The time constants of beat-by-beat heart rate decay for the first 30 seconds (T30) after exercise is a specific index for the vagally mediated component of heart rate recovery. The aim of our study was to determine whether cardiac rehabilitation (CR) can accelerate T30 in patients after coronary artery bypass grafting (CABG) . Thirteen male patients who underwent CABG (aged 60.5±7.7years) were assigned to 7-21 day Phase I CR. Exercise training consisted of 30 minutes of aerobic exercise (bicycle ergometer) at the anaerobic threshold 2 times per day. T30 was measured as the heart rate decay regulated in patients who rested immediately after 5 minutes of pedaling exercise. After CR, T30 significantly improved from 413.3±129.7 to 300.1±124.5 sec (p<0.01) . Peak oxygen uptake (peak V02: 14.0±4.0 16.7±3.2mlin/kg: p<0.01) and heart rate at anaerobic threshold (HR @ AT: 111.9±13.4 103.6±11.7 beatsin: p<0.01) also improved significantly. There was no correlation between ΔT30 (Δ: difference before and after CR) and Δpeak VO₂or ΔHR @ AT. These results suggest that CR for patients following CABG accelerates vagally mediated heart rate recovery after dynamic exercise.

With respect to statistics on out patients with senile psychiatric disorders, a few reports have thus far been made available by university hospitals in major urban areas but none from any rural general hospitals. This study is an attempt to grasp the real status of senile psychiatric disorders as observed in outpatient clinics.
1) There have been signs for a yearly rise in the prevalence rate of senile psychiatric diseases, and there is the possibility of diagnosing new patients at a rate of one to six aged people (60 years of age and over).
2) Of all the patients, 45% came directly to our hospital, whereas 55% either were referrals from other clinics or came to the hospital after their consultation with other clinics. Of the latter group, 55% were referred by other departments of the hospital, 38% by outside physicians in our district, and 7% by local administrative offices. This finding appears to suggest that the incidence of hypertension and other somatic complications is high among aged people and also that phsychiatric disorders may sometimes manifest due to somatic disorders.
3) A check of the prevalence by month reveals that the prevalence is highest in March, high from spring to summer, lowest in autumn and low in winter. In this respect, there exists a difference between the organic diseases and the functional diseases. In the former group, the prevalence is concentrated in spring and summer, whereas in the latter, the prevalence remains high from spring to early summer, low in summer and transiently becomes high in early autumn.
4) By sex, the prevalence rate is 52% for males and 48% for females. By age, the prevalence decreases with age and takes a sharp downturn after the age of 75.
By type of disease, senile organic diseases (Group A) account for 54.4%, functional diseases (Group B) 40.0%, and other organic diseases (Group C) 14.5%. Group A increases with age among males, whereas it is concentratedly high among males of 75 years of age and over. Group C is significantly greater among males.
5) A check of the trend of each disease group in the past 15 years indicates that there have been signs for a rise for each group but the rises are significant particularly for Groups B and C. In the latter half period, the percentage of Group B is greater than that of Group A. Against this background, there seems to be a rise in the incidence of psychiatric diseases among rural females.
6) The hospitalization rate stood at 17.5%. By sex, the rate was 20% for males and 15% for females. By type of disease, the ratio stood at 21% for Group C, 17% for Group A and 16% for Group B.
By place of residence, differences between the towns and the villages (27% for the towns and 9% for the villages) were observed in Group A of females, suggesting that many females in the towns are placed in the circumstances where difficult problems tend to crop up with respect to their matrimony or their sharing the same house with other members of their families. As regards clinical symptoms, it was found that there are many patients with severe auxiliary symptoms, such as delirium, hallucination and paranoid symptoms, in addition to advanced dementia.

  Recently, the diversification of chemotherapy has brought about an increase in the number of outpatients who receive prescription drugs at insurance pharmacies after the intravenous infusion of anticancer agents at hospitals. The problem is that insurance pharmacies do not have ample knowledge of treatment plans and disease stages, and the presence or absence of cancer notification. Moreover, medication regimens, including washout, periods, have become so complicated that patient compliance rates have shown a tendency to decline gradually.
  Such being the circumstances, we have come to think that it would be better to enter into partnership with the dispensary of Senboku Kumiai General Hospital for sharing information in order to give the patients more beneficial medication instructions.
  For a start, we met with the hospital pharmacists, exchanged necessary information and ideas, got acquainted with chemotherapy regimens, and shared the tools of medication teaching. Through the participation in the guidance given by hospital pharmacists to outpatients who began to receive chemotherapy, and lectures on chemotherapy and medication by physicians and hospital pharmacists of the general hospital, we have become able to offer more appropriate counsel to the outpatients. Furthermore, we created a channel between the dispensary and Senboku Chozai Pharmacy for feedback and for asking questions about not only the conditions of the patients but also the presence or absence of cancer notification.
  We believe that our efforts have contributed toward increasing the safety and efficacy of chemotherapy.

Background: Necrotizing fasciitis is a rare but severe condition associated with high mortality. We encountered a patient with severe and rapidly progressing necrotizing fasciitis. Patient: A 40-year-old male was hit by a tractor and received a wide laceration wound spanning the length of his posterior thigh. Soon after the accident, the wound was washed and debridement was performed. Two days postoperatively, we observed septic changes in the wound and diagnosed this condition as necrotizing fasciitis. Consequently, the patient's leg was amputated at the thigh. The patient, however, developed toxic shock syndrome after the amputation. Endotoxin adsorption using a polymyxin B-immobilized fiber column was performed for 2 days. Finally, a hip joint amputation was performed after 11 days, following which the patient's general condition gradually improved. Discussion: Treatment for necrotizing fasciitis should be initiated promptly. Early debridement is associated with a significant decrease in mortality. In severe conditions, endotoxin and cytokine removal by blood purification is one of the most effective treatments. Although group A streptococci are widely known as "flesh-eating bacteria," we should also consider a wide variety of pathogenic organisms to be the probable cause of severe necrotizing fasciitis. Conclusion: Management of necrotizing fasciitis requires careful investigation as well as an aggressive therapeutic approach, which may include urgent surgical intervention. In addition to surgery, endotoxin adsorption therapy should be considered.
Patients ; Fasciitis ; Endotoxins ; Therapeutic procedure ; Amputation

The purpose of this study was to examine effects of moderate-intensity endurance exercise on reactive oxygen species production and leukocyte activation markers in young and middle-aged persons. Blood samples were collected before and after the jogging of 10 km. Although cytokines recruiting and priming neutrophils and monocytes were released into the circulation and functional after the jogging of 10 km, reactive oxygen metabolites-derived compounds (d-ROMs) were not significantly increased. It was indicated that chemokines and leukocyte activation markers at rest were increased with aging, and that might be accompanied by the higher level of d-ROMs in the elderly.

A 52-year-old male was diagnosed as having aortic stenosis secondary to a bicuspid aortic valve associated with Klippel-Feil syndrome. Aortic valve replacement was successfully performed without any problems in the surgical or anesthesiological management. Only five such cases including ours, who underwent cardiac surgery have been reported. It is possible to perform cardiac surgery for patients with Klippel-Feil syndrome of their cardiac function can be well preserved.

This paper discussed the introductory medical training system and medical team care problems at University Hospital of Tsukuba.
The characteristics of this training system are that the duration of training is the fourth year medical students at the University of Tsukuba and to exercise the roles of nursing service at University Hospital.
In this practice, medical students are expected to comprehend about the significance of team work in medical care, to practice in the work of nurses and c-medical workers for learning their roles. We introduce our purpose and practice of this medical team care. Problems of this trial are discussed in this paper. But we have confirmed that this experimental. Trial is useful experience to all medical students and the items of this practical exercise are one of the most effective training method for them.