Purpose: The objective of this study was to investigate whether body fat rate (BFR) and triceps skinfold thickness (TSF) are associated with estimated fentanyl absorption in patients treated with the fentanyl transdermal matrix patch for moderate to severe cancer pain, by measuring the residual content of fentanyl in used matrix patches. Methods: Adult Japanese inpatients experiencing chronic cancer-related pain and receiving treatment for the first time with a transdermal fentanyl matrix patch (Durotep®MT patch) were included in the present study. During the initial application period, BFR was measured using a body fat scale, and TSF was measured by an experienced nurse with an adipometer. One patch was collected from each patient. The residual fentanyl content in used matrix patch was determined by high-performance liquid chromatography. The transdermal fentanyl delivery efficiency was estimated based on the fentanyl content of the used matrix patches. Results: Fifteen adult patients (5 males and 10 females) were included in this study. Nine patches with a release rate of 12.5μg/h and 6 patches with a release rate of 25μg/h were collected. The application site was the chest or upper arm. BFR and TSF both showed a significant positive correlation with delivery efficiency. Conclusion: In malnourished or low-body fat patients receiving DMP, pain intensity should be more carefully monitored, and fentanyl dose adjustment may be required. Additional parameters, such as nutritional status including body fat change, the degree of dry skin, and plasma fentanyl concentration, also require detailed evaluation. Palliat Care Res 2010; 5(2): 206-212

Blow-out type cardiac rupture after acute myocardial infarction (AMI) is usually a fatal complication. We report the case of a 64-year-old man, admitted to our hospital for AMI with cardiac shock. ECG and echocardiography showed a cardiac rupture after anterior AMI. We performed an emergency operation with a percutaneous cardiopulmonary support system (PCPS) and intra-aortic balloon pumping (IABP). The actively bleeding site, located at the anterior wall, was approximated using a large mattress suture with felt strips to close the rupture site, and the site was covered with fibrin glue. The patient was discharged on POD 48. We report a successful surgery for a case of blow-out type cardiac rupture after AMI.

Aneurysmectomy with bifurcated graft replacement was initially performed on a patient with a ruptured abdominal aortic aneurysm, and an emergency operation was performed successfully on a proximal anastomosis pseudoaneurysm-rectal fistula that was diagnosed by bloody stool a year after operation. On the 10th postoperative month, CT detected a small pseudoaneurysm at the anastomosed prosthetic aortic graft. On the 1st postoperative year the patient first passed a slight amount of bloody stool, after which there was a large amount of bloody stool. Emergency CT and barium enema showed a pseudoaneurysm extending from near the anastomosed prosthetic aortic graft to the upper margin of the rectum and perforation into the upper rectum (Rs). An abscess covered the prosthetic aortic graft in the pseudoaneurysm, extending to the retroperitonerum on the left. We judged the case to be prosthetic aortic graft infection caused by the abscess and performed an emergency operation. The operation consisted of removal of the bifurcated prosthetic aortic graft, right axillo-bifemoral artery bypass, debridement, lavage, and packaging of the gastrocolic omentum. We report a successfully operated case of prosthetic aortic graft infection caused by pseudoaneurysm, rectal perforation and retroperitoneal abscess.

Floating masses in the descending aorta are an uncommon source of embolism. We report a 43-year-old woman, with no previous history of thrombotic events, who was admitted to our hospital for renal and splenic infarction. Transesophageal echocardiography and computed tomography showed a floating mass in the descending aorta. We started anticoagulant therapy immediately and performed surgical removal of the mass that had caused multiple embolic episodes. The postoperative course was uneventful. In cases of a free floating thrombus in the aorta, it is important to prevent catastrophic complications by removing it surgically after anticoagulant therapy.

We carried out three measurements on 12 healthy men to investigate the positional perception in forward or backward flexions of the trunk while standing. In measurement (I), the subjects reproduced the target angle perceived by forward flexion (FF) or backward flexion (BF) of the trunk with their eyes blindfolded. In measurement (II), the subjects first visually perceived the angle shown by an angular, indicator, and then reproduced it by manually by operating the indicator with their eyes open. In measurement (III), the subjects first visually perceived the angle shown by an angular indicator, and then expressed the target angle by FF or BF with their eyes blindfolded. In measurements (I) and (III), indication of the target angle was set at in 5° increments from 5° to 60° in FF, and from 5° to 30° in BF, and in measurement (II) from 5° to 60°. The ability of positional perception was evaluated using the constant error (CE) and the absolute error (AE) of the reproduced or expressed angle.
In measurement (I), CE was small for all target angles, ranging from -0.2°to 2.6°in FF and from 0.3°to 1.6°in BF. However, CE from 5° to 25°in FF was significantly positive. In BF, significant CE was not recognized for any target angles, and AE at each target angle was smaller than that in FF. These results suggest that the sensitivity of positional perception of the trunk in FF is relatively low for small target angles which are close to the quiet standing position.
In measurement (II), CE was very small for all target angles, ranging from -1.2° to 0.9°. Significant CE was recognized only at 10°, 20°and 55°. AE was also small for all target angles, ranging from 0.5° to 1.8°, and no significant difference in AE was recognized among the target angles. These results suggest that visual perception, memorization and recall of the target angle is well retained.
In measurement (III), a relationship between the target angle and the CE was shown on a negative regression line in both FF and BF. As viewed from the regression line, the angle at which the CE became zero was 36°in FF and 18° in BF. AE in target angles close to these angles was also small. This indicates that angles smaller than these are perceived as smaller than they actually are, while angles larger than these are perceived as larger than the actual ones.

This study focused on the effect of pressure sensation from the each plantar surface of the feet on postural control. The plantar surfaces of the feet were made less sensitive by cooling, using a specially designed apparatus set on a force plate. Three areas were cooled: the plantar surface of the heel, the forefoot, and the entire plantar surface of the foot. And the non-cooling condition was the control. The subjects, seven healthy men, were asked to track a continuously moving target spot displayed on a visual monitor while standing on the force plate. This tracking was done by controlling the center of foot pressure (CFP) by leaning forward and backward at the ankles. The target was moving at 0.025 Hertz (once per 40 seconds) with a triangular waveform. The moving range of the target was from 30 to 70 percent (%) of the total foot length from the heel, and this range was divided into 10 percent (%) subranges. Postural controllability was evaluated by the difference between movements of the CFP and target for each subrange. When the entire surface of the foot was cooled, postural controllability of moving the CFP anteriorly was significantly worse than the control. Postural controllability of moving the CFP anteriorly for the anterior and the posterior moving subranges was significantly worse than the control when the heel was cooled. When the forefoot was cooled, postural controllability of moving the CFP anteriorly for the anteriorly moving subrange was significantly worse than that of the control. These results suggest that pressure sensation from the plantar surface definitely participates in moving the CFP anteriorly for postural control. When the CFP is situated on the heel, pressure sensation from the heel alone may play a necessary role for postural control. When the CFP is situated on the forefoot, however pressure sensation from the forefoot may need to be the supplemented by sensation from the heel for adequate postural control.

A study was conducted to investigate the influence of motor learning on functional specialization of the upper and lower limbs by comparing automatized levels in upper and lower limb movements between 17 soccer (S group) and 14 basketball (B group) players at a university. They carried out transitory palmar flexion of both hands while stepping and performing alternate flexion-extension movements of both ankle joints, and transitory plantar flexion of both feet while performing alternate flexion-extension movement of both shoulder joints and both wrist joints. The automatized levels of the upper and lower limb movements were evaluated by the degree of interference between the upper and lower limb movements.
It was shown that automatization of lower limb movements was more advanced than that of upper limb movements in both groups. The automatized levels of stepping in the S and B groups showed no significant difference, and were similar to those of university students in general obtained in our previous study. However, the automatized levels of ankle joint movements in both groups were higher than those for university students in general.
In both groups, the insertion of transitory palmar flexion was restricted to within the phase where the degree of interference was small during the stepping and ankle joint movement. However, this tendency was not clear in the trial where transitory plantar flexion was superimposed on shoulder joint and wrist joint movements.
As for the difference between the groups, the S group showed a higher automatized level of ankle joint movement than the B group. On the other hand, the B group showed higher automatized levels of both upper limb movements than the S group, and this tendency was especially evident for shoulder joint movement.
These results suggest that the change in the automatized level of upper and lower limb movements by specific motor learning is added to the functional specialization of the upper and lower limbs acquired by daily basic motor learning in an upright position.

The purpose of this study was to evaluate the relationship between the position of the center of foot pressure (CFP) and control of standing posture in ten healthy men by tracking the CFP to the moving target.
Subjects were required to track a continuously moving target displayed on a screen while standing on a force plate. The velocity of the target movement was 0.05, 0.10, and 0.15 hertz (Hz) with a triangular waveform. The target was moved 30-70% within the range of the heel regarding the foot length as 100%, and the range was divided by 10%. Each subrange was named (A), (B), (C), (D) for backward movement from 70% to 30%, and (E), (F), (G), (H) for forward movement from 30% to 70%.
The standing posture control was analyzed by mean error and absolute error at turning point between target- and CFP-movement.
The mean error of backward movement was significantly greater than that of forward movement in the two forward subranges at 0.15 Hz. As for the other frequencies, there was no significant difference between directions of CFP movement. Mean error of A was significantly greater than that of B and C in higher frequencies, but there was no significant difference at 0.05 Hz. Regarding absolute error, there was no significant difference between the forward and backward turning point with a decrease in frequency. Mean error of D or E was greatest among the section in all frequencies. The ratio of the greater D or E and A or H was greatest at 0.05 Hz.
These results suggested that CFP tracking at 0.05 Hz is hardly influenced by direction and velocity of the target movement. Terefore, we conclude that controllability of the stand-ing posture differs markedly in various CFP positions. In addition, control of the standing posture in a backward direction is inferior to that in a forward one.

A study was conducted to investigate the effects of a sagittal position of the body gravity center (GCP) and manual weight-load on postural control during rapid arm-lifting. The subjects were five males aged 21 to 36 years. They stood on a force plate while maintaining the GCP at 30%, 45% and 60% from the heel, regarding the fool length as 100%, and anteriorly lifted both arms spontaneously as rapidly as possible. These trials were carried out ten times under a 5 kg weight or no weight. EMGs of the biceps femoris muscle (BFM) and anterior deltoid muscle (ADM), the fluctuation of the center of foot pressure (CFP) and body motion were analyzed by focusing on their time sequences.
At 45% and 60% GCP the BFM action started prior to the ADM action, whereas at 30% GCP it tended to lag behind. The lag times under no weight were 13.9±12.75 ms (mean±SD) at 30% GCP, -32.7±18.18 ms at 45% GCP and -46.0±19.40 ms at 60% GCP. Those under 5 kg weight were 15.0±11.40 ms at 30% GCP, -22.0±6.74 ms at 45% GCP and -28.9±7.63 ms at 60% GCP. These results indicate that the anticipatory action of the muscle related to postural control arises only at specific GCPs.
The difference of starting points for BFM action to ADM action showed no significant difference between 45% and 60% GCP for either as 5 kg or no weight. The CFP position moving in a forward direction during arm-lifting showed a marked difference between 45% and 60% GCP. The time for arm-lifting showed a marked difference between 5 kg and no weight. These results suggest that the starting point of anticipatory muscle action related to postural control does not change according to the magnitude and time course of the distance to the body equilibrium as a result of arm-lifting.

The voluntary exercises consist of different automatized levels and are mostly a combination of the upper limbs and the lower limbs exercises.
This study was to examine the interference of the upper limbs exercise to the periodic lower limbs exercise with different automatized levels. Seven male university students, aged 19 and 20 yrs., served as subjects. The periodic lower limbs exercises were the stepping (walking on the place) and the alternate plantar-flexion of the right and left foot while standing. The frequencies of the lower limbs exercises were 120, 160 and 200 times/min, The stepping, which is similar to the motion of the lower limbs in walking or running, may be performed more frequently in daily life than the plantar-flexion in which only the ankle angle was changed. Therefore, we assume that the stepping is a higly automatized exercise compared with the plantar-flexion. Upper limbs exercise, which was combined with the lower limbs exercise, was the simultaneous tapping of one time by both hand. The interference degree was evaluated by the change of step intervals of the lower limbs exercise. The results were:
1) The fluctuation of step intervals on the plantar-flexion was greater than the fluctuation on the stepping and the smallest in the frequency 120 compared with that in the other frequencies.
2) When the tapping was combined with the lower limbs exercises, one step interval at that time was lengthened and one step interval immediately before the tapping was shortened. This change of step intervals was greater in the plantar-flexion than that in the stepping. The change in the plantar-flexion was the smallest in the frequency 120 compared with that in the other frequencies.
The above mentioned findings suggest that the automatized level of the lower limbs exercise can be clearly evaluated by the interference degree of the upper limbs exercise to the periodic lower limbs exercise.