Outcome of Out-of-Hospital Cardiac Arrest in Tsuchiura and its Surrounding Rural Areas / 日本農村医学会雑誌

To determine survival from out-of-hospital cardiac arrest in Tsuchiura and its surrounding rural areas, we conducted observational study. Consecutive 555 out-ofhospital cardiac arrests (206 cardiac etiology and 349 noncardiac etiology) occurring between July 1, 1992, and June 30, 1998 were participated.<BR>In all, 422 (76%) patients were pronounced dead in the emergency room, and other 125 (22.5%) were admitted to the hospital but subsequently died. There were 8 survivors the overall survival rate was 1.4%.<BR>Cardiopulmonary resuscitation was initiated by a bystander in 14 (11.2%) of 125 witnessed cardiac arrest with cardiac etiology. Among patients in whom cardiopulmonary resuscitation had been initiated by a bystander, 29% were discharged alive versus 0.9% of the remaining patients (p<0.01). The survival rate of patients with an initial rhythm of ventricular fibrillation was significantly greater than that of those with an initial rhythm of asystole or pulseless idioventricular rhythm (p<0.05).<BR>These results indicated that critical factors in survival from out-of-hospital cardiac arrest of cardiac etiology were bystander-initiated cardiopulmonary resuscitation and initial arrhythmia.

Increasing Use of Morphine in Our Hospital and Cancer Pain Relief in Our Pain Clinic / 日本農村医学会雑誌

This study was performed to evaluate management of cancer pain in 322 patients who were treated in our pain clinic between January 1986 and December 1997. For this purpose, the change in the number of cancer patients and the annual morphine consumption during the period in our hospital were investigated. We found that as morphine consumption increased, the number of cancer patients visited the pain clinic decreased. Although 90% of them who visited the pain clinic underwent neural block therapy before 1996, the parcentage dropped to only 79% in 1996 and 50% in 1997. The increasing rate of morphine consumption in our hospital was on a par with the national average between 1986 and 1996. The use of adjuvant drugs did not change throughout the 12-year period.<BR>We believe the consumption of morphine is not enough. It is necessary for us to become more skilled in using narcotics for relief of cancer pain along the guidelines of the World Health Organization.

Sudden Death in a Rural Area. Investigation into DOA and Autopsy Records / 日本農村医学会雑誌

Sudden death (SD), which unexpectedy occurs in the middle aged and the elderly, is a subject worth studying. Much about the cause of the demise remains shrouded in mystery from the standpoint of medicine and has a significantly great impact on the community.<BR>We conducted a fact-finding survey of SD by gathering data on dead-on-arrival (DOA) cases stored by five general hospitals affiliated with the National Welfare Federation of Agricultural Cooperatives. Examined were 292 DOAs that were registered between January 1993 and December 1993 and autopsy findings of 45 cases obtained from one of the hospitals over the past eight years. The results are summed up as follows:<BR>(1) The largest number of DOA cases was found in the age group of 70 to 79 years. About half of the total number was accounted for by people older than 70.<BR>(2) Cardiovascular disease topped the list of causative and basal ailments that might have led to SD. Especially ischemic heart disease was evident in many cases.<BR>(3) In many cases, death occurred during sleep or at rest.<BR>(4) Cardiopulmonary resuscitation was performed according to rule on most of the victims, but the priamry resuscitation ratio came out at 26%.<BR>From these observations, we concluded that for the prediction and prevention of SD and DOA it is necessary to work on measures to help prevent and cure ischemic heart disease.