Many patients who receive general acupuncture treatment have many complaints concerning their autonomic nervous systems. Applying CMI and CMI type classification (Abe method-a variation of CMI) to 100 new patients who came to our clinic last year, we found vegetative dystonia in half of them. Upon this finding, the following examinations were carried out by means of an function test of autonomic nervous system developed by Kageyama et al.: the coefficient of variation (CV) of R-R interval in ECG obtained through the function test is regarded as an expression of vagal function.
(1) Using this test, the participation of the autonomic nervous system in the condition of those patients who visited our clinic was examined.
(2) Effects of acupuncture treatment on the autonomic nervous system were examined.
(3) Acupuncture stimulation was separately applied to S36 (Zusanli), P4 (Ximen) and Liv3 (Taichong) to examine the influence of the acupuncture point location on the CV obtained through the test.
Results:
(1) 15 new patients (25%-comparatively high rate) showed low CV (less than 2%) of R-R interval in ECG.
(2) In some cases, acupuncture treatment caused an increase in CV.
(3) Acupuncture caused pulse infrequens: R-R interval showed a tendency toward prolongation during the in situ needle technique and after withdrawing the needle on each of the three points (S36, P4 and Liv3). CV increased after withdrawing the needle on either S36 or Liv3 and shortly after needle insertion and after withdrawing the needle on P4.
These result suggest that many patients who receive acupuncture treatment have additional disorder in parasympathetic nervous system which can be improved through acupuncture.

Idiopathic normal pressure hydrocephalus (iNPH) is a disorder observed in elderly patients causing gait disturbance, urinary incontinence and cognitive impairment. Due to the rapidly aging society, the number of patients with iNPH continues to increase yearly. However, iNPH is often overlooked because of its insidious and variable presentation. In the primary care setting, iNPH can be coincidentally discovered by neuroimaging findings, including disproportionately enlarged subarachnoid space hydrocephalus (DESH). We report two cases of iNPH in the elderly living alone that had different outcomes depending upon the availability of neurosurgery specialists. It is essential for primary care physicians to consult neurosurgeons without delay because prompt diagnosis and treatment can improve the patient's quality of life and prolong their duration of living at home.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

In a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.

Blood oxygen saturation, keton boby ratio and endotoxin concentration of arterial and hepatic venous blood were measured in 12 adult patients before, during and after extracorporeal circulation (ECC). When rectal temperature returned to 32°C during ECC, the levels of hepatic venous blood oxygen saturation (ShvO₂) and arterial keton body ratio, hepatic venous keton body ratio decreased. The serum level of endotoxin concentration was within normal limits on the operative day and increased at the first and second day after surgery. In three patients in whom the level of ShvO₂ was under 50% at 60 minutes after ECC, postoperative liver dysfunction occurred frequently. Endotoxin changes on the first day after surgery is probably due to recovery differences between hepatic and gastrointestinal circulations.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.

The preoperative pulmonary arterial pressure of 38 patients aged over 50 undergoing surgical closure of a secundum atrial septal defect was studied. They were divided into three groups according to systolic pulmonary arterial pressure (PAP): Group A (PAP<30mmHg, n=14), Group B (30≤PAP<50mmHg, n=16), and Group C (PAP≥50mmHg, n=8). The mean age of group C patients was older than that of group A patients. With higher PAP, the Pp/Ps, Rp/Rs and cardiothoracic ratios increased, atrial fibrillation and heart failure (NYHA≥2) were more frequent, and PaO₂ levels declined. There were no differences in left to right shunt ratio and Qp/Qs among the three groups. The PAP and Rp/Rs were under 70mmHg and 0.30, respectively in all patients. High pulmonary blood flow seems to be the cause of pulmonary hypertension in most elderly patients because PAP and Rp/Rs decreased after surgery in all groups. Findings of cardiomegaly and heart failure also improved after surgery. Surgical intervention is recommended even in elderly patients with a ASD.

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.

A follow-up study of 98 patients undergoing abdominal aortic aneurysm (AAA) repair for 44 months, ranging 2 to 113 months, revealed no difference in 5-year actuarial survival between patients aged 75 or older and patients aged less than 75. The 5-year actuarial survival of ruptured and nonruptured AAA cases was 469% and 71.2%, respectively (p<0.01). Late deaths after the repair of ruptured AAA were all due to atherosclerotic diseases. During a follow-up period after AAA repair, 9 patients were diagnosed as having malignant diseases with a fatal outcome in 6. Careful attention to atherosclerotic and malignant diseases is indispensable for follow-up management after AAA repair.

Objective: The aim of this study is to explore the factors associated with the burden of home care for doctors. Methods: In July 2013 a survey was mailed to a cross-section of clinics and hospitals in Kobe City. Results: Questionnaires were sent to 1,589 clinics and hospitals and 899 (57%) responded. Of these, data from 807 respondents were available for analysis. The burden of home care was felt to be considerable for 30% and slight for 31% of respondents. Determinants associated with the burden of home care were; 80 years and older doctors (P=0.05), particular medical measures (P=0.036), building links with other medical facility or care staff (P=0.002), and ensuring the sufficient time and staff (P<0.001). Conclusion: The majority of doctors reported a burden associated with home care.