic mushroom poisoning.