Kani city, Gifu is yet a typical small local town of 100,000 populations but has Japanese Brazilian and Filipino increased recently and shares 7% of total population that is a foreigner residing town.
 The foreigner residing towns to be called are facing similar several issues at every place. The working and educational environment for the people as the migrant worker from Central and South America and their health condition which is the most important became worsen.
 4 years ago in Kani city, we made a survey for the educational environment of the children of foreigners for 2 years period, which was reported in public and gained favorable evaluation from several sectors.
 Nowadays we are promoting to assure their social status who live in the local community. They are working as same as Japanese, and sometime to do the job that Japanese would not, but it seems that they are ignored on their treatment in the social life. If they spoil their own health, their life planning may cause a serious problem. Once they dropout, they may not have any chance to recover themselves. This means the “healthy condition” of the local society will be damaged before long. Therefore, we started the foreign nationality citizen's committee where we can maintain not only the individual health but also to be healthy local society from the concept that the foreign residents would not rely on the local society but they act themselves as the citizen and the local residents to participate with the local activities so that they can enjoy their independency, health, pleasure and hope.

We evaluated the efficacy of sternal coaptation pins used to improve the fixation of the transected sternum after coronary artery bypass grafting (CABG) with the internal thoracic artery (ITA). The subjects were 37 patients who underwent scheduled single CABG with ITA in our department and they were classified into two groups, i. e., Group A, without sternal pins (18 patients), and Group B, with sternal pins (19 patients). The efficacy was assessed by the following measurements : drain bleeding volume up to 12 and 24 h after ICU admission, the time until the removal of drain, surgical site infection (SSI) and the maximum split level between the sternal body and manubrium after surgery. Drain bleeding volume up to 12 and 24 h after ICU tended to be less in Group B. The time until the removal of drain was significantly shorter in Group B. SSI was 17% in Group A but 0% in Group B. The use of sternal coaptation pins reduced misalignment of the coapted sternum, and we belive that the use of sternal coaptation pins contributed to the early removal of drain, and SSI reduction.

1) Tension development during rapidly grip strength exertion of athletes and nonathletes was by Natori's method analyzed.
2) Subjects of athletes were 71 healthy men of 17-26 ages and of non-athletes were 54 healthy men of 17-30 ages. Athletes were 26 high school students of 17-19 ages, 22 physical education college students of 19-21 ages and 23 general adult men of 20-26 ages. High school students were 3 Sumo-men, 4 Judo-men, 6 Kendo-men and 13 Baseball-men. Physical education college students were 6 Handball-men, 9 Rugby-men and 7 Gymnasticsmen. General adult men were 11 Judo-men and 12 Kendo-men. Non athletes were 20 high school students of 17-18 ages, 6 university students of 19-21 ages and 28 general adult men of 21-30 ages.
3) Isometric grip strength manometer were used a new device, to improvement on Smedley's manometer straingauge added.
Tension development were amplifired and recorded by portable Visigraph (Sanei-Sokki Ltd.) with paper-speed of 10cm/sec.
4) In the each case was 3 portions of a whole curve of time course of tension and Pmax.P₁, P₂; log t₁, log t₂; tan θ, tan ψ estimated according Natori's method.
5) Except general adults of 26-30 ages of non-athletes were Pmax. of athletes greater than non-athletes.
Pmax, of a Judo-man of general adult was greatest 68.5kg, and Pmax. of a high school student of 17 age of non-athlete smallest 35.8kg.
6) Tan θ and tan ψ of athletes were greater than non-athletes.
Tan θ of a Sumo-man of high school student was greatest 0.3628 and tan θ of a Judoman of general adult was greater 0.3500, but tan θ of a high school student of non-athletes was smallest 0.1624.
Tan ψ of a Kendo-man of general adult was greatest 1.6308 and tan ψ of a Sumoman of high school student was greater 1.5769, but tan ψ of a high school student of non-athlete was smallest 0.5278.
7) Muscle strength of non-athletes may well increased to be about 25 age, so that Pmax. of general adults of non-athletes were greater and of high school students of nonathletes smaller.
But athletes exercised usually for athletic sports, so that Pmax, and tan θ, tan ψ independent of age was greater than non-athletes, these were an each event varied. Pmax. of Judo-men of general adults were relative greater and tan θ, tan ψ were greatest. Pmax. of Handboll-men were greatest but tan θ, tan ψ were relative smaller. Pmax. of Gymnas-tics-men were relative greater but tan θ, tan ψ were smallest. So that were varied pattern of time course of tension development of hand grip exertion an each event of athletics.

A 77-year-old man was hospitalized for a proximal anastomotic aneurysm 9 years after surgery for an abdominal aortic aneurysm. The aneurysm was located 3cm distal to the renal artery. The maximum diameter was 55mm. His medical history included a reoperation for the proximal anastomotic aneurysm and cerebral infarction. Endovascular stent grafting was performed because it was possible anatomically. Postoperatively, no endoleak nor migration were found. At present, the patient is being followed up regularly in the outpatient department. Endovascular stent graft placement can be an effective method for reoperation cases of an abdominal aortic aneurysm, and if it is possible anatomically, it should be attempted.

A 67-year-old man was referred to our department for surgical treatment of ischemic cardiomyopathy. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 62% and pulmonary congestion. CAG revealed multiple obstructive lesions in the left coronary artery system. LVG and UCG showed ventricular dilatation and dysfunction. ECG showed complete left bundle branch block with a QRS duration of 180ms. He underwent autologous bone marrow cell implantation and biventricular pacing concomitant with coronary artery bypass grafting. He is doing well after 15 months without any complications. Combination with therapeutic angiogenesis and cardiac resynchronization therapy may contribute to the development of new regenerative strategy for patients with severe ischemic cardiomyopathy.

Under scheduled anticoagulation therapy, surgery for abdominal aortic aneurysm was performed in 4 patients who had undergone heart valve surgery and implantation of a mechanical prosthesis. Warfarin and antiplatelet agents were prescribed in all cases preoperatively. Antiplatelet agents were discontinued from seven to 10 days before operation. Warfarin was stopped from two to three days before operation and heparin (200IU/kg/day) was administered by continuous intravenous infusion to produce an activated clotting time of around 150 seconds. Bolus intravenous heparin of 3, 000 IU was added before aortic crossclamp. Oral anticoagulants were resumed from the beginning of oral intake, and heparin was stopped when the prothrombin time reached therapeutic levels (% PT=40%). In three patients perioperative courses were uneventful. Intraperitoneal hemorrhage occurred in one patient who simultaneously underwent cholecystectomy and aneurysmectomy with Y-grafting. He required blood transfusion and interruption of anticoagulation. Brain thromboembolism occurred in this patient 26 days after the operation. We believe that scheduled anticoagulation for the operation of abdominal aortic aneurysm is safe and useful in patients with prior prosthetic heart valve surgery. However, the coexistence of coagulopathy requires more intensive anticoagulation therapy.

Introduction: The importance of estimating the prognosis of advanced cancer patients is well known, but clinicians do not estimate survival time accurately. Since there is a need for an objective index to estimate survival time, the utility of the Prognostic Nutritional Index (PNI), which depends only on objective factors, was evaluated. Methods: The PNI was calculated using the following formula, PNI=10×serum albumin value (g/dL)+0.005×lymphocyte count in peripheral blood, at 3 months, 2 months, 1 month, 3 weeks, 2 weeks, 1 week, and within 3 days before death in 278 cancer patients (166 men, 112 women; age range, 33-99 years; mean age, 69.8 years) who died in a hospital surgical unit. Results: Sites of primary diseases included lung, breast, esophagus, stomach, colorectum, liver, biliary tract, and pancreas. The PNI values showed a gradual decrease over time. Changes in the PNI values were lower in non-gastrointestinal cancer patients than in gastrointestinal cancer patients. The mean PNI value was significantly higher in patients who lived >3 weeks (38.8) than in those who died within 3 weeks (32.4). When the PNI cut-off point was set at 35, and it was assumed that the life expectancy was within 3 weeks in cases with PNI <35, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 74.8%, 62.2%, 68.1%, and 69.6%, respectively. Discussion: The PNI appears to be a useful and simple parameter to predict clinical outcomes of patients with terminal stage cancer. Particularly, the PNI is considered feasible for gastrointestinal cancer patients.

OBJECTIVETo characterize the symptoms of neurogenic intrapelvic syndrome and the pathogenic mechanisms.

METHODSA total of 537 patients with neurogenic intrapelvic syndrome were treated in the Takano Hospital between 2001 and 2005. Clinical data were analyzed retrospectively.

RESULTSThe mean age was 58.5 years old. There were 205 males and 332 females. There were 80 patients(14.9%) who presented with only one symptom with anorectal pain being the most common one (43.8%, 35/80). One hundred and fifty-six(29.1%) patients had two symptoms with anorectal pain and difficult evacuation being the most common combination (26.3%, 41/156). There were 144 patients (26.8%) complained of 3 symptoms and the most common combination was anorectal pain, difficult evacuation, and abdominal discomfort (30.0%, 43/144). A combination of 4 symptoms was reported in 105 patients(19.6%) with the combination of anorectal pain, incontinence, abdominal discomfort, and lumbar discomfort being the most often(65.7%, 69/105). In addition, there were 52 patients(9.7%) who had above 5 symptoms simultaneously. The frequencies of the 5 symptoms were 73.6% for anorectal pain, 27.9% for incontinence, 69.6% for difficult evacuation, 55.3% for abdominal discomfort, and 53.6% for lumbar discomfort.

CONCLUSIONSSymptomatology of neurogenic intrapelvic syndrome is complicated. The pathogenic mechanism may be related to concurrent dysfunction of sacral nerve and pelvic splanchnic nerve.

Encopresis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pelvic Pain ; etiology ; Retrospective Studies ; Syndrome

Introduction: Early clinical exposure (ECE) is an educational methodology where medical students are exposed to the clinical settings in the undergraduate curriculum. This study aimed to examine the implementation status of ECE at medical schools in Japan. Methods: Based on published syllabi, we investigated the existence, location, and subjects (medical/non-medical staffs) of the training programs in medical schools. Results: Of 78 universities, 74 (95%) offered a total of 173 ECE practical training courses, and 51 (69%) combined on-campus and off-campus ECE training. Regarding the location and subjects, 81% of the on-campus ECE training was for medical personnel, 47% of the off-campus was for non-medical personnel, and 61% of the on- and off-campus was for both medical and non-medical personnel. Conclusions: More medical universities combined ECEs on-campus and off-campus and did not offer exposure only to medical staffs. The national trend can serve as a reference to discuss the circumstance of ECE and to plan ECE courses in the near future.

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.