One of the complications in patients on long-term hemodialysis is spondyloarthropathy resulting from amyloidosis due to abnormal accumulation of β2-microglobulin. With deposition of β2-microglobulin in soft tissues, such as ligaments and joints, destruction of bones and cartilages begins at the site of ligament attachment and proceeds with the accompanying inflammatory reaction, fibrosis and ligament thickening. The soft tissue proliferative lesion and destruction of bones and cartilages produce spinal canal stenosis and, ultimately, compression of the spinal cord and cauda equina, to give rise to various clinical symptoms.
We tried acupuncture treatment on two patients with lumbar spinal canal stenosis due to hemodialysis-related spondyloarthropathy who presented with neurogenic intermittent claudication, and evaluated its effects. Acupuncture treatment involved placement of acupuncture needles chiefly in the stenotic region, once weekly, for about three months. Marked improvement was obtained regarding claudication distance and JOA score in patient number one, who had radicular type intermittent claudication. Slight improvement of claudication distance and improvement of JOA score (particularly relief of pain) were obtained in patient number two, who had mixed type intermittent claudication. These results suggest that acupuncture treatment might be effective for dialysis patients with lumbar spinal canal stenosis associated with hemodialysis-induced spondyloarthropathy.

We executed an acupuncture therapy to 62 lumbar spinal canal stenosis cases who were diagnosed by CT, MRI photo state and clinical symptom and examined the result.
The 36 men and 26 women in this study had a mean age of 67.3 years.
An acupuncture was executed by aiming to give an effect to the soft tissues and a blood circulation around the area where the stenosis was recognized then pierced facet joint closely and deeply and gave an electric acupuncture stimulus.
14 cases were very good and 17 cases had good results according to the JOA score. No cases worsened.
We concluded an acupuncture treatment was effective for treating lumbar spinal canal stenosis.

The effect of acupuncture treatment on ending peripheral facial nerve paralysis was examined using standard set by the Japan Society of Facial Nerve Treatment. A comparison was made of how recovery was affected by acupuncture treatment alone, drug treatment alone, and a combination of drugs (steroids) and acupuncture.
As a result we found that 1) in groups having an ENoG of 41% or more, the acupuncture-only group showed less recovery than did the group that received oral steroids. 2) Among the groups having an ENoG of 21% or more, there was no significant difference between the group given oral steroids and the group given both steroids and acupuncture treatment. 3) For groups having an ENoG of 1%-20%, there was no difference in recovery between the group given large doses of injected steroids and the group given large doses of injected steroids concommitant with acupuncture. But the group that was given both oral steroids and acupuncture did not recover as well as the other groups. 4) A comparison of the groups receiving only medication and receiving medication with acupuncture showed there was no special hastening of recovery seen with the administration of acupuncture; in fact, the acupuncture may have even delayed recovery.
The above results indicate that the administration of steroids is more important than the use acupuncture in the treatment of peripheral facial nerve paralysis, and that a suitable treatment should commence within 7 days after the occurrence of symptoms.

We studied the outcome of the surgical treatments, mainly on the walking ability, of the 113 femoral neck fractures of 113 limbs in the elderly, 70 and over, who were admitted in our hospital during the period between Nov. 1992 and Nov. 1996.
Sixty-six of the 113 cases (60.0%) regained the pre-traumatic walking abilities. The rest of the cases, particularly patients over age 85, failed to make good recoveries because of advanced age aging, presence of various complications, types of fractures, and/or poor pre-traumatic walking abilities.
Among various types of complications, dementia appeared as the number one factor in the poor recuperation. We, therefore, recommend that speech therapy as well as occupational therapy be used in the elderly with dementia to arrest further deterioration, and those without to prevent the occurrence of dementia during the perioperative periods with particular emphasis on the preoperative period while patients are still in bed with their legs under traction.
The cases with inside neck fractures of Garden classification type III/IV recovered excellently, for which we applied bipolar arthroplasty (bipolar prosthesis with femoral stem). This is because the bipolar arthroplasty technique ensured much firmer fixation at the fracture site, earlier rising from bed, and earlier weight bearing than in the case of other operative techniques.
The cases with the unstable lateral type of fractures, that are to be cured in osteosynthesis, and so treated by the Ender technique, did not recover well, because of infirm fixation at the fracture site, late rising and bearing times, and eventual concurrence and/or worsening of dementia.
We, therefore, inclined to think that bipolar arthroplasty surgery would be more appropriate for the case of an unstable, complex type of fracture than the Ender fixation maneuver would be, because the former ensures the better outcome.

In our department, we use Jinnaka's Rehabilitation method as a means of aftertreatment of patients who underwent surgery to repair fresh Achilles tendon ruptures. In this paper, we compared the results of tendon ruptures in farmers with those in other occupational workers, who visited our hospital for surgical treatment from April 1990 to December 1996. The data required in this study were collected by interviewing each patient by telephone.
We repaired 22 tendons in farmers, another 22 tendons in manual, laborers, and 36 tendons in non-manual laborers (office workers, 32 tendons and housewives, 4 tendons.) The average period of follow-up was 4 years and 3 months. Re-rupture was observed in only one of the non-manual laborers. The average age of the farmer group was 50.4 years, which was higher than those of the other two groups-43.0 years for the manual laborer group, and 38.4 years for the non-manual laborer group. 83.3% of the patients in the non-mnual laborer group could return to engaging in sports. However, a smaller number of patients, 50.4%, look part in sports in either the farmer group or the manual laborer group respectively.
This low rate of comeback to sports in the farmer group may reflect their belief that physical exercise is unnecessary in light of the farmer's life style.
There are some reports that claim that farmers should engage in some kinds of sport, repeatedly and at regular intervals, to promote and maintain their health, because physical activity in farming is not necessarily sufficient or appropriate from the view point of health preservation.
It is good to promote the idea that farmers, who perform physical labor, should also take part in some kind of sport.

Objective CD4+ T lymphocytes have been shown to play an important role in the pathogenesis of systemic lupus erythematosus (SLE). To identify the commonly accumulated T cell clones and to investigate its role in murine lupus models, it was analyzed that the T cell clonality infiltrating in different tissues derived from (NZB?NZW)F1 as well as MRL/lpr mice. Methods The expressions of T cell receptor (TCR) V? gene were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) combined with single-strand conformation polymorphism (SSCP) study. The phenotype of T cells expanded in different organs was determined by magnetic cell sorting (MACS). Results RT-PCR and SSCP study of TCR V? chain demonstrated that there were some identical T cell clonotypes expanded and accumulated in different organs in aged diseased mice. Most of these identical clonotypes were CD4+ T cells in both of the two strains. In contrast, young mice exhibited little accumulation of common clone in different organs. The TCR V? usage of these identical clonotypes was limited in V?2, V?6, V?8.1, V?10, V?16, V?18 in MRL/lpr mice and V?6, V?7 in (NZB?NZW)F1 mice respectively. Conclusion The results suggest that activated and clonally expanded CD4+ T cells commonly accumulated in different tissues in aged murine lupus models. These CD4+ T cell clonotypes may be involved in specific immune responses of SLE, thus playing a pathogenic role in these lupus mice.

Objective There were some identical T cell clonotypes expanded and accumulated in different organs in aged diseased (NZB?NZW)F1 and MRL/lpr mice. The amino acid motifs in the third complementarity determining region (CDR3) from the T cell receptor (TCR) V? chain was analyzed to demonstrate the antigenic specificity of these identical clones. Methods The TCR V?6 gene in kidneys and brains from different individuals of aged diseased lupus mice were amplified by reverse transcriptase polymerase chain reaction (RT-PCR) respectively. The amino acid motifs in CDR3 loops of TCR V?6 chain were demonstrated by DNA cloning and DNA sequence analysis. The amino acid motifs from the identical T cell clones accumulated in different organs were identified by single-strand conformation polymorphism (SSCP). Results Some conserved amino acid motifs such as isoleucine (I) and aspartic acid (D) were observed in CDR3 loops of TCR V?6 from these identical T cell clones in different individuals of aged diseased (NZB?NZW)F1 mice. Likewise, I, glycine (G) and D or glutamic acid (E) were also found in MRL/lpr mice. Conclusion These identical T cell clones may recognize restricted T cell epitopes on autoantigens and are involved in specific immune responses in SLE.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis (RA), 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 quality of life (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 RA, 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) 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.