Rheumatoid arthritis and interstitial pneumonitis were diagnosed in a 72-year-old man and thoracic computed tomography revealed an aortic arch aneurysm 50mm in diameter. Steroid therapy gave symptomatic relief and improved laboratory findings, but hyperglycemia and hypertension developed. Two months later the thoracic aneurysm ruptured, and computed tomography revealed expansion of the aneurysm to 60mm in diameter and surrounding hematoma. Emergency total arch replacement was performed successfully with deep hypothermic cardiopulmonary bypass and selective cerebral perfusion. The steroid therapy was considered to be responsible for the rapid expansion and rupture of the thoracic aneurysm. When prescribing steroids for a patient who has a concomitant atherosclerotic cardiovascular disease, we should not only control the steroidal side effects strictly, but also carefully watch the course of the atherosclerotic lesion.

For the purpose to clarify the industrial fatigue and causative factors, the health examinations and the investigations of daily life were made to 138 workingwomen in a cotton-yarn factory in the rural district.
1) Comparing with other occupations, the fatigue in workingwomen was generally severe, especially in the middle-aged women who engaged in an agricultural labor besides the labor in the factory. As for the characteristics of their fatigue, the mental fatigue was more predominant than the physical fatigue. The results of Flicker test, autonomic nerve function test and urine creatinin test revealed the alternate shift working system in the factory was one of the causative factors which was responsible for the fatigue of the workingwomen.
2) The health examination revealed the high prevalence of anemia. The occurrence of the mild hypertension, the localized muscle fatigue and low back pain were also noteworthy. The investigations on the workingwomen's daily lives revealed that they engaged in an agricultural labor and households early in the morning or in the holidays, and worked for 8.6 hours in the average, and 16 hours in the maximum.
In addition to the industrial fatigue, the burdens of the agricultural labor and the households got worse the health conditions of the workingwomen. In the rural district it becomes very important to promote the comprehensive health care activities from the both sides of community health care system and occupational health care system.

A questionnaire was sent to school health nurses in rural districts of Shimane Prefecture asking them about health conditions and emergency accidents of children, problems of the health care, and safety administration in schools.
The health conditions of children in rural districts were almost common with those of children in cities of Japan. It was suggested that the increase of psychosomatic complaints and disorders of children was directly or indirectly affected by the changes of life conditions in households of side-work farmers, the inhumane competition in education and the drastic urbanization of life style.
The cooperative approach to comprehensive health care of children by the participants of school health and community health is urgently needed to promote the health level.

The state and problems of health care to farmers in the rural district, San-in, the west northern part of Japan were studied in cooperation with Agricultural Cooperative Associations, Municipalities, Health Centers, Agricultural Mutual Benefit Association and Agriculture Guide Center since 1977.
Various features of interrelationship among the demographic, living, and physical conditions were analysed from the standpoint of promoting community health level.
In our investigation almost of the farmers complained commonly of some diseases such as hypertension, anemia and lesion concerned with bone-muscle-connective tissue system. The health problems on connection with the community characteristics in each district were as follow;
1) In the truck gardening district, the fatigue, overwork, lumbago and greenhouse workers' syndrom were found in a high rate.
2) In mountainous rice crop district, anemia and fatigue in women were prevalent.
3) In the urbanized area around the city, hypertension was prevalent. High frequency of the discontinued treatment type in hypertensive patients and low consiousness for self health care were noted.
4) In the tea and grape plantation district, lumbago, cervical syndrom, osteo-arthritis of knee joint and numbness of fingers which is similar to “vibration syndrom” were noted.
It is, therefore, clear that the adequate, comprehensive medical care program in a community on the basis of socioeconomical characteristics of each district is needed to promote the cooperative activity of health service of administration, agricultural policy and inhabitant participation.

An 11-year-old boy, who underwent a Rastelli operation using a 14mm artificial graft and left pulmonary artery (PA) plasty with an autologous pericardium patch 7 years previously, had severe recurrent left pulmonary stenosis. Reoperation was performed including right ventricular outflow tract reconstruction and left PA plasty. The PA at the most stenotic site was only 2mm in diameter; it was enlarged to 10mm by good exposure and an incision on the pulmonary intima. A bovine pericardium patch with a handmade ePTFE valve was sutured onto the autologous tissue not onto the pulmonary intima to avoid restenosis and in expectation of the growth of the pulmonary orifice. On postoperative 3-D CT, the left pulmonary artery was patent and 9mm in diameter. Pulmonary scintigraphy showed an improvement in the left pulmonary perfusion. This sutureless technique was useful in this case of severe pulmonary stenosis.

Divers' heart rates were measured under real ocean diving conditions with the purpose of evaluating the workload during SCUBA diving. For the subjects, all-out tests were conducted and evaluated in each of the following conditions: 1. ergometer cycling, 2. ergometer cycling using diving regulator, 3. fin-swimming in a swimming pool with diving equipment. No significant heart rate difference was found between the pre-dive and post dive of each subject; although, in novice divers, high heart rates such as 140/min or more were observed especially during the dive gear wearing phase on the topside and/or floating on the surface phase, suggesting there should be some high heart rate inducing factors, other than the exercise, like stress. Whereas, in the results of the all-out tests, the heart rate for fin-swimming was 16~18 beats/min lower, as well as 5.7~14.2 ml/kg/min lower for VO₂max, as compared to the ergometer cycling. This may suggest that fin-swimming like scuba diving could give a diver some degree of physical load without on increased heart rate.