The effects of the gravitational potential energy change (GPEC) and the thermal stress on finger microvascular responses were studied by laser Doppler and ultrasonic Doppler flowmetry. Seven healthy male subjects, aged 21 to 31 yrs, participated in the experiment after giving their informed consent. The hand was moved upward (about 60 cm) or downward (about 55 cm) from the heart level to change the vascular transmural pressure of the finger (GPEC) . Sensors of laser Doppler and ultrasonic Doppler flowmeters were attached to the lateral side of the first finger and the skin surface over the radial artery, respectively. Experimental room temperature was maintained at 24°C. Laser Doppler flow (LDF) was decreased at an elevated and lowered arm position. The pulsatile component of LDF, evaluated by the difference between systolic and diastolic LDF, increased when the arm was elevated, but it showed no significant changes when the arm was lowered. Mean blood velocity (MBV) and diastolic blood velocity (DBV) of radial artery decreased when the arm was elevated, whereas the pulsatile blood velocity (PBV), evaluated by the difference between systolic blood velocity (SBV) and DBV, were increased. At the lowered arm position, SBV and PBV decreased significantly, but DBV showed no significant changes. The thermal stress (43°C, 10 min) increased the PBV when the arm was elevated, but the PBV diminished the decreasing rate when the arm was lowered.
These results suggest that the measurements used may be useful for the analysis of arteriolar compliance and microvascular response to the change of transmural pressure pro-duced by the gravitational potential energy change.

In addition to the histological study of tendon blood circulation, high level of resting blood flows have been functionally observed in the in-vivo tendon tissue preparation. Interest has been directed to investigate the phenomenon from the measurement of tendon tissue Po2 changes which may indicate the activity of capillary blood flow. Simultaneous measurements were done in tendon synovial fluid, tendon and muscle tissues of the 15 rabbit hindlimbs, in conditions of hypoxia and hyperoxia. Continuous measurements of tissue Po₂ were performed by polarographic method using a pair of the wire platinum electrode (80μm in diameter) with polymer membrane to the indifferent silver electrode. Average Po₂ of tendon synovial fluid, tendon fiber and muscle tissues at rest (mean±SD, n) were 37.36±24.32 (10), 30.96±14.72 (10) and 19.54±8.05 (8), respectively. These data increased gradually to the maximal level of 45.46±27.46 (10), 39.23±16.23 (10) and 25.96±9.77 (8) after cutting of sciatic nerve. Reactive hyperemia-like Po₂ increase immediately after release of femoral arterial occlusion was observed neither in tendon synovial fluid nor in tendon tissue. There was no significant difference between each other of tissues in the process of Po₂ increase during oxygen intake and the decrease after cessation of oxygen flushing. During exercise, a marked decrease of Po2 was obtained in muscle, but not in tendon synovial fluid.
These data indicate that high level of Po₂ in tendon and the surrounding tissuse may have some oxygen supply channels including segmental blood supply system with a short length of and/or a large size of capillary.

A study was designed to determine the effect of cooling down and massage on lower leg volume after heel-raising exercise in men. The subjects were six healthy athletes ranging in age from 18 to 23 years. Lower leg volume was measured at rest and after heel-raising exercise using Lundvall's volumetric method with a water-filled“boot”. Ten minutes of rhythmic heel-raising, performed at 45 times per minute, was monitored continuously using a mech-anograph.
Immediately after the end of exercise, each subject lay in a relaxed supine position and the leg was raised to 45 degrees. A cuff was then attached around the thigh, and the cuff pressure was increased to occlude the leg circulation. The leg volume was then determined in a standing position. After the first measurement of the lower leg, three kinds of treatment were applied for each subject (no treatment, one minute walking : total seven minutes, one minute massage : total five minutes) .
The results obtained were as follows ;
1) The slopes of the recovery curve of lower leg volume were more gentle with no treatment than with cooling down and massage.
2) The time constant (min) obtained from the decreasing curve of lower leg volume after heel-raising exercise was 10.2 for no treatment, 9.4 for cooling down and 6.4 for massage.
3) The total fluid accumulation volume in the lower leg (ml/l lower leg) following heel-raising exercise was 450.9 for no treatment, 288.9 for cooling down and 198.6 for massage.
It is suggested that such a disappearance of fluid accumulation in exercising muscles of the lower leg following cooling down and massage is due to a mechanical pump action against the surrouding local skeletal muscle tissues.

Background：Although octreotide is effective in the relief of symptoms of gastrointestinal obstruction, it is also effective for gastrointestinal bleeding. It has been reported that octreotide reduced the splanchnic blood flow, and reduced the bleeding from esophageal varices, peptic ulcer and the tumor of gastrointestinal tract. We experienced four cases of end―stage cancer patients admitted to a palliative care unit whose symptoms of gastrointestinal bleeding were alleviated by octreotide（300μg／day）. Case：Case 1；A 75―year―old woman with gastric cancer developed melena and received octreotide. After octreotide was discontinued, melena and hematemesis recurred. Octreotide was restarted subsequently, and hematemesis resolved. Case 2；An 87―year―old woman with gastric cancer received octreotide for increase of bloody drainage from a stomach tube. She had epigastric pain and emotional distress from the blood. These symptoms were alleviated following the administration of octreotide. Cases 3 and 4；A 76―year―old man with gastric cancer and a 62―year―old man with bile duct cancer received octreotide for massive vomiting of blood. After the administration of octreotide, there was no reoccurrence of hematemesis in both patients. Conclusion：Octreotide may alleviate symptoms of gastrointestinal bleeding in end―stage cancer patients.

Skeletal muscle is comprised of multiple fiber types. Slow-twitch oxidative muscle fibers have greater capillary density compared with fast-twitch glycolytic fibers of skeletal muscle. To gain insight into the molecular mechanism underlying the difference of capillary density, we investigated whether the basal gene expression of vascular endothelial growth factor (VEGF), a major angiogenesis-related factor, and its transcriptional factors (hypoxia-inducible factor-1α, transforming growth factor-β1, c-jun, and c-fos) differs between these two fiber types of rat skeletal muscle. The mRNA expression of VEGF and its transcriptional factors was significantly higher in slow type fiber of muscle (soleus muscle) compared with fast type fiber of muscle (plantaris and tibialis anterior muscles). These results suggest that the difference of basal gene expression of VEGF and its transcriptional factors between slow and fast fiber types of skeletal muscle may partly contribute to the difference in capillary density between these two fiber types.

The effect of changes in vascular transmural pressure upon differential digital plethysmogram (delta DPG) was studied in seven normal subjects. Changes in vascular transmural pressure were produced by the gravitational potential energy change (GPEC method) of an extremity from the heart level. Delta DPG which was characteristic of stability, discrimination and low speed record by modified devices was applied for the experiments including postural, static and dynamic exercises. Room temperature during experiments was kept constant. The Delta DPG-P wave amplitude in maximal elevation of upper and lower extremities (mean±S. D., n) increased to 162.3±33.5% (38) and 176.7±33.4% (12), respectively, and that in maximal lowering of upper and lower extremities decreased to 36.9±10.5% (35) and 37.5±12.6% (15), respectively. These data reveal that the GPEC method may be useful for the determination of arteriolar sensitivity in humans.

The patient was a 61-year-old male, who underwent thoracoabdominal aortic aneurysm repair with Gelseal Triaxial prosthetic graft 2 years previously. False-aneurysm due to prosthetic graft dilatation was diagnosed. The direct closure of the ostium of the disruption of the anastomosis was successfully performed by an emergency operation. The postoperative course was uneventful. This case suggests that prosthetic graft dilatation may cause false-aneurysm at the site of end-to-side anastomosis.

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.
2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.
3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

Purpose: We report a case in which oral sodium valproate through a percutaneous endoscopic gastrostomy (PEG) tube for palliative decompression drainage in inoperable ileus achieved an effective drug concentration and ameliorated delirium and extrapyramidal side effects. Case Report: The patient was a male in his seventies who suffered from bladder cancer. He underwent PEG because of paralytic ileus with cancerous peritonitis. He had been receiving continuous intravenous infusion of haloperidol for the management of delirium, but needed to discontinue treatment with this agent due to tremor, an extrapyramidal side effect of haloperidol. Oral sodium valproate was therefore administered through the PEG tube for palliative decompression drainage. Plasma valproate concentrations showed effective levels, and his irritability was relieved. A good combination of sodium valproate and quetiapine fumarate allowed successful reduction of and eventual withdrawal from haloperidol, and tremor then improved. Conclusion: We often encounter difficulty with symptom control for patients who cannot use oral medications. When medication by other routes is difficult, this case suggests that sodium valproate through a PEG tube for palliative decompression drainage may be useful as a last resort for improving delirium.