Abstract
 Sometimes experienced doctors and nurses have an intuitive sense of alarm about an apparently stable patient, a sense which may be expressed as, for instance, ‘He/she seems seriously ill.’ However, this intuitive sense of alarm remains a rule of thumb, even though it is recognized as an important “diagnostic” indicator in clinical decision-making. In this review, we have attempted to clarify the meaning of the phrase by proposing a pathophysiologic/symptomatologic model that suggests that the sense of alarm is a premonitory sign of a homeostatic crisis characterized by acute systemic autonomic symptoms and acute sickness behavior. The model proposed here may help novices to avoid missing potentially critical diseases.

Event-related potentials (ERPs) were recorded from 9 normal subjects engaged in a somatosensory target discrimination task. Subjects were instructed (1) to keep a mental count of each target or (2) to rotate a grip in the direction of abduction after each target stimulus using the right hand. Target stimuli were electrical pulses delivered randomly through ring electrodes to the left second digit with probabilities of 0.2, and nontarget stimuli were delivered to the left fifth digit with probabilities of 0.8.
P 100 was prominent in somatosensory tasks, and had a widespread distribution on the scalp without having any relation to kinds of tasks, therefore, P 100 reflects the sensation of somatosensory stimulation. N 140 was largest at Fz in both counting and movement tasks, so our result supported the hypothesis that N 140 is generated in the frontal lobes regions. Moreover, N 140 latency was shorter during movement than during counting. These results indicate that N 140 is related to carrying out movement. P 300 was largest at Cz during counting, and largest at Pz and C4' during movement. These results also indicate that P 300 may have multiple intracerebral generators since P300 origin differs based on the kind of tasks or stimuli. In addition, the appearance of P300 after nontarget stimuli indicates that P 300 reflects a non-selective postdecision closure of cognitive activity. In conclusion, each component of ERPs may have a specific origin and specific characteristics.

The immunological effects of spa bathing and its influence on the systemic performance were studied in 15 patients with stomach or colon cancer who had received operations and were treated by lentinan. Ten patients were treated by spa bathing and five patients were not treated.
Immunological performance was assessed in terms of white blood cell count, lymphocyte count, surface markers of lymphocytes, natural killer activity and immunoglobulins. There were no significant differences in immunological parameters between the bathing groups and non-bathing group of patients. The systemic performance improved in the majority of patients of the bathing group and became more aggravated in the majority of patients of the nonbathing group. The results of this study suggest that spa bathing is beneficial, not harmful, to the systemic performance of patients with cancer.

This time the statistics for injuries and disorders due to sports in the five-year period up to 1985 were taken, evaluated and compared with those of the last five-year period. The following results were obtained :
1. There were 1, 300 cases of injuries and disorders due to sports in the five-year period up to 1985, which was 4.4% of the total number of outpatients in the department of orthopaedics.
2. Sex : There were more male patients, but the rate of female patients has been increasing lately.
3. Age : Patients in their teens or twenties accounted for about 70%.
4. Body Side : There was no significant difference between incidence of injury on the right side of body or the left, but cases of injuries on both sides have been increasing recently.
5. Kind of Sport : The largest number of trauma were due to skiing, although the number of trauma resulting from playing tennis has been high in the past five-years of investigation.
6. Time of Injury ; Most patients were injured during practice, followed by recreation and game.
7. Position of Truma : Most cases were injuries to their knee joints from skiing.

This time the statistics for injuries and disorders due to sports in the five-year period up to 1985 were taken, evaluated and compared with those of the last five-year period. The following results were obtained :
1. There were 1, 300 cases of injuries and disorders due to sports in the five-year period up to 1985, which was 4.4% of the total number of outpatients in the department of orthopaedics.
2. Sex : There were more male patients, but the rate of female patients has been increasing lately.
3. Age : Patients in their teens or twenties accounted for about 70%.
4. Body Side : There was no significant difference between incidence of injury on the right side of body or the left, but cases of injuries on both sides have been increasing recently.
5. Kind of Sport : The largest number of trauma were due to skiing, although the number of trauma resulting from playing tennis has been high in the past five-years of investigation.
6. Time of Injury ; Most patients were injured during practice, followed by recreation and game.
7. Position of Truma : Most cases were injuries to their knee joints from skiing.

It is essential to prolong the term as possible in the treatment of threatened premature delivery. We report a case of threatened abortion successfully treated with hochuekkito. The patient was 31 year-old pregnant woman with lower abdominal pain. She was diagnosed to be at the risk of premature delivery on 21 weeks and 5 days of gestation. Intravenous ritodrine hydrochloride was started and she had to stay in bed. Severe side effects of ritodrine hydrochloride such as palpitation, tachycardia, tremor, nausea, and loss of appetite were appeared and she was consulted to our department on 23 weeks and 1 day of gestation. Those symptoms were markedly improved after administration of hochuekkito extract. She delivered a male infant of 1230g birth weight on 28 weeks of gestation. Hochuekkito suppressed severe side effects, and enabled to continue the infusion of ritodrine hydrochloride, suggesting the usefulness of Kampo therapy in the treatment of threatened premature delivery.

We measured oxidative stress and antioxidative stress in clinical cases of cardiac and aortic surgery, especially in extracorporeal circulation cases. From June to October 2007, 18 cases who underwent cardiac and aortic surgery with extracorporeal circulation (ECC group) and 8 cases with an infra-renal abdominal aortic aneurysm (AAA group) were studied. We measured reactive oxygen metabolites (d-ROM) in oxidative stress for the operative time, after the operation endpoint, and at one day postoperatively, one, two, and three weeks postoperatively, and one, two, three, and four months postoperatively. Regarding d-ROM, the level in the ECC group was significantly higher than that in the AAA group (p<0.0001). Peak values were observed 3 weeks postoperatively in the ECC group and 2 weeks postoperatively in the AAA group. Although the oxidative stress increased in both groups, the peak value in the ECC group was more marked than that in the AAA group. We concluded that oxidative stress under surgical stress in cardiovascular surgery with extracorporeal circulation was higher than that under surgical stress in cardiovascular surgery for infra-renal abdominal aortic aneurysms.

We report 3 cases of ascending aorta-abdominal aorta bypass for atypical coarctation with Takayasu's aortitis. We performed an extra-anatomical bypass from the ascending aorta to the terminal abdominal aorta. The graft was arranged to pass through the diaphragm from the pericardium, behind the left lobe of the liver and the stomach, to the front side of the pancreas to the terminal abdominal aorta. Although the graft was exposed in the abdominal cavity in part behind the stomach, it was completely covered with the great omentum thus avoiding direct contact between the graft the abdominal organs. Decrease in the pressure gradient between the ascending aorta and the abdominal aorta was achieved using a large prosthetic graft 14-16 mm in diameter. There are several advantages with this technique. (1) Positional change during surgery can be avoided. (2) Anastomosis can be performed in non-diseased vessels. (3) This bypass graft can be branched off to visceral arteries if necessary. Reduction of the after load on the left ventricle and long-term graft patency by using a large diameter prosthetic graft were anticipated. The postoperative courses of all cases were satisfactory. Case 1 died of another disease 11 years and 11 months postoperatively, but the graft to was still patent.

No abstract available.
Glycosylation End Products, Advanced* ; Lysine*

Since distal femoral varus osteotomy (DFO)
Asian Continental Ancestry Group ; Humans ; Japan ; Knee ; Osteoarthritis ; Osteotomy ; Tibia ; Weight-Bearing