The effects of visual information about object size on grip force programming were investigated. Fifteen subjects (26.1±7.6 yrs) repeated lifts of a cube-like grip apparatus (30×30×30 mm, 30g) using a thumb and index finger, while three boxes of different sizes but equal weight (small : 10×10×60 mm, medium : 30×30×60 mm, large : 60×60×60 mm, 25g) were pseudorandomly presented by attaching beneath the grip apparatus. Lifting tasks were performed in two visual conditions. In the full-vision condition, subjects could perceive the box size prior to the lift-off of the grip apparatus, similar to normal everyday conditions. In the obstructed-vision condition, subjects could not perceive the box size due to the placement of a screen during the initial lifting phase, and only the grip apparatus were visible over the screen. The grip apparatus measured grip and load forces during the trial and we found that the grip and load force applied to the grip apparatus in the full-vision condition significantly increased with box size regardless of equal weight. In contrast, when the size information was removed in the obstructed-vision condition, the force applied for a given box of any size was always that adequate for the largest box, suggesting that the scaling of fingertip force by utilizing size information may be achieved by reducing forces for the smaller boxes on the basis of the force output applied for the largest box, but not by increasing forces on the basis of the force output applied for the smallest box.

An 89-year-old woman had undergone a medical examination and treatment due to exertional dyspnea symptom and cardiac enlargement, but her symptoms had not improved. According to images from a computed tomography scan, a huge intrapercardial mass excluding the heart was detected, and the patient was referred to our department for surgical treatment. Because of cardiac failure due to the mass excluding the heart, we planned to excise the tumor for cure and also for diagnosis. We did not distinguish the tumor before operation as is often the case with cardiac tumor. The tumor arose from the epicardium of the left ventricular (LV) anterior wall, and was attached to the LV wall with a broad stalk (approximately 3×10 cm) along the left anterior descending coronary artery (LAD). We had to operate under cardiopulmonary bypass and cardiac arrest, since the tumor involved the LAD, so we underwent resection of a part of the LAD. The patient was discharged uneventfully on postoperative day 37. On histopathology, the tumor was diagnosed as a solitary fibrous tumor (SFT) of the epicardium. Cardiac SFTs are rare. Above all, SFTs arising from LV epicardium are very rare. We report this case with some literature review.

A 65-year-old man, who had undergone the aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis (CEP 25 mm) 18 years previously (at age 48), was admitted to our hospital with a diagnosis of acute heart failure due to acute aortic regurgitation. Redo surgery was performed. The ascending aorta was cross clamped, and cardiac arrest was induced, and aortotomy was done. One of the leaflets of the CEP was entirely collapsed and dislocated to the LV side, which caused acute aortic regurgitation. Although there was no evidence of endocarditis, the other two leaflets of CEP were severely calcified. Aortic valve replacement was performed with a CEP 23 mm. He was discharged in good condition on the 16th post-operative day.

　　The patient is a women in her 60s. After medical examinations, she was told that the result of fecal occult blood reaction testing was positive. Moreover, colonoscopy found type 2 cancer in her sigmoid colon. The patient underwent sigmoidectomy. The 3D dissection of lymph node and colorectal side-to-end anastomosis were performed. Pathologically, the case was diagnosed as moderately differentiated adenocarcinoma (stage II). Adjuvant chemotherapy was not given. During follow-up observation, the tumor marker levels were elevated above normal. A work-up revealed a recurrence of the cancer on the abdominal wall. The lesion was surgically removed with a margin of about 2 cm from the tumor secured. Pathological diagnosis of this recurrent case was not inconsistent with the previous diagnosis of sigmoid colon cancer. As the relapse was thought to be due to the implantation of cancer cells in the abdominal wall, we need to follow the surgical procedure with scrupulous care and exercise the utmost precaution to protect incision wound on the abdominal wall.

The authors carried out neurometry and CMI investigation on 512 subjects in June and July '87. The subjects were devided into four groups according to the CMI criteria by Fukamachi: CMI. I Diagnosed to be normal, II Provisionally to be normal, III Provisionally diagnosed to be neurotic, IV Diagnosed to be neurotic. Comparison was done not only among these groups, but also among age groups and between male and female.
Although there were no great differences among the group I, II and III, each current through F2, F4, F5 and F6 significantly decreased from the group I to IV (p<0.01). A similar tendency was seen in F2 and F6 of the male subjects in each age group, but no tendency in the female subjects.

The effects of the surface friction of a grasped object on the regulation of grip force during holding tasks using a precision grip were investigated. Using a force transducer-equipped grip apparatus, the grip force and load force acting on the object were measured continuously while surface materials (silk, wood, suede and sandpaper) and load weights (0.98N, 1.96N, 2.94N, 4.90N and 9.81N) were varied. From the recorded data, the average static grip force, slip force, safety margin force and static friction coefficient were evaluated.
It was found that both the slip force and safety margin force increased as the slipperiness of the object surface increased. Significant interactions between surface type and weight were observed in the slip force and static friction coefficient. The interaction effect resulted from the fact that the frictional relationships with the fingers changed according to both weight and surface conditions. This was considered due to the viscoelastic nature of finger skin. An increase in the safety margin force with surface slipperiness was considered due to psychological reaction, probably fear of dropping the object. Unexpected changes in surface conditions caused a greater safety margin force than trials without a surface change, which might also have been associated with psychological reaction to uncertainty of the new surface condition. A relatively large inter-subject variation was found in the slip force and safety margin force relative to slippery surfaces.

We report a case of redo aortic valve replacement by right minithoracotomy approach for aortic stenosis after coronary artery bypass grafting (CABG). An 81-year-old man was followed-up once a year for 9 years after CABG. He complained of increasing respiratory distress, showed narrowing of the aortic valve area, elevation of the aortic valve pressure gradient, and tricuspid valve regurgitation by echocardiography. He was admitted for surgery. We considered minimally invasive operation would be better for him and performed aortic valve replacement (Carpentier-Edwards Perimaunt valve 19 mm) by a right minithoracotomy approach because graft injury could occur by median sternotomy after CABG, and he had the risks of advanced age, low activities of daily living, and mild dementia. His postoperative course was uneventful. On echocardiography performed at postoperative days 9, the ejection fraction recovered to 75% from 53% before surgery and the mean aortic valve pressure gradient was 8 mmHg. He was discharged on postoperative day 12. Right minithoracotomy approach with port access is a good option for redo operation for aortic valve stenosis after CABG.

　　Although axillary lymph node dissection (ALND) is conventionally indicated for metastasis in the sentinel lymph node (SLN), the omission of ALND is being discussed more often in recent years. However, because of the lack of specific guidelines, it is unclear which cases should be treated without ALND. In this study, we performed one-step nucleic acid amplification of the SLN with metastasis to determine the total tumor load (TTL), that is, the number of cytokeratin (CK) 19 mRNA copies. After ultrasonography (US) of ALN, the ultrasonographic findings were combined with TTL to rate SLN metastasis. In the rating, a total score was obtained by assigning 1 point each for (a) TTL of ≥15000 copies/μL, (b) US findings of a long-to-short LN diameter ratio of ≤2, and (c) US findings of no echogenic hilus. We then investigated the association between the total score and metastasis in the non-SLN. Results showed that while 87.5% (5/6) of patients with positive non-SLN scored ≥2 points, only 3.1% (1/34) of patients with negative non-SLN did so, suggesting that a total copy number of CK19 mRNA, US findings of a long-to-short LN diameter ratio, and the presence/absence of echogenic hilus are important predictors for non-SLN metastasis. This novel scoring system is expected to help determine which patients need ALND or what postoperative therapy is necessary.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis (RA), by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the quality of life (QOL) of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of RA, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2 (2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire : Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.

The effects of aging on adaptive force control of precision grip while manipulating a small object were compared between older (84.2±8.9 yrs, n=33) and young adults (19.1±0.24 yrs, n=18) from the following perspectives: (1) adaptation to an unfamiliar object with uncertain physical properties during 16 consecutive lifts ; (2) adaptation to an object with a non-slippery (sandpaper) surface during 12 consecutive lifts, followed by 12 consecutive lifts with a slippery (silk) surface ; and (3) adaptation to objects with different weights (0.49, 0.98, 1.96 and 2.94 N) during 24 lifts (6 consecutive lifts for each weight) .During each trial, grip and load forces were monitored. Safety margin force and slip force were evaluated from the data obtained.
The majority of older adults employed a considerably greater safety margin for an unfamiliar object in the initial trials than did young adults, while the minority of the older adults were able to adapt their safety margin force with a few trials, like the young adults. The older adults who overestimated the safety margin force, however, successfully adjusted their grip force to more optimal levels with repeated lifts, suggesting that the adaptive capability of grip force remained even at 90 years of age. The adaptation of older adults, however, was found to be slower (i. e., required more trials) than that of young adults. Upon encountering surface friction change, the safety margin forces in older adults were more strongly affected by the previous surface condition than those in the young adults. In addition, adaptation to a non-slippery surface seemed more difficult than that to a slippery surface with aging. Upon encountering weight change, older adults showed more difficulties in scaling their safety margin forces according to object weights.
Slower adaptation and difficulty in adaptation to the friction or weight change in older adults may reflect the agerelated decline of tactile sensitivity which impaired the signaling of frictional conditions and various discrete events in the hand. In addition, the lift repetition for force adaptation may possibly reflect the age-related deficit or slowing of central processing capacities related to grip force production.