A 25-year-old man crashed his car into an electric light pole, and was brought to our hospital. Pericardial effusion inducing cardiac tamponade was detected on computed tomography, but there was no findings suggesting traumatic injuries of any other organs. Since he demonstrated shock during the examination, we performed pericardial drainage following pericardiocentesis to eliminate the cardiac tamponade. After approximately 150 ml of blood was drained, his blood pressure increased and stabilized. Blunt cardiac rupture was diagnosed after blood drainage, and midsternotomy was then performed. Percutaneous cardiopulmonary support was established for exploration and confirmation of the injured site. The injured site was confirmed at the junction of the right lower pulmonary vein and right basal pulmonary vein. However, surgical repair under partial circulatory support was impossible because the injury was complicated and hemorrhage was not controllable. Furthermore, there was a risk of air embolization during the process of repair. Therefore, an additional drainage tube was inserted into the superior vena cava, and then the injury was repaired by direct closure under total perfusion using another circulatory circuit with a venous reservoir. No cases of isolated injury of intrapericardial pulmonary vein injury have been reported previously. It was suspected that the development of this injury was related to air bag deployment. This case could be saved by surgical repair under total perfusion using cardiopulmonary bypass.

  Ibusuki hot spring sand bath (SB) (Sunamushi) has traditionally been used for the relief of musculoskeletal pain. It is specified by piling up heavy (40-60 kg) and hot (50°C) sands on the lied body heated by the hot spring water gushed at the seashore of Ibusuki. In this study, remarkable circulatory activation and metabolic improvements probably due to thermal vasodilation and higher hydrostatic pressure is examined. Subjects: The subjects examined were 20 healthy males (34.3±10.5 yrs) who accepted informed consents. Methods: The subjects were thin bathrobe and kept rest for 30 min in the supine position. BP, HR and sublingual temperature measurements and venous blood sampling from the indwelling catheter was done. Blood counts, blood gas pressure and plasma chemistry were examined. Then sand bath carried out for 10 min and 30 min rest under keeping sufficient warmth by blankets. Results: Systolic blood pressure was significantly increased though diastolic blood pressure was significantly reduced. HR and sublingual temperature were significantly increased by +22 bpm and +1.1°C, respectively, just after 10 min SB. Venous blood pO2 and pH were significantly increased by +18.3 mm Torr and +0.03pH, and pCO2 was significantly reduced by -5.8 mm Torr. Lactate and pyruvate were significantly reduced after 10 min and 30 min after sand bath suggesting the improved peripheral oxidative metabolism. Conclusion: Increase in blood pressure and heart rate indicating cardiac acceleration was considered to be induced by hydrostatic pressure with heavy sands and thermal vasodilation. Improved peripheral circulation and oxidative metabolism were also suggested by increased pO2, decreased pCO2 and decreased lactate and pyruvate level. Sufficient O2 supply and removal of wasted substances due to activated circulation was considered to be the basic mechanism of the effects of sand bath.

We present the case of a 68-year-old woman with abdominal aortic aneurysm (AAA) complicated by right ectopic kidney, in another term, congenital pelvic kidney. The patient underwent AAA repair and right renal artery reconstruction using renal perfusion with cold Ringer's acetate, and no deterioration of renal function was observed. 3D-CT was essential diagnostic procedure in order to identify the blood supply to the ectopic kidney for planning a careful surgical technique.

  Ibusuki hotspring sand bath (SB)(Sunamushi) is a special thermal therapy using heated sands by natural hotspring gushed at the seashore of Ibusuki city. Heated heavy sands (50°C, 40-60kg) was piled on the lied body. It has traditionally been used here for 250 years to relieve muculoskeletal and neuralgic pain, and still accepts 260 thousands visitors a year. In the present study, cardiovascular and metabolic effects by SB was studied from the viewpoint of accelerated circulation. Subjects and Methods: General physical parameters (BP, HR, sublingual temperature) and plasma chemistry were examined in 20 healthy males(36 ± 10yrs). The subjects wore thin bathrobe and a venous catheter for blood sampling were set in the forearm. They kept rest in the supine position for 30min and subjected 10min SB at the municipal SB institute with hotspring piping under the sands. In another 28 healthy subjects (44.3 ± 2.4yrs), cardiac outputs and plasma catecholamines (CA) and renin activity (PRA) were measured. In 6 subjects intracardiac study by Swan-Ganz catheterization were performed. Results: Diastolic pressure were significantly decreased by 6mmHg, and heart rate and sublingual temperature were significantly increased by +20bpm and +1.1°C, respectively, after 10min SB. Venous blood pO2 and pH was significantly increased by 20mm Torr and 0.03pH, and pCO2 was significantly reduced by 5mm Torr. Lactate, pyruvate and L/P ratio were significantly reduced suggesting improved oxidative metabolism of peripheral tissues. Plasma CAs and PRA were elevated after SB. All of these results gradually returned to the resting level after 30min. Cardiac output (CO) measured by dye dilution or thermo-dilution method was significantly increased from 5.6l/min to 10.5 l/min after 10min SB, and reduced to 8.1 l/min by removing piled heavy sands. Calculated total peripheral resistance (TPR) was significantly decreaased suggesting thermal vasodilation. Although mean right atrial pressure and pulmonary arterial pressure were increased during SB, they were immediately decreased by removing piled sands. Discussion: All of these results indicate that the basic effects of SB are derived from strong hydrostatic pressure of piled heavy sands and thermal vasodilation. Increased CO due to accelerated venous return and reduced afterload (TPR) will induce sufficient oxygen supply and increased discharge of wasted matters from peripheral tissues. These data seem to be compatible with the clinical effects of SB to relieve musculoskeletal pain and fatigue. Conclusion: Significant clinical effects is induced by increased CO due to the increased hydrostatic pressure of piled sands and thermal vasodilation.

Objective：The aim of this study was to examine the relationships between the timing of gait acquisition and the length of hospitalization, and to clarify the differences in background factors and functional recovery during the early postoperative period and their effect on the variability in gait acquisition.
Methods：We recruited 148 patients who underwent total knee arthroplasty (TKA) at three hospitals. The participants were divided into two groups on the basis of the number of days needed to achieve independent gait at ≤14 days after surgery (group A) and ＞14 days after surgery (group B). We compared the background factors between the two groups. Additionally, we compared the preoperative and postoperative function in each group.
Results：We observed a significant positive correlation between the number of days needed to achieve independent gait and the length of hospitalization. In group A, the significant background factors were younger age and higher preoperative activity level. In group A, compared with the level of preoperative function, the postoperative maximum knee extension angle on the operated side and pain had significantly improved. In both groups, the postoperative knee extensor strength on the operated side, knee extensor strength on the nonoperated side, knee flexion strength on the operated side, maximum knee flexion angle on the operated side, and walking speed were significantly reduced.
Conclusion：During early rehabilitation, it is necessary to consider the age and previous activities of patients. In addition, we suggest that early rehabilitation with a focus on reducing pain by alleviating inflammation and improving maximum knee extension angle on the operated side may be effective for fast acquisition of gait.

Objective：To elucidate factors associated with physical function and clarify the actual condition of functional deterioration in patients with knee osteoarthritis (OA) prior to total knee arthroplasty (TKA)．

Methods：We enrolled 467 patients with severe knee OA and preoperatively assessed the following parameters：background factors (sex, age, BMI, K-L grade, and pain) and physical function (muscle strength of knee extensors and flexors, and knee joint angles). A multiple regression analysis was performed to determine the relationship between the independent background factors and dependent physical functions. The median of preoperative function based on selected factors of physical function was calculated.

Results：Based on the multiple regression analysis, sex, BMI, K-L grade, and pain statistically significantly correlated with muscle strength of knee extensors and flexors. Sex and BMI statistically significantly correlated with knee joint flexion angle. K-L grade statistically significantly correlated with knee joint extension angle. The median of muscle strength for knee extension was 0.98/0.92 Nm/kg (Grade 3/Grade 4) for males and 0.70/0.59 Nm/kg for females. The median of muscle strength for knee flexion was 0.53/0.45 Nm/kg for males, 0.36/0.30 Nm/kg for females. The median for knee joint flexion angle was 130° for males and 120° for females. The median for knee joint extension angle was -5°/-10° (Grade 3/Grade 4)．

Conclusion：We clarified the degree of muscle strength and range of motion before TKA in patients with knee OA. We believe that the findings obtained in this study will contribute to explaining the functional deterioration of patients with knee OA.

Left ventricular thrombus is a complication of left ventricular dysfunction, including acute myocardial infarction, cardiomyopathy, and severe valvular heart disease. Surgical removal should be considered when a thrombus is mobile, when thromboembolism occurs, and when cardiac function has the potential to improve. Two patients with left ventricular thrombus underwent totally thoracoscopic transatrial thrombectomy. A thrombus developed in the apex of the left ventricle after acute myocardial infarction in one patient (Case 1) and during treatment for congestive heart failure in the other (Case 2). The minimally-invasive transatrial approach requires no sternotomy or left ventriculotomy and is thus particularly beneficial for treating left ventricular dysfunction. Moreover, totally endoscopic surgery confers the advantage of a deep and narrow visual field. Therefore, we consider that this strategy is highly effective for treating left ventricular thrombus.

[Introduction]There are few studies on the effect of acupuncture on QOL and work ability. Therefore, by this prospective study, we examined the effect of acupuncture treatment for QOL and work ability of visual display terminal (VDT) workers.
[Methods]Sixty-one VDT workers participated as subjects (41 males, 20 females). Acupuncture sessions were performed once a week for 4 weeks. Acupuncture points were decided by individualized VDT workers neck and shoulder symptoms points. Disposable press tack needles were used. Improvement of SF-36 and the work ability index were evaluated.
[Results]All VDT workers completed follow-up. There were statistically significant improvements in Mental Component Score (MCS), Physical Component Score (PCS), Role Physical and Body-Pain of the SF-36, and WAI. Regular correlations between before WAI and MCS, PCS, and 8 subscales of the SF-36 were observed. In addition improvement rate of WAI and Body-Pain were observed.
[Conclusion]Symptoms in the neck shoulder stiffness of the VDT workers was improved by acupuncture, and QOL/work ability improved.

A 69-year-old woman was admitted with severe hypertension and intermittent claudication. The results of further examination, showed that the hypertension and intermittent claudication were due to stenosis of the descending aorta and we diagnosed atypical aortic coarctation. We performed median sternotomy and ventrotomy with side-to-end anastomosis a woven Dacron graft and the ascending aorta. The graft was passed through the lesser omentum, and mesocolon and to abdominal aorta. The postoperative state was stable, and the hypertension and intermittent claudication were remarkably ameliorated. Many cases of extra-anatomical bypass were reported, and the ascending aorta-abdominal aorta bypass was useful method and, very successful with no complications in this case.