A 70-year-old woman who was bedridden because of right hemiplegia attributable to a history of cerebral hemorrhage underwent surgical thrombectomy for pulmonary embolism four years previously. Symptoms of heart failure appeared one year previously, and she was diagnosed with constrictive pericarditis and had been treated with medication by a previous doctor. In the current situation, she visited the previous doctor with the chief complaint of fever, and pericardial effusion was observed on echocardiography. Cardiac tamponade was suspected and she was transferred to our hospital. She was then diagnosed with purulent pericarditis because purulent fluid was observed during pericardiocentesis drainage. Bacteroides fragilis was isolated from the culture of the abscess. The abscess was resistant to conservative antibiotic therapy ; therefore, we performed a pericardiotomy with a left small thoracotomy. The pleural effusion was found to be negative for culture and the patient exhibited a good postoperative course. Purulent pericarditis is refractory with poor prognosis. An appropriate surgical procedure must be chosen considering the patient's activities of daily living. Here, we report a surgical case wherein we chose the left thoracotomy approach and achieved positive results.

The first case was a 67-year-old woman. She had been given a diagnosis of fulminant myocarditis and received a biventricular assist device as a bridge to recovery. A Nipro ventricular assist device (VAD) was implanted into her left heart. She was also found to have moderate aortic insufficiency before the operation, so she received aortic valve replacement (AVR) with a bioprosthetic valve (CEP Magna Ease 21 mm) at the same time. Her cardiac function recovered gradually. Therefore, a weaning operation was scheduled for three months after the VAD implantation. However, her left ventricle motion was very poor when she was taken off of the extracorporeal circulation after removing the VAD, and transesophageal echocardiography (TEE) revealed severe bioprosthetic valve stenosis. When her heart was stopped again and the bioprosthetic valve was observed, the leaflets of the bioprosthetic valve were fused. Commissural fusion of bioprosthetic valve was able to be released using forceps, and the punnus extending under the leaflet was removed. In this way, the function of the bioprosthetic valve was restored. Her cardiac motion became good, and removal from extracorporeal circulation was easily achieved. She left the hospital 100 days after weaning from the VAD. The second case was a 68-year-old woman. She also had fulminant myocarditis. She underwent biventricular assist device implantation and AVR (CEP Magna Ease 19 mm). Her cardiac function recovered, and a weaning operation was scheduled on the 73rd-postoperative day. Preoperative TEE before the weaning of VAD showed severe bioprosthetic valve stenosis. The commissural fusion of the bioprosthetic valve was released and the punnus extending under the leaflet removed at the same time as the VAD was removed. Re-valve replacement was not required. We should therefore consider the possibility of bioprosthetic valve stenosis when VAD implantation and AVR with a bioprosthetic valve are performed at the same time in patients with an extremely reduced cardiac function.

In a 63-year-old male patient Jehovah's witness, IABP was introduced due to acute myocardial infarction and cardiogenic shock, and PCI (BMS) was carried out to CAG #7 100%. Stent placement was carried out and his hemodynamics stabilized. A left-to-right shunt was observed upon carrying out LVG, so the patient was referred to our hospital for surgery purposes due to a diagnosis of ventricular septal perforation (VSP). Upon transferring the patient to hospital, his PA pressure elevated to 53 mmHg although the blood pressure was maintained, and no findings of right heart failure were observed. His respiratory condition was stable. Emergency surgery was considered, but the patient was taking Clopidogrel following PCI, and so VSP repair (extended endocardial repair) was carried out following 4 days discontinuation of Clopidogrel. Preoperative anemia was not observed ; however, postoperative hemorrhagic anemia improved due to iron preparation administration, and the patient was discharged from hospital 22 days following surgery without blood transfusion.

We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.

A 76-year-old woman with a sudden onset of chest and back pain was admitted to our hospital. Computed tomography (CT) showed a giant thoracoabdominal aortic aneurysm. Therefore, the patient underwent emergency operation. Under a left anterolateral thoracotomy and pararectal laparotomy with left heart bypass, we performed graft replacement of the thoracoabdominal aorta and reconstruction of the celiac artery, superior mesenteric artery and renal arteries. The left lung was tightly adhered to the aneurysm because of the contained rupture. Copious pulmonary bleeding and air leakage occurred due to thrombectomy of the aneurysm. During the operation, critical air leakage was repaired using the remaining aneurysmal wall. The postoperative course was uneventful. The patient was discharged 16 days after surgery. Copious air leakage due to lung injury was a potentially life-threating condition in the postoperative course of this case of thoracoabdominal aortic aneurysm. Surgical treatment of critical air leakage due to lung injury is very important in thoracic surgery.

With household digital compact wrist blood pressure monitors, blood pressure was measured in hemiplegic patients who were receiving kinesitherapy.
During the training program routinely worked out by physical therapists, most patients had shown elevated levels of both systolic and diastolic blood pressure. There were some patients whose blood pressure went up so high as to call doctors' attention.
As changes in blood pressure are affected by various factors, we cannot say at once that doing exercise alone adds to blood pressure. Nonetheless, by using a household blood pressure monitor, it would be easy to know the extent to which blood pressure rises in accordance with the amount of exercise, so that it would be possible to make patients and their family aware of the importance of blood pressure readings. We thought it possible to obtain an index of the amount of exercise at home.

Using several electrophoretic techniques, this study examined the effects of 3 weeks hindlimb suspension on the patterns of isomyosins, myosin heavy chain (HC) isoforms and myosin light chain (LC) isoforms in the soleus muscle of the rat. The suspended soleus showed a shift in the HC isoform distribution with a marked increase in fast HC isoforms and a commensurate decrease in HCI. In addition, the change in the fast HC isoforms consisted of the expression of HCIId and HC IIb absent in the normal soleus. In contrast to HC isoforms, suspension did not lead to appreciable changes in LC isoform distribution. Analyses of electrophoresis under nondenaturing conditions demonstrated that the normal soleus expressing HCI and HCIIa isoforms contained two isomyooins. Although, of the two isomyosins observed in the normal soleus, the faster migrating band most likely represented the HCIIa-based one (FMas), its mobility was not identical with that of the HCIIa-based isomyosin (FMaf) found in fast-twitch muscles, migrating in the order FMaf>FMas. FMas was designated as intermediate isomyosin (IM) . Some of the suspended soleus contained slow isomyosin (SM) and IM whereas the others comprised FM 3 and/or FM 2 as well as SM and IM. In spite of the expression of HCIIb and HCIId in the suspended soleus, FM 3 and FM 2 observed in these muscles exhibited distinct mobilities from either HCIId-based or HCIIb-based isomyosins comprised in fast-twitch muscles. These results suggest that some of newly expressed HCIId and/or HCIIb isoforms in the suspended soleus are associated with not only fast but also slow LC isoforms and function as a constitutive element of the myosin molecule.

The main purpose of basic clinical training for housestaff is to acquire the ability to be a primary physician who can properly manage acute medical problems, develop intimate bonds with patients, and provide them with continuous care. We emphasize the importance of training in the office, clinic, or patients' homes. Although residents have so far spent most of their clinical rotations in an inpatient setting, a training program that devotes substantial time to ambulatory care is indispensable to improve basic clinical training in primary care medicine.

A questionnaring was conducted on farmers in Akita Prefecture who went in for sports in the intervals of farming. Notably one group of farmers who answered that they took regular exercise showed the following results:
1. The self-consciousness of being healthy and having good physical fitness is by far more intense in this group than in the groups of farmers who took irregular or occasional excercises.
2. The chief reasons why they continued to practice sports were:
a. that they had developed closer friendship among them through sporting activities.
b. that they obtained a good understanding and cooperation from the rest of the family members.
c. that they had leisure time.
3. To find time for sports they saved, above all else, their farming hours, indoor leisure time and homekeeping hours.
4. General endurance, agility and balance were the top three qualities of physical fitness that the greatest number of the farmers referred to as essential to modern farming. Further inquiry will be required into sports which might help to develop these qualities.