Prevalence of Metabolic Syndrome in Rural Populace: A Study of Its Association With Adipocytokines / 日本農村医学会雑誌

The purpose of this study was to shed light on the prevalence of the metabolic syndrome (MetS) in a rural community and examine whether or not serum adipocytokine levels are associated with the Diagnostic Criteria for MetS and how many MetS components laid down in the standards subjects have. The subjects were 2,858 people (1,744men and 1,114 women, mean age 49.8+/-9.9 yrs) who had participated in our health screening program between April and December, 2005. After obtaining informed consent from them, we measured serum leptin, adiponectin and high-sensitivity C-reactive protein levels, while performing routine blood tests. In the present study, these measurements were used in combination with the number of MetS components applicable to the conditions of our subjects. Two hundred men (11.5%) and 25 women (2.2%) were diagnosed with MetS. The number of MetS women was extremely small. Those women who were above the standard waist circumference of above 90cm accounted for 8.7% of the total. Thus, most women subjects were excluded as MetS candidates here. The leptin levels of the MetS group were higher than those of the non-MetS group in accordance with the number of applicable components in the diagnostic standards for MetS. Especially, the MetS group which met three MetS criteria showed significantly high leptin levels (p/5=0.0081) of 5.26+/-1.86 (ng/ml) compared to 3.31+/-1.44 (ng/ml) of the non-MetS group with waist circumference below 85cm. On the other hand, no significant difference was noted between the groups in adiponectin level. However, in contrast to leptin levels, adiponectin levels were lower in the group having three MetS components than the non-MetS group 4.37+/-1.57 (ng/ml) as against 5.52+/-3.34 (ng/ml). High-sensitivity CRP levels did not show any significant difference between the two groups.As regards the cutoff value of women's waist circumference, further study needs to be done. It was suggested that serum leptin levels might be closely related to the diagnostic criteria for MetS and the number of MetS components applicable.

Evaluation of the Appropriateness of the Japanese Metabolic Syndrome Diagnostic Criteria on Routine Medical Health Checkups in a Rural Area / Journal of Rural Medicine

Objective: The diagnostic criteria for the metabolic syndrome (MetS) were published in Japan in April 2005. However, there have been no large-scale studies in rural areas to confirm these criteria. We examined the prevalence of MetS in subjects who had undergone a routine medical health checkup at our hospital, located in a rural area. This data was used to investigate the appropriateness of the diagnostic criteria for MetS.Subjects and Methods: The MetS status was examined retrospectively in 2340 subjects (1408 men, 932 women ; mean age 49.6 ± 9.7 years) who underwent a routine medical health checkup at our hospital between April 2004 and March 2005.Results: Of the 1408 men and 932 women, 209 men (14.8%) and 23 women (2.5%) were diagnosed with MetS. Forty-four men (3.1%) and 4 women (0.4%) met all three diagnostic criteria for metabolic disorders. In the female group, only 8.7% of the 932 women met the waist circumference criterion of ≥90 cm. Because this waist circumference criterion was used during the first screening but was not met by most of the women, they were eliminated from our study. Using receiver operating characteristic (ROC) analysis, the cutoff values for waist circumference were 85.0 cm (sensitivity 0.750, specificity 0.564) in men and 79.5 cm (sensitivity 0.787, specificity 0.709) in women. If the women's waist circumference criterion had been set at the value of ≥79.5 cm, this would have resulted in 48 (5.2%) women meeting the criterion.Conclusion: From the viewpoint of preventive medicine, the Japanese male MetS diagnostic criteria are fairly appropriate. However, for the women, the waist circumference criterion of ≥90 cm has been set too high and was not met by most of the female subjects. Therefore, the Japanese MetS criteria for women, particularly the cutoff value for waist circumference, requires further verification.

Effects of Vaccination Against Influenza Administered by Our Hospital: A 3-Year Retrospective Study / 日本農村医学会雑誌

To review the outcome of our vaccination program against influenza, an investigation was made into the incidence of this acute infectious disease in our community from 2002 through 2004.Enrolled for this retrospective study were 1) all vaccinated individuals, 2) those who underwent nasal examinations by use of the swab, and 3) patients diagnosed as contracting influenza.The number of those administered with influenza virus vaccines increased year after year during the period under review. Over 70% of them were those aged 65years or above. The mean age of those who caught influenza was 42.9±21.3 in 2002, 34.9±20.4 in 2003 and 45.4±20.2 in 2004. Compared with unvaccinated old people, many unvaccinated young and middle-aged people contracted influenza, but among the vaccinated old people, there were some who came down with the flu.Morbidity was low for the old people whose vaccination rate was high.Therefore, it can be said that vaccination was effective in achieving adequate immunity. Nonetheless, for all the preventive injection, the fact that people of advanced age could be infected should be taken note of.

Danger of Saponated Cresol Solution in the Tohno Area ; / 日本農村医学会雑誌

We experienced a clinical case of a patient with psychotic depression who ingested the residual saponated cresol solution from a 500ml bottle of cresol, a disinfectant, with the intention of committing suicide. Through this experience, we felt it neccessary to investigate the present commercial situation of cresol for domestic use, and to come up with some safty measares.All the 128 drugstores and pharmacies in four cities located in the Tohno area of Gifu Pref. (Mizunami, Toki, Tajimi and Ena) were queried by telephone about the sale and stock of cresol.Almost 80% of the drugstores in these four cities, excluding pharmacies, were found to deal in saponated cresol solutions. They carried a little more than two 500ml bottles of cresol on average. This volume exceeds an estimated adult lethal dose of 250ml.Although it is unlikely that an ordinary household will use the whole of 500ml bottle of the disinfectant at a time, the residual saponated cresol solution could increase the risk of accidental cresol poisoning at home.So, it would be desirable not to sell 500ml bottles in ordinary drugstores. Furthermore, before selling a bottle of cresol, the pharmacists, who have a specialized knowledge about it, should kindly explain to the user about its toxicity and usage.

Evaluation of Medium-term Pharyngeal Candidiasis Rate after Switchover from Beclomethasone Dipropionate to Fluticasone Propinate in Elderly Patients with Bronchial Asthma / 日本農村医学会雑誌

[Background]: Fluticasone propinate (FP), an inhaled steroid agent, has greater clinical efficacy in bronchial asthma than Beclomethasone dipropionate (BDP), but it has been reported that the rate of oropharyngeal candidiasis becomes high. In this study, we evaluated the medium-term pharyngeal candidiasis rate in elderly patients after BDP was replaced with FP in maintenance therapy.<BR>[Method]: A total of 53 elderly patients 65 and over, who had previously received stable maintenance therapy with BDP, were switched to treatment with half doses of FP, and they were taught to gargle again.<BR>Eight weeks and six months later, pharyngeal swabs were taken for culture and assessment of candidiasis. These results were compared with those of 24 patients 64 and below. We also measured the inspiratory peak flow rate with inhaled FP.<BR>[Results]: Eight weeks later, candidiasis appeared in 11 patients in the advanced age group (20.8%), which was significantly high compared with only one patient in the age group under 65 (4.2%). Although the pharyngeal candidiasis of 8/11 patients became negative by teaching them thoroughly how to gargle with povidone-iodine, candidiasis appeared in another seven patients six months later, bringing the total up to 10/53 (18.9%).<BR>[Conclusion]: The appearance rate of pharyngeal candidiasis in the elderly patients, who changed for FP, was unexpectedly high. It was suggested that the frequncy of gargling after inhaling FP and the inspiratory peak flow rate when FP is inhaled could be big influential factors. When we use FP, it may be important to give medium and long term-persistent instructions to patients.

The Clinical Efficacy of Change of Medication from Beclomethasone Dipropionate to Fluticasone Propionate in Elderly Patients with Bronchial Asthma / 日本農村医学会雑誌

[Introduction] Fluticasone propionate (FP), an inhaled corticosteroid, has almost twice as much clinical efficacy as Beclomethasone dipropionate (BDP) in the management of asthma. The inhalation of FP dry powder by using a handy and portable inhalator is effective for young and middle-aged patients with bronchial asthma. However, the inhalator are not always easy for elderly patients to operate because it requires some manual dexterity and a knack for quick inhalation.<BR>[Methods] A total of 47 outpatients aged 65 years or above who had achieved a stable asthmatic condition were enrolled for this study, and changed the drugs from BDP to FP. The amount of FP to be taken at one time was equivalent to half the dose of BDP. Twelve check points of inhalation skills were repeatedly taught until patients understoodfully. We checked these points after 2-4 weeks and 8 weeks. We used a questionnaire to survey the patients' impression of FP and its adverse effects. We also evaluated peak flow values (PEF) in the morning and at night, results of pulmonry function tests and asthmatic grades.<BR>[Results] We found clear weak points for the 12 skills in the elderly patients. PEF both in the morning and at night significantly improved after 2-4 week treatment with FP, but pulmonary function tests found no statistically significant change. Eventually 71.4% of the patients in the 65-74 year age range and 50.0% of those of 75 years or above hoped to continue to receive FP therapy. The total number of the patients with adverse effects was 14 (29.8%): These were 7 cases of dryness in the mouth, 5 cases of hoarseness and 2 cases of nausea and vomiting.<BR>[Discussion] Although we confirmed the clinical usefulness of FP in elderly patients with asthma, we must recognize that it requires much time and labor for the eldrely to get used to FP inhalation and that it is important to give them repeated instruction.

Present State of Emergency Care in To-No District / 日本農村医学会雑誌

A survey was carried out on how the To-no District is coping with the need of first aid for patients requiring life-supporting treatment before hospitalization. Although there were cities in this district where statistics on first aid were not available, the survey found that, during the 4-year period from 1994 through 1997, bystander CPR (cardiopulmonary resuscitation) saved 11.2% of the lives of patients with CPA (cardiopulmonary arrest). Incidentally, 11.3% of the population attended CPR courses offered by public institutions. Gifu Prefecture has helicopters for use in rescue work, but the survey found that some cities had not ever sponsored drills using helicopters in life-saving operations. Our findings revealed the indifference of the general public as well as administrators in this district toward emergency care. Public recognition of the importance of the care of suddenly ill or injured patients must be gained. Furthermore, acquisition of skills required for first aid by lay people and technical improvement of these skills in professional rescuers are necessary. The authors think that these are the community educational responsibility of hospitals and other medical institutions.

A Case of Lemmel's Syndrome in which Endoscopic Sphincterotomy(EST) was Effective / 日本農村医学会雑誌

A 73-year-old man visited our hospital with complaints of fever, epigastric painand jaundice. Laboratory examinations showed elevation of GOT, GPT, ALP, LAP and amylase. Abdominal ultrasonography revealed gall bladder stones. Endoscopic findings showed parapapillary diverticulum, but the common bile duct stone was not revealed by endoscopic retrograde cholangiography. He was conservatively treated and then discharged. Two months after, the patient was readmitted for cholecystitis and underwent cholecystectomy. After further 2 months, he was again admitted for the same symptoms as those on first admission. We diagnosed this case as Lemmel's syndrome and performed emergency endoscopy. Endoscopic findings revealed the meal rest inside the parapapillary diverticulum. After we removed the meal rest obstructing the orifice of the papilla of Vater using grasping forceps, we performed EST. Purulent bile gushed out from the orifice. Two years have elapsed since them. Cholangitis has not recurred during this period. Therefore, we concluded that EST is effective in treating Lemmel's syndrome.