We have carried out a health developing project for three years at two flat rural areas in Ibaraki prefecture, O in Ushiku town and N in Iwai city, taking female farmers as the subjects.
As a result, people in these areas obtained by developing reciprocal assistance a belief in selfsupport and knowledge of diseases, which lead to remarkable progress of their health such as improvement of nutrition and cosolidation of agricultural and life environment. Some observations in the study are discussed below.
1) In the two areas, the number of people with no abnormality increased while those requiring care decreased, The number of people to be treated or under treatment was nearly unchanged, probably because of chronic deseases. No death and complication occured during the three years.
2) Owing to the difference between O and N areas in the age structure of examinees, areal characteristics and types of agricultural products, the results of health examinations in these two areas were somewhat different.
3) The health developing project will become more effective if male farmers participate together with the female farmers.
4) Continuation of the health care activity in these areas will establish voluntary organizations of residents.

Introduction: This study evaluated the effectiveness of co-management of the neurosurgery department by general physicians.Methods: A retrospective observational study was conducted in a tertiary hospital. Length of stay, in-hospital mortality, number of transfers to the intensive care unit (ICU) due to emergency medical problems, prescription sharing ratio with neurosurgeon, and impression reported by nurses were evaluated by comparing one year before and after the co-management of the neurosurgery department was initiated.Results: Length of stay (Median 14 days, 14 days), mortality rate (7.58%, 5.75%) and transfer rate for ICU (3.23%, 1.94%) were not significantly different between one year before and one year after, respectively. Subgroup analysis of patients over 70 years of age hospitalized for cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage showed that the number of patients transferred to the ICU due to medical problems associated with internal medicine significantly decreased (P = 0.04). A general physician was responsible for half of the prescriptions. The nurse's report was highly positive.Conclusion: Co-management of the neurosurgery department by general physicians did not have a significant effect on reducing length of stay or mortality rate; however, we found a decrease in the number of patients transferred to the ICU due to medical problems among elderly stroke patients.

Magnification of the surgical field is considered an essential technique for performing accurate surgery on small caliber arteries. For this reason, we use the transmicroscopic technique of vascular surgery on the tibial arteries. We obtained good results in long term patency. Our experience and results in bypass grafting to the tibial artery using a microscope are reported. Forty-four tibial artery bypasses using transmicroscopic techniques were performed in 38 consecutive patients between June 1984 and December 1992. Twenty-seven patients had arteriosclerosis obliterans, 5 had thromboangitis obliterans, 5 had acute arterial occlusion and 1 had traumatic vascular injury. Patient ages ranged from 37 to 78 years old. Thirty-five were men and 3 were women. Twenty-six surgeries were performed for limb threatening and 14 were for disabling claudication. All patients were examined with conventional aortic lower extremity angiography preoperatively. The reversed saphenous vein was used in 38, in-situ saphenous vein in 3 and composite vein to vein graft in 2. All distal anastomoses were performed by the transmicroscopic technique. Continuous sutures were used for recipient vessels larger than 1.0mm in diameter. However interrupted 8-0 sutures were chosen for smaller vessels. Distal anastomosis was made at the proximal portion of the tibial artery in 24 cases, while the distal portion of the tibial artery was used in 20 cases. On preoperative angiography, the condition of the tibial arteries affected the patency rate when runoff was poor or fair. Nine cases were judged to have “poor” runoff. Three of these became occluded during the early postoperative period, and 1 during the late phase. Eight cases were judged to have “fair” runoff. One of these became occluded during the early postoperative period, and 3 during the late phase. There were no graft failures identified throughout the follow-up period in patients with good runoff. Cumulative patency rates were 86.2% after 1 year, 79.0% after 5 years, and 67.7% after 8 years, respectively. The patency rate of the 24 grafts in which distal anastomosis was performed on the proximal tibial artery was 71. 4% after 5 years. The patency rate of the 20 grafts on the distal tibial artery was 93.3% after 5 years. There was no significant difference observed in the patency of these two groups. Hospital mortality was 2.6%. Femorotibial bypass using transmicroscopic technique could save severely ischemic limbs while maintaining hospital mortality at a low level and reducing limb loss. The advantage of microscopic surgery is achieving fine observation because the magnification level is changeable, depending on the field needed. In anastomosis of small caliber vessels like the tibial artery, magnification by 10 times is important to observe the characteristics of the intima of the recipient artery. Subsequently, the procedure is performed by transmicroscopic techniques under magnification by 5 times, which provides much higher accuracy for suture than surgical loupe. High magnification prevents intraoperative technical error and unexpected injury.

We began gastric mass survey at our hospital in May, 1980. During 3 years and 8 months since then, (May, 1980-December, 1983) we performed screening examinations to 16, 341 people by indirect radiography, and checked 2, 824 cases (17.3%) for thorough examination. Among these cases, 2, 083 (73.8%) received endoscopic examination actually, and 55 cases of gastric cancer were discovered. The discovery rate of gastric cancer was 0.336 per cent.
35 cases of these 55 gastric cancer were operated in the surgical department of our hospital. 34 cases were resected (rate of resection was 97.1%) and 33 cases were resected curatively (rate of curative resection was 94.3%). These results were better than that of gastric cancer cases from out-patient clinic of the same period. The results of cases from out-patient clinic of our hospital were: total number of cases 321, resected cases 254 (79.1%), curative resection 189 cases (58.9%), respectively.

The authors' developed a new methods of preparing and inserting intradermal needles for small experimental animals.
To create the new type of needle, the tip of a filiform needle (0.14mm in diameter) was pinched into a wavy shape using mosquito forceps. A length of about 1.5mm of this wavy section was then cut off and used as an intradermal needle.
Designated areas of the mice were depilated, and the acupoints marked. For insertion, an injection needle (27 gauge) was used to penetrate directly beneath the marked point, starting from slightly above the marking. The wavy needle was then inserted into the tip of the injection needle and a filiform needle (0.18mm in diameter; adjusted length) used to push the wavy needle out, thereby inserting it into the intended point.
Using this method, insertion of the needles was easily carried out, and they stayed in places. This method therefore seems to be highly applicable for the insertion of intradermal needles in experimental animals.

Background/Aims: Crohn’s disease is a chronic disorder; therefore, it is essential to investigate long-term safety and efficacy of treatments. This study assessed the safety and effectiveness of adalimumab for up to 3 years in Japanese patients with Crohn’s disease in real-world settings. Methods: This was a multicenter, single-cohort, observational study of patients with Crohn’s disease. Safety assessments included incidence of adverse drug reactions. Effectiveness assessments included clinical remission, mucosal healing, and Work Productivity and Activity Impairment (WPAI). Results: The safety and effectiveness analysis populations comprised 389 and 310 patients, respectively. Mean (standard deviation) exposure to adalimumab in the safety analysis population was 793.4 (402.8) days, with a 58.1% retention rate. A total of 105 patients (27.0%) and 43 patients (11.1%) experienced adverse drug reactions and serious adverse drug reactions, respectively, with no patient reporting tuberculosis or hepatitis B. Infections and serious infections were reported in 37 patients (9.5%) and 17 patients (4.4%), respectively. Malignancy was reported as an adverse drug reaction in 2 patients (0.5%). Remission rate increased from 37.8% (98/259) at baseline to 73.9% (167/226) at week 4 and remained > 70% over 3 years. Proportion of patients without mucosal ulcerations increased from 2.7% (2/73) at baseline to 42.3% (11/26) between years > 2 to ≤ 3. WPAI improvement started at 4 weeks, with the overall work impairment score improving from 42.7 (n = 102) at baseline to 26.9 (n = 84) at 4 weeks. Conclusions Results from this study confirm the long-term safety and effectiveness of adalimumab treatment in Japanese patients with Crohn’s disease in the real-world setting.

Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.