Life Style ; Future ; Disease

Myocardial Ischemia

Deaths in the young are due largely to suicide and unexpected accidents rather than sickness. When the cause of death in the young in their 20s to30s is studied as to death from sickness, it consists of malignant neoplasm, cerebro-vascular diseases and heart diseases, low as the proportion is, showing the same trend as in the adult diseases. To study these backgrounds, the cause of death, the incidence of abnormalities and mean of the test values obtained from medical examinations in the southern rural of Akita Prefecture were studied in comparison with adults. The results obtained are summarized as follows.
(1) The number of young people with cerebro-vascular diseases in this locality was more than twice the national average. It was conspicuously large in women, but those with the blood pressure were many in men. So, involvement of factors other than the blood pressure need to be considered.
(2) On the whole, the abnormality in the test values was found more often in 30sthan in 20s, which substantiates an increase in the incidence death. However, the sharp increase in the mortality rate in 30s compared with 20s did not manifest itself markedly in the test values. So, it appears necessary to study factors including the family history.
(3) Studies on the high blood pressure and dietary life in the obese people revealed no difference between the group of people with high blood pressure and the group of normal individuals. The influence of hereditary predisposition (the diastolic pressure in already high in case of there being high blood pressure in the family history even in the young) rather then the dietary habit appears to be great in the young people.
(4) Anemia was often found in women of the agricultural group. Both protein and animal protein tended to show low values.
(5) The GOT, GPT and γ-GTP levels were high in men of the non-agricultural group. Insufficient intake of animal and poultry meat (P<0.01) and tendency to heavy drinking were noted.
(6) Those with hypercholesterolemia were found to take plenty of lipid (P<0.05, male), By food, the percentage of milk of and dairy products taken was high (P<0.05, male).
(7) Neutral fat showed high levels in both men and women of the agriaultural group. When the dietary life was examined in men with high neutral fat levels, amount of carbohydreate taken (P<0.01) and grain energy (P<0.05) were unexpectedly low in the neutral fat group compared with the nomal group. The insufficient caloric intake appears to be compensated by alcohol.

In Japan, hypertension and cerebrovascular diseases are reported to be more prevalent in rural than in urban areas, while the age-corrected prevalence of ischemic cardiac diseases is thought to be higher in urban areas. Not all rural areas show the same cardiovascular disease prevalence trend, however. In recent years in particular, the pace of urbanization of life-style has differed significantly from one region to another, a major factor contributing to regional differences in the cardiovascular morbidity pattern in rural areas. Another contributing factor is the fact that the aging of the population is progressing more rapidly in some areas than in others. As a whole, however, salt consumption is still greater is rural areas than in urban areas, although it has decreased significantly in recent years. Animal fat consumption is still smaller in rural than in urban areas. It is recommend-ed that cardiac disease prevention measures with special focus on problems specific to rural areas be taken, while maintaining good life-style in these areas. For example, there are a number of reports that serum cholesterol levels are similar in rural and urban areas in children, although they are lower in the former than in the latter in adults. When discussing cardiac diseases in rural areas from a long-term prospective, therefore, this fact must also be taken into account. Since the growing total number of elderly patients with cardiac diseases is expected to be much greater in rural areas than in urban areas, appropriate countermeasures, including the development of convenient diagnostic methods, care and rehabilitation methods, and creation of treatment facilities, are urgently required in rural areas. As mentioned above, each rural area has its own characteristics and problems. For this reason, it is desirable that appropriate measures be implemented taking into account the different characteristics of each region, backgrounds of disease and various risk factors. This paper therefore presents rural area-specific characteristics and problems related to major diseases.

Age-corrected mortality due to ischemic heart diseases was low in mountainous rural areas but high in rural areas near large cities in Japan. Total cholesterol levels, a risk factor of ischemic heart diseases, were high in rural areas near large cities but no clearly significant increases were seen in mountainous rural areas. HDL cholesterol levels showed negative correlation with prevalence of ischemic heart diseases and positive correlation with the atherogenic index in typical mountainous rural areas in Akita, Nagano and Shimane Prefectures. Nationwide data on the degree of lesions, determined by coronary angiography, when compared with that on serum lipid levels, showed positive correlation with total cholesterol, LDL-cholesterol, atherogenic index, Apo-A₁, Apo-B, Apo-B/Apo-A₁ and negative correlation with HDL-cholesterol. TG showed positive correlation only in females. The lack of significant differences in TG in males is thought to be partly due to large variability in males due to their life-style, e. g. eating habits and alcohol consumption patterns. Eating habits change not only with time and geography but with age as well, and people show a tendency to like fish and shellfish as they get older, making it difficult to determine fatty acid-related risk factors of arteriosclerosis. In addition, fatty acid levels are likely to be affected by meals taken on the previous day. It will therefore be necessary to compare the date on fatty acid obtained with that on fatty acid composition in phospolipid fractions, which is less influenced by meals.
The findings obtained in the present study suggest that low calorie and low serum albumin levels contribute to the progression of coronary arterial lesions.

Urbanization is progressing gradually in rural areas, but there still are large differences between rural areas near major cities and those far from them. In order to determine differences between these two types of rural areas, we compared the results of group medical examinations conducted in 1997 and 1999 in villages near Hiroshima City (rural area A), Hiraka-gun in Akita Prefecture and Minamisaku-gun in Nagano Prefecture, rural areas far from major cities (rural area B), and villages near Izumo City, Shimane Prefecture, rural areas in-between rural areas A and B (rural area C). The results of group medical examinations conducted in 1995 and 2000 were compared in each area to determined changes in the five years. A questionnaire survey on eating habits and life style was conducted during the group medical examinations in the 4 areas in order to evaluate the effects of life style on health-related parameters. In addition, mean health-related parameters were compared before and after exercise (at least 8, 000 steps per day) in the 4 areas in order to evaluate the effects of exercise on health. HDL cholesterol levels increased significantly in each area and overall in only 3 months. Findings obtained in areas where data from a non-exercise control group were obtained indicated that exercise inhibited increases in the percent of body fat.
A study on the effects of exercise on life style-related diseases and QOL of patients was conducted in Ibaraki Prefecture. No apparent correlation was seen between exercise and QOL in patients with myocardial infarction, but exercise showed a tendency to increase the QOL score in patients with good cardiac function. In diabetic patients, exercise seemed to improve not only glucose tolerance but patients' QOL as well. In hypertensive patients, exercise reduced blood pressure and improved patients' QOL. In addition, co-investigators in each area conducted the following area-specific studies: Akita Prefecture, 1) study on the relationship between the survival rate and the results of group medical examinations by age and the life style and 2) study on the effects of eating habits on health-related parameters; Nagano, study on the effects of primary prevention in the life style; Shimane, 1) cross sectional survey on the life style and health and 2) clinical epidemiological study on multiple risk factor syndrome in rural areas; and Hiroshima, study on the effects of education and guidance in high-risk patients receiving regular medical examinations.

Measures of lifestyle-related diseases affecting and younger citizens need to viewed in different lights.
1) BMI: The survival rate was lower among slimmer men. Among elderly men, this was also true even if those who died of cancer were excluded. 2) Serum total cholesterol level: The survival rate curve showed only minor differences in the middle-aged male group, but the survival rate was significantly lower in those with low cholesterol levesl (170mg/dl or less) than in those with higher cholesterol levels. However, these differences were negligible when residents who died of cancer were excluded, indicating that the differences were due to the effects of cancer. In the elderly male group, the survival rate in those with low serum total cholesterol levels was apparently lower than in the middle-aged group, and this trend was not changed after exclusion of residents who died of cancer within five years. This finding indicates that the same dietary guidance provided to younger patients should not be provided to elderly hypercholesterolemia patients discovered in basic medical examinations. 3) Serum albumin and serum total cholesterol levels: A significant positive correlation was noted in both men and women regardless of age, even if residents who died of cancer were excluded. The correlation increased with age. This finding also indicates that the same dietary guidance should not be given to the elderly and younger groups.

It has been reported by many workers that the patients with atrial fibrillation have risk factors that give rise to cerebral infarction. Nonetheless, no report has been made on whether or not there can be a difference in the development of ischemic cerebrovascular disorders, depending on the actual condition at the onset of atrial fibrillation, particularly a varying degree of ventricular pause and heart rate, etc.
Investigations were made on 318 patients with continuous atrial fibrillation and 114 with paroximal atrial fibrillation in a total of 432 patients, ranging in age from 22 to 89 years in a ratio of 2: 1 between male and female with a mean of 65.1±11.2 years, who were included in the current study.
The results have proved to be worthwhile when ventricular pause was studied by Holter's ECG. When ischemic cerebrovascular disorders were observed at varying intervals longer than 2.5, 3 and 4 seconds, a significant difference was noted between the intervals longer than 2.5 and 4 seconds in the incidence of ischemic cerebrovascular disorders (p<0.05). Lone atrial fibrillation showed a similar tendency in this aspect, regardless of the presence or absence of basic diseases.
The duration of ventricular pause remained unchanged in the therapy combined with digitalis, but significantly extended when Ca-antagonist, and Beta-blocker were used. Thus, it may be important to be carafau in the selection of medications.

We performed a retrospective study on the clinical data of 13 remission failure cases in 53 patients who had received remission induction therapy for acute leukemia (AL) in our hospital over the past seven years.
The outstanding clinical manifestations of the remission failure cases, as compared with the successful cases, included (a) disseminated intravascular coagulation (DIC) syndrome (b) complex chromosomal abnormalities (c) leukocytosis over 100, 000/μl and (d) markedly elevated seum LDH level and thymidine kinase activitis at the time of initial admission.
The greater majority of these cases (10 out of 13) resulted in death within 90 days after the start of induction therapy.
The causes of death were predominantly hemorrhagic events associated with DIC syndrome, cerebral hemorrhage and severe infectious diseases such as sepsis and pneumonia.
Earlier death within 14 days after therapy was caused from hemorrhagic events and later one was severe infections.
In the G-CSF treated group, the febril term of over 38°C was shorter and the number of days taken for the neutrophil counts to be restored to the 1, 000/μl level was fewer than in the non G-CSF treated group.
Thus, it was suggested that G-CSF was expected to be one of the useful supporting agents to prevent infections in remission induction therapy for acute leukemia.

Introduction: A clinicopathological study of diagnosis and treatment for esophageal cancer in Hiraka General Hospital was performed.Patients and Methods: We retrospectively analyzed clinical records of 417 esophageal cancer patients treated between January 1998 through December 2009.Results: It was presumed that we took care of about 10% of esophageal cancer patients in Akita prefecture. Sixty-six percent of the patients were referred to our hospital from other medical facilities during the period under review. On the other hand, those patients with esophageal cancer detected by medical examination or health screening accounted for only 9.6%. The rate of those patients who could receive definitive therapies was 75% (313 cases), and 308 cases (98%) underwent curative surgical resection in Hiraka General Hospital. Among the patients who had received therapy aimed for complete cure, 285 patient (91.1%), went through treatment as planned, and the complete response rate was 73%. Five-year survival rates of all the patients in stage 0, stage I, stage II, stage III and stage IV were 44.7%, 76.3%, 67.3%, 38.0%, 31.6% and 15.6%, respectively. These survival rates are never be inferior to those of major centers for esophageal cancer in Japan. Long term survival rates of the patients who had been diagnosed with esophageal cancer by medical examination or health screening were statistically significantly better than those of the patients who were diagonosed by another categories. Among the 209 patients who responded completely to definitive therapy, the cancer recurred in 50 patients (23.9%). Among the 50 recurrent group, recurrence has been primarily recognized in 33 patients (67%) with in 12 months after definitive therapy and in 40 patients (82%) within 24 months. Therefore, a close follow-up is very important up to 24 months after treatment. As for the cause of death in patients who underwent curative resection the death from esophageal cancer accounted for 66% whereas the death from other diseasea and/or other type of cancer accounted for 34%.