From the standpoint of pediatricians, we have cautiously watched the increased prevalence of obesity among children as a phenomenon concomitant with the urbanization of agricultural communities.
In this paper the findings of the latest survey of obesity in primary school children are axamined in comparison with the results of 1970 survey.
The number of the children covered by the latest survey was 10, 606, of which 839 children (79.1%) were found in the condition of obesity, or 20% or more over a desired weigth, showing the incidence of obesity is 9 times higher than that in the previous survey.

We set out to assess our treatment strategy of acute aortic dissection associated with atherosclerotic aortic aneurysm, and to assess its results. A total of 228 patients with acute aortic dissection were admitted to our hospital between 1994 and 2009. Among these, 30 cases were associated with atherosclerotic aortic aneurysm and we retrospectively analyzed their patient data. Of these, 5 patients received diagnoses of Stanford A dissection and 25 patients demonstrated Stanford B. Coexisting aneurysms consisted of postabdominal aortic replacement in 9 patients, ascending aortic aneurysm in 1, arch aortic aneurysm in 6, descending aortic aneurysm in 2, thoracoabdominal aortic aneurysm in 3, and abdominal aortic aneurysm in 9. Patients were divided into 3 groups based on the relationship between aneurysm and dissection : acute aortic dissection occurred after graft replacement of an aortic aneurysm (Group 1, n=9), dissection coexisted with aneurysm in a different segment of the aorta (Group 2, n=8), and dissection extended to or involved the aneurysm (Group 3, n=13). Our treatment strategy for all patients excluding those with aortic rupture or malperfusion is described below. In the cases of Stanford A dissection, emergency ascending aortic replacement or total arch replacement was performed. In cases of Stanford B, patients were treated conservatively in the acute phase. Surgery for the coexisting aortic aneurysm was then performed in the chronic phase, if the aneurysm was large. We think that the interval between dissection onset and aneurysm surgery should be extended to at least 1 month, because the aortic wall was too fragile to perform anastomosis in the acute phase in the present cases. As a result, there were 2 hospital deaths in Group 3, but there was no aortic rupture during treatment in the acute phase in any of these 3 groups. There were no vascular-related deaths during follow up. Our treatment strategy obtained favorable outcomes.

Introduction: We evaluated the risk of shortness of inhalation when using laninamivir without inhalation practices.

Method: We counted the number of attempts required by each patient to sound the whistle. We classified the patients into the following categories: ①Sound rang in the first attempt; ②Sound rang within 3 attempts; ③Sound rang with in 5 attempts; ④Sound rang within 10 attempts; ⑤The whistle did not sound. We assessed the following: 1. the rate of patients younger than 10 years of age assessed category ② or less,; 2. the rate of patients of teen-age, and 3. the rate of patients of 20 years of age or older, assessed category ③ or less.

Results: We examined 56 patients, and we found that the rate for 1. was 7/11= 63.6%, for 2. was 4/33= 12.1%, and for 3. was 2/12= 16.7%.

Conclusion: We found that more than 60% of patients younger than 10 years of age and more than 10% of patients of 10 years of age or older were at risk of shortness of inhalation when using laninamivir without inhalation practices. And we propose other medication if patients cannot sound the whistle within about 5 attempts.

On twenty patients and ten healthy adult volunteers, pain threshold was measured by a dolorimeter (Pain meter NYT-5) to clarify whether analgesic effects of electrical acupuncture on various body surface may be changed by acupuncture points or not.
Electrical acupuncture was performed to the traditional acupuncture points on the two meridians. A group is the combination of LI 10 (Shousanli) and LI 14 (Hoku) on the right side, the other is the combination of ST 36 (Tsusanli) and ST 40 (Liangchiu) on the right side.
Measured points of pain threshold are (1) face, (the point 2cm above from the center of both eyelids), (2) (3) left and right upper extremities (LI 11; Chuchih) and (4) (5) left and right lower extremities (ST 41; Chiehhsi).
In the Shousanli-Hoku group, pain thresholds of face, both upper extrimities increased significantly. However, those of both lower extremities were not significantly changed.
In the Tsusanli-Liangchiu group, pain thresholds of the upper and lower extremities on both sides increased significantly. However there were no significant changes in the forehead.
In comparison of two groups, increases of pain thresholds of both lower extremities were observed in significantly more cases with acupuncture to Tsusanli and Liangchiu points than those with Shousanli and Hoku points by the Chi-square test (p<0.01). From this fact, acupuncture of Tsusanli-Liangchiu points seems to be more effective on the lower extremities than that of the Shousanli-Hoku points.
Therefore, we conclude that effects on pain threshold by electrical acupuncture depend on various points on meridians and are not evenly shown on the whole body surface.

A 73 year old female, who had suffered from serious bronchial asthma and had been taking prednisolone and theophylline, was treated with acupuncture and herbal medicine. Twenty points, which are so called effective points for bronchial asthma, were used for acupuncture, e. g. LU 1: Zhongij, LU 2: Yunmen, and CV 22: Tiantu, etc. As Ryoudouraku mesurments showed suppression of F3 (Kidny Meridian) and F5 (Gallbladder Meridian), the exciting points on those meridians (KI 7: Fuliu and GB 43: Xiaxi) were also mildly stimulated by acupuncture. The severity of asthmatic attack, the strength of cough and the amount of sputum were expressed by a scoring system, where the most sever one which had been experienced before was scored as 10.
At the initiation of acupuncture, the frequency of asthmatic attack was 5 times a day, the severity of asthmatic attack was 6/10, the strength of cough was 6/10 and the amount of sputum was 8/10. Recently prednisolone was successfully reduced from 20mg to 7.5mg per day with acupuncture and the severity of asthmatic attack, the strength of cough and the amount of sputum were improved to 2/10, 1/10 and 3/10, respectively.
On the other hand, % FVC, FEV 1.0% and blood gas analysis data were not improved.
In summary, we believe that acupuncture acts beneficially to reduce the subjective symptoms of asthma even when the dose of prednisolone were decreased.

Objective: To clarify the involvement of Japanese family physicians with patients and their families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checks. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checks and external checks.Results: Eight physicians participated at first, but five of them dropped out because of job commitments or death. The involvement by Japanese family physicians consisted of three stages. The first stage was "the approach of repeated hypothesis testing and normalizing" as safety interventions. The second stage was "reevaluation of the family" utilizing family genograms, family conferences, and others. After exhausting all other efforts, they engaged in "accepting the one who comes to them" in collaboration with the patient and families. The outcomes included awareness of patients, their smiles due to feeling accepted, and their expressed emotions. They did not explicitly boast that they were able to engage with family members. In addition, they also needed case studies of instances of "failure." Conclusion: Japanese family physicians engaged in three-stage involvement with families.

Previously we reported that acupuncture to the stellate ganglion stimulates the parasympathetic nervous system as well as the sympathetic nervous system. We measured effects of laser acupuncture to the stellate ganglion (SGL) or electrical acupuncture to the same (SGA) on R-R intervals, deep tissue temperature and blood presure by using 45 patients; 12 in SGL-group and 33 in SGA-group.
Results are as follows; (1) Means of heart rate (HR) decreased with 2bpm in the SGL-group, 3bpm in the SGA-group. (2) Coefficient of variation (CV) of R-R intervals increased with 1% in the SGA-group only. (3) Deep tissue temperature of the ipsilateral anterior forearm of the stimulation did not increase significantly after SGA, while deep tissue temperature increased with 0.3-0.5°C after SGL. Deep tissue temperature of the contralateral anterior forearm showed no significant change in the both groups. (4) Systolic blood pressure increased with 2-4mmHg after SGA and 4-5mmHg after SGL, respectively.
It is suggested that SGL increases deep tissue temperature by affecting autonomic nervous system, but not directly.

Objective : To investigate how rehabilitation outcomes improved after the rehabilitation plan was changed. Subjects : 54 patients that were admitted to a kaifukuki rehabilitation ward in a regional hospital from January 2007 to June 2007 and 679 patients that admitted from January 2008 to June 2011. Methods : We changed the rehabilitation plan as follows to improve rehabilitation outcomes. Physiatrists estimated the rehabilitation goal and the length of hospital stay (LOS) at the first examination. All patients had intensive rehabilitation with standing up exercises and ADL training toward the goal. LOS, Functional Independence Measure (FIM) gain, FIM efficiency and the percentage of patients discharged home during 6 months before the change were compared with those during the same period after the change. In stroke patients, hip fracture patients and deconditioned patients, the same comparison was performed. Results : In the 4 years after the change was initiated, LOS was reduced significantly from 96.5 days to 29.2 days (p<0.001). The change of FIM gain was not significant, but FIM efficiency increased significantly from 0.22 to 0.91 (p<0.001). The percentage of patients discharged home also increased significantly from 85.2% to 99.1% (p<0.001). Also in stroke patients and hip fracture patients, LOS was reduced and FIM efficiency was increased significantly. The sample of deconditioned patients was small, but their LOS was reduced significantly. Conclusion : The changed rehabilitation plan reduced LOS, increased FIM efficiency and enabled most patients to discharge home.

Objective: To clarify how and when Japanese family physicians assess families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checking. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checking and the checking by external members.Results: Physicians assessed families naturally while examining patients for common cold, during vaccination, and during registration in the Japanese care insurance system.Additionally, the physicians assessed the families when they observed or suspected something strange regarding the patient and/or the family.Families were assessed based on how they spent their time during special Japanese events that the family members attended together (e.g., Bon festival or Japanese style New Year holidays), the patient's illness behavior in non-reserved outpatient clinics, and their communication patterns. Furthermore, the family photograph technique for family therapy was also used for assessment.Conclusion: Participants utilized skills of family therapy such as communication patterns and family photographs. They also employed unique skills such as assessment of the families' sharing time during traditional events, assessment of the patient's illness behavior, and general assessments regarding the Japanese care insurance system.

During the 18-month period from January 1, 1981 to June 30, 1082, we encountered a total of 11 cases of child peptic ulcer-three gastric ulcer and eight duodenal ulcer casen.
There is every indication that the incidence of child peptic ulcer will increase in a rural area like Yuri, which is situated in Japan's northeastern prefecture of Akita.
To be noted is the fact that 10 cases out of 11 of peptic ulcer were found in three-year lower secondary schoolchildren and the remaining one was found in a sixth grader of six-year elementary school. The incidence as well as the number of visits to our clinics went up as the age advances and reached a peak in third graders of lower secondary school.
The reason why third graders of lower secondary school were attacked most by peptic ulcer is probably that they, at puberty, are under psychic or psychogenic stress with anxiety over high school entrance examinations, mental strain from forced attendance at a cramming school, trouble in getting along with friends, and dissatisfaction with parents.
Therefore, child peptic ulcer should not be treated as a disease of the digestive organ alone but as a disorder in the autonomic nervous system with an aid of psychosomatic medicine and psychiatry. For the prevention of the disease, it would also be necessary to take account of socio-cultural factors.