To determine the minimum duration of exercise for improving the aerobic capacity of patients with coronary heart disease (CHD), 23 female patients with CHD and/or hypertension, aged 52.8±8.7 years, were studied. After pre-testing, all the patients were conditioned for 4 months in order to elicit improvements in their aerobic capacity and other healthrelated factors. Duration and contents of daily activities were recorded by each patient. After 4 months, oxygen uptake at lactate threshold (VO_2LT) and VO_2peak were increased significantly from 12.9±2.6 to 16.0±3.4ml/kg/min and from 18.5±4.2 to 22.3±5.6ml/kg/min, respectively. Duration of exercise conditioning for the 4 months averaged 23.8±12.2min per day, ranging from 4.6 to 49.7min. Correlational analyses were applied in order to determine the extent to which the improvement in aerobic capacity was associated with the individual mean duration of exercise conditioning. As a result, changes in VO_2LT and VO_2peak correlated significantly with the exercise duration (Pearson's r=0.51, Spearman's rho=0.47 for VO_2LT; Spearman's rho=0.58 for VO_2peak) . Both VO_2LT and VO_2peak tended to improve markedly when daliy exercise duration was 20 min or longer. Furthermore, it was shown that the improvement in aerobic capacity remained almost the same within a range of exercise duration of 20 to 60min. We suggest that the minimum exercise duration for improving the aerobic capacity of cardiac patients is 20 to 30min per day or 140min or more per week.

To estimate how much physical activity is needed to improve overall health status in female patients with ischemic heart disease (IHD), the dose-response relationship between the duration of daily aerobic exercise and change in vital age (VA) was assessed for 4 months of exercise training. VA was considered as an index of physical health status and was computed from various coronary risk facotrs and physical fitness elements. Eighteen female patients with IHD, aged 54.3±9.1 yrs, continued the supervised exercise training 1-2 d/wk and the self-controlled exercise training 1-5 d/wk for 4 months. The intensity of exercise was set at individually determined lactate threshold. Daily duration of aerobic type exercise calculated for each patient averaged 21.1±11.0min/d, rang ing from 4.6 to 46.7 min/d. After the 4-month exercise training, VA decreased from 59.6±12.1 yrs to 54.2±11.8 yrs (P<0.05) . Significant correlation was found between daily duration of exercise and the change in VA (Spearman's rho=-0.60 ; Pearson's r=-0.62) . In this relationship, 10 min/d of exercise induced the decrease in VA and no further decrease in VA was found over the 30 min/d of exercise. In the 11 variables which constitute the equation of VA, oxygen uptake at lactate threshold (Spearman's rho=0.65; Pearson's r=0.64) and balancing on one leg with eyes closed (Spearman's rho=0.48; Pearson's r=0.51) significantly correlated with daily duration of aerobic exercise. From these results, it is suggested that the amount of moderate intensity exercise required to improve physical health status in female patients with IHD may be 10-30 minutes per day.

The number of senile eye cataract cases increases year by year. Recent developments in new operation techniques have brought more safety and ease i.e. ultrasonic phacoemulsication and lens replacement. However, some complications of these techniques result in troublesome outcomes. In this paper the authors report a female patient aged 74 years old who suffered from severe photophobia after cataract surgery, which was successfully treated with the Kampo formulation, ryokeikansoto. Such troublesome cases tend to be neglected to in medical journal publications when the background of the complaint is unknown.

Papillary muscle rupture after acute myocardial infarction (AMI) is an infrequent but fatal complication. We report a case of mitral valve repair performed in a patient with partial papillary muscle rupture after AMI. An 85-year-old man was admitted to our hospital for AMI with cardiac shock. Emergency coronary angiography revealed triple-vessel disease, and percutaneous coronary intervention for the culprit lesion of the left circumflex artery was successfully performed. Eleven days after the onset of the AMI, the pulmonary artery pressure abruptly increased to 60 mmHg and a pansystolic murmur was detected. Transesophageal echocardiography showed severe mitral regurgitation (MR) with flail in the A1—A2 region of the anterior mitral leaflet. We demonstrated erratic motion of the ruptured anterior head in the left ventricle, and this was diagnosed as partial rupture of the posterior papillary muscle. Intra-aortic balloon pumping (IABP) was performed to maintain the systemic circulation. Four days after the onset of acute MR (15 days following AMI), we performed mitral valve repair with coronary artery bypass grafting. We reattached the ruptured head to the viable posterior head with pledget sutures and performed annuloplasty using Carpentier-Edwards classical ring M28. Postoperative echocardiography showed no MR, and the patient was uneventfully discharged on the 45th postoperative day.

A 79-year-old man developed congestive heart failure. He was given a diagnosis of severe mitral regurgitation with calcification of the posterior mitral annulus and secondary tricuspid regurgitation. He had a history of esophageal resection with retrosternal gastric tube reconstruction about 20 years previously. We replaced the mitral valve with a mechanical prosthesis and performed tricuspid ring annuloplasty through a right parasternal approach. We did not risk resecting the calcified annulus, but fixed the prosthesis and annulus with the equine pericardium in between as a cushion and collar, to prevent perivalvular leakage. The postoperative course was uneventful.

In general strategy for postcardiotomy heart failure includes inotropic support followed by the use of an intra-aortic balloon pump and percutaneous cardiopulmonary bypass support (POPS). The insertion of a ventricular assist system (VAS) may become necessary when these procedures fail to restore hemodynamic stability. The ABIOMED BVS 5000 left ventricular assist support system (LVAS) has been approved for clinical use in Japan since 1998. Here we describe our experience with the recovery of a 52-year-old man from postcardiotomy heart failure after using an ABIOMED BVS 5000 LVAS. The patient was admitted to our institution with dyspnea. Heart failure with severe left ventricular dysfunction was diagnosed, and recent myocardial infarction was suspected from his history and electrocardiogram. Two days after admission, ventricular fibrillation occured and the arrythmia was hard to control. PCPS was connected and emergency coronary angiography showed triple vessel disease. We performed emergency coronary artery bypass grafting with the heart beating under PCPS and immediately implanted an ABIOMED BVS 5000 device to achieve myocardial recovery after stopping PCPS. He was weaned from the LVAS at 6 days after surgery. His postoperative course was relatively uneventful and he was discharged after recovery.

Background: Complementary medicine and alternative medicine have been included in the curricula of many medical schools and colleges; however, teaching methods have not been standardized. We gave lectures and practical instruction on acupuncture and moxibustion medicine to medical students during their clinical clerkship in anesthesiology. We used a questionnaire to evaluate the usefulness of small-group teaching.
Methods: The subjects were 93 fifth-year medical students doing clinical clerkships in anesthesiology. The clinical clerkship consists of small-group learning with 2 or 3 students per group. After a lecture and practical instruction on acupuncture and moxibustion were given, students were asked to fill out a questionnaire about their interest in and basic knowledge of acupuncture and moxibustion and whether they would like to master the technique.
Results: All 93 students answered the questionnaire （response rate, 100%）. After the small-group teaching, students became more interested in acupuncture and moxibustion and learned that the costs of treatment were covered by health insurance. Most students were interested mastering acupuncture and moxibustion in the future.
Discussion: Our results suggest that lectures and practical instruction during clinical clerkship are useful for getting medical students interested in acupuncture and moxibustion medicine.

Biological age based on the assessment of various physiological factors measured in a resting state has been proposed as an appropriate index of aging. We have recently developed an equation for estimation of physical fitness age (PFA), which is composed of eight age-related physical fitness variables. These include oxygen uptake corresponding to lactate threshold (Vo₂@LT), maximal oxygen uptake (Vo₂max), side step, grip strength, vertical jump, foot balance with eyes closed, trunk extension, and trunk flexion. In this study, the validity of PFA as a critical index of physical health and/or aging status was investigated from a longitudinal standpoint on the assumption that exercise habituation does contribute to health promotion. The subjects were 14 Japanese middle-aged and elderly men, aged 50 to 70 years, all of whom were patients with coronary heart disease (CHD) . The subjects participated in a supervised exercise conditioning program for 90 to 120 min each session, 2 times weekly for 4 months. Analyses of the data indicated that the mean PFA of the subjects (66.0±9.0 yr) after conditioning was significantly (P<0.05) lower than the mean PFA (72.8±8.6 yr) obtained before conditioning. After the exercise program, significant increases were documented in Vo₂@LT (17%), Vo₂max (12%), side step (26%), trunk flexion (109%), trunk extension (7%), vertical jump (12%), and foot balance with eyes closed (31%) . Therefore, we conclude that our exercise conditioning program may alter the overall physical fitness of patients with CHD, and that PFA could be a valid physical health and/or aging index.