The purpose of this study is to investigate the prevalence of and to classify the types of silicosis patients who were working at that time as migrant workers in the eastern part of Toyama Prefecture. Migrant workers are known in Japanese as “dekasegi” This term refers to workers who migrate seasonally from their home towns to areas where work is more available.
Questionnaires were sent to all male inhabitants aged 30 or over in the selected five areas. Eighty-seven percent of the questionnaires were answered and returned. Based on the results, 482 inhabitants were selected as migrant workers with experience in jobs where they were exposed to large amount of dust. Chest roentgenography and subjective symptoms were examined in these subjects.
The results obtained were follows;
(1) Eight hundred and eighty-five of the respondents (41%) had worked as migrant workers.Of these, 580 men (66%) had worked in jobs with exposure to dust.
(2) Of the 482 migrant workers whose jobs exposed them to dust, 424 silicosis cases (88%) were found by chest roentgenographic examination. Silicosis is classified into four types according to the national Pneumoconiosis Law on the basis of chest roentgenographic findings. These patients included 195 cases of type 1, 123 cases of type 2, 59 cases of type 3 and 47 cases of type 4 silicosis.
(3) The prevalence of disease symptoms in the silicosis patients included ; cough 39%, phlegm 40%, shortness of breath 41%, palpitations 17% and wheezing in 20% of the cases. The silicosis patients showed a higher frequency of respiratory disease symptoms than those dust-exposed workers who did not evidence signs of silicosis.
(4) The silicosis patients were found in 98% of the migrant workers whose exposure to dust lasted a period of more than 20 years, 89% in men whose work was between 10 and 19 years and 76 % in men who had worked less than 10 years.
(5) The silicosis in 297 cases (70% of the total number of disease patients) was first detected during the examinations in the course of this research.

We recently encountered a case of fatal pneumococcal infection in a previously healthy 19-year-old female. She had no history of splenectomy, but on autopsy she was found to have hyposplenism. It has been widely reported that life-threatening pneumococcal infection can occur after splenectomy, though cases of hyposplenic or asplenic adults, without a history of splenectomy, are very rare. We report this case and review the literature dealing with 6 similar cases.

In patients with the visceral fat type obesity, there is a high incidence of glucose and lipid metabolic abnormalities and hypertension. We obtained the following results from a study of the relationship between the degree of visceral fat obesity and metabolic and vascular complications in 98 obese patients with various complications.
1. Viceral fat obesity (V/S ratio ≥ 0.4) was found in 74% of the subjects. The incidence was higher in males than females. The highest incidence was observed in both men and women in thier 40s, and there was no increase with age.
2. The V/S ratio was high in patients with hyperlipidemia, diabetes, and fatty liver in that order. In the V/S ≥ 0.4 group, there was a higher incidence of hyperlipidemia and ischemic heart disease than in the V/S<0.4 group.
3. The V/S ratio was higher in the patients with two or more metabolic and vascular complications than in those with only one complication.
4. A questionnaire survey showed that there were many individuals who did almost no exercise and had a long history of obesity in the V/S ≥ 0.4 group.
5. The V/S ≥ 0.4 group had high triglyceride levels. There was a positive correlation between the V/ S ratio or V value and the trigyceride level, but no correlation between S value and triglyceride level.

BACKGROUND/AIMS: We aimed to evaluate whether the advanced techniques have influenced the minor papilla approach. METHODS: We studied the success rate of guide wire insertion by using ordinary techniques and advanced techniques (rendezvous method and precut method) in 30 patients via the minor papilla. We compared the selection of the access routes between before (52 patients) and after (28 patients) the introduction of the Soehendra stent retriever. RESULTS: In 19 out of 30 patients (63%), guide wire insertion via the minor papilla could be achieved by using ordinary techniques. In total, the guide wire could be inserted in 27 patients (90%) by using the advanced techniques. Before introduction of the Soehendra stent retriever, the major papilla approach was chosen in 38 cases (73%), and the minor papilla approach in 14 cases (27%). After introduction of the Soehendra stent retriever, the major papilla approach was used in 26 cases (93%) and the minor papilla in 2 cases (7%). The frequency of selecting the minor papilla approach has significantly decreased (p<0.05). CONCLUSIONS: The advanced techniques have contributed to the improvement of endoscopic approaches via the minor papilla, and decreased the frequency of selecting the minor papilla approach.
Humans ; Stents

BACKGROUND/AIMS: Self-expandable metallic stent (SEMS) placement is effective for dysphagia that results from malignant obstruction of the esophagus or gastric cardia; however, stent-related complications may be life-threatening. Thus, the goal of this study was to identify risk factors associated with complications following esophageal stenting. METHODS: Of the 71 patients who underwent SEMS placement for dysphagia as a result of malignant stricture of the esophagus or gastric cardia, 53 patients with squamous cell carcinoma or adenocarcinoma, without previous SEMS placement, without a fistula, and without recurrent tumor after surgery were retrospectively identified. The occurrence of stent-related complications was used as an endpoint. RESULTS: Stent-related complications were identified in 26 patients (49.1%), and major complications occurred in 14 patients (26.4%). The use of an Ultraflex stent (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.54 to 30.00; p=0.011) and prior chemotherapy (OR, 6.13; 95% CI, 1.46 to 25.70; p=0.013) were significantly associated with stent-related complications. Moreover, the use of an Ultraflex stent (OR, 19.60; 95% CI, 2.26 to 170.00; p=0.007) and prior radiation (OR, 25.70; 95% CI, 2.37 to 280.00; p=0.008) significantly increased the risk of major complications. CONCLUSIONS: The use of an Ultraflex stent and prior radiation and/or chemotherapy may represent risk factors for complications following esophageal SEMS placement.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cardia* ; Constriction, Pathologic ; Deglutition Disorders ; Drug Therapy ; Esophagus* ; Fistula ; Humans ; Retrospective Studies ; Risk Factors ; Stents

Because of societal aging, Japanese pharmacists have an increasingly important role in home medical care. This is particularly true because more pharmacists are required to perform physical assessments to optimize patient treatment. However, few investigations have examined whether patients understand the role of pharmacists and the importance of home medical care. In this study, a questionnaire was provided to 260 patients aged 20-90 years to determine patients’ attitudes toward home medical care and pharmaceutical interventions. After conducting factor analysis, items related to home medical care were excluded at the stage of exploratory factor analysis, indicating that patients are not interested in home medical care. However, regarding pharmaceutical interventions, the questionnaire revealed that 42% of the patients required the pharmacists to provide information regarding the prescribed drugs during home medical care visits. Furthermore, it was demonstrated that 85% of the patients were unaware that physical assessments are also perform by pharmacists. In contrast, >50% of the patients believed that pharmacists had an important role in physical assessment interventions.

BACKGROUND/AIMS: A barbed puncture needle with a side hole was recently developed to improve sample quality and quantity in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In this study, we retrospectively assessed the usefulness of this puncture needle. METHODS: Factors affecting diagnostic yield, safety, and diagnostic accuracy were investigated in 76 patients who consecutively underwent EUS-FNA for neoplastic lesions at our hospital between January and December 2013. RESULTS: The procedure was successful in all cases; the rates of sample collection and determination of the correct diagnosis were 92.1% and 89.5%, respectively. The mean number of needle passes required for diagnosis was 1.1. Complications included mild intraluminal bleeding in two patients (2.6%). Multivariate analysis revealed that lesion size (< or =20 mm) was significantly associated with a decreased chance of determining the correct diagnosis. CONCLUSIONS: Core biopsy needles with a side hole are safe and provide a satisfactory diagnostic yield. However, the side hole may potentially reduce the rate of making the correct diagnosis in small lesions.
Adult ; Aged ; Aged, 80 and over ; Digestive System Neoplasms/*diagnosis/ultrasonography ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*instrumentation ; Equipment Design ; Equipment Safety ; Female ; Gastrointestinal Tract/pathology/ultrasonography ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Needles/adverse effects/*statistics & numerical data ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Statistics, Nonparametric