The purpose of this study was to investigate the usage of the lower limb muscles (quadriceps femoris : QF, m. vastus lateralis : VL, m. rectus lemons : RF, m. vastus medialis : VM, m. vastus intermidialis : VI, hamstring : HM, m. gastrocnemius : UN, tihialis anterior : TA) and blood lactic acid concentration during uphill ( : UR +5 %) and downhill running ( : DR - 5 %) . We used magnetic resonance imaging (MRI) as one of the major indices. Seven healthy male volunteers participated in this study. T 2-weighted MR imaging, muscle surface temperature and blood lactic acid concentration were measured before and after UR and DR. In MRI imaging, the T2 value was defined as the area in which a high signal appeared after exercise.
The value of the blood lactic acid concentration of UR was higher than that of DR (p<0.001) . After DR, the muscle surface temperature of RF was lower in comparison with other muscles (p< 0.05) . After UR, the T2 value of RF (p<0.05), HM (p<0.01) and UN (p<0.05) was higher than after DR exercise. During UR, a positive correlation (r=0.818) existed between the T 2 value of GN and blood lactic acid concentration (P<0.05) . During DR, a positive correlation (r=0.739) was also observed between the T 2 value of QF and blood lactic acid concentration (p<0.05) .
From these results, we conclude that (1) the pattern of usage of lower limb muscles differs during UR and DR, (2) the most mobilized muscles in the lower limbs for UR are GN and HM, and (3) the most mobilized muscle in the lower limbs for DR is QF, respectively. These findings show that different exercises affect the blood lactic acid concentration differently.

Gait disturbance is a serious problem in Parkinson's disease (PD). Exercise therapy is used to alleviate this complaint. We investigated the effects of a videotaped arm swinging-based home exercise program on gait in PD patients. The subjects included 25 outpatients aged between 55 and 77 years (average age 68.9 years) with PD in Hoehn and Yahr stages II-IV. We prepared a master video tape in which a trainer was shown to be performing an arm swinging exercise or steps in synchrony with a metronome. The exercise menu consisted of 4 parts : arm swinging in a seated position, arm swinging in an upright position without stepping, arm swinging with stepping, and walking on the floor or taking a walk. The patients performed the arm swinging exercise while watching a video tape everyday for a period of 3.4 weeks. Of the 25 patients, 22 completed the exercise program. Following the program, these patients showed significant improvements in their walking times for a 20m walk (10 m, return, 10 m) (before/after=29.6/24.3 sec, p=0.002) and in the step length (before/after=43.7/50.1 cm, p<0.001). Frozen gait was a negative factor to complete the programs. Improvement of gait speed after the exercise was related with less frequency of cadence. Loss of arm swinging in PD may be associated with a disturbance in the internal rhythm formation process. Arm swinging exercises are one of the exercise methods that use rhythmic cues. This study suggests that a videotaped arm swinging-based home exercise therapy is effective in such patients.

To investigate the influence of long-distance running on bone metabolism, we measured bone metabolism markers in eight healthy young men before and 4 months after the start of training program of 10 km running. Measurements were then taken the day before a marathon race, immediately after, and 1 day, 2 days and 5 days after.
As a result of exercise, the levels of serum osteocalcin (OC), a bone formation marker, and urinary deoxypyridinolin (D-Pyr), a bone resorption marker, decreased significantly. After the marathon race, the OC level decreased further corresponding to an increase of hydrocortisone right after the race. However, from the day following the race, the OC level showed a slight increase. D-Pyr showed an increasing tendency immediately after the race, and the levels of OC and D-Pyr increased significantly 5 days after the race.
Bone formation and resorption decreased as a result of light, low-frequency endurance exercise. However, both of them increased after intense physical stress. From this result, it is suggested that the intensity and frequency of exercise affect bone metabolism differently, even though the type of exercise load is similar.

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.

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.

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.

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.

　　With the introduction of the diagnosis procedure combination (DPC) system, the reduction of the health expenditure is expected. The use of generic drugs is promoted. It is imperative for introduction of generic drugs to assure the appropriate use of drugs to decrease medical costs without reducing medical services. Additionally, we should make a concerted effort to prevent the injudicious use of antimicrobial agents resulting in the emergence of drug resistance. In this study, we assessed the effects of switching to generic antimicrobial drugs on drug purchases cost, AUD (antimicrobial use density), hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. This study was carried out at Yashima General Hospital for the period from April 2008 to September 2011. The Health, Labor and Welfare Ministry designated Yashima General Hospital as a DPC hospital from July 2009. Since the DPC introduction, the drug purchase cost has been decreased about 40% without reduction of AUD, hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. Hospitals are making efforts to assess and improve management efficiency while maintaining the quality of medical care. Our results suggested that the introduction of generic drugs with assessment of efficacy may be one of the useful methods for pharmacy management.

A total of 120 measurements were made for pulse waveform of the radial artery in 73 male subjects in their twenties to forties. We then calculated the parameters in the four-factor concentrated constant circuit model using the method we had developed. From the waveform of the radial artery, we extracted forms equivalent to those referred to as normal, slippery, and string-like pulses according to the pulse-wave models described in the literature. By comparing these parameters, we could show quantitatively the differences in waveforms and related diagnoses of pulses.

Tokishakuyakusan has been used widely to treat various diseases including gynecological disorders. Currently, tokishakuyakusan is frequently used to treat female patients, while indications for use in male patients are unclear. Furthermore, there are few reports of male patients having been effectively treated with tokishakuyakusan or tokishakuyakusanryo. Here, we report four male patients successfully treated with tokishakuyakusanryo. Case 1 was an 84-year-old man who had uncontrolled nasal allergy, and treatment with tokishakuyakusanryo was effective in relieving the patient's allergy symptoms that were accompanied by chills and oketsu (blood stasis) findings. Case 2 was a 63-year-old man whose chief complaints were bronchial asthma, benign prostate hypertrophy, and nasal allergy. All his symptoms improved considerably with tokishakuyakusanryo and hangekobokuto, especially the symptoms of nasal allergy. Case 3 was a 70-year-old man whose chief complaint was persistent proteinuria. Tokishakuyakusanryo was prescribed, in consideration of his clinically observed condition, which included sensitivity to cold, blood stasis and fluid retention. His proteinuria disappeared four months later, along with his other complaints of chills, oketsu, and fluid retention. Case 4 was a 56-year-old man whose chief complaint was ulcerative colitis. He had responded well to treatment with ifuto, but he developed hypertension. His prescription was changed to tokishakuyakusanryo, a similar prescription that does not contain the Glycyrrhiza radix which can cause hypertension. Afterwards, his blood pressure decreased to normal levels and his abdominal symptoms remained stable. Nangai Yoshimasu published the opinion that tokishakuyakusan could be applied not only in female patients but also male patients. Additional reports on male cases would provide helpful information to clarify tokishakuyakusan indications in male patients.