The national health insurance record is an important source of information regarding the trend of morbidity throughout Japan. Using the record, we clarified the characteristics and annual trends of morbidity for main diseases in municipalities in Ibaraki Prefecture.
Age-adjusted morbidity rates in each municipality were calculated from the number of patients actually covered by the national health insurance and the number of the insured population from 1980 to 1992. To classify municipalities by the degree of urbanization, the proportions of farming population were used. Eighty-seven municipalities were classified into the three groups; urban group (UG), middle group (MG) and rural group (RG).
According to the pattern of annual morbidity in the three groups (UG, MG, RG) from 1980 to 1992, main diseases were classified as follows. The diseases for which the rates in UG were always higher than that in RG during the study period: Total morbidity rate in UG was about 10% higher than other two groups. Diabetes, heart disease and liver disease were included in this category, and especially, morbidity rate for allergic rhinitis in UG was nearly twice as much as that in other groups. The diseases for which the rates in RG are higher than UG during the study period: Only hypertension was included in the category. The diseases for which the rates in RG were higher than that in UG in the beginning while the rate intersected in the study period: Cerebral hemorrhage and cerebral infarction were included in this category.
There were no differences between UG and RG in morbidity rates for gastric cancer, intestinal cancer and lung cancer.
The results were confirmed by classifying the maps of municipalities into the three categorieswith 12-year average morbidity rates for main diseases.

A system for making prolonged measurements of oxygen uptake without the use of mask or mouthpiece is described. A subject wears a hood through which air is drawn by a exhaust pump located on the end of hoses. The flow rate of main stream is measured by a pulsed wire flowmeter located between flexible hose and rigid hose. The flow rate is essentially constant during a run. One sample pump bypasses small amount of mixed air from the main stream. The other pump draws the room air. Two sample pumps operate alternatively at 2 min interval. The sample gas is dried by passing through molecular sieve desiccant and is delivered to in-line oxygen analyzer. Both signals of flow rate and oxygen concentrations of room air and mixed air are converted to digital quantities and then stores in memory devices at 5 min interval. All measuring devices were assembled to small package which the subject carries on his back. The weight was about 7 kg. The memory chip is removed from the device after experiment and oxygen uptake is estimated by connecting the memory chip to a microcomputer. This measurement compared favorably with measurement with Douglas bag collection and gas analysis.

828 female agricultural workers were studied. Their age, blood pressure, Broca index, hemoglobin content, serum total cholesterol, activity of serum cholinesterase and transaminase (GOT and GPT) was measured. The distribution of each factor was examined in the sample of agricultural workers. The data for mean blood pressure, total cholesterol, activity of cholinesterase, GOT and GPT showed a log normal distribution.
For the screening of the data, Mahalanobis's distance was calculated and the abnormal data (P<0.01) was compared with the worker's medical record. The data of non healthy women was excluded from the following calculation.
The correlation coefficients between the activity of cholinesterase and other factors (age, Broca index, mean blood pressure, hemoglobin content, GOT and GPT) were statistically significant. This result indicates that the activity of cholinesterase somewhat depends on these factors.
It is important to investigate the relationships between the activity of cholinesterase and some biochemical factors, and to establish the standard value of its activity in order to estimate the effect of pesticides.

The regression analysis between the activity of serum cholinesterase and some biochemical factors of female agricultural workers was examined.
To normalize the value of the factors, logarithmic value was calculated. Multiple regression analysis between the activity of cholinesterase and the factors related to liver function, such as the activity of GOT, GPT and total cholesterol content were calculated. The most significant factor related to cholinesterase was total cholesterol content, and the activity of GPT was the second. The Multiple regression coefficients of the equation between the cholinesterase and total cholesterol and GPT were from 9.7 to 18.3.
Using all biochemical factors as independent variables, the most suitable equation was determined from calculating the predictive sum of square (PSS). The activity of cholinesterase (ln (ChE)) depends upon the following factors, age, ln (GPT), ln (TCh) and Broca index. Hemoglobin content could also be added as a variable. The equation is;
ln (ChE) =0.002126 (age) +0.04028 ln (GPT) +0.2112 ln (TCh) +0.002188 (Broca index)-1.5687+α Where α is the parameter of each population.
From this equation, the standard value of the activity of cholinesterase of each woman was calculated. The estimate of cholinesterase activity may be useful to examine the inhibitory effect of pesticides on cholinesterase.

Mediastinitis following graft replacement of the ascending and total arch aorta is a fatal complication of cardiac surgery. When graft infection is suspected, one choice of treatment is to remove the infected prosthesis and replace it with a new one. However such a procedure seems to be very risky. We report 2 successfully treated cases of mediastinitis following graft replacement of the ascending and total arch aorta. In one case, we treated with primary sternal closure after debridement and omental flap implant. In another case, the wound was left open and irrigation with iodine solution was undertaken for 6 days. The sternum was closed with pectoralis major muscle flap implantation. When graft infection is not suspected, primary sternal closure with implantation of tissue flaps is recommended. When graft infection is strongly suspected, we prefer secondary sternal closure after open irrigation.

A 44-year-old man underwent total arch replacement for acute type A aortic dissection. He was treated postoperatively in the intensive care unit for acute renal failure and respiratory failure. Although recovery of organ functions was seen, an unexpected fall in platelet count (PLT) occurred abruptly on postoperative day (POD) 7. The patient was treated with gabexate mesilate and platelet transfusion because disseminated intravascular coagulation (DIC) was initially suspected. Nevertheless, PLT dropped rapidly below 1.0×10⁴/μl. We suspected heparin-induced thrombocytopenia (HIT) and stopped all heparin administration including flush solution for pressure monitoring lines. The platelet factor 4-reactive HIT antibody test was performed and we began to give intravenous argatroban, 60mg/day. However, PLT did not increase at all. Multiple organ failure developed and metabolic acidosis deteriorated rapidly resulting in death on POD 15. HIT antibody was positive on POD 13 and a definitive diagnosed of HIT was made. For those patients treated with heparin continuously or repeatedly, HIT may occur and increase the mortality risk if the diagnosis is delayed.

Respiratory and dermal exposures of the sprayman to pesticide sprayed by a dilute spray machine (speed sprayer) were studied in fruits orchards. Aerial concentration change of pesticide in the air were also investigated. The degrees of respiratory and dermal exposures were nearly independent on the size of machine, while they were higher in spring than in summer. The degree of respiratory exposure of pesticide was proportional to that of dermal exposure. The dermal exposure of sprayman was greatly reduced by the use of the machine equipped with a hood, which was not so effective against his respiratory exposure.
Serum choline esterase activity of the sprayman was almost unchanged after pesticide spraying. The pesticide in orchard air was detected more than 3 hours after spraying. When pesticide was sprayed by the speed sprayer, the pesticide mist drifted into the house near the orchard.

High concentration of airborne particles was detected in greenhouse air after suspended particulate pesticide spraying. The reduction of aerial concentration of resprirable particulate pesticide was relatively slow.
To study the potential health effects of inhaled pesticide, the animals were exposed to the pesticide, methidathion particles in the inhalation exposure chamber. The exposed pesticide particles were approximately 2.16 μm mass median diameter.
The animals exposed to suspended particulate pesticide had a considerable amount of particles within alveolar macropharges and alveolar epithelia. The serious lesion of alveolar epithelia and capillary endothelia of the animals occured after inhalation of methidathion particles.
The vacuolar degeneration of hepatic cell was also cytosol decreased significantly after inhalation of methidathione particles.
The exposure to suspended particulate methidathion induced production of thiobarbituric acid reacting substances (TBARS) in hepatic cells of the exposed animals. The induction of TBARS formation in hepatic cells was remarkable at early period of exposure.
The change of serum transaminase (GOT) activities after exposure to methidathion particle was remarkable. GOT activities also markedly increased at early period of exposure.

A simple exercise test with vertical jumping was developed for children. The vertical acceleration wave form of back was measured with strain gauge type transducer. After amplification and rectification, the signal of positive acceleration was converted to frequency with voltage-to-frequency converter (VFC) and VFC signals were decoded by a digital counter. The digital output was normalized by gravitational value and defined as physical activity rate. 10 young males and 24 schoolchildren jumped at several frequencies and oxygen uptake, physical activity rate and heart rate were measured. Also 28 children under school age jumped arbitrary and heart rate and physical activity rate were recorded. The results showed that the oxygen uptake per body weight had good correlation to the physical activity rate (r=0.95) . Although heart rate was significantly different with ages, physical activity rate which was defined as an index of exrecise test, was no significant difference with ages and weights (α<0.05) . The results indicated that this jumping test was helpful to make exercise stress test for younger children.

Papillary fibroelastoma is a rare, benign heart tumor. We successfully treated a patient with multiple fibroelastomas derived from both the mitral valve and the chordae by surgical excision. A 59-year-old man was admitted to our hospital with a history of myocardial infarction three years before admission. Preoperative transthoracic and transesophageal echocardiograms showed multiple, mobile, rounded cardiac tumors in the left ventricular cavity and the mitral valve. Under cardiopulmonary bypass, we performed prosthetic mitral valve replacement after excising the valve with the tumor. The patient was discharged and remains asymptomatic. Histologic examination of 6 specimens of the excised tumor confirmed the diagnosis of papillary fibroelastoma. When papillary fibroelastoma is diagnosed, surgical treatment must be considered because of the high risk of embolization.