Clinical cases of pesticide poisoning from 2007 through 2009 were analyzed based on data collected from the hospitals affiliated with the Japanese Association of Rural Medicine.
  Two hundred and twelve cases of pesticide poisoning were reported from 48 hospitals. By gender, males accounted for 54%. By age group, those in the 60-69 age band accounted for 23%, followed by those 70-79 years old (22%) and those 50-59 years old (19%). By month, the incidence peaked in May or August accounted for 12% respectively. When it comes to occupational poisoning, the majority of the cases occurred in spring and summer, when pesticides were used frequently.
  By type of pesticide exposure, suicide accounted for 77%, followed by occupation exposure (16%) and accidental ingestion (4%).
  By type of clinical manifestation, acute poisoning was most frequent (90%), followed by dermatitis (3%) and ocular disorders (2%). When it comes to occupational exposure, the rate of acute poisoning decreased to 70%, and dermatitis and ocular disorders increased to 11% respectively.
  Organo-phosphate insecticides topped the list of agricultural chemical compounds causing poisoning (32%), followed by amino acid herbicides (22%) and bipyridilium herbicide (10%). When it comes to main ingredients, glyphosate was the most frequent inducer (32 cases), followed by fenitrothion (25 cases) and paraquat (21 cases).
  Thirty-six death cases were reported, of which 16 cases were by paraquat and 9 cases by organo-phosphate insecticides. The death rate and number from paraquat poisoning were by far larger than those from any other pesticides. A ban on the use of paraquat must be considered.

  The number of dialysis patients in Japan is increasing every year. The medical expense for dialysis patients has now surpassed well over 7 per cent of all medical costs. This has become a great burden on national finance. The D3-30 project was started in April 2006 for Toride city residents. The purpose of this project was a 30% reduction of the yearly number of new dialysis patients in three years. Toride city is located in southern Ibaraki prefecture; it had a population of 112, 152 in fiscal 2006, and 19% of the residents were over 65 years of age. The treatment procedure for chronic kidney disease (CKD) patients at the predialysis stage comprised the following four parts: 1. control of blood pressure, 2. mild restiction of protein and sodium intake, 3. administration of antiproteinuric drugs (angiotensin receptor blocker, angiotensin converting enzyme inhibitor, some calcium channel blocker, etc.), and 4. multifactorial treatment.  CKD patients were recruited through introductions from hospital registered doctors and public health nurses. Some patients entered voluntarily. The number of patients that started dialysis was counted by inquiring at the dialysis center of Toride Kyodo General Hospital and eighteen neighboring dialysis centers. In 2005, before intervention, 36 patients started dialysis; subsequently, the number of patients was 30 in 2006, 33 in 2007, 22 in 2008, and 23 in 2009. The rate of decrease was 39% in 2008 and, 36% in 2009, so the aim of the project was achieved.  If this treatment becomes widespread, it will contribute greatly to the curtailment of medical expenses. However, the difficulty of the treatment may hamper its spread. For it to spread, it is necessary to add the new medical fee for guidance and management for CKD patients.

  Recently, the relevance of Helicobacter pyroli (H. pylori) infection to atrophic gastritis and gastric cancer in has been elucidated. Therefore, to diagnose H. pylori infection is important for suspecting the existence of those diseases of the stomach. We investigated the relationships of the H. pylori IgG antibody to H. pylori infection, atrophic gastritisor various stomach lesions to understand the significance and usefulness of evaluating the antibody level in the annual multiphasic health check-up participants. The subjects in this study were 148 people (male: 93, female: 55, average age: 56.4) in Toride city, which is located in the suburb of Tokyo. They had visited our hospital for medical checkups. Eighty-seven subjects underwent upper gastric endoscopy and 55 (63%) tested positive for H. pylori IgG antibody and H. pylori infection was confirmed in 41 (75%). Although 32 subjects tested negative for the antibody, 8 cases (25%) was diagnosed with H. pylori infection. The frequencies of positive antibody in atrophic gastritis, erosion and ulcer, fundic gland polyp, hyperplastic foveolar polyp, adenoma and malignancy were 17%, 70%, 61%, 77%, 31%, 62%, 0% and 100%, respectively. On the other hand of 80 subjects were who underwent barium X-ray examination, 44 tested positive for the antibody (55%). The frequency of positive antibody in no lesion, depressed lesion, elevated lesion and malignant lesion were 61%, 59%, 36% and 100%, respectively. Taken together, H. pylori antibody was a good marker for H. pylori infection and the positive antibody indicated high frequencies of atrophic gastritis and malignancy. Therefore, advices to have participants who have a positive antibody should be strongly an endscopic examination stomach lesions.

Generalized

In Japan, the number of dialysis patients as of the end of fiscal 2007 has hit the 275,000 mark. The nation is now ahead of the rest of the world in the number of patients per million population. The largest problem that confronts us is that the enormous cost of dialysis is putting a great strain on the nation's finances. In addition, it should be mentioned that the quality of life of dialysis patients is aggravating. It is very rare for renal disease patients to receive kidney transplants, because only 200 kidneys are offered per year in Japan. So most of the patients have no choice but to depend on dialysis for the rest of their life.In the treatment of chronic kidney disease (CKD), it is important to for physicians to delay initiating dialysis as much as they can in Japan. In 1987, I began the programmed treatment of patients in a predialysis state with two nephrologists. The treatment is based on the “Toride guidelines for CKD”. There is an annual meeting of patients. Laboratory data and the history of medication are preserved in sheets.In the CKD clinic of our hospital, there are many devices for time-consuming. Full laboratory data apear quickly on the computer panel, and a clerk enters main data in patients, CKD records.The principles of the clinic iuclude control of office blood pressure and home blood pressure, mild restriction of protein intake, salt intake restriction, monitoring the diet from the data of 24 hours urine collection, control of hemoglobin concentration, serum bicarbonate and phosphate concentration. Reduction in urine protein excretion to less than 0.5 gram per day is done by dietary protein restriction, control of blood pressure and administration of angiotensin converting enzyme inhibitor or angiotensin receptor blocker.The outcomes of the Toride Cohort Study in the past 21 years are as follows:1. Reduction in medical cost by slowing the progression of CKD;2. Reduction in the dialysis-to-non dialysis rate;3. Appearance of the “arrested” or “remission” cases; and;4. Detection of the new risk factors for progression of CKD such as hyperphosphatenia and metabolic acidosis by multivariate analysis.There is a bare possibility open for a CKD patient to receive the “right” treatment of CKD, because only four to five clinics adopting the Toride guidelines are available in Japan.Physicians in CKD clinics have to judge and adjust many variables. The clinics spend plenty of time and effort on the treatment of CKD.In Japan, the medical fee in clinics is dependent on the number of visiting patients and on the number and quality of laboratory examinations, so the physicians keep away from CKD clinics.For the reduction of cost of dialysis, spread of “right” treatment is needed. For spread of the treatment, additional medical fee per patient visit is necessary as incentive.
Dialysis procedure ; therapeutic aspects ; Japan ; Reduction - action ; control

Non-tubercuous mycobacterial (NTM) infection in peritoneal dialysis (PD) patients has been rarely reported. We report a case of a 55-year-old female on continuous ambulatory peritoneal dialysis (CAPD). After a 2-year-history of recurrent exit-site infection of a PD catheter caused by Mycobacterium abscessus (M. abscessus), the patient was admitted to the hospital with signs of peritonitis. Since the same species, M. abscessus, was isolated from the CAPD effluent, multiple antibiotics were administered. However, the treatments could not relieve the symptoms of her infection. Consequently, the PD catheter was removed. Her condition gradually recovered over the course of subsequent, long-term, empirical antimicrobial therapies. NTMs, especially a rapidly growing NTM infection, have rarely been reported in PD patients and are commonly resistant to a variety of antimicrobial agents. Routine acid-fast staining is most likely helpful in promptly initiating treatment against NTM infection in PD patients. Moreover, an appropriate treatment regimen for a rapidly growing NTM infection should be established by accumulating data from cases as reported here.
Infection as complication of medical care ; PUPILLARY DISTANCE ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Patients

Japanese language ; Medicine ; Mental association

We report on three elderly patients with stroke-like onset of atypical Miller Fisher syndrome (MFS). The serum titer of anti-GQ1b IgG was markedly elevated in these patients. Their prognoses were sufficiently good with immunoadsorption therapy with or without intravenous immune globulin (IVIg) therapy. However, some neurological findings were not characteristic of typical MFS. Patient 1 suffered from prolonged dysesthesia in her left extremities, and Patients 2 and 3 showed no ataxia. Moreover, complete bilateral gaze limitation is rare in MFS. The sudden stroke-like onset along with the gaze limitation of these patients suggests that the unexpected elevation in the serum titer of anti-GQ1b IgG due to unknown immune dysregulation might have severely affected the third, fourth, and sixth nerves and this potent antibody rapidly attacked these nerves and induced stroke-like clinical features and complete ophthalmoplegia.
Cerebrovascular accident ; Miller Fisher Syndrome ; Right and left ; Serum ; Atypical

We report on a right-handed 43-year-old policeman with atypical Marchiafava-Bignami disease (MBD). The typical clinical manifestations of MBD are reduced consciousness, confusion, seizures, psychotic and emotional symptoms, hemiparesis, dysarthria, ataxia, and coma and death. However, our patient had not developed any of the above symptoms except for slowly progressive cognitive impairment mimicking that of Alzheimer disease. The incidence of MBD may be higher and its prognosis less severe than generally believed. MBD has been underdiagnosed and underreported, and nonspecific general symptoms and encephalopathy in an alcoholic might indicate undiagnosed MBD.
Impaired health ; symptoms <1> ; Marchiafava-Bignami disease ; Problem drinker ; prognostic

A reduction in electricity and heating expenses is a major consideration with every hospital in Japan. In our hospital, all the personnel including the members of the facilities division have joined forces to mount the “1,300kW campaign” aimed at cutting down on the amount of maximum instantaneous electric power consumption (demand) from 1,500kW to 1,300kW in one year, and succeeded in curtailing heating and lighting expenses by well over 4 million yen. The key to success was how to control the amount of demand. The cooperation of all the personnel of the hospital was vital. Therefore, it was important to raise the awareness of all the personnel concerning energy conservation. We thought that setting the concrete numerical target “from 1,500kW to 1,300kW” was effective. It is no exaggeration that such a cutback in energy consumption contributes not only to the management of a medical institution but also to the environmental preservation on a global scale. Finally, the medical institutions should put contribution to the community into the basic principles at the time when environmental preservation (ecology), energy consumption reduction, risk management and catastrophic disaster etc. have become topics of conversation.
Hospitals ; Consumption of goods ; Human Resources ; success ; Economic demand