A 54-year-old man was admitted to our hospital because of hypertrophic obstructive cardiomyopathy (HOCM). Medical treatment was not effective. Cardiac catheterization showed a peak systolic pressure gradient of 143mmHg between the left ventricle and the ascending aorta. Echocardiogram showed a systolic anterior motion and moderate mitral regurgitation without asymmetric septal hypertrophy. He underwent mitral valve replacement (MVR) with a 27-mm SJM instead of myectomy due to his relatively thin ventricular septum of 16mm. Postoperative cardiac catheterization revealed no significant pressure gradient between the left ventricle and the ascending aorta. MVR is the most effective surgical treatment of HOCM without asymmetric septal hypertrophy.

A 45-year-old woman was admitted for acute left hemiplegia and left hypogastric pain. Central CT showed a right parietal lobe infarction. Abdominal CT demonstrated ovarian tumor and infarction of the liver, spleen and kidney. Chest radiography showed moderate cardiomegaly. Transthoracic echocardiography demonstrated vegetation in the aortic valves and severe aortic regurgitation. Aortic valve replacement and bi-adnexectomy were performed urgently. Intraoperative examination revealed normal aortic valves except for small amounts of vegetation on leaflet surfaces. Pathological diagnosis of vegetation was fibrin without inflammatory cells or bacteria. The postoperative course was uneventful, and the patient was discharged 13 days after surgery without a permanent neurological deficit. Trousseau syndrome caused by ovarian cancer and nonbacterial thrombotic endocarditis is rare, and it is important to be aware of this syndrome in the case of a young cerebral infarction patient with malignant disease.

A 73-year-old man presented with gastric adenocarcinoma 14 months after coronary artery bypass grafting with an in situ right gastroepiploic artery (RGEA) to left circumflex branch (LCx). He underwent a partial gastrectomy after successful percutaneous coronary intervention (PCI) to the occluded lesion of LCx. Though the RGEA graft was injured and sacrificed intraoperatively, gastrectomy was safely accomplished without any complication and the postoperative course was uneventful. Preoperative PCI was useful for a gastrectomy in a patient with an in situ RGEA.

We have tried to design a method to measure health degrees as one of ideas to grasp the activity of general population.
We should like to suggest to measure relative local endurance and to observe its index or their mutual index ratio measurement of their endurance in each item.
Exercise method was already reported in the report (1) .
Loading time by standing arm test (SAT) is 1 minute, knee test (KT) is 30 seconds, sit up test (ST) is 30 seconds for general population.
Extimate formulas on index are given as follows,
SAT=120-2Y/ (P₁+P₂) ×4×1.36×100=2206-37Y/P₁+P₂
KT=120-2X/ (P₁+P₂) ×4×1.22×100=2459-41X/P₁+P₂
_??_ST₃₀=120-3Z/ (P₁+P₂) ×4×1.20×100=2500-63Z/P₁+P₂
_??_ST₃₀=120-3Z/ (P₁+P₂) ×4×1.38×100=2174-63Z/P₁+P₂
X, Y and Z show frequency of impossible in each exercise.
The above index itself can be compared with index in another person, but for the individual SAT/KT and ST/KT show that balance of moving and in case need SAT+ KT and SAT+KT+ST can be compared as the whole body endurance.
After this, we are expected to investigate whether the health degree in each individual can be observated or not, by these methods.

To date a uniform set of standards for the kinesiology and measurement of the degree of flexibility of the human body are not available in Japan. In the methods of measurement of the suppleness of the human body, various distances and angles have been used separately as frames of reference. In the selection of angles for lateral observation on the human body, some investigators have set the standard point of reference at the major trochanter, while others have taken the anterior superior iliac spine as their standard point of reference.
In the present study, the lateral angle of the human body was measured using the anterior superior iliac spine and the major trochanter as the standard points. The values from the measurement of these two points were comparatively studied around the rotation of the pelvis. In 4 male and 4 female university students without joint abnormalities, measurement was carried out in 5 postures (1) normal (2) lordosis (3) flat back (4) flexion of the trunk (5) hyperextension of the trunk.
As the standard points for angle analysis, 4 points, the acromion, anterior superior iliac spine, the major trochanter, and the lateral malleolus were selected. As the angle to express each posture, the anterior angle of the acromion-anterior superior iliac spine-lateral malleolus and anterior angle of the acromion-major trochanter-lateral malleolus were measured.
For the observation of pelvic inclination, the internal angle of the anterior superior iliac spine-major trochanter and the lateral malleolus was measured. In order to analyze this, the range of fluctuation of the postural angle against pelvic inclination around the major trochanter and anterior superior iliac spine was calculated.
As a results, a small variance in the fluctuation of the values of measurement in each test subject would express a change of posture due to pelvic rotation. In each case, the use of the major trochanter gave a small unbiased variance.
In our experience, palpation of the major trochanter or anterior superior iliac spine especially in females revealed less resistance by the former. Consequently, based on these results, the use of the tip of the major trochanter appears to be more reasonable than the anterior superior iliac spine as a reference point for the observation of the human body from the lateral aspect.
It is proposed that the standard point should be placed on the center of the major movable joint to express the posture and other movement, in addition to the anterior superior iliac spine.

As a method of agility measurement under wide current use, the repeated side step is well-known. At present in Japan, a duration of 20 seconds is employed to test agility ; but it is often reported that the factor of endurance is included in this. When a diagnosis involving agility is made based on the performance of exercise, the duration of the time of measurement was controlled in order to avoid the mixing of other factors and to ensure measurement of as few factors as possible. The distance of step was made flexible according to the age. Since a constant distance makes the longitudinal tracing easier, the distance of step was also studied.
Side steps were tested and duration of measurement was examined based on determinations in 1857 subjects, Junior and Senior school boys and girls and male university students. During the 20 seconds of measurement, scores were recorded every 5 seconds to study the time course of the fluctuations of scores. Taking into consideration factors of endurance such as the endurance of the lower extremity system, the knee test was conducted to see the relationship between scores of the repeated side step and knee test values. As to the distance of the step, 200 high school girls were tested over a distance of 100cm ×2 and 120cm ×2, for 10 seconds each.
As to the time of measurement, the average score during the first 10-15 seconds after start tended to decrease. In the time course of fluctuations of the scores in each subject, a decrease in the fall of scorse was seen about 10 seconds after the start in approximately 55% of the test subjects.
Based on the assumption that the endurance of the lower extremity system participates in this, high and low groups with a significant difference in the endurance of the lower extremity at the level of P<0.001 were compared. While no difference was seen in the slope of the score increase over a 10-second period from the start, changes of scores were distinctly different between 10 and 20 seconds, the lower values in the low group being obvious. The endurance of the lower extremity system was then studied in the two groups with high and low scores in the side step between 10 and 20 seconds. In the group with high scores, the endurance of the lower extremity was high : and a significant difference at P<0.01 was noted in this index.
These results would definitely indicate that mixing of other factors is unavoidable under the current measurement duration of 20 seconds
As to the distance of the step, scores are apparently different even in the same test subject, depending upon the distance of the step. The scores are also different depending upon the body length.
In both of the two groups, however, the scores for each different distance of the step showed a high correlation between each other, giving a correlation coefficient of γ= 0.88 in the group with high body length and γ= 0.82 in the group with low body length, indicating a high correlation.
Based on the diagnosis of agility and performance of exercise, in order to obtain the results of measurement of as simple a factor as possible, the agility time measurement is corrected to 10 seconds ; and the distance of the step is made constant at 100cm×2 regardless of the age, to a distance without unnatural effort even by a primary school pupil, in order to obtain a better diagnosis and tolerance for exercise for the desirable development and maintenance of agility.
The influence of body height on the score should be studied in the future.

A simple method of evaluation and measurement of endurance of the whole body for exercise prescription for sportsmen was previously reported. In the present study, a method of loading for general population was deviced and is the subject of the present communication.
The site of loading was divided into relatively localized portions of the lower extremity, upper extremity and trunk.
By substituting the kneeling exercise with step test, individual difference in body height was corrected.

We measured oxidative stress and antioxidative stress in clinical cases of cardiac and aortic surgery, especially in extracorporeal circulation cases. From June to October 2007, 18 cases who underwent cardiac and aortic surgery with extracorporeal circulation (ECC group) and 8 cases with an infra-renal abdominal aortic aneurysm (AAA group) were studied. We measured reactive oxygen metabolites (d-ROM) in oxidative stress for the operative time, after the operation endpoint, and at one day postoperatively, one, two, and three weeks postoperatively, and one, two, three, and four months postoperatively. Regarding d-ROM, the level in the ECC group was significantly higher than that in the AAA group (p<0.0001). Peak values were observed 3 weeks postoperatively in the ECC group and 2 weeks postoperatively in the AAA group. Although the oxidative stress increased in both groups, the peak value in the ECC group was more marked than that in the AAA group. We concluded that oxidative stress under surgical stress in cardiovascular surgery with extracorporeal circulation was higher than that under surgical stress in cardiovascular surgery for infra-renal abdominal aortic aneurysms.

We report 3 cases of ascending aorta-abdominal aorta bypass for atypical coarctation with Takayasu's aortitis. We performed an extra-anatomical bypass from the ascending aorta to the terminal abdominal aorta. The graft was arranged to pass through the diaphragm from the pericardium, behind the left lobe of the liver and the stomach, to the front side of the pancreas to the terminal abdominal aorta. Although the graft was exposed in the abdominal cavity in part behind the stomach, it was completely covered with the great omentum thus avoiding direct contact between the graft the abdominal organs. Decrease in the pressure gradient between the ascending aorta and the abdominal aorta was achieved using a large prosthetic graft 14-16 mm in diameter. There are several advantages with this technique. (1) Positional change during surgery can be avoided. (2) Anastomosis can be performed in non-diseased vessels. (3) This bypass graft can be branched off to visceral arteries if necessary. Reduction of the after load on the left ventricle and long-term graft patency by using a large diameter prosthetic graft were anticipated. The postoperative courses of all cases were satisfactory. Case 1 died of another disease 11 years and 11 months postoperatively, but the graft to was still patent.

As regards obesity screening tests, it's a widly known fact that there are many problems in the existing notation of various body indices.
Moreover, in regards to the determination of skin-fold thickness, measurments must be taken at two or three places, and this, plus the fact that a certain amount of expertise is necessary, represent a shortcoming.
Using abdominal girth, which can be relatively easily measured, together with the chest girth measurment, the author examined a method for assessing obesity.
Various body indices were computed from height, weight, chest measurement, abdominal girth, etc. and the correlation between their value and skin fold thickness and average skin fold thickness was determined.
As a result of this, abdominal girth measurement and evaluation may be used in obesity screen tests in the following way.
1. Method for measuring abdominal girth.
[1] Have the patient assume normal posture.
[2] Girth is measured (in centimeters) around the area mid way above the navel while the patient resting expiratory state with arms hanging limp and shoulders relaxed.
2. Method for computing obesity index.
obesity index=height (in cm) ×10/abdominal girth (in cm)
The subject of the above research is extreamly limited in respect to age range. Therefore, the authors would like to examine further to see if this method is applicable to all age renges.