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.

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.

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 report a case of left internal iliac aneurysm that ruptured into the left common iliac vein and formed an arteriovenous fistula. A 79-year-old man who had general fatigue was admitted to our hospital with a diagnosis of left internal iliac artery aneurysm, left hydronephrosis, dehydration and low renal function. After dehydration and low renal function resolved rapidly by medical treatment, an enhanced computed tomography was performed. This demonstrated a 69 by 67 mm diameter left internal iliac artery aneurysm with an arteriovenous fistula. During the operation, left common iliac artery and left external iliac artery were resected and the stumps sutured. External iliac-external iliac artery bypass was performed. An occlusive balloon catheter was inserted from the left femoral vein and the balloon was dilated to patch the fistula before opening the aneurysm. After clamping the proximal artery the aneurysm was opened. Bleeding from the fistula was controlled by this maneuver and digital compression of the left common iliac vein where was proximal side of fistula. An arteriovenous fistula with a 18 by 3 mm orifice was found between the left internal iliac artery and left common iliac vein. The fistula was closed from the inside of the aneurysm. His postoperative course was uneventful.

In recent years, arteriosclerosis obliterans (ASO) has become one of the most common diseases with obesity, high blood pressure and other lifestyle-related diseases such as hyperlipemia. Westernization of the eating habits of the Japanese and progress of the aging society accounts for the increasing occurrence of these health problems. Early detection and early treatment of ASO help not only improve the quality of life of the patients but also get off without amputation of lower limbs and better the prognosis for survival. It is necessary to evaluate the narrowing of blood vessels or the form of occlusion for treatment of ASO. It is particularly important to know the state of the peripheral arteries below the obstructed region in cases with the complete occlusion. Lately, with the addition of many lines to multislice CT (MSCT) and the improvement of the performance of the workstation, angiography for diagnostic purposes has gradually been replaced by MSCT. In this paper, we report two cases of ASO and the successful application of MSCT using 64 Data Acquisition System (DAS) in the examination prior to ASO bypass surgery.
Antistreptolysin O antibody titer ; System ; X-Ray Computed Tomography ; Cases ; seconds

A 47-year-old man was found to have a thoracic aortic aneurysm. When the patient was 20 years old, he underwent aortic correction with Dacron graft for coarctation of the descending aorta. CT showed an enhanced true aneurysm and a pseudolumen in the proximal anastomotic site of the graft of the distal arch and an aneurysm in the left subclavian artery bifurcation. The operation was performed. Because we anticipated severe adhesion due to the preceding left thoracotomy, we approached by median sternotomy and the transmediastinal replacement method (pull-through method). Before cardio pulmonary bypass was started, an 8-mm Dacron graft was anastomosed to the left subclavian artery via a subclavian incision. The patient was given heparin and we cannulated the ascending aorta via the right femoral artery. A venous cannula was placed in the superior and inferior vena cava and patent left superior vena cava confirmed during operation. Antegrade cardioplegia was initially administered. During deep hypotheremic circulatory arrest antegrade cerebral perfusion was employed. The heart was retracted and the descending aorta was exposed through the posterior pericardium. The old graft was excised and a new Dacron graft was pulled down into the descending aorta from the distal arch. The graft was anastomosed to the descending aorta. After we repaired the other aortic arch branch and ascending aorta, the left subclavian graft and graft branch were anastomosed. There was no bleeding or other complication and the patient was discharged. The pull-through method should be considered for such descending aortic aneurysm cases.

A 66-year-old woman who had percutaneous mitral valve commissurotomy 12 years before was admitted complaining of dyspnea on effort. Echocardiography showed severe mitral stenosis and regurgitation, and moderate tricuspid regurgitation associated with atrial fibrillation. Based on her past history we suspected allergy to metal, and skin patch tests showed a positive reaction to zinc, manganese, nickel, cobalt, dichromate, stainless steel, titanium alloys, and nickel-chromium-cobalt alloys. We selected an artificial organ which would not cause an allergic reaction. The St. Jude Medical standard cuff mechanical valve was the only compatible prosthetic valve. Anterolateral right thoracotomy, instead of median sternotomy, was selected. Mitral valve replacement with a 27-mm St. Jude Medical standard cuff mechanical valve and tricuspid valve annuloplasty with a 27-mm Duran flexible band were performed. Her postoperative course was uneventful. She is doing well without any allergic symptom 18 months after the surgery.