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.

Abstract
Introduction : For stable patients, we actively performed a reverse introduction into peripheral medical institutions, but “the interinstitutional relations in medical treatment which a hospital doctor hopes for” were not promoted or established.
Aim : Our primary aims were to understand “the interinstitutional relations in the field of medical treatment that outpatients demand” and to obtain materials to promote and establish such relations. Another major aim was to substantially investigate the backgrounds of the patients, the coordinated medical institutions, and general hospitals by using structural equation modeling, and to identify latent factors promoting interinstitutional relations in medical treatment.
Method : We enrolled 471 outpatients as subjects and conducted a questionnaire survey.
Results : Both the hopes and expectations of patients for coordinated medical institutions were related to a “strong connection with the general hospital and with the specialists”. On the other hand, the issuing of a “long-term prescription” with the purpose of reducing the burden on the outpatient department was a strong factor that disturbed such relations.
Conclusions : Our study suggested that the strong relationships that exist among these three elements--patients, peripheral medical institutions, and general hospitals--are latent factors that satisfy the medical demands of the patients and are promoted by smooth interinstitutional medical cooperation.

Purpose: To investigate the indications for use of the Japanese version of the Liverpool Care Pathway (LCP), we evaluated the conditions of patients using and those not using the LCP. Methods: We retrospectively investigated the medical records of 71 LCP patients and 60 non－LCP patients who died in our palliative care unit between March and December 2013. Results: There was no significant difference in patients’ background between the LCP and non－LCP groups. For patients in the non－LCP group, sudden changes in condition were significantly more frequent and deep continuous sedation was used significantly less than in the LCP group. In the LCP group, the average duration on the LCP was 4.0 days, and the beginning criterion was met by three－point or more of all the patients. The initial assessment was achieved except for one case. In the non－LCP group, reasons for not using the LCP were a sudden change in condition (35 patients), a rapid change in medical condition (14), and a risk of falling (4). Conclusions: The LCP met the beginning criterion and was started at suitable time in the LCP group. The LCP is not useful for all patients; it cannot be used for a patient with sudden or rapid changes in condition, or at a risk of falling.

The purpose of this study was to investigate differences between first-year (n=97) and second-year medical students (n=102) in their reactions to a community-based early clinical exposure program. Questionnaires completed after their participation in the program showed that first-and second-year students did not differ in their interest in practical training in nursing homes and wards of the university hospital or in a presentation given by a family member of a cancer patient who had died in the hospital (Chi square test, p<0.05). However, second-year students were more likely to report that they understood the family's presentation well, whereas first-year students were more likely to report they could communicate with elderly or disabled persons. Several facilities in the community criticized the students' attitudes toward practical training. We believe the reason for the criticism was insufficient advance preparation.

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.

Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.

A 45-year-old man was admitted with several histories of cerebral infarction. Transesophageal echocardiography showed a small tumor on the anterior mitral leaflet. Open heart surgery was performed. The tumor was removed including a part of the anterior mitral leaflet and mitral valve plasty was done. The post-operative course was uneventful. Papillary fibroelastoma was diagnosed pathologically. To avoid embolic complication, an early surgical procedure is recommended.

No abstract available.
Mitral Valve Insufficiency