The purpose of this study was to identify the factors affecting the stair-climbing ability of patients with hip fractures.　　Out of a total of 75 inpatients with hip fractures, 14 disabled elderly patients, whose ability to perform independently the basic activities of daily living was assessed as rank B or C before injury, and 10 demented elderly patients, whose ability was rank II, III, IV or M, were excluded. The remaining 51 patients were selected for the present study. The subjects were divided into two groups: 19 patients who were able to ascend and descend the stairs (the riser height: 20cm) by holding the handrails and 15 patients who could not.. In another experiment, the 51 subjects were divided into two groups: 19 patients who were able to go up and down the stairs without the aid of the handrails and 32 patients could not. Age, gender, height, weight, fracture type, number of postoperative days, hip abductor strength, knee extensor strength, level of pain, leg length discrepancy, tandem stance time, and stair-climbing ability were investigated.　　First, the correlation between the parameters and stair-climbing ability was verified using a univariate analysis. Subsequently, a multiple logistic regression analysis was performed using the parameters that represent a significant correlation with the stair-climbing ability as the dependent variable.　　These analyses revealed that “non-fractured knee extensor strength” was significantly associated with the stair-climbing ability when the subjects were allowed to use the handrails, while “non-fractured knee extensor strength” and “tandem stance time” were significantly associated with the stair-climbing ability without the aid of the handrails.　　These findings suggested that the improvement of non-fractured knee extensor strength was important for the acquisition of stair-climbing ability with the aid of the handrails and the improvement of static balance as well as non-fractured knee extensor strength was important for the acquisition of stair-climbing ability without the aid of the handrails.

A case is described of the staged surgical repair of thoracic aortic aneurysm after revascularization of single functioning ischemic kidney of a 68 year old man. A hitological evaluation of renal function was obtained before renal revascularization, which encouraging us to perform the repair of thoracic aortic aneurysm with less risk of post-surgical acute renal failure. In case of single ischemic kidney, renal revascularization should be preceded to other major surgeries in order to prevent renal shut down.

A 55-year-old man was admitted with a thoracic aortic aneurysm causing wheezing. Computed tomography and angiography revealed a large distal aortic saccular aneurysm, occupying the retrotracheal space and compressing the trachea. There has been only one report of this type of aneurysm. This patient needed emergency intubation because of severe dyspnea caused by premedication for surgery. Replacement of the distal arch was performed via left posterolateral thoracotomy. Profound hypothermia was used during open proximal anastomosis, which helped to make this procedure safe and simple. This patient recovered uneventfully.

Students in their 5th and 6th year of University of Tsukuba, School of Medicine, enter into a clinical clerkship. They record medical charts and flow sheets and they present at clinical rounds.
1) From 2000 to 2005, a questionnaire survey was conducted to evaluate the clinical clerkship in the rheumatology division. We also evaluated the influence of the introduction of infliximab therapy (October 2003) on the students' experience.
2) Evaluation of the clinical clerkship by the students was improved by attending the infliximab ward. Students felt more involved in the treatment of the patients by preparing drip infusion sets, disssolving infliximab, assisting with the drawing of blood and drip infusions, checking of the vital signs every 30 minutes, and recording charts.
3) Students realized the improvement of rheumatoid arthritis with therapy and the changes in the patients' emotional status after the introduction of infliximab.

　　This study sought to identify whether the inter-rater reliability of lower limb muscle strength measurements made using a hand-held dynamometer differs for patients with hip fracture according to the severity of their cognitive impairment. Of the 144 patients with hip fracture hospitalized at our institution, we excluded 28 from this study (18 with level III, IV, or M of independence in daily living for the demented elderly, 8 with a history of central nervous system disorders, and 2 who were transferred to another department), leaving 116 patients for analysis. These 116 patients were divided into three groups according to their severity of cognitive impairment: 44 with a normal level of independence in daily living for the demented elderly, 38 with level I independence, and 34 with level II independence. We compared the intra-class correlation coefficients and the standard error of measurement between the groups. There were no significant differences in the intra-class correlation coefficients between the groups. The standard error of measurement in the group with level II independence in daily living for the demented elderly was significantly lower than that in the other two groups. These findings indicate that the inter-rater reliability of lower limb muscle strength measurements using a hand-held dynamometer in patients with hip fracture did not differ between patients with mild or moderate cognitive impairment. Furthermore, the inter-rater reliability was high.

There are many published studies on postoperative deep venous thrombosis (DVT) which can develop after hip joint arthroplasty, but very few reports are available on the incidence of thigh DVT following or thopedic treatment of transcervical fractures. In this study, therefore, we tried to find out a screening method just right for the early detection of clots that develop in the deep femoral veins after treatment of the feactures in the neck of femurs. Between March and September 1999, a total of 24 patients were operated on for fractures on the cervix of thighbone in our hospital. Of the total, 19 were recruited for this study. The five cases were excluded because some of them were on medication that could affect the coagulation/ fibrinogenolysis factors and some were under management of other departments. After surgery, a series of blood biochemical tests were performed, and changes in the partial pressure of arterial blood oxygen and D-dimer (??) level were examined with the passage of time. In the cases which were suspected to have thrombosis in the veins in the lower extremities by ultrasonography performed six to 18 days after surgery, definitive diagnosis was made by the aid of venography. DVT was found in three in the 19 cases. Routine blood biochemical tests and measurements of oxygen partial pressure in the artery were not so much helpful as were expected in the early detection of thrombosis, whereas measurements of D-dimer levels were considered useful because the levels were well over 20μg/ml one week after surgery in the positive-DVT cases.

This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.

From January 1979 through May 1982, 36 premature infants less than 2.5kg and less than 35 weeks of gestation, including 24 patients with respiratory distress syndrome, underwent ligation of patent ductus arteriosus (PDA) due to being unresponsive to medical treatment. Ten patients died postoperatively mainly from intracranial hemorrhage and necrotizing enterocolitis. Surviving 26 patients were examined for developmental sequelae based on questionnaire survey. One infant died of respiratory failure secondary to severe bronchopulmonary dysplasia 28th month after operation. We found no evidence of recurrent ductal patency following ligation during the follow-up period. Twenty four patients exhibited normal motor and mental development to attend the ordinary elementary school everyday, but one patient shows mental retardation. Most of patients suffered from the frequent upper respiratory infection in childhood to require rehospitalization. There are no patients with hoarseness, but 2 patients developed funnel chest and one required the operation. One third of the patients had ophthalmological handicap (myopia or strabismus). Surgical ligation of PDA in premature infants seems to reduce the duration of postoperative mechanical ventilation and the incidence of bronchopulmonary dysplasia. Analyzing long-term follow-up indicates that infants who undergo PDA ligation grow almost normally and do not appear to be at increased risk for sensorineural handicaps. Therefore we emphasize that surgical ligation of PDA is an effective and appropriate treatment of choice for significant PDA in premature infants.