Lithium, prescribed for bipolar disorder, is known to induce thyroid dysfunction, most commonly hypothyroidism. Thyrotoxicosis due to lithium-induced painless thyroiditis is a rare complication. We have previously reported that the serum concentration of immunosuppressive acidic protein (IAP), an α1-acid glycoprotein, increased during the acute phase of subacute thyroiditis, but was within the normal range in patients with painless thyroiditis. In the present case, a 31-year-old woman, receiving long-term lithium therapy for bipolar disorder, had a recurrent episode of painless thyroiditis, and her serum IAP was increased. The pathogenic mechanism for lithium-associated painless thyroiditis may differ from that of autoimmune conditions.
Thyroiditis ; Lithium measurement ; Lithium ; PROTEIN.IMMUNOACIDIC ; Painless

Patients with hemifacial spasm (HFS) sometimes visit acupuncture practitioners for treatment. We can find descriptions of acupuncture procedures and methods for treating facial spasm in textbooks of clinical acupuncture. However, there is almost to literature that presents data on the actual responses of HFS patients to acupuncture. Therefore, we cannot judge satisfactorily whether acupuncture is suitable for treating of HFS at this time.
Six HFS patients (37 to 56 years old) who had not responded to conventional medical treatment were treated with electro-acupuncture therapy (EAT). EAT was applied to facial muscles for twenty minutes once or twice a week.EAT was continued until the patient dropped out or changed treatment. The period of treatment ranged from one month to one year. After a course of weekly treatments, ranging from one week to one month, the frequency and degree of spasms decreased in five of the six patients. No serious adverse events due to the treatments were observed.
It seems that EAT is safe and produces a gentle anticonvulsant effect. Therefore, it is conceivable that EAT could be applicable for HFS. Thus, if the treatment with microvascular decompression or botulinum toxin is contraindicated, EAT may possibly be an alternative.

No Abstract Available.
Inovirus* ; Pandemics* ; Vibrio parahaemolyticus* ; Vibrio*

The eight subjective symptoms (shoulder stiffness, lumbago, urinary frequency at night, numbness of extremities, shortness of breath, sleep disturbance, dizziness and abdominal distension) were checked at the screening of circulatory diseases performed in a rural district in Ehime prefecture.
1. The complaint rates of the eight subjective symptoms were higher in female than those in male. The influence of aging was observed in urinary frequency at night and sleep disturbance. The higher complaint rates in the agricultural workers were not evident in the subjective symptoms except lumbago.
2. Factor analysis indicated that the eight subjective symptoms were constituted by (1) fatigue of circulatory system, (2) fatigue of musculoskeletal system and (3) aging effect.
3. The higher complaint rates were observed in these diagnosed as circulatory diseases, musculoskeletal diseases or gynecological diseases. The correlations between the eight subjective symptoms and the laboratory findings were not apparent. The result of path analysis indicated that the eight subjective symptoms were independently referable to the presence of illness.
4. The eight subjective symtoms were considered considered to be to evaluate health status of inhabitants in rural district.

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.

To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.

This study was carried out to examine the influence of mouthguards on speech intelligibility. Nine male rugby football players with normal personal occlusion and normal speech served as subjects. All players took the speech intelligibility test while wearing self-adapted mouthguards, custom-made mouthguards and without wearing mouthguards.
The ratio of correct judgments for speech intelligibility wearing self-adapted mouthguards was significantly lower than that of wearing custom-made ones or of not wearing one. When misjudged syllables were evaluated by using the manner of production for articulation, plosives had a tendency to be misjudged as flapped sounds or as other plosives while subjects were wearing self-adapted and custom-made mouthguards. When misjudged syllables were evaluated by the points of production for articulation, bilabials and velars had a tendency to be misjudged as alveolar sounds while subjects were wearing self-adapted and custom-made mouthguards, and alveolar sounds had a tendency to be misjudged as various sounds while subjects were wearing self-adapted ones.
The findings showed that speech intelligibility with custom-made mouthguards was better than with self-adapted ones. Speech intelligibility may be better with mouthguards with reduced palatal thickness than with the current ones because points of prodution for alveolars and velars approach the normal points.

We reviewed the clinical course of 127 patients who underwent treatment for atherosclerotic disease between June 1993 and January 2001. There were 108 men and 19 women. The ages ranged from 49 to 88 years with a median age of 71.2 at the time of the first operation. Major risk factors included ischemic heart disease (21%) and diabetes mellitus (20%). Ninety-five percent of the patients were followed successfully and the follow-up period ranged from 0 to 90 months with a mean of 33 months. Two patients died perioperatively due to myocardial infarction. There were 29 late deaths. The overall actuarial survival rate was 69.7% at 5 years. The 5-year actuarial survival rate and the mean survival time for men and women were 71.6%, 66.1 months and 62.3%, 58.9 months. The 5-year late survival rate and the mean survival time for patients with and without ischemic heart disease were 57.0%, 57.4 months and 74.2%, 68.5 months. The differences were not statistically significant. The 5-year late survival rate and the mean survival time for patients with and without diabetes mellitus were 65.5%, 59.1 months and 70.9%, 67.4 months. The differences were not statistically significant. Amputation was performed in 7 patients, the actuarial survival rate at 1 year and the mean survival time were 42.9%, 7.1 months for patients with amputation, and 93.0%, 69.5 months without amputation (p<0.01).