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.

The patient was a 44-year-old male, who had undergone hemodialysis for these 13 years. He underwent combined aortic and mitral valve replacement for aortic and mitral regurgitation due to infectious endocarditis. Operative findings included torn chorda of the mitral valve associated with perivalvular abscess and perforation of a non-coronary aortic cusp. Double valve replacement was performed with mechanical prosthetic valves. We used continuous hemodiafiltration (CHDF) for his perioperative renal management. Nafamostat mesilate was applied to the CHDF circuit as anti-coagulant therapy. Serum creatinin, urea nitrogen and potassium were maintained at the optimal level. CHDF was continued until the twelfth day after operation, and maintainace hemodialysis was re-started thereafter. CHDF is widely accepted for blood purification in the intensive care unit, and applied safely even in patients with unstable hemodynamic conditions. we considered that CHDF might have helped to avoid multiple organic failure in this case.

We report a 78-year-old man who had an impending ruptured atherosclerotic arch aneurysm combined with chronic dissecting ascending aortic aneurysm. The patient underwent a graft replacement of the ascending aorta and aortic arch using the elephant trunk method with the aid of profound hypothermia and continuous retrograde cerebral perfusion. Cerebral blood velocity was measured with transcranial Doppler (TCD) during operation. The TCD flow pattern after weaning of cardiopulmonary bypass indicated a state of brain edema. Therefore it is important in extensive retrograde cerebral perfusion to control the perfusion pressure and prevent destruction of the blood brain barrier aggressively. Pharmacological intervention could improve the safety of retrograde cerebral perfusion. Postoperative diagnostic images showed that the part of the distal anastomosis around the elephant trunk was not surrounded with thrombus. At this stage, it is not necessary to perform next extensive aortic replacement. It is important to consider the occurrence of complication, who using elephant trunk method, including paraplegia, thromboembolism, kinking of prothesis.

The changes of hemodynamics during bathing in patients with heart diseases were studied by invasive methods using a Swan-Ganz catheter and UCG. As a population, we have used 37 peatients with heart disease, ages 20 to 76 (average age 52.9). There were 26 cases of myocardial infarction, 5 cases of valvular disease, 5 cases of cardiomyo pathy, and 1 case of VSD. Bathing was done with tap water in a Hubbard tank, for 10 minutes at 40°C and for 5 minutes at 43°C in a supine position. Arterial pressure, heart rate, pulmonary arterial pressure, pulmonary wedge pressure, right atrial pressure, cardiac output, stroke volume and stroke work index were increased during bathing and decreased after bathing. Systemic vascular resistance and pulmonary arteriolar resistance were decreased during bathing. Their changes were marked with a bath of 40 to 43°C. These findings suggest that preload may be increased during bathing, and preload and afterload reduced after bathing. Hydrostatic pressure, autonomic nervous reflexes or endocrine system were thought of as possible reasons for the increase in pulmonary arterial pressure. Because pulmonary arterial pressure, pulmonary wedge pressure and right atrial pressure increased during bathing even though systemic vascular resistance and pulmonary arteriolar resistance decreased, increase in venous return was thought of as the biggest possibility. And because the patients with low cardiac function could not control the extent of increase in venous return, pulmonary arterial pressure increased markedly in patients with low cardiac function. The patients with myocardial infarction were classifed into a group showing elevation of pulmonary arterial pressure (PAP) and a group showing no elevation of PAP. The group showing elevation of PAP, compared with that without PAP elevation, included many cases of severe myocardial infarction deter-mined by Forrester's classification, Killip's classification and Peel's prognostic index at admission to hospital. Among these patients showing PAP elevation, there were more cases having low physical work capacity and low ejection fraction at discharge from hospital than among the patients without PAP elevation.

Hot water extract of adlay (Coix lachryma-jobi L. var. ma-yuen Stapf) seed, commonly called Yokuinin, has been used as herbal medicine for treating verruca vulgaris, et al. Although there have been a number of studies on the usefulness of Yokuinin, the pharmacological assessment of its husk, pellicle, and astringent skin remains unclear. In this line, we evaluated the effect of methanol extract from all parts of adlay grain (seed, husk, pellicle, astringent skin) on cancer cells and identified its useful chemical components. Results revealed that a fraction of the extract have weak growth-suppressing activity on human cervical cancer cell line (HeLa cell). In particular, 5,7-dihydroxychromone and coixol were isolated and identified from the active fraction. This indicates the possible cancer chemopreventive efficacy of methanol extract from adlay. Moreover, further tests are needed to determine the role of 5,7-dihydroxychromone.

Farmers are constantly exposed to the hazards of agrochemicals. Especially those who regularly spray their fields with pesticides are at high risk of being contracted with pesticideinduced maladies.
During the three-year period from 1980 to 1982, health examinations were conducted, covering a total of 1, 164 pesticide sprayers in eight rural communities, Miye Prefecture. Of the number, 869 were women. Mercury residues in hair were also measured.
The findings are as follows:
1. Abnormal lipid metabolism topped the list of disorders, followed by hypertension, ECG abnormalities, anemia, albuminuria and liver dysfunction in that order.
2. The rates of detection of these abnormalities were not particularly high as compared with those in ordinary health checkups.
3. When compared with previous findings, the cases of abnormal lipid metabolism and anemia decreased in number both in men and women, whereas the cases of abnormal cholinesterase activities and albuminuria increased in both sexes.
4. The majority of pesticides used by the farmers were organophosphorous.
5. The average level of mercury residues in hair was 5.35 ppm for men and 2.97 for women. 6. More than 6.0 ppm of mercury were detected in 23.1 % of the men and 1.9% of the women. None were found to carry more than 20 ppm of mercury in their hair.

A 66-year-old man with an unknown medical history developed chest pain and a diagnosis of acute myocardial infarction (AMI) was given by his physician. Percutaneous coronary intervention was performed in the left anterior descending artery. Echocardiography revealed ventricular septal perforation (VSP) ; therefore, the patient was transferred to our hospital. After admission, his platelet count dropped rapidly during heparin administration, and left ventricular thrombosis and deep vein thrombosis were noted, raising a suspicion of heparin-induced thrombocytopenia (HIT). To establish cardiopulmonary bypass, argatroban alone was insufficient to prolong the Powered by Editorial Manager^® and ProduXion Manager^® from the Aries Systems Corporation activated clotting time (ACT) ; thus, nafamostat mesilate was also used for coronary artery bypass grafting and surgical repair of VSP. It took many hours to normalize the ACT, requiring re-exploration for excessive bleeding. On the 37th postoperative day, the patient was transferred to another hospital. We performed cardiac surgical procedures using argatroban in a patient who developed HIT during the course of VSP following AMI ; however, we had difficulty in controlling the ACT. Since, to the best of our knowledge, there are no previous studies reporting surgical case of VSP complicated by HIT, we present this case with a review of the relevant literature.