The correlation between perioperative factors including preoperative complications, treatment, ischemic duration, degree of ischemica as well as the embolized artery and limb salvage and mortality was retrospectively reviewed based on clinical charts and the recurrence rates of emboli and survival rates were followed up. No limb was amputated, but four cases died within 30 days after admission. The causes of death were cerebral embolism in two and SMA embolism and acute renal failure in one each. There was no significant difference in mortality according to any perioperative factor. The recurrence rates of emboli were 23%, 49% and 90% at 1, 2 and 4 years, respectively, and the duration of anticoagulant therapy after discharge did not affect the recurrence rate significantly. The survival rates were 94%, 52%, 29% and 11% at 1, 2, 4 and 5 years respectively. The causes of late death were heart attack in six, cerebral embolism in five, and SMA embolism and cancer in one each. Age and ischemic heart disease were risk factors reducing the long-term survival rate. Although acute arterial embolism of the upper limb does not lead to loss of limbs or life directly, recurrence of embolism was frequently encountered despite anticoagulant therapy and both early and late prognoses were poor.

A pressure pain, frequently associated by an induration, is usually perceptible in the suprascapular region of the normal subjects. We considered the relation of the pressure pain with the anatomical structures of that region, firstly by investigating the locus of the pressure pain and whether it is associated by an induration or not, using the living subjects and in several cases, followed by a X-ray examination of the final destination of the needle which was inserted in the pressure pain zone; and lastly by dissecting the anatomical structures penetrated by that needle in a woman's cadaver.
We obtained the follwing three results from the above investigation and observations. (1) The most conspicuous pressure pain was perceptible in the middle of the upper margin of the suprascapular region, and a long and slender induration extending sagitally was palpable there. (2) The second rib lay in the deepest layer of the pressure pain zone, the layer which were overlain by the serratus posterior superior muscle, the serratus anterior and the omohyoid, many branches of the transversus colli artery and vein and the accessory nerve, and the trapezius muscle with the posterior suprascapular nerves running on its superficial surface, in order of lower to upper layer. (3) The transversus colli vessels, which forms a complex network of branchings crossing sagitally above the second rib, was suggested to have some relationship to the occurence of the pressure pain associated by the induration, because only the formation of such vascular network was peculiar to the pressure pain zone.

Purpose: This retrospective study aims to evaluate the effectiveness and safety of morphine for the management of dyspnea in terminal cancer patients. Methods: 64 terminal cancer patients, who had morphine administered for dyspnea management, were investigated. Dyspnea was assessed daily on the numerical rating scale (NRS; 0-5) before and 48 hours after the administration, and at the point of dose modifications. Result: The medication period was 34.7 days and the daily dose of morphine was 93.0 mg. The mean NRS decreased from 3.5 to 1.6 (p<0.001). 46 patients (72%) were started with an oral administration of normal-release morphine when-required. The major side effects of morphine, such as hypoxemia or decrease in respiratory rate, were not observed. Conclusion: Morphine is effective and safe for the management of dyspnea even in terminal cancer patients with careful titration.

We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.

The anatomical structures penetrated by a needle which was inserted in an acupuncture point into the stellate gaglion, 1.5cm lateral to and 2.5cm above the point Tentotsu, were studied bilaterally with dissection of 19 cadavers. Furthermore, the size of the dissected stellate ganglion, its anatomical position, and its positional relation to structures located near it were measured or observed.
Though 8 out of 38 inserted needles pricked the medial margin of the ganglion, the remaining 30 needles all missed medially from the ganglion. In the cases pricking the ganglion, all of 8 needles penetrated either the vertebral or the subclavian artery before reaching the ganglion, and 7 of these did also the dome of the pleura in addition to the artery. In the cases missing from the ganglion, however, a frequency of penetrating the above structures were considerably lower.
The dissected stellate ganglion almost lay on beteen the mid-level of the vertebral body of the 7th cervical vertebra and the upper level of body of the second thoracic vertebra, with their mean size 27.1, 7.7 and 2.8mm in length, width and thickness, respectively. All of the ganglions were located dorsal to the vertebral and subclavian arteries and the dom of the pleura the distances from the median line to their upper and lower extremity being 21.9 and 22.7mm in average, respectively.
The pricked point for directly aiming at the stellate ganglion from the body surface is within a range 20 to 30mm lateral to and 10 to 40mm above the point tentotsu on the right, and on the left it is within a range 15 to 25mm lateral and 10 to 35mm above; the depth from the point is about 4.0 and 3.8cm on the right and left, respectively. But when directly aiming at the ganglion, the possibility of injuring the vertebral or subclavian artery and the dome of the pleura was suggested to increase considerably owing to their location ventral to the ganglion.

We report a case of methicillin-resistant Staphylococcus aureus (MRSA) infectious endocarditis (IE) which was successfully treated with linezolid (LZD). The patient was a 44-year old woman. She was referred to our hospital because of fever of unknown origin. MRSA was detected from blood cultures and echocardiography revealed vegetation on the right coronary cusp of the aortic valve. She was diagnosed with MRSA endocarditis according to the Duke criteria, and was immediately give vancomycin (VCM) and isepamicin. Sixteen days after administration of VCM, she had a progressively increasing skin rash. It was considered a side effect of antibiotics and VCM was replaced with teicoplanin (TEIC). Eventually, LZD was given to her at 22 days after hospitalization because TEIC was not effective. LZD alleviated the fever and diminished the signs of vasculitis due to endocarditis within a week. LZD was continued for 4 weeks with cardiac failure medically controlled, and she underwent aortic valve replacement using a mechanical prosthetic valve. LZD was injected just before the operation and continued for 15 days postoperatively, followed by oral administration of levofloxacin. She was discharged 35 POD and no recurrence of the infection had been observed at 1 year after the surgery. LZD could be an alternative therapy for MRSA endocarditis, but further examinations are warranted to determine the most appropriate regimen.

This study sought to determine whether aerobic exercise training affects cognitive functioning among semi-independent (> 75 years) and independent elderly people. Seventy-six semi-independent and independent elderly subjects were divided into the following groups: semi-independent control (n = 16); semi-independent training (n = 13); independent control (n = 22); independent training (n = 25). During the 12-week intervention, subjects in both training groups performed a bench-stepping exercise at the intensity of the lactate threshold. Subjects were assessed at baseline and post-intervention using the Frontal Assessment Battery test (FAB), the Modified Mini-Mental State Exam (3MS), and a bench-stepping test of aerobic capacity. During the intervention, FAB scores improved only in the semi-independent training group (p = .002), while 3MS and MMSE scores improved in both the semi-independent training (p = .032 and p = .004) and independent training groups (p = .001 and p = .013). FAB and 3MS scores were higher in the semi-independent training (p = .001 and p = .002) compared with the semi-independent control group after the intervention. Finally, post-intervention scores for FAB, and 3MS in the semi-independent training group almost reached the baseline levels of the independent control and independent training groups. These results indicate that moderate intensity bench-stepping exercise training can improve cognitive and frontal lobe functioning in semi-independent elderly people, almost to the level exhibited by independent elderly people.