Each medical specialist certification system in internal medicine and its subspecialities was founded and controled byeach medical society, but not by the public. Thus, each system had not been harmonized each other, and not recognizedas the public system until the the Ministry of Health, Labour and Welfare (MHLW)'s declaration of permission for publicnotification of each certificated medical speciality when approved according to their criterion. Based on the longstandingdiscussion and negotiation in the special committee on internal medicine of the Japanese Board of MedicalSpecialist, on the other hand, the Japanese Society of Internal Medicine (JSIM) and the societies of subspecialities in theinternal medical fields agreed to build up the so-called 2 stair-system as the framework of medical specialist certificationsystem, where the Certified Member of the JSIM is inevitable for application or renewal of the Fellow of the JSIM andother certifications of medical specialist of the internal medical subspecialities. In face to the new compulsory postgraduateclinical training system with super-rotation for 2 years starting from 2004 fisical year, JSIM decided that 2 yearpostgraduate clinical training is included to the 3 year training period necessary for the application of the Board CertifiedMember of JSIM, because clinical training with super-rotaion system aimed to master the capability of primary medicalcare is recognized to be also an essential part of the training program for internists. For the better medical specialist certificationsystem in the future, the Japanese Board of Medical Specialist should be approved to be the public and independentorganization for quality control of Japanese medical specialist certification system as a whole to improve medicaland welfare quality which fit for the requirement of Japanese people in the 21th century.

A 66-year-old woman had hypertensive heart failure and intermittent claudication due to coarctation of the aorta with severe calcification. Consequently, axillo-bilateral iliac artery bypass was performed. Postoperatively, the difference in blood pressure between the upper and lower limbs decreased, the heart failure improved, and the intermittent claudication disappeared. The postoperative course was uneventful and the patient was discharged without complication 15 days after surgery. There are many case reports of aorto-aortic bypass for this disease ; however, axillo-bilateral iliac artery bypass is an effective and less-invasive procedure. On the other hand, from the perspectives of long-term graft patency and abdominal visceral perfusion, careful postoperative follow-up of upper and lower limb blood pressure and renal perfusion is necessary.

A 72-year-old man presented with low back pain, intermittent claudication, atrophy of the muscle of the lower extremities, and impotence. Laboratory tests revealed inflammation, and computed tomography showed an abdominal aortic aneurysm with severe stenosis of the terminal aorta. Consequently, we diagnosed an infected aortic aneurysm and antibiotics were administered intravenously. Bacterial culture of the blood on admission demonstrated Listeria monocytogenes. On day 27 after admission, in situ replacement with a rifampicin-soaked vascular prosthesis and omentopexy were performed. After the surgery, intermittent claudication, atrophy of the muscles of the lower extremities, and impotence improved dramatically. The postoperative course was uneventful. Antibiotics were administered for a long period, and the C-reactive protein levels decreased to a normal range. For 18 months thereafter, the patient has been doing well without any sign of infection.

A 90-year-old man was referred to our hospital for lower abdominal pain and ecchymotic discoloration around the anus. A laboratory test revealed severe anemia (hemoglobin level, 5.7 g/dl), and computed tomography (CT) showed a ruptured left internal iliac artery aneurysm (diameter, 60×44 mm). Consequently, emergency endovascular stent-grafting treatment was performed. Under local anesthesia, the stent-graft was successfully inserted in the left common and external iliac arteries, covering the ostia of the internal iliac artery. A follow-up CT scan showed complete thrombosis of the left internal iliac artery aneurysm and no evidence of an endoleak. After the procedure, the patient was treated with hemodialysis for acute-on-chronic renal failure and was discharged after 2 months.

A 73-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm (TAAA). Computed tomography (CT) showed a ruptured saccular TAAA (maximum diameter, 70 mm) located just above the celiac trunk. The patient chose to undergo endovascular repair because of the high risk associated with conventional repair, so an emergency endovascular stent-graft treatment was performed. The collateral pathway from the superior mesenteric artery (SMA) to the celiac branches via the pancreaticoduodenal arcades was confirmed by selective angiography of the SMA before stent-grafting. The stent-graft was successfully deployed just proximal to the origin of the SMA with intentional coverage of the celiac axis to achieve sealing. Postoperatively, the patient was free from abdominal organ disorder or paraplegia/paraparesis and was discharged from the hospital after 36 days procedure. Follow-up CT scans performed at 1 week, month and 6 months showed patency in the SMA and the celiac branches, and there was no evidence of an endoleak. A less invasive endovascular repair procedure such as this can be an alternative treatment of a ruptured TAAA.

A 62-year-old woman presented with acute chest pain. An enchanced CT scan showed type A closing aortic dissection. An ulcer-like projection (ULP) was observed in the abdominal aorta above the superior mesenteric artery on aortography. At 3 months after onset, recurrent chest pain appeared. An enchanced CT scan showed a false lumen in the ascending aorta and a new ULP and localized false lumen were opacified in the distal ascending aorta on aortography. The graft replacement of the ascending aorta was performed using open distal anastomosis under circulatory arrest and retrograde cerebral perfusion. Two intimal tears were found in the aortic root and distal ascending aorta. The patient recovered without complications. Postoperative CT scan and aortography revealed no residual false lumen.

This study was intended to examine the specific nature and an aerobic value of jumping jacks (Fig. 1) which has a greater movement in shoulders and is easy to perform in standing position without specific skill and equipment and in also a narrow place.
Individual's self-selected (free) tempo in jumping jacks was determined for 92 subjects by administering it for 5 minutes.
The optimal tempo was obtained from measuring energy expenditures on two subjects when they performed five minutes of jumping jacks at each tempo of 50, 60 and 70 times/min and also at one's free tempo. Exercise intensity of jumping jacks as a general endurance activity was determined from energy expenditures and % Vo₂2max of 9 subjects who performed 5 minutes of jumping jacks at 60 times/min. Training effect of jumping jacks was examined on the basis of the changes in Vo₂max and heart rate (jumping jacks at 60 times/min for 3 min) before and after one month of training on 7 subjects who participated 180 jumping jacks at free tempo a day, averagely 6.3 times a week. Subjects were all college male students aged between 18 and 22. Followings are the results obtained in this study.
1) Individual's self-selected (free) tempo in jumping jacks was about 60 times/min.
2) The optimal tempo in jumping jacks determined on the basis of energy expenditure was also about 60 times/min.
3) Oxygen requirement and RMR at the optimal tempo (60 times/min) in jumping jacks were 40.9 ml/kg/min and 12.3, respectively. Percent Vo₂max, Oxygen requirement and RMR in jumping jacks was smaller for persons who have greater Vo₂max/body weight.
4) One month of training by jumping jacks demonstrated significant increases in Vo₂max and Vo₂max/body weight, which were 2.59 to 2.751/min (p<0.01) and 43.5 to 46.1 ml/kg/min (p<0.05), respectively. Significant decreases in heart rate were also observed during and recovery after the exercise.
5) From above results, jumping jacks could be used as an effective general endurance exercise, provided that some necessary modifications should be made according to each individual's fitness level.

A 72-year-old man presented with low back pain, intermittent claudication, atrophy of the muscle of the lower extremities, and impotence. Laboratory tests revealed inflammation, and computed tomography showed an abdominal aortic aneurysm with severe stenosis of the terminal aorta. Consequently, we diagnosed an infected aortic aneurysm and antibiotics were administered intravenously. Bacterial culture of the blood on admission demonstrated Listeria monocytogenes. On day 27 after admission, in situ replacement with a rifampicin-soaked vascular prosthesis and omentopexy were performed. After the surgery, intermittent claudication, atrophy of the muscles of the lower extremities, and impotence improved dramatically. The postoperative course was uneventful. Antibiotics were administered for a long period, and the C-reactive protein levels decreased to a normal range. For 18 months thereafter, the patient has been doing well without any sign of infection.

Background: Acute lower respiratory tract infection, mainly pneumonia, were the main reasons cause death for children under 5 years old. Objectives: Determine the isolated rate of bacteria inpatients under 5 years old with acute lower respiratory tract infection in Ha Noi and antibiotic resistance of pneumococcal isolated form patients. Subjects and method: Patients under 5 years old with acute lower respiratory tract infection in National hospital of pediatrics and Bach Mai hospital from 01/2002. Using quantitative culturedand PCR method. Results: Out of total 164 patients with lower respiratory tract infection, there were 91 diagnosed pneumonia by chest X-ray, 73 cases of acute bronchitis. 73,6% of the pneumococcal isolated were penicillin resistance (gPRSP) with different genes such as pbp 1a+2x+ab. Most of the S.pneumoniae strains were serotype 19F or 23F. There were no statistic differences by comparison charactersistics of weight, vessel, subclinical symptoms such as: dissolved oxygen level (S\xac\xacp\xac\xac\xac\xacO\xac2\xac), the amount of leucocyte in blood. However, temperature of pneumonia patients was higher than bronchitis patients, breathing of pneumonia patients was also faster than bronchitis patients. Isolated bacteria with amount \ufffd?106 cfu/ml was H.influenzae, S.pneumoniae and Moraxell catarrhalis in pneumonia group, bronchitis group was 28,8% and control group was 17,1%. Conclusion: Penicillin, erythoromycin and co-trimoxazole resistance rate of S.pneumoniaein patients with acute lower respiratory tract infection was high. Quantitative cultured method has prognostic value in diagnosis pneumonia.
Genes ; MDR/ drug effects ; immunology ; Streptococcus pneumoniae/ growth & ; development ; Anti-Bacterial Agents