We examined values of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA_1c) in 8, 870 subjects who underwent the mass screening conducted by Naganoken Koseiren Kenkokanri Center. The mean values of FPG and HbA_1c were 95.3±15.0mg/dl, and 5.12±0.50%. Both values increased significantly withage. FPG was correlated significantly with HbA_1c. Neither age nor body mass index wasrelated with HbA_1c statistically. 60.8% of the cases of the HbA_1c value of 5.8 werediagnosed as impaired fasting glucose (IFG) or diabetes mellitus (DM). 68.7% of the cases of at the HbA_1c value of 5.9 were in normal FPG range. In a mass screening, diagnosis of IFG or DM by FPG value is easy and lessens a burden of those who take on a group checkup. But diagnosis by FPG level may bring about excess diabetic patients who arehealthy. So diagnosis of IFG or DM in a mass screening should be made by both FPG and HbA_1c values instead of FPG alone.

The patient was a 61-year-old man. He was diagnosed as having dermatomyositis-pulmonary fibrosis in February 2005. Immediately home oxygen therapy (HOT9L/min.) and home visiting care were commenced. Since the patient had difficulty in breathing due to chronic respiratory failure, cyclophosphamide, an immunosuppressant drug, was given to him intravenously when a physician made house calls. The results were satisfactory.The Community Care Department of our hospital has a staff of physicians who exclusively provide home medical services and keep track of patients' health state systemically. Nurses in the Home Visit Care Station and the Home Care Support Center provide health services in patients' homes including nursing care and care of caretakers.The physician who visited the patient's home in this case belonged to the Department of Internal Medicine as a specialist of collagen diseases teamed up with the community care department staff to give home medical treatment using the immunosuppressant drips. This was a good example of the successful home medical treatment and care for a patient who was unable to go to hospital because of chronic respiratory failure.
Chronic ; Respiratory Insufficiency ; Patients ; Pulmonary Fibrosis ; House Call

The Saku Central Hospital started a joint undertaking for home health care with four village offices of Minamisaku-gun, Nagano Prefecture, from 1988. From 1995, the joint project was taken over by its satellite institution, Koumimachi Clinic. During the year, care services were provided in patients' homes by a full-time visiting nurse 665 times. She helped physical therapist with rehabilitation 228 times, attended many meetings related to health care with local people and public health nurses, and held case conferences about patients. The joint undertaking for home health care with local goverments may be important for better home health care.

The Patient was a 30-year-old woman. Four years previously, the woman had undergone ileectomy for thrombotic ileal erosion. After being discharged, she received regular medical treatment for thrombotic renal hypertension at our Department of Internal Medicine, and eventually her case was diagnosed as a collagen disease. She was dosed up with depressors and aspirins. Two years later, she got married. Next year, she became pregnant, but miscarried. A causal link between collagen disease and miscarriage was suspected. In the same year, she became pregnant for the second time. The administration of low molecular weight heparins was initiated in addtion to doses of aspirin. In the last trimester of pregnancy (In the latter half of pregnancy?), pregnancy-induced hypertension developed. The woman was immediately hospitalized and placed at bed rest. The dose of low molecular weight heparin was increased. She gave birth to a healthy child. This experience taught us that working in closer collaboration between doctors of internal medicine and obstetricians is of vital importance for the health and safety of pregnant women with a collagen disease and successful childbirth.
Pregnancy ; Human Females ; Heparin, Low-Molecular-Weight ; Collagen ; Aspirin

Since 1994, our clinic has had monthly study meetings for those who looked after bedridden patients in their homes. As of June 1996, we have gotten together 39 times and a total of 168 persons have participated (mean 4.8). We have discussed the welfare system (3 times) and diseases such as bed sore and lumbago (16 times), visited participants' homes and demonstrated medical equipment (4 times each) and talked about general affairs (12 times). In home health care, a role of those who look after bedridden patients in their homes is very important. Social and medical systems should support them. We think ther meetings could continue to support them morally and psyehologically.

We performed echocardiography on 19 hemodialysis patients before and after dialysis session. The patients were divided into three groups (normal pressure group; N=9, pre-dialysis hypertension group; N=6, pre-and post-dialysis hypertension group; N=4). The findings of echocardiography (Left ventricular end-diastolic dimension; LVDd, Left ventricular ejection fraction; EF, Left atrial dimension; LAD, Interventricular septal thickness; IVT) were compared in the three groups. There was no significant difference in LVDd and LAD between three groups. The mean value of EF was significantly (P=0.03) higher in the pre-dialysis hypertention group (68±9.4%) than in the normal pressure group (65±9.6%). The mean value of IVT was significantly (P=0.01, 0.01) higher in the pre-dialysis hypertention group (11±0.9 mm), pre-and post-dialysis hypertention group (11±0.6 mm) than in the normal pressure group (10±1.7 mm). These findings suggested thet hypertension may affect cardiac function. Therefore, we concluded that to keep normal blood pressure is important in hemodialysis patients.

The numbers of cases of high level of serum lactate dehydrogenase (LDH) found in the mass screening program by Naganoken Koseiren Kenkokanri Center was 1, 358 (1.5% of total 89, 837 examinees) in 1995. In 235 of these cases, 141 cases (60.0%) were diagnosed as normal; 56 cases (23.8%), hyper lactate dehydrogenasenemia; 27 (11.5%), diseases of the liver or gallbladder. Close medical examinations including abdominal ultrasonography and check on viral hepatitis may be necessary for cases of increased LDH levels detected by mass screening.

We reexamined the cases of renal disease found in urinalyses which had been performed as part of the mass screening, to ascertain its efficacy. During 1990, a total of 94, 913 people underwent physical checkups made by the Naganoken Kouseiren Health Screening Center. The mean positive rates of proteinuria, occult blood in urine and both were 2.4%, 6.2% and 0.5%. Of the total number of examinees, 59, 803 had undergone the previous year's checkup. The mean positive rates of proteinuria, occult blood in urine and both for two consecutive years were 0.8%, 3.4% and 0.1%. The mean positive rates of proteinuria and occult blood increased with age. The mean positive rate of proteinuria was 1.7 times higher in males than in females. On the other hand, the mean positive rate of occult blood was 2.7 times higher in females than in males. However, there was no difference what so ever between men and women in the mean positive rate of both proteinuria and occult blood.
In the mean time, we reviewed the 85 cases in which renal biopsy was performed at the Saku Central Hospital from 1985 through 1990. Among them, 35 (41.2%) were the cases which had been suspected to have kidney disorder in the urinalysis conducted as part of a mass screening, and IgA nephropathy accounted for about 60% of them. The reports from medical institutions which made follow up examinations using the results of the health screening showed that the rate of renal disease was highest in the proteinuria positive cases; that of urological diseases, in the occult blood positive cases; that of chronic glomerulonephritis and urological diseases, in the proteinureal occult blood positive cases. We concluded that urinalysis included in a battery of tests at the time of the mass health screening is an effective procedure for detecting chronic glomerulonephritis and urological diseases.

Koumimachi Clinic attached to Saku Central Hospital is located in an underpopulated rural area. We have annually performed a close medical examination by upper gastrointestinal endoscopy since 1982. Since 1986, it has been done early in the morning. In 1995, a total of 1, 513 radiographic examinations were performed and 555 cases were examined by upper gastrointestinal endoscopy. Two cases of gastric cancer-one being early stage and the other, advanced stage-were detected. Despite the busy season all the farmers who had been advised to have the endoscopic examination attended because it was performed early in the morning. The early morning examination was performed in cooperation with Saku Central Hospital, Naganoken Kouseiren Health Screening Center, and public health nurses of local governments. Without such cooporation, any health care project could not be carried out a rural area.

We have provided home health care to 42 patients with terminal cancer over the past five years. The pancreas was the most common site of the primary cencers (9 cases). The average age of the dead was 74.6 years, which was younger than that from heart failure or brain infarction. The average duration of stay of home was 60.1 days. The average frequency of visit to a patient's home was 15.8 times. In 52.4% of the cases, morphine were administered for pain control. The average dose was 48.2 mg per day, and term of administration was 30.6 days. In most cases, those who looked after the patients were daugh-in-laws or wives.
In some cases, a local government lent a bed to a patient. Of the patients 21.4% were fold by their physicians what they are up to were. In conclusion, home health care of cases of terminal cancer will be more important in the future. Pain control by morphine, support for those who look after the patients by frequent visits, practical use of the welfare system and full-time medical care system which meets patients' need are thought to be necessary.