The electrocardiographic findings in more than 20, 000 athletes are studied.
I. Resting electrocardiograms (ECG) of 10, 149 high school athletes are analysed. Abnormal ECG are encountered in 12.45%. Following findings are found: Right bundle branch block (RBBB) (4.03%), Left ventricular hypertrophy (2.89%), Premature beats (1.09%), A-V block (0.86%), Right ventricular hypertrophy (0.85%) . RBBB are further analysed and divided into 4 types from the QRS pattern in V1. The frequent RBBB in young athletes is confirmed and its significance is also discussed.
II. T wave abnormalities are observed in 5 cases of resting ECGs of all this sample. Essential abnormalities are T wave inversion simulating myocardial infarction in limbs leads (usually in II, III, aVF) and precordial leads and concomitant slight elevation in precordial leads.
Physical and laboratory examinations in 5 cases disclose no evidence of organic heart disease. In 4 of 5 cases, exercise ECGs are revealed the normalisation-tendency of the T wave change. A brief discussion concerning the possible mechanisms of these changes are made.
III. ECGs of middle and old age athletes are also observed at rest and after the long distance running. The distance are different in each age-group, but all of them run at least more than 5 km. The 409 resting ECGs are taken before the running game and the 201 post running tracing are obtained as soon as possible after the game.
At rest, ECG findings suggestive of coronary insufficiency are detected in 4 of 108 samples of sixties group and in 1 of 25 samples of seventies group.
Ischemic electrocardiographic responses after the running game are found as follow: 3/51 (5.8%) of fourties group, 9/59 (15.1%) of fifties group, 20/70 (28.6%) of sixties group and 6/21 (28.6%) of over seventies group.
Arrhythmias are not so frequently observed in each group. These ischemic re-sponses suggest that medical check-up especially cardiovascular evaluation is necessary in middle and old age athletes to prevent accidents on sports.

There have been some reports that keishikaryukotsuboreito improves climacteric symptoms such as palpita tion, but none have reported coldness successfully treated with this formulation. We report a case of palpita tion and coldness, successfully treated with keishikaryukotsuboreito.
The patient was a 48-year-old female. She complained of palpitation and coldness for 2 to 3 years. She had coldness of the hands and feet without hot flushes. She consulted our clinic on May 8, XXXX. We prescribed keishikaryukotsuboreito (7.5 g/day) because of suggestive symptoms of insomnia, as well as palpitation in the abdomen. Her symptoms improved in 2 weeks. Keishikaryukotsuboreito is usually prescribed for cold feet with hot flushes. The results experienced in this case suggest that keishikaryukotsuboreito may be effective for cold feet without hot flushes, especially with palpitation and pulsation at the navel, which are known symp toms of qi counterflow in Kampo medicine.

Many patients who receive general acupuncture treatment have many complaints concerning their autonomic nervous systems. Applying CMI and CMI type classification (Abe method-a variation of CMI) to 100 new patients who came to our clinic last year, we found vegetative dystonia in half of them. Upon this finding, the following examinations were carried out by means of an function test of autonomic nervous system developed by Kageyama et al.: the coefficient of variation (CV) of R-R interval in ECG obtained through the function test is regarded as an expression of vagal function.
(1) Using this test, the participation of the autonomic nervous system in the condition of those patients who visited our clinic was examined.
(2) Effects of acupuncture treatment on the autonomic nervous system were examined.
(3) Acupuncture stimulation was separately applied to S36 (Zusanli), P4 (Ximen) and Liv3 (Taichong) to examine the influence of the acupuncture point location on the CV obtained through the test.
Results:
(1) 15 new patients (25%-comparatively high rate) showed low CV (less than 2%) of R-R interval in ECG.
(2) In some cases, acupuncture treatment caused an increase in CV.
(3) Acupuncture caused pulse infrequens: R-R interval showed a tendency toward prolongation during the in situ needle technique and after withdrawing the needle on each of the three points (S36, P4 and Liv3). CV increased after withdrawing the needle on either S36 or Liv3 and shortly after needle insertion and after withdrawing the needle on P4.
These result suggest that many patients who receive acupuncture treatment have additional disorder in parasympathetic nervous system which can be improved through acupuncture.

In Japan, doctors inexperienced stent-graft new devices are required to secure agreement on criteria and choice of the device size in endovascular aneurysm repair (EVAR) from experienced doctors. It was hoped that strict patient selection might reduce the learning curve for initial successes in given procedures. In a leading center in Japan, a number of cases which were scheduled for operation at other institutes were evaluated anatomically. We surveyed the initial success of Zenith AAA system implantation in the remaining cases by inexperienced doctors and evaluated the results. This study aimed to verify the validity of strict patient selection in improving the success rate of inexperienced doctors. We enrolled 112 consecutive patients from 19 institutes, who were scheduled for repair between January and October in 2007. All patients were evaluated on the basis of a less-than-3mm reconstructed CT image. Mean patient age was 76±5.7 years. All cases satisfied the Zenith's anatomic prerequisites. Fifteen cases were excluded for various reasons, the major reason being insufficiency of the proximal landing zone (LZ) length, angle and contour. The second reason was difficulty to approach via the iliac artery. Ninety seven cases were included, of which 17 cases were low-risk candidates for EVAR. Medium-risk seventy two cases requiring some advice to avoid problems with device size, technique of implantation and choice of main-body side. Eight cases were high-risk, requiring the presence of an experienced surgeon. Excluded cases had significantly shorter proximal LZ, larger aortic diameters 15mm below the renal artery and tortuous access routes on preliminary measurement by inexperienced doctor. Perioperative mortality was 0%, while the major complications were injury to the iliac artery in one high-risk case and thromboembolism of the superficial femoral artery in another. Perioperative proximal type I endoleak occurred in 5 cases. In 3 of these cases, the endoleak was eliminated by implantation of a Palmatz stent. In the other 2 cases, it disappeared within a month without additional procedures. These cases had a significantly greater angle between the proximal LZ and the suprarenal aorta and significant amount of mural thromboses in the proximal LZ. Perioperative type III endoleak occurred in 3 cases. In all cases the endoleak was eliminated by additional procedure. Perioperative type II endoleak occurred 8 cases. In 3 of these cases, the endoleak disappeared within a month. In the 5 other cases, the endoleak did not disappear. Mid-term results showed iliac leg thromboembolism in one case and new type II endoleaks in 3 cases. Type II endoleak occurred in cases which had significantly greater angles between the proximal LZ and the aneurysm. The results which were evaluated in our center had excellent perioperative and mid-term outcomes. We think this evaluation system is effective for risk assessment and reduces the learning curve in EVAR. In anatomically marginal cases, it is possible for proximal type I endoleak and injury of the iliac artery to occur. It is impossible to exclude these marginal cases if treatment need for EVAR is a priority. In these cases, lessexperienced operators should be trained in troubleshooting techniques in advance.

Herb supplies can become unstable because of climate change and the economic development of herb exporters. In this paper, in order to increase the self-sufficiency of herbal resources we examined the possibil ity of changing to herb crop production from tobacco, for which demand is declining. Firstly, we considered demand, quality and the price of raw herb materials to make recommendations for corrections, and selected Angelica (A. ) acutiloba and Bupleurum (B. ) falcatum Linne. Next, we compared the profitability of tobacco and the herbs. Profit margins for A. acutiloba were less than for tobacco. It was thought that the profitability of A. acutiloba could become equivalent to tobacco if an adjustment subsidy were provided. The self-sufficiency rate for A. acutiloba would be one hundred percent with 35 million yen in every year. Although the profitabil ity of B. falcatum has exceeded tobacco, its selling price was about 3 times that of imports, while the price of medical B. falcatum was lower than its selling price. It was thought that the price competitiveness problem of B. falcatum can be covered if a production subsidy is provided, and to reach a 50 percent B. falcatum self sufficiency rate with 660 million yen per year.

The surface-coated vascular stent of shape memory alloy was made for use of occlusion of pseudo-lumen of the dissecting aneurysm of the aorta, as the usage of shape memory alloy in angioplasty, and the metal flexible delivery catheter was also made for the introduction of the stent. In the present study, antithrombogenicity of the vascular stent was much improved by surface-coating with EPTFE and segmented polyurethane. The long-term usage of the stent was confirmed by radiological, macroscopic, and electron microscopic examinations. Moreover, the metal flexible delivery catheter was demonstrated to be of much benefit for the introduction of the surface-coated vascular stent of shape memory alloy.

In order to reduce the blood transfusion volume in open heart surgery, the new blood autotransfusion technique using cardiotomy reservoir unit BCR 3538, which was configured to serve also as a receptacle for postoperative mediastrinal drainage, was introduced. To investigate the utility and the problem in this system, every clotting factor, platelets' function and the extent of the hemolysis were measured serially both in patients' arterial blood and the shed mediastinal blood. The bank blood transfusion was significantly reduced to 250ml±330ml by this system compared to the 1080ml±820ml in the cases of usual system (p<0.01). Every clotting factor recovered well in patients' arterial blood after cardiopulmonary bypass (CPB). In the reservoir blood, the clotting factor IX, XI, XII were extremely suppressed at 1h CPB, and 3h after the CPB, every clotting factor except fibrinogen (42±28mg/dl) showed the quite higher activity, such as factor VIII 400%, IX 365%, XI 72%, XII 267%. Namely, the anticoagulability of the reservoir blood was maintained due to the effect of the residual heparin at 1h after the CPB, and due to the contact defibrinogation of the shed mediastinal blood at 3h after CPB. The free hemoglobin level was extremely high on the reservoir blood at 3h after CPB. In 6 cases, the autologous blood retransfusion was abandoned by clott formation in the unit because of the contamination of the intraoperatively used fibrin glue. From this study, the autologous blood transfusion using cardiotomy reservoir BCR 3538 was useful not only for saving the transfusion of the bank blood but also the hemostasis after CPB. But to reduce the hemolysis in this system, and to establish the safety against the other clotting material such as fibrin glue were the problems which should be resolved in future. I appreciate the kind support of Alexander von Humboldt Foundation for this study.

Ischemic mitral regurgitation (IMR) is a serious and increasingly common clinical disorder, but at present, the relationship between left ventricular shape and IMR is not completely understood. Thirty patients with moderate or severe IMR who underwent mitral valve surgery combined with coronary artery bypass grafting were studied retrospectively. Left ventricular shape, left ventricular regional wall motion, hemodynamic index, condition of the coronary artery, severity of IMR and long term results were assessed using ventriculography and angiography. Left ventricular shape at end diastole and end systole were quantified based upon the ratio of the major-to-minor axis and the sphericity index. Hospital mortality rate was 13.3%, 5 years survival rates were 10.5%, and 5-year rate of freedom from congestive heart failure (CHF) were 7.8%. Significant difference between cardiac deaths (n=11) and survivors (n=19) included requiring intensive care admission, requiring intra-aortic balloon pumping, recurrent myocardial infarction, the ratio of the major-minor axis at end diastole, the sphericity index at diastole, and the sphericity index at end systole. Multivariable regression analyses were performed with the Cox proportional hazards model. Significant determinants of survival were the sphericity index at end systole and LV regional wall motion at the site of the anterobasal segment or apex. These findings indicate that the shape of the LV and LV regional wall motion in IMR may be important determinants of prognosis and suggest that surgical attention to shape may be helpful for mitral valve surgery.