Bone mineral density (BMD) at the distal one-third of the radius bone was measured by the dual energy X-ray absorptiometry (DEXA) method and cytoplasmic free calcium concentration ([Ca²⁺] _i) of urinary granulocytes was by flow cytometry. Enrolled in this investigation were healthy aged people (male: n=34, female: n=36, mean 74.4 yrs) in a rural area of southern Nagano prefecture. We used acetoxymethyl ester of fluo-3 (fluo-3AM) to measure [Ca²⁺]_i, in human urinary granulocytes. BMD of the male population (0.67g/cm²) was higher than that of the female population (0.47g/cm²).[Ca²⁺] _i, of urinary granulocytesin the female population (78.7nM) was higher than in the male population (48.2nM).[Ca²⁺] _i, in urinary granulocytes of the aged population was 63.5±51.2nM (mean±SD). These values were within the values of healthy adult peripheral blood cells, suggesting that these granulocytes were functional like blood cells. These data indicated that [Ca²⁺] i, of urinary granulocytes increased when BMD decreased, suggesting that the measurement of [Ca²⁺] _i, would give us a clue for the understanding of the pathophysiological mechanism of osteoporosis in the aged.

Background: There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan.
Methods: We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG.
Results: The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no.
Conclusions: Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG.

In an attempt to study the effect of physical training in a hot environment on physiological responses to heat and heat tolerance of men, six male university students were exposed to a combination of muscular exercise and environmental heat for 20 successive days in summer. Muscular exercise was performed on a bicycle ergometer at constant work of about 8 R.M.R.t at the cycling rate of 50 r.p.m. for 2 hrs in the room with a temperature of 30°C and 70%, R.H. Sweat test was performed on the day before the beginning of physical training, on 7th, 14th and 211th days of physical training. Sweating was produced by immersing both legs to just below the knees into stirring water of 42°C for 90 min after staying for 30 min in a climatic chamber of 30CC with 70%, R.H. Sweat volume observed in sweat test increased progressively throughout the period of physical training. Na concentration in sweat at a given sweat rate continued to decrease during the period of physical training and heterogeneity of the local sweat rate and Na concentration in local sweat was reduced by physical training in a hot environment. Rise in rectal temperature induced by a given heat stress decreased significantly during the first week, thereafter showed a trend bo be smaller. The mean value of heat tolerance index I, the magnitude of disturbance induced in the body concerning thermal regulation and water-electrolyte metabolism, decreased considerably during the first week of physical training, thereafter decreased slightly. Thus it might be said that improvement of heat tolerance was induced mostly during the early period (about 1 week) of successive exposure to a combination hard work and environmental heat. This improvement of heat tolerance accompanied by marked reduction of physical strain in terms of temperature regulation might be induced at the cost of increase in disturbance of water-electrolyte metabolism.

In order to know the present state of mass survey for large-bowel cancer in rural areas, we gathered the results of colorectal screening in 1989 from 45 hospitals or cancer detection center related to agricultural cooperatives of all over Japan.
In all of the 45 institutions, method of screening was fecal occult blood test, and in most of them, the stool study was immunological, of one day, and without meal restriction. Methods of further precise examination such as barium enema, total colonoscopy, sigmiodoscopy, or proctoscopy, solely or combined, were employed depending to the facilities.
The total number of examinees were 194, 834, and 8, 523 (4.4%) had a positive reaction for occult blood. Further precise examinations were performed in 4, 351 (59.7%) examinees, and 148 cases of large-bowel cancer were detected. The detective rate of cancer in total examinees was 0.08%. Among these 148 cases of colorectal cancer, 43 cases (51.8%) were in early stage. Examinees in their fifties were the most in number, and both the rate of positive reaction and the rate of cancer detection were increased as the age gets older.

Physiological responses to heat and heat tolerance were examined in summer and winter on 13 male athletic university students and male nonathletec university students. After staying for 30 min. in a climatic chamber maintained at 30°C with 70% relative humidity, sweating reaction was examined far 90 min, by immersing both legs up to the knees in a stirring water bath of 42°C.
Both groups showed significantly greater sweat volume, significantly lower Na concentration in sweat and considerably lower rise in rectal temperature and less increase in heart rate in summer than in winter. In both seasons, athletes showed smaller volume of sweat, lower Na concentration in sweat, lower rise in rectal temperature and less increase in heart rate than nonathletes.
It is concluded that heat tolerance of athletes was superior to that of nonathletes when assessed by our heat tolerance indices and this superior heat tolerance of athletes could be explained due to a result of physical training. Heat tolerance index, representing the magnitude of physiological strain in the body induced by heat load, was modified by using relative increase in heart rate in place of salt loss. It can be said that the modified heat tolerance index is useful as a substitute of the original heat tolerance index in field studies.

The purpose of this study was to determine the effects of well-rounded exercise program (WREP) on cardiorespiratory fitness, muscular strength, flexibility, body composition, and serum lipid concentration in a group of older outpatients. WREP was composed of programmed aerobic/ anaerobic accommodating circuit exercise (PACE) and flexibility exercises. Twenty-two volunteers (69.6±3.2 yr) were used as subjects. All participants engaged in a supervised exercise program (50 min/day and 3 days/week) for 12 weeks. After 12 weeks of training, there was a significant increase in VO₂ corresponding to lactate threshold (13.4%) but peak V0₂ did not change. There were significant increases for knee extension (17.1%) and flexion (12.3%), chest pull (10.9%), low back flexion (26.6%), and shoulder press (14.6%) after training. Side stepping agility (13%), trunk flexion (129%) and trunk extension (19%) were also significantly improved. There were significant decreases in percent of body fat (-8.3%), total cholesterol (-7.1%) and low-density lipoprotein cholesterol (-9.7%) . Blood pressure also decreased in SBP (-lOmmHg) and DBP (- 5 mmHg) . The decline in SBP was significant in thirteen hypertensive patients (-14 mmHg) compared to non-hypertensive patients (- 5 mmHg) . These results indicate that WREP elicits significant improvement of overall fitness in older outpatients.

An 11-year-old boy, who underwent a Rastelli operation using a 14mm artificial graft and left pulmonary artery (PA) plasty with an autologous pericardium patch 7 years previously, had severe recurrent left pulmonary stenosis. Reoperation was performed including right ventricular outflow tract reconstruction and left PA plasty. The PA at the most stenotic site was only 2mm in diameter; it was enlarged to 10mm by good exposure and an incision on the pulmonary intima. A bovine pericardium patch with a handmade ePTFE valve was sutured onto the autologous tissue not onto the pulmonary intima to avoid restenosis and in expectation of the growth of the pulmonary orifice. On postoperative 3-D CT, the left pulmonary artery was patent and 9mm in diameter. Pulmonary scintigraphy showed an improvement in the left pulmonary perfusion. This sutureless technique was useful in this case of severe pulmonary stenosis.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

STUDY DESIGN: Retrospective case-control study. PURPOSE: To evaluate the primary outcomes and radiographic results of percutaneous vertebroplasty (PVP) in patients with singlelevel osteoporotic vertebral fracture (OVF) with intravertebral cleft (IVC) to identify the risk factors for cement loosening after PVP. OVERVIEW OF LITERATURE: PVP is a widely accepted method for managing painful OVF; however, cement loosening occasionally occurs with poor outcomes. METHODS: This retrospective study involved 195 patients treated with PVP for single-level OVF with IVC. Six months thereafter, the primary outcomes were evaluated using the Visual Analog Scale (VAS) for back pain and the modified Oswestry Disability Index. Computed tomography was conducted to detect cement loosening. Possible risk factors, such as age, sex, wedging angle, intravertebral instability, Parkinson’s disease, spinous process fracture, ankylosing spinal hyperostosis, split vertebrae, and adjacent intervertebral vacuum, were assessed. RESULTS: Forty-nine patients (25%) experienced cement loosening 6 months after PVP. The mean VAS scores were significantly higher in patients with cement loosening than in those without (50 vs. 26 mm, respectively; p < 0.01). Cement loosening was closely associated with intravertebral instability (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04–1.40; p =0.015), Parkinson’s disease (OR, 54.31; 95% CI, 4.47–659.53; p =0.002), spinous process fracture (OR, 7.11; 95% CI, 1.65–30.60; p =0.009), and split vertebrae (OR, 11.59; 95% CI, 1.64–82.02; p =0.014). CONCLUSIONS: Patients with cement loosening experienced worse back pain than those without cement loosening. The important risk factors that influenced cement loosening after PVP were high intravertebral instability, Parkinson’s disease, spinous process fracture, and split vertebrae.
Back Pain ; Case-Control Studies ; Humans ; Hyperostosis ; Methods ; Retrospective Studies ; Risk Factors ; Spine ; Vacuum ; Vertebroplasty ; Visual Analog Scale

No abstract available.
Retrospective Studies ; Risk Factors ; Vertebroplasty