Objective : We analyzed changes in the affected side motor function according to the region and severity of motor paralysis in patients during convalescent rehabilitation. Methods : The subjects recruited were 1,903 hemiplegic patients with primary stroke from a supratentorial unilateral lesion, for which a full-time integrated treatment (FIT) program was implemented. We excluded patients with severe complications, those in whom the stroke recurred or its condition rapidly changed during hospitalization, and those in whom the duration from the onset to admission to our hospital was 61 days or longer. The remaining 1,634 patients served as the study subjects, from among whom we chose 917 patients who had been hospitalized for 8 weeks or longer. The affected side motor function was assessed using 5 motor items of the Stroke Impairment Assessment Set (SIAS) every 2 weeks starting from admission. Results and Conclusion : The affected side motor function significantly improved from admission to a convalescent rehabilitation ward through to week 8 in stroke patients, who were actively engaged in daily routines and had mainly walking and ADL exercise. In addition, improvement was more likely to occur for the lower-limb compared to upper-limb, as well as for the proximal compared to distal motor function. This tendency was more marked for more severe cases of paralyses.

Persistent fifth aortic arch has been thought to be rare but often relevant to systemic circulation, however when it connects to the pulmonary artery (PA) in pulmonary atresia, it may be the sole arterial supply to the lung. This report describes a case of rare arch anomaly including right aortic arch (RAA), PA sling in conjunction with persistent left fifth aortic arch (PLFAA) and left subclavian artery arising from the left fourth arch. The tetralogy of Fallot, pulmonary atresia, and total anomalous of pulmonary venous connection (cardiac) were also diagnosed. A neonate was referred to our hospital for surgical treatment of cardiac and extracardiac anomalies. Persistent fifth aortic arch connecting with pulmonary artery was initially thought to be patent ductus arteriosus (PDA), so prostaglandin E 1 administration was commenced. He underwent emergency colostomy for anal atresia. Subepiglottic tracheal stenosis was diagnosed at initiation of anesthesia. At age 1-month-old, he required systemic to pulmonary shunt and reimplantation of left pulmonary artery through a median sternotomy using extracorporeal circulation. At the operation the PDA was divided and oversewn, and the wall structure was the same as that of a normal artery. The left pulmonary artery behind trachea was dissected and we then cut away and reimplanted to pulmonary trunk. Tracheostomy was performed at the age of two months. With the technical development of diagnostic imaging, the morphological features of arch anomaly were clearly demonstrated, but some understanding of embryological aspects are still required for diagnosis.

Horseshoe kidney is an unusual abnormality occurring in 0.25% of the population. In surgery for AAA with horseshoe kidney, reconstruction of aberrant renal and preservation of renal isthmus is important. We report 3 cases of AAA with horseshoe kidney treated successfully without division of the isthmus.

High-quality terminal care cannot be given without good communication and understanding among patients, their family members and health as well as medical professionals.Recently, we have taken a questionnaire survey on new inpatients in our hospital to sound them out on their thinkings about hospital care, and examined the findings along with the validity of survey.Many respondents including those contracting either benign or malignant diseases wished to be keptposted on what they are really up against and to partake in the decision-making process before treatment plans are put into practice. The recent questionnaire survey has proved to be worthwhile as a tool to know the wishes of hospitalized patients and suggested an effective way to promote the practice of obtaining informed consent before specific test and therapautic procedure.

One is inclined to imagine that the incidence of respiratory diseases will be negligible among rural people who live and work in fresh and clean air. On the contrary, however, we have reports on the high incidence of chronic obstructive pulmonary diseases and on the existence of a variety of specific respiratory diseases which are incidental to farm work. To clarify this situation, the Japanese Association of Rural Medicine organized a special study group and carried out various studies with grants from the Ministry of Health and Welfare. This is the study group's summary report of the four year research project prepared in conclusion of the project.
The actual state of respiratory diseases among rural people, as investigated by the present study group, can be summarized as follows:
1) In rural districts, in spite of its freedom air-pollution, there exist in high percentages people suffering from respiratory symptoms and patients of obstructive pulmonary diseases. As the important cause of this phenomenon, farm operations, especially thrashing, rice-hulling, compost preparation, scattering of agricultural chemicals can bementioned, which invite the development of symptoms and their aggravation.
2) Pathologically, farmer's pneumoconiosis attributable to farm operation dust was evidenced, crying for the necessity of dust prevention measure during farm operations.
3) In connection with atopic asthma the study group proved the antigenicity of rice-straw, wheat-straw, celiae of tea-sprout, young leaves, and chrysanthemum leaves. There are also anumber of already known antigens. It is necessary to establish measures for its prevention and treatment.
4) In rural districts of Japan, esp. in stock-raising farm houses, there are in comparatively high percentages those who react positive to fungous antigens which are the causes of farmer's lung. However, there have hitherto been reported only two cases, and the study group added one more. In the future, more extensive practice of immunological tests and clinical follow-ups of the positive cases will be necessary.
5) In view of the results reported above, it is considered that there are numerous questions concerning respiratory troubles and diseases in rural districts which are awaiting further study.