In this report we surveyed 548 cases of combine accidents which had occurred in the perefecture of Toyama from 1970 to 1975 gathering information mainly from medical facilities and analyzed its causes.
In analyzing the causes, we classified them into 7 groups. They were 3 groups as a single factor-machine factor, environment factor, and human factor-and 3 groups as a complex cause of two factors-machine-human factor, machine-environment factor and environment-human factor and 1 group as a complex cause of three factorsmachine-environment-human factor.
The contents were summarized as follows.
1. The machine-human factor accounted for the greater percentage 69.4%, human factor 14.2%, machine-environment- human factor 10.0%.
2. As for the machine-human factor, unsafety equipment-unsafe act accounted for 48.9%, imperfect functionunsafe act 32.4%. Much of these accidents relating to this factor were due to unsafe act of operators and unsafety equipment and imperfect function of machine.
3. As for the human factor, the accidents caused by unsafe act of operators accounted for the largest percentage 80.7%, subsconscious accidents by unsafe age (by persons unfitted for its operation because of their age) 16.7% and those by unsafe personal protective equipments 2.6%.
4. As for the environment-human factor, the accidents caused by the unsafe time-unsafe act accounted for 37.5% and unsafe location-unsafe act 25.0%. That is to say, much of the accidents due to this factor occurred when the bad environment of the sunset and unsafe location were related to the unsafe act of operators.
5. When tne combine accidents were classified by the part of the machine which was direct causer of injuries, those by feed-chain accounted for 38.3%, chopper 33.9%, belt 17.9%. As for the machine factor, feed-chain accidents caused by the unsafety equipment accounted for 30.6%, chopper accidents by the imperfect function 68.5% and belt accidents by unsafety equipment 87.0%, the largest percentage.

The effect of non-noxious and noxious stimulation of various skin areas on peristaltic movements of the ureter was examined in anesthetized rats. Experiments were performed on 17 rats anesthetized with urethane-chloralose under artificial respiration. Peristaltic movements of the ureter were continuously recorded by means of an electromyogram recording technique on a polygraph, and either pinching or brushing mechanical stimulation for one minute was delivered to a skin area such as neck, chest, abdomen, perineum or hindpaw.
Under the resting condition without cutaneous stimulation, regular peristaltic movements of the ureter at a frequency of 18+1/min (mean+S. E.) were observed. The frequency of these peristaltic movements was often increased significantly by noxious cutaneous stimulation to hindpaw, perineum or chest, while it was sometimes excited by the noxious stimulation to the other area, such as neck and abdomen. The non-noxious stimulation of various skin areas, however, did not influence these movements.
The increased frequency of the ureteral movements by pinching of hindpaw, perineum or chest after bilaterally sectioning vagal, hypogastric or pelvic nerves persisted, but were totally abolished after bilaterally sectioning splanchnic nerves.
It is suggested that splanchnic nerves play a substantially important role as a efferent arc in production of the reflex response of peristaltic movements of the ureter following the cutaneous noxious stimulation.

Objectives : Muscle imbalance poses a problem for adequate motor function in patients with cerebral palsy. The adductor and flexor muscles around the hip become dominant, leading to a high risk of hip dislocation. When left untreated, flexion and adduction contracture progresses, leading to various impairments ; hence, it is important to undertake preventive measures at an early stage. Selective muscle release is one form of surgical treatment that has been proven effective, but there is no consensus on the timing of the surgery. Here, we investigated the difference in outcome after muscle release surgery with respect to age. Subjects and methods : The subjects were 26 patients (52 hips) from our medical center who underwent muscle release (partial modification of Matsuo's method) around the hip and were followed up for at least 6 months. Abduction was retained postoperatively by using a cast or prosthetic device. Migration percentage (MP) was measured by simple hip radiography image, and the rates of improvement (preoperative MP . final MP during observation/preoperative MP ×100%) were compared. Results : Higher rates of improvement were observed among patients aged 5 years or less at the time of surgery than those among patients aged 6 years or more. Conclusion : We consider that surgery performed at the age of 5 years or less could lead to favorable results.

A 68-year-old female who had suffered from lumbar vertebral fractures due to osteoporosis six years before was admitted to our hospital because of thoracodorsal pain of an unknown origin, and systemic contact dermatitis, on November 2000. The patient had been forced into a bedridden state due to severe pain. A bone scintigram showed multiple high accumulations in the thoracispinal region, but malignant disease could not be detected. Furthermore, a MRI demonstrated multiple thoracolumber vertebral compression fractures. Keishi-bushi-to was administered to control severe and superficial pain, and the presence of cold limbs. Pain was gradually diminished and the patient could be started on rehabilitation one month after treatment. Furthermore, several Kampo formulas, such as Ogi-kenchu-to, Keikyososo-oshinbu-to and Hachimi-jio-gan were administered on the basis of pain and skin condition. In the end, the patient could stand up with support eleven months after treatment.
Based on this experience, it is suggested that Keishi-bushi-to may be an effective treatment for severe pain arising from multiple fractures with osteoporosis.

The reflex mechanisms of the responses in heart rate elicited by acupuncture stimulation in anesthetized rats were examined. An acupuncture needle measuring 160μmin diameter was inserted into skin and the underlying muscles to the hindlimb to a depth of about 5mm and was twisted once every second for 1min. A decrease in the heart rate was observed in 55% of 22 trials and in 70% of 20 trials when muscles separated from the overlying skin were stimulated. The response was abolished completely by cutting the femoral and sciatic nerves. The response was not influenced by transecting of the bilateral vagi but was totally abolished by transecting of the cardiac sympathetic nerves. Therefore, we conclude that the decrease in heart rate elicited by acupuncture stimulation of a hindlimb is based on a somato-autonomic reflex, in which the afferent pathway is composed of hindlimb muscle afferents and the efferent pathway is composed of cardiac sympathetic nerves.

The effect of moxibustion on duodenal motility was examined. Duodenal motility was measured by the balloon method in anesthetized, artificially ventilated rats. The stimulation temperature and duration of moxibustion varied. Treatments were applied to the hind paw and abdomen.
The duodenal motility exhibited an excited response by pinch stimulation of hind paw, and inhibitory response by abdominal pinch stimulation. Duodenal motility did not show any response to indirect moxibustion stimulation of the hind paw and abdomen. Duodenal motility exhibited an excited response by direct application of moxibustion to the hind paw and an inhibitory response by direct application of moxibustion to the abdomen.

Morphine is the only opioid that has been found effective for the relief of dyspnea in cancer patients. However, efficacy has not been fully demonstrated for other opioids such as fentanyl. Here, we report a case of lung cancer in which the use of fentanyl was effective for the relief of dyspnea. The patient was an 88-year-old man who had cT4N2M0, cStage IIIB lung cancer with right bronchial involvement and mediastinal lymph node metastases. Although the patient complained of dyspnea, he was not given morphine due to underlying renal dysfunction. He instead received oxygen therapy, and treatment with oral steroids and oxycodone. As oral administration became more difficult with subsequent lung cancer progression, the patient underwent opioid switching from oxycodone to subcutaneous injections of fentanyl. Dyspnea was not exacerbated following the switching, and was thereafter effectively managed by increasing the fentanyl dose and using rescue medication. Fentanyl is suggested to be a possible therapeutic option for dyspnea in cases where the use of morphine is difficult.

Background & Objective: It is well established that the effectiveness of vagus nerve stimulation (VNS) therapy increases over 2-3 years. When increasing the dose of VNS, some patients were noted to respond even at low-dose stimulation in the first few months. The purpose of this study was to evaluate the relationship between an initial response to VNS and long-term response in a retrospective study of patients with intractable epilepsy. Method: We retrospectively analysed 56 patients who had VNS implantation in our centre. All patients had undergone complete presurgical evaluation. After implantation, the patients were examined at regular intervals of one month for 6-9 months and then followed up regularly for more than 2 years. Their seizure frequency and intensity were documented in their seizure logs. Results: Six patients achieved Engel class I (11%) seizure outcome, 16 achieved Engel class II (28%), and 19 achieved Engel class III (34%). Of the 22 patients with Engel I and II, the 19 in Engel class I (100%) and II (81%) showed an initial response within 6 months, an earlyonset response of VNS implantation. Conclusions: Early-onset response could be an independent predictor for achievement of Engel class I and II in long-term follow-up. Keyword: Background & Objective: It is well established that the effectiveness of vagus nerve stimulation (VNS) therapy increases over 2-3 years. When increasing the dose of VNS, some patients were noted to respond even at low-dose stimulation in the first few months. The purpose of this study was to evaluate the relationship between an initial response to VNS and long-term response in a retrospective study of patients with intractable epilepsy. Method: We retrospectively analysed 56 patients who had VNS implantation in our centre. All patients had undergone complete presurgical evaluation. After implantation, the patients were examined at regular intervals of one month for 6-9 months and then followed up regularly for more than 2 years. Their seizure frequency and intensity were documented in their seizure logs. Results: Six patients achieved Engel class I (11%) seizure outcome, 16 achieved Engel class II (28%), and 19 achieved Engel class III (34%). Of the 22 patients with Engel I and II, the 19 in Engel class I (100%) and II (81%) showed an initial response within 6 months, an earlyonset response of VNS implantation. Conclusions: Early-onset response could be an independent predictor for achievement of Engel class I and II in long-term follow-up. Keyword: Vagus nerve stimulation, long term outcome, early onset response, predictor, epilepsy