Electrocardiographic studies were made on 676 excellent, well-trained atheletes.
The values of voltage and interval of each deflection were compared with normal value for the Japanese reported by Ueda et al. and were analysed statistically.
The results obtained were as follows:
1) R-R intervals were longer in atheletes than in untrained controls. Sinus bradycardia was markedly observed in atheletes in their twenties.
2) P-Q interval showed no difference between the atheletes and controls in a younger than twenty years group while that was more increased in the former than the latter in an older than 20 years group. Abnormal P-Q prolongation i. e. over 0.2 sec. was more frequent in excellent atheletes than non-excellent atheletes in a younger than 20 years group.
3) QTc (corrected QT, measured QT/√R-R) proved considerably large in atheletes especially those of a 15-19 year old group.
4) There was observed a trend of delay of the ventricular activation time (V. A. T.) in the right precordial lead, but no delay in the left precordial lead.
5) The duration of P-deflection showed a trend of enlargement in an older than 20 years group unlike in a younger group. The duration of P-deflection increased generally as age advanced. The same trend was also observed for P/PQ segment (Macruz' index) .
These findings might suggest the presence of left atrial enlargement, but they revealed neither left axis deviation in frontal plane nor mitral configuration of the P wave. They constituted a difficult problem explain.
6) R-deflection in the left precordial lead generally showed high voltage and especially in a younger group. In many of the atheletes studied SV₁ + RV₅ and RV₅ corresponded to Sokolow & Lyon's criteria for left ventricular hypertrophy (SV₁ + RV₅≥35mm, RV₅≥26mm), but those atheletes were without left axis deviation in frontal plane. In many of the atheletes R-deflection in the right precordial lead showed high voltage with a considerably correspondence to Sokolow & Lyon's criteria for right ventricular hypertrophy (R/S V₁>1. 0, RV₁≥7mm), and these atheletes revealed delayed V. A. T. in the right precordial lead.
The physiological right bundle branch block (Reindell) was also commonly observed, thus there was suggested the presence of right ventricular hypertrophy or overloading, but no right axis deviation was encountered.
It was assumed that a hard training might effect the right ventricle if not prod-uced a pathological ventricular hypertrophy
7) Atheletes in their twenties and thirties showed high voltage in T-deflection especially in V5, but they revealed almost the same T/R ratio as controls.
8) Abnormal ECG findings wree higher in an excellent group than a non-exce-llent group or an under-trained group.

Renal function, hemolysis and hematologic parameters after transfusion using a cell-separation (CS) device were retrospectively evaluated during abdominal aortic aneurysm repair. Fifty-eight patients were divided into two groups, that is, the CS group (n=39) who received autologous retransfusion using the CS device and the non-CS group (n=19) who were operated before 1989, when we started to use CS device in our operating theater. Hematologic parameters and levels of GOT, GPT, LDH, BUN and creatinine were assessed before and 1, 2, 3, 4 and 7 days after the operation. Mean transfused homologous blood was 1.3±1.8 units in the CS groups and 4.9±3.1 units in the non-CS group (p<0.05). Peak levels of LDH and GPT were significantly higher in the CS group than the non-CS group (p<0.05) after the operation (GOT, CS group: 60.4±29.1IU/l vs non-CS group: 34.8±12.3IU/l, LDH, CS group: 643±324IU/l vs non-CS group: 446±108IU/l). There was no significant difference in the levels of BUN and creatinine levels between the two groups. Hemoglobin levels decreased gradually after the operation in CS group patients who did not receive a homologous blood transfusion. These data suggested that mild hemolysis occurred after retransfusion of autologous blood, but that the hemolysis due to the CS device had no effect on the renal function of the patients.

Magnetic acupuncture achieved by plastering is a particular type of acupuncture whose “pressure stimulation effect” deriving from a needle type minor process produces a synergetic effect due to “magnetic stimulation effect” originating in the magnetism concentrated on and discharged from the process. This magnetic acupuncture charged with low frequency is called “low frequency magnetic acupuncture.” The major factors in effective non-needle electro-stimulus anesthesia (T. N. S.) are the shape and condition of electrodes in their contact with the skin. Since the electrode utilizing a magnetic needle fully meets these conditions, “acupuncture sensation, ” which is clinically considered important, can be adequately expected. The following are the results obtained from our studies on the objective evaluation of a stimulation property and therapeutic effects of low frequency magnetic acupuncture.
The subjects involved in the study were 15 healthy adults and 5 patients with various symptoms at Naka Izu Rehabilitation Center. The method adopted was the measure of MV as an index of a comfortable sense of stimulation. An MV pick-up was attached to the subject's thum ball —if right-handed, attached to left thumb, if left-handed, attached to right thumb— with cellophane tape and was recorded by 13ch multi-purpose electro-encephalograph and DTR manufactured by Sanei Sokki K. K. before the results were analyzed by a signal processor.
Results:
1) In 10 healthy adults whose MV bands before and after T. N. S. of a general type were compared, a decrease of theta band and an increase of alpha band were recognized. When stimulation effects noted in 5 healthy adults given T. N. S. of a general type and low frequency magnetic acupuncture were compared in terms of MV pattern, a generally increasing trend of alpha band was observed in magnetic acupuncture electrodes.
2) MV patterns noted in 5 patients with various symptoms who were given low frequency magnetic acupuncture showed a decrease of theta and beta bands as well as an increase of alpha band, while MV amplitude showed a decrease depending on the patient. From the above results, the magnetic acupuncture electrode was found to have a more comfortable sense of stimulation than that of an electrode of an ordinary type.

We performed entry closure for the chronic type B dissecting aneurysms by open surgical procedure or endovascular stent-graft placement. The purpose of this study is to evaluate the mid-term results of these patients with respect to mortality, morbidity, change of aneurysm diameter and outcome of the false lumen. From 1996 to 2003, entry closure was performed on 8 patients with chronic dissecting aortic aneurysm with an entry site in the descending aorta and visceral arteries that originated from the true lumen. The study population consisted of 4 men and 4 women with a mean age of 63.8±10.9 years. One patient had a DeBakey type III a and 7 patients had a DeBakey type III b dissecting aneurysm. Five patients underwent surgical entry closure and 3 patients underwent endovascular stent-graft placement. The mean follow-up period was 40±29 months. No operative mortalities, complications of paraplegia or visceral ischemia occurred. A leak was identified in 3 patients, 1 patient underwent an open repair with descending aortic replacement and 1 patient required additional stent-grafting. In the follow-up period, 1 patient died of cancer, but there were no dissection-related mortalities or re-operations for increase in size. With the exception of 1 case with a graft replacement, complete thrombosis of the thoracic aortic false lumen was achieved in 6 cases. There were no significant differences in the pre- and postoperative aortic diameter. Overall, complete thrombosis of the thoracic aortic false lumen was achieved with a high rate of success without a dissection-related mortality. Long-term follow-up, however, is necessary because a reduction in size did not occur in some cases.

Although the pressure gradient (PG) and the effective orifice area (EOA) have been used as indices of prosthetic valve function, these values show correctly neither energy loss, nor increased workload. This study aimed to evaluate the prosthetic valve function using echocardiography and PG, EOA and energy loss index, a new index advocated by Garcia et al. These were calculated for 40 patients with aortic prosthetic valve replacement by SJM valve (19HP, 6 cases; 21mm, 16 cases; 23mm, 14 cases; 25mm, 4 cases). Preoperative and postoperative echocardiographic measurements and their variations were analyzed and compared according to the size of implanted valve. In the comparison before and after aortic valve replacement, left ventricular mass (383±151g vs 288±113g, p<0.01), SV1+RV5 on ECG (5.07±1.73mV vs 3.83±1.5mV, p<0.01), and diastolic left ventricular posterior wall thickness (14.4±3.7mm vs 12.9±2.8mm, p<0.05) decreased significantly after the operation. However, there was no significant difference according to the size of the prosthetic valve in these reduction rates caluculated by (preoperative value-postoperative value)/preoperative value. Small size prosthetic valves were used for patients with small diameter of left ventricular outflow tract (LVOT) (19HP, 18±2mm; 21mm, 21±2mm; 23mm, 23±4mm; 25mm, 27±3mm; p<0.01) and small body surface area (19HP, 1.5±0.2m²; 21mm, 1.5±0.2m²; 23mm, 1.7±0.1m²; 25mm, 1.8±0.1m²; p<0.01) in our study. There was a signifcant difference in EOA (19HP, 1.2±0.4cm²; 21mm, 1.9±0.7cm²; 23mm, 2.2±0.9cm²; 25mm, 3.5±1.1cm²; p<0.01), but not in ELI (19HP, 1.01±0.41cm²/m²; 21mm, 1.87±1.03cm²/m²; 23mm, 1.83±1.09cm²/m²; 25mm, 3.08±1.21cm²/m²; p=0.055) according to the size of the prosthetic valve. Small size prosthetic valves had small EOA, but showed satisfactory valve function in decreasing left ventricular hypertrophy and reducing LVM and ELI of small size was similar to that of large size.

We evaluated the efficacy of evoked spinal potential (ESP) monitoring during thoracoabdominal aortic replacement to prevent intra-operative spinal ischemia. Nine patients underwent intraoperative ESP monitoring. The ESP was unchanged in 5 patients and decreased in 4 patients. However, ESP recovered in 2 of them by the following techniques: (1) perfusion of intercostal arteries, (2) elevation of distal bypass perfusion pressure, (3) slight hypothermia. Postoperative paraplegia occurred only 1 patient of the 2 whose ESP was not restored. The sensitivity and specificity of the efficacy of ESP monitoring were 100% and 87.5%, respectively. We concluded that ESP is the most useful monitoring for prevention of operative spinal ischemia during thoracoabdominal aortic replacement.

Infectious endocarditis associated with Streptococcus bovis, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the S. bovis-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. S. bovis was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.

Infectious endocarditis associated with Streptococcus bovis, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the S. bovis-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. S. bovis was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.

We report a case of tricuspid infective endocarditis with peripheral pulmonary artery aneurysm. A 31-year-old man with a history of intravenous drug abuse was admitted to our institution. Echocardiography showed severe tricuspid valve insufficiency and large vegetation (10 mm) attached to the tricuspid valve. Computed tomography (CT) revealed a right peripheral pulmonary artery aneurysm. We operated because of the large amount of vegetation. Before the operation, we performed coil embolization for peripheral pulmonary aneurysm. During the operation, we removed the posterior leaflet with vegetation, and performed tricuspid valve repair. The postoperative course was uneventful. Postoperative echocardiography did not show any tricuspid valve insufficiency or vegetation.

A 52-year-old woman who had been treated for miliary pulmonary tuber culosis complained of left flank pain. Abdominal aortic angiography revealed a saccular type aneurysm in the supra-renal abdominal aorta. We resected the aneurysm and reconstructed the aorta by arificial graft patch under partial extracorporeal circulation. The left renal artery was reconstructed by an artificial graft. During the operation, the superior mesenteric artery and the bilateral renal arteries were perfused by blood from the extracorporeal circuit. On pathological examination, it was shown that the aneurysm was caused by tuberculosis.