A 76-year-old woman was admitted to our hospital because of sudden onset of chest pain and dyspnea. Echocardiography, chest CT, and cardiac catheterization revealed an isolated extracardiac unruptured left sinus of Valsalva aneurysm, with stenosis of the main trunk of the left coronary artery. Neither aortic regurgitation nor aortic annular dilatation was recognized. As an infection associated sinus of Valsalva aneurysm could not be ruled out, we performed patch closure using autologous pericardium and coronary artery bypass grafting to the left coronary system. The postoperative course was uneventful. One year after the operation, CT revealed that aneurysm of the left sinus of Valsalva had disappeared and that the grafts were patent.

A research team from the Center for Health Promotion (CHP) at the University of Toronto published a book entitled “Quality of Life in Health Promotion and Rehabilitation” in 1996. In this paper we will introduce the conceptual models of QOL made up of the components of QOL and the QOL field presented by the CHP researchers. They defined QOL as “the degree to which a person enjoys the important possibilities of his or her life” and proposed a QOL model comprised of nine measurable areas, which are grouped into three broad categories of “Being, ”“Belonging” and “Becoming.” The “Being” cluster encompasses the most basic aspects of human beings as individuals, consisting of such three sub-components as physical, psychological and spiritual being. The “Belonging” cluster is concerned with the fit between individuals and their environment, consisting of social, community and ecological belonging. The “Becoming” cluster focuses on the purposeful activities in which individuals engage in an attempt to realize their goals, aspirations and hopes, consisting of practical, leisure and personal growth becoming. In the QOL field as a conceptual model of comprehensive health and well-being and QOL framework, QOL is viewed as the result of identifiable determinants, divided into environmental and personal categories in interaction with such moderating conditions as control, potential opportunities, resources, support systems, skills, life events, political changes and environmental changes. Recently the importance of understanding health issucs at community level from the ecological and phenomenological viewpoints and of directing our attention to the people's living has been recognized anew. The conceptual models presented by the CHP team are considered to have great potential for guiding health and social policy and for implementing various health promotion practices in the community.

Objectives: This study was carried out to verify the usefulness of the Japanese version of the Hearing and Disability and Handicap Scale (HDHS) in the self-evalution of hearing disorders and to clarify the relationships between the hearing disability/handicap scores and such QOL components as life satisfaction, self-rated health conditions and social support networks, etc.
Methods: A questionnaire survey was conducted in Soyo village in Kumamoto Prefecture. The subhects were 136 residents aged 40 years or older who had received health check-ups in accordance with the Health and Medical Service Law for the Aged and who had complained of mild to profound hearing loss in one or both ears. The questionnarie was composed of three parts; back-ground question, the HDHS, and question regarding QOL components. Evalution of language adequacy regarding the Japanese translation of HDHS was carried out with the assistance of four bilinguals.
Results: Data from 123 respondents who completed the questionnaire were analyzed. The results were as follows:
1) Chronbach's alpha coefficients for the three subscales of HDHS ranged from 0.873 to 0.899-all within satisfactory levels.
2) Maximum likelihood factor analysis with varimax roataion suggested that 20 items of HDHS could be categorized according to three factors: Fl-handicaps; F2-detection of such verbal sound as the TV or radio or daily conversation; F3-detection of such nonverbal sound as door chimes or the sound of boiling water.
3) The response rates of “Always or Sometimes” for five questions regarding verbal sounds ranged from 65.8% to 82.1% compared with 47.9% to 58.6% for those questions regarding nonverbal sounds. Those for 10 questions regarding handicaps showed a great disparity; 25.2% for Q15 and 60.1% for Q4.
4) Analysis of covariance structures suggested that increases in hearing disability and handicap scores were indirectly related, through the lowering of self-rated health levels, to a perceived deterioration of QOL.
Conclusion: To ensure high QOL levels among middle aged and elderly residents, the creation of supportive environments that contribute to the alleviation of the affects of communication disorders induced by age-related hearing impairments is extremely important.

We describe our surgical experience of localized thoracoabdominal aneurysm in a 60-year-old woman with hypertension and hyperlipidemia. She was admitted for severe nausea associated with uremia. The initial CT scan revealed bilateral hydronephrosis, retroperitoneal fibrosis, inflammatory abdominal aneurysm, and localized thoracoabdominal aneurysm. To resolve the bilateral urinary tract obstruction, bilateral ureteral stents were inserted. After the renal function improved, the thoracoabdominal aneurysm was removed and replaced with an 18-mm woven-Dacron graft under partial cardiopulmonary bypass. The inflammation and fibrosis along the abdominal aorta did not extend to the thoracoabdominal aneurysm. Following the case presentation, we discussed the pathophysiologic aspects of this patient.

Persistent sciatic artery (PSA) is a rare congenital vascular anomaly with an incidence ranging from 0.025 to 0.06% of the general population. We report a 65-year-old male patient with bilateral PSA suffering from intermittent right-calf claudication. Peripheral pulsations could be palpated well at the right common femoral artery but not at the right popliteal artery. His ankle brachial index (ABI) was 0.79 on the right and 0.99 on the left. Computed tomographic (CT) angiography demonstrated that the bilateral PSAs were branched from the internal iliac arteries and the right PSA was completely occluded, whereas aneurysmal change was not evident. Both superficial femoral arteries were incompletely developed. Blood flow to the peroneal artery, anterior and posterior tibial arteries were maintained in both lower legs via a network of collateral arteries. Arterial bypass from right common femoral artery to the above-knee popliteal artery using knitted Dacron graft was performed and postoperative ABI of the right lower limb improved to 1.06. Ten months after the intervention, the patient was then suffered from intermittent left-calf claudication caused by complete occlusion of left PSA, therefore, above-knee femoropopliteal arterial bypass using knitted Dacron graft was performed. PSA is often asymptomatic until a complication develops and the careful monitoring to prevent the risk of thromboembolic and aneurysmal events are recommended.

A 67-year-old man was considered a candidtate for CABG because coronary angiogram showed obstruction segment 6 and stenoses of segments 9 and 12. He underwent emergency CABG due to acute myocardial infarction (AMI) with cardiogenic shock caused by hemorrhage from a gastric ulcer. Because of hypoxia due to pulmonary edema and acute renal failure an intraaortic baloon was inserted. He had a history of cerebrovascular stroke. Although coronary angiogram revealed multiple vessel disease, we performed off-pump coronary artery bypass (saphenous vein graft-left anterior descending artery) for salvage, because cardiopulmonary bypass was considered very risky and further systemic heparinization might be fatal. He has returned to his job, and is now free from angina. As AMI with cardiogenic shock is often caused by a lesion in the LAD, CABG without cardiopulmonary bypass may be an effective technique in certain selected patients.

This study was conducted to determine whether the regional factors were related to the increase in the percentage of low birthweight(LBW: <2, 500g) infants in Kumamoto Pref., and to establish a tentative structure model for predicting low birthweight infants. Analyses for frequency of LBW infants between 1974 and 1997, and a multiple regression model and covariance structure model were conducted using data from the vital statistics between 1992 and 1997 and regional indicators concerned with LBW infants from official registered statistical data between 1992 and 1997. The 72 regional factors were clustered into four groups linked with agricultural areas such as Urban, Flat, Hilly and Mountainous areas. The recent increase in the incidence of LBW infants resulted from the increase in moderate−LBW(MLBW: 2, 000−2, 500g) infants of full term−LBW infants. There was a steady annual increase in the Urban agricultural area LBW infants since 1992. The two structure analyses revealed that the Urban area had a marked effect on the increase in LBW infants, whereas, farm villages in Hilly or Moutainous areas had less effect on the increase in LBW infants. These findings suggest that the regional factors relating to the mothers’ life−style or regional environments play a key role in the etiology and prevention of LBW, and will be a useful in the analyses using official registered material.
Birth Weight ; Urban brand of Al hydroxide/Mg hydroxide/simethicone ; structure ; Models ; Analysis

Retroperitoneal lymphocele is a very rare complication of abdominal aortic aneurysm repair. An abdominal aortic aneurysm 5cm in diameter was repaired with the retroperitoneal approach in a 70-year-old man. On the 17th postoperative day, mild abdominal distention was reported and a fever of 38°C had developed. A computed tomography scan demonstrated massive fluid collection in the retroperitoneal cavity. Total parenteral nutrition with complete fasting was initiated. A pigtail catheter was inserted into the cavity, and 1, 000ml of milky, odorless, alkaline and sterile fluid was drained. Subsequently, a retroperitoneal lymphocele following abdominal aortic surgery was diagnosed. The leaking lymph tract was ligated because the lymphocele did not improve with long term drainage. Administration of ice cream through the nasogastric tube was used to detect the leaking lymph tract, and we ligated the leaking lymph tract completely. We believe that surgical repair is an alternative strategy when conservative treatments, i. e., fasting, intravenous hyperallimentation and drainage are not effective.

NIPPV provides positive pressure ventilation through a face mask without intubation. We performed NIPPV for 2 patients with acute respiratory failure following cardiovascular surgery. (Case 1) A 63-year-old man, who had had COPD (Hugh-Jones class III), underwent replacement of the aortic arch. He was extubated after 5 days. However, he was re-intubated under controlled ventilation because of deterioration of his respiratory condition. The patient had NIPPV after extubation on postoperative day 14 because he was alert and had no cardiovascular compromise. On the 18th postoperative day he was weaned from NIPPV. (Case 2) A 67-year-old man underwent coronary artery bypass surgery. On the next day he was extubated, but he suffered from hypoxemia due to impaired respiratory condition on postoperative day 3. The patient underwent NIPPV instead of conventional mechanical ventilation because his condition was stable except for respiration. Respiratory condition improved quickly and he was weaned from NIPPV on the 7th postoperative day. NIPPV is an effective method for managing patients with acute respiratory failure after cardiovascular surgery.

The purpose of this study was to investigate the factorial structure of life satisfaction in agricultural workers. One hundred and sixty−five (87 males and 78 females) agricultural workers mainly engaged in plastic greenhouse cultivation in southern Japan, ranging in age from 19 to 72 years (mean = 44.3 years), completed a questionnaire. Scores of life satisfaction showed a higher tendency in males than in females, and those in elders were higher than in younger people. Conversely, females showed higher stress scores than males, and younger people’s score were higher than the elders. Multiple regression analysis was performed to analyze the factorial structure of satisfaction. It is suggested that the level of life satisfaction is positively related to social support, and is negatively related to the impact of stressful life events, globally perceived stress and subjective symptoms of ill health. Stress levels depended on factors concerning the psychological demands of work, work posture, work hours and work environment. Different factorial structures were observed between female and male workers. Findings from this study suggest that a strong social support network may assist in enhancing life satisfaction. Furthermore, the ill health and stress experienced in agricultural work were associated with a reduced life satisfaction.
life satisfaction ; seconds ; Agricultural Workers ; Work ; Satisfaction