A 2-year-old boy was admitted to our service with a diagnosis of double-outlet right ventricle (DORV) complicated by mitral valve stenosis. On echocardiographic measurement, the mitral annulus was 11mm (69% of normal) in diameter and 1.67cm²/m² in annular area. He underwent intraventricular tunnel repair and patch reconstruction of the right ventricular outflow tract under cardiopulmonary bypass. No attempt was made to operate on the mitral valve. DORV with mitral stenosis is a rare cardiac anomaly, the last 20 years only 21 cases have been reported, of which only 4 were cases with hypoplastic mitral rings. Although the patient made an uneventful recovery and remains well 5 months after surgery, a close observation is required for the mitral valve stenosis.

A study was performed to elucidate the effect of physical training on the cold tolerance in human beings. Physically well trained men (T group) and untrained ones (U group) were exposed to cold stress in summer and winter. Each subject was dressed in experimental clothes and exposed to 10°C DB for 60 minutes in both seasons. Moreover, he was exposed in the semi-nude to 20°C DB in summer and to 17°C DB in winter for 60 minutes. During the period of exposure to cold, rectal and mean skin temperatures and respiratory metabolic rate were measured. To confirm the training effect further, the untrained men were asked to follow an experimental training program of daily routine which consisted of about 7 km outdoor running for 40 consecutive days in July and August. Before and after the training, they were exposed to the same cold stress as in the aforementioned summer experiments and subjected to the same measurement. Resting metabolic rate was higher in the T group than in the U group. Although no significant group differences were shown in the metabolic rate during the period of exposure to cold, the rate of increase from the resting value was lower in the T group than in the U group. There were no group differences in rectal or mean skin temperature during this period. When the untrained men were subjected continually to physical training, the resting metabolic rate was higher and the rate of increase from the resting value during the period of exposure to cold lower after the training than before. It was concluded that physical training could be a means to increase the cold tolerance.

Infectious abdominal aortic aneurysm is a relatively rare disease, and there is no consensus regarding its surgical treatment. Medical infectious control should be concerned comparison with surgical treatment if there is sepsis, however we sometimes have no other choice but emergency operation for uncontrollable cases. In many reports, cryopreserved homografts were used as in-situ alternative grafts for infectious aortic aneurysms because they had some merits such as anti-infectious effects, suitability and so on. However the number of in-situ cryopreserved homograft replacement cases are few, and the long term result is unclear. We encountered a ruptured cropreserved homograft case 7 months after urgent in-situ cryopreserved homograft replacement. We report the case and refer to the relevans literature.

The guidelines for the prevention of heat disorders during sports activities were established 13 years ago in Japan. Since then, various studies on preventive measures against heat disorders have been done, yielding new knowledge about its prevention. It has been reported that the incidence of heat disorders is high in children and the elderly, and heat acclimatization and clothing are the factors involved in this disorder. We proposed to lower the WBGT (wet-bulb globe temperature) limit for warning (discontinuation of hard exercise) from “28°C or more” to “25°C or more” (corresponding to an ambient temperature of 28°C) for non-acclimatized persons, children, the elderly, and persons wearing clothes covering the entire body. We also indicated that heat disorders can occur due to unpredictable causes, because the mechanism is very complicated.

　　A 77-year-old woman was admitted to our hospital because of low-grade fever and lightheadedness 7 days after the removal of a carious broken tooth. Neurological examination revealed disturbed consciousness and meningeal sign with mild ophthalmoplegia. Cerebrospinal fluid examination showed elevated levels of polymorphonuclear cells and enhanced magnetic resonance imaging revealed a left masticator space abscess. On the basis of these findings, the diagnosis was meningitis complicated by a masticator space abscess. Although her symptoms were ameliorated after the administration of antibiotics, her consciousness deteriorated accompanied by bilateral total ophthalmoplegia. Enhanced head computed tomography revealed a filling defect of the superior orbital veins with enhancement of the cavernous sinus, suggesting cavernous sinus thrombosis. After the addition of anticoagulants to antibiotic therapy and surgical drainage of the abscess, she recovered without residual neurological impairment. Because cavernous sinus thrombosis is potentially life-threatening, early diagnosis and initiation of appropriate therapy are extremely important.

A new therapy was recently developed by combining low frequency in situ needle acupuncture with Body Sonic Pad therapy. With this therapy, the patient lies on a bed fitted with Body Sonic Pads which vibrate slightly, in synchrony with the low-pitched sounds of the music which is played during the therapy. The patient listens to music and can feel the music-synchronized vibration of the pads while receiving in situ needle acupuncture. We recently assessed the effectiveness of this combined therapy.
The subjects were 30 patients with chronic shoulder stiffness who visited our department of anesthesiology. These patients received each of the following 5 treatments at different times in random order: (1) Method M (listening to music without any other therapy), (2) Method B (Body Sonic Pad therapy without listening to music), (3) Method MB (Body Sonic Pad therapy while listening to music), (4) Method L (conventional continuous low-frequency (3Hz) in situ needle acupuncture), and (5) Method MBL (continuous low-frequency (3Hz) in situ needle acupuncture combined with Body Sonic Pad therapy while listening to music). The direct therapeutic effect and the degree of comfort during treatment were compared among these five methods. The acupuncture therapy for shoulder stiffness consisted of stimulating the standard points in the shoulder and neck region with 30mm acupuncture needles (No. 20). The electrical stimulation lasted for 20 minutes. The music used for Body Sonic Pad therapy was primarily classical music selected according to the desire of the patients. The effectiveness was rated by the patients on a 4-point scale (markedly effective, effective, slightly effective and ineffective). Effective or markedly effective cases were regarded as responding to the therapy. The level of comfort during treatment was rated on an 11-point scale.
The number of patients who responded to the therapy was 7 (23%) for Method M, 6 (20%) for Method B, 10 (34%) for Method MB, 18 (60%) for Method L and 23 (77%) in Method MBL. The response rate was significantly higher for Method MBL when compared to Method M or MB. The mean level of comfort during treatment (rated on a visual analog scale; 0=most uncomfortable; 10=most comfortable) was 6.3±2.1 for Method M, 6.0±2.1 for Method B, 7.0±1.6 for Method MB, 7.2±1.9 for Method L and 8.3±1.6 for Method MBL. Thus, low frequency in situ needle acupuncture combined with Body sonic Pad therapy was slightly superior to the other therapies.

The World Health Organization (WHO) standard assay for determining antibody level is the rapid fluorescent focus inhibition test (RFFIT) and is used to determine the degree of immunity after vaccination against rabies.To compare the difference in RFFIT results between the laboratories of The National Institute of Infectious Disease in Japan (NIID) and the Chinese Centre for Disease Control (CCDC) as well the influence of the choice of standard serum (STD) for the detection,the two laboratories detection methods were simultaneously manipulated by RFFIT.The reference serums used in NIID and the WHO standard serum used in CCDC were compared in the same RFFIT detection to determine the titer of four sera samples C1,S1,S2 and S4 in parallel,and the titers of the detected sera samples were calculated using the standard formula for neutralizing antibody titer.No significant difference was found in RFFIT methods from the two laboratories and the RFFIT testing procedures of the two laboratories have good consistency.However,different titers were obtained with the tentative internal standard serum (TI-STD) produced by adjusting to 2.0 IU of WHO standard serum in NIID and the WHO STD.The titer determined with the TI-STD was higher than that determined with WHO STD,This difference appears to be significant and requires further investigation.

The therapeutic effect of a cordless mini TENS on shoulder stiffness and painful diseases and patients' favorite intensity of stimulation were studied. Effect of this apparatus on peripheral circulation was also examind using a laser Doppler measuring instrument. The 114 cases with shoulder stiffness used the TENS only once (SS group), and the 53 cases continuasly (SC group). The 65 cases with painful diseases used the TENS only once (PS group) and the 53 cases continuasly (PC group). A great majority of the patients prefered stimulation with moderate frequency and high intensity. Effectiveness was seen in 76% of SS group and 87% of SC group, and in 75% of PS group and 91% of PC group. Peripheral circulation was significantly increased after the stimulation of the apparatus.