Hiroshima General Hospital and Its Involvement in Community Health Care-Especially with Respect to Prevention and Control of Cardiovascular Disorders / 日本農村医学会雑誌

Hiroshima General Hospital dates back to 1947. Initially it was known as the Saiki Hospital affiliated with the Agricultural Association of Hiroshima Prefecture. It had 60 sickbeds and four departments-internal medicine, surgery, otolaryngology and dentistry. In those days, there were a large number of atomic bomb survivors in this medically underserved province of Saiki, so that the hospital was extremely busy treating these hibakushas. With the increase in the number of patients, the hospital kept expanding. It was not until 1979 when the number of beds increased to 270 that the hospital was reorganized and assumed the present name. Since then, it has continued to expand and its medical facilities improved. Having been accredited with the type B general hospital by Japan Council for Quality Health Care, it has now become the nucleus of the health care system in the western part of Hiroshima Prefecture, with 570 beds.By way of illustrating how our hospital has been involved in community health care, we will take a look at the trend of the number of emergency cases admitted at night or on holidays. Up until 1998, the annual number of such cases had stood at somewhere around 4,000 but in 2003 the figure exceeded 10,000. For routine physical checkups, electrocardiograms are used. In 1975, 1,800 patients underwent ECG tests and in 2000 the number leapt to 27,000. This author has taken it upon himself to interpret all these ECG records.The Department of Cardiology in our hospital had made it a rule to conduct noninvasive testing in diagnosis. In 1984, the x-ray examination system to make a diagnosis of circulatory troubles was introduced. In 1988 when the Department of Cardiovascular Surgery was set up, it started employing percutancous transluminal coronary angioplasty (PTCA) procedures and other interventional techniques. At first, coronary artery imaging was preformed on not more than 40 cases annually, but now the number of such cases surpasses 500. Interventional treatment is given to well over 130 cases, 85% of which have stents implanted. The initial success rate of intervention is 90.3% and the rate of restenosis was 35.8%. The cases of A-C bypass grafting performed at the department of cardiovascular surgery are increasing in number. Now the use of skeletonized artery bypass graft surgery with extracorporeal circulation at normal temperature has become standard procedure. By the use of the multi-detector row helical CT (MDCT), we are now studying coronary bypass patency and imaging quality. Except for some cases, it has become possible to obtain three-dimensional reconstruction images comparable to angiocardiographic images in terms of quality. We expect that MDCT will replace catheterization and become a standard noninvasive diagnostic procedure in the foreseeable future.We will adopt new thechniques and new therapeutic methods positively but not blindly placing too much confidence in state-of-the-art technology. Based on the fundamental principles of our hospital, we will devote ourselves to medical care, putting the needs of patients before everything else.

The Prevalence of Non-Insulin-Dependent Diabetes Mellitus in a Rural Community of Hiroshima / 日本農村医学会雑誌

The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) as defined by WHO criteria was studied in a rural community of Hiroshima. All the inhabitants over the age of 30 were asked to participate in this study, during the month of December in 1990 and 1991. Eventually, 307 males (23.2%) and 620 females (41.5%) agreed to participate and had an oral glucose tolerance test (75g of glucose).<BR>The crude prevalence rates of NIDDM were 11.4% for males and 6.9% for females, and the adjusted prevalence rates by population in 1985 were 9.5% for males and 4.5% for females, respectively.<BR>The results suggest that both males and females over the age of 50 showed a higher-rate of prevalence than those under the age of 50.

Epidemiological investigations on carcinoembryonic antigen levels. Comparison between urban and rural areas / 日本農村医学会雑誌

Epidemiological investigations were made on carcinoembryonic antigen (CEA) levels in 3, 259 rural inhabitants and 3, 200 urban inhabitants. Abonormally high CEA levels were found in 12.0% of male rural inhabitants and 6.8% of male urban inhabitants. For women, the percentage was 2.4% in rural areas and 1.6% in urban areas. Correlations between high CEA levels and age were noted in men. However, cigarette smokers had higher CEA levels than non-smokers in both rural and urban areas irrespective of age. Smokers' CEA levels were higher rural areas than in urban areas. These disparites in CEA levels between rural and urban inhabitants were studied, but remain unaccounted for.

Health conditions of young adults living in an agricultural community adjacent to a city in the western part of Hiroshima prefecture / 日本農村医学会雑誌

The future of Japanese agriculture depends a great deal on the young adult. In this study, preventive health strategies for young people living in a farming area are discussed. The following is a summary of the conclusions we have arrived at.<BR>1. There is much to be desired in their eating habits. Hence, the necessity of drawing up adequate guidelines and educational programs.<BR>2. Young men must be dissuaded from smoking cigarettes and drinking a lot.<BR>3. There is too much stress in living and working environments.<BR>4. Overworking must be avoided.<BR>5. Individuals must realize the importance of protecting and promoting their own health.

Prediction of cerebral apoplexy - Survey results / 日本農村医学会雑誌

Cerebrovascular disease is still considered a serious health problem in Japanese rural areas. The rate of death from the disease is very high. Many clinical and epidemiological studies have been conducted so far. However, they have failed to come up with answers effective for prediction and prevention of the scourge.<BR>As part of the agricultural coop commissioned research project entitled “Study of Cerebral Apoplexy: Its Prediction and Prevention, ” we took a questionnaire survey in 1985-86, to obtain data as regards patients' subjective symptoms, electrocardiographic observations, hematological findings and many others before the onset of cerebral apoplexy. Five medical research institutes affiliated with the national welfare federation of agricultural cooperatives responded to our questionnaire.<BR>As a result, the subjective symptoms that showed stochastically significant increases from one year to three months before the onset of the disease as a whole were fatigue, forgetfulness and insomnia. When it comes to cerebrovascular infarction, shortness of breath, angina, forgetfulness, and nocturia were particularly notable.<BR>All these symptoms are not peculiar to cerebral apoplexy, but it should be noted that these are the warning signals of the killer disease.

Risk factors of CVA at the rural areas near the cities in hiroshima prefecture / 日本農村医学会雑誌

Risk factors examined within one year before the onset of the attack were investigated in 92 cases with cerebrovascular accident.<BR>Systolic and/or diastolic hypertension, hyperuricemia, elevated SUN and abnormal ECG findings (atrial fibrillation, T wave abnormality, QRS high voltage, abnormal Q wave) were related with CVA.<BR>Also, CVA were frequently encountered with thinness, anemia, hypoproteinemia and hyperglycemia in male, and obesity, hypertriglyceridemia and elevated serum creatinine in female.<BR>Hypertension, hyperglycemia, elevated SUN and serum creatinine played inportant roles in the occurrence of cerebral infarction, and hypertension and hypertriglyceridemia in cerebral hemorrhage.

Prediction of impending attacks of cerebral stroke in rural areas and their prevention / 日本農村医学会雑誌

Cerebral stroke in rural areas is a very important disease both from medical and social aspects. Among strokes, infarction which occurs most frequently in elderly persons is liable to result from atherosclerosis. And for the development of atherosclerosis, essential hypertension is the most important predisposing factor. Other than hypertension, aging, diabetes mellitus, hyperlipemia, esp. low HDL/Tch ratio, increased hematocrit values, coronary insufficiency, cardiac failure, arythmia, esp. atrial fibrillation, are also accepted important risk factors. Affirmative of such findings, the authors are convinced of the fact that atrial fibrillation which is increasing recently is closely related to both cerebral thrombosis and embolism.<BR>But, in regard to cerebral infarction no signifying or trigger factor, similar to very high blood pressure, that trigger cerebral hemorrhage, is clarified as yet. It is made clear in this connection that cardiac failure predisposed by hypertensive heart disease in old age, assisted by pathophysiological and other environmental conditions, is the important factor. The authors also studied the clinical predisposing parameters and preventive measures about strokes.

Clinical study on cancers in the bile duct, the pancreas head region and the liver and liver cirrhosis / 日本農村医学会雑誌

We evaluated the therapeutic results of cancers in the bile duct, the pancreas head region and the liver and cirrhosis.<BR>The former two types were examined in a total of 49 cases: 10 cholecystocarcinomas, 18 cholangiocarcinomas, 6 papillocarcinomas, and 15 pancreas head cancers. Radical surgery was performed in only 9 cases: 1 cholecystocarcinoma, 1 cholangiocarcinoma, 5 papillocarcinomas and 2 pancreas head cancers. The surgical success rate was satisfactory 83%(5/6) for papillocarcinoma, yet showed 18.4% overall.<BR>Liver cancer and cirrhosis were examined in 102 cases: 78 cirrhoses and 24 livercancers. Of the former, 15% were viral cirrhosis, 44% alcoholic, 1% specific and 40% unknown. Ofthe latter, 29% were viral liver cancer, 29% alcoholic and 42% unknown.<BR>Treatment of these cancers, with the exception of one type, was unfavorable. To increase the surgical success rate, cancers will have to be discovered earlier using such recent, highly-advanced technological means as endoscopy, ultrasonography, angiography and computerized tomography. At the same time, radical surgery should be actively applied in a broader range of cases.<BR>In cirrhosis, bleeding in the upper digestive tract and complicating liver cancer are increasing in frequency due to prolonged life expectancy. How to manage this increase remains subject for further study in the future.

Health conditions and life-working style of oyster farmers in Hiroshima Bay / 日本農村医学会雑誌

An investigation was made into the health conditions of oyster farmers in Hiroshima Bay with reference to their job requirements and way of life. The findings are as follows:<BR>Their working conditions are harsh. However, compared with those engaged in agriculture, the oyster farmers eat fairly large amounts of calorific foods, especially animal products. Their alcoholic consumption is also large. They get enough sleep and rest on a regular basis.<BR>Mild obesity, hypertension and hyperlipidemia are prevalent among men, and tendency of obesity is more common among women. Furthermore, those with the risk factors for arteriosclerosis account for more than 50% of the people examined.<BR>From these findings, it could be said that their health is at risk. Appropriate and effective measures should be taken promptly so as to reduce the risks, particularly those risks associated with arteriosclerotic damage. Mechanization will be one of the measures against the health resks that oyster famers are now exposed to. Without preventive measures, there might be an outbreak of the diseases originating in the blood vessels.