Objective : We analyzed changes in the affected side motor function according to the region and severity of motor paralysis in patients during convalescent rehabilitation. Methods : The subjects recruited were 1,903 hemiplegic patients with primary stroke from a supratentorial unilateral lesion, for which a full-time integrated treatment (FIT) program was implemented. We excluded patients with severe complications, those in whom the stroke recurred or its condition rapidly changed during hospitalization, and those in whom the duration from the onset to admission to our hospital was 61 days or longer. The remaining 1,634 patients served as the study subjects, from among whom we chose 917 patients who had been hospitalized for 8 weeks or longer. The affected side motor function was assessed using 5 motor items of the Stroke Impairment Assessment Set (SIAS) every 2 weeks starting from admission. Results and Conclusion : The affected side motor function significantly improved from admission to a convalescent rehabilitation ward through to week 8 in stroke patients, who were actively engaged in daily routines and had mainly walking and ADL exercise. In addition, improvement was more likely to occur for the lower-limb compared to upper-limb, as well as for the proximal compared to distal motor function. This tendency was more marked for more severe cases of paralyses.

Higher brain dysfunction generally refers to cognitive and/or behavioral changes resulting from stroke, traumatic head injury, hypoxic encephalopathy, or any other of a number of cerebrovascular events. In 2004, the Ministry of Health, Labour and Welfare of Japan released a provisional figure of the probable prevalence of higher brain dysfunction in Japan as some 300,000 individuals. The aim of this study was to provide an estimate of the number of people with higher brain dysfunction in Tokyo. All 651 hospitals in Tokyo were surveyed between January 7, 2008 and January 20, 2008 by questionnaire. Analysis of the data showed 118 incidents of brain damage which resulted in higher brain dysfunction. This roughly converts to 3,010 incidents per year in Tokyo. Taking life expectancy into consideration, we estimate the current number of higher brain dysfunction survivors to be 49,508 (male : 33,936, female : 15,572) in Tokyo. The social impact of higher brain dysfunction has recently emerged amid growing recognition that disturbances of attention, memory, and behavior overshadow the contribution of focal motor deficits to chronic dependency. Our data provide information about the number of people that may require appropriate provision in the community.

Transluminal angioplasty during vascular reconstructive procedures was performed to 18 lesions in 13 patients. Ages ranged from 57 to 81 years with a mean of 72.7 years, and all patients were men. Transluminal angioplasty during the thromboendarterectomy or bypass grafting was performed to 3 patients for inflow dilatation, 3 patients for outflow dilatation and 1 patient for renal artery dilatation. Transluminal angioplasty with thrombectomy for the anastomotic stenoses of EPTFE grafts was performed 11 times for 7 patients. The results of this method for arteriosclerotic lesions were as follows; patency was 100% at 1 year and 80% at 3 year. Four patients died during the follow-up periods and the dilated lesions were all patent at the time of death. The results of this method for anastomotic stenoses were as follows; patency was 34.6% at 6 month and 0% at 10 months. Graft infection occurred in 1 of 4 patients to whom transluminal angioplasty was performed 2 times. The patency of transluminal angioplasty during vascular reconstructive procedures for arteriosclerotic lesions was good. Transluminal angioplasty for anastomotic stenoses was noninvasive and easily performed with the thrombectomy, but the patency was not so good and there was the risk of graft infection by repeated operations.

Objective: In previously reported comparisons of aminoglycoside antimicrobials administered once daily versus multiple administration, toxicity was found to be equal or lower while efficiency remained high.  However, there are few reports on the clinical condition of targeted elderly persons.  The objective of this study was to evaluate the once-daily dosing regimen of 400 mg of AMK involving elderly pneumonia patients aged 75 years or older with regard to clinical evaluation including the efficacy and toxicity.
Methods: A survey to clinically evaluate the efficacy and toxicity of 400 mg AMK administered once daily for 30 min at 24 h intervals was carried out.  One hundred twenty-seven patients with pneumonia and who were 75 years or older at Funabashi General Hospital were targeted, with the aim of an expected clinical effect of C_max/MIC≥ 8-10.  Serum concentration monitoring was carried out after administration began.
Results: There were 121 patients (95.3%) of controlled AMK concentration with a trough serum concentration of <10 μg/mL, which is a safe concentration range.  There were 6 patients (4.7%) where trough serum concentration in the toxic range >10 μg/mL, with an average at 15.1±5.0 μg/mL, and the average administration days were 7.5 ± 3.3 days.  Moreover, before/after AMK administration, there were 3 patients (2.4%) where CRE values increased more than a 150% over the previous values, and were evaluated as renal dysfunction.  Average trough serum concentration at that time was 3.6 ± 1.1 μg/mL, and average number of days of administration were 13 ± 1.4 days.  Patients of trough serum concentration in the toxic range >10 μg/mL were not included.  The average peak serum concentration calculated by Winter’s pharmacokinetic parameter and the 1-compartment model was 35.3 ± 8.0 μg/mL, and the average C_max/MIC which correlates with the AMK effect was 9.9 ± 2.2.  The treatment was effective for 83 (65.4%) of the 127 patients.
Conclusion: By once-daily administration of AMK 400 mg to aged persons 75 years or older, change in trough serum concentration into a safe range and C_max/MIC≥ 8-10, the level at which clinical effectivity can be expected, could be achieved.  This administration method is shown to be useful in maintaining AMK in the target serum concentration range for aged persons.

This study examined and improved the quality of inter-professional moral case deliberation (MCD) in a home-based medical care clinic by altering the MCD process and evaluating it using the REFLECT rubric. After altering the MCD process, four of the five main evaluation items in the questionnaire were shifted to a higher evaluation level employing a scaled evaluation. The free-entry field revealed future tasks. This report suggested that improving the quality and assessment of MCD using REFLECT promotes the reflection skills of clinical teams.

This paper describes a clinical review of cases of gastric cancer treated surgically at the Department of Surgery of the Shirakawa Kosei General Hospital, the core medical institution in the southern part of Fukushima Prefecture.
During the period of 20 years from January 1981 through December 2000, a total of 1, 132 cases were operated on for gastric carcinoma. Surgical resection cases totaled 1, 023 (resection ratio: 90.4%); curative resection cases, 894 (curative resection ratio: 79.0%); 5-year survival rate for resection cases, 68.3%; and 5-year survival rate for curative resection cases, 75.6%. When the cases were divided into those treated during the first half of the 20 years nad those treated during the latter half of the 20 years, the number or resection cases was smaller during the latter than during the first half but the resection ratio was larger. The early stomach cancer cases in terms of the degree of progress, histological classification, depth and metastasis to lymph nodes have been increasing and the 5-year survival rate has been on the rise.

The purpose of the present investigation was to examine the relationships between the exercise history and the bone mineral density (BMD) and bone mineral content (BMC) in female Japanese young adults using dual X-ray absorptiometry (DXA). One-hundred twenty females, aged between 18 to 28 years, participated in the present investigation. The BMD at the lumbar spine (L-BMD), whole body BMD and BMC (WB-BMD and WB-BMC), lean body mass (LBM) and fat mass (FM) were measured by DXA. Using a self-administrered questionnaire, the exercise habits during preschool (4-6 years), primary school (7-12 years), junior high school (13-15 years), high school (16-18 years), and the current habits (>18 years) were eveluated. The L-BMD, WB-BMD and WB-BMC were significantly higher in the subjects with exercise habits during both the period of <18 years and >18 years compared with those in the subjects without an exercise history during all periods (p<0.05). In a separate analysis with the data stratified by the school age, the subjects with an exercise history during primary school, junior high school, or high school had significantly higher BMD and BMC values compared with the non-exercisers (each, p<0.05). In contrast, the BMD and BMC did not differ significantly according to either the exercise history during pre-school nor the current exercise status. A multiple stepwise regression analysis revealed that the body weight, LBM, FM, age of menarche, and exercise habits during high school were significant determinants of the L-BMD, WB-BMD and WB-BMC (p<0.001). The results of the present investigation show that both the exercise history during school age and the current exercise habits affect the BMD and BMC in young adults. In particular, high school females should be encouraged to participate in the regular exercise to increase their bone health. Future studies will be needed to confirm the targeted age-group(s) for participation in sports/exercise for the improvement of bone health, including an analysis of the type and intensity of exercise/sports.

During the period of 25 years from January 1978 through December 2002, a total of 808 colorectal cancer cases were operated on in Shirakawa Kosei General Hospital. The number of sugical resection cases came to 713 (ratio : 88.25%). Curative resection was performed on 593 cases (ratio : 73.4%). The total number of cases was broken down into 446 cases of cancer of the colon and 369 cases of cancer of the rectum (7 multiple cancer cases included). By sex, male cases numbered 329 and female cases 379. Clinically or histologically, many cases were diagnosed as stage IIIa or stage II cancer. The 5-year-survival rate for the resection cases was calculated at 67.2% and that for the cure resection cases, at 79.5%.
Excision ; Malignant Neoplasms ; Colorectal Cancer ; Cases ; Review of

A 68-year-old man underwent percutaneous transluminal coronary angioplasty (PTCA) to left anterior descending artery (LAD) seg 7 after acute anteroseptal myocardial infarction 8 years previously. He was admitted because of syncope attack due to sustained ventricular tachycardia and subsequent fibrillation. He was treated medically in the ICU after cardiopulmonary resuscitation. Medical treatment with amiodarone and lidocaine was not successful and he was transferred to our hospital for surgical treatment of malignant ventricular tachycardia (VT) associated with left ventricular aneurysm and acute cholecystitis that occurred during admission. Left ventriculogram showed left ventricular aneurysm (ejection fraction: 35%) without any significant coronary lesions. The patient successfully underwent a Dor operation (left ventriculoplasty), double encircling endocardial cryoablation without endocardial resection, and preoperative and intraoperative endocardial mapping. Cholecystectomy was simultaneously performed after complete closure of the median chest incision. The recurrence of VT was never recognized clinically or electrophysiologically. The extended encircling endocardial cryoablation without endocardial resection and preoperative and intraoperative electrophysiological study, was a simple and effective method for ventricular tachycardia.

We report here a surgical case of sinus of Valsalva and right atrium fistula associated with acute infective endocarditis (AIE) without perivalvular abscess cavity or aneurysm of the sinus of Valsalva (ASV). A 51-year-old man, who had been given a diagnosis of rheumatic aortic stenosis and regurgitation (AsR) and mitral stenosis and regurgitation (MsR) and tricuspid regurgitation (TR) by echocardiography, had a high fever 2 months after removal of teeth and AIE was diagnosed. He was referred to our hospital because sinus of Valsalva and right atrium fistula were detected by echocardiography and congestive heart failure (CHF) deteriorated during medical treatment. Perivalvular abscess cavity and ASV were not detected by preoperative echocardiography. Medical treatment was continued after admission, and operation was done after amelioration of the CHF and infection were recognized. The aortic valve was removed together with vegetation, two areas of the aortic wall in which the tissue was fragile were cauterized by electrocautery, patch closure at the sinus of Valsalva was performed using a partial of e-PTFE graft and aortic valve replacement (AVR) and mitral valve replacement (MVR) were done. Though residual aortic-right atrium shunt was detected after the operation, the postoperative course was good with no CHF or signs of infection.