The relation of needles inserted to the points of the posterior neck with the anatomical structures was investigated with dissection of four cadavers. The points investigated here are the five points of “Amon”, “Tenchuu”, “Fuuchi”, “Kankotsu”, and “Eifu”. The needles inserted to the respective points of the former three were found to penetrate the posterior atlantooccipital membrane and then the dura mater, and finally to reach the medulla oblongata. The depth from the inserted spots on the surface of the skin to the dura mater are 50, 51, and 49mm in the Amon, Tenchuu, and Fuuchi, respectively, in a cadaver with 39.1cm of circumference of the neck. Furthermore, it was found that the vertebral, the occipital, and the external carotid and the maxillar arteries were penetrated by or located near the needles which were inserted to the Fuuchi, Kankotsu, and Eifu, respectively.

The positional relation between the dorsal sacral foramina and a needle inserted in the point “T, ze-Liao” according to the method of Takenouchi-Hamazoe, and the projection positions of the respective foramina to the body surface were anatomically and bilaterally examined using fifteen cadavers. The results were as follows. (1) The needles inserted in the point “T, ze-Liao” missed the second dorsal sacral foramen caudally or latero-caudally in many cases. (2) In the mediolateral direction, the first to fourth dorsal sacral foramina were located in the middle zone between the dorsal median line and the posterior superior iliac spine. (3) In the rostro-caudal direction, the first dorsal sacral foramen were, approximately located at the same level as that of the posterior superior iliac spine. The second to fourth foramina corresponded to three points which divided the rostro-caudal distance between the posterior superior iliac spine and the sacral cornua equally into four.

The lower one-third point of a line connecting the posterior superior iliac spine and the middle of the lower margin of the ischial tuberosity is used as the acupuncture point to the pudendal nerve. The present study anatomically examined the positional relation between a needle inserted in the acupuncture point and the pudendal nerve as well as examined the projection region of the nerve to the body surface, using the bilateral pudendal nerves of 18 Japanese cadavers.
The needle inseted in the acupuncture point to the pudendal nerve missed the nerve caudally or laterocaudally in many cases, but with twelve cases directly pricking the caudal portion of the nerve. The pudendal nerve lying on the sacrospinous ligament was projected just on or lateral to a line connecting the posterior superior iliac spine and the medial edge of the lower margin of the ischial tuberosity, and in rostro-caudal direction the pudendal nerve was situated in a range 50 to 60% from the top of that line. The height of the sacral cornua corresponded to that of the rostral half of the pudendal nerve lying on the sacrospinous ligament or that more rostral than the rostral tip of the nerve, and the height of the lower tip of the coccyx corresponded to that more caudal than the caudal tip of the nerve.

The following two aspects will be considered in this paper. First, in order to elucidate the effects of experimental increase of heat production on the cold-induced vasodilation (CIVD), we examined 20 males in CIVD before and after each exercise. Second, in terms of the difference in CIVD between trained and untrained individuals, 160 trained and 34 untrained males were examined. The results obtained from both of the experiments may be summarized as follows.
1. The CIVD after one hour's outdoor exercise was enhanced in comparison with that before exercise. After exercise, the temperature before water immersion (TBI), mean skin temperature (MST) and temperature at first rise (TFR) during immersion were significantly higher, and the time to temperature rise (TTR) during immersion was significantly shorter.
The amplitude of temperature (AT) was likewise significantly higher. These scores were calculated into resistance indices (RI) by Yoshimura's method and Nakamura's method (3 point method and 5 point method) . As a result, the RI by Yoshimura's method was significantly higher after exercise while that by Nakamura's method showed no difference. This suggests that a transient increase of heat content by physical exercise is ignored in the latter method.
2. In regard to the features of CIVD in the trained as compared with the untrained, TBI, MST, TFR and AT were higher, and TTR was shorter and RI was significantly higher. There was a significant positive correlation between the years of experience of sports and RI.
3. The CIVD was higher in those trained in outdoor sports than in indoor sports. The RI, classified by sport events was the highest in swimming followed in decreasing order by rowing, karate, baseball, track and field, judo, tennis, rugby, basketball, soccer, kendo, badminton, volleyball and table-tennis.
This order was almost the same even after eliminating the effects of the years of experience of sports. Thus, it follows from this observation that the RI was higher in the trained in outdoor sports than in the trained in indoor sports. This result may be atrributed to the fact that outdoor sportsmen have more opportunities to be exposed to outdoor cold as compared with indoor sportsmen.

The severity of mitral regurgitation (MR) and tricuspid regurgitation (TR) was evaluated semiquantitatively by Doppler color flow imaging. The maximum MR area/body surface area (MRA/BSA) correlated significantly to the severity of angiographyic changes (tau=0.897). The maximum TR area/body surface area (TRA/BSA) also correlated significantly to the severity in angiography (tau=0.874). The cutoff values were 0.5, 2, 4, and 8cm²/m² for MRA/BSA and 1, 2.5, 5, and 10cm²/m² for TRA/BSA. Fourteen children (mean age 4.2 years) underwent repair of partial atrioventricular septal defects (P-AVSD) from 1985 to 1992. The cleft in the anterior leaflet was closed in the mitral valve; other procedures such as annuloplasty were not performed. They have been followed for periods from 7 months to 7 years and 5 months (mean 4 years); they were examined by echo cardiography and the Holter electrical cardiogram at the end of the period. MR had reduced to grade 0-II in all cases. No patients were given any medication, and all remained in NYHA Functional Class I. Paroxysmal supraventricular tachycardia developed in only one patient. We concluded that no annuloplasty in mitral valve is needed in children suffering from P-AVSD.

We describe a case of ruptured coronary artery aneurysm with a coronary artery to a pulmonary artery fistula. An 89-year-old woman with general fatigue and dyspnea was admitted. At the visit she went into shock and was restored by rehydration therapy. Enhanced computed tomography shows a coronary aneurysm (maximum diameter of 50 mm) at the left side of pulmonary artery and mild pericardial effusions. She was scheduled for an emergency operation due to the ruptured coronary artery aneurysm with a coronary artery to pulmonary artery fistula. We performed aneurysmectomy and ligation of the coronary artery to the pulmonary artery fistula under cardiopulmonary bypass. We also reviewed 23 cases of ruptured coronary artery aneurysm with coronary artery extending to a pulmonary artery fistula in Japan. The disease is a rare clinical state and regarded as an indication for emergency surgery.

A 64-year-old man originally underwent Bentall procedure for annulo-aortic ectasia for the first time at the age of 38 years. The surgery was to repair a pseudoaneurysm at the anastomotic site of the left coronary artery by direct closure 11 years after the first Bentall procedure. The anastomosis of the right coronary artery was normal at the time of the first reoperation. However, he had surgery to repair a pseudoaneurysm at the anastomotic site of the right coronary artery 26 years after the first operation ; this was accomplished using the button technique. However, seven months after the second reoperation, he again manifested a pseudoaneurysm at the anastomotic site of the left coronary artery and died of rupture of the pseudoaneurysm. We report the case of pseudoaneurysms at the right and left coronary artery anastomoses that occurred three times after the first Bentall procedure.

The positional relation between the point Jingei and the bifurcation of the common carotid artery was investigated with dissection of the neck after inserting a needle into the bilateral Jingei, using nineteen Japanese cadavers. We determined first the position of the point Futotsu as a point in the sternocleidomastoid lying about 10cm lateral to the laryngeal prominence along the neck wrinkle, and defined the location of Jingei in the cadavers as the mid-point between the laryngeal prominence and Futotsu mentioned above. The common carotid artery shows a dilatation, termed the carotid sinus, at its point of division into the external and internal carotid arteries. The needle did not prick the carotid sinus in all of the thirty-eight cases of insertion; it pricked the common carotid artery at a lower level than the carotid sinus in four of these cases, and in the other cases the needle did not prick the vessel, but rather a portion of the neck medial to the vessel at the lower level, similarly as in the former cases. The points of division of the common carotid arteries of the cadavers dissected were all located at a considerably higher level than the laryngeal prominence; the average level was 32.8mm higher than the prominence on the left, with maximum and minimum values of 52 and 11mm, respectively, and 29.9mm upper on the right (maximum and minimum values: 45 and 8mm). Furthermore, it was suggested that the insertion of a needle at the level of the hyoid bone has a higher possibility of reaching the carotid sinus than that at the level of the laryngeal prominence in acupuncture of the sinus.

Fifty-three patients who had received aortic valve replacement (AVR) using tilting disc valve prostheses (Lillehei-Kaster valve, Omniscience valve, Omnicarbon valve), underwent replacement of their aortic valve prostheses over the past 13 years. The indications for reoperation were non-structural opening failure in 35 patients, thrombosed valves, including 2 stuck valves in 8, prosthetic valve endocarditis (PVE) in 7 and perivalvular leakage (PVL) in 3. The interval periods until reoperation for opening failure and thrombosed valve were 112 and 118 months respectively, and for PVE and PVL were 21 and 25 months. There were 7 hospital deaths (13.2%). Surgical results in cases of active PVE with root abscess and stuck valve required emergency operation were significantly worse than these for nonstructural opening failure. Opening failures, which accounted for two-thirds of the indications for reoperation was found to be due to subvalvular pannus formation on minor orifices which hindered the disc from opening properly. It was suggested that reoperation for these types of prosthetic valve should be done before they develop into emergency cases, taking account of these valve-related complications.

About 7, 000 workers migrated from Kochi Prefecture in 1965. Recently the number of patients with pneumoconiosis and vibration syndrome has increased among these persons who worked on constructing tunnels. To investigate the health status of these workers, we interviewed 73 of these workers with regard to history of migration, work situations, health condition and so on in Niyodo Village in Kochi Prefecture. Thirty workers were examined for pneumoconiosis and vibration syndrome. Geographical distribution of the areas from which these workers had migrated were also analysed by using the statistical data of Kochi Prefecture in 1965.
The results were as follows:
1) Numerous migrant workers come from the mountain villages along the Shikoku Mountains. In the middle-northern areas, included Niyodo Village, the number of migrant workers was large.
2) Their working conditions in the tunnel were poor and measures for prevention of pneumoconiosis, such as wearing of a dust respirator and drilling the rock with water, were poorly carried out. Vibrating tools were also used for long periods of time.
3) Of 73 workers, 40 have been given the compensation follwing a diagnosis of pneumoconiosis or vibration syndrome.
4) In 23 examinees, silicosis was detected in the chest X-ray examination. Classifications included 13 of type 1, 7 of type 2, and 3 of type 4. Also examinees had subjective symptoms and/or objective findings of vibration syndrome. Eighty seven percent were classified as Grade III according to the criteria of Andreeva-Galanina. Thus, most of migrant workers involved in tunnel construction work had complications of pneumoconsosis and vibration syndrome.