I chose this subject for the chairman's lecture without a moment's hesitation. During the four years at the graduate school, I studied virology and enjoyed a wide range of researches from molecular biology and electron microscopy to field work on the wintering of Japanese encephalitis viruses, etc. Then, I was engaged in research in the field of tropical medicine in Kenya, Africa. Half a year after I returned to Japan, still obsessed by Africanism, I came to Oita on a three-year contract.
I found Oita blessed with nature and rich in wonderful food, However, the first thing I came across here was a parasite that is much larger than viruses. It was Paragonimus which would infect humans not through crab meat but raw boar meat. I also discovered the 12th case in Japan of pulmonary dirofilariasis in the human lungs that is an infection with filaria immitis. Later, I had opportunities to diagnose a variety of zoonosis, but I realized wrong diagnosis had been made for each of those infections. I came to Oita as a doctor of pulmonary medicine, but living in Africa had changed my view of life and my clinical view. In Africa, illesses were greatly affected by the natural environment and socio-economic factors in local areas.
To present my experiences in discovering rare diseases in local areas, to talk about how I discovered them, and to mention the present situation and future themes are thought to be suitable for the Rural Medicine Congress which will be held in Kyushu for the first time in 22 years.
In Japan, we have to keep zoonosis always in mind, when making diagnoses, because of an increasing number of people going overseas, the pet boom, the gourmet boom, the increase in imported foods, etc.
Also zoonses, both new and reviving ones, are told to break our by unusual changes in this modern society. Now is the time to reexamine agriculture in Japan. I believe this is the task for people who are associated with the cause of rural medicine.

In this paper, we reported a case of congenital aplasia of dorsal pancreas. This case in 35th case in Japan. The case is 72-year-old male. He feels general fatigability as chief complaint and was taken Diabetes Mellitus. In ERP examination, it was found a short main pancreatic duct of about 4.5 cm length and defect of pancreatic body and tail in Ultrasonogram and Computed Tomogram. In arteriography, it was not found feeding artery to pancreatic body and tail. Accordingly, we diagnosed this case as congenital defect of pancreatic body and tail. This one was normal range for P. F. D. andnormal exocrine pancreatic function. But, this one was operated because of taking cholecystolithiasis. On Retroperitoneal space that shoud be originally pancreatic body and tail, we confirmed only fat tissue without inflammation, fibrosis and carcinomatous tissue. We could not be confirmed Langerhans islet and pancreatic tissue in the biopsy sections of fat tissue.

A 60-year-old man who developed a nephrotic syndrome underwent a renal biopsy, and the case was diagnosed as membranoproliferative glomerulonephritis (MPGN). Despite chemotherapy using steroid, immunosuppresive and anticoagulant drugs, the patient exhibited persistently high urinary protein levels (above 8 g/day), and the renal function deteriorated gradually.
One and half years later, hemodialysis was started, but soon he had a high fever (above 38-40°C). Laboratory data revealed high levels of both antinuclear antibody titer and immune complex (IC) titer, and a low level of CH50.
Considering an active collagen disease like SLE, steroid pulse therapy and plasma exchange were instituted. The therapy was very effective this time.
It is well known that many patients with SLE and a long term history of hemodialysis develop a condition of so called “burn out” in which the activity of SLE declined to allow the withdrawal of steroid therapy. Also well known is the developement of hypocomplementemia in many patients with MPGN.
In our case, it was difficult to clarify what caused the high fever and other clinical symptoms. We must carefully observe the clinical symptoms of SLE.

A 60-year-old woman visited our hospital, complaining of hyperpigmentation and itching of the skin. The case was histologically diagnosed as acanthosis nigricans by skin biopsies. It is usually associated with malignancies, of which gastric cancer is by far the most common. Upper endoscopy revealed advanced gastric cancer (Borrmann type 3). Total gastrectomy was performed, but the patient died of peritonitis carcinomatosa 21 months after resection. It is important to examine the upper GI tract periodically when acanthosis nigricans is present from the early stage.

As a strategy for making people in enjoy good health by preventing disease, various forms of guidance for improvement of lifestyle have been recently been introduced. The purpose of the health guidance is to help people who do not have a disease but have abnormality in their physical examination data change their behavior patterns of daily living habits.
In this study, we chose local residents with hyperlipidemia as the subjects of this study and carried out the guidance for one year for improvement of their lifestyle focusing eating habits and physical exercise in order to improve their serum lipid levels. We looked at the effects of this intervention activity on their conciousness and behavior, and the values of their body weight, body fat and other biochemical blood test results. When their living habits between before and after our intervention activity were compared, the residents had more interested in meals and physical exercises, and improved their dietary habits, especially on the in take of eggs, vegetables, eating between meals and salt. In addition, analysis of residents' nutritive values supported this result.
Our investigation also indicated a tendency of increase in the frequency of physical exercise expect for working time after our intervention activity. The values of total cholesterol, body weight, obesity and fasting blood sugar in the general and blood examinations significantly reduced.
Altogether, our intervention activity proved to be effective in changing people's conciousness and personal lifestyle at, and improving the values of body weight and serum lipid.

In Oita prefecture, where ATL is relatively endemic, the authors carried out hematology analysis using an E-4000 hematology analyzer in a health examination. This analysis screened a group of 104 males and 181 females out of randomly collected 11, 568 persons in terms of a higher (exceeded 50%) W-SCR rate (i. e. lymphocyte rate in cell size distribution). The collected peripheral blood smears from this group were further subjected to the examination of lymphocyte morphology.
Abnormal lymphocytes exhibiting dyscaryosis, such as indentation or lobulation, were observed in 11 cases, and further examination of anti-ATLA antibody and earlobe blood smears revealed eight suspected cases of ATL-related condition.
Clinical symptoms characteristic of ATL were not observed in the above eight cases, though the anti-ATLA antibody titer measured by the ELISA method increased by more than 25. In one case, being diagnosed as chronic-type ATL, abnormal lymphocytes amounted to 70% and the leukocyte count was 28, 000/μl. In the other seven cases, abnormal lymphocytes amounted to only 1-11%, and the leukocyte counts ranged from 5, 300 to 11, 100/μl, which was almost within the normal limits.
The method in reported as an useful means for screening cases of nonsymptomatic chronic or smoldering type ATL through a health examination.