The purpose of this study was to investigate the hypothesis that the reduction in walking ability is due to muscle atrophy in the lower limb muscles with aging using equational structure modeling as well as investigate the influence of muscle on walking ability. The subjects consisted of 127 persons (57 males and 70 females) aged 20-84 year, who were grouped into 6 age brackets of 20-39, 40-49, 50-59, 60-69, 70-74, and 75 or older. Using MRI, muscle cross-sectional area was measured on psoas major and thigh muscle (divided into extensor and flexor) . For walking patterns, each subject walked along a 7-m walking passage at normal speed for VTR-recording of the motion. The resulting pictures were used to analyze stride length, trunk inclination and walking speeds. Walking speeds showed a statistically significant decrease in value from the 50's age group in males and the 60's age group in females when compared with the 20-39 age bracket (p<0.05) . In males, a significant co-relationship was observed only between the muscle cross-sectional area of thigh extensor and walking speed (p<0.01) while in females, a significant co-relationship was found between the muscle cross-sectional area of psoas major (p<0.001) /thigh muscle extensor (p<0.01) and walking speed. These results indicate that the muscle atrophy with aging in psoas major and thigh muscle extensor is a factor responsible for the decrease in walking speed. Meanwhile, a difference in sex was observed between the muscle cross-sectional area of psoas major and walking speed. It was considered that the muscle atrophy rate of the female's psoas major being higher than the male's influenced this. Furthermore, it was suggested possibility that the decline of walking ability is due to decreased muscle mass of the lower limbs with aging.

The effect of daily physical activity on oxidative stress is still an unknown issue, especially in middle-aged and elderly individuals. In this study, we examined the relationships of oxidative stress and antioxidant capacity with daily physical activity, taking into consideration the dietary antioxidant vitamin intake (vitamin B₂, C and E) of middle-aged and elderly people (66.0±7.0 years, n= 21; 10 males and 11 females, including 5 male trained runners) . Daily physical activity was measured using both a calorie counter and a questionnaire over a period of two weeks. The plasma concentration of thiobarbituric acid reactive substance ( [TBARS] ) and both oxidized and reduced glutathione concentrations ( [GSSG] and [GSH] ) in whole blood were determined in blood samples obtained at rest and immediately after two periods of acute exercise: maximal cycle ergometric exercise and steady state cycle exercise at 80% of ventilatory threshold (VT) for 30 minutes. At a given statistically controlled dietary antioxidant vitamin intake level (vitamin B₂, C and E), the amount of daily physical activity was associated with neither [TBARS], [GSH] and the ratio of [GSSG] / [GSH] at rest, nor changes in levels of these substances after both exercise tests. These data suggest that the amount of daily physical activity may have little influence on oxidative stress or antioxidant capacity at rest and after acute cycle ergometric exercise. Further investigation would be necessary to clarify how much volume or intensity of physical activity induces increased oxidative stress, from the aspect of habitual physical training and nutrition.

A 92 year-old-female with melena was admitted to our hospital. She underwent Y-graft replacement of the abdominal aorta at the age of 65. Gastroduodenal fiberscopic examination and computed tomography (CT) confirmed the diagnosis of aortoduodenal fistula. The fistula in the proximal anastomotic site was occluded with a suture ligature and omentopexy was performed. On the 15th post-operative day she developed high-grade fever. CT revealed a pseudoaneurysm formation at the proximal anastomosis site. She underwent emergency endovascular aneurysmal repair (EVAR). Her postoperative course was uneventful. She is doing well without symptoms of recurrent infection.

A 55-year-old man was brought to our hospital with a knife penetrating his left anterior chest wall following a suicide attempt. Massive left hemothorax was identified on echocardiography ; however, there was no evidence of cardiac tamponade. After draining blood from the left thorax, computed tomography (CT) revealed that the tip of the knife had penetrated the left lung and reached the left pulmonary vein. In preparation for cardiopulmonary bypass, an emergency thoracotomy was scheduled with a plan to access the left lung and left pulmonary vein. The patient was transferred to the operating room, and the procedure was started with the patient in the supine position. During dissection of the femoral vessels, the patient suddenly developed hypotension. After surgical access to the heart was achieved via median sternotomy, a pericardiotomy was performed and cardiopulmonary bypass was established. A 50-mm stab wound was identified at the lateral wall of the left ventricle. The knife was removed, and the left ventricular wound was repaired. The lingular segment of the left lung was partially resected. The patient had no postoperative complications and was transferred to the referral hospital on postoperative day 25. This case report emphasizes the importance of taking appropriate measures for thoracotomy and cardiopulmonary bypass in patients with penetrating thoracic trauma with massive hemothorax, even in the absence of cardiac tamponade on imaging. We were able to successfully manage a life-threatening condition by taking appropriate measures.

The case was a 70-year-old female. Atrioventricular septal defect was diagnosed in her childhood, however, surgical treatment had not been performed. The patient had suffered from heart failure at the age of 69, and she was referred to our hospital for treatment. Her diagnosis was intermediate type atrioventricular septal defect, moderate left atrioventricular valve regurgitation, membranous ventricular septal aneurysm and atrial flutter. An autologous pericardial patch was used to close the ostium primum type atrial septal defect associated with simultaneous covering of membranous ventricular septal aneurysmal wall. Concomitant left and right atrioventricular valvuloplasty and arrhythmia surgery were performed. Her postoperative course was uneventful and the patient was discharged from our department on the 16th postoperative day. To our knowledge, there are few reports of surgery for incomplete type atrioventricular septal defect in the elderly and no report for intermediate type atrioventricular septal defect in Japan. In incomplete type atrioventricular septal defect, symptoms such as supraventricular arrhythmia and heart failure develop according to aging. Reported surgical results in the elderly are quite good, and improvement of excise tolerance is expected. Precise evaluation and proper indication of surgical treatment is mandatory even in older patients.

Background/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO. Methods: This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events. Results: A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration. Conclusions The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration.