A dermatitis of unknown etiology has occurred among about 60 residents working in paddy fields in a rural district of Hyogo Prefecture, located in the side of Seto inland sea (Takasago City).
The dermatitis had been brought about from June, 1981 to August, 1981 after rice-planting and weeding were done, which was characterized by erytemato-papulo-vesicular eruptions with severe itching, mostly during 5 to 15 days. The chief complains and symptoms were obtained on the body parts exposed to paddy field water, especially back of hands, fingers, wrist-joints and lower parts of legs.
The results of questionaries in the patients, clinical observations and seroepidemiological survey by indirect fluorescent antibody method in the use of Schistosoma mansoni cercariae as an antigen, seemed that the dermatitis was due to the invasion of cercariae of anavian schistosome.
The surveillance for snail intermediate hosts has been performed in the fields where the dermatitis occurred. Up to date the cercariae causing the dermatitis has not been clarified yet.
The etiological survey of cercariae from the fresh water snails is proceeding under survey.

A 76-year-old man was admitted to our hospital to receive optimal medical therapy for acute type B aortic dissection with a thrombosed false lumen. Eighteen days after admission, computed tomography (CT) was performed because of back pain and showed new retrograde acute type A aortic dissection. Emergency total arch replacement was performed with the aid of a J-graft open stent graft (JOSG). Postoperatively, the blood pressure in the lower extremities decreased to 70% of systemic blood pressure without symptoms. Enhanced CT showed severe stenosis from the non-stent part of the aorta to the proximal part of the JOSG. On postoperative day 2, thoracic endovascular aortic repair (TEVAR) was performed for stent graft stenosis. The blood pressure of the lower extremities promptly recovered after the procedure, and the patient was extubated without any neurologic deficits on the next day. Postoperative CT demonstrated that the stent graft stenosis had been effectively alleviated. The patient's subsequent course was uneventful and he was discharged on postoperative day 24.

A JOSG should only be deployed after precise evaluation of the anatomy of the target aorta and careful attention should be paid to the length of the non-stent part of the graft in order to prevent unpredictable graft retraction that could cause stent graft stenosis. TEVAR is considered to be a good option to treat complications related to open stent grafts.

The sudden development of cyanotic lesions on the foot and toes may be a result of atheroembolic disease referred to as “blue toe syndrome”. During the last 7 years, 10 patients, consisting of 7 men and 3 women, were treated for ischemia of the toes of varied severity. The patients' ages ranged from 58 to 85 years (mean 73 years). Five patients had lesions on both legs and 5 on one leg. Contrast-enhanced abdominal CT scan revealed atherosclerotic changes of the abdominal aorta concomitant with intramural thrombus in every examined case. Four patients were treated medically and 4 underwent surgery consisting of replacement of the abdominal aorta in 3 and minor amputation of the toes in the other case. Two other patients developed acute renal failure within two months after the diagnosis of blue toe syndrome and succumbed to either heart failure or bleeding peptic ulcer. Contrast-enhanced CT scan is important for the diagnosis of blue toe syndrome. Though the prognosis of patients with blue toe syndrome is good in most cases, multiple microembolization to the viscera may cause renal failure and the prognosis of those patients is less favorable. Surgical intervention should be considered if the blue toe syndrome patient has an abdominal aortic aneurysm or history of multiple embolic episodes.

A case of aortic valve replacement in a 92-year-old woman is reported. Severe aortic valve stenosis was pointed out when she suffered from congestive heart failure (CHF). After medical treatment for CHF, she complained of leg edema even with only mild exercise. Aortic valve replacement was performed, because her general condition and her left ventricular contraction on UCG were good. Her postoperative course was good except for a transient rapid atrial fibrillation. We think that surgery should not be withheld on the basis of age alone.

In the insured of the agricultural cooperative life insurance program (12, 156, 022 cases), 12, 588 persons were involved in accidents in 1973 fiscal year. The following analysis was conducted on these 12, 588 persons with special reference to the 2, 218 persons who were involved in farm machine accidents.
1. There were 3, 945 cases of traffic accidents. Of them, there were 2, 499 deaths and the fatality ratio stood at as high as 63.3%. There were 57 cases of traffic accidents involving farm machines. Of them, there were 42 deaths and the fatality rate was evidently high with 73.6%
2. There were 54 deaths caused by farm machines excluding those caused by traffic accidents. Of them, 45 were caused by cultivators. The ratio was extremely high with 83.3%.
3. Of the 45 deaths caused by cultivators, 26 were the cases in which the operators were pressed by fallen cultivators. In 13 cases, the operators were caught in between the machine and tree or building.
4. There were the other 2, 164 cases of farm machine accidents in which the patients were later seized with sequelae. Of these cases, 564 cases (26.0%) were caused by cultivators, 379 cases (17.5%) by thrashing machines and 316 cases (14.6%) by reapers. The accidents caused by these three types of machines accounted for 1, 259 cases (58.1%).
5. In the overwhelmingly large portion of the cases of accidents, sequelae broke out in fingers. Thus, 89.6% of those who were involved in machine accidents suffered from sequelae in fingers.
6. There were 1, 939 cases of finger accidents, of which 1, 032 accidents were caused by machine belts and 441 by machine blades. The accidents caused by these two items accounted for 75.9%.
7. From the statistical analysis, it might be said that the correlation coefficients between the number of farm machines available in a given area and that of accidents are less significant for cultivators and reapers, and that the environmental and working conditions are just as important elements as the number of machines.

We evaluated the therapeutic results of cancers in the bile duct, the pancreas head region and the liver and cirrhosis.
The former two types were examined in a total of 49 cases: 10 cholecystocarcinomas, 18 cholangiocarcinomas, 6 papillocarcinomas, and 15 pancreas head cancers. Radical surgery was performed in only 9 cases: 1 cholecystocarcinoma, 1 cholangiocarcinoma, 5 papillocarcinomas and 2 pancreas head cancers. The surgical success rate was satisfactory 83%(5/6) for papillocarcinoma, yet showed 18.4% overall.
Liver cancer and cirrhosis were examined in 102 cases: 78 cirrhoses and 24 livercancers. Of the former, 15% were viral cirrhosis, 44% alcoholic, 1% specific and 40% unknown. Ofthe latter, 29% were viral liver cancer, 29% alcoholic and 42% unknown.
Treatment of these cancers, with the exception of one type, was unfavorable. To increase the surgical success rate, cancers will have to be discovered earlier using such recent, highly-advanced technological means as endoscopy, ultrasonography, angiography and computerized tomography. At the same time, radical surgery should be actively applied in a broader range of cases.
In cirrhosis, bleeding in the upper digestive tract and complicating liver cancer are increasing in frequency due to prolonged life expectancy. How to manage this increase remains subject for further study in the future.

A 24-year-old woman had been injured in an automobile accident. The chest X-ray showed widening of the mediastinum and computed tomography showed mediastinal hematoma around the aortic arch. Aortic rupture was suspected, so we performed aortography, which revealed pseudoaneurysm of the descending aorta. Moreover, she also had splenic rupture and pelvic fracture. She underwent an emergency operation 4 hours after the accident. Medial tear of the descending aorta was replaced with a graft under temporary bypass without heparin. Simultaneously, splenectomy was performed. Her postoperative course was uneventful. We consider that temporary bypass without heparin is a useful method during repair of the descending aortic rupture due to trauma.

Prompt and accurate diagnosis of malarial patients is a crucial factor in controlling the morbidity and mortality of the disease. Effective treatment decisions require a correct diagnosis among mixed-species malarial patients. Differential diagnosis is particularly important in cases of Plasmodium vivax, a species that shares endemicity with P. falciparum in most endemic areas. Moreover, it is difficult to identify P. knowlesi on the basis of morphology alone, and rapid diagnostic tests are still not available for this malaria species. Therefore, the development of diagnostic tests applicable to the field is urgently needed. 1-Cys peroxiredoxin (1-Cys-Prx) in P. falciparum is abundantly expressed in the mature asexual stages, making it a promising candidate as a diagnostic antigen. In this study, we produced five monoclonal antibodies (mAbs) against P. falciparum 1-Cys-Prx (Pf1-Cys-Prx) by immunizing BALB/c mice with recombinant Pf1-Cys-Prx and subsequent hybridoma production. Cross reactivity of established mAbs with the orthologous molecule of Pf1-Cys-Prx in P. vivax (Pv1-Cys-Prx) and P. knowlesi (Pk1-Cys-Prx) was examined. Western blot analyses showed that three mAbs reacted with Pv1-Cys-Prx and Pk1-Cys-Prx but two mAbs did not. These results indicate that the two mAbs were effective in differentiating P. falciparum from P. vivax and P. knowlesi and could be used in differential diagnosis as well as comparative molecular studies of human Plasmodium species.

PURPOSE: The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. METHODS: Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. RESULTS: A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. CONCLUSIONS: The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.
Asian Continental Ancestry Group ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Informed Consent ; Medical Records ; Reproducibility of Results ; Thorax ; Tokyo ; Surveys and Questionnaires