Morbid obesity is synonymous with “clinically severe obesity” and correlates with a body mass index (BMI) of 40kg/m², being associated with real severe physical problems inducing to highly mortality rates. While obesity, of itself, is a risk factor, most mortality and morbidity is associated with the co-morbid conditions, including hypertension, hypertrophic cardiomyopathy, hyperlipidemia, diabetes, cholelithiasis, sleep apnea syndrome, hypoventilation, degenerative arthritis and psychosocial impairments. And, most obvious is an increased mortality and morbidity rates directly related to weight increase. Therefore, it must be emphasized that morbidly obese patients should be treated positively and urgently in USA and European countries, where have had the common social problem of obesity. With the obvious failure of conservative medical treatments of producing permanent weight reduction in patients with morbid obesity, which successfully achieved initial weight loss but failed to maintain it, operative approaches have to be adopted occasionally and become popular in Western countries.
Although the population of morbidly obese patients in Japanese people is muchsmaller than in Western people, the hazardous due to obesity is recognized more serious among Japanese people. Furthermore, the rate of obesity as well as morbid obesity among a people in our country is increasing apparently not only in urban but also in rural district. The most important strategy against the problem of morbid obesity is the precausion. But, we have to recognize even in Japan that surgical treatment is medically necessary because it is the only proven method of achieving long term weight control enough to treat the severe complications for the morbidly obese patients. Bariatric surgery involves reducing the size of the gastric reservoir, with or without a degree of associated malabsorption.

Health education provided by a group of professionals from different disciplines, so-called “team medical care”, is considered essential for the treatment of diabetes. When each specialized professional educates diabetic patients on how to manage their condition, patient-centered medical care is realized, and it becomes possible to provide appropriate support to individual patients. The treatment of obesity is somewhat similar to that of diabetes. Diet therapy and exercise are the basic therapies, and diabetes in many obese patients can simply be improved by weight loss. Metabolic syndrome has been reported to be associated with visceral fat-type obesity. In order to prevent the development of atherosclerotic occlusive diseases due to weight loss, individual counseling after each medical checkup is provided by public health nurses or registered dietitians.  Behavior modification is necessary to improve lifestyle. Helpful education and advice by various professionals help patients to modify their behavior, and thus patient-centered medical care can be achieved.  Recently, for the treatment of diabetes, new oral hypoglycemic agents and insulin preparations as well as incretin preparations have become available, indicating that diabetes treatment strategies are increasing. This has allowed better glycemic control in diabetes than was possible before. Nonetheless, diet therapy and exercise remain the basic treatment methods, and they should not be made light of.

Based upon the 8 years' experience in vertical banded gastroplasty (VBG) for the treatment of morbid obesity in our department, we analysed the clinical results after operation. As a result, the weight-reducing effect and safety of VBG were found favourvable, but some of complications developed in a few, causing serious conditions. Therefore, a modification of VBG was tried in order to utilize the characteristics of VBG and to lessen the factors of complications development as much as possible. Its essential points are to utilize the His-angle by making an oblique staple line instead of a vertical one, and to block the stomach with GIA90 and EEA28 and embed the staple line by suturing the serous membrane. Because the stomach is formed into a K-shape, it has been named k-gastroplasty. Its operative mode is discussed.

Several studies have reported that molecular hydrogen (H₂) acts as a therapeutic medical gas owing to scavenging reactive oxygen species (ROS). However, little is known about effects of H₂ on exercise-induced oxidative stress. The purpose of this study was to investigate the effects of weekly hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness (DOMS). Nine healthy and active young men participated in this study, and each subject performed hydrogen bathing trial and placebo bathing trial in a crossover design. The subjects performed downhill running (8 % decline) at 75 % peak oxygen uptake (VO₂peak) for 30 min, and each subjects conducted hydrogen or placebo bathing for 20 min, respectively, 1-6 days after downhill running. Before and after exercise, we measured visual analogue scale (VAS) and collected blood samples (Pre- and 5 min, 60 min after the end of bathing, 1day, 2days, 3days, 7days after downhill running). Blood sample analyses include creatine kinase (CK), myoglobin (Mb), malondialdehyde (MDA), reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-17a (IL-17a) and lactate concentrations. Weekly hydrogen bathing had no effects of exercise-induced oxidative stress and muscle damage. On the other hand, hydrogen bathing significantly reduced DOMS (VAS) 1 and 2days after downhill running (p=0.033). These findings suggest that hydrogen bath after downhill exercise can be effective for reduction of DOMS.

The patient was a 63-years-old female with early gastric cancer in her upper stomach. Widely spreading on the mucous membrane, the cancer was too big to remove by endoscopical mucosal resection, although she wanted minimal invasive treatment. Therefore, we adopted total gastrectomy with hand-assisted laparoscopic surgery (HALS) after obtaining “informed consent” from her. Five small skin-incisions were necessary to perform it-one 7cm' for hand-port and four 1.2cm' for trocars.
The dissection was started from greater omentum and proceeded counterclockwise to remove primary lymphnodes. The abdominal esophagus and the duodenum were devided with a single or double application of Endo GIA stapler (linear stapler). All these steps were accomplished safely and securely with the effective support of the left hand of the operator. After extraction of the whole stomach through the 7cm-incision, Roux-en Y reconstruction was performed laparoscopically (esophago-jejunostomy) followed by hand sewing through the 7cm-incision (jejuno-jejunostomy). The anvil of 21mm circular stapler (EEA) was inserted orally in order to anastomose the esophagus to the jejunum. The patient had acceptable results intra-operatively as well as postoperatively by HALS total gastrectomy, which had been considered to be very hard to perform up to present time.

Objectives: Few studies examined the association between deterioration of masticatory ability assessed by objective marker and physical function. Therefore, we examined the association between salivary flow rate which is one of the objective and surrogate marker of masticatory ability and lower Timed Up & Go (TUG) performance which is one of major measurement of physical function among aging Japanese. Methods: This cross-sectional study enrolled 464 Japanese aged 60e84 years old. Participants chewed tasteless and odorless gum for 5 min, calculated stimulated salivary flow rate (g/min) during all chews.The 3 m TUG was conducted, and 75th percentile value (6.8 s for men and 7.0 s for women) or higher was defined as lower TUG performance. Logistic regression analysis was used to examine the association between stimulated salivary flow rate and lower TUG performance. Results: We found that the stimulated salivary flow rate tended to be negatively associated with the TUG time. We also observed significant negative association between stimulated salivary flow rate and lower TUG performance; the multivariable-adjusted OR (95% confidence interval, CIs) of lower TUG performance for the highest quartile of stimulated salivary flow rate compared with the lowest quartile was0.34 (0.16e0.69, P for trend ¼ 0.02). Further adjusting for BMI, the association was attenuated but remaind significant; the OR (95% CIs) in highest quartile was 0.37 (0.18e0.76, P for trend ¼ 0.04). Conclusions Higher stimulated salivary flow, which means well masticatory ability, was inversely associated with lower TUG performance in the aging Japanese population.

To investigate the factors affecting the rate of improvement in endurance exercise performance following pre-cooling with ice slurry, we focused on individual physical characteristics and thermoregulatory capacity. Twenty-four healthy adults (12 males and 12 females) ingested 7.5g kg-1 of either ice slurry at -1°C (ICE) or control water at 20°C (CON) before cycling at 55% VO2max and continued cycling until the rectal temperature reached 38.5°C or untill exhaustion in a hot environment (controlled at 38°C, 40% relative humidity). The relationship between the rate of improvement in exercise performance and physical characteristics and thermoregulatory factors (changes in rectal temperature, the rate of rectal temperature increase, whole body sweat loss, mean metabolic heat production, and heat storage) was investigated. No correlation was noted between the rate of improvement in exercise performance and physical characteristics and heat storage. On the other hand, the rate of improvement in exercise performance showed significant correlations with changes in rectal temperature (r = -0.497), the rate of rectal temperature increases during exercise (r = -0.784), whole body sweat loss (r = 0.407), and mean metabolic heat production (r = -0.436). The rate of inhibition of sweating and the rate of increase in metabolic heat production by ice slurry ingestion during exercise have been suggested to be related to the rate of improvement in exercise performance. On the other hand, there was no relationship between body composition or VO2max and the rate of improvement in exercise performance.