We simulated mountain climbing using walking on a treadmill in order to systematically evaluate the physical load during mountain climbing. The conditions of three types of load-(1) inclination of the walking path (walking uphill and downhill), (2) walking speed, and (3) backpack weight-were varied within the range assumed for normal mountain climbing (40 sets of conditions in total). When the three types of load were expressed as vertical work rate, energy expenditure (VO₂) during walking uphill and downhill was distributed along roughly the same curve. The following characteristics of walking uphill and downhill were observed.A. Walking uphillFor all three types of load, increase in load gave a linear increase in VO₂ and heart rate (HR). A lactate threshold (LT) appeared at an intensity of 62%VO_2max, when HR was 78% HR_max. Rating of perceived exertion (RPE) was evaluated for the “Breathlessness” and “Leg Fatigue”, and both of these increased roughly in proportion to %VO_2max.B. Walking downhillWhen walking downhill, VO₂ was 35-50% the intensity of VO₂ when walking uphill on the same slope and at the same speed. Energy expenditure did not exceed 60%VO_2max in any of the load conditions, and no LT was seen. RPE values were higher for walking downhill than walking uphill, even when %VO_2max values were the same. RPE values for the “Leg Fatigue” tended to be higher than for the “Breathlessness” at the same speed in downhill walking.Using these data, we created a table giving the intensity of exercise of mountain climbing expressed as VO₂ per unit body mass and metabolic equivalents (Mets) with vertical migration velocity and total weight (Body weight + Backpack weight) as variables. This table gives mountain climbers a systematic understanding of the physical load under various mountain climbing conditions. It is likely to be of use as a reference for mountain climbers of different levels of physical fitness when practicing mountain climbing appropriate to their individual level. The present results suggest that in downhill walking, it is insufficient to express the physical load in energy expenditure (VO₂ and Mets) alone, and the load on the leg muscles must also be judged using the RPE in the “Leg Fatigue”.

This report takes up a 65-year-old woman. Suspecting a tumorous superior fovea in the left clavicle, she consulted with our hospital’s Department of Otolaryngology. As a result of the lymph node biopsy performed at the department, she was diagnosed as having moderately differentiated tubular carcinoma. CT scanning revealed a number of swollen lymph nodes and parietal tylosis in the sigmoid colon. Endoscopy produced no abnormalities in the upper digestive tract, but an endoscopic check of the lower digestive tract revealed an all-around Type II tumor. The ailment was pathohistologically identified as tubular carcinoma. That said, the patient was diagnosed as suffering from sigmoid colon accompanying Virchow lymph node metastasis. Then, sigmoidostomy and the dissection of the D3 lymph node were performed. Pathohistological diagnosis revealed moderately differentiated tubular carcinoma, SE, N3, HO, PO, M1 (Virchow lymph node metastasis), Stage IV. Chemotherapy was postoperatively initiated with mFOLFOX6.

A cervical aortic arch is a very rare congenital malformation of aortic arch. A case is reported of a 42-year-old woman with an extensive circular aneurysm of a left-sided cervical aortic arch. The arch aneurysm was successfully removed surgically and replaced with woven Dacron graft. Histologic examination of the aneurysm revealed atherosclerosis and intimal defect.

In a consecutive series of 160 surgically treated abdominal aortic aneurysm, four patients with acute aortic thrombotic occlusion of an abdominal aortic or iliac aneurysm were encountered. Three of four aneurysms were 7cm in diameter or smaller. Also, 3 of 4 patients had chronic occlusive disease of legs. Our mortality rate was 75%. The recommendation is made that all abdominal aortic aneurysms be resected if there is substantial associated distal occlusive disease.

A 44-year-old woman with over 20 years history of rheumatic heart disease developed progressive heart failure from aortic stenosis and mitral restenosis after open mitral commissurotomy. In December, 1986, she underwent aortic and mitral valve replacements with Medtronic Hall prosthesis (aortic: 21mm, mitral: 27mm). Following an eventful recovery, she was discharged from the hospital and continued on a regimen of Coumadin. In February, 1991, the patient developed chest and back pain, which necessitated her emergency admission to our clinic. During the coronary examination, the aortic prosthetic occluder was not moving, fixed in the opening position, lasting from one to several minutes. She underwent emergency operation for replacement of the defective valve. At operation, we noted the pannus formation into the valve orifice on the inflow side of aortic prosthesis. She made a satisfactory recovery and has enjoyed good health since that time.

To investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α₂ plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.

This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.

The diagnosis of pituitary carcinoma cannot be made easily histologically, and most cases of pituitary carcinoma are diagnosed only after the clinical detection of metastasis. Distant metastasis of pituitary tumor occurs in 0.1% to 0.2% of cases and has been reported in the liver, bone and central nervous system, with only one case of metastasis to the cauda equine reported. This study describes a rare case of the drop metastasis of adrenocorticotropic hormone-producing pituitary adenocarcinoma to the cauda equina, causing cauda equina syndrome.
Adenocarcinoma ; Adrenocorticotropic Hormone ; Cauda Equina* ; Central Nervous System ; Diagnosis ; Liver ; Neoplasm Metastasis* ; Pituitary Neoplasms* ; Polyradiculopathy

  A 86-year-old woman visited us, complaining about sharp abdominal pain she had very morning when she got up. Ultrasound and computer tomography scans of the abdomen revealed notable parietal hypertrophy and swelling of the gallbladder. The old woman was diagnosed with acute cholecystitis and immediately admitted to the hospital. Her condition did not improve on conservative management. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The bile thus aspirated was bloody, which led us to suspect necrotizing cholecystitis. Emergency cholecystectomy was done. The abdominal operation found the gallbladder wandering with a torsion of 360 degrees around the gallbladder neck as the axis and the leakage of bile in the abdominal cavity from what could be presumed to be the area where the PTGBD was placed. After the torsion was corrected, the gallbladder was surgically removed. Neither gallstones nor tumors were found in it. There were signs of hemorrhagic necrosis in the mucus membrane. The patient made good progress after the operation and was discharged on the 15th hospital day. Torsion of the gallbladder is a comparatively rare entity and its symptoms are not always specific. Therefore, it defies preoperative diagnosis. In this paper, we report our experience with a case of this disease which presented characteristic radiographic images and discuss the treatment strategies including PTGBD.

　　Case I was a 85-year-old woman. She was referred to us as her serum CEA level was found as high as 9.2ng/ml at a clinic in her neighborhood. CT and ultrasound scans revealed a cystic tumor in the appendix area. A barium enema examination showed a tubercular lesion in the subcecal area. The surface of the lesion was flat and smooth. The vermiform appendix was not scanned with the contrast medium.　　She was diagnosed with mucinous cystadenoma of the appendix. Partial cecotomy was performed. The postoperative serum CEA fell to a normal level of 4.7ng/ml.　　Case II was also a woman . The 74- year-old inpatient was being treated for high blood pressure and hyperlipemia when her serum CEA level was found elevated to 12.3ng/ml. CT and ultrasonograph examinations revealed a cystic tumor in the appendix area. A barium enema examination showed a mucocele-like tubercle in the appendix. The patient was diagnosed with mucinous cystadenoma of the appendix and partial cecotomy was performed. The CEA level was normalized postoperatively with 1.5ng/ml.　　The pathologic tests confirmed either of these two cases was mucinous cystadenoma of the appendix. Immunohistochemical staining showed a CEA positive.