Agriculture has been reported as one of the most dangerous industries, but there are a very few statistical reports about agricultural injuries and accidents in Japan. The authors conducted analyses of agricultural injuries and accidents data from 1992 to 1995 (n=333) in Kochi, in order to discuss issues of agricultural safety and health, and the characteristics of agricultural injuries and accidents among aged farmers.
The average age of 333 patients, including 13 deaths, was 57.1 years old, and 174 patients (52.3%) were over 60 years old. One hundred and thirty seven accidents (41.4%) occurred during the period from July to September. Injuries resulting from falls topped the list with 101 patients (30.3%), followed by pinchs and involvements with 58 (17.4%), cuts and lacerations with 54 (16.2%), and slips with 36 (10.8%). The injury causes were agricultural machinery in 134 patients (40.2%), agricultural facilities in 34 (10.2%), motor vehcles in 27 (8.1%), and farm animals in 18 (5.4%). The rate of fall accidents was significantly higher among people over 60 years old than among those under 60 years old (p<0.001). The rate of serious injuries and accidents was significantly higher among people over the age of 60 than among those under the age of 60 (p<0.01).
Considering these results, effective and feasible preventions for agricultural injuies and accidents must be safety education and training, safety procedure manuals, which should be easy to understand for aged farmers, and improvements of agricultural machinery and eqiupments.

In order to protect farmers from health hazards posed by soil fumigation with methyl bromide in greenhouses, the authors monitored the concentrations of the fumigant inside greenhouses, before and after fumigation and measured occupational exposures. In the meantime, a questionnaire survey was conducted to find out the facts about working conditions, health effects and personal protective equipment in 1996.
As environmental concentrations of methyl bromide decreased from 2200ppm to 1100ppm gradually in three days, two farmers were exposed to 57ppm and 25ppm, in opening up the greenhouses, respectively, which are above ACGIH's TLV-TWA (1ppm) and OSHA's PEL-C (20ppm). The questionnaire survey (n=164) found that about 80% of the respondents have fumigated inside the whole greenhouse without mulch, above 90% have opened up greenhouses within 5 days, and that only 10% have worn effective gas masks and clothes. Regarding subjective symptoms after fumigation, 2%-6% of respondents complained about eye and respiratory tract irritation.
These results suggest that farmers might be exposed to high concentrations of methyl bromide in opening up greenhouses. In order to prevent health hazards of methyl bromide, education programs on toxic information and health effects of methyl bromide, and safety training in soil fumigation should be provided to farmers.

A 66-year-old female who complained severe abdominal pain with hemorrhagic shock underwent emergency laparotomy. Further inspection revealed a ruptured aneurysm (φ3cm) of the main trunk of the right renal artery. To avoid the prolonged hemorrhagic shock status, a right nephrectomy was performed. The pathological examination revealed the fusiform atherosclerotic aneurysm of the renal artery located at 1cm proxymal from the hilm of the right kidney. Convalescence was uneventful. In previous reports, most cases with ruptured aneurysm of the renal artery underwent the nephrectomy. Although it is important to serve the renal function, we also performed the nephrectomy to limit the duration of shock status. The procedures such as aneurysmectomy with revascularization may apply on further cases, if possible.

Five cases are reported where Daiobushi-to was used for prevention of ileus. The abdominal symptoms that had occurred daily disappeared, and ileus did not recur.
The first case was a 78-year-old female. She had had a uterine myomectomy 23 years previously, and had suffered from ileus repeatedly since then. In November of 1987, she was admitted to the emergency room of the author's hospital for abdominal pain and vomiting. Slight relief of the abdominal pain and vomiting was obtained upon administration of Daikenchu-to via enema, but the Kampo formula was changed to Daiobushi-to due to a lack of bowel movements. Progress has been normal for seven years after this.
The second case was a 34-year-old male. In 1986 he received emergency surgery for a punctured duodenal ulcer. After surgery, he experience attacks of abdominal pain that would appear and disappear. In July of 1989, he was admitted to the hospital complaining of abdominal pain and vomiting. He was diagnosed as having ileus and given a Daikenchu-to enema. Shakuyakukanzo-to-go-Daiobushi-to was also administered, and, five years later, he continues to progress well.
Case 3 was an 87-year-old male who came to the hospital complaining of repetitative ileus. In 1975 he underwent partial gastrectomy for stomach cancer. After surgery he would have to be hospitalized once or twice a year for ileus. In 1984, following unsuccessful preventative treatment, he had surgery for ileus. However, despite the surgery he continued to suffer from symptoms of ileus, finally coming to the authors' clinic in March of 1990. First, Daikenchu-to-go-shokenchu-to was administered for one year, during which ileus did not occur, but in October of 1991 he had a reccurrence requiring hospitalization in the author's department. After a Daikenchu-to enema, Daiobushi-to was administered. He has been free of recurrence for the three years since he was released from the hospital, and has continued to do well up until the present.
Case 4 was a 67-year-old female, who came to the author's department to receive treatment for recurring ileus. She had had a total hysterectomy in 1970 for uterine cancer, and had also recienved radiation therapy. Five years after surgery, she began to suffer form repetitative ileus. Now, two and a half years after commencement of Daiobushi-to administration, her progress is good.
Case 5 was a 70-year-old female who had undergone a partial gastrectomy for stomach cancer in 1992. She began to suffer from constipation after surgery, and developed ileus two months after surgery, requiring emergency hospitalization. She was given Daiobushi-to and has been progressing well for the two years since then.

It has been reported that Choto-san (diao teng san) is effective for the treatment of patients suffering from hypertension. Narrowing of the retinal arterioles is one of the important findings in hypertension.
The authors examined the pharmacological effects of Choto-san on the blood pressure and narrowing of the retinal arterioles in spontaneously hypertensive rats (SHR) and strokeprone SHR (SHRSP).
SHR and SHRSP rats (nine treatment cases and five control cases) were used. 200mg/kg/day of Choto-san was administered orally to the SHR and SHRSP for 12 weeks. After the 12 weeks of administration, the blood pressure was measured by the tailcuff method. Narrowing of the retinal arterioles was measured by the percentage ratio of the artery to vein caliber.
After three months of administration of Choto-san, the blood pressure of the SHR and SHRSP was shown to be significantly lower than that of the control. The percentage ratio of the artery to vein caliber in the treatment group was shown to be significantly higher than that of the control group SHR and SHRSP.
These findings suggest that Choto-san may lower the blood pressure and inhibit narrowing of the retinal arterioles in SHR and SHRSP.

Hypovolemia and hyperosmolality due to thermal dehydration suppress thermoregulatory responses of sweating and cutaneous vasodilation in humans, resulting in increasing a risk of heat illness. Recently, we found in young and older subjects that an ingestion of carbohydrate-protein supplement immediately after a bout of exercise during training accelerated an increase in plasma volume and an improvement of thermoregulatory responses. These results suggest that change in plasma volume alters cutaneous vasodilation and sweat rate through baroreflexes; however, no electrical signals in the efferent path of the reflex loop have not been identified. We have recently successfully recorded skin sympathetic nerve signal components synchronized and non-synchronized with cardiac cycles, separately, in passively heated young subjects, and found that although both components increased with cutaneous vasodilation and sweat rate in hyperthermia, an increase in synchronized component was suppressed by hypovolemia with suppressed cutaneous vasidilation, while an increase in non-synchronized component was not suppressed as sweat rate. On the other hand, we found that hyperosmolality suppressed the increases of both components with suppressed cutaneous vasodilation and sweat rate. These results suggest that a synchronized component controls cutaneous vasodilation while a non-synchronized component controls sweat rate, and also that beat-by-beat changes in atrial pressure due to a fluctuation of venous return to the heart varies cutaneous vasodilation through baroreflexes but not sweat rate.

Objective: The purpose of this study was to clarify the importance of therapeutic drug monitoring (TDM) at acute care hospitals using Diagnosis Procedure Combination (DPC) data.
Methods: We used DPC data from about 3,500,000 inpatients at about 950 acute care hospitals.  The investigation period was from July 2010 to December 2010.  Patients were divided into 2 groups: TDM intervention (n=22,012); and non-TDM intervention (n=26,400).  We compared the clinical indicators (length of hospital stay, payment based on performance and drug costs) and use of antimicrobials.
Results: TDM intervention was carried out in 45.5% patients for whom an anti-MRSA agent was prescribed.  The duration of anti-MRSA agent administration was significantly longer in the TDM intervention group than in the non-TDM intervention group.  The total daily cost of anti-MRSA agents was significantly lower in the TDM intervention group than in the non-TDM intervention group.
Conclusion: Our results suggest that TDM intervention is often performed for seriously ill patients who require continuous treatment.  TDM intervention may prevent adverse reactions as a result of adjusting the dosage of the anti-MRSA agent.