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The purpose of this study was to identify risk factors for throwing shoulder injury. 50 junior high school baseball players were included in the study. Data were collected on baseline information, limb mobility, muscle tightness, and the development of throwing shoulder injury. 1 year after the baseline measurements, the same measurements were taken again, and the subjects were divided into 2 groups according to whether or not they had developed throwing shoulder injury. All data were compared between groups by t-test or Mann-Whitney's U test. The variables with p<0.25 for between-group comparison were used as explanatory variables, and risk factors for throwing shoulder injury were analyzed by logistic regression analysis. 47 patients were included in the analysis, 14 of whom were in the throwing shoulder injury development group. The group with impaired shoulder had significantly restricted non-throwing side HBD (p=0.007), which was a risk factor for impaired shoulder (Odds ratio: 1.201, 95% CI: 1.058-1.374). Tightness of the rectus femoris muscle of the non-throwing lower extremity was found to be a risk factor for the development of throwing shoulder injury. [ABSTRACT FROM AUTHOR]

The purpose of this study to investigate the incidence and the location of injuries in throwing athletes. Collegiate and professional throwing athletes were given a questionnaire pertaining to their injury histories. In throwing athletes, the most common injury location was the lower back, with the exception of javelin throwers, who had the most injuries to the elbow joint. Low back injuries were the most common in throwing athletes, and elbow joint injuries were significantly more common in javelin throwers than in other throwers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relative growth of muscle thickness in the lateral abdominal muscle groups of junior high school students as well as the differences in growth patterns between the three individual muscles. The subjects were 191 junior high school students from a local club team and the right external oblique; EO, internal oblique; IO and transversus abdominis; TrA muscle thicknesses were measured using an ultrasound imaging device. The height and these parameters were plotted on a logarithmic graph to obtain the allometric equation y = bxa. EO and IO were represented by three-phase straight lines with two inflection points, EO's allometry coefficients being 2.58,1.56, and 2.76, and the inflection points being 142.0 cm and 171.3 cm. IO's allometry coefficients were 0.82, 2.05, and 4.55, and its inflection points were 157.4 cm and 170.4 cm. TrA was depicted as two-phase straight lines with allometry coefficients of -1.53 and 1.56, with the inflection point of 145.3 cm. This suggests that TrA which has a stabilizing effect on the trunk, grows early. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the accuracy of lumbosacral angle using MRI and an in¬clinometer, and to examine predictive regression of these two methods. Seventy adolescent boys experienced MR imaging of the lumbar region and lumbosacral alignment measurement using an inclinometer. Sacral slope was calculated as the angle between the top of the sacrum and the horizontal line. The lumbosacral angle was defined as the angle between the lumbosacral joint and the horizontal axis. Statistical analysis was performed using linear regression analysis to determine whether sacral slope can be predicted by the lumbosacral angle, and Bland-Altman method was used to evaluate the agreement between the two measurement methods. The fixed error cal¬culated as the difference between the sacral slope by MRI and the lumbosacral angle by inclinometer was 10.06 ± 3.29° (95%CI: 9.27-10.84), with small proportional and random errors. The regression equation was y=0.85x + 13.49. Although the results of this study indicated that the inclinometer underestimated the lumbosacral angle, if fixed error is taken into account, the measurement by inclinometer may be useful in predicting the lumbosacral angle in adolescent athletes. [ABSTRACT FROM AUTHOR]

(Objective) Many sport instructors have indicated that increased muscle tightness carries an increased risk of sustaining of sports injuries. However, the reliability of the methods used to determine muscle tightness remains unclear. The purpose of this study was to investigate the intrarater and interrater reliability of measuring muscle tightness. (Materials and Method) The subjects were 12 healthy college students (9 males and 3 females; age: 20-28 years). The tightness values of 4 muscles of the lower limb (iliopsoas, quadriceps femoris, hamstrings and gastrocnemius were measured for resistance to muscle elongation using the Muscle Tightness Test, a conventional method modified for this study. The tightness values of muscles were measured three times by the same therapist to test intrarater reliability [ICC (1, 1) ICC (1, 3)] and twice by two other therapists to test interrater reliability [ICC (2, 1)]. (Results) ICC (1, 1) ranged from 0.73 to 0.90, ICC (1, 3) from 0.89 to 0.96, and ICC (2, 1) from 0.36 to 0.74. (Conclusion) Although this study showed high reliability of the Muscle Tightness Test when measured by the same therapist, it was unreliable when measured by different therapists. In conclusion, we recommend that assessment of muscle tightness over time is conducted by the same therapist when using the Muscle Tightness Test. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the morphology of rotator cuff muscles and shoulder isokinetic strength in adolescent baseball players. Junior high school baseball players were divided into a skilled group (SG, 6 players) and an unskilled group (USG, 6 players), according to their baseball history. The maximal anatomical cross-sectional area, and the volume of the rotator cuff muscles (supraspinatus, external rotators: infraspinatus and teres minor, and subscapularis) were mesured on both sides of their shoulders using magnetic resonance imaging. In addition, isokinetic shoulder internal and external rotation strength (180 and 300°/sec) were measured with the shoulder abducted 90° and the elbow flexed 90° on both sides. The external/internal strength ratio was also calculated. The paired and unpaired t-tests were used to analyze the difference between the throwing and nonthrowing sides and between both groups, respectively. Although the maximal cross-sectional area and the volume of each muscle in the SG tended to be greater than those in the USG on both sides of the shoulder, both groups showed significantly greater subscapularis on the throwing side, regardless of their baseball history. Concerning the shoulder strength and the strength ratio, there were no significant differences between the throwing and nonthrowing sides in each group, or between groups. However, there was a significant correlation between the maximal cross-sectional area of the external rotators and the shoulder external rotational strength (180 and 300°sec) on both sides of the shoulder. This study suggests that remakable characteristics of repetitive throwing activities were not found in the morpholgy of the rotator cuff muscles and the shoulder rotation strength in junior high school baseball players. [ABSTRACT FROM AUTHOR]

This study investigated the morphology of shoulder rotator cuff muscles and shoulder function in tennis players. Ten collegiate male tennis players (tennis group: TG) and 10 adult males (control group: CG) participated in this study. The muscle length, maximal anatomical cross-sectional area, and volume of shoulder rotator cuff muscles (supraspinatus, external muscle: infraspinatus and teres minor, and subscapularis) were mainly measured in their dominant shoulders using magnetic resonance imaging. In addition, isokinetic shoulder internal/ external strength (180 and 300deg/sec) was measured with the shoulder abducted to 90° and the elbow flexed to 90° in both groups. The external/internal strength ratio was also calculated. The unpaired t-test was used to analyze the difference between both groups. The TG showed a significantly larger value than the CG in the maximal anatomical cross-sectional area of the subscapularis (p<0.01). The TG also showed significantly larger values than the CG in the muscle volumes of the subscapularis, the shoulder external muscle, and total shoulder rotator cuff muscles (p<0.01). In addition, the isokinetic shoulder strength (180 and 300deg/sec) of the TG was significantly larger than that of the CG in internal and external rotations (p<0.01). It is possible that the repetitive racket motions resulted in muscle hypertrophy of shoulder rotator cuff muscles and elevated shoulder rotational strength in tennis players. [ABSTRACT FROM AUTHOR]

Causative factors of low back pain are controversial among researchers who have been treating young athletes. We investigated the relationship between spinal alignment, muscle tightness of the lower limbs, and low back pain in 64 male junior high school soccer players. We evaluated spinal alignment of the lumbus (lumbar lordosis: LL) and the sacrum (sacrum inclination angle: SIA) in an upright, flexion, and extension position. In addition, we evaluated muscle tightness (MT) of the iliopsoas, quadriceps, and hamstrings, and collected information on the history of low back pain. The subjects were divided into LBP (group with a history of low back pain) and an NBP (group without a history of back pain). There were no differences in the parameters of MT of hamstrings and spinal alignment in the upright and flexion position between LBP and NBP. In the extension position, however, the parameters of MT of the lower limbs and spinal alignment showed a different relationship between LBP and NBP. MT of the iliosopas and LL, MT of the quadriceps and SIA, and the range of motion of SIA and LL were correlated in NBP, but not in LBP. These results suggest that a spine-pelvis relationship is not seen in LBP, because spinal alignment is restricted by problems of disc or facet origin in lumbar flexion or extension. [ABSTRACT FROM AUTHOR]

Lateral ligament insufficiency of the ankle (LLIA)caused by inversion sprain is the most frequent injury in athletes. Kinetic analysis was conducted to determine the influence of LLIA on kinetics of the adjacent joint(knee) for thirty collegiate athletes with experience of ankle inversion sprain. The athletes were divided into three groups according to their instability: negative group, positive group, and severe group. The severe group showed increased knee varus moment and decreased subtalar valgus moment. The sum of the values of these two moments was similar between groups, and two moments negatively correlated with each other. It is suggested that LLIA results in increase of the knee varus moment, and management for the knee should be considered for those athletes with LLIA. [ABSTRACT FROM AUTHOR]

To investigate the relation between major joint injury in collegiate athletic activity and degenerative joint disorder and pain in later life, we surveyed the alumni of nine athletic clubs aged 45 years old and above considering the characteristics of the athletic activity (American football: AF; weight lifting: WL; rugby football: RG; track and field: TF; judo; swimming: SW; rowing; tennis; and baseball: BB) for lumbar, knee and ankle injury in college, and current lumbago, gonalgia and ankle pain using a questionnaire. A total of 760 alumni responded (the response rate was 36.2%) and their answers were analyzed. Although the occurrence of joint injury varied between athletic clubs (lumbar injury, knee injury and ankle injury were frequent in WL and judo, in AF, RG and judo, and AF, RG, TF, judo and BB, respectively), a significant relation was observed between past history and current pain at all three sites. Significant relations were observed in AF, WL, judo and tennis between lumbar injury and lumbago, in AF, RG and tennis between knee injury and gonalgia and in AF, RG, WL, rowing, tennis and BB between ankle injury and ankle pain. To minimize degenerative joint disorder and pain related to athletic activity, preventive methods should be undertaken for major joint injuries in collegiate athletic clubs. [ABSTRACT FROM AUTHOR]

The condition of 10 elite male collegiate long distance runners was assessed by hematological (RBC, WBC, hemoglobin and hematocrit) and hormonal (cortisol: CS and free-testosterone: f-T) examination and mood test /POMS by McNair) as well as subjective assessment (will for training, sense of body at training, feeling of fatigue, progression of training and physical condition ;by five degrees). The examination was conducted between 9:00 and 10:00 AM. The scores of will for training, sense of body at training and physical condition correlated with f-T and T/C (ratio of f-T to CS), and that of feeling of fatigue correlated with T/C. Only the score of progression of training correlated with RBC, hemoglobin and hematocrit. The scores of subjective assessment also correlated with POMS scores, especially vigor, fatigue and their ratio (V/F). The score of anger in POMS correlated with RBC, hemoglobin and hematocrit, the score of vigor correlated with WBC, CS and T/C, and the score of fatigue correlated with T/C. Some previous studies demonstrated a correlation between physical condition and T/C, and other studies did not. But in this study, high correlation was observed between T/C. the scores of subjective assessment and the score of POMS. From those correlations, we conclude that T/C as hormonal index and VF as mood index are useful tools for the objective assessment of athlete's condition. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate incidence and risk factors for permanent pacemaker implantation for sick sinus syndrome( SSS) after maze procedure., Methods: Medical records of 59 patients who underwent maze procedure for atrial fibrillation at our hospital from 2018 to 2022 were retrospectively reviewed., Results: Mean age was 70 years and 32 patients (54%) were male. Major cardiac procedure was mitral valve surgery in 43( 72%). Radiofrequency ablation device was used in 35( 59%) and cryoablation was used in 24 (41%). Nineteen patients (32%) required temporary pacing after surgery;7 for type Ⅰ or Ⅱ SSS, 9 for type Ⅲ SSS and 3 for bradycardiac atrial fibrillation. Of these, all the 7 patients with type Ⅰ or Ⅱ SSS regained sinus rhythm, whereas 2 with type Ⅲ SSS underwent permanent pacemaker implantation. Overall, permanent pacemaker was implanted in 3( 5%). Forty-six patients( 78%) were in sinus rhythm at the outpatient clinic after surgery., Conclusions: Type Ⅰ or Ⅱ SSS after maze procedure is likely to resume sinus rhythm at the time of discharge whereas type Ⅲ is not. For type Ⅲ SSS after maze procedure, adequate anti-arrhythmic medication early after surgery may be required to avoid permanent pacemaker implantation.

A 78-year-old man underwent pacemaker implantation via the left internal jugular vein 36 years ago. After 30 years, a new device was implanted via the right subclavian vein and the old lead was cut and buried underneath the skin due to infection. This time, the patient presented with persistent lead infection of the left side. We chose open heart surgery to excise the old lead because of severe adhesion and surrounding calcification. The infected lead was completely removed using cardiopulmonary bypass without complication. Old pacemaker leads tend to develop adhesion and calcification within the innominate vein and superior vena cava, and therefore, it is often difficult to remove it with percutaneous technique. It was considered that open heart surgery was useful to excise a very old pacemaker lead.

Nusinersen (Spinraza ® ) was approved as Japan's first antisense oligonucleotide (ASO) drug for treatment of SMA (spinal muscular atrophy) patients with a deletion or mutation of the survival motor neuron (SMN) 1 gene and ≥1 copy of the SMN2 gene. Nuseinersen is a fully modified 2'-O-(2-methoxyethyl) (2'-MOE) ASO designed to bind the SMN2 pre-mRNA and alter splicing, such that a mature mRNA is produced and is translated as full-length SMN protein. In 4 types of mouse SMA disease models, treatment with nusinersen improved the form of the neuromuscular junction, increased myofiber size, improved righting reflex and grip, and prolonged survival. The efficacy of nusinersen was verified in 2 multinational, randomized, double-blind, sham-controlled clinical studies in SMA patients with differing ages of onset and ages (ENDEAR study and CHERISH study), and improvement and maintenance of motor function by nusinersen were demonstrated regardless of the type of SMA. Moreover, both studies showed that greater efficacy may be obtained with early initiation of nusinersen treatment. Therefore, treatment with nusinersen should be started as early as possible to delay or halt progression of the disease and maximize therapeutic effect. As nusinersen is the only ASO currently available for SMA, it will be widely used, therefore we will expect that nusinersen will contribute to improve patients' QOL and reduce the burden of caregivers and the healthcare system by improving motor function of patients with SMA.

To investigate the safety and effectiveness of the interferon β-1a intramuscular injection under clinical conditions in Japan, we conducted an all-case postmarketing surveillance with a 2-year follow-up of patients who were registered during the period between November 2006 (product launch) and December 2010. Case reports were collected from 397 institutions. The safety analysis included 1,476 patients, and the effectiveness analysis included 1,441 patients. Of the patients included in the safety analysis, 86.3% had relapsing-remitting multiple sclerosis. The most common adverse drug reaction was pyrexia (19.24%). Serious adverse events included multiple sclerosis relapse (26 cases) and abnormal hepatic function (10 cases). In the effectiveness analysis, the annualized relapse rate improved significantly from 1.07 to 0.29 (P < 0.001). There was also a significant improvement in in the expanded disability status scale from 3.08 to 2.94 (P < 0.001). The results of the safety and effectiveness profile were consistent with those in previous reports.

In contemporary Japan, there is a polarizing trend in children who exercise more than 1,800 minutes a week and those who exercise less than 60 minutes a week. Quite a lot of girls in particular hate exercise,and therefore they don't get enough of it. Osteoporosis is a preventable disease from childhood. It is crucial for girls to exercise and to provide appropriate stimulation to bones before menarche, which increases bone mineral content. Exercise and sports in childhood are characterized as the ways to the lifelong prevention strategies against osteoporosis and fractures. It is hoped that all children practice appropriate exercise program based on scientific evidence to promote bone health. In this review article, the effects of exercising in childhood on bone health, and the points to be noted regarding childhood sports are described.

Recently, due to the progress in patient managements with antibiotics, the prognosis of the active phase infectious endocarditis (IE) has improved, but in some cases, urgent or emergent surgical treatment is inevitable because of the uncontrollable acute heart failure due to valve regurgitation, uncontrollable infection with circulatory collapse, or high embolization risk. We reviewed the outcomes of the 57 IE patients who underwent surgical treatment in our hospital from January, 2000 to April, 2012. Preoperative state including inflammatory responses, bacterial blood culture, antibiotic administration, and surgical procedures were examined. No statistical significances were detected in the mortalities between elective cases (n=43)and urgent or emergent cases (n=14). Totally, mortality was 5.3% including one case in prosthetic valve endocarditis, and was satisfactory.

The airway tract involvement is known to be one of the most important prognostic factors in patients with relapsing polychondritis (RP). Sequential evaluations of airway tract involvements are necessary, however, the insertion of flexible bronchoscope into the affected airway tract may exacerbate their airway tract stenosis. Three-dimensional computed tomography (3D-CT) showed stenosis of the trachea and bilateral main bronchi in 2 patients with RP. 3D-CT is an effective non-invasive method for evaluating airway tract involvement in RP.

'Sick house syndrome' (SHS) is a health issue that closely resembles sick building syndrome (SBS) that had occurred in European countries. The aim of this review is to clarify the characteristics of SHS by reviewing previous reports rigorously. We propose the definition of SHS as "health impairments caused by indoor air pollution, regardless of the place, causative substance, or pathogenesis". Cases of SBS are reported to occur predominantly in offices and sometimes schools, whereas those of SHS are usually found in general dwellings. In many cases, SHS is caused by biologically and/or chemically polluted indoor air. Physical factors might affect the impairments of SHS in some cases. It is considered that symptoms of SHS develop through toxic, allergic and/or some unknown mechanisms. Psychological mechanisms might also affect the development of SHS. It is still unclear whether SBS and SHS are very close or identical clinical entities, mostly because a general agreement on a diagnostic standard for SHS has not been established. Previous research gradually clarified the etiology of SHS. Further advances in research, diagnosis, and treatment of SHS are warranted with the following measures. Firstly, a clinical diagnostic standard including both subjective and objective findings must be established. Secondly, a standard procedure for assessing indoor air contamination should be established. Lastly, as previous research indicated multiple causative factors for SHS, an interdisciplinary approach is needed to obtain the grand picture of the syndrome.

Purpose: We compared the efficacy of naftopidil with that of tamsulosin hydrochloride for 154 symptomatic benign prostatic hyperplasia (BPH) patients who also suffered from overactive bladder (OAB) symptoms., Materials and Methods: Naftopidil and tamsulosin hydrochloride were administered for eight weeks. The international prostate symptom score (IPSS), QOL index, maximum flow rate (Q(max)), residual urine volume (RUV) and side effect profile were determined before the administration and after eight weeks of treatment., Results: In the naftopidil group, seven parameters of IPSS and QOL index were improved significantly at the endpoint compared to the baseline. In the tamsulosin group, all parameters except frequency and straining were also improved. Both drugs improved the Q(max) at the endpoint, too. The RUV did not change in both groups. Naftopidil was also superior to tamsulosin hydrochloride regarding general treatment outcome by the Japanese clinical guideline of urinary disturbance., Conclusions: This study demonstrated that naftopidil was clinically efficacious in the treatment of BPH patients with OAB.

Purpose: This study was designed to clarify the definition of sick house syndrome (SHS)., Methods: SHS was defined based on the disease related to habitation as follows. 1. The cause of the onset of a disease relates to house. 2. Symptoms appear within house. 3. Symptoms will be less serious or disappear if patient away from house. 4. If patient goes into house, symptoms will appear repeatedly. When it corresponded to all above, it was defined to SHS, and it classified as MCS (multiple chemical sensitivities) without above conditions. Even if SHS is isolated from similar disease completely, characteristic symptoms of MCS are hard to be detected because MCS are combination of two or more diseases. Based on this working hypothesis, the logistic regression by setting MCS as reference was performed so that characteristic symptoms of SHS show odds ratios with exceeding one., Results: The odds ratios with more than two of characteristic symptoms in SHS were "nausea or vomiting" "Troublesome in everything" and the causative substances to which symptoms get worse was "The smell of a perfume and cosmetics". Characteristic symptoms of an allergy disease were detected by comparison with the allergic conjunctivitis, allergic rhinitis, and bronchial asthma, respectively., Conclusion: These results showed that the classification method was appropriate. This definition is not fundamentally differed from the definition of the sick-building syndrome of WHO.

Objective: To assess the significance and current status of the benign prostatic hyperplasia (BPH) impact index (BII) in the evaluation of subjective symptoms of impaired urination in so-called QOL disease, BPH., Patients and Methods: Over the past 2 year-period, in 159 patients with the diagnosis of BPH were asked to reply to each of the international prostate symptom score (I-PSS), QOL index and BII questionnaires. The subjective symptom scores (a total of 246 points) were evaluated from the viewpoint of clinical statistics in the search for any these and to find which questions cover the BII, most., Results: 1) Statistically significant but moderate correlations were observed among I-PSS total score, QOL index and BII. The correlations among Qmax, BII and QOL were very weak. 2) Out of the 11 domains in both IPSS and BII, 2 questions of BII ("bothersomeness caused by urinary problems" and "degree of worry about well-being") and 4 questions of IPSS ("residual sense," " pollakisuria," "weak urinary stream" and "nocturia") were shared as QOL indices. Patient satisfaction was affected also by the questions in the BII. 3) Of the 7 BPH symptoms assessed in IPSS, 4 symptoms ("residual sense," "pollakisuria," "weak urinary stream" and "nocturia") affected the QOL index, and 4 symptoms ("urgency on micturition," "residual sense," "nocturia" and "strain at urination") affected BII. 4) Of the 7 symptoms assessed by IPSS, different symptoms affected each of the 4 BII questions., Conclusion: It is needed to assess BPH symptoms not only by the IPSS and QOL index but also based on BII to provide the detailed therapeutic instructions and thorough patients consultation.

Eosinophilic inflammation of the airways is a key characteristic of asthma. Glucocorticoids can suppress the inflammatory response in part by promotion of eosinophilic apoptosis. We investigated the effects of glucocorticoids on leukocyte infiltration and apoptotic resolution of eosinophils and neutrophils in Sephadex-treated rat lung. Sephadex beads were injected intravenously, followed 24 h later by i.p. administration of dexamethasone (DEX, 0.1 mg/kg) or its vehicle. At 24 h post-DEX treatment, the bronchoalveolar lavage fluid (BALF) was collected. Differential leukocyte counts and the numbers of apoptotic eosinophils and neutrophils, and macrophages with engulfed eosinophils or neutrophils in BALF were determined microscopically from Diff-Quik stained cytospin preparations. Sephadex beads markedly increased cell counts of eosinophils and neutrophils in BALF. Compared with a vehicle-treated group, the DEX treatment significantly decreased the number of eosinophils, but not neutrophils, in BALF. Dexamethasone in BALF also significantly increased eosinophilic apoptosis and engulfment of apoptotic eosinophils by macrophages, but had no effect on neutrophilic apoptosis and engulfment of apoptotic neutrophils by macrophages. These results suggest that the increased clearance of eosinophils from airways by glucocorticoids may be partly due to the promotion of eosinophilic apoptosis.

Food allergy is frequently associated with atopic dermatitis (AD) in children. Appropriate elimination diet is necessary in the case of immediate food hypersensitivity, regardless it causes worsening of the chronic eczema or not. Here we report the prevalence of immediate type food allergy diagnosed by oral food challenge or the episodes of apparent acute allergic reaction in the AD patients (n=182, average age 4.9+/-5.1), who visited our clinic within one year. The prevalence of food allergy in the AD patients was 85.7% in age 0 years, 75.6% in age 1,65.4% in age 2, and declined to 13.9% in age 7 years old or more. The offending foods were egg, milk, wheat, fish and so on. The symptoms of food allergy included skin, gastrointestinal or respiratory manifestations, and also anaphylaxis. In conclusion, immediate type food allergy is frequently associated with childhood AD, and appropriate elimination of the offending food is necessary to avoid the acute allergic reaction including anaphylaxis.

Levocabastine is a selective histamine H1-receptor antagonist exerting inhibitory effects on the release of chemical mediators from mast cells and on the chemotaxis of polymorphonuclear leukocytes and eosinophils. Both histamine and antigens induced conjunctivitis was inhibited by levocabastine in several allergy models. Levocabastine moderately inhibited histamine-release from guinea pig conjunctive induced by antigen-antibody reactions and prevented an increase in the vascular permeability of the conjunctive elicited by both histamine and antigen instillation. Symptoms of allergic rhinitis, which were induced by histamine, substance P and antigen, were also reduced by levocabastine. Levocabastine prevented an increase in the vascular permeability of nasal mucosa elicited by instillation of these three inducers. Furthermore, levocabastine has shown a large difference between the antiallergic dose and other non-specific pharmacological effective dose than that with other antiallergic drugs. The non-specific pharmacological effect of levocabastine reveals only blepharoptosis. With these pharmacological effects and topical usage, levocabastine was shown to be useful for allergic conjunctive and rhinitis in both seasonal and perennial clinical use.

We developed a questionnaire form on quality of life (QOL) designed for data entry by parents or caregivers of asthmatic children, which consisted of five domains: physical, social, family, emotional, and individual growth domains. QOL scores were determined according to the five-point scale by which one point was given for maximal impairment and five points for no impairment. The form included 23 questions for children under the age of four and 31 questions for children over the age of four. This study examined reproducibility, reliability, and factorial validity of the form. The numbers of asthmatic children, whose symptoms of asthma attacks had been stable for the 2 weeks before this study, were as follows: eight children under the age of four; and 26 children over the age of four. The intra-class correlation coefficients for these two categories of children were 0.879 and 0.793, respectively; therefore, reproducibility was shown. The values of Cronbach's alfa for the total scores of QOL were 0.6329 to 0.8829 in 102 asthmatic children, 40 healthy children, and 12 non-asthmatic children, e.g., children affected by cold. Therefore, internal consistency was shown. The rank-orders of the replies to the questions associated with the physical, social, family, and emotional domains other than the individual growth domain decreased significantly (p < 0.05) in asthmatic children as compared with healthy or non-asthmatic children. Factor analysis confirmed the five established domains and each facets therein at the cumulative variance of 60% or higher. In conclusion, this questionnaire form on QOL of asthmatic children was considered to have reproducibility, constitutional reliability, and factorial validity, to be applicable at the time of medication, and to be useful in investigating approaches for the management of bronchial asthma and the targeting of treatment.

A quality of life (QOL) questionnaire for asthmatic children and their parents or caregivers was shown to exhibit reliability, factorial validity and possibility for application study in our previous report. The aim of this study was to examine longitudinal study of the questionnaires, including changes of QOL, responsibility to asthmatic symptoms, consistency with conventional asthma scores and clinical outcomes during treatment with theophylline dry syrup for about three months. Overall QOL scores increased significantly (p < 0.01) with improvement in clinical outcomes. Longitudinal changes of QOL were compared with differences (after-before) and changes of ratio [(after-before/before)] in QOL by correlation analysis between differences of asthma scores. Changes of ratio in QOL were reflected by the clinical outcomes. Results of investigation of correlation between differences in asthma scores and changes of ratio in QOL domains were considered as follows. Physical domain was correlated with asthma symptoms, given the moderate correlation (rho = 0.497). Social and family domains showed fair correlation (rho = 0.382 - 0.384 respectively), both domains were hard to correlate with differences in asthma scores. Emotional domain showed fair correlation (rho = 0.264) for reflecting family's emotion. Poor correlation (rho = 0.071) was observed in individual growth domain which was necessary to evaluate for longer term. Changes of ratio in QOL responded significantly (p < 0.01) to improved and worst-unchanged groups which were categorized by the differences in asthma scores. In conclusion, QOL questionnaires showed longitudinal validity for clinical outcomes and responsibility to asthmatic symptoms. It yields useful information for understanding how asthmatic symptoms affect parents or caregivers and investigating what treatments should be prescribed for the patients with asthma.

One hundred and ninety one subjects showing histories of immediate hypersensitive response to egg white ingestion and/or positive IgE antibody titers specific for egg white were enrolled in double-blind placebo-controlled oral challenge with freeze and dried, heated or heated and ovomucoid-depleted egg white antigens. Seventy seven were male and 114 female, and their ages ranged from 11 month to 10 years 5 month; 118 of them had atopic dermatitis, seven had asthma and 33 had both atopic dermatitis and bronchial asthma and 33 had urticaria. One hundred four children developed 147 positive symptoms including 131 immediate reactions and 16 non-immediate reactions by oral challenge tests. Respiratory symptoms were observed in 25 cases (17%) including cough alone in 12 cases (8.2%), and both wheezing and cough in 13 cases (8.8%). These were all observed as immediate reactions and accompanied with dermal symptoms. Frequency of respiratory symptoms correlated with specific IgE antibody titers for egg white. Heated and ovomucoid-depleted egg white was more hypoallergenic that heated or freeze and dried egg white with respect to respiratory symptoms as well as other symptoms. We concluded that respiratory symptoms were provoked through oral challenges with egg white in a part of egg-allergic children.

The prophylactic effect of intravenous immunoglobulin (GB-0998) on the recurrent acute otitis media, bronchitis and bronchopneumonia in IgG 2 deficient infants was investigated in a multicenter trial. GB-0998 was administered 6 times every 4 weeks. The doses were 300 mg/kg wt. during the first treatment, followed by 5 doses of 200 mg/kg wt. The results indicated that GB-0998 was effective in the prophylaxis of the recurrent infection of acute otitis media, bronchitis and bronchopneumonia in infancy with IgG 2 deficiency and/or IgG 2 antibody deficiency specific for Streptococcus pneumoniae.

Thirty-nine children with Kawasaki disease have undergone coronary revascularization since 1976. The attrition rate of saphenous vein grafts (SVG) was so high that we have used the internal thoracic artery (ITA) as the graft since 1984. ITA showed excellent early and mid-term patency. We, however, still had to use SVG for the distal portion of right coronary artery (RCA) and left circumflex artery (LCx) where ITA was difficult to reach. In 1988, we first successfully applied the right gastroepiploic artery (GEA) for revascularization to the posterior descending artery of a six-year-old boy. Nine children were then bypassed with the combination of ITA and GEA. GEA was anastomosed to the distal portion of RCA (7 cases) and the branch of LCx (2 cases). In 4 cases GEA showed string sign 1 month after surgery, but the angiographic finding revealed improvement after 1 year interval in 2 cases. The patency of GEA grafts was excellent after 1 month (100%:9/9) and 1 year (100%:9/9), respectively. The use of GEA in addition to ITA as the arterial graft may contribute to the improvement of long-term graft patency in revascularization of children with Kawasaki disease.

We studied the biocompatibility and the clinical usefulness of heparin-coated cardiopulmonary bypass circuits (Duraflow-II) compared with non-coated circuits. First study was done to clarify the biocompatibility of heparin coated circuit. 33 cases of elective coronary artery bypass grafting were randomized into two grops. Both group had full dose heparin in this study and laboratory tests were done such as blood cell count, free hemoglobin, AT-III, fibrinogen, FDP, and complement system. The use of heparin-coated circuits resulted in a reduction of C3a generation, and a reduction of fibrinogen consumption. The decline of AT-III may be due to bonding of coated heparin to AT-III, leading to effective anticoagulation. Next study was carried out in 26 cases. In heparin coated group, the amount of heparin was reduced to 200 IU/kg compared to 350 IU/kg in control group. ACT was maintained above 300 sec. and 400 sec. respectively. The amount of post operative bleeding was identical in both groups. There was no case which required autologous blood transfusion, re-operation for bleeding in both groups. Myocardial infarction and hospital mortality were not seen in this study. Concerning the fear of graft occlusion in low dose heparin surgery, there was no statistical difference of graft patency in both groups. In conclusion, heparin coated CPB circuits (Duraflo-II) are favorable in the meaning of biocompatibility and sefely used with low dose heparin.

The purpose of this article is to describe our technique for performing coronary artery bypass grafting without cardiopulmonary bypass and to demonstrate that this operation is safe and useful to the case of LV dysfunction. Between April 1988 and March 1994, 2 men and 1 woman aged 61 to 69 years (mean 65 years) with LV dysfunction (EF < or = 30%) underwent coronary artery bypass grafting without cardiopulmonary bypass. Saphenous vein grafts were placed to the right coronary artery (n = 2), left anterior descending artery (n = 2), and internal thoracic artery grafts were placed to the right coronary artery (n = 1), left anterior descending artery (n = 1). The post operative course were uneventful in all patients and discharged with no complications. All patients underwent coronary angiography, and 5 of 6 (83.3%) grafts placed without cardiopulmonary bypass were patent. In selected patients, coronary artery bypass grafting to the case of LV dysfunction without cardiopulmonary bypass can be performed safe and satisfactory graft patency rates.

A 71-year-old man with a descending aortic aneurysm was admitted to the hospital because of abnormal chest CT. Aortogram revealed an aneurysm of the descending aorta. His coronary angiogram showed 75% stenosis at LCX (Seg II). The graft replacement of descending aortic aneurysm and coronary artery bypass grafting (CABG) were performed through a left lateral thoracotomy. Postoperative course was good. Postoperative angiogram demonstrated successful reconstruction of the descending aorta and a patent bypass graft. The patient discharged healthy without any complications.

A lipophilic yeast, Pityrosporum orbiculare, found in normal microflora of the human skin, is considered to be a pathogenic allergen of atopic dermatitis (AD). We measured IgE antibody to P. orbiculare using a CAP RAST FEIA kit in 44 patients with AD (AD alone 17, AD+bronchial asthma (BA) 27). The incidence of positive RAST was 88.2% in the patients with AD alone and 74.1% in the patients with AD+BA. The IgE RAST index was 2.77 +/- 1.34 (mean +/- SD) in severe AD patients (n = 23), which was significantly higher than that in mild AD patients (1.88 +/- 1.41, n = 21). The patients with eczematous skin on the face, neck and scalp (n = 27) showed higher IgE titers (2.79 +/- 1.26) than those without skin lesions (1.64 +/- 1.44, n = 17). These results suggest that P. orbiculare is a pathogenic allergen of severe AD. IgE levels for P. orbiculare showed a statistically significant relation to those for Candida albicans (r = 0.62, p < 0.01). In RAST inhibition tests on five patients' sera, C. albicans extract significantly inhibited IgE RAST to P. orbiculare in only one serum, indicating that P. orbiculare shares some IgE binding epitopes with C. albicans, but that P. orbiculare-specific epitopes also exist.

We report a rare case of aortic insufficiency due to the tears of the aortic cusps during percutaneous transluminal coronary angioplasty (PTCA). A 62-year-old man successfully underwent simultaneous aortic valve replacement and coronary artery bypass grafting. The post operative course was uneventful, and the patient was discharged in a stable condition. This report emphasizes the need to consider the possibility of acquired aortic insufficiency due to the complication of PTCA.

IgE is considered to be involved in immediate hypersensitive reactions (IHR) following egg ingestion. IgE antibody levels to egg-white (EW) antigens in the IHR-positive group (n = 19, mean age +/- SD = 5.2 +/- 4.5 yr) were higher than those in the IHR-negative group (n = 13, mean of age +/- SD = 3.6 +/- 2.2 yr). However, even in the IHR-negative group, some patients showed high IgE to EW. RAST inhibition tests with heat-treated (100 degrees C, 5, 10, and 30 min) egg-white antigens were performed on 13 serum samples from subjects with IHR and 9 serum samples from subjects without IHR. Heat treatment decreased the IgE-binding activity of egg white and it was speculated that IgE from IHR-negative subjects bound to relatively heat-unstable sites of egg-white antigens. Furthermore, we selected IHR-negative subjects (n = 8, mean of age +/- SD = 3.0 +/- 1.7 yr) with higher IgE antibody levels than the lowest limit of IgE to EW of the IHR-positive group and compared IgE to ovomucoid (OM), ovalbumin (OA), conalbumin (CA), and lysozyme (Ly) between these IHR-negative and positive groups. IgE-binding activities to egg-white components, including OA, CA, and Ly but not OM, were significantly decreased with heat treatment. The IHR-negative group showed significantly lower IgE to OM (untreated, 5, 10, 30 min treatment) and 5 min treated OA alone than the IHR-positive group, while no difference was found in IgE to other components between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A 64-year-old male presented with a large decubitus ulcer of the sacrum which had not healed for thirteen years in spite of various conservative treatments. His primary disease was paraplegia following spondylitis. Although he was not ambulatory, he was able to manage a wheelchair. The decubitus, which had a 8 x 13 cm dead space, was successfully closed with a single operation using two fasciocutaneous flaps. The patient was discharged two months postoperatively. The medical cost of his treatment before and after the surgery was investigated. The expense including the surgery and postoperative care until discharge was five times more than the monthly cost of the preoperative period. These findings suggest that a decubitus ulcer which does not respond to conservative treatments for more than several months should be considered for a surgical management, as long as the patient's general condition permits an operation.

Immediate hypersensitive reactions (IHR) induced by buckwheat ingestion are considered to be IgE-mediated. However we found 28 subjects without IHR to buckwheat ingestion out of 46 subjects who had positive RAST values for both buckwheat and rice antigens. The IHR-positive group showed significantly higher RAST values for buckwheat antigens (p < 0.01) but lower RAST values for rice antigens (p < 0.01) than did the IHR-negative group. RAST values for buckwheat and rice were significantly correlated with each other (p < 0.01) in the IHR-negative group, but not in the IHR-positive group. An effective dose-dependent inhibition was obtained in a RAST inhibition assay between homologous combinations of inhibitor and disc antigens such as rice and rice or buckwheat and buckwheat. The IHR-positive group showed no significant RAST inhibition between heterogeneous combinations of rice and buckwheat antigens. In contrast, the IHR-negative group showed a significant decrease in IgE binding even in the RAST inhibition assay between heterogenous combinations. These results led to the conclusion that there is cross-reactivity with IgE antibodies between buckwheat and rice and that IgE antibodies from IHR-negative subjects might recognize the epitopes on buckwheat antigens which cross react with rice antigens, whereas IgE antibodies from IHR-positive subjects might bind to buckwheat-specific epitopes.