With advancing age, large conduit arteries (e.g., the aorta and carotid arteries) lose their ability to distend in response to fluctuations in arterial pressure. The impaired buffering or compliance function of the arteries contributes to a number of cardiovascular and autonomic nervous systems disorders, including increased systolic blood pressure and aortic impedance, decreased coronary perfusion, left ventricular hypertrophy, and a blunting of cardiovagal baroreflex sensitivity. Because of the clinical significance of this function, a number of methods have been developed to characterize the elastic property of the arteries. However, there is no consensus as to which method should be used. In regard to the prevention of arterial stiffening, mounting evidence suggests that regular physical activity could retard age-related arterial stiffening. The purpose of this review is to introduce methodologies used to derive arterial stiffness, to describe clinical significance of this measure, and to review the impacts of habitual physical activity on central artery stiffness.

There has been increasing emphasis on maintaining the patients' quality of life while on antihypertensive therapy (e. g., regular physical activity as a lifestyle modification) . However, no information is available on the effects of regular swimming exercise on mental health despite the popularity and potential benefits of this life-style modification. To determine the efficacy of swim training on mood states, 19 obese subjects with stages 1 to 2 essential hypertension were randomly assigned to either a swim training (n=12) or control group (n=7) . Subjects were assessed before and after a 10 week supervised swim exercise program with the Profile of Mood State (POMS) questionnaire. The swim training group completed an average of 94% of the scheduled exercise sessions, and were able to gradually and significantly (p<0.05) increase daily swim distance. Additionally, resting heart rate was significantly reduced (p<0.05) . Swim training resulted in significantly higher (p<0.05) vigor-activity scores. In addition, anger and fatigue scores were 34 and 28% lower after the swim training period. No significant changes were observed in any of the POMS scores in the control group. The improved mood state observed after swim training may have a clinically important influence on the quality of life in these subjects with essential hypertension.

The surface-coated vascular stent of shape memory alloy was made for use of occlusion of pseudo-lumen of the dissecting aneurysm of the aorta, as the usage of shape memory alloy in angioplasty, and the metal flexible delivery catheter was also made for the introduction of the stent. In the present study, antithrombogenicity of the vascular stent was much improved by surface-coating with EPTFE and segmented polyurethane. The long-term usage of the stent was confirmed by radiological, macroscopic, and electron microscopic examinations. Moreover, the metal flexible delivery catheter was demonstrated to be of much benefit for the introduction of the surface-coated vascular stent of shape memory alloy.

Medical education in Japan has centered upon Western medicine since the Meiji Era. Nevertheless, because patients have a great interest in Oriental medicine, many physicians have treated patients with traditional Chinese medicine. The Oriental Medicine Research Institute of Tokyo Women's Medical University opened in 1992, when education in Oriental medicine became a part of the curriculum. To understand the status of education in Oriental medicine in Japan, we conducted a questionnaire survey of all medical schools in the nation. With a response rate of 97.5%, the survey found that one university in four teaches Oriental medicine.
Since 1990, recognition of “alternative medicine, ” in contrast to “modern medicine, ” has gradually increased in both research and education around the world. In Germany, which was the model for the introduction of western medicine to Japan, the use of traditional herbs and spa treatment is already taught in medical school. In the United States, where the National Institutes of Health have established an alternative treatment clinic, research and education are already ongoing at many medical schools.
In such a global situation, the need for education in traditional Oriental medicine will increase, and systematizing such education may become a great challenge. We expect that Oriental medicine will one day be taught at all medical schools in Japan and will become part of the state medical examination.

A 69-year-old man, who had undergone coronary artery bypass grafting using the right gastroepiploic artery 2 years previously, was hospitalized with acute epigastralgia. Gastroscopy showed an early gastric cancer in the greater curvature of the corpus and ultrasonography of the abdomen revealed acute cholecystitis due to a stone impacted in the cystic duct. The subtotal gastrectomy and the cholecystectomy with preservation of the right gastroepiploic artery graft were performed. The surgical margin of the resected specimen was negative for cancer. The postoperative course was uneventful. After coronary artery bypass grafting using the right gastroepiploic artery, annual gastroscopy is recommended.

It is commonly believed that prosthetic valve implantation in actively infected patients is to be avoided. After normalization of C-reactive protein and white blood cell counts, and sterilization of blood cultures by treatment with antibiotics, we performed valvular surgery. We performed mitral valve repair in cases where the mitral valve lesion did not involve the annulus. From July 1992 to November 1996, 13 patients (mean age, 50 years) were treated surgically for infective endocarditis (IE) at Kansai Medical University. Twelve of the patients had native valve endocarditis (NVE), and 1 had prosthetic valve endocarditis (PVE). In 6 patients, the causative organisms were determined. These included: α-Streptococcus in 4 patients, Enterococcus in 1, and methicillin-resistant Staphylococcus aureus (MRSA) in 1. The affected valves were as follows: aortic valve alone in 4 patients, mitral valve alone in 6, aortic and mitral valves in 2, and a prosthetic aortic valve in 1. The PVE was due to a MRSA infection which occurred 9 months after aortic valve replacement. All patients were treated preoperatively for heart failure and the infection. The surgical procedures performed were: aortic valve replacement in 4 patients, mitral valve replacement in 3, mitral repair in 3, double valve replacement in 2, and re-aortic valve replacement in 1. There were no deaths or recurrences of IE in hospital or during follow-up to date. In all of the mitral valve repair cases, the mitral regurgitation on follow-up echocardiograms was grade I. Our results show that surgical treatment of IE after management of preoperative conditions can be successful. Furthermore, despite the absence of laboratory findings indicative of ongoing inflammation or infection, pathologic examination revealed active inflammatory reactions and organisms in 4 cases. In 1 patient, MRSA was culthued from an annular abscess that was resected intraoperatively. We suggest that cessation of antibiotic therapy be regarded with caution and suggest that the infected site must be resected surgically.

Infra-renal abdominal aortic aneurysms were electively treated by bifurcated endovascular stent grafts (Power Web^TM system, Endologix Co., USA) at 5 Japanese centers. The stent grafting (SG) was applied for candidates nominated by the selection committee after informed consent was obtained according to the IRB in each center. The delivery success rate of 60 patients (53 males) was 96.7%. There were 2 patients with type I endoleaks, resulting in a technical success rate of 93.3%. The operation time of 193±55min and blood loss of 440±240g were significantly shorter and less, respectively in the SG group when compared with 303±88min and 1, 496±2, 025g in 97 patients (83 males) treated by conventional open surgery. Endoleaks were detected in 4 patients (type I: 3, type II: 1) by CT scan taken at the time of discharge or 1 month after SG procedure. Type I endoleak was observed in patients with short and severely angulated SG landing zones. Renal artery obstruction, and temporary buttock pain caused by internal iliac artery occlusion occurred, but there was no hospital death. In 56 patients excluding an SG-unrelated death and a dropout from surveillance, there was no secondary endoleak or marked adverse events at all except 1 SG limb occlusion during a 6-month follow up period. The aneurysm size shrank in 26 patients and remained unchanged in 30 patients. No aneurysm enlargement was observed. The Power Web^TM system is appropriate for minimally invasive surgery for abdominal aortic aneurysms. Long-term follow-up studies will follow.

Purpose: Incisional hernia (IH) is a frequent complication following laparoscopic colorectal surgery. The present study investigated the risk factors for IH after laparoscopic surgery for colorectal cancer. Methods: A retrospective study was conducted on 202 patients who underwent laparoscopic surgery for colorectal cancer. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with IH. Results: The overall incidence of IH was 25.7% (52 of 202). The univariate analysis showed that female sex (P=0.004), a high body mass index (P<0.001), noncurrent smoking habit (P=0.043), low level of hemoglobin (P=0.035), high subcutaneous fat area (P<0.001), high visceral fat area (P=0.006), low skeletal muscle area (P=0.001), long distance between the inner edges of the rectus abdominis muscle (P=0.001), long protrusion of the peritoneum at the umbilical site (P<0.001), and lymph node metastasis (P=0.007) were significantly more frequent in the group with IH than in the group without it. The multivariate logistic regression analysis revealed an older age (10-year increments: odds ratio [OR], 1.576; 95% confidence interval [CI], 1.027–2.419; P=0.037), lymph node metastasis (OR, 2.384; 95% CI, 1.132–5.018; P=0.022) and lengthy protrusion of the peritoneum at the umbilical site (10-mm increments: OR, 5.555; 95% CI, 3.058–10.091; P<0.001) were independent risk factors for IH. Conclusion Our findings suggest that older age, lymph node metastasis, and lengthy protrusion of the peritoneum at the umbilical site are risk factors for IH after laparoscopic surgery for colorectal cancer. An assessment using these factors before the operation and the implementation of countermeasures might help prevent IH.

Background/Aims: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus. Methods: Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated. Results: Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching. Conclusions Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.