We investigated the effect of the difference of exercise intensity on the changes in ammonia and oxypurines (hypoxanthine·xanthine) . The subjects were 7 male university students who belonged to the Judo club. By using a bicycle ergometer with the same total work load (kpm), they performed following exercise : light exercise (27.1±0.8% HRmax), moderate exercise (72.6±2.5% HRmax) and exhaustive exercise. After light exercise, blood ammonia, serum oxypurines and urinary oxypurines excretion did not increase. Urinary uric acid excertion increased significantly, but serum uric acid decreased slightly. After moderate exercise, the significant increase was observed with blood ammonia (+ 35.3±5.9μmol/l) . Urinary oxypurines excretion also increased significantly, while serum oxypurines did not change. Also, serum uric acid rose slightly. After exhaustive exercise, the significant increase was observed with blood ammonia, serum oxypurines and serum uric acid. Each peak level and appearance time were +67.2±15.1μmol/l after 3 min, +31.4±7.6μmol/l after 30 min, 155.7±39.9μmol/l after 1 hr of exercise, respectively. These results suggest that AMP deamination occur during moderate intensity, while remarkable production of oxypurines which lead the increase of serum uric acid occur in higher exercise intensity.

In order to elucidate effects of the exercise intensity on purine catabolism, we performed exhausitve exercise (Exh-ex), 80% VO₂max exercise (80%-ex) and 70% VO₂max exercise (70%-ex) test by a bicycle ergometer, and estimated the purine catabolism by the changes in blood ammonia, plasma oxypurines and urinary oxypurines in five healthy male subjects who were given allopurinol. The results were summarized as follows;
1) Plasma oxypurines concentrations (POP) increased gradually after exercise with each intensity. The order of their maximal levels and of cumulative areas under the curves of POP were exh-ex>80%-ex>70%-ex>control, respectively, and that of urinary excretions of oxypurines was exh-ex>80%-ex>70%-ex≥control.
2) Blood ammonia concentrations (BNH₃) increased sharply after exercise with each intensity. The order of their maximal levels was 80%-ex = exh-ex>70%-ex>control, and that of cumulative areas under the curves of BNH₃ was 80%-ex>exh-ex>70%-ex>control.
3) Blood lactate concentrations (BLA) increased sharply after exercise with each intensity. The order of their maximal levels and of cumulative areas under the curves of BLA were exh-ex =80%-ex>70%-ex>control, respectively.
These results suggest that the purine catabolism leading to uric acid production is activated by the physical exercise in the order of increasing intensities. The discrepancy between the increase in ammonia and those in oxypurines suggests that the increased purine catabolic pathway was mediated not only by AMP deamination but also by other factors.

To clarify the experience in clinical practice of students at Osaka University Medical School, a questionnaire survey was performed according to the International Classification of Primary Care. More than half of the students had observed only 6 of the 23 reasons for seeking primary care such as headache and hypertension but had not experienced 17 of the 23 reasons, such as cough and abdominal pain. Most students had observed malignancy and chronic diseases, but more than half had only knowledge of 54 of 105 diseases such as appendicitis. In conclusion, medical students' experiences in clinical practice are not well balanced.

Six (1.2%) of 501 patients sustained phrenic nerve injury during operation for congenital heart disease at our institutions between 1992 and 1998. The diagnosis was confirmed by percutaneous stimulation of the phrenic nerve. All but 1 patient were less than 9 months old, and the average weight was 3.6kg. All 6 patients underwent diaphragmatic plication and were extubated by 7 days after operation. Percutaneous stimulation of the phrenic nerve allowed direct assessment of phrenic nerve function which was difficult to detect by clinical and radiological evidence. This method can be non-invasively used at the bedside to facilitate early and accurate diagnosis of phrenic nerve palsy.

A 64-year-old man who underwent aortic valve replacement with a 25mm Bjork-Shiley valve in 1993 began to have severe anemia and required repeated transfusions by November 2003. Doppler echocardiography showed only mild aortic regurgitation, but revealed turbulent flow around the mechanical valve. Autoimmune hemolytic anemia (AIHA) was diagnosed and he was treated with prednisolone (PSL) starting May 2004. Because of unremitting hemolysis requiring multiple transfusions and the occurrence of renal dysfunction, he underwent rereplacement of the aortic valve with a 25-mm Freestyle valve. His hemolysis and general condition immediately improved. This case suggests the possibility that mild regurgitant jet and turbulent jet stress can cause severe hemolysis when AIHA develops.

In recent years, depression has become diverse, particularly in the younger population. In the field of medical education, it is assumed that a number of educators often experience difficulties in attending to their learners with depression. In this review article, information which contributes to the promotion of mental health for medical residents is provided, considering the knowledge of recent depression in the younger population, including its diversity together with the characteristics of the "generation educated with latitude".

A 50-year-old man with an extensive thoracic aortic aneurysm underwent staged surgery which consisted of preceding total aortic arch replacement with the frozen elephant trunk technique using J Graft Open Stent Graft^®, followed by open thoracoabdominal aortic aneurysm repair. During the second operation, the descending aorta was cross clamped along with the preexisting stent graft, and Dacron graft was anastomosed directly to the stent graft using a running 4-0 monofilament suture. The anastomosis site was then covered with a short piece of Dacron graft identical with the stent graft in size to secure hemostasis. We herein discuss our approach in this complex case, focusing on prevention of inadvertent events such as deformation of the preexisting stent graft and unexpected bleeding.

The prevalence of gastric cancer after eradication (GCAE) is increasing dramatically in Japan. GCAE has characteristic features, and we must understand these features in endoscopic examinations. Differentiated cancer types were frequently found after eradication and included characteristic endoscopic features such as reddish depression (RD). However, benign RD can be difficult to distinguish from gastric cancer because of histological alterations in the surface structures (nonneoplastic epithelium or epithelium with low-grade atypia [ELA]) as well as multiple appearances of RD. Recently, we clarified similar alterations in genetic mutations between ELA and gastric cancer, suggesting that ELA is derived from gastric cancer. Clinically, submucosal invasive cancer was frequently found in patients after eradication therapy even if they received annual endoscopic surveillance. We can improve the diagnostic ability using image-enhanced endoscopy with magnified observation.

The prevalence of gastric cancer after eradication (GCAE) is increasing dramatically in Japan. GCAE has characteristic features, and we must understand these features in endoscopic examinations. Differentiated cancer types were frequently found after eradication and included characteristic endoscopic features such as reddish depression (RD). However, benign RD can be difficult to distinguish from gastric cancer because of histological alterations in the surface structures (nonneoplastic epithelium or epithelium with low-grade atypia [ELA]) as well as multiple appearances of RD. Recently, we clarified similar alterations in genetic mutations between ELA and gastric cancer, suggesting that ELA is derived from gastric cancer. Clinically, submucosal invasive cancer was frequently found in patients after eradication therapy even if they received annual endoscopic surveillance. We can improve the diagnostic ability using image-enhanced endoscopy with magnified observation.

As regards to low back pain of agricultural worker, there are many problems still as to a syndrom of “Nofusho” in rural medicine, a disease in ocupational medicine and clinic of orthopedic.
Agricultural worker who complained of low back pain varies with their country and farm products, and it tend to increase with adding to their age. Further, the female rate of low back pain showed slightly high tendency than the made rate, 8.5-12.5 % of male, 6.5-13.4 % of female always complained of low back pain.
According to the findings of roentogenographic examination of back bone, the deformed vertebrae was found clearly, especially, low back pain caused by a trauma of soft tissue and iscogenic pain showed in farmers. Therefor, it is necessary to be improved working posture and condition.
In comparrison with non-farmer, it is located in order of truck drivers. bus drivers and repairmen.