The establishment of experimental peripheral neuropathy and effect of moxibustion on it have been studied using male S. D. rats. To determine the condition of experimental peripheral neuropathy, rats were fed on the solution of acrylamide in the concentration of 100, 200, 300, 400 and 500p.p.m. The body weight decreased dependently on its concentration and the behavior in rats was also detriorated. Especially, ataxia, hindlimb weakness and muscle wasting in rats were remarkably observed.
The effect of moxibustion has been studied on the rats which fed on the 400p.p.m. acrylamide solution. The method of moxibustion is followes; 25mg of moxa was divided into 10 cones and they were treated by each 5 cones on right and left B-18, B-25 and G-34, respectively. The treatment of moxibustion was 6 times in 3 ones a week for 13 days.
As a results, after 12-13 days, moxibustion treated rats showed to improve the deterioration of behavior and muscle wasting induced by acrylamide. Especially, B-25 treated rats showed the improvement of weight in anterior tibial, gastrocnemius and soleus muscle. On the other hand, steadiness on slope was decreased by acrylamide feeding and decrease of the steadiness was not improved by the treatment of moxibustion.
It is suggested that the sutable stimulation of moxibustion improved the deterioration of behavior and muscle waste on the acrylamide induced peripheral neuropathy in rats.

Morphological changes of sciatic and tivial nerves have been observed microscopically and cholinesterase activities of anterior tibial, gastrocnemius and soleus muscles have been examined by the biochemical determination and histochemical method. 25mg of moxa/body (3 times a week, x6) were treated on the acupuncture point, B-18, B-25 and G-34 in acrylamide neuropathy rats.
After 400p.p.m. acrylamide treatment, the degeneration of peripheral nerves with myelin ovoids and foldes, and shrunken myelinated axons were observed. These lesions were advanced in the tibial nerve than in the sciatic nerve. In B-25 and B-18 moxibustion rats, good results were obtained to decrease myelin degeneration in peripheral nerves, but the lesions were advanced in G-34 rats than in acrylamide ones.
In the acrylamide rats, no change of muscle cholinesterase activity was found except the increase in the enzyme activity in the homogenate of anterior tibial muscle. In the gastrocnemius muscle of moxibustion treated rats, the microsomal fraction which contained much more sarcoplasmic reticulum showed high cholinesterse activity. And the activity per muscle protein showed various changes.
It showed that the stimulation of moxibustion had a mild effect to recover the experimental peripheral neuropathy induced by 400p.p.m. acrylamide because of morphological changes of sciatic and tibial nerves and weight of skeletal muscles.

Injuries to the aorta complicating cardiovascular operations can be very challenging. This type of injury is usually related to manipulation of the aorta during surgical exposure or aortic cannulation. From March 1994 to October 1997, five patients with intraoperative injuries to the thoracic aorta occurred. Their ages ranged from 7 to 71 years old (mean, 43.5 years). Two were male and 3 female. Intraoperatively, trouble occurred suddenly due to acute aortic dissection related to aortic traumatic hemorrhagic disruption in three patients, and aortic cannulation in two patients. The confirmation of the diagnosis was prompted clinically, and all patients immediately underwent further surgical intervention. In terms of technique, we used a cardiopulmonary bypass (mean cardiopulmonary bypass time 239min, range 196 to 367min), and hypothermic circulatory arrest (mean arrest time 34min, range 20 to 44min, at deep hypothermia with 21.0°C urinary bladder temperature) during repair. Retrograde cerebral perfusion was utilized in two cases to assure protection for cerebral damage. Fortunately, there was no postoperative neurological complication and no hospital death in any of the cases. When such intraoperative injuries of the aorta once occur repair using aortic clamps often fail or is not feasible, and in such cases hypothermic circulatory arrest combined with retrograde cerebral perfusion should be applied to resolve this type of the serious troubles.

We performed endovascular stent grafting of a perforated descending aorta, caused by empyema after surgery for lung cancer, in a 75-year-old man. After diagnosing hemorrhage from a perforation of the proximal descending aorta, caused by left empyema, the perforation was repaired with a saphenous vein patch and a pectoralis major muscle flap. However, re-hemorrhage from the same lesion occurred 2 months postoperatively. Temporary hemostasis was achieved with gauze packing and he was transferred to our hospital for endovascular stent grafting. The infection did not resolve after fenestration, so the descending aorta was cropped out to the fenestration lesion. Therefore, endovascular stent grafting was performed on the same day. Postoperatively the bleeding stopped completely without any signs of graft infection, and he was transferred to another hospital on postoperative day 9. No re-hemorrhage or graft infection of the aortic perforative lesion occurred in the early postoperative period. However, the patient died of massive bleeding from the aorta wall of the proximal stump of the stent graft, caused by recurrence of the infection 2 months after the 2nd operation. In this situation, endovascular scent grafting provides the only chance of saving the patient's life. If endovascular stent grafting is performed as a lifesaving procedure, meticulous operative technique is imperative.

To clarify the core competencies developed through postgraduate clinical training, we analyzed the conditions of our residency program with qualitative research methods. Seven residents (6 first-year residents and 1 second-year resident) answered a questionnaire and underwent semistructured interviews about postgraduate training. We also worked with the residents as “participant observers” of the treatment team. We found that residents often had trouble formulating diagnostic/treatment plans and tended to rely excessively on laboratory data to make decisions. We attribute these problems to a lack of practice in questioning expectations. We hypothesized that mitate-ryoku, the ability to describe the course of a patient's illness, is an extremely important clinical competency. According to the hypothesis, we tried to listen to the residents' description and to discuss it logically as colleagues. The residents described the patients expected condition over the next few days, considering both data and information they obtained from interviews and physical examinations. They adapted their ideas through logical discussion and were thus able to make acceptable decisions by themselves.

Objective: Aerobic exercise on land decreases arterial stiffness, however, the effect of exercise in water on arterial stiffness has not been clear. This study investigated the effect of a 15-min cycling exercise on land and that in water on pulse wave velocity (PWV) as an index of arterial stiffness. Methods: Nine healthy young men were randomly performed exercise on land and exercise in water equivalent to 50% of each maximum oxygen uptake on separate days. The PWV from carotid to femoral artery (aortic PWV) and femoral to posterior tibial artery (leg PWV) were measured at baseline and 15, 30, 60 min after exercise. Results: The heart rate in water was significantly lower during exercise than that on land. In addition, the carbon dioxide output and respiratory exchange ratio during exercise were significantly greater in water. Body temperature increased after the exercise on land but decreased after the exercise in water. Although the aortic PWV and leg PWV decreased concomitantly with decrease in SBP and DBP after the exercise on land, there were no significant changes after the exercise in water. Conclusion: Although acute exercise on land decreased arterial stiffness after exercise, acute exercise in water of the same exercise load did not. The differences in body temperature and blood pressure after exercise may result in diverse arterial stiffness after exercise.

PURPOSE: High tibial valgus osteotomy (HTO) is a well-established surgical procedure for patients with medial compartment osteoarthritis (OA) of the knee. The hybrid closed-wedge HTO (CWHTO) procedure permits extensive correction in patients with severe deformities or patellofemoral joint OA. The aim of this study was to report the short-term results in a consecutive series of patients treated with hybrid CWHTO. MATERIALS AND METHODS: We retrospectively evaluated the clinical outcomes and radiographic parameters in 29 consecutive knees that underwent hybrid CWTHO to correct medial compartment OA at an average follow-up of 52.6 months. Clinical outcomes were assessed using the Lysholm score and knee scoring system of the Japanese Orthopedic Association (JOA). The Kellgren-Lawrence grading system and pre- and postoperative mechanical axis (MA), femorotibial angle (FTA), posterior tibial slope, and patella height were assessed. RESULTS: The FTA and MA significantly changed from 180.7° to 170.4° and from 22.0° to 60.2°, respectively. No significant differences were observed between the mean pre- and postoperative posterior tibial slope, Insall-Salvati ratio, or Caton-Deschamps index. The postoperative JOA and Lysholm scores significantly improved from 76.7 to 95.8 and from 58.8 to 90.2, respectively. CONCLUSIONS: Satisfactory outcomes can be achieved with hybrid CWHTO in patients with medial OA.
Asian Continental Ancestry Group ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Knee ; Orthopedics ; Osteoarthritis ; Osteotomy ; Patella ; Patellofemoral Joint ; Retrospective Studies

Morphology, location, timing of operation, and complications of multiple aortic aneurysms were investigated in 14 patients (10 men and 4 women with a mean age of 66 years). The locations of the aneurysms were as follows: aortic arch and thoracoabdominal aorta in 1, aortic arch and infrarenal abdominal aorta in 6, descending thoracic aorta and suprarenal abdominal aorta in 1, descending thoracic aorta and infrarenal abdominal aorta in 5, and thoracoabdominal aorta and infrarenal abdominal aorta in 1. Thoracic aortic aneurysms had a mean diameter of 63±13mm. The mean diameter of the abdominal aortic aneurysms was 54±13mm. In 1 patient, thoracoabdominal and infrarenal abdominal aortic aneurysms were operated on simultaneously. Eight patients, 5 with aneurysms of the aortic arch and infrarenal abdominal aorta, 2 with aneurysms of the descending aorta and infrarenal abdominal aorta, and 1 with aneurysms of the aortic arch and thoracoabdominal aorta, underwent two-staged operation. Aortic arch aneurysm was operated first in 3 patients, and abdominal aortic aneurysm in 5. Postoperative complications included spinal cord injury in 1 patient, bowel necrosis in 1, renal impairment in 2, respiratory impairment in 2, and hepatic impairment in 1. There was no perioperative death. Three late deaths occurred. Two staged operation is better for multiple aortic aneurysms. The first operation should be performed for the larger aneurysm.

PURPOSE: The purpose of this study was to investigate the clinical and hormonal features of patients with incidentally discovered adrenal adenomas in relation to corticotropin releasing hormone (CRH) testing and the clinical outcome of adrenalectomy. MATERIALS AND METHODS: Twenty-three consecutive patients with incidentally detected adrenal adenomas were included in this retrospective study. All the patients underwent abdominal computed tomography scans and hormonal assays, including assessment of circadian rhythms of plasma cortisol and corticotropin (adrenocorticotropic hormone, ACTH), a corticotropin stimulation test, and low-dose and high-dose dexamethasone tests. The patients were reevaluated at regular intervals (6, 12, and 24 months) for a median period of 24 months. Subclinical Cushing's syndrome (SCS) was diagnosed in patients with subtle hypercortisolism who did not present clinical signs of Cushing's syndrome. RESULTS: We calculated the responsive index (peak value of ACTH in CRH test/baseline value of ACTH in CRH test). Of 23 patients, 6 had Cushing's syndrome, 8 had SCS, and 9 had a non-functioning tumor. All patients underwent laparoscopic adrenalectomy. Several patients (5 of 6 with Cushing's syndrome and 2 of 8 with SCS) required cortisol replacement therapy after surgery. The remaining patients required no hormonal replacement after surgery. Those who required hormone replacement had a responsive index of less than 1.2. Those who did not need hormone replacement therapy had a responsive index of more than 2.0. CONCLUSIONS: In our limited experience, the responsive index of the CRH test might be a valuable tool for predicting the need for cortisol replacement after surgery in patients with SCS.
Adenoma ; Adrenalectomy ; Adrenocorticotropic Hormone ; Circadian Rhythm ; Corticotropin-Releasing Hormone ; Cushing Syndrome ; Dexamethasone ; Hormone Replacement Therapy ; Humans ; Hydrocortisone ; Plasma ; Retrospective Studies