The purpose of this study was to assess the effects of different daily lengths of physical training on postoperative walking ability and functional performance among elderly inpatients following hip fracture. Fifty-eight eligible elderly patients (mean age 81 years, SD 8) undergoing inpatient rehabilitation after fall-related hip fracture were randomized to receive either 2 units (40 minutes in 29 patients) or 6 units (120 minutes in 29 patients) of daily physical training postoperatively. There were no significant differences in patients' age, preoperative walking ability, type of femoral neck fracture and preoperative QOL functional score (FIM, BI and EQ-5D). All patients commenced the same postoperative rehabilitation program immediately after surgery consisting of bed-side sitting, wheelchair mobilization and progressive muscle strengthening exercises on the second day, followed by weight-bearing exercises and walking between the second and the 14th day. All patients walked with a stick or a rollator at the time of discharge from the hospital after 4 weeks of inhospital rehabilitation. There was no significant difference in the BI, FIM and EQ-5D scores and walking ability between the two groups during 12 weeks postoperatively, however, medical expenses in the 2 units group were decreased by US$ 2,000. Postoperative rehabilitation of elderly patients with femoral neck fracture aims to return the patients to pre-injury conditions as early as possible. This can be achieved with the help of a 2 unit (40 minutes) a day training program.

The efficacy of acupuncture-moxibustion for hypertension is often experienced by many clinicians. Nevertheless the mechanism whereby the therapy improves the symptoms has been scarcely elucidated. Our present study was designed to examine some effects of acupuncture upon the organism, especially upon the renal function which is implicated in hypertension.
Experiment I
Acupuncture therapy was undertaken four times on a patient with essential hypertension who was given no hypotensive drugs. In each therapy, needles (No. 2, Seirin) were perpendicularly inserted to the depth of 1.5cm at V₂₀ Fengchi, VU₂₁ Weishu, and G₃₆ Zusanli and left there for 15 minutes. The blood samples and urine were collected three times: before the insertion, 15min. and 60min. after withdrawing the needles. At the same time, blood pressure, pulse, and the amount of urine were measured. The amount of Na, K, Cl, kallikrein, catecholamines, etc. was measured in urine. The renin activity and the concentration of aldosterone, catecholamines, and BUN were determined in the blood. Result: a marked increase was seen in the excretion of urine, Na, and Cl. An upward tendency of kallikrein excretion which is correlated with urine volume, and a downward tendency of renin in the blood were found. Blood pressure and pulse showed a slight tendency to decline. However, neither catecholamines in the blood, nor K in urine changed significantly.
Experiment II
Subjects were two healthy adult men. Urine was collected once an hour for twenty-five times by means of a balloon inserted in the bladder. Immediately after the twenty-first collection, acupuncture stimulation was given to VU₂₁ Weishu in the same manner as Exp. I. With the same measurements and determinations undertaken, a marked increase of urine, Na, and Cl excretion was observed 15min. after withdrawing the needle.
Experiment III
Subjects were three healthy adult men. Urine was collected for two days. The amount of urine and the electrolyte content were calculated on a per hour basis. Without having breakfast after rising, the subjects were given a transfusion of glucose-electrolyte solution, equivalent to the calculated urinary output, every hour for four hours. The VU₂₁ Weishu was stimulated in the same manner two hours after the onset of the first transfusion. Result: a marked increase was seen in the excretion of urine, Na, and Cl.
Conclusion
It can be seen from the above that acupuncture stimulation to the VU₂₁ Weishu facilitates the selective excretion of Na and Cl in the urinary tubule.

A study was conducted to evaluate the clinical and hemodynamic performance of the 19-mm Medtronic Mosaic Valve (MMV) in the aortic position, which is a third-generation stented porcine bioprosthesis. Between 2003 and 2006, 9 patients underwent AVR using the 19-mm MMV. None of the patients were suitable for a 19-mm Perimount bioprosthetic valve due to having a small annulus and sinotubular junction. The patients included 3 men and 6 women with a mean age of 73.2±4.97 years and mean body surface area of 1.35±0.11m². Preoperatively, 8 patients were in New York Heart Association class II and 1 was in class III. The reason for surgery was aortic stenosis in 8 patients and aortic regurgitation due to infective endocarditis in 1 patient. Four patients had chronic renal failure and were on hemodialysis, while 1 patient had Crohn's disease. Concomitant coronary artery bypass grafting was performed in 3 patients, and tricuspid valve annuloplasty was done in 1 patient. The follow-up period was 12.0±7.71 months. No deaths occurred, but there was 1 cerebral infarction. Postoperatively, the peak pressure gradient decreased from 81.3±32.7 to 40.3±16.3mmHg (p<0.01). The mean pressure gradient also decreased significantly from 48.8±11.6mmHg to 23.9±9.32mmHg (p<0.01). Left ventricular end-diastolic diameter was 47.9±3.82mm preoperatively and 45.1±7.53mm postoperatively, showing no significant change. The left ventricular mass index also improved from 217.3±46.9 to 160±54.9g/m² (p<0.05). The ejection fraction was 72.0±8.93% preoperatively and 67.6±6.37% postoperatively, showing no difference. Although the postoperative indexed effective orifice area (EOAI) was 0.90±0.11cm²/m², mild patient-prosthesis mismatch (EOAI 0.77cm²/m²) was noted in 1 patient. In conclusion, the early clinical and hemodynamic performance of the 19-mm MMV in small elderly patients was acceptable.

A 38-year-old woman was referred to our hospital for treatment of infective endocarditis associated with abscesses in the brain and the left lower limb. A causative organism had not been detected by serial blood cultures. Preoperative brain CT revealed mycotic aneurysms and echocardiography showed a mobile vegetation (8mm in size) on the anterior leaflet of the mitral valve. We performed resection of the vegetation together with a small triangle of the anterior leaflet, after which the margins of the defect were approximated. Then bilateral Kay procedures and reinforcement with autologous pericardium were done to obtain proper coaptation. The patient's fever, left lower limb pain, and intracerebral mycotic aneurysms resolved after surgery. The brain abscess also became smaller. Mitral valve plasty should sometimes be considered in the active phase of endocarditis, even in patients with cerebral complications and without congestive heart failure.

Perivalvular leakage (PVL) is one of the serious complications of mitral valve replacement. Between 1991 and 2006, 9 patients with mitral PVL underwent reoperation. All of them had severe hemolytic anemia before surgery. The serum lactate dehydrogenase (LDH) level decreased from 2,366±780 IU/l to 599±426 IU/l after surgery. The site of PVL was accurately defined in 7 patients by echocardiography. PVL occurred around the posterior annulus in 3 patients, anterior annulus in 2, anterolateral commissure in 1, and posteromedial commissure in 1. The most frequent cause of PVL was annular calcification in 5 patients. Infection was only noted in 1 patient. In 4 patients, the prosthesis was replaced, while the leak was repaired in 5 patients. There was one operative death, due to multiple organ failure, and 4 late deaths. The cause of late death was cerebral infarction in 1 patient, subarachnoid hemorrhage in 1, sudden death in 1, and congestive heart failure (due to persistent PVL) in 1. Reoperation for PVL due to extensive annular calcification is associated with a high mortality rate and high recurrence rate, making this procedure both challenging and frustrating for surgeons.

No abstract available.
Adult ; Choledochostomy/*adverse effects/instrumentation/methods ; Duodenum/*injuries ; Endosonography/*adverse effects/instrumentation/methods ; Female ; Humans ; Jaundice, Obstructive/diagnostic imaging/etiology/surgery ; Self Expandable Metallic Stents/adverse effects

Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.
Abdominal Abscess/surgery ; Drainage/*methods ; Endosonography/*methods ; Humans ; Necrosis/surgery ; Pancreas/*pathology/surgery ; Pancreatic Diseases/*surgery ; Pancreatic Pseudocyst/surgery ; *Stents ; Surgery, Computer-Assisted/*methods ; Ultrasonography, Interventional/methods

PORPOSE: This study aimed to compare the prevalence of metabolic syndrome (MS) risk factors and its components in different levels of aerobic fitness established by “Exercise and Physical Activity Reference for Health Promotion 2006 (EPAR2006)” in Japanese middle-aged and elderly people.METHOD: Men (n=102) and women (n=133), aged 30-69yrs, participated in this study. The prevalence of MS risk factors was evaluated as the number of MS risk factors, according to the diagnostic criterion for Japanese-specific MS. Aerobic fitness was quantified as maximal oxygen uptake (VO₂max). Subjects were classified into the three groups by aerobic fitness level based on “Reference values” and “Reference range” established in EPAR2006; 1) High fitness group (H); VO₂max (mL/kg/min) is higher than “Reference values”, 2) Medium fitness group (M); VO₂max is below “Reference values” but within “Reference range”, 3) Low fitness group (L); VO₂max is lower than “Reference range”.RESULTS: In men, M and L groups showed significantly higher frequency of risk factors for MS than H group (H: 1.09±0.98, M: 1.81±1.07, L: 2.27±0.70, P＜0.01). In women, L group showed significantly higher frequency of risk factors for MS than H and M groups (H: 0.57±0.80, M: 0.81±1.01, L: 1.53±1.07, P＜0.01).CONCLUSION: These results suggest that higher MS risk appears when the VO₂max is lower than “Reference values” in men, and below “Reference range” in women, and that particularly, men with low aerobic fitness have higher MS risk.

PORPOSE: This study aimed to investigate the relation between cardiorespiratory fitness(CRF) and physical activity, especially vigorous physical activity, in Japanese middle-aged and elderly men.METHODS: Eighty-five men aged 30-69 years participated in this study. CRF was assessed by measuring the maximal oxygen uptake based on weight (VO₂max/wt) in an incremental test on a bicycle ergometer. METs·h/week was measured as the parameter of physical activity by using accelerometers. We defined the amount of physical activity higher than 3 METs as “Physical activity ; PA”in this study. Then, PA was divided into “Moderate physical activity ; MPA”(higher than 3 METs and below 6 METs)and “Vigorous physical activity ; VPA”(higher than 6 METs).RESULTS : CRF was positively correlated with PA(r=0.318, P<0.01), MPA(r=0.230, P<0.05), and VPA(r=0.301, P<0.01) and negatively correlated with age(r=-0.607, P<0.001), BMI(r=-0.369, P<0.01), and waist circumference(WC)(r=-0.486, P<0.001). After adjusting for age and WC, the multiple regression analysis revealed that PA was positively correlated with CRF(P<0.01). VPA was positively correlated with CRF(P<0.05) after adjusting for age, WC, and MPA. MPA was not correlated with CRF in the case of adjusting for age and WC.CONCLUSION : This study suggested that physical activity higher than 3 METs was positively associated with cardiorespiratory fitness independently of age and waist circumference, and particularly vigorous physical activity may contribute to increased cardiorespiratory fitness in middle-aged and elderly men. Thus physically active life with maintenance of adequate waist circumference may help to prevent age-related decline in cardiorespiratory fitness.

The purpose of this study was to analyze the relationship between activity pattern and temporal changes in the oxygen dynamics of human femoral medial vastus muscles. Oxygen dynamics were evaluated from the surface of the body by near-infrared spectroscopy (NIRS) . Arterial occlusion tests were performed in the femoral region at a cuff pressure of 300 mmHg. Exercise type and speed were controlled by CYBEX 6000. The exercise types examined were concentric contraction (CON) and eccentric contraction (ECC) . The 3 angular velocities of 90, 120 and 180 degrees were used as the exercise speeds. Exercise was performed continuously 60 times at maximum effort. The subjects were 7 healthy males with a mean age of 19.6±0.5 years. A transient decrease in oxygen concentration was observed during circulatory occlusion ; and rapid hyperemia occurred immediately after the removal of pressure. Oxygen concentration peaked above the control level and then returned to the initial level. In the CON exercise, the initial decrease in oxygen concentration was the largest at CON 90, and a gradual increase in oxygen concentration was clearly observed during exercise. In the recovery stage, after exercise at CON 90, 120 and 180, oxygen concentration exceeded the control level before exercise, then peaked and returned to the initial level. In the ECC exercise, an initial decrease in oxygen concentration was similar to that in the CON exercise, but a gradual increase in oxygen concentration was not observed during the exercise ; nor did oxygen concentration exceed the control level in the recovery stage after the exercise.
These results indicate that an increase in oxygen level after the removal of arterial occlusion, during and after the CON exercise was much higher than the control level before the exercise, sug-gesting the involvement of reactive hyperemia and exercise hyperemia.