Percutaneous endoscopic gastrostomy (PEG) is a common procedure for placing a feeding tube in the stomach to provide fluids and nutrition to patients who have difficulty in swallowing or in taking enough noutrishment through the mouth. Thought the procedure is simple and easy, PEG is not without its risks. The reported complication ratio is not low-, -between 5.7% and 33.3%. This is probably because the patients are lacking in reserves of physical faculties.The present study was conducted to work out measures to reduc the incidence of PEG complications by reviewing the complications cases treated in our hospital.From March 1997 to December 2005, we performed PEG on 110 patients, of which 11 patients (9.6%) had complications. In some cases, we inadvertently perforated the colon. From our experience, we have learned that it is not safe to perform PEG with the aid of radiography alone on cases in which the intervention of the transverse colon between stomach and abdominal wall was suspected by CT scan, and concluded PEG should be done using gastrography of the transverse colon, to guide the placement of a feeding tube in the stomach. In view of the systemic condition of the patients, we thought it necessary to take safety measures by all possible means.
Percutaneous endoscopic gastrostomy ; Complications Specific to Antepartum or Postpartum ; Stomach ; Management ; Prevention

Lipolytic activity of adipose tissue with age has been widely investigated by many authors. There are differences on the conception of intrinsic lipolytic activity of a cell changed with aging. Since lipolytic activity has been expressed by amount of FFA release per wet weight, per triglyceride or per protein, increase of triglyceride or wet weight seems to be a main factor to affect on it. It is of interest, therefore, to investigate the intrinsic lipolytic activity of adipose tissue with aging from the relationship among FFA release, wet weight, protein and triglyceride content in adipose tissue.
In the present paper, we investigated effect of aging on lipolysis by using epididymal adipose tissue in 29, 35, 43, 57, 105 and 350 days rats. Rats were anesthetized by intraperitoneal injection of pentobarbital sodium (4mg/100g body weight) and after that epididymal adipose tissue were removed and washed out the blood by 25°C Krebs-Ringer solution. The fat pads were placed in glass bottles containing Krebs-Ringer bicarbonate buffer solution (pH 7.2-7.4), bovine serum albumin (4°C/ w/v) and epinephrine (3.9 pM/ litre) . Incubations were carried out in a shaking water bath for 120 min at 37°C under an atmosphere of 95% O₂-5% CO₂. Rate of lipolysis were determined by assaying the production of free fatty acids. Free fatty acids were titrated by Dole's method. Triglyc-eride and protein content in fat pads were assayd by Stern and Shapiro's method and Lowry's method, respectively.
The following results were obtained
1) Triglyceride-to-wet weight ratio and triglyceride-to-protein ratio in the adipose tissue corresponded to age (days) remarkably increased between 35 days and 43 days rats. However, after that, triglyceride-to-wet weight ratio was unchanged up to 350 clays rats.
2) Maximum lipolytic activity of adipose tissue in rats with aging was observed at 29 days in the range studied and after that its lipolytic activity decreased with aging. This decreased phase of lipolytic activity seemed to be divided into two phases : one was fast decrease phase which was observed in the rats before 43 days, and the other was slow decrease in the rats after 57 days.
3) Relationship between lipolytic activity and triglyceride-to-protein ratio in adipose tissue during aging showed inverse curvelinear relation, and it was found that lipolytic activity of adipose tissue was extremely inhibited at triglyceride-to-protein ratio more than ten.
From these results, we assumed that increase of triglyceride content in adipose tissue was related with the decrease of lipolytic activity during aging and that the lipolytic activity of adipose tissue would be enhanced with decrease in triglyceride-to-protein ratio inversely.

34 male rats (13 weeks old) were used in this experiment. 11 rats were at rest and 23 rats were loaded to run on a treadmill with 2 degree slope at a speed of 25m/min. Relation between quantities of blood substances (plasma glycerol, blood lactate and plasma free fatty acids ; FFA) and lipolytic activity of epididymal adipose tissue was studied to clarify a mechanism of lipolysis of the adipose tissue in the exercise.
1) Plasma FFA and glycerol began to increase in parallel at 30 min after the run, but at exhaustion only plasma glycerol enhanced.
2) Blood lactate increased at 10 min after the run and more at exhaustion.
3) Basal lipolytic activity of epididymal adipose tissue in vitro was not influenced by the run, while norepinephrine induced lipolysis of the adipose tissue decreased with lapse of running time. Relation between plasma FFA and lipolytic activity of epididymal adipose tissue was inverse during the run.
4) There was also inverse relation between blood lactate and lipolytic activity of adipose tissue induced with norepinephrine. From these results, it is assumed that the increase of plasma FFA during the exercise was not resulted from the increase of lipolytic activity of the adipose tissue stimulated with only norepinephrine and effects of other hormones (ACTH, Glucagon, Growth hormone and etc.) and their interactions on the lipolysis might be considered.

Triglyceride contents of liver, heart muscle and skeletal muscles (rectus femoris, tibiaris anterior, soleus, plantaris and extensir digitrum longus) were determined on 1, 3.5, 14, 18 and 21 months-old rats, and especially on 14 and 21 months-old rats composition of triglyceride fatty acids was analyzed and interrelation of these triglyceride contents with aging of rats was studied quantitively and qualitatively. Following results were obtained
1) Changs in liver and muscular triglyceride contents appeared on 14 months-old rats and were significant increase at 21 months-old rats.
2) Liver triglyceride content significantly decreased at 21 months-old rats (p<0.05) .
3) lrriglyceride contents of tibiaris anterior and extensor digitrum longus muscles were mostly unchangeable through the aging of rats.
4) But triglyceride contents of soleus, rectus femoris and plantaris muscles in 21 months-old rats significantly increased (p<0.05) and the individual difference was great.
5) In composition of triglyceride fatty acids, increase of C₁₈, C_18-1, C_18-2 and C_18-3 was observed in epididymal adipose tissue, soleus and rectus femoris muscle on 21 months-old rats, but in extensor digitrum longus and tibiaris anterior muscles.
From these results, changes of tissue triglyceride contents with aging of rats are different in each tissue and increase of triglyceride content is present with qualitative changes in composition of triglyceride fatty acids, increase of long chain and unsaturated fatty acids, and organic specificity, which is related to the functional changes with aging of rats is considered.

We have developed the new dynamometer to measure twist strength of upper limbs that was not investigated sufficiently before. This dynamometer can measure both twisting hold strength and torque at a time. Therefore, it can be applied to motion analysis at demonstrating muscle strength. Both development curve of the age group's average of the average hold strength of left and right hand { (LH⋅HS+RH⋅HS) /2} and the average twisting hold strength of left and right hand { (LF⋅HS+RF⋅HS) /2} showed the peak of development in man's thirties and in woman's twenties-thirties and then marked depreciation gradually with ageing. The average torque of forward twisting of left hand and that of right hand { (LF⋅T+RF⋅T) /2} showed the same tendency in respect of the peak of development too, but woman's curve showed the peak in twenties different from that in man and then didn't mark depreciation remarkably. From the analysis with respect to twisting motion by the subjects of right handedness, we have recognized that the twisting hold strength of right hand by the action of left or right forward twisting (LF·RH·HS, RF·RH·HS) is greater than that of left hand (LF·LH·HS, RF·LH·HS), the torque of forward twisting of left hand (LF·T) is greater than that of right hand (RF·T) and that the hand of back twisting supports the grip-torque dynamometer from the result of EMG. Therefore, we can understand that the stronger torque is generated by the motion of forward twisting of left hand which can support stronger than by that of right hand. But we have recognized too that the average hold strength and the average torque correlate to one another closely. Therefor, we can understand that it requires the stronger hold strength to generate the higher torque.

1) Children's data (10-18 years old) of back strength, height, grip strength and running long jump from data book of Japan Education Ministry (1964-1981) were analyzed. Back strength was mainly studied and was compared with other data (grip strength etc.) . The groups with high average values for back strength at 10-14 years old did not necessarily show high values for back strength at 17 years old, or vice versa. Values for back strength at 10-14 years old were not significantly correlated with those at 17 years old.
2) Using the data from data book mentioned above, tension of deep back muscle (FMUS) was calculated based on kinetic models (FMUS. I, II, III) . Calculated FMUS values were 3-5 times larger than measured back strength values at each age.
3) Relative change of back strength and FMUS in 1964-1981 were compared. All values for back strength were lower than those for FMUS except in 1967. During the late 1960th and the 1970th, average back strength values gradully decreased, but the decrease of FMUS was less obvious than that of back strength.
4) Based on the data of 422 children (7-12 years old, male and femele), values of diaphragm area were approximated with some assumptions, and then FMUS values were calculated. FMUS values calculated by approximate diaphragm area were significantly larger than those calculated by constant diaphragm area (465 cm2) .
The figure for getting FMUS values easily was offered to avoid troublesome calculation. This consists of two graphs, and one can read FMUS values with reasonable precision. Parameters needed for getting FMUS values are sexuality, height, body weight and back strength.

Since manifestation of exercise proteinuria was reported by Leube (1878), the nature of exercise urinary protein has been extensively studied. The physiological mechanisms of increased excretion of urinary protein during and after exercise still remain to be obscured. The investigation presented here, were performed for the purpose of knowing the decreasing rate of soccer players body weight in each position during the soccer game, which was considered as a prolonged heavy exercise, of identifing the excretion of exercise proteinuria after performance of the game, and of studying the relation among urinary total protein at that time and its fraction in disc-electrophoresis.
The protein fractions of urine by disc-electrophoresis, compared with serum, manifested slight albumin fraction at rest, but it much increased after the game, and furthermore α₁-, α₂-globulin, transf errin and γ-globulin were observed.
The decreasing rate of body weight, total protein level and its albumin fraction mutually have the parallel relationship. Urine albumin fraction could have a relation to the decrease of body weight of athlete in each position rather than total protein.
These results mentioned above would suggest the exsistence of some relationship between the total volume of exercise and excretion of urine protein, especially albumin.

For adult rats fed on the following six kinds of diets for about 80 days, intermediate metabolic substrates in serum, liver and skeletal muscle were determined. The components of feeding diet are as follows:
1. STANDARD DIEF : 18% protein, 100 oil & 65% dextrin.
2. HIGH PROTEIN-HIGH FAT DIET: 29% protein, 25% oil & 39% dextrin.
3. LOW PROTEIN-LOW FAT DIET: 9% protein, 2% oil & 82% dextrin.
4. STANDARD DIET modified with choline chloride & vitamin B, C & E.
5. HIGH PROTEIN-HIGH FAT DIET modified with choline chloride & vitamin B, C & E.
6. LOW PROTEIN-LOW FAT DIET modified with choline chloride & vitamin B, C & E. (reference : 1, 2, 3 ; due to National Institute of Nutrition)
As the results increase of body weight was the least 3rd diet group, and by addition of choline chloride (above 4th, 5th & 6th diet groups) it were generally inhibited. Especially the latter phenomenon was remarkably observed in 6th diet group. Although intermediate metabolic substrates in skeletal muscle were no difference from their control levels, triglyceride and cholesterol of liver reduced also in 4th, 5th & 6th diet group, and FFA level of it increased on contrary. The triglycerides of interscapular brown fat and white fat of epididymis reduced in 4th, 5th & 6th diet groups. Furthermore, increase of triglyceride, FFA and cholesterol in serum observed in above 4th, 5th & 6th diet group, which will suggest that they might be removed from brown or white fat and choline chloride might play an important role of lipid-releasing effect from those tissues.

Teaching ambulatory-care medicine is essential for primary-care education. However, few studies of ambulatory-care training have been done in the past decade. We performed a nationwide survey to examine whether and how ambulatory medicine is taught to medical students and residents. We sent questionnaires to all medical schools (n=80) and accredited teaching hospitals (n=389) in February 2001. The response rates were 83.3% and 79.2%, respectively. Fifty-one (78.5%) of the 65 medical schools provided ambulatory-care education, although the programs varied considerably from school to school. Only 104 teaching hospitals (26.7%) had an ambulatory-care training program.

Although postgraduate training in an ambulatory care setting is recognized as beneficial in Japan, such training has not been widely implemented. In April 2001 we surveyed all 389 accredited teaching hospitals in Japan about their ambulatory care training. We asked 1) whether they provide a postgraduate training program in ambulatory care, particularly for problems commonly encountered in primary care settings, 2) if such a program was provided, how it was organized, and 3) if such a program was not provided, what the reasons were. One hundred eighty physicians responsible for the residency programs of 120 hospitals replied (response rate, 87%). Most residents at these hospitals see patients in outpatient clinics regularly during their training. Many faculty members supervise their residents at the outpatient clinic and also see their own patients. Sixty-eight percent of the respondents did not set teaching objectives for ambulatory care training. Frequently mentioned barriers to providing ambulatory care training were limited space and tight outpatient schedules. To promote postgraduate ambulatory care training in accredited teaching hospitals, adequate resource allocation and a national policy are needed.