A 79-year-old man was admitted for thoracoabdominal aortic aneurysm repair. He had already twice undergone coronary artery bypass grafting, 19 and 2 years previously. The value of the ejection fraction of the left ventricle was 36%, measured by ventriculography; and transthoracic echocardiography revealed moderate aortic valve regurgitation. In the presence of aortic valve regurgitation or coronary artery disease, myocardial perfusion under hypothermic fibrillatory arrest may be significantly impaired. Therefore, to maintain a beating heart we used separate perfusions of the upper and lower body that enabled individual temperature control of each organ. The femoral and axillary arteries were cannulated, and a long cannula was inserted into the right common femoral vein and positioned in the right atrium. Cardiopulmonary bypass was established, and the upper body was mildly cooled until the pharyngeal temperature was 33°C, while the lower body was cooled until the bladder temperature reached 20°C. Mild hypothermia of the upper body maintained the beating heart, and deep hypothermia in the lower body provided adequate protection to the spinal cord. Furthermore, in a case of aortic valve regurgitation and low left ventricular function, left ventricular venting is essential for the heart. However, it was difficult to insert the venting tube through the apex of the left ventricle or through the left inferior pulmonary vein; therefore, we selected the left main pulmonary artery for left ventricular venting, and maintained a non-working beating heart. After cardiopulmonary bypass was discontinued, cardiac function was good although a bleeding tendency became apparent. Postoperatively, the maximum dose of dopamine we needed was only 3γ. There were no remarkable complications and the patient was discharged on postoperative day 30. This experience suggests that pulmonary artery venting and separate perfusion of the upper and lower body to individually control organ temperatures is a useful procedure for thoracoabdominal aortic aneurysm repair in patients with low left ventricular function.

A comprehensive health survey of 618 inhabitants from 1 to 90 years old was conducted in Kathmandu City and in a neighboring village. It included the measurements of height and weight, examinations of blood, feces, urine as well as clinical findings. It also covered the examinations of drinking water and the inquiries of the living conditions.
The anthropometric measurements revealed that Nepalese children are generally small in height for age and 4.2 per cent of them were malnourished. The symptoms relating to avitaminoses, such as xerosis of the skin, angular lesions of the lips, hypotrophic papillae of the tongue were not seldom seen.
Thyroid enlargements over the grade II of Shichijo's classification or grade I of Perez's were found in 9.2 per cent of males and 18.6 per cent of females.
Among clinical abnormal findings, infective eye diseases were most frequent, followed by skin and respiratory diseases. Anemia and iron deficiency were found in high rates among children under 10 years, the aged over 50 years and the females in child-bearing ages.
Parasite infestation rate was 92.8 per cent as a whole, trichuris trichiura (81.6 per cent) was the most prevalent, followed by ascaris lumbricoides (61.8 per cent) and hookworm (29.3 per cent). Cystes of entamoeba histolytica (5.5 per cent) and giardia lambria (12.8 per cent) were also found in apparently healthy persons.
No available residual chlorine was found in the city water of Kathmandu, though chlorination was carried out in the treatment plant, suggesting some defects in transmission system. In the village, water is supplied without treatment and was found contaminated by E. coli.

Every disorder makes an appearance on the command points in the extremities. Taking three command points, we examined variations of electric resistivity in vertigo.
The termal point showed low level in general, whereas the connecting was high, especially in the lower extremities. Post treatment it had a tendency to get the mean.
About the laterality we were able to improve their instability, but were not able to establish whether it was effective or not.
Vertigo made an appearance on various meridians and points.

The authors undertook acupuncture-moxibustion therapy for 34 patients with vertigo. In order to objectify the patients' condition and the efficacy of the treatment, we ranked the severity of symptoms and standardized the treatment procedure, and also we set up the criterion for evaluation of efficaciousness.
The severity of symptoms was determined according to the result of some tests (for nystagmus and balance) as well as patient's chief complaints: the incidence and the intensity of feelings of rotation, giddiness, etc.
Treatment was undertaken once a week. One course was consist of ten treatments. Scarless moxibustion was applied to the Second Dadun point in the first course, and body-acupuncture was added to the moxibustion in the second course. In the third course, the scarless moxibustion, the body-acupuncture, auricular-acupuncture and scalp skin acupuncture were undertaken.
The efficaciousness of the treatment was rated as “remarkably efficacious”, “very efficacious”, “efficacious” or “no change” according to the changes in patients' complaints and the results of the tests performed after each course.
Twelve of the patients showed improvement after the first course (remarkably efficacious) and other twelve after the second course (very efficacious), and five of them after the third course (effecacious). The other five patients underwent more than four courses (no change).
In conclusion, improvement was seen in 85% of the patients after 30 sessions of acupuncture-moxibustion treatment including scarless moxibustion to the Second Dadun, body and auricular-acupuncture.

Acupuncture-moxibustion treatment was undertaken on two patients (a 34-year-old man and a 67-year-old woman) who were diagnosed as allergic rhinitis in an otorhinological department. The patients underwent the treatment once a week, in which direct-or scarless-moxibustion (15 pieces) was applied to Tachui (GV14) and acupuncture for whole body adjustment. The subjective symptoms, eosinophil in pituita and the results of other blood examinations were compared with those of their first visits. The eosinophiles in the pituita disappeared and those in the blood fell to the average level. Although there are individual differences, a certain prolonging effect was seen in the follow-up data.

A survey was carried out in a rural area in Thailand as a part of the study on the physical development and nutritional status of children of developing countries in Asia. Four hundred and sixty-three school children of both sexes, from 6 to 14 years of age, had anthropometric measurements and examinations of clinical signs related to nutritional deficiencies. Blood, urine and feces were also exaimined.
1) Thai children were remarkably smaller than Japanese and growth retardation was observed at 21.4% and 37.3% of those in age groups 6-9 and 10-14 years, respectively. And judging from the weight-for-height, about one-fourth of them were considered malnourished in varying degrees
2) Upper arm muscle circumference, calculated with upper arm circumference and subcutaneous skinfold of the same place, revealed that the development of muscle was obviously retarded.
3) Signs of hypovitaminoses such as xerosis of the skin, decreased patellar reflex, cheilosis, angular lesion were frequently observed.
4) Mean values of hemoglobin and serum iron concentrations were low in general and about 20% of the children were judged anemic according to the WHO criteria for nutritional anemias. Cholesterol values were also lower than those of Japanese and American children
5) The overall positive rate of intestinal parasites' eggs was 43.2% and hookworm eggs were most frequently observed, follwed by Giardia lambria
For the improvement of growth and nutritional status of Thai children, the preventive measures against parasitic and infectious diseases through improvement of environmental hygiene are essential as well as food supply.

A 24-year-old woman underwent successful repair of a traumatic pseudoaneurysm of the aortic isthmus concomitant with right diaphragmatic hernia which developed after a traffic accident, and the steering wheel of the crashed car was considered responsible for both lesions. Due to the right diaphragmatic hernia, she could breathe mainly with the left lung only. The aortic isthmus aneurysm was considered to be a pseudoaneurysm, and because of the potential risk of rupture, we performed urgent aortic surgery. Prior to a left thoracotomy, we anastomosed an 8-mm prosthetic graft to the right axillary artery. When the left lung was collapsed in order to perform a femoro-femoral bypass, the SpO₂ level of her right index finger and her cerebral rSO₂ markedly decreased. Therefore, we administered additional perfusion via the right axillary artery, which provided sufficient oxygen to the upper body and brain. The patient underwent Marlex mesh reinforcement of the right diaphragmatic hernia 30 days after grafting, and is doing well 1 year postoperatively.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis, by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the QOL of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of rheumatoid arthritis, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males, 2dropped) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2×2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire: Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.

PURPOSE: The International Organization for Standardization-5fluorouracil (FU) 10 trial found that bolus 5-FU and l-leucovorin was not inferior to S-1 in the treatment of gastric cancer (GC). Continuous 5-FU and the rapid injection of 5-FU have different anti-cancer effects. Thus, bolus 5-FU and l-leucovorin treatment might be useful for oral FU-resistant GC. MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients with S-1 or capecitabine-resistant, unresectable, or recurrent GC treated with bolus 5-FU and l-leucovorin between January 2010 and December 2015 at Hokkaido University Hospital. The bolus 5-FU and l-leucovorin regimen consisted of intravenous l-leucovorin (250 mg/m²/2 h) and bolus 5-FU (600 mg/m²) administered once weekly followed by a 2-week rest period; each cycle was repeated every 8 weeks. RESULTS: A total of 14 patients were identified. The disease control rate was 35.7%. The median progression-free survival was 1.6 months (95% confidence interval [CI], 1.3~2.0 months), and the median overall survival was 6.3 months (95% CI, 4.7~7.9 months). No patient died from treatment-related causes. The most common severe adverse event associated with bolus 5-FU and l-leucovorin was neutropenia, which occurred in 21.4% of patients. CONCLUSIONS: Bolus 5-FU and l-leucovorin treatment might be useful for oral FU-resistant GC. We are planning a multi-center prospective phase II trial to evaluate the efficacy and safety of bolus 5-FU and l-leucovorin treatment for pre-treated unresectable or recurrent GC to confirm the results of this limited, retrospective study.
Disease-Free Survival ; Drug Therapy* ; Fluorouracil* ; Humans ; Leucovorin ; Medical Records ; Neutropenia ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms*