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.

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 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.

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.

During winter months, lotus growers have to harvest edible roots, waist-deep in the muddy fields. In addition to such an external factor as the cold, physical labor involved is so hard that a level of stress is considered high, especially on the cardiovascular system. In this study, we examined how hard the labor is on the cardiovascular system, based on the measurements of hemodynamic parameters taken in the fields while farmers were working. The subjects were comprised of a total of 18 lotus growers-11 men and 7 women-aged between 41 and 66 years (mean: 56.7 years old). During a week before the measurement was performed, a physical examination and an anaerobic threshold (AT) test were given. In the field, each examinee carried an ambulatory electrocardiograph with him or her and levels of blood Pressure (BP), heart rate (HR), and blood saturation-O₂ (SO₂) were measured. During work, the heart rate was elevated significantly, but did not exceed the evaluated maximum heart rate in every case. Immediately after the work, the HR returned to the level measured before the work began. No significant fluctuation was noted in BP, pressure-rate-products (PRP) and SO₂ even during the work. Any sign associated with ischemia was not observed on ECG, either. Soon after the work began, the blood pressure level tended to lower in women compared with that in men and the PRP did not rise in women so much as it did in the opposite sex. However, in two elderly subjects of over 60 years, arrhythmia was noted along with the elevation of blood pressure soon after the stop of the work. These results showed that harvesting lotus roots did not bring about marked changes in the hemodynamic parameters and that the caraiovascular load was slight. However, an adequate health control system should be worked out for the lotus growers of advanced age over 60.

There are many acquired and hereditary coronary risk factors, and the gender is known as a factor influencing the development of acute myocardial infarction (AMI). To evaluate the role of the gender in the occurrence of AMI, we compared patient backgrounds, their clinical manifestations, outcomes, and coronary angiographic findings between 390 male and 110 female AMI patients, who had been admitted to the coronary care unit (CCU) of the Tsuchiura Kyodo General Hospital and undergone coronary angiography on an emergency basis. The incidence of AMI was the highest in the age group of 60s for males, while for females in the age group of 70s. As coronary risk factors, smoking habit was more common in males, while hypertension, hyperlipidemia and diabetes meritus were more common in females. Coronary angiograms revealed no differences in the number of diseased vessels and location of infarction. Frequencies of urgent PTCA were also identical between the two groups. In clinical outcomes, elder females had poorer prognosis mainly due to a higher incidence of death caused by cardiac rupture. It has been reported that definite increase of AMI after menopause is attributable to disturbed lipid metabolism due to a reduced estrogen level. Our study showed that aged female AMI patients had poorer prognosis possibly due to associated multiple risk factors, mutiple organ disorders and delayed admission to hospital and higher risk of cardiac rupture. Therefore, in the treatment of aged female AMI patients, these tendencies must be taken into account.

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.