The present study examined the effects of having bigger amount of protein than usual in competitive season on lean body weight (LBW), cross-sectional area of thigh and abdomen, muscle strengths, blood constituents and urinary urea nitrogen. Seventeen male varsity throwers (javelin, discus, hammer and shot put) ranging from 19 to 22 years of age, were divided into two groups ; Group A (N=9) with a more protein diet (2.1 g·kg^-1·d^-1), and Group B (N=8) with a usual amount diet (1.5 g·kg^-1·d^-1) . The experimental period was 62 days. During this period, they practiced six days a week. Three days were for throwing practice. Other three days were for weight training. All subjects lived in the same dormitory, and their life styles were similar to each other. The averaged daily diet of Group A evaluated by means of a weighing method had 3824 kcal with 175 g of protein (2.0 g·kg^-1·d^-1), 115 g of fat and 552 g of carbohydrate. The averaged daily diet of Group B had 3441 kcal with 130 g of protein (1.5 g·kg^-1·d^-1), 76 g of fat and 559 g of carbohydrate. All the intakes of vitamins (A, B₁, B₂, C) and minerals (calcium and iron) of the diet of each group were higher than the Japanese recommended dietary allowance. After the period, body weight, %fat, fat and LBW of both groups did not change significantly. Muscle strengths and cross-sectional areas in abdomen and thigh of both groups did not change significantly. Urinary urea nitrogen of both groups did not change significantly. Blood constituents (RBC, Hb, Ht, TP, Alb, BUN) of each group were still in normal ranges in spite of significant changes. No significant changes in body composition and muscle strengths were found in each group. These results, therefore, indicated that the more protein diet (2.0 g·kg^-1·d^-1) was not effective for increasing LBW and muscle strength of varsity throwers in competitive season.

A 74-year-old man had a right common iliac aneurysm perforating into his inferior vena cava. He showed a pulsating abdominal mass, claudication of the right leg and swelling of both legs. The fistula was preoperatively diagnosed by aortography. The fistula was closed with two interrupted 3-0 monofilament sutures with pledgets within the aneurysm, by clamping all vessels communicating to it. The aneurysm was replaced with a Y-shaped Dacron graft. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day without any leg claudication or swelling of the legs. This complication is rare, with only 7 such reports in Japan. It should be surgically managed as soon as the diagnosis is confirmed. Clamping all vessels communicating to the fistula in closing it is a safe and reliable approach.

An 87-year-old woman with unknown fever origin was admitted to our internal department. We could not determine the fever origin from clinical findings, serious blood data, urine data, bacteriological data, and images obtained by ultrasonography, computed tomography and magnetic resonance. Body inflammatory findings did not respond to several antibiotics we used. Gallium scintiphotography revealed abnormal radioisotope uptake in the bilateral inguinal region. And ultrasonography and enhanced computed tomography showed tumors in front of the bilateral femur neck. Moreover, bone scintiphotography (^99mTc) revealed abnormal radioisotope uptake in the bilateral hip joints. We performed resection of the right inguinal tumor. The tumor was solid mass 30×20×20mm in size. It was covered with an articular capsule in front of the right femur neck. We identified the mass as bilateral tuberculous granulation with Langhans-type giant cells pathologically. It was only with difficulty that we firmly diagnosed the case as tuberculous arthritis of bilateral hip joints because the fever origin was unknown. It is important to diagnose tuberculous arthritis by use of various imaging techniques. We should take tuberculous infection into consideration when we encounter a case of arthritis of unknown fever origin or a case of antibiotics resistant arthritis.

Upper gastrointestinal endoscopy is an invasive examination. Cardiovascular and respiratory adverse effects are commonly observed in patients undergoing endoscopy. We investigated prospectively the cardiovascular and respiratory changes every oneminute before, during and after routine endoscopy. Sixteen healthy adult patients were enrolled in this study. Systolic blood pressure, diastolic blood pressure, pulse rate and percutaneous arterial oxygen saturation (SpO₂) were recorded every one-minute throughout the procedure. Systolic and diastolic blood pressure increased significantly one minute after the insertion of the endoscope. Increases in pulse rate were noted after the insertion of the endoscope. Rate pressure product increased significantly one minute after the insertion of the endoscope. No significant change in SpO₂ was observed during endoscopy. Our results indicated that upper gastrointestinal endoscopy might induce cardiovascular stress and abnormality. Therefore, we should carefully insert and manipulate upper gastrointestinal endoscope.

　　With the introduction of the diagnosis procedure combination (DPC) system, the reduction of the health expenditure is expected. The use of generic drugs is promoted. It is imperative for introduction of generic drugs to assure the appropriate use of drugs to decrease medical costs without reducing medical services. Additionally, we should make a concerted effort to prevent the injudicious use of antimicrobial agents resulting in the emergence of drug resistance. In this study, we assessed the effects of switching to generic antimicrobial drugs on drug purchases cost, AUD (antimicrobial use density), hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. This study was carried out at Yashima General Hospital for the period from April 2008 to September 2011. The Health, Labor and Welfare Ministry designated Yashima General Hospital as a DPC hospital from July 2009. Since the DPC introduction, the drug purchase cost has been decreased about 40% without reduction of AUD, hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. Hospitals are making efforts to assess and improve management efficiency while maintaining the quality of medical care. Our results suggested that the introduction of generic drugs with assessment of efficacy may be one of the useful methods for pharmacy management.

A dermatitis of unknown etiology has occurred among the farmers working in paddyfields in some districts of Tokushima Prefecture, such as Anan, Kainan and Komatsujima.
The dermatitis occurs from March to May when rice-planting and weeding are on and is characterized by erythemato-papulo-vesicular eruptions accompanied with severe itching. The chief symptoms are observed on the parts exposed to water, especially on forearms and lower legs. The results of the epidemiologicaland clinical observations indicated that the dermatitis was due to the invasion of cercariae of an avian schistosome.
The investigation for snail intermediate hosts was carried out in the paddy fields where the dermatitis occurred.
Cercariae of apharyngeal furcocercous type were detected from the fresh water snails (Austropeplea ollula) which were collected most abundantly from the paddy fields during the season of occurence of the dermatitis.
The cercaria wasidentified as species belonging to the genus Trichobilharzia and was regarded as the same species as so far described in Saitama Prefecture by Suzuki et al (1973).
An experimental infection with the cercaria was performed. A few drops of watercontaining cercariae was placed on the fore-arm of. a voluntor. The cercariae invaded into the skin and produced a dermatitis quite similar to that prevailing in the endemic areas.
Therefore, it was concluded that theetiological agent was the cercaria of a species of an avian schistosome.

An epidemiological study reported that low serum cholesterol is one of the causes of cerebral hemorrhage. Furthermore, differences in the Apoprotein E (ApoE) genotype influence the amount of low density lipoprotein in serum. The value of standardized mortality ratio (SMR) for cerebral hemorrhage or infarction in residents of Kikai island (KI) is higher or lower than 100, respectively. The aim of this educational activity is to assess whether our lectures on “prevention of stroke” ─(1) relationship between cholesterol and stroke, (2) test items involved in cholesterol of serum and role of lipoprotein, (3) relationship between gene and disease, and (4) prevention of disease by diet─were effective for junior high-school students (JHS) in KI. To be improve their understanding of lecture (3), we performed genetic analysis (for ApoE polymorphism) using DNA extracted from their hair roots. Although we also conducted lectures after the results of the analysis, the pretest (40.7%) and posttest (50.0%) indicated that lecture (3) had been difficult for JHS. The total scores for the posttests for second- and third-year JHS (72.5% and 80.3%, respectively) were significantly higher than those for the pretests for second- and third-year JHS (49.6% and 55.9%, respectively). However, for first-year JHS, the total scores for posttests (63.0%) and pretests (61.7%) were not significantly different. Based on these results, we concluded that our lectures facilitated a substantial understanding about the “prevention of stroke” among JHS and were educationally beneficial for second- and third-year JHS, in particular.

As regards to low back pain of agricultural worker, there are many problems still as to a syndrom of “Nofusho” in rural medicine, a disease in ocupational medicine and clinic of orthopedic.
Agricultural worker who complained of low back pain varies with their country and farm products, and it tend to increase with adding to their age. Further, the female rate of low back pain showed slightly high tendency than the made rate, 8.5-12.5 % of male, 6.5-13.4 % of female always complained of low back pain.
According to the findings of roentogenographic examination of back bone, the deformed vertebrae was found clearly, especially, low back pain caused by a trauma of soft tissue and iscogenic pain showed in farmers. Therefor, it is necessary to be improved working posture and condition.
In comparrison with non-farmer, it is located in order of truck drivers. bus drivers and repairmen.

With the advancement and complexity on present society it has been called the “age of depression”. One gets the feeling that depression, following a singular path of increase in recent years is one sort of “sickness of the era”. This time we conducted a screening test for masked depression, selected those showing such a tendency, and here report the remarkable improvement in a short period of time the condition of depression using acupuncture.
Method: Nakajima's test for masked depression (abbr MD test) was carried out on students from Meiji special school of Oriental Medicine and Meiji Junior College of Acupuncture and Moxibustion and screened 65 subjects with depression tendencies. Twenty-seven of these 65 subjects were randomly selected and divided into two groups of 16 in “actual group” and 11 in “placebo group”. Acupuncture method: In the actual group six acupoints that commonly applied on the psychic disease were used as follows; HYAKUE (GV 20), SHINCHU (GV 12), SHIN-YU (BL 15), KOKETSU (CV 14), SHINMON (HT 7) and SAN-INKO (SP 6) and the other hand in the placebo group five acupoints close to these in the former group but which are not directly related to psychic disease were applied as follows; TOH-DO (GV 13), FU-MON (BL 12), SUIBUN (CV 9), GEREN (LI 8) and KENSYO (GB 39). Acupuncture was performed for 10 minutes stationally by using gold needle (0.20mm wide, 40mm length) and was undertaken three times in a week for four weeks. Its clinical effect was evaluated by the MD test and the CMI test every two weeks.
Results: 1) In the actual group the score on the MD test averaged out to a return to normal range within two weeks whereas in the placebo group even after four weeks the score still remained in the sphere of depression.
2) In the actual group a 80% of the subjects showed in area IV (the sphere of neurosis) on the CMI test was resistant to the therapy. Even they did not relieve into the sphere of normality.
3) The acupuncture therapy indicated a tendency to the improvement of both physical and psychic symptoms in the actual group.
Conclusion: It was demonstrated that the acupuncture therapy applying acupoints suitable for psychic disease brought rappydly improvement of not only psychic symptoms but also physical symptoms and then gave a relief from the condition of depression.

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.