This paper deals with a case which was firmly diagnosed as ileum perforation caused by an ingested fish bone during an emergency operation for acute appendicitis.
A 49-year-old man was referred to our hospital because of right lower abdominal pain. On close exploration, acute appendicitis was suspected, and an emergency laparotomy was performed. During the operation, we confirmed redness and swelling of the appendix, thickening of the mesoappendix, and typical presentations of appendicitis. Moreover, there was massive retention of blood in the small intestine, and an intestine about 20cm from the terminal ileum was adherent to the inside of the right common iliac artery. When the adhesion was dissected, a fish bone was detected. From these findings, it was thought that iliac perforation due tothe fish bone had involved the appendix. Appendectomy and a partial excision of the ileum were performed.
It was inferred that, since the patient had previously undergone a total gastrectomy with Roux-en Y reconstruction, there was no secretion of gastric juice, resulting in poor digestion of the fish bone. Though the fish bone could be easily evacuated to the small intestine because of a lack of physiological barriers such as the pyrolic ring, it was considered, the perforation occurred because of astricture of the intestine caused by adhesion.

Two experiments were performed to clarify the effects of balneotherapy on platelet glutathione metabolism. One experiment, in which healthy men were subjected to water immersion at temperatures of 25°C, 36°C, and 42°C for 10min, showed that the level of platelet lipid peroxides (LPO) tended to increase at 25°C and 42°C, suggesting the presence of oxidative stress at these temperatures. When an antioxidative defense system was induced at these temperatures, the levels of platelet glutathione (GSH), glutathione peroxidase (GPX) and glutathione reductase (GR) activities increased. The other experiment, in which 4 weeks of balneotherapy was applied to type II (non-insulin-dependent) diabetic patients, showed that the level of GSH on admission correlated well with that of fasting plasma glucose (FPG, r=0.692, p<0.050). After 4 weeks of balneotherpy, the level of GSH increased (p<0.01) in well-controlled patients (FPG<150mg/dl) and decreased (p<0.05) in poorly controlled patients (FPG≥150mg/dl), There was a negative correlation between GPX activities and the level of FPG (r=-0.430, p<0.05). After the balneotherapy, the activity increased in five patients, decreased in three patients, and showed no changes in four patients.
These results indicate that, in diabetic patients, 1) platelet GSH synthesis is obviously induced in response to oxidative stress, 2) lowered GPX activities suggest an impaired antioxidative defense system, and 3) platelet glutathione metabolism was partly improved by 4 weeks of balneotherapy but depended on the control status of plasma glucose levels. From these findings, we conclude that 1) patients whose platelet antioxidative defense system is damaged such as those with diabetes mellitus should not take hot or cold bath, and that 2) balneotherapy improves platelet glutathione metabolism, leading to normalization of platelet aggregability.

　A system for Physiology Educator Accreditation was established by the Physiological Society of Japan in 2013 and then implemented. The accreditation process starts by the applicant participating in the education program during the society’s annual meeting, after which the applicant’s teaching and research experiences are reviewed. The education program consists of model lectures to learn teaching skills and lectures to obtain up-to-date knowledge about physiology. The main purpose of the system is to provide an opportunity to obtain a wide range of knowledge and skills for physiology teaching for teachers working at medical universities and universities of life sciences and for young researchers aiming for a tenure-track academic position.

This study was conducted to examine the effect of exercise training on heat-shock response, the protective response to heat, oxidative stress and other stresses characterized by elevated synthesis of heat-shock proteins (HSP), in strenuous exercise. Five untrained men (aged 20-21 ) participated in the study. The protocol included strenuous exercise to exhaustion by bicycle ergometer (1 st Ex), 4 weeks of training (a 2 km run three days per week) and a repetition of the strenuous exercise (2 nd Ex) . We measured VO₂ and VCO₂ with a respiratorygas analyzer, 70 kDa heat-shock protein (HSP 70) of mononuclear cells by western blotting, and rectal and mean skin temperatures by thermistors during the strenuous exercise. After 4 weeks of training, VO₂max was increased significantly (p<0.05) . HSP 70 increased immediately after the exercise in 3 of 5 subjects in the 1 st Ex, but not in the 2 nd Ex. Rectal temperatures rose significantly after both the 1 st and 2 nd Ex (p<0.05) . Mean skin temperatures fell significantly after both the 1 st and 2 nd Ex (p<0.05) . There was no correlation between rectal and mean skin temperatures and HSP 70. We observed the heat-shock response during strenuous exercise and the attenuation of this response after 4 weeks of exercise training. These results suggest that exercise training may have suppressive effects on the heat-shock response during strenuous exercise.

Clinical effect of a new TENS apparatus SOMA DYNE and its influence on blood constituents were studied.
1. Treatment was performed for four consecutive days, 10min a day, in the patients with chronic pain in their various parts of the bodies. After the treatment, the range of movement (ROM) was improved in fifty out of fifty-two patients (96%).
2. Effect of electrotherapy on blood constituent was examined in six male normal controls after treatment for two consecutive days, 10min a day.
1) Red blood cell counts, levels of hemoglobin and hematocrit decreased. Whole white blood cell (WBC) counts decreased; however, no changes were observed in analysis of WBC.
2) Levels of serum sodium and calcium decreased, whereas those of potassium increased.
3) Levels of plasma adrenaline and endorphin decreased.
These changes suggest that
1. SOMA DYNE is very effective for the patient with chronic somatic pain.
2. Electrotherapy may affect the cell ion channels.
3. Sympathetic nerve activity decreases by the treatment.

We report 2 patients with unilateral pulmonary edema after heart surgery who were successfully treated using venovenous extracorporeal membrane oxygenation (VV ECMO). Case 1 : A 35-year-old woman presented with dyspnea. Echocardiography showed severe mitral regurgitation (MR) and tricuspid regurgitation (TR) and therefore, mitral valve plasty (MVP) and tricuspid annular plasty (TAP) were performed via right thoracotomy. After weaning from cardiopulmonary bypass, respiratory failure occurred with expectoration of foamy sputum and it was difficult to maintain oxygenation. Therefore, we performed VV ECMO to maintain oxygenation. A chest X-ray film after surgery showed ipsilateral pulmonary edema. After weaning from VV ECMO, deep venous thrombosis occurred and therefore we inserted an IVC filter. Case 2 : A 67-year-old man, who had previously received aortic valve replacement experienced dyspnea and visited our hospital. Echocardiography showed an aortic root abscess, and therefore Bentall operation was performed. After weaning from cardiopulmonary bypass, oxygenation was difficult to maintain, and therefore we performed VV ECMO. A chest X-ray film post operatively showed right ipsilateral pulmonary edema. The patient was weaned from VV ECMO 5 days post operatively and was discharged 60 days post operatively. We believe that VV ECMO can be beneficial for patients with respiratory failure after heart surgery, but complications related to this approach such as DVT should also be considered.

Pulmonary arteriovenous malformations (PAVMs) are often treated by pushable fibered or non-fibered microcoils, using an anchor or scaffold technique or with an Amplatzer plug through a guiding sheath. When performing percutaneous transcatheter microcoil embolization, there is a risk of coil migration, particularly with high-flow type PAVMs. The authors report on a unique treatment in a patient with a giant high-flow PAVM whose nidus had a maximum diameter of 6 cm. A detachable coil, not detached from a delivery wire (an anchored detachable coil), was first placed in the feeding artery under flow control by balloon occlusion, and then multiple microcoils were packed proximally to the anchored detachable coil. After confirming the stability of the microcoils during a gradual deflation of the balloon, we finally released the first detachable coil. The nidus was reduced in size to 15 mm at one year postoperatively.
Arteriovenous Malformations/*therapy ; Balloon Occlusion/*methods ; Catheterization ; Contrast Media/diagnostic use ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Artery/*abnormalities ; Pulmonary Veins/*abnormalities ; Tomography, X-Ray Computed