In previous assessments of body composition by whole body bioelectrical impedance (BI) analysis, electrodes have almost always been placed on the right side of the body. In fact, the most commonly used equations of Lukaski et al, were developed using BI measurements obtained on the right side of the body. However, in some individuals with traumatic injury or orthopedic problems, it would sometimes be necessary to measure BI on the right left side of the body. In the present study, we investigated the effects of electrode placement on BI and the derived percentage body fat. Subjects were 72 nontrained, healthy adult women : age ; 28.1±12.6 yr (1866), height ; 156.3±6.0cm, weight ; 50.5±7.7 kg, percentage body fat ; 24.4±5.2%. BI was measured for each subject in a supine position by use of a Selco SIF-881 plethysmograph (800 μA, 50 kHz) and ECG electrodes (Nikon Kohden) . The tetrapolar configuration was adopted in order to minimize contact impedance or skin-electrode interation. Eating and exercise were prohibited for at least 3 h prior to assessment. The effects of electrode placement were determined under four conditions: 1) the right arm and right leg (R side), 2) the right arm and left leg (R side-L side), 3) the left arm and right leg (L side-R side), 4) the left arm and left leg (L side) . Body density was predicted from the equation developed by Nagamine et al., and percentage body fat was derived from the body density according to Brozek et al. There were significant differences in BI values among the four conditions. Dominant side BI values were significantly lower than those on the non-dominant side. Percentage body fat values estimated under four different BI test conditions (i, e., R, R-L, L-R, and L) in terms of electrode placement were found to be highly correlated (r= 0.9420-0.956) with hydrodensitometrically determined percentage body fat. However, the mean percentage body fat on the dominant side of the body were significantly lower than that on the non-dominant side. We suggest that electrodes can be placed either on the dominant side or on the non-dominant side of the body for normal individuals, assuming that the lowest value from the four combinations of measurements can be used as the criterion value of BI. When the subjects are athletes, BI values obtained on the dominant side or a mean of the values measured on both sides should be adopted.

Thirty two years-old man with arthralgia in both hands was given with non-steroid anti-inflammatory drug and followed. The symptoms persisted, and hematuria and signs of infection were getting apparent. The patient was referred to our hospital with increasing dyspnea. The patient presented acute heart failure, acute renal insufficiency and respiratory failure. Echocardiography revealed vegetation and regurgitation in the aortic and mitral valve. Blood culture demonstrated α-Streptococcus. CT revealed enlargement of the aortic root. The patient was diagnosed with infectious endocarditis, and referred for surgery. At surgery, the aortic valve and mitral valve were severely destroyed. Aortic root and mitral valve replacement were performed. Pathological findings demonstrated valve destruction as a result of endocarditis due to active rheumatic fever. Clumps of bacteria were not noted around the valves. This is a rare adult case with valve destruction by acute rheumatic fever.

The aim of this study was to clarify the influence of buoyancy on physiological responses during treadmill walking. Six subjects participated in this experiment. The water level was adjusted to the greater trochanter. Normal water (NW) and 1.135 kg/l of specific gravity (high buoyancy ; HB) were set. Oxygen uptake (VO₂), heart rate (HR), and rating of perceived exertion were measured during exercise. VO₂ in HB at all walking speeds were higher than those in NW significantly. HR enhanced in HB over the walking speed of 70 m/min significantly. It was clear that the workload of walking in HB increased remarkably over the walking speed of 70 m/min. This suggested that the water resistance acted on the phenomenon of increase of the workload in HB. Furthermore, it was suggested that walking in HB was useful for rehabilitation and therapeutic exercise in the low-speed and for physical training in the high-speed.

Combined surgery for left Subclavian artery revascularization and CABG was performed in a 74-year-old man with diabetes mellitus. The preoperative coronary angiogram showed critical stenoses in all three major branches, and arteriography revealed obstruction at the left proximal subclavian artery. Severe atherosclerotic calcification was acknowledged circumferentially in the ascending aorta and in the aortic arch. For this patient axillo-axillary crossover bypass grafting was performed first using and expanded PTFE graft, followed subsequently by off-pump CABG using all in situ grafts (right internal thoracic artery-left anterior descending artery (RITA-LAD), left internal thoracic artery-diagonal branch (LITA-diagonal branch), gastroepiploic artery-right coronary artery (GEA-RCA)). Postoperative recovery was smooth, with disappearance of significant pressure difference between both arms (preoperatively, 46mmHg). An angiogram on the 7th postoperative day showed a widely patent axillo-axillary bypass graft along with good flow of all three coronary grafts, in which LITA was visualized well through the axillo-axillary bypass graft. For complex atherosclerotic disease of the proximal aorta and incipient portion of neck vessels associated with severe coronary sclerosis, this technique is a suitable option.

This study examined if modified Wingate Anaerobic Test (Wingate method) and Evans-Quinney Anaerobic Test (Evan-Quinney method) procedures could be applied to the meas-urement of maximal anaerobic power output (POmax) which is usually determined during 8-s maximal cycling depending predominantly on alactacid energy sources. The criterion measure of POmax was either the highest power output among 5 to 7 power outputs meas-ured at different workloads (Selection method) or the peak power output estimated from quadratic regression (Peak method) . POmax and anaerobic power outputs with these four methods were measured during 8-s maximal cycling on Monark bicycle ergometer with toe-stirrups. Forty-four young athletes (25 males and 19 females) served as subjects. Analysis of the data indicated that: 1) There was a very high correlation (r=0.995, P<0.001) between POmax determined by Selection and Peak methods, with no statistical difference in their absolute means. 2) POmax determined by Wingate method correlated (r=0.937, P<0.001) significantly with POmax determined by Peak method, while mean values differed signif-icantly. 3) POmax determined by Evans-Quinney method also correlated (r=0.890, P<0001) significantly with that determined by Peak method; however, mean values differed significantly and degree of the difference in POmax was particularly greater in females. It is concluded that both Wingate and Evans-Quinney methods with a cycling duration of 8 s might be applicable for the assessment of POmax by utilizing linear regression equations developed in this study. Further studies are needed as to the feasibility of using these methods, particularly on females.

Since April 1992 we have introduced a beclomethasone dipropionate (BDP) inhalation therapy with a large spacer for patients with bronchial asthma who were admitted to the internal medicine department of our hospital because of the exacerbation of asthma.
To find out the effect of this BDP inhalation therapy, we investigated the number of emergency room visits by the patients with bronchial asthma who had been admitted to our hospital with asthmatic attacks before and after the introduction of the new therapy.
From April 1991 to March 1994, the proportion of asthma patients decreased significantly (p<0.05): from April 1991 to March 1992 (before the introduction of the BDP inhalation therapy) 10.4±3.0%; from April 1992 to March 1993 5.3±1.4%, from April 1993 to March 1994 3.7±1.4%.
We checked the inhalation technique of 21 patients who visited our hospital regularly during the same period. The BDP therapy could decrease the number of emergency-room visits by 10 patients whose inhalation technique was imperfect, as well as by the other 11 patients whose inhalation technique was perfect.

The purpose of the present investigation was to examine the relationships between the exercise history and the bone mineral density (BMD) and bone mineral content (BMC) in female Japanese young adults using dual X-ray absorptiometry (DXA). One-hundred twenty females, aged between 18 to 28 years, participated in the present investigation. The BMD at the lumbar spine (L-BMD), whole body BMD and BMC (WB-BMD and WB-BMC), lean body mass (LBM) and fat mass (FM) were measured by DXA. Using a self-administrered questionnaire, the exercise habits during preschool (4-6 years), primary school (7-12 years), junior high school (13-15 years), high school (16-18 years), and the current habits (>18 years) were eveluated. The L-BMD, WB-BMD and WB-BMC were significantly higher in the subjects with exercise habits during both the period of <18 years and >18 years compared with those in the subjects without an exercise history during all periods (p<0.05). In a separate analysis with the data stratified by the school age, the subjects with an exercise history during primary school, junior high school, or high school had significantly higher BMD and BMC values compared with the non-exercisers (each, p<0.05). In contrast, the BMD and BMC did not differ significantly according to either the exercise history during pre-school nor the current exercise status. A multiple stepwise regression analysis revealed that the body weight, LBM, FM, age of menarche, and exercise habits during high school were significant determinants of the L-BMD, WB-BMD and WB-BMC (p<0.001). The results of the present investigation show that both the exercise history during school age and the current exercise habits affect the BMD and BMC in young adults. In particular, high school females should be encouraged to participate in the regular exercise to increase their bone health. Future studies will be needed to confirm the targeted age-group(s) for participation in sports/exercise for the improvement of bone health, including an analysis of the type and intensity of exercise/sports.

Objective: The mechanism underlying the development of neuropsychiatric symptoms such as unconsciousness, abnormal behavior, delirium, hallucinations, and convulsions in influenza has not been thoroughly investigated. The relationship between drug administration and neuropsychiatric symptoms during influenza is also poorly understood. This study is the first pharmacoepidemiologic study focused on investigating the relationship between drug administration and neuropsychiatric symptoms.
Design: Cohort study
Methods: Study subjects were patients under 18 years old who had influenza during the 2006/07 season. We prepared two kinds of questionnaires for doctor and for patient's family, and carried out the survey between January and March, 2007. Using data from 9,389 patients, we analyzed the relationship between neuropsychiatric symptoms, such as delirium, unconsciousness and convulsion, and drug administration of acetaminophen and oseltamivir.
Results: Analysis of the relationship between delirium and drug administration provided hazard ratios of 1.55(p=0.061)for acetaminophen and 1.51(p=0.084)for oseltamivir. These hazard ratios, which were adjusted for risk factors by multivariate analysis of the proportional hazard model, showed an increasing tendency of delirium after administration of each drug. In patients who received oseltamivir, a high incidence of delirium was observed between 6 and 12 hours after onset of fever. Furthermore, delirium was found to develop in a shorter time following oseltamivir use than it did after acetaminophen use. There was no relationship between unconsciousness and acetaminophen administration, as demonstrated by a hazard ratio of 1.06(p=0.839). The incidence of unconsciousness increased significantly with oseltamivir use with a hazard ratio of 1.79(p=0.0389), and unconsciousness was found to occur in a short time after oseltamivir use.
Conclusion: The results obtained from this study suggest that there are increased risks of delirium and unconsciousness with drug administration. Further pharmacoepidemiologic studies for hypothesis testing are required to study the relationship between abnormal behavior and drug administration.

An 81-year-old man who had a saccular abdominal aortic aneurysm (AAA) with a narrow terminal aorta underwent endovascular aortic aneurysm repair (EVAR) with the Medtronic Endurant^® stent graft system. After 4 days, computed tomography (CT) showed stenosis of the stent graft left limb, which was pressed flat against the right limb at the narrow terminal aorta. We performed re-intervention to dilate the narrow terminal aorta and bilateral limbs with kissing stenting using Express Vascular LD^® (Boston Scientific). After operation his ankle brachial pressure index rose from 0.88 to 0.99 and there was no evidence of stenotic limbs at CT image. We need to be careful about the stenotic limb after EVAR with Medtronic Endurant stentgraft system for AAA with a narrow terminal aorta.

Objective: The purpose of this study is to identify the problems in the adverse drug report (ADR) system in early post-marketing vigilance phase (EPM phase) in Japan.
Methods: The incidence of all ADRs and the ratio of serious ADRs were compared between the new drug application phase (ND phase) and the EPM phase.  The target medicines were Moxifloxacin (Avelox®tablets, 400mg), Gatifloxacin (Gatiflo®tablets, 100mg) and Prulifloxacin (Sword®tablets, 100mg).
Results: The average incidence of all ADRs in the ND phase was 100-fold greater than that in the EPM phase.  There were also 2-fold differences in the ratio of serious ADRs of individual medicines.
Conclusion: There are several problems with the ADR system in the EPM phase in Japan.  It is currently possible that the implementation of EPM will vary between in individual medicines and companies.  This suggests that the present data cannot be applied universally.  Thus, there is an urgent need to standardize the implementation of EPM.