Cardiovascular surgeons have strong preferences regarding basic surgical skills. However, those basic skills have never been discussed great detail. The aim of this study is to survey the approach methods for axillary and subclavian artery targeting cardiovascular surgeons in Japan aged under 40, and to share the results of those basic skills.

I surveyed the actual patterns of dietary life and work in rural communities, in which the changes are so great as to lead one to fear about their future, and checked them against health issues. In the dietary life, the intake of carbohydrate has generally dropped (the intake of rice even by farming families is on the decrease), while that of proteins-and lipids in particular-hassignificantly increased. In some rural communities, however, the conventional practice of taking in much carbohydrate is observed. As farm work has been increasingly mechanized, the types of farm work with heavy work loads have decreased, and the loads are now medium and small in range. But there are few farming families to take holidays on a regular basis. They are busy all the year and the length of working hours a day is great. Many of the farming families with nonagricultural side jobs engage in farm work on Saturdays. Few farm workers enjoy sports. In terms of health indices, anemia is on the decrease, though there used to be many cases, and there are signs of a rise in the prevalence of obesity. Then there are many patients with hypertension and other circulatory problems and there are signs of a rise in the prevalence of adult disease. It is to be hoped that health care be strengthened, but for this, is necessary first of alle to bring up farming families so that they may be able to enjoy a socially stable life.

Studying the causes of death among inhabitants in mountain villages located alongside the middle stream of the Tenryu River, and farming-fishing villages located along Tokyo Bay, we found that the death rate from lung cancer was high in the former, and that from stomach cancer was high in the latter. So, in those two districts, we carried out case-control studies about both kinds of cancer. Investigation was made into the dead cases from lung cancer, 84 male cases and 168 male controls, and the dead cases from stomach cancer, 83 male and 39 female cases and the same number of controls. We selected these controls, matching district, sex, age, and year of death, and studied occupation and smoking in lung cancer cases ; occupation, eating habits, kinds of food, drinking and smoking in stomach cancer cases. The odds ratio concerning to lung cancer was as low as 0.40 among people engaged in agriculture, forestry or fishery. But that was as high as 3.25 among people exposed to metal dust, and also as high as 3.10 among those exposed to wood dust. The multiplier effect could be suggested between smoking and metal or wood dust exposure. The odds ratio concerning to stomach cancer was as low as 0.69 among males engaged in agriculture, forestry or fishery. Regarding eating habits, ‘rapid eating’ was as high as 2.57 in males, 3.00 in females. Concerning the kinds of food, ‘salted fish’ was as high as 1.90 in males, and ‘white vegetables’ was as low as 0.36 in females. No assocciation was found between stomach cancer and smoking or drinking.

Over the three years from 1980 to 1982, investigations were carried out into the health conditions of inhabitants aged 30 to 69 in rural regions of Chiba Prefecture.
The major findings are as follows:
(1) Significant sex differences exist for many blood test findings.
(2) Significant correlations are found among values of many blood test findings.
(3) These values are analyzed by principal component analysis and some factors are extracted. First of them is found both men and women in all districts similarly and is identified as something of nutritional condition.

A survey concerning primary health care was taken in two mountainous villages (populations: 8, 600 and 5, 400) in Shizuoka Prefecture and two farming and fishing villages (12, 000 and 7, 100) in Chiba Prefecture. In these four communities, the aged account for more than 17% of the population. The crude death rate is high. The rate of population growth is below zero. The infant mortality rate and the stillbirth rate are low.
The major causes of death are malignant neoplasms, cerebrovascular diseases, and heart diseases. Pneumonia, accidents and suicide are above the national average. The annual revenue and expenditure of the national health insurance system are below the national average. Among the impatients, the rates of those suffering from mental disorder and circulatory diseases are high, while many cases of the outpatients are circulatory diseases.
Medical institutions have difficulty in meeting with the demand of inhabitants. Some town cannot bear the burden of medical expenditures and gets into financial trouble. Health and Welfare services are inadequate due to the shortage of personnel. Health activities among inhabitants are in the doldrums. Clinics do not function as a provider of family medicine.
These are the major findings of the survey. The establishment of primary health care is badly needed.

We have made a survey of living, labor and health about fishermen-122 males, 87 females-living in three coastal villages in the south of Chiba prefecture.
The fisheries of this district are mainly done by using hooks and nets; the former has three types, that is, “tatenawa”, “haenawa” and “saozuri”, the latter has three types, that is, “teichiami”, “sashiami” and “aguriami”. The fishing boats are smaller than 5 tons. In men, the days of labor all the year round are 220 more or less, and women assist men in doing the fishery.
On food life, both men and women intake fish & shellfish, white vegetables, and fruits in plenty, but they intake milk and dairy products scantily. The average rates of drinking and smoking are each about 70% in men, and each 15%, 8% in women.
Executing health examination, we find that the average rates of hypertention arenot high, and the ones of ECG abnomality are low. The average rates of obesity about BMI-greater than 26-are 20% in men, and 24% in women.
Moreover, the rate of anemia is low, the rate of hyperlipemia (serum triglyceride, greater than 150 mg/dl) is high, and the rate of the persons with high serum binding urea nitrogen (greater than 20.0 mg/dl) is high.
As for Nofusho syndrome, fishermen frequently suffer from nycturia or sleeplessness, adding shoulder stiffness or lumbago.

Over the three years from 1980 to 1982, investigations were carried out into the living and working conditions of fishermen and farmers aged 30 to 59 in a coastal region of Chiba prefecture. The major findings are as follows:
(1) Man-years of work are less in the fishing communities than in the farming villages. Especially, women in the fishing communities work less.
(2) As for food intake, Fishing people consume larger amounts of fish and shellfish (animal protein) than farmers, while farmers eat a good deal of vegetables and rice compared with fishermen.
(3) Blood' tests revealed that hemoglobin, serum iron, total serum cholesterol, uric acid, GOT and GPT values are higher in fishermen than in farmers. HDL cholesterol levels were higher in the agrarian population. There was no great difference in serum protein, albumin, triglyceride, alkaliphosphatase, and cholinesterase levels.
(4) The obesity rate is higher in the fishing villages than in the farming villages. Especially the obesity incidence is notably high among women in the fishing communities.

It is a well-known fact that the environment has been globally contaminated with the persistent organochlorine insecticides and PCBs, and that all over the world the general populations have been polluted with them in spite of their minute quantity for some decades. These chemicals except PCBs are mainly neuropoison, and according to De Vlieger (1968), DDT and Dieldrin are translocated to human brain, and these concentrations of the tissue are greater than those of the blood. The adverse and ill effects of these residues on human central nervous system can be determined incompletely. In addition, their production and use have not yet been prohibited in some countries. Therefore, according to the previous report (1981), the contents of these compounds have been surveyed about wild yellowtails migrating around the Islands of Japan, and cultured ones fed on a sort of sardine catched near the Islands.
In the case of DDT, the content of wild samples catched in 1983, showed not only low level of total DDT, but the increase of its metabolites, compared with those of two years before: i. e., the mean concentration decreased to about one-half (from 0.38 to 0.17 ppm), and the ratio of its meabolites per total DDT inversely increased from 41 to 57%. In addition, the same tendency was also observed in those of cultured samples.
With regard to PCBs content, however, the fish of wild type showed the same level (0.10 ppm) as that of cultured type in 1983, and their peak patterns were observed similar. The PCBs contents have been almost unchanged in these two types since 1980 over a period of 3 years.

DDT, one of the residual organochlorine pesticides, has been still used in China and perhaps in developing countries of the equatorial hemisheric zone. Therefore, wild and cultured yellowtails were selected as the indices of DDT residue levels of the marine fishes, considered a main source of the residue in the general population of Japan.
Total DDT level of wild one, large type of fishes distributed from South China Sea to nearly north end of Hokkaido in latitude, increased severalf old during two years from Feb.-Mar. 1979 to Mar. 1981. Consequently, the levels of total DDT in wild yellowtail were higher than those in cultured one in 1981. It is noteworthy that especially three wild fishes catched from Nagasaski area were not only high in the levels, but low in the ratio of pp-DDE plus pp-DDD per total DDT. It is suspected that they were going forward to North with the Japan Current. Close relations were recognized among DDT residues, PCB patterns and sea areas catched, and marked differences of the residue levels were observed on account of the areas.
Furthermore, slight increase was also recognized about the level of cultured type in 1981 compared to the samples in 1979.
On the other hand, the level of dieldrin was higher in the cultured one than the wild as well as in the two years before.

Three essential factors of the sympathetic nervous functions, sympathetic nervous tone (β-, α-secretion), adrenoceptor sensitivity (β-, α-sensitivity) and adrenergic manifestations, were assessed integratedly by the sequential administration of specific adrenoceptor agonists and blockers. The examination procedures were designed to provide all parameters under the blockade of the autonomic regulation without affecting the basic sympathetic nervous functions.
Decrease in β- and α-secretion associated with the increase in β- and α-sensitivity in patients with diabetic neuropathy, idiopathic orthostatic hypotension and cervical radiation myelopathy were exactly compatible with the autonomic dysfunctions of them and convinced the validity of the methods. Synchronized firings of the sympathetic nerves of the cardiovascular system and harmonized regulation of the adrenoceptor sensitivity were shown by the positive correlations between β- and α-secretion and between β- and α-sensitivity, respectively. Negative correlations between “secretion” and “sensitivity” over wide ranges of these parameters suggested that the concept of denervation hypersensitivity was not specific for patients with organic autonomic neuropathies but was commonly avairable for usual subjects in proportion to the sympathetic nervous tone of the individual subject.