We treated a case with bilateral pneumothorax. A 58-year-old woman was treated with acupuncture on the back, neck and chest for poor general condition, and later complained chest discomfort and respiratory difficulty. She was transferred to our center. Her consciousness was clear, blood pressure was 200/110mmHg, pulse rate was 151/minute, respiration rate was 36/minute, and she presented with a cold sweat with no cyanosis, as well as respiratory sounds in both sides of her chest. Cardioechography and electrocardiogram showed no abnormality, and blood examination showed few abnormalities except leukocytosis. Arterial blood gas analysis showed pH 7.215, PaO2 118.7mmHg, and PCO2 63.9mmHg. We made a diagnosis of bilateral pneumothorax upon chest x-ray examination with information from her previous clinic, and performed bilateral thoracic drainage. Arterial blood gas then improved to pH 7.326, PaO2 181.6mmHg, and PCO2 42.8mmHg. She became asymptomatic, recovered, and was discharged on the 13th hospital day. Commonly a patient, who has complications such as pneumothorax after acupuncture therapy, is managed by doctors other than acupuncture therapists. The management of complications after acupuncture therapy is thought insufficient, and under-developed. It is necessary to qualify informed consent, and to better establish cooperation between acupuncture therapists and doctors who managing such complications.
Acupuncture ; Right and left ; Thorax ; Complications Specific to Antepartum or Postpartum ; Pneumothorax

　　We encountered a case of Japanese spotted fever in Unnan City, Shimane Prefecture. A 77-year-old woman visited our hospital complaining of fatigue. Initially, we diagnosed tsutsugamushi disease based on the constellation of presenting symptoms and clinical signs including fever, systemic erythema, and an eschar. However, the eschar was submitted for polymerase chain reaction analysis and was found to be positive for Rickettsia japonica. The final diagnosis was Japanese spotted fever. To the best of our knowledge, this is the first report of Japanese spotted fever in Unnan City, and there is a possibility that the condition has spread not only in the north of the prefecture but also in the south. This may be due to the widening habitat of ticks harboring R. japonica. Interestingly, the wild boar, a suspected vector, has expanded its habitat to the south of the prefecture. Research on the ecology of the wild boar is warranted.

Introduction: Our aim was to determine the relationship between pediatric wheezing attacks and sugarcane harvest work.

Methods: We recorded daily symptoms, including wheezing attacks, from 167 children attending kindergarten, elementary and junior high school on Minamidaito Island, Okinawa. We calculated wheezing attack frequency every two months and checked the seasonal changes. Logistic regressions were performed to examine the relationship between wheezing attacks and background factors.

Result: The collection rate of the check sheets was 62.5%. The median age was 7.5 years old, male-to-female ratio was 8:7 and the percentage of children with asthma was 36%. Wheezing attack frequency during sugarcane harvest work (January-March) had increased significantly compared with other periods. There was a number of wheezing attacks even in children without asthma.

Conclusion: There is a possibility that sugarcane harvest work is related with pediatric wheezing attacks.

Introduction : This study examines the feasibility of providing end-of-life care at a residential aged care facility using advance patient directives from the perspective of the non-medical facility staff.
Methods : Efforts were made by the facility staff to obtain advanced patient directives (APD) from 240 residents. Compliance by staff and residents in documentation of APDs for cardiopulmonary arrest (CPA) was examined.
Results : APDs were obtained from 204 residents (85%) and all responded to questions regarding end-of-life care in the facility without resuscitation or emergency transfer, indicating their autonomous wishes. Of the 204 respondents, 196 indicated preferences for both resuscitation and emergency transfer, 62% of which indicated preference for no resuscitation and no emergency transfer. No statistical differences were noted based on age, sex, or diagnoses. Fourteen residents died eight (58%) of whom received end-of-life care in the facility.
Conclusion : Non-medical staff can effectively document resident's wishes using APDs addressing clinical deterioration and CPA.