The +2 ions in the extenal fluids of the cells touching the outer surface of the nerve membranes are indespensible to excitation; if a +1 ion is added, excitation becomes easy. In the inner fluids touching the inner walls of the membrane with the existence of +1 ions only there is no problem, but if a +2 ion happens to come to exist within these inner fluids generally, this results in a decrease in the active electrical potential.
Very little is known about the quantitative tendencies of trace metal elements (or ions) within the local domain of the human tissue however the verification of the amounts of VIa (Cr, Mo), VIIa (Mn), VIII (Fe, Co, Ni, Pt), Ib (Cu, Ag, Au) transition metal elements and IIb (Zn, Cd) among the heavy metal elements existing in the human body is a matter of great physiological and pathological importance.
We will report information concerning metals among heavy metals and the transition metals in which characteristic X-rays appeared notably in this experiment.
The results of this experiment indicate the following: (1) We can induce the equation of diffusion and distribution concerning to the ions of metal element introduced into the skin and the muscle. (2) The amount of ionization of metal elements introduced into the tissues is not abided by Farady's law of electrolysis. (3) In proportion as time of stimulation increases the amount of K-ions in the local domain punctured by Au-needle. (4) As the effect of metal element punctured and introduced into the tissues, the ions of the transition metal elements that were already existing in the tissues are acting in conjunction with the introduced element. (5) The cause of variation on the trace element is not analyzed in this experiment.

Experience and the significance of cardiopulmonary arrest on arrival (CPAOA) for residents were examined through an investigation of 47 cases of CPAOA at the department of emergency medicine of Saga Medical School Hospital from December 1, 1996, through November 30, 1997. Causes of CPAOA, outcomes, issuance of death certificates or inspection certificates, and whether a judicial inspection was performed were analyzed in each case. The cause of CPAOA was intrinsic in 31 cases and extrinsic in 16 cases. Eleven patients were admitted, one of whom recovered completely. Death certificates were issued in 25 cases, of which 7 underwent judicial inspection. Inspection certificates were issued in 21 cases, all of which underwent judicial inspection. Twenty-nine residents received 3 months of clinical training in the emergency department. The percentages of residents who encountered cases of CPAOA, CPAOA caused by extrinsic factors, cases in which inspection certificates were issued, and cases in which judicial inspection was done were 51.7%, 79.3%, 82.8%, and 89.7%, respectively. These findings show that residents receive practical experience in our department of emergency medicine.

Anticoagulation management in cardiac surgery can be difficult in patients with heparin-induced thrombocytopenia (HIT). We report a patient who underwent reoperation of cardiopulmonary bypass (CPB) using argatroban in combination with nafamostat mesilate. A bolus of 0.25 mg/kg argatroban was administered, followed by continuous infusion of 5-10 μg/kg/min argatroban and 100 mg/h nafamostat mesilate. No complications such as thrombosis were observed during either CPB or the perioperative period. Although we used argatroban and nafamostat mesilate, which has a shorter half-life than argatroban, the anticoagulant effect was prolonged, and the patient had an uneventful postoperative course despite requiring substantial blood transfusion.

A university hospital plays roles as a specific functional hospital and as a teaching hospital in primary care because most medical school graduates receive basic clinical training in this area. An important objective of primary care education for all residents is the initial treatment of patients with first-to third-level emergencies. We examined the number of patients, the level of emergency (first, second, and third level) and the diagnoses that each resident encountered. Subjects included 29 residents (3 in the first year, 4 in the second year, and 2 in the third year) who had undergone clinical training for 3 months in the department of emergency medicine at the Saga Medical School Hospital which treats 7, 000 to 8, 000 patients per year with first-to third-level emergencies. Residents were involved with 214.6 emergency cases, which included approximately 59 types of first-level emergency, 31 types of second-level emergency, and 15 types of third-level emergencies. These results were largely compatible with the Objectives of Postgraduate Basic Clinical Training proposed by the Japan Society for Medical Education. These results show that university hospitals as specific functional hospitals should accept numerous emergency patients and that residents must receive clinical training in emergency medicine to achieve the objectives of primary care education.

Recent remarkable advances in medical computer technology have allowed earlier and more accurate diagnosis. These improvements in diagnosis have led to the wider recognition of the importance of computer literacy and teaching medical students to use computers. However, establishing a well-defined course for teaching computer science is difficult because of the rapid advances in computer technology. In this paper we present an outline of an educational program and practical exercises for the development of computer literacy which were introduced at Iwate Medical University in 1998.

The patient was 62-year-old woman was brought to the emergency room with chest pain and dyspnea. Computed tomography revealed a hematoma around the ascending aorta, a notch in the aortic wall, pericardial effusion and a hematoma around the pulmonary artery. We diagnosed early thrombotic type of acute aortic dissection. An ascending aorta replacement was performed via median sternotomy under hypothermic circulatory arrest. Upon operation, there was a 1.0 cm intimal tear just above the left main trunk and there was no specific evidence of aortic dissection. So we diagnosed spontaneous aortic rapture. Her postoperative course was uneventful and she was discharged 18 days after surgery.