A 74-year-old man had been taking warfarin for atrial fibrillation, but warfarin was discontinued due to upper gastrointestinal bleeding. One week later, left hemiplegia occurred, and cranial magnetic resonance imaging revealed multiple cerebral infarctions. Systemic examination revealed thrombi in both atria as well as duodenal cancer. Because all of the thrombi in both atria were larger than 30 mm in diameter, the risk of embolism or sudden death was assumed to be high. Although the use of cardiopulmonary bypass for cancer patients is controversial, bilateral atrial thrombectomy was performed 4 weeks after cerebral infarction onset because reasonable survival duration was expected with surgery for duodenal cancer after thrombectomy and further treatment. The timing of and indications for surgery in this case are discussed.

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.

During the period between January 1975 and April 1991, 37 patients with acute arterial occulusion of the extremities were admitted to our department and were classified into 2 groups according to their causative factors, including thrombosis and embolism. Among 16 thrombosis patients with involvement of 17 limbs, 4 patients died and 6 limbs were amputated at the time of discharge. On the contrary, among 21 embolism patients with involvement of 25 limbs, 2 patients died and only one limb was amputated. Sixteen of 17 limbs with thrombosis were operated on. Arterial reconstruction was carried out initially on 5 limbs, resulting in successful limb salvage; 3 of 6 limbs which had undergone thrombectomy initially were occluded again soon after the procedure. In the end, 1 limb had to be amputated. On the other hand, 22 of 25 limbs were operated on. Three arterial reconstructions, 18 embolectomies and 1 amputation were carried out initially. All arterial reconstructions and embolectomies were successful. From these results, it was concluded that arterial reconstruction must be done initially for thrombosis patients. For the embolism patients, embolectomy is preferable.

Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.

Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.