Exposure of applicators to metalaxyl was assessed during the spraying to greenhouse cucumbers by power sprayers. Of four applicators wearing work clothes with a hood, a mask and gloves, two moved forward holding the nozzle in their hands so that they passed through the area sprayed by them. The other two went backward and sprayed both sides. Each of the applicators sprayed 14 to 18 g of metalaxyl during one hour of application. The estimated systemic expoure level in the forward moving group was 1 to 10 mg, 3 to 40 times higher than the exposure level of 0.25 to 0.29 mg in the backward group. But, skin exposure was insignificant or not detected in both groups. Also it was suggested that respiratory exposure was higher in the forward moving group than that in the backward group. In conclusion, when applying metalaxyl by any spraying techniques, the risk of poisoning was thought to be negligible under this research condition. However, the workers should employ the spraying technique moving backward, and be protected with suitable protective gear for preventing acute or chronic pesticide intoxications.

When workers were applying the same volume of a TPN formulation to asparagus fields of the same acreage by a speed sprayer or a conventional power sprayer, their exposure levels to the pesticide were compared. The estimated body exposure level of workers using power sprayer was more than 10 times higher than that of workers using a speed sprayer. The fate of TPN residues in the fields was also assayed. The foliar residues reduced rapidly in one day, but thereafter its reduction rate was very slow, and TPN was expected to remain on the foliage for a long period. However, the airborne TPN concentration was reduced to nil at 1 day after application.

The exposure levels of nine spray-operators in apple orchards to Fenitrothion (MEP) was measured. The pesticide was sprayed in the form of a 1, 000-fold diluted solution of a 40% MEP wettable powder by using power sprayers.
The operators were wearing protective non-woven clothes, masks (Sumitomo 3M 1780) and rubber gloves.
The estimated exposure amount of MEP per operator was 217mg on average when a sprayer with a short rod (50-70 cm) was used. In the case of using a long rod (100-120 cm), the amount was less, indicating 44mg on average.
The estimated amount of MEP penetrating the operator's clothing was 7.6mg on average, ranging from 1.2 to 23.9mg.
The penetration rate averaged 6.3%.
We calculated the MEP concentration in the air around the worker's mouth estimated from the amounts of MEP on the masks and from those in the sampling columns. The results averaged 0.258 mg/m₃ and 0.022 mg/m₃, respectively.
MEP was detected in blood samples from all the operators (0.0004-0.0222 ppm) immediately after the spray work and in blood samples from four of the nine operators (0.0004-0.0009 ppm) after one day, but not detected in any of the nine blood samples after three days.
A decrease in blood ChE activities of the operators was not observed.
The amount of MEP absorbed into the operator's body was calculated to be 0.34 to 2.59 mg. These calculations were based on the amount of the metabolites (converted into nitro-m-cresol) in the urine samples collected from the operators over a period of 24 hours after the spray work. However, the metabolites were detected in the spot urine samples of only one of the nine operators after three days and in none of the spot samples after seven days.
These results show that a small amount of MEP was absorbed into the operator's body, suggesting that the spray-operator should not do the spray work day after day. However, from the point of view of the percutaneous and inhalation toxicity of MEP, we concluded that the sprayoperators were not affected by MEP exposure in this case.

We performed waiting time prediction using the data collected from prescription pick-up. A regression equation was used to predict waiting time. An explanatory variable was adopted as “a number of retention prescriptions at the time of acceptance”, “the variety of drug to dispense”and “the presence or absence of a particular task of time-consuming work in computing multiple medications into one package”. Using waiting time as an objective variable, three regression equations were formulated. Method ①: A single regression equation using the number of retention prescriptions with only one explanatory variable. Method ②: Multiple regression equation using factors such as number of prescriptions and variety of drugs to be dispensed as explanatory variables. Method ③: Multiple regression equation using number of prescriptions, variety of drugs and the presence or absence of particular tasks involved in the preparation of the prescription. Compared to the prediction of Method ①, the prediction of Method ② resulted in better accuracy. Compared to Method ①, Method ② resulted in better accuracy, and Method ③ resulted in even better accuracy than Method ②, as predicted.

The physical work load of farmers and dust conditions in the harvesting process of chrysanthemums were investigated for two households (seven workers for A and three for B household, respectively) at mid March in 1984.
The total working hours a day of each household were 3225 min (460 min as average per a worker) for A and 1954 min (652 min) for B, being allotted more times to males than females. However, all of the house keeping hours were carried out only by females.
The intensity of each working load of farmers was not so heavy, as “light” and “moderately heavy” by Christesen's criteria and energy expenditure a day was calculated 2895-3604 kcal for males and 2155-2295 kcal for females.
In this working process farmers were enforced to keep careful handling with chrysanthemums and fixed body posture for 4 to 6 hours a day. Particulary, the working posture of sorting and bundling chrysanthemums may cause over strained load to the muscle and joint of the lower back and legs.
The dust concentrations of the sorting room were not so high. However, the farmers were exposed a large quantity of cilia of chrysanthemum leaves, calculated 37-259 pieces/cm² on the slide grass a day. The numbers of cilia varied with amounts of handling chrysathemums.
It was suggested that the cilia of chrysanthemums may be the most important allergen to the immediate type of allergy of the chrysanthemum growers.

A 73-year-old man visited our hospital with complaints of fever, epigastric painand jaundice. Laboratory examinations showed elevation of GOT, GPT, ALP, LAP and amylase. Abdominal ultrasonography revealed gall bladder stones. Endoscopic findings showed parapapillary diverticulum, but the common bile duct stone was not revealed by endoscopic retrograde cholangiography. He was conservatively treated and then discharged. Two months after, the patient was readmitted for cholecystitis and underwent cholecystectomy. After further 2 months, he was again admitted for the same symptoms as those on first admission. We diagnosed this case as Lemmel's syndrome and performed emergency endoscopy. Endoscopic findings revealed the meal rest inside the parapapillary diverticulum. After we removed the meal rest obstructing the orifice of the papilla of Vater using grasping forceps, we performed EST. Purulent bile gushed out from the orifice. Two years have elapsed since them. Cholangitis has not recurred during this period. Therefore, we concluded that EST is effective in treating Lemmel's syndrome.

A survey was carried out on how the To-no District is coping with the need of first aid for patients requiring life-supporting treatment before hospitalization. Although there were cities in this district where statistics on first aid were not available, the survey found that, during the 4-year period from 1994 through 1997, bystander CPR (cardiopulmonary resuscitation) saved 11.2% of the lives of patients with CPA (cardiopulmonary arrest). Incidentally, 11.3% of the population attended CPR courses offered by public institutions. Gifu Prefecture has helicopters for use in rescue work, but the survey found that some cities had not ever sponsored drills using helicopters in life-saving operations. Our findings revealed the indifference of the general public as well as administrators in this district toward emergency care. Public recognition of the importance of the care of suddenly ill or injured patients must be gained. Furthermore, acquisition of skills required for first aid by lay people and technical improvement of these skills in professional rescuers are necessary. The authors think that these are the community educational responsibility of hospitals and other medical institutions.

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

Objective : Carvedilol is a non-selective β blocker with an α blocking activity. Since this drug is highly fat-soluble, it can pass through the blood-brain barrier, and thus may induce depression and lower QOL. In the present study, physicians and pharmacists collaborated to evaluate the antihypertension effect of carvedilol and post-administration changes in QOL. Furthermore, the relationship between QOL and antihypertension effect was analyzed.
Design : Self-controlled study.
Patients and Methods : Subjects were outpatients with hypertension above the age of 70 years who visited one of 42 medical institutions in Japan between April 1995 and March 1996. A total of 243 patients were registered, and 10-20 mg of carvedilol was administered once a day for six months. Pharmacists assessed the QOL of these patients by asking 82 questions on three separate occasions : before administration and one and six months after administration. The antihypertensive effect of this drug was investigated in patients in whom all three QOL questionnaires were collected. The main test items were antihypertensive effect, changes in QOL (subjective QOL with a special emphasis on patient psychology), and the relationship between antihypertensive effect and QOL. The antihypertensive effect of this drug was statistically analyzed by a paired t-test, and changes in QOL were statistically analyzed using generalized estimating equations.
Results : All three QOL questionnaires were collected from a total of 146 patients. Their pre-administration systolic blood pressure was 159.6±1.4 mmHg, and diastolic blood pressure 94.0±0.9 mmHg, and their blood pressure decreased significantly one month after the start of administration. This antihypertensive effect of carvedilol persisted, and the systolic and diastolic blood pressure of these patients six months after the start of administration was 141.1±1.2 and 85.2±0.7 mmHg, respectively (significant decreases when compared to pre-administration levels ; both p<0.05).
Subjective QOL improved significantly after carvedilol administration. And, changes were not seen in sexual function. Changes in the five categories of subjective QOL were as follows : psychological stability, disease-induced inconvenience, and independence improved significantly after carvedilol administration, but changes were not seen in gratification or vitality. However, improvements in subjective QOL did not correlate with improvements in blood pressure.
Conclusions : The results of the present study showed that carvedilol improved QOL without negatively affecting sexual function. Subjective QOL reflects the psychological well-being of patients. In the present study, psychological stability, disease-induced inconvenience, and independence improved significantly, but changes were not seen in gratification or vitality. Since β blockers can suppress the central nervous system, they can reduce psychological stability, gratification and vitality. Even though carvedilol is highly fat-soluble, the results of non-clinical studies have shown that it does not suppress the central nervous system as much as propranolol. The results of the present study showed that carvedilol does not strongly suppress the central nervous system of humans. Moreover, significant changes in QOL were not seen between one and six months after the start of administration of carvedilol, suggesting that it is possible to estimate the QOL of patients on antihypertensive therapy after six months of administration by assessing their QOL one month after administration.

OBJECTIVESThe aim of this study was to investigate the determinants of serum total homocysteine level (tHcy) in patients with type 2 diabetes mellitus (DM) according to sex.

METHODSA total of 1,276 Japanese, diabetics (n = 280) with a control group of non-diabetics (n = 996), were enrolled into the study from 2003 to 2005. This cross-sectional study was conducted for all the subjects, using personal data regarding clinical characteristics and lifestyle. Multiple regression analysis was performed to analyze the association of tHcy with selected factors.

RESULTSIn diabetic subjects, estimated glomerular filtration rate (eGFR) and serum creatinine levels (Cre), even those within the normal range, were strongly associated with tHcy after adjustment in both sexes; the standardized partial regression coefficient of eGFR for tHcy was -0.251, (p = 0.001) in diabetic men and -0.523, (p < 0.001) in diabetic women. Furthermore, the eGFR of the diabetics, except patients with nephropathy, also had significant association with tHcy in both sexes. Fasting plasma glucose levels and serum triglyceride levels were strongly associated with tHcy in diabetic men only. HbA1c was also associated with tHcy in diabetic men only, though not as significantly. Age and presence of hypertension were significantly associated with tHcy in women.

CONCLUSIONSThis study suggests that there are some differences in the factors associated with tHcy between diabetics and non-diabetics, and between the sexes. There is, therefore, circumstantial evidence that elevated tHcy should be evaluated clinically. Because tHcy was strongly associated with eGFR and Cre, even within the normal ranges, tHcy may have important implications regarding the microangiopathy of the kidney and atherosclerosis.