Three essential factors of the sympathetic nervous functions, sympathetic nervous tone (β-, α-secretion), adrenoceptor sensitivity (β-, α-sensitivity) and adrenergic manifestations, were assessed integratedly by the sequential administration of specific adrenoceptor agonists and blockers. The examination procedures were designed to provide all parameters under the blockade of the autonomic regulation without affecting the basic sympathetic nervous functions.
Decrease in β- and α-secretion associated with the increase in β- and α-sensitivity in patients with diabetic neuropathy, idiopathic orthostatic hypotension and cervical radiation myelopathy were exactly compatible with the autonomic dysfunctions of them and convinced the validity of the methods. Synchronized firings of the sympathetic nerves of the cardiovascular system and harmonized regulation of the adrenoceptor sensitivity were shown by the positive correlations between β- and α-secretion and between β- and α-sensitivity, respectively. Negative correlations between “secretion” and “sensitivity” over wide ranges of these parameters suggested that the concept of denervation hypersensitivity was not specific for patients with organic autonomic neuropathies but was commonly avairable for usual subjects in proportion to the sympathetic nervous tone of the individual subject.

In the last decade, 78 patients received operations for abdominal aortic aneurysms with a transperitoneal approach (TP) while in 82 patients we used an extraperitoneal approach (EP). Forty-two patients in the TP group and 40 in the EP group who required no concurrent repair of the inferior mesenteric artery, renal artery or lower extremity arteries were compared. There was no difference between the two groups in mean operative time, mean amount of intraoperative bleeding or mean amount of required homologous blood transfusion. The mean interval after surgery to beginning peroral alimentation and the mean duration of postoperative fluid therapy were significantly shorter in the EP group than in the TP group. An extraperitoneal approach for abdominal aortic reconstruction is preferable for an early postoperative recovery.

Aims: To verify the significance of medical and dental cooperation over the past 10 years in Haramachi Red Cross hospital, which does not have a dental department. We will also investigate the situation of inpatients' oral cavities in our hospital. From these results, we will discuss future activities about medical and dental cooperation.

Methods: We analyzed questionnaire and the field survey data related to medical and dental cooperation. We also compared the current oral assessments by a dentist and the past assessments without a dentist.

Results: A dental hygienist has participated in NST (Nutrition Support Team) rounds at our hospital since 2005. From then, we started oral assessments for inpatients and we recommend for patients to visit a dentist before surgery or chemotherapy. Furthermore, we have held oral care seminars for medical staff. As a result, medical staff have demonstrated an improvement in awareness and technique for oral care. Since 2013, a dentist from the Agatsumagun Dental Association has started oral assessments for preoperative inpatients at our hospital. However, we found that the frequency of problems in their oral cavities and that of postoperative pneumonia have not decreased.

Conclusion: Medical and dental cooperation is effective for our hospital. We think that it is important not only to promote medical and dental cooperation, but also to perform a dental checkup and educate the general population on periodontal disease.

In the postoperative treatment of ruptured abdominal aortic aneurysm surgery, the relationship between intra-abdominal pressure (IAP) and the clinical course is not been clearly understood. From April 2000 to January 2003, we treated 109 cases of abdominal aortic aneurysm surgery (non-rupture 71 cases, rupture 38 cases) and measured intra-abdominal pressure in 30 of the ruptured cases which we analyzed in this study. The patients were divided into 2 groups. The H-group included 12 patients with maximum IAP equal to or higher than 20mmHg, and the L-group included 18 patients with a maximum IAP less than 20mmHg. Clinical characteristics were compared between the 2 groups. The mean age was 79.3±7.6yr in the H-group and 70.7±10.1yr in the L-group (p=0.019). Preoperative shock was diagnosed in 83.3% of the H-group patients, and 61.1% of the L-group patients the (p=0.26). Postoperative maximum values of intra-abdominal pressure were 22.3±2.0mmHg in the H-group, and 15.4±2.4mmHg in the L-group. Duration of intubation was 87.7±110.0h in the H-group, and 25.1±29.2h in the L-group (p=0.04). Food intake was started 14.4±11.2d after surgery in the H-group, and 8.5±4.8d after surgery in the L-group (p=0.094). The length of ICU stay was 6.7±6.5d in the H-group, and 2.9±2.1d in the L-group (p=0.033). Length of hospital stay after surgery was 54.1±25.8d in the H-group, and 25.2±6.8d in the L-group (p=0.001). Complications occurred in 8 cases out of 11 surviving cases (73%) in the H-group, and in 3 cases out of 17 surviving cases (18%) in the L-group (p=0.0024). Complication in the H-group included acute renal failure, paralytic ileus, respiratory failure, abdominal wall dehiscence, and acute arterial occlusion, and that in the L-group included acute renal failure, upper limb paresis, and lower limb paresis. Monitoring of intra-abdominal pressure was considered beneficial to recognize complication and decide therapeutic strategy after ruptured aortic aneurysm surgery.

Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.