The voluntary exercises consist of different automatized levels and are mostly a combination of the upper limbs and the lower limbs exercises.
This study was to examine the interference of the upper limbs exercise to the periodic lower limbs exercise with different automatized levels. Seven male university students, aged 19 and 20 yrs., served as subjects. The periodic lower limbs exercises were the stepping (walking on the place) and the alternate plantar-flexion of the right and left foot while standing. The frequencies of the lower limbs exercises were 120, 160 and 200 times/min, The stepping, which is similar to the motion of the lower limbs in walking or running, may be performed more frequently in daily life than the plantar-flexion in which only the ankle angle was changed. Therefore, we assume that the stepping is a higly automatized exercise compared with the plantar-flexion. Upper limbs exercise, which was combined with the lower limbs exercise, was the simultaneous tapping of one time by both hand. The interference degree was evaluated by the change of step intervals of the lower limbs exercise. The results were:
1) The fluctuation of step intervals on the plantar-flexion was greater than the fluctuation on the stepping and the smallest in the frequency 120 compared with that in the other frequencies.
2) When the tapping was combined with the lower limbs exercises, one step interval at that time was lengthened and one step interval immediately before the tapping was shortened. This change of step intervals was greater in the plantar-flexion than that in the stepping. The change in the plantar-flexion was the smallest in the frequency 120 compared with that in the other frequencies.
The above mentioned findings suggest that the automatized level of the lower limbs exercise can be clearly evaluated by the interference degree of the upper limbs exercise to the periodic lower limbs exercise.

A study was conducted to investigate the influence of motor learning on functional specialization of the upper and lower limbs by comparing automatized levels in upper and lower limb movements between 17 soccer (S group) and 14 basketball (B group) players at a university. They carried out transitory palmar flexion of both hands while stepping and performing alternate flexion-extension movements of both ankle joints, and transitory plantar flexion of both feet while performing alternate flexion-extension movement of both shoulder joints and both wrist joints. The automatized levels of the upper and lower limb movements were evaluated by the degree of interference between the upper and lower limb movements.
It was shown that automatization of lower limb movements was more advanced than that of upper limb movements in both groups. The automatized levels of stepping in the S and B groups showed no significant difference, and were similar to those of university students in general obtained in our previous study. However, the automatized levels of ankle joint movements in both groups were higher than those for university students in general.
In both groups, the insertion of transitory palmar flexion was restricted to within the phase where the degree of interference was small during the stepping and ankle joint movement. However, this tendency was not clear in the trial where transitory plantar flexion was superimposed on shoulder joint and wrist joint movements.
As for the difference between the groups, the S group showed a higher automatized level of ankle joint movement than the B group. On the other hand, the B group showed higher automatized levels of both upper limb movements than the S group, and this tendency was especially evident for shoulder joint movement.
These results suggest that the change in the automatized level of upper and lower limb movements by specific motor learning is added to the functional specialization of the upper and lower limbs acquired by daily basic motor learning in an upright position.

The present studies on gallstones, made by macroscopic morphology and infrared absorption spectra, were carried out in order to clarify recent features of cholelithiasis in rural district. One hundred and sixty-one stones obtained from 152 patients who had cholelithiasis, and who were operated-on at our clinics during the past 10 years, were used for this study.
The average age of the patients was 62 years, and about half of them were over 65 years of age. The patients included 100 women and 52 men. The types and frequency of gallstones are classified as follows: cholesterol stones, 50.9%; pigment stones, 40.4%(black stones, 7.5%; bilirubin stones, 32. 9%) and rare stones, 8.7%. Considerin sexual differences, the frequency of cholesterol stones was nearly 2 times greater in women than in men; on the other hand, that of pigment stones was nearly 2 times higher in men than in women. Regarding the age groups of the patients, although the incidence of cholesterol stones was greater in the group under 64 years of age than in the 65-year-old group, the incidence of bilirubin stones was 4 or more times higher in the latter group than in the former.
From the above observations it is suspected that one of the major reasons for the low incidence of cholesterol stones in rural districts, is because of the high percentage of elderly patients with cholelithasis in these areas. The incidence of black stones was not significantly greater in rural districts.

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.
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:
(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.
(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.
(3) In many cases, death occurred during sleep or at rest.
(4) Cardiopulmonary resuscitation was performed according to rule on most of the victims, but the priamry resuscitation ratio came out at 26%.
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.

We present a case of juvenile type dermatomyositis and severe retinopathy. A 10-year-old girl presented with progressive weakness of proximal muscles, generalized rash, including heliotrope-type eyelid erythema, and bilateral visual disturbance. Laboratory data showed a markedly elevated serum creatine kinase and electromyography revealed a myogenic pathology. Funduscopic examination showed numerous cotton wool spots and macular edema. She developed massive rhabdomyolysis, generalized skin lesions, systemic edema, renal failure, and respiratory failure. After she received steroid pulse therapy, plasma exchange, and high-dose immunoglobulin, her general condition and visual symptoms improved. She remained well when we followed up her condition 5 years after the discharge.

A study was conducted to investigate the effects of a sagittal position of the body gravity center (GCP) and manual weight-load on postural control during rapid arm-lifting. The subjects were five males aged 21 to 36 years. They stood on a force plate while maintaining the GCP at 30%, 45% and 60% from the heel, regarding the fool length as 100%, and anteriorly lifted both arms spontaneously as rapidly as possible. These trials were carried out ten times under a 5 kg weight or no weight. EMGs of the biceps femoris muscle (BFM) and anterior deltoid muscle (ADM), the fluctuation of the center of foot pressure (CFP) and body motion were analyzed by focusing on their time sequences.
At 45% and 60% GCP the BFM action started prior to the ADM action, whereas at 30% GCP it tended to lag behind. The lag times under no weight were 13.9±12.75 ms (mean±SD) at 30% GCP, -32.7±18.18 ms at 45% GCP and -46.0±19.40 ms at 60% GCP. Those under 5 kg weight were 15.0±11.40 ms at 30% GCP, -22.0±6.74 ms at 45% GCP and -28.9±7.63 ms at 60% GCP. These results indicate that the anticipatory action of the muscle related to postural control arises only at specific GCPs.
The difference of starting points for BFM action to ADM action showed no significant difference between 45% and 60% GCP for either as 5 kg or no weight. The CFP position moving in a forward direction during arm-lifting showed a marked difference between 45% and 60% GCP. The time for arm-lifting showed a marked difference between 5 kg and no weight. These results suggest that the starting point of anticipatory muscle action related to postural control does not change according to the magnitude and time course of the distance to the body equilibrium as a result of arm-lifting.

Between 1974 and 1991, we treated 10 aortic arch branch aneurysms in eight men and two women, who ranged in age from 17 to 81 years old (mean age, 55 years). Five patients had subclavian artery aneurysms, four had carotid artery aneurysms, and one had an inominate artery aneurysm. The chief complaint was a mass on the neck and supraclavicular fossa in five patients, rupture and an abnormal shadow on chest X-rays in two patients each, and acute artery occlusion in the upper limb in one patient. The operative method was usually excision of the aneurysm and reconstruction. The causes were arteriosclerosis in five patients, the thoracic outlet syndrome in two patients, and inflammatory, traumatic and iatrogenic in one patient each. Intraoperative hemorrhage occurred in one patient and graft occlusion in another one. The other patients have had a good course. This disease is rare, but because of complicated rupture and acute artery occlusion, it is desirable to perform surgery as soon as possible after the first diagnosis.

A case of idiopathic enlargement of the right atrium (IERA) is described. A 28-year-old woman was admitted to our hospital because of cardiomegaly and a mass in the right atrium. She had had cardiomegaly for at least 8 years. Echocardiography showed an enlarged right atrium and a large mass. Cardiac catheterization demonstrated normal hemodynamic data. Based on these findings, we diagnosed this case as IERA and the right atrial mass was suspected to be myxoma. At operation, a markedly enlarged right atrium was found. The right atrial wall was paper-thin. Through right atriotomy, a giant round thrombus (5×4×4cm) was found. The tricuspid valve showed a normal configuration. After extirpation of the thrombus, the right atrial wall was excised and plicated. The postoperative course was uneventful. IERA is extremely rare and heart failure and sudden death have been reported. Therefore, symptomatic or complicated cases should be treated surgically.

A rare case of juxtarenal aortic occlusion due to Takayasu's arteritis is reported. A 46-year-old man who had been suffering from intermittent claudication from the age of 44 when Buerger's disease was suspected at another hospital because of exacerbation of the symptom. Occlusion of the abdominal aorta and severe aortic wall thickness were identified by the abdominal CT scan. After the improvement of inflammation, under the diagnosis of juxtarenal aortic occlusion due to inflammatory disease, we performed an aortobifemoral bypass grafting using a Y-shaped prosthesis (proximal anastomosis was end-to-end) found a tight inflammatory adhesion around the abdominal aorta. Histopathological examination of the resected specimen revealed an infiltration of lymphocytes, plasma cells in aortic media and adventitia, severe fibrosis in the aortic adventitia, and a diagnosis of Takayasu's arteritis was made. The postoperative course was uneventful but we should periodically check for inflammatory signs, and anastomotic aneurysms.

As part of the rehabilitation program for myocardial infarction patients, assisted exercise under the eye of therapists is an effective rehabilitation therapy during the period from hospital discharge to the returning to work. Regrettably, however, this part of the program is not put into regular practice in rehabilitation centers yet.
Under the circumstances, we have conducted this type of therapy for myocardial infartion convalescents, and assessed it significance and benefits by examining therapeutic effects and changes in the endurace test results as well as changes in the cardiac output during exercise.
In this study, we used data obtained from 25 out of the 68 acute myocardial infarction patients treated in the coronary-care unit of our hospital between Nov. 1, 1990 and May 31, 1992.
Exercises were performed three times a week for eight to 12 weeks, kinetic intensity correspond-ing to 70-80 % of the highest heart rate in stress tests. The heart rate, blood pressure and cardiac output were measured based on ECG recordings.
As a result, it was found that the kinesitherapy helps (1) increase the tolerability to exercise, (2) lower the heart rate, blood pressure and double product and (3) elevate the stroke volume index during exercise.
From these findings, it is safe to say that the kinesitherapy can be given to myocardial infarction victims without causing them anxiety and is very helpful for them to restore good health and normal cardiac function and to resume their place in society.