Coronary artery disease (CAD) is common in patients with abdominal aortic aneurysms (AAA). Myocardial infarction is the leading cause of postoperative death and late death after AAA repair. In an attempt to reduce the incidence of perioperative myocardial infarction, routine coronary angiography has been recommended in all patients scheduled for elective AAA repair, and staged myocardial revasculization has been performed using percutaneous transluminal coronary angioplasty (PTCA), if indicated. From March 1987 to February 1995, 40 consecutive patients receiving elective repair of AAA underwent preoperatively coronary angiography. Twenty-one of the 40 patients (53%) had CAD, and in 9 coronary revasculization was indicated. Seven of those patients underwent successful PTCA prior to surgery. One patient had PTCA following surgery for AAA because of technical difficulties in advancing a catheter due to the elongated abdominal aorta. The other patient with triple vessel disease was considered to be unsuitable for PTCA in those days and underwent coronary bypass grafting before AAA repair. There was no operative mortality or perioperative myocardial infarction during and after the repair of AAA. Our results suggest that PTCA should be considered one of the best treatment strategy options for patients with coexistent AAA and CAD.

Generally, sport players of boxing or football who contact roughly with other players use mouth guard during match or game to prevent the breaking of jow boneor bursting of soft oral cavity. Moreover, mouth-guard are used for the purpose to lighter the load to root of teeth and to improve the skill and power of sport's player.
The purpose of this study was to examine the charactaristic of unfitted by H shape-mouth guard compared to U shape mouth guard.
The following results were obtained.
1. The H shape-mouth guard of this study could reduce the impact to 1/7 level.
2. A relative decrease in ventilation level was shown when H shape mouth guard fitted.
3. With reference to respiratory function, reduction of the amount of oxygen up-take was not observed at heart rate lower than 170 beats/min, and in this case a player feells subjective symptom of stiffing.

Recently, the authors experienced five cases of chronic primary headache in children which were successfully treated with shokenchuto. This report describes the details of these five cases and results of references in past literature. The common physical findings in these five cases were soft abdominal walls with a spasmodic bilateral m. rectus abdominis. There was only one case report of headache which was successfully treated with shokenchuto. We believe that our case report sheds light on a new aspect of shokenchuto, which might be a useful formulation for chronic headache. In this paper, we also speculate about the mechanism of this formulation for headache from the view point of former research showing the relationship between brain orexin behavior, and ghrelin which is induced from the digestive system.

Ryoukeigomikanzoto is a Kampo formulation originally described in the text Kinkiyouryaku. This formulation has also been described as an indication for respiratory disease in some texts, because it was classified under respiratory diseases in the Kinkiyouryaku.
The authors, however, considered that indications for ryoukeigomikanzoto could be wider than previously thought. The composition of this formulation is very similar that of ryokeimikanto and ryokeijutsukanto. And we have prescribed ryokeigomikanzoto for patients with a reddish face and coldness of the legs, whose chief complaints were a reddish nose, coldness of the leg, dysuria, spioncerebellar degeneration and ringing of the ears. Moreover, we have obtained good results from the current trial. This report is intended to elucidate indications for this formulation by means of past clinical results and our own experience.

Previously, the authors reported that a painful point at the epigastrium may be closely related with the term “shinkashiketsu” for the Kampo formulation saikokeishito (SKT) which was described in the textbook, shoukanron. In order to find conclusive evidence for our hypothesis, we tried SKT in four patients, whose chief complaints were headache, epigastralgia with headache, irritable bowel syndrome, and anorexia due to Behcet's disease. In this trial, we obtained satisfactory clinical results, which strongly suggest that the symptom of a painful epigastral point correlates with the term shinkashiketsu in the shoukanron description.

It has been thought that the term “shukuben” does not mean a simple constipation but rather that a substance is stagnating in the digestive tract despite ordinary defecation. However, there has been no concrete evidence for this shukuben definition.
The authors have obtained evidence for what may be one type of shukuben, by means of X-ray photography after an upper digestive tract examination using a barium sulfate contrast medium, in a patient with irritable bowel syndrome. The X-rays showed the contrast medium adhering to the colon wall three days post-examination despite subsequent diarrhea, suggesting one type of shukuben. In this paper, the authors also reported the result of a historical search for the term shukuben in the past medical textbooks, which revealed that the first description of this term is found in hougizashi and was described by Yodo Odai. We also considered that this term is a derivation of shukushoku meaning a stagnation of digestive tract contents.

Chukenchuto is often reported to be useful for constipation. We experienced patients with diarrhea or loose stool, successfully treated with chukenchuto. In this report, five cases are documented. Of these, four cases did not present with constipation. We emphasize that chukenchuto is also effective for diarrhea or loose stool. Other clinical manifestations such as gargling sound or abdominal distension, tension of abdominal rectus muscle, and feeling of cold are common in cases where chukenchuto is effective.

Background : The aim of this study was to assess the effects of repeated injections of botulinum toxin type A (BoNT-A) combined with a rehabilitative program for treating spastic upper limb hemiparesis after stroke. Subjects and methods: Subjects were 112 poststroke hemiparetic patients with spastic upper limb (mean age : 55.5±11.6 years ±SD, mean period between onset and first injection : 5.1±3.5 years). For each patient, BoNT-A (maximum dose of each injection : 240 units) was injected in the spastic muscles of the affected upper limb twice with a minimum interval of 3 months. Following each injection, detailed one-to-one instructions for homebased functional training was provided. At the baseline (before injection) and at 1 and 3 month follow-ups after each injection, the patient's modified Ashworth scale (MAS), the range of motion (ROM) and Fugl-Meyer Assessment (FMA) were evaluated. Results : The total score for the upper limb and the scores of categories A and B of the FMA increased significantly not only after the first injection but after the second injection compared with the second baseline, while the FMA score for category D increased significantly only after the second injection. MAS also decreased significantly not only after the first injection but after the second injection compared to the second baseline. Conclusion : A more significant improvement was found not only in muscle spasticity but also in upper limb motor function after two BoNT-A injections. It is suggested that repeated BoNT-A injections followed by a comprehensive rehabilitative program would be an effective treatment for limb spasticity after a stroke.

Backgroud
Sri Lanka is a developing and multiracial country, located in the Indian ocean near the equator, with a population of approximately 20 million. It has a parliamentary democratic system of government and over 80% of hospitals belong to government and medical services are free of charge. Literacy rate of Sri Lanka is higher than the neighbouring countries of the region, and the government's health policies, based on the promotion of Maternal & Child and Geriatric health, are on the way to success.
According to the Health Master Plan (HMP) by the Ministry of Healthcare & Nutrition (MOH&N) ,the health problems in this country are classified into three categories based on epidemiological and medical economics:
i) Continuing Problems such as dengue fever, ii) Emerging Problems such as HIV/AIDS, and iii) Evolving Problems such as lifestyle-related diseases.
It is apprehensive thatthe health conditions and economics of individual Sri Lankan and Nation's economics will be compelled to face the multiple burdens in the near future.
JICA's Technical Support (JTS)
JTS on the first prevention against non-communicable diseases (NCDs) has been already startedby JICA after receiving the request by the government of Sri Lanka in order to avoid the catastrophic situations pointed out by HMP. Futhermore, the trend analyses on the data of inpatients suffered 59 types of communicable or NCDs from 1983 to 2003 were performedto propose the tagets and contents of the new JTS. As a result, ffifteen diseases were statistically significant, and nine out of the above15 cases were NCDs.
Because lifestyle-related diseases such as ischemic heart disease, cardiovascular diseases occupy four positions out of five leading causes of death in recent past of Sir Lanka, new model system which combines the first prevention and screening of high-risk persons and early treatment system was proposed to MOH&N.
The flow of the basic model projiect, composed of two screening steps to detect thespecific persons having high-risks such as obesity, hypertension, high cholesterol, etc., is classified into three groups to receive optimum healthcare sevices at the nearby hospitals.
Fortunately, MOH&N made a request for the new JTS based on this proposal to the government of Japan. Consequently, the budget of this project proposal was approved and is now under the practical arrangements by JICA.

Purpose and Methods: Aiming at the relief of suffering by the palliative care team and prompt information sharing between healthcare professionals with various specialties, We introduced new IT cloud system, carried out questionnaire survey and examined the usefulness to 11 persons of healthcare professionals. Five cases where the palliative care team was concerned during the hospitalize became a home palliative care to the tried half a year. Results: All the members were using the personal computer as an input device. Four persons were using the iPhone. Two persons had the experience inputted on the spot. Nine persons of the input time were 5 or less minutes. All the members were perusing at various places by various device. Urgently and vital mail was useful: 3 in six, 2 in three, 1 in one, 0 in one. Information content were suitable: 3 in nine, 2 in two. Cooperation were completed in the smooth: 3 in nine, 2 in two. Have you utilized EIR for the home palliative care?: 3 in nine, 2 in two. Conclution: To the support of information sharing and palliative care team by IT cloud system transduction, the useful probability was suggested in the home palliative care.