Purpose: The purpose of this study was to examine the influence of the exercise program for Osteoarthritis of the knee (knee OA) which American Geriatrics Society Panel on Exercise and Osteoarthritis (AGS) recommends on physical function in Japanese independent elderly with knee joint pain.Methods: Subjects of this study were 36 (7 males : aged 74.7±5.1 years, 29 females : aged 72.3±4.6 years) community-dwelling independent elderly with knee joint pain who voluntary participated in our exercise program. The program consisted of massage around knee, flexibility exercises in knee and ankle joints, and leg muscle development exercises. They performed these exercises twelve times for a month at regular intervals. Physical function were evaluated by the muscle strength during knee extension and flexion, the range of motion of knee joint and the center of pressure during upright standing. There were three times measurements at one month before starting of the program (the 1 st), immediately before beginning of the program (the 2 nd), and just after ending of the program (the 3 rd). Difference between change in measurement values during the observation period (subtract the 1 st from the 2 nd ; Δ1) and that during intervention period (subtract the 2 nd from the 3 rd ; Δ2) were analyzed by Students't-test.Results and Conclusion: There was significant difference between Δ1 (0.01±0.05 kg/wt) and Δ2 (0.04±0.05 kg/wt) on maximal muscle strength during knee extension. This result suggested that the exercise program recommended by AGS was improved the leg muscle strength in Japanese elderly with knee joint pain. However the effects of the exercise intervention were not clarified on the other physical function. As for the reasons it seems to affect the initial level of joint pain and physical function in the subjects. Therefore, reexamination of this point with a greater number of samples which the worse level of knee joint pain is needed in the future.

A 48-year old man consulted a doctor at a nearby medical clinic due to dyspnea and increased body mass which he began to experience in October, 2011. Further evaluation revealed the presence of three-vessel severe coronary artery disease, poor left ventricular function, and mitral valve regurgitation. Transthoracic echocardiography showed anterior wall asynergy and left ventricular enlargement. Reconstruction of the left ventricle was contemplated during the preoperative evaluation. The patient underwent hemodialysis for chronic renal failure prior to admission. Generally, delayed gadolinium-enhanced MRI is used for cardiac viability assessment. However, gadolinium is contraindicated in a patient with chronic renal failure owing to the risk of development of nephrogenic systemic fibrosis. Thus, gadolinium-enhanced MRI is contraindicated in the patient. Instead, we used fluorodeoxyglucose-positron emission tomography (FDG-PET) computed tomography (CT) to assess myocardial viability. Consequently, viability was assessed except for a part of the apical electrode in the left anterior descending artery territory. Subsequently, revascularization and mitral valve annuloplasty with coronary artery bypass grafting of five vessels were performed in January, 2012 without left ventricular reconstruction. A left ventricular assist device was used postoperatively, from which he was later weaned. The outcome was good because post-operative left ventriculography revealed improvement in left ventricular wall motion. This case is presented including bibliographical comments on the effectiveness of FDG PET-CT for assessment of myocardial viability.