1.A Survey on the Health Status and the Living Environment of Nepalese in Kathmandu Valley
Hiroshi Sunaga ; Kiyoko Sawada ; Kunio Miyanishi ; Yutaka Sunaga ; Hiroo Sekikawa
Journal of the Japanese Association of Rural Medicine 1983;31(5):713-724
A comprehensive health survey of 618 inhabitants from 1 to 90 years old was conducted in Kathmandu City and in a neighboring village. It included the measurements of height and weight, examinations of blood, feces, urine as well as clinical findings. It also covered the examinations of drinking water and the inquiries of the living conditions.
The anthropometric measurements revealed that Nepalese children are generally small in height for age and 4.2 per cent of them were malnourished. The symptoms relating to avitaminoses, such as xerosis of the skin, angular lesions of the lips, hypotrophic papillae of the tongue were not seldom seen.
Thyroid enlargements over the grade II of Shichijo's classification or grade I of Perez's were found in 9.2 per cent of males and 18.6 per cent of females.
Among clinical abnormal findings, infective eye diseases were most frequent, followed by skin and respiratory diseases. Anemia and iron deficiency were found in high rates among children under 10 years, the aged over 50 years and the females in child-bearing ages.
Parasite infestation rate was 92.8 per cent as a whole, trichuris trichiura (81.6 per cent) was the most prevalent, followed by ascaris lumbricoides (61.8 per cent) and hookworm (29.3 per cent). Cystes of entamoeba histolytica (5.5 per cent) and giardia lambria (12.8 per cent) were also found in apparently healthy persons.
No available residual chlorine was found in the city water of Kathmandu, though chlorination was carried out in the treatment plant, suggesting some defects in transmission system. In the village, water is supplied without treatment and was found contaminated by E. coli.
2.Separate Perfusion of the Upper and Lower Body under Different Temperatures during Thoracoabdominal Aortic Aneurysm Repair in a Patient with Low Left Ventricular Function
Kiyohito Yamamoto ; Hisato Itou ; Yasuhiro Sawada ; Takane Hiraiwa ; Hiroshi Hata
Japanese Journal of Cardiovascular Surgery 2006;35(4):217-221
A 79-year-old man was admitted for thoracoabdominal aortic aneurysm repair. He had already twice undergone coronary artery bypass grafting, 19 and 2 years previously. The value of the ejection fraction of the left ventricle was 36%, measured by ventriculography; and transthoracic echocardiography revealed moderate aortic valve regurgitation. In the presence of aortic valve regurgitation or coronary artery disease, myocardial perfusion under hypothermic fibrillatory arrest may be significantly impaired. Therefore, to maintain a beating heart we used separate perfusions of the upper and lower body that enabled individual temperature control of each organ. The femoral and axillary arteries were cannulated, and a long cannula was inserted into the right common femoral vein and positioned in the right atrium. Cardiopulmonary bypass was established, and the upper body was mildly cooled until the pharyngeal temperature was 33°C, while the lower body was cooled until the bladder temperature reached 20°C. Mild hypothermia of the upper body maintained the beating heart, and deep hypothermia in the lower body provided adequate protection to the spinal cord. Furthermore, in a case of aortic valve regurgitation and low left ventricular function, left ventricular venting is essential for the heart. However, it was difficult to insert the venting tube through the apex of the left ventricle or through the left inferior pulmonary vein; therefore, we selected the left main pulmonary artery for left ventricular venting, and maintained a non-working beating heart. After cardiopulmonary bypass was discontinued, cardiac function was good although a bleeding tendency became apparent. Postoperatively, the maximum dose of dopamine we needed was only 3γ. There were no remarkable complications and the patient was discharged on postoperative day 30. This experience suggests that pulmonary artery venting and separate perfusion of the upper and lower body to individually control organ temperatures is a useful procedure for thoracoabdominal aortic aneurysm repair in patients with low left ventricular function.
4.Variations in the Value of Electric Resistivity to the Command Points (the terminal points, the source points and the connecting points) in Vertigo
Hiroshi SAWADA ; Makiko TAGUCHI ; Norio WATABE ; Reiko TAKIZAWA ; Mitsushi TAKENOUCHI ; Misao TAKENOUCHI
Journal of the Japan Society of Acupuncture and Moxibustion 1982;32(1):48-53
Every disorder makes an appearance on the command points in the extremities. Taking three command points, we examined variations of electric resistivity in vertigo.
The termal point showed low level in general, whereas the connecting was high, especially in the lower extremities. Post treatment it had a tendency to get the mean.
About the laterality we were able to improve their instability, but were not able to establish whether it was effective or not.
Vertigo made an appearance on various meridians and points.
5.Study on the growth and nutritional status of school children in a rural area of Thailand.
Hiroshi Sunaga ; Kiyoko Sawada ; Kunio Miyanishi ; Hirokazu Horikoshi ; Kazuo Endo ; Yutaka Sunaga
Journal of the Japanese Association of Rural Medicine 1985;33(5):897-906
A survey was carried out in a rural area in Thailand as a part of the study on the physical development and nutritional status of children of developing countries in Asia. Four hundred and sixty-three school children of both sexes, from 6 to 14 years of age, had anthropometric measurements and examinations of clinical signs related to nutritional deficiencies. Blood, urine and feces were also exaimined.
1) Thai children were remarkably smaller than Japanese and growth retardation was observed at 21.4% and 37.3% of those in age groups 6-9 and 10-14 years, respectively. And judging from the weight-for-height, about one-fourth of them were considered malnourished in varying degrees
2) Upper arm muscle circumference, calculated with upper arm circumference and subcutaneous skinfold of the same place, revealed that the development of muscle was obviously retarded.
3) Signs of hypovitaminoses such as xerosis of the skin, decreased patellar reflex, cheilosis, angular lesion were frequently observed.
4) Mean values of hemoglobin and serum iron concentrations were low in general and about 20% of the children were judged anemic according to the WHO criteria for nutritional anemias. Cholesterol values were also lower than those of Japanese and American children
5) The overall positive rate of intestinal parasites' eggs was 43.2% and hookworm eggs were most frequently observed, follwed by Giardia lambria
For the improvement of growth and nutritional status of Thai children, the preventive measures against parasitic and infectious diseases through improvement of environmental hygiene are essential as well as food supply.
6.Acupuncture-moxibustion therapy in vertigo.
Misao TAKENOUCHI ; Kenji NAKAZAWA ; Hiroshi SAWADA ; Mitsushi TAKENOUCHI ; Kaoru KUME ; Minoru TORIYAMA
Journal of the Japan Society of Acupuncture and Moxibustion 1985;35(2):117-125
The authors undertook acupuncture-moxibustion therapy for 34 patients with vertigo. In order to objectify the patients' condition and the efficacy of the treatment, we ranked the severity of symptoms and standardized the treatment procedure, and also we set up the criterion for evaluation of efficaciousness.
The severity of symptoms was determined according to the result of some tests (for nystagmus and balance) as well as patient's chief complaints: the incidence and the intensity of feelings of rotation, giddiness, etc.
Treatment was undertaken once a week. One course was consist of ten treatments. Scarless moxibustion was applied to the Second Dadun point in the first course, and body-acupuncture was added to the moxibustion in the second course. In the third course, the scarless moxibustion, the body-acupuncture, auricular-acupuncture and scalp skin acupuncture were undertaken.
The efficaciousness of the treatment was rated as “remarkably efficacious”, “very efficacious”, “efficacious” or “no change” according to the changes in patients' complaints and the results of the tests performed after each course.
Twelve of the patients showed improvement after the first course (remarkably efficacious) and other twelve after the second course (very efficacious), and five of them after the third course (effecacious). The other five patients underwent more than four courses (no change).
In conclusion, improvement was seen in 85% of the patients after 30 sessions of acupuncture-moxibustion treatment including scarless moxibustion to the Second Dadun, body and auricular-acupuncture.
7.Acupuncture treatment in two cases of allergic rhinitis.
Hiroshi SAWADA ; Masao TAKENOUCHI ; Mitsushi TAKENOUCHI ; Shigehiro SAKASHITA ; Kenji NAKAZAWA ; Minoru TORIYAMA
Journal of the Japan Society of Acupuncture and Moxibustion 1986;36(4):261-264
Acupuncture-moxibustion treatment was undertaken on two patients (a 34-year-old man and a 67-year-old woman) who were diagnosed as allergic rhinitis in an otorhinological department. The patients underwent the treatment once a week, in which direct-or scarless-moxibustion (15 pieces) was applied to Tachui (GV14) and acupuncture for whole body adjustment. The subjective symptoms, eosinophil in pituita and the results of other blood examinations were compared with those of their first visits. The eosinophiles in the pituita disappeared and those in the blood fell to the average level. Although there are individual differences, a certain prolonging effect was seen in the follow-up data.
8.Multi-Center Randomized Controlled Trial of Acupuncture and Moxibustion for Rheumatoid Arthritis
Daichi KASUYA ; Tetsuji SAWADA ; Hideyuki ISOBE ; Seigou AKAO ; Makoto KIKKAWA ; Kumiko TAKATA ; Satoru YAMAGUCHI ; Hiroshi OMATA ; Kazuhiko YAMAMOTO
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 2005;68(4):193-202
We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis, by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the QOL of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of rheumatoid arthritis, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males, 2dropped) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2×2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire: Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.
9.Successful Repair of a Traumatic Aortic Isthmus Pseudoaneurysm Concomitant with Right Diaphragmatic Hernia
Taisuke Nakayama ; Masashi Kano ; Shingo Isshiki ; Takashi Tominaga ; Hiroshi Ishitoya ; Katsuhiko Hiratani ; Takahiro Sawada ; Hirotsugu Kurobe ; Tetsuya Kitagawa ; Takaki Hori
Japanese Journal of Cardiovascular Surgery 2011;40(3):94-97
A 24-year-old woman underwent successful repair of a traumatic pseudoaneurysm of the aortic isthmus concomitant with right diaphragmatic hernia which developed after a traffic accident, and the steering wheel of the crashed car was considered responsible for both lesions. Due to the right diaphragmatic hernia, she could breathe mainly with the left lung only. The aortic isthmus aneurysm was considered to be a pseudoaneurysm, and because of the potential risk of rupture, we performed urgent aortic surgery. Prior to a left thoracotomy, we anastomosed an 8-mm prosthetic graft to the right axillary artery. When the left lung was collapsed in order to perform a femoro-femoral bypass, the SpO2 level of her right index finger and her cerebral rSO2 markedly decreased. Therefore, we administered additional perfusion via the right axillary artery, which provided sufficient oxygen to the upper body and brain. The patient underwent Marlex mesh reinforcement of the right diaphragmatic hernia 30 days after grafting, and is doing well 1 year postoperatively.
10.Results of Abdominal Examinations by Sonography at Hokkaido Koseiren-Affiliated Facilities over the Past 10 Years
Akikazu NAGANUMA ; Yasufumi TODA ; Norio KONDO ; Kazuhisa MATSUMOTO ; Hidenori SAWADA ; Shunsuke NAKAYA ; Shunichi NAKAMURA ; Takahiro YAMAGISHI ; Hiroshi AZUMA ; Kazurou KUBOTA ; Masakazu KURITA ; Akimichi IMAMURA
Journal of the Japanese Association of Rural Medicine 2010;59(2):92-96
The Association of Radiologists under the umbrella of the Hokkaido Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Hokkaido Koseiren) set up in 2003 a committee with the aim of improving the accuracy of mass health examinations. Recently, the committee reviewed the results of abdominal examinations by sonography performed at the eight hospitals affiliated with the Koseiren during fiscal 2006 that ended March 31, 2007. Of those individuals who underwent thorough health checkups, 91.3% had their abdomen examined by ultrasound. Something anomalous was detected in 68.1% of the examinees and 4.5% needed to undergo closer checkups, the rate of response to which was 74.5%. The detection ratio of cancer by ultrasonography was worked out at 0.048%. The ratio of patients requiring a closer exam to the total and the cancer detection ratio varied widely from hospital to hospital. The wide dispersion was ascribable to the difference in the standard of judgment for indicating closer examinations and the difference in the number of examinees so far as the cancer detection ratio was concerned, from hospital to hospital. A look at the primary findings of anomalies revealed that fatty liver topped the list accounting for 27.4% followed by cholelithiasis with 3.6%. From this, we realized that the abdominal examinations by sonography served to detect cancer and lifestyle-induced health problems as well. Organ-wise, the cancer cases found during the period from 1998 to 2009 broke down as follows: kidney (79 cases), liver (40 cases), pancreas (30 cases), gall bladder (24 cases), others (8 cases) and spleen (none). The cancer detection ratio per year ranged from 0.03 to 0.05% during the period.