The purpose of this study was to investigate the effects of contraction force and the pooled blood volume in the calf on the pumping action of calf muscle contraction. Calf blood volume was controlled by lower body negative pressure (LBNP) and isometric contraction of calf extensor muscle was performed using a handmade dynamometer in recumbent position. The relative volume changes (ΔV/V%) of calf were determined using rubber straingage, when isometric contractions (5, 10, 20, 40 and 60 kg) of the calf muscle were repeated under LBNP of 0, -20, -40, and -60 mmHg.
During resting condition, Δ V/V was increased by 1.04% under -20 mmHg LBNP, 1.88% under -40 mmHg, and 2.54% under -60 mmHg. These increases of ΔV/V were due to the increased blood pooling in the calf. It was shown that the increased blood volume was almost expelled by several bouts of muscle contractions of proper force. The optimum force of contractions for expelling pooled blood was 20 kg under -20mmHg LBNP, and 40 kg under -40 and -60 mmHg LBNP. And it was apparent that the effectiveness of muscle pump was accumulated with repeating contractions, arriving to a plateau after several bouts.
It was shown that the effect of muscle pump in the given contraction force was more effective under the condition with more amount of blood contained in the calf, but the muscle pumping action by light contraction forces couldn't overcome the effect of severe LBNP.

The purpose of this study was to investigate the effects of contraction force and the pooled blood volume in the calf on the pumping action of calf muscle contraction. Calf blood volume was controlled by lower body negative pressure (LBNP) and isometric contraction of calf extensor muscle was performed using a handmade dynamometer in recumbent position. The relative volume changes (ΔV/V%) of calf were determined using rubber straingage, when isometric contractions (5, 10, 20, 40 and 60 kg) of the calf muscle were repeated under LBNP of 0, -20, -40, and -60 mmHg.
During resting condition, Δ V/V was increased by 1.04% under -20 mmHg LBNP, 1.88% under -40 mmHg, and 2.54% under -60 mmHg. These increases of ΔV/V were due to the increased blood pooling in the calf. It was shown that the increased blood volume was almost expelled by several bouts of muscle contractions of proper force. The optimum force of contractions for expelling pooled blood was 20 kg under -20mmHg LBNP, and 40 kg under -40 and -60 mmHg LBNP. And it was apparent that the effectiveness of muscle pump was accumulated with repeating contractions, arriving to a plateau after several bouts.
It was shown that the effect of muscle pump in the given contraction force was more effective under the condition with more amount of blood contained in the calf, but the muscle pumping action by light contraction forces couldn't overcome the effect of severe LBNP.

Tuberculous spondylitis, or so-called Pott's disease, seems to be overlooked because of a lack of severe inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever, weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between Pott's disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory process in Pott's disease tends to spare the disk space, while that of pyogenic infection typically affects the area. Herein, we present a patient with Pott's disease who showed the characteristic clinical and radiological findings.

A 59-year-old man was admitted to our hospital with severe mitral incompetence. Mitral valve repair, tricuspid annuloplasty and the Maze procedure were performed. After weaning from cardiopulmonary bypass, his systolic blood pressure (SBP) dropped to 40 mmHg. Immediate administration of catecholamines markedly increased SBP but his continuing low blood pressure required additional treatment with vasopressin and hydrocortisone. On postoperative day 12 in the general ward, he suddenly lapsed into an intractable hypoglycemic coma. Endocrine function tests revealed adrenocorticotropic hormone deficiency. Since the time of writing has been doing well with 20 mg of hydrocortisone.

A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.
Abdominal Pain ; Biopsy ; Constriction, Pathologic ; Diagnosis ; Duodenal Ulcer ; Duodenitis* ; Endoscopy, Digestive System ; Eosinophils ; Humans ; Lung ; Middle Aged ; Nausea ; Rare Diseases

This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.

We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma ; Audiometry ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Dizziness ; Ear, Inner ; Female ; Head ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; Humans ; Lung ; Lymphocytes ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Middle Aged ; Neoplasm Metastasis ; Radiography, Thoracic ; Spinal Puncture ; Steroids ; Temporal Bone