We investigated the degree of fatigue among medical students during the second trial of the Common Achievement Tests, which use a computer-based testing (CBT) method. A revised questionnaire for subjective fatigue symptoms proposed by the Industrial Fatigue Research meeting of the Japan Society for Occupational Health was used to examine the degree of fatigue. The CBT examinee group (n=41) sat for the examination for 6 hours using video display terminals. Significant changes were seen in 19 of the 25 items for subjective symptoms. At the end of the test period, significant differences between the CBT examinee group and the lecture participant group (n=50) were found for 15 of the items for subjective symptoms. Subjective symptoms were classified into 5 categories: sleepiness, instability, displeasure, feeling languid, and blurred vision. In the CBT examinee group, rates of symptoms increased significantly in all 5 categories. The increase in the rate of “blurred vision” was especially marked.

The present study was intended to determine max. Vo₂ and its relation to body weight of Japanese athletes. The subjects in this study were 151 male and female athletes who were Japanese excellent or good runners and swimmers.
Max. Vo₂2 was determined during the maximum running on the treadmill. Treadmill test was made with a constant slope of 8.6%. During the first 2 minutes, the treadmill was set in motion at a certain speed (180 or 200 m/min for male and 160 m/ min for female), and then the speed was increased by 10 m/min every succeeding minute until exhaustion. Expired air during running was collected in Douglas bag every 1 minute upto exhaustion. The sampling gas was analyzed by means of a Beckman oxygen and carbon dioxide analyzer.
The results obtained in this study were as follows ;
1) The regression equations were calculated between max. Vo₂ and body weight in relation to sex and sports (Table 1) .
2) Max. Vo₂ per body weight of the male swimmers ranges from 50 to 70 and that of the male runners is 70 ml/kg/min. For the female swimmers max. Vo₂ is between 40 and 60 and the female runners approximately 60 ml/kg/min.
3) The regression equation was calculated between the mean speed of 5000 m running as performance (Y) and max. Vo₂ per body weight as physical resources (X) for the runners.
Y=0. 0431X+2.50±0.232

This study aims to analyze the perinatal care provided to non-Japanese speakers in one hospital in Tokyo from 1990 to 2001. It attempts to identify critical issues in perinatal care services and to recommend measures which should be taken to improve them.
Two major problems were identified: firstly, communication difficulties between health-care providers and the women and, secondly, a severe lack of information available to the women regarding health, medical and welfare services in Japan.
In particular, communication difficulties were a big burden for health care providers in that they presented an obstacle to collecting medical histories, to finding out about symptoms, to establishing good rapport with the patients and to providing spiritual support. It also made it difficult to provide health care based on informed consent.
Systematic assistance from medical interpreters is urgently needed in order to provide foreign women with the same level of care as that provided to Japanese patients.

As well known, the adreno-sympathetic hormone - catecholamine - plays an important role in maintaining the stability of “milieu interieur”. Accordingly, a marked change may occur in catecholamine secretion in case of prolonged strenuous exercise such as marathon race where is required remarkable augmentation of cardiovascular functions. The authors had an opportunity of examining the physiological functions of all the participants in the First Tokyo International Women Marathon Race held on November 18, 1979, and collected urine samples from them before and after the race to evaluate the physiological load of the race in each woman participant by changes in urinary excretions of catecholamine metabolite (VMA) and some other substances.
As for the subjects of examinations, 19 foreign runners were 31.1 years of age on the average (ranging from 20 to 48 years) and their average Rohrer's Index was 119.0, while 33 Japanese runners were 27.8 years of age on the average (ranging from 18 to 42 years) and their average Rohrer's Index was 125.8. The urine samples at rest were collected at 8 a.m. on the day before the race after more than 10 hours fasting, and the samples after running were collected in 30 minutes after finishing the race. Just after the collections, the authors made determinations of the urine volume and pH and qualitative tests for sugar, protein, occult blood, Keton bodies and bilirubin. Then the determinations of VMA were made by Pisano's method. The resulte obtained were compared among six groups classified by the performance, viz., the order of the arrival. The classification was made as follows : 1) 1-5, 2) 6-10, 3) 11-15, 4) 16-20, 5) 21-25 and 6) 26-46. The comparison was also made between the foreigners and the Japanese.
Results:
Although there could be no significant correlation between the performance and the age or physique, the Rohrer's Index was smallest in Group 1) and largest in Group 6) .
The qualitative urine tests disclosed no marked change due to the running but protein less than 300 mg/dl was detected in the urine after running in 31 out of 40 runners. This fact seems to suggest that their physiological loads were considerably heavy. The urine volume on the average showed a decrease from 41.5 ml/hr at rest to 16.3 ml/hr after running, viz., 60.7 % decrement. The decrement was 53.2 % in the foreigners while it was 65.3 % in the Japanese. The urine volume was rather larger in Groups 5) and 6) than in the others. The urine pH on the average showed a decrease from 6.4 at rest to 5.6 after running, viz., 12.5 % decrement, and the decrement was 6.9 % in the foreigners while it was 14.9 % in the Japanese. Regarding the relation between the performance and the urine pH, there could be noted a tendency, the upper the ranking of the group, the smaller the change in pH.
The urinary excretion of VMA on the average of all the runners showed a striking increase from 155.8 mg/hr at rest to 383.1 mg/hr after the running. The increase due to running was 121.4 % in the foreigners while it was 144.1 % in the Japanese. Regarding the relation between the performance and the VMA excretion, Group 1) showed no increase in the excretion on the average, while the other groups generally showed 100 % - 200 % increase in the excretion.
On the basis of the above-mentioned findings, it was presumed that the physiological load of the marathon race was heavier in the Japanese runners than in the foreign runners, and in the lower ranking groups than in the upper ranking groups of the performance. In other words, the foreigners who showed excellent performance seemed to be highly adapted to the prolonged strenuous exercise by training and to have a regulatory mechanism of metabolism so efficient as to cope with heavy physiological load by small increase in catecholamine secretion.

Controlled Freezing-point Storage (CF Storage) is a new method of preserving foods in minus non-frozen temperature range. So, we tried to apply this method to entrails preservation and investigated the effect of controlled freezing-point storage of hearts on ventricular function in isolated perfused rat heart (male, Sprague dawley strain, in body about 300g weight). The hearts were perfused by working heart mode for 10min, and received infusion of cardioplegic solution which was followed by 4 hours of cardiac arrest at a myocardial temperature 4°C (4°C group) or minus non-frozen temperature (CF storage group). Then, the aerobic reperfusion by working heart mode was continued for an additional 30min. The recovery rate of cardiac output was 33.5% and 62.5% respectively of the preischemic value in 4°C group and CF storage group, which was statistically significant (p<0.01). ATP activity after 4 hours of cardiac arrest in 4°C group was significantly lower than that in CF storage group (p<0.05). These data suggest that CF storage of hearts might have a protective effect against an ischemic insult upon myocardial cell during hypothermic cardiac arrest.

We report 18 cases of thoracoabdominal aortic aneurysm repair. Most causes of the thoracoabdominal aortic aneurysm were atherosclerotic lesions (56%) or inflammatory changes (39%), such as Takayasu's aortitis and Behçet's disease. The Crawford procedure was performed in 13 patients, patch aortoplasty in 3, the Hardy procedure in 1 and extra-anatomic bypass in 1. As an adjunct, temporary bypass was employed in 8 patients and F-F bypass in 7 patients. Visceral arteries were perfused selectively during aortic cross-clamp. A total of 39% of all patients required emergency surgery for rupture, and among inflammatory aneurysms 86% of them ruptured. The early mortality rate was 0% in non-ruptured thoracoabdominal aneurysms, 42.9% in ruptured and 16.7% overall. There were 3 severe post-operative complications including one each of paraplegia, non-occlusive intestinal ischemia and rupture. All of them turned resulted in in-hospital death and the in-hospital mortality rate was 33.3%. There was no late death among atherosclerotic thoracoabdominal aortic aneurysms. However both Behçet's disease cases required re-operation for rupture at the anastomotic site in the late postoperative period and one patient died. One Marfan's syndrome patient also died 3 years postoperatively. We conclude that the Crawford procedure with F-F bypass is an effective and safe approach to thoracoabdominal aortic aneurysm repair and yields good clinical results.

Nine patients with type IIIb dissecting aortic aneurysm underwent graft replacement of the thoracic and abdominal aorta between 1988 and 1992. The spiral opening method was used to expose the thoracic and abdominal aorta. Temporal bypass was employed in 2 patients and F-F bypass in 7 patients. Visceral arteries were perfused selectively during aortic cross-clamp. The entire descending thoracic aorta and abdominal aorta was reconstructed in 6 patients and the proximal descending thoracic aorta to renal arteries in 3 patients. The Crawford graft inclusion technique was used in all cases. Three patients required emergency surgery for rupture in one and impending rupture in 2. Operative deaths occurred in 2 patients (22.2%). Morbidity included renal failure (2), bleeding requiring reoperation (2), arrythmia (1), paraplegia (1), paraparesis (1), respiratory failure (1) and ileus (1). In the past two years, we operated on 5 cases of type IIIb dissecting aneurysms and there was neither operative death nor paraplegia.

The patient, a 71-year-old man, was admitted to our department with fever from unknown causes. Ultrasonic examination of the abdominal regions revealed abnormal multiple low-density echo legions (that could be) associated with splenomegaly. For diagnostic purposes, splenic puncture was performed with the aid of an ultra-sound imaging device. Pale yellow-green pus was obtained from the lesions. Based on this finding, we made a diagnosis on the case as multiple abscess of the splean. The patient underwent intensive chemotherapy. However, he dontinued to have a high fever. On the ninth day from hospitalization, splenectomy was performed. Since then, his fever has subsided. Abscess of the spleen is a rare disease. It is generally classified into two types: one is a multiple type, and the other, a solitary type. Multiple splenic abscess mostly occurs as one of the abnormal conditions during the course of a primary disease, which is often severe. Our case, however, did not exhibit any sign of a primary disease.

1)We reproduced a problem–based learning (PBL) tutorial at our school and developed our own PBL tutorial, which we call "Fujita–style PBL." This is a clinical problem-solving type of PBL, in which both a monitoring room and small–group learning rooms are used.
2)To maintain the present number of PBL lessons despite the limited number of tutors, one tutor supervises several groups simultaneously. Coordinators observe the progress of PBL from a monitoring room and support the tutors.
3)Students learn the given scenario and identify their learning issues. After they study the learning issues by themselves, the students return to tutorials to explain their learning issues. Thereafter, each group's findings are presented to the groups supervised by one tutor.