Two patients with spondylosis deformans and three patients with psychosomatic disease were treated by partial bathing with artificial spring of sodium sulfate. Fifteen minutes a day of bathing in artificial spring water prepared by dissolving 1000mg of sodium sulfate into 1 liter of 38°C-tap water was continued for one month.
Based on the findings on thermography, temperature changes were classified into four types. Correlation was found in three types as follows: p<0.01 in the crossing type, p<0.01 in the converging type, p<0.001 and p<0.05 in the ascending type. No correlation was found in the diffusing type. Plethysmography revealed a significant difference in the converging type and also a difference of p<0.01 in the diffusing type. MCV disclosed a slower change in temperature on the affected side than on the normal side. Blood gas analysis revealed a slight increase in PO₂, SATO₂ after one month of bathing. Subjective symptoms were improved from point 9 to point 3 to 4 on the VAS scale. Numbness changed from the trembling stage to the slightly smarting sensation stage. Psychroesthesia disappeared from all patients.
A combination of nerve block therapy and warm bath cure with sodium sulfate brought good therapeutic results in patients with chronic pain including psychosomatic disease.

AIM To study the effects of superox- ide anion (O ) on Ca2+ homeostasi and contractility in cultured bovine aortic smooth muscle cell. METHODS Using Fura-2 fluorescence technique to determine Ca2+ level and collagen gel contraction system to analyze muscle contractility. RESULTS ATP (10 ?mol? L-1 )-induced Ca2+ transient was smaller in xanthine oxidase treated cells(X/XO) than control. The mean peak increment of [Ca2+ ]i (△[Ca2+ ], peak) and the time integral of the elevated [Ca2+ ], (∫ △[Ca2+ ]i dt) for 5 min were decreased from (206. 1 ? 10.2) to (147.4 ? 14.7) nmol? L-1, and from (12.2 ?0.5) to (9.8 ? 0.8) ?mol?L-1 .s-1. △ [Ca2+ ], peak induced by thapsigargin(1 ?mol. L- 1 ) in Ca2+ -free solution was not affected by X/XO, but was decreased from (27. 3 ? 1 .0) nmol? L－l to (13 .5 ? 1 .0 ) nmol? L- １ in Ca2+ -containing solution be cause of the activation of CRAC(△［Ｃa2+ ], CRAC). X/XO accelerated the velocity of thapsigargin-induced Ca2+ leak from (78.7 ? 3.4) s to (64.8 ? 4.40) s. Gel contraction area in X/XO-treated cells induced by ATP or thapsigargin (in Ca2+ free solution and in Krebs solution) was decreased from 23.6% ? 4.6% to 7.4% ?0.2%, from 3.5% ?0.6% to － l.0% ? 0.5%, and from 7.9% ? l.4% to － 0.5% ? 0.7%, respectively. CONCLUTION O2- attenuats smooth muscle contraction by impairing some of Ca2+ mobilization pathways.

AIM　To study the effects of superoxide anion (O.2) on Ca2+ homeostasi and contractility in cultured bovine aortic smooth muscle cell. METHODS　Using Fura-2 fluorescence technique to determine Ca2+ level and collagen gel contraction system to analyze muscle contractility. RESULTS　ATP (10 μmol*L-1 )-induced Ca2+ transient was smaller in xanthine oxidase treated cells(X/XO) than control. The mean peak increment of ［Ca2+］i(△［Ca2+］i peak) and the time integral of the elevated ［Ca2+］i(∫△［Ca2+］i dt) for 5 min were decreased from (206.1±10.2) to (147.4±14.7) nmol·L-1,and from (12.2±0.5) to (9.8±0.8) μmol·L-1·s-1. Δ［Ca2+］i peak induced by thapsigargin（1 μmol·L-1 ）in Ca2+-free solution was not affected by X/XO, but was decreased from (27.3±1.0) nmol·L-1 to (13.5±1.0) nmol·L-1 in Ca2+-containing solution because of the activation of CRAC(△［Ca2+］i CRAC). X/XO accelerated the velocity of thapsigargin-induced Ca2+ leak from (78.7±3.4) s to (64.8±4.40) s. Gel contraction area in X/XO-treated cells induced by ATP or thapsigargin (in Ca2+ free solution and in Krebs solution)was decreased from 23.6%±4.6% to 7.4%±0.2%, from 3.5%±0.6% to -1.0%±0.5%, and from 7.9%±1.4% to -0.5%±0.7%, respectively. CONCLUTION　O.2 attenuats smooth muscle contraction by impairing some of Ca2+ mobilization pathways.

Adipose triglyceride lipase (ATGL) catalyzes the first step of triglyceride hydrolysis. The gene mutations cause neutral lipid storage disease with myopathy (NLSDM) and/or triglyceride deposit cardiomyovasculopathy (TGCV) . Here we give the first report on rehabilitation of a patient with NLSDM and TGCV. The 62-years-old patient was admitted to our hospital for rehabilitation for skeletal myopathy and rehabilitation for cardiac dysfunction (NYHA class Ⅲ , ejection fraction 20%) . He complaint of dyspnea during the activity of daily life and exercise torelance was low. Our rehabilitation program consisted of physical therapy, occupational therapy, nutrition and cardiac education. We had paid a special attention to the intensity of exercise (aerobic training and resistance training) due to the low cardiac function, energy dysfunction and myopathy. After rehabilitation for two months, muscle strength had increased and 6MWT, ATVO₂ had improved. Importantly, the reduction of dyspnea on exertion as well as the increase in exercise capacity are considered to have led to improvement of quality of life.

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.
2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.
3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

Background: In terminally ill patients with cancer, sleep disturbance makes worse their quality of life. Midazolam has not ever been used for the treatment of sleep disturbance in general wards of our hospital, used in palliative care unit of other hospital, however. Method: This is a retrospective study based on chart review. Twenty-eight patients who were treated with midazolam for sleep disturbance included in this study. We designed evaluation methods to strictly follow the actual chart descriptions. Efficacy was rated as good, fair, or poor. Safety was defined by the presence or absence of respiratory depression and hypotension. Results: The median administration periods and initial doses were 6 days (range, 1-151) and 5.0 mg/night (1.8-20.0), respectively. Fourteen patients showed good sleep a night after midazolam infusion, four and nine patients showed fair and poor sleep, respectively. No patient demonstrated a respiratory rate of less than 8/min and systolic blood pressure of <60 mmHg at any point during and after midazolam infusion. Conclusion: Intravenous midazolam appeared to be safe for sleep disturbance of terminally ill patients with cancer in general wards. A future improvement administration methods are necessary to treat for sleep disturbance more effectively as well as PCU.

Purpose： The aim of this study was to create a list of psycho-social problems and solutions for patients with pancreatic cancer by applying the social problem-solving process. Methods： A semi-structured interview of approximately 1 hour was conducted on two occasions. The participants were 17 patients with pancreatic cancer. Results： Psycho-social problems were divided into two themes: “facing the future uncertainty” and “facing the effects of treatment received”. A list of problems and solutions was created for each problem theme. Realistic goals for “facing the future uncertainty” were ‘maintaining this living condition （n=7）’, ‘preparing for changes to the environment （n=5）’, ‘keeping a sense of control over my own life （n=5）’ and ‘dealing with anxiety （n=3）’. Realistic goals for “facing the effects of treatment received” were ‘restoring the self of pre-illness（n=2）’. Conclusion： For seemingly unsolvable problems, patients can formulate realistic goals that they want to have clarified, and then the problems can be recaptured as solvable problems.

1) The faculty development at each medical school from 2003 through 2005 was analysed.
2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.
3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

  Our palliative care team intervened in a patient with sciatica resulting from metastasis to sacral bone after surgery for rectal cancer. Rapid pain control and a change in the route of rescue drug administration from the stoma were needed. Partial opioid rotation was performed. The dose of 25.2 mg in 72 hours in a transdermal fentanyl patch decreased to 16.8 mg in 72 hours, and the dose of 3.6mg in an hour by continuous intravenous injection of morphine was added. The change in the rescue root to intravenous administration by a patient-controlled analgesia pump gave the patient relief from his pain. He was able to attend his daughter's wedding. His family were all pleased with the relief provided. The advantages of this partial opioid rotation are summed up in the following three points: (1) The required time is relatively short; (2) It can be expedient for analgesia due to the addition of different opioids; and (3) The partial opioid rotation produces fewer adverse effects than a full opioid rotation. Adjustment of the amount of drugs for pain relief in cancer patients is important with the situations of the patient and the family taken into consideration fully.