The subjects are farm housewives in two different agricultural communities of southern Tokushima Prefecture. Most of them are engaged in mixed farming on hilsides facing south. The climate is mild all the year around.
The people in the two communities, like others in the district, undergo medical checkups regularly executed under the outreach health program of our hospital.
In order to obtain data related to their way of living and working conditions, a questionnaire was conducted. In a similar way, a survey was carried out to measure the change in the attitude of the subjects toward health care after medical examination and consultation.
In Community A, the economy is largely based on orange growing in vinyl-covered hothouses and bamboo shoots. Of the housewives who responded to our survey, 87.3% said their livelihood depends chiefly on agriculture.
Working hours were longest among those in their 40s, 26.8% of whom were found suffering from anemia, in the latest health checkup.
Lower levels of neutral fat and a lower degree of albuminurea were noted among those aged 40 or under. These findings suggest that health promotion measures be taken from the standpoint of nutrition.
The latest health checkup also revealed that the health conditions remained poor among those who had given little thought to the results found in the previous group medical examination.
In Community B, agriculture is dominated by paddy rice and orange growing. But the community is suburban.
In formulating a health control program for women in Community B, emphasis should be placed on prevention of hypertension, obesity and other conditions associated with the adult disease.

The purpose of this study was to investigate the influence of a shoulder injury on rotator cuff muscle thickness and shoulder muscle strength in baseball players. Based on orthopedic medical checks performed by a doctor for 57 male collegiate baseball players, two groups, the pain-free normal group (NOR group, n=19) and the impingement test positive group (IMP group, n=17) volunteered to participate in the study. Muscle thickness of the supraspinatus, infraspinatus and posterior deltoid muscles was measured bilaterally using a B-mode ultrasound apparatus (SSD-500, Aloka) with a 5-MHz transducer. Isometric shoulder abduction strength was measured bilaterally with a hand-held dynamometer in the sitting position with the arm at 45 degrees abduction, and shoulder external and internal rotation strength were measured bilaterally with an isokinetic dynamometer in the sitting position with the upper arm at 90 degrees abduction.
When the two groups were compared, the NOR group showed significantly greater values on the dominant side than on the non-dominant side for muscle thickness of the posterior deltoid. However, the IMP group showed significantly greater values on the non-dominant side than on the dominant side of muscle thickness of the supraspinatus, the muscle strength with the abduction and external rotation (300 deg/sec) and external internal rotation strength ratio (180 deg/sec) .
Also, the IMP group had a significantly weaker dominant/non-dominant ratio of supraspinatus muscle thickness (p<0.05) and abduction strength than the NOR group (p<0.01) .
These results suggest that baseball players with positive impingement show both a morphological and functional decline in the supraspinatus muscle. The dominant side supraspinatus weakness observed in the IMP group of this study may reflect muscle atrophy and chronic fatigue.

A 33-year-old woman underwent aortic root replacement for aortic regurgitation and an aneurysm of the ascending aorta due to annuloaortic ectasia. Ehlers-Danlos syndrome was diagnosed by skin biopsy when she was 23 years old. At operation, to avoid mechanical stress to the residual aorta, cardiopulmonary bypass was established via cannulation of the left femoral artery and we used the open distal anastomosis method under hypothermic circulatory arrest with selective cerebral perfusion. Moreover, the sutures of the aortic annulus were reinforced sewing the aortic wall together. Her postoperative course was uneventful. Despite the fragility of the cardiovascular tissues in Ehlers-Danlos syndrome, cardiac surgery could be performed safely with appropriate surgical procedures.

A 45-year-old man was hospitalized with sudden-onset chest pain. He was in cardiogenic shock with a systolic pressure of 68 mmHg. His electrocardiogram (ECG) showed ST segment elevation in leads I, aVL, and V2-5. An emergency coronary angiogram (CAG) showed that the true lumens of bilateral coronary arteries were compressed, showing acute Stanford type A aortic dissection involving bilateral coronary artery. A bare metal stent was promptly implanted in the left main trunk (LMT) to restore coronary blood flow because of his hemodynamic instability. Soon afterwards, the ischemic changes on ECG disappeared and he was transferred to the operating room in a stable hemodynamic condition. We performed emergency graft replacement of the ascending aorta and coronary artery bypass grafting. The postoperative CAG showed patent bypass grafts. Implantation of LMT stent, as a bridge to surgery, should be the treatment of choice for acute type A dissection involving LMT.

We report a case of type A acute aortic dissection in a patient with situs inversus totalis. A 51-year-old man was hospitalized with sudden-onset back pain. Contrast-enhanced computed tomography revealed Stanford type A acute aortic dissection and situs inversus totalis. Total arch replacement using selective cerebral perfusion and mild hypothermic circulatory arrest was successfully performed. He was discharged home 23 days after the operation.

Objective Peritoneal lymphatic features are studied to provide necessary data for understanding transport capabilities of the endothelial and mesothelial cells. Methods Enzyme\|histochemical staining methods were employed to investigate organization of the lymphatic networks and their endothelial ultrastructures in the monkey peritoneum using light,scanning and transmission electron microscopy. Results 5' Nase positive initial lymphatics showed extensive network,obvious valve like structures and numerous blind ends.The calibre of lymphatics with extremely irregular lumen varied greatly from 40 to 120?m.Lymphatic endothelium was usually separated from mesothelium by a small quantity of loose connective tissue,or they directly contacted each other in some areas.No basal lamina occurred between the peritoneum and the lymphatics originating from milky spots in the omentum and mesovarium.Milky spots are oval or round visible bodies aggregated by macrophages and lymphocytes.Both the endothelium of lymphatic lacunae and the mesothelium that forms the peritoneal stomata,represent a strong 5' Nase activity.Abundant microfibrils attached the stomatal edge. Conclusion The distribution and structure of peritoneal initial lymphatics reveal significant regional variations,and lymphatic endothelium has a close morphological and functional relationship with the mesothelium. [