Objectives
 Vietnam, where leprosy used to be highly endemic, through governmental implementation of MDT in 1983 and nationwide disease control efforts, has achieved WHO's leprosy elimination goal at a national level since 1995.
 However, a number of patients who suffered from leprosy prior to the governmental control programme remain institutionalised. Although these patients have severe physical disabilities, social services provided to improve their quality of life appear inadequate.
 The purpose of this study is to report the findings of an investigation of the current state of leprosy and to clarify the problems of leprosy control in Vietnam.
Methods
 402 leprosy patients from two leprosy hospitals and four leprosy resettlement villages in Vietnam were investigated their disabilities on upper limb, inferior limb, and facial appearance. And their disabilities classified according to the WHO classification scheme for disabilities in leprosy patients.
Results
 The group “Visible deformity or damage present” (G2) made up 70.1% of the study participants; the group “Anaesthesia present, but no visible deformity or damage” (G1) made up 18.9%; the group “No anaesthesia, no visible deformity or damage” (G0) made up 10.9%. More than half of those with visible physical disabilities were in their 60s or 70s. The level of disability of pre-MDT leprosy sufferers was significantly more severe than that of the post-MDT group.
Conclusions
 The effect of MDT for prevention of occurrences of physical disability was reaffirmed, but for many patients who contracted the disease prior to the implementation of MDT in Vietnam, the after-effects of leprosy are ongoing and they are forced to live in resettlement villages due to their disability. Vietnam has reduced the prevalence rate, but there are still a number of former patients who are not receiving adequate help. Providing help that is needed to raise their quality of life is the next step.

A clinical study was carried out on 336 patients diagnosed with nasal allergic symptoms in Otolaryngological Clinic of Obihiro Kousei Hospital from April 1993 to July 1995. The diagnosis was made based on their history, numbers of eosinophils in the peripheral blood and nasal secretion and the results of the radioallergosorbent test (RAST).
House dust and mites were the most frequent allergens, as reported by almost all clinics in Hokkaido. On the other hand, in this Tokachi district, pollinosis allergens include birch pollinosis in 98 patients (40.8%), orchard grass pollinosis in 66 patients (27.5%), regweed pollinosis in 75 patients (31.6%) and timothy pollinosis in 77 patients (32.1%).
It seems that Pecatnres are due to the local characteristics such as cllimate, geographical features and plant distribution in the Tokachi area.

A preparticipation examination for athletes should be performed to prevent severe athletic injury by examining physical characteristics related to various injuries. The general joint laxity test has been included among the check-up items considering as relating factor of joint injury. Authors investigated the relationship between the score of general joint laxity for freshmen examination and the incidence of major joint injury, during the succeeding 5 athletic seasons, in eighty-seven collegiate American football players.
Significant higher scores were observed in athletes affected by shoulder injury, and slightly higher scores in those affected by knee joint injury. But, the scores were similar between athletes with and without elbow or ankle injury.
The degree of laxity was associated with shoulder and knee joint injury in a comparison of incidence of these injuries among tight, medium and lax groups.
Authors concluded that general joint laxity is related to the incidence of shoulder and knee joint injury.

A 63-year-old man suffered from multisystem trauma including pelvic bone fracture and lung contusion caused by a traffic accident. Chest CT revealed mediastinum and periaortic hematoma. Because of hemorrhagic complications, a emergency operation was avoided, and conservative therapy was decided on. Though his blood pressure was controlled strictly, re-bleeding appeared. An urgent operation was performed 4 days after the injury. Under partial cardiopulmonary bypass, the aortic isthmus disruption was resected and replaced with an artificial graft. The postoperative course was uneventful. In cases of traumatic aortic disruption with multisystem trauma, the delayed operation is more common than urgent operation. However, there is always the possibility of rupture. It is extremely important to appropriately judge the timing of the operation.

In 2011, we reported the usefulness of a database（DB）that was established by the members of a palliative care team（PCT）. Since then, we updated DB depending on the requests of PCT. We revised DB mentioned below. We developed a form for keeping a record of PCT members’care for patients, their family members or others, and a record of recommendation for each problem list. We also updated another form so that the evaluation of Support Team Assessment Schedule of Japan（STAS-J）had been showed sequentially, added an entry form of Palliative Prognostic Index, and extracted data required by Japan Society for Palliative Medicine in order to evaluate the activity of PCT. The database could be used by many hospitals, because it was created by the commercially available software.

ImmunoglobulinG4 (IgG4)-related sclerosing disease can occur in various organs, rarely in cardiovascular lesions. We report a case of IgG4-related cardiac tumor which was concomitant with aortic dissection. A 72-year-old woman visited our hospital with chief complaints of difficulty swallowing and weight loss. A tumor was found in the pericardium adjacent to the left ventricle on echocardiography, and a dissecting aneurysm of the ascending aorta with a maximum of 60 mm in the short diameter was noted on contrast CT. There had been no episodes related to the onset of aortic dissection such as chest pain, and chronic dissection was also identified on diagnostic imaging. A tumor biopsy was performed via a left lateral thoracotomy for tumor tissue diagnosis. Histopathologically, the tumor showed no malignant findings and we identified infiltration of IgG4-positive plasmacytes. The IgG4 level in blood exceeded the reference level, but no findings of IgG4-related disease were observed in other organs. Coronary artery CT showed the left circumflex branch of the coronary artery to run over the tumor. It was thus judged to be difficult to surgically resect the tumor. Oral steroid administration was started to reduce the size of the tumor. However, due to an enlarging trend of the aortic aneurysm involving the ascending aorta on CT at 1 month, the patient underwent ascending aorta replacement. Although infiltration of IgG4-positive plasmacytes was found in the outer lining of the resected arterial wall, the association between IgG4 and the onset of aortic dissection was unclear.

A 53-year-old woman with atrial septal defect (ASD) and atrial fibrillation (AF) with idiopathic thrombocytopenic purpura (ITP), was scheduled to undergo ASD closure and the maze procedure. Because steroid therapy was not effective, high-dose γ-globulin administration (400mg/kg/day) was performed for 5 days before surgery. The platelet count increased from 5.4×10⁴/mm³ to 14.0×1⁴/mm³. ASD patch closure and modified bilateral appendage preserving (BAP) maze procedure were performed. No hemorrhagic tendency was recognized. The postoperative course was uneventful, and the sinus rhythm was recovered. The maze procedure become possible in this ITP patient with preoperative administration of high-dose γ-globulin.

A six-month follow-up study of athletic injury and physical fitness was conducted on ten players in a nationally ranked boys' high school water polo team. The first medical check-up was conducted on May 28th, 1995, and the second just 4 days before the national athletic meet on September 2 nd. The final check-up was done on November 18 th. A thorough examination in addition to X-ray evaluation by an orthopedist was done on June 26th after the first medical check-up.
In our check-ups, athletic injuries were defined as injuries due to water polo or disorders which prevented individuals from playing. In the thorough examination, athletic injuries included any physical conditions that required further investigations or treatment by the doctor.
Six players had taken part in swimming before taking up water polo, and seven had played water polo since junior high school. Of the athletic injuries sustained, 55% occurred at the age of 13-14 yr. Injuries due to carelessness and over-enthusiasm amounted to six. Motion pain in the pes anserius, iliotibial tract, and hip joints without traumatic episodes were thought to originate from the characteristic leg action under the water.
Although body weight and height varied among the players, the differences in the values of body fat percentage, body mass index, and lean body mass were slight.
Since the players had few complaints, athletic injuries were difficult to find. However, with periodic medical check-ups and a thorough examination, we are able to prevent some problems such as pain in the pes anserius or iliotibialtract.

Injury of the anterior cruciate ligament (ACL) occurs frequently in female gymnasts and basketball players. However, there is no effective method for preventing ACL injury. Recently, a fatigue phenomenon of the ligament tissue has been considered to be the main causative factor in ACL injury.
The present study was done to investigate the relationship between knee laxity and general joint looseness in 34 female college basketball players at an orthopedic medical check-up.
Knee laxity was evaluated in terms of the anterior displacement (AD) value measured by a KT-2000 knee ligament arthrometer at 20 lb. General joint looseness was evaluated in terms of the general joint laxity (GL) score including six major joints and the spine.
There was a significant correlation between the AD value and GL score, the correlation coefficients being 0.48 (p<0.01) at the right knee and 0.54 (p<0.01) at the left knee.
The ACL of athletes with a higher AD would always be exposed to higher anterior stress than in athletes with a lower AD, thus possibly leading to a fatigue state. Therefore, we consider that athletes with a high AD are at greater risk of ACL injury. Our results suggest that the easy GL test is an effective screening method for differentiating those with a high AD and a greater risk of ACL injury.

Thromboembolic events after cardiac surgery, including ischemic strokes, can be devastating complications, however only a few studies manifest the platelet activation and coagulation state after off-pump coronary artery bypass (OPCAB). Platelet-derived microparticles (PMP) are observed as released vesicles from platelets following platelet activation, and are believed to play a role in some clinical diseases because of their procoagulant activity. The aim of the present study was to evaluate the hypercoagulant state after OPCAB using PMP and other indices. Data were obtained from 15 patients (aged 69±7 years; only men) undergoing elective OPCAB surgery. One hundred milligrams of aspirin were used as postoperative antiplatelet drugs. Preoperative risk factors, operation time, postoperative hospital stay, transfusion and blood samples of CBC, PMP, βTG, PF 4, platelet aggregation, FDP, D-dimer and TAT of pre- and postoperative days (POD) 3 and 7 were studied. There was no difference between the PMP level with or without risk factor. The PMP levels of POD 3 and 7 were significantly higher compared to the preoperative levels (pre-op, POD 3, 7:9.1±5.1, 15.2±10.3, 28.4±24.5/10⁴plt respectively, p<0.05). The levels of FDP, D-dimer and TAT rose significantly on POD 3 and 7 and significantly correlated with the PMP levels. Beta TG, PF 4 and platelet aggregation did not change after OPCAB surgery, and no correlation was found with the PMP levels. Elevated levels of PMP, TAT, FDP and D-dimer persisted until POD 7 and suggested not only platelet activation, but also activation of the coagulation and fibrinolytic system. The findings suggest that 100mg of aspirin may not be adequate for the inhibition of platelet activation after OPCAB surgery.