Introduction:
The mechanism of moxa-needle therapy is unknown to us in spite of its significant effect. We observed variations in the temperature of the moxa-needle and that of the microwave-applied needle.
Method:
Chinese needles of the said two types were inserted into meat specimens (3×3×2cm) nd a house rabbit to the depth of 1.0cm and 1.5cm, respectively, and temperature was taken by a thermister around the needles at the depth of 15, 10, 5, and 1.0mm, respectively.
Effect:
1. In the moxa-needle, the temperature went up mainly at the top surface of the specimen or the surface of rabbit skin.
2. In the microwave-applied needle, from the beginning the temperature increased and as it plateaued, the heat was transmitted to the needle tip.
3. Typical temperature curve of the rabbit was found rather flat as compared with the same of meat specimen.
Conclusion:
1. In the moxa-needle, a rise in the temperature was limited under the subcutaneous area, it was not transmitted to the acupoint.
2. In the microwave-applied needle, it elevated the temperature around the needel; therefore, we believe that it stimulated the acupoint greatly.
3. In the light of the foregoing observations, it may be concluded that the microwave-assisted acupuncture would be significantly useful.

With the advent of a society in which the number of elderly people is increasing and the number of babies a woman gives birth to in her lifetime is decreasing, how to address to the future financial broblem of the nation's health insurance schemes has come up for discussion. Against the backdrop of quantitative repletion of medical care, the government has come pu with a policy calling for the containment of medical costs. Under the circumstances, it is expected that the proceeds from medical treatment will level off in years to come. To cope with the situation, the Federation of Agricultural Cooperatives for Welfare in Aichi Prefecture has planned to install a department-wise cost control system in its member hospitals with eht aim of making all staff members cost-conscious, profit-minded and futrure-oriented in every department. In this paper, the authors will present the system in outline and show the target number of patients set on the basis of the break-even point, financial analyses of departments where revenues are below the break-even point and measures to deal with deficits case by case. In addition, as a task to be tackled with, the need for the omprovement of the accuracy and the standardization of the system will be discussed.

As a management improvement tool useful for cost containment and adaptable to the trend of reform in recent years, we introduced the SPD system of medical materials. Since there had been no precedent for the introduction of the SPD system in the hospitals affiliated with Kouseiren and even for the dealer it was the first trial, an original system was built. The quantity of materials in stock was fixed by entrusting, so-called the shelf control system. This system has been left in charge of one hospital employee and one individual employed by the dealer.The condition at the time when this system was introduced was not to increase personnel but to lower costs. The maintenance costs of this system were as cheap as 137,700 yen per month on a five-year lease. As a result, the quantity of inventory at the time of the term-end settlement of accounts reduced by about 18 million yen. Moreover, in marked contrast with increased income, the amount of money expended in the purchase of medical materials decreased from that in the pervious year. Though the number of items used in each department has increased by 480 items now from the start, the inventory is 0 yen.This system is very useful especially for the inventory management of specific insurance medical materials, because it can take in insurance claim data on MO (Magneto Optical Disk), compare it with the purchase data of materials and check the income-and-expenditure balance of specific insurance medical materials immediately. The sum of the amount of temporary stock curtailment for the past two years and six months and the annual purchase curtailment amount was 93,380,000 yen.It is concluded that the introduction of the SPD system has contributed much to the improvement of inventory management.
Insurance ; System ; Reduction - action ; Effective ; Original

Introduction: Compared with faculties in clinical and medical research departments, those in medical departments are not appropriately evaluated in terms of their contributions to or achievements in medical education. Therefore, the aims of this study were to investigate the contributions of medical department faculties to medical education, and to examine differences in contributions according to duty positions and specialties.

Methods: Five-grade self-assessments in relation to 20 items on a rating form for performance in medical education, which was developed by the Japan Society for Medical Education's Committee for Performance Evaluation, were carried out by medical department faculties in Japanese universities. The data were then totalized and analyzed.

Results and Discussion: Although faculties belonging to departments other than medical education units did not actively participate in examinations or the education system, they still made contributions to lectures and practice. In addition, faculties with positions with more duties tended to show greater participation in the education system.

Conclusion: Based on these findings, we recommend the use of a rating form as a standard scale to evaluate performance in medical education.

Effects of environmental (cold) stress and aging on cells in monocyte/macrophage lineage were investigated. We demonstrated that immune suppressive states seen in acute cold-stressed mice (8-10 weeks of age) is attributable to FcγRIIbright suppressor macrophages. Serum corticosterone levels were markedly increased in acute cold-stressed mice. In addition, expression of glucocorticoids (GC) receptor mRNA was observed in FcγRIIbright cells from these mice. The increase of FcγRIIbright cells in peritoneal exudate cells caused by acute cold stress was inhibited by adrenalectomy or administration of a saturating amount of the GC antagonist RU 38486 (mifepristone). On the contrary, administration of the GC agonist, dexamethasone, markedly increased the proportion of FcγRIIbright cells in peritoneal exudate cells of control mice. These results suggest that the generation of FcγRIIbright suppressor cells of monocyte/macrophage lineage by acute cold stress was mediated by action of GC through the GC receptor. We likewise found that the proportion of FcγRIIbright suppressor macrophages is increased in aged mice (22-24 months of age). Meanwhile, activated macrophages which function as antigen presenting cells were decreased in aged rats. Both the basal corticosterone concentrations in serum and the expression of mRNA for GC receptor in peritoneal macrophages increased significantly in aged animals, suggesting that these populational and functional changes of macrophages in aged animals were mediated, in part, by the increased basal levels of GC. This is probably being responsible for immunosenescence.
Neisseria gonorrhoeae ; Laboratory mice ; Acute ; Macrophages ; receptor

Surgical results in eight octogenarians who were operated upon for abdominal aortic aneurysms were compared to those of 42 patients under 80 years of age. Seven of eight octogenarians were operated on an emergency basis, and four of them were ruptured aneurysms. The size of the ruptured aneurysms was over 6cm in all cases of both groups. Postoperative complications occurred more frequently and postoperative mortality were significantly higher in octogenarians than in patients under 80. Early surgical intervention is recommended for elderly cases with large abdominal aortic aneurysms.

A 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.

The preoperative pulmonary arterial pressure of 38 patients aged over 50 undergoing surgical closure of a secundum atrial septal defect was studied. They were divided into three groups according to systolic pulmonary arterial pressure (PAP): Group A (PAP<30mmHg, n=14), Group B (30≤PAP<50mmHg, n=16), and Group C (PAP≥50mmHg, n=8). The mean age of group C patients was older than that of group A patients. With higher PAP, the Pp/Ps, Rp/Rs and cardiothoracic ratios increased, atrial fibrillation and heart failure (NYHA≥2) were more frequent, and PaO₂ levels declined. There were no differences in left to right shunt ratio and Qp/Qs among the three groups. The PAP and Rp/Rs were under 70mmHg and 0.30, respectively in all patients. High pulmonary blood flow seems to be the cause of pulmonary hypertension in most elderly patients because PAP and Rp/Rs decreased after surgery in all groups. Findings of cardiomegaly and heart failure also improved after surgery. Surgical intervention is recommended even in elderly patients with a ASD.

A case of pseudoaneurysm of the external iliac artery after a total hip arthroplasty is reported. A 48-year-old man had undergone a total left hip arthroplasty 5 years previously. Acute arterial occlusion (AAO) of the left lower extremity occurred 3 times. AAO was due to pseudoaneurysm of the external iliac artery, which was detected by rotating digital subtraction angiography (DAS). Aneurysmectomy and reconstruction were carried out. Rotating DSA was useful for the diagnosis of this unusual case of pseudoaneurysm of the external iliac artery after a total hip arthroplasty is unusual.