As you know, we have met with the patients suffered from cervical spondylosis with so to speak paresthesia in daily living. We planned, this time, to search for how clinical assessment about like that kind of paresthesia was to be in practical scene.
The subjects of this studies, they were cared in the out-patient programs, the department of rehabilitation medicine at Teikyo University, 26 cervical spondylosis patients complained of any paresthesia on their arms.
In the first place, to clarify the differences between the normal and patient groups clinicaly, we were planing to check and count sensory and motor conduction velocity, somato-sensory evoked potential and latency of each component. And then, plethysmogram was also checked but decidedly, there was no significant difference between the normal and innormal group statistically.
Accordingly, it has become clear that we had so many items which was to be solved scientifically in these investigations. And that we got to know its difficulities and possibilities to put like this clinical assessment in practice.

Inserting a tangusten microelectrode into the peroneous nerve of the conscious human subject, the authors recorded the discharge of primary afferent C and A δ fibers. Most of the C fibers belonged to the polymodal group, as these were excited by both mechanical and thermal stimulations. These units responded to painful mechanical or thermal stimuli, as well as to non-painful stimuli of these modalities. These polymodal receptors were capable of responding to a wide range of stimulation intensity.
Only some of the Aδ fibers responded to mechanical stimulation of a high intensity and painful thermal stimulation. These units increased their discharge to repeated heat administration showing a marked sensitization. This sensitization corresponded to the sense of increased heat experience by the human subjects who had hyperalgesia from the increasing heat. These findings indicate that these Aδ afferent fibers transmit sensation of hyperalgesia from the hairy skin to the higher centers.

Muscle tenderness or stiffness is generally attributed to local muscle spasm or aggravated tonus however electro-myographic studies have indicated no spontaneous discharge as usual and any kind of change of N M U weve patterns, certainly. There is a great deal of uncertainty about the fundamental chracter, identified factor of these conditions.
To analize (_??_-S curves) -the mean inteerval (_??_) of the single unit NMU discharges and the standard deviation (S) of the same it was learned that these phenomena could be classified into two types of muscle activities, the one is kinetic activity (K-curve) and the other is tonic one (T-curve) so to speak. We conducted examinations concerning about the character of the notor unit activity of the trigger point in low back pain patient with _??_-S relation. In comparison with the distribution of (_??_-S) of the low back pain patient group (14 patients, 295 units) and that of the control group most (_??_) was up to about 120 msec. with (S) relatively stable, an almost horizontal distribution along the x-axis with an increase when (_??_) was any larger.
As compared to this, in most examples in the lumbago group (_??_) was horizontally up to 120 msec. after which a gradual rise xas indicated. The various distributions showed that that of the lumbago group was moved to the right of the awis of co-ordination as was the recovery line. Consequently, we observed that the NMU discharges of the trigger point in low back pain patients showed more tonic activity than that of normal subjects. And this finding strongly indicates that voluntary muscular activity in trigger points is under the predominant influence of spinal motoneuron than homonymous neuron segmentally.

Due to the increasing number of patients with repaired tetralogy of Fallot (TOF), the amount of subsequent sequelae has also increased along with the need for further surgical interventions. This case report described a patient who underwent multiple reoperations for late sequelae over a period of 48 years after repair of TOF. The patient was a 58-year-old man who underwent a reparative operation for TOF at the age of 9 years. At the age of 30, he underwent patch closure of residual VSD and reconstruction of right ventricular outflow tract (RVOT) with a mono-cusped trans-annular patch combined with aortic valve replacement. At the age of 47, he underwent aortic root replacement for aneurysmal dilatation of the Valsalva sinus, and he was implanted with a pacemaker for bradycardia atrial fibrillation at the age of 51. By the age of 58, he required pulmonary valve replacement and tricuspid valve annuloplasty for right ventricular dysfunction resulting from regurgitation of the pulmonary and tricuspid valves as 4th midline sternotomy surgery. His status improved to NYHA functional class III to II after the most recent procedures, although he still needed strict medical control. A proactive approach during long-term follow-up after TOF repair is important for timely and appropriate surgical intervention in the event of late sequelae.

We sometimes encounter the case that we have to make an anastomosis between a prosthetic graft and an autologous vein graft in revascularization of a lower extremity. However, it is said that the intimal hyperplasia in the anastomosis site of a prosthetic graft and autologous vein graft has a tendency to become severe in the long term postoperatively. We herein report a case in which a vein cuff (St. Mary's boot) technique was very useful to prevent recurrent stenosis due to intimal hyperplasia. No recurrence of stenosis in repair lesion has been detected for 7.5 years after operation.

Neonatal Marfan syndrome is the most severe form of Marfan syndrome usually showing critical cardio-respiratory symptoms from the neonatal period or early infancy. We report a boy with this syndrome who presented with heart failure at 3 months of age and was referred to our department at 6 months old after intense medical treatment. He had enophthalmos, funnel chest, arachnodactyly, and Steinberg's thumb sign, but had no family history of Marfan syndrome or other cardiac diseases. Left ventricular dilatation, severe mitral regurgitation and moderate tricuspid regurgitation were noted on echocardiography. Mitral valvuloplasty and tricuspid annuloplasty were performed, and the regurgitation improved to trivial and mild level, respectively. However, rapid exacerbation of mitral regurgitation occurred, and the patient fell into circulatory collapse which needed circulatory support with extracorporeal membrane oxygenator (ECMO) on 18th postoperative day. In the emergency operation, the previous surgical procedures on the mitral valve were intact and we thought that rapid progression of the mitral annular dilatation and valve expansion to be the cause of exacerbation. Mitral valve replacement (Regent® 21 mm aortic) was performed, and the cardiac function improved, but ECMO was still needed because of the depressed respiratory function. Furthermore, tricuspid regurgitation due to annular dilatation and valve expansion was aggravated rapidly which needed tricuspid valve replacement (ATS® 20 mm mitral) 9 days after the mitral valve replacement. ECMO was ceased on the 37th day and the patient was extubated on 71st day. He was discharged from the hospital 5 months after the first operation. One year has passed after discharge, and he is doing well with anticoagulation. In the treatment of neonatal Marfan syndrome, surgical procedure for valve repair is still controversial and it should be remembered that rapid exacerbation of the atrioventricular valve can occur even after satisfactory valve repair and there should be no hesitation regarding surgical intervention when needed.

A 67-year-old man with dilated cardiomyopathy was admitted to our hospital for treatment of cardiac failure. After using heparin because cerebral infarction developed during hospitalization, in acknowledgment of thrombocytopenia, we reach the diagnosis of HIT. We judged surgery to be necessary because heart failure had difficulty with catecholamine secession and the left ventricular dilation progressed rapidly, and performed left ventriculoplasty, mitral valve plasty. There were no complications such as the thrombosis during cardiopulmonary bypass, and the postoperative course was good without leading to re-thoracotomy due to bleeding. He passes without a heart failure symptom by the follow of one year 6 months after surgery at home.

Cardiac leiomyosarcoma and atrial intramural hematoma are extremely rare. Here, we present the case of a 52-year-old woman with dyspnea. Echocardiography showed a large mass in the left atrium. Tumor resection was performed. A pathological diagnosis of intramural hematoma was made. Ten months later, she presented to our hospital again with dyspnea. Echocardiography and computed tomography showed recurrence of the left atrial tumor. Another tumor resection operation was performed. The tumor originated from the inferior wall of the left atrium, and it was surrounded by atrial wall thickening. Complete resection was not possible. Although postoperative chemotherapy was prescribed, the patient died of heart failure nine months after the second operation.

When mitral valve dysfunction occurs in infants and mitral valve repair is difficult, mitral valve replacement (MVR) is required. However, commercially available prosthetic heart valves can be too large to implant in infants with a small annulus. In these children, the technique of supra-annular MVR is useful. Here we report two cases of supra-annular MVR, which were performed using an expanded polytetrafluoroethylene (ePTFE) graft as a skirt for a prosthetic valve. This method has been previously reported by Sung et al. The first case was a 16-month-old, 6.7-kg male infant who suffered from Shone' syndrome, mitral stenosis (MS) with a parachute mitral valve, coarctation of the aorta (CoA), and ventricular septal defect (VSD). MS progressed after CoA repair and VSD closure and a supra-annular MVR was performed. The second case was a 5-month-old, 4.9-kg female infant who suffered from polysplenia, intermediate atrioventricular septal defect (AVSD), and severe left atrioventricular valve regurgitation. AVSD repair was performed at the age of 3 months. However, valve stenosis and regurgitation gradually progressed postoperatively and consequently, a supra-annular MVR was performed. Postoperative prosthetic valve function was good in both cases. We believe that this method of performing supra-annular MVR is useful for infants with a small annulus.

We present a successful case of a patient with multiple metal allergy—cobalt, nickel, chromium, and zinc—who had a past history of systemic metal dermatitis. He was a 58-year-old man who complained of exertional chest discomfort. After admission, he had a fever and his blood culture was positive with methicillin-sensitive Staphylococcus aureus. Three days later, multiple micro cerebral infraction was detected in magnetic resonance imaging. After an improvement of inflammatory reaction, he was transferred to our facility for cardiac examination. Moderate mitral regurgitation due to valve perforation and multiple coronary vessel stenosis were detected. Mitral valve replacement and coronary artery bypass grafting were planned to perform. We chose surgical materials based on a preoperative epicutaneous (patch) test and his clinical course was uneventful without any allergic reaction. Metal contact allergy is an important issue in cardiovascular surgery. A collaboration with dermatologists is essential for the preparation of surgical materials.