Eight cases of isolated iliac artery aneurysms treated between January 1991 and December 1997 were reviewed. All patients were men and their ages ranged from 51 to 85 years (mean 69.6 years). The incidence rate relative to abdominal aortic aneurysm during the same period was 9.3%. The location of the iliac artery aneurysms was the common iliac artery in 6 patients and common and internal iliac artery in 2 patients. Rupture occurred in 3 patients (37.5%). Aneurysms ranged in size from 25mm to 55mm (mean 39.1mm) in 5 non-ruptured cases and from 50mm to 90mm (mean 71.7mm) in 3 ruptured cases (p<0.05). The operative procedures for common iliac artery aneurysms were aneurysmorrhaphy with prosthetic graft replacement in 7 patients and with common iliac-external iliac artery anastomosis in 1 patient. For internal iliac artery aneurysms, obliterative endoaneurysmorraphy was performed in 2 patients. Hartmann's operation with sigmoid colostomy was concomitantly performed in 1 case of rupture. Seven patients had good postoperative courses, however, one case of rupture that underwent Hartmann's operation died of multiple organ failure on the 13th postoperative day. Early diagnosis and elective surgery before rupture are recommended.

A 37-year-old woman had a permanent transvenous cardiac pacemaker inserted previously in the left subclavian region to treat complete atrioventricular heart block. As infection occurred in the left subclavian subcutaneous pacemaker pocket after generator replacement, the generator was removed and a new permanent transvenous cardiac pacemaker was inserted in the right subclavian region. After two months, she developed fever and productive cough, and was admitted to our hospital. Echocardiography showed vegetation on the pacemaker electrodes and the tricuspid valve. Chest-computed tomography showed scattered bilateral peripheral nodules with various degrees of cavitation. We diagnosed right-sided infective endocarditis (IE) with septic pulmonary emboli (SPE) and performed cardiac surgery. We observed vegetation on the pacemaker electrodes and the tricuspid valve. The vegetation, the electrodes, and the generator were all removed and a permanent epicardial pacemaker was inserted subcutaneously in the left subcostal region. Methicillin sensitive Staphylococcus aureus (MSSA) was isolated from cultures of vegetation. Postoperative antibiotic therapy was performed and SPE was completely cured. We removed the pacemaker and the electrodes, and performed postoperative antibiotic therapy.

Students in their 5th and 6th year of University of Tsukuba, School of Medicine, enter into a clinical clerkship. They record medical charts and flow sheets and they present at clinical rounds.
1) From 2000 to 2005, a questionnaire survey was conducted to evaluate the clinical clerkship in the rheumatology division. We also evaluated the influence of the introduction of infliximab therapy (October 2003) on the students' experience.
2) Evaluation of the clinical clerkship by the students was improved by attending the infliximab ward. Students felt more involved in the treatment of the patients by preparing drip infusion sets, disssolving infliximab, assisting with the drawing of blood and drip infusions, checking of the vital signs every 30 minutes, and recording charts.
3) Students realized the improvement of rheumatoid arthritis with therapy and the changes in the patients' emotional status after the introduction of infliximab.

A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/l). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.

We evaluated the influence of a twice-weekly group exercise program on visceral fat area (VFA) and plasma adiponectin (APN) in the elderly. Thirty-three community-dwelling elderly (age : 72.4±6.9 yrs) participated in a 12-week supervised, geriatric exercise training program (GET) followed by a 12-week unsupervised GET (u-GET), which included stretching, strengthening, and balance-training exercises. Participants were evaluated for physical fitness, blood glucose, HbA1c, triglyceride, cholesterol, insulin, and APN. VFA was measured by computed tomography. All measurements were taken before the GET (TR1), after 12-weeks of GET (TR2), and at the end of the u-GET (TR3). Twelve weeks of GET produced significant increases in physical function measures. Both walking speed and functional mobility values at TR3 were significantly higher than TR1 values. A significant reduction in VFA was seen at TR3 in men. APN progressively elevated from TR1 to TR3 in women. In the frail elderly, 12 weeks of GET effectively increased functional ability and APN. The beneficial effects on VFA and APN were sustained following the participation in the unsupervised setting, suggesting that the frail elderly should be encouraged to participate and maintain a resistance training routine to achieve preferable effects on both functional ability and cardiovascular risk factors.

We report the case of a 55-year-old woman with aortitis syndrome. She was admitted to our hospital because of repeated chest pain and syncope. An electrocardiogram and the laboratory data suggested acute myocardial infarction, and coronary angiography showed severe bilateral coronary ostial stenosis. No valvular disease was observed. Aortitis syndrome was suspected because of the stenosis of the brachiocephalic artery in addition to the bilateral coronary ostial stenosis, while the patient did not have elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Coronary artery bypass grafting was performed, and the patient's postoperative course was uneventful. However, she again experienced chest pain 9 months after surgery due to aortic regurgitation (AR) and diffuse narrowing change of the left internal thoracic artery graft. Aortic valve replacement and Re-CABG was performed, and the patient was treated with steroid therapy postoperatively. The postoperative course was uneventful, but the patient thereafter died due to bleeding of a malignant adrenal tumor at 21 months after the second surgery.

A 49-year-old woman with systemic lupus erythematosus (SLE) underwent grafting for abdominal aortic aneurysm. She had been receiving steroid therapy for 23 years. The abdominal aneurysm was a saccular type, 7cm in width. It had thick mural thrombi with focal calcification, however, no inflammatory findings were recognized around it. Replacement with 16mm Dacron tube graft was performed. The postoperative course was uneventful. Pathological examination showed only atherosclerotic change with no specific inflammation in the aneurysmal wall. It is rare that SLE patients have aortic aneurysm. However, SLE patients should be carefully followed because of their premature atherosclerotis.

［Purpose］This study aimed to evaluate the differences in the immediate postoperative muscle strength around the hip and knee joints, joint range of motion, pain, and mobility between the anterolateral-supine (AL-S) approach, as a form of minimally invasive total hip arthroplasty (THA), and the posterior approach (PA), as a form of small-incision THA.

［Methods］The subjects were 68 patients with hip osteoarthritis who underwent unilateral THA for the first time. Maximal isometric muscle strength around the hip and knee joints, joint range of motion, walking ability, and pain were measured before surgery, and on Day 10, Day 21, and 2 months after surgery.

［Results］Significant interactions were found between the time and the type of surgery for hip abduction, external rotation, and extension strength. Interaction was also found between the surgical approach and the time required to achieve optimal hip extension range of motion.

［Conclusion］The differences in the functional recovery after AL-S approach and PA were most likely caused by differences in muscle damage. Therefore, it is necessary to customize rehabilitation programs according to the characteristics of each approach.

BACKGROUND/AIMS: Epidemiological studies suggest that there is a considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS). The aim of this study was to examine concurrent gastrointestinal symptoms in FD and IBS. METHODS: A total of 186 college students filled out a questionnaire regarding whether they had uninvestigated dyspepsia (UD, FD without endoscopic examination) and IBS based on Rome-II criteria. Gastrointestinal symptoms were measured using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. RESULTS: A total of 181 students (98 males, mean age 24.6 years) completed both questionnaires. The prevalence of UD, IBS, and UD+IBS overlap was 12 (6.7%), 40 (22.1%), and 8 (4.4%), respectively. A significant UD+IBS overlap was observed (66.7% IBS in UD, 20.0% UD in IBS). Reflux scores of GSRS in either UD or IBS were significantly greater than in those without. Gastroesophageal reflux disease (GERD), defined as weekly occurring moderate symptoms of heartburn and/or acid regurgitation and evaluated using the GSRS, was found in 16 (8.8%) of the subjects. The prevalence of IBS was significantly higher in GERD patients than in non-GERD patients (50.0% vs 19.4%). CONCLUSIONS: The considerable overlap not only between UD and IBS, but also between GERD and IBS, suggests the involvement of common pathophysiological disturbances in the two conditions.
Dyspepsia ; Epidemiologic Studies ; Gastroesophageal Reflux ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Male ; Prevalence ; Surveys and Questionnaires

We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.
1) A questionnaire was distributed to all participating patients and students in 2006.
2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.
3) Results of the questionnaire showed that both students and patients rated this program highly.
4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.
5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.