In this study, we investigated the effects of L-Arginine, which increases the production of nitricoxide (NO) with vasodilative actions, on forearm bathing. The subjects were 12 healthy adult males with 24±1 years old. We compared the changes of blood pressure, heart rate, deep/superficial temperatures, and dermal blood flow by forearm batlmg with or without the oral ingestion of 2000mg L-Arginine. After a 30-minute rest following ingestion, the subjects took a forearm bathing ; immersion of the right forearm below the elbow in 41°C hot water for 15 minutes. There were no significant differences neither in blood pressure, heart rate, nor sublingual temperature between the changes by L-Arginine and water ingestion. Although the superficial temperature of the left toe was significarttly increased 15 minutes after the start of bathing regardless of the presence or absence of L-Arginine (p<0.01), the increase with L-Argilline ingestion was significantly greater (p<0.01) than that without L-Arginine. Furthemore, an increase in left dorsal skin blood flow after 10 to 15 minutes bathing with L-Arginine was more marked than that without L-Arginine. The increasing ratio of blood flow after 15 minutes of right forearm bathing against pre-bathing value was significantly higher (p<0.05) in case with L-Argitme than that in its absence. These results suggest that the oral administration of L-Arginine accelerates thermal vasodilative effects during forearm bathing.

We experienced a case of chronic pain responding to electrical acupuncture therapy while on spinal cord stimulation. A 35 year-old male presented with chronic neck pain. At 16 years of age, he had neck pain due to traffic accident with stellate ganglion block and epidural block. At 29 years of age, he sensed radiating pain in the 3rd to 5th digits of the left hand during epidural block. At 33 years of age, nerve root injury occurred after insertion of an epidural catheter, resulting in epidural abscess. Although the abscess resolved after antibiotic treatment, he had stiff fingers in the left hand together with neck pain and restricted range of motion of the neck. At 34 years of age, a spinal cord stimulation device was inserted which improved the stiff fingers in the left hand, but not the neck pain and restricted neck motion. He therefore visited our institute. At presentation, neck pain together with dysphagia and mastication pain were observed, and the patient was on a liquid diet. He was given electrical acupuncture treatment in additional to trigger point block and stellate ganglion laser. After two treatments, he was able to resume a normal diet. With reduced neck pain, he also undergo rehabilitation mainly through voluntary neck movements. This case demonstrates that electrical acupuncture treatment may be safe and effective for patients fitted with spinal cord stimulation device.

In stroke patients, excessive oxidative stress impairs brain nerve cells and leads to arteriosclerosis. On the other hand, rehabilitative exercise is necessary for the functional improvement and maintenance after stroke, and exercises themselves increase reactive oxygen species production simultaneously. Therefore, it is essential to elucidate how exercises influence oxidative stress in stroke patients. We assessed the effects of exercises on 29 Japanese subacute-phase stroke patients (exercise group, 20; control group, 9), in terms of oxidative stress by examining changes in reactive oxygen metabolite (ROM) level (i.e., oxidative stress) and biological antioxidant potential (BAP) level (i.e., antioxidant capacity) in blood plasma. The exercise group performed two sets of 1-hour exercises 6 days/week for 56 days. The control group performed the same 1-hour exercises, but only on days 1 and 56. ROM and BAP levels in blood plasma in both groups were measured immediately before and after the exercises and at rest on days 1 and 56. ROM level significantly decreased and BAP level significantly increased at rest from days 1 to 56 in the exercise group. However, no significant change was observed in these levels in the control group. Conclusion: Regular rehabilitative exercise can improve antioxidant capacity and attenuate oxidative stress even in stroke patients.
Oxidative Stress ; Stroke ; Arteriosclerosis

Background: Given the shortage of medical professionals in the Philippines, Barangay Health Workers (BHWs) may play a role in providing postpartum healthcare services. However, as there are no reports regarding BHW activities in postpartum healthcare, we conducted this study to understand postpartum healthcare services and to explore the challenges and motivations of maternal health service providers. Methods: Focus group interview (FGI) of 13 participants was conducted as qualitative research methodology at Muntinlupa City. The results were analyzed according to the interview guide. The proceedings of the FGI were transcribed verbatim, and researchers read and coded the transcripts. The codes were then used to construct categories. Results: Four important activities were highlighted among 11 analysis codes. These activities were “Assessment of postpartum women’s conditions,” “Recommendation to visit a health facility,” “Measurement of blood-pressure and vitamin intake,” and “Providing postpartum health information.” Among five analysis codes, we identified three challenges that BHWs face, which were “No current information regarding postpartum care,” “Some postpartum women do not want to receive healthcare services from BHW,” and “Too many assigned postpartum women.” Among five analysis codes, we identified two reasons for continuing BHW activities, which were “Hospitality to help postpartum women and their family in the community” and “Performance of mission in providing BHW services.” Conclusion: This study is the first to evaluate BHW activities in postpartum healthcare services. Our results indicate that BHWs play a potentially important role in evaluating postpartum women’s physical and mental conditions through home-visiting services. However, several difficulties adversely affected their activities, and these must be addressed to maximize the contributions of BHWs to the postpartum healthcare system.

Background: Given the shortage of medical professionals in the Philippines, Barangay HealthWorkers (BHWs) may play a role in providing postpartum healthcare services.However, as there are no reports regarding BHW activities in postpartumhealthcare, we conducted this study to understandpostpartum healthcare services and exploring the challenges and motivations ofmaternal health service providers. Methods: Focus group interview (FGI) of 13participants was conducted as Qualitative Research Methodology at Muntinlupa City. The results were analyzed according tothe interview guide. The proceedingsof the FGI were transcribed verbatim, and researchers read and coded thetranscripts. The codes were then used to construct a categories. Results: Four important activities were highlighted among 11 analysiscodes. These activities were “Assessment of postpartum women’s conditions,”“Recommendation to visit a health facility,” “Measurement of blood-pressure andvitamin intake,” and “Providing postpartum health information.” Among fiveanalysis codes, we identified three challenges that BHWs face, which were “Nocurrent information regarding postpartum care,” “Some postpartum women do notwant to receive healthcare services from BHW,” and “Too many assigned postpartumwomen.” Among five analysis codes, we identified two reasons for continuing BHWactivities, which were “Hospitality to help postpartum women and their familyin the community” and “Performance of mission in providing BHW services.” Conclusion: This study is the first to evaluate BHW activities in postpartumhealthcare services. Our results indicate that BHWs may play an important rolein evaluating postpartum women’s physical and mental conditions throughhome-visiting services. However, several difficulties adversely affected theiractivities, and these must be addressed to maximize the contributions of BHWsto the postpartum healthcare system.

Left ventricular thrombus is a complication of left ventricular dysfunction, including acute myocardial infarction, cardiomyopathy, and severe valvular heart disease. Surgical removal should be considered when a thrombus is mobile, when thromboembolism occurs, and when cardiac function has the potential to improve. Two patients with left ventricular thrombus underwent totally thoracoscopic transatrial thrombectomy. A thrombus developed in the apex of the left ventricle after acute myocardial infarction in one patient (Case 1) and during treatment for congestive heart failure in the other (Case 2). The minimally-invasive transatrial approach requires no sternotomy or left ventriculotomy and is thus particularly beneficial for treating left ventricular dysfunction. Moreover, totally endoscopic surgery confers the advantage of a deep and narrow visual field. Therefore, we consider that this strategy is highly effective for treating left ventricular thrombus.

We investigated causes of interrater disagreements in the observational assessment of clinical training for first-year postgraduate trainees. In 1998 25 first-year postgraduates rotated through the Second Department of Surgery for 3 months, including 1 month in cardiovascular surgery, thoracic surgery, and upper-gastrointestinal surgery. Each trainee cared for several patients at most with a senior resident under the supervision of senior staff members. Nine attending physicians (staff members), 3 doctor-course graduates, and 2 chief residents assessed the trainees at the end of the rotation with special reference to clinical, social, and supervisory abilities. Trainees were given scores of “Good, ” “Fair, ” “Pass, ” or “Fail” for each ability. Interrater disagreements often involved responsibility and activeness, which reflected social abilities, and rapid patient consultations, orderly arrangement of laboratory examinations and procedures, and avoiding ordering of unnecessary laboratory examinations and medications, which reflected supervisory abilities. Assessments of poorly performing trainees often disagreed. Some interrater disagreements were seen among 4 of 14 attending physicians, but disagreements were fewer among the 3 doctor-course graduates and 2 chief residents who were graduates of the college. Both the proper training of assessors and a good relationship between assessors and rotators are necessary to make appropriate evaluations that might affect the career of postgraduates trainees.

At Tokyo Women's Medical University, our curriculum for first-year students is designed to teach the dynamics and etiquette of human relations. During the third year, medical students are expected to anticipate and plan effective therapeutic communication and interaction with patients. A discussion group of 6 students and a member of the human-relations committee first clarify the purpose and develop the training; students then independently participate in human-relations training during the summer vacation. After training, experiences are discussed during class. Although this curriculum has been used for some 10 years, its benefits have been assumed but not validated. We used student reports and questionnaires to examine the effects of this curriculum. The results clearly show that planning and training give the students an opportunity to learn how to establish an effective physician-patient relationship.

In order to study the physical fitness of rural children in Gifu prefecture, a total of 128 rural boys and girls aged 8-14 years old in the Tokuyama-Elementary School and-Middle School, which are in a far rural district from busy civilized urban distriet, were measured for the developmental status, i. e, physique, examination of physical fitness, maximum working capacity, cardiorespiratory function and urinary excretion in summer, 1962, and the comparison was made on the results obtained there with those of the average Japanese children of the same age.
The results obtained were as follows:
1) Little or no difference was found between physical development of rural children and that of average Japanese boys and girls ; i. e, the physique of rural children was not superior nor inferior to the value of the average Japanese children.
2) The record of sprint games, such as 50m-sprint-run, broad jumping, ball throwing, Sargent-jump, grip strength and back strength of rural children was lower than that of the Japanese average. Whereas, the endurance ability measured with a long-distance running (1500m for boys and 1000m for girls) was tended to be higher in the rural children, especially in the girls, than the average Japanese value. However, no significant difference was presented in the flexibility test (forward bending of the upper-body in standing posture) between rural and average Japanese values.
3) The examination of cardiopulmonary function : i.e. E.C.G., blood pressure, heart rate, vital capacity and maximum expiratony flow rate exhibited no abnormal sign. The systolic and diastolic blood pressure tended to increase with age, but the heart rate tended to decrease. The examination of the urinary glucose, protein and occult-blood remained normal, and most of the urine pH of the girls were within the range between 6 and 7, whereas, those of boys were between 5 and 6.
4) The maximum working capacity (maximum oxygen intake, vital capacity) showeda linear increase proportional to age and physique (body height, body weigmt, body surface, etc, ) over the range of the age tested. Sexual difference appeared after 12 years of age.
5) The possibility was suggested that the maximum O₂ intake could be predicted from the vital capacity of the same individual regardless of age, sex and physique, and a theoretical background for that was discussed.