Regular physical activity has been regarded as a possible means to minimize the adverse physiological changes associated with aging, as well as to contribute to mental health and well-being in later life. To encourage increased participation in exercise among elderly people, and to emphasize the value of exercise in geriatric health care, this article provides an overview of the effects of primary care based physical activity on healthy aging. It is clear from the number of recently published papers on this topic that daily participation in 30 minutes or more of moderate physical activity should be recommended for elderly people. The results of physical activity interventions focusing on balance and resistance training in both home- and group-based exercises suggest that it is possible to improve physical functions and to prevent falls and disabilities in daily living. Multiple-element interventions (e. g., advice, as well as strategies to increase self-efficacy and motivation, and to eliminate barriers to participation), tailored to individual activity preferences, are likely to be more successful than more prescriptive single-focus interventions. A home-based physical therapy program can successfully enhance the independence of the frail elderly in community dwellings.

We reviewed 15 cases of reconstruction of cervical esophagus by grafting with free jejunum, which has been performed in our hospital since 1987. Primary disorders were hypopharyngeal cancer (8 cases), cervical esophageal cancer (4 cases), mesopharygeal cancer (2 cases) and laryngeal cancer (1 case). Our team for this operation consisted of otolaryngologists, abdominal surgeons and a microvasucular surgeon. We took, on the average, 15 hours and a half for total operation and four hours and half for blood isolation of the jejunum. Postoperative troubles were as follows ; necrosis of the grafted jejunum (1 case), suture failure at the phyayngojejunal anastomosis (1 case), fistural formation at the pharyngoesophageal anastomosis (1 case), light dysphagia (3 cases), ileus (2 cases) and perforation of the jejunostoma (1 cace).

Dialysis treatment was first introduced in the convalescent rehabilitation ward after the medical fee revision in April 2012 in Japan. In this study, we examined 4 stroke patients who underwent rehabilitation in the convalescent rehabilitation ward while receiving dialysis. We collected information on the patients' age, sex, disease, dialysis period, duration of hospitalization during the acute and recovery phases, the number of units of exercise, discharge destination after hospital, complications, and their Functional Independence Measure (FIM) scores. The average age of the subjects( 2 men and 2 women) was 71.0±9.5 years. Two of the 4 patients had cerebral hemorrhage and the other 2 had cerebral infarction. The dialysis period was 16.8±21.7 months. The duration of hospitalization during the acute phase was 50.0±20.3 days, while that in the convalescent rehabilitation ward was 120.0±28.2 days. The average exercise amount per day was 6.01±1.17 units in the convalescent rehabilitation ward. The total FIM score was 59.3±19.2 at admission and 94.5±27.0 at discharge. The FIM efficiency was 0.29±0.16. In all cases, the discharge destination was home. Three of the subjects showed progression of their renal anemia. One subject developed shunt vessel stenosis and one developed delirium as complications. We conclude that rehabilitation in the convalescent rehabilitation ward for dialysis is beneficial to patients due to the increased amount of exercise that they receive. In addition, such rehabilitation enables the patients to return home in good health, similar to the case of non-dialysis patients.

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.

A 24-year-old woman with patent ductus arteriosus underwent division of the ductus. On the fifth postoperative day (POD 5), MRSA was detected in pus from the wound. On POD 8, an emergency operation was performed for left tension hemothorax due to a ruptured aorta with MRSA infection. The bleeding site in the descending aorta was covered with a viable omental flap under deep hypothermic circulatory arrest. Although MRSA was detected in the pleural effusion and the aortic wall, the patient recovered from pyothorax, and pneumonia caused by Pseudomonas aeruginosas and acute renal failure. On POD 37, a pseudoaneurysm of the descending aorta was found and graft replacement was performed on POD 56 due to enlargement of the aneurysm. However, MRSA was not detected in the left pleural effusion. The postoperative course was uneventful. Omental transfer should be considered for the treatment of severe aortic wall infection, even in the presense of MRSA infection.

We have organized the Seminar and Workshop for Medical Education (SWME) 10 times from 2000 through 2003. More than 1, 200 persons have participated, including teachers, physicians, students, and simulated patients. The themes of the SWME have included a problem-based learning tutorial system, medical interview skills, objective structured clinical examinations, medical ethics, advanced cardiac life support/basic life support, evidence-based medicine, coaching technology, medical English education, and crisis management education. Invited lecturers from throughout the country organized most of these workshops. Advantages of the SWME are two-fold:(1) improving the medical teaching skills of each participant and (2) scouting for good young lecturers. Workshop reports are published in our annual monographs and other materials. The present paper is a historical review of the SWME and also describes the nationwide scope of faculty development.

We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
therapeutic aspects ; Steroid hormone, NOS ; Hepatitis, Alcoholic ; Combined ; Review [Publication Type]

A 47-year-old man had suffered from high grade fever and dyspnea for 10 days. He was transferred to our hospital in a condition of shock. Echocardiography showed severe diffuse hypokinesis of left ventricle (EF 21%), and multiple mobile thrombi in the left ventricle. Under a diagnosis of LV thrombi due to acute myocarditis, transatrial removal of LV thrombi was performed using video-assisted cardioscopy. He was weaned from cardiopulmonary bypass under IABP support. Postoperatively, he suffered from thromboembolism of the cerebral and right brachial artery. Thrombectomy of the right brachial artery and anticoagulation therapy was performed. IABP was removed on POD 3, and he no longer needed respiratory control on POD 4. Echocardiography on POD 6 showed marked improvement of the LV contraction (EF 52%). After rehabilitation, he was discharged on POD 23 on foot. Video-assisted cardioscopy allowed transatrial removal of LV thrombi, and preserved left ventricular function by avoiding ventriculotomy. Perioperative thromboembolism must be taken care of for a patient with multiple LV thrombi.

To avoid homologous blood transfusion, the effectiveness of autologous blood predonation was evaluated in patients with elective abdominal aortic aneurysm (AAA) repair. From January 1993 to July 1996, 53 patients underwent Y graft replacement by using autologous rapid transfusion device AT1000^® (Electromedics. Inc, Englewood, CO). The patients were devided in to 3 groups. Thirty one patients had no blood donation (Group A). Twelve patients had 400ml blood donation with administration of an iron preparation (Group B). Ten patients donated the same amount of blood as those in Group B, with administration of both an iron preparation and recombinant human erythropoietin (rHuEPO) (Group C). There were no significant differences in terms of age, gender, operating time, intraoperative bleeding, and total amount of homologous and autologous blood transfusion in the 3 groups. In Group A, the mean volume of homologous blood transfusion was 250±370ml and in both Groups B and C, no homologous blood was required and 400ml autologous blood was used. Homologous blood transfusion was avoided in 58.9 (18/31) of patients in Group A and all of the patients in Groups B and C. Due to the blood predonation prior to surgery, a hemoglobin level decreased significantly at the time of operation in Group B (without rHuEPO), but in Group C (with rHuEPO) the hemoglobin level was kept constant. During the first postoperative week, the minimum hemoglobin level in Group C was significantly higher than in the other groups. In conclusion, by donating 400ml autologous blood before surgery and using an intraoperative autotransfusion system, homologous blood transfusion could be avoided in elective AAA repair. With rHuEPO, the hemoglobin level could be maintained, despite predonation and intraoperative blood loss.