The present study aimed to examine the effects of community-based intervention on cognitive function and hand finger dexterity in older adults at different levels of time to go out. Forty men and women (age, 73 ± 1 years) participated in supervised group activity and seated exercise for 60 min per session, once each week during an 8-week intervention. The participants wore an activity monitor for 1 week to determine baseline values and for the 8 weeks of intervention. Mini-mental state examination (MMSE) and pegboard test, which is related to cognitive function, were assessed before and after the intervention. Based on the total time to go out at baseline, the participants were assigned to Control group (> 60 min/day, n = 18) or Short group (≦ 60 min /day, n = 22), and then analyzed. After the 8 weeks of intervention, the Control and Short groups improved physical fitness parameters such as handgrip strength. Although MMSE in the both groups did not reach statistically significant level, these values tended to increase slightly from the baseline. Interestingly, two-way repeated-measures analysis of variance indicated significant interaction of pegboard test, and the score significantly increased only in the Short group. Total physical activity and moderate-vigorous physical activity in the both groups did not change significantly between the baseline and intervention periods. Therefore, these results suggest that the trainability of pegboard test, which is an index of hand finger dexterity and is related to cognitive function, would differ depending on the time to go out at baseline in older adults.

A 62-year-old man, who had been given a diagnosis of chronic idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital for an operation for abdominal aortic aneurysm (AAA). Preoperative coronary angiography revealed severe triple vessel disease, and we chose to treat this first. The platelet count on his first admission was 2.1×10⁴/μl and preoperative immunoglobulin infusion was introduced for 5 days. Off-pump coronary artery bypass grafting (OPCAB) was performed safely with platelet transfusion, and he was discharged on the 14th postoperative day. Thirty-eight days later, graft replacement of AAA was performed with preoperative immunoglobulin infusion and no platelet transfusion, and he was discharged at the 11th postoperative day. Preoperative immunoglobulin infusion therapy and selection of OPCAB were useful to prevent perioperative bleeding complications. This is the first report of staged cardiac and aortic surgery in a patient with ITP.

We report the succesful treatment for improvement of orthostatic hypotension of a case of Shy-Drager syndrome (SDS).
CASE REPORT
A 56 year-old man diagnosed with SDS was admitted to our hospital on July 8, 1988 because of orthostatic hypotension. He had been suffering from dizziness, dysuria and muscular rigidity for 2 years. He had been treated with drug-therapy, but these sympton had progressed. Physical examination on admission revealed severe orthostatic hypotension due to disorders of autonomic nervous system, so he could not stand still.
For the treatment, we performed Yushi and punctured its points (Geshu. Hachiyu, Danshu, Pishu, Weishu) or 3 points (Sanyinjiao, Taixi, Taichong) that is located on legs. Acupuncuture therapy was applied from July 13, 1988 to December 10, 1988, every day except on holiday. We estimated the effect of acupuncture therapy with transition of blood pressure and orthostatic hypotension. Transition of acupuncture therapy were as follows.
(1) Yushi were performed alone.
(2) 3 points of legs (Sanyinjiao, Taixi, Taichong) were punctured alone.
(3) Yushi were performed, and 3 points of legs were punctured.
(4) Geshu, Genshu, Pishu and 3 points of legs were punctured.
(5) Subcutaneous needle at Yushi points.
(6) Punctured depth of 1cm to Yushi points.
Symptomatical respons was observed at about 70th treatment, and blood pressure was stabilized constantly and activity of daily life was improved.
Kinoshita et al. reported that Yushi act to sympathetic nervous system inhibitory, so serve to treat for hypertension. But in this case, its act was accelerate. It is speculated that Yushi act to autonomic nervous system homeostatically.

We examined relation between mucosal findings of tongue and gastric mucosal lesion by comparison photographic findings of tongue with gastroendoscopic findings of stomach. Subjects of this study were 115 cases undergoing gastroendoscopic examination in our hospital. The state of tongue surface was evaluated by thickness and color of tongue coating and tongue fissure. Especially, the tongue area was divided into 9 sections in order to investigate distribution of coating and fissure. The cases showing thick coating at the lateral sections of tongue were significantly numerous in patients who had gastric ulcer, compared with the cases in those who had no gastric ulcer. From these results, it was suggested that inspection of tongue mucosa could become one of the useful examination of oriental medicine for gastrointestinal disease.

A 39-year-old woman was referred for assessment of abnormality of on a CT scan with a vascular anomaly of the aortic arch. This patient was completely asymptomatic with no concomitant pathologies and no reported prior trauma. Laboratory data for syphilitic or other microbial infections were negative. The diagnosis was confirmed by angiographic computed tomographic scan with 3-dimensional reconstruction. This technique documented the presence of the aneurysm and the left subclavian artery arising from the unique form of aneurysm. Early surgery was preferred because of the young age of the patient and the morphology and the size of the aneurysm (50 mm). Surgery was performed by a left postero-lateral thoracotomy through the forth intercostal space. Femoro-femoral partial cardiopulmonary bypass was used for distal perfusion. An aortic clamp was placed just distal to the left carotid artery, and a second clamp was placed in the descending thoracic aorta. The aortic isthmus was replaced with a 20-mm Dacron graft, and the left subclavian artery was reimplanted to the prosthesis with an 8-mm Dacron graft interposition. This aneurysm was the result of abnormal organogenesis of a primitive aortic arch and the remnant of the dorsal aorta, in other words, Kommerell's diverticulum. Microscopic examination demonstrated severe medial layer atrophy. In the light of the high risk of rupture, which was proved to be present by the very thin aneurysm wall at the time of surgery, we suggest early surgical treatment of idiopathic isthmus aneurysms in young patients regardless of aneurysm diameter.

Left ventricular thrombus is a complication of left ventricular dysfunction, including acute myocardial infarction, cardiomyopathy, and severe valvular heart disease. Surgical removal should be considered when a thrombus is mobile, when thromboembolism occurs, and when cardiac function has the potential to improve. Two patients with left ventricular thrombus underwent totally thoracoscopic transatrial thrombectomy. A thrombus developed in the apex of the left ventricle after acute myocardial infarction in one patient (Case 1) and during treatment for congestive heart failure in the other (Case 2). The minimally-invasive transatrial approach requires no sternotomy or left ventriculotomy and is thus particularly beneficial for treating left ventricular dysfunction. Moreover, totally endoscopic surgery confers the advantage of a deep and narrow visual field. Therefore, we consider that this strategy is highly effective for treating left ventricular thrombus.

Objective: Many patients in Kagawa University Hospital are administered medicines prepared by the simple suspension method.  Pharmacists in charge of these patients receive inquiries from doctors and nurses regarding the suitability of medicines for the simple suspension method.  Answering these inquiries is complicated and time-consuming as multiple data sources need to be searched.  In order to simplify these complicated procedures, we herein attempted to develop a novel database to provide valuable information that could contribute to the safe performance of the simple suspension method, and evaluated its usefulness.
Method: The specifications of the database were determined by analyzing previously answered inquiries.  To evaluate the usefulness of the database, we used test prescriptions and compared the amount of time required to gather information using the database and the conventional method, i.e., using books alone.  We also analyzed previous prescriptions with the database in order to determine what kinds of problems could be detected.
Results: The investigation of previous prescriptions indicated that some medicines needed to be examined not only for their suitability for the simple suspension method, but also their incompatibility.  Therefore, we added a feature regarding the incompatibility of medicines to the database.  The time required to gather the information needed to answer the test prescription was shorter with our database than with the conventional method.  Furthermore, the database improved the detection of medicines that require particular attention for their properties including incompatibility.  An analysis of previous prescriptions using our database indicated the possibility of incompatibility in half of the previous prescriptions examined.
Conclusion: Our database could rapidly provide information related to the simple suspension method, including the incompatibility of medicines.

Methods: We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient. Results: The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations. Conclusions The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.